2013 Year in Review

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Wow, 2013 sure saw a lot of changes in the health and nutrition scene. As 2014 approaches, let's look back at the highlights of the last 12 months...

The Year According to Dr. Jay

As you well know, James J. Kenney, PhD, RDN, FACN does an excellent job of cutting through media hype and taking a look at the cold, hard facts of the latest studies. For a whirlwind review of his articles this year, we're doing a bottom line lineup! (That's where we take the summaries of each of his articles and post them all in one place). Let's take a look at what this year has brought...

  • Single Fast Food Meal Damages Arteries: Each meal rich in saturated fat and cholesterol appears to alter blood lipids and promote inflammation that impairs endothelial function in ways associated with increased cardiovascular disease risk. While oils rich in unsaturated fatty acid do not appear to adversely impact arterial health, this may not be so if the oils are used repeatedly for frying.
  • Does High Fructose Corn Syrup Promote Type 2 Diabetes?: A narrow focus on the impact of either high fructose corn syrup (HFCS) or sucrose becomes a fairly meaningless "debate" (fueled by the economic battle for market share) between anti-HFCS, the Corn Refiners Association (CRA), and the Sugar Association. Obviously, the increasing consumption of both these sweeteners combined is the problem. This is especially so when they are added to a growing number of sweetened drinks being consumed around the world. Both HFCS and sucrose are likely promoting obesity and type 2 diabetes mellitus (DM).
  • Potassium Citrate Increased Bone Density: Americans should consume more potassium-rich foods like fruits and vegetables to help stop or reverse bone loss. It is important to cut back on foods like meats, eggs, cheeses, sodas, etc that acidify the blood and urine and contribute to the loss of bone mineral density (BMD) over time. Those who already have weakened bones may also benefit from replacing even some of the whole grain products in their diets with more potatoes and yams as the latter are much higher in potassium and would reduce their renal acid load and the loss of BMD.
  • Is Being Overweight Healthier?: There is a big difference between losing weight unintentionally and intentionally. People with Alzheimer's, congestive heart failure, emphysema, renal failure, and numerous other ills often lose weight unintentionally for years before succumbing to their disease. Unintentional weight loss is often associated with serious disease that markedly increases the risk of dying. However, this is very different than healthy but overweight people intentionally losing weight by adopting a healthful diet and exercise program. This results in a marked improvement in numerous disease risk factors and ultimately reduces the risk of dying from many serious degenerative diseases. For most, this almost certainly increases longevity.
  • Is Fructose Fattening?: This study adds to mounting evidence from epidemiologic, metabolic-feeding, and animal studies that the increasing consumption of fructose may well be contributing to weight gain and a host of other metabolic changes associated with the development of type 2 DM and cardiovascular disease (CVD).
  • Are Phosphates the New Trans Fats?: As the number of Americans with failing kidneys and on dialysis continues to rise, the American food industry continues to add increasing amounts of phosphate-rich additives to a wide variety of foods. Excessive phosphate intake, like that of trans fats, poses a threat to public health. The required labeling of trans fat has resulted in a marked reduction in the US food supply. It is time the Food & Drug Administration demands that the food industry start putting the amount of added phosphates and total phosphate content on their labels. At the very least, the amount of added phosphates ought to be made public, which could help RDNs better plan a reduced phosphate diet for patients with impaired renal function and/or other metabolic problems associated with an excess acid load and excessive phosphate absorption.
  • More Fruits and Vegetables for Kidney Patients: One year of increased fruits and vegetables or sodium bicarbonate medication in individuals with stage 4 chronic kidney disease (CKD) lowered urine indices of kidney injury. The data suggests that more fruits and vegetables can improve metabolic acidosis and reduce kidney injury even in stage 4 CKD without producing hyperkalemia.
  • Could Paleo Diets Promote Heart Disease?: While some aspects of the paleo diet (like the low sodium/potassium ratio) have credible scientific support, the now widespread belief among paleo dieters that CVD is largely promoted by the intake of even whole grains and not by the intake of saturated fat and cholesterol, even if derived almost entirely from omega-3 rich seafood, is simply not supported by credible scientific evidence.
  • Are CLAs Healthful Trans Fatty Acids?: Starting in 2006, the US Food and Drug Administration started to require food labels to list trans fat content and a growing number of consumers started avoiding foods with trans fats on the label. However, the FDA allowed one type of trans fatty acid (TFA)-rich product to avoid being labeled as trans fat content. This product is promoted as a food supplement, and the special treatment offered to conjugated linoleic acid (CLA) supplements allows them to be promoted for weight loss and yet escape the growing stigma associated with TFAs. Most researchers now believe CLA supplements should not be advocated and certainly not prescribed by health professionals until large, randomized, controlled trials are conducted to establish the efficacy of CLA and especially also the safety of taking synthetic CLA supplements in high doses for many years.
  • New Way Red Meats and Eggs Promote Atherosclerosis: This research certainly questions the wisdom of taking food supplements of lecithin/choline and L-carnitine unless there is evidence such supplements have proven benefits in cases of deficiency or for the treatment of some disease. Many energy drinks also contain L-carnitine and probably should be avoided as well. This research, contrary to some naïve media reports, in no way undermines the dangers of eating foods high in saturated fat and cholesterol or discredits their central role in raising LDL cholesterol (LDL-C) and promoting the growth of atherosclerotic plaques. However, it does provide a bit more evidence as to how a diet high in animal products may promote coronary artery disease (CAD) and suggests a plausible mechanism to help explain why a low-fat, near vegetarian diet appears more effective than statin drugs for reversing atherosclerosis, even though the drugs are more effective in high doses at lowering LDL-C levels. There is no reason to suspect statins would alter trimethyl-amine-N-oxide (TMAO) production. Coincidentally, some of the same foods highest in saturated fat and cholesterol such as red meats, eggs, fatty dairy products, and liver are also the same foods that are more closely linked to CAD, perhaps because they increase the production of trimethylamine (TMA) by gut bacteria more than other foods. Thanks to the research of Dr. Hazen and associates, we know that this bacterially-produced TMA gets converted to TMAO in our livers, and TMAO appears to speed up atherosclerosis by interfering with the RCT system.
  • Institute of Medicine's (IOM) 2013 Report on Sodium Intake: There is very good quality research from the DASH-Sodium Trial and others demonstrating that reducing sodium to about 1,500 mg/day from 2,300+ mg/day significantly lowers blood pressure (BP), especially in those with hypertension (HTN). And no one questions the overwhelming data showing that elevated BP is the #1 risk factor for CVD, accounting for about half of all CVD events. So would reducing all Americans' sodium intake to less than 1,500 mg per day prevent all hypertension? Probably not, but it would certainly prevent the vast majority of primary HTN and nothing in the recent IOM Report undermines these facts.
  • B-Vitamins Reduce Alzheimer's Disease: Given the huge cost to society and the devastating effects on individuals and their families caused by Alzheimer's Disease (AD) and vascular dementia, this is indeed very encouraging news. Since these B-vitamins cannot be patented, it is likely that the type of research needed to validate and extend this study will have to be funded by the NIH/NSF, not pharmaceutical companies.
  • Are Vegetarian Diets Healthful?: A typical modern diet is likely to contain far too much saturated fat and cholesterol for optimal health. Most or all of these atherogenic dietary components typically come from animal products. So cutting back on fatty dairy products, eggs, and meats is generally a step toward a more healthful diet. However, switching to nonfat dairy and egg whites is likely to be more healthful than replacing fatty dairy products with processed foods rich in refined grains and/or sugars. A healthful diet can certainly contain small amounts of foods like omega-3 rich seafoods, nonfat dairy, and egg whites. In addition to avoiding foods high in saturated fat, trans fat, and cholesterol, it is also important to avoid too much salt, refined carbohydrates, and refined fats and oils. Calorie-dense, nutrient-poor foods promote obesity and other metabolic ills, even if they contain nothing from an animal.
  • For Heart Attack Prevention, Is Diet More Important than Statins?: Reducing LDL-C levels with statin drugs alone is insufficient for stopping and reversing CAD and preventing most heart attacks and strokes. A diet low in fat, salt, cholesterol, and refined carbohydrates, coupled with increased activity and loss of excess weight may also be necessary to stop and reverse CAD in part by reducing remnant cholesterol levels in the blood. (Didn't this dovetail beautifully with the CVD prevention guidelines that were also released this year?).
  • Nutrition Science or Pseudoscience?: Science is a process and any credible evidence-based opinion ought to be based on the best data available and not on cherry-picked data that superficially appears to support one's beliefs or claims. Basing health claims on such cherry-picked data while ignoring more compelling scientific evidence is pseudo-science and not real science. Sadly, pseudoscience is what most people read when they pick up a book by some supposed nutrition guru at the bookstore or when they Google some nutrition topic on the internet. TV and radio also provide a forum for those who promote nutrition quackery. Even news reports of new scientific data rarely put such data into a credible big picture view of how diet and nutrition impact health and longevity.

Of course, those studies and papers aren't the only things this year has brought. Let's take a closer look at nutrition and health policy in the news over the last year...

Healthful Snacks in Schools: This year, the USDA set up nutrient guidelines for food items sold at schools. Basically, these guidelines covered calorie limits, sugar caps, and nutrient requirements. All snacks, including extras like butter and cream cheese, are now required to have no more than 200 calories per serving. Fat must make up no more than 35% of the total calorie count, with saturated fat content at less than 10% and trans fat content at 0. Moreover, only 35% (or less) of the weight in any snack food may come from sugar. The last factor in the healthful snack push comes in the form of nutrient requirements. In order to meet the USDA's guidelines, school snacks must now either be rich in whole grains, contain at least a quarter cup of fruit and/or vegetables, have a fruit, vegetable, protein food, or dairy product as the first ingredient, or contain 10% or more of the percent daily value of potassium, dietary fiber, vitamin D, or calcium.

Healthful School Snacking Resources: When it comes to understanding and aligning with the new USDA school snack rules, there are lots of great resources out there. Some of the most popular ones are below...

School Breakfast and Lunch Rules: Let's not leave the schoolroom just yet. There were even more upheavals in the realm of school breakfasts and lunches this year. The Nutritional Standards in the National School Lunch Program required most schools to increase availability of fruits, vegetables, and whole grains, along with fat-free and low-fat fluid milk. Schools were also required to reduce the levels of sodium, saturated fat, and trans fat in meals while meeting nutrition needs within set calorie requirements. These improvements to the school meal programs, largely based on recommendations from the Institute of Medicine of the National Academies, were and are expected to enhance the diet and health of schoolchildren. The National School Lunch Offer Versus Serve Program, which has reimbursable credits, requires schools to offer a certain number of food groups. The kids must make at least the minimum choices from them for breakfast or lunch each day. To meet the new lunch requirements, kids now have to choose items from 3 of 5 food groups, and one of those has to be a fruit or vegetable.

School Breakfast and Lunch Resources: Whether you're looking to understand, explain, or adhere to the new guidelines, we've got you covered. We spent a good deal of this year researching and creating new school breakfast and lunch videos, posters, handouts, blog posts, and more! Here are some of the most useful options...

New Cardiovascular Disease Risk Guidelines: 2013 was a banner year for publications about heart health and disease risk. This fall, new cardiovascular disease risk guidelines from the American Heart Association (AHA) and the American College of Cardiology (ACC) provided a valuable updated roadmap to help clinicians and patients manage heart disease prevention and treatment challenges. Recommendations included reducing saturated fat, trans fat, and sodium intakes below the levels that most people employ. They also include engaging in physical activity — an average of 40 minutes of moderate to vigorous-intensity aerobic exercise — 3-4 times a week. In addition to the new health risk calculator, the guidelines also identified four major groups of patients for whom cholesterol-lowering HMG-CoA reductase inhibitors, or statins, have the greatest chance of preventing stroke and heart attacks.

Resources for Understanding the New Cardiovascular Disease Risk Guidelines: These guidelines can be confusing, and much of the media coverage was controversial. To best understand the changes and implementation of the new guidelines, review the materials below...

Trans Fat and Your Food: This year, the U.S. Food and Drug Administration (FDA) announced its preliminary determination that partially hydrogenated oils (PHOs) — the primary dietary source of artificial trans fat in processed foods — are not "generally recognized as safe" for use in food. The FDA's preliminary determination was based on available scientific evidence and the findings of expert scientific panels.

Trans Fat Elimination Resources: For everything from press releases to posters, we've got the latest on trans fat below...

MyPlate Turns Two: Can you believe that it has been over two years since MyPlate first came onto the scene? On June 2nd, 2013, MyPlate turned two years old. MyPlate is the USDA's guide to healthful and balanced eating. It replaced the Food Guide Pyramid with an easier visual to help prompt good choices. With 5 food groups — vegetables, fruits, protein, dairy, and grains — and an emphasis on portion control, MyPlate is a great guide for healthful eating.

MyPlate Resources: Here are a few of the most popular MyPlate resources.

Gluten-Free Labeling Rules: As more and more people adopted gluten-free diets, manufacturers started using "gluten-free" labels to promote sales. This labeling was somewhat helter-skelter, but that all has begun to change this year thanks to new regulations from the FDA. In 2013, the FDA finalized the definition of the term "gluten-free" and began regulating its use on food labels. No longer can manufacturers simply slap that label on their foods without following proper guidelines first. In fact, manufacturers will have only one year to get everything up to speed and comply with the regulations. Remember, these guidelines only apply to FDA-regulated foods and dietary supplements, not to foods labeled by the United States Department of Agriculture (USDA) or the Alcohol and Tobacco Tax and Trade Bureau.

Gluten-Free Resources: Understanding and properly treating a gluten intolerance can be difficult, especially with crazy labeling claims and unclear ingredient lists. Get the facts and review valuable tips with the following resources...

Dietary Guidelines for Americans: While the 2015 Dietary Guidelines for Americans (DGA) will not be released until... well... 2015, 2013 was still a banner year in their development. This year marked the start of the meetings about the guidelines, and one has already taken place. The committee is very open about its progress and welcomes questions from the public. Are you excited about these new guidelines? Because we are pretty darn excited.

Dietary Guidelines Resources: There are lots of links for anyone who wants to know about past guidelines, guideline updates, and plans for the future guidelines. Check out your favorites below...

What do you think? Did we miss any big health or nutrition trends for 2013? Let us know by tweeting us @foodandhealth or writing on our Facebook wall...

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