Category Archives: Wellness

CBD is a Phytocannabinoid: One of Many

CBD? Let’s clear the air.

Cannabidiol (CBD) is just one phytocannabinoid of over 80, and researchers are uncovering more phytocannabinoids all the time. CBD is everywhere (CBD beers and kombuchas, CBD for dogs, CBD gum, you name it), but do you have an accurate understanding of what it really is? 

I’ll just tell you right now – apologies for any bubbles burst – that your local brewery serving up a “CBD ale” has not found some sneaky way around recreational marijuana laws (if you don’t live in one of the 11 states or Washington, D.C. where recreational marijuana is legal). The CBD in your beer is not going to get you high; at most, you might benefit from the positive effect all cannabinoids have on the body. But those benefits aren’t exactly unique to CBD. CBD is just the phytocannabinoid that found its way into the spotlight of the hemp and cannabis industry, which is valued at more than $10 billion in the United States.

Phytocannabinoids like CBD are just one piece of the puzzle that is the endocannabinoid system (ECS). This is a system of the body not unlike the systems you learned in school: immune, digestive, cardiovascular. But for whatever reason (conspiracists cite the government and its misunderstanding of the cannabis plant and its products), the ECS was not taught in school like the other systems were.

The ECS is named for the puzzle pieces found naturally in the human body: endocannabinoids (endo = internal/within; cannabinoid = active constituent of cannabis). Endocannabinoids bind cannabinoid receptors, which are also found naturally in the human body. Anandamide and 2-arachidonoylglycerol (2-AG) are two widely known endocannabinoids.

If the ECS is a puzzle, the cannabinoid receptors are the corner pieces; they provide a foundation for ECS-regulated activity in the human body, whether it’s a “high” produced by tetrahydrocannabinol (THC; another phytocannabinoid) or anti-anxiety effects elicited by CBD (this claim requires further support from reliable clinical trials and randomized studies). There are two cannabinoid receptors: CB1 and CB2. These two cannabinoid receptors are complex and multifaceted, but for simplicity’s sake, you can associate CB1 with the central nervous system (brain, spinal cord) and CB2 with the immune system. When a cannabinoid binds a cannabinoid receptor, stuff happens. 

Discussing the external components of the ECS is where things get a little tricky. Phytocannabinoids (phyto = plant; cannabinoid = active constituent of cannabis), including THC and CBD, are found most densely in the cannabis plant and associated products, like hemp and marijuana. It’s difficult to study phytocannabinoids because of the legal status of cannabis (another story for another day, but this is a good reference for legal status). It’s legal here, but not there. It’s legal for this reason, but not for that reason. It’s legal in this form, but not this form. It’s not surprising that we don’t know as much about cannabis and the endocannabinoid system as is needed to support health claims; it’s much easier to study ingredients with less baggage.

There’s a lot more to the story when it comes to cannabis and the ECS that I want to cover. But today, I wanted to start by describing CBD for what it is: one phytocannabinoid, one puzzle piece. The ECS is the puzzle, and it’s not finished yet. 

Other topics I want to explore in the near future:

  • Non-cannabis sources of phytocannabinoids, like carrots
  • The connection between polyunsaturated fatty acids and the ECS
  • Legal status of cannabis: marijuana versus hemp; recreational versus medical

PREDICT 2 Study Experience: Reflecting on Recruitment

On June 10, 2019, I read a New York Times article that immediately drew my attention and inspired me to take the first step of my personal nutrition journey. Authors Cynthia Graber and Nicola Twilley were writing about a new nutrition company called ZOE and a series of studies ZOE was sponsoring to investigate individual responses to food, appropriately called “PREDICT.”

Graber and Twilley began by describing the growing interest in the DNA testing industry, as individuals continue to become increasingly invested in how their unique genetic information affects their health choices and physiological responses. They transitioned into talking about the impact of genetics versus lifestyle choices on diet-related health conditions like obesity. This is when the Tim Spector story came into play; the authors discussed his complex experience with twin studies and how that transformed into the studies we now know as PREDICT and the founding of ZOE. 

The article was published just hours after Tim Spector and his team presented the first findings from PREDICT 1 at the American Society for Nutrition’s annual conference. The authors briefly described the participant experience from PREDICT 1, and they mentioned that Tim Spector was actively recruiting for a second study in the U.S. If I wasn’t already enthralled at this point, I guarantee that after reading about PREDICT 2, I snapped to attention. 

I’ve participated in studies before (read more), but it was more about the cash and less about the personal interest (although the personal interest was definitely a factor in my motivation to complete the studies). Like I mentioned in past blogs, I was not paid for my participation in PREDICT 2. I was, however, given the opportunity to experience the scientific process in its rawest form, and to hopefully receive meaningful results afterward. Immediately after reading the New York Times article in its entirety, I filled out an initial screening questionnaire for PREDICT 2 online.

After submitting the questionnaire, I received an email from the PREDICT 2 team stating they would review my information and let me know if I qualified for the study. Two hours later, I got another email that said I was eligible to proceed with the recruitment process. I clicked a link to take an additional screening questionnaire, which described the details of the study process – what the researchers were looking for and how they planned to gather the right data. Four days after completing this questionnaire, an email from the study team let me know I was eligible to take part in the study. 

Thus began the Informed Consent process. I was instructed to read the Informed Consent form carefully, a document that explained what I would do as a study participant, described what the researchers would do with my data, and included many disclaimers about what I was agreeing to when I signed on to participate in the study. After reading the form, the next step was to schedule a call with a member of the study team. To ensure I took ample time to read and comprehend the content of the Informed Consent form, I couldn’t schedule the call for less than 24 hours after receiving the form (I thought this was interesting). I got the Informed Consent form on a Friday, and I scheduled my call for the following Wednesday.

On the phone call, the study team member told me more about the study, answered questions, and helped me schedule when I would begin the study. Originally I was going to begin the study at the end of July/beginning of August, but I ended up postponing until September as I would be traveling for work frequently in August. After the call, I signed the Informed Consent form. 

Later I got an email prompting me to download the study app and the data within the app needed for participating in the study. After that, all of my communication with the study team would be through the study app. A few days later, I got my study pack in the mail, and the rest is history.

Throughout the recruitment process, the study team emphasized in our correspondence the value of “contributing to ground-breaking science that can help improve our understanding of human biology for everyone.” They also, of course, add that if you complete the study successfully, you will eventually receive “non-clinical results” with information on how you uniquely respond physiologically to different types of food and how that can be applied to making positive, healthy lifestyle changes.

The organized and streamlined recruitment process I experienced before participating in the PREDICT 2 study gave me confidence going into the study that I was signing up for a legitimate experience. I found out about PREDICT 2 from reading the New York Times article, and according to one of the study team members who I chatted with on the study app, most participants found PREDICT 2 through the media, particularly the Gastropod podcast episode I mentioned a few days ago (link here). I’m glad I read that New York Times article, and I’m grateful for everything I learned during the study and the support I’ve received from ZOE.

My DNA Has a Story to Tell, So I Gave it a Pen and Paper

I just took a DNA test, turns out I’m a hundred percent that health nerd who’s definitely gonna blog about it… 

Thanks to a serendipitous sequence of events, I procured two DNA test kits right around the time I began the PREDICT 2 study in early September 2019. Genetic factors are an important piece of the personalized wellness puzzle. What will my DNA test say about me?

The test kits come from a company called Pathway Genomics, and the two DNA analyses I submitted were “PathwayFIT” and “CannabisDNA.” I’ll talk about CannabisDNA in another blog post, but PathwayFIT provides a personalized genetic report about what my DNA says about my unique diet, nutrition, and exercise needs and tendencies as well as addictive behaviors and weight-related health conditions. 

My plan is to compare the results of this PathwayFIT DNA test with the results of the PREDICT 2 study, which will provide a similar report based on my blood glucose and blood lipid responses to food as well as a microbiome analysis (at a later time). As a reminder, I did provide a DNA sample for the PREDICT 2 study, but at this time, DNA analysis is not part of the report I’ll receive from them. The comparison between PathwayFIT and PREDICT 2 will potentially be extremely insightful, but just to clarify, there are a lot of factors that affect the content of these types of health response reports, and we should keep this in mind while drawing insights from the comparison.

Pathway Genomics cites research estimating that genetics is responsible for 40 to 70 percent of an individual’s predisposition for obesity. Whether someone taking the PathwayFIT test is wanting to lose weight or maintain weight, Pathway Genomics claims that the information provided in the report may help someone “modify” their behavior. In the report, they recommend that an individual talk to their primary care doctor before making changes as a result of the content of the report.

The tests included mailing a simple cheek swab to a lab for analysis. It went like this:

  1. I registered the kit online, creating a profile on Pathway.com.
  2. There are two cheek swabs per test kit, so I filled out two labels and placed each one on a collection tube.
  3. I swabbed the inside of my right cheek for one tube and the inside of my left cheek for the second tube. The test instructions recommended swabbing with the “same force you use to brush your teeth.” I brushed up and down while rolling the swab for at least one minute per cheek/tube. After the minute was up, I was careful to insert the swab into the collection tube without touching any other surfaces to prevent contamination. 
  4. After that, I placed the tubes in the prepared bag for mailing, and I dropped it off in a post box later that day. 

I sent in my samples on September 6, and I received an email 5 days later confirming the receipt of the samples:

Once my results are ready, I will be able to log in to my account on Pathway.com and view my results on an interactive dashboard optimized for a computer, smart phone, and tablet. I couldn’t find any information on the website about how long it will take to receive a report with my results, but here is what I’m expecting to find out: 

  • Diet & Eating Behaviors
    • Diet Type
    • Satiety (feeling full)
    • Food desire
  • Nutrients
    • Vitamin A
    • Vitamin B2
    • Vitamin B6
  • Food reactions
    • Caffeine Metabolism
    • Response to polyunsaturated fats (omega-3 and omega-6 fatty acids)
    • Response to monounsaturated fats
  • Health predispositions
    • Obesity
    • Metabolism
    • Weight loss-regain
  • Exercise & fitness
    • Muscle power
    • Endurance training
    • HDL (good) cholesterol response to exercise
  • Diet Guidelines

Here’s a link to a sample report. It’s pretty conclusive so it’s a long report, but SUPER interesting for a health nerd like me. Pathway Genomics uses a “scientific strength” four-star rating system to express the “strength of the research evidence for the genetic marker and the associated result.” The more stars, the more confident one could feel about the volume of research supporting a given finding or claim. The less stars, the more cautious one should feel about a statement.

If you’re interested, there are different kinds of DNA collection kits you can order from Pathway Genomics (not promoting a product here, just an FYI):

  • PathwayFIT (this is the kit I submitted)
  • Sport iQ
  • Skin iQ
  • Nutrition iQ
  • FIT iQ
  • SkinFIT

Pathway Genomics heavily advertises their various accreditations:

  • College of American Pathologists (CAP)
  • U.S. Health and Human Services’ Clinical Laboratory Improvement Amendments (CLIA)
  • California Department of Public Health

And leading institutions that have provided input in the development of the test:

  • UC Berkeley
  • Harvard Medical School
  • Scripps Clinic
  • Pennington Biomedical Research Center
  • Salk Institute for Biological Studies
  • University of Copenhagen

I’ll be writing again once I receive my results and have time to analyze the report and make comparisons with the PREDICT 2 results. Stay tuned!

What is Metabolic Syndrome?

You might have heard the term “metabolic syndrome” and envisioned it as some sort of specific disease, but it’s not quite a “disease” in the typical sense. Metabolic syndrome is better described as a health state in which you are at an increased risk for conditions like diabetes, hypertension, and heart disease.

Metabolic syndrome has been defined in a few different ways. Here are a couple of different explanations:

Depending on how many metabolic risk factors you have, you could be classified as having “metabolic syndrome.” The four health states listed under the NCEP/ATP III definition can be considered as “risk factors” for metabolic syndrome. There are a lot of science-y words in that definition, so let’s break it down.

  • Central obesity: Fat accumulation in the abdominal area, which is particularly associated with obesity and its negative effect on health.
  • Dyslipidemia: Unhealthy levels of lipids (fat) in your body. This could either be too-low levels of “good” HDL cholesterol, too-high levels of “bad” cholesterol “LDL,” or too-high levels of triglycerides (TGs) – a type of fat saved as energy when your body can’t use all of the calories you’ve consumed.
  • Hypertension: It’s basically common knowledge that high blood pressure isn’t a good thing, but why is that again? When you have high blood pressure, it means your heart and arteries are working extra hard to pump blood through the body. Remember, blood carries nutrients and oxygen that all of your cells rely on to survive.
  • Insulin resistance: People develop type 2 diabetes when their cells form a resistance to insulin. Insulin is the hormone that facilitates the use of glucose for energy, so when cells aren’t responding to it, glucose levels in the blood increase. High blood glucose levels cause a myriad of problems, plus it means that your cells aren’t getting the glucose they need.

Mechanisms Behind Metabolic Syndrome

Metabolic changes leading to heart disease, diabetes, and hypertension don’t happen overnight. Lifestyle choices like diet and physical activity levels play a huge role in metabolic syndrome development, but some factors are unavoidable. For example, risk for metabolic syndrome increases with age.

Physiological changes in the body as a result of certain lifestyle choices like poor diet and low exercise levels lead to underlying, systemic inflammation, and oxidative stress. These metabolic changes are what ultimately lead to conditions like heart disease, diabetes, and hypertension.

Prevent or Manage

A healthy diet and active lifestyle can help prevent metabolic syndrome (and a lot of disease, really), but these qualities can also help manage metabolic syndrome if you’ve already started to develop it. Healthy food and physical activity support the liver and help your body better manage glucose.

For example, antioxidants found in micronutrients and phytonutrients like vitamin C, vitamin E, and beta-carotene can address oxidative stress. Antioxidants also promote healthy glucose metabolism and diabetes prevention, and they are associated with reduced risk of heart disease.

Ultimately, the solution here isn’t shocking. Eat healthy food. Be active. Reduce your risk of metabolic syndrome.

(*drops the spinach*)

You, Your Metabolism, and Science: How Research Studies Can Fight the Obesity Epidemic

Note: This is an article I wrote that was originally published on TransformingScience.com.

The one-of-a-kind Human Whole-Room Calorimeter at the UNC Chapel Hill Nutrition Research Institute can be used for a wide variety of research studies. Read on to learn about how this technology works, how experts at the Appalachian State University Human Performance Laboratory are studying metabolism, how these studies are vital for improving human health, and what a typical day as a study participant is like (including getting paid).

ABOUT THE CHAMBER

What they call the Human Whole-Room Calorimeter or Metabolic Chamber is essentially a small room that can calculate how much energy (calories) a person expends (both while resting or moving). This is balanced with the energy taken in through the diet over a 24-hour period. By controlling what you do and what you eat while in the chamber, researchers can accurately measure how much energy it takes to do certain things.

The metabolic chamber at the Nutrition Research Institute (NRI) is equipped with a bed, toilet, and sink. It also has the space to accommodate a treadmill or a stationary bike depending on the requirements of the study being conducted. Research staff can send food and other items through an airlocked compartment, and there are also ports for blood draws if a certain study requires them. There is also a television and – of course – WiFi.

The metabolic chamber is unique; there are only about 26 other similar rooms in the country, and it’s the only one in the Carolinas. This type of technology is essential for researchers who want to study energy balance and fuel use.

The first chamber study was conducted in 2011. The NRI and teamed up with the Appalachian State University (ASU) Human Performance Laboratory, recruiting 10 male participants to test the effect of 45 minutes of vigorous cycling on post-exercise RMR as measured in the metabolic chamber and contrasted with a rest day to determine how much and how long that exercise affected post-exercise energy expenditure. They found that 45 minutes of vigorous exercise resulted in 519 more calories burned compared to the rest day, and post-exercise calorie-burning was significantly elevated for 14 hours, resulting in an additional 190 calories expended, again compared to the rest day.

PARTICIPATING IN A CHAMBER STUDY 

The DEXA

Orientation and baseline testing is the first step of any chamber study. Before your first day in the metabolic chamber, you’ll have a DEXA (Dual-Energy X-ray Absorptiometry) scan done at the NRI as part of your orientation and baseline testing. This machine provides precise measurements of total and regional body composition through high-resolution imaging. However, it is noninvasive and includes very low radiation exposure. Plus, you’ll be able to have a copy of your DEXA results, which include measurements like percent body fat, resting metabolic rate, and bone mineral density.

On your day in the chamber, you’ll arrive at the NRI in the morning between 7:00 and 7:30 to change into (very comfortable) scrubs and take any necessary measurements before entering the chamber around 8:00. Once you’re in the chamber, you can essentially do whatever you want (read, watch TV, use your laptop) as long as you are seated and remain as still as possible. There will always be a monitor on duty if you need anything. Every hour, the monitor will remind you to stand up, stretch, and walk for about two minutes. They will also give you a sheet of paper to take notes about your activity so you can replicate it to the best of your ability on your second visit. To exit the chamber, all you have to do is turn a big red button, and there’s an arrow pointing to it on the wall. Plus, there’s a window inside the chamber that faces the outdoors. No need to get claustrophobic!

View of the chamber from the entrance.

The monitors serve you breakfast, lunch, and dinner, with a snack in between lunch and dinner. Don’t worry at all about getting hungry – the meals provided are tasty and filling. Plus, thanks to the metabolic chamber providing live data, the staff know your calorie needs at all times.

If it’s your exercise day, you’ll run on the treadmill around mid-morning. You rest for 45 minutes after the exercise, then you use sanitary wipes to feel clean again, and you can change into clean scrubs. If the study requires you to take supplements or provide blood samples, the monitors will tell you what to do. In the chamber, there are two intercoms that you can use to communicate with the monitor, one near the treadmill and one near the bed. There’s also a window where you can see the monitor, and a webcam so they can see you. Don’t forget – the toilet is not within view of the webcam and there is a curtain over the window. Your privacy is respected while you are in the chamber! The lights go out for “bedtime” at 10:00, and you sleep (or stay as still as possible when you’re awake) until 6:45 or so. You will be compensated well for your time, even if you complete just one visit.

In studies investigating exercise and energy expenditure, the second day is essentially the same as the first but with one key difference: on this visit you will spend 45 minutes on a treadmill, exerting yourself to 75 percent of your “V02 max,” the maximum amount of oxygen that you use during intense exercise (measured as milliliters of oxygen used in one minute per kilogram of body weight). Before you begin the study, they will test your V02 max by having you run on a treadmill at an incline. In the chamber on your exercise day, it’s a tough workout. But you can do it!

Metabolism studies are important because there is an obesity epidemic in the United States, caused by excessive calorie intake and a lack of physical activity: 69 percent of adults are overweight, with a BMI of 25 or higher, and 35 percent of adults are obese, with a BMI of 30 and higher. Obesity increases the risk of a variety of conditions that are linked to heart disease, including high blood pressure, diabetes, and high cholesterol. Heart disease is the leading cause of death for men and women worldwide.

So by studying the human metabolism, researchers from ASU and the NRI also want to help people effectively and safely lose weight to reach a healthy weight, lowering their risk of heart disease and other complications. Here a few simple recommendations:

  • Eat more carbohydrates and dietary fiber from whole grains
  • Eat more fruits and vegetables
  • Eat less fat to reduce overall caloric intake
  • Engage in physical activity most days of the week, with a total of 150-300 minutes per week

ASU and NRI experts have found that limiting calorie intake – eating less – has the biggest impact on weight loss. Exercise helps, but it must be more than 60 minutes per day to be meaningful. In other words, physical activity is more important for improving health (a good thing!) than for accelerating weight loss.

Sources: UNC Nutrition Research InstituteAmerican Heart AssociationASU Human Performance Laboratory

To Supplement or Not to Supplement: That Is the Question

TIME reported on a new study this week that ultimately concluded that taking nutritional supplements is not the same as eating a healthy diet. Researchers report that you cannot be truly healthy without getting your nutrients from the source – from fruits, vegetables, and other plant-based foods.

My first thought: We call them “supplements” for a reason, right? They are intended to be “supplemental” to a mostly healthy diet. They are “supplements” not “replacements.”

A second thought: Not all supplements are created equal. I’m certainly not an expert on what makes a nutritional supplement effective or not, and I’m not sure how the scientists from this study qualified a “supplement,” but I do feel compelled to mention briefly the philosophy behind the nutritional supplements produced at Standard Process, my current employer.

An SP Aside

Standard Process produces nutritional supplements using ingredients from their organic farm in Palmyra, Wisconsin. Unlike other supplement companies, they boast a whole-food philosophy. This is based on the science of a whole food matrix, the idea that macronutrients (fat, carbohydrate, protein), micronutrients (vitamins, minerals), and phytonutrients (carotenoids, resveratrol, etc.) are the most bioavailable/biologically active/effective when they are consumed in the natural “matrix” in which they are found in nature. This separates Standard Process and other companies with a similar whole food philosophy apart from supplement companies that simply extract vitamin D or beta-carotene and insert them into a capsule to sell as a supplement.

That being said, I should clarify that my personal philosophy is food first, supplements second (if at all). We may not know for sure what types of supplements are most effective or if any are effective at all at improving nutrition, but you certainly can’t go wrong with getting your nutrition straight from the source (plant foods).

Okay, let’s talk about this new research.

TIME reporter Jamie Ducharme begins the story with two important facts:

I think it’s fair to extrapolate from those two statistics that many of those 90% of Americans that do not eat enough fruits and vegetables are among the 75% who are taking dietary supplements, likely because they know that they aren’t getting enough nutrients from their diet. Fair – it’s certainly easier to pop a pill than to get enough servings of leafy greens every day, but those 75% might be wasting their money on supplements that aren’t giving them the nutrition they really need.

The Study: Annals of Internal Medicine

The study’s main point is this: “nutrients consumed via supplements do not improve health and longevity as effectively as those consumed through foods.” Pretty simple. Supplements are not as good as food. Anyone surprised?

More specifically, researchers report that nutrients consumed through supplements are not as strongly associated with living a longer life as nutrients consumed through food. The data comes from the National Health and Nutrition Examination Survey (NHANES) 1999-2010, including 30,000 American adults as participants who were followed for about six years (at the end of this period, there were more than 3,600 deaths).

Researchers factored in monthly supplement use and dietary habits when establishing nutrient levels for each participant. This data initially led them to the result that dietary supplements are associated with a lower risk of early death, but that result did not hold true with researchers factored in certain other details about the participants: education levels, socioeconomic status, and demographics. After controlling for these variables, researchers found that it was mostly the higher-income and better educated people who were taking supplements, and this group is on average more likely to be healthy anyway. Put another way: for this group, it wasn’t supplement usage that was improving health, it was the impact of wealth and education on health (another story for another day).

The study showed that sufficient consumption of micronutrients like vitamin A, vitamin K, magnesium, zinc, and copper are associated with a lower risk of dying early, but only when obtained from food – not supplements.

Researchers even mentioned potential negative health associations with supplement usage. For example, high doses of calcium via supplement was associated with a 53% higher risk of dying from cancer compared to people who did not take supplements. Excess calcium from food did NOT have that association.

Regulatory Considerations

I think it’s important to note that the Food and Drug Administration (FDA) not does not regulate nutritional supplements as tightly or in the same way as “conventional” foods and drugs are regulated. Whether it’s safety or efficacy that one is worried about, the regulatory difference is a significant factor.

Supplements for Specific Populations

Lastly, I’ll highlight that the study scientists did mention that nutritional supplements may provide positive health benefits particularly for two groups:

  • The elderly: because the ability to absorb nutrients from food can decrease with age
  • People with dietary restrictions (allergies, vegan, vegetarian, etc.): because they are more likely to have nutrient deficiencies from lacking certain foods

Take-home Points

  1. While I acknowledge that it’s certainly easier said than done (I struggle in my own life), I agree with study co-author Fang Fang Zhang (Tufts University Friedman School of Nutrition Science and Policy) when she recommends that instead of relying on nutritional supplements, people should just eat a healthy diet rich with fruits, vegetables, and whole grains.
  2. There’s always more to the story. That’s why I included my SP aside earlier. The conclusion is never going to be “all supplements are bad” or “all supplements are good.” There are so many factors that affect what makes an effective nutritional supplement, and the only way to truly determine what’s effective and what’s not is to follow reputable research like this study from Zhang and others at Tufts University.

What’s Killing Us? What We’re NOT Eating

Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017
The Lancet

All the major news media outlets are reporting on this story today as if it’s some big surprise. But is it really surprising that a diet high in sodium, processed food, and sugary beverages and low in whole grains, fruits, and vegetables leads to millions of deaths worldwide?

The new study, funded by the Bill & Melinda Gates Foundation and published in The Lancet yesterday, investigated the burden of a diet devoid of healthy foods and its effect on non-communicable diseases.

Non-communicable diseases, also referred to as chronic diseases, are those that are the result of “genetic, psychological, environmental, and behavioral factors,” opposed to being caused by bacteria or other microbial agent. For example, you don’t “catch” heart disease from someone – you develop the disease as a result of factors like what you eat and what genes your parents passed on to you.

More on non-communicable diseases from the World Health Organization.

Researchers evaluated consumption of major foods and nutrients across all of the world’s 195 countries in adults 25 and older, analyzing how a diet lacking healthy food impacts mortality and morbidity.

Note: I didn’t realize that there were 195 countries in the world until I googled it to see how many countries were missing from the study. Here’s one of many resources that said 195 is the correct number.

They took a “comparative risk assessment approach” that accounted for:

  • Intake of each dietary factor
  • Effect size of dietary factor on disease endpoint
  • Level of intake associated with the lowest risk of mortality

Diet factors include:

  • Unhealthy red and processed meats
  • Sugar-sweetened beverages
  • Trans fatty acids
  • Salt
  • Fruits
  • Vegetables
  • Whole grains
  • Milk
  • Calcium
  • Nuts and seeds
  • Fiber
  • Legumes and beans
  • Omega-3 fatty acids and other polyunsaturated fatty acids

They found that the top three dietary risk factors associated with non-communicable disease are high sodium intake, low whole grains intake, and low fruit intake. These three dietary factors account for more than half of all deaths attributable to diet.

The report showed that the same risks associated with poor dietary choices affected people regardless of age, sex, and “sociodemographic development of place of residence.”

Finally, the study calls attention to the importance of acting in light of these and other similar findings. Experts call for dietary interventions based on evidence, a way to evaluate health and efficacy of dietary interventions on a regular basis. Past efforts have focused largely on salt, sugar, and fat. While high intake of those things definitely isn’t good for health, the current study highlights a second issue, one that now seems more important: yes, lowering intake of salt, but also increasing intake of healthy foods like whole grains, fruits, vegetables, and other plant-based options.

Algorithm for a Healthy Diet

What can artificial intelligence do for human health? Revolutionize the way we eat, potentially. An opinion article published in the New York Times on Saturday covers the idea of personalized nutrition, made possible by super advanced algorithms and artificial intelligence (A.I.).

The article “The A.I. Diet” is written by cardiologist Eric Topol, and he begins by describing his experience as one of more than a thousand participants in a two-week health study where a sensor and a smartphone app helped track everything he did: eating, sleeping, exercise, and more.

Topol’s data was analyzed by A.I. to ultimately produce a personalized diet algorithm. His results consisted of specific foods receiving a grade, like you would on a test. It seems to me that both his experience and the study design overall highlight the importance of understanding how different foods are good or bad for different people – i.e. blueberries affect me differently than they affect someone else with a different genetic code and lifetime of environmental exposures.

Interestingly, a version of Topol’s study exists as an actual test – commercially available – but analyzes gut microbiome only, not glucose levels or eating habits (here, but it is likely other companies sell something similar).

Topol points out that the main problem is that we often perpetuate the “idea that there is one optimal diet for all people.” More or less, any specific guidance that goes beyond Michael Pollan’s famous quote (and a personal favorite of mine), “Eat food, not too much, mostly plants” is assuming too much about the similarities between individuals, complex and important factors like microbiome status, genetics, and environmental history. Topol: “[This assumption] contradicts the remarkable heterogeneity of human metabolism, microbiome and environment.”

“We know surprisingly little about the science of nutrition.”

Why? Topol cites difficulty with high-quality randomized trials, which are vital for nutrition science (or any type of science for that matter).

“The more understanding we have of foods and nutrition, the more complex food and nutrient interactions become,” explains nutrition scientist Kristine Polley, PhD. “Therefore, controlled and well thought-out study designs are becoming essential to interpret and translate results. High-quality randomized clinical trials provide insight into how nutrients affect human physiology and allow for accurate and critical interpretation of the data collected and the opportunity to apply these outcomes to better overall human health and quality of life.”

Another issue specific to nutrition science studies is that experiments with food habits require strict diet adherence, and there is not always an effective or easy way to ensure study participants are actually following the study’s prescribed diet.

Thirdly, where does the money come from for these types of studies? Unfortunately, often from companies that benefit from the results of the studies, increasing the chances that the results will be swayed one way or the other or misconstrued. In Topol’s words:

“The field [of nutrition science] has been undermined by the food industry, which tries to exert influence over the research it funds.”

The future of individualized/personalized nutrition depends heavily on the success of dependable nutrition studies. This data is vital for building the sophisticated A.I. technology needed to analyze the mass amounts of data to determine each individual’s specific nutritional needs. So the question that remains unanswered is, can nutrition scientists get it together (and find the funding) to obtain the needed results? I think they can.