What is Lactose Intolerance? Lactose intolerance is a condition in which there is not enough of the enzyme, lactase in the small intestine to digest the milk sugar, lactose. Most infants produce enough, but many people also become intolerant as they age. Intolerance occurs more commonly in certain ethnic groups (African American, Native Americans, Asian Americans and about 15% of Caucasian Americans. On the other hand, about 90% of Asian Americans are affected.)
When people with lactose intolerance consume milk, e.g. the lactose is not digested in the small intestine but instead passes into the large intestines and attracts more water by osmosis. The lactose is quickly metabolized by intestinal bacteria (the microbiome) and produces acid and gas. This process causes symptoms of abdominal distention, flatulence, cramping, and diarrhea. In some people, this occurs only when they consume a large amount of lactose such as a glass of milk or certain types of cheeses. In others, symptoms occur even when the food consumption contains only small amounts of this sugar (lactos
How to determine what Cheese to Eat (or not) While it’s true that some cheeses are lower in lactose, it’s important to keep serving sizes in mind. Even a low lactose cheese may affect your stomach if you eat a ton of it. And the truth is that even among folks with diagnosed lactose intolerance, sensitivity to lactose can vary greatly. Something that barely affects one person could leave another curled up in the fetal position with stomach cramps. No matter what cheese you’re eating (even if it’s supposedly low in lactose), it is recommended tasting a small amount first, then giving yourself time to see how your body reacts. In general, it’s also best to eat cheese as part of a larger meal whenever you can, because eating it with other foods can make it easier to digest. And unfortunately, There isn’t always an easy way to know for sure how much lactose is in a product, unless it’s explicitly marked low-lactose or something similar. So if you’re really not sure how much lactose you should (or shouldn’t eat,) check in with your doctor first.
The Bottom Line If you can’t tolerate even a small amount of Parmesan, your problem with dairy might be something else—like a milk allergy. Most experts say that while lactose intolerance isn’t life threatening, a severe allergy definitely can be, so if you’re not sure what you have or just how sensitive you are, talk with your doctor or registered dietitian before experimenting with any cheeses.
FOOD AND CULTURE Ethic influences on the North American Diet
As cultures tend to mingle and assimilate throughout the world they blend with the so called American diet (cheeseburgers) and bring with them their ethnic uniqueness, for example, about 25% of all restaurants in the U.S. have an ethnic theme. To study these influences, we need to be aware of the nature of their traditional diets as well as how they have changed within the cultures due to migration to the new way of eating,
Native American Influences
“Studies have shown that the diseases that affected these societies differed significantly from the diseases in North American societies today. For example, Alaskan natives who sill eat the traditional diet have cardiovascular disease rates lower than those in the general North American population. Younger generations of Alaskan natives, however, who usually do not eat the traditional diet have developed cardiovascular diseases at rates similar to North American in general. This diet is often also called the “Western Diet”. It is also true of the Pima Indian tribe in Arizona compared to their counterparts in living in Mexico.” You can search Pima Indians on this blog from Food, Facts, and Fads.
Hispanic Influences
“Mexican cuisine today shows regional variety. In Southern Mexico, savory sauces and stews and corn tortillas reflect the native heritage. Yucatan cuisine follows Mayan tradition, with fresh produce adding color, flavor and nutrition to authentic Mexican dining. Traditional Mexican is healthful in that is high in complex carbs, beans, fruits and vegetables, particularly rich in vitamins A and C.”
Today true Mexican cooking bears little resemblance to the dishes usually found in “Mexican restaurants in North America. Usually it is based primarily on rice and beans. Restaurant Mexican foods tend to use large portions of meat as well as added portions of high-fat sour cream, guacamole, and Cheese to many dishes.”
Northern European Influences
Immigrants from Western Europe are responsible for the “meat-and-potates traditional manner of home cooking. This group contained large groups from The English, French, and Germans. A sizable portion of meat arranged with vegetables and potatoes that could be a dinner plate of boiled, mashed vegetables, sauerkraut, boiled or mashed still is the favorite of many Northern European dinners.
The traditional pattern provides abundant protein, starch, and dairy nutrients. However, the protein contains insufficient amounts of whole grains, vegetables and fruits or whole grains. Many people from these cultures eat less than healthy dishes combined with high-fat versions that contribute to the high rates of heart disease and obesity and cancers.
African Influences
The “soul food” of African Americans is the basis of the regional cuisines of the southern U.S. African American women. The combination of these foodways with Native America, Spanish and French traditions produced Cajun and Creole cuisines enjoyed today in Louisiana and through out the nation. Pork and corn products were the basis of soul food. Today we all enjoy it as barbecued meat since many enjoy the foods brought from Africa as well as yams, African sweet potatoes, okra, and peanuts. Corn was ground for cornbread, greens like collards, mustard, and turnip and kale. were usually cooked with a small portion of smoked pork as well as black-eyed peas. This diet is obviously high in unhealthy components as well as increased heart disease and cancer rates. For example, the South east states of the typical American or “Western’ diet” is often called “The Stroke Belt? indicating diets high in calories and/or sodium.
Asian Influences More than 200 different vegetables are used in the Chinese cuisine, bok choy and other forms of Chinese cabbage are perhaps the most widely eaten vegetable in the world. Rice is the core of the diet in southern China, home to the Cantonese culture whereas in Northern China wheat is used to make noodles. China is the original home of pasta, bread, and dumplings. Stir fried includes hot pot stews containing many vegetable mixtures and protein sources like legumes, nuts and seeds.
Chinese migration to North America began with the California gold rush in the middle of the 19th century. Chinese workers brought with them food preparation that tend to preserve nutrients, as well as a variety of sauces and seasoning, used today in Chinese cookery. North American restaurant versions of Chinese dishes are generally not authentic. Such food is often prepared with far more fat than true Chinese cooking which tends to use flavorful but fat free sauces and seasonings. The restaurant versions of Chinese dishes also contain much larger portions of protein.
Italian Influences
Pasta is the heart of the Italian diet. Italians eat six times more of it than do North Americans. Although some components of the Italian diet contain substantial amounts of saturated fat, we now know that other components, such as pasta, olive oil, and vegetables can contribute to healthy diets. Italian traditional diets do combine healthy food along with fat in the diets and seem to handle the diet just fine. Italians lean to a diet pattern called the Mediterranean Diet. This is a plan based on food choices like those traditionally found in the simple cuisine of Greece and Southern Italy. It now allows up to 35% of total calories in Northern Italy, the more affluent part of the country, and is the principal producer of meat and dairy products, such as butter and cheese. Rice dishes such as risotto, are popular there. Fish is more important in regions near the sea and lighter foods, such as fresh vegetables are prepared with herbs, garlic and olive oil, are characteristic. The poorer regions south of Rome, as well as the island of Sicily, have a diet rich in grains, vegetables, dried beans and fish, with little meat or oil. Olive oil is the preferred fat.
Note: “It is impossible to define a healthy diet with the space found in this post due to the diversity of many combined cultures and regions. However, it can be simply stated with the seven words from Micheal Pollan, author of “In Defense of Food: An Eater’s Manifesto: Eat Food. Not too Much. Mostly Plants..” I would add Bon Appetit. AMEN!!! (SJF)
Source: Gordon M. Wardlaw. Contemporary Nutrition, Issues and Insights . Fifth Edition
Every once in a while, it is fun to go back into history and rediscover the fads that were popular then – the story of Bernaar MacFadden is one of them. He was however, very successful and in my opinion, a very fascinating human being.
“In 1913, twenty year old Mary Williamson, a runner and muscular swimmer was crowned “Great Britain’s Perfect Woman and as part of her prize was a job offer from fitness guru, forty-four year old, Bernarr MacFadden. The job involved a traveling physical fitness show billed as “The World’s Healthiest Man and Woman.” They performed feats of physical prowess with the big finale featuring Mary’s nightly jump from a seven-foot platform onto MacFadden’s stomach. Another “prize” was becoming Bernarr’s third wife. He proposed one day when the pair was halfway through a ten-mile run and when she accepted, she recalled: “He stood on his head on me for one minute and four seconds.” Who was this man?
EARLY YEARS
Bernarr MacFadden was a man that brought physical culture to America and Europe. “He stood five foot six inches tall and built a fortune from often, but not totally, misinforming the public about nutrition and health.. He was born in 1868 on a farm near Mill Springs, Missouri where his father died when he was four from chronic alcohol consumption.
Bernarr, a sickly boy, was raised by a TB-ill mother who sent him away to a cheap boarding school. He later referred to this school as the “starvation school”. Bernarr remembered often having peanuts as his only source of nourishment. His mother died from tuberculosis when he was eleven and Bernard, (he changed his name later to Bernaar) was sent to a northern Illinois farm to work for two years where his heath improved. He was then shipped off to St. Louis where his waiting relatives welcomed him, namely Uncle Harvey.
When walking in downtown St. Louis with his uncle one day, he discovered the Missouri Gymnasium and was impressed by the posters of musclemen displayed there. “The sickly young Barnard swore an oath: I’m going to be like them. I’m going to look like them.”
Bernarr obtained a copy of How to Get Strong and Stay So, a bestseller in 1879 written by William Blaikie, a strongman and endurance athlete. He was further inspired to follow his dream; therefore, in the spring of 1891, Bernarr hung a shingle out that read:
“BERNARR MCFADDEN – KINISITHERAPIST
TEACHER OF HIGHER PHYSICAL CULTURE”
He declared himself a “teacher of physical culture” to become the nation’s first personal trainer. He made up the term, kinisitherapist. No one knew what he meant.
BELIEFS
MacFadden’s core belief mimicked the philosophy of Sylvester Graham that blamed toxins, improper diet and exercise habits, lack of sunshine and the use of tobacco and alcohol to be the reasons for most diseases. Bernard despised white flour and called it “dead food” and said: “ I saw that white bread was frequently condemned and I whenever available, secured whole wheat or Graham bread.” He did not, however, carry on the sexual restrictions of Graham.
He began a lecture series on physical culture and put up posters and small ads in the local newspapers. Each lecture started with Macfadden dressed only in a loincloth posing artistically in front of a cabinet lined with black velvet and lit from below to make him appear larger than he was. His lectures became popular in both the U.S. and Europe.
He taught his nation-wide audiences that fresh fruits, vegetables, and whole grains were vital to good health. Today we know that his teachings about diet were relatively accurate in an era when nutrition knowledge was meager. He was not a true vegan, but used meat sparingly. His favorite food was carrots and he dutifully avoided sugar foods such as candy, cakes, pies and ice cream. He advocated eating only two meals a day and preached moderation while fasting once a week. There are some advocates that now suggest the same regimen. He did not believe in pasteurization or homogenization of milk. He said that milk could cure many diseases. He avoided alcohol, tobacco. Of course, he advocated brisk walking, lifting weights, and prescribed calisthenics. Today’s body builders consider him the “father of physical culture.”
MacFadden published a culture magazine called Physical Culture. In 1901, he wrote: “Every disease in the human body is simply an endeavor on the part of the body to correct an abnormal condition…. It is the presence of impurities in the blood that make the production of a cold possible…Disease germs consume these poisons, or render them harmless.” By 1910, he ruled over a physical fitness empire. The empire included spas called “healthatoriums”, Physical Culture City and then Physical Culture University. He continued by promoting raw foods and salads every day and used fresh fruits to keep the intestines “antiseptic” to avoid autointoxication. He continued to avoid processed white sugar and flour.
LATER YEARS
His empire began to crumble. Research led to more knowledge about food components such as vitamins and minerals in the nutrition field. People began to lose interest in MacFadden’s ideas and his popularity declined.
In the final decade of his life, his previous wealth dwindled. He did not give up, however. He jumped out of a plane on his 83rd birthday; he did the same stunt the next year. In 1955, he was 87 and was experiencing liver and urinary tract problems. He fasted to treat his condition, but ironically died three days later due to complications from jaundice and dehydration.
LEGACY
Bernaar MacFadden was one of the most flamboyant and bizarre personalities in American culture; yet many people have forgotten him or have never heard of him today. He was the first food crusader to be known internationally and single-handed created the health and fitness awareness for millions of people. He continued to support detoxing and fasting that carried on the principles of Sylvester Graham. Even though some considered him a “quack,” he fought against medical quackery that began in the early 20th century. At the same time, he supported the medical practices of chiropractic and osteopathic treatments. In many aspects of his career like publishing and advertising, he was truly a genius.
The above link about Woodstock tells the story most vividly about what the sixties were all about.
“The decade started graciously enough – by the end of the decade we were given a health-food movement based on partly by Rachel Carson and her book, Silent Spring and environmental pollution (DDT) and the hippie lifestyle of communal, back-to -nature living. The hungry and disenfranchised made their plights public with lunch-counter sit-ins and the Poor People’s March on Washington. These acts began the civil rights movement in 1960; CBS profiles the plight of migrant farmers in California.
Our cultural past changed when the Immigration Act of 1965 begins the influx of millions of people from China, Hong Kong, Taiwan, Japan, Korea, Thailand, Eastern Europe, the Philippines, India, the Middle East, Africa, Mexico, and Central and South America.
On the other side, humor was in full force. “Happiness is …finding two olives in your martini when you’re hungry,” writes Johnny Carson in Happiness Is a Dry Martini (Doubleday, 1965).
There were other notable events that formed this decade. From Bon Appetit, Sept. 1999.
The above link about Woodstock tells the story most vividly about what the sixties were all about.
Our cultural past changed when the Immigration Act of 1965 begins the influx of millions of people from China, Hong Kong, Taiwan, Japan, Korea, Thailand, Eastern Europe, the Philippines, India, the Middle East, Africa, Mexico, and Central and South America.
On the other side, humor was in full force. “Happines is …finding two olives in your martini when you’re hungry,” writes Johnny Carson in Happiness Is a Dry Martini (Doubleday, 1965).
There were other notable events that formed this decade. From Bon Appetit, Sept. 1999.
The White House: The Kennedy Years
“From the moment Jacqueline and John F. Kennedy moved into the White House in 1961, the world could see that a new generation had arrived. With their keen interest in history, literature, the arts, food and entertaining, the youthful, scholarly, charismatic Kennedys roused stodgy Washington by setting new standards in everything from clothing to table decor and cuisine.” The First Lady hired a French Chef and the “Kennedys hosted legendary dinners with dance, concerts, poetry readings, performance of Shakespeare, and other entertainment that showcased the best America had to offer.”
Kennedy wedding
The Kennedy years were often referred to “Camelot” sadly came to an end with the assassination of the President on November 22, 1963.
The French Cooking Invasion – From Bon Appetit, September, 1999
“In the 1960s, Americans learned to cook French food and Julia Child was their teacher.. With her distinctive voice and down-to-earth manner, Child rose to national fame as the host of “The French Chef” television series….an unpretentious graduate of the Cordon Bleu cooking school in Paris…Julia is at ease in front of the camera, taking some delight” in her own goofs in the kitchen. Please pass the butter!!!!
One more thing:
The Beatles invaded the U.S. in 1969 with their music. Ringo Starr, Paul McCartney, John Lennon, and George Harrison, became rock and roll legends by doing everything else in a new way. Just in one decade – The World was alive again!!!
In England, William Banting consulted Dr. William Harvey for weight loss who recommended he cut most sugar and starch from his diet since foods containing those substances tend to create body fat. He lost 50 pounds and wrote the first diet book, “Letter on Corpulence Addressed to the Public” in 1862.
1898
Horace Fletcher loses 42 pounds by advocating that we need to chew food about 32 to 80 times before being swallowed and it should be in liquid form. He later became known as “The Great Masticator”.
1918
Dr. Lulu Hunt writes the first best selling diet book, “Diet and Health with a Key to the Calorie”. She promoted calorie counting over her entire life.
1919
The Continental Scale Company produces the first bathroom scale called the “Health O Meter”.
1929
A cigarette advertisement tells women to “reach for a Lucky instead of a sweet”. Another slogan says: “Light a Lucky and you’ll never miss sweets that make you fat”.
1930
The “grapefruit diet” also known as “The Hollywood Diet” is promoted which involves eating only 585 calories a day for 18 days with boiled eggs, green vegetables and Melba toast.
1936
Self-proclaimed diet guru Victor Lindlahr reaches thousands via the radio to produce his regular broadcasts entitled “reducing party”. He wrote the book You Are What You Eat, one of the earliest texts of the health food movement in the United States, which sold over half a million copies and introduced the phrase still used today.
1942
The Metropolitan Life Insurance Company published standard weight tables for “ideal weight”. The charts used weight, height, frame size, and gender but only used data from life insurance policyholders.
1948
Amphetamines were first prescribed for some obese patients but later research determined that these were dangerous. Amphetamine –like drugs are still used today in a limited fashion.
1958
Saccharin, the first manufactured artificial sweetener is produced and becomes a popular sugar substitute. It is still used today after years of research that absolved critical reports of its cancer connection.
1961
Weight Watchers was born as a result of Jean Nidetch and several friends who met in her apartment to offer each other support about dieting.
1967
Twiggy, 5’7” and weighing about 92 pounds becomes a supermodel and icon for the slender female.
1972
Dr. Atkins introduced his first “Diet Revolution”, a high protein, high fat, low carbohydrate diet.
Richard Simmons opens Ruffage and the Anatomy Asylum, a Beverly Hills restaurant and exercise studio. He quickly becomes known as a fitness and diet guru.
1978
Dr. Herman Tarnover introduces the “Complete Scarsdale Medical Diet”, another version of the high protein, low-carb diet.
1979
The Pritikin Diet answers the trend of the high protein, low – carb diets with a high fiber, very low fat diet. The system was originally designed for heart patients but became popular for those who followed the newer trend of the low –fat diet approach.
1981
The Beverly Hills Diet is introduced – it recommends eating nothing but fruit for the first 10 days.
1982
Aspartame is introduced as another alternative sugar substitute. It was marketed as NutraSweet and is still used today in many products.
Liposuction is performed in the U.S. for the first time and now becomes a popular cosmetic procedure for the obese.
1983
Jenny Craig is formed which sells their own line of diet foods and offers diet counseling. Nutrisystem soon followed.
1988
Oprah Winfrey loses 67 pounds on the liquid diet Optifast.
1994
The FDA mandates that food labels must include detailed information about calories, fat, and fiber. We must thank Dr. Lulu Hunt Peters for this.
1995
“The Zone Diet” is introduced by Dr. Barry Sears. He promotes eating lots of fruits and vegetables and protein, while cutting back on breads and pastas.
1996
It is reported that 40% of nine and ten-year-olds are dieting and trying to lose weight.
2000
Experts are stating that there is now a global epidemic of obesity and that for the first time in history, this number of overweight people equals the number of underfed and undernourished.
2002
Dr. Atkins introduces his second diet book, the “New Diet Revolution” to a new generation of dieters. The Low-carb diet is back after multitudes of diet books promoting low fat diets.
2013
It appears we may have come full circle – we are now promoting cutting sugars and counting calories (again). We have progressed from low carbohydrate, low fat, and low carbohydrate diets again along with some pretty scary schemes, e.g. the tapeworm diet. Many weight loss books, gimmicks and pills have come and gone over and over again and many still exist, but with no real breakthroughs. I doubt they will not end at least in the near future – what do you think?
2023
For the last 10 years, we as a culture have waged a new diet war – Keto diet, paleo diets are the latest “experiments,” trending to the low carb side with higher fat – right back where we started. According to Bittman and Katz, “everything we learned in the late 20th century, the range for fat is considerably broader.” There are claims for good outcomes with diets that have 10% or less of calories from fat (like in Okinawa); those would be the low fat-diets. There are the Mediterranean diets that get well over 40% of their calories from fat and seem to produce the same great health outcomes.” (Mark Bittman and David L. Katz, M.D. How to Eat: All Your Food and Diet Questions Answered.)
Source:
James Trager(1995) The Food Chronology: A Food Lover’s Compendium of Events and Anecdotes, From Prehistory to the Present.
“People crave fatty and sugary foods when they consume them daily — and the pattern can be hard to break, researchers at Yale University and the Max Planck Institute for Metabolism Research in Germany have determined in new research.”People crave fatty and sugary foods when they consume them daily — and the pattern can be hard to break, researchers at Yale University and the Max Planck Institute for Metabolism Research in Germany have determined in new research.
The study, published online Wednesday in the journal Cell Metabolism, found eating a snack high in fat and sugar every day alters the reward circuits in human brains to create lasting preferences.
Participants were divided into two groups and told to continue their normal eating habits, except for one major difference. Researchers gave one group yogurt high in fat and sugar twice daily for eight weeks, while the other group received a placebo.
At the end of the eight weeks, participants were offered puddings with varying fat contents and apple juice containing differing sugar levels and told to rate them for fattiness, creaminess, oiliness, sweetness, desire and satisfaction.
Scientists found the group that was used to eating the yogurt higher in sugar and fat didn’t enjoy the healthier options as much as they had before the study.
The participants also underwent MRI scans to track brain activity while drinking milkshakes, which showed increased activity for the high-sugar, high-fat group, but not for the other group.
“Let’s say a new bakery opens up next to your work and you start stopping in and having a scone every morning. That alone can rewire your basic fundamental dopamine learning circuits,” Dana Small, the study’s senior author and director of Yale University School of Medicine’s Modern Diet and Physiology Research Center, told NBC News.
The authors likened the findings to the effects of addictive drugs, saying exposure to foods high in sugar and fat indicates that habitual factors contribute to obesity — not just genetic and environmental influences, as previously thought.”
The study found those eating food higher in fat and sugar continued to crave it.
Small told NBC News the study is the first to show that even small human dietary changes can rewire brain circuits and increase the long-term risk of overindulgence or weight gain.
The findings support a rat study published in January in the Journal of Physiology, which showed that a consistent diet of high-fat and high-caloric foods can change the neurological pathways in your brain, reducing its ability to regulate calorie intake.
While a “brief exposure” of three to five days of fatty foods didn’t appear to affect the pathways between the brain and stomach, the researchers noted the decline with 10 to 14 days of high-fat and high-calorie diets.
Sales of cookies, chips, candy and popcorn are soaring as America binges on snacks. Stunning stat: Nearly half of U.S. consumers are eating three or more snacks a day — up 8% in the last two years, The Wall Street Journal reports, citing market-research firm Circana. Snack sales ballooned to $181 billion last year, up 11% from the year before, according to Circana. What’s happening: Mondelez International — maker of Oreos, Ritz Crackers, Swedish Fish and more — saw sales jump 22% between 2019 and 2022. Hershey’s sales rose 30%. America’s love of snacks is leading to “the ‘snack-ification’ of everything,” Andrea Hernández, who writes Snaxshot, a newsletter on food and beverage trends, told The Journal. Kellogg is pitching breakfast cereal, including Apple Jacks andFroot Loops, as snacks.
The health risks of eating ultraprocessed foods —including sausages and burgers as well as pizza and ice cream — are well documented. They have been shown to raise the risk of obesity, diabetes, and cancer among other ailments. (CNN.com).
In a new study, researchers followed more than 10,000 Brazilians with an average age of 51 for more than 10 years. They found that people who consumed more than 20% of their daily calories from ultra processed foods had a 28% faster cognitive decline compared with those whose intake was less than 20%. Unfortunately, that 20% is not a high threshold: just 400 calories out of the 2000 calorie diet. And most Americans are well over that, getting on average a whopping 58% of their calories from ultraprocessed foods.
“The sample size is substantial and the followup extensive,” says Dr. David Katz, a nutrition specialist who was not involved in the study. While short of proof, this is robust enough that we should conclude ultraprocessed foods are probably bad for our brains,”
Source: The Week. December 23, 2022, Volume 22, Issue 110.
Adhering to healthy eating patterns was associated with lower risk of total and cause-specific mortality, a prospective cohort study with up to 36 years of follow-up showed.
Among 75,230 women from the Nurses’ Health Study and 44,085 men from the Health Professionals Follow-up Study, those who scored in the highest quintile for healthy eating patterns recommended by the Dietary Guidelines for Americans (DGAs) had a 14% to 20% lower risk of total mortality versus those in the lowest quintile, reported Frank Hu, MD, PhD, of the Harvard T.H. Chan School of Public Health in Boston, and colleagues in JAMA Internal Medicineopens in a new tab or window.
The pooled multivariable-adjusted hazard ratios of total mortality with four healthy eating patterns were (P<0.001 for trend for all):
Healthy Eating Index 2015 (HEI-2015): HR 0.81 (95% CI 0.79-0.84)
Alternate Mediterranean Diet (AMED): HR 0.82 (95% CI 0.79-0.84)
Healthful Plant-Based Diet Index (HPDI): HR 0.86 (95% CI 0.83-0.89)
Alternate Healthy Eating Index (AHEI): HR 0.80 (95% CI 0.77-0.82)
This lower risk was consistent across all racial and ethnic groups.
“This is one of the largest and longest-running studies that examine the associations of dietary scores for four healthy eating patterns recommended by the DGAs with the risk of total and cause-specific mortality in large cohort studies,” Hu told MedPage Today.
“Every 5 years, the U.S. Department of Agriculture (USDA) and U.S. Department of Health and Human Services (HHS) release an updated version of the Dietary Guidelines for Americans,” he explained. “It is important to evaluate adherence to DGA-recommended eating patterns and health outcomes, especially mortality, so that timely updating of DGAs can be made.”
Hu noted that these findings will be valuable for the 2025-2030 Dietary Guidelines Advisory Committee, which is being created by the USDA and HHS to evaluate the current evidence on different eating patterns and health outcomes.
Beyond total mortality, healthier diets were also significantly linked to lower risk of cause-specific mortality.
Across the four different dietary patterns, people in the highest quintile saw a 6% to 13% lower risk of death from cardiovascular disease versus those in the lowest quintile. Likewise, those in the highest quintile saw a 6% to 15% lower risk of death due to heart disease, a 7% to 18% lower risk of cancer-related death, and a 35% to 46% lower risk of respiratory disease-related death.
In addition, those with the highest scores on the AMED and AHEI also saw a modestly lower risk of death due to neurodegenerative disease (HR 0.94, 95% CI 0.90-0.99 and HR 0.93, 95% CI 0.87-0.99, respectively).
“Although previous studies have found an inverse association between healthy eating patterns and mortality, our study provides evidence that healthy eating patterns reduce the risk of cause-specific mortality including cardiovascular disease, cancer, respiratory, and neurodegenerative mortality,” said Hu. “The findings on respiratory and neurodegenerative mortality are novel.”
However, eating a healthy diet according to any of the four patterns did not appear to be protective against stroke-related deaths.
Hu said clinicians can recommend a “variety of healthy dietary patterns” to patients in order to reduce their risk for chronic diseases and premature death.
“These patterns such as the Mediterranean diet, DASH diet, vegetarian diet, or other versions of healthy diets can be adapted to meet individual health needs, food preferences, and cultural traditions,” he noted. “These healthy dietary patterns typically include high amounts of plant foods such as fruits, vegetables, whole grains, nuts, and legumes, and lower amounts of refined grains, added sugars, sodium, and red and processed meats.”
“It is also important to balance caloric intake with physical activity to maintain a healthy weight,” he added.
Among the women included in the analysis, mean baseline age was 50.2 and 98% were white; for men, mean age was 53.3 and 91% were white. In total, 31,263 women and 22,900 men died during follow-up. The leading cause of death was cancer, followed by cardiovascular disease, heart disease, neurodegenerative disease, respiratory disease, and stroke.
Dietary data were taken from semiquantitative food frequency questionnaires including more than 130 items, which were completed every 2 to 4 years.
Kristen Monaco is a staff writer, focusing on endocrinology, psychiatry, and nephrology news. Based out of the New York City office, she’s worked at the company since 2015.
Disclosures
The study was supported by a grant from the National Heart, Lung, and Blood Institute.
Hu reported no disclosures. Other co-authors reported relationships with Kubara Honke, Grants-in-Aid for Scientific Research, the G-7 Scholarship Foundation, the Japan Diabetes Society, the LOTTE Foundation, Layer IV, the U.S. Department of Agriculture, the U.S. Highbush Blueberry Council, the National Institutes of Health, Mars Edge, and the National Heart, Lung, and Blood Institute.
Primary Source
JAMA Internal Medicine
Source Reference: opens in a new tab or windowShan Z, et al “Healthy eating patterns and risk of total and cause-specific mortality” JAMA Intern Med 2023; DOI: 10.1001/jamainternmed.2022.6117.
This fact sheet by the National Institutes of Health (NIH) Office of Dietary Supplements (ODS) provides information that should not take the place of medical advice. We encourage you to talk to your health care providers (doctor, registered dietitian, pharmacist, etc.) about your interest in, questions about, or use of dietary supplements and what may be best for your overall health. Any mention in this publication of a specific product or service, or recommendation from an organization or professional society, does not represent an endorsement by ODS of that product, service, or expert advice.
The amount of vitamin B12 you need each day depends on your age. Average daily recommended amounts for different ages are listed below in micrograms (mcg):
Vitamin B12 is found naturally in a wide variety of animal foods, and manufacturers add it to some fortified foods. Plant foods have no vitamin B12 unless they are fortified. You can get recommended amounts of vitamin B12 by eating a variety of foods including the following:
Fish, meat, poultry, eggs, milk, and other dairy products contain vitamin B12.
Clams and beef liver are some of the best source of vitamin B12.
Some breakfast cereals, nutritional yeasts, and other food products are fortified with vitamin B12.
To find out if a food has added vitamin B12, check the Nutrition Facts label. Manufacturers are not required to list vitamin B12 on the label if a food naturally contains this vitamin.
What kinds of vitamin B12 dietary supplements are available?
Vitamin B12 is available in multivitamin/multimineral supplements, in B-complex supplements, and in supplements containing only vitamin B12. It is usually in a form called cyanocobalamin. Other common forms are adenosylcobalamin, methylcobalamin, and hydroxycobalamin. Vitamin B12 is also available in a form that’s dissolved under your tongue (called sublingual vitamin B12). Research has not shown that any form of supplemental vitamin B12 is better than the others.
The amount of vitamin B12 in supplements varies widely. Some provide doses of vitamin B12 that are much higher than recommended amounts, such as 500 mcg or 1,000 mcg, but your body absorbs only a small percentage of it. These doses are considered safe. Check the Supplement Facts label to see how much vitamin B12 a supplement contains.
A prescription form of vitamin B12 can be given as a shot. This is usually used to treat vitamin B12 deficiency. Vitamin B12 is also available by prescription as a nasal gel that’s sprayed into the nose.
Am I getting enough vitamin B12?
Most people in the United States get enough vitamin B12 from the foods they eat. But some people have trouble absorbing vitamin B12 from food. The body absorbs vitamin B12 from food in a two-step process. First, hydrochloric acid in the stomach separates vitamin B12 from the protein that it’s attached to. Second, the freed vitamin B12 then combines with a protein made by the stomach, called intrinsic factor, and the body absorbs them together.
Vitamin B12 in dietary supplements isn’t attached to protein and doesn’t require the first step. However, B12 in supplements does need to combine with intrinsic factor to be absorbed.
People with pernicious anemia, an autoimmune disease, can’t make intrinsic factor. As a result, they have trouble absorbing vitamin B12 from foods and dietary supplements.
Vitamin B12 deficiency affects between 3% and 43% of older adults. Your doctor can test your vitamin B12 level to see if you have a deficiency.
Certain groups of people may not get enough vitamin B12 or have trouble absorbing it:
Many older adults don’t have enough hydrochloric acid in their stomach to absorb the vitamin B12 that’s naturally present in food. People over 50 should get most of their vitamin B12 from fortified foods or dietary supplements because, in most cases, their bodies can absorb vitamin B12 from these sources.
People with an autoimmune disease called atrophic gastritis might not absorb enough vitamin B12 because they make too little hydrochloric acid and intrinsic factor in their stomach.
People with pernicious anemia do not make the intrinsic factor needed to absorb vitamin B12. As a result, they have trouble absorbing vitamin B12 from foods and dietary supplements. Doctors usually treat pernicious anemia with vitamin B12 shots, although very high doses of vitamin B12 given by mouth might also be effective.
People who have had some types of stomach or intestinal surgery (for example, to lose weight or to remove part or all of the stomach) might not make enough hydrochloric acid and intrinsic factor to absorb vitamin B12.
People who eat little or no animal foods, such as vegetarians and vegans, might not get enough vitamin B12 from their diets. Only animal foods have vitamin B12 naturally. When pregnant women and women who breastfeed their babies are strict vegetarians or vegans, their babies might also not get enough vitamin B12.
What happens if I don’t get enough vitamin B12?
Your body stores 1,000 to 2,000 times as much vitamin B12 as you’d typically eat in a day, so the symptoms of vitamin B12 deficiency can take several years to appear.
If you have a vitamin B12 deficiency, you may feel tired or weak. These are symptoms of megaloblastic anemia, which is a hallmark of vitamin B12 deficiency. You might also have pale skin, heart palpitations, loss of appetite, weight loss, and infertility. Your hands and feet might become numb or tingly, a sign of nerve problems. Other symptoms of vitamin B12 deficiency include problems with balance, depression, confusion, dementia, poor memory, and soreness of the mouth or tongue.
Vitamin B12 deficiency can damage the nervous system even in people who don’t have megaloblastic anemia, so it’s important to treat a deficiency as soon as possible.
What are some effects of vitamin B12 on health?
Scientists are studying vitamin B12 to understand how it affects health. Here are several examples of what this research has shown.
Heart disease and stroke Vitamin B12 supplements (along with other B vitamins) reduce blood levels of homocysteine, a compound linked to an increased risk of having a heart attack or stroke But despite reducing homocysteine, research shows that these vitamins don’t reduce the risk of developing cardiovascular disease or stroke.
Dementia and cognitive function Most studies show that low blood levels of vitamin B12 don’t affect the risk of cognitive decline in older people, regardless of whether they have dementia or Alzheimer’s disease. More clinical trials are needed to better understand the effects of vitamin B12 supplementation on cognitive function in older adults.
Energy and Endurance Manufacturers often promote vitamin B12 supplements for energy, athletic performance, and endurance. But vitamin B12 doesn’t provide these benefits in people who get enough B12 from their diet.
Can vitamin B12 be harmful?
Vitamin B12 has not been shown to cause any harm, even at high doses.
Does vitamin B12 interact with medications or other dietary supplements?
Yes. Vitamin B12 supplements can interact or interfere with some medicines that you take. Here are several examples.
Gastric acid inhibitors People take gastric acid inhibitors to treat certain digestion problems, such as gastroesophageal reflux disease and peptic ulcer disease. These drugs can interfere with vitamin B12 absorption from food by slowing the release of hydrochloric acid into the stomach, leading to vitamin B12 deficiency. Gastric acid inhibitors include omeprazole (Prilosec®), lansoprazole (Prevacid®), cimetidine (Tagamet®), and ranitidine (Zantac®).
Vitamin B12 and healthful eating
People should get most of their nutrients from food and beverages, according to the federal government’s Dietary Guidelines for Americans. Foods contain vitamins, minerals, dietary fiber, and other components that benefit health. In some cases, fortified foods and dietary supplements are useful when it is not possible to meet needs for one or more nutrients (for example, during specific life stages such as pregnancy).
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