Thursday, October 26, 2017

Strategies to Reduce Energy Drink Consumption in Young People

Informing Intervention Strategies to Reduce Energy Drink Consumption in Young People: Findings From Qualitative Research

Energy drinks have been associated with negative health concerns, especially in people who are vulnerable due to existing medical conditions such as diabetes, cardiovascular disease, mood disorders, etc. Children and adolescents also are more vulnerable to negative effects from energy drinks, especially when combined with alcohol or drugs. Regulations on caffeine levels, age restrictions, labeling, and marketing are variable across the world and many consumers are unaware of recommendations regarding energy drink intake and drink content.

The study interviewed a total of 41 young adults and adolescents aged 12-25 that lived in Australia in 8 small focus groups to determine energy drink awareness and consumption, side effects of energy drinks, knowledge about energy drinks, factors influencing consumption, and ways to reduce consumption. Themes emerging from these topics revealed that many participants have little knowledge about energy drinks. Age and gender play a role in determining consumption, with males and younger adults drinking more than females and adults age 18 and over. Participants were also more likely to consume energy drinks if they were in a location with high access to them, with a common theme of consuming energy drinks for staying awake to study and to play video games.  Some participants said they did not consume energy drinks because of negative health effects. Taste and cost were both deterrents and incentives to choosing energy drinks. Peer pressure, marketing and promotions, and parental influence also played a role in consumption.

Strategies to reduce energy drink consumption include restrictions, increasing cost, increasing education, changing packaging, and reducing visibility in retail locations. Participants thought restrictions should be made on drinks with sizes larger than the maximum serving size recommendations, as well as to children 12 and under, and in schools. Participants thought that packaging should be made less attractive and have larger warning labels. They also believed that making the drinks more expensive and putting them on shelves not at eye level would deter purchase and consumption. In regards to education, participants thought interactive education would be more effective, and they also wanted to see more news stories and television announcements educating about energy drinks. Education would also need to be tailored to the age being targeted because there were differences between younger and older participants regarding reasons influencing consumption of energy drinks.


Francis, J., Martin, K., Costa, B., Christian, H., Kaur, S., Harray, A., . . . Trapp, G. (2017). Informing intervention strategies to reduce energy drink consumption in young people: findings from qualitative research. Journal of Nutrition Education and Behavior49(9), 724-733.

Sunday, October 22, 2017

Risk factors for exercise-associated hyponatremia in Non-elite marathon runners

Chorley, J., Cianca, J., Divine, J. (2007). Risk factors for exercise-associates hyponatremia in non-elite marathon runners. Clinical Journal of Sports Medicine (17)6, 471-477.

The purpose of this study was to examine the relationship between the development of decreases in post-race serum sodium (Na+) levels and exercise-associated hyponatremia (EAH), between the risk factors of non-elite marathon runners. Risk factors include low body weight, female gender, slower running time, excessive drinking, and altered renal excretory capacity (Chorley, Cianca, Divine, 2007). Hyponatremia or low sodium levels in prolonged endurance events can lead to nausea, dizziness, confusion, and even death.

This was a longitudinal study conducted at the Houston Marathon from 2000-2004, and consisted of ninety-six runners (2000, N = 10; 2001, N = 44; 2002, N = 32; 2003, N = 6; 2004,
N = 4). The runners were recruited from the local running community and volunteered with completed informed consent before participating in the study. An independent t-test was used to determine if a difference exists between baseline characteristics and physiologic estimates of hyponatremic and normonatremic runners, and those who lost 0.75 kg or more or failed to lose 0.75 kg during the race. There were many significant values related to difference by weight change category. Including the measured values of: 
Post Na+ and change of Na+, finish time, fluid consumed, sweat rate, and fluid balance), as compared to 1) Those Who Lost at Least 0.75 kg, and 2) Those Who Lost Less Than 0.75 kg.

Significance was also established for many of the baseline characteristics and physiologic estimates by hyponatremia status. Determinates of hyponatremic (N=19) versus normonatremic (N = 77) runners of measured values included:
Pre-race weight, weight change, post-race Na+, change in Na+, intake of total cups of fluid, water intake, and fluid ingestion rate in mL/hr. Estimated values included: Fluid ingestion rate in mL/hr., and fluid balance in mL/hr. .

The significance between variables in this study confirms the seriousness and the influential factors of hyponatremia in recreational marathon runners. Runners who did not lose weight and consumed more fluid, mainly water are more likely to experience hyponatremia and lower post -race Na+. “A combination of fluid overconsumption beyond sweat rate and inappropriate fluid retention can explain the pathophysiologic process of EAH that accounts for a portion of decreased serum Na+ in marathon runners” (Chorley, Cianca, Divine, p. 474, 2007). In addition, the pathophysiology associated with perception of thirst and overconsumption of fluid, and the mechanism of the syndrome of inappropriate antidiuretic hormone (SIADH) has been compromised in marathon runners which contributes to the effects of hyponatremia. This study proves the need for education on appropriate individualized fluid strategies for non-elite runners.


Nutritional intake and gastrointestinal problems during competitive endurance events

Pfeiffer, B., Stellingwerff, T., Hodgson, A. B., Randell, R., Pöttgen, K., Res, P., & Jeukendrup, A. E. (2012). Nutritional intake and gastrointestinal problems during competitive endurance events. Medicine & Science in Sports & Exercise, 44(2), 344-351.

       “The purpose of the present study were 1) to quantify and characterize the food and fluid intake of athletes during marathon running, road cycling, and long-distance triathlon using a large subject pool with the same GI questionnaire based method and 2) to investigate whether nutrient (especially CHO) intake, fluid consumption, training status, and race distance is correlated with the incidence of GI distress and/or performance outcomes” (Pfeiffer, Stellingwerff, Hodgson, Randell, Pöttgen, Res, & Jeukendrup, p. 345, 2012).

        All recruited athletes where informed about the risks associated with the procedures of this study and gave written consent. The athletes were recruited from event exhibitions and contacted via email. The subjects consented to participate in this study consisted of, amateur runners, amateur and pro triathletes, and amateur and pro cyclists. The sample for this study consisted of both male and females and totaled 221 endurance athletes.

        Did carbohydrate (CHO) and fluid intake rates vary among the three events of a marathon, triathlon, cycling? One way ANOVA was used to compare the mean values between the different endurance events and between the three triathlons. Mean CHO intake rates were not significant between the Iron Man Hawaii, Iron Man Germany, and Iron Man, yet there was a significant effect of the event on CHO intake rate between the marathon, cycling, and triathlons. Fluid intake rates were also not significant among the three triathlons, but were significantly different between the marathon, cycling, and triathlon races.

       This study represented three different endurance events that require different fueling and hydration plans. The reported correlation between finishing time and CHO intake is worth mentioning. CHO intake was negatively associated with finishing times and was not associated with higher scores for upper and lower GI distress. However, CHO intake reported to be a risk factor for flatulence and nausea. “The American College of Sports Medicine (ACSM) and the American Dietetic Association (ADA) advises athletes to consume CHO at rates of 0.7 g/kg body weight per hour (30-60 g/h) during endurance events” (Pfeiffer, et al., p. 344, 2012). CHO intake and GI distress varied greatly between events and individual. This study supports previous research and provides a foundation for future research studies. In addition, the current study proves that practitioners need to focus on athlete’s individual nutritional needs specific to their event and previous history of GI distress.


Thursday, October 19, 2017

A2 Milk and Dairy Intolerance

A2 Milk and Dairy Intolerance

Many people believe they are lactose intolerant, but it may be a protein intolerance to the beta-casein protein A1 instead of a decrease in lactase enzymes. Research is showing some associations between A1 beta-casein and gastrointestinal distress. Another form of the protein, A2, does not cause these symptoms. Beta casein is the second most common protein found in cow’s milk and the difference between A1 and A2 beta casein is one amino acid: histidine on A1 and proline in the same location on A2. This amino acid variance changes how the protein is cleaved, and therefore the byproduct of the protein, beta casomorphin-7 (BCM-7). Studies have found higher inflammation markers, softer stools, and increased bloating and abdominal pain from consumers of A1 milk than in those drinking A2 milk. These studies were connected to the dairy industry, and are being used to promote A2 containing milk products.

The A1 protein is also being studied for its impact on other disease processes such as heart disease, diabetes, schizophrenia, autism, and SIDS, but studies are conflicting.  Studies found some association of A1 milk with heart disease, type 1 diabetes, and cholesterol levels but the research has numerous flaws and is questionable.

Addressing public concern is important right now because there is not abundant, clear information on the implications of A1 milk, and news and research is often interpreted incorrectly by the public, causing fears to circulate and people to stop buying milk. The a2 milk company has had success marketing A2 milk in other countries and has started selling milk in the U.S.. Clients may ask questions regarding intolerance to dairy and it is important to explain to them how products differ, and how they are the same. Clients can be encouraged to try different products to see which they tolerate best as long as they don’t have an allergy.


Thalheimer, J. C. (2017). Is A2 milk the game changer for dairy intolerance? Today's Dietitian, 19(10). Retrieved from:  

Monday, October 16, 2017

Food Safety Mistakes

Food Safety Mistakes

Food poisoning is a common issue that can be prevented by following food safety procedures.  Food poisoning can occur in any setting where food is being handled and cooked and can also occur in the home.  Following food safety tips can help create a safer food atmosphere and keep you from getting sick.

One mistake is tasting food to see if it is still good.  Food might still taste okay even if it is expired or contains bacteria that could make you sick.  Never use this to determine if food is still safe to eat.  Another mistake is putting cooked food back on the same plate that once held raw meat.  This can be a common practice that might occur when grilling food outside, but this can cause cross-contamination.  Bacteria from the raw meat can now be in the read-to-eat food, which can cause food poisoning.  Always keep raw and ready-to-eat foods separate. Another mistake is thawing food on the counter.  This is dangerous because the room temperature can cause foods to get in the temperature danger zone which is between 40 °F - 140 °F.  This zone creates an environment when pathogens grow.  This also goes with letting food cool before refrigerating.  Never leave food out for more than two hours without refrigeration to avoid illness-causing bacteria to grow.

Washing meat or poultry is another practice that should be avoided.  Doing this can spread the bacteria from the raw meat to your kitchen surfaces.  Another unhealthy practice is eating raw cookie dough or foods that contain raw ingredients.  The eggs may contain Salmonella or flour may contain E. coli which are types of bacteria that can make you sick.  Using the same marinade for raw meat and then again for the cooked meat is also a harmful practice that could cause food poisoning.  This spreads bacteria to the food you will be eating.  Undercooking meat, poultry, seafood, or eggs should also be avoided because you need a high enough temperature to kill any harmful bacteria from those products.  Checking food with a food thermometer is a good practice to see if the food is safe to eat.

Another mistake is not washing your hands.  Bacteria can live on your hands so it is important to always wash your hands thoroughly to kill illness-causing bacteria.  The last mistake is not replacing sponges and dish rags.  These items can also contain harmful pathogens so it is important to regularly sanitize and replace them to protect yourself from getting sick. 

It’s important to follow these food safety practices in the kitchen to help avoid food poisoning and foodborne illness.  Avoiding food safety mistakes will creating a healthier environment and decrease the opportunity for harmful bacteria to grow and live.


Wolfram, T. (2017). 10 common food safety mistakes. Retrieved from

Thursday, October 12, 2017

Barriers to Shopping at the Farmers' Market

A study was performed on urban, WIC-enrolled women to see what their perceived influences were to shopping at local farmers markets. In 1992, the WIC Farmers’ Market Nutrition Programs (FMNP) was created to provide local fruits and vegetables to WIC enrolled women, as well as raise awareness of local famers’ markets. Unfortunately, the redemption rate of these FMNP vouchers are not optimal (63%) so research has been conducted to see the barriers to shopping at farmers markets.

In the study being reviewed, the first barrier to shopping at farmers market were transportation issues. With many individuals not having a car, it can be a problem getting to the farmers’ market, especially if it is far away. Because there is a higher rate of supermarkets versus farmers’ markets, it is more likely that these individuals were closer and more conveniently located to a supermarket. Another barrier was that many of the women did not know where the farmers’ markets were at, especially if the markets move to a new venue weekly/monthly. Other barriers dealing directly with the farmers’ markets were limited hours that they were open and the quality of the fruits and vegetables at the markets. Many of the individuals were used to the clean, well displayed food at the supermarket, so the looks of possibly dirty, bruised items at the farmers’ market could definitely be a barrier to some individuals who might not think it is sanitary or safe.

Although this study was conducted on WIC-enrolled women, many points can be reflective of general populations. Location and hours of farmers’ markets could definitely be a set-back to many individuals considering work schedules. Better advertisement of farmers’ markets in communities could help individuals be more aware of when and where their local markets are.




Di Noia, J., Monica, D., Cullen, K. W., & Thompson, D. (2017). Perceived Influences on Farmers’ Market Use among Urban, WIC-enrolled Women. American Journal Of Health Behavior41(5), 618-629. doi:10.5993/AJHB.41.5.11

Wednesday, October 11, 2017

Examining Children's Snack Choices

Post #1

Originally published in the journal Appetite, a study examined why children choose to spend money on certain snacks. The study followed 119 children ages 8-11 in Boston with their own disposable income (allowances from their parents) to buy snacks. Researchers presented the children with photos of various brands and prices. The photos were of cookies, apple slices, and tubes of yogurt. The children were presented two photos at a time, 10 different times, and were asked to pick one of the two choices or neither. After the children were presented with pairs of items 10 different times, they were told one of the 10 chosen items would be picked for them at random and the child would be obligated to purchase the item. The children were all given $2 for participating in the study. The prices for snacks all ranged between $0.30 and $0.70. One group of snacks was from McDonald's so that the researchers could test branding significance as well.

One result found that children were more likely to choose cookies over apple slices or yogurt, regardless of packaging or brand. They found that brand awareness did not necessarily influence children's choices, but their like or dislike of that specific brand did influence their choices. Children who received an allowance from their parents every week were more cautious about the money they spent on snacks than those who didn't have an allowance. It was found that children without an allowance did not have much experience with handling money and thus were less cautious about spending the money that was give to them. The researchers deduced that experience with handling cash is an important part of understanding what prices mean. Researchers suggest more research needs to be conducted on this population. They state their limitations were that the study sample was small, regionally biased, and with limited choices of snacks to offer