‘Pie hole’, colloquial for one’s mouth, is believed to have evolved in the USA in the 1980s from the British expression ‘cake hole’ (coined in the mid 20th century). Pie hole refers to a mouth, as in: Shut your pie hole or, in this case: Put less in your pie hole.

Thursday, January 21, 2016

Gluten-Free: Not Guilt-Free

It's no longer the season to overeat and be merry. But many people have this problem year-round, followed by the oh-so familiar guilty feeling. That's when folks turn to fancy advertising claims to make themselves feel better. What am I talking about? The crowd buying into the "fat-free", "sugar-free", "gluten-free", "wheat-free", "all natural", "science-free" jibber jabber.

new study found that a significant number of people believed that a product with a "free-from" claim on it (especially "gluten-free") was healthier than the conventional counterpart that sported no such claims. That's good news for no one, unless of course you're the company pocketing the (gluten-free) dough... Get it? You know you chuckled.

People who "identified" as gluten intolerant, or unsure about gluten intolerance, were significantly more likely to choose the "gluten-free" product and rate it "healthier" than the conventional alternative. So, by that logic the "gluten-free" chocolate chip cookies are healthier than regular chocolate chip cookies. Same, I guess with gluten-free chips, pretzels, or lard...

There are really two issues here: The psychology behind people making these choices, and the people who "identified" as gluten-free. Let's discuss the latter.

"Identifying" as gluten free
This statement in and of itself is flawed. One does not "identify" as having Parkinson's or dementia or cancer until one is actually diagnosed with it. Celiac disease is no different. But many "identify" (AKA they self-diagnosed themselves) as gluten intolerant.

Gluten intolerance is yet to have a clinical definition or clinical diagnosis (1, 2, 3). But Celiac disease (aka someone who MUST be gluten free) does have a definition (read more here and here).

"Gluten intolerance", or non-celiac gluten sensitivity (NCGS) is a relatively new condition. And since there's no diagnostic criteria, it's currently diagnosed based on excluding other illnesses/condition like wheat allergy or actual celiac disease. This is because NCGS has a lack of viable biomarkers (things that show up on blood tests) to accurately determine a person has NCGS (1, 2, 3, 4, 5, 6).

But no. You shouldn't use this as an excuse to say that you have NCGS and therefore need to follow a gluten free diet. That remains controversial in the scientific community due to insufficient evidence that a gluten free diet is effective (1, 2.)
In fact, one study found that NCGS patients significantly decreased their gastrointestinal (GI) symptoms when put on a low FODMAPs* diet. Further, when gluten was introduced it only caused GI upset in 8% of participants. Another study also found that FODMAPs, rather than gluten, were the cause of GI symptoms in NCGS patients.

* What's a FODMAP? That's a whole other article. In the meantime, you can read about it here and here.
What did we learn?
  • A self-diagnosis (or non-medical diagnosis) doesn't make you gluten intolerant
  • Buying a product that touts itself as gluten free or free from other things, doesn't make it healthier than the conventional version... Just more expensive

Thursday, January 7, 2016

Dietary Guidelines: Better Late than Never

The highly anticipated revised Dietary Guidelines for Americans are finally available. Who cares that they're titled 2015, even though it's not anymore?! And happy new year to all the readers, btw!

After reading about the dismal state of our nation's nutritional needs, I'm wet-my-pants excited to translate the fascinating, and frankly feeble, feeding figures for you. So let's get down to business! Here are the discussion points:
  1. What are we eating and why does it suck? A breakdown of the food groups.
  2. What's new in the guidelines? (Hint: It's a not-so-sweet surprise)
  3. What about cholesterol?
  4. What about red and processed meat?
What are we eating and why does it suck?
Americans, I know it's hard to hear the truth... But we collectively suck at eating fruit and veggies. Across both sexes and all ages groups, we're not meeting the vegetable recommendations. Even starchy veg like corn and potatoes.

Fruit: In the early years, young children meet the fruit recommendations (three cheers.) But once you're over 8 years old, it's all downhill (even earlier for boys).

Grains: Collectively, we are meeting the recommendations for grains. But wait. Don't get excited. Nutritionally, not all grains are equal. There are whole grains and there are refined grains. At least half our daily grains should be whole grains.

Bingo, that's where we're mucking it up. All age groups across both sexes are above the recommendation of refined grains and below the recommendation for whole grains (fig 1). That's a whole lotta not good.
Fig 1: Average intake of whole vs refined grains compared to daily recommendations. Adapted from: http://health.gov/dietaryguidelines/2015/guidelines/chapter-2/a-closer-look-at-current-intakes-and-recommended-shifts/
Dairy: We're doing great at this... Well, the 4 years and under crowd is. Older kids, teens, parents, and oldies, they're not in the game... At all. We force our youngsters to kick back the cow juice, and then we forget that we all actually need dairy, till death do us part... Or till a diagnosis of osteoporosis to get our attention.

Protein: Not an issue for most. We have no problem meeting, and often exceeding the recommendations for protein (especially men.) If we break it down to where we get out protein, we get above the recommended amount from meat, poultry, and eggs. But no one is meeting the recommendations for fish and seafood.

Oils and fats: We are faring a little better here. As an average, we're close to meeting the lower end of the recommendations for oils. The bad news is that we're still eating too much solid fat (the stuff that contains the dreaded, artery-clogging saturated fat.)

What's new in the guidelines?
As expected, there's a guideline for limiting added sugar to <10% of your total calories... Which, (surprise surprise!) we really stink at (fig 2).
Fig 2: Average intake of added sugar compared with the new recommendation of <10% calories from added sugar. Adapted from: http://health.gov/dietaryguidelines/2015/guidelines/chapter-2/a-closer-look-at-current-intakes-and-recommended-shifts/
Where's all the sugar coming from? Good question:
  • 47% is from beverages
    • Of this: 25% comes from soft drinks, 11% from fruit drinks, 7% from tea/coffee, 3% from sport/energy drinks, 1% from alcohol
    • Wow, we are a thirsty nation
  • 31% from snacks and sweets
What about cholesterol?
An interesting one. The previous recommendation limited cholesterol to <300mg/d. This is no more (cue doom music.) Actually, cue applause and whooping.

There's a large body of evidence that shows dietary cholesterol doesn't increase blood cholesterol*. Trans and saturated fat do that. So the guidelines finally reflect the research.

*A little disclaimer: It was controversial to remove this guideline because many foods that contain high amounts of cholesterol (red meat, full fat dairy, baked goods, and processed foods) also contain high amounts of saturated and/or trans fat. So bear in mind, the updated cholesterol guideline is not a green light to eat those foods. Which brings us to...

Red meat, and processed meat.
Controversial indeed. Both these meats were recently revamped by the media as causing butt (colon) cancer (and other cancers.) However, more research is needed to know at what "dose" these meats have the highest butt (colon) cancer-causing potential. This is probably why it didn't get its own guideline.

These meats, particularly processed/cured meats, are ones to limit - especially due to their high salt content.

Well folks, that's the breakdown of the new guidelines. We've got our work cut out for us. It is a new year, maybe this is the year  our "be healthy" resolutions will stick... Fingers crossed.