Category Archives: Food

Metabolism of Sugar

Posted on by

Nutrition 101 Series for Healthcare Providers:

Keeping Healthy Eating Simple for You and Your Patients Part II

Metabolism of Sugar: How Added Sugars Lead to Weight Gain

a spoonful of sugar cubes.isolated on white

By Jenna Larsen, MS

“Food was just as abundant before obesity’s ascendance. The problem is the increase in sugar consumption. Sugar both drives fat storage and makes the brain think it is hungry, setting up a vicious cycle”- Robert Lustig, MD, University of California San Francisco [1]

A calorie is a calorie is a calorie.

This is a notion that America has been taught to believe, allowing consumers the freedom to trust that any food from the supermarket or restaurant has a place in our diet- as long as we manage to balance calories in with calories out.

And yes- it’s true. If we can balance calories, weight will not increase. So why has it become so difficult to maintain a healthy weight? Consider that 1) a significant increase in added sugars has seeped into the U.S. food supply since the 1970s; and 2) the way that sugar affects our brain and eating behaviors is unlike any other food particle we consume.

The onset of the obesity epidemic directly correlates with the advent of the U.S. dietary guidelines in 1977 [2]. As a result of the recommendation to decrease fat consumption, food companies dialed down the fat in their products while substituting sugar to maintain palatability [3]. The result…Screen Shot 2015-09-21 at 11.25.02 AM

Americans doubled their intake of sugar by 2000 and 80% of products available in the supermarket now contain added sugar [4]. What we lacked was an understanding of how sugar hijacks the brain’s ability to recognize satiety leading to an overall increase in total calorie consumption. 

Comprehending how added sugars are processed for energy helps explain why calories from different foods have varying impacts on fat storage and appetite. Consider 150 calories from an apple versus 150 calories from apple juice.

When you eat an apple, the fiber allows the sugar to gradually absorb into the bloodstream. Insulin is steadily released and glucose is taken into cells where it is used for energy. However, unlike an apple, apple juice lacks fiber. So instead of a gradual release, the bloodstream is bombarded with sugar. Insulin rises quickly, telling the liver to convert the sugar into fat for storage [5,6]. That newly formed fat is released into the bloodstream, blocking the effect of the satiety hormone, leptin [7]. The result? The brain tells you to eat more.

Furthermore, insulin spikes lead to blood sugar crashes, advancing the signal to the brain that you need to more food. These processes combine to induce lethargy and hunger that contributes to more eating, less physical activity, more fat formation, and overall weight gain [4].

In short- the calories in the apple lead to satiety and energy while the calories from the apple juice lead to hunger and lethargy- all due to the way sugar is metabolized.

The American Heart Association recommends just 6 grams of added sugar per day for women and 9 grams for men [8]. The average American consumes 80 grams of sugar per day [9] while a 12 ounce can of regular soda contains 32 grams of sugar [10]. Offering perspective as to how much added sugar we consume can help patients gain awareness and motivate them to make a change.

Supplement your discussion with these points:

  • For an effective visual, fill empty bottles of soda, juice and a sports drink with the number of teaspoons of sugar they contain (1 gram= 4 teaspoons). Patients will be surprised at how much sugar they are drinking when they see it presented in this way.
  • All sugars are processed the same way. White bread, white rice, and potatoes are no different than other types of sugar. Purchasing whole grain products keep the fiber intact so that the sugar is absorbed more gradually.
  • Food consumed closest to its natural form will have fewer added sugars and more fiber. Preparing fruits and vegetables is the best way to ensure that metabolism is functioning properly (Nutrition 101: Whole Foods)
  • Added sugars go by many different names, yet they are all a source of extra calories. Click here for a list of added sugars that doubles as a handout for patients.
  • Just as our palates have been conditioned to crave sugar, they can be conditioned to crave it less [4]. Coffee drinkers can train their palate by gradually decreasing the number of sugars while soda drinkers can start by diluting them with water.

The link between sugar consumption and chronic disease is not a new concept. In fact, more than 8,000 scientific papers have been published on the health effects of added sugars [11]. By investing a few minutes to discuss their importance, you play a key role in drastically improving patients’ overall health and well-being.

References:

  1. https://www.ucsf.edu/news/2009/06/8187/obesity-and-metabolic-syndrome-driven-fructose-sugar-diet
  2. Source: National Center for Health Statistics (US). Health, United States, 2008: With Special Feature on the Health of Young Adults. Hyattsville (MD): National Center for Health Statistics (US); 2009 Mar. Chartbook.
  3. http://www.npr.org/blogs/thesalt/2014/03/28/295332576/why-we-got-fatter-during-the-fat-free-food-boom
  4. Fed Up Movie
  5. Newman, Cathy. “Why are we so fat.” National Geographic 206.2 (2004): 46-62.
  6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC380258/
  7. http://diabetes.diabetesjournals.org/content/53/5/1253.full.pdf
  8. http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyEating/Added-Sugars_UCM_305858_Article.jsp
  9. http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyEating/Added-Sugars_UCM_305858_Article.jsp
  10. http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyDietGoals/Frequently-Asked-Questions-About-Sugar_UCM_306725_Article.jsp
  11. https://www.ucsf.edu/news/2014/11/120751/ucsf-launches-sugar-science-initiative

 

 

post

Nutrition 101 Series

Posted on by

Nutrition 101 Series for Healthcare Providers:

Keeping Healthy Eating Simple for You and Your Patients Part I

PT2Go Nutrition 101 Series

Written By Ms. Jenna Larsen, M.S.

Edited By Dr. Jessica B. Schwartz PT, DPT, CSCS

“Eat food, not too much, mostly plants.” – Michael Pollan

In the United States, a society that can be overly satiated with consumer information, we’ve made healthy eating complicated.

As a nutrition education professional working in the public health sector in New York City, I’ve learned that the most effective methods for delivering nutrition education to the community is to shift language away from weight loss and highlight the benefits of healthy eating.

Goals need to be clearly delineated with the limited amount of time providers have with patients. When speaking with patients, gently introducing nutritional concepts in a digestible format can make healthy eating fun and accessible.

I challenge you to move away from directly discussing weight loss and facilitate open ended conversation.

This shouldn’t take more than 3 minutes of an office visit. Keeping time constraints in mind, you should be able to quickly assess if your patient is eating primarily a whole food, fast food, or processed food diet.

This is a great segway to engage mutual conversation and ask your patient what their barriers are to healthy eating? (time, cost, lack of cooking skills, education) and gently facilitate the thought process of how eating healthy can benefit their life.

I’ve found that high yield language delivery can be as simple as educating communities with the following points*.

1. Choose more whole foods. A whole food has NOTHING added and NOTHING taken away from how it was found in nature.

2. To determine if a food is more whole, focus on the ingredients list instead of specific nutrients on a label. Choose foods that have the fewest ingredients. This removes confusion associated with marketing and labeling language found in supermarkets. Better yet- choose foods without a label (i.e. fruits and vegetables).

3. View food choices on a spectrum – the most whole foods on one end and the most processed on the other- rather than focusing on whether a food is ‘good’ or ‘bad’. Starting with short-term achievable goals, will be easier and more realistic for patients to turn healthy eating into a habit.

4. Taste buds will change and you’ll learn to like fruits and vegetables. Help patients understand that they will truly enjoy the experience of eating healthy, although perhaps not right away. They will feel more energized as they incorporate more whole foods into their diet.

Have patients set one goal for themselves to address at the follow up**. This will range depending on the patient, but it should be something they view as feasible. Encourage them to keep a journal.

Journal ideas include:

1. Try three new fruits or vegetables you don’t normally eat.

2. Drink fewer sugary drinks and more water. Carrying a water bottle will help.

3. Replace at least one snack with a fruit or vegetable each day.

4. Cook at home at least twice per week. Encourage friends and family- including children- to cook with you.

5. Make a salad for lunch at least one day per week.

It is important provide easily accessible and reliable resources to help patients address barriers.

If you work with low-income families, encourage them to check eligibility for SNAP (Supplemental Nutrition Assistance Program), or food stamps, and provide them an avenue for signing up.

Just Say Yes to Fruits and Vegetables (JSY) ***, a USDA-funded program, features valuable money-saving tips that can provide excellent talking points in a discussion where cost barriers are almost certain to surface. Over 200 fruits and vegetable recipes are the highlight of the website and are featured in both English and Spanish. All recipes are simple with few ingredients, low-cost, and easy to prepare. They also offer valuable storage and preparation tips. Print some to offer as a resource. Make a few recipes yourself to provide a personal recommendation.

If you are be excited about healthy eating, your patients will be too!

Until next time,

Jenna

*Please note that these messages may require tweaking for certain patient populations, such as those with involved medical problems.
** Follow-up at subsequent appointments throughout your provider-patient relationship is key. This will let your patients know you are connected to them
***Just Say Yes to Fruits and Vegetables (JSY) is one of New York State’s premiere nutrition education services available to low income families. JSY is a nutrition education initiative designed to prevent overweight/obesity and reduce long term chronic disease risks through the promotion of increased fruit and vegetable consumption.

 

 

post

Concussion & Nutrition Series Part III

Posted on by

Concussion and Nutrition Series Part III:

The Most Promising Nutrients for Affecting TBI Outcomes and Recommendations for Patients

475 vege brain

Ms. Jenna Larsen, M.S.

As Traumatic Brain Injuries (TBIs) continue to lead to a third of all injury-related deaths in the United States each year, researchers remain at a loss for a drug to treat them. The fact that brain injuries vary depending upon the location, type, intensity, and duration of force make them difficult to study and an even bigger challenge for the healthcare practitioner making recommendations for appropriate care.

The concept that the brain is an impressionable organ affected by its environment is finally gaining acceptance. Much remains to be discovered, but nutrition as a preventive intervention is a practical and safe proposal. The ability of nutrients to interact with a variety of physiological processes associated with TBI suggests that including nutritional approaches as a complementary therapy when managing a brain injury could be beneficial.

In 2011, the Institute of Medicine (IOM) published a report entitled Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes in Military Personnel. In the report, the committee cites the most promising connections between specific nutrients and TBI. Nutrients are suggested based on the evidence behind their ability to affect physiological processes involved in TBI. Those nutrients deemed most likely to be effective target four main mechanisms- decreasing brain swelling, decreasing inflammation and oxidation, decreasing cell death and increasing energy production.

Choline, creatine*, omega-3 fats, zinc, magnesium and Vitamin D were identified as the most promising nutritional interventions, although more research is warranted. Table 1 below explains their modes of action, foods highest in nutrient density, and an easy way to prepare a dish high in them. I encourage you to share this with your patients and colleagues.

Table 1: Whole Foods and Recipe Preparations Highest in Suggested Nutrients for Adjunctive TBI Therapy 

PT2Go Concussion & Nutrition Table

©PT2Go.co 2014

Should TBI patients be supplementing or are food sources better?

There is a double edged sword when conducting studies as supplementation is necessary for researchers to separate the nutrient of interest from the other nutrients in food. However, it can lead the public to assume that supplementation will be effective for their health.

When considering the connection between brain injuries and nutrition, it is helpful to separate acute versus long term symptomatic events. Supplementation may be beneficial to improve treatment outcomes immediately after the injury as a high turnover of nutrients required. However, for those most at risk for traumatic brain injuries (i.e. athletes, motor vehicle accident survivors, etc) and for those that experience long-term symptoms, whole foods such as fruits, vegetables, nuts, fish and legumes may be a better option for acquiring resilience.

We have to also be cognoscente and connected to our patients that have no intention or ability to eat well. A supplement may be indicated, but it should be emphasized that it won’t replace the enhanced benefits they’ll get from whole foods. Our bodies evolved to respond to whole foods and all of the benefits they have to offer- not just one specific nutrient. Prescribing them offers not only fiber, energy, satiety but also the brain-boosting effects of so many other vitamins, minerals and protective substances (see Evidence Behind Flavonoids and Their Role in Anti-Inflammatory Foods) that are missing in a supplement.

*Creatine is created in our bodies and there are few foods that contain it.  Therefore, they are not listed on the chart. Supplementation may be beneficial immediately after injury and requires further scientific investigation.

Until next time,

Jenna