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Dispelling nutrition myths, ranting, and occasionally, raving


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Blog by request: folate

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Lacking in blogspiration, I went back through my inbox and realised that I had a few topic suggestions that I’d never written about. While this isn’t my usually ranting hopefully it will be useful information to some!

So… folate/folic acid, what is it?

Folate refers to the generic name for the vitamin as well as the various forms found naturally in foods. Folic acid is the form of the vitamin found in supplements and fortified foods. Naturally occurring folate usually has additional glutamate molecules attached that can reduce absorption as they need to be removed before the folic acid can be absorbed in the intestine.

What does folic acid do?

The main reason that the government introduced mandatory fortification of white flour with folic acid is due to the role it plays in preventing neural tube defects in infants. While prenatal vitamins contain folic acid many women don’t begin taking them until after they learn that they’re pregnant. This is often too late to promote proper neural tube development. However, as bread and other refined grains are widely consumed, the government decided to have it added to most refined grain products.

Folic acid plays an important role in DNA synthesis and repair as well as in the formation of neurotransmitters. It’s also involved in amino acid metabolism and blood pressure normalization.

How much folate do I need?

The RDA (recommended Dietary Allowance) for adults is 400 mcg a day. However, about 10% of the North American population has a defect in folate metabolism and may need up to twice the RDA to compensate. The RDA is based on the amount of folate needed to maintain normal blood concentrations as well as to prevent neural tube defects during fetal development.

Where do I get folate?

As mentioned above, most refined grain products and flours are fortified with folic acid. This includes breakfast cereals and dried pasta. Foods naturally containing folate include dark leafy greens (e.g. asparagus, spinach, romain lettuce, broccoli, brussels sprouts, and kale), lentils, peas (black-eyed peas, chickpeas), beans, turnips, beets, orange juice, sunflower seeds, avocado, edamame, okra, artichoke, potatoes, papaya, marmite and vegemite, and everyone’s faves: fried liver and brewer’s yeast.

This list, while extensive, may not include all food sources of folate. You can search for food items using the USDA Nutrient Database to find out how much folate they contain. Yes, Canada has a similar database but I’m not confident it’s entirely up to date and I find it  little bit more frustrating to use.

What happens if I don’t get enough?

Folate deficiency can result from low intake, inadequate absorption (often due to alcoholism), increased need (often due to pregnancy), poor utilization (often due to vitamin B12 deficiency), excessive excretion (often due to long-standing diarrhea), and the use of certain chemotherapy medications.

One of the first signs of folate deficiency is a form of anemia called megaloblastic anemia. It may also result in persistent diarrhea and decreased immune function.

If insufficient folate is consumed or absorbed during the first 28 days of pregnancy there is an increased risk of the infant experiencing neural tube defects (i.e. spina bifida or anencephaly).

Can I get too much folate?

The upper level for synthetic folic acid is set at 1000 mcg due to its ability to mask B12 deficiency when consumed in high doses. There is no upper level given for folate naturally occurring in foods as absorption is limited.


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Is 63 grams of liquid sugar the answer to high cholesterol?

A friend recently shared this tweet with me:

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She had asked the tweeter for more details but hadn’t received a response. My response: “Ugh. No wonder so many people don’t trust us as dietitians”.

Of course, it’s Florida orange juice that imparts these benefits. Because oranges from other locales couldn’t possibly impart the same benefits (<— please note this should be written in the yet to be developed sarcasm font). Even so, is the benefit even all that meaningful? I’d argue no.

While I can’t be certain that the study I found is the one the tweeter was referring to it was the top hit and was sponsored by Tropicana orange juice so it fits the bill. The study looked at a very small group of individuals with elevated cholesterol. There were only 25 participants, 16 healthy men, and 9 post-menopausal women. This means that the results cannot be extended to apply to pre-menopausal women or “unhealthy” individuals. There were additional strict criteria that participants had to meet: 1. have initial fasting plasma triacylglycerol (blood lipid) concentrations in the normal range, 2. be habitual or occasional orange juice drinkers, 3. be free of thyroid disorders, kidney disease, and diabetes, 4. have an alcohol intake of ≤2 drinks/d, 5. not be receiving hormone replacement therapy if female. With such a small sample size of people meeting such precise criteria, no concrete conclusions can be drawn from this study.

However, the researchers still drew conclusions. Namely that three cups of orange juice a day can lower LDL and increase HDL blood levels. They found that HDL levels were increased by 21% and the HDL-LDL ratio was decreased by 16%. That sounds fairly impressive but is it really? Well, no, not really. The average HDL level increased from 1.0 to 1.3. Anything over 1.0 is good anyway so they weren’t all that badly off to begin with. The HDL-LDL ratio really only changed because of the increase in HDL as LDL levels went from an average of 3.6 to 3.5. Not a significant change.

What the study doesn’t tell you is that cholesterol recommendations are only made in relation to risk of cardiovascular disease. If your risk level is low then an LDL of under 5.0 is fine. If your risk is high then an LDL of less than 2.0 is ideal. Risk level is determined by family and medical history. None of these factors were discussed in the current study despite the fact that the cholesterol levels measured are essentially meaningless without being placed in the context of CVD risk.

Can we just go back to that THREE cups of OJ a day again? The researchers found no significant change in cholesterol levels at one or two cups of OJ a day. Only at three cups a day. That’s a considerable amount of orange juice. Considering that a serving size of juice is 1/2 cup and most dietitians recommend no more than one serving per day I find it hard to fathom recommending 6 servings of juice every day for a slight increase in HDL levels. The researchers note that as OJ increased fibre intake decreased. They didn’t mention any other aspects of diet. There was no comparison to consumption of whole oranges, other fruit or vegetable juices, or any other dietary changes. Based on this study alone I would absolutely not advise anyone wishing to improve their blood cholesterol levels to drink 63 grams (more than 15 teaspoons) of liquid sugar daily.


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Grocery store lessons: Natural Peanut Butter

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I know that “natural” is a meaningless marketing term. It still drives me nuts when peanut butter that consists of any ingredients other than peanuts is described as “natural”. So, what got me going this time? The Kitchn’s peanut butter taste test purporting to test seven natural peanut butters. But just how natural are all of those peanut butters?

1. Smucker’s Natural Creamy Peanut Butter

INGREDIENTS: PEANUTS, CONTAINS 1% OR LESS OF SALT.

Not too bad. Although that 1% of salt amounts to 105 mg of sodium in a two tablespoon serving. Compare that to 0 mg of sodium in a truly natural peanut butter.

2. Justin’s Classic Peanut Butter

INGREDIENTS: Dry Roasted Peanuts, Palm Fruit Oil*.

I’m not sure why there’s an asterisk on the palm fruit oil as it doesn’t appear to lead to anything. Strangely, that addition of oil doesn’t appear to increase the fat content in comparison to a peanut butter that’s 100% natural.

3. Brad’s Organic Peanut Butter

INGREDIENTS: Organic Peanuts

Thumbs up for this one!

4. Whole Foods Creamy Peanut Butter

INGREDIENTS: Organic dry-roasted peanuts, organic palm oil, organic pure cane sugar, sea salt

Face palm. There is nothing natural about this. Organic ingredients and sea salt do not a natural product make. Thumbs way down.

5. Trader Joe’s Creamy Unsalted Peanut Butter

INGREDIENTS: Organic Peanuts

Another thumbs up. Funnily enough, I noticed that this is a product of Canada but we don’t have Trader Joe’s here.

6. Skippy Natural Peanut Butter

INGREDIENTS: Roasted peanuts, sugar, palm oil, salt

Skippy didn’t even bother to trick people into thinking their ingredients are healthy by using organic ones. Another faux natural peanut butter.

7. Smart Balance Natural Creamy Peanut Butter

INGREDIENTS: Peanut butter (peanuts, dried cane syrup, salt, molasses), natural oils (palm fruit and flax seed oils)

Is there something less than thumbs down? I give this one that rating. Two added sugars, two added oils, and salt. Pass.

If you want a natural peanut butter you’re going to have to look beyond the marketing terms on the front of the label. Check the ingredients. If you see anything other than peanuts it’s not truly “natural” and you need to decide if those extra ingredients are worth the extras (i.e. sugar, sodium, fat) they bring with them.


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Restaurant rehab: Kill the Kid’s Menus

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You know what sucks? Kid’s menus. In theory they make sense; children generally don’t eat as much as adults and it’s nice for parents to have less expensive options when eating out with their kids. In practice, however, they suck. Most kid’s menus offer processed and fried bland options. When you think of a kid’s menu what do you think of? I usually come up with burgers, chicken fingers, pasta, and lots of french fries.

Children don’t need entirely different options from adults. They can handle spice and flavour. They’re also highly susceptible to suggestion. If you imply to kids that they’re not going to like something or it might be too spicy for them they’re far more likely to confirm those suggestions. They’ll live up (or down) to expectations.

I know that kids can be fussy. Just ask my mum. I could spot a speck of onion a mile away. I don’t think that this should mean that they should be offered entirely separate meal options from adults, whether at home or at a restaurant. What kind of a lesson does that teach children? What kind of eaters does that mean we’ll be raising? Another generation of people with unadventurous palates that prefer bland, processed, fried foods. More people who dislike vegetables and think that a meal can be complete with the only sign of a vegetable being ketchup, and maybe a tiny cup of mayonnaise laden coleslaw.

Restaurant owners and chefs, please consider the nutritional balance of meals. Both for children and adults. It’s not a meal without vegetables. And no, ketchup is not a vegetable. Please consider eschewing traditional kid’s menus and simply offer smaller plates of adult meals with kid-friendly names. We need to stop teaching kids that they won’t like flavourful nutritious food.


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Haters gonna hate

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It’s been a while since I lacked blogspiration. But here I am, I’ve scrolled through facebook and twitter for something to get riled up about and I must admit it was slim pickings. Sure, it’s irksome that Pippa Middleton has “secretly” become a nutritionist. Not so much so that I could be bothered to write an entire blog post about it. Mother Jones has moved on from almonds and is now telling us that there will be no more salads because of the drought in California. Yes, I know that this drought is a serious issue and I really feel for the people of Cali. However, for now, my local farmer’s market has got me covered thank you very much. The only thing that really got even the tiniest bit under my skin was a tweet from a doctor saying that nutritionists think they have more information than they actually do. By nutritionists, I’m pretty sure he also meant dietitians, based on the thread. Why thank you doctor, I’m sure that your nutritional expertise far exceeds that of those of us who studied nutrition at university for four years and continue to do so after graduation. Thank you ever so much for the professional support. Obviously we should just give up on this emerging field and let you do all of the nutrition educating.

To be honest, sometimes I do want to give it up. To say “screw it! Let them have their gluten-free charcoal smoothies. See if I care!”. It’s frustrating working in a field where the science is constantly changing and which is incredibly difficult to study at all. In a field that everyone fancies themselves an expert in based on the sole fact that they eat. A field that is constantly being attacked by hacks, journalists, and other healthcare professionals alike. All of them pushing their latest miracle diet. A field in which so few people understand what exactly it is that we do. Sometimes I wish I could go back in time and become an electrician. Kids, trades are where the jobs are at. Uni is great and all but a BA is the new high school diploma.

The thing is though, I love food. I love cooking it, eating it, and sharing that love with others. And despite what some may believe, I know quite a bit about it. Just because we don’t know the optimal amount of kale to eat each week doesn’t mean that we don’t know enough to help others improve their health through good nutrition. Healthy eating isn’t complicated, it’s true. It’s not rocket science or neuro-surgery. Yet, somehow, most people don’t seem to be able to manage it anymore. Helping people learn how to improve their diets isn’t just about vitamins and minerals. In fact, it’s not really about them at all. It’s about helping people prioritize their health and food. Getting them into the kitchen. Yes, we can tell you all about the different types of fibre, how to make cheese, the structure of all of the essential amino acids. We know the science behind food. We also know that this isn’t what’s important when helping people to lead healthier lives.