Bite-Sized Medicine

In this episode we cover green tea, discussing whether the evidence points to any truth behind its purported health benefits. Highlights include studies on green tea and blood pressure, inflammation, cancer mortality, and more. Enjoy! 

References:

Xu, R., Yang, K., Ding, J., & Chen, G. (2020). Effect of green tea supplementation on blood pressure: A systematic review and meta-analysis of randomized controlled trials. Medicine, 99(6), e19047. https://doi.org/10.1097/MD.0000000000019047

Xu, R., Yang, K., Li, S., Dai, M., & Chen, G. (2020). Effect of green tea consumption on blood lipids: a systematic review and meta-analysis of randomized controlled trials. Nutrition journal, 19(1), 48. https://doi.org/10.1186/s12937-020-00557-5

Lin, Y., Shi, D., Su, B., Wei, J., Găman, M. A., Sedanur Macit, M., Borges do Nascimento, I. J., & Guimaraes, N. S. (2020). The effect of green tea supplementation on obesity: A systematic review and dose-response meta-analysis of randomized controlled trials. Phytotherapy research : PTR, 34(10), 2459–2470. https://doi.org/10.1002/ptr.6697

Asbaghi, O., Fouladvand, F., Gonzalez, M. J., Aghamohammadi, V., Choghakhori, R., & Abbasnezhad, A. (2021). Effect of Green Tea on Anthropometric Indices and Body Composition in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Effekt von grünem Tee auf anthropometrische Indizes und die Körperzusammensetzung bei Patienten mit Diabetes mellitus Typ 2: eine systematische Übersicht und Metaanalyse. Complementary medicine research, 28(3), 244–251. https://doi.org/10.1159/000511665

Asbaghi, O., Fouladvand, F., Gonzalez, M. J., Ashtary-Larky, D., Choghakhori, R., & Abbasnezhad, A. (2021). Effect of green tea on glycemic control in patients with type 2 diabetes mellitus: A systematic review and meta-analysis. Diabetes & metabolic syndrome, 15(1), 23–31. https://doi.org/10.1016/j.dsx.2020.11.004

Haghighatdoost, F., & Hariri, M. (2019). The effect of green tea on inflammatory mediators: A systematic review and meta-analysis of randomized clinical trials. Phytotherapy research : PTR, 33(9), 2274–2287. https://doi.org/10.1002/ptr.6432

Filippini, T., Malavolti, M., Borrelli, F., Izzo, A. A., Fairweather-Tait, S. J., Horneber, M., & Vinceti, M. (2020). Green tea (Camellia sinensis) for the prevention of cancer. The Cochrane database of systematic reviews, 3(3), CD005004. https://doi.org/10.1002/14651858.CD005004.pub3

Yu, S., Zhu, L., Wang, K., Yan, Y., He, J., & Ren, Y. (2019). Green tea consumption and risk of breast cancer: A systematic review and updated meta-analysis of case-control studies. Medicine, 98(27), e16147. https://doi.org/10.1097/MD.0000000000016147

Zhao, H., Mei, K., Yang, L., Liu, X., & Xie, L. (2021). Green tea consumption and risk for esophageal cancer: A systematic review and dose-response meta-analysis. Nutrition (Burbank, Los Angeles County, Calif.), 87-88, 111197. https://doi.org/10.1016/j.nut.2021.111197

Awortwe, C., Bruckmueller, H., & Cascorbi, I. (2019). Interaction of herbal products with prescribed medications: A systematic review and meta-analysis. Pharmacological research, 141, 397–408. https://doi.org/10.1016/j.phrs.2019.01.028

Supported by the Innovation Studio at the Ohio State University

In this episode we interview Phil Anjum, a member of the Bite Sized Medicine crew and The Ohio State University College of Medicine Class of 2022.

Phil earned his bachelor's in biomolecular science and film at University of Michigan and plans to pursue primary care after graduation from medical school.

During the interview, we talk about Phil's contributions to the Bite Sized Medicine podcast and connecting with patients about nutrition.

In this episode we interview Dan Sosh, who is currently a medical student at the Ohio State University College of Medicine, Class of 2022. 

Dan earned his bachelor's in food science and technology at Ohio State and plans to pursue dermatology after graduation from medical school. 

During the interview, we talk about the journey to medicine, intersections between food and health, and connecting with patients about food.

Tune in for a special episode with one of the founders of Bite-Sized Medicine, Katie Petro! She is finishing up her degree in dietetics and provided the nutrition expertise to support the early episodes. Hear her perspective on working with medical students and sharing resources to create the episodes that started the podcast.

A run through of the evidence, theory, and effect of common fad diets.

Resources:

1. Agaston, Arthur. The South Beach Diet: The Delicious, Doctor-Designed, Foolproof Plan for Fast and Healthy Weight Loss. Rodale, 2003.
   
2. Atkins, Robert C. "Dr. Atkins' diet revolution; the high calorie way to stay thin forever." (1972).
   
3. Cordain, Loren. The paleo diet: lose weight and get healthy by eating the food you were designed to eat. Houghton Mifflin Harcourt, 2007.
   
4. D'adamo, Peter J., and Catherine Whitney. The Eat Right 4 Your Type The complete Blood Type Encyclopedia. Penguin, 2002.
   
5. Dansinger, Michael L., et al. "Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial." Jama 293.1 (2005): 43-53.
   
6. Davis, William. "Wheat belly: lose the wheat, loss the weight and find your path back to health." New York: Rodale (2011).
   
7. Ornish, Dean. "Eat more, weigh less: Dr. Dean Ornish's life choice program for losing weight safely while eating abundantly." (1993).
   
8. Pittet, P. H., P. H. Gygax, and E. Jequier. "Thermic effect of glucose and amino acids in man studied by direct and indirect calorimetry." British Journal of Nutrition 31.03 (1974): 343-349.
   
9. Wang, Jingzhou, et al. "ABO Genotype,‘Blood-Type’Diet and Cardiometabolic Risk Factors." PloS one 9.1 (2014): e84749.
   

Which foods play a role in cognitive function and how can we be sure to eat to protect our brains? We will review the evidence on what foods seem to promote brain function and the understanding behind why they are helpful!

Resources:

1. Geijselaers et al. “Glucose regulation, cognition, and brain MRI in type 2 diabetes: a systematic review.” Lancet Diabetes Endocrinology 2015; 3:75-89.
   
2. Edwards et al. “Short-term consumption of a high-fat diet impairs whole-body efficiency and cognitive function in sedentary men.” The FASEB Journal. March 2011, Vol 25.
   
3. Shinto et al. “A randomized placebo-controlled pilot trial of omega-3 fatty acids and alpha lipoic acid in Alzheimer's disease.” Journal of Alzheimer’s Disease. 2014;38(1):111-20.
   
4. Resnick. “Iron and mechanisms of emotional behavior.” Journal of Nutritional Biochemistry. 2014;25(11):1101-1107.
   
5. Lomagno et al. “Increasing iron and zinc in pre-menopausal women and its effects on mood and cognition: a systematic review.” Nutrients. 2014 Nov 14;6(11):5117-41.
   
6. Konofal et al. “Iron Deficiency in Children with ADHD.” Archives of Pediatric and Adolescent Medicine. 2004;158(12):1113-1115.
   
7. Joseph, James A., Barbara Shukitt-Hale, and Lauren M. Willis. "Grape juice, berries, and walnuts affect brain aging and behavior." The Journal of nutrition 2009;139(9): 1813S-1817S.
   
8. Krikorian, Robert, et al. "Blueberry Supplementation Improves Memory in Older Adults." Journal of agricultural and food chemistry 2010;58(7): 3996-4000.
   
9. Devore, Elizabeth E., et al. "Dietary intakes of berries and flavonoids in relation to cognitive decline." Annals of neurology 2012;72(1): 135-143.
   

Enjoy some of the back-story on Bite-Sized Medicine's origins and the meaningful impact it has made on one of the podcast's founders, Dr. Kelsey Sicker.

In this episode we focus on optimizing the body's ability to regulate inflammation and cope with stress. We also touch on some foods that are associated with increased risk of certain cancers.

Resources:

1. Bennett, Jeanette Marie, et al. "Inflammation, nature’s way to efficiently respond to all types of challenges: Implications for understanding and managing “the epidemic” of chronic diseases." Frontiers in Medicine 5 (2018): 316.
   
2. Keeren, Kathrin, et al. "Effect of different omega-6/omega-3 polyunsaturated fatty acid ratios on the formation of monohydroxylated fatty acids in THP-1 derived macrophages." Biology 4.2 (2015): 314-326.
   
3. Masters, Rachel C., et al. "Whole and refined grain intakes are related to inflammatory protein concentrations in human plasma." The Journal of nutrition 140.3 (2010): 587-594.
   
4. AICR
   

In this episode we explore gluten, Celiac disease, and the evidence behind utilizing gluten-free diets as a weight loss tool.

Articles/references:

• Aziz, I., Dwivedi, K., & Sanders, D. S. (2016). From coeliac disease to noncoeliac gluten sensitivity; should everyone be gluten free? Current Opinion in Gastroenterology,32(2), 120-127. doi:10.1097/mog.0000000000000248
  • NCGS and the benefits of a GFD are reported amongst patients with irritable bowel syndrome, inflammatory bowel disease, and non intestinal disorders such as neuropsychiatric diseases and fibromyalgia. However, no reliable biomarkers currently exist to diagnose NCGS and hence confirmatory testing can only be performed using double-blind placebo-controlled gluten-based challenges. Unfortunately, such tests are not available in routine clinical practice. Furthermore, recent novel studies have highlighted the role of other gluten-based components in contributing to the symptoms of self-reported NCGS. These include fermentable oligo, di, mono-saccharides and polyols, amylase trypsin inhibitors, and wheat germ agglutinins. Therefore, NCGS is now seen as a spectrum encompassing several biological responses and terms such as 'non coeliac wheat sensitivity' have been suggested as a wider label to define the condition.
• Jamieson, J. A., Weir, M., & Gougeon, L. (2018). Canadian packaged gluten-free foods are less nutritious than their regular gluten-containing counterparts. PeerJ,6. doi:10.7717/peerj.5875
  • And in Canada - Jamieson study: GF staples (cereals, breads, flours, pastas) contained 1.3 times more fat and less iron (by 55%), folate (by 44%) and protein (by 36%), than GC counterparts (P < 0.0001). On average, GF pastas had only 37% of the fibre in GC pastas (P < 0.0001). Notably, GF and GC flours were equivalent in nutrient content. Despite GF and GC flours having similar nutritional content, the vast majority of the processed GF foods fell short in key nutrients.
• Missbach, B., Schwingshackl, L., Billmann, A., Mystek, A., Hickelsberger, M., Bauer, G., & König, J. (2015). Gluten-free food database: The nutritional quality and cost of packaged gluten-free foods. PeerJ,3. doi:10.7717/peerj.1337
  • Missbach: Similar GF discretionary food database → less fiber, less protein overall, and ranging from 206% to 267% higher in cost than their gluten-containing ( glutenous) counterparts. 
• Taetzsch, A., Das, S., Brown, C., Krauss, A., Silver, R., & Roberts, S. (2018). Are Gluten-Free Diets More Nutritious? An Evaluation of Self-Selected and Recommended Gluten-Free and Gluten-Containing Dietary Patterns. Nutrients,10(12), 1881. doi:10.3390/nu10121881
• Theethira, T. G., & Dennis, M. (2015). Celiac Disease and the Gluten-Free Diet: Consequences and Recommendations for Improvement. Digestive Diseases,33(2), 175-182. doi:10.1159/000369504
• Wu, J. H., Neal, B., Trevena, H., Crino, M., Stuart-Smith, W., Faulkner-Hogg, K., . . . Dunford, E. (2015). Are gluten-free foods healthier than non-gluten-free foods? An evaluation of supermarket products in Australia. British Journal of Nutrition,114(03), 448-454. doi:10.1017/s0007114515002056
  • Wu study: Australian supermarket health index comparison between foods labelled gf and those containing wheat or wheat product/rye or barley were equivocal and overall contained less protein
• http://freakonomics.com/podcast/demonization-gluten/
• Notes from AND Evidence Analysis Library

The ketogenic diet has been prescribed medically as a regimen for children with refractory seizures. It has since gained popularity recently as a weight loss strategy. This diet is important to understand because of its effect on overall body physiology in order to best counsel patients, especially as patients may be bringing it up more frequently as a current "fad diet"!

Resources:

1. Nordmann AJ, Nordmann A, Briel M, et al. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med 2006; 166:285.
2. Hall KD, Chen KY, Guo J, et al. Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men. Am J Clin Nutr 2016; 104:324.
3. Fung TT, van Dam RM, Hankinson SE, et al. Low-carbohydrate diets and all-cause and cause-specific mortality: two cohort studies. Ann Intern Med 2010; 153:289.
4. Martin‐McGill  KJ, Jackson  CF, Bresnahan  R, Levy  RG, Cooper  PN. Ketogenic diets for drug‐resistant epilepsy. Cochrane Database of Systematic Reviews 2018, Issue 11. Art. No.: CD001903. DOI: 10.1002/14651858.CD001903.pub4.
5. McKenzie A, Hallberg S, Creighton BC, Volk BM, Link T, Abner M, et al. A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes. JMIR Diabetes. 2017;2(1):e5
6. Hallberg SJ, McKenzie AL, Williams P, et al. Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at One Year: An Open Label, Non-Randomized, Controlled Study. Diabetes Ther. 2018. DOI: 10.1007/s13300-018-0373-9
7. Sumithran, Priya, and Joseph Proietto. "Ketogenic diets for weight loss: a review of their principles, safety and efficacy." Obesity Research & Clinical Practice 2.1 (2008): 1-13. 

 Dietary changes are commonly recommended for patients with hypertension or at risk for developing it. So what does the research say about specific changes to make and how does this translate to real life and the foods that we eat?

Articles/references:

• Sacks, F. M., MD et al. (2001). EFFECTS ON BLOOD PRESSURE OF REDUCED DIETARY SODIUM AND THE DIETARY APPROACHES TO STOP HYPERTENSION (DASH) DIET. New England Journal of Medicine,344(1), 3-10. 
• Academy of Nutrition and Dietetics' Evidence Analysis Library

There is a lot of nitty gritty in dietary modifications recommended for patients with diabetes. In this episode, we make it simple, realistic, and high yield for practitioners to better motivate real dietary changes for their patients.

Resources: 

1. MacLeod, Janice, et al. "Academy of Nutrition and Dietetics Nutrition practice guideline for type 1 and type 2 diabetes in adults: nutrition intervention evidence reviews and recommendations." Journal of the Academy of Nutrition and Dietetics 117.10 (2017): 1637-1658.
2. Powers, Margaret A., et al. "Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics." The Diabetes Educator43.1 (2017): 40-53.
3. Franz, Marion J., et al. "Academy of Nutrition and Dietetics nutrition practice guideline for type 1 and type 2 diabetes in adults: systematic review of evidence for medical nutrition therapy effectiveness and recommendations for integration into the nutrition care process." Journal of the Academy of Nutrition and Dietetics 117.10 (2017): 1659-1679. 

An up-and-coming fad diet that has rapidly gained interest. What do we know about it and how can we advise patients that have questions?

References:

1. Patterson, R. E., Laughlin, G. A., LaCroix, A. Z., Hartman, S. J., Natarajan, L., Senger, C. M., ... & Gallo, L. C. (2015). Intermittent fasting and human metabolic health. Journal of the Academy of Nutrition and Dietetics, 115(8), 1203-1212.
2. Chaix, A., Zarrinpar, A., Miu, P., & Panda, S. (2014). Time-restricted feeding is a preventative and therapeutic intervention against diverse nutritional challenges. Cell metabolism, 20(6), 991-1005.
3. Froy, O. (2009). Metabolism and circadian rhythms—implications for obesity. Endocrine reviews, 31(1), 1-24.
4. Hatori, M., Vollmers, C., Zarrinpar, A., DiTacchio, L., Bushong, E. A., Gill, S., ... & Ellisman, M. H. (2012). Time-restricted feeding without reducing caloric intake prevents metabolic diseases in mice fed a high-fat diet. Cell metabolism, 15(6), 848-860.
5. Trepanowski, J. F., Kroeger, C. M., Barnosky, A., Klempel, M. C., Bhutani, S., Hoddy, K. K., ... & Ravussin, E. (2017). Effect of alternate-day fasting on weight loss, weight maintenance, and cardioprotection among metabolically healthy obese adults: a randomized clinical trial. JAMA internal medicine, 177(7), 930-938.
6. Farshchi, H. R., Taylor, M. A., & Macdonald, I. A. (2005). Deleterious effects of omitting breakfast on insulin sensitivity and fasting lipid profiles in healthy lean women. The American journal of clinical nutrition, 81(2), 388-396.
7. Morgan, K. J., Zabik, M. E., & Stampley, G. L. (1986). The role of breakfast in diet adequacy of the US adult population. Journal of the American College of Nutrition, 5(6), 551-563.
8. Cho, S., Dietrich, M., Brown, C. J., Clark, C. A., & Block, G. (2003). The effect of breakfast type on total daily energy intake and body mass index: results from the Third National Health and Nutrition Examination Survey (NHANES III). Journal of the American College of Nutrition, 22(4), 296-302.
9. Albertson, A. M., Anderson, G. H., Crockett, S. J., & Goebel, M. T. (2003). Ready-to-eat cereal consumption: its relationship with BMI and nutrient intake of children aged 4 to 12 years. Journal of the American dietetic association, 103(12), 1613-1619.
10. Berkey, C. S., Rockett, H. R. H., Gillman, M. W., Field, A. E., & Colditz, G. A. (2003). Longitudinal study of skipping breakfast and weight change in adolescents. International journal of obesity, 27(10), 1258.
11. Ma, Y., Bertone, E. R., Stanek III, E. J., Reed, G. W., Hebert, J. R., Cohen, N. L., ... & Ockene, I. S. (2003). Association between eating patterns and obesity in a free-living US adult population. American journal of epidemiology, 158(1), 85-92.
12. Taylor, M. A., & Garrow, J. S. (2001). Compared with nibbling, neither gorging nor a morning fast affect short-term energy balance in obese patients in a chamber calorimeter. International journal of obesity, 25(4), 519.

Nicklas, T. A., Myers, L., Reger, C., Beech, B., & Berenson, G. S. (1998). Impact of breakfast consumption on nutritional adequacy of the diets of young adults in Bogalusa, Louisiana: ethnic and gender contrasts. Journal of the American Dietetic Association, 98(12), 1432-1438. 

Although easy to overlook, beverage consumption (specifically, sugar sweetened beverages) can have profound effects on a person's health. Here, we discuss how to advise patients and what the research says as far as beverage consumption for all ages.

Articles/references

1. Uptodate- dietary recommendations for toddlers kids 
2. The effect of increased beverage portion size on the energy intake of a meal
3. Home Matters: Adolescents Drink More Sugar-Sweetened Beverages When Available at Home.
   Haughton CF1, Waring ME2, Wang ML3, Rosal MC4, Pbert L4, Lemon SC4.
4. Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction.
   Imamura F1, O'Connor L2, Ye Z2, Mursu J3, Hayashino Y4, Bhupathiraju SN5, Forouhi NG2.
5. The European Society for Paediatric Gastroenterology, Hepatology, and Nutrition Committee on Nutrition provides similar recommendations [53]. Studies evaluating added sugars in children are limited [25]. Pending additional information, these consensus guidelines seem reasonable.This limit is based upon the recommendation in the 2005 Dietary Guidelines for Americans to limit discretionary kilocalories (ie, those available for consumption as added sugars or solid fats after essential daily nutrient requirements are met) to 6 to 10 percent of total daily energy intake [57]; the 2015 Dietary Guidelines suggest limiting added sugars to