Nutrition

To address iron deficiency in Africa, researcher develops fortified version of popular hibiscus drink

Christopher.Sorensen — Wed, 19 Oct 2022 14:06:30 +0000

To address iron deficiency in Africa, researcher develops fortified version of popular hibiscus drink

Christopher.Sorensen Wed, 10/19/2022 - 10:06

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Folake Oyewole, a PhD candidate in the Faculty of Applied Science & Engineering, is developing an iron-fortified hibiscus drink that could help women with iron deficiency in Sub-Saharan Africa (photo by Safa Jinje)

Safa Jinje

Topic

Global Lens

Chemical Engineering

Faculty of Applied Science & Engineering

Food

Global

Graduate Students

Nutrition

Research & Innovation

Folake Oyewole’s doctoral thesis project was inspired, in part, by the potential health benefits of a refreshing drink: Zobo, a hibiscus-based beverage that is popular in Oyewole’s home country of Nigeria.

“People consume Zobo as a cold beverage in Nigeria because it’s refreshing and claimed to provide many health benefits,” says Oyewole, a chemical engineering PhD candidate in the University of Toronto’s Faculty of Applied Science & Engineering.

“I wanted to ascertain whether these drinks actually add micronutrients to the body, and if they didn’t, whether we could make it so that they did in a way that could be absorbed and used by the body.”

Supported by the Schlumberger Foundation’s Faculty for the Future Fellowship, Oyewole says she has always been interested in value-added processing of food and beverages, particularly ones with ingredients sourced from Nigeria. Her passion led her to join the lab of Levente Diosady, a professor emeritus in the department of chemical engineering and applied chemistry, who specializes in food engineering.

Diosady’s lab group is developing a new way to fortify beverages like Zobo with iron – a mineral that many across Sub-Saharan Africa, particularly women, are lacking in sufficient quantities. The new iron-fortified beverage will make use of hibiscus sourced from Nigeria.

Iron deficiency is the leading cause of anemia world-wide. For women of reproductive age, iron-deficiency anemia can lead to poor health outcomes and pregnancy complications such as preeclampsia, postpartum infection and low infant birth weight. In Nigeria alone, the World Health Organization estimates that 55 per cent of women of reproductive age have anemia.

That’s why fortifying foods with iron has been a key focus of Diosady’s Food Engineering Laboratory for years. Past projects have included a double-fortified salt, which in trials of 60 million consumers in India was found to significantly improve the iron status of women.

“Folake’s work continues our goal of improving the iron status of women and infants by providing a natural fortification of a locally produced beverage,” says Diosady. “If properly marketed, this fortified beverage could improve the iron status of women of reproductive age, without medical infrastructure or any change in dietary habits.”

Hibiscus calyces are used to make Folake Oyewole’s cold beverage, which is then fortified by adding ferrous sulphate heptahydrate, an iron salt that tops up the iron already present in the drink (photo by Safa Jinje)

Creating an iron-fortified beverage isn’t as simple as adding some mineral salts into the recipe. Oyewole’s new product needs to account for the unique challenges associated with the dietary habits of the population she is working with.

The human body absorbs iron from well-rounded diets that include meats, eggs and leafy greens, as well as foods fortified with iron. But in Sub-Saharan Africa, many households are limited to eating mostly plant-based diets with very little variety due to the prohibitive cost of iron-rich meat.

On top of this, many plants have an abundance of polyphenols. This family of naturally occurring molecules – which includes flavonoids, phenolic acids and resveratrol – has many disease-fighting properties, including inhibiting cancerous tumor generation and growth. But polyphenols also bind to iron in a way that prevents the latter from being absorbed by the body.

Oyewole’s fortified hibiscus beverage needs to address both the inadequate dietary iron intake, as well as the reduced iron uptake that results from a diet rich in polyphenols.

“The most at-risk groups who are dependent on plant-based diets often don’t realize that they can’t absorb iron efficiently,” says Oyewole.

“This is why when addressing micronutrient deficiencies at the population level through food fortification, it’s really important to choose the right food vehicle. We want to reach this population with something they are familiar with, something they already produce and consume widely so we can predict the consumption pattern of the population.”

It’s also important to choose a food that can be centrally processed so that the iron dosage can be controlled, adds Oyewole. And the fortification process shouldn’t be so expensive that it significantly raises the cost of the food.

Oyewole began her research by analyzing the iron content of the hibiscus calyces – the part of the plant that protects the bud and supports blooming petals – used to make Zobo. While Oyewole found it to be relatively rich in iron, 70 per cent is lost during the extraction process since most of the iron is bound to the residue that is not transferred into the beverage. She also found that the calyces contain 25 times more polyphenols than they do iron.

Oyewole then fortified the beverage by adding ferrous sulphate heptahydrate, an iron salt, to top up the iron already present. Her goal was to provide a total of six milligrams of iron per 250 milligrams – 30 per cent of the target recommended daily allowance for women of childbearing age.

To prevent the iron-polyphenol interaction, she introduced disodium EDTA into the beverage. Previous results in the lab suggest that this substance can release iron from the iron-polyphenol complex and make it available to be absorbed by the body.

Oyewole is also working on ensuring that her iron fortification method will preserve the organoleptic properties of the original beverage – that is, the flavour, texture and colour.

“Iron has a very distinct, metallic taste, so another layer of my work is to make sure that the sensory properties of the fortified beverage – the taste, mouthfeel, aftertaste and colour – matches the original,” she says. “Otherwise, we risk formulating a fortified beverage that will be rejected by the consumer.”

Once this is achieved, the next step will be to form partnerships with stakeholders, including government agencies in Sub-Saharan Africa, to make the fortified beverage accessible for the target population.

“Working in the Food Engineering Laboratory has been a great privilege,” Oyewole says. “From an outside perspective, it may seem like we just add micronutrients to food and that’s it. But there are a lot of complexities with the materials we are dealing with, including preventing unwanted interactions between the food vehicle and the added micronutrients.

“Our research outcome has the potential for significant impact globally. Invariably it challenges poverty, increases productivity and promotes health – it is all intertwined.”

Kids with vegetarian diets record similar growth, nutrition measures as those who eat meat: Study

Christopher.Sorensen — Thu, 05 May 2022 13:14:46 +0000

Kids with vegetarian diets record similar growth, nutrition measures as those who eat meat: Study

Christopher.Sorensen Thu, 05/05/2022 - 09:14

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(Photo by Ekaterina Goncharova via Getty Images)

Jennifer Stranges

Topic

Breaking Research

Temerty Faculty of Medicine

Unity Health

Children

Nutrition

Research & Innovation

St. Michael's Hospital

A study of nearly 9,000 children has found those who eat a vegetarian diet had similar measures of growth and nutrition compared to children who eat meat.

The study, led by researchers at the University of Toronto and St. Michael’s Hospital of Unity Health Toronto, also found that children with a vegetarian diet had higher odds of underweight status – emphasizing the need for special care when planning the diets of vegetarian kids.

The findings, published in the journal Pediatrics, come as a shift to consuming plant-based diets grows in Canada. In 2019, updates to Canada’s Food Guide urged Canadians to embrace plant-based proteins, such as beans and tofu, instead of meat.

Professor Jonathon Maguire (photo courtesy of St. Michael's Hospital, Unity Health Toronto)

“Over the last 20 years we have seen growing popularity of plant-based diets and a changing food environment with more access to plant-based alternatives, however we have not seen research into the nutritional outcomes of children following vegetarian diets in Canada,” said Jonathon Maguire, principal investigator on the study who is a professor in U of T’s department of pediatrics in the Temerty Faculty of Medicine and a pediatrician at St. Michael’s Hospital.

“This study demonstrates that Canadian children following vegetarian diets had similar growth and biochemical measures of nutrition compared to children consuming non-vegetarian diets,” said Maguire, who is also a scientist at U of T’s Joannah & Brian Lawson Centre for Child Nutrition. “Vegetarian diet was associated with higher odds of underweight weight status, underscoring the need for careful dietary planning for children with underweight when considering vegetarian diets.”

The researchers evaluated 8,907 children aged six months to eight years. The children were all participants of the TARGet Kids! cohort study and data was collected between 2008 and 2019. Participants were categorized by vegetarian status – defined as a dietary pattern that excludes meat – or non-vegetarian status.

The team found children who had a vegetarian diet had similar mean body mass index (BMI), height, iron, vitamin D and cholesterol levels compared to those who consumed meat. The findings showed evidence that children with a vegetarian diet had almost two-fold higher odds of having underweight, which is defined as below the third percentile for BMI. There was no evidence of an association with overweight or obesity.

Underweight is an indicator of undernutrition, and may be a sign that the quality of the child’s diet is not meeting the child’s nutritional needs to support normal growth. For children who eat a vegetarian diet, the researchers emphasized access to health-care providers who can provide growth monitoring, education and guidance to support their growth and nutrition.

International guidelines about vegetarian diet in infancy and childhood have differing recommendations, and past studies that have evaluated the relationship between vegetarian diet and childhood growth and nutritional status have had conflicting findings.

“Plant-based dietary patterns are recognized as a healthy eating pattern due to increased intake of fruits, vegetables, fiber, whole grains and reduced saturated fat; however, few studies have evaluated the impact of vegetarian diets on childhood growth and nutritional status. Vegetarian diets appear to be appropriate for most children,” said Maguire, who is also a scientist at the MAP Centre for Urban Health Solutions at St. Michael’s Hospital.

A limitation of the study is that researchers did not assess the quality of the vegetarian diets. The researchers note that vegetarian diets come in many forms and the quality of the individual diet may be quite important to growth and nutritional outcomes. The authors say further research is needed to examine the quality of vegetarian diets in childhood, as well as growth and nutrition outcomes among children following a vegan diet, which excludes meat and animal derived products such as dairy, eggs and honey.

The study was funded by the Canadian Institutes of Health Research (CIHR), St. Michael’s Hospital Foundation and SickKids Foundation.

A version of this story was first published on the website of St. Michael's Hospital, Unity Health Toronto.

Evidence grows for iron deficiency screening in childhood: U of T researchers

Christopher.Sorensen — Mon, 06 Jan 2020 13:59:43 +0000

Evidence grows for iron deficiency screening in childhood: U of T researchers

Christopher.Sorensen Mon, 01/06/2020 - 08:59

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Two studies from U of T and the Hospital for Sick Children look at iron deficiency and suggest that Canadians would benefit from more screening programs in early childhood (photo by Godong/Universal Images Group via Getty Images)

Jim Oldfield

Topic

Breaking Research

Joannah & Brian Lawson Centre for Child Nutrition

Pediatrics

Dalla Lana School of Public Health

Faculty of Medicine

Hospital for Sick Children

Nutrition

Research & Innovation

Research and Innovation

Two recent studies from the University of Toronto and the Hospital for Sick Children are adding to mounting evidence that Canadians would benefit from more screening for iron deficiency in early childhood.

One study details the known association between iron levels and cognitive function, and identifies a new threshold in blood tests that could guide more effective clinical intervention. The other is the first health-economic analysis of potential screening programs for iron deficiency in Canada, which shows that both targeted and universal screening would be cost-effective.

Iron is critical for growth and development, yet experts estimate that over 10 per cent of young children in developed countries are iron deficient. Canada has no recommendation on screening, which is left to the discretion of physicians and parents.

The current studies, published in The Journal of Pediatrics and CMAJ Open, respectively, build on the researchers’ previous work that showed screening with a ferritin blood test can detect iron deficiency earlier than the more standard hemoglobin test, which only reveals a deficiency that has progressed to anemia.

“We found a fairly strong association between serum ferritin and cognitive function, but also that the association peaks and does not improve beyond a certain level,” says Patricia Parkin, a professor of paediatrics at U of T and a clinician-investigator at SickKids. “That threshold is important for clinicians, because it enables them to make a quick and accurate decision on further tests or therapies.”

Parkin and her colleagues identified a cut-off of 17 micrograms of serum ferritin per litre, which is five micrograms higher than the current level that clinicians use in practice. Five micrograms may sound small, but the researchers found the increase in cognition associated with a five-unit rise in ferritin is similar to the increase in IQ associated with a 1000-gram increase in birth weight, in a comparison with data from another study.

The results were based on screening tests in more than 700 participants in TARGet Kids!, the largest research cohort of young Canadian children recruited in primary care.

Parkin says that while the new cut-off is not definitive, she hopes it will open up discussion about the suitability of the current number in clinical practice. She also hopes that more practitioners in the U.S. will consider measuring ferritin in addition to a hemogloblin test, which they typically administer to children at the age of one.

“A serum ferritin test with a well defined threshold would identify far more children in the U.S. and prevent many more from developing a chronic deficiency or anemia,” says Parkin, who is also the research director of the Paediatric Outcomes Research Team at SickKids and a scientist in the Joannah & Brian Lawson Centre for Child Nutrition at U of T.

In Canada, a key question for researchers and policy-makers has been the potential cost of new screening programs. The health-economic study in CMAJ Open offers an answer on the possible cost of screening for iron deficiency in childhood through a comparison of costs for universal screening, targeted screening for high-risk groups, and no screening (the current standard of care).

“We found that, across the board, screening would be cost-effective,” says Sarah Carsley, an assistant professor at U of T’s Dalla Lana School of Public Health who completed her PhD in the Parkin lab. “Moreover, universal screening was almost a third more cost-effective than targeted screening, although both were clearly cost-effective, using standard willingness-to-pay thresholds.”

Carsley and her colleagues estimated health care costs and quality-adjusted life years to arrive at an “incremental cost-effectiveness ratio,” which for both types of screening and with conservative estimates was well below the level at which an intervention would be deemed too expensive.

Children in Ontario typically see a primary care physician for an in-depth, enhanced well-baby visit at 18 months of age. Parkin, Carsley and others have previously suggested that this might be an ideal time to discuss screening with a serum ferritin test, which is inexpensive and available in most labs.

One drawback with the ferritin and hemoglobin tests is that they require a small blood draw, which many children find upsetting. Parkin says more research is needed on whether parents would feel the value of screening outweighs the upset of a blood draw, and whether family physicians and pediatricians would embrace screening based on the existing evidence.

Meanwhile, parents can reduce the risk of iron deficiency by providing children with a diet rich in iron and in vitamin C (which helps iron absorption), and by limiting cow’s milk to two cups a day, as it can inhibit iron absorption and may reduce consumption of other healthy foods. Those worried about iron deficiency can discuss risk factors and options with health-care providers, before birth and in the first year of life.

Treatment for iron deficiency is very effective, and can include dietary advice and daily supplements in pill or liquid form. “The fix is pretty easy,” says Parkin. “It’s short in duration and inexpensive, which should drive interest in a broader discussion about how we can better address this issue. Iron deficiency has been an under-recognized public health problem for too long.”

The research was supported by the Canadian Institutes of Health Research, The Hospital for Sick Children Foundation and St. Michael’s Hospital Foundation. The Applied Research Group for Kids (TARGet Kids!) is a partnership among primary care physicians in the community and researchers at SickKids, St. Michael’s Hospital and McMaster University.

Access to nutritious foods crucial to improving Canadians’ health: U of T experts in the Toronto Star

rahul.kalvapalle — Wed, 27 Nov 2019 17:21:53 +0000

Access to nutritious foods crucial to improving Canadians’ health: U of T experts in the Toronto Star

rahul.kalvapalle Wed, 11/27/2019 - 12:21

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(photo by structuresxx via Getty Images)

Topic

Our Community

Institute of Health Policy Management and Evaluation

Dalla Lana School of Public Health

Faculty of Medicine

Nutrition

Psychiatry

University Health Network

Nutritious food is out of the average Canadian’s financial reach, and it’s having a devastating impact on their health.

That’s according to a Toronto Star op-ed written by the University of Toronto’s Andrew Boozary and Kwame McKenzie that argues more needs to be done to improve Canadians’ diets.

“More than one-in-10 Canadians are worried they won’t be able to afford their next meal or are forced to skip meals or spend days without eating. And it is only getting worse,” writes Boozary, the executive director of health and social policy at the University Health Network and an assistant professor in U of T’s department of family and community medicine and the Institute of Health Policy, Management and Evaluation, and McKenzie, a professor in the department of psychiatry in the Faculty of Medicine.

There’s “compelling” evidence of the influence of diet on public health outcomes, the authors add, citing nutrition-based initiatives in California and Massachusetts that have shown promise in reducing hospital admissions and health-care spending. Policy measures such as controlling advertising targeted at children and using pricing strategies to reduce consumption of sugary drinks can also have a beneficial impact on Canadians’ food choices, they write.

“One of the fundamental principles of our medicare system is that every Canadian should have access to evidence-based treatments,” Boozary and McKenzie say. “But we are failing Canadians when it comes to one of the most essential medicines – access to nutritious and healthy food.”

Read the op-ed in the Toronto Star

Food as therapy: U of T health-care symposium tackles questions about diets, nutrition

Christopher.Sorensen — Mon, 10 Dec 2018 17:25:58 +0000

Food as therapy: U of T health-care symposium tackles questions about diets, nutrition

Christopher.Sorensen Mon, 12/10/2018 - 12:25

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The Food as Medicine event drew over 170 physicians, dietitians, researchers, pharmacists and other health professionals who were looking to update their nutrition knowledge (photo by Eszter Biró via Unsplash)

Topic

St. Michael's Hospital

Health professionals from across Canada attended a recent University of Toronto conference to hear research and practical advice on nutrition and aging, fats, sugar, the ketogenic diet and gluten sensitivity, among other hot topics.

The 2018 Food as Medicine Update, hosted by U of T and St. Michael's Hospital at the Li Ka Shing Knowledge Institute, drew over 170 physicians, dietitians, researchers, pharmacists and other health professionals – and many more online – who were looking to update their nutrition knowledge.

“Last year’s conference was focused on basic research, so we tried to offer a broader perspective this time with more clinical takeaways, and that seemed to resonate,” said John Sievenpiper, an associate professor in U of T’s department of nutritional sciences and a researcher at the Joannah & Brian Lawson Centre for Child Nutrition, which co-sponsored the event.

Originally created to address a knowledge gap when it comes to the role of nutrition in patient care, the Food as Medicine symposium addresses the growing interest among physicians in theraputic diets for chronic disease prevention.

Discussions at the 2018 event were lively, as attendees lined up to ask questions and provide comments following speakers' presentations.

A talk on the ketogenic diet by Jennifer Sygo, a dietitian and sports nutritionist with Cleveland Clinic Canada, generated particular interest. Attendees asked about the keto diet’s safety and long-term effects on weight loss, given that it typically involves a radical reduction of carbohydrate intake and a large increase in fat. The unconventional combination spurs a metabolic state called ketosis, which can lead to efficient fat burning and a greater supply of energy for the brain.

Sygo, who is also the team dietitian for the Toronto Maple Leafs and Toronto Raptors, said there is little evidence the keto diet is a sustainable way to maintain a healthy body weight over time. But she said she's seen significant improvements in cognitive function in some of her clients with brain injuries.

Sygo noted Google searches on the diet have skyrocketed since 2016, rivalling veganism as the most-researched diet trend online.

Kristie Srichaikul is a member of the Food as Medicine steering committee, a family physician in Toronto and a research collaborator at St. Michael’s Hospital. She said the event provided answers to several common questions that patients ask in her practice.

“There is a lot of mixed messaging out there around what to eat, so people ask about specific diets, or they may want more universal advice,” Srichaikul said. “But it’s important to draw on credible, peer-reviewed, published evidence as a clinician. Tailoring nutritional advice to individuals is also a good strategy, as patients can incorporate these changes into their day-to-day routine easier.

Srichaikul said she emphasizes therapeutic dietary patterns such as the low glycemic index, Mediterranean and portfolio diets with her patients because clinical trial evidence has shown they can lower cardiovascular disease markers. The wide variety of food choices in these patterns can also accommodate individual tastes and cultural differences.

“I like a holistic approach that focuses on whole foods, which gives patients options and flexibility,” Srichaikul said. “For example: more dahl and less rice, and don’t beat yourself up. Food should be fun and tasty.”

The event also featured a talk by David Jenkins, a professor in U of T’s departments of nutritional sciences and medicine, and a staff physician at St. Michael’s Hospital. Jenkins spoke about value of plant-based diets for disease prevention and planetary health.

The conference was supported by the Lawson Centre for Child Nutrition, U of T's department of nutritional sciences and the U of T Faculty of Medicine's continuing professional development office in partnership with St. Michael’s Hospital, Margaret Rundle and Stephen Lister.

Please don't call it a food swamp: U of T expert

noreen.rasbach — Wed, 05 Sep 2018 04:00:00 +0000

Please don't call it a food swamp: U of T expert

noreen.rasbach Wed, 09/05/2018 - 00:00

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(photo by Shutterstock)

Sarah Elton

Topic

City & Culture

Dalla Lana School of Public Health

Food is sold everywhere – at the gas station, in the drugstore, at the coffee shop and the corner store – even where you go to buy discount homewares you’ll find caramel corn to go with your towels. Then there are the ubiquitous fast food joints promising to nip your hunger at any time of day and supermarkets selling baked goods, chips and ready-to-go just about anything.

Generally, what’s for sale at these places is not the kind of food that is good for your body. That’s why in public health several years ago, people began to call this retail landscape a “food swamp.”

Food swamp describes an urban environment where there is a lot of food for sale that is not nutritious, or worse, and therefore is seen to be a threat to public health. This foodscape is typical of the North American food system that is corporate, industrial and increasingly global. A whole lot of us live in food swamps.

A food swamp is different from a food desert. Food deserts are neighbourhoods where it is not easy to buy healthy foods, like fruits and vegetables, because there aren’t any grocery stores selling healthy options.

Food swamps have lots of food for sale – just not healthy food (photo by Shutterstock)

Interestingly, food deserts are mostly an American phenomenon, while in Canada, food swamps are more common.

And this retail environment filled with sweet drinks and ultra-processed foods is not good for our bodies. In Baltimore, one study found that adolescent girls living in a food swamp had consumed more in snacks and desserts than those not living in food swamps. In Ontario, young adults living closer to a high number of fast food restaurants relative to other kinds of restaurants were significantly associated with a higher incident rate of diabetes.

So, the term food swamp plays on old meanings of swamp — a landscape assumed for centuries to be dangerous to health and life.

But by calling this neighbourhood a swamp, we miss fingering a fundamental problem with food today. The term food swamp is not helpful in identifying the underlying issue in the food system that threatens all our health.

Read the research

Using the metaphor food swamp to describe the risk posed by the retail foodscape distracts from a serious health consequence of the food system: It obscures the food system’s impact on ecosystems and the biosphere, our life support systems.

Rethinking the term and coming up with another way to articulate the health risks of the retail food environment can better help to distinguish healthy from unhealthy food.

Swamps support us

What is a swamp anyway?

A swamp is a forested wetland where the soil is rich with nutrients and where there is great species diversity. Global society recognized the interdependence of humans and their environment in 1971 when the Ramsar intergovernmental treaty was signed to protect wetlands.

Of course, these soggy ecosystems haven’t always been viewed positively because disease-spreading mosquitoes do breed in them. However, wetlands are also seriously supporting health.

Minesing Swamp in Ontario (photo by Jane Ball/BruceGreySimcoe, CC BY-NC)

They filter and detoxify water, including water we use to grow food. Swamps protect our communities by retaining floodwaters and support biodiversity. And they provide food and hold profound cultural significance, specifically for some Indigenous communities.

Swamps also support ecological determinants of health. Just as social factors such as racialization and gender affect our health, ecosystems play a role in shaping human health. So wetlands – swamps – are essential ecosystems because they support our health and our food system too.

The problem with the term food swamp is that it denigrates the swamp and its ecological determinants of health. By trash-talking this vital ecosystem, we obscure the fact that our food systems pose a grave threat to human health – because of their consequences for the body and their grave impact on our environment.

Food system health

The corporate and industrial food system contributes substantially to environmental degradation such as water pollution, biodiversity loss and soil erosion. It also contributes significantly to greenhouse gas emissions, including from the livestock industry. The problem isn’t with swamps. The problem is with how we’re treating the swamps and other ecosystems.

The risk of this term isn’t merely semantic. Historians such as William Cronon and David Arnold have demonstrated how the way we construct nature and its landscapes in Western society – the way we talk about nature and the beliefs we hold about it – can have a profound impact on people’s lives. Cronon describes how American society’s idea of nature in the 19^th century as a virgin wilderness was a harmful colonial idea.

The belief that nature was wild and empty flourished among settlers in the United States after Indigenous people were forcibly removed from their lands. This settler fantasy inspired the creation of the National Park System and erased for them the fact that their violence was the reason these parks were no longer home to Indigenous people.

A version of nonhuman nature that is hostile to the connection between our species and the biosphere is constructed when the characteristically North American retail foodscape is called a food swamp. In some ways it’s an obvious metaphor – in the Middle Ages in Christian Europe, swamps were seen to be evil places with monsters and, in the 19^th century, the miasmas, a poisonous vapour the medical community thought caused infection, were associated with the swamp.

Is a kale salad healthier than a burger? The question of what is healthy should extend to our entire food systems (photo by Shutterstock)

So, food swamp conjures up an idea of the danger that can be found in a glut of unhealthy food there. But this term misses the mark, not only because it miscasts wetlands. By equating the retail foodscape with this important landscape feature, we perpetuate the idea that humans are an exceptional, self-maintaining species when in reality we rely on the biosphere and its ecosystems to live and to be healthy.

This criticism has broader implications for what we call healthy food. If you consider an ecosystems approach to health and think of human health in relation to ecological systems, then the question of what food is good for you shifts.

The question isn’t whether a kale salad is healthier than a hamburger because of what happens in your body. Rather it evaluates the healthiness of a food based on the food system.

It judges its impact from the farm all the way to the store – and then to the body. It’s a way of looking at the health of food that you might not find in popular theories about nutrition. But if we begin to look at our food ecologically we may find a path to long-term healthier food systems.

Sarah Elton is a PhD candidate in social and behavioural health sciences at the Dalla Lana School of Public Health.

This article was originally published on The Conversation. Read the original article.

A U of T nutritionist and a prominent Toronto chef on the benefits of grass-fed beef (with recipes)

noreen.rasbach — Wed, 15 Aug 2018 21:15:59 +0000

A U of T nutritionist and a prominent Toronto chef on the benefits of grass-fed beef (with recipes)

noreen.rasbach Wed, 08/15/2018 - 17:15

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While the science is being established, there are still reasons to try grass-fed beef, including environmental, ethical and culinary, say U of T's Richard Bazinet (pictured) and chef Tyler Shedden

Topic

Richard Bazinet is an associate professor and Canada Research Chair in Brain Lipid Metabolism in the department of nutritional sciences at the University of Toronto.

Tyler Shedden (pictured below) is the culinary director for the Chase Hospitality Group based in Toronto.

Eight years ago Mark Schatzker published Steak, which argued that grass-fed beef was tastier and possibly more nutritious. The book greatly influenced both of us (a nutritional scientist and a chef), and we have been reaffirming his ideas ever since by chemically analyzing, cooking, eating and enjoying grass-fed beef.

But let’s get something straight. Nutrition is not about the occasional superfood, supplement or what you blend into your coffee. It is about all the foods you choose over the long term. The idea of a grass-fed steak making you healthier is about as silly as thinking that boiling some broccoli makes you unhealthy. And, while the fat and vitamin makeup of grass-fed beef looks healthier than standard beef, we don’t yet have the definitive studies in humans proving that it makes a meaningful difference.

If that research bears out, perhaps one day grass-fed meat will become a separate category, being considered a more healthful meat – the opposite of cold cuts and other processed meat, which are now in their own category, with nutritionists advising limited consumption due to health concerns. But while the science is being established, there are still reasons to try grass-fed, including environmental, ethical and culinary.

Choosing truly grass-fed can be tricky. More and more meats and dairy products are being stamped with this label, but there are no established standards for it. Did the animal only ever eat grass with no grains at all, even in the winter? And what do we mean by grass? Technically, some plants we might consider to be a grass are not really grasses. One quick rule-of-thumb is to look at the fat: Grass-fed is slightly yellow as opposed to white. Also, we suggest talking to the butcher or farmer and asking questions.

Pasture-raised meat is more expensive, as you would expect. But here’s where you can experiment with cheaper cuts of meat. Many top chefs know that those cheaper cuts are more flavourful than prime steak, and prepared properly, can be the best part of the animal. But they do take some planning and know-how to get the best out of them. Consider shank, flank, brisket, or top butt and neck and cheeks, to name a few. Below we offer three easy recipes for cooking cheaper cuts – to delicious effect!

But remember that your meal is not just about the meat. What are you going to serve with it? In many kitchens they say, “If it grows together, it goes together.” For instance, a lot of pastured animals are roaming freely on the farm and eat grass that comes out of the same ground that many vegetables are growing in. Chances are, there are orchards above the animals dropping apples and pears onto the ground that the cows will eat. Not to mention mushrooms, leaves of watercress, potatoes, onions and celery root. This truly gives you a sense of place or as the French say of wine, terroir.

The terroir concept very much applies to farming, especially in regard to pasture-raised animals and the dairy they produce. Sometimes you can find people who have a more holistic approach to growing at the farmers' market. If you are lucky enough to find someone who practises this type of farming (and it’s becoming much more common) you will then have access to vegetables, dairy and meat that all share the same ground – providing you with a very good terroir. Generally, these types of farms rotate multiple species over the pasture taking advantage of symbiotic relationships between the animals, plants and insects. Holistic farming uses minimal, if any, fertilizer or pesticides and aims to enrich the soil naturally. Having healthy soil is key for growing plants and animals with higher nutritional content and more flavour.

Pot au Feu

This is an interpretation of a classic French dish, which translates literally to Pot of Fire. The addition of marrow bones makes this a real treat.

1 large onion, peeled, trimmed, and halved crosswise

2 tablespoons extra-virgin olive oil

1 beef shank cross cut 6cm thick

1 piece beef brisket 500g

3pcs large beef cheeks

Salt and freshly ground black pepper

Bouquet garni (1 bay leaf, 2 sprigs flat-leaf parsley, 2 sprigs thyme, wrapped in a leek green and tied with a string)

1 tablespoon whole black peppercorns

4 litres water

1 small head Savoy cabbage, cored and leaves separated

2 large carrots, peeled and roughly chopped

½ celery root, peeled and roughly chopped

8 button mushrooms, trimmed

4 baby leeks, trimmed

4 baby white turnips, peeled

4 cippoline onions

2 Yukon Gold potatoes, peeled and roughly chopped

1 stalk celery, roughly chopped

Condiments:

Cornichons

Whole grain mustard

Dijon mustard

Crushed black pepper

Freshly grated horseradish

Coarse salt

Herbed oil (chopped parsley, tarragon, chives, shallots, and black pepper in olive oil)

Heat a Dutch oven or large pot to medium/high heat and add some olive oil. Place the onion halves cut side down in the pan and cook until very dark brown/burnt.
Remove the onion from the pot and sear the shank, brisket and cheeks on all sides until browned.
Add the onion back to the pan with the beef, water, peppercorns and bouqet garni and bring to a boil. Reduce to a simmer and place into the oven at 300 F for 3 hours or until the meat is very tender.
Once the meat is cooked, allow it to rest in the cooking liquid for at least one hour and remove from the liquid.
Strain the broth through a fine sieve while reserving the liquid and discarding all of the solids.
Return the broth back to the pot, bring to a boil and season with salt and pepper to taste.
Place the cabbage, carrots and celery root in the broth and simmer for 10 minutes
Add the mushrooms, leeks, turnips, onions, potatoes and celery and simmer for 15 minutes.
Add the brisket, shank, and cheeks back to the pot and gently simmer for an additional 10 minutes.
Serve everything including the broth in a large shallow bowl with all condiments around the table.

Korean style beef tartare

Beef tartare is a classic Parisian bistro dish that truly showcases the flavour of the beef. Here we have used Korean flavours as they have a rich tradition of using beef in many ways.

350g top butt (diced into 1cm cubes)

½ hosui pear (peeled and diced into 1cm cubes)

2 tsp toasted sesame seeds

2 tbsp chives (chopped)

4 tbsp kimchi (chopped)

1 egg yolk

3 tbsp soy sauce

2 tbsp sesame oil

1 tbsp honey

Whisk together the soy sauce and honey. Once incorporated, whisk in the sesame oil.
In a small mixing bowl, mix together the beef, sesame seeds, chives, pear, kimchi and egg yolk.
Dress the mix with the soy and sesame dressing to taste.
Finish with grey sea salt (sel de guerand).

Serve with puffed rice crackers

Red wine marinated flank steak

600g flank steak

4 garlic cloves (chopped)

3 shallots (chopped)

1 cup red wine (consider one from Ontario)

½ cup red wine vinegar

3 tbsp olive oil

1 tbsp rosemary (chopped)

½ tsp black pepper

1 tsp salt

Mix all ingredients together except for the steak.
Pour half of the marinade into a glass container and place the steak on top.
Pour the rest onto the top of the steak and let stand in the fridge for 6 hours minimum, 12 hours maximum – while turning the meat over every 3 hours or so.
Grill on a very hot BBQ, over coal if possible, for 6-7 minutes per side.
Let rest for 5-10 minutes and slice thin.

This is a dish best served in the summer alongside anything fresh and in season that you can put on the grill with the steak, such as corn, eggplants, sweet peppers, radicchio, broccoli, rabe, sweet onion, mushrooms and peaches.

The leftover red wine should also pair great with the dish.

How U of T expert used gaming to improve student nutrition in Nigerian schools

noreen.rasbach — Mon, 16 Jul 2018 16:02:12 +0000

How U of T expert used gaming to improve student nutrition in Nigerian schools noreen.rasbach Mon, 07/16/2018 - 12:02

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Women sell farm produce in Jos, Plateau State, Nigeria (photo by Shutterstock)

Topic

Research & Innovation

The Conversation

University of Toronto Scarborough

Subheadline

The Conversation with U of T's Obidimma Ezezika

The worsening of dietary habits among youth appears to have no geographical bounds. And improving dietary behaviour has become a critical public health challenge around the globe.

This is especially true in many parts of sub-Saharan Africa (SSA), where we have seen a rapid transition from wholesome traditional diets to a more Western diet consisting of foods high in sugar, saturated fat and salt.

This trend – generally referred to as the nutrition transition – has imposed a double burden of diet-related chronic diseases in SSA, a place where malnutrition and obesity now coexist.

This transition is affecting many youth, who make up approximately 33 per cent (344.4 million people) of the population. And the size of this demographic group is set to double – to reach 605 million by 2050.

With the exception of South Africa, where over 40 per cent of the adult population is now overweight or obese, most countries in SSA are still in the early stages of the nutrition transition.

This offers a window of opportunity to learn from other countries and take proactive steps to intervene at earlier ages and lessen the harm to the health of the population.

I have just published the results of a new study that documents the effectiveness of a nutrition gamification program – Nutrido – in improving dietary behaviour among youth in Abuja, Nigeria.

Why a nutrition game?

Given my experience working on food security issues for more than 10 years and teaching a food security and food sovereignty course at the University of Toronto, one question I see a lot is: How do I get youth to eat more fruits and vegetables and less junk food?

This question was very pronounced for me during a seven-year food security study across nine African countries, where I witnessed first-hand the rapid nutrition transition occurring in many urban city centres, from Nairobi to Abuja to Cape Town and Cairo.

Canal Walk food court in Cape Town, South Africa (photo by Henry M. Trotter via Wikimedia Commons)

During the same time period, there has been an increased interest in games and social media platforms among African youth.

This raised the possibility of piggybacking on this trend, to nudge youth towards healthier eating habits.

We wondered: Could games play an important role in nutrition education, and even in reversing this trend?

Designing for adolescents

Gamifying nutrition can be referred to as the strategy of employing game design elements to improve dietary behaviour.

A good example is the FIT Game, which was shown to increase the intake of fruits and vegetables by at least 30 per cent among elementary school children in the United States.

Looking at how we could bring this concept to the sub-Saharan African context, our teams in Abuja and Toronto came together to develop a gamification program (Nutrido) tailored for adolescents. It consists of a nutrition board game, student clubs and vouchers that are redeemable for fruits and veggies.

The board game comes with a stack of playing cards, dice, playing pieces, play money and a list of rules. Players must navigate scenarios such as choosing whether to purchase a healthy meal or an unhealthy meal (given their play money) or landing on an action card that requires them to perform physical activity exercises (e.g., “Do 10 push-ups”).

The core strategy of the game is to buy healthy food cards to get as many points as possible. These points can be “cashed in” through a voucher system, integrated in the game, to buy real fruits and vegetables from partnering tuck shops.

More fruits and vegetables

To test the impact of our idea, we tried this program in three secondary schools in Abuja. Participants were male and female students in Grade 11 and Grade 12.

Each student took part in a game session (20-30 minutes) once per week over a period of about six weeks. We then assessed its impact on students’ nutrition knowledge, attitudes toward healthy eating and eating behaviour – using semi-structured focus groups.

Grade 11 and Grade 12 students in Abuja, Nigeria, play the Nutrido game (photo courtesy of Obidimma Ezezika)

Importantly, we found that the game improved eating behaviour, specifically the intake of fruits and vegetables. One student said: “I used to skip fruits sometimes, like give it out, but now, I take my fruits.”

When asked exactly how her consumption of fruit had changed, she explained that “on a daily basis, I will say like one or so, but after the game, like five to four times.”

There was also a change in behaviour whereby students spent their own money to buy fruits from the tuck shop while forfeiting junk food. For example, a female student said: “When we go there (the store) every weekday, there’s a section for fruits and all that, but then when nobody ever used to look at that area but now that Nutrido started coming around, people like fruits like apple, people begin to like and learn to have some bit of fruit.”

By extension, participants also redeemed their Nutrido vouchers to purchase fruits from merchants at participating tuck shops.

‘Let food be thy medicine’

The results of the study are now published in the journal Nutrition and Health, and the Nutrido program has been introduced in 10 secondary schools across Abuja.

Almost 2,500 years ago, when Hippocrates made the statement, “Let food be thy medicine and medicine be thy food,” he was pointing at the profound impact that nutrition has on our health.

Until entire communities begin to think differently about the way they approach food, Hippocrates’ words serve merely as a motto – rather than a lifestyle we should strive for.

Obidimma Ezezika is an assistant professor, teaching stream, at the University of Toronto.

This article was originally published on The Conversation. Read the original article.

Time for some vitamin D? U of T researchers find lactose intolerance related to low vitamin D levels

ullahnor — Fri, 12 May 2017 16:40:02 +0000

Time for some vitamin D? U of T researchers find lactose intolerance related to low vitamin D levels

ullahnor Fri, 05/12/2017 - 12:40

Cutline

New research shows people intolerant to lactose also have low levels of vitamin D. Some sunshine could help (photo by Joslynn Gallant via Flickr)

Heidi Singer

Author legacy

Heidi Singer

Topic

New research from the University of Toronto shows that people genetically intolerant to lactose, the main sugar found in dairy, have lower blood levels of vitamin D than the general population.

The researchers found those who had a gene associated with lactose intolerance (called LCT) consumed lower amounts of dairy products than those without that variation. The lactose intolerant also had lower levels of vitamin D in their blood – unsurprisingly, since dairy products are fortified with vitamin D, and most people don’t get enough of this vitamin from the sun or from other foods.

“We were not surprised that lactose intolerant people ate less dairy, but we were surprised that they did not compensate by supplementing or eating other foods fortified with this crucial nutrient,” said Ahmed El-Sohemy, a professor of nutrition at the Faculty of Medicine, who authored the study with Ohood Alharbi, a PhD candidate in U of T’s department of nutritional science.

“These findings speak to the need for greater awareness for those who limit dairy because of lactose intolerance. They need to be mindful of getting enough vitamin D from other fortified foods like certain brands of orange juice, or to consider trying lactose-free dairy products.”

The researchers also confirmed previous findings that those who have the gene for lactose intolerance are slightly shorter than those who don’t – suggesting insufficient intakes of these essential nutrients are limiting bone growth.

And for the first time, they found that people with just one – instead of two copies – of this variant were also affected by lactose intolerance, albeit to a lesser degree, suggesting that clinical definitions and genetic classifications of lactose intolerance could be expanded.

Lactose intolerance was found across ethnic groups – although the largest proportion by far occurred in people of East Asian heritage.

The study of 1,495 Canadian men and women from different ethnicities will be published in the June 2017 issue of the Journal of Nutrition. It is available now online.

U of T researchers find health benefits differ for probiotic yogurts

ullahnor — Wed, 19 Apr 2017 14:53:21 +0000

U of T researchers find health benefits differ for probiotic yogurts

ullahnor Wed, 04/19/2017 - 10:53

Cutline

A new study of probiotic yogurts finds that not all probiotics found in supermarkets have the same health benefits (photo by denAsuncioner via Flickr)

Heidi Singer

Author legacy

Heidi Singer

Topic

A University of Toronto study, the first of its kind, reveals that not all probiotic yogurts are created equal.

While all probiotic yogurts support intestinal health, a study of common supermarket yogurts marketed for their probiotic health properties, found that products could offer a variety of additional health benefits not advertised on their label. However, in many cases the dosage of probiotics in these products are too low to offer the health benefits found in clinical trials.

The study was published online today in the journal Nutrients.

Read the story at CBC News

Read the Metro story

“Most people don’t realize that different products contain different types of probiotic bacteria and therefore may offer different health benefits,” says Mary Scourboutakos, a postdoctoral researcher who co-authored the study along with Assistant Professor Elena Comelli and Professor Mary L’Abbé, chair of the Faculty of Medicine's department of nutritional science. “Our study showed there’s a gap between the health benefits found in clinical trials and the benefits that consumers can expect to receive from the probiotic food products in the marketplace.”

Read the CTV News story

Probiotics are “good” bacteria that survive digestion and reach our intestines. All probiotic yogurts are healthy because these good bacteria support the intestines, aid digestion and crowd out harmful bacteria in the gut. Currently, Health Canada requires that products labelled as “probiotic” contain at least one billion per serving.

“Products are meeting the minimum standards to be called probiotics but we found that with higher doses some products could be doing much more,” says Comelli.

Probiotics are one of the fastest-growing product markets globally. Emerging research has shown probiotics can improve conditions such as irritable bowel syndrome (IBS) and decrease risk for the common cold. But not all yogurts contained the strains that help with these specific conditions. And sometimes, yogurts that contain these strains have dosages that are up to 25 times lower than has been found to be effective in clinical trials.

The researchers found that the strain Bifidobacterium lactis DN-173 010 contained in Dannon’s Activia has been shown to improve regularity as well as decrease stomach pain and bloating in individuals with irritable bowel syndrome. But they found that two to 25 servings of this yogurt per day may be necessary, depending on the condition being addressed.

Another common brand, DanActive, contains the Lactobacillus casei DN 114-001 strain, which helps decrease the frequency and length of the common cold and the flu. In this case, two servings per day are needed to achieve these effects.

Yoptimal contains the Bifidobacterium lactis BB12+ and Lactobacillus acidophilus LA-5 strains, which decrease cavity-causing bacteria and may marginally improve glycemic control and cholesterol levels in diabetics. One-half to two servings per day are needed, according to the study.

BioBest also fights the common cold, but due to its lower dosage, 20 servings a day would be needed to achieve the effect observed in clinical trials.

But none of the yogurt brands makes these other health claims. In Canada, food labelling laws prevent them from doing so. Consumers looking for protection against specific conditions would have to research which strains help, and then search yogurt labels to find those strains. The research shows that more specific probiotic labelling laws could help consumers make more informed choices.

Scourboutakos noted that kefir (fermented milk) products in the study (produced by Liberté and Iogo) had the greatest variety of different types of probiotic bacteria (sometimes greater than 10) and often contained the highest dosage. While there were no studies testing the particular combinations of strains found in these products, some research suggests that products with a larger number of strains (such as these kefirs) may have greater health benefits compared to products that only contain one or two strains. The study results underscored the lack of research on probiotic foods.

The researchers focused on the most common supermarket brands, and did not study health-food store yogurts. To receive benefits, probiotics need to be consumed regularly because these bacteria are constantly passing through the body.

Comelli has received funds from a probiotic company to support her research, but the company was not involved in this study.