Newsletter – Aileen Burford-Mason, PhD

October 14, 2025

Who’s Afraid of the Big Bad Egg?

In this issue

Who’s afraid of the big bad egg? Why eggs deserve a regular place in your diet
Recipe: The brainiacs breakfast
Fall webinar series: Register now

Who’s Afraid of the Big Bad Egg?

Why Eggs Deserve a Regular Place in Your Diet

For decades, eggs were unfairly demonized. Branded as cholesterol-laden artery-cloggers, they were pushed off breakfast tables in favour of their fat-free whites. But science has gradually reversed that view, revealing eggs – yolks and all – as a near-perfect food.

The Cholesterol Myth

The idea that eggs raise blood cholesterol has been largely debunked. Dietary cholesterol has minimal impact on blood cholesterol because the liver produces most of what is circulating in the blood. When dietary intake falls, the liver simply makes more. So, cutting out eggs won’t reliably reduce blood cholesterol.¹

That’s not to say that raised blood cholesterol isn’t a problem. It is. High levels, particularly of LDL cholesterol, are strongly associated with increased cardiovascular risk. But the key point is that for most people, it’s not cholesterol-rich foods like eggs that’s driving those levels up. Instead, it’s excess intake of sugar, refined carbohydrates, trans fats, and ultra-processed foods that are more significant contributors. One study of patients with high blood pressure found that those who ate more than seven eggs per week had up to 29% lower mortality over 11 years than those who ate fewer than two.²

However, despite decades of reassuring evidence suggesting eggs have been unfairly implicated in heart disease risk, the anti-egg headlines still persist.

Are the Negative Studies Reliable?

Many studies claiming eggs harm heart health don’t stand up to close scrutiny. One Finnish study, often cited as evidence that eggs are bad for us, examined egg intake at the start of the study, then linked it to mortality rates 31 years later—with no information on diet or lifestyle changes that may have occurred during the intervening decades.³ That’s not robust science.

Another major flaw is failure to consider what other foods are eaten with the eggs which may affect cardiovascular health. In North America, they are often served with bacon, sausages and fried potatoes. By contrast, in European countries eggs are commonly eaten with vegetables, whole grains, or olive oil—as in Spanish tortillas or Italian frittatas. In many studies, eggs consumed in cakes or pastries are still counted as “egg intake,” ignoring the fact that any health risks are just as likely to be due to the sugar, white flour, and trans fats these foods contain.

Nutrient-Dense by Design

Eggs are nutritionally rich. The white of an egg provides 6 grams of high-quality protein. But it is in the yolk where you’ll find most of the nutrients—including all the fat-soluble vitamins (A, D, E, K), B12, folate, selenium, iodine, and zinc.

Egg yolks are a rich source of choline, essential for liver and brain health. Choline is needed to produce the neurotransmitter acetylcholine, sometimes called the brain’s memory manager. Deficiency of choline has been linked to poor memory and brain fog, and even dementia⁴ [More about choline in future newsletters]. Egg yolks also contain eye-protective carotenoids (lutein and zeaxanthin) needed to prevent macular degeneration, omega-3 fatty acids (especially in pasture-raised or flax-fed hens), and natural vitamin D in summer-laid, free-range eggs.

Eggs are one of the few unprocessed, whole foods that have remained virtually unchanged throughout human history. When consumed in the context of a healthy diet, they deserve their place as a regular part of your plate.

What Do Current Guidelines Say?

Given that the evidence linking eggs to heart disease is weak, and that stronger studies showing no such connection, current guidelines generally state that eating up to two eggs a day is safe and compatible with heart health.

The Brainiac’s Breakfast (Serves 1)

High-protein, brain-supportive fuel to carry you through the day

This breakfast of elevated scrambled eggs and anti-oxidant-rich vegetables is designed to fuel both mental focus and physical energy. It features 30 g of protein from eggs – nature’s original brain food and a rich source of choline, B12, and high-quality protein – together with 2 servings of anti-oxidant-rich vegetables. This powerhouse plate is naturally gluten-free and keto-friendly, making it ideal for a wide range of dietary preferences.

For the scrambled eggs:

2 whole eggs
½ cup egg whites (from a carton)
30g (about ¼ cup) grated sharp cheddar or crumbled feta
1 finely chopped green onion
1 teaspoon butter or olive oil
Salt and pepper to taste

For the vegetables:

1 teaspoon olive oil
½ cup chopped red bell pepper
1 cup fresh spinach
Salt and pepper, to taste

Method

1. Sauté the vegetables

Heat a little oil in a skillet over medium heat.
Add chopped red bell pepper and cook 3–4 minutes until soft.
Add spinach and cook until just wilted (about 1 minute).
Season with salt and pepper. Set aside.

2. Scrambled eggs

In a bowl, whisk together 2 whole egg plus ½ cup egg whites.
Season lightly with salt and pepper.
In a non-stick skillet, heat 1 tsp butter or oil over medium-low heat.
Pour in the egg mixture plus the chopped green onion.
Stir gently and cook slowly until just set and creamy.
Stir in the cheese, allowing it to melt slightly.

To serve

Plate the scrambled eggs alongside the sautéed vegetables for a flavour-packed, balanced breakfast.

Nutrition Highlights

Contains 30g protein; 2 servings of vegetables; 335mg choline, 70mg magnesium

THE NEW NUTRITION, FALL 2025

Register now for our live webinar series:

The New Nutrition Webinar Series has been running each Spring and Fall since 2003. This series of 4 live webinars is an up-to-date exploration of the critical role diet and supplements play in maintaining health.

The series breaks down complex nutritional science into practical, easy-to-understand information, offering actionable advice on optimizing diet and supplements, should interest anyone concerned with maintaining good health.

Rooted in the latest scientific research, the webinars should also appeal to doctors, nutritionists, and other health professionals seeking timely, evidence-based insights into the rapidly evolving field of nutrition.

WEEK 1. Vitamin D, Mood and Immunity:
The Sunshine vitamin’s role in mental health and immune resilience
Wednesday 5th November 2025

Best known for its role in bone health, vitamin D is also critically important for immunity and brain health. Low vitamin D levels are linked to depression, seasonal affective disorder (SAD) and increased risk of infection, especially in winter. This webinar explores how vitamin D supports mood and immune defenses, and offers practical guidance on recognizing and correcting deficiency.

WEEK 2. High Cholesterol:
Can it be controlled without medication?
Wednesday 12th November 2025

High cholesterol is a major risk factor for heart disease, yet medication may not be the only approach to cholesterol control. This webinar reviews the evidence for non-pharmaceutical approaches, including diet and lifestyle changes and the use of carefully curated nutritional supplements. We also consider when lifestyle measures may not be enough and medication needed.

WEEK 3. Should everyone avoid gluten?
Wednesday 19th November 2025

Gluten-free diets are hotly debated as a dietary approach to better health. While everyone agrees that anyone diagnosed with celiac disease must avoid gluten, growing evidence suggests that gluten and other wheat proteins may also affect individuals without celiac disease. This webinar will explore the science behind non-celiac gluten sensitivity (NCGS), explore who might benefit from a gluten-free diet and provide practical guidance on identifying and managing gluten-related health issues.

WEEK 4. Those Senior Moments:
Can diet and supplements save your memory
Wednesday 26th November 2025

Memory lapses are often dismissed as an inevitable part of aging, but growing evidence suggests that nutrition plays a vital role in supporting brain health and preventing memory decline. This webinar will review the substantial amount of recent research linking memory decline with inadequate nutrition, and show how dietary patterns and specific supplements can help preserve cognitive function, reduce the risk of decline, and support sharper memory at any age in life.

COST: Single webinars are CAD 39.00. Register for the complete series for CAD 125.00

To register visit https://isom.ca/learning/events/new-nutrition-fall-2025/

References

1. Carter S, et al. Impact of dietary cholesterol from eggs and saturated fat on LDL cholesterol levels: a randomized cross-over study. Am J Clin Nutr. 2025 Jul;122(1):83-91

2. Zhang Y., Zhang D. Red meat, poultry, and egg consumption with the risk of hypertension: A meta-analysis of prospective cohort studies. J. Hum. Hypertens. 2018;32:507–517

3. Zhong VW et al. Associations of Dietary Cholesterol or Egg Consumption With Incident Cardiovascular Disease and Mortality. JAMA. 2019 Mar 19;321(11):1081-1095.

4. Goldberg E et al. Working Memory and Inadequate Micronutrient Consumption in Healthy Seniors. J Nutr Gerontol Geriatr. 2019 Jul-Sep;38(3):247-261

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January 6, 2025

Nutrition 2025: Working towards the optimal diet

As we enter this fresh new year, it’s the perfect time to embrace renewed intentions for a healthier, more balanced lifestyle. Whether you’re looking to fuel your body with nourishing foods, cultivate mindful habits, or find motivation to stay active, this space is here to support your every step. Let’s commit to making small, sustainable changes that empower us to feel our best—physically, mentally, and emotionally.

Here’s to a year of growth, wellness, and lasting positive transformations!

In this issue

Nutrition 2025: Working towards the optimal diet
Back on the treadmill?
Recipe: Curried Coconut Cod

Nutrition 2025: Working towards the optimal diet

In the world of diet and nutrition, a new concept is emerging: positive nutrition. Positive nutrition is an approach to food that emphasizes nourishing the body with wholesome, nutrient-dense foods while fostering a healthy relationship with food.[1] It is not merely about avoiding “bad” foods, but rather about cultivating a lifestyle that supports overall well-being through balanced dietary choices. However, achieving positive nutrition involves more than just focusing on what we should eat; it requires mindful consideration of what we should limit or avoid, particularly when it comes to ultra-processed foods that can undermine our health.

Positive Nutrition: What is it?

At its core, positive nutrition is grounded in the basic biochemical needs of the human body. Our bodies require a variety of macronutrients—proteins, fats, and carbohydrates—as well as micronutrients—vitamins and minerals—to function optimally. These nutrients are essential for cellular repair, energy production, immune function, heart and brain health, and so much more. Some of these nutrients are classified as essential – meaning we can’t survive without them. These include vitamins and minerals, essential amino acids (from protein), and essential fatty acids (omega 3 and omega 6).

This is where the concept of “getting the good stuff in” becomes crucial. Positive nutrition encourages the consumption of whole, minimally processed foods such as fruits, vegetables, lean proteins, healthy fats, and whole grains. These foods are not only rich in essential nutrients but also offer fiber, antioxidants, and phytochemicals that support long-term health and prevent chronic disease.

Can we get everything we need from Food?

The challenge, however, is that it is difficult to ensure that we are meeting all of these needs through food alone, especially without relying on nutritional supplements. Even the most carefully planned diet can sometimes fall short of providing all the required micronutrients and in sufficient amounts.

The bioavailability of nutrients in foods can vary, and factors like soil depletion, food storage, and transportation can affect nutrient content. For example, when it comes to getting vitamin C through food, we naturally think of oranges and other citrus fruits. But how much vitamin C really is in that orange? Well, it depends on how fresh the orange is, since the vitamin C content degrades over time, being influenced by both the temperature the orange is stored at and how long it is since the orange was picked.[2]

What not to eat

Equally important to the concept of positive nutrition is the need to “get the bad stuff out,” particularly factory-altered ultra-processed foods, which have become a staple in modern diets. These foods are often high in added sugars, unhealthy fats, excess sodium, and artificial additives while being low in essential nutrients. Their overconsumption can lead to negative health outcomes, including obesity, heart disease, and type 2 diabetes.

Ultra-processed foods can also disrupt the delicate balance of gut microbiota and impair the body’s ability to properly metabolize nutrients. Therefore, part of positive nutrition is reducing the intake of these foods to minimize their potential harm, while still leaving room for occasional indulgences that contribute to the enjoyment of life.

The challenge in balancing the good and the bad is that modern food systems often prioritize convenience and taste over nutritional quality. In our fast-paced world, it is easy to rely on packaged snacks, sugary beverages, and quick meals that are far removed from their natural, nutrient-rich origins. This disconnect from real food makes it even harder to ensure that we are meeting our biochemical needs without external supplementation.

Supplements can fill the gaps

Ultimately, positive nutrition is about finding a balance: ensuring that we are getting the “good stuff” in—nutrient-dense, whole foods—while minimizing our exposure to ultra-processed, nutrient-poor options. Getting the bad stuff out! Supplements like multivitamins or fish oil can certainly help fill gaps, but they can never replace the complex array of nutrients found in whole foods.

While it may be difficult to meet all of our biochemical needs purely through food, mindful eating – making whole food choices and minimizing harmful foods – can go a long way in supporting health and well-being. Positive nutrition isn’t about perfection but about making consistent, sustainable choices that nourish both body and mind.

You can read more about my science-based approach to healthy eating and supplementation in my books: Eat Well, Age Better (Dundurn Press); The Healthy Brain (HarperCollins Canada), and The War Against Viruses (HarperCollins Canada)

Back on the treadmill?

Getting Back to Exercise After the Holidays

For most of us, the holiday season is a time of relaxation, indulgence, and a well-deserved break from regular routines. However, after weeks of festive foods and less physical activity, it’s important to refocus on fitness. Getting back into a consistent exercise routine can be daunting, but the benefits of exercise are worth the effort and can help you regain your energy, strength, and overall health.

This season of the year is often associated with increased depression, and a recent meta-analysis confirms what we have known for some time – exercise can go a long way to countering the winter blahs. Whether you favour walking or jogging, yoga, or strength training, many different types of exercise are effective treatments for depression, particularly when that exercise is intense.[3]

Aerobic Exercise: Boosting Cardiovascular Health

Aerobic exercises, such as walking, running, cycling, or swimming, are crucial for improving heart health. They help increase your heart rate, improve lung capacity, and boost overall stamina. Regular aerobic activity also supports weight management, burns calories, and reduces the risk of chronic conditions like heart disease, diabetes, and high blood pressure.[4] Even after a break, just a few sessions of aerobic exercise each week can have noticeable benefits on your energy levels and mood.[5]

Strength Training: Rebuilding Muscle Mass

Strength training, using free weights, machines, or bodyweight exercises, is equally important after the holidays. During a break from exercise, muscle mass can diminish, and strength may decline.[6] Regular strength training helps rebuild muscle, strengthens bones, and improves metabolism by increasing muscle mass, which in turn helps burn more calories, even at rest. It also reduces the risk of injuries by stabilizing joints and improving posture.

Strength training is especially important as we age, and has been shown to increase muscle mass, strength, and physical performance in older people, even in those older than 85 years.[7]

Stretching: An Overlooked Essential

One aspect of fitness often overlooked is stretching. While many people focus on cardiovascular and strength exercises, stretching is essential for maintaining flexibility, reducing muscle stiffness, and preventing injury. A good stretching routine can improve mobility, making it easier to perform other physical activities and daily tasks. Regular stretching can improve balance as well as help with joint and muscle pain,

Stretching can even help alleviate stress and boost mood[8] by relaxing both the mind and body, yet it is the one type of exercise that is often neglected.

Exercise Alone Isn’t Enough

While regular exercise is important, it’s important to remember that the best outcomes come when exercise is paired with a balanced diet. Diet is essential for maximizing the benefits of exercise by providing the necessary energy for performance, supporting muscle recovery and growth, preventing injury, and maintaining overall health. Without proper nutrition, even the most rigorous exercise routine may not lead to optimal results.

Current evidence shows that 2.5 to 5 hours of moderate or vigorous physical activity per week confers maximum benefits for longevity, as well as reduces the risk of chronic diseases like heart disease and diabetes. But can you over-exercising? Some research does suggest that more than 10 hours a week of vigorous exercise might reduce some of these health benefits.[9]

Conclusion

As the holiday season wraps up, getting back into a routine of regular exercise is essential for overall health. Whether it’s aerobic exercise, strength training, or a dedicated stretching regimen, each type offers unique benefits for your body. Remember that a good diet is just as important as the exercise itself—together, they create the foundation for better health, stronger muscles, and a more energized life.

Curried Coconut Cod:

Makes 4 servings

Ingredients:

¾ cup unsweetened coconut milk
1/2 teaspoon of bottled or freshly grated ginger
1 teaspoon of finely grated or bottled garlic
½teaspoon turmeric
¼ to ½ teaspoon red pepper flakes to taste
1 tablespoon honey
2 limes
½ cup of chopped cilantro
4 (6-ounce) fillets of cod, skin off
8 strings of cherry tomatoes on the vine
3 tablespoons olive oil

Preparation:

In a large bowl, whisk together the coconut milk, ginger, garlic, turmeric, red pepper flakes, honey and 1 teaspoon salt.
Zest and juice 1 lime directly into the coconut milk mixture. Stir in ¼ cup chopped cilantro. In a large oven-proof dish, add the fish fillets and turn to coat. Marinate in the refrigerator for 15 to 30 minutes. (Note: Do not leave for longer, or the lime juice will begin to ‘cook’ the fish.)
Heat oven to 425 degrees.
Place the tomatoes around the marinated fish and spoon all the marinade in the dish over the fish. Drizzle 1 tablespoon of oil over the tomatoes and fish.
Transfer to the lower-middle rack of the oven and roast until the surface of the fish is opaque and the center is not quite cooked through – 8 to 10 minutes.
Remove the pan from the oven and turn on the broiler. Broil the fish on high rotating the pan once, until the fish is tender and the tomatoes are wrinkled but not browned – about 5 to 6 minutes, depending on the thickness of the fish.
Serve the fish and tomatoes with the remaining lime cut into wedges. Spoon over the remaining sauce and garnish with the reserved cilantro.

Serve with buttered green beans or other green vegetable.

To serve: drizzle with cream or add a dollop of yogurt for creaminess. If desired, garnish with a sprig of fresh thyme or a few slices of pear.

References

[1] Martini D et al. Positive nutrition: shifting the focus from nutrients to diet for a healthy lifestyle. Eat Weight Disord. 2023 Jun 21;28(1):51

[2] Budiarto R, et al. Vitamin C variation in citrus in response to genotypes, storage temperatures, and storage times: A systematic review and meta-analysis. Heliyon. 2024 Apr 10;10(8):e29125.

[3] Noetel M et al. Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ. 2024 Feb 14;384:e075847.

[4] Scatigna M et al. Physical activity as a key issue for promoting human health on a local and global scale: evidences and perspectives. Ann Ig. 2019 Nov-Dec;31(6):595-613

[5] Hearing CM et al. Physical Exercise for Treatment of Mood Disorders: A Critical Review. Curr Behav Neurosci Rep. 2016 Dec;3(4):350-359

[6] Dirks ML, Wall BT, van Loon LJC. Interventional strategies to combat muscle disuse atrophy in humans: focus on neuromuscular electrical stimulation and dietary protein. J Appl Physiol (1985). 2018 Sep 1;125(3):850-861

[7] Marzuca-Nassr GN et al. Muscle Mass and Strength Gains Following Resistance Exercise Training in Older Adults 65-75 Years and Older Adults Above 85 Years. Int J Sport Nutr Exerc Metab. 2023 Oct 24;34(1):11-19

[8] Sudo M, Ando S. Effects of Acute Stretching on Cognitive Function and Mood States of Physically Inactive Young Adults. Percept Mot Skills. 2020 Feb;127(1):142-153

[9] O’Keefe EL, Torres-Acosta N, O’Keefe JH, Lavie CJ. Training for Longevity: The Reverse J-Curve for Exercise. Mo Med. 2020 Jul-Aug;117(4):355-361

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October 24, 2024

Protein: Are we eating too much?

In this issue

Protein: Are we eating too much?
Resetting our relationship with alcohol
Recipe: Parsnip and Pear Soup

Protein: Are we eating too much?

Understanding Protein and Its Role in Our Health

Protein is a fundamental component of the human body, playing a crucial role in maintaining our health. The term “protein” comes from the Greek word protos, meaning “first,” highlighting its vital importance. Our skin, nails, and hair are made of protein, as are our muscles and connective tissues. Protein acts as the framework for our bones, anchoring minerals that help them grow strong. Additionally, vital organs like the lungs, heart, kidneys, and bladder are primarily composed of protein. All of which need constant upkeep through diet.

Our body’s key functions are regulated by two interconnected systems: the nervous and endocrine systems, collectively known as the neuroendocrine systems. This system produces messenger molecules that coordinate various activities throughout the body. Molecules produced by the nervous system, called neurotransmitters, include important substances like dopamine and serotonin, which influence our mood, concentration, memory, and sleep. The endocrine system consists of glands that produce hormones, such as insulin. Most neurotransmitters and hormones are derived from amino acids—the building blocks of protein. So having a consistent supply of protein in our diet is vital for our neuroendocrine system to function effectively.

Unlike fats and carbohydrates, our bodies have a limited ability to store protein. Within just a few days of not consuming enough protein, we will start to break down muscle tissue to obtain the necessary amino acids. This can lead to noticeable muscle loss, particularly after prolonged periods of inadequate protein intake.

Older adults, especially those living alone or with reduced appetites, are often at risk for a condition known as sarcopenia. This age-related loss of muscle mass and strength can significantly impact their overall functioning. Research has shown that protein supplementation can help maintain muscle mass and prevent frailty in those at risk.[1]

There’s a misunderstanding not only among the public, but also somewhat in our profession about the [protein] RDA. People in general think we all each too much protein. On the contrary, doubling up on the RDA for protein is a safe and good range to aim for.

The American Journal of Clinical Nutrition 2015;101(6):1317S-1319S

How much protein do we really need?

There’s a common belief that North Americans consume too much protein, often exceeding the Recommended Dietary Allowance (RDA). However, the RDA is the minimum amount required to prevent deficiencies, not necessarily what’s optimal for health. Currently, the RDA for protein is set at 0.8 grams per kilogram of body weight per day. However, more recent research suggests that 1.2 g per kilogram of body weight is more realistic.[2] For an average adult weighing around 70 kilograms, this translates to a minimum of 85–90 grams of protein per day.

For weight loss and maintenance: 1.2–1.6 grams per kilogram
For bone health and osteoporosis prevention: 1.2–1.6 grams per kilogram
For adults aged 65 and older: At least 1.2 grams per kilogram
For surgical recovery or in intensive care: 1.2–2.5 grams per kilogram

Interestingly, many people tend to consume most of their protein at dinner, while breakfast often consists of carbohydrates with little protein. Recent research has highlighted the importance of spreading protein intake throughout the day, benefiting not only older adults but healthy individuals of all ages as well.

The Bottom Line?

Far from eating too much protein, recent research suggests that many of us are consuming too little. For optimal mental and physical well-being, and to maintain muscle mass, the average person should aim for 30g of protein at each of three meals – breakfast, lunch, and dinner.

Resetting our relationship with alcohol: The rise of mindful drinking

As the holiday season approaches, many of us look forward to parties, family gatherings, and celebrations that often feature alcohol. However, as conversations around health and wellness evolve, so too does our relationship with alcohol. This article explores the latest trends in reducing or eliminating alcohol consumption, the health implications of alcohol, and practical tips for navigating social situations while prioritizing well-being.

In recent years, a growing movement has emerged advocating for mindful drinking, which encourages individuals to evaluate their alcohol consumption and make intentional choices. This trend has led to an increase in non-alcoholic beverages and low-alcohol options, catering to those looking to enjoy social settings without the drawbacks of traditional alcoholic drinks.

Popular brands now offer sophisticated non-alcoholic wines, beers, and spirits, making it easier than ever to partake in celebratory toasts without the buzz. This shift reflects a broader societal interest in health and wellness, prompting many to reassess their drinking habits.

Are there any health benefits from drinking alcohol?

Much research over the last several decades has shown modest health benefits from drinking moderate amounts of alcohol, which is defined as up to one drink per day for women and up to two for men.

Cardiovascular Health: Some studies suggest that moderate drinking may improve heart health, particularly red wine, which contains antioxidants like resveratrol.[3]
Risk of Dementia: Low intakes may be protective but more than moderate consumption can increase the risk.[4]
Diabetes: Moderate alcohol intake may decrease the risk, especially in men.[5]

Conversely, excessive alcohol consumption—whether through daily drinking or binge drinking at weekends – can lead to serious health issues:

Physical Health Risks: Chronic drinking can lead to liver disease, heart problems, and an increased risk of certain cancers.
Weight Gain: This was especially obvious when alcohol consumption increased during the COVID pandemic.[6]
Mental Health Impact: Alcohol is a depressant and can exacerbate anxiety and depression, leading to a cycle of reliance and mental health decline.
Addiction: Regular heavy drinking can lead to alcohol dependence and addiction, complicating personal and professional relationships.

Practical Tips for Reducing Alcohol Intake

If you’re considering a reduction in your alcohol consumption, here are some practical strategies to help you along the way:

Set Clear Goals: Decide how many days a week you want to drink and how many drinks you’ll allow yourself on those days.
Choose Alcohol-Free Days: Designate specific days each week as alcohol-free.
Mindful Drinking: When you do drink, savor each sip. Pay attention to the flavors and aromas, and enjoy the experience rather than consuming mindlessly.
Stay Hydrated: Drink water or other non-alcoholic beverages between alcoholic drinks to pace yourself and stay hydrated.

Enjoyable and Healthy Alternatives

There are numerous enjoyable and healthy substitutes for traditional alcoholic beverages:

Mocktails: Create festive non-alcoholic cocktails using fresh fruit juices, herbs, and sparkling water.
Non-Alcoholic Beer and Wine: Explore the growing market of non-alcoholic beers and wines that offer similar flavors without the alcohol.
Herbal Teas and Infused Water: Experiment with various herbal teas or infuse water with fruits and herbs for a refreshing alternative.

Finding Balance

Ultimately, resetting our relationship with alcohol involves finding a balance that suits your lifestyle and health goals. It’s about making informed choices, understanding the impact of alcohol, and recognizing that it’s perfectly acceptable to enjoy celebrations without relying on alcohol as a centerpiece.

As we gather with friends and family this holiday season, consider how you can navigate social situations with mindfulness and intentionality. Whether you choose to reduce your intake, explore non-alcoholic options, or simply enjoy alcohol in moderation, the key is to prioritize your well-being while still celebrating the joys of connection and togetherness.

Fall is one of my favourite times of the year, marked by a stunning palette of reds and yellows as the leaves change colour and the air turns crisp. This time of year also brings a bounty of seasonal vegetables and fruits. Pumpkins, squash, and sweet potatoes take center stage, while apples and pears are ready for picking. Root vegetables like carrots and turnips are at their best.

These seasonal foods are rich in phytochemicals. Pumpkins, for instance, are high in beta-carotene, which supports eye health, while sweet potatoes are packed with antioxidants that help combat inflammation. Apples and pears provide dietary fiber and quercetin, promoting heart health and aiding digestion.

The following recipe celebrates this abundance in a tasty combination of seasonal flavours and offers both comfort and numerous health benefits, perfect for cozy evenings and festive gatherings.

Pear and Parsnip Soup:

Ingredients:

2 medium parsnips, peeled and diced
2 ripe pears, cored and diced
1 large onion, chopped
2 cloves garlic, minced
2 tablespoons olive oil
4 cups vegetable or chicken broth
1 teaspoon fresh thyme (or ½ teaspoon dried thyme)
Salt and pepper to taste
Optional: cream or yogurt for garnish

Instructions:

In a large pot, heat the olive oil over medium heat, sauté the onions until translucent, about 5 minutes. Stir in the minced garlic and cook for another minute, until fragrant.
Add the diced parsnips and pears to the pot with the thyme, salt, and pepper. Cook for about 5 minutes, allowing the flavors to meld.
Pour in the vegetable or chicken broth, bringing the mixture to a boil. Reduce the heat and let it simmer for about 20 minutes, or until the parsnips are tender.
Use an immersion blender to puree the soup until smooth.
Adjust Seasoning, adding more salt, pepper, or thyme as desired.

To serve: drizzle with cream or add a dollop of yogurt for creaminess. If desired, garnish with a sprig of fresh thyme or a few slices of pear.

References

[1]. Douglas Paddon-Jones, Kevin R Short, Wayne W Campbell, Elena Volpi, Robert R Wolfe, Role of dietary protein in the sarcopenia of aging, The American Journal of Clinical Nutrition, Volume 87, Issue 5, May 2008, Pages 1562S–1566S

[2]. Hurt RT, McClave SA, Martindale RG, Ochoa Gautier JB, Coss-Bu JA, Dickerson RN et al. Summary Points and Consensus Recommendations From the International Protein Summit. Nutr Clin Pract. 2017 Apr;32(1_suppl):142S-151S

[3]. https://news.harvard.edu/gazette/story/2023/06/is-drinking-in-moderation-good-for-your-heart/

[4]. Zarezadeh M, Mahmoudinezhad M, Faghfouri AH, Mohammadzadeh Honarvar N, Regestein QR, Papatheodorou SI, Mekary RA, Willett WC. Alcohol consumption in relation to cognitive dysfunction and dementia: A systematic review and dose-response meta-analysis of comparative longitudinal studies. Ageing Res Rev. 2024 Sep;100:102419

[5]. https://www.hsph.harvard.edu/news/features/moderate-alcohol-intake-may-decrease-mens-risk-for-type-2-diabetes/

[6] . Itatani T, Nakai H, Takahashi Y, Togami C. Factors associated with behavioral and weight changes across adult to elderly age groups during the COVID-19 pandemic. Nutr Res Pract. 2024 Aug;18(4):544-553

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June 18, 2024

Young-Onset Dementia and Vitamin D

Now that the weather is getting warmer my thoughts turn to that most important of nutrients: Vitamin D. From the beginning of April onwards we can make our own vitamin D whenever the weather cooperates and the sun shines! While vitamin D plays a role in the prevention of many chronic diseases, in this issue I focus on the prevention of just one – dementia. Not just in the elderly, but in the growing number of younger adults developing this frightening affliction.

In this issue

Young-onset dementia and vitamin D
Vitamin deficiencies during pregnancy
Recipe: Mid-week main course salad

How young is too young for dementia?

Currently, over half a million Canadians are living with dementia, a number that is projected to double in the next 15 years. Particularly distressing is the fact that while dementia predominantly affects older adults, the condition is not exclusive to the very old.

Young-onset dementia, also known as early-onset dementia, refers to dementia diagnosed between the ages of 30 and 65. While it is less common than dementia in older adults, it still represents a significant and growing portion of cases, with approximately 5% of all dementia cases occurring in individuals under 65 years old.¹ To date, a 19-year-old Chinese youth is the youngest person to be identified with dementia.²

Vitamin D and the brain

Why is young-onset dementia increasing? We really don’t fully understand that yet, and multiple factors may be at play. Now a new study suggests low blood levels of vitamin D may be one of those factors.

The UK biobank is a large-scale biomedical research resource containing genetic, life-style and health information and biological samples (blood, urine, etc.) from half a million people in the UK. The new study, published in the journal JAMA Neurology, analyzed data from everyone in the database who initially has no signs of dementia and followed them for an average of 8 years, and found a clear link between low blood levels of vitamin D and increased risk of developing young-onset dementia.³

We often worry that if a parent or near relative had been diagnosed with dementia that we might be genetically predisposed to the same disease, and in this study genetic factors did increase the risk. But in line with many other published studies, genetics accounted for only a tiny proportion of cases. According to Health Canada only 1% of all dementia cases in Canadians can be attributed to genetics.⁴

Apart from low blood levels of vitamin D, the presence of other health conditions, such as heart disease, diabetes or depression increased the risk of developing young-onset dementia. Many of these factors may be beyond our control. However, making sure we get sufficient vitamin D is something we all should do.

And since vitamin D deficiency is also implicated in the development of conditions like breast and colorectal cancers – two cancers that also appear to be increasing in younger individuals – it makes sense to make sure we maintain healthy blood levels of the sunshine vitamin from an early age.

The all-round benefits of vitamin D

At least 1,000 different genes governing virtually every tissue in the body are now thought to be regulated by 1,25-dihydroxyvitamin D3 (1,25[OH]D), the active form of the vitamin, including those involved in absorption of calcium, immune system functioning and cancer prevention.⁵

Vitamin D is often referred to as the “sunshine vitamin” because it is synthesized in the skin on exposure to ultraviolet light (UVB), so historically we obtained most of our vitamin D from sun exposure. But the further north we live, the more difficult it is for our skin to manufacture vitamin D. For part of the year the angle of the sun is too oblique and contains too little energy to generate vitamin D. Sunscreen is designed to block UVB and prevent sunburn, so when properly applied it will also lower vitamin D synthesis.

In the winter months at latitudes above 37 degrees north or below 37 degrees south of the equator, the skin can’t make vitamin D from the sun, and if you live in these areas, you are at greater risk of vitamin D deficiency. In Toronto where I currently live, we can only make vitamin D form the beginning of April to the end of September, so unless we take vitamin D supplements, we develop progressively lower blood levels over the winter. Even in summer, work often keeps us indoors. If we cover up for religious or cultural reasons, we also court vitamin D deficiency.

Skin pigmentation is a major risk factor for deficiency as skin pigmentation acts as a natural sunscreen. Compared with light-skinned individuals, very dark-skinned individuals require approximately six times the sun exposure to produce the same amount of vitamin D.⁶

Practice sun safety

Harnessing the benefits of sunlight while avoiding its potential risks requires careful planning. For most light-skinned individuals, a half-hour in the summer sun in a bathing suit can initiate the release of 50,000 IU (1.25 mg) vitamin D into the circulation within 24 hours of exposure, and about and 8,000–10,000 IU in dark-skinned individuals.⁷

So, should we increase our sun exposure? Exposing skin to the sun for about 10 to 20 minutes during the summer months is considered safe for most people. But know your skin type: Individuals with fair skin may require less time in the sun compared to those with darker skin. After that, practice sun safety. Wear protective clothing, such as hats, long sleeves and sunglasses, and use sunscreen on exposed skin if staying in the sun for prolonged periods. And never, never, never burn!

Supplementing with vitamin D – how much is enough?

In regions with limited sunlight or during the winter months, it is wise to take vitamin D supplements. But how much is enough? Curiously, the recommended daily intake (RDI) has been officially set in North America at 600 IU regardless of skin type – a trivial amount compared to the amount our ancestors who hunted and gathered, or toiled in the fields would have been acclimatized to making.

What matters most is not so much the amount of vitamin D you take, but the blood level you achieve. This is because the blood level of vitamin D is the best indicator of how much vitamin D is available for use by the body’s tissues and organs. The reference range for blood levels of vitamin D runs from 75 – 250 nmol/L (30 – 100 ng/ml in the USA). After a week’s winter sunshine holiday, vitamin D levels of are likely to be near the top of the current reference range.

Blood levels can vary wildly between individual taking exactly the same amount of vitamin D.⁸Below is an illustration of just this phenomenon. You can see with doses of vitamin D from 1000-10,000, blood levels achieved can range from almost zero (extreme deficiency) to the mid-to high end of the reference range.

Garland CF et al. Anticancer Res. 2011 Feb;31(2):607-11

So, there is no one size fits all regarding vitamin D supplementation: The amount of supplements needed varies from one person to another, depending on various factors such as genetics, age, health status, and gut health. Hence the desirability of blood tests.

Optimizing vitamin D intakes

According to Health Canada, anyone over the age of nine can safely take 4000 IU of vitamin D daily, without a blood test or supervision. This may, or may not, ensure your blood levels will be in the therapeutic range. Optimal blood levels are necessary for a multitude of physiological functions, including bone health, immune function, cancer prevention and overall health. For example, studies have shown an 80% decreased risk of breast cancer with blood levels of 150 nmol/L (60 ng/ml) or higher. ⁹

Therefore, it’s essential to monitor blood levels of vitamin D from time to time. A knowledgeable healthcare professional will help you adjust your supplement doses accordingly to ensure optimal health outcomes. Don’t test blood levels during the summer months, or within 8 weeks of a winter sunshine holiday.

For more information on brain health and vitamin D see my book The Healthy Brain published by HarperCollins Canada

Nutritional deficiencies common in pregnancy

A mother’s vitamin status before she gets pregnant and during the entire pregnancy is extremely important for healthy outcomes – not just for the baby, but also for the mother. Adequate intakes of essential nutrients such as folic acid, iron, calcium, magnesium, omega 3 fats and vitamin D are crucial during this critical period and shortfalls of any of these vital nutrients can lead to serious consequences, such as compromised bone health and impaired immune function.

Multivitamins specially formulated for prenatal use and during pregnancy are widely available and can provide a convenient way to address nutritional gaps. However, a recent research study suggests that some lower dose prenatal multivitamins on the market may be inadequate for preconception and pregnancy. Researchers looked at nutritional intakes in 1,729 women aged 18 to 38 years who were pregnant or planning to become pregnant. Blood levels of multiple essential nutrients were checked, starting in preconception and continuing throughout pregnancy and later during breastfeeding. ¹⁰

Although all the women lived in high-income countries (the UK, The Netherlands and Singapore), where access to healthy food and/or nutrient supplements was not an issue, the researchers found that at the start of the study an astonishing 90% of all participants had low or marginal blood levels for one or more vitamin or minerals.

Half the women were given a standard vitamin supplement, and the other half an enhanced vitamin supplement containing additional B-vitamins, vitamin D and zinc. Blood levels of vitamins and minerals were then measured at regular intervals during the pregnancy and for 6 months after delivery.

After one month blood levels of nutrients were substantially higher among participants in the group given the enhanced supplement than those in the control group, and this continued throughout pregnancy. Vitamin D deficiency (blood levels less and 50 nmol/L) during late pregnancy was seen in 35 percent of those given the standard multivitamin and mineral supplement, and in 8.5 percent of those given the enhanced supplement.

For some time now we have known that inadequate nutrition, especially in the last trimester, adversely affects the baby’s brain development, potentially leading to long-term cognitive and developmental issues. And so, supplementing with multivitamins is the standard recommendation during pregnancy and breast feeding.

This study suggests that women planning to get pregnant should seek out a product that contains higher levels of B-vitamins and add additional vitamin D. Other studies have shown that 4000 IU of vitamin D is safe during pregnancy and significantly reduces the risk of complications of pregnancy including primary Cesarean section. ¹¹

If possible, consult with a knowledgeable health care practitioner about the use of other supplements during pregnancy.

More information on optimal diet and supplements during pregnancy can be found in my book The Healthy Brain (HarperCollins Canada 2017)

Steak (or Chicken) Salad with Balsamic Vinaigrette:

Use leftover protein for a tasty and filling midweek dinner that’s quick and easy to prepare. Serves 4. Provides 3-4 servings of vegetable and 30g of protein per serving.

Ingredients:

12 oz. leftover steak, turkey or chicken, sliced
8 oz. mixed salad greens (lettuce, spinach, arugula) – about 8 cups
1 cup lightly cooked sweet corn kernels (frozen)
1 large avocado, sliced
1 cup of sliced, bottled roasted red pepper
8 oz. cherry tomatoes, halved
1 medium red or sweet white onion, finely sliced

For the Balsamic Vinaigrette:

1/4 cup white balsamic vinegar
1/3 cup extra virgin olive oil
1 clove garlic, minced
1 tablespoon Dijon mustard
Salt and pepper to taste

Instructions:

In a large bowl, combine the mixed salad greens, sweet corn, avocado slices, roasted red peppers, cherry tomatoes, and finely sliced red onion
In a small bowl, whisk together balsamic vinegar, olive oil, minced garlic, Dijon mustard, salt, and pepper. Adjust the seasoning to your taste.
Drizzle the balsamic vinaigrette over the salad. Toss gently to coat all the ingredients evenly.
Arrange the leftover steak or chicken slices on top of the salad.

Feel free to make this dressing your own by adding other favorite ingredients or herbs, and adjusting the dressing ratios to suit your palate. I like to use white balsamic vinegar, as it is lighter than regular balsamic vinegar and has a natural sweetness. But apple cider or white wine vinegar will work just as well.

Bon appétit!

References

[1]. Young-onset dementia diagnosis, management and care: a narrative review Loi SM, Cations M, Velakoulis D. Med J Aust. 2023 Mar 6;218(4):182-189

[2]. https://www.psychiatrist.com/news/a-19-year-old-is-youngest-ever-to-be-diagnosed-with-alzheimers/

[3]. Risk Factors for Young-Onset Dementia in the UK Biobank. Hendriks S et al. JAMA Neurol. 2024 Feb 1;81(2):134-142

[4]. https://www.canada.ca/content/dam/phac-aspc/documents/services/diseases/dementia/risk-factors-prevention/dementia-quiz-eng.pdf

[5]. Benefits of sunlight: a bright spot for human health. Mead MN. Environ Health Perspect. 2008 Apr;116(4):A160-7.

[6]. Vitamin D and skin physiology: a D-lightful story. Holick MF, Chen TC, Lu Z, et al. J Bone Miner Res 2007;22 Suppl 2:V28–33.

[7]. Benefits of sunlight: a bright spot for human health. Mead MN. Environ Health Perspect. 2008 Apr;116(4):A160-7

[8]. Vitamin D supplement doses and serum 25-hydroxyvitamin D in the range associated with cancer prevention. Garland CF, French CB, Baggerly LL, Heaney RP. Anticancer Res. 2011 Feb;31(2):607-11

[9]. Breast Cancer Risk Markedly Lower with Serum 25-Hydroxyvitamin D Concentrations ≥60 vs <20 Ng/Ml (150 vs 50 Nmol/L): Pooled Analysis of Two Randomized Trials and a Prospective Cohort. McDonnell, S.L. et al. PLoS ONE 2018, 13, e0199265.

[10]. Maternal B-vitamin and vitamin D status before, during, and after pregnancy and the influence of supplementation preconception and during pregnancy: Prespecified secondary analysis of the NiPPeR double-blind randomized controlled trial. Godfrey KM et al.PLoS Med. 2023 Dec 5;20(12):e1004260.

[11]. Vitamin D supplementation during pregnancy: double-blind, randomized clinical trial of safety and effectiveness. Hollis BW et al. J Bone Miner Res. 2011 Oct;26(10):2341-57

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December 19, 2023

Healthy Holiday Eating

In this issue

Healthy eating for the Holiday Season
The dairy fat controversy
Recipe: Mid-week main course salad

With the holiday season in full swing, it’s often difficult to navigate the sea of tempting foods that are part and parcel of festive gatherings. From sugary treats to savory snacks laden with salt, bad fats and artificial additives, the impact of these foods extends far beyond that tired and bloated feeling after overindulging, or the extra pounds we might pack on over the next month or so, but also influences brain health. In this issue I focus on the research that shows how regular consumption of ultra-processed and sweet and starchy foods increases the likelihood of mood disorders, particularly in teenagers.

Healthy eating for the holiday season

In our fast-paced world, convenience often takes precedence over the nutritional value of the food we eat. Time constraints frequently means resorting to an excess of take-outs or fast foods, most of which are considered ultra-processed.

As we discussed in our August newsletter, ultra-processed foods are basically factory altered foods which use many industrial ingredients and additives – chemical compounds that would not normally be found in any home kitchen. Such foods lack the essential nutrients found in whole, minimally processed foods – the fibre, vitamins and minerals and other trace compounds (phytochemicals) we need to maintain health. In addition, they are generally high in sugar, salt and unhealthy fats.

The rise of ultra-processed foods is a cause for concern, not only for our physical health but also for the well-being of our brains. So, let’s take a deep drive into why these highly processed foods pose a health risk, focusing particularly on their profound impact on the brain, especially young people’s mental health.

Depression, anxiety and the sugar paradox

Recent research shows that eating a lot of highly processed foods is not good for our mental health, especially in teenagers prone to anxiety. These foods, heavy in added sugars, preservatives, and artificial flavourings and colourings are connected to a higher chance of developing or exacerbating depression and anxiety disorders. [i]

There is a good biological reason for this: Glucose is the brain’s primary source of energy, and sufficient circulating blood glucose is essential for cognition, which, simply put is how we think. Cognition encompasses all the processes of the brain, including how we perceive the world around us, how we learn and retain knowledge, solve problems and make decisions. Symptoms like anxiety and depression appear when there is a disruption in the balance of cognitive activity. While there can be more than one reason for this, including genetic predispositions, there are dietary habits that definitely contribute, consistently worsening symptoms.

The insulin connection

When blood sugar rises it cause a release of insulin from the pancreas. Insulin helps blood sugar enter cells so it can be used for energy. It also signals the liver to store any excess sugar for later use. When we consume a lot of sugary foods, blood sugar (glucose) goes too high, triggering an excessive insulin response. In turn this causes a rapid drop in blood sugar levels, depriving the brain of the very glucose it needs to function. This can also happen after eating starchy carbohydrates like bread or potatoes, cookies and pies, since the body metabolizes these starchy carbohydrates into glucose. The resulting low blood sugar level we experience after eating sugar or starchy foods (hypoglycemia) has been shown to affect moods and making feelings of anxiety and stress worse. [ii]

An extreme form of anxiety – Generalized Anxiety Disorder or GAD – is on the increase in teenagers and adults alike. According to the Canadian Psychological Association, one out of every twelve Canadians will suffer from GAD at some time in their life. [iii] GAD is characterized by excessive fear and worrying over common everyday events or problems, and is accompanied by unpleasant physical symptoms – heart palpitations, chest tightness, irritability and difficulty concentrating. Many studies now link depression and anxiety to a diet high in sweets – cookies, candies and desserts – and refined grains, like bread, pasta, rice and potatoes. On the other hand, a high fruit and vegetable consumption has been shown to lower the risk. [iv]

Fruits and vegetables in their whole form – not juices – contain ample sugar to keep the brain humming along nicely, but they also contain much needed fibre, and fibre can help stabilize blood sugar.[v] In addition, adequate protein with each meal can benefit brain function in two ways. Firstly, it provides amino acids – the basic building blocks needed to make neurotransmitters like serotonin and dopamine that control mood and sleep. And secondly, a high protein diet is known to improve blood sugar control.[vi]

A Tale of two diets

An interesting case study that illustrates how every-day diets can impact mood appeared a few years ago in the journal Case Reports in Psychiatry. [vii]

A 15-year-old girl being treated for long-standing GAD rated the intensity of her anxiety as 8/10 (with 10 being the highest level of anxiety possible). Her symptoms included not just extreme anxiety but also heart palpitations, shakiness, stomach discomfort and muscle tension. Her daily diet consisted of the following:

Breakfast:	Fruit smoothie made with fruit, fruit juice, and water.
Morning snack:	Bagel with margarine.
Lunch:	Pasta or white rice with vegetables.
Afternoon snack:	Granola bar or cookies or candies.
Dinner:	White rice or spaghetti; sometimes included meat.
Evening snack:	Cookies and toast.

After her initial visit the following diet was prescribed. Note that it was higher in protein and fibre, and the source of carbohydrates was mainly from fruit and vegetables.

Breakfast:	Fruit smoothie made with fruit, fruit juice, and water.
Lunch:	Protein (meat, legumes or soy) and vegetables
Dinner:	Protein and vegetables, similar to lunch
Snacks:	Included protein with fruit and/or vegetables (e.g., apple with sunflower seed butter, vegetable sticks with hummus; pumpkin seeds).

Eggs, nuts, and fish were excluded, but only because the patient was severely allergic to them – normally they would have been encouraged.

One month later she reported a significant decrease in her anxiety levels (from 8/10 to 4 – 5/10), as well as improved energy, fewer headaches (once per week compared to daily) and greatly improved concentration and mood. However, at a follow-up visit four weeks later the patient reported that she had returned to her original diet for one week and within a day had experienced a worsening of anxiety. Persuaded that her new diet had indeed helped her, she returned to the diet she had been prescribed, and within two days her anxiety symptoms had again decreased. Hopefully she learned a valuable life lesson, and would remain on her new, more nutritious diet indefinitely.

We all know the old adage that we are what we eat. Perhaps we should add another saying to our list of dietary rules to live by: As we eat, so will we think. In the pursuit of convenience, we need to take care not to compromise the health of our most vital organ—the brain. Ultra-processed foods pose a significant threat to brain health, contributing to depression and anxiety in many young individuals.

They also increase the risk of dementia in the elderly [i], but that’s another story!

The dairy fat controversy

A recently published study in The European Heart Journal has confirmed what those of us who follow the research on dietary fat and health have believed for a long time: Choosing low or zero fat over full fat dairy is not helping us stay healthier!

The idea that dietary fat was the primary cause of heart disease emerged during the 1950’s and from then on ‘fat-free’ or ‘fat reduced’ foods began creeping into grocery stores, until by the 1980s they were everywhere. Experts warned that fat not only increased our risk of heart disease, but it was also largely responsible for making us fat. To stay in good shape, we should ‘substitute low fat food items for high fat ones, and decrease our intake of fatty meats and fish’, as one doctor wrote in the Globe and Mail in the early 2000s.

All of which left me scratching my head and wondering if I had been asleep during biochemistry classes. Was I wrong about fat? Were there no fats that were essential? What about the omega 3 fats you get from fatty fish and omega 6’s in vegetables oils? Didn’t immune health and good brain function depend heavily on the availability of these fats?

Then the tide changed and nutritional scientists began to realize that perhaps the baby had been thrown out with the bathwater. Certainly there were bad fats, found mainly in heavily processed or deep fried foods, but not all fat was bad. And so the emphasis changed to encouraging ‘good’ fats. Fats like olive oil, nuts and seeds and avocados. Whole grains were encouraged not just because of their fibre content, but because of their healthy fats.

But saturated fats were still bad – fats contained in butter, cream, eggs or yogurt made from full fat milk, were still off the menu.

What the research says

In the most recent study. The researchers examined the diets of 147,642 people in 21 countries taking part in a study called the PURE (Prospective Urban Rural Epidemiology PURE) study. Begun in 2003 and led by researchers at McMaster University, this large-scale global study which has been on-going since 2003 examines the impact of various lifestyle and environmental factors on cardiovascular disease and other health outcomes.

In the PURE study, a previously developed healthy diet score was developed based on six foods, each of which has been associated with a significantly lower risk of mortality. The foods include a higher intake of fruit, vegetables, nuts, legumes, fish, and dairy (mainly whole-fat). In individuals with or without pre-existing heart disease a higher intake of the protective foods was associated with lower risks of cardiovascular events like heart attacks and strokes. And contrary to the fat-reduced dairy trend, the research suggests that full-fat dairy could offer potential benefits for heart health. The PURE study is just one of multiple studies that have accumulated over the years that should reassure us that saturated fat by itself is not the villain when it comes to heart health, and contrary to some current advice, offers potential benefits for heart health. The main takeaway from the PURE study is that it is the overall quality of the entire diet that is most important. Other previous studies support the idea that full-fat dairy products may lower the risk of developing central obesity – that stubborn, difficult-to-lose extra weight that accumulates around the waist line.

In general, the evidence suggests that, compared to consuming zero fat yogurt or skimmed milk, consumption of full-fat dairy products is linked to better heart heath and weight control.[i]

Cranberry Baked Pears

Although this season is a time for an excess of sugary, sweet foods, and overindulgence in these treats is a major reason for the weight gain and sluggishness that often heralds in the New Year, it is possible to indulge a little and not pay a hefty price for it later.

This delightful combination of baked pears, sweet dried cranberries, and warm spices is a comforting and elegant dessert and smells so good while it’s cooking in the oven. Besides capturing the essence of the holiday season, it is packed with health-giving fibre and antioxidants.

Ingredients: Serves 4

4 ripe but firm pears
1/2 cup dried cranberries, finely chopped
1/4 cup chopped nuts (walnuts or pecans)
2 tablespoons honey
1 teaspoon cinnamon
1/2 teaspoon nutmeg
1/4 teaspoon ground cloves
1/4 teaspoon of orange or lemon zest
1 tablespoon butter, melted
Whipped cream for serving

Instructions:

Preheat your oven to 375°F (190°C).
Wash the pears and cut in half lengthwise. Scoop out the core and seeds to make a hollow in the center of each pear half.
In a bowl, mix together the cranberries, toasted nuts and honey with the cinnamon, nutmeg, and cloves.
Place pear halves on a baking dish, cut side up. Spoon the cranberry and nut mixture into each pear and drizzle with melted butter, ensuring each pear receives a light coating.
Bake in the preheated oven for 25-30 minutes or until the pears are tender. The filling should be bubbly, and the pears golden brown.

Let the pears cool slightly before serving with a generous dollop of whipped cream. For an added festive touch, garnish with fresh mint leaves and a sprinkling of dried cranberries and chopped nuts.

References

[1]. Zheng, L.; Sun, J.; Yu, X.; Zhang, D. Ultra-Processed Food Is Positively Associated with Depressive Symptoms Among United States Adults. Front. Nutr. 2020, 7, 600449.

[1]. Kwon M, Lee M, Kim EH, Choi DW, Jung E, Kim KY, Jung I, Ha J. Risk of depression and anxiety disorders according to long-term glycemic variability. J Affect Disord. 2023 Dec 15;343:50-58

[1]. https://cpa.ca/psychology-works-fact-sheet-generalized-anxiety-disorder/

[1]. Haghighatdoost F., Azadbakht L., Keshteli A. H., et al. Glycemic index, glycemic load, and common psychological disorders. The American Journal of Clinical Nutrition. 2016;103(1):201–209

[1]. Fuller S, Beck E, Salman H, Tapsell L. New Horizons for the Study of Dietary Fiber and Health: A Review. Plant Foods Hum Nutr. 2016 Mar;71(1):1-1

[1]. Gannon MC, Nuttall FQ, Saeed A, Jordan K, Hoover H. An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes. Am J Clin Nutr. 2003 Oct;78(4):734-41

[1]. Aucoin M, Bhardwaj S. Generalized Anxiety Disorder and Hypoglycemia Symptoms Improved with Diet Modification. Case Rep Psychiatry. 2016;2016:7165425.

[1]. Gomes Gonçalves N, Vidal Ferreira N, Khandpur N, Martinez Steele E, Bertazzi Levy R, Andrade Lotufo P, Bensenor IM, Caramelli P, Alvim de Matos SM, Marchioni DM, Suemoto CK. Association Between Consumption of Ultraprocessed Foods and Cognitive Decline. JAMA Neurol. 2023 Feb 1;80(2):142-150

[1]. Kratz M, Baars T, Guyenet S. The relationship between high-fat dairy consumption and obesity, cardiovascular, and metabolic disease. Eur J Nutr. 2013 Feb;52(1):1-24

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October 23, 2023

Strong Bones, Protection Against Long COVID

In this issue

Building strong bones: the impact of vitamin K
Can you protect yourself against long COVID?
Recipe: Salsa and cheese fish bake

Osteoporosis, a disorder characterized by weakened and fragile bones is one of the most common bone-related health conditions. To maintain strong, fracture resistant bones and prevent osteoporosis we are encouraged to consume calcium rich foods and/or take calcium supplements. However, the story of bone health is much more intricate and the maintenance of healthy bones involves not only calcium but also a complex interplay of many other nutrients.

This issue focuses on the role of vitamin K, and its interaction with vitamin D and calcium in the prevention of osteoporosis.

Building strong bones – more than just calcium

Calcium is one of the most abundant minerals in all tissues of the human body. It plays an essential role in various bodily processes, including muscle contraction, blood clotting, and nerve function. In bones calcium provides structural support, making up to 30-35% of total bone weight.

Bones also act as a reservoir for minerals like calcium and magnesium. If our diets are short of calcium, there will be insufficient calcium in the bloodstream. When that happens, we draw calcium from our bones to meet our physiological needs. Over time, this can lead to a decrease in bone density, which will increase the risk of fractures. So, for decades we have been cautioned to optimize our intake of calcium to prevent osteoporosis, and many women have been encouraged to take high dose calcium supplements, regardless of how much calcium is in their diets.

The absorption of calcium depends on adequate circulating levels of vitamin D, so is compromised if we are vitamin D deficient – a common problem in northerly countries like Canada. [1] More recent clinical trials seeking evidence for osteoporosis prevention therefore used various combinations of calcium and vitamin D. [2]

The calcium paradox

Although insufficient intake of either calcium or vitamin D is detrimental not only to bone health, but also to health in general, too much calcium may also be a bad thing. Studies have shown that excessive calcium intake, particularly in the form of high-dose supplements, may not provide the bone health benefits we’ve come to assume, and could cause unwanted side effects, including an increased risk of cardiovascular disease. Some studies have shown a higher risk of heart attacks in those taking calcium supplements compared to those who don’t. [3]

One reason calcium supplements might increase heart disease risk is that excess calcium can end up as hard deposits attached to blood vessel walls. [4] This is called calcification. Calcification causes blood vessels to become stiff, making it harder for them to expand and contract as needed. And so the heart has to work harder to pump blood, and blood pressure becomes difficult to control.

Calcification can also occur in other tissues, and interfere with their function. In kidneys this may lead to kidney stones. In joints, calcification contributes to the pain of osteoarthritis. Calcification in the brain may even increase the risk of developing Alzheimer’s Disease. [5]

Vitamin K – the calcium traffic cop

Enter vitamin K. Vitamin K is actually a group of fat-soluble vitamins that play an essential role in various bodily functions, primarily blood clotting and bone metabolism. The two main forms are vitamin K1 (phylloquinone), found in leafy greens and other plant-based foods, and vitamin K2 (menaquinone) mainly found in animal foods. K2 is also synthesized by bacteria in our gut and found in fermented foods like cheese, yogurt and kefir.

While both K1 and K2 are needed to regulate blood clotting, vitamin K2 is a star when it comes to bone health, as it is needed for the production of a protein called osteocalcin. Osteocalcin ensures that calcium binds to bones. K2 is also needed for the production of another protein – matrix Gla-protein (MGP) – which helps prevent calcium from building up in blood vessels and other tissues, keeping the arteries clear and flexible.

Here’s how vitamin K2 helps to prevent osteoporosis: [6]

Enhances Calcium Utilization: Vitamin K2 activates osteocalcin, which helps calcium bind to the bone matrix, making bones denser and stronger.
Reduces Calcium Buildup in Arteries: As well as ensuring that calcium is directed to the bones, vitamin K2 blocks calcium buildup in arteries, reducing the risk of calcification.
Stimulates Bone Formation: Vitamin K2 also plays a role in stimulating bone-forming cells, ensuring a balance between bone formation and breakdown.

Sources of vitamin K

To obtain vitamin K1 from diet load up on leafy greens – spinach, kale, broccoli, and Brussels sprouts are all good sources. Vitamin K2, on the other hand is present mainly in animal products. Chicken, egg yolks, liver and other organ meats are all good sources. Fermented soy products and sauerkraut are appropriate sources for vegetarians. Dairy products like hard cheeses are also good sources, as are fermented dairy foods like kefir and yogurt. But beware! Vitamin K is a fat-soluble vitamin. While full fat Greek yogurt is a good source of K2, zero fat yogurt contains, well, zero!

One welcome innovation in the supplement industry is that many vitamin supplements now also include vitamin K2. I always recommend taking vitamin D capsules that include vitamin K2. Usually, you will find that for every 1000 IU of vitamin D3 there are 120 mcgs of K2.

Vitamin K2 and warfarin

Warfarin, also known as Coumadin, is a blood thinner that works by inhibiting the action of vitamin K, which is crucial for blood clotting. If you take warfarin you may need to avoid taking additional vitamin K2 as it might interfere with warfarin’s effectiveness, and make it harder for your doctor to manage your drug dose effectively.

Newer generation blood thinners, like rivaroxaban (Xarelto), Apixaban (Eliquis) or dabigatran (Pradaxa) work differently from warfarin, and don’t directly interfere with vitamin K metabolism, according to current research.[6]

Vitamin K2 – how much is too much?

The tolerable upper limit of a nutrient is the maximum amount considered to be unlikely to pose a risk of adverse health effects in humans. For vitamin K, no tolerable upper limit has been set because no adverse effects have been shown, even at high intakes. Toxicity is rare and unlikely to result from eating foods containing vitamin K.

While in Canada there are no recommendations for vitamin K supplements to prevent osteoporosis, in Japan, where most of the studies that demonstrated the benefits of vitamin K for bone health were carried out, supplementing with vitamin K is routinely recommended. Daily doses of up to 45mg (45,000 mcg) have been given to elderly patients at risk of osteoporosis without adverse effects [7].

Natto, a popular dish in Japan made from fermented soybeans, is rich in vitamin K2. In my opinion it is an acquired taste, and not everyone is a fan. But if you like it and can get it, one serving (100g) of natto contains approximately 1mg (1000 mcg) of vitamin K2 [8].

But, as always, if you have specific concerns about your vitamin K intake and any interactions it may have with your medications, consult with your doctor.

Can you protect yourself against long COVID?

It might be a smart move to routinely start wearing a mask again, especially in crowded spaces as the cold and ‘flu season approaches and COVID infection rates increase. Hospitals across the country are seeing a surge in test positivity and admissions. No doubt the disease is milder since vaccination. However, even those with mild cases can be susceptible to what has become known as ‘long COVID.’

Also known as post-acute sequelae of SARS-CoV-2 infection (PASC), long COVID refers to persistent symptoms that linger for weeks or months after acute COVID-19 infection. Most people recover from COVID-19 within a few weeks. However, some individuals experience lingering symptoms that can significantly impact their daily lives. These symptoms can vary widely, and may include fatigue, shortness of breath, chest pain, joint pain, brain fog, difficulty concentrating, and more. One prediction suggested that, worldwide, up to ten percent of those who have had COVID will suffer from this debilitating condition.

Is there any way to predict who will get long COVID?

Predicting who will develop long COVID is challenging, since it affects such a diverse range of individuals, including those whose original infection was mild or even asymptomatic. But we do know that certain risk factors may increase the likelihood of experiencing long-term symptoms. Research suggests that individuals with severe initial infections, older adults, and those with pre-existing health conditions, especially obesity and diabetes, may be at a higher risk of developing the condition.

A recent study from the UK conducted on women in the Nurses’ Health Study 2 found that a healthy lifestyle before COVID-19 infection was linked to a significantly lower risk of long COVID. The healthy lifestyle factors included [9]

Normal body weight (BMI)
Never smoking
A high-quality diet
Moderate alcohol intake
Regular exercise
Adequate sleep

The study suggests that women with all these healthy life style factors had a 49% lower risk of long COVID compared to those without any, and that 36.0% of long COVID cases could have been avoided if all participants had 5 or 6 healthy lifestyle factors. Healthy BMI and adequate sleep were independently associated with a lower risk of long COVID.

Adequate exercise was defined as at least 150 minutes per week of moderate to vigorous physical activity
Moderate alcohol intake was defined as 5 to 15 g per day (one drink contains about 10 g of alcohol)
A high-quality diet was defined as the upper 40% of the Alternate Healthy Eating Index-2010 score.

The Alternative Healthy Eating Index (AHEI) was developed by Harvard researchers, and rates foods and nutrients according to whether they can help prevent chronic diseases [ ]. Basing your diet on a combination of foods now known for their health promoting qualities has been shown to lower your risk for cancer, diabetes, heart disease and dementia. The highest scores come from higher intakes of fruits and vegetables, nuts, legumes, fish, healthy fats like olive oil, and whole grains.

Salsa and cheese fish bake

This quick and easy fish recipe is a handy middle of the week dish which uses only 3 ingredients, all of which can be stock items in your fridge or freezer. The combination of a mild flavoured fish like plaice and the tasty salsa and cheese topping make it acceptable to children (or adults) who are reluctant fish eaters!

Any white fish can be used as long as the pieces are not too thick. Use a mild or hot salsa depending on everyone’s tolerance for spiciness. A well-flavoured cheddar cheese makes a good topping. No measuring is involved – just scale up the recipe depending on the number of people you are feeding.

Ingredients:

Frozen plaice fillets
Salsa
Grated cheddar cheese

Instructions:

Preheat your oven to 375°F (190°C).
Place the frozen plaice fillets in a single layer in an oiled baking dish.
Spread a generous layer of salsa over each plaice fillet, ensuring even total coverage.
Sprinkle a generous amount of grated cheese on top of each fish fillet.
Bake in the preheated oven for about 15-20 minutes or until the fish is cooked through and the cheese is melted and bubbly.
For a golden finish, you can broil the dish for an additional 2-3 minutes, keeping a close eye to prevent burning.
Serve with a side of fresh salad or broccoli or other vegetables for a delicious, low-carb meal!

References

1. Addressing vitamin D deficiency in Canada: a public health innovation whose time has come. Schwalfenberg GK, Genuis SJ, Hiltz MN. Public Health. 2010 Jun;124(6):350-9

2. Jin J. Vitamin D and Calcium Supplements for Preventing Fractures. JAMA. 2018;319(15):1630. doi:10.1001/jama.2018.3892

3. Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg). Li K, Kaaks R, Linseisen J, Rohrmann S. Heart. 2012 Jun;98(12):920-5.

4. Calcium supplements: Good for the bone, bad for the heart? A systematic updated appraisal. Morelli MB, Santulli G, Gambardella J. Atherosclerosis. 2020 Mar;296:68-73.

5. Arterial calcification and cerebral disease : stroke and dementia. Jashari F, Wester P, Henein M. In: Cardiovascular calcification [Internet]. 1st ed. Cham: Springer; 2022. p. 237–58

6. Molecular Pathways and Roles for Vitamin K2-7 as a Health-Beneficial Nutraceutical: Challenges and Opportunities. Jadhav N et al. Front Pharmacol. 2022 Jun 14;13:89692

7. Vitamin K administration to elderly patients with osteoporosis induces no hemostatic activation, even in those with suspected vitamin K deficiency. Asakura H et al. Osteoporos Int. 2001 Dec;12(12):996-1000.

8. Vitamin K fact sheet. National Institutes of Health. https://ods.od.nih.gov/factsheets/VitaminK-HealthProfessional/#h3

9. Lifestyle risk factors, inflammatory mechanisms, and COVID-19 hospitalization: A community-based cohort study of 387,109 adults in UK. Hamer M, Kivimäki M, Gale CR, Batty GD. Brain Behav Immun. 2020 Jul;87:184-187

10. Alternative dietary indices both strongly predict risk of chronic disease. Chiuve SE, Fung TT, Rimm EB, Hu FB, McCullough ML, Wang M, Stampfer MJ, Willett WC. J Nutr. 2012 Jun;142(6):1009-18

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August 1, 2023

Weight and Health, Alternatives to Ozempic

In this issue

Weight and health
Natural alternatives to Ozempic
Recipe: Breakfast Bowls

Struggling with weight is a challenge that many of us can relate to. The desire to shed those extra pounds, improve our health, and enhance our overall well-being often leads us down various paths in search of effective solutions, some of them healthy, some of them risky and almost all of them difficult to sustain.

In this issue of The New Nutrition Newsletter I focus on the latest hot topic in the world of weight control – ground-breaking medications like Ozempic that have emerged as potential game-changers in the battle against obesity. What are they? How do they work, and can we mimic their effect naturally, using diet rather than drugs?

Weight and health

Like all developed countries, Canada is facing an obesity crisis. Throughout history there have always been individuals who suffered from obesity (think Henry Vlll or Queen Victoria), but current rates have reached epidemic proportions, and are growing year on year. A study published in the Canadian Medical Association Journal in 2019 predicted that if current trends continue, almost 1 in 2 adults in Canada could be classified as obese by 2040.

The cost to Canada’s health care service is almost incalculable. Being obese increases the risk of most of the major health conditions affecting us today, including type 2 diabetes, heart disease and stroke, cancers, like breast, colon, and brain cancers, with parallel increases in health care spending.

Obesity is a complex condition

While the causes of obesity are complex, unhealthy diets are a major factor. Anyone who watched the movie Super-Size Me saw how easy it was for someone – initially fit and slim and with no history of weight problems – to gain weight rapidly on fast food. But genetics, environment and lifestyle also factor in. So does overeating.
Our everyday environment is designed to encourage overeating. Indeed, eating has become almost a continuous all-day pastime. We are surrounded by highly palatable, calorie-dense foods, available on every street corner 24/7. This constant exposure to food cues triggers the desire to eat even when we are not hungry, and makes it difficult to control overeating through willpower alone.

Enter Ozempic, currently the weight loss drug of choice, not just of the overweight and obese but of the rich and famous with normal healthy body weights who want to be skinnier. The drug has been hailed as a game changer in the battle to lose weight.

Ozempic, serendipity and appetite

Originally prescribed to manage type 2 diabetes, Ozempic and a number of similar new drugs that are coming on to the market, works by regulating insulin and blood glucose, critical for diabetics. But an incidental and unexpected finding from early clinical trials in diabetics was that those taking the drug not only regulated their blood sugar levels, they also lost significant amounts of weight.

Pharmaceutical executives were ecstatic! They had not set out to find a weight loss drug, but accidently they had. And it wasn’t just diabetics who experienced weight loss. Non-diabetics also benefitted. The weight loss was largely because of a dramatic reduction in appetite. Some patients even found they didn’t want to eat at all. So, no need for willpower; no particular diet necessary. The weight simply melted off.

How does Ozempic work?

Ozempic (generic name semaglutide) and other similar drugs coming on to the market belongs to a class of drugs called GLP-1 (glucagon-like peptide-1) receptor agonists. These drugs mimic a natural hormone, glucagon-like peptide or GLP-1.

One role of GLP-1 agonists is to increase levels of incretins – molecules normally released in the gastrointestinal tract in response to food intake. Incretins manage insulin and blood sugar levels, and so help to control diabetes. Because they slow down the rate at which the stomach empties, we feel full for longer. One pivotal role for incretins is to signal the brain that we have eaten enough, and switch off the desire for more food. Thus, incretins play a vital role in regulating appetite.

Food chatter

A new term has recently entered the nutrition vocabulary: food chatter. Food chatter, or noise, is defined as intrusive and distracting thoughts about food – an on-going awareness of food, unrelated to meal times or hunger.

It starts as soon as you wake up. “What am I going to have for breakfast today? For lunch; for snacks?” As soon as lunch is over you are thinking about dinner. Even when you have eaten a substantial evening meal and shouldn’t be hungry, you visit the fridge to see what else you can eat. If you battle weight and are health conscious, you wonder what you can snack on that doesn’t contain too many calories. Whatever you eat, satisfaction is short-lived and the food chatter continues.

This obsession with food is one key reason that most diets are difficult to maintain. Studies show that more than half of the weight lost by dieting is regained in two years, and that more than 80% weight loss is regained after 5 years. Indeed, according to some researchers, many have even given up on the battle of the bulge and have kissed dieting goodbye.

“Semaglutide was associated with less hunger and food cravings, better control of eating and a lower preference for high-fat foods.”

Effects of once-weekly semaglutide on appetite, energy intake, control of eating, food preference and body weight in subjects with obesity. Diabetes Obes Metab. 2017 Sep;19(9):1242-1251

But for those taking Ozempic, reports suggest that food chatter disappears. The desire for food diminishes. Excess weight simply evaporates.

Is Ozempic a game changer?

Drugs like Ozempic clearly work, but not for everyone. Some patients just don’t respond to them, or they may get side effects that are severe enough that they stop the drug. These include nausea, diarrhea, abdominal pain, constipation and vomiting.

One drawback I see to the long-term use of GLP-1 receptor agonists is their potential to cause malnutrition. The drugs don’t change the requirement for nutrients – the vitamins, minerals, protein and essential fats need for body maintenance and functioning. When eating less food, less of these essential nutrients will be consumed, and intake may be insufficient to meet the body’s daily metabolic needs.

To reduce the risk of malnutrition if using weight loss drugs, it is crucial to obtain guidance on proper nutrition and advice on how to eat a balanced diet that meets nutritional requirements, despite having less appetite. Supportive nutrition counselling and regular monitoring of your nutritional status can help identify any potential nutritional shortfalls or imbalances and address them promptly.

Natural alternatives to Ozempic

Most drugs that are effective work because they mimic natural biological functions, either by boosting a metabolic process that isn’t working efficiently, or by inhibiting a chemical pathway in the body that’s overactive.

That got me thinking. If incretins are released in the gastrointestinal tract in response to food, are some foods better than others at stimulating incretin release? If so, could creating a diet based mainly on such foods naturally limit appetite. And, like Ozempic, effortlessly reduce food chatter and help with weight control?

On the flip side, I wondered if there were foods that evoked only a weak or negligible incretin response. If so, would a diet mainly composed of these foods lead to incessant food chatter, chronic over-eating and weight gain?

Foods that stimulate incretins

A close scrutiny of the medical and scientific literature shows that indeed there are many foods that can enhance incretin secretion. Eating a diet rich in these foods has the potential to help us battle food cravings and control overeating without resorting to drugs.

“In light of this literature review, it is evident that manipulating the composition of the diet in order to promote GLP-1 secretion represents a promising lifestyle strategy for obesity and T2D management.”

Nutritional modulation of endogenous glucagon-like peptide-1 secretion: a review. Nutr Metab (Lond) 13, 92 (2016).

The following are some foods with the potential to control appetite naturally.

Protein-rich foods, like lean meats, eggs, fish and dairy, tofu and legumes. Whey protein supplements have been shown to have a particularly powerful effect.
Good fats: Foods containing healthy fats, particularly monounsaturated fats, have been associated with increased GLP-1 secretion. Examples include avocados , nuts (almonds, walnuts), seeds and olive oil. Eggs are also potent stimulators of appetite-suppressing hormones.
Coffee and tea, including green and black tea, and the south American herbal tea, yerba mate.
Dietary fiber, found in vegetables and fruits, whole grains and legumes, has been linked to increased GLP-1 levels.
Phytochemicals from vegetables and fruit, spices and herbs stimulate incretin release. Cinnamon, turmeric, ginger, and fenugreek are among the spices that have been associated with increased GLP-1 production.
Resveratrol – a powerful phytochemical found in grapes, red wine, peanuts, cocoa, blueberries and cranberries – also stimulates GLP-1 production.

Sounds very like a Mediterranean Diet, doesn’t it – the same diet that is now linked to multiple health benefits, reducing the risk of most major chronic diseases? From heart disease to diabetes and many cancers, the Mediterranean Diet seems to be one of the best at promoting better health.

A recent large observational study of more than 60,000 adults showed that greater adherence to a Mediterranean diet was associated with up to a 23% lower risk of developing dementia over an average of 9 years. And this was regardless of whether individuals were genetically prone to developing the disease.

What not to eat

Highly processed foods, also known as ultra-processed foods, such as packaged snacks, fast food, and ready-to-eat meals, contain refined ingredients, and excessive fat, sodium, and added sugars. While the healthy fats listed above support incretin hormone release, a high fat diet, especially one high in saturated fats, may do the reverse.

So what are ultra-processed foods? These are food that are factory-processed from whole natural foods. In the factory they are deconstructed – refined, stripped of their natural nutrients – and then reconstructed. They are usually packed with additives, preservatives, and artificial flavors. Many of our favourite foods and drinks are ultra-processed, like soft drinks, white bread, white rice, sugary snacks, biscuits, muffins and pastries, breakfast cereals and bars, sweetened yogurts. Generally, these foods lack the beneficial nutrients and fiber that stimulate incretin hormone release.
If a diet is high in ultra-processed foods it will be less satisfying, and lead to food cravings and eventually, more obesity.

“Ultra-processed food [UFP] consumption is rising, accounting now for more than half of the daily calories of US, Canadian, or British diets….[and] leads to a nutritionally unbalanced diet, rich in energy, saturated fat, sugar, and salt and poor in fiber, vitamins, and minerals, potentially affecting the risk for obesity.”

Ultra-Processed Food Consumption and Incidence of Obesity and Cardiometabolic Risk Factors in Adults: A Systematic Review of Prospective Studies. Nutrients. 2023 Jun; 15(11): 2583

The bottom line

When it comes to preventing overeating, focusing on the quality of food we are eating may naturally limit the quantity we consume. Weight loss diets that simply reduce calories without any consideration of the quality of the food eaten are likely to be impossible to sustain in the long term. This is precisely because they fail to stimulate incretins, and the brain never receives the message: Stop eating.

Try limiting your daily eating to whole, unprocessed foods: Choose fresh fruits and vegetables, lean proteins, healthy fats like olive oil and avocados, eggs, and whole grains, nuts and seeds. This approach to eating should stimulate a healthy incretin response, and not only help with weight loss but should also be sustainable in the long term.

Recipe: Breakfast Bowl

Here’s a recipe for a delicious and nutritious breakfast bowl incorporating foods known to stimulate incretin release and make a filling and satisfying start to the day.

The recipe can be made in bulk and will store for up to 3 days in the refrigerator. It also makes a good snack or lunchbox addition. Make it the night before it is needed so that the oats have time to soften.

Ingredients:

3/4 cup full-fat yogurt
1/2 cup blueberries (crushed slightly)
1 tablespoon rolled oats (not quick cook)
25g whey protein, plain or vanilla flavoured
1/4 cup chopped nuts or pumpkin seeds
1 tablespoon ground flax seed or 1 tablespoon unsweetened shredded coconut
½ teaspoon cinnamon or other spice

Instructions:

In a bowl, add the whey protein to the full-fat yogurt and crushed blueberries.
Mix in all the other ingredients
Store in the fridge for up to 3 days.

You can scale up this recipe and customize it by adding different fruits, nuts and spices. Try grated or finely chopped apple and cinnamon, or pear with freshly grated ginger. Chopped orange with a little of the grated orange zest and added cocoa powder can also make a tasty alternative.

For those who want a little extra sweetness, only stevia has so far been seen to be without negative effects on digestion and the gut microbiome.

References

[1] Anderson JW et al. Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr. 2001 Nov;74(5):579-84

[1] Snook KR et al. Change in Percentages of Adults With Overweight or Obesity Trying to Lose Weight, 1988-2014. JAMA. 2017 Mar 7;317(9):971-973

[1] Chen YC et al. Co-ingestion of whey protein hydrolysate with milk minerals rich in calcium potently stimulates glucagon-like peptide-1 secretion: an RCT in healthy adults. Eur J Nutr. 2020 Sep;59(6):2449-2462

[1] Wien M, Haddad E, Oda K, Sabaté J. A randomized 3 × 3 crossover study to evaluate the effect of Hass avocado intake on post-ingestive satiety, glucose and insulin levels, and subsequent energy intake in overweight adults. Nutr J. 2013;12:155

[1] Amodeo S et al. EVOO’s Effects on Incretin Production: Is There a Rationale for a Combination in T2DM Therapy? Int J Mol Sci. 2022 Sep 4;23(17):10120.

[1] Vander Wal JS et al. Short-term effect of eggs on satiety in overweight and obese subjects. J Am Coll Nutr. 2005;24:510–515

[1] Johnston KL, Clifford MN, Morgan LM. Coffee acutely modifies gastrointestinal hormone secretion and glucose tolerance in humans: glycemic effects of chlorogenic acid and caffeine. Am J Clin Nutr 2003; 78: 728–733

[1] Bodnaruc AM, Prud’homme D, Blanchet R, Giroux I. Nutritional modulation of endogenous glucagon-like peptide-1 secretion: a review. Nutr Metab (Lond). 2016 Dec 9;13:92.

[1] Hira T, Trakooncharoenvit A, Taguchi H, Hara H. Improvement of Glucose Tolerance by Food Factors Having Glucagon-Like Peptide-1 Releasing Activity. Int J Mol Sci. 2021 Jun 21;22(12):6623

[1] Haldar S, Chia SC, Henry CJ. Polyphenol-rich curry made with mixed spices and vegetables increases postprandial plasma GLP-1 concentration in a dose-dependent manner. Eur J Clin Nutr. 2018 Feb;72(2):297-300

[1] Chung JY, Jeong JH, Song J. Resveratrol Modulates the Gut-Brain Axis: Focus on Glucagon-Like Peptide-1, 5-HT, and Gut Microbiota. Front Aging Neurosci. 2020 Nov 24;12:588044.

[1] Shannon OM et al. Mediterranean diet adherence is associated with lower dementia risk, independent of genetic predisposition: findings from the UK Biobank prospective cohort study. BMC Med. 2023 Mar 14;21(1):81.

[1] Thombare K, Ntika S, Wang X, Krizhanovskii C. Long chain saturated and unsaturated fatty acids exert opposing effects on viability and function of GLP-1-producing cells: Mechanisms of lipotoxicity. PLoS One. 2017 May 16;12(5):e0177605

[1] Detopoulou P, Dedes V, Syka D, Tzirogiannis K, Panoutsopoulos GI. Relation of Minimally Processed Foods and Ultra-Processed Foods with the Mediterranean Diet Score, Time-Related Meal Patterns and Waist Circumference: Results from a Cross-Sectional Study in University Students. Int J Environ Res Public Health. 2023 Feb 4;20(4):2806.

[1] Mahalak KK, Firrman J, Tomasula PM, Nuñez A, Lee JJ, Bittinger K, Rinaldi W, Liu LS. Impact of Steviol Glycosides and Erythritol on the Human and Cebus apella Gut Microbiome. J Agric Food Chem. 2020 Nov 18;68(46):13093-13101

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April 19, 2023

The Dark Side of Dark Leafy Greens

In this issue

The dark side of dark leafy greens
At the supermarket: What’s trending in food shopping?
Recipe: A healthy green smoothie

The dark side of dark leafy greens

Over recent years we have learned that a high intake of fruits and vegetables – higher than the 5-a-day we have previously been urged to eat – is critical for both physical and mental health. ^[1]

The main health benefits of plants are derived from their phytochemical content – naturally occurring compounds that give fruits and vegetables, herbs and spices their colour, aroma and flavour. These compounds are not essential for life, like vitamins and minerals, but do have amazing health benefits. A diet rich in phytochemicals plays a major role in the prevention and reduction of most chronic diseases, from heart disease, to cancer, dementia, diabetes and many others.

And the more we eat, the more disease-resistant we’ll be. Phytochemicals are important for health because they are anti-inflammatory, antioxidant and have anti-cancer properties. For optimal health, Health Canada recommends 7 to 10 servings/day for adults, and stresses red and orange vegetables like carrots, peppers, tomatoes and sweet potato. We are also urged to include at least one serving of dark green vegetables like spinach, kale and broccoli every day.

How well are we doing?

Not very well, according to Statistics Canada. Despite continuing educational efforts, total fruit and vegetable intake sadly remains low, and the number of adults consuming the now outdated 5 servings a day is actually decreasing year over year. ^[2]

One way to bump up daily fruit and vegetable intake that busy people often use is to start the day with a smoothie. Using a blender (not a juicer) you can pack 2, 3 or more servings into one jumbo drink. However, depending on the fruits or vegetables you use, the resulting smoothie may be very high in sugar, so select lower sugar fruits such as apples, blueberries and citrus as well as non-starchy vegetables. Otherwise, you could end up creating a ‘sugar bomb in a blender’!

Check out the infographics of British diet doctor Dr David Unwin where he converts everyday foods, including fruits and vegetables into their equivalent in teaspoons of sugar [https://phcuk.org]. And if you are using a smoothie as a meal replacement it needs to contain protein – 30 grams is usually recommended. It also should include some fat, since phytochemicals need to be consumed with fat to be absorbed. ^[3]

Antinutrients

Recently, a new client told me how her favourite way of making sure she gets her greens is by making a green smoothie for breakfast. Among a selection of fruits and vegetables, she always throws in a large handful of raw spinach. Spinach is a nutritious leafy green that is low in calories and high in vitamins, minerals, and antioxidants. It is a particularly good source of magnesium. Blending a handful of spinach or kale into a morning smoothie is a quick and easy way to get those daily greens.

But be warned. There are pitfalls to consuming some leafy greens in their raw state. Spinach, and to a lesser extent, kale contains oxalates which act as ‘anti-nutrients’. Antinutrients are natural compounds found in some plant-based foods that can bind to important minerals like magnesium, calcium and zinc, and block you absorbing them. Although not harmful in small amounts, consuming large amounts of anti-nutrients on a regular basis can have negative effects, depleting valuable minerals.

All the benefits without the drawbacks?

Lightly cooking spinach will reduce antinutrients and make the vitamins and minerals in the spinach more bioavailable. Wondering if freezing raw spinach will reduce the anti-nutrients? Its hard to be sure. Commercial spinach is often blanched before being frozen, and that should be sufficient to reduce the anti-nutrients. However, spinach can also be frozen without blanching, and food companies rarely state on the label how greens were treated before freezing.

So, if you like spinach in your morning smoothie (and it’s an excellent addition), buy a large container of baby spinach, wash the leaves thoroughly and then lightly steam. When cold, squeeze out handfuls of the cooked greens onto a baking tray and freeze. Once frozen, store the spinach pucks in a Ziplock bag, and add 1 or 2 to the blender. This way, you get all the many nutritional benefits of the spinach, without the drawbacks.

If eating raw spinach salads, do so in moderation, and mix spinach with other leafy greens – arugula and romaine lettuce, for example.

At the supermarket: What’s trending in food shopping?

Have the food items you regularly pile into your shopping cart changed recently? If so, you’re not alone. At the height of the pandemic grocery stores reported a big upsurge in the sale of foods that buyers associated with improved immune health and accelerated the trend toward “food as medicine”. In other words, lots of fresh produce, seafood, as well as more luxury items like premium meats and cheeses.

But with grocery prices skyrocketing way ahead of inflation, it’s not surprising that grocery shoppers are prioritizing affordability and convenience. ^[4]When we visit the supermarket these days, what we are looking for is value, value, value….

Can we save money and still eat well?

As we try to adjust to rising prices, there are ways we can reduce spending without compromising on food quality or allowing our diets to deteriorate. Here are a few tried and tested tips that can help stretch your grocery dollars and still eat well.

Plan meals before you go shopping: This way you avoid impulse buys and reduce food waste. Make a list of the items you need and stick to it. It’s all about being intentional about what you buy and making smart choices.

Avoid all heavily processed foods: These are foods that have been altered in factories. Processed foods can be expensive and are always less healthy than fresh foods, as they are high in calories, unhealthy fats, sugars, and salt, and low in essential nutrients such as fiber, vitamins, and minerals. They typically contain multiple ingredients, including additives used to make them more palatable and therefore more appealing, especially to kids.

Examples are sugary drinks, packaged snacks, frozen meals, breakfast cereals, chicken nuggets, and other fast foods. These foods are designed to be convenient, easy to prepare, and have a long shelf life. But you are often paying as much for packaging as you are for any nutrition they contain, so try to stick to whole foods as much as possible.

Shop seasonally and locally: Shopping for produce that is in season can be cheaper than buying out-of-season items. Check out your local farmers’ market for fresh and affordable locally grown fruits and vegetables. Then you are not paying for high transportation costs and expensive packaging.
Explore the frozen food aisles. Frozen fruits and vegetables are usually flash-frozen at the peak of their health and may retain more of their nutrition than fresh produce that has been hanging around in the supermarket or in our fridges for some time.

Frozen fish is a good source of protein and is often less expensive than fresh fish because it can be bought in bulk and stored for longer periods of time, reducing waste.

Use cheaper cuts of poultry and meat: Swap out chicken breasts for chicken thighs. Although cheaper cuts ofmeat are tougher and require longer cooking but they can be just asdelicious as expensive cuts when cooked properly. Consider using a slowcooker or pressure cooker to tenderize tougher cuts.
Cook at home: Cooking at home is generally cheaper than eating out. Try to prepare meals in advance so that you can avoid expensive takeout options.

Recipe: Green Smoothie

As outlined above, green smoothies are really worth considering if you’re looking for a quick and healthy start to the day. They can be delicious and energizing, setting us up for a good day’s work or school. Here’s a simple recipe for a single serving smoothie.

Ingredients:

2 cups of spinach cooked, then frozen (see above)
½ banana
½ avocado or ½ cup of frozen avocado pieces
1 scoop of protein powder (vanilla)
1 cup whole milk, unsweetened almond milk or other non-dairy milk
Stevia to taste

Instructions:

Place the frozen spinach, and all other ingredients in the blender and blend until smooth
Taste and, if necessary, sweeten with stevia to your liking.
Serve and enjoy!

You can also customize this recipe by adding other ingredients such as frozen berries, nut butters, ground flax seed, or the juice and zest of a lime to make it even more nutritious and delicious.

For further information about Aileen Burford-Mason or to contact the practice visit her website at www.aileenburfordmason.ca

References

[1]. Miller V et al. Prospective Urban Rural Epidemiology (PURE) study investigators. Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study. Lancet. 2017 Nov 4;390(10107):2037-2049

[2]. statcan.gc.ca/n1/pub/82-625-x/2019001/article/00004-eng.htm

[3]. Brown MJ, et al. Carotenoid bioavailability is higher from salads ingested with full-fat than with fat-reduced salad dressings as measured with electrochemical detection. Am J Clin Nutr. 2004 Aug;80(2):396-403

[4]. https://www.prnewswire.com/news-releases/affordability-will-top-immunity-as-leading-food-purchase-driver-in-2023-301735523.html

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March 30, 2020

Challenging Times

News from the practice of Aileen
Burford-Mason PhD

At the start of this year I could never have imagined the challenges we are now facing. Although alarms were being sounded about the situation in China, we could not have dreamed how rapidly the virus we now call COVID 19 would spread, or the disruption to daily life it would bring.

It is my hope that the supplement regimes I have my clients develop, as well as the ongoing nutritional education I have tried to pass on for the last 20 years, will now bear fruit and help you and your families stay strong in these anxious times.

Needless to say, our office has been inundated with many questions regarding any additional advice I could offer that would benefit immunity and give an extra edge in the battle against COVID-19. This newsletter is my attempt to pull together my best current advice and to answer some of those questions.

Protect yourself, your family and your community – stay a hockey stick apart from others.

Our health doesn’t only depend on what we do to protect ourselves, but also needs the coordinated effort of our family, friends and community. To slow the spread of this highly contagious virus, social and physical distancing – 6 feet or two meters apart from the nearest person – is essential at all times. If you find this distance hard to visualize, it’s about the length of a hockey stick.

Regular and thorough hand washing should now be part and parcel of your day. Don’t forget to use hand cream to stop hands getting dry and cracked.

If you get sick

Most people who get the virus have mild to moderate symptoms and are not currently recommended to seek medical attention. Rest, stay hydrated and isolate from other family members who are still well. The Ontario Government has prepared a questionnaire you can use to determine if you need medical attention (https://www.ontario.ca/page/2019-novel-coronavirus) and if so, how to go about getting it.

Reduce stress

The anxiety of uncertainty and the isolation that comes with social distancing can seriously impact mental and physical health. Stay active. Go for a brisk walk every day, or create a walking track around your home. Try to do 10,000 steps but remember they don’t all have to be done at once.

Use any tool you can to relax. Meditation and mind-body practices like yoga, tai chi, qi gong, and deep breathing exercises are well documented stress reducers. To help you destress now might be a good time to learn some new tricks. There are many exercise and meditation videos you can find on-line.

Don’t underestimate the power of a simple phone call or video chat with family and friends. Connecting with one another during stressful times can help reduce feelings of isolation. But if you are working from home save personal calls for the evening.

Focus on sleep

Stress can disrupt sleep, and this in turn compromises our ability to fight a virus. Although sleeping pills are widely prescribed they are not without side effects.[1] Before resorting to medication, try creating the best possible environment for sleep. Sleep in a cool room with full blackout.

Melatonin is a hormone we make naturally which controls sleep but also plays an important role in immune functioning. We make less melatonin as we age, and light pollution in our bedrooms interferes with our natural production. If you can see the outline of furniture in your bedroom there is too much light to make melatonin. Wearing an eye mask can help you sleep sounder and for longer.

Be wary of misinformation

Make sure that anything you are reading on the internet is from a trusted source. Unfortunately there are always unscrupulous people seeking to exploit our anxiety to sell products that may be worthless using unsubstantiated health claims.

The flip side of the coin is that some ‘experts’ interviewed on TV will dismiss many of the supplements you are using, saying they are unproven and therefore not worth taking. Often such comments come from physicians or other healthcare practitioners with little knowledge of nutrition, or familiarity with the scientific literature on nutritional supplements.

Please don’t stop taking your current supplements based on these sorts of dismissive comments.

SUPPLEMENTS AND COVID 19

Those of you who take supplements following my protocols should be taking a well-rounded supplement regime optimized to your personal needs. Since all essential nutrients work as a team to support immunity, it is important to continue the whole programme. The basic programme will include a multivitamin, additional vitamins C, D and E, magnesium and omega 3 fats (fish oil).

Many of you are also wondering if you should increase your intake of certain supplements or include new supplements during the pandemic. Here are a few to consider.

Vitamin C.

In scurvy (severe and usually fatal vitamin C deficiency) one of the most frequent complication and cause of death is pneumonia.[2] Vitamin C impacts immunity in many ways. It acts as an antioxidant, protecting immune cells against the inflammatory damage – oxidative stress – caused to the lungs as immune cells fight to subdue infection. Vitamin C can also decrease the replication of viruses.^[3]

Some COVID 19 patients in New York hospitals are being treated with high dose vitamin C intravenously[4] and China has begun a clinical trial to determine if vitamin C reduces the severity or death rate from, COVID 19. But we will have to wait until later in the year before we know the results.

Stress increases the need for vitamin C as your adrenal glands depend on vitamin C to make essential stress hormones. Most non-primate animals make their own vitamin C, and when stressed rapidly increase their output. Humans rely on diet or supplements for vitamin C and studies have shown we also need more when stressed.

Time release formulations are the only form of vitamin C I recommend. When you take up to 200mg of vitamin C orally it stays in the blood for about 20 days – enough to prevent scurvy. But if you take higher doses, vitamin C has a very short half-life – 30 minutes – so a lot of what you have taken does not remain in blood but is excreted in urine.

To overcome this you would either need to take regular vitamin C in small doses continuously throughout the day, or use time-released forms of vitamin C. These tablets are formulated to break down slowly, releasing small amounts over a period of about 12 hours.

Recommendation:

Time release formulations are the only form of vitamin C I recommend.

If you are currently taking 1000mg twice daily, increase dose to 2000mg twice a day.

Vitamin D

The control of immune responses is very dependent on vitamin D. Although no studies have yet shown that higher blood levels of vitamin D can protect against COVID 19 we do know that vitamin D is very important for healthy lung function and for protecting against infection in general. Lower blood D in winter compared to summer is thought to be responsible for the increased incidence of upper respiratory tract infections in the winter months.[5] Low D levels also increase the risk of pneumonia.[6]

It has also proposed that adequate vitamin D is needed to prevent the development of a cytokine storm – where the immune system goes into overdrive and produces an overabundance of anti-inflammatory molecules, overwhelming organs and their capacity to respond normally.[7] This is when viral infections like SARS and COVID 19 turn lethal. According to Health Canada’s last survey 1/3^rd of Canadians have insufficient blood levels of vitamin D.[8]

Recommendation:

If you have been working with me for some time and have had your blood tested for vitamin D (25-hydroxy D) we will have identified an optimal daily intake of vitamin D for you. Continue taking this dose – you are unlikely to benefit from more.

For everyone else I recommend taking 4000 IU daily. This is the amount Health Canada says anyone from the age of nine can safely take without supervision or blood tests. Take vitamin D with food for proper absorption.

Zinc

Zinc is required for optimal innate immune responses. [9] Innate immunity requires no previous exposure to a virus to work, and is therefore our first-line defense against novel infections like COVID 19. Zinc has been shown to reduce the symptoms and duration of colds[10] which are often caused by coronaviruses, so possibly it would be helpful for COVID 19 too. However, zinc is a tricky supplement to dose correctly – either too little or too much can compromise immunity.[11]

Zinc deficiency affects our ability to taste and smell things normally. It is interesting that one of the symptoms recently recognized as a clue that someone may test positive for COVID 19 is loss of the sense of smell and taste.[12] If you are taking a multivitamin it will usually contain 10-15mg of zinc, and for most people this is sufficient for regular use. However, during infection, extra zinc may be required.

Recommendation:

Sucking low dose zinc lozenges (8-10mg each) up to a total daily dose of 80mg has been shown to shorten the duration of sore throats and colds.[13] However, for some people 80mg might be a bit too much. Luckily there are ways to tell when you are taking too much zinc.

Most zinc lozenges have some strong flavoring like licorice or elderberry added. As you start to take them they taste good. But as you take more they may begin to taste unpleasantly metallic. This is your sign to stop taking the lozenges for that day. Resume taking them the next day but make sure to stop when they begin to taste bad again. Regardless of how they taste, stick to a maximum of 80mg of extra zinc per day (not counting what may be in your multivitamin).

One sign of ongoing poor zinc status is little white flecks on your nails, known medically as leukonychia.

If your nails look like those above, you definitely need more zinc. If you already take a multivitamin and still have leukonychia, start taking zinc lozenges as described above.

Melatonin

Melatonin acts as an “immunological buffer” – it will help restore immunity in immunosuppression or chronic stress, but can also suppress the overreaction of the immune system – the cytokine storm.[14] Melatonin supplements appear quite safe. They are not habit forming so you won’t become addicted or dependent on them. However, in my experience dosages that work well vary a lot from person to person.

To improve sleep start with a low dose – 3mg or even 1.5mg. If you have difficulty falling asleep, take melatonin 30-60 minutes before bed. If you fall asleep easily but wake too soon, take melatonin immediately before bed.

You can try increasing your dose by 1-2mg every 2-3 days to find the dose that works for you and gives you the most satisfying sleep. I usually recommend not going beyond 10mg without professional advice.

Stay well and keep busy!

References

[1]. Benzodiazepines and Related Drugs as a Risk Factor in Alzheimer’s Disease Dementia. Miren Ettcheto et al. Front Aging Neurosci. 2019; 11: 344.

[2]. Vitamin C may affect lung infections. Hemilä H, Louhiala P. J R Soc Med. 2007; 100(11): 495–498

[3]. Ibid.

[4] Time Magazine March 27^th 2020. https://www.newsweek.com/new-york-hospitals-vitamin-c-coronavirus-patients-1494407

[5]. Age and low levels of circulating vitamin D are associated with impaired innate immune function. Alvarez-Rodriguez L et al. J Leukoc Biol. 2012 May;91(5):829-38.

[6]. The association between vitamin D deficiency and community-acquired pneumonia: A meta-analysis of observational studies.
Zhou YF et al. Medicine (Baltimore). 2019 Sep;98(38):e17252.

[7]. The possible roles of solar ultraviolet-B radiation and vitamin D in reducing case-fatality rates from the 1918-1919 influenza pandemic in the United States.Grant WB, Giovannucci E. Dermatoendocrinol. 2009 Jul;1(4):215-9

[8]. https://www.dairynutrition.ca/nutrients-in-milk-products/vitamin-d/vitamin-d-status-of-canadians-results-from-the-canadian-health-measures-survey

[9]. Modulating the immune response by oral zinc supplementation: a single approach for multiple diseases. Overbeck S et al. Arch Immunol Ther Exp (Warsz). 2008;56(1):15-30.

[10]. Zinc for the common cold. Singh M1, Das RR. Cochrane Database Syst Rev. 2011 Feb 16;(2):CD001364

[11]. Modulating the immune response by oral zinc supplementation: a single approach for multiple diseases. Overbeck S et al. Arch Immunol Ther Exp (Warsz). 2008;56(1):15-30.

[12]. https://www.bloomberg.com/news/articles/2020-03-28/have-coronavirus-and-can-t-smell-harvard-scientists-explain-why

[13]. The effectiveness of high dose zinc acetate lozenges on various common cold symptoms: a meta-analysis. Hemilä H, Chalker E. BMC Fam Pract. 2015 Feb 25;16:24.

[14]. Immunoregulatory action of melatonin. The mechanism of action and the effect on inflammatory cells. Mańka S, Majewska E. Postepy Hig Med Dosw (Online). 2016 Oct 4;70(0):1059-1067.

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Curried Coconut Cod:

Ingredients:

Preparation:

References

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Enjoyable and Healthy Alternatives

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Pear and Parsnip Soup:

Ingredients:

Instructions:

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Supplementing with vitamin D – how much is enough?

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Nutritional deficiencies common in pregnancy

Steak (or Chicken) Salad with Balsamic Vinaigrette:

Ingredients:

For the Balsamic Vinaigrette:

Instructions:

References

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Healthy eating for the Holiday Season

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Burford-Mason PhD