Being mindful about eating animal products

My main motto about eating healthy is the closer to nature, the better. The American food supply has become further away from nature. And it’s not just the highly processed junk foods: animal and plant products have also gotten further away from nature. Large companies have taken over American livestock and agriculture and have largely replaced the local farmer.

It was my daughter that made me more aware of the problems with America’s animal product industry. She said “I feel more bad for the animals than the meat makes me feel good”. So I started to read and look into it, and uncovered some unhealthy and sad facts.

And again, this is another level of trying to get as close to nature as possible with healthy eating. Sometimes it’s not possible to get to the healthiest level, but here is the information for when it is possible. It takes work to educate yourself and compare products to make the best decisions possible. In other countries, most of the food is local and there are stricter standards, so it is easier to purchase food you can trust is healthy. In America, unfortunately corporate interests have come before the consumer, so it is up to the consumer to have to figure out the best option.

*Note: there are some sad pictures of animals in this article, I chose to include them to show a little of what the livestock industry is trying to hide

The Problem

Humans used to consume animal products that were hunted: i.e animals ate and grew naturally in their natural habitat. Humans then started raising livestock for the purpose of consumption of dairy, eggs and meat. This usually was in a controlled environment but still replicated their natural habitat, such as farm pastures. This has rapidly shifted away to a more crowded and unnatural environment. In the last 50 years, the livestock industry has become more and more industrialized. It used to be the local farmer with a barn and a pasture with cows, chickens and pigs that supplied a local community with dairy, eggs and meat. Now barns and pastures are replaced with Confined Animal Feeding Operations (CAFOs). In these “factory farms” the animals are treated like an object (a food product) instead of a living being: they have very little movement, do not have access to natural diet, are crowded and exposed to waste and disease. We are told by the companies these large facilities are needed to to “keep up with demand”. But like any other business, their goal is profit, and the more “product” they produce the more money they can make. Just like junk food, cheaply raised animal products costs less. And when it costs less, it is less valuable, and more is consumed and wasted. Americans eat more animal products than ever before. Animal product consumption has more than doubled in the past 50 years.

This unnatural way of raising livestock has created many problems I will outline below.

http://3.bp.blogspot.com/-iu3YHAVq6Ag/T6RXENemD4I/AAAAAAAAAAs/x9JuU4tmOH0/s400/cows-in-the-pasture-of-a-wisconsin-dairy-farm-wi139.jpgcowcafo

Antibiotic use and drug resistant bacteria.

Again, the livestock industry has gotten away from nature, and more crowded and unnatural. In 1987, the average pig farmer had 1,000 pigs. Today the average factory farm has 30,000 pigs. You can imagine this unnatural crowding of animals causes problems, including infection. To solve this problem, factory farm animals are often given antibiotics regularly to prevent infection and promote growth (it is often an ingredient in animal feed: a concoction of grain and antibiotics). In fact, 80% of the antibiotics used in America is in the livestock industry. This causes bacteria in the animal’s guts to grow resistant to antibiotics. The animals are then slaughtered with fecal matter with drug resistant bacteria contaminating the food product, and that is how it enters humans. This is what happens when humans get too far away from nature, a snowball of one problem causing another: livestock crowding causes high risk for infections, so antibiotics are given to prevent infections, which causes drug resistant bacteria, which causes human disease. In fact, approximately 20,000 humans die of resistant bacteria per year, and it is estimated the majority of those “superbugs” started in the livestock industry. And this is also the reason why there are an increasing number of food recalls, which is ironic when industrialized animal product has to be thrown away because it is mass produced (small farms have less antibiotic and recalled products, so in the end is more efficient). Antibiotic use in livestock

https://whativegan.files.wordpress.com/2014/04/factory_farm_pig-454x301.jpg

Low nutrients.

Animals in their natural environment are healthier and have healthier products to consume. When animals spend most of their time outside they get vitamin D from the sun. When animals eat grass and grubs they get omega 3 fats. In the livestock facilities they don’t get sun, so their products lack vitamin D. They are fed corn and grains, which are high in omega 6 fats and not omega 3 fats, so their products are high in omega 6 fats (which in my nutrition blog I told you increases inflammation). Animal products from animals raised in industrial ways are less nutritious. I think of them as factory made plastic protein without the other nutritional value that natural animals have.

Maltreatment of animals.

Animals that are mass produced face many ethical problems. The farmer used to care for his animals. Now in the factory farms they are treated like inanimate objects instead of living beings.

Broiler chickens grown for meat are bread and modified to be unnaturally large.  Their legs cannot support their unnaturally large body, often they can’t even stand, and so they lay in waste and suffer. Hens for eggs are kept in cages they can barely move in, and suffer from overcrowding, injuries, and disease.

chicken-industry-info-graphic1Egg-Laying-Hens

Female dairy cows are inseminated to have calves so they produce milk, but their baby is not allowed to drink their milk so it is saved for humans. Dairy cows are sometimes given hormones to produce 4 times more milk than they would naturally, and they are so engorged sometimes they cannot stand with the weight of the milk. Maltreatment of animals in CAFOs

Pigs in CAFO’s are the saddest.  They are kept in cages they cannot even turn around in. Mom pigs are kept in gestation crates that separates her from her piglets. The worst part is they are the 5th smartest animal on earth: smarter than dogs, and as smart as a 3 year old human. So I think of how much a 3 year old child is aware of and understands. A pig is aware of the unhappiness and pain they experience in a CAFO being confined to a cage, showed no love and only neglect and abuse, and before their life is lived they are thrown into a semi truck and mass slaughtered.  I will never forget passing a semi truck full of pigs heading to slaughter: the squealing was stuff nightmares are made of, and I knew they knew what was happening.

pignull

Beyond neglect (not able to live a happy and healthy life), many animals are abused and tortured. Untrained workers (instead of a trained farmer) are in charge of thousands of animals, and again the animals are seen as dispensable objects instead of living beings. All that is a set up for abuse. There has been many hidden videos taken of animals beaten, set on fire, inhumane mass slaughtering practices, skinning and starting to butcher meat while still alive, etc. Organizations are starting to go undercover and reveal this neglect and abuse.

The livestock industry does not want consumers to know what happens behind the walls. And most of the CAFO facilities are hidden in rural America. They put pictures of pastures and barns on the packages to make you think the animals grew up in a happy farm instead of a CAFO. But more and more information about the true origin of industrial animal products is coming out. If you don’t know the farmer, you have no idea how the animals are treated. And if consumers stop buying mass produced animal products, then the industrialized animal companies will be a thing of the past and we will go back to the local farmer. Hindu culture believes that if an animal is treated humanely, the meat is more nutritious: turns out they are right.

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Environment

Plants have a positive influence on the environment: they use CO2 and produce oxygen. Humans and animals do the opposite: consume oxygen and produce greenhouse gasses. The bigger the animal the more greenhouse gasses. For instance, a cow produces methane, which is 24 times per potent than CO2 as a greenhouse gas. In fact, the agricultural industry is responsible for 18% of greenhouse gas, that is more than all the transportation industry. The amount of greenhouse gas from 1 cow is equal to driving a car 7800 miles! Eating less animal products is one of the most high yield things to decrease carbon footprint. For every meal that you don’t consume animal products, that is equal to not driving a car for 100 miles. Environmental problems

Image result for meatless monday

There are other ways livestock hurt the environment. Industrialized agriculture is focused on short term production and not long term sustainability. It comes with hidden costs: pollution of the land water, and air, climate change, chronic disease, loss of land and resources. The livestock yards produce lots of waste, the average CAFO produces more waste than 16,000 humans. This waste eventually gets back into our air, land and water. One of the most disturbing things I discovered is that CAFO waste is often sprayed onto crops (no wonder we have drug resistant bacteria ending up on our romaine lettuce). This also causes air pollution when the particles are sprayed into the air. There is increased asthma and COPD in people who live by and work in factory farms. Pollution from CAFO

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The inefficiencies of the livestock industry is becoming more apparent: corn is grown in one place, shipped to another place to be fed to animals, animals are shipped to another place and sold, and 30-50% of the product is wasted in the process.

Sustainable agriculture is being researched and implemented with comparable efficiency. A local farmer can have the animal feed it’s natural diet in pastures, and local people buy it and use it quickly and closely. Research has shown we can feed the world in a sustainable manner. Plus 30% of Americans are overweight or obese, and this is in part due to Americans eating twice as many animal products as necessary. So if we eat the recommended amount of animal products, we don’t need the factory farms! Sustainable agriculture

Chronic Disease. Increased production equals increased consumption. It used to be hard to have animal products: raise and milk own cow, gather own eggs, kill an animal. Families used to not kill a chicken and eat it everyday. Now animal products are commonly in every meal. Americans eat twice as much animal products as recommended in a healthy diet. Chronic disease

We are now learning increased animal consumption increases risk of diseases such as heart disease, inflammatory conditions, and cancer. Therefore, increased animal product consumption is another contributing factor of the standard American diet causing chronic disease. Animal products are high in saturated fat and pro-inflammatory compounds. Fat and proteins in animal products form polycyclic aromatic hydrocarbons and heterocyclic amines when cooked at high temperatures and/or long length of time. Also highly processed meats, such as deli meat and hot dogs, have artificial ingredients that are unhealthy. One preservative, nitrite, is a known carcinogen. Healthy eating

Image result for meatless monday

Not only do excessive animal products promote disease, the animal products from factory farms are lacking nutrients such as omega 3’s and vitamin D that help prevent disease. Those nutrients are crucial for anti-inflammatory and anti-cancer effects. So the quality of animal products has decreased, and the quantity has increased, which is not a healthy combination.

The Solution

There is hope. Humans are starting to realize the problem and demanding humane animal products. People are becoming more mindful about what they purchase and eat. Communities are blocking companies from putting CAFOs and processing plants in their area, like the Tonganoxie community did with Tyson. https://www.cbsnews.com/news/kansas-town-rejects-tyson-chicken-plant-1600-jobs/

There is a local food and farmer movement. There is a movie just released, “The Biggest Little Farm” about a family who starts an old fashioned and sustainable farm. Biggest Little Farm

biggestfarm

Personally, my daughter and I became so concerned, and it became more and more difficult to find animal products we trusted, that we rarely eat animal products. It is possible to eat a healthy plant based diet that is good for your body, the animals, and the environment. I will write another article on the logistics of eating plant based. For the rest of our family who still eat animal products, I make sure the quantity and quality is the best possible.

Quantity: Animal products do provide nutrients. They are a source of complete protein (provides all 9 essential amino acids). There are nutrients that are harder to find in plant products such vitamin B12. But plants are meant to be majority of our diet, and animal products are meant to be a maximum ⅓ of our diet. And it is possible to live a healthy life without animal products (I always point out that elephants are herbivores!).

It’s relatively easy to decrease the amount of animal products. When possible I provide plant based, such as plant based milk. And watch the portion size, each person doesn’t need a full steak or giant chicken breast. I try to provide more white meat than red meat. Most breakfasts are meatless, and I make some dinners meatless for the whole family. Meatless Mondays is a movement that helps families have at least 1 day a week without meat.

Quality: Be mindful of where and how your animal products came about. Most of the branded products come from the industrialized livestock. And be wary of labeling and marketing. If it says “cage free”, it may mean the chickens are still in a building with no access to outside, they just aren’t in cages.

I have researched farms and where I can get the best quality.  I try to get eggs, dairy and meat from animals that I know are treated nicely, out in the sun, and eating grubs and grass. Luckily more people are getting more aware and mindful about food, and local good food is becoming easier to find. Our closest grocery store carries chicken and eggs from a local farm. Local farmer’s markets are great to find farm to table sources. One of my favorite is Pastimes Farm.

The common thing I hear is “local small farms are more expensive than industrialized food”. My response is: 1. It is healthier for you, so lessens risk of disease that you will pay for later 2. You should only eat 1/3 of food as animal products, so its better to eat smaller more nutritious animal products. Again we need to decrease our quantity of animal products and increase the quality. 3. There is less waste when food is valued, and no recalls of local farmer’s food. 4. Maybe local food isn’t so “expensive”, but that the industrialized food is too cheaply made. Plus we are supposed to spend a large portion of our income on food which is a necessity. And if you really cannot afford the top option, there are ways to find the best possible option: such as Aldi’s has grass fed beef (you can’t be guaranteed how they were treated, but at least it’s a step above regular beef).

pastimes farm

In summary: be mindful of your food, the closer to nature the better!

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Magnesium: Important for every cell

Magnesium is a nutrient that deserves it’s own article. Every cell in the human body needs it to function. Magnesium is a helper molecule in over 600 reactions that happen in the body! Unfortunately, over half of Americans get less than the recommended amount of magnesium. Therefore, my goal is to explain why magnesium is important and how to make sure you get enough!

Functions

Magnesium has many functions. One of magnesium’s main roles is acting as a co-factor or “helper molecule” in the chemical reactions performed by the body. The “Mg+2” in the diagram above is magnesium which is necessary to perform the cell’s functions.

Magnesium is important to all cells and all systems as seen in the chart below. Magnesium functions When there isn’t enough magnesium, those functions aren’t done as well, and dysfunction or problems can occur.

BODY SYSTEM FUNCTION DISEASE IF DEFICIENT/USE OF SUPPLEMENT
All cells Energy production Fatigue, slowness of bodily functions
Skeletal muscles Muscle contraction Muscle weakness
Gut muscles Movement of stools Constipation
Respiratory tract/lungs Movement of mucous, opening of airways Congestion, asthma
Brain and nerves Calming effect, mood regulation Insomnia, depression, anxiety, headaches, trouble focusing, difficulty with memory and learning
Bones Calcium regulation and hardening Osteoporosis
Heart and blood vessels Regulates blood vessel wall contraction High blood pressure, heart disease
Metabolism Blood sugar regulation Can increase blood sugar such as in diabetes
Pain nerves and all cells Decrease inflammation and pain Headache, inflammation, pain

Deficiency

Magnesium helps a body stay healthy in many ways. If you do not get enough magnesium, these bodily functions are affected. Too little magnesium can cause decreased energy, fatigue, and muscle weakness. Magnesium plays a role in brain function, and deficiencies can contribute to problems such as depression, ADHD, and anxiety. Because the gastrointestinal tract uses muscles to move food along, not enough magnesium can cause constipation. The lungs and respiratory tract also need magnesium for its muscles, therefore low magnesium can worsen nasal congestion and asthma. Blood vessels also have muscles in their wall, and low magnesium plays a role in high blood pressure. Magnesium is used to regulate blood sugar, so low amounts can contribute to high blood sugar in diabetes. It is anti-inflammatory, so deficiency can increase pain and inflammation. For the reasons above, I use magnesium to help patients with conditions such as headaches, asthma, mental health troubles, and constipation.

Sources

Magnesium is a naturally occurring mineral. It can be combined to form compounds or salts. For instance, epsom salt is magnesium with sulfur called magnesium sulfate. Magnesium can be found in vegetables, seeds, and nuts. The standard American does not eat much of these foods, that is why most Americans are deficient in magnesium. Magnesium is not found in highly processed and fast foods. For instance, a McDonald’s hamburger has 10 mg of magnesium. The recommended daily amount is 400 mg, and that would be hard to do with highly processed foods that only have 10-20 mg of magnesium.

Supplements

So how do you make sure you get enough? Well, make sure to eat whole, real foods such as vegetables and nuts at least a couple times per day. For most Americans I recommend a daily supplement, since magnesium is so important and not easy to get in the standard diet. The 2 forms of magnesium I recommend are citrate or glycinate. Citrate is the form that has more action in the gastrointestinal tract, so it is the form I use for patients with constipation. In individuals without constipation, the citrate form can cause diarrhea. The glycinate form has less action on the gut, so it is what I use for patients without constipation but with other ailments such as migraines, depression/ADHD/anxiety, or asthma.

Typically I tell patients who are above 90 pounds to start with 200 mg once a day, if tolerated go up to 300-400 mg per day divided twice a day. For children less than 90 pounds, they will most likely need a liquid or chewable form, and the directions will be on the bottle. Pedialax brand has a chewable magnesium that is easy to give kids, and is my treatment of choice for constipation. If a calming effect is needed, Natural Vitality has Kid Calm supplement which has Magnesium and other nutrients that support calming. There are many options I discuss with families to find the best supplement for your child.

pedialaxkid calm

Conclusion

In summary, every cell in your body needs magnesium to function, yet magnesium is found in foods that aren’t consumed in high amounts by most Americans. Therefore, magnesium deficiency may be another unhealthy part of the standard American diet of highly processed foods that maybe contributing to the rise in chronic diseases such as asthma, heart disease, chronic fatigue, and mental health problems. Another reason to eat whole real foods such as vegetables, fruits, beans and nuts!

Vitamin D: Important to have, but hard to get

This micro-nutrient deserves its own article, and you’ll soon see why. It is one of the most important nutrients that every cell in our body needs, but unfortunately it is very hard to get. Almost half of Americans are deficient in Vitamin D. Therefore I recommend everyone take Vitamin D supplement, and this is why:

Forms

There are different forms of Vitamin D. Vitamin D2 is called ergocalciferol, and it is found in the skin and plant products. Vitamin D3 is called cholecalciferol, and is found in animal products. But this isn’t even the form the body uses. The liver changes D3 to 25-D3, and this is the storage form of the vitamin. When vitamin D is needed, the liver releases it to the blood, and then the kidney and other cells convert that to 1, 25-D3 which is called calcitriol. Calcitriol is like a hormone, it can go into the cells and make changes and help cells find balance.

Functions

I think of vitamin D as the hormone that helps every cell find balance. It’s most famous for its role in the bones: regulating how calcium is used, and regulates bone growth and bone remodeling. But it also helps all cells in the body. It helps cells know when to grow, but not grow too much, and when there is too  much growth it tells some cells to die. It helps immune cells know what and when to attack. It helps muscle cells know when to contract, but not too much. It helps glands know when to secrete hormones, but not too much. It helps the brain know what chemicals to release and how much. And we are learning more and more about the effects of vitamin D on regulating cells and systems in the body. So as you can imagine, when there isn’t enough vitamin D, these cells and systems can get out of balance, not work right, and can lead to dysfunction and disease.

Acute deficiency

If the human body gets very little vitamin D, the first thing it effects is calcium. Low calcium levels cause the bones to soften. In kids this is called rickets. In adults it causes osteoporosis. With severely low levels, the calcium can get so low that seizures happen.

Chronic deficiency

If the body doesn’t get enough vitamin D for a long time, the cells don’t work as well. It can increase the body’s risk of getting certain diseases, such as high blood pressure and autoimmune disorders (such as multiple sclerosis and rheumatoid arthritis).  New research is emerging about vitamin D’s role in preventing disease, right now there is evidence for a connection with 200 conditions. http://www.greenmedinfo.com/substance/vitamin-d

Now going back to my very first article: chronic disease typically have 2 hits. Environmental Exposures: Overview One is usually a genetic predisposition, and the 2nd is usually environmental. For some people who have a genetic predisposition, low vitamin D could possible be the 2nd hit that causes disease. Not only can vitamin D help prevent disease, it can also be used to help improve disease. It is true: you are what you eat, and food can be medicine!

All cells: Vitamin D helps with cell regulation of growth and death. When cells do not have regulation of growth and death, then cancer can occur. Therefore vitamin D can help decrease risk of cancer. Vitamin D and cancer

Bone: As mentioned above, vitamin D is important for calcium and bones.

Immune system: Vitamin D is used in immune cells to help regulate when an immune cell “attacks” and when it doesn’t. Low vitamin D can increase infection and autoimmune disease because the cells don’t know when to attack and when not to. Vitamin D and Autoimmune disorders

Pancreas: Vitamin D is used to help regulate release and response to insulin, so low levels can increase risk of type II diabetes. Vitamin D and diabetes

Cardiac: Heart and blood vessel muscles use vitamin D to know how much to contract. Low levels of vitamin D can cause an imbalance in blood vessel contraction causing high blood pressure and increased risk of heart attacks. Vitamin D and Heart

Muscle: Just with heart and blood vessel muscles, skeletal muscles use vitamin D

Brain: We are starting to learn that the brain uses vitamin D to balance the chemicals used to signal. Vitamin D increases levels of chemicals such as dopamine and serotonin that helps to improve mood. This maybe a contributing factor for seasonal affective disorder, the increase in depressive and anxiety symptoms in the winter when less sun is exposed. Vitamin D and depression

Research has also demonstrated that vitamin D helps older people with brain function. Vitamin D has a variety of brain protection roles, including helping to rid the brain of beta-amyloid, an abnormal protein that is believed to be a major cause of Alzheimer’s disease. An international study showed that seniors with very low levels of vitamin D are at twice the risk of Alzeimer’s disease. (http://n.neurology.org/content/83/10/920)

Weight regulation: Vitamin D is important to the effectiveness of leptin, the appetite hormone that tells you when you are full. When vitamin D is low, it is harder to feel full. When vitamin D levels are replenished and back to normal levels, leptin’s actions are restored, thus creating feelings of satiety and aiding in weight loss.

It is estimated that 43% of Americans do not have an adequate blood level of Vitamin D. As you can see, that may be contributing to America’s high rate of obesity, depression, heart disease, cancer, diabetes, autoimmune diseases, etc.

Sources

I warned you getting vitamin D naturally is difficult, and you are about to find out why.  There are basically 4 sources: the sun, animal fat, fortified foods, and some plants. But it is more complicated than that!

It is difficult to get from the sun: light skinned people would have to spend 2 hours a week outside in the sun with majority of skin exposed without sunscreen. The average American spends 93% of their time indoors, and sun through windows doesn’t increase vitamin D as well. Darker skin people would have to spend even more time since their pigment reflects the sun’s rays. It also depends where you live: the further away from the equator the less sun rays get to the earth’s surface. Interestingly, years ago it was noted autoimmune diseases (such as multiple sclerosis) and cancer rates were highest in places further away from the equator. We now know sunlight and vitamin D was the reason! But direct sun exposure causes skin cancer (especially with less ozone layer to filter out harmful rays), so we need to wear sunscreen or clothing to prevent direct sun. But only direct sun increases vitamin D.  Therefore direct sunlight is not the best way to get vitamin D because the benefit of too much direct sun exposure to get vitamin D is not worth the skin cancer risk.

It is also hard to get in food. Vitamin D is a fat soluble vitamin, so it is found in fat. Fat from aquatic animals and egg yolks contain vitamin D. But how the animal was raised makes a difference. Fresh caught salmon contains 3-4 times as much vitamin D as farmed salmon. Free range chickens who get enough sun may have good amount of vitamin D, but chicken that is in a livestock building without access to sun will not have vitamin D. Fortified food is another source. Some of our food and processed food is fortified: dairy and cereals have some vitamin D. But without being in fat, it may not be absorbed very well.

There are some plant based sources, such as mushrooms and algae. But most of these are in the D2 form which is hard for the body to turn into the D3 form, so it isn’t as good at helping active form levels.

For this reason I advise everyone to take at least 400-600 units of vitamin D per day. And depending on your diet and sun exposure, even more maybe needed. The goal blood level of 25, D3 is 30-50 ng/ml. Research shows that consuming 1,000 IU daily would help 50% of people reach a vitamin D blood level of 33 ng/ml. Consuming 2,000 IU daily would help nearly everyone reach a blood level of 33 ng/ml.

Since it is a fat soluble vitamin, it can be stored in our liver, and at high amounts for a long time can be toxic. But it is very rare, it would take daily intake ranging from 40,000–100,000 IU for several months to be toxic. Also it is impossible to get too much vitamin D from sunlight, so not to worry when you’re on a beach vacation (but you should be wearing sunscreen anyways;)

Supplements

As you can see it is very hard to get enough vitamin D naturally from sun and food. Therefore I recommend everyone take a supplement. But as usual, it is deeper than that. You have to make sure it is Vitamin D3, cholecalciferol. That is the form that is best at raising body’s levels of the active form of vitamin D.

d3

Infants who are fed less than 34 ounces of fortified formula (exclusively breastfeeding, or feeding small amounts of formula), need to be supplemented with at least 400 units of vitamin D. AAP Prevention of Vitamin D deficiency

Besides infant formula, there isn’t a reliable way for children to get the right amount of vitamin D. Basically anyone not drinking 1 liter of fortified infant formula needs to take at least 400 units of vitamin D3 per day! I personally have me and my family take 1000-2000 units per day. And I recommend people with conditions such as asthma and psoriasis, to take at least 2000 units per day.

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I also recommend people be informed consumers. Supplements are not as regulated as medications, so just because it says something on the label, may not mean that is what or how much is in it. Research the company and make sure they are reputable. One company our practice recommends is Metagenics. The products are backed by science and verified by 3 independent organizations.

Conclusion

I hope I demonstrated that vitamin D is important and hard to get. Low levels of vitamin D in the standard American diet maybe one of the factors contributing to the increase in chronic disease in America. So take 400-2000 units of vitamin D3 supplement everyday!

Nutrition 101: Macronutrients (carbs, fat and protein)

What is a balanced diet? Well, basically it’s eating the right amount and type of food to get all the nutrients the body needs in the right amounts. A nutrient is a substance that provides nourishment essential for growth and the maintenance of life. Your body needs over 40 types of nutrients! The food you eat gets broken down into nutrients. Nutrients are the building blocks of the body. Not only to build and repair the structure of the body, but also for all the functions of the body like moving, thinking, heart beat, breathing, etc, etc. For my dietetics degree, I had to take the highest class of biochemistry, which is all the reactions and pathways in the body. I had to learn what nutrient is required for everything the body does, and there are thousands of spots where the nutrients are required (represented as dots in the photo below, notice how many dots there are!). That is why when someone is eating an unhealthy diet, I wonder what functions their body is not able to perform without nutrients. The burden of knowledge I guess;)

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There are many types of nutrients, the main groups are macronutrients and micronutrients. Macronutrients are those we need in larger quantities (protein, carbohydrate, fat and water). Water is considered a macronutrient because it is essential for the body to function and is needed in large amounts (actually the body is mostly made of water!). Micronutrients are those we need in smaller quantities, but they are still essential (vitamins and minerals).

This article is going to focus on the macronutrients: purpose, and how to get the right amount and type for healthy balanced diet. My next article is going to be on micronutrients. Again, I have a dietetics and medical degree, and it’s still difficult to interpret information. But this is knowledge and conclusions I have drawn.

Balanced macronutrients

Scientists and health professionals have figured out what percent of calories of a diet is balanced for each macronutrient. You have probably seen the pie graph with % of calories from each macronutrient.

I do not like that pie graph because it is misleading, since calories and grams are not the same. So for some nutrition 101: Calories is a measurement of energy, grams is a measurement of weight. Carbs and protein give us 4 calories of energy per gram, but fat gives us 9 calories per gram. So the % of calories is not grams, fat is double the calories per gram, so it’s about half the amount in a balanced diet. For instance, in a 2000 calorie diet: 50% carbs is 1000 calories, 25% protein is 500 calories, and 25% fat is 500 (this example is simplified the average %, it can fluctuate 10-20% and doesn’t have to be exact). So that makes it look like you can eat ¼ of your plate as fat?! Not so fast: Those calories converted to grams are in below table, so fat amount is actually about 1/10 of your plate. So when looking at your daily intake amount in grams, about half carbs (and that’s more than just bread as you’ll learn below), about 1/3 protein, and about 1/10 fat (since fat is double calories, the actual amount in grams is small).

Macronutrient % calorie Calories in 2000 cal diet Grams in 2000 cal diet Avg amount in diet
Carb 50% 1000 cal 250 g 1/2
Protein 25% 500 cal 125 g 1/3
Fat 25% 500 cal 50 g 1/10

Carbohydrate

The main purpose of carbohydrates is for energy. All carbohydrates are broken down to the building block glucose which your body uses for energy. Relatively little is required, because the body can turn glycerol (a building block of fat) and amino acids (the building block of protein) into glucose. The lowest amount is what is needed by the brain, about 50-100 grams per day. But it is an easy form of energy, so the typical balanced diet has about 50% of calories from carbohydrates.

GLUCOSE MOLECULE

There are 2 main types of carbohydrates: simple and complex. Complex is in the natural state with protein and nutrients. Such as in vegetables, whole grains, fruits and dairy (yes lactose is a carbohydrate). Simple is just the white starchy part, where humans thought “this white stuff is yummy, let’s take it out and make stuff from it”, like white bread, cookies, cakes, etc. The reason it tastes so good, is because it is quickly converted to sugar. So eating white flour is basically like eating sugar.

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You can probably guess what I’m going to say is the healthier type of carbohydrate: the closer to nature complex carbohydrate! Vegetables, fruit and whole grains (such as oats, brown rice, quinoa, barley, etc). Processed carbs such as bread, white flour pasta, and white flour cereal should be a small part of a good diet, and even then try to get as whole grain/closer to nature as possible (i.e. instead of white bread, get whole grain. Instead of apple jacks, eat bran flakes, etc)

Protein

Protein is an essential part of our diet. There are proteins that we cannot make in our body. The building blocks of proteins are amino acids which join together with peptide bonds to form proteins.

There are some key phrases when talking about proteins that I want to explain

Essential amino acids: There are 9 a building blocks (amino acids) that our body cannot make. The other amino acids our body can make from other building blocks. But 9 we cannot make so we have to eat.

Complete protein: Has all 9 essential amino acids. Animal products typically are complete, because animals need the same amino acids to build their structures like we do. Plant proteins can be complete or incomplete, as plants don’t need all 9 essential amino acids to build their structure. But you can eat complete plant proteins (this is why soy and quinoa are so popular in plant based diets), or combine different ones to get all 9 essential amino acids. Which brings me to:

Plant based protein: It is a common misconception that you can’t get enough protein from plants. I think this came from the livestock and dairy industry, with messages like “got milk” and “beef it’s what’s for dinner”. In fact, because of this, Americans tend to eat too much protein. For instance: 1 portion of chicken (100 grams) has about 25 grams of protein (about ¼ of protein for the day). Many plant foods have a high amount of protein, for instance 100 grams of sunflower seeds, almonds, or quinoa has about as much protein as chicken. So plant based diets have been labeled as “not enough protein” by the livestock industry. But the real problem is most Americans eat above the recommendation of animal protein a day, almost twice as much required (plus too much animal products is inflammatory and linked with heart disease, cancer, etc. But more on plant based eating later!) My daughter and I eat plant based, and we are doing just fine;)

http://healthfitnessboss.com/wp-content/uploads/2014/08/protein2.jpg

Fat

Fat is needed by every cell in the body for many functions. The building blocks are glycerol and fatty acids which form glycerides (also called lipids).

There are essential fatty acids that we need for structure and functions of the body, but cannot make in our body, so we have to get it by eating it. Fat literally makes up the wall of every cell in the body! Kids especially need fat, since their nervous system and brain are growing, and every cell in the nervous system needs a lot of fat to function. Plus it is a concentrated form of energy (remember 1 gram = 9 calories) so rapidly growing and active children require fat.

 

Since there are essential fats we have to eat, the lower limit is 15% of diet, but recommended average is around 25% of calories (remember that doesn’t mean ¼ of your plate is olive oil, since it has double the calories it is more like 1/10 of grams of food)

Fat is the most misunderstood macronutrient. It has been blamed for heart disease and obesity, etc, etc. But it was an easy scapegoat (see my last article What is healthy eating?). Now there are different types of fat based on the type of fatty acid. This is probably why fat as a whole has gotten a bad rap, is people think if 1 type is bad, they must all be bad. But doctors use fish oil (omega 3 fatty acids) to treat high fat in the blood, so case in point that all fats are not created equal!

Fat is first broken down into saturated and unsaturated. Chemistry 101: saturated has no double bonds, so is “saturated” with hydrogen. Unsaturated fat has double bonds, so is less saturated with hydrogen. Unsaturated fat is then broken down based on how many double bonds are: monounsaturated (1 double bond) and polyunsaturated (more than 1 double bond). Polyunsaturated is then broken down based on where the double bonds are: omega 6, omega 3, and trans.

Type fat Found in Key points amount
Saturated coconut oil, butter (solid at room temp) Not really bad, but not really good

But is good for cooking at high temperatures

Yellow light:Middle

About 10% of energy, about 22 grams in 2000 calorie diet (about 2 tablespoons coconut oil)

monounsaturated Olive oil, avocado, nuts Anti-inflammatory

Cooking at medium temperatures

Green light: The most! Mono and omega 3 combined: 15-20 % of energy (44 grams in 2000 cal diet)
Omega 3 Fish, flax, walnuts, grass (so animal products who are grass fed) Anti-inflammatory

Not the best when heated (except you have to cook animal products)

Green light: The most! See monounsaturated
Omega 6 Pressed oils (canola, corn): aka french fries and processed foods Causes inflammation! Yellow/almost red light: The least! Limit to 5% of energy (0-10 grams)
trans Frankenfoods (not natural) Ugh-causes a lot of problems in body Red light: Avoid at all costs!

A couple key points I want to point out: Omega 3 fat reduces inflammation and is healthier, omega 6 fat tends to be more inflammatory (it is closer to forming inflammation hormones called cytokines). We are supposed to eat more Omega 3 to Omega 6, but unfortunately the standard American diet has 10 times more Omega 6 than Omega 3 (which contributes to the high rate of heart disease, autoimmune disorders, and cancer).  Americans need to eat less french fries and more salads with flax oil and walnuts!

Now trans fat is a totally different beast: it is not found naturally, it is made by humans when companies tried to capitalize on the low saturated fat craze, and tried to turn unsaturated fat into saturated fat to spread on toast (aka margarine). We are now learning that the body doesn’t really know what it is, and it causes all kinds of inflammation and problems. So avoid trans fats!

A couple logistics I use this information to do in my household:

For cooking at high heat I use coconut oil.

For cooking at medium heat I use olive oil.

For salad dressing I use olive oil or flax seed oil.

I add whole foods with good fat to my family’s diet: avocados, nuts, fish

Avoid processed foods that use omega 6 oils (there is a chip Boulder brand that uses coconut oil and olive oil)

So now you can see why the mediterranean diet (high in vegetables, fish and olive oil) is the healthiest diet in the world! (Mediterranean diet)

Conclusion

Congratulations, you passed nutrition 101! All this information (and more) is what I used to develop my healthy plate handout.

It’s not about counting calories or grams, but getting the right variety and amount of the right types of whole food. Meals should be modeled off the healthy plate, and snacks should be a plant and a protein (credit to my partner Dr. Mellick at Pediatric Partners for that snack line!).

So just take what you’re doing now, compare it to the healthy plate and healthy snack, and find ways you can modify it to be closer to nature!

What is healthy eating?

What is healthy eating? Seems like a simple question. But there is so much information (and misinformation) out there, that it can be hard to tease out the answer. I have a bachelor’s degree in dietetics, a doctorate in medicine, training in integrative medicine: and it is still hard for me to interpret all the information out there. But I have taken my knowledge and training to come to conclusions on this topic: not only to know what to feed my own family, but for the families I help in my pediatric practice. The short answer: eat when hungry, eat the right variety and types of real food and stop when full.

healthy-eating

Seems simple, right? But in today’s society that can be hard to do. In this article I’m going to review the problem with the standard American diet (ironically the acronym is SAD), the barriers to eating healthy, and an overview of what is the solution.  

 The Problem 

Americans are unwell: 1/3 of kids are overweight or obese (so only 2/3 are healthy weight), 2/3 of adults are overweight or obese (so only 1/3 are healthy weight). CDC statistics Chronic disease is increasing: type 2 diabetes, heart disease, cancer, asthma. (chronic disease in children). Pediatricians used to manage acute illnesses and not chronic illnesses.  But unfortunately now 10% of American children have a chronic condition, and pediatricians are having to manage things that used to be “adult” conditions, such as type 2 diabetes and high blood pressure.

The average American today eats too many “empty calories”, meaning the SAD has high calorie foods that has low nutrients. Today’s children are overweight and malnourished. And again, today’s children are already getting unhealthy diseases such as type 2 diabetes and heart disease. Because of this they may have a shorter lifespan than their parents. For the first time in human society, we are regressing instead of making progress with health.

Evolution-of-Obesity

This increase in overweight and chronic disease started in 1970, before that childhood obesity had been at 5% for decades, which was mostly due to genetic disorders (such as Prader-Willi, etc).  ChildObes71toPres

So what were we doing better before 1970? Simply put: We grew, prepared, and cooked our own food. Americans are getting further away from the food we eat. We’ve been told that we don’t have the time or money to make food, so we should let the companies do it for us. 

swanson

The problem is when we rely on someone else to make our food, they don’t care if they make it healthy, they are a business and goal is to make it as cheaply as possible to increase their profit.  Again, we are eating more food, but less nutrients (again which increases profit for the companies). 

 The Barriers

Time and money: Again, our society has shifted it’s values, mostly due to increase in consumerism. We are surrounded by messages that food doesn’t have to be a priority so the companies can do it and make money. We need to shift our value back to valuing food as a priority. I hear all the time that families feel they don’t have the time or money for healthy food. But the average American watches 4.5 hours of tv per day, how about using part of that to cook a healthy meal? And the amount of money we spend on food has declined in the past 100 years, how about at least going back to spending 15% of household income on good healthy food?  

thr-income-spent-on-food_custom-ed63b133b0b3914191e299c179a61271caa0db71-s1400-c85

 Environment: The food companies have infiltrated our society. It’s easier in America to eat junk food. It’s harder to find, prepare and eat healthy food.  

130627100234-vending-machine-school-student-horizontal-large-gallery

 Misleading information: One reason for this is research is hard to do for eating due too many variables involved.  Also consumerism uses that information and twists it to their advantage (I will discuss this below about fat and sugar). A comical example of this is fiber one bars. So a study shows fiber decreases cholesterol, so a company makes fiber one bars to make people think it is “healthy” and sell the bars. But was it really the fiber itself, or that fiber is found in plant based highly nutritious foods? Again I find myself laughing at the commercials: the poor guy is eating a salad missing all the fun with his friends, but with a fiber one bar he’s much more cool! The message they try to convey is “There’s a better way to eat your fiber”: so instead of nutritious salad, it’s “cooler” in society to eat a chocolate bar with some wood pulp “fiber” in it?!

fiber-one-oats-and-chocolate-bowling-alley-song-by-berlin-large-2fiberone

 The solution 

To solve a problem, we have to get to root of problem. So what changed from 1970? The All American meal changed from homemade meals of vegetables and protein; to fast food meals of hamburger, fries and soda.  

There is evidence to show this for America: the amount of carbohydrates increased, mostly in the form of corn syrup in processed foods.

cdc carb

You may also notice that fat consumption went down in that graph. Another thing that happened around 1970 was fat started to get a bad reputation.  A study showed a diet low in saturated fat decreased heart disease. But America misinterpreted the information, and misinformation spread. The real information was that Mediterranean countries that had a diet low saturated fat, but high in unsaturated fat (think Italy with fish and olive oil), had less heart disease. But instead American consumerism latched onto “low fat” craze: Americans were brainwashed to think that fat made us fat, and to replace it with sugar. (fat versus sugar) We are now learning sugar is worse for us than the saturated fat we originally thought was “bad”. Plus the low fat “diet” did not make us feel full (fat increases fullness, and sugar actually makes you hungrier), so people had to count calories to self restrict because they never felt full (this is when Weight Watchers became successful).

wwLow fat, so it must not make you fat, right?!

So all of this sounds confusing: so the egg yolks and nuts that we were told would make us unhealthy was actually making us full and more nourished, so now we can eat them again?! See how misinformation and consumerism can mix the messages. I will try to re-teach “what is healthy” more in depth in future articles. A useful website is healthline, it uses evidence to come to conclusions and has lots of great information, it explains some of the myths around fat: healthline.com . There are also a couple of interesting books: 

Salt sugar fat: how the food giants hooked us. By Michael Moss

Food rules: An eater’s manual. By Michael Pollan

Ok, so the problem is relying on companies to make our food, and fat isn’t necessarily the enemy but sugar is the enemy.  So how do we get back to the 1970 diet? Below is some big picture target behaviors that I made in a handout for children:

healthyruleshandout

  1. Limit portion size

Food companies have gotten really good at making a lot of food cheaply. Plus the more food they sell the more money they make. The average portion has tripled since 1970. A normal portion size is the size of a person’s palm, keep this in mind. In our home, if you’ve eating a palm size portion and you’re still hungry, eat a different food to increase variety.

portion

  1. Limit consumption of high calorie, low nutrient foods

The further away from nature, the more good stuff has been taken out, and the more bad stuff is added. Plus companies make processed food taste supernatural so you eat more. Kids are literally addicted to processed foods. It starts young: “baby cheetos” and “baby sugar melts” changes taste buds to like more salty and sugar food, so natural food like vegetables taste like dirt in comparison.  

The solution is to eat food that is “closer to nature” as possible. Take a look in your fridge and pantry, and make a list of what you usually eat, and see if there are better choices. For instance, if you eat a nutrigrain bar for breakfast or snack, the closer to nature form would be oatmeal with real fruit.   

  1. Meal choices

Nutrients are building blocks we need for our body to grow and function, and we need certain types in certain amounts. 

Macronutrients are carbohydrate, fat, and protein. Micronutrients are vitamins and minerals. I will give you more information in a future article on nutrition 101 about how to balance food variety to get the right mix of nutrients. But for now, here is a handout I developed of a healthy plate which is a good visual of what a healthy type and variety: 

healthyplate

Also eat homemade meals as family. Again, if you make your own food you make it healthy. And when kids eat with parents they eat better. Parents are in charge of the what kids eat, kids are in charge of how much they eat: KIDS ARE NOT IN CHARGE OF THE WHAT THEY EAT. Kids do not have insight to know what is healthy, they only know what tastes good and is familiar, so they will trick adults into feeding them granola bars and mac/cheese (aka “mom I’m going to starve if I don’t get Mac/cheese” or they don’t eat their meal but then they ask for granola bar). Dr. Ellyn Satter has done lots of research on how to prevent “picky eaters”, and she terms it division of responsibility of eating (Division of responsibility feeding children) Kids will not let themselves starve even if the only food available was broccoli. The problem is in American there is a plethora of types and amount of foods. In our home: I make healthy meals and and have healthy snack options, and that’s what’s to eat (if they don’t eat at least half of meal, it goes in fridge and that’s what they eat later, to avoid them just snacking all day), and we only have water and white milk to drink (anything else is a treat, like at a birthday party). And the tough love worked: now my family eats any vegetable and prefers water to sugary beverages, and they didn’t starve😉  

  1. Physical activity

Another thing that is changed is Americans aren’t as active. Children should have at least 60 minutes of activity per day. Their screen time should be limited to maximum of 2 hours: for many reasons, but also to get them off the couch and get moving! 

  1. Increase fruits and vegetables

Vegetables and fruit are literally the healthiest thing you can eat: they have the most nutrients per calorie. Unfortunately they are the least eaten in America.  Studies estimate the average American child eats 2 servings of vegetables and fruit per day, and that includes potatoes and iceberg lettuce (aka french fries and lettuce on hamburger). (AAP prevention of obesity) 

It is recommended children eat at least 5 servings of vegetables and fruits per day to get the recommended nutrients. Plus, those are replacing less nutritious forms of food. In our home our rule is: every meal and snack needs a vegetable or fruit. Therefore 3 meals and 2 snacks a day = 5 servings vegetables and fruit.  

*A note on juice: juice is the squeezed out sugar and water from fruit and vegetables. And it’s sugar without the good stuff in the whole piece of fruit with fiber. Plus, it’s concentrated source of sugar. For instance, it takes about 4 oranges to make 8 oz of orange juice, that’s about 30 grams of sugar! Therefore, I consider juice a sugary beverage and is a “treat” a maximum once a week.

  1. Limit sugar 

At high levels sugar is a poison to the body: causes endocrine problems such as diabetes, causes inflammation, increases risk of cancer and heart disease. In fact, sugar directly increases the risk for cardiac death: the only controllable thing that has been proven besides tobacco use to increase death from heart disease (Sugar and heart disease). There is also no nutrients in sugar, so it’s just empty extra calories that get stored as fat. Also, when you eat sugar, it makes you hungrier because of the sugar high that then leads to sugar low that stimulates hunger .

Added sugar is sugar not naturally found in natural food (aka the sugar mixed into processed foods like flavored yogurt). Sugar in fruit and vegetables has the nutrients, plus nature is smart and doesn’t put too much sugar in a serving (1 serving of fruit is typically 5-10 grams of sugar).  The maximum daily amount of added sugar is 25 grams for children. Unfortunately the average American child eats 90 grams of added sugar per day.  Most people don’t realize 4 grams of sugar = 1 teaspoon of sugar (food companies use this as another way to trick the consumer, if you knew the yogurt had 6 teaspoons of sugar dissolved in it, you probably would think twice about eating it, but 24 grams sounds like 24 little granules and doesn’t sound as bad). So if it’s a poison in high amounts, then why is so much sugar added to processed foods? Well companies know if they add sugar, it will taste good, and people will be more likely to buy it.  And that’s the companies goal: to sell more and make more money (AAP Sugar)

SugarStatement-Infographic-08.16.161-1024x712yoplait

 Take home message

Well those are the key points of what this pediatrician and mom has come to the conclusion of what is healthy eating. You don’t have to memorize a bunch of rules, or count calories, or start the latest fad “diet” (I dislike the way the term diet has turned into a fad, the best diet is a healthy lifestyle of the right balance and type of real food!).

Just choose the right type and variety of real food: the most of what you should eat is plant based (vegetables, fruit, nuts, whole grains, beans, olive oil, coconut oil), in the middle is whole animal products (eggs, dairy, meat), and lowest amount of what you should eat is processed foods and added sugar. 

Simple, right?! Everyone can improve their lifestyle. What you’re doing now is a habit, meaning that  you do it so often that your brain makes a short pathway so you don’t have to think hard about doing it. When you are changing habits, at first you have to work and think harder, but eventually it becomes a new habit. So just take a look at what you do now, and see if you can improve, and work on 1 thing at a time.  Once the healthier choice is a habit that you don’t have to think or work hard to do, then work on the next habit, etc. So set 1 goal right now: ready, set, go! And I will keep writing and giving knowledge and tips to help!

Food additives and children’s health

Introduction

Humans need food to provide energy and nutrients. But how we get that food has changed in the last 100 years. The settlers spent most of their time and resources towards growing, gathering, and raising their own food for their family. With time our society transferred this work outside the home. There were some advantages to this. But with most things, humans have taken it to the extreme, and now we are learning some problems that has created, and need to find a balance again. Today, most Americans are far removed from the source of their food. When you rely on someone else to make your food, most of the time they are not as concerned with making it nutritious. Most processed food company’s goal is for profit, and so their goal is to make things desirable to the consumer (with a perfect combination of fat, sugar, salt and flavorings that you can’t just eat 1!), and also make with as cheap of ingredients as possible to make as big of a profit as possible. The result is a society that is eating supernatural tasting “franken-foods” that resemble food but are not real food. Food markets have changed from colorful produce to colorful boxes and containers.

Our goal should be to provide our children with high yield, higher nutrient to calorie foods. But for numerous reasons (for instance easier and cheaper) most children eat more food that is further away from nature. The average American child gets 30-40% of their calories from what the American Academy of Pediatrics terms “energy-dense, nutrient poor foods and drinks”, aka junk food (AAP Snacks and sugar ). The more processed, further away from nature food is, the more good nutrients are taken out, and potentially bad additives are added in. This has potentially bad consequences on the body because not getting nutrients need, but also causing potential harm. In this article I want to focus on potential harm of food additives, because the AAP recently released a policy statement on food additives and children’s health, and more and more families are learning about the new information and asking what they can do. AAP Food additives and child healthI will discuss getting the nutrients kids need in a future article.

Today more than 10,000 chemicals are allowed to be added and in contact with food in the United States. There is increasing concern about processed food additives, not only because it is something that is increasingly being used and eaten without much knowledge about the effects on our bodies, but also because chronic disease in children is on the rise as I pointed out in my environmental exposures article: Environmental Exposures: Overview. This increase in illness has prompted research into what factors maybe causing it, and we are starting to learn about some of the effects these compounds. As usual, the AAP is on the forefront of taking this information and giving recommendations to help children. The purpose of the AAP’s policy statement is to highlight emerging health concerns related to food additives. This includes direct additives, such as colorings, flavorings, and other chemicals like preservatives. As well as indirect additives that are in contact with the food through packaging and manufacturing equipment such as adhesives, dyes, coatings, cardboard ingredients, plastic, and other polymers. This is to not only inform pediatricians and families to help them make choices for children, but also to propose urgently needed reforms to current regulation of food products and additives.

Oversight and regulation of food additives

The AAP points out regulation and oversight of food additives by The US Food and Drug Administration (FDA) is inadequate.  A little political background: federal agencies can only follow laws, they are not granted power to do anything outside that law. So the main law the FDA follows is the Federal Food, Drug and Cosmetic act (FDA). This law was originally made in 1938 largely before manufacturing of food substances, so a Food Additives Amendment was made in 1958 (although think of all the new additives that have been added since then!). The amendment’s goal was to set forth a formal agency review, public comment, and open rulemaking process for new chemical additives. Unfortunately, very little of food additives went through this formal process that uses agency and public review. Because the law also called for an exemption for common food additives, originally meant for things like vinegar, saying a company can use “generally recognized as safe” (GRAS) designation, and under these specific scenarios a formal rulemaking process was not required. Unfortunately, the GRAS process has been used as a loophole for companies and the FDA has allowed this for virtually all new food additives entering the market (remember in my environmental exposure blog how I mentioned the US allows chemicals on the market that other countries do not allow, this is one of the ways that happens). Even the Government Accountability Office has conducted a review of the FDA GRAS program and determined this is not adequate for the FDA to ensure the safety of existing or new additives GAO report.  Concerns also have been raised about conflicts of interest in scientific review of food additives with GRAS designation. An evaluation of 451 GRAS evaluations revealed that 22% of evaluations were made by an employee of the manufacturer and 64% were made by an “expert panel” selected by the manufacturer or manufacturer’s consulting firm. They found that none of the evaluations were done by a non-biased 3rd party: that means the “scientific” evaluations on chemicals in food humans were exposed to were made by parties on the side of the companies Conflict of interest in approvals of additives to food. (On the topic of conflict of interest: I don’t want to get too political, but I just want to add that most legislators who make the laws that govern the FDA, receive campaigning help from the companies that use these chemicals, so this motivates them to not pass legislation against these companies, see information about citizens united decision, again before we can solve a problem we have to get to the root, and the ability for companies to donate to politics is sort of like legal blackmail. But I digress!)

On top of all this, the FDA has NOT been given authority to obtain data on the safety of chemicals already on the market, so that means once a chemical passes as GRAS, it is untouchable. For instance, styrene has been classified by the US National Toxicology Program (report) as reasonably anticipated to cause human cancer, but because it is already passed as GRAS, the FDA is not allowed to reassess the safety. There are so many other problems, such as the FDA does not consider cumulative (dose and time) or synergistic (chemicals with similar effects working to double the effect). This is important because in their lifetime children maybe exposed to daily, large amounts of different chemicals that all cause endocrine disruption, therefore cumulatively and synergistically all effect the thyroid hormone system for example. The AAP and other organizations have said all of this is insufficient to ensure the safety of additives and do not protect against conflict of interest.

Why children are vulnerable 

Children are especially vulnerable to exposure to potentially harmful substances. They are still growing, so they eat, drink and breathe more per weight than adults. They are still developing, so exposures can potentially cause lifelong and irreversible damage. (WHO children and environment).  Children also have less ability to detoxify, since their gut, respiratory, skin and metabolic pathways are not fully developed. But it is more difficult to do research on children due to their personal inability to participate directly in direct recall of what they are exposed to (for instance, you can just ask an adult what they ate today!). But there still is accumulating evidence from nonhuman laboratory and human epidemiological studies that some of these chemicals maybe contributing to pediatric disease and disability.

Endocrine disruption

The potential for endocrine system disruption is of great concern in children (WHO endocrine disruptors).  The endocrine system is the hormone system responsible for things like thyroid hormone for metabolism, adrenal hormones for urine regulation and stress response, pituitary which helps control all the glands, pancreas that helps regulate insulin and weight, and even puberty and fertility hormones from gonads. Therefore, as you can imagine, in children this can have life altering consequences. Endocrine disruptor compounds can mimic hormones or affect the glands, and have the potential to interrupt hormone balances and have lifelong effects such as on metabolism and fertility. International medical and scientific communities have called attention to these issues in several recent landmark reports: Endocrine society, World Health Organizations and United Nations Environmental program joint report, and International Federation of Gynecology and Obstetrics report in 2015.

Summary of key food additives 

The AAP policy statement summarized some of the evidence we currently have on key food additives. Long story short, to be more well, eat real food that is least processed and doesn’t come in a package. Long story about additives to help back that statement up (with the caveat that these indicate increasing risk, doesn’t mean if you eat it will for sure cause, again like I said in my environmental exposures overview, it’s all about decreasing risk when possible. For instance: in this society it’s hard to avoid all driving, but you wear a seatbelt and put down your phone to decrease risk):

Bisphenols: They can be found in plastic containers, resins in cans. Possible effects include endocrine disruption, promotion of obesity, nervous system development disruption. The compound that has gotten the most attention is bisphenol-A (BPA). Despite mounting evidence about harmful effects of BPA, the FDA still says it’s safe in the amount exposed to humans (although with plastic being in and on everything the amount of exposure has increased, and studies have shown low nanomolar concentrations that humans are at least exposed to, have caused toxicity like conversion of cells to fat cells and disrupt pancreatic cell dysfunction BPA Nature article), and has only abandoned BPA’s use from infant bottles and formula cans, not because of safety, but because of public demand such that the companies voluntarily took it out of these products.

Phthalates: Found in plastic food wrap, plastic storage, food manufacturing equipment. Possible effects include endocrine disruption, promotion of obesity, oxidative stress (see my first blog about this causing toxic effects in body), cardiac toxicity

Perfluoroalkyl chemicals (PFCs): Food manufacturing equipment, grease proof paper and paperboard. Possible effects include endocrine disruption, immune suppression, promotion obesity, decreased birth weight

Perchlorate: food packaging. Can cause thyroid hormone disruption and maybe contributing to increase in neonatal hypothyroidism that is occurring in the United States (if untreated can lead to stunted growth and developmental problems)

Nitrates and nitrites: In processed meats like deli meat, hot dogs, sausage, etc. Known carcinogen (cancer causing). Also thyroid hormone disruption

Artificial colors: Maybe associated with exacerbation of attention deficit/hyperactivity (ADHD) symptoms. Again, like in my environmental exposures blog, this is dose and person dependent. But if junk food that is made out of “paint and sugar” isn’t nutritious anyways, it’s also worth avoiding artificial color if it can potentially cause worsening symptoms

Pesticides: This will be in another blog about organic foods, and the AAP wrote a separate policy statement about AAP Organic foods

This policy statement did not address contaminants that inadvertently enter the food and water supply, through environmental contamination like runoff from power plants and factories into fields and water supply. I eluded to this in my environmental exposures blog, and will talk more about it in a climate change article later.  But it’s another reason to be mindful of what you consume, remember when things are “thrown away”, they never really go away, they end up somewhere and in something.

Short story: just eat close to nature

Well that was the long story. But we don’t have to memorize all the chemical names and effects, plus we don’t even know all the chemicals and their potential effects. So what I try to do is choose as close to nature as much as possible to try to avoid the alphabet soup of chemicals. When that’s not possible, choose foods with least number of ingredients, and foods without added artificial color/flavor/preservatives, and with minimal processing and packaging. My plan is to do a video blog to show examples of how I implement this in our household.  But it can be simple, which is closer to nature:

The diet of more unprocessed foods can be easier for families from higher socioeconomic status. There are barriers for families from lower socioeconomic status, such as time (single parent homes maybe less able to make their own food), money, and access (food deserts exist in underserved areas, sometimes the only source of food is a convenient store where there is less fresh food).  This has been shown in studies, such as urinary BPA concentrations inversely associated with family income.  So not only are low income and minority children eating the high calorie low nutrient food, the packed food is exposing them to potential obesity causing chemicals such as BPA.  It makes my heart hurt that America is setting these kids up to be unhealthier.

What can we do?

So what can we do?! There are 2 levels, public health and individual family. For public health, we can help raise awareness, support organizations who are trying to improve knowledge and evoke change, and vote for representation that supports campaign finance and FDA reform.  The AAP is doing what it can to gain more evidence and lobby for FDA reform and GRAS process revision.

For your individual family, you can inform yourself to make best decision and choice possible for your individual family. Again this means different things for different families who have different means, but with what time and money you can apply to the best food you can. Prioritize eating vegetables and fruits and food that doesn’t have an ingredient list. Avoid processed meats (nitrates and nitrites can be found). Consume less food and beverage in contact with plastic as much as possible, remember many of the potentially toxic chemicals and endocrine disruptors are found in plastic. Especially do not heat plastic around food as it releases more of the chemicals, such as avoid microwaving food in plastic. Also avoid placing plastic in dishwasher, as with the microwave, whenever you heat plastic it releases particles onto the food or other dishes in the dishwasher. Use alternatives to plastic, such as glass and stainless steel, when possible (more to come on this in my video blog of my own kitchen!). And for many reasons, hand wash before handling food, not only to get rid of germs, but any chemical residues you may have touched (like my laptop keyboard I’m touching now😉

Remember, consumers have the ultimate power, every time we buy some thing we are telling that company “keep making this”. Simple supply and demand: if we refuse to buy it because it’s not healthy and is potentially harmful, then they won’t make money, and will have to change. We are starting to see it, people are catching on and starting to be more mindful and informed consumers. For instance, Kraft took artificial color out of some of their products because it wasn’t selling. Knowledge is power, and as we do more research and learn more things, we will protect our families more. This is why the more natural food and product market is one of the fastest growing market (natural industry article)

So do we can back to the old settler’s days?! I think there is a balance somewhere between the settler’s way of getting food, and the highly processed food in bags and boxes. More to come in the next eating healthy blog😉

Environmental Exposures: Overview

Caveat: This is knowledge and a lifestyle I have developed from what I have read and experienced with my family and patients. This is generalization, and since I do not know you personally, there is no way for me to give you personalized advise. This is meant to open up minds and start conversations within families and medical homes to improve knowledge and lifestyle.

There is an increase in chronic disease in children: ADHD, asthma, eczema, allergies, autism, obesity, etc. And the rate is too quick to be some kind of genetic shift, so it is most likely environmental contribution. I was taught most chronic illnesses are caused by 2 “hits” (or insults) to the body (first coined Knudson hypothesis and applied to cancer, now we are learning it can apply to many illnesses that are termed “multifactorial”). The 1st “hit” is genetic predisposition to an illness, and then a 2nd environmental insult puts the body over the edge into illness.
The current generation of children live in a different environment than past generations. As a child I said I would never say this, but “When I was a kid”, not only did I walk through snow uphill both ways to school, but we carried around books instead of electronic tablets, we used plain unscented soap, my mom made our food and we rarely went out to eat, our pantry had ingredients like rice/flour/beans and less packaged processed food, used Pyrex instead of plastic, people bought less “stuff” so less “stuff” was manufactured and wasted into the environment, had a garden we picked the bugs off the leaves, the weather was more stable, etc, etc. There are so many things different that today’s kids are exposed to that maybe causing the “2nd hit” of chronic diseases, that it is very hard for us to determine what are the biggest things that are causing the “2nd hit”, so that we can reduce those things to decrease the risk and improve health of children. It is also hard to research and generalize environmental factors because there are so many factors to filter through; you are not just comparing apples and oranges, you are sifting through and comparing every fruit to every other fruit. Plus every body is different, and what is toxic to one person may not be for another person who is able to detoxify that chemical or react differently to the environmental insult, etc.
As more research is done hopefully we will be able to know more about this, and hopefully be able to control parts of the environment that maybe contributing to chronic diseases. The American Academy of Pediatrics, as usual, has been on the forefront of interpreting the evidence to give guidance to pediatricians and families. They are the first organization to come out about concerns on environmental exposures that are negatively affecting children such as plastics and food additives (reference 1, AAP Food Additives and Child Health).

In this article my purpose is to give background and overview on this emerging area of concerns over children’s health and environmental exposures. I will then write separate articles on specific topics: food and drink, household supplies, climate change, functional medicine, etc.

I have a personal story about how I learned how much environment plays a role in wellness and illness. My daughter has a chronic skin disorder, at one point she was on strong topical and oral medications and still not improving. So I seeked the expertise of my friend, Dr. Anna Esparham, who is an integrative medicine pediatrician (see reference 2, the AAP clinical report that she helped write AAP Pediatric Integrative Medicine) She suggested environmental modifications to make my daughter’s environment “cleaner”, to try to reduce oxidative stress from environmental toxins and optimize nutrition to help her immune system “calm down”, which will help reduce inflammation and improve her body’s ability to heal. One step at a time, we slowly modified her environment and nutrition on a journey that ultimately helped our whole family. I like to say my daughter’s illness and skin was a “barometer for harmful chemicals and poor nutrition”, and I will be ever grateful to her skin for showing us we needed to improve! I started being mindful of everything that touched her skin and body: we changed bath and body products to simpler forms, like coconut oil for “lotion” and bars of natural soap instead of scented body wash. I used vinegar for laundry soap and wool balls instead of dryer sheets. My pantry changed from boxes of processed foods to glass jars of whole grains, lentils and other whole food “ingredients” as I replaced processed foods with real food. Our family changed dairy milk to plant based milk (Interestingly, my husband had suffered from chronic congestion and sinusitis which resolved when he stopped drinking dairy milk!). On top of her multivitamin we added extra vitamin D and magnesium to help her skin. Today she rarely has symptoms without any of the medications she was on before. And yes, our family’s experience is anecdotal and may not apply to all illnesses, and families may not be able to do all the modifications we did. But there is increasing evidence that environmental exposures and pro-inflammatory/nutrient lacking standard American diet (ironically the acronym is SAD) is contributing to pediatric problems. Therefore it is important to educate ourselves and make whatever improvements in children’s environment and lifestyle we can.

We have always known things can “run in families”. And we have known for obvious things that DNA and genes play a direct role in: for instance, cystic fibrosis is caused by a gene that codes for a protein that regulates salt in cells. But we are starting to piece together why certain families are predisposed to things that environment plays a role in the 2nd hit, what we call things that have “multi-factorial” causes. For instance, there are gut, liver, cellular and kidney enzymes filter and detoxify the body from substances we ingest, breath, or come in through our skin. There are different amounts and types of proteins/enzymes that are inherited. This may explain why people react to different things different ways. There are new studies showing that people with autism have certain enzymes that may not detoxify as well as others. So it maybe the enzymes that is inherited and the reason why families with autism have higher risk of having other children with autism, not necessarily the brain problem itself that is inherited, but the inability to detoxify may make the individual more sensitive to toxins that may cause the brain development problem. This is any interesting area that has a lot of ongoing research, as it is always important to find the real root of the problem before we can find the solution.

Because we are learning how much environment and nutrition impact our body, and if optimized can help be more well, there is new fields of medicine that follow this. Functional medicine focuses on interactions between the environment and the gastrointestinal, endocrine, and immune systems to optimize the function and natural healing of the body. It focuses on finding the root cause of symptoms as a sign that the body is unwell and solving that instead of just covering up the symptoms. Integrative medicine integrates traditional medicine with functional medicine. For instance: treats the asthma symptoms with albuterol, but also optimizes environment, nutrition and supplements to decrease the inflammation in the airway to decrease the symptoms that way. This is how I try to approach common medical problems in children: use medications and modern medicine to help the child be functional and symptom free, but also optimize the body’s ability to heal and become well. I will write more about this in another post, but for now here is big picture of 3 basic areas:
1. Heal Gut through diet and probiotics
2. Improve nutrition and replace nutrients that are deficient in standard American diet: Vitamin D, magnesium and omega 3 is most common that is hard to get in diet but important to keep body well
3. Detoxify, reduce oxidative stress to help the body be in anti-inflammatory state. This is what this article is giving an overview about

Right now we cannot control the 1st hit of genetics. But what we can control is environment: what we breath, eat, drink, put on our skin, etc. Again, we are just starting to tease out factors that are high yield in causing unwell bodies, so right now we don’t know all the factors that are playing a role. So for now, with my family I have tried to take a “simplify as much as possible” approach. Below I will give an overview of each area. In future articles I will give more specific evidence and risks for each area. For now, I have families who are asking me about ways they can start improving, so I included a logistics part of each section I include hints and things our family has done. When I name a product or a store/website, I am NOT getting any benefits for naming them. I also name things that I have found beneficial, I am not saying it is perfect or I know everything, just a general suggestion that you may want to consider.
As another caveat, we are living in an industrialized country, so it’s hard to eliminate all environmental exposures, so don’t get overwhelmed. Stressing about things will be counterproductive! And when I mention one factor increases risk for something, it doesn’t mean if you use that you’re going to get the illness. But what it means is we should recognize that risk and try to improve our environment as best we can. For instance, we know we can get injured in a car accident, but we still have to drive in today’s society, but we reduce the risk by wearing seatbelt and driving as safe as possible. Same thing with environmental exposures, unless we move to secluded island (which sounds great!). So every family’s lifestyle is variable based on the ability of that family and the illnesses and needs of the bodies. To find a balance, our family does what we call 80/20 “rule”: about 80% of time eat well and live “clean”, but we don’t live on a secluded self-sustainable farm and we have kids who go to school with friends and birthday parties, etc. So we have the weekend sleepovers with birthday cake and scented face mask “facials”, but most days it’s homemade food and coconut oil for lotion;). Also, with children, go slow with change, and pick the battles that are more impactful and important.

Plastics
The invention of plastic helped humans in many ways, such in healthcare. But like most things, humans have taken it too far and abusing the convenience of plastic. The use of plastic is something that has definitely increased. We are now learning some adverse effects on the body. For instance, some plastic chemicals mimic hormones in our body, they have been termed endocrine disruptors. This maybe one of the factors causing an increase in infertility, obesity, premature puberty, cancer risk, among other things. It’s hard to avoid plastic all together, but minimize our use of plastic as “convenience”
Logistics: A big thing we did was replace kitchenware with glass, metal and silicone. A website, mightynest.com is great resource. Try to limit food/drink that’s been “sitting” in plastic on shelf. Little things like I started cutting up carrot sticks instead of buying the bag of precut carrots (bonus: they actually taste better too!). Plastic is also in a lot of clothing, so switching to cotton and natural materials when able. Micro plastic particles (from clothing, pollution, microbeads, etc) are not filtered out in water processing plants, so we use a water purifier called “Berkey”, looks like a water cooler (no electricity, minimal maintenance, long lasting). I would say purifying water is one of most high yield things we do. Yes, the water out of faucet does not have large levels of toxic things like lead (ugh except that poor town of Flint) or bacteria. And filters help by getting more of the large contaminants out. But if you want the micro plastic particles and pesticides out, then a purifier like the Berkey will help.

Food additives
This will be my next article to write since there is important new information (see reference 1AAP Food Additives and Child Health ) on potential toxins that are directly added to food (colorings, flavorings, preservatives) and in contact with food (adhesives, dyes, coatings, plastic and other polymers).
Logistics: Kind of simple, we try to eat real food that doesn’t have a package or ingredient list: produce, nuts, oatmeal, rice, meat. Food should rot, if it doesn’t then it has additives. If we buy processed foods, we try to choose minimal ingredients that we can read and understand. Whole Foods and Natural grocers have standards for their food without certain additives. Aldi’s brand food has standards to limit additives (not the pop tarts in Aldi’s, though;) Otherwise buy food without labels or read the labels!

Industrial agriculture and livestock
My dad likes to say, “you know what we used to call organic food: food”. And he’s right, our food supply is not the same, and we used to know where our food came from and trusted that local farmer or supplier. Produce used to be grown in home gardens or local farms, now they are mass produced in faraway agricultural fields, and with this mass production comes more chemicals to help increase the production. Animal products were from a local farm with a small number of animals roaming in pasture and barns, now the animals are in huge livestock facilities (called CAFOs: confined animal feeding operations), which have ethical, environmental, and nutritive issues. Not only is there possible toxins and harmful things like drug resistant bacteria, but there can be less nutrients (mass production of a single crop can deplete the soil, animals are fed corn instead of grass and natural diet, animals don’t have access to sun for vitamin D, etc)
These are the things we know have changed in our food supply, and we are learning more about the effects of this changing food supply, and how we can improve, more to come in next article…
Logistics: Again more to come in next article! But basically we try to be mindful of our food: how it was grown or raised, what was used, etc.

Household, cleaning, Bath and body products
The average American uses on average 20 bath and body products per day. And if you start to read labels you realize we don’t know what is in them. The Food and Drug Administration (FDA), allows companies to put things in products that are determined “generally recognized as safe”. This is different than other countries, such as European countries an ingredient has to be proven safe before it goes on the market. The FDA allows it until it is proven harmful.
The Environmental Working Group (www.ewg.org) is an independently funded group that is not biased towards corporations and is seeking the truth to protect humans. For instance, their research about triclosan (a chemical used as antibiotic in things like soap) showing it is carcinogenic (can induce cancer), got the FDA to ban it from future use. But it makes me wonder why the FDA allowed it in the first place, all the while people who have trusted the FDA and companies could have been put in harm.
(Caveat on EWG: most of their reducing toxin recommendations are evidence based, low risk, and helpful. They do have some misleading information on vaccines. For the record, I am all for natural, except for getting “natural” vaccine preventable diseases. Vaccines are more “clean” than most things kids are exposed to (like what I’ve mentioned about plastics, food, water, etc), and vaccines prevent disease and deaths, so benefit far outweighs anything. To me, a lot of the scary anti-vaccine propaganda is perpetuated by the industrial corporations so families blame the vaccines instead of the company’s toxins and don’t stop buying their toxic chemical containing products. But I digress!)
Logistics: Hint: most of the “new and improved” stuff on the shelf is for companies to try to sell more. The simpler it is, like plain soap worked just fine for centuries, and probably has less potentially harmful ingredients. Lots of simple natural cleaning and BB products, think the pioneers using lard soap (I’m not recommending lard soap, but you get the picture;). Most of them are cheaper and easier and less wasteful! Vinegar and baking soda are great cleaning agents, I even use white vinegar as laundry detergent. I use wool dryer balls instead of dryer sheets (the chemicals and fragrance in dryer sheets are last thing that gets put on your clothes, and gets aerosolized in the air). Coconut oil is a great makeup remover, moisturizer, shaving cream, etc (and cheap!). Cosmetics are difficult to get with low risk ingredients, but more consumers are becoming aware, so there are certain brands that have less toxic ingredients. EWG has a list on their website

Pollution and Climate change
This is a whole other article, also. But in short: Pollution from transportation, factories, agriculture, livestock waste, and other waste is putting large amounts of potential toxins in the water, air and environment. Climate change is changing the environment in many ways. Longer summer and shorter/milder winters causing increase in pollen, allergens, and pollution. Natural disasters with an array of negative effects on children like mold, release of toxins like from livestock sewage ponds, etc, etc.
Logistics: Our family tries to minimize our use, asking ourselves “do I really need this”, or is there a better alternative. We try to buy used, or most sustainable choice. Our family eats plant based as much as possible, because livestock is the biggest producer of green house gasses (more than all the transportation industry). Eating more plant foods and less animal products is better for health, earth, and animals. More to come on plant based eating in a healthy eating blog;)
Again, our family is not perfect, and we do live in this society, but we try to be as mindful consumers as possible

Conclusion:
Genetics we cannot control (yet?!), Environment we can control. Different people are sensitive to different things in different amounts. Therefore it is very hard to study and apply to the “masses”. But individualized medicine: optimize the body’s ability to heal and be well using things that have lower risk and help that individual patient. I have seen things like improving diet, increasing nutrients, and decreasing environmental exposures can really help improve numerous ailments and help people be more well. No lifestyle is perfect, but little changes on a journey to improve wellness can make a big difference!

References:
1. Trasanda L, Shaffer RM, Sathyanarayana S; AAP Council on environmental health. Food additives and child health. Pediatrics. 2018;142(2):e201814082.

2. McClafferty H, Vohra S, Bailey M, et al. Pediatric Integrative Medicine. Pediatrics. 2017;140 (3):e20171961