Public Health Report

Tag: nutrition

The First 1,000 Days Define the Rest of Our Lives: New Infant Nutrition Research


The Lancet recently published a review paper emphasizing the importance of nutrition in the first 1,000 days after birth. New scientific research is supporting this concept to a remarkable degree, with a Brigham Young University study finding that infant feeding practices predict obesity in adults. Additional studies released in the last few weeks indicate extensive health effects in formula-fed infants and increased brain development in breastfed infants.

You Are What You Ate

What you consume as an infant impacts your health for the rest of your life. According to the Lancet paper, malnutrition as a baby can have particularly lasting effects on an individual, and may be a contributing factor to the growing epidemic of metabolic diseases like diabetes.

While the consensus that breastfeeding leads to better health is not new, the mounting evidence shows that breastfeeding deserves a strong public health push. What little money is available for public health right now would be well spent on an issue that has such broad potential health benefits.

A study in Rhesus monkeys highlights the wide range of benefits of breast milk. Researchers at UC Davis found that compared to breastfed monkeys, those that were formula fed had altered gut flora as well as (possibly related) reduced function of their immune systems and metabolism.

Additionally, a Brown University brain development study employed several methods to measure brain development in infants. The researchers found that children who had been breastfed had much stronger development in some brain regions. While this is just a single study, it supports previous findings in adolescents.

The figures examining myelin water fraction, a measure of white matter growth, are particularly remarkable. By that measure, some brain regions experienced as much as 34% greater development in breastfed children as compared to formula-fed.

Science Needed

While many studies have shown long term health benefits of breastfeeding, there is still a need for more research.

Ethical considerations make true randomized studies difficult in this field. As a recent WHO review of long-term breastfeeding effects points out, the well-recognized short term benefits to infant disease and mortality make it unethical to assign a formula-only group at random. Because of this, long term effects can be obscured by the effects of parenting and environment (parents who choose to breastfeed may share other characteristics).

Additionally, the current recommendations would benefit from more information on the cause of long term benefits. Not all mothers have the option of breastfeeding, so there needs to be a better alternative.

The real story in this new research is that the development of baby formula has not progressed as well as one would hope. It is currently a poor alternative and while we may never (in the near future) be able to reproduce all of the benefits of breastfeeding, it is hard to believe that we can’t do better.

Seeking a Fertile Middle Ground: A Reasonable Approach to GMOs

Genetically Modified Organisms (GMOs) are in the news again: unwelcome GMO wheat was found in an Oregon wheatfield, the Senate recently voted not to allow states to mandate GMO labeling, and extensive global protests were held against GMO monopolist Monsanto. The issue of GMO foods is full of misunderstandings and misinformation, so it is important to learn the facts behind the rhetoric.

New Food

The term GMO itself is based on a misleading premise. In fact, genetic modification of crops has been going on in some form throughout the history of farming. We have been changing the genes of plants through selective breeding and other methods for thousands of years, possibly even in ways that make our food less healthy. The FDA uses the term GE or Genetically Engineered to ” distinguish plants that have been modified using modern biotechnology from those modified through traditional breeding.”

Modern genetic engineering is certainly a new level of  modification of our food supply. While many of these genetic modifications are simple and fairly predictable, there are still unknowns involved in the process. In addition, GE foods are very widespread in the US. The FDA has some figures: “In 2012, GE cotton accounted for 94 percent of all cotton planted, GE soybeans accounted for 93 percent of soybeans planted, and GE corn accounted for 88 percent of corn planted.”

While the European Union requires GMO foods to be labeled, the US has never had such a requirement and most foods’ GMO status is not easily attainable. Last Thursday, the Senate rejected a measure that would have allowed individual states to require labeling of GMO foods.

The process of genetically engineering a plant usually involves inserting a gene that codes for a specific protein. A popular modification is to add a gene that allows a plant to become resistant to the common herbicide Roundup (Glyphosate). Another example is Golden Rice, which adds a gene for Vitamin A production to rice crops in order to prevent Vitamin A deficiency (and resulting blindness) in poor regions. Other modifications improve drought resistance, pest resistance, and growth and efficiency in crops. The FDA provides an infographic on how the modification process goes, ideally:

Methods of Plant Breeding Source: FDA

What’s the Problem?

There are potential problems with the modification process. New genes could cause unexpected allergies, have other unexpected effects on humans, aid in the creation of herbicide resistant superweeds, or spread their new genes to non-GMO crops. Other concerns include the overuse of glyphosate products in herbicide resistant crops. Though glyphosate is widely considered one of the safest herbicides for humans, some toxicity reports raise concerns about the forms used in herbicide products (no one has established that there is a significant danger to humans in the levels of glyphosate they might consume). The herbicidal mechanism of glyphosate involves disrupting the action of a protein (EPSPS) which humans do not produce.

The Rise of Superweeds


Because genetic engineering of food has emerged so recently and has quickly become dominant in agriculture, there are concerns that the new products are not well vetted before being made available to the public. The FDA guidance document on genetically modified plants requests that data be submitted to the FDA before their use.  It does say, however,  that “during the consultation process, the FDA does not conduct a comprehensive scientific review of data generated by the developer.” In other words, the conclusions of the safety studies commissioned by the new plant owners are not independently verified. The WHO seems to leave safety assessments of these new plants to national regulators.

Seeking a Fertile Middle Ground

While there are always potential health risks in creating new organisms, there is a broad consensus in the scientific community that the widely used strains of genetically engineered crops do not impose significant risks over conventional crops. Numerous reports and meta-analyses have indicated that there is very little potential danger to humans. Studies which have found possible risks have been almost universally discredited (though scientists have been known to be particularly harsh on these findings for giving ammunition to GMO opposition which has otherwise had very little scientific backing).

In addition, the world’s population is increasing. It is difficult to produce enough food for the world’s population, and genetic engineering holds promise for increasing crop yields, allowing for agriculture in dry or otherwise inhospitable regions, and adding essential nutritional content to easily grown staple foods.

The scientific journal Nature’s May special on GMOs  includes an article calling for nonprofit research to develop GE foods beyond the commonly used pest and herbicide resistant strains. Newer GE technology will allow for much more precise gene insertions, opening up new possible modifications while decreasing the chances of unintended effects.

The future of genetically engineered foods is full of promise, but is hindered by misunderstanding of the technology. If health and environmentally conscious groups can accept the idea of genetically engineered foods, they may be able to successfully push for higher safety standards and more consumer-focused modifications rather than the elimination of this area of research.

Mediterranean Diet Prevents Cancer, Protects Heart and Brain


A trio of new studies of the Mediterranean diet add to growing evidence of incredible health benefits:

A study released yesterday by the University of Ohio indicates that a molecule found in celery and parsley (among other foods), Apigenin, encourages normal cell death through apoptosis, reversing the immortality cancer cells tend to develop.

Another pair of recent publications were released as part of the PREDIMED program, which was designed to “assess the efficacy of the Mediterranean diet in the primary prevention of cardiovascular diseases.”

One PREDIMED study shows that high-risk patients following the Mediterranean diet supplemented with either olive oil or nuts had a significantly lower incidence of major cardiovascular events compared to a low fat diet.

A smaller study in the PREDIMED program indicated that the Mediterranean diets also displayed cognitive benefits in relation to a low fat diet. Significantly lower rates of mild cognitive impairment and dementia were observed in the Mediterranean diet groups supplemented with olive oil or nuts.

Caveat: It should be noted that there is no small amount of bias inherent in all this studying of the trendy Mediterranean diet. On PubMed, a simple search for “Mediterranean Diet” research since January yields 80 results. An identical search for “low fat diet” yields 49 results (this is the diet used as a comparison in the PREDIMED studies because it is commonly recommended by doctors). Another search for the admittedly more obscure “indian diet” gives a single result. Perhaps an Indian diet is the healthier diet; we may not find out until Indian food becomes the next health trend and funding is granted for this research. The key takeaway from these studies is that high vegetable-fat diets have been shown to produce better health outcomes than the standard low fat diet currently recommended for patients with major cardiovascular risk factors.


New Research: What Sodium Intake Levels are Healthy?



report by the National Academies’ “Committee on the Consequences of Sodium Reduction in Populations” has found that evidence supports a daily diet which limits daily sodium intake to 2300 mg. Surprisingly, they did not find sufficient evidence to support still lower sodium diets, even in populations at risk for heart disease. In fact, there is some (inconclusive) evidence that low sodium diets may be harmful to those with diabetes, kidney failure, or heart disease

The current US guidelines for sodium intake give an adequate Dietary Reference Intake (DRI) of 1500 mg and an Upper Limit (UL) of 2300 mg, but adult intake levels in the United States average 3400 mg. There is a growing call for increased public health measures to keep America’s runaway sodium intake levels down. 

The focus of the study is on sodium’s direct effect on health outcomes rather than on intermediate biomarkers such as blood pressure, which are a more controversial measure of health impact. The committee refrained from making any direct recommendations of intake ranges due to a lack of data.

Readers, what can we do to prevent the high sodium intake which is the norm in American diets? Have you been recommending low sodium diets to patients?

Read the whole report here.