I am so glad you asked!
Most people don't know; and honestly that is why I am now going by "Not Your Average Nutritionist" as my new business name, despite being an actual Registered Dietitian.
*2018 update - YouTube video on this topic (see bottom of this post)
As of 2018: Anyone, even with no training, can call themselves a "nutritionist." Literally.
You can buy a certification online with no education, you can just call yourself a nutritionist without buying anything, or you can have a degree in nutrition and dietetics.
A Registered Dietitian (or RD, or RDN) is also a "nutritionist," but there is a key difference - specific educational requirements! The same way a medical doctor or nurse goes through specific training, degree programs, and supervised residency/internships, dietitians have requirements.
A RD has at minimum completed:
-A Bachelor's of Science in Nutrition and Dietetics (or a Master's Degree in the same, if their B.S. was in a different field). This is heavy in biology and chemistry courses that get more specific to the molecules that make up foods/vitamins/minerals, and how the body processes them. Classes in counseling and teaching are also important aspects of the nutrition curriculum.
-A dietetic internship (D.I.) of at least 1200 hours in a variety of settings that RDs work in, under supervision. This is similar to a medical residency, and has strict requirements for what must be experienced, and competencies met and signed-off by supervising RDs. Dietetic Internships are also highly competitive, with less than 50% acceptance rate (at least that was the case in 2011). The process of being accepted requires not only good grades, but multiple essays, recommendation letters, work experience, interviews, and fees to apply to most sites.
-Upon completion of the D.I., the person, will study for, and take a national registration exam of 140+ questions covering areas of clinical nutrition, calculations, food service, counseling theory, and metabolism. A passing score makes the test-taker a RD!
-But wait - there's more! Every 5 years, there is a minimum of 75 hours of continuing education that must be documented and submitted to the Commission on Dietetic Registration (CDR), including at least 1 hour of Ethics training, to maintain the credential. Most RDs, like myself tend to go well over our required 75 hours, because there is constantly more to learn!
What else is special about RDs?
-Registered Dietitians are the only profession that can legally call themselves "nutrition experts," and give "Medical Nutrition Therapy" (MNT). MNT is diets/diet advice for specific medical concerns that is beyond generic nutrition advice like "eat more vegetables." Some disease states are very nutrition dependant for life and health. Medical Doctors are legally allowed to give nutrition advice, and sign off on dietary components in clinical settings, but most MDs have had only class of nutrition education in their whole college experience! (Some, of course, understand the importance and go on to do more).
(pssst... get a free macronutrient handout HERE for general healthy eating)
RDs can have many different kinds of jobs.
-Many work in hospitals or clinical settings where they are dealing with acute illness, and providing MNT.
-Some (like myself) go on to have additional training in counseling skills and psychology, to deal with clients on a behavioral and mental health basis.
-Other's get additional certifications in specialty areas like diabetes (certified diabetes educator), or renal (kidney) nutrition.
-Some work in food service, creating menus, ordering food in bulk, running a kitchen staff (doing staffing), working with food allergies and calorie counts.
-Research /or/ Research and Development have many RDs working to find best practices or develop new food products.
-Education. Whether teaching nutrition in colleges, or teaching classes or individuals in public health, RDs have a lot of info to cover that can help increase quality of life and prevent disease.
-Work in food technology and agriculture to create more nutritious food or solve hunger problems.
.....and many more potential areas! The field is growing, and so are options for dietitians!
I believe the median salary is low, because most people still do not understand what RDs can do for individuals, and the world. My hope is that more people will understand the importance of RDs, and the difference between "Registered Dietitian" and "Nutritionist" so that the jobs will go to the educated.
"All RDs are nutritionists, but not all nutritionists are RDs." - Academy of Nutrition and Dietetics.
Get weekly education from this RD by signing up here:
(originally posted 12/20/2016. libbysfitnutrition.com)
A gift to my lovely readers, a printable format for a food and feelings journal. I use this format with all my clients so we can search for connections between triggers and eating behaviors.
Simply add your e-mail below to get a PDF to print off your own copies.
One page does not mean that is all the space you get for a day, use more paper if necessary. If you are working with a dietitian or therapist, this format can be helpful to show them several days of logging what you eat.
Let me know what you think.
(originally posted 12/10/2016. libbysfitnutrition.com)
It's the time of year when gift-giving is on the mind, and I know that many of you, like myself, love to give donations in a loved-one's name to help others in need.
I would like to put a shout-out to "Dancing With Ed,"
a 501(c)3 organization dedicated to raising awareness of eating disorders in the dance community through online eating disorder education, resources and social media awareness projects.
You can donate to Dancing With Ed through Paypal.me:
Or, if you prefer to donate by mail send to our corporate office:
1025 Southwood Drive Unit D
San Luis Obispo, Ca. 93447
*make checks payable to Dancing With ED, Inc.
Connect on social media:
Thank you, and happy holidays!
(originally posted 12/2/2016. libbysfitnutrition.com)
You have probably read other articles on tips for eating around the holidays, but in my experience, repetition is never a bad thing when it comes to making a new habit. In fact, maybe there will be things on this list that you have NOT heard yet...you never know what is going to be of great use to you...so read on, and apply as needed. :)
1) Drink water! Hydration is often forgotten with coffee, hot cocoa, and alcohol fighting for top contenders in your liquid category at this time of year. Thirst is readily mistaken for hunger when tasty options are before you. So remember to drinkyour 8 glasses of water (or tea) every day. Try drinking a pint before you leave the house, carrying a water bottle with you, alternating alcohol with water, and eating water-rich foods such as apples, cucumber, grapes, and salad greens.
2) Eat what you really want. Don't keep munching on things you "should" eat, and end up over eating because you are not fulfilling your cravings. This is probably the only time of year for your aunt's famous sugar cookies, Grandma's pie and stuffing, and other family goodies; enjoy them, savor them. You will probably end up eating less over all if you don't deny what you want.
3) Fit in exercise every day. Whether it is a dance DVD in your living room, a run in the brisk morning air, a gentle walk with the family (or the dog), or a class/weights at the gym. Be like Nike and, "Just Do It." Exercise will keep you in a better mood - and that is helpful to everyone around you as well!
4) Don't let ALL your meals be splurges. Big Christmas dinner? Eat healthy breakfast and lunch that day so you are not overdoing it (do NOT skip meals!!!). It is easy to fall into the habit of splurging at every meal during this season, whether that is what is in the house, or you feel so stressed you "deserve it," remember there are celebrations all year round, and you need to focus if you do not want to become 'round.' Do eat what you love, but you don't have to sample that so-so dish, just because Aunt Sally made it.
5) Send away the leftovers. Hosting a get-together? At the end of the meal, pack up leftovers into small containers and send most of it away with guests. If there is less in your fridge, there is less for you to pick at later.
Have other tips that work well for your holiday stress levels around food? Share in the comments below!
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(originally posted 10/18/2016. libbysfitnutrition.com)
I am honored to have been chosen one of the
"Top 100 Nutrition Blogs You Must Follow to Live A Healthy Life" at http://blog.feedspot.com/nutrition_blogs/
Thank you so much, my readers!
(originally posted 10/16/2016. libbysfitnutrition.com)
The Power of Habit: A Review
Author Charles Duhigg is a graduate of Harvard Business School (MBA) and Yale University (history major), and is a “Pulitzer-prize winning, investigative reporter for The New York Times” (1) since 2006 (2). Since writing The Power of Habit (New York Times Bestseller List for over 60 weeks!1), Duhigg has written another book, Smarter Faster Better, has appeared on NPR, as well as other well-known media platforms, and has spoken at colleges (including MIT), companies (like SC Johnson), and is available to speak at events by request (2).
The Power of Habit: Why We Do What We Do In Life And Business, is a book written for consumers to figure out how to change habits they do not like, such as smoking, or create new habits, like daily jogging after work. The book uses a simplified “habit loop” to teach readers how to break down their habit into three sections - the “cue” or trigger, the “routine” or habit, and the “reward” or reason for doing the routine. Duhigg uses examples of famous people and companies to illustrate why certain patterns develop, and how changing certain patterns can influence more than one area of work or life.
In Chapter 1, Duhigg describes “The Habit Loop”: where a “cue” triggers us into our “routine” which produces the “reward” (1).
The habit is built from doing something that gives us a “reward” (positive reinforcement). Once someone has experienced the “reward” in correlation to the “cue,” memory starts to connect the two in the basal ganglia of the brain (a primitive part of the brain near the spinal cord). The “routine” part of the equation (how we get from the cue to reward) is formed into habit that requires less and less thought every time we do it. This is how fast food chains get us. They keep everything the same so every time you visit the restaurant, whether in Minnesota or Tennessee, you have the same visual, auditory, and verbal “cues” prompting a sense of routine or habit to the reward of cheap/ easy/ tasty food.
Chapter 2, discusses how marketing moguls created new habits to sell mass quantities of products like toothpaste and Febreze. Creating new habits comes from creating a “craving” as the “cue” or trigger.
By creating a trigger to do something you can create a habit every time that trigger emerges. Duhigg uses the example of marketing toothpaste: the trigger is removing the “film” of plaque you notice as time elapses (usually over several hours, or a day), feeling this film (which naturally occurs) causes a cue to want to clean it off. The action? - Brushing your teeth. The reward - clean, film-free, teeth. This is the habit loop as explained in chapter 1. While people had always had this “film” on their teeth, the advertiser brought attention to it, and made a craving for “clean.”
The moral of this? Find a cue that comes up naturally to elicit a habit response. The author makes the example of: after work you put on your running shoes and go run, afterwards you reward yourself by watching tv. By choosing a specific cue (after work = run) and reward (run = tv), the habit is more likely to occur.
Chapter 2 also covers anticipation of rewards being a driving force to action. When one has experienced a reward for doing something enough times, the anticipation of reward makes the action automatic. The anticipation of the endorphin rush can make it easier for someone to continue exercising on a regular basis, but the first time it occurs will not be enough to develop the reward loop to create the habit. This must be repeated several times before the reward is worth the action. The expectation of the reward must be great enough to drive the action when the cue is presented.
Chapter 3 shows that to change a habit, the cue and the reward are kept the same, and the routine is changed. Routines are hard to change, so what makes it possible? Believing. Chapter 3 details how Alcoholics Anonymous (AA) works, not through scientific method, but through belief in a power greater than oneself to change the routine of an old cue. This is done by creating a list of triggers for the old routine (like triggers to drink, example: get off work), and the reward desired (example: socializing) and change the routine by addressing the desire for socializing by meeting up to talk to their sponsor. Belief that God (“as we understand him”/ a belief that things can get better/ belief there is something bigger than ourselves) will give strength to change the routine, when the triggers arise, is the premise of AA.
Groups are another major catalyst for maintaining change in routine. Whether it is seeing something as being for the greater good of the group, having accountability, or changing the status quo of life, groups give people a network of like-minded individuals to help them stay on course. As Duhigg put it,” Belief is easier when it occurs within a community”(1).
Chapter 4 looks at “keystone” habits that influence everything else. By finding the small habit that affects others, and changing it, you can make huge waves in the system. By creating a routine that builds on other routines, you can prepare yourself with small “wins” that make the bigger “victory” just the logical next step. This chapter uses Michael Phelps, Gay Pride, and safety in the workplace as examples of changing one, seemingly tiny, action to create big victories. Another example from this chapter is writing down what you eat to lose weight. As people make food journaling a habit, without being asked to do anything else, they start changing their diet to be healthier because they notice patterns emerging.
Chapter 5 tells us that self-discipline (willpower) is a learnable skill but, like a muscle, can be worn out over the course of a day and works best when rested. This means that we have less willpower to do hard things/ detailed work after a long day of using willpower and making decisions, than if we had a day where we did not have to think too hard. Strengthening willpower and discipline in one area of life makes that more automatic, and will spill over to other areas of life. A favorite quote from this chapter is, “That’s why signing kids up for piano lessons or sports is so important. It has nothing to do with creating a good musician or a five-year-old soccer star, when you learn to force yourself to practice...you start building self-regulatory strength”(1).
Planning ahead is another skill that foresees progress towards a goal. People who think through potential obstacles and how they will deal with them, in detail, are able to push through hard times and make the most progress toward their goal. Likewise when people are empowered to do something because they enjoy it or have it explained how it will help someone else, they use less willpower than if they were forced into doing something.
Chapter 6 shows how crises situations can change organizational habits. Vignettes of companies that had major crises showcase how big problems can lead to big changes.
Chapter 7 shares how companies like Target gather data on individual customers to drive marketing and sales. Retailers note that people tend to change brands of products when they are going through a life change such as marriage or divorce. The biggest life event for change in purchasing? A new baby. New parents will buy anything the need/want in one place because it is easy. If a company can get them to start buying diapers at their store, they know they can get them to buy other things because they are already in the store. Target looks at purchases made and, by looking at common trends, can determine fairly accurately when a woman is pregnant and due. What do they do with this information? Slip in subtle marketing cues next to the familiar. If a woman received coupons for just baby stuff she would get suspicious as to how the company knows, but mixed in among common items it does not see as personalized.
Chapter 8 explains how personal ties and social peer pressure can influence people to do things that they would find hard to choose on their own, at the risk of losing social benefits. “Weak social ties,(1)” as opposed to close friends, tend to have the strongest pull on obligation. An acquaintance could tell unfavorable comments about you to others for not fulfilling an obligation, where a close friend might understand why you would pull out of a commitment.
Chapter 9 looks at the neurobiology of habits and what is free will. Examples are sleep-terrors and gambling addiction. Do people have choice in these scenarios? It comes down to the primitive brain and ingrained habits. The parts of the brain (basal ganglia and brainstem) where habits form are the same parts where sleep terrors stem from. Duhigg believes that any habit that is cognizant can be changed with the decision to change it, and the knowledge of what your cue or trigger is.
The “Afterward” shares stories from people who contacted the author after the initial publication of the book on how it helped them. This chapter discusses lapses and relapses, and not looking at them as failure but as learning experiments.
The “Appendix: A Readers Guide To Using These Ideas” is a step-by-step guide to figuring out your own habit loop and how to make a plan to change the habit.
This book is aimed at readers who are looking to change a “bad” habit they have. It gives real-life case-studies of companies and people that readers have heard of, to explain how a habit change works. By breaking down how habits form, the author explains how habits can be broken and changed into more desirable habits that will get the reader to their goal. The design of the book is similar to a “business-help” book, which might draw in more readers that are in either a traditional corporate or entrepreneurial business sector.
Personally, I loved this book. It was engaging to read how prominent public figures from Michael Phelps to Rosa Parks made small habits work towards bigger goals, as well as how every-day habits, like eating an afternoon snack, are a summation of cues, routines, and rewards.
The strengths I identify in this book are: extensive research - mostly in personal interviews and scientific articles; easy-to-read format; a singular focus throughout the entire book; and the idea of “classical conditioning,” as Ivan Pavlov explained, to describe Duhigg’s “habit loop.” The ideas of “habit loop” and “classical conditioning” are very much the same in a stimulus or cue eliciting a routine that leads to a reward or positive reinforcement3. Another factor Duhigg lists is obligation towards an outside influencer (chapter 8), which authors Rowland and Splane liken to reasons of success in dietary restraint often stemming from religious “diets” such as Lent or Ramadan, or ethical reasons (Ex: vegetarian for animal rights)(3).
Duhigg is very effective at making his main point - the habit loop- clear, through writing that is both engaging, and easy to follow. His extensive background as an investigative journalist allows him to be an effective writer and good at finding necessary information. He shows how to take action on research already known, like the fact that overeating is typically due to cues in our environment triggering intake (4).
The weaknesses I see in this book are mainly from credentials and my perception of potential bias. As a journalist, Duhigg is trained to pick up a story and flush it out to make something people want to read. Science is not usually fascinating to the general public, so I wonder if he took any liberties to elaborate where there was not enough information. Additionally, Duhigg is not a science or health professional. Many of the topics he covers are in neurobiology and psychology, of which, I would assume he has not had formal training.
Overall, I highly recommend this book to anyone, professional or consumer, that wants to make a change in a habit they do, or help someone else figure out their habit loops. It brings insight into why we do what we do, and offers a way to pick and choose which habits we keep and change. It is not specific to any one type of change (such as weight loss), but rather encompasses the skills and case-studies to change any habit. I will be re-reading The Power of Habit soon.
(originally posted 9/19/2016. libbysfitnutrition.com)
I danced from age 3-13 in ballet, tap, jazz, and lyrical before taking a break to pursue my equestrian passions. But at age 16 I had a gnawing feeling that something was missing, and asked to re-enroll in dance lessons. At 16 I had no interest in ballet, leotards on my pudgy adolescent body, or the slow piano music; so I signed up for hip hop and break dancing. That lasted all of 3 months, when I found even with the technical steps in place, I didn't look the part.
Around that same time I got really into east-coast swing dance, and my real love emerged. I started taking ballroom, then teaching my peers. I went off to college, and started the first swing dance club on campus where I taught, performed, and lived out my dream. Then I transferred schools to a major university known for dance. I knew I was going to be a small fish in a big pond, but I joined their swing and salsa clubs, and let the music take me away. Dance became my stress reliever, my social crutch, and the way to make my science degree have a creative side. By the end of college I was known as a dancer at my school, and was president of the salsa club.
photo of my tattoo from last year: a reminder that I need to dance
During college, I had taken a break from acting. A musical theatre geek in high school, college was too demanding to allow for more rehearsals especially with dance taking up my evenings.
When I left to move to California for an internship, the first group I sought out besides a church community was a dance community. My people.
Fast forward a year, and I was getting married, he had dislocated his knee and was not up for dance, and the clubs started too late for this early-bird. Slowly social dance became almost non-existent in my life, let alone studio dance or lessons that I had not touched in 10 years. I was becoming clinically depressed, but had not idea why.
Then I got cast in our community production of "A Chorus Line." Rehearsals were rigorous. 8 hour dance rehearsals on Sundays, 3-5 hours several other days each week. My body had changed from when I had last danced. I did not know where my balance was, I had no idea of the terminology I had long forgotten, and my body struggled with the complicated combinations. But I was so alive!
That show did so much for me. Though I was "only" a swing that never got to go on for any of my overstudies, I had made friends, and re-ignited my passion for dance!
Now three years have passed, and I have been back in the studio taking dance lessons (yes, even ballet) and appreciating every moment in a way I hadn't when I was a kid. Now my struggles are a place to grow from, my hour of class a time of pure freedom and meditation, separate from "real life." I have gone on to act in more shows, dance in more classes, and I am not letting dance out of my life again.
This article was first posted on "OnStage.com" as part of national dance week.
originally posted 7/21/2016. libbysfitnutrition.com)
People intrinsically want to believe and have hope in something. When “big-pharma” and doctors are not making patients feel significant and understood, people will go searching for healing elsewhere, this is where dietary supplements (DS) come in. Most DS work under the realm of “placebo effects,” unless they are being used to treat a nutritional deficiency.
The definition of “placebo effect” is, “improvement in the condition of a patient that occurs in response to treatment but cannot be considered due to the specific treatment used(1).” This phenomenon has been identified in several studies. One of which was a study of patients with irritable bowel syndrome (IBS) which “treated” patients with either “open-label placebo (non-deceptive and non-concealed administration)” or no treatment. Even knowing that the pill they were given was a placebo made of an inert substance, the sufferers found significant relief over those receiving no treatment. The conclusion was that “Placebos administered without deception may be an effective treatment for IBS (2).”
Doctors have long-known the benefits of placebo effects in patients and will utilize this in treatment. While the “placebo” thinking may help people heal, “no-cebo” thinking can render even an active drug useless. This phenomenon is summed up well in Henry Ford’s famous quote: “whether you think you can or cannot, you are correct.” It may be that doctors owe it to their patients to boost healing by any means possible, including treatment by placebos for more effectiveness (3). Nonetheless, the American Medical Association stated in 2006, that it is unethical for doctors to give patients undisclosed placebo treatment/medications (4). If doctors are ethically not allowed to give undisclosed placebos, then suggesting a DS labeled, “This product is not intended to diagnose, treat, cure, or prevent any disease” might be their way around this ethical dilemma.
Psychological effects of placebos
The placebo effect often is used, consciously or not, in the context of classical conditioning. Discovered by Ivan Pavlov, classical conditioning takes a neutral stimulus (which should cause no response - the “placebo”) and, through learned response, makes it a conditioned stimulus to elicit a conditioned response (5). An example of this in the medical setting would be giving a patient a pain medication that actually works to reduce pain every day for five days, then giving a sugar pill that looks the same on the sixth day and eliciting the same pain-reducing response.
The conscious expectations by a patient of a treatment to work may cause an inert substance to have a desired effect on the patient. These expectations can be elevated by how the health care professional (HCP) interacts with the patient. The study of medicine “generally does not pay adequate attention to psychological and social variables (6),” which are determined by the relationship of the HCP and patient. This may interfere with drug study controls. If the person in the placebo group of the study is getting attention and believes the treatment will work, then they may exhibit signs of the placebo working that may make the active treatment not have a significant desirable outcome over the placebo.
Yet, how can an inert substance elicit a similar response to an active treatment? A large part of this stems from the psychological variants at play. Much of the patient’s outcome may be determined by the HCP’s confidence in a treatment's ability to work, empathy, active listening, and care setting. “[it is] suggested that the success of the many forms of psychotherapy [are] due to a placebo effect rather than the distinctive features claimed by the different therapists (6).” Hope that it will work, and follow-through on actually seeking treatment, are other reasons that patients have better outcomes with either the active treatment or the placebo (7). DS are often prescribed either by licensed HCPs (like doctors) or “alternative healers” (like acupuncturists). The diplomas on the wall, or the attention given by the healer can contribute to the patient “feeling” the DS responding to treatment. Additionally, since chronic conditions often ebb and flow with severity, the patient is likely to look for treatment when symptoms are about to naturally decrease, leading to the belief that the DS “healed” them (8).
Physiological effects of placebos
Placebo effects are not “all in the head” as once thought. They can make actual physical changes in the body, under the right circumstances. A test group for an antidepressant medication versus a placebo showed interesting brain activity in the results. By viewing brain activity with fMRI studies, placebo responses increased activity in the prefrontal cortex of the brain, while the medication suppressed this activity. Both groups exhibited less perceived depression, though on different timelines (the drug working weeks faster than the placebo). To this finding, researchers said, “administration of an inert pill appears to be an active treatment rather than a no-treatment comparison as previously thought. [however, the] placebo response is not equivalent to an active drug response, since the two groups' brain physiology was altered differently (7).”
Even people with Parkinson’s disease can potentially have real physiological benefit from placebo “treatment.” The effect of the placebo increasing dopamine in the brain, modifying the neuron that is promoting the abnormal activity that causes the tremors (9). People in this study physically had reduced shaking while taking the placebo, showing that there is true physical effects in some placebo “treatments”.
Studies should have tighter placebo controls
The Food and Drug Administration requires new drugs to significantly outperform the placebo control before going to market (3). Placebo controlled, double blind trials have been the gold standard of research (8). However, most research studies for medical treatment (whether drug, DS, surgery, or other) could be better controlled for placebo response. This could be met with a few tweaks to methods of “treatment.”
Dr. John Farrar, a neurologist and epidemiologist, provides some insight into what can strengthen study design to control for placebo effects (3):
(originally posted 7/16/2016. libbysfitnutrition.com)
A paper I wrote for my Master's program class on dietary supplements. Bottom line- multi vitamin supplements may do more harm than good. If you cannot get all of your needed nutrients from food (which is totally do-able), then specific single nutrient supplements are a better choice than a multi. (HERE is a free handout on basic macronutrient composition we need to be eating.)
Here is the research:
Use of Multi Vitamin and Mineral Supplements for “Health Insurance” and Disease Prevention
Do “multi vitamin and mineral dietary supplements” have a place in health prevention and treatment? As will be discussed below, the answer appears to be a resounding no.
Background of Multi Vitamin and Mineral Supplements
Multi-Vitamin and Mineral Supplements (MVM) have been available to Americans since the 1940’s (1), and have only increased in use since that time. The general consensus is that a MVM contains three or more vitamins or minerals without other herbs or drugs (3); However, there is no one-definition for what a MVM is or contains (ingredient, number of ingredients, or level of potency). In fact, there are many dietary supplements (DS) on the market that are not labeled as MVMs that are essentially the same as other products labeled MVM (1). The 2011-12 NHANES data shows approximately 40% of Americans took at least one DS in the last 30 days (2). Many of the people surveyed listed to [maintain health, or prevent health problem(s)] as their reason for taking a DS (2). But what is the actual role of MVMs?
Usefulness, role, and dangers of MVMs
In the 1920s, the United States started fortifying major food sources starting with adding iodine to salt to counter widespread deficiency and prevent goiter. In the following years Vitamin D was added to commercially sold milk, and some B vitamins and iron were added to flour (3) minimizing deficiencies in the majority of Americans. Nowadays, many more foods for purchase are fortified with additional vitamins and minerals. With fortification meeting the needs of the general population, benefits of MVMs seem to be limited.
What is the reality of MVM use? MVMs may be beneficial if the blends of ingredients are tailored to the needs to the individual. According to the National Institute of Health (NIH), “several studies have found that MVM users tend to have higher micronutrient intakes from their diet than nonusers. Ironically, the populations at highest risk of nutritional inadequacy who might benefit the most from MVMs are the least likely to take them (1).”
Several large studies show this irony: In a large study of adult participants from Los Angeles and Hawaii, food frequency analysis showed that the majority of people (~75%) had adequate intakes from food alone (1). With MVM adequacy improved, especially for vitamins E, A, and zinc; but there was an increased risk of excessive intake, especially in vitamin A, iron, zinc, and niacin (1). A study of U.S. children under four, concluded that, “usual nutrient intakes were adequate for the majority of US infants, toddlers, and preschoolers, except for a small but important number of infants at risk for inadequate iron and zinc intakes (4).” They also noted that many children were at additional risk of excessive intake for folate, vitamin A, zinc, and sodium even without supplementation (4). Many children with autism are given MVMs, which are unnecessary, and contribute to excessive intake in many. Even with MVMs, there may be additional need for calcium and vitamin D in children, according to the Academy of Nutrition and dietetics (5).
There is an increased risk of nutrient toxicity when taking DS. The NIH states, “MVMs did not reduce the risk of any chronic disease (1).” and “There is potential for adverse effects in individuals consuming dietary supplements that are above the upper level. This can occur...in individuals who consume a healthy diet rich in fortified foods in combination with MVM supplements (3).” Typically MVMs have nutrient levels that are lower than the RDA for a particular nutrient, and without adequate food sources MVM users may need additional supplementation of nutrients (such as magnesium or calcium) not contained in high enough doses from the MVM; however, as discussed above, toxicity from supplementation is all too common (1), sometimes with irreversible health consequences.
Just a few examples of health issues caused by excess vitamin or mineral intake include: excess vitamin A or beta-carotene correlated to increased risk of lung cancer in smokers or former smokers (1); excess vitamin A (as preformed retinol) increasing risk of birth defects in fetuses of pregnant women taking supplements (1); and iron supplements have been noted as a “leading cause of poisoning in children until age 6 years (1),” due to children getting into supplement containers. Additionally, people taking blood thinning medications need to keep vitamin K levels steady, so any supplements should be checked and confirmed with their doctor before taking or changing doses (1).
Though many large-scale studies have been done separately with either male or female participants, there is not a significant difference in health risks between the genders. The Physician’s Health Study II was a large-scale, double-blind, placebo-controlled RCT of over 14,000 male doctors in the United States, the study showed that, “daily multivitamin supplementation modestly but significantly reduced the risk of total cancer (6).” In conflict, another study of the “295,344 men enrolled in the National Institutes of Health (NIH)-AARP Diet and Health Study (7) found that low-dose MVM use had no discernable increase in risk of prostate cancer, but those who took higher doses (more than 7 times/week) of MVMs had an “increased risk of advanced and fatal prostate cancers is of concern and merits further evaluation (7), than non MVM users (1). Another large study (n= 83,639) of male physicians found no association between cardiovascular disease and MVM use(1).
Women were no different in terms of conflicting research. A study of Swedish women (n= 35,329) found an increased risk of developing breast cancer with MVM use (1); while another study of U.S. women (n=37,920) “found no such association but did find indications that MVM use might reduce the risk of estrogen- and progesterone- receptor– negative breast cancer and breast cancer overall in women who consume alcohol (1).” Swedish women in a cohort study had a lower risk “of myocardial infarction when taking MVMs, especially when taken for at least 5 years (8).” A cohort study of Iowa women found a slight increased risk of mortality from long term MVM use compared with non-MVM-users (1). And finally, long-term MVM use appeared to have benefit for men but not women in total cancer and mortality risk in a NIH study, but no benefit to either group for CVD (3). Overall, the data is inconclusive of significant benefit to either gender taking MVMs long-term.
Is there still a use for MVM?
The NIH, Office of Dietary Supplements (ODS) states, “supplements cannot take the place of the variety of foods that are important to a healthy diet (1).” Eating a well-balanced nutritious diet is the goal for everyone, and can be done. That being said, there are populations that do benefit from taking specially-formulated MVMs or DS.
The American Academy of Pediatrics and the (formerly) American Dietetic Association, list potential populations that will benefit from use of MVMs: “[people with] nutritional risk....those who have anorexia or an inadequate appetite, follow fad diets, have chronic disease, come from deprived families or suffer parental neglect or abuse, participate in dietary programs for managing obesity, consume a vegetarian diet without adequate dairy products,..have failure to thrive...people with medical conditions and diseases that impair digestion, absorption, or use of nutrients [bariatric surgery]… some supplements might help people who do not eat a nutritious variety of foods to obtain adequate amounts of essential nutrients (1).”
However, not every MVM on the market is appropriate of any of these populations. In these scenarios, it would be far better to use specific formulations of needed vitamins and minerals to make up for lacking nutrients. The 2010 Dietary Guidelines for Americans, and the NIH–sponsored State-of-the-Science Conference, claims there is no supporting evidence for the general population to take a MVM to prevent chronic diseases (1, 7).
How should MVM be regulated?
Currently the Food and Drug Administration (FDA), or any government body, does not have the ability to test DS, legally (due to the Dietary Supplement Health Education Act, or “DSHEA”), or in resources (staff or funds) to do so. “Both the [FDA] and the Federal Trade Commission (“FTC”) regulate claims made by food and dietary supplement manufacturers (9).” The FDA regulates labeling, which prohibits false or misleading information on the supplement labels “under the Food, Drug and Cosmetic Act” (9). The FDA issues warning letters to manufacturers against law violations in labeling, but rarely uses other methods of enforcement (9) mainly due to inability to keep up with the booming DS industry. This means the regulating agencies are bound to fail when the staff is disproportionately small, and the enforcement of laws is poorly executed (9). If a DS was listed as a food additive, or drug, it would require pre-market approval (3), and there would not be the insurmountable task of keeping up with the production of DS.
While the FDA focuses on the direct product label, the FTC regulates the advertising of DS. This may include “evaluat[ing] dietary supplement labels if they are being used by an advertiser to promote the product...under the FTC Act, claims in advertising made about foods and dietary supplements may not be “unfair” or “deceptive” (9).” As presented in the American Journal of Law & Medicine, a “limited private right of action [private sector lawsuits] under the FTC act” would more easily bring “enforcement actions in federal court” to protect consumers regarding DS (9), and would greatly increase the amount of products being enforced.
The NIH has excellent recommendations regarding change in regulatory laws and action, for instance, “The FDA should have the authority to better inform consumers and health professionals regarding the existence of upper levels as well as the possible risks of exceeding those levels; [the FDA should] develop a formal, mandatory adverse event reporting system for dietary supplements; and mandate provision of a MedWatch toll-free telephone number or Web site on product labels to facilitate reporting of adverse events. Furthermore, we recommend that healthcare professionals, consumers, and manufacturers use the FDA MedWatch adverse event reporting system to report adverse events associated with the use of dietary supplements. Finally, we recommend that Congress revise and update the law to reflect current knowledge...design and conduct rigorous randomized control trials of the impact of individual supplements (or paired supplements, when biologically plausible) to test their efficacy and safety in prevention of chronic disease, using well-validated measures.(3).” Ultimately, DS should be regulated as drugs, due to the fact that they interact and “medicate” like drugs in the body.
Should this information change consumer behavior?
If approached properly, there may be a way to help consumers better understand the dangers and lack of regulation of DS. Two studies on consumer education about DS, showed that consumers taught about DSHEA and the regulation of DS “rated DS as less safe and less effective” than the control group (10). This gives us a starting place on what message needs to be making its way to consumers. “Consumers may be especially susceptible to health claims, because they usually lack the knowledge to assess claims referring to physiology or metabolic processes and may be especially impressed by purported scientific evidence bolstering the claims (9).”
MVMs, particularly due to the lack of content consistency, are not useful in human health and disease prevention or treatment. The Medical Letter, an unbiased publication for pharmacists, declares that long-term use of MVMs, or any substance, is not without risk; and taking vitamins A, C, E, or beta-carotene in high doses or long-term may be more harmful than helpful (12). They furthermore suggest the only beneficial supplements (in healthy people consuming a normal diet) are folic acid, vitamin D and B12, in specific populations (12). If supplemental nutrients are necessary for populations listed previously who cannot obtain enough from diet alone, they should be carefully chosen as individual (well-researched) DS, and not in MVMs which may (with or without accurate labeling) contain excessive levels of substances (vitamin/minerals, or drugs/herbs) that may be harmful. I strongly recommend against the use of MVMs given the research available to us today.
(originally posted 6/17/2016. libbysfitnutrition.com)
"A message to everyone who has wondered or is “concerned” about my weight:
I've been overeating since my sophomore year of high school. For a long time I tried to stop overeating and lose weight but I always failed because the reason I overeat has nothing to do with food. Just last year I was diagnosed with a binge-eating disorder. In January of this year I enrolled in a local outpatient treatment program for individuals with eating disorders and it has helped me tremendously.
As an adolescent I experienced multiple traumatic events that have critically influenced the way I view myself and the world I live in. What I’ve struggled with the most in my life is feeling like I am enough. When I was in high school I thought: “If I could just lose weight / be good at sports / get perfect grades / get into the best college, I’ll be enough!” When I was at Cal Poly I thought: “If I could just lose weight / get perfect grades / be involved in 5,000 activities, I’ll be enough!” Except when I didn’t live up to my (and others’) expectations, I felt like a failure as person.
Nowadays, I’m trying really hard to be okay with myself no matter what; to be proud of myself and love myself and be gentle with myself no matter what I’ve done or how I feel that day or most importantly, how much I weigh.
So for the first time in my life, I don’t give a shit about losing weight. I’m not trying to eat healthy or workout a lot. I haven’t even gotten to the step where I try to LIKE what I look like. So it really doesn’t help when it seems like everyone around me has a problem with what I look like too.
With that said, here are a few tips on what’s helpful and what’s not, or as I like to say ever so satirically:
Tips for the “fat person” in your life (moi):
- Don’t tell me I’m overweight. I can assure you, I’m already 100% aware.
- Don’t encourage me to lose weight, workout, or eat healthier.
- Don’t give me diet tips.
- Don’t scold me when you see me eating something you deem as “unhealthy” or say things like “are you sure you want to eat that?”
- You don't need to congratulate me when I eat salad or exercise.
- Try not to be so visibly and vividly surprised when I do eat a salad or exercise.
- Avoid fat jokes and derogatory commentary about overweight individuals.
Things that I really appreciate and find supportive and encouraging in my growth as a person:
- Ask me how I’m doing with managing my binge-eating disorder.
- Treat me with the same respect you would someone of a different size.
- Offer me recipes and cooking tips. (Because I am trying to learn how to make more food that I would enjoy and feel satisfied eating.)
- Any mental health advice you have from your own experience or just in general.
I also want to note that me not currently focusing on losing weight doesn’t mean that I think I’m at a medically healthy weight. I am very overweight and I do want to lose weight. But I’m not currently at a point in my life where I can focus on that. And when I do feel ready to lose weight I’m going to do it on my own terms for once in my life.
Also keep in mind that whenever you make someone feel bad about what they’re eating or the fact that they aren’t exercising, you’re just creating guilt and shame for that person. If someone is going to change the way or how much they eat or exercise, they have to find a way that works for them and is enjoyable. Motivation stemming from guilt and sheer willpower doesn’t work. I know because I’ve tried that! It’s when you do it for yourself and your health and it’s coming from a place of love within yourself."
Reprinted with permission from Sydney Van Hoose, 2016.
Libby is a Registered Dietitian focusing on student eating disorder treatment and prevention. She is working on the central coast to create wellness in individuals and the community.
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