Author: Annette (amw52004)

As we learn more about the benefits of school gardens and farm-to-school programs, we need to ensure that we do not gloss over the food safety aspect. Many people are utilizing local farmers or their own school gardens to provide food in their school cafeterias or salad bars, so they need to think about the steps involved to prevent the students from getting any food-borne illness. This webinar did a great job of outlining the different ways health professionals can maintain food safety while utilizing a farm-to-school program.

It is important to ensure that all local partnerships are with farmers that have good food safety practices to reduce risk. Some farmers may already have completed training or a certification, for example Vermont has a Practical Produce Safety certification that farmers can obtain. If you are not currently buying from a local vendor, you can encourage your vendor (who is likely to have a certification) to make purchases from a local farmer. In lieu of a certification, you can complete on-farm checklists that are provided by Iowa State University or the Institute for Child Nutrition. By going to the farm, you can check their practices yourself and develop trust with the farmer. When you are on the farm, it is important to inspect the incoming product and check the transporting vehicle to ensure that it is clean, to prevent any contamination.

Another way to maintain food safety is to keep records of where you get produce from. Traceability, knowing where your food is coming from and where it is going to, to very important to quickly identify any source of contamination. Even if it is a handwritten receipt from a vendor, it is better than no record at all.

Lastly, some schools utilize their school garden produce for their cafeterias or in their salad bars. In order to do this, ensure that all components of the process are safe, including but not limited to, clean water, proper composting, animal prevention, and safe produce handling. When you utilize food from the garden, store it in a separate container to maintain traceability. School salad bars are a great way to incorporate local produce and provide education to the students, and it should be treated like any other salad bar (proper temperature, tongs for serving, and clean area).

Overall, farm-to-school programs are a great way to get local produce into the schools, but it is important for health professionals to maintain proper food safety across all aspects of the food procurement process to prevent illness. Also, food safety may be a great learning avenue for the students to start implementing safe practices. Innovation is the key here, because farm-to-school programs have so much potential.

1. Nwadike, Londa. “Food Safety for Farm to School Success.” USDA webinar. 3 March 2016.

Farm-to-School programs are great for helping children and youths learn more about healthy eating. However sometimes after everything is going smoothly, there is a point where funding levels or community interest decreases. There a few solutions that a Farm-to-School program in Burlington, Vermont have implemented to overcome these barriers and expand their program. They have shared their solutions in a USDA webinar as a way to help others create their own sustainable programs.

To begin, the garden is deeply rooted in the school. Students from all classes get the opportunity to go out to the garden. Students sketch the fruits and vegetables as a part of art class, they identify them food items in Spanish as a part of Spanish class, and they also use the garden in math, science, and physical education classes. Having the garden so involved in all of the classes creates an atmosphere that encourages responsibility from all of the students, not just a select few.

One of the biggest solutions for creating a sustainable program is to get an overwhelming amount of community support, as well as student and teacher participation. The Burlington program really worked to make their presence known throughout the community. They worked to create partnerships with many local companies that had the same mission:  local hardware stores, mom and pop stores, greenhouses, the Gardener’s Supply Company, and health food stores. In addition to creating these partnerships with companies that helped to provide supplies, they took pictures of everything. The partnerships were able to display photo evidence of the impact of the gardens, which enhanced their business as a result, thus developing a cycle of events that continues to fuel their gardens and the community.

Another way to create a sustainable program is to keep it exciting and in the community’s face. The Burlington
program started a youth run food truck (Fork in the Road) which pays students minimum wage while teaching them valuable information. The students meet with farmers, learn culinary skills, develop an awareness for the community which is very impactful. It was an innovative way to create leaders, boost education and get more community buy in.

Overall, as health professionals, if we have a farm-to-school program we need to think about expanding to the next level and becoming more than gardens or kids eating new fruits and vegetables. Food can be an umbrella for education. The students are benefiting by gaining responsibilities and becoming self-advocates. They are learning more about food systems and truly becoming consumers in their community. This gives us the opportunity to really elevate the community and impact more than just the students in the schools.

1. Heusner, Sarah. Sustaining Your Farm to School Program. USDA webinar. 28 April 2016.

Technology is such a great tool. So many people are using for health reasons, by tracking their food consumption, their physical activity and daily steps, or even their sleep quality. It is truly the way of the future. So, when Pokémon Go, a gaming app, was released and the craze began getting people off their couches to “catch” Pokémon, many people wondered how this could be helpful for the obesity epidemic.

Lo and behold, Nature World News came to our rescue, releasing an article titled “Pokémon Go Could Help Prevent Type 2 Diabetes, Study Finds.” Well, wowzers. We went from tracking step count, to completely preventing chronic diseases. My grandmother was right; technology is advancing fast. However, in all seriousness, this article was intriguing and caught my attention immediately.

The Nature World News article stated that “According to the study, users are leaving their homes to walk for miles by just playing the game, engaging in intense physical activity without them noticing.” That’s all well and good but where is this study they were talking about? I was thinking the same thing. Spoiler alert: there is no study. It appears that researchers from the University of Leicester in the UK, released a press release that stated that Pokémon Go, as a smartphone app, could be an innovative solution to the rising obesity levels and chronic disease, and that is what this particular article was based off of. The researchers at the University of Leicester cited previous studies that have shown that breaking up prolonged periods of sitting regularly with five minute bouts of light movement every 30 minutes could significantly reduce blood sugar and insulin levels, which is vastly different from Pokémon Go preventing Type 2 Diabetes.

As future health professionals, we all understand the importance of physical activity. Therefore, it is important to not discourage Pokémon Go players. Utilizing technology to get people to move and be active can be innovative, however, the real struggle is getting people to stay active for longer than a few days or few months. Right now, Pokémon Go is too new to make any conclusions about how sustainable it is. In addition, health professionals really need be careful about popular media articles like this one. “Study” was mentioned several times in the article, yet, there was no study to be found. Even if there was a study that was conducted, we need to be careful because this a very new app, and we cannot draw conclusions from just one study.

Overall, Pokemon Go can be a great way to get people of all ages to start moving, and we as health professionals need to be there to help them continue to move. Even if it is not the cure to Type 2 Diabetes, it is a great way to get some steps in!

1. A. Jaime. “Pokemon Go Can Prevent Type 2 Diabetes, Study Finds”. Nature World News. 26 July 2016.
2. “Pokemon Go can ease Type 2 Diabetes burden.” University of Leicester. 25 July 2016.

It is evident that obesity is a global problem. In the United States about 40% of the population is obese. There are many different treatment options for people who are overweight or obese, but for extreme obesity bariatric surgery has been proven to be the most effective.

There are a few different types of bariatric surgery methods. The most common is the Vertical Sleeve Gastrectomy. In this method, 80% of the stomach is removed. Another method is the Roux en Y method. This used to be the most common, however, this is becoming less popular. This method bypasses the duodenum and creates a 30-mL (1/2 to 1 oz) stomach.

Bariatric surgery does have many advantages, such as long-term weight loss and favorable hormonal and metabolic changes (including reduced diabetes, hypertension, and sleep apnea), however it also has many disadvantages. Some disadvantages include the irreversibility of these methods, the short-term complication rates, and potential for long-term nutrient deficiencies. In addition, there is few studies about the effect of bariatric surgeries on bone and skeletal fractures.

Two studies (Nakamura et al. and Lu et al.) that were conducted found that after several years post-surgery there is an increase in the number of fractures in the clavicle, feet and toes, as compared to non-bariatric patients. So why are they getting fractures? Is it bone dependent, meaning that the quality of bone is affected? Or is bone-independent, meaning that bariatric patients just have an increased risk for falling?

Well, utilizing tools like the DEXA, which measures area bone mineral density, and Computed Tomography, which provides 3D measurements that the DEXA does not have, it was found that there was decrease in bone density. In addition to that, post-surgery bone formation increased, however, bone reabsorption also increased much more. Therefore, there was a decrease in bone density and size which leads to fracture. While the mechanism is not known, some possibilities are: hormones (parathyroid hormone, estrogen), diet, and muscle loss.

So, what can be done by health professionals? Supplementation is very important for bariatric patients. They should have 1200-1500 mg of calcium a day, and most should come from their diet. Their protein requirement is 60-90 g per day and their vitamin D requirements can be greater than 3000 IUs a day. In addition to supplementation, antireabsorptive therapies may be helpful. Most importantly, monitoring. Health professionals should conduct DEXA scans biannually, and vigilantly monitor older populations and children’s bone densities.

Overall, bariatric surgery can be a great way to lose weight quickly and long-term. However, there is not enough research currently on the relationship to bones and skeletal fractures, and future studies need to be conducted. Hopefully, in the future, there are clear recommendations and guidelines created for bariatric patients as a way to prevent fractures in this population.

1. Kindler, Joseph. Bariatric Surgery and Skeletal Fracture. Seminar. 26 October 2016.

Sure, running is healthy, but don’t go too fast because you could die. Well at least that is what this article by The Telegraph suggests. The eye-catching article title is “Fast running is as deadly as sitting on couch, scientists find” because if you end an article title with scientists find then it is 100% accurate.

This article begins by letting the reader know that running faster than 7 miles per hour is damaging and is actually doing more harm than good when it comes to heart and overall health benefits. They then cite the research article and mention that runners that ran the fastest were nine times more likely to die prematurely within 12 years, while those who were the tortoise in this tortoise and hare analogy, were not.

So what is the truth? Well, The Telegraph had it half right. The Copenhagen City Heart Study was a prospective study that was composed of random sample of 19,329 white men and women between 20 to 93 years old, which was narrowed down to 1,098 joggers and 413 healthy non-joggers. With analysis of all-cause mortality and adjusting for age and sex, the researchers found that jogging quantity and frequency were all associated with low mortality. In addition to that, all joggers had lower blood pressure and BMI, lower prevalence of smoking, and lower incidence of type 2 diabetes, which is great news for runners.

However, that’s not the end of the story. When looking at low, moderate, and strenuous joggers, there was a U-shaped association between jogging and mortality and interestingly enough, the fast-paced joggers’ mortality was not statistically different from that of the sedentary non-joggers. What the popular media article failed to mention was that the researchers believe that there could be an upper limit for exercise where the health benefits are no longer effective. The researchers go on to explain that further research needs to be done to test this hypothesis before making any recommendations. Hmm… seems like The Telegraph did not get that memo.

Anyone working in the health field needs to be mindful of these types of articles because while they can contain some interesting information, they can also be greatly exaggerated, thus losing its overall message. This particular study has some great information that health practitioners can utilize. Exercise might have an upper limit, and that is worth investigating. However, for right now, I believe most of the people we will be interacting with will not be included in the strenuous exercising group. It is something we should be aware of, but I am not sure how much clinical application it will have. Overall, we can conclude that (1) 7 miles per hour is not a magical cutoff point, (2) jogging has some great benefits and (3) we should not try to scare people away getting exercise.

1.  Knapton, Sarah. “Fast running is as deadly as sitting on couch, scientists find.” The Telegraph. Published 2 Feb 2015.
2. Schnohr, Peter, et al. “Dose of jogging and long-term mortality: the Copenhagen City Heart Study.” Journal of the American College of Cardiology 65.5 (2015): 411-419.

While scrolling through your preferred news outlet in the morning while eating a bowl of oatmeal, you may stumble across several food items or activities that can all of the sudden cause cancer. So what’s the latest? Well, according to New York Post, vegetarianism.

What?, you may be saying to yourself. I thought vegetarianism was the way of the future, the optimal diet for humans? How is this possible? Did I give up steak for nothing? Well, according to the New York Post long-term vegetarianism leads to a genetic mutation that leaves individuals vulnerable to heart and colon conditions, cancer included.

Genes? Now I’m confused. Let’s dive a little deeper into the literature. The study in question was looking specifically at a gene variant that causes the body to increase the amount of arachidonic acid that it can make from smaller omega-6 molecules found in plants. So, this mutation creates more omega-6 fatty acid from smaller molecules. What we know about omega-6 fatty acid is that it is pro-inflammatory and that having a large ratio of omega-6s to omega-3s in the body could play a role in lifestyle related diseases like colon cancer, heart disease, and other inflammatory-related diseases (however, even the research for that is unclear).

As the researchers were studying this predominantly vegetarian Indian city, they identified the genetic mutation, or vegetarian gene variant, in 68% of the residents. Therefore, they hypothesized (hypothesized being the key word here) that perhaps these individuals were also at a higher risk for inflammatory-related diseases. However, the New York Post skipped over all of this and made the connection without any research backing this information. The study did not even look at any data linking genes to the disease risk.

This study is one of the first looking at vegetarianism gene mutations, and any potential implications that it has need to be further studied. Research needs to done on possible disease risk outcomes in people with this genetic mutation. Perhaps prospective cohort studies or observational studies can be conducted on prominently vegetarian communities with this mutation to see their mortality risk for omega-6 related inflammatory diseases.

Until then, health practitioners should take these popular media articles with several grains of salt. Reading articles like the New York Post can really discourage someone on the fence of changing diets to not adopt this new behavior, based on one [incorrectly summarized] research study, when several studies have documented the benefits of vegetarianism, especially for lowering disease risk. Health practitioners need to be really well-informed on the current research to educate individuals to may be reading that vegetarianism causes cancer over their morning oatmeal.

1. Kothapalli, Kumar SD, et al. “Positive selection on a regulatory insertion-deletion polymorphism in FADS2 influences apparent endogenous synthesis of arachidonic acid.” Molecular biology and evolution (2016): msw049.
2. Li, David. “Being a vegetarian could kill you, science warns.” The New York Post. March 30, 2016.