Inside the Changing American Diet

Does Diet Pop Cause Cancer?

First of all, I’m from Pittsburgh and we call it POP, not soda.

Second of all, the above question is a bit too broad. The question we should be asking is, “Does the artificial sweetener, aspartame, cause cancer”? Found in Diet Coke, Diet Pepsi, and Diet Mountain Dew, aspartame is one of the most common artificial sweeteners used in today’s food industry.

What Is Aspartame?

Aspartame is also commonly known as NutraSweet or Equal. It is comprised of a methyl ester of aspartic acid and phenylalanine dipeptide. The majority of use for aspartame is in low-calorie, low-carbohydrate, sugar-free beverages. Gram for gram, aspartame has the same caloric content as sucrose (4 calories/gram). However, because aspartame is nearly 200 times sweeter than sucrose (table sugar), much less is needed in order to obtain the desired sweetness in foods and drinks. So much less, in fact, that companies can claim “zero calories” on food labels.

Physiologically, aspartame is digested by becoming hydrolyzed in the intestinal lumen by esterases and peptidases into aspartic acid, methanol, and phenylalanine, where these individual components are then absorbed into the general circulation. Aspartame is a white powder that is stable under dry conditions, but degrades in high temperatures.

Artificial sweeteners, such as aspartame, are regulated by the U.S. Food and Drug Administration (FDA). The FDA approved the use of aspartame for use in dry foods in 1981 and for general purposes in 1996. The first use of aspartame in carbonated beverages was in 1983. Today, aspartame can be found in more than 6,000 foods and pharmaceuticals worldwide.

What Products Contain Aspartame?

You may be surprised at the extensive and varied list of products that contain aspartame.

• NutraSweet
• Equal
• diet or sugar-free soft carbonated soft drinks
• breath mints
• cereals
• chewing gum
• flavored syrups for coffee
• flavored water
• frozen ice cream novelties
• fruit spreads
• sugar-free gelatin
• hard candies
• ice cream toppings
• no-sugar-added or sugar-free ice cream
• iced tea
• instant cocoa mix
• jams and jellies
• juice drinks
• maple syrups
• meal replacements
• mousse
• nutritional bars and drinks
• puddings
• sugar-free cookies
• sugar-free ketchup
• vegetable drinks
• yogurt (drinkable, fat-free, sugar-free)

How Much Is Too Much?

The FDA has set an “acceptable daily intake”, or ADI, for each artificial sweetener. The ADI is set as the maximum amount considered safe for consumption each day during a person’s lifetime.

The U.S. ADI for aspartame is 50 mg per kg of body weight (mg/kg). The European Food Safety Authority has recommended a slightly lower ADI at 40 mg/kg.

To put this into perspective…

The average 12 oz can of diet pop contains 180 mg of aspartame.

For an average individual weighing 68 kg (or 150 pounds), the ADI level would be 3409 mg of aspartame

That is nearly 19 cans of diet pop per day!

It is safe to say that even the most avid diet beverage drinkers consume well below their ADI for aspartame. To prove this, diet soft drink consumption has increased over the past 20 years from 4.8 oz per person per day in 1984 to 5.5 oz per person per day in 2004 (see graph below). Nevertheless, the 5.5 oz is WELL below the FDA approved ADI for aspartame consumption.

Does Aspartame Increase the Risk for Cancers?

This is a question that has been debated for over the past 20 years. The overall consensus from most national health agencies is that, NO, there is no conclusive evidence that aspartame consumption increases the risk for cancer.

In a 100-page scientific review paper, the safety of aspartame was evaluated on several parameters. In regards to cancer, “There is no evidence to support an association between aspartame and brain or hematopoietic tumor development”. This extensive journal article reviewed both animal and human studies and found that most of the animal studies used aspartame levels well above the ADI, often in doses up to 4,000 mg/kg of body weight.

In a study published in 2012 in the American Journal for Clinical Nutrition, researchers prospectively evaluated and assessed the diets of >125,000 individuals over a 22-year period (from the Nurses Health Study and Health Professionals Follow-Up Study). Results found that, in men, >1 serving of diet soda increased the risk of non-Hodgkin lymphomas (RR: 1.31, 95% CI) and multiple myeloma (RR: 2.02, 95% CI) compared to men who reported no diet soda consumption. There was no significant difference found in women subjects. Interestingly, however, researchers also found a significantly greater risk of men (not women) developing non-Hodgkin lymphoma in subjects who consumed regular sugar-sweetened sodas. In summary, because of the differential effects on men vs. women and because of the apparent cancer risk in individuals who consume regular soda, it is difficult to interpret these results and put the full blame on aspartame as the cancer culprit.

In conclusion, the following are statements made by several national health agencies and associations regarding the consumption of aspartame and cancer:

• The American Cancer Society states, “There are no health problems that have been consistently linked to aspartame use”.
• The National Cancer Institute states, “There is no clear evidence that the artificial sweeteners available commercially in the United States are associated with cancer risk in humans”.
• In a position paper by The Academy of Nutrition and Dietetics, “Studies have found no evidence of a wide range of adverse effects of aspartame, including hypersensitivity reactions, elevated blood methanol or formate levels, and hematopoietic or brain cancers”.
• The FDA states, “The food additive aspartame may be safely used in food”.

Sources:

Magnuson BA, et al. (2007). Aspartame: a safety evaluation based on current use levels, regulations, and toxicological and epidemiological studies. Crit Rev Toxicol. 37(8):629-727.

Schernhammer, et al. (2012). Consumption of artificial sweetener and sugar-containing soda and risk of lymphoma and leukemia in men and women. Am J Clin Nutr. 96(6):1419-28.

http://www.cancer.org/cancer/cancercauses/othercarcinogens/athome/aspartame

http://www.cancer.gov/cancertopics/factsheet/Risk/artificial-sweeteners

http://www.eatright.org/About/Content.aspx?id=8363

Nutrition for Older Adults

For the past few months, I have been working as a Registered Dietitian for two nursing homes in the Pittsburgh, PA area. Because I did not have a long-term care rotation during my dietetic internship, this has been my first opportunity working with the elderly. I have been gaining invaluable experience learning about the nutritional issues and needs of the aging population and applying that knowledge to help residents in a skilled nursing facility.

The golden question I know everyone is wondering is, “Sooooo, exactly how old is…OLD?” Well, according to The Academy of Nutrition and Dietetics, the category of “older adults” includes those aged 60 years and older (or about 1 in every 8 individuals in this country).

Before I have some of my reader’s up in arms about the 60 year “young” marker, I will put a disclaimer out there that I sincerely believe there is a distinct difference between someone’s “chronological age” and someone’s “physiological age”. Someone’s physiological age is a person’s age as estimated from their body’s health, while someone’s chronological age is person’s actual age in years from their date of birth

Regardless of your beliefs, it is hard to ignore the fact that “baby boomers” are now reaching retirement age and the number of older adults is thus “booming” at a rapid pace. From 1990 to 2010, the percentage of Americans 65 years or older increased from 4.1% to an astonishing 13.1% of the total population. Not to mention, with the advancements in healthcare and technology, Americans are now living longer than ever. To illustrate this, I really like this interactive map of the United States, which demonstrates the increased life expectancy over the past 25 years. According to the CDC, the life expectancy is 81.1 years for females and 76.6 years for males. Unfortunately, many of the elderly may end up in a nursing home, skilled nursing facility, or assisted living facility. In the U.S., over 1.5 million residents are living in nursing homes…88% of those are 65+ years old. And these individuals aren’t just staying for a month or two either. According to the 2004 CDC National Nursing Home Survey, the average length of stay is 835 days.

Why does nutrition play such an important role in the health of older adults? To start, nutrition has a major influence on 5 out of the 8 most common causes of death in older adults (see figure below). Secondly, 80% of older adults have at least one chronic disease, with about 50% having 2 or more chronic diseases.  Diet not only plays a MAJOR role in the prevention of chronic diseases, diet also helps to minimize their complications and associated risks (thus having a factor in your physiological age).

There are many health, physiologic, and functional factors that change our nutritional status and nutritional needs as our bodies age.

1.) Medical/Health Status

• Presence of chronic or acute illness
• Medications
• Sensory changes – taste, smell, appearance, texture
• Disability and immobility
• Oral health – Missing teeth and ill-fitting dentures can effect your ability to chew

2.) Physical/Functional Status

• Physical limitations
• Balance
• Physical strength and endurance
• Physical activity – There are numerous health benefits for older adults. Please refer to the figure below.

3.) Cognition and Mental Status

• Change in mental status
• Education level
• Depression – Nearly 19% of adults 65 years and older suffer from depression.
• Emotional needs
• Habitual food intake
• Health/nutrition-related beliefs
• Advertising

4.) Environmental Status

• Living situation – About 29% of non-institutionalized older adults live alone, making it more difficult for them to prepare meals.
• Economics
• Cultural beliefs and traditions
• Religious beliefs and traditions
• Environment
• Lifestyle
• Access to food and proper food storage/preparation
• Socialization – Living alone versus living with a family member

5.) The Nutritional Needs Of Older Adults

• Energy – There is about a 15% decrease in calorie needs between age 30 and age 80. With decreasing physical activity, lean muscle mass diminishes and fat mass increases. To estimate calorie needs:

– For men: subtract 10 calories/day for every year of age above 19

– For women: subtract 7 calories/day for every year of age above 19

• Protein – Evidence has found that dietary intake of protein declines with age, despite the fact that the body’s protein requirements generally stay the same throughout life. (Click here to find out how much protein you should be consuming). It is recommended for adults to consume about 30 grams of high-quality protein at each meal, or a total of 0.8 grams of protein for every kilogram of body weight. Protein malnutrition can lead to other health complications such as muscle wasting, fatigue, and sarcopenia. In long-term care, we measure an individual’s protein needs based on their serum albumin or pre-albumin levels (which is a measure of a visceral protein status or lean muscle mass).

• Nutrients – Many nutrient needs stay the same throughout the lifespan. Because of decreased energy expenditure and decreased caloric requirements, this makes it difficult for individuals to consume an adequate amount of nutrients while still consuming less calories.

• Vitamin D and Calcium – These are two important nutrients older adults should be consuming through their diet due to increased risk of osteoporosis. However, many do not consume enough through dietary sources and thus resort to supplementation. Diet daily requirements for calcium and vitamin D are:

– Calcium – 1200 mg/day

– Vitamin D – Adults 51-70 years old need 10 mcg/day and adults 70+ need 15 mcg

• Vitamin B-12 – To prevent anemia, older adults should be consuming the RDA of vitamin B-12, which is 2.4 mcg. Older adults are at a greater risk for vit. B-12 deficiency due to malabsorption, lack of intrinsic factor, atrophic gastritis, and poor diet.

• Hydration – Dehydration can be a major concern for older adults because many do not consume adequate amounts of water.  There are multiple reasons for this, including: decreased perception of thirst, endocrine changes, alterations in cognitive status, side effects of medications,  fear of incontinence, and immobility. An individual’s estimated fluid needs is about 25-30 mL of water for every kilogram of body weight.

 

Lastly, here is an easy and quick tool that I like to use to DETERMINE if someone over the age of 65 is at risk for malnutrition.

Disease – Do you have any chronic illnesses that changes what you need to eat?

Eating poorly – How is your appetite? How many meals a day do you eat? Do you eat fruits and vegetables?

Tooth loss or mouth pain – Do you have problems chewing such as ill-fitting dentures?

Economic hardship – Do you have enough money to buy the types of foods you need?

Reduced social contact – Do you eat alone or with others?

Multiple medications – Do you take 3 or more prescribed or over-the-counter medications?

Involuntary weight loss or gain – Have you lost or gained more than 10% of your body weight over the past 6 months?

Needs assistance – Are you physically able to shop, prepare foods, cook, and feed yourself?

Elderly person – Are you over the age of 80?

 

Sources:

Position of the Academy of Nutrition and Dietetics: Food and Nutrition for Older Adults: Promoting Health and Wellness

www.cdc.gov

How Much Protein Do I Need?

This is probably the most common question I am asked as a dietitian. Whether someone is an elite athlete or a casual weight lifter, it seems they all want to supplement with this magic muscle powder. However, most of the population has major misconceptions about what protein is, how your body uses it, and how much you should be consuming.

What Is Protein?

Protein is one of the three major macronutrients (along with carbohydrates and fat) that contain amino acids and nitrogen.  There are 20 different amino acids. The human body can synthesize 9 of the amino acids on its own (non-essential amino acids), but cannot synthesize the other 11 amino acids (essential amino acids) and need to be consumed through the diet. Thus, it is important to consume a variety of protein in your diet in order to have a balance of essential and non-essential amino acids. Proteins provide a variety of biochemical functions in the body.

Functions Of Protein

1. Energy – 1 gram of protein = 4 calories

2. Antibodies – to help defend again foreign pathogens (ex: Immunoglobulin G)

3. Muscle building and contraction – (ex: actin and myosin muscle fibers)

4. Messaging – protein hormones help send chemical messages throughout the body (ex: insulin, growth hormone)

5. Storage

6. Transport – transport proteins help move molecules to different parts of the body (ex: hemoglobin)

7. Structure – provide structure and support to cells

8. Enzymes – help to catalyze biochemical reactions (ex: lactase)

Daily Protein Requirements

The general population:            0.8 grams protein/kg body weight   OR  10-35% of total energy intake

Endurance athletes:                  1.2 – 1.4 grams protein/kg body weight

Resistance-trained athletes:    1.6 – 1.7 grams protein/kg body weight

*Key Point To Remember: These ranges are in KILOGRAMS of body weight, NOT pounds of body weight. (1 kilogram = 2.2 pounds)

Example – For an average 150 lb individual:   150 lbs x (1 kg/2.2 lbs) = 68 kg

68 kg x 0.8 g protein/kg body weight = 55 grams of protein per day

If you don’t feel like doing the calculations, below is a table of the RDA for protein by gender and age.

In general, Americans are consuming well over the RDA for protein. The graph below depicts the average amount of protein consumed by Americans. Throughout the lifespan, the amount of protein is consumed the greatest between the ages of 19-30 years old. Since I am a part of this age group, maybe that is why so many of my peers are asking me questions about how much protein they need.

Source: NHANES 2003-2004

Amount of Protein in Common Foods:

• 1 oz beef = 7 g
• 1 oz chicken breast = 9 g
• 1 oz soft cheeses = 6 g
• 1 oz medium cheese = 6-7 g
• 1 oz hard cheese = 10 g
• 1 oz tuna = 7 g
• 1 cup soybeans = 29 g
• 1 large egg = 6 g
• 1 oz nuts = 9 g
• 1 oz tofu = 2 g
• 1 slice bread = 2 g
• 1 slice bacon = 3 g
• 2 TB peanut butter = 8 g
• 8 oz milk = 8 g

How Much Is Too Much?

“The more protein I eat, the bigger my muscles will get.” This is not necessarily true. First of all, consuming an excess of calories, whether it’s via protein, carbs, fat, or alcohol…will be stored in the body as fat. Second of all, the human body cannot properly utilize protein beyond a certain amount.

The upper limit for protein is generally 2 grams protein per kg body weight.

Side effects of excess protein consumption include metabolic imbalance, toxicity, nervous system disorders, and kidney problems. When excess protein is consumed, your body uses more water in order to excrete it. For this reason, individuals consuming a high protein diet should also be consuming adequate water in order to prevent dehydration. High protein diets also tend to be higher in cholesterol and saturated fat, which can increase your risk for heart disease and stroke.

Does Whey Protein Aid In Muscle Building?

Please refer to one of my previous blog posts for an in-depth explanation behind the research on whey protein.

Bottom Line:

1. Most Americans consume far more protein than they need.

2. Consume a variety of different protein sources to get a variety of other nutrients.

3. Do not OVER supplement with protein, this can cause long-term damage to your kidneys as well as your wallet.

Join the Pittsburgh Dietetic Association!

This is the first year I joined the Pittsburgh Dietetic Association (PDA). This association has allowed me to network with other dietitians in my area, connect with new people, and participate in opportunities for continuing education credits. I am very excited because I will be contributing to the organization’s social media sites. If you are an RD, RD-to-be, DTR, or dietetics student in the Pittsburgh area, please visit PDA’s website for more information on becoming a member.

Also, please like and follow PDA on Facebook, LinkedIn, and Twitter!

RD Exam…PASSED!

As of July 24, 2013, I am officially a Registered Dietitian! I am also currently employed as a dietitian in two long-term care facilities in the Pittsburgh, PA area. I love putting everything I learned in my internship into use in the real-world. I could not be happier 🙂

Scheduled: RD Exam!

After over 1200 hours of supervised practice throughout my dietetic internship at WVU, I am finally eligible to take the RD (Registered Dietitian) exam! It’s been a long, long road, but this comprehensive exam is the final step towards becoming a Registered Dietitian.

The RD exam consists of 4 domains:

DOMAIN I: Principles of Dietetics (12% of exam)

A. Food Science and Nutrient Composition of Foods

B. Nutrition and Supporting Sciences

C. Education and Communication

D. Research

E. Management Concepts

DOMAIN II: Nutrition Care for Individuals and Groups (50% of exam)

A. Screening and Assessment

B. Diagnosis

C. Planning and Intervention

D. Monitoring and Evaluation

DOMAIN III: Management of Food and Nutrition Programs and Services (21% of exam)

A. Functions of Management

B. Human Resources

C. Financial Management

D. Marketing and Public Relations

E. Quality Improvement

DOMAIN IV: Foodservice Systems (17% of exam)

A. Menu Development

B. Procurement, Production, Distribution, and Service

C. Safety and Sanitation

D. Equipment and Facility Planning

E. Sustainability

I have scheduled my exam for one month from now (mid-July). I already ordered Jean Inman’s review course and CD’s and have been slowly reviewing the material. I also have two RD exam prep apps on my iPhone for studying on the go. However, I would love to hear any tips/suggestions/advice from anyone who has already taken the RD exam! Please feel free to comment below. 🙂

Ah, I’m so nervous/scared, but now it’s off to study! Wish me luck 🙂

I Am On The Job Hunt!

Now that graduate school is coming to a close, it is now time for me to move on to the next stage of my life. Eek! So nerve-racking, yet I am SO excited to start my dietitian career.

For employers:

I will be graduating in May from West Virginia University with an MS in Nutrition and Food Science and will be taking the Registered Dietitian (RD) examination in mid-June. I am currently seeking employment around the Pittsburgh, PA area. If you know of any companies or healthcare facilities who are hiring dietitians that meet my qualifications, please do not hesitate to contact me!

Thank you 🙂

Master of Science Oral Defense – PASSED!

Last Friday, I presented my research and defended it to the public as well as my graduate committee at WVU. Thankfully, I PASSED! Which means I am one step closer to graduating and completing my MS in Nutrition and Food Science!

Below is my PowerPoint presentation (sorry some of the formatting is off).

HMB Supplementation and Athletic Performance in Exercised Adults

This was an hour-long, graduate-level presentation I gave in a nutrition seminar course. The audience was master’s students and professors in the West Virginia University Animal & Nutritional Sciences Department.