Systematic Reviews: Clearing the confusion in nutrition messages

Wine, chocolate, soy products, and more have starred on both the "eat this" list and the "not that" list. How can scientific studies done on the same food yield such contradictory results!? Well, there are factors that affect overall quality, applicability, and strength of research results. If researchers don't account for these in their study design, they could skew results.

1. Baseline exposure – Unlike a drug trial, people already have a level of nutrients in their diets when they enter a study. This level can be affected by food choices, supplements, and at times endogenous synthesis (e.g. vitamin D from sun).  
2. Nutrient status – Refers to whether a person is nutrient replete at the start of the study.  Current diets are not always an indicator of nutrient status.  For example, someone may have a micro-hemorrhage that could affect nutrient status.
3. Bioequivalence of different chemical forms of nutrients – Nutrients occur in multiple forms that differ in biological activity. It's important to calculate nutrient equivalents (like acknowledging folate to be essentially the same as folic acid).
4. Bioavailability of nutrients – There are factors that affect the body’s absorption of the nutrient. For example, tannins blocks the absorption of iron. If you drink tea during your steak dinner, you're getting far less iron than you might think from that slab of meat.
5. Multiple and interrelated biological functions of a nutrient – Since most nutrients have multiple biological functions, it’s important to clearly define the nutrient-specific scope of the study. 
6. Undefined nature of nutrient intervention – Food-based nutrient interventions make it hard to quantify change in intake. For ex, if you’re measuring EPA and DHA by asking subjects to eat fish, there are variable levels of these nutrients within species of fish, or depending on the time of year the fish were caught, or the animal husbandry practices for farm-raised fish.
7. Uncertainties in assessing dose-response relationships – Measurement procedures across studies can be subject to error, bias, or inconsistencies. 

What's the solution? Well, systematic reviews exist to clear up some confusion. A systematic review is a paper that tries to sum up the best available research on a specific science question. Like, "Are soy products good or bad for your health? To answer that question, a research team scours the scientific literature for reliable studies. They apply critical appraisal skills to understand the methods and results of studies and assess the research quality. These reviews can be done on nutrition topics too, and in that case the research team weighs factors 1-7 above to decide just how influential results from a particular study should be on their final consensus. The procedure for researching and writing the systematic review is thoroughly documented, completely transparent and fully reproducible at every stage, proving the research team that writes it has no vested interest in the outcome, and that the report is free of bias. This is important because systematic reviews are often referred to when policy makers need to develop health practice guidelines.

References:
1. LichtensteinAH, et al. Application of systematic review methodology to the field of nutrition. J Nutr 2008; 138 (12):2297-2306.

2. Hill A, et al. What is critical appraisal? Skills Programme, Institute of Health Sciences, Hayward Medical Communications 2001; 3 (2):1-8. 

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Food Comedy! Jim Gaffigan

Great food comedian? Or greatest food comedian ... you decide. For a particularly scrumptious selection of grub guffaws, check out his stand up special, "Beyond the Pale," available on instant watch netflix. Jim's sarcastic drawl depicts the joys of modern convenience as enablers for our sloth and gluttony. Hailed as an "everyman" towards whom American audiences are apt to relate, he dishes out lines like: food "delivery is really a combination of my two favorite activities: eating, and not moving." His trademark trick though, is to remark on his material in a high-pitched effeminate whisper of a hypothetical disappointed audience member. Supposedly inspired by his sister, this alter-ego counters his jabs with asides like, "He has his pants off in a lot of jokes..." He uses this humor device to knock himself and his material, which inevitably draws bigger laughs. The tactic deftly deflects any anger or estrangement the audience may feel.  By calling himself out with criticisms listeners might be thinking, he's winning them to his side by validating their thoughts. A family-friendly comic free of curse words (maybe b/c he's got four kids and a wife on tour with him usually), Gaffigan's a master of observational comedy. He's built much of his career on junk food jokes. I've pasted a sample below. Cinnabons, Bacon, Cake, and of course - debatably his crowing career bit - the Hot pocket. Enjoy. And if you're hungry for more food comedy, pick up his next special, "King Baby," as your second course.

Cinnabon


Bacon


Cake


Hot pocket

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America's Fat Future

My Blog was selected from a number of Food and Fitness Blogs to feature this infographic on America's current obesity epidemic. It shows where we currently stand and where we'll be if we don't take steps to alter our country's trajectory. A team at MedicalCodingCareerGuide.com created the infographic, and they'd appreciate any feedback you have. Leave comments letting them know what you think! What did you get out of it? Is it effective? Does it depress you or motivate you to take action?







Created by: MedicalCodingCareerGuide.com

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Greg Plitt - World's Top Fitness Model

I wanted to not like this guy. For starters, claiming the title of World's Top Fitness Model struck me as pretentious. But consider a quote by Muhammad Ali: "It's not bragging if you can back it up." Having graced the cover of one (usually more) fitness magazine(s) per month for the past five years, safe to say Greg can back his title. Over 100 fitness magazines and 24 romance novel covers later, Greg isn't slowing down.

My next line of defense was to think that he was just a pretty face. But his acting performances on infomercials, commercials, soap operas, tv shows, and movies attest otherwise.

Ok fine, he's a pretty face with acting chops. Probably the self-absorbed Hollywood type? Hardly. He devoted nine years of his life to serving our country. After graduating from the United States Military Academy at West Point, he became an officer in the Army Rangers.

Well there goes my next accusation that he just looks tough but couldn't hold his own in a real fight. Greg was on the wrestling and skydiving teams while at West Point. He's certified in Airborne Combat, Air Assault, the Mortar Leader's course, a Master Fitness Trainer, and Combat Lifesaver. When he retired from army life in 2005, he was captain and company commander of 180 people.

In an interview with Muscle&Body magazine, Greg describes his role forging tomorrow's soldiers: "That transformation that you see when someone becomes a soldier," he says, "many of them come in with real bad attitudes. They’re tough guys on the street and nobody’s going to tell them what to do. Then one day, they’ll come to you crying, saying, ‘I need someone to talk to.’ All of sudden they start changing their ways and they become the men they always wanted to be. Then other soldiers start looking up to them as role models. Then they’re proud and they hold their heads high. That’s more gratifying than anything I’ve done. That’s what’s so cool about it — to be able to train somebody and transform them and bring out all of the great qualities that everyone possesses."

Determined to find a flaw, I wager he's of average intelligence, at best. Only to find he graduated high school with a 4.0, and sailed through West Point at the top of his class. Well, maybe he's just book smart but incapable of deeper philosophical conversations. Nooope, I'm wrong again. In the members only section of Greg Plitt's website, his vlog responses to fan questions cover topics like the transformation mentality, overcoming adversity and self paralysis, and finding yourself through fear.

This man's character and mental fortitude are infectious in the best way. For him, success isn't a secret club for the elite. It's something of which we are all capable. His messages challenge us to rediscover our potential.

This blog entry is my pitch for you to visit his website. And I encourage joining the members only section. It's $10 a month and well worth it. The site's routinely updated with inspiring pep talks and practical advice on fitness/nutrition. Oh, and he's got cooking lessons on there too. Yes, ladies, he even cooks.

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