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.

diet coke

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.

aspartame chemical structure

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.

diet drinks graph

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


elderly

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). common cause of death 65

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.

physical activity benefits in older adults

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

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.

 

The DASH Diet ranked #1 Best Overall


As a future dietitian, the number one health question I get asked by friends, family, and patients is: “What is the best diet?”.

“The answer is not so simple”, I tell them, “You have to do what works best for you”.

fad diet

Luckily, health professionals at U.S. News & World Report ranked 29 of the “Best Overall Diets”. The overarching winner?…(drum roll please)…The DASH diet.

The DASH diet recieved a total score of 4.1 out of 5 possible points. The diets were judged based on the following categories: short-term weight loss, long-term weight loss, easiness to follow, nutrition, safety, best for diabetes, and best for heart health. However, not all categories were weighted equally. For example, long-term weight loss was weighted twice as much as short-term weight loss…which I completely agree with (because I believe long-term weight loss is the most imporant factor in determining the success of a diet).

Also known as the Dietary Approaches to Stop Hypertension, the DASH diet was developed by the National Institutes of Health (NIH). The diet is rich in fruits, vegetables, whole-grains, and low-fat dairy and limits foods with added sugar, red meat, and added fats.  Originally, the DASH diet was designed with the purpose of lowering blood pressure and, after several randomized control trials in the 1990’s, it has proved successful at this. In more recent years, the DASH diet is supported by the USDA in promoting overall health and weight loss for the general public.

If you are thinking about following the DASH diet, daily serving suggestions and a sample menu are available below. For more information, the NIH has published a very informative document with complete details about the DASH diet.

dash2

The “Best Overall Diets” according to the U.S. News & World report are ranked as follows:

#1.  DASH Diet

2.     TLC Diet

3.     Mayo Clinic Diet

3.     Mediterranean Diet

3.     Weight Watchers

6.     The Flexitarian Diet

6.     Volumetrics Diet

8.     Jenny Craig

8.     The Biggest Loser Diet

9.    The Dean Ornish Diet

 

 

Drink Diet Soda, Gain More Weight?


I know the concept seems counterintuitive: drink more diet soda, gain more weight. However, there has been a media buzz revolving research studies which indicate just that. These artificially sweetened, zero-calorie beverages are marketed as a way to consume less liquid calories, resulting in an energy deficit and thus weight loss. The FDA recognizes stevia, aspartame (Equal), sucralose (Splenda), and other no-calorie sweeteners as safe for the general population to consume.

In addition, food products containing artificial sweeteners has been on the rise over the past 20 years. Know what else has been on the rise? America’s rates of obesity. Are the two linked? I’m not so sure.

Source: Yang Q. Gain weight by “going diet?” Artificial sweeteners and the neurobiology of sugar cravings. Yale J Biol Med. 2010 June; 83(2): 101–108.

Now I’ll be completely honest here, I’m not afraid to admit I absolutely love an ice-cold glass of (fountain) Diet Coke/Pepsi every now and then (or perhaps more often than I care to admit). I’ve also had a few of my peers ask me about this diet soda-weight gain dilemma as well. So I thought it made perfect sense for a food blogger, such as myself, to delve into the sticky and sugary research to find the “truth” behind these claims.

However, when I began my literature search, the articles that supported this claim were only rat studies and human observational studies. For the most part, most large health organizations do not feel that these research studies are strong enough evidence to support the conclusion that diet soda can lead to weight gain.

The Rat Studies

In a 2008 article by Swithers and Davidson, 27 rats were randomly assigned to three diet treatment groups for 5 weeks. A control group, a group that consumed yogurt sweetened with glucose for half of the days, and a group that consumed yogurt whose sweetness alternated between glucose and saccharin for half of the days. Therefore, these two groups of mice were consuming the same number of calories, but with differing amounts of prolonged sweetness. Results found that rats gained significantly more weight and gained significantly more fat mass when they received the artificially sweetened yogurt.

There were a few more studies very similar to this one conducted by the same researchers on rats with different artificially flavored colas, puddings, etc…all revealing similar results.

So what did these studies tell us? They indicate that sweetness was associated with weight gain in rats, even when the “sweetness” was coming from a no-calorie sweetener.

These results are very intriguing because they support the link between artificial sweeteners and weight gain. But I have two problems with this study. One is that the test subjects are rats. It is difficult to compare a rat’s food intake to a human’s because, let’s face it, us humans tend to have more complicated reasons for what and how much we eat. Number two, the sample size is extremely small with only 8-10 rats per experimental group, which doesn’t tell us a whole lot.

The Human Observational Studies

An observational study of over 5,000 participants in San Antonio, Texas followed subjects for 7-8 years. Results found that, not only was artificially sweetened beverages associated with weight gain, but that the more people consumed the more weight they gained (shown in the graphs below).

How Much Is Too Much?

The upper limits of how much non nutritive sweeteners are deemed “safe” for the general population is surprisingly very high.

In a 2009 article from the American Journal of Clinical Nutrition, authors reported common zero-calorie sweeteners and their Acceptable Daily Intakes (ADI), presented in the chart below.  What do these numbers actually mean in terms of real food?

For aspartame, consumers would need to drink upwards of 18-19 cans of diet soda per day in order to reach the ADI, 8-9 sweetener packets for saccharin, and 6 cans of diet soda for sucralose.

Maybe We’re Just Looking for an Excuse?…

This same article looked at dozens of studies relating to the topic of artificial sweeteners, and the authors concluded that there wasn’t enough substantial evidence to link nonnutritive sweeteners with increased appetite and weight gain.

In addition, The Academy of Nutrition and Dietetics released a position paper this year which encourages the use of zero-calorie sweeteners as an aid in weight loss along with a reduced calorie, healthy diet. The Academy also made the conclusion that artificially sweetened beverages are not associated with poor appetite control or weight gain. The paper does state, however, that some of the research may be limited and more research may be needed. I’d have to agree with that. I would like to see many double-blind, randomized control studies which directly proposes an intervention on humans as opposed to just retrospective, observational, and animal studies.

That being said, after looking into some of the literature I still find it hard to completely associate diet sodas with weight gain. Even though the obesity epidemic is on the rise, artificial sweeteners can not be to blame when there are (literally hundreds of) other contributing factors as to why people are gaining more weight. For example, individuals may be choosing more higher calorie, higher-fat foods in conjunction with their diet sodas. For example, have you ever been in line at McDonald’s and seen someone order a Big Mac and a Diet Coke? I highly doubt it’s the Diet Coke adding inches to their waist line…

So in my opinion, if you feel the need to crack open a fizzy can of diet soda…at least it’s better than drinking regular soda which has an extra 140 calories per can. That’s a plus, right? And anyways, I’m more worried about artificial sweeteners being associated with a higher risk of cancer…but that story’s for another blog post some other time.

The Dr. Dean Ornish Program for REVERSING Heart Disease


Dr. Dean Ornish on the cover of Newsweek.

During this week of my clinical nutrition rotation at Charleston Area Medical Center, I have had the privilege to shadow the dietitian who works with the Dr. Dean Ornish Program.  I knew a little bit about the program previously, but I did not fully understand the wonderful health outcomes it truly has, not only in reversing heart disease, but in improving the overall quality of someone’s life.

Who is Dr. Dean Ornish?

Dr. Dean Ornish is a physician and president and founder of the nonprofit Preventative Medicine Research Institute in Sausalito, CA as well as Clinical Professor of Medicine at the University of California, San Francisco. While he was a medical student in the 1970’s, he began conducting research on the prevention of Coronary Artery Disease, which included lifestyle modifications such as a low fat, whole-grain, plant-based diet, smoking cessation, moderate exercise, stress management techniques, and psychosocial support.

For the next 30 years, he has conducted scientific, clinical research proving that his program aids in the reversal of heart disease. He has since written several books and had dozens of television appearances on shows such as The Oprah Show, The Dr. Oz Show, and Larry King Live. He is also a consulting physician for former president, Bill Clinton. After the former president’s bypass surgery, Ornish encouraged him to make similar lifestyle changes and to consume a plant-based diet.  Recently, Ornish also published a research article showing that these lifestyle changes can slow, stop, or reverse the progression of prostate cancer. Ornish’s compelling, groundbreaking research has proven that his four-tiered lifestyle changes can actually turn back the hands of time in the development of heart disease.

Dr. Dean Ornish, creator of the Program for Reversing Heart Disease.

The Dr. Dean Ornish Program

There are four main components that comprise the Ornish program: exercise, nutrition, stress management, and group support. All of these components work synergistically to help heal the heart from the inside out.

1. Exercise

Includes moderate exercise such as walking, cycling, and strength training.

  • The program encourages aerobic exercise for a minimum of 30 minutes a day or for an hour every other day for a total of 3-5 hours of aerobic exercise per week.
  • If medically appropriate, participants are also encouraged to engage in strength training exercise 2-3 times per week.

2. Nutrition

The lifestyle change requires a low-fat, whole foods nutrition plan that is high in whole grains, fruits, and vegetables. The diet also requires the elimination of all animal products and fish except for fat-free dairy and egg whites.

  • The composition of the Ornish diet is typically around 70% carbohydrate, 20% protein, and 10% of calories from fat (take note that the average American consumes ~35% of calories from fat). Therefore, the diet is VERY low in fat in order to reduce the “stickiness” of the blood and to improve heart function.
  • No meat, poultry, or fish.
  • No caffeine (with the exception of green tea due to it’s health benefits from polyphenols and antioxidants).
  • No more than 10 mg of cholesterol per day
  • One serving per day of a “full-fat” soy food. A full-fat soy food is one that contains >3 grams of fat per serving, with none of the fat coming from added fats or oils. Always read the label for portion sizes and ingredient content.
  • Food products with added fat (such as soybean oil or canola oil) is allowed 3 times per day as long as a product has ❤ g of fat per serving.
  • Whole grain bread and pasta products with ❤ g of fat per serving.
  • There’s no counting calories, however portion control is strongly recommended.
  • Limiting alcohol consumption is encouraged to not exceeding one alcoholic drink per day.
  • The addition of a fish oil supplement and a senior multivitamin is encouraged. Why?? Because fish oil has been shown to reduce the risk of heart disease and a senior multivitamin has no iron and contains more Vitamin B12 (which may be lacking in the Ornish diet due to the elimination of meat products) compared to a regular multivitamin.
  • Where’s the protein? Legumes, wheat products, and soy products with ❤ g of added fat

The Ornish Diet Food Pyramid.

Ornish Diet Sample Meal Plan

Breakfast:

  • 1¾ egg white zucchini frittata
  • 1/3 cup each—blueberries, strawberries, blackberries
  • ½ cup non-fat milk
  • 1 slice whole-grain bread
  • 1 cup herbal tea or decaf coffee-alternative

Lunch:

  • 1-7/8 cup mango-beet salad
  • 1-7/8 cup vegetarian chili
  • 1 slice corn bread

Snack:

  • 5/8 cup green pea guacamole
  • 6 whole-wheat pita bread wedges
  • ½ cup red grapes

Dinner:

  • 1-7/8 cup fennel and arugula salad with fig vinaigrette
  • 2 cups whole-wheat penne pasta with roasted vegetables
  • 2-1/3 cup fruit-and-yogurt trifle
  • Glass of wine or sparkling water

Nutrition Analysis of Sample Meal Plan

3. Stress Management

The program is not going to eliminate stress from everyday life, but it teaches participants to better manage their stress. Stress management techniques include stretching, yoga, relaxation, deep breathing, guided imagery, and meditation.

It is recommended for participants to practice stress management techniques for about 60 minutes everyday.

4. Group Support

The participants have regular group meetings where they learn to better their communication skills with one another as well as within their personal relationships. Group support is meant to create a social network who will encourage and support each other along the journey.

Group support sessions are meant to help participants in:

  • Rediscovering inner sources of peace, joy, and well-being
  • Learning how to communicate in ways that enhance intimacy with loved ones
  • Creating a healthy community of friends and family
  • Developing more compassion and empathy for both yourself and others

______________________________________________________________________________________________________

Does the program actually work? …YES. It’s scientifically proven.

Dr. Ornish has published dozens and dozens of research articles in premier scientific journals proving that this program not only helps participants lose weight, but is the only program that has been proven to REDUCE heart disease without surgery or medications.  If you would like more information on Dr. Ornish’s published research articles, click on the link here to read the full versions.

In order to give a general sense of the benefits, here are the latest findings from all of the 3,780 patients who went through Dr. Dean Ornish’s Program for Reversing Heart Disease via Highmark Blue Cross Blue Shield in Pennsylvania, Nebraska, and West Virginia as of October 2011:

  • The average patient lost 13.3 pounds in the first 12 weeks and 15.9 pounds after 1 year
  • Significant reductions in systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides, and LDL-cholesterol after 12 weeks were still significant after 1 year
  • Exercise capacity increased from 8.7 to 10.6 METS after 12 weeks (18% increase) and to 10.8 METS after one year (24% increase)
  • Significant reductions in depression and hostility (the emotions most strongly linked with heart disease) after 12 weeks that were still significant after 1 year
  • Hemoglobin A1C in diabetics decreased from 7.4% at baseline to 6.5% after 12 weeks and 6.8% after one year (complications of diabetes such as blindness, kidney failure, heart disease, and amputations can be prevented when hemoglobin A1C is less than 7.0%)
  • 96.5% of patients reported improvement in severity of angina (chest pain) after 1 year

Who can benefit from this program?

  1. Those who are contemplating, or have already had, bypass surgery.
  2. Those with a history of cardiac events or surgery and want to minimize the chance of a recurrence.
  3. Those who have been diagnosed with coronary artery disease or diabetes.
  4. Those with significant risk factors for heart disease, such as: a family history of heart disease, high blood pressure, high cholesterol, obesity, and central or abdominal obesity.

How long is the program?

There are two program options:

1.) The Reversal Program: This is a one-year treatment program. The first 12 weeks are more intensive and include meeting two times per week for four hours each. Sessions include lectures, group exercise, stress management, nutrition education, and group support sessions. As the year progresses, the amount of time committed to on-site sessions decreases.

2.) The Spectrum Program: This is a six-week education-only program based on Dr. Ornish’s best-selling book, The Spectrum, which can be tailored to suit almost anyone who wants to make healthy lifestyle changes.

Okay, so how much will this cost me?

The 1 year program costs over $8,000, BUT luckily most participants have their insurance providers cover 100% of the programs costs! Medicare, Highmark Blue Cross Blue Shield, and PEIA all cover the Ornish program for qualifying individuals.

Where are Ornish program locations?

Most programs are located in Pennsylvania and West Virginia. Go to the ornish.com website to find specific locations near you!

The Ornish 10-Year CAMC Celebration!

Just last week, Charleston Area Medical Center (located in Charleston, WV) celebrated it’s 10th anniversary of hosting the Dean Ornish Heart Disease Reversal program! Read more about the 10 year celebration in this newspaper article printed in The Charleston Gazette.

Jim Perry and John Linton try some of the healthy food last week at the 10-year celebration of the Ornish program, which is offered through CAMC Memorial Hospital. Perry and Linton were part of the program’s original group that started to reduce the effects of and prevent heart disease.

CAMC had the privilege to have Dr. Dean Ornish speak at the celebration via Skype!

Learn more about the benefits of the Dr. Dean Ornish program in this video!

“Assault” Pre-Workout Supplement


I have recently had a special request from an undergraduate student to blog about a specific nutritional supplement.  Like many other college-aged males, this student is physically active with an overall goal of increasing lean muscle mass and decreasing body fat. It is rare that I look into one specific brand or supplement, but he asked me to investigate the type of pre-workout supplement he uses, which is called Assault (sounds kind of scary, right?)

Traditionally, pre-workout supplements are consumed prior to training in the hope of enhancing focus, energy, and endurance during exercise as well as decreasing muscle fatigue post-workout.  Pre-workout supplements typically have an array of different ergogenic ingredients. When ingested together, these components are meant to work synergistically to enhance athletic performance. There are literally thousands of nutritional supplements being marketed to the public.  Therefore, athletes need to be wary of  exactly what they are putting into their body, the ingredients, the side effects, and the dosage.  What many individuals do not realize is that the Food and Drug Administration does not federally regulate nutritional supplements. Therefore, there is no 100% guarantee in regards to the manufacturer’s ingredients, nutritional claims, and safety regulations.

Assault Nutrition Facts

Assault is manufactured by MusclePharm in Denver, CO. It contains a vast variety of ingredients, thus making it difficult to pinpoint which ones specifically are the active ingredients that provide the greatest benefit.

One serving of Assault is half a scoop.  However, it is more realistic to assume that many athletes use one whole scoop at a time, making it twice the serving size.

One scoop (or 2 servings) provides:

  • 80 calories
  • 18 g carbohydrates
  • 28 mg Vit. B6 (1400% DV)
  • 170 mcg Vit. B12 (2833% DV)
  • 5 g creatine monohydrate
  • 6 g branched chain amino acids (BCAA)
  • 4 g beta alanine
  • Nitric oxide – Citrulline malate, L-arginine
  • 300 mg caffeine – That’s as much as about 3 cups of coffee…but imagine drinking them all at one time!

The main active ingredient in Assault is more than likely the caffeine content.  The other ergogenic ingredients are the B-vitamins and nitric oxide.  B-vitamins assist with energy metabolism, DNA synthesis, the formation and repair of red blood cells.  Nitric oxide (such as L-citrulline and L-arginine) increases blood flow and oxygen supply to skeletal muscles, which also helps the body to pump out the lactic acid that creates muscle soreness (4).

However, researchers state the creatine and beta-alanine in the supplement both require “loading periods” of ingestion over several weeks in order to provide the best effects. (3)

Proposed Claims and Possible Risks

A 32-serving tub of Assault will run consumers around $30-$40, which will last about a month if used 3-4 times per week. Many users rave about its drinkability because of it’s variety of flavors, such as green apple, blue arctic raspberry, raspberry lemonade, fruit punch, and watermelon.  In fact, bodybuilding.com dubbed Assault the “Best New Supplement of Year, 2011”.

Proposed Claims (1)

  • Fights muscle fatigue and decreases recovery time
  • Boosts performance
  • Builds lean muscle and decreases body fat
  • Amps up intensity
  • Increases focus and intensity
  • Hydrates muscles – From what I can tell, it really doesn’t “hydrate” your muscles. Instead, it will dehydrate your body because caffeine is a diuretic. In fact, the manufacturer’s recommend drinking a gallon of water a day while taking Assault.  In terms of electrolytes, it certainly doesn’t contain enough to have a hydrating effect…with one serving containing only ~1% DV for potassium and ~2% DV for sodium.

Possible Risks and Side Effects (the company suggests staying hydrated by consuming 1 gallon of water per day to avoid some of these side effects)

  • Fidgety – Probably due to the large dose of caffeine
  • Prickly or tingly feeling of the skin – Probably due to beta-alanine. There are two theories as to why beta-alanine causes itchiness of the skin. 1) Beta-alanine stimulates nerve receptors to trigger the firing of neurotransmitters at random, and 2) Beta-alanine perpetuates the response of nitric oxide, causing a person to literally “feel” the blood running through the capillaries that are close to the skin. (2)
  • Increased heart rate – Caffeine
  • Dizziness – Caffeine or dehydration
  • Headaches – Caffeine or dehydration
  • Trouble sleeping – Caffeine
  • Nausea

Down to the Science

A study published earlier this year investigated the effects of Assault on athletic performance.   The randomized, double-blind study was conducted by researchers at the University of Alabama, the University of Oklahoma, and the University of South Alabama. Twelve recreationally-trained males (average age of 28) participated in the three-week study. Participants were required to attend three separate training sessions. The first session consisted of baseline testing.  During the next two sessions, subjects were randomly assigned to ingest either 1 scoop of the Assault supplement or a placebo drink 20 minutes prior to exercise. The placebo was a flavored carbohydrate drink with similar color and flavor to the supplement.

Subjects were asked to perform exercises to determine 1 repetition max (1 RM) on the bench and leg press, 75% 1 RM on the bench and leg press repetitions to exhaustion, VO2 max, and various choice reaction time testing (which basically tested agility).  Participants were also asked to complete a subjective survey to describe feelings of energy, fatigue, alertness, and focus on a 5-point likert scale.

Results found that ingesting the Assault supplement 20 minutes prior to training provided significant increases only in leg press repetitions to exhaustion, perceived energy, alertness, focus, and some agility exercises.  Most of the benefits of the supplement were seen in anaerobic exercises with no significant increases seen in aerobic endurance performance. (3)


PROs of this study:

  • It was a randomized, double-blind study, meaning neither the researchers nor the participants knew the contents of the drink at that particular time.
  • The researchers were not funded by the manufacturer.
  • The supplement and placebo were similar in color, taste, and size.
  • Subjects completed a 2-day food diary prior to the second training day in order to calculate caffeine intake from other sources.

CONS of this study:

  • Small sample size of only 12 participants.
  • Participants were all male, with no females.
  • Short time period of only 3 weeks
  • Participants were all recreationally trained (with strength values in the 75th and 90th percentile in the bench and leg press 1 RM and VO2 max in the 60th percentile).  It would have been interesting to observe the inclusion of individuals with varying levels of physical activity to see if there are differences in benefits based on a person’s baseline fitness level.
  • According to the 2-day food diaries, subjects consumed an average of 31.5 + 109.4 mg of caffeine per day through other food sources in their diet. To give some perspective, a 12 oz can of Coke contains 35 mg of caffeine and a cup of coffee can contain up to 100 mg of caffeine.  Thus, men who consumed larger quantities of caffeine on a daily basis may not have experienced the same effects of the supplement due to increased tolerance.

What’s the bottom line?

As a nutrition professional, my opinion is always to avoid taking any unnecessary supplements and to get proper nutrients from whole food sources. That being said, Assault DOES seem to work. In the study described above, participants felt more energized and alert during training sessions and the men were able to perform more leg press repetitions compared to the placebo.  The main effect of Assault is most likely due to the high caffeine content. For this reason, habitual caffeine users may not experience the same effects as non-caffeine users due to a higher tolerance. My concern with caffeine is the dangers it has to the body as well as the heart…ESPECIALLY when someone is exercising and their heart rate is increased to begin with.  I also do not like the fact that several users claim to feel “tingly” or “itchy” while using this supplement. I’m no doctor, but I’d say that definitely isn’t normal and definitely isn’t a good thing.

 

Sources:

1.       www.gnc.com

2.       http://www.cnpprofessional.co.uk/blog/?p=186

3.      Spradley, et al. Ingesting a pre-workout supplement containing caffeine, B-vitamins, amino acids, creatine, and beta-alanie before exercise delays fatigue while improving reaction time and muscular endurance. 2012. Nutrition & Metabolism, 9:28.

4.      http://www.nutritionexpress.com/showarticle.aspx?articleid=286

WVU Researcher Spotlight – Dr. Janet Tou


Click on the link below to learn more about the esteemed Human Nutrition and Foods professor and nutritional researcher, Dr. Janet Tou.

http://research.wvu.edu/researcher_spotlight/2011/10/20/janet-tou–ph-d

FDA approves weight loss drug, Qsymia


The FDA has approved yet another weight loss drug, Qsymia.  It is the second diet drug to be approved by the FDA in the past month (along with Belviq).  Qsymia and Belviq are the first FDA-approved drugs in over 13 years.  In a study conducted by the manufacturer Vivus, participants lost an average of 10% of their body weight.  Qsymia seems to be more effective than Belviq.  Participants taking Belviq only lost 4% of their body weight.

Qsymia is a combination of two drugs.  Phentermine, a stimulant related to the amphetamines that suppresses the appetite, and topiramate, a drug used to treat migraines and epilepsy that has weight-loss effects. The side effects of Qsymia are possible heart problems, birth defects, mental fogginess, ad lack of concentration.

What is my personal opinion of Qsymia and weight loss drugs in general? I believe this quote sums it up the best:  “I do think it will help a subpopulation lose weight.  However, I am concerned that mass marketing of this drug will perpetuate the magic bullet approach to weight loss, which is limiting and does not address the root problem,” said Dr. Gerard Mullin, an associate professor at Johns Hopkins School of Medicine.

Do people ACTUALLY read nutrition facts labels?


A recent publication in The Journal of the American Dietetic Association reported that most people tend to overestimate the amount of time they spend looking at food labels.  The authors used eye-tracking technology to discover that the position and location of nutrition information on packaging of food can have an impact on the viewer.  Information at the top of the label was viewed more than at the bottom, and information in center of the screen was viewed more than at the sides.

Bottom line? People have a short attention span when it comes to food labeling.  Therefore, the location and eye-appeal of an item’s packaging and labeling can have a great impact on disseminating nutrition information to the public.

Take a look at this video created by the authors, which summarizes the study and their results!

If you want to read the full scientific report, here is the citation:

Graham DJ, Jeffrey RW.  Location, location, location: eye-tracking evidence that consumers preferentially view prominently positioned nutrition information. J Am Diet Assoc. 2011 Nov;111(11):1704-11.