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Food addiction has become a popular term, that some feel is thrown around carelessly. According to the manual used to diagnose mental disorders, DSM-5, addiction is “compulsive substance use despite harmful consequences, characterized by an inability to stop, failure to meet obligations, tolerance, and withdrawal.” Considering this definition, is food addiction the same as drug or gambling addiction? It is known that excessive food intake over time can lead to adverse health outcomes, but it is not known if food is addictive in the same way as a drug. A seminar given by Foods and Nutrition PhD student Carolina Cawthon provided some interesting research that attempts to shed light on this concept.

First, it should be noted that our body has several mechanisms to regulate food intake. Short-term regulation in the gastrointestinal tract sends signals to the brain that you are full. Long-term hormonal regulation responds to how many calories you have consumed. Both of these pathways together help you to maintain a relatively balanced food intake. However, eating for pleasure (reward) can override this balance and make you reach for that second serving or dessert even when your body is saying you are full. Triggering the reward pathway stimulates dopamine release, which makes you feel good. Over time sensitivity to dopamine declines, so the levels drop. A dopamine release is needed to reach baseline level and improve mood, so an individual wants to be exposed to the substance again and again to feel normal. This mechanism is how addiction occurs.

One reason food addiction has not been established is that it is difficult to conduct this research. One way is to monitor brain activity to see what areas of the brain are being stimulated as a result of the substance. For example, a study found that individuals who scored higher on a food addiction scale had brain activity similar to someone with dependence. It indicated that they were more motivated by reward and had less control to stop the behavior. Another study found that subjects who were obese had fewer dopamine receptors. Fewer receptors results in a lower dopamine response like what is experienced with addiction, suggesting that a similar mechanism may be present. It appears that food addiction and drug addiction are alike in some ways, but for now it cannot be determined if someone can become addicted to food.

Classifying food as an addictive substance could have important implications. First, it could emphasize therapy as a treatment for obese individuals to promote behavior change and weight loss. Raising awareness could also promote obesity prevention by demonstrating the consequences of continually overriding hunger cues. Finally, recognizing snack foods and sugar-sweetened beverages as addicting could provide more evidence for a tax on them to discourage consumption. For now, it is important to recognize that food addiction is distinct from substance addiction. However, it is always a good idea to practice mindful eating – following hunger and satiety cues – and not continuing to eat once you are full.

Dr. Ben Chapman from North Carolina State University spoke to the Foods and Nutrition Department about his food safety research and observations. Foodborne illness seems to be in the news more than in the past. Besides the improved access to media platforms making these headlines more prevalent, detection and reporting methods are also improving, which makes it appear that there are more foodborne illness outbreaks than before. Dr. Chapman provided his point of view on the status of food safety today and what the next steps should be to ensure better safety in our food supply.

At a national level, better safeguards in the food industry are needed. Much of this has to do with research. For example, consider the increase in listeria outbreaks in frozen vegetables. One reason for the outbreaks is using frozen leafy vegetables, like kale, in smoothies. Product development teams did not anticipate the green smoothie trend; they assumed that frozen vegetables would be properly heated before being eaten. It’s important to consider trends and potential food safety implications. More research is also needed to strengthen the FDA Food Code, a national document that provides food safety regulations. Methods of cleaning and sanitizing should be more prescriptive and specific to make sure that foodborne pathogens are controlled.

Dr. Chapman also pointed out incorporating food safety practices into recipe information that is available to consumers. Cookbooks rarely provide food safety instructions, and how often do you see someone on Food Network or the Cooking Channel use a meat thermometer? The trendy recipe videos you see on Facebook also fail to show good habits to prevent cross-contamination. If all of these outlets provided food safety messages, it could influence the attitudes towards those behaviors and change the perception of the norm.

Another important point was that individuals need both knowledge and supplies to handle food safely. This principle is important both at home and in restaurants. In restaurants, at least one person needs to have a food safety certification and often multiple individuals do. However, if they know proper handwashing practices but do not have easy access to hot water, soap, and paper towels, will they exhibit safe behaviors? It is up to restaurant managers to make the safe choice, the easy choice. For home cooks, the same principle applies. Clean dishes, sanitized surfaces, and temperature control are all still important, so individuals should equip their homes with the proper equipment. Setting up your kitchen with everything you need to keep everything safe will make it easier to do!

As Dr. Chapman discussed, many players are involved in food safety on a local and national level. Certainly, government and academic researchers, the food industry, and professional chefs and cooks play a large role in influencing and implementing good behaviors. On an individual level, anyone who prepares and cooks food has the responsibility to use good practices. It is up to every individual to be a good example of food safety to those around them.

What is a food additive? This presentation defines a food additive as any substance the intended use of, which may reasonably be expected to, directly or indirectly, becoming a component or otherwise affecting the characteristics of food. This excludes pesticides, color additives, prior sanctioned substances, and substances that are generally recognized as safe (GRAS).

Dr. Clemens discusses addresses why we use food additives and food preservatives. Food additives preserve nutritional quality of food, provide necessary ingredients for those with special diet needs, enhance the stability of food, and aid in the manufacturing, processing, preparation, treatment, packaging, etc. of food. He also gave some examples of what our foods would look like if we did not have food additives. One example he gave was strawberry ice cream. Most would expect the ice cream to be pink, so a food color is added. Food additives are also added to make the consistency for ice cream. Another interesting point he discussed was food sustainability. Food additives allow for longer shelf life, which can help to reduce waste. Food preservatives are substances added to foods to inhibit microbial growth. 3 fundamental functions of food preservatives include: promoting food safety, providing greater food choices, and promoting food convenience. The 2 types of food preservatives are direct and indirect. Direct food additives are added during processing and provide nutrients, keep the product fresh, and make the food more appealing. Indirect food additives can be found during or after the food has been processed.

Amy Miller discussed consumers and she starts with recognizing some of the latest trends when it comes to consumers shopping for food. Consumers are reporting that additives have a strong influence on what they purchase. 25% of consumers are seeking products with ingredients they recognize or with the shortest list of ingredients. Consumers are also shopping for foods without preservatives, high fructose corn syrup, and chemical additives. I thought it was interesting because less preservatives could increase food waste and decrease shelf life as mentioned by Dr. Clemens.  59% (6 out of 10) of consumers believe that that fewer ingriedents mean it’s healthier which is not always the case.

Nutritionists or any experts in food have an opportunity to educate consumers and clear up any misconceptions that people have about food and what’s in it. There is some fear and uncertainty about ingredients and the proper advice and education will allow consumers to make more informed decisions when shopping. The food industry has responded by decreasing artificial additives, sweeteners, MSG, trans fat, etc.  Overall, I think the trends of eating healthier will continue to grow, but there’s still a gap in understanding what is “good” and what is “bad”. As mentioned in this presentation, ingredients that are clean and natural do not always equate to safe or healthful.

“Workplace Wellness: Walk this Way” was hosted by experts from ChageLab Solutions, a group who works to develop innovative policies to achieve healthier communities. The webinar focused on ChangeLab’s newest resource Walk This Way which seeks to promote policies to increase physical activity in and around workplaces in hopes of helping more Americans meet the Physical Activity Guidelines. The guide is provided as a resource to wellness promoters who may be working with communities, or as a champion for their workplace.

The first few policies discussed are focused on increasing physical activity in the workplace itself. Benefits of physical activity in the workplace are numerous and include improved employee health, greater productivity, and decreased healthcare costs. One of the most interesting policies was giving paid time for physical activity. This type of policy encourages employees to be active during the workday by including it as part of their paid time. Employees don’t have to “clock out” or add extra time at the end of the day to make up for time spent exercising. While it is effective, this policy may be difficult to implement given the amount of buy-in needed from leadership. In addition to paid time for activity, another interesting policy was a workplace wellness tax credit. Under this policy, private employers who develop, adopt, and implement workplace wellness policies are provided monetary incentives. This strategy is often used to promote workplace wellness programs in small businesses, who are less likely to have such programs. Again, because these policies require buy-in at higher levels, such as local government, they may be somewhat difficult to implement.

The second part of the webinar focused on policies to increase physical activity around workplaces. For most people, commuting to work involves sitting in a single-occupant vehicle for 30 minutes to an hour each way. However, if we work to improve the infrastructure of communities around our homes and workplaces, more people would have the opportunity to include active transportation as part of their commute. The Walk This Way guide focuses on four different strategies to improve the infrastructure and systems related to active commuting. One policy, complete streets, involves re-thinking the design of our streets, which typically cater to automobiles, to include safe and accessible transportation options for pedestrians and cyclists. Using this strategy, streets are re-designed to include features such as bike lanes, parking lanes, sidewalks, and median islands, which make it easier and safer for people to walk and bike.

Overall, Walk This Way provides excellent recommendations for anyone looking to improve access and opportunities for physical activity. These days, many people spend a majority of their time at or around their workplace. Using strategies like those described in this resource will allow us help people incorporate physical activity into their workday, which may be more effective than trying to increase physical activity during leisure time. As resources like this continue to become available, physical activity promoters have even more tools at their disposal to help people lead more active lifestyles.

Dr. Amy Goss of the University of Alabama Birmingham studies the effects of macronutrient manipulation (or manipulations of the proportion of carbohydrate, fat, and protein in the diet) on body fat distribution and metabolic health in adults with obesity.

A quick note on body fat distribution: body fat can be distributed under the skin (subcutaneously), around the organs (viscerally), and in muscle (intermuscular). Visceral and intermuscular fat pose greater health concerns than subcutaneous fat. Dr. Goss’ work on many studies has shown that a reduced carbohydrate and higher fat diet results in a more optimal body composition and lower risk for type II diabetes in obese individuals.

When carbohydrates are ingested, the body secretes the hormone insulin. Insulin blocks fat burning and stimulates lipogenesis (fat synthesis) in the liver. Not all individuals produce the same amount of insulin in response to the same amount of carbohydrates, however. For example, African Americans secrete 2-3 times the insulin to the same amount of glucose as Caucasian individuals. Because some individuals are prone to excessive insulin secretion and subsequent fat accumulation, they may respond better to a lower carbohydrate diet.

Dr. Goss conducted a macronutrient manipulation diet study in women with polycystic ovary syndrome (PCOS). She used this population because patients with PCOS are at increased risk for visceral fat accumulation, which can cause resistance to insulin, and high insulin secretion. She tested a low carbohydrate high fat diet in these women and found that they had a selective depletion of their visceral and intermuscular fat without overall weight loss, retention of muscle mass, and improved metabolic outcomes for type II diabetes when compared to controls on a higher carbohydrate low fat diet.  The women also had improved blood lipid values from baseline on the low carbohydrate high fat diet.

The potential impact of these findings is a change in the dietary recommendations given to obese individuals with high levels of visceral fat. The evidence from Dr. Goss’ work suggest that a low carbohydrate high fat diet may have beneficial body fat redistribution effects that help patients lower their risk for insulin resistance and type II diabetes. Pending further corroboration, practitioners could use this information to adjust their recommendations for obese individuals to strive for a diet higher in healthy fats (such as olive oil, avocado, nuts) and lower in carbohydrates. The fascinating thing to me is how different people respond to carbohydrates and insulin in different ways. The findings of this study and others conducted by Dr. Goss point to the idea that blanket recommendations, such as the low fat recommendations from the Dietary  Guidelines for Americans, may not be ideal for everyone in the population.

We need transportation every day: to get food, to go to school or work, to attend to social and cultural activities, to access healthcare services, etc. As an initiative of the National Complete Streets Coalition, and as part of the webinar series Implementation & Equity 201: The Path Forward to Complete Streets, a panel of experts discussed how will emerging technology (ET) impact cities and streets in terms of new mobility and the built environment. ET includes autonomous (i.e., driverless shuttles), shared automated (SAV) and connected vehicles. They all have changed the way we use, design, build and think about roads (e.g., how far and fast people travel), and might have potential benefits including a reduction in congestion and the need for parking spaces, extending the reach of public transit and improving safety.

The experts also stated that historically, cars parked 94% of the time, 87% of daily trips are in personal vehicle and 38% of all trips are single occupancy, needing an average land-use of 3.4 spaces per car for parking. SAV could replace 12 conventional vehicles that serve to 31-41 persons a day eliminating 11 parking spaces. ET would also mobilize historically underserved populations (i.e., improve the safety and mobility of all users of the road regardless of age, ability, or mode of transportation), help to reduce amount of subsidy needed for paratransit operation, and improve accessibility to goods and services extending the reach of public transit.

New vehicles will also need less space and lanes so stakeholders can repurpose extra roadway for people and bikes promoting healthier lifestyles among walkable communities and sharing vivid streets with sustainable infrastructure for pedestrians; which has been a priority topic in recent summits about physical activity promotion.

Finally, they displayed a summary of benefits of ET where basically they seem to be sustainable, affordable, equitable, accommodating, influencing disruptive and diverse. The end-goal would be the implementation of shared roads where pedestrians, cyclists, and vehicles (either automatic or not) can operate altogether in a commingled setting. There are several cities and companies involved, but this initiative is just taking baby steps so launching a pilot project or further studies showing tangible outcomes to gain transit planners, policy makers and stakeholder confidence to be promoted as a “healthy change” for improving quality of life are needed.

As practitioners, we could encourage people who reach out to us for help to think about their environment and its influence on their choice of transportation and mobility. There could be also pilot studies comparing cities that are implementing any sort of ET with “regular/control” cities, including physical activity, leisure time, or access to healthy food as outcome variables.

The presentation by Dr. Ben Chapman covered many interesting topics but was primarily centered on food safety and the spread of Norovirus through unsafe hygiene practices.  Dr. Chapman is an associate professor and food safety extension specialist at North Carolina State University.  He specializes in consumer and retail food safety culture, home food preservation, and food safety risk reduction.

Dr. Chapman began by educating the audience on what Norovirus is and going over some facts on the virus and how it’s spread.  Norovirus has been identified by the CDC (Center for Disease Control) as “an agent of viral gastroenteritis” and is widely known for causing outbreaks of illness among large numbers of people.  The CDC estimated that at least 50 percent of food borne outbreaks in the United States were attributed to Norovirus in 2006.  According to ServSafe.com, a food safety website mentioned by Dr. Chapman, Norovirus causes “acute gastroenteritis: nausea, frequent and violent vomiting, and/or diarrhea. Other symptoms include low-grade fevers, chills, headaches, muscle aches and fatigue.  Onset of symptoms usually occurs 24-48 hours after ingestion of the virus and it can be contracted from as little as 10 viral particles.”  Dr. Chapman stated, Norovirus is present in feces and vomit of those infected and is commonly spread by the handling of food without proper hand washing.  He went on to say, Norovirus could be spread in the air around a source by aerosol particles; this fact makes the proper handling and clean up of potential infectious sites critical to preventing transmission.

Dr. Chapman next spoke about food safety procedures and how when followed properly they can prevent the spread of food borne illnesses such as Norovirus.  Dr. Chapman stated, “One of the main ways to control virus outbreaks is by following proper hand washing procedures”.  The CDC lists 6 steps to proper hand washing, “wet your hands with warm water, apply a generous amount of soap, rub hands together for 20 seconds, rinse hands, dry hands with a paper towel, and use the paper towel to turn off the faucet and open the door”.  The other major factor cited by Dr. Chapman in preventing food illnesses was insuring you cook foods to proper temperatures by using a food thermometer.  Servsafe.com states, “cooking food to 158 degrees for five minutes or boiling for one minute has been shown to destroy Norovirus”.  Dr. Chapman mentioned that this is where “the issue” he had with Gwyneth Paltrow stems from.

The last topic Dr. Chapman brought up was changing the behaviors of people when it comes to food safety practices.  He stated, “People use things differently than we expect them to (when it comes to preparing foods)” and “using an integrative behavior model to find out why people do what they do is an important step to fixing problems.”  It is important to know what people value in order to change their behavior.

Overall I thought that Dr. Ben Chapman was a good presenter and I enjoyed his horror stories on food safety issues he had seen over the years.  I thought the presentation was informative and found it interesting that cooking to temperature is such an important aspect of food safety; before this presentation I cooked foods until the juices ran clear, something Dr. Chapman specifically stated was incorrect.  Since listening to this presentation I know I have practiced better food safety techniques in my own kitchen in hopes of avoiding any potential food borne illnesses.

This presentation’s topic was “Sodium Reduction Monitoring and Applied Research”; the presenter Dr. Mary Cogswell covered background information on sodium then discussed sodium reduction and the types and accuracy of sodium intake measurement methods.  Dr. Cogswell is a Senior Scientist with the Epidemiology and Surveillance Branch, Division for Heart Disease and Stroke Prevention at the Centers for Disease Control and also a Registered Nurse.

Dr. Cogswell’s introduction covered the differences between salt versus sodium, how the human body uses, processes and excretes sodium, its adverse affects, as well as additional facts on the topic.  Sodium (Na) is an element found in nature, while table salt (NaCl) is a compound made of forty percent sodium and sixty percent chloride.  Once ingested through the oral cavity and absorbed in the blood, the kidneys are the body’s main form of sodium regulation/filtration; almost 90% of consumed sodium is excreted through urine.  In the body, sodium is essential to many functions, it is used to generate muscular contractions, maintain cell’s ion gradient, and regulate blood pressure.  When your intake of sodium exceeds the body’s requirement, your kidneys can’t keep up and the body retains water to regulate levels; this excess fluid can increase blood pressure over time.  The dietary reference intake (DRI) for sodium is just 2,300mg a day, however the average American’s intake is 3,400mg a day; Dr. Cogswell stated, “about 9/10 Americans exceed the DRI”.  This excess consumption is evidence to the fact that forty-one percent of Cardio-Vascular Disease (CVD), the number one cause of death in the United States, can be attributed to high blood pressure.  Dr. Cogswell explained that she addresses these facts initially because of a lack of public knowledge on sodium in general and the prevalence of problems that occur from its excess consumption.  She went on to say, “current research shows that seventy-one percent of American’s daily sodium consumption comes from prepared or processed foods with restaurant food making up a large portion of this”.  Taking this fact into consideration, sodium reduction seems simple; if Americans prepared more fresh food at home versus fast-food or carry-out we could greatly reduce or even eliminate excess sodium intake and/or high blood pressure.  This is much easier said than done.

Different methods of sodium reduction monitoring was the next topic discussed in the presentation.  Sodium intake can be measured with dietary recalls or biomarkers in the urine.  In a dietary recall you record everything eaten and drank over the past 24-48 hours and add up the sodium content from each item to determine your daily intake.  There are two different urine tests to determine sodium intake, a 24 hour urinary sodium excretion test and a one time (spot) urine assessment.  The 24 hour method is accepted as the most accurate approach, in which an entire day’s worth of urine is collected and analyzed for total sodium content.  In the spot assessment, one urine sample is collected and the volume is then multiplied by sodium content; this method is less accurate because it is a predicted amount and one sample’s sodium content can vary greatly.

One of the most interesting aspects of the presentation to me was the fact that 9/10 Americans are exceeding the DRI for sodium.  I am a very health conscious person and it made me think to myself whether or not I might be over the DRI..  I actually brought up the conversation with my roommate and we discussed the foods we most commonly consume that might be sneaking extra sodium into our diets.  With a quick Internet search we found that meat and dairy both contain a naturally high amount yet they pale in comparison to processed foods.  I challenge those reading to also sit down and determine whether they are consuming over the DRI – your own consumption may surprise you!

As for how these facts are relevant to health intervention implementations, with CVD as the number one cause of death in the United States being attributed to high blood pressure, a condition frequently caused by high sodium intake, it seems that health practitioners could combat CVD by increasing public awareness of american’s high sodium intake.  An intervention spreading tips for reducing sodium consumption in your diet could be implemented in neighborhoods and the effects studied.  Before this presentation I had no idea that high sodium intake was such a prevalent issue; I can only assume that if I am lacking this knowledge so are many other Americans.

Carolina Cawthon, a PhD student in Foods and Nutrition department at the University of Georgia, recently gave a seminar on food addiction. Ms. Cawthon’s talk shed some light on the debate about whether or not food addiction is an actual addiction. During her talk, she covered how our brains make decisions about food, what addiction is, and the evidence we have concerning the addictive capabilities of foods in animals and humans. Understanding food addiction is important area in the arena of public health because it is a topic that is impacted by the design of our food system and the availability of “addictive” foods, as well as policy surrounding taxation of such foods.

Our food intake is regulated by many things, including stretch receptors in our stomachs (sense the amount of food that is being taken in) and hormones (send signals to our brains about hunger and fullness). The decision-making portion of our brain, which decides to eat or not eat a food, is influenced by both reasoning and reward areas of the brain. The reasoning areas operate by objectively analyzing how much we have eaten already and how hungry or full we feel. The reward areas of the brain send messages related to anticipation of how good it will feel to eat something.

Addiction is an illness in which an individual is dependent on a substance and seeks it out to avoid distress (withdrawals, anxiety, etc.). The individual continues to use the substance in spite of consequences and has a high level of motivation to obtain the substance. Use of the substance becomes a compulsion. In the physiologic state of dependence on a substance (like drugs or alcohol), the individual’s body adapts so that they need more of the substance to achieve the desired effects.

Scientists have used rats to study addiction related to food and drugs. They have found that rats become addicted to substances at rates comparable to humans and thus are useful in addiction studies. Researchers have found that rats with more impulsive traits are more likely to demonstrate addicted behaviors in relation to food intake, especially when offered a diet high in fat and sugar.

The Yale Food Addiction Scale is a tool used to measure food addiction traits in human subjects. Brain imaging data has revealed that individuals with higher scores using this scale (indicating food addiction) have higher anticipation for food and lower reward after receiving the anticipated food. This aligns with the classic attributes of addiction- heightened desire for a substance but lower satisfaction after receiving it. Researchers have used this scale to identify individuals with a greater risk for food addiction to be: women, overweight or obese, over 35 years of age, and with a previous history of disordered eating. Dopamine is a neurotransmitter involved in the brain’s reward system. Some research has shown that individuals with higher BMIs have lower densities of dopamine receptors, which support hypothesis overweight or obese individuals could feel less rewarded by food and thus eat more to compensate. So we have some data that points to the addictive capabilities of food. However, a complicating factor is that while alcohol and drug addicts can be advised to stop using the substances completely, people need food to live and thus could never be advised to stop eating.

Even though great strides are being made in food addiction research, it is not entirely clear whether food addiction is the same type of illness as drug or alcohol addiction. There is no consensus among professionals about the validity of food addiction yet. Given the rise of obesity in our nation and the detriment it is to health, a better understanding of food addiction and its characteristics will continue to be important to the success of public health efforts.