Weight Down Living

“I fear all we have done is awaken a sleeping giant and fill him with a terrible resolve.”

– Admiral Isoroku Yamamoto, upon learning of the success of the attack on #PearlHarbor

This article was published in the November 2018 edition of NHD Magazine.

Toddlerhood (between one and three years old) is a time of rapid growth and development.

Malnutrition during these early years can lead to stunted growth, and problems with behavioural development and learning1.

Following the exposure to new tastes and feeding experiences during infancy, toddlers are continuing on their journey of food discovery. Development of biting and chewing skills also continues at this age. For example, between 18 – 24 months toddlers will begin to chew with their lips closed2.

The results of the most recent National Diet and Nutrition Survey (NDNS) from 2014 – 2016 are outlined in table one, along with an explanation of what role these nutrients play in a toddler’s diet3-8.

Table one: Results of NDNS survey of children aged 1.5 – 3 years*

* Table devised using references 3 – 12

Sugar intake for those who were 18 months to three years old was found to be more than double the recommended limit

Only 13% of toddlers achieved a sugar intake which was below or equal to 5% of total energy. The main source of free sugar intake in this age group was found to be ‘cereal and cereal products’, with the second highest source being fruit juice and soft drinks, followed by ‘sugar, preserves and confectionery’.

One of the risks associated with excess sugar intake in children is dental caries, and 28% of 5 year olds in England are already found to have tooth decay7,13.

Fibre intake was found to be 5g below the daily recommended amount for toddlers

‘Cereals and cereal products’ being the main source of fibre, followed by ‘vegetables and potatoes’ and then fruit.

After the age of two, wholegrain foods can be gradually introduced to a toddler’s diet14. Before this, the high fibre content of wholegrains can make a toddler feel full before they have consumed enough calories and nutrients.

Although protein is an important nutrient for toddlers to consume, the overall protein intake from the NDNS appears to be very high in this group. This is worrying as this can effect bone health, kidney health and increase the risk of obesity in later life.

Another notable results of the NDNS was that iron intake was slightly low and vitamin D intake was very low in toddlers, even when intake from supplements was included.

Toddlers in the UK tend to have a good intake of iodine, however those who avoid cow’s milk are at a higher risk of deficiency as this is the main source of iodine in the UK15.

The amount of salt in a toddler’s diet should also be limited, especially as the average intake in the age group in the UK was found to be 2.3g of salt per day, which is above the recommended limit of 2g per day16.

The recommended portion sizes and distribution of food groups is outlined in the ‘5532-a-day’ image from the British Nutrition Foundation below17.

When the data for daily energy intake from various food groups from the most recent NDNS are compared with this, it seems that intake of starchy foods, dairy foods and protein are close to the recommended amount.

But toddlers seem to have a low intake of fruit and vegetables.

And although these are not necessary in most toddlers’ diet, they also appear to be having a regular intake of: sugary drinks, sugary snacks, and savoury snacks.

Image source: https://www.nutrition.org.uk/healthyliving/toddlers/5532aday.html

Remaining daily energy intake (labelled as ‘other’ in the pie chart) included:
Fish – 2%, eggs – 2%, nuts – 1% Fat spreads – 3%, sugar preserves and confectionery – 4%,
juice and soft drinks – 3% , Savoury snacks – 3%

The World Health Organisation (WHO) advise that babies should be breastfed exclusively for the first six months of life, and “thereafter infants should receive complementary foods with continued breastfeeding up to 2 years of age or beyond”18

This advice to continue breastfeeding beyond twelve months is because breast milk continues to provide energy, hydration and key nutrients.

However, it is rare in the UK to breastfeed beyond 12 months19

In developing countries continued breastfeeding is linked with improved growth and a lower risk of infant mortality20.

There is not much research which has examined the effect of breastfeeding past infancy in developed countries. A relatively small study from America in 2016 found that the mothers’ breast milk in the second year of lactating had a significant increase in total protein, prebiotics (oligosaccharides) and proteins which boost immunity, as compared with mothers in the first year of lactating21. This study also found that zinc and calcium levels reduced in breastmilk in the second year of lactating, and no changes were found in lactose, fat, iron or potassium levels.

An older study also found that 448ml of breastmilk in the second year of lactation provides:22

• 29% of energy requirements
• 43% of protein requirements
• 36% of calcium requirements
• 75% of vitamin A requirements
• 60% of vitamin C requirements
• 76% of folate requirements
• 94% of vitamin B12 requirements

A systematic review by Victora et al. (2016) identified an increase in tooth decay in children who were breastfed for more than 12 months. However this study also highlighted that “this should not lead to discontinuation of breastfeeding, but rather to improved oral hygiene”23.

In the UK, all children from the age of one to five are advised have a daily age-appropriate supplement which contains vitamin A, vitamin C and 10 microgram of vitamin D24-25.  

These can be bought in a pharmacy or supermarket, or they can be obtained on the ‘Healthy Start Scheme’ for those who are eligible.

Water is the best drink for toddlers.

Baby bottles should be stopped by age of one, as this can become a comfort and can cause tooth decay26. Instead, drinks should be given from a beaker with a free-flow lid, and when a toddler is ready they should be encouraged to drink from an open cup26.

Milk can be given to toddlers, and it is an important source of calcium. However, toddlers should ideally have no more than two or three glasses of milk per day, depending on how many other dairy foods they eat14. This is because drinking too much milk is associated with increasing the risk of anaemia and providing excess protein27.

Full fat milk should be given until a toddler is two years old, but from the age of two the fat content of most toddler’s diet can be reduced; as long as they are growing well and have a balanced and varied diet2. Semi-skimmed milk can be given from two years old, but skimmed milk should not be offered until they are five years old2. Rice milk should not be given to children under five years, as it can contain traces of arsenic26.

Fruit juice is a good source of vitamin C, but to reduce the risk of tooth decay it needs to be diluted with one part juice to 10 parts of water for toddlers26.

Squash, ‘juice drinks’, fizzy drinks, flavoured milk, diet or reduced sugar drinks, or ‘baby drinks’ should not be offered to toddlers.

Tea and coffee are also not recommended for this age group, as these drinks can reduce the amount of iron which is absorbed from meals26.  

Infants usually start to become hesitant about trying new foods at around 18 months, this is called ‘food neophobia’2.

This is a stage where fussy eating behaviour can start to emerge and become reinforced.

To avoid fussy eating becoming a long-term problem it is best to:28

• Establish eating routines
• Eat together as a family to model good eating habits
• Provide varied and balanced meals of appropriate portion sizes
• Encourage self-feeding and messy play
• Give praise when a new food is tried
• Try to remain calm when food is refused

It is also important that everybody involved in taking care of the toddler (including both parents, other family members and nursery staff) are consistent in handling food refusal in an appropriate way.

References:

1. Huffman & Schofield (2011) “Consequences of malnutrition in early life and strategies to improve maternal and child diets through targeted fortified products” [accessed August 2018 via: http://fsnnetwork.org/sites/default/files/consequencs_of_maternal_and_child_nutritution.pdf]
2. Manual of Dietetic Practice. edited by Joan Gandy in conjunction with The British Dietetic Association (5th Edition, 2014).
3. Results of the National Diet and Nutrition Survey (NDNS) rolling programme for 2014 to 2015 and 2015 to 2016 [accessed August 2018 via: https://www.gov.uk/government/statistics/ndns-results-from-years-7-and-8-combined].
4. Department of Health. Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. London. HMSO,1991.
5. Great Ormond Street Hospital for Children (2015) “Nutritional Requirements (6th Edition)”.
6. SACN (2016) “Vitamin D and Health” [accessed August 2018 via: https://www.gov.uk/government/publications/sacn-vitamin-d-and-health-report]
7. SACN (2015) “Carbohydrates and Health” [accessed August 2018 via: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/445503/SACN_Carbohydrates_and_Health.pdf].
8. Manual of Dietetic Practice. edited by Joan Gandy in conjunction with The British Dietetic Association (5th Edition, 2014). Table A.2.1 p. 923.
9. NIH (2012) “Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents” [accessed August 2018 via: https://www.nhlbi.nih.gov/files/docs/peds_guidelines_sum.pdf]
10. SACN (2017) “Draft Feeding in the First Year of Life Report”  [accessed August 2018 via: https://www.gov.uk/government/publications/feeding-in-the-first-year-of-life-sacn-report]
11. Lozoff & Georgieff (2006) “Iron deficiency and brain development” [accessed August 2018 via: https://www.ncbi.nlm.nih.gov/pubmed/17101454]
12. Pearce (2014) “Iodine deficiency in children” [accessed August: https://www.ncbi.nlm.nih.gov/pubmed/25231449]  
13. National Dental Epidemiology Programme for England: oral health survey of five-year-old children 2015
14. NHS Choices (2016) “What to Feed Young Children” [available August 2018 via: https://www.nhs.uk/conditions/pregnancy-and-baby/understanding-food-groups/]
15. BDA Food Fact Sheet ‘Iodine’ [accessed August 2018 via:  https://www.bda.uk.com/foodfacts/Iodine.pdf]
16. Gibson & Sidnell (2014) “Nutrient adequacy and imbalance among young children aged 1–3 years in the UK” [available August 2018 via: https://onlinelibrary.wiley.com/doi/abs/10.1111/nbu.12087]
17. BNF (2014) “5532-a-day resource” [available August 2018 via: https://www.nutrition.org.uk/healthyliving/toddlers/5532aday.html]
18. WHO Website “Breastfeeding” [available August 2018 via: http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/]
19. NCT (2010) “Key Baby Feeding Statistics
    from the 2005 UK Infant Feeding Survey” [available August 2018 via: https://www.nct.org.uk/sites/default/files/KeyBabyFeedingStatistics.pdf]
20. WHO Website “Continued breastfeeding for healthy growth and development of children” [available August 2018 via: http://www.who.int/elena/titles/continued_breastfeeding/en/]
21. Agarwal & Fulgoni (2016) “Assessment of the Infant and Toddler Nutrition Status in the US: A Recent Literature Review”
22. Dewey (2001) “Nutrition, growth, and complementary feeding of the breastfed infant” [available August 2018 via: https://www.ncbi.nlm.nih.gov/pubmed/11236735]
23. Victora et al. (2016) “Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect” [available August 2018 via: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/abstract]
24. SACN (2016) “Vitamin D and Health” [accessed August 2018 via: https://www.gov.uk/government/publications/sacn-vitamin-d-and-health-report]
25. NHS Choices (2018) “Vitamins for Children” [accessed August 2018 via: https://www.nhs.uk/conditions/pregnancy-and-baby/vitamins-for-children/]
26. NHS Choices (2015) “Drinks and cups for babies and toddlers” [accessed August 2018 via: (https://www.nhs.uk/conditions/pregnancy-and-baby/drinks-and-cups-children/)
27. Ziegler (2011) “Consumption of cow’s milk as a cause of iron deficiency in infants and toddlers” [accessed August 2018 via: https://www.ncbi.nlm.nih.gov/pubmed/22043881]
28. GOSH Website “Fussy eaters” [accessed August 2018 via: https://www.gosh.nhs.uk/medical-information/general-health-advice/food-and-diet/fussy-eaters]

Health authorities have told us to eat more carbohydrates – “healthy whole grains” – for the past several decades, as a benign alternative to allegedly deadly saturated fat. Their story is now unraveling, as recent and divergent lines of evidence point to carbohydrates as detrimental to lifespan and healthspan. In this article we’ll look at the evidence that dietary carbohydrates increase death rates.

The PURE Study

The PURE Study looked at over 135,000 people in 18 countries, and tracked what they ate and at what rate they died. The study found that dietary carbohydrates were positively associated with death and cardiovascular disease rates, and dietary fat was negatively correlated, i.e. the more dietary fat, the lower the death and disease rate. Results shown in the graph below.

This is an epidemiological study and therefore cannot prove causation.

Nevertheless, at least a couple other epidemiological studies have found the same: 1) carbohydrates, not saturated fat, are associated with cardiovascular disease; 2) “high carbohydrate consumption (mainly in the form of cereals and wheat, in particular) as the dietary factor most consistently associated with the risk of CVDs” (ref.)

What about evidence beyond epidemiology? If animal and other evidence supports it, then we can have better confidence in the result.

Ketogenic diets increase lifespan

A ketogenic diet extends longevity and healthspan in adult mice. (Ref.)

In fact, ketogenic diets may be equivalent to fasting and/or calorie restriction in their effects on lifespan and health. (I wrote about that here.) Since calorie restriction is the most robust lifespan-extending intervention yet found, if a ketogenic diet produces the same result, that’s great news.

You wouldn’t have to restrict calories in order to get longer life and better health, you would merely restrict carbohydrates, and eat as much as you wanted.

Much interesting new research proposes that calorie restriction produces its benefits via ketones. “Ketone bodies mimic the life span extending properties of caloric restriction“.

Benefits of fasting due to fewer carbohydrates

Intermittent fasting duplicates many of the physiological benefits of calorie restriction.

Much of the benefit of fasting may be due to the absence of carbohydrates.

One study calculated that 100% of the changes wrought by fasting was due to eating no carbohydrates. Carbohydrate restriction regulates the adaptive response to fasting. When volunteers either fasted for 3.5 days, or got an infusion of lipid for the same time, “Changes in plasma glucose, free fatty acids, ketone bodies, insulin, and epinephrine concentrations during fasting were the same in both the control and lipid studies.”

Oncologist Rainer Klement wrote: “I propose carbohydrate restriction as probably the best way to mimic CR [calorie restriction] in humans without the need to restrict energy intake.” (Ref.)

Another study estimated that 71% of the lowered glucose seen in short-term (24-hour) fasting may be due to no carbohydrates. (Ref.)

Acarbose and metformin

Acarbose is an anti-diabetic drug that inhibits an enzyme responsible for uptake of glucose from the intestines, and it increased lifespan by by 22% in male mice, 7% in female. (Ref.) In humans, acarbose dramatically reduced the incidence of cardiovascular events in diabetics. (Ref.)

Since carbohydrates break down into glucose upon ingestion, and acarbose prevents that and increases lifespan and lowers the rate of CVD, then it seems that simply not eating carbohydrates would do the same.

Metformin is another anti-diabetic drug that lowers glucose and insulin by inhibiting gluconeogenesis, the production of glucose from amino acids and fats in the liver. Diabetics who take metformin may live longer than non-diabetics who do not take metformin. (Ref.)

That’s a startling fact, but must be tempered by the knowledge that even most non-diabetics in this day and age have high insulin and impaired glucose tolerance.

Metformin also increases lifespan in lab animals. (Ref.) “Treatment with metformin mimics some of the benefits of calorie restriction, such as improved physical performance, increased insulin sensitivity, and reduced low-density lipoprotein and cholesterol levels without a decrease in caloric intake.” [My emphasis.]

Metformin mimics CR, which is recapitulated by fasting, which is all (or mostly) about carbohydrate restriction.

By the way, there’s even a rapamycin connection here. Rapamycin, a drug that extends lifespan, also results in the production of ketones and better insulin sensitivity. (Ref.)

And a ketogenic diet inhibits the mechanistic target of rapamycin (mTOR). (Ref.)

Conclusion

Multiple lines of evidence lead to the conclusion that dietary carbohydrates, especially refined grains and starches, promote mortality and are bad for health.

Decreasing carbohydrates, either entirely via a ketogenic diet, or even somewhat, improves health and increases lifespan.

If you want to avoid these carbohydrates, then avoid the following foods:

• breakfast cereal
• bread, tortillas, naan, bagels
• pasta
• pizza
• donuts, candy
• soft drinks, fruit juice
• potatoes.

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Pain in your mouth can make the joy of eating disappear – especially if the pain seems to get worse right as you’re about to eat.

That’s a hallmark symptoms of a salivary gland stone, or sialolithiasis. It’s not one of the more common causes of mouth pain, but it’s one that can be identified and usually treated successfully by someone who specializes in ear, nose and throat (ENT) issues.

A stone forms when salivary material mixes with a substance in the salivary glands and calcifies.

ENT specialist Tony Reisman, MD, describes it as essentially a plumbing problem.

The stone blocks one of the ducts that your saliva travels through to get from the gland (where it’s produced) to your mouth (where it’s needed to break down food and keep teeth strong), causing saliva to get backed up in the gland. The gland swells and can become infected and painful.

There are several glands on each side of your face that produce saliva. Salivary stones most often occur in or near the submandibular glands under the jaw, but they can also occur in the parotid glands on the sides of the jaw.

Pain accompanied by a visibly swollen gland on the side of your face or under your jaw is the telltale sign of a salivary gland infection, and possibly a stone, Dr. Reisman says.

The other thing is that you might be able to actually see a stone under the tongue or on the inside of the cheek. According to Dr. Reisman, stones have a whitish or yellowish color and can get as large as 2 centimeters in diameter.

They’re most likely to occur in:

• People who are prone to dehydration (including the elderly)
• People with conditions that cause dry mouth
• People with chronic dental disease

Salivary stones may be discovered by accident during a dental X-rays, Dr. Reisman adds.

Removing a salivary stone

If a doctor is able to see the stone, he or she may be able to remove it in the office by giving the patient a local anesthesia and making a tiny incision over the stone.

If it’s not visible, a doctor will use a CT scan with contrast to locate it. If the stone is very deep, the doctor may want to remove it using a relatively new technique called salivary sialendoscopy.

“It’s done in the operating room, where you use a tiny scope to go through the actual duct in the floor of the mouth or the side of the cheek, and then there are baskets you can use to retrieve these stones,” Dr. Reisman says.

If the stone is very close to the gland, or stuck inside of the gland, the patient may require surgery to remove the gland.

The good news is, while salivary stones can be painful, they aren’t usually a symptom of a bigger problem or disease.

Dr. Reisman says, “For most patients, it’s one-and-done.”

The results of a new study published in the Journal of the American Medical Association (JAMA) suggested that a healthy diet does not reduce dementia risk.

These findings contradict earlier studies which concluded that a healthy diet reduces the risk of mental decline and helps to prevent abnormalities that can precede dementia.

In this first-ever study to evaluate the long-term effects of diet on the risk of developing dementia, participants’ eating habits were observed from middle-age with follow-ups continuing for 25 years. The research team monitored 8,200 middle-aged adults, of which 344 were eventually diagnosed with dementia.

There was no marked decrease in the onset of dementia between the 30 percent of participants who stuck to a healthy diet rich in; fruit, vegetables, whole grains, nuts and legumes and consumed unsaturated fats including olive oil and the 30 percent with a poor diet that who regularly consumed red meat and ate sugar-rich foods.

See more: Health News

The study was carried out by a team from the French National Research Institute (INSERM). Ironically, lead researcher Tasnime Akbaraly published a study in 2018 which concluded that a healthy diet could help prevent the onset of depressive orders as well as contributing to overall health and wellbeing.

The Alzheimer’s Association, who are themselves currently sponsoring a trial looking into the effects of dietary changes along with other preventative measures for older adults at risk of mental decline, have continued to advise that eating a heart-healthy diet low in saturated fats is beneficial to mental and physical health.

While they have stated on their website that further research is needed on the relationship between diet and cognitive function they have advised that the Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet are considered to be beneficial in reducing the risk of dementia.

“I would certainly not want anyone to come away from this thinking a healthy diet is futile,” Keith Fargo, director of scientific programs and outreach at the Alzheimer’s Association, told Health Day. “This study has to be viewed within the context of the larger scientific literature on diet and cognition, which does suggest there’s a benefit [from healthy eating].”

Fargo believes that clinical trials give more definitive answers.

“Studies like this one which examines lifestyle habits cannot answer the question, will changing my diet reduce my risk of dementia, because they do not prove cause and effect,” he said. “You can’t rely on observational studies like this to tell you what to do.”

Earlier this year, Olive Oil Times reported that key nutrients of the Mediterranean diet were associated with healthy brain aging.

By Debora MacKenzie

Claims are surfacing in press reports today that two Russians charged by the UK government for the Novichok nerve agent poisonings in Salisbury were carrying enough of the stuff to kill 4000 people.

Given that only Russia is known to have a stockpile of Novichok agents, the suspicion levelled at the Russians seems reasonable. But could they really have killed thousands?

Claims like this are regularly made about chemical and biological weapons, which are usually lumped together as weapons of mass destruction (WMDs) although they are quite different – …