Hot off the presses, we review a study on the gluten-free diet in patients with irritable bowel syndrome and a fascinating report from an organization called Eat Drink Politics, which published a kind of exposé on the Academy of Nutrition and Dietetics.
In this episode, we cover:
1:00 The latest update from Chris’ new projects (including the
10:42 New study: can gluten cause IBS-D?
27:04 Overcoming Histamine Intolerance
38:53 Are America’s Nutrition Professionals in the Pocket of Big Food?
Links We Discuss:
- A Controlled Trial of Gluten-Free Diet in Patients with Irritable Bowel Syndrome-Diarrhea
- Are America’s Nutrition Professionals in the Pocket of Big Food?
Full Text Transcript:
Steve Wright: Hey everyone, welcome to another episode of the Revolution Health Radio Show. This show is brought to you by ChrisKresser.com. My name is Steve Wright, and you can find my work at SCDLifestyle.com, but we’re both here to learn from the man, integrative medical practitioner and healthy skeptic, Chris Kresser, so Chris, how’s your day going?
Chris Kresser: It’s busy, but it’s going well. How are you? You sound a lot better this week.
Steve Wright: Yes. The flu symptoms are gone, the cold symptoms are gone, and I’m charged up. I’m ready to get rockin’ in 2013 here with the Revolution Health Radio Show.
Chris Kresser: Glad to hear it.
Steve Wright: So, what’s got you so busy, Chris?
The latest update from Chris’ new projects (including the book)
Chris Kresser: Good question. Well, let’s see. I’m writing a book. I actually just passed the 50,000-word mark on that, which is pretty exciting, so that’s about 150 pages. And it’s going to be a doorstopper because I’m only about a third of the way through the content that I have planned out. I mean, obviously there’s going to be some editing there too, but it’s been really fun. I love to write. Of course, I write a lot for my blog, but I’ve never actually written a book, and so I was curious about what my experience of that would be like, and it’s turning out to just be a really rewarding and satisfying creative project. And I like that I have a chance to kind of summarize tightly my general core philosophy on a number of different issues and put it all in one place in a really succinct and practical way. And new things that I haven’t even had a chance to write on the blog yet are going into the book, which is really cool. So, it’s exciting for me, and I’m pleased with the progress I’m making. It’s going a little faster actually that I even thought it would because I sometimes just get in this zone, and I look up like four or five hours later, haha, and there are 5000 words done or something.
I think part of it, too, has been that most of the writing is happening on the treadmill desk, which is just amazing because I get to the end of the day and I’ve made massive progress on my book, but I don’t have this tradeoff that I used to have of feeling really zonked out from sitting too much or even standing for too long. Yesterday I logged 23,000 steps, I think, and wrote a lot for my book and just felt great at the end of the day, so I’m digging the new movement/work productivity routine a lot.
Steve Wright: Well, 50,000 words is no joke, and neither is 23,000 steps because I just got a Fitbit and I’m working hard to get my 10,000 every day, so the fact that you’re just surpassing mine and bragging about how untired you are is a little annoying.
Chris Kresser: Haha, well, you know, it took a while. I built up to that somewhat gradually, I guess, but it is pretty amazing how my endurance has increased because I was up to 11,000 steps… let’s see, let me check right now… what is it? It’s 1:00 and I’m at 14,957, or it’s 1:30. This morning I looked at it at 10:00; I was already up at 9000 or 9500 by 10:00. So, it’s like, OK, this is going to be a good day. But, yeah, if I would have just started at 25,000, I think I would have been pretty sore and unhappy the next few days after that.
So, there’s the book, right? And then there’s not just writing the book, there’s all of the stuff that goes around producing the book, and you know, we haven’t talked that much about this on the show, but I’ve decided not to self-publish and I’m going to be publishing traditionally, so I’m in discussions with a number of different publishers. I’m going back to New York City in a couple weeks for some meetings, and that’s very time consuming, too, putting the proposal together and doing everything related to that.
So, yeah, that’s a few things that are going on right now, Steve, but I think I’ll stop there because we could take up the whole show talking about how busy I am!
Steve Wright: Haha, Chris Kresser is getting work done. That’s the summary, folks.
Chris Kresser: Yeah. Oh, yeah, and then there are my patients and all of the work that I do with that. And that’s actually the best part of my work, and lately I feel like I’ve been learning so much from my patients, and that’s another cool thing about my practice is I feel like the people that I see are not the usual patient population. That’s probably fairly obvious. By the time people get to me, they’re already on usually some version of the paleo diet, they’ve tried a whole bunch of other things, and they’re usually really well educated on certain health issues, and so I learn a ton from my patients, and I’ve felt that way in particular lately, so I’m really grateful for that. Whew. I get tired actually just saying all that!
Steve Wright: OK, OK, well, before you go on, rest a little bit and then I want to tell the listeners about Beyond Paleo. If you’re new to the Revolution Health Radio Show, if you’re new to the paleo diet, or you’re just someone who’s listening because you’re interested in optimizing your health, I would like to encourage you to go over to Chris’ site, ChrisKresser.com and look for this giant red box. It’s a big red box and it has an ad for Beyond Paleo. And this Beyond Paleo that I’m speaking about is a 13-part, free email series that Chris has put together, and it’s all of his best tips and tricks for burning fat, boosting energy, and preventing and reversing disease, and that’s without drugs, by the way. So, if that’s something you might be interested in, because it’s free, I would encourage you to go ahead and put your name and email in the box, the big red box, and sign up, because Chris obviously knows a lot and he shares a lot of stuff for free. So, take advantage of that offer, and now we’ll get back to our program here.
Chris, are you OK now?
Chris Kresser: I’m here. I just took a little nap. I’m ready.
Steve Wright: All right.
Chris Kresser: I still haven’t figured out how to walk doing the podcast yet, so it’s kind of the way that my standing treadmill desk is structured. I’ll have to work on that. Or I’ll just have to settle for standing, which I’m doing right now.
Steve Wright: Maybe we need to get you a mic that’s mounted on your body. That way the mic’s not stationary.
Chris Kresser: Or like a lavalier. Well, I have one of those, but the quality isn’t quite as good. The show comes first, Steve.
Steve Wright: I love the passion! So, what are we talking about today?
Chris Kresser: Just hot off the presses, you, I think, sent me this study. Was it this morning or last night? It’s all a blur, but it’s a study on gluten-free diet in patients with irritable bowel syndrome, and I want to talk about it because first of all, I think it’ll be useful for people, but in addition to just the general or the main findings of the study, there were some other findings that lead to some more kind of general conclusions about how gluten might affect the gut in people with gluten sensitivity and even without gluten sensitivity and in people with IBS and maybe people without IBS. So, I thought it would be interesting to take a much closer look at a study. We often talk about studies in a kind of general way, but I thought it might be a good exercise to dive a little deeper into this one and look at some of the mechanisms and talk about the way they structured it and just go through it in more detail, so we’re going to do that.
And then someone else sent me a really fascinating report from an organization called Eat Drink Politics, which is like a watchdog organization concerned about food policy, and they just published a kind of exposé on the Academy of Nutrition and Dietetics, which is the country’s biggest association of nutrition professionals with about, I think, 75,000 members or something like that. And the premise of this report is — and of course, this won’t be a surprise to probably most people listening to the show — but the premise is that America’s nutrition professionals are in the pocket of Big Food, and big companies like Coca-Cola and Hershey are playing a significant role in determining food policy in this country.
Steve Wright: Oh, no. Really?!
Chris Kresser: Haha, yeah. Believe it or not, Steve.
Steve Wright: Oh, wow. That’s… wow.
Chris Kresser: Yeah, a revelation, right? But I want to talk about it not because it’s going to surprise anyone, but just to sort of flesh out a little bit the details of that arrangement and how it does affect food policy and choices that some people make — you know, surely not anyone listening to this show, but people in general.
Steve Wright: Should we tell the listeners to get out the tinfoil hats? Is it going to get controversial here?
Chris Kresser: Haha. I don’t think it’ll be very controversial actually. It’s pretty straightforward when you look at it. But it’s disturbing, at least to me, especially as a parent, and I’ll tell a couple of personal anecdotes, too, about that. And if we have any time left over after my rambling, then we’ll get to a few questions that we have stored up, so there it is.
Steve Wright: All right. That’s the outline.
Chris Kresser: I feel like that was a very long introduction to the show, so sorry for those of you who are just waiting for me to get to the meaty stuff. Here we are.
Steve Wright: Steak number one is up!
New study: can gluten cause IBS-D?
Chris Kresser: Yeah. OK, so this was a four-week, randomized, controlled trial, which is, as you all know, the gold standard in medical research. And they took 45 patients and they separated them into two groups, and they put one group on a gluten-containing diet, or GCD they call it, and the other group on a gluten-free diet, or GFD. And they further separated each of the groups according to their HLA-DQ genotype. So, the short version of this is there is a particular genetic susceptibility, a pattern of genetic susceptibility to gluten intolerance and celiac disease, and so this is one of the things that was really great about the way that they did this study, is they included people who had this genotype and didn’t have it in both of the groups, both the gluten-containing diet and the gluten-free diet, so they were hoping to see whether this genetic influence had any effect on the patient’s response to gluten. And some other studies that have looked at gluten-free diets haven’t done that, so it’s really cool that they did. Another good thing, I think, is that they excluded people who had tried gluten-free diets before or had been diagnosed with gluten intolerance, and the reason they did that is they wanted to demonstrate that their results, whatever they were, would be generalizable to the entire IBS population. I should have mentioned this, that the two groups in the study both had IBS-D, which stands for diarrhea predominant. So, this isn’t the general population. This is a group of people who had already been diagnosed with IBS-D, and then they further separated them as I just described. So, the goal of this study was to find out if people with IBS-D benefit from a gluten-free diet, and of course, by extension, if they do, that would suggest that gluten may play some causative role in the symptoms of IBS-D and maybe even the pathogenesis of IBS-D.
So, the endpoints they were looking at in this study included stool frequency; transit time, which is similar but a little bit different; gut permeability, which we’ve talked about a lot, and they measured that in two ways. I’m glad, because as those of you who have been listening to the show for a while know and caught the interview with Dr. Fasano, the typical way of measuring intestinal permeability is the lactulose/mannitol challenge, where you swallow this solution with these sugars, and the sugar molecules are rather large and they shouldn’t pass through the gut barrier, and if they do, then that suggests that the gut barrier is permeable, but that test has a number of issues, as we discussed with Dr. Fasano. It’s not 100% accurate by any means. So, the researchers also included a DNA PCR measurement of the tight junction proteins, so these are proteins that regulate the tight junctions, which in turn regulate intestinal barrier function. So, they were looking for expression, mRNA expression of those proteins as another way of determining whether the gut was permeable or not. And then lastly, they looked at inflammatory cytokine production by peripheral mononuclear cells, or PBMCs, so that was another endpoint that they were examining in terms of how gluten affected these two groups of patients.
This was an outpatient trial, meaning the participants were not in a medical ward. They were living in their homes, but they were only allowed to eat meals prepared by the Mayo Clinic, which is the group that did the study. And my understanding of it is that the meals were, they could select from a list and then the dietitians in the study delivered them to the study participants. And apparently there will be a table or chart listing the foods that they had access to. I was hoping it would be in the PDF that I got, but it wasn’t, possibly because it’s a preliminary copy that was just accepted and it wasn’t formatted yet in its final form. But I do remember the composition of the diet was 20% protein, 30% fat, and 50% carbohydrate, and I really wish I could have seen the foods, but it’s pretty safe to say it wasn’t a paleo diet!
Steve Wright: Yeah, that 50% carbohydrate.
Chris Kresser: Yeah. My guess is they just removed gluten, but there was still a fair amount of grains and processed food, I would imagine, and things like that. Of course, that begs the question, like, wow, how would it be to do a study like this where they’re comparing even a schwaggy kind of gluten-free diet with a lot of processed food and grains with a paleo type of diet? That’s the study I’d like to see.
Steve Wright: Yeah, that’d be good to see.
Chris Kresser: Or maybe like a third group. You know, you have like the gluten-containing diet with the full-fledged just crappy diet, and then gluten-free crappy diet, and then paleo diet. That’s the one I’d love to see. Anyhow, I digress!
Steve Wright: Well, I think you hit on a good point, though, because depending on whenever that food list comes out, whatever goods they did include on the gluten diet, I think it’s going to make the results even more profound if all they did was exclude wheat and not other grains that include prolamins that we know people who have digestive issues typically react to.
Chris Kresser: And people who have gluten intolerance also have a cross-reaction to some of those grains, of course, too, so I’m virtually certain, Steve, that they didn’t remove all grains. So, yeah, I think you’re right. It does make the results even more significant because you and I both know that oftentimes when people go gluten free they get some improvement, but the real improvement often comes when they remove the other grains and foods in general they might be cross-reacting to.
So, what did they find here? They found that the subjects on the gluten-containing diet had greater stool frequency compared to those on the gluten-free diet, so they had more frequent bowel movements, which was already an issue for them because these were people with diarrhea-predominant IBS. And the effect was greater in carriers of the DQ2 or DQ8 genotype, but it was still significant in non-carriers, so let me break that down. Both groups in the gluten-containing diet had greater stool frequency, regardless of whether they had a genetic susceptibility to gluten intolerance. But the people that did have a genetic susceptibility had even greater increase in stool frequency. And this was pretty much consistent all throughout the study. All of the endpoints that we’re going to discuss, I think with the exception of one, the effect was greater in DQ2 and DQ8 carriers, you know, the people with genetic susceptibility to gluten intolerance.
So, the next thing they found was that gluten-containing-diet people also had increased small bowel permeability, and this was measured by both lactulose/mannitol challenge and mRNA expression of the tight junction proteins like zonulin, occludin, and claudin, and this is significant because there have actually been a few other studies that have suggested that in people with non-celiac gluten intolerance, there is no increase in intestinal permeability when they eat gluten. So, I’m not sure what to make of the results other than that there may be something with the diarrhea-predominant IBS patients that makes them more susceptible to that. There may be some underlying cause, for example, like dysbiosis, that predisposes them to gluten sensitivity and intestinal permeability as a result of exposure to gluten. I’m not sure. But it’s interesting.
Another interesting note is that the study suggests that the response to gluten in IBS patients is mediated by both adaptive and innate immune mechanisms. Innate immunity refers to the nonspecific defense mechanisms that come into play right after or within hours of being exposed to an antigen. The innate immune system includes the physical barriers like the skin or the intestinal mucosa or the lungs, all of the surfaces of the body that are designed to keep things out of the interior of the body, and it also includes immune cells that attack foreign invaders in a kind of nonspecific way, and then the immune response that’s activated by the chemical properties of a particular antigen. Whereas, adaptive immunity refers to an antigen-specific response. So, this is a lot more complex than the innate response because the antigen or the foreign invader must be first recognized and then processed. So, most people know about this. This is when the immune system creates antibodies. Like, if you’re exposed to a virus or something, the immune system creates antibodies to that so that when you’re exposed to it later on, you won’t get sick again. I mean, that’s the theory, at least, of how it will work. And the memory cells can retain that imprint, so to speak, for many, many years. So, that’s the difference between innate and adaptive immunity.
Now, as it relates to this study, the association with DQ genotype, meaning the fact that the people with genetic susceptibility to gluten intolerance were affected more than people who didn’t have that susceptibility suggests that there’s some kind of adaptive immune mechanism going on that explains how gluten affects the intestinal barrier function. On the other hand, there was some data in this study that suggests that gluten might cause an immune response through the innate pathway. In fact, other studies have also shown increased levels of toll-like receptors in the mucosa of gluten-sensitive patients, and toll-like receptors are a class of proteins that play an important role in the innate immune system. They’re expressed in sentinel cells, like macrophages and dendritic cells, and their job is to recognize microbes or antigens that have broken through the physical barriers, like the skin or the gut mucosa, and then activate immune cell responses.
Another possibility is that the reaction to gluten is mediated by increased inflammatory cytokine production in the PBMCs, the peripheral mononuclear cells, and this was actually observed in this study. The PBMC cytokine response to gluten suggested that it was stimulating the innate immune system to produce monocytes, which are a nonspecific type of white blood cell involved in the inflammatory response. And they also suggested that other cells, like dendritic cells or eosinophils or natural killer T cells, could have been stimulated by gluten and that might contribute to the reaction.
So, that was a lot of scientific mumbo-jumbo! I hope your eyes aren’t glazing over, but the important takeaway from this study in plain English is that it’s one of the first to show that gluten can cause gut inflammation in people with IBS but without known gluten intolerance or celiac disease, and it also suggests that a genetic susceptibility to gluten intolerance makes the reaction to gluten stronger, but that it can still occur even without that genetic susceptibility. I think this will be an important study, especially for some of the skeptics and naysayers who don’t really believe that gluten is a problem or can be a problem, especially in people who aren’t necessarily diagnosed with gluten intolerance.
Steve Wright: Yeah, I really respect the studies, all the tests they did and all of the data provided. I mean, you just hit the home runs, but just to throw in another couple things I thought were really interesting about it is that they show the charts about how they tested rice versus gluten, and like the IL-10, the average gluten response was about two, maybe two and a half times stronger than rice. And then the TNF-alpha was three, maybe three and a half times, and if you did the range of that, it could be up to five or six times stronger than rice. So, just the amount of inflammation that was happening in these people just from that wheat is pretty striking.
Chris Kresser: Yeah. It was much more immunogenic and inflammatory. And they also did point out — I’m not sure if you saw this — they didn’t specifically measure the effects of gluten. They were measuring the effects of wheat. So, it’s possible that some other proteins in wheat, like wheat germ agglutinin or glutenin or deamidated gliadin or other proteins that aren’t gluten per se, but are part of wheat could have been contributing to this response. And I mean, from a practical perspective, that’s not that important because if you’re eliminating wheat, you’re also eliminating those proteins, but it is probably worth at least pointing out.
Steve Wright: Yeah. And I think the other thing that is kind of interesting about this study, like you pointed out, they had very good inclusion/exclusion criteria that really screened for problematic things, like tobacco and artificial sugars and NSAIDs and things like that, but I found it really interesting to find out that 95% of the study participants were basically females.
Chris Kresser: Yeah. That’s somewhat expected because the prevalence of diarrhea-predominant irritable bowel syndrome is heavily skewed towards females. I don’t think it’s 90%, but off the top of my head, I think it is like three out of four.
Steve Wright: And that’s probably because men just don’t go to the doctor, right?
Chris Kresser: That could very well be! Yeah, maybe they think it’s normal or something. I don’t know. There might be something to the gender difference, but there’s certainly that factor. There’s no doubt about that.
Steve Wright: Yeah, I was listening to somebody else’s podcast, and hopefully this doesn’t make us explicit, but they basically said most men don’t go to the doctor until their genitalia doesn’t work anymore.
Chris Kresser: Or they have a heart attack.
Steve Wright: Yeah, that too.
Overcoming Histamine Intolerance
Chris Kresser: So, yeah. Actually just something else occurred to me that’s somewhat related but not directly that I want to talk about before we go on to the food politics report. I wrote an article last week about histamine intolerance, which is something I’ve been seeing a lot more of in my practice, and it seems like there’s a lot more discussion about it online, and awareness of it is increasing. And of course, I’m always thinking about things like that and interested in the ‘whys’ in addition to the practical application because the ‘why’ often informs the practical application.
In the case of histamine intolerance, the part of it that’s most fascinating to me is the role that disturbances in the gut flora play in histamine intolerance. And that if it is on the rise — I haven’t seen any statistics on that. I don’t even know that any statistics exist, because there’s no really accurate way to measure histamine intolerance, and a lot of people who have it aren’t even aware that they do have it, and doctors aren’t aware of it for the most part, so I don’t think there are any statistics. But if it’s true that it is more common, and I think we could reasonably make an argument that it may be, because it could be another emerging consequence of the effects of the modern lifestyle on the gut microbiota, because there are dietary sources of histamine, and a low-histamine diet is, of course, one of the main ways that you treat histamine intolerance, but many of the bacteria that live in the gut, particularly the colon, produce histidine decarboxylase, which is the enzyme that’s capable of converting histidine, which is an amino acid and protein, into histamine. So, you eat protein that has histidine, and if you have a lot of the specific types of bacteria in the colon that produce this enzyme, then you will convert more of the histidine in protein to histamine. And the more of those kinds of bacteria you have, the more histamine you’ll produce in the colon, and then that histamine can be conveyed through the bowel wall to all the different sites in the body where it produces the inflammatory response and all of the symptoms that we associate with histamine intolerance.
Antibiotic overuse and gut infections and poor diet, lack of soluble fiber or fermentable fibers, lack of fermented foods, other medications like birth control, which adversely affect the gut flora, chronic stress — There are so many aspects of the modern lifestyle that are hostile to healthy gut bacteria and that can change the balance of gut bacteria. I think that that probably is changing the gut microbiota on a population-wide basis. I mean, we know that that’s happening from the DNA testing that is happening now, the sequencing of the gut microbiota, and there are plenty of studies that show that even a single course of antibiotics can permanently alter the gut flora. We don’t know what the consequences of that are, so I don’t want to scare people from taking antibiotics when they need to. There are times when that’s necessary, but I think the point here is that we’re in the midst of a kind of society-wide experiment that we don’t really know what the effects of it are going to be, but from the data that we have so far, it would seem to me that the effects are not great. I’m glad to see that there’s more attention being brought to this issue and more of an effort made to preserve healthy gut microbiota, and I think in the future fecal transplants or synthetic fecal transplants, which are now being developed, might be a much more common treatment than they are now.
One of my patients that has histamine intolerance discovered, I guess, a German study that was translated and posted in a Facebook group that talks about these issues, a fecal bacteria therapy group. And this study apparently looked at various microbial strains and broke them into three categories: one category that’s histamine producing; another category, which seems to be sort of neither histamine producing, nor histamine degrading; and then the third category would be histamine degrading. And so obviously you have histamine intolerance, you’d want to focus on the ones that are histamine degrading, and you’d want to avoid the ones that are histamine producing. And the histamine-producing category is Lactobacillus casei, Lactobacillus reuteri, Lactobacillus plantarum, and Lactococcus lactis, Enterococcus faecalis, and various types of E. coli. And then the ones that seem to degrade histamine and be beneficial are lots of bifidobacteria species, but particularly Bifidobacterium infantis and then Lactobacillus rhamnosus and salivarius and sporogenes and Lactobacillus gasseri.
This is the tip of the iceberg because there are a lot more species, obviously, of probiotics out there, and I personally wonder about soil-based organisms. I just anecdotally in my practice have observed that soil-based organisms are much better tolerated by people with histamine intolerance and people with SIBO, so my suspicion is that those are not histamine builders and may even be histamine degraders, but I don’t have any evidence to back that up. It’s been interesting, though, to observe that, that the soil-based organisms are better. And in fact, pretty soon here I’m going to write an article about one of the products that I’m using a lot in my practice called Prescript-Assist that I really like. I’m using it actually myself personally and having some really good results, and I’ve been using it with my patients with good results, so stay tuned for an article about that.
Steve Wright: All right, well, you better get that article out soon.
Chris Kresser: Haha, OK.
Steve Wright: I’m just kidding. You’ve got a lot of work on your plate!
Chris Kresser: Yeah, I’ll put it on my list.
Steve Wright: Before you run away with the histamine talk, I’m just curious, anecdotally — I just read an awesome article by Dave Mayo about using magnesium for histamine intolerance, and I was just curious if some of your clinical experience had shown that people with histamine intolerance were potentially magnesium deficient as well and if that played a role or not.
Chris Kresser: Yeah, I think it probably is true. A lot of people are magnesium deficient, in my experience, maybe most that I see in my practice. Magnesium can be helpful. Another natural substance that’s really helpful is a flavonoid called quercetin. Sort of higher doses of quercetin, like 1000 mg to 2000 mg a day in divided doses, can be really, really good for histamine and all kinds of allergic responses, actually, which are usually histamine mediated. And the enzyme bromelain can be good for histamine intolerance as well. So, I’m going to continue talking about histamine intolerance. We’ll do a follow-up post where we go into a little more detail and stuff on treatment or talk about it again on the podcast because it is a really interesting issue, and I am definitely seeing it in a lot more of my patients, and a lot of my patients are really benefitting from doing a low-histamine diet. I mean, people with longstanding, really intense, severe symptoms that are clearing up almost completely in some cases, so it’s a pretty exciting, encouraging tool to have available, especially because it’s noninvasive, there are no side effects, it’s a completely food-based approach, with the exception of some of the natural supplements that I just mentioned.
Steve Wright: And just for the record, what’s a flavonoid?
Chris Kresser: Flavonoid you’ve probably heard referred to bioflavonoid maybe. They’re a class of secondary metabolites in plants, and they have a number of functions, but one of them is that they give plants their characteristic pigmentation. So, you hear the recommendation to eat the rainbow, you know, eat green and red and yellow, all the color spectrum. That’s the whole range of different flavonoids in plants that can have beneficial properties, like antioxidant properties, or some people, like Stephan, have written that they may actually have pro-oxidant properties, which in small amounts can be hormetic, meaning they induce an adaptive response that is beneficial to us, but if they’re taken in extremely large amounts for long periods of time, then they may not be beneficial. I think that there’s a lot of room for learning here. I personally am looking forward to learning more about the various bacteria and how they affect histamine production, how antimicrobial treatments for SIBO might contribute here. Of course, we have to be careful with that because it’s possible that overuse of antimicrobials in the first place might have contributed. Fermented foods are eliminated or greatly reduced on a low-histamine diet because the fermentation that’s happened in the fermented foods has produced histamine, so they’re some of the highest dietary sources of histamine. But it’s not clear what contribution eating a lot of fermented foods might make to someone who’s not — like if that might predispose someone to histamine intolerance. I tend to doubt it. It doesn’t really make that much sense from an evolutionary perspective. So, there are a lot of questions still to answer about this, and I’m looking forward to learning more.
So, now let’s talk about food politics. It’s always a fascinating subject for me, and it can get me pretty worked up on the one hand. On the other hand, nothing surprises me anymore! So, it’s kind of like, duh, of course, yeah. Why are we even talking about this? But we’re going to talk about it anyway!
Steve Wright: I’m going to go get my tinfoil. Hold on.
Chris Kresser: Haha.
Steve Wright: I forgot this is real life. This is fact.
Are America’s Nutrition Professionals in the Pocket of Big Food?
Chris Kresser: Yeah, this is fact here. And you know, what’s maybe controversial, although I doubt it, is how this would be interpreted, but I think the vast majority of people, including dietitians, are against this kind of influence, as you’ll see. But I’m just going to kind of zip through the executive summary and a few of the salient points that I found to be interesting, and I notice we’re already kind of getting late in the show here, so I’ll just pick out the ones that I thought were most interesting, and then we’ll see where we’re at time wise.
So, the press release was “Public health attorney and author Michele Simon asks: Are America’s nutrition professionals in the pocket of Big Food?” Well, that’s a rhetorical question, haha, really.
“While the Academy of Nutrition and Dietetics’ 74,000-member trade group partners with the likes of Coke and Hershey’s, the nation’s health continues to suffer from poor diet.” “The report details how registered dietitians can earn continuing education units from Coca-Cola,”
— that’s great, haha —
“in which they learn that sugar is not a problem for children and how Nestlé, the world’s largest food company, can pay $50,000 to host a two-hour ‘nutrition symposium’ at the Academy’s annual meeting.”
So, there were some pretty choice bits in here. One of my favorites was this doctor who is an MD at Harvard, you know, got Chief Physician at Massachusetts General Hospital, etc., I mean, got serious chops, right? So, if someone sees this guy on paper, they’re going to think he’s extremely credible, but his résumé also reads like a Who’s Who of the corporate food industry. He consults with Coca-Cola, Burger King, and General Mills and was tapped by Monsanto to be one of the numerous so-called experts speaking out against Proposition 37 in California, you know, which would have required labeling of genetically modified foods here in California.
Steve Wright: That sounds like a guy I’d trust my health with.
Chris Kresser: Yeah. Well, the problem is a lot of people do. So, he does this continuing education seminar sponsored by Coca-Cola, and the takeaway message from his seminar is how sugar is just fine for kids and the goal is to assuage parents’ concerns about sugar’s impact on their kids’ health. And he dismissed such ideas as “urban myths” and “misconceptions,” which is really, really hard to swallow. I mean, even for someone that can sometimes be as jaded as I am, that’s pretty, pretty hard to swallow.
Steve Wright: Yeah. You know, that’s bad for everyone, including Harvard.
Chris Kresser: Yeah, really. I mean, what are the standards here? So, here are a few other bullet points from the executive summary that stood out for me. Beginning in 2001, the AND — we’re going to abbreviate it that way, Academy of Nutrition and Dietetics — they had 10 food industry sponsors, and now as of 2011, their annual report lists 38 sponsors, more than a threefold increase during that time. And these are companies like Coca-Cola, Kraft Foods, Nestlé, Pepsi — you know, all paragons of healthy nutrition, right? And these companies pay for the privilege of doing CEU seminars that then dietitians can take for credit. And some of the themes and messages that are taught in these seminars are that sugar is not harmful to kids, as we just talked about; that aspartame, the artificial sweetener, is completely safe, including for children one year old; and the Institute of Medicine is too restrictive in its school nutrition standards. Roughly 23% of speakers at the annual meeting of the AND have industry ties, although very few of them actually disclose those ties. Almost all registered dietitians that were surveyed, 97%, thought that the Academy should verify that a sponsor’s corporate mission is consistent with that of the Academy prior to accepting them — well, duh — And a majority of RDs surveyed found that the current AND sponsors, like Coca-Cola and Mars and Pepsi, were completely unacceptable. And then the lobbying agenda of this organization mostly revolves around safety issues for registered dietitians. They don’t even get involved in controversial nutrition policies that could upset their corporate sponsors, like limiting soft drink sizes or taxing sodas or GMO labeling or things like that.
So, the reason this matters — I mean, it’s fairly obvious why it matters — but specifically, there’s a lot of evidence that shows that the food industry’s marketing of these processed, packaged, and refined foods, especially to children, is at least partly to blame for poor eating habits. And I think personal responsibility obviously plays a huge role here, and it’s a cop out to just blame advertising, but it’s also naïve to assume that advertising doesn’t have a significant impact. There is a lot of research that shows that it does, and it’s impossible, really, for any kind of ‘eat healthy’ messages, as misguided as some of the ‘eat healthy’ messages are that come out of the conventional establishment — that’s a whole other ball of wax! — but those will never be able to compete with an industry that spends billions of dollars a year marketing these processed food products.
The last little bit that I’m going to share that I thought was, haha, pretty amazing was that during the annual meeting, there was a series sponsored by Pepsi and Kellogg, it looks like, called the “Kids Eat Right Breakfast Series.”
Steve Wright: Haha. Oh, yeah?
Chris Kresser: Yeah, haha. They had a Breakfast in the Classroom: Convictions and Controversies, sponsored by Pepsi, and Shaping up America’s Breakfast: RDs and Consumers Choose My Bowl, sponsored by Kellogg Company, as if a bowl of cereal, of course, is going to be a really healthy breakfast.
Steve Wright: Yeah, a bowl of cornflakes with a Pepsi Max poured on top.
Chris Kresser: Haha, exactly! You know, Pepsi owns Odwalla, which is their healthy drink that has about 60 grams — I don’t even know how many grams of sugar are in those things. They might even be sweeter than sodas. I’m not sure, but there’s a lot of sugar in those. Yeah, and so Kellogg and Pepsi specifically, of course, manufacture tons of “child-friendly” cereals that are really, really high in sugar, and they’re going around in this annual meeting trying to educate registered dietitians to basically tell them that cereal, even sugary cereals like that, are part of a healthy breakfast because they don’t have saturated fat or cholesterol. That’s essentially the take-home message from these seminars. This is what we’re up against.
Steve Wright: This is awful. I mean, I’m laughing because I don’t want to get angry and ruin this microphone in front of me, but gosh, I feel so bad for the RDs and MDs or anyone in the medical field who wants to make a change and unknowingly might buy into this.
Chris Kresser: Yeah. I have some fantastic RDs on staff and soon-to-be RDs. Many of you know Kelsey and Laura, and they’ve told me just how hard it is to sit through some of their classes and the material and the things that they’ve had to put up with as they’ve gone through school. I don’t know how they’ve done it. I never could have, for sure! It was hard enough for me to get through my program, and it was pretty open-minded as far as that stuff goes and a lot more with-it.
But here’s the thing, here’s kind of what brought this home for me. Sometimes I feel like I live in my own little world because a lot of my friends eat really healthy and are really conscious around food, and if I just stay in my little sphere, I can feel pretty disconnected from the way that most the rest of the world is operating and eating — or the rest of this country, I should say, because it’s a lot different in other places. But I was out the other day with Sylvie, and we went to a class that she had with some of her other little friends, and then afterwards some of the parents, we went to a café, and everyone had food for their kids, right? So, Sylvie has some hard-boiled eggs and some sauerkraut and — what else did she have? I think a little bit of salmon leftover and some blueberries. That’s what’s in her little food container. But everyone else is buying huge rice krispie treats, like seriously the size of two fists put together, like the biggest rice krispie treat I’ve ever seen. And cookies and super sugary drinks, and they’re bringing this stuff back to the table and passing it around and asking: Oh, can Sylvie have some of that? And I’m like: No, she can’t. She can’t eat that. Sometimes I’ll just tell people that she’s gluten intolerant. I don’t even know if she is or not, but as far as I’m concerned she is!
Steve Wright: Haha.
Chris Kresser: And that’s just the easiest way to quickly explain it to people without going into a lot of detail. And then there were a couple parents that you could see were not totally comfortable with the huge sugar binge thing that was about to happen, but they didn’t speak up, so they just kind of were resigned to letting it happen, and then their kid got a hold of the sugar, and then when their parent tried to intervene and say that’s enough, what do you suppose happened? You know, full-fledged meltdown and all these kids are screaming, screaming, and going crazy. And Sylvie’s there, eating her hard-boiled egg.
What struck me about that is that I’m really convinced that all of those parents want the best for their kids, and as a parent myself, I think that for most parents that’s true. But what I also was thinking about at that time is that — And I was sitting there going, OK, so what’s happening here? Do these parents just not even think about it? Or do they think about it and go: Oh, yeah. We know sugar’s not that great, but so what. It’s not the end of the world, and they’ll live. You know, just kind of discounting how significant of an issue it will be? Or do they know it’s an issue but they feel socially awkward about saying no, which I think was maybe the case for some of them? Or was it some combination of all of that? I don’t know, but it struck me that it was, I think for at least a significant portion of those people, just not really on their radar. And when their kid later, like an hour or two later, goes home and is like a complete basket case, they’re not even going to make the connection between the food that their kid was eating and the behavior later on. My wife used to run a preschool co-op, and she saw this firsthand all the time. The kids that would eat all of this sugar and flour were just wrecks later, and their parents did not understand that connection. And she struggled a lot with what was appropriate for her to talk about with them, and I just think it’s still, even with the increased awareness of food and the role of food in health, I think a lot of parents just don’t really get the connection. That’s what’s so disturbing about it. And that’s where, I think, this kind of advertising and food politics is really important and significant.
Steve Wright: Yeah, I think that is the underlying factor right there. The billions that they spend on marketing — They’re not trying to get us to buy their foods. We are the, I would say, informed minority. Their billions of dollars are on marketing and advertising for the uninformed who aren’t able to make those connections at this point, who haven’t spent extra time to figure out what might be going on with their children, and that’s what’s so sad.
Chris Kresser: That’s right. It’s the lowest hanging fruit, right?
Steve Wright: Yup. And guess what? That is the biggest majority of the market.
Chris Kresser: Absolutely. That’s the vast majority of people who live in this country. That’s what gets me angrier and more upset than anything else, is the stuff that’s directed to kids, because I know how big of a deal the food choices are for young kids, how much it can affect their growth and development, how crucial. I mean, any adult probably who is listening to this show knows firsthand how important diet is to how they feel, but that’s magnified by many times for kids who are still in the growth and development phase. So, if there’s one thing that I hope my work does in my lifetime, some way that I hope I can make an impact, it’s convincing parents to feed their kids the right food. I mean, that’s why the Healthy Baby Code was the first thing that I did, and I’m sure I’ll write a book with that kind of material expanded at some point, too, because I just can’t think of a more important thing to devote myself to.
Steve Wright: Yeah. I couldn’t agree more, and the sad thing is that kids don’t even realize. Like you just said, an adult is conscious enough and understanding of the world enough to realize that if I do an action, it produces a result, and maybe that doesn’t feel good every day, but kids aren’t at that level of development yet, and so they don’t have those choices and they can’t make those connections usually for a while. I mean, there are some kids that do, but I would say the vast majority can’t.
Chris Kresser: Yeah, exactly. So, I think that’s the end of our time. We didn’t get to any questions. We’ll definitely pick that up again soon. Also, send us your ideas for any guests, people that you’d like to hear us interview on the show. I want to do some more of that this year. We’ve been reaching out to some researchers in the field. I really enjoyed the interviews with Dr. Fasano and Dr. Ralston, and we’ve had Stephan and Dan on the show. I really like to talk to people who are out there getting their elbows dirty in the research world, because I think they can bring a lot to the conversation. So, if anyone listening has any ideas for people they’d like to hear, any researchers or people working in the field or any connections to people, let us know. Drop us a line through the contact form.
Steve Wright: Well, thanks, Chris, for breaking down these two noteworthy and newsworthy new studies. I think it was a good talk today and a little bit of a departure from the usual Q&A, but we’ll be back at those questions in no time.
Chris Kresser: All right.
Steve Wright: OK, well, you can find out in between shows more about what Chris is up to if you go to Facebook.com/ChrisKresserLAc or follow him on Twitter at Twitter.com/ChrisKresser. He likes to post a lot of these studies that he reads and maybe we don’t ever talk about on the podcast, so it’s a great place to follow him and get the latest updates on what he’s reading. We really appreciate you listening to the show today. As Chris mentioned, if you have any thoughts about people for us to talk with or you have questions for the Q&A, please go to ChrisKresser.com and submit them using the podcast submission link. Also, if you enjoyed the show, please head over to iTunes and leave us a review. Thanks and we’ll talk to you on the next episode.
Chris Kresser: Thanks everyone. Talk to you next time.
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