Food addiction frontier looms

  Not surprisingly, nutrition found its way into plenty of headlines again this year, as populations continue to age and the health problems from not eating well become more apparent in medical stats. Several significant trends emerged in 2010. Here’s a summary of the most important: 1. Cardiovascular carbs and protein power We’ve all suspected it for years, but 2010 was the year we got some data to confirm the potential impact the so-called “bad” carbohydrates (white or refined) have on our hearts. Emerging evidence suggests a diet rich in high glycemic carbs (the ones that cause our blood sugar to rise rapidly) can impact our so-called “bad” (or LDL) cholesterol in a subtle, but significant way by causing our body to produce LDL cholesterol that is particularly dense and “sticky.” The result is more cholesterol stuck to arteries, which can trigger a cascade of plaque-building and inflammation that is the hallmark of atherosclerosis. 2. Calcium conundrum The other big news of the year came from the bombshell British Medical Journal study that highlighted the potential harm of taking high doses of supplemental calcium. A compilation of data from several studies indicated those taking high-dose calcium supplements, in particular postmenopausal women, could be putting themselves at risk of a cardiovascular event (i.e. a heart attack), especially if they exceed the Dietary Reference Intake (1,200 mg per day for men and women over 50, or 1,000 mg per day for those 50 and under). The take-home message was not that calcium supplements should be avoided, but that supplementation should only be used within the recommended range. In other words, it’s best to first figure out how much calcium you are getting from your diet (online calculators can help with this), then add only a supplement to reach an intake of 1,000-1,200 mg per day, but not more. 3. Vitamin D: Finally, some new guidelines With much ballyhoo, this year finally brought the long-awaited new recommendations for vitamin D intake from the U.S. Institute of Medicine, but not without controversy. While the IOM recommends adults triple their intake of the so-called “sunshine vitamin” from 200 to 600 IU per day to optimize bone health, that number still falls short of the 1,000-2,000 IU per day that many researchers believe is needed to help prevent various forms of cancer, not to mention heart disease, type 2 diabetes, and other conditions ranging from chronic pain to multiple sclerosis. The reason for the conservative increase largely relates to a dearth of randomized, controlled trials — the perceived gold-standard for assessment of benefit of a vitamin, drug or supplement — comparing vitamin D against placebo. On the other hand, the report, which is expected to trigger revisions to the daily recommended intakes established by Health Canada, also doubled the upper level, or safe limit, for vitamin D from 2,000 IU to 4,000 IU per day, providing clinicians with significantly more flexibility to recommend supplementation as the individual may require. 4. Sodium reduction As a result of the recently released Sodium Working Group’s report, the pressure is on the food and restaurant industries to cut salt levels in prepared foods. While the voluntary reductions have so far been modest — most companies are looking to cut salt in their products or meals by 10% to 25% over the next one to three years — the reality is that this might be the most realistic way to wean us all off our collective addiction to salt. Much like spicy foods, salt is something we adapt to over time, so the more salt we consume, the more we feel we need. By that logic, cutting sodium gradually might be the only way most people will be able to reduce their intake without feeling deprived. 5. On the horizon: Food addiction? The concept of food addiction is one that’s been batted around for years, but in 2010 the media started to take more notice. While food addiction will likely never make its way into the Diagnostic and Statistical Manual of Mental Disorders — because food is a necessity in our lives, unlike cigarettes, alcohol or drugs — there is a growing appreciation that, for some people, food can trigger a response in parts of the brain consistent with addictive drugs. Most commonly, foods that we usually think of as less healthy, such as salty, fatty or very sweet foods, elicit a stronger addictive-type response than, say, vegetables or fruit. While some individuals seem to be partly immune to these addictive pathways, be it for genetic or environmental reasons, others are much more susceptible. The challenge for researchers will be to determine which individuals are at risk for food addiction, and then to develop tools and strategies to help break the cycle of addictive behaviours in a world where temptation from food is all but omnipresent. – Jennifer Sygo is a dietitian in private practice at Cleveland Clinic Canada, which offers executive physicals, prevention and wellness counselling and personal health care management in Toronto.

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