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Like obesity, inflammation has been identified as a common contributing factor to many chronic diseases. But how are the two interconnected? Adipose tissue, or fat cells, are an active endocrine organ which modulates and synthesizes hormones and various metabolites. These processes are amplified when obesity is present (Lee et al 2013). Some of the metabolites secreted by adipose tissue include cytokines and chemokines, which have been identified as pro-inflammatory and may contribute to chronic conditions such as heart disease and diabetes (Hajer et al 2008). The consistent elevated levels of pro-inflammatory cytokines have been seen in obesity, leading to the chronic condition of low-grade inflammation (Gregor & Hotamisligil 2011). The two disease states have been proposed to play off each other where obesity leads to inflammation and inflammation leads to symptoms that may trigger greater weight gain. Is it a never ending cycle? Or is there something to be done about it?

First, what exactly is inflammation? Inflammation occurs when the immune system responds to an irritant within the body. Inflammation is often associated with redness, heat, swelling, pain, and loss of function and becomes activated as the population of white blood cells and other metabolites increase within the blood to protect the body (Cleveland Clinic). With obesity, low-grade inflammation is sustained at a chronic state. This puts stress on metabolic tissues because the sympathetic nervous system, or fight or flight response, is constantly active. This sympathetic overactivity may also contribute to increased blood pressure, insulin insensitivity, and chronic diseases like heart failure (Smith & Minson 2012). It is known that stress itself is related to obesity and eating behaviors. Associations have been found between stress, BMI, weight, and adiposity, as well as blood sugar, insulin, and insulin response. Individuals with obesity may also be more sensitive to stress potentially leading to greater systemic inflammation (Agustí et al 2018).

Another condition that may be associated with both obesity and inflammation is rheumatoid arthritis or RA. RA is an autoimmune and inflammatory disease where the immune system attacks healthy cells within the joints causing them to become inflamed and leading to tissue damage. Symptoms of RA include pain, aching, tenderness, or stiffness in more than one joint, overall weakness, and fatigue. The exact cause of the disease is unknown, however, obesity is a common risk factor among individuals diagnosed. In fact, those with RA and obesity often have greater difficulty with movement and joint function and experience increased pain sooner than people with RA who have a healthier weight (Baker et al 2018).  Yet, it is known that maintaining a healthy weight is an effective management strategy of RA and associated symptoms (CDC).

So what can be done? Obesity, inflammation, and RA are all interconnected, but may potentially be managed the same way. One action is to increase anti-inflammatory foods and nutrients in day to day eating. This may be done by following an anti-inflammatory eating plan including greater intakes of fruits, vegetables, whole grains, nuts and seeds, and legumes within the diet. Some highlights of the foods to add include:

• Berries such as raspberries and blackberries contain polyphenols, which give them their bright colors and modulate inflammatory status within the body (Joseph et al 2014).
• Whole grains including whole-wheat, oats, quinoa, brown rice, and barley may reduce systemic inflammation by reducing inflammatory markers throughout the body (Xu et al 2018).
• Nuts and seeds like walnuts, flax seeds, pumpkin seeds, and peanuts contain omega-3 fatty acids, which have been shown to reduce inflammation by reducing the substances and molecules within the body that spark inflammation (Calder 2010).

Consuming adequate lean protein and healthy fats including omega-3 fatty acids also align with the anti-inflammatory nutrients. Additionally, research shows that increasing your daily protein intake is useful for lowering body weight. The high intake of protein contributes to a sense of fullness after eating, a term deemed satiety (Veldhorst et al 2008). Anti-inflammatory eating has been shown to be beneficial in weight and inflammation reduction although research is promising but limited at this time (Harvard School of Public Health).

HealthWise products can be of great assistance for those struggling with inflammation seen in conditions like RA and its associated signs and symptoms.  Not only are the shakes, smoothies, and meal replacements a great source of protein, but fruits and vegetables can be added to these products, which contain antioxidants. An example is adding berries and spinach to HealthWise’s High Protein Wild Berry Splash Shake to assist with inflammation reduction. Similarly, additional protein and fiber can be added to HealthWise soups by including extra vegetables, beans, lentils, or whole grains like quinoa or farro to continue to decrease inflammation throughout the body. The additional protein will also assist with weight loss, which may also potentially lead to a decrease in inflammatory signs and symptoms.

Overall, decreasing inflammation can help minimize the signs and symptoms of rheumatoid arthritis and promote weight loss for those struggling with obesity. Inflammation can be lessened by adding in anti-inflammatory foods and daily movement. HealthWise products are a great way to help increase anti-inflammatory foods eaten and assist in combating the interplay between inflammation, obesity, and other chronic conditions like rheumatoid arthritis.

Citations:

Agustí A, García-Pardo MP, López-Almela I, Campillo I, Maes M, Romaní-Pérez M, Sanz Y. Interplay Between the Gut-Brain Axis, Obesity and Cognitive Function. Front Neurosci. 2018 Mar 16;12:155. doi: 10.3389/fnins.2018.00155. PMID: 29615850; PMCID: PMC5864897.

Baker JF, England BR, Mikuls TR, Sayles H, Cannon GW, Sauer BC, George MD, Caplan L, Michaud K. Obesity, Weight Loss, and Progression of Disability in Rheumatoid Arthritis. Arthritis Care Res (Hoboken). 2018 Dec;70(12):1740-1747. doi: 10.1002/acr.23579. PMID: 29707921; PMCID: PMC6205912.

Calder PC. Omega-3 fatty acids and inflammatory processes. Nutrients. 2010 Mar;2(3):355-74. doi: 10.3390/nu2030355. Epub 2010 Mar 18. PMID: 22254027; PMCID: PMC3257651.

Centers for Disease Control and Prevention – Rheumatoid Arthritis – https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html. July 27th, 2020.

Cleveland Clinic – Inflammation – https://my.clevelandclinic.org/health/symptoms/21660-inflammation. July 28th, 2021.

Gregor MF, Hotamisligil GS. Inflammatory mechanisms in obesity. Annu Rev Immunol. 2011;29:415-45. doi: 10.1146/annurev-immunol-031210-101322. PMID: 21219177.

Hajer GR, van Haeften TW, Visseren FL. Adipose tissue dysfunction in obesity, diabetes, and vascular diseases. Eur Heart J. 2008;29:2959–2971.

Harvard School of Public Health – The Nutrition Source: Diet Review Anti-Inflammatory Diet – https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/anti-inflammatory-diet/. Accessed July 6th, 2022.

Joseph SV, Edirisinghe I, Burton-Freeman BM. Berries: anti-inflammatory effects in humans. J Agric Food Chem. 2014 May 7;62(18):3886-903. doi: 10.1021/jf4044056. Epub 2014 Mar 17. PMID: 24512603.

Lee H, Lee IS, Choue R. Obesity, inflammation and diet. Pediatr Gastroenterol Hepatol Nutr. 2013 Sep;16(3):143-52. doi: 10.5223/pghn.2013.16.3.143. Epub 2013 Sep 30. PMID: 24224147; PMCID: PMC3819692.

Smith MM, Minson CT. Obesity and adipokines: effects on sympathetic overactivity. J Physiol. 2012 Apr 15;590(8):1787-801. doi: 10.1113/jphysiol.2011.221036. Epub 2012 Feb 20. PMID: 22351630; PMCID: PMC3573303.

Veldhorst, M., Smeets, A., Soenen, S., Hochstenbach-Waelen, A., Hursel, R., Diepvens, K., Lejeune, M., Luscombe-Marsh, N., & Westerterp-Plantenga, M. (2008). Protein-induced satiety: effects and mechanisms of different proteins. Physiology & behavior, 94(2), 300–307. https://doi.org/10.1016/j.physbeh.2008.01.003

Xu Y, Wan Q, Feng J, Du L, Li K, Zhou Y. Whole grain diet reduces systemic inflammation: A meta-analysis of 9 randomized trials. Medicine (Baltimore). 2018 Oct;97(43):e12995. doi: 10.1097/MD.0000000000012995. PMID: 30412134; PMCID: PMC6221555.

By Katie Chapmon, MS, RD

About the Author:

Katie Chapmon, MS, RD is a Registered Dietitian Nutritionist specializing in Bariatric Nutrition, GI Issues and Hormonal Health and with 10+ years of hands-on clinical experience for leading medical providers.  She is the proud recipient of the 2010 Recognized Young Dietitian of the Year Award and 2018 Excellence in Weight Management Practice Award through the Academy of Nutrition and Dietetics.

She spent the first decade of her career as the lead dietitian for Kaiser Permanente Southern California.  For the past several years, she has been working with industry partners and consumers to improve nutrition education within the field and maintains a virtual private practice.  In April 2021, she launched Bariatric Nutrition Pro – to provide healthcare practitioners education to start (or continue!) their bariatric career with the confidence and knowledge to succeed.

She is a past Chair of the American Society of Metabolic and Bariatric Surgery Integrated Health Clinical Issues Committee and Chapter author of the 3rd Edition of the Academy of Nutrition and Dietetics Pocket Guide to Bariatric Surgery.  She is a national speaker and enjoys time hiking and cooking in the kitchen.

One of the most overlooked aspects of diet therapy is the correct use and the reasons for routinely using essential fatty acids (EFAs) as part of the diet program. EFAs are required in every diet to perform a number of functions in the body.

Essential fatty acids are important nutrients. For patients following a low calorie diet and for patients wishing to maintain good health, the intake of adequate amounts of EFAs is essential.

Essential fatty acids provide the following health advantages:

• The effective use of EFAs increases thermogenesis.

• EFAs, in adequate amounts, have been shown to help prevent heart disease, hypertension, diabetes mellitus, rheumatoid disorders, visual disorders, and skin diseases.

• Adequate intake of EFAs has been shown to help prevent eczematous lesions, refractive impetigo, dry scaly skin, coarse and sparse hair. EFAs minimize many common complaints making the dieting process more comfortable for patients.

• EFAs in adequate amounts help to ensure a healthier patient during the dieting process.

• EFAs are particularly important in maintaining weight loss in formerly obese people after weight loss.

• Adequate amounts of EFAs are particularly important in obese patients, whose need for a balanced intake of EFAs may be greater than the general population.

Nutritional Resources Inc., Healthwise EFAs provide Omega3 and Omega 6 in the correct physiological ratio, and because the unique formula, which provides EFA sourcing from Borage, Flax and Fish oil, is a product that is well tolerated by patients. The unique blend provided in Healthwise EFAs provides the benefits of essencial fatty acids without the fishy after taste.

So, from a business prospective, the use of EFAs as a routine component of your program creates an opportunity to increase the overall profitability of your business.

Download our EFA Brochure to learn more about HealthWise EFAs.

Sources:

Ide T, Kobayashi H, Ashakumary L, Rouyer IA, Takahashi Y, Aoyama T, Hashimoto T, Mizugaki M. Comparative effects of perilla and fish oils on the activity and gene expression of fatty acid oxidation enzymes in rat liver. Biochim Biophys Acta. 2000;1485(1):23-35.
Willumsen N, Skorve J, Hexeberg S, Rustan AC, Berge RK. The hypotriglyceridemic effect of eicosapentaenoic acid in rats is reflected in increased mitochondrial fatty acid oxidation followed by diminished lipogenesis. Lipids. 1993;28(8):683-90
Schirmer MA and Phinney SD. Gamma-linolenate reduces weight regain in formerly obese humans. Journal of Nutrition – 2007;137(6):1430-5.
Andreassi M, Forleo P, Di Lorio A, Masci S, Abate G, Amerio P. Efficacy of gamma-linolenic acid in the treatment of patients with atopic dermatitis. J Int Med Res. – 1997;25(5):266-74.
Nissen, H.P., Blitz, H., and Mugglie, R. The effects of gamma linolenic acid on skin smoothness, humidity and TEWL – a clinical study. Inform – 1995 6;4:5 19
Hannia Campos, Ana Baylin, and Walter C. Willett. α-Linolenic acid and risk of nonfatal acute myocardial infarction. Campos: α-Linolenic acid myocardial infarction Circulation. 2008 July 22; 118(4): 339–345.
Lemaitre RN, King IB, Mozaffarian D, Kuller LH, Tracy RP, Siscovick DS. n-3 polyunsaturated fatty acids, fatal ischemic heart disease, and nonfatal myocardial infarction in older adults: the Cardiovascular Health Study. The American Journal of Clinical Nutrition. 2003;77(2):319–325

Olendzki BC, Leung K, Van Buskirk S, Reed G, Zurier RB.
Treatment of rheumatoid arthritis with marine and botanical oils: influence on serum lipids. Evid Based Complement Alternat Med. 2011;2011:827286. Epub 2011 Oct 9.
Samuel S, Peskin B, Arondekar B, Alperin P, Johnson S, Blumenfeld I, Stone G, Jacobson TA. Estimating health and economic benefits from using prescription omega-3 fatty acids in patients with severe hypertriglyceridemia. Am J Cardiol. 2011;108(5):691-7.
Brignole-Baudouin F, Baudouin C, Aragona P, Rolando M, Labetoulle M, Pisella PJ, Barabino S, Siou-Mermet R, Creuzot-Garcher C.
A multicentre, double-masked, randomized, controlled trial assessing the effect of oral supplementation of omega-3 and omega-6 fatty acids on a conjunctival inflammatory marker in dry eye patients. Acta Ophthalmol. 2011 Nov;89(7):e591-7.
Rand AL, Asbell PA. Nutritional supplements for dry eye syndrome.
Curr Opin Ophthalmol. 2011 Jul;22(4):279-82.
Neukam K, De Spirt S, Stahl W, Bejot M, Maurette JM, Tronnier H, Heinrich U. Supplementation of flaxseed oil diminishes skin sensitivity and improves skin barrier function and condition. Skin Pharmacol Physiol. 2011;24(2):67-74.

Sweets just taste good!  And, that preference gets reinforced by rewarding ourselves with sweet treats, which can make one crave even more. “Sweet is the first taste humans prefer from birth,” says Christine Gerbstadt, MD, RD, a Dietitian and American Dietetic Association (ADA).

Two hundred years ago, the average American ate only 2 pounds of sugar a year. In 1970, we ate 123 pounds of sugar per year. Today, the average American consumes almost 152 pounds of sugar in one year. This is equal to 3 pounds of sugar per week!!

Replacing foods and beverages high in calories and added sugars with ones that are lower in sugar is one option to help reduce intake of excess calories. This may help reduce the risk of obesity and related chronic diseases. One type of no-calorie sweetener, is sucralose, which is about 600 times sweeter than sugar.

Sucralose was discovered in 1976 by researchers at Tate & Lyle and Queen Elizabeth College, University of London. Tate & Lyle subsequently developed sucralose-based Splenda in partnership with Johnson & Johnson subsidiary McNeil Nutritionals, LLC.

Sucralose is made from a process that begins with regular table sugar (sucrose). Chlorination is used to convert the hydroxyl groups of sucrose to galactose. Then, hydrolysis is used to remove the acetate groups on the galactose to yield sucralose.

Sucralose is not sugar, its structure prevents enzymes in the digestive tract from breaking it down, so most consumed sucralose (about 85 percent) is not absorbed. Unlike other sweeteners, sucralose is heat-stable, which means you can incorporate it into your cooking and baking recipes while saving calories.

This sweetener was approved in 1998. And is one of 6 no-calorie sweeteners permitted by the FDA for use in the US food supply. The six FDA-approved high-intensity sweeteners in the United States are: saccharin, aspartame, acesulfame potassium (Ace-K), sucralose, neotame, and advantame.

Researchers have conducted more than 100 scientific studies on sucralose safety over the past 20 years.

Nutritional Resources, Inc. makes many excellent products sweetened with sucralose and other approved sweeteners. These products may be helpful in maintaining a healthy, balanced diet.

Sources:

Foodinsight.org by the International food information Council Foundation Nov. 26, 2018

WebMD: Wendy C. Fries contract senior editor with WebMD.

pubchem.ncbi.nlm.gov  :from the NIH National Library of Medicine

DHHS.nh.gov (Dept of Health and Human Services)

FDA.gov/food/food additives-petitions/ high intensity-sweeteners, concerning sucralose safety

You may have heard the term “thermogenic” before or that something has thermogenic properties, but what exactly is it? And more importantly, how can it help you in your weight loss journey? Thermogenics are natural ingredients that help your body use calories quicker and easier. And, when partnered with other efforts, can help to lead to more weight loss.

What does a thermogenic do? Thermogenic, by definition, simply means an induction of heat. When it comes to your body, you use energy (i.e., calories) to produce heat. This is often referred to as metabolism or metabolic rate. Each person has a different metabolic rate – or how quickly or slowly calories are used. The higher someone’s metabolic rate (or metabolism) is, the quicker calories are burned from our body fat storage.

Thermogenic products contain natural ingredients designed to boost your metabolism and ultimately, increase fat burning. Depending on the ingredients, thermogenic products work in a variety of ways. Some will increase hormone levels, such as adrenaline and dopamine, to release fat that is stored in cells and allow them to be easily used. Other ingredients enhance metabolism by keeping adrenaline in the body longer to boost the fat burning results. Lastly, thermogenic products have also been shown to reduce appetite.

How can they be added to a weight loss program? Thermogenic ingredients have small, positive effects on metabolism to increase caloric expenditure and weight loss over time. Although more studies are needed, it has been shown that thermogenic products provide a metabolism boost, especially when combined with exercise. On their own, they will not likely make a huge impact on body weight change but can provide additional weight loss when involved with a nutrition and exercise program. Depending on the thermogenic ingredients, the increased metabolism boost can extend to up to 24 hours.

A powerhouse of abilities. Most thermogenic products include natural ingredients, such as caffeine, green tea, capsaicin (a component in peppers) and other plant extracts. Some products contain just one ingredient, while others use a proprietary blend of compounds known to increase metabolism.While using an herbal and antioxidant thermogenic blend, you also unleash a mighty dose of other nutrients that provide additional health benefits as well. Antioxidants are known to reduce the risk of diseases, such as certain types of cancers and heart disease. They also reduce inflammation and fight off free radicals. While other herbal ingredients may boost immunity, improve brain function and increase energy levels.

Thermogenic products can provide a safe and healthy way of burning fat better, while giving you a boost in energy. Results are best seen when combined with an effective nutrition and exercise plan, as they provide small benefits on their own.

Contact Us to learn more about our Thermogenic Antioxidant Drinks for contract manufacturing services.

By: Katie Chapmon, MS, RDN

Katie Chapmon, MS, RDN is an award-winning Registered Dietitian Nutritionist specializing in Bariatric Nutrition and Weight Management with 10+ years of hands-on clinical experience for leading medical providers.  She is the proud recipient of the 2010 Recognized Young Dietitian of the Year Award and 2018 Excellence in Weight Management Practice Award through the Academy of Nutrition and Dietetics.  For the past several years, she has been working with industry partners and consumers to improve nutrition education within the field, and maintains a private practice counseling pre and post-surgical patients.  She is a national speaker, consultant and published author and enjoys time hiking and cooking in the kitchen.  Katie also partners with Nutritional Resources (d/b/a HealthWise) for creation of educational content for weight managment professionals.

It seems lately all the rage amongst consumers is the desire for “Clean Food Labels.”  However, currently the U.S. Food and Drug Administration (FDA) has no parameters or definitions as to what a clean label is.  This leaves food companies at their own liberty to interpret what the consumer believes to be a clean label.

In looking at data collected from Canadean Limited, a London based company that conducts market research worldwide and provides analysis services, consumers are even confused as to what a “clean label is or means.  It appears the meaning of a clean label is different to different people.  At the 2016 Clean Label Conference in Illinois, Canadean Limited presented consumer’s concepts on clean labels with these being the four major themes¹:

• The closer to nature an ingredient or product is, the more “clean” it is perceived to be.
• Simplicity and familiarity of ingredients is important.
• The transparency of ingredients and how a product is made are critical.
• The more processed a food or drink is, the less “clean” it is perceived to be.

Canadean Limited research reveals that just over 1/3 of consumers globally and nearly 50% of Americans do not know what “clean label” means.¹  With consumer’s not knowing what it means, how can food companies know? The data, from the 2015 global survey conducted by Canadean Limited also reveals that older generations in the United States do not understand or know what the term “clean label” means, while the younger generations identify with the term.  Younger consumers tend to see “clean label” as intrinsic to a product where older consumers view “clean label” as more in the context of removing “bad” ingredients.¹

In this confusion, what do healthcare professionals do when they are offering a weight loss program that uses high protein, low carb foods that are packaged and have ingredients lists that can be long?  Educate your clientele.  Doesn’t the magnitude of harm that adipose tissue contributes to overall health far out-way the ingestion of ingredients that are FDA approved as Generally Regarded as Safe (GRAS)?

To help you to better educate your patients about the foods used in their nutritional intervention for weight loss, we list all the ingredients found in delicious HealthWise foods on our website and in the below ingredient table.   Many of these FDA approved ingredients have important functions in the appearance, consistency, mouth-feel and taste of the HealthWise foods.

White color does not have a ‘harmful effect’ on Coronavirus, as claimed in a widely shared Facebook post; nor does the color of a handkerchief have any effect on the virus, according to Sri Lanka’s Health Promotion Bureau. Also, there is no evidence that asafoetida, a plant often used in traditional Indian medicine, is a prevention or cure for Covid19. (1)  These are just a few posts on-line that are spreading misinformation but the Internet is full of false stories about Covid-19.

Here are just a few popular social media posts that spread misinformation accross the Internet

• Posts on social media claimed that volcanic ash from the eruption of the Taal Volcano on January 12, 2020, in the Philippines was the cause of low infection rates in the country, stating that consuming Taal Volcano ash could kill the virus and had “anti-viral” and “disinfectant qualities”. (2)
• In China and Japan social media misinformation led to increased purchases of fruits, yogurts, and seasoned food, such as natto, a common fermented bean dish, driving up sales and triggering panic as supermarkets rushed to restock shelves. (3)
• Also, in China, rumors that foods such as garlic, onion, ginger, and chili were useful in preventing coronavirus infection were spreading as of early March. (3)
• Saltwater sprays were given at the door of the River of Grace Community Church in South Korea in the false belief that this would protect people from the virus; the same unsterilized spray bottle was used on everyone, and may have increased the risk. Subsequently, 46 devotees were infected with the virus.
• In the Middle East and North Africa consuming honey, herbal teas, and Vitamin C rich foods was a prevention encouraged by experts in herbal medicine. (3)
• In Iran, camel’s urine, milk with honey, and olive oil have been touted as cures. (3)
• The official Iranian news agency reported that more than 210 people died from drinking toxic alcohol after claims circulated online that it could treat or ward off COVID-19. (4)
• In India and Nepal, false claims circulated in various countries online that medicinal herbs such as wormwood, sagebrush, and tarragon, Agarwood and Neem leaves were effective. (3)
• An on-line merchant offered a product called a Corona Necklace Air Purifier. The product was described as providing “All Day Protection.” “Capturing pollutants 10X smaller than viruses”. The vendor has since been removed from the e-commerce platform.
• In South Korea, a company exaggerated claims that a car air purifier they produce destroyed 99 percent of bacteria, including COVID-19, despite the fact that the coronavirus is not a bacteria
• Another firm sold a line of deodorant with promised but unproven virus killing effects. (3)
• In France, cocaine and bleach-like solutions are risky fake cures shared thousands of times on Twitter.  The French government tweeted in response, “No, cocaine does NOT protect against #COVID-19.” (5)

Lesson learned:  Before you push that share button, be sure you are sharing facts from a reliable source!.

(1) AFP Sri Lanka, Dr. Ashan Pathirana of Sri Lanka’s Health Promotion Bureau: March 20 2020.

(2)  Bangalore Mirror, Sept 02.2020

(3) The Bulletin of the Atomic Scientists, Alaa Ghoneim, July  24, 2020

(4) Gulf News, Dona Cherian, March 26^th 2020, and The Body.com,  Michael Broder June 22^nd 2020

(5) MSN.com Thomas Colson, March 9, 2020

Many people are jumping on the “Gluten-Free Diet” band-wagon as they believe it is a healthier lifestyle; however, people with celiac disease and non-celiac gluten sensitivity must follow a gluten-free diet for their condition!

It is estimated that 3 million Americans are diagnosed with celiac disease and another 18 million have non-celiac gluten sensitivity (1). Non-celiac gluten sensitivity (NCGS) has been created to describe those individuals who cannot tolerate gluten and experience symptoms like that found with celiac disease but do not have the antibodies and intestinal damage as presented in persons with celiac disease.

Early research suggests that NCGS is an innate immune response, as opposed to an adaptive immune response (such as autoimmune) or allergic reaction (1). Celiac Disease is antigen specific (including tissue-transglutaminase, endomysium and delaminated gliadin antibodies) and does result in an attack on its own tissue with enteropathy being the end result.
Non-celiac gluten sensitivity has been clinically recognized as less severe than celiac disease (1). It is not accompanied by the enteropathy, elevations of antibodies or the increased mucosal permeability that are characteristic in celiac disease (1). Individuals with NCGS would not test positive for celiac disease based on blood testing, nor do they have the same intestinal damage found in individuals with celiac disease. People with celiac disease and non-celiac gluten sensitivity benefit from the same treatment: a gluten-free diet.

The general guidelines for a gluten-free diet include (2):

1. Avoid all foods made from wheat, rye, bran, enriched flour, bulgur and barley (cereals, breads, pasta, croutons, crackers, cakes, etc.).
2.Avoid beer and other alcohols that are grain-based.
3.Avoid Oats. Some oat preparations can lead to cross contamination with wheat.
4.Use caution with processed foods that may contain gluten (canned soups,salad dressings, soy sauce, seasonings, ice cream, candy bars, instant coffee, ketchup, mustard, processed and canned meats, etc.)
5.Read food and product labels before buying or consuming any product.Manufacturers are required to provide information about the ingredients used to make their food products.
6.Avoid milk and other dairy products that contain lactose. Untreated individuals with celiac disease are often lactose intolerant as well.
7.Foods that can be eaten that are harmless include: corn, millet, sorghum, teff, ice, wild rice, amaranth, quinoa, and buckwheat.

For more helpful information about gluten free living go to FDA US Food and Drug

Sources:
1.www.celiaccentral.org

2.www.medicalnewstoday.com

What are sugar alcohols and what is their purpose in the human diet?  Are they friend or foe in obesity treatment?

Sugar alcohols are carbohydrates and their chemical structure resembles both a sugar molecule and an alcohol molecule (not the alcohol found in alcoholic beverages). Many people do not realize that sugar alcohols are found naturally in small amounts of a variety of vegetables and fruits. For example, pineapples, olives, asparagus and sweet potatoes all contain mannitol, while blackberries, raspberries, apples and pears all contain sorbitol naturally.

Sugar alcohols can also be commercially produced (see Table 1). Commercially produced sugar alcohols are added to sweeten foods without the caloric hit that sugar would provide. As a sugar substitute, they provide fewer calories than regular sugar.

Sugar alcohols are beneficial in foods intended for persons living with diabetes or being treated for obesity. This is because sugar alcohols are converted to glucose more slowly, require little or no insulin to be metabolized and do not cause sudden increases in blood sugar.

Sugar alcohols are regulated by the Food & Drug Administration (FDA) as food additives and are generally recognized as safe (GRAS.)

The PROS of sugar alcohols:
*They provide sweetness with fewer calories.
*They add bulk and texture to products.
*Some produce a cooling sensation in the mouth.
*They do not react with plaque bacteria in the mouth, so they do not cause dental cavities.
*They do not affect blood sugar levels the same as sugar.

The CONS of sugar alcohols:
*Sugar alcohols are slowly and incompletely absorbed and may contribute to gastrointestinal upset; because they are not fully absorbed, gut bacteria ferment sugar alcohols in the large intestine producing gas, bloating and diarrhea in some individuals.

*Products containing 50 grams or more of sorbitol or 20 grams or more of mannitol must carry the warning statement “excessive consumption may have a laxative effect.”

HealthWise uses a combination of nutritive and non-nutritive sweeteners including sugar alcohols. Sugar alcohols are found only in certain products. The content ranges from <1 to 5 grams per product.

Table 2. Sugar Alcohol and HealthWise Products

*Some products listed may no longer be available. Contact us for an up to date list of products that contain sugar alcohol.

The bottom line is, appropriately used, sugar alcohols have a role in weight management and in meal plans for patients with diabetes. Long-term benefits have not been established and more research is needed to document health benefits.

Sources:
1. Sugar Alcohols; www.fda.gov/nutritioneducation
2. Eat Any Sugar Alcohol Lately? Yale-New Haven Hospital; www.ynhh.org/services/nutrition/sugar-alcohol.aspx
3. What are Sugar Alcohols and How Do They Work? The Sugar Association; www.sugar.org

4. Sugar Alcohols Fact Sheet.  foodinsight.org/sugar-alcohols-fact-sheet

Obesity is one of the pressing global public health concerns. It is commonly associated with several co-morbidities and can be treated effectively with a high protein, low fat and low carbohydrate diet for successful body weight loss and maintenance. It is extremely important to ensure the quality of protein used in a calorically restricted diet will provide the necessary amino acids to maintain muscle mass and overall health in subjects.

Below is a list of proteins and the pros & cons associated with each.

What Does This Mean for Protein Needs?

Ultimately, which protein source depends upon the person’s personal goals and the way their body functions best. It is important to focus on a protein source that is clean and is made from clinically proven ingredients.

¹ Westerterp-Plantenga, M. S., Lemmens, S. G., & Westerterp, K. R. (2012). Dietary protein–its role in satiety, energetics, weight loss and health. British journal of nutrition, 108(S2), S105-S112. HealthWise blog, Know Your Proteins.

Asthma, lupus, irritable bowel syndrome, Crohn’s disease, glomerulonephritis, allergies as well as other chronic conditions are all characterized by inflammation. Inflammation is a normal bodily response to protect us from trauma, toxins, heat, or infection from foreign organisms such as bacteria and viruses. The damaged cells release various chemicals including bradykinin (causes blood vessel dilation), histamine (causes contraction of smooth muscle and dilation of capillaries), and prostaglandins (causes inflammation, pain, and fever as part of the healing process). The swelling caused by the dilation of blood vessels and capillaries is part of the immune system’s ability to sequester the foreign matter, thereby isolating it from further contact with other tissues. The chemicals released during an inflammatory response, signal and attract phagocytes (white blood cells) to the damaged cell site to start the healing process.

Acute inflammation is short-term and beneficial to the body as part of a normal healing process; however, chronic inflammation can be destructive to the body. Chronic inflammation occurs due to a malfunction of the immune system not turning “off” when it should. Chronic inflammation destroys healthy tissues and can play a role in the development of various diseases.

Chronic inflammation can occur anywhere in the body and is very damaging because it acts like a slow-burning fire that continues to stimulate pro-inflammatory immune cells.² Excess immune cells and their signaling molecules circulating in the body can damage blood vessel linings (in atherosclerosis), pancreatic tissue (diabetes), and joint tissue (in arthritis).² Chronic inflammation also occurs in autoimmune diseases such as lupus, asthma, inflammatory bowel disease and allergies.

Over time, chronic inflammation can cause changes in DNA and can lead to cancer. For example, people with chronic inflammatory bowel diseases, such as Crohn’s disease, have an increased risk of colon cancer. People who are overweight and/or obese also experience chronic inflammation which lends itself to weight gain, due to the water retention.
Inflammation can cause people to feel pain, stiffness, distress, discomfort and even agony depending on the severity. Inflammation primarily causes pain because the swelling pushes against nerve endings which sends pain signals to the brain. Living with chronic inflammation and pain can be debilitating and can lead to depression.

There are many treatment modalities for chronic inflammation:

Non-steroidal anti-inflammatory drugs (NSAIDS) Non-steroidal anti-inflammatory drugs (NSAIDS) (i.e. Naproxen, Ibuprofen, Aspirin, etc.) counteract an enzyme that contributes to inflammation.

Corticosteroids – There are two types of corticosteroids used to treat inflammation. Glucocorticoids (i.e. cortisone, prednisone, triamcinolone, budesonide, etc.) are used to treat conditions such as systemic lupus, arthritis, dermatitis, allergic reactions, Inflammatory bowel disease (IBS). Glucocorticoids are offered in both oral and topical forms. Mineralcorticoids are used to treat salt imbalances in the body which contribute to inflammation.

Disease Modifying Antirheumatic Drugs (DMARDs) – DMARDs are a class of drugs that inhibit T cells and B cells and suppress the body’s immune and inflammatory responses. Common drugs in this category include methotrexate, sulfasalazine, and azathioprine.

Biologic Drugs – Biologic drugs such as Enbrel®, Stelara® and Humira® all work by targeting chemicals and cytokines such as necrotic tumor factor (TNF), interleukin 1 (IL-1) and interleukin 6 (IL-6) which all cause inflammation. Many of these pharmacotherapy agents work very well in controlling inflammation, however many people experience side effects and these treatments can be expensive. Most common side effects include nausea, headache, dizziness, diarrhea, extreme weakness or fatigue and dry mouth. However, some medications can create severe side effects such as hepatic problems, blood disorders and even fetal harm in pregnant women.

Nutrition Therapy – The one treatment modality that has little to no side effects is…………….. diet. The typical American diet is very rich in pro-inflammatory fried foods and processed foods. The unhealthy food that people are eating affects the body in many ways and chronic inflammation is just one of them. We commonly hear about hypercholesterolemia, hypertension and atherosclerosis being associated with dietary intake, however just in recent years has diet been linked to chronic inflammation. Increasingly more research pertaining to chronic inflammation is proving that the body reacts to the types of foods we eat, whether healthy or unhealthy.

Foods that are pro-inflammatory include fried foods, red meat, processed meats (i.e. sausage, bacon, deli meats), snack foods, sugar sweetened beverages (i.e. soda, energy drinks, juices), baked goods, vegetable oil laden products, and refined carbohydrate foods. Omega-6 fatty acids are pro-inflammatory and are found in all kinds of foods that are fried. These products as well as highly processed foods contain high levels of AGEs (advanced glycation end products). AGEs are compounds produced in the body through an array of chemical reactions. These reactions happen when blood sugar levels are elevated. The danger of AGEs is that they can clog the microvascular system of eyes, heart, kidneys, and brain thus contributing to higher risks of complications of disease states like diabetes mellitus and heart disease.

Foods high in saturated fat are also pro-inflammatory. Although a moderate intake of yogurt with active cultures can be beneficial to the GI tract, dairy foods high in saturated fat can decrease levels of good gut bacteria which are crucial participants of the immune system in reducing inflammation. Saturated fats have also been found to inflame white adipose tissue; this type of tissue stores energy while brown adipose tissue is catabolic and burns energy. In addition to ingesting many saturated fat foods, if fat cells increase in size, through the intake of excessive calories of processed foods, they release pro-inflammatory mediators that provoke a systemic inflammation response as well. Therefore, staying at a healthy body weight or losing weight if overweight or obese also helps in managing chronic inflammation.

Although there is no set “Anti-Inflammatory Diet,” combatting chronic inflammation with nutrition is as easy as getting back to the basics. Consuming more fresh fruits and vegetables, choosing whole grains, nuts, omega-3 rich fish and healthy oils such as olive oil. Anti-inflammatory foods contain phytochemicals. Phytochemicals carry out healthy biochemical and biological activity at the cellular level which is beneficial for the body. The processing of foods can damage and destroy phytochemicals, therefore whole foods are advocated to ensure the best nutritional benefit is being consumed.

Sources:

1. Foods That Fight Inflammation – Harvard Health Publishing, August 13, 2017.
2. What Is Chronic Inflammation? – Dr. Amber Hayden DO, 2017.
3. Want X, et. al Inflammation Markers and Risk of Type 2 Diabetes – Diabetes Care Vol. 36, January 2013.
4. Minihane A. et. al Low-Grade Inflammation, Diet Composition and Health: Current Research Evidence and Its Translation.
British Journal of Nutrition 114 (999-1012) 2015.
5. Calder P. Long Chain Fatty Acids and Gene Expression in Inflammation and Immunity Current Opinion in Clinical
Nutrition & Metabolic Care 16 (425-433) 2013.
6. Immune Responses Medline Plus www.medlineplus.gov/ency/article/000821.htm
7. Nordqvst C. Everything You Need to Know About Inflammation – Medical News Today Nov. 24, 2017.
8. Rowe B. Davis L., Anti-Inflammatory Foods For Health: Hundreds of Ways to Incorporate Omega-3 Rich Foods Into Your
Diet to Fight Arthritis, Cancer, Heart Disease and More. 2008.
9. International Journal on Inflammation https://www.hindawi.com/journals/iji/

10. The Journal of Inflammation – www.ncbi.nlm.nih.gov/pmc/articles/PMC1074343/