An eclectic November collection

Confession time: For the past 3 weeks, I've been feeling twinges of guilt and anxiety every time I see Greens & Berries in my web browser's toolbar. Yes, my blog. I've been avoiding it. Until earlier today.

You see, I've convinced myself I don't have enough uninterrupted time for writing and publishing posts on a regular schedule. Inspiration has been hiding, too, perhaps behind the heavy, grey November clouds. Or more likely, she's gone south, looking for sunshine. I would if I could.

That said, reviewing, organizing and annotating Web links don't require inspiration. Just self-discipline and a couple of focused hours, which -- amazingly -- I had this morning between 10 and noon!

Here's a sample of November's additions to my Connotea (clinical nutrition) and Delicious (food and all other interests) bookmarks.

Applying nutrition science

• If you don't have time to read every article or abstract in the latest issue of the American Journal of Clinical Nutrition, you can keep up with nutrition research by checking out the highlights page and 50 Most-Frequently Read Articles.
  

• Leslie Beck, RD, on her web site and in her weekly Globe and Mail column, translates the latest nutrition science into practical guidelines. Recently she provided timely tips on how to boost your immune system with the right foods and supplements.

• New York Times health writer Jane E. Brody explores and clearly, succinctly explains how a low-acid diet promotes bone health. If you're interested in reading other studies, you can find them listed in a post I published earlier this month: Nutrition & Bone Health: How to build & maintain healthy bones on a plant-based diet

• Are Vegetarian Diets OK? - In her typical, no-nonsense style, Marion Nestle says "yes", which is no surprise. But I'd encourage you to read beyond Dr. Nestle's post for evidence-based and ethical reasons why they're more than "ok" for humans (adults AND children), animals and the environment.
  

   For example, two of my trusted sources are the Vegetarian Resource Group (look for articles by Reed Mangels, Ph.D, RD) & The Vegan Dietitian (Virginia Messina, MPH, RD.)  Also, in May 2009 the American Journal of Clinical Nutrition published a supplement on the 5th International Congress on Vegetarian Nutrition.

Writing with integrity

Avoiding plagiarism, self-plagiarism, and other questionable writing practices: A guide to ethical writing (PDF) - Even though I'm not writing my own research now or in the foreseeable future, I'll be applying these guidelines to blog posts where I summarize study results.

Nourishing the senses

These past two weeks there have been many posts and tweets about Vegetarian and Vegan Thanksgiving recipes and I'm not going to repeat them here. However, I'd be remiss if I didn't share this one, my pick for the most elegant meal I've seen on any blog this year: chef and writer Viviane Bauquet Farre's Vegetarian Thanksgiving Feast.

Nourishing the spirit

And one evening, at the end of a day heavy and dark with rain, I found the perfect poem for the moment:

Then too there is this

joy in the day's being done, however
clumsily, and in the ticked-off lists....

(you can read the rest of the poem here)

And let me add there is also joy (!) in this post's being done, however clumsily.

Thank you for reading. I hope you find something in this post to help you get through your day with greater knowledge, better health, and deeper commitment to doing your best work in all things.

Supplemental vitamins & minerals: benefits & risks

Though most dietitians promote obtaining nutrients from food sources, recent research suggests certain supplements may prevent chronic disease and enhance performance; other supplements are associated with increased risk of disease. What should we recommend for our clients?

Here is an excellent, professional resource from Dietitians of Canada that summarizes recent studies on benefits and harm and lists practice points:

Current Issues - The Inside Story: The continuing debate on the benefits and risks of supplemental vitamins and minerals (PDF)

Please note the document is copyright ©2008 Dietitians of Canada. All rights reserved. May be reproduced for educational purposes.

Nutrition & Bone Health: How to build & maintain healthy bones on a plant-based diet

If you haven't already read (or at least skimmed the abstracts) listed in the the previous post, you may want to do so to get the full story -- i.e., bones are made of more than calcium and vitamin D.

Vegan Guidelines (developed by vegan dietitians):

Calcium in the Vegan Diet

FAQs About Vitamin D

Vegan Foods are Good for Bone Health

Meeting Calcium Needs:Tips for Vegans

Bones, Vitamin D, and Calcium

Vegetarian Guidelines (include dairy sources):

Building Bones That Last - Even though more than 5 years old, I've included this resource by Vesanto Melina and Brenda Davis because it contains a table of the calcium content of many different plant foods as well as the percentage of calcium absorbed from each source.

Bone Health for Women - An "all-in-one" web site with pages on Food, Exercise, Supplements, and Tips & Recipes.

Food Sources of Calcium and Vitamin D - A helpful reference that includes an easy-to-read table of nutrient values for common and not-so-common (e.g., daylily flower, sea cucumber) plant sources of calcium.  Not strictly a vegetarian resource, though, as it includes fish.

Note: The D*action consortium recommends higher Vitamin D supplementation levels than stated in these resources.

Other Greens & Berries posts in this series:

• Nutrition in Bone Fracture Prevention & Healing: Part 1
• Nutrition in Bone Fracture Prevention & Healing: Part 2
• Nutrition in Bone Fracture Prevention & Healing: Part 3
• Nutrition in Bone Health: Selective Literature Review
  

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Image credits: top - Kale Almond Pesto by elana's pantry; bottom - Parsley, cottage cheese & yogurt dip (recipe here)

I've included it here, however, as it has an extensive range of Asian sources plant sources, including

Nutrition & Bone Health: Selective Literature Review

"A generalization from the literature, without a formal metaanalysis, may be that we need adequate supplies of both vitamin D and calcium to obtain significant reductions in nonvertebral fractures (especially hip fractures), and that those effects may be seen only in those persons who have insufficient vitamin D or calcium (or both). In addition, persons need to consume an overall healthful diet that meets all nutrient requirements. Protein for fracture prevention and healing and plenty of fruit and vegetables for overall health are of particular importance. A well-rounded diet is important, and evaluation of one element or vitamin does not give the whole story. [emphasis added.]

So where does that leave clinicians? The best public health recommendation would be that people should consume an overall healthful diet including adequate consumption of both calcium and vitamin D. This meta-analysis highlights the importance of not  segmenting nutrition into heterogeneous populations and isolated nutrients. Bone is not just calcium, and calcium does not function in isolation.

Source: JW Nieves, R Lindsay
Calcium and fracture risk (editorial)
Am J Clin Nutr. 2007 Dec;86(6):1579-80.

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Today, I'm publishing the "sifted" results of several literature searches I conducted during the past two weeks.

HA Bischoff-Ferrari, B Dawson-Hughes, J A Baron, PBurckhardt, R Li, DSpiegelman, B Specker, JE Orav, JB Wong, HB Staehelin, E O’Reilly, DP Kiel, and WC Willett
Calcium intake and hip fracture risk in men and women: a metaanalysis of prospective cohort studies and randomized controlled trials
Am J Clin Nutr 2007;86(6):1780–90.
Full article (PDF)

JZ Ilich and JEKerstetter
Nutrition in Bone Health Revisited: A Story Beyond Calcium
J Am Coll Nutr 2000;19(6):715-737.
Full article (PDF)

(Note: Though this review is 9 years old, it led me to other valuable research and review articles and has been cited by many so I'm including it here. All other resources have been published within the past 6 years.)

SA New and DJ Millward
Calcium, protein, and fruit and vegetables as dietary determinants of bone health
Am J Clin Nutr 2003;77(5):1340 - 1341.
Letter to Editor

SA Lanham-New
Fruit and vegetables: the unexpected natural answer to the question of osteoporosis prevention?
Am J Clin Nutr 2006;83(6):1254-1255.
Editorial with detailed reference list & links
Full article (PDF)

CJ Prynne, GD Mishra, MA O'Connell, GMuniz, MA Laskey, L Yan, APrentice and F Ginty
Fruit and vegetable intakes and bone mineral status: a cross-sectional study in 5 age and sex cohorts
Am J Clin Nutr 2006;83(6):1420-1428.
Abstract
Full article (PDF)

J-P Bonjour
Dietary Protein: An Essential Nutrient For Bone Health
J Am Coll Nutr 2005;24,(90006):526S-536S
Abstract
Full article (PDF)

A Devine, IM Dick, AF Islam, SS Dhaliwal and RL Prince
Protein consumption is an important predictor of lower limb bone mass in elderly women
Am J Clin Nutr 2005;81(6):1423 - 1428.
Abstract
Full article (PDF)

RP Heaney and DK Layman
Amount and type of protein influences bone health
Am J Clin Nutr 2008;87(5):1567S - 1570S.
Abstract
Full text (PDF)

JW Nieves
Osteoporosis: the role of micronutrients
Am J Clin Nutr 2005;81(5):1232S - 1239S.
Full article (PDF)

RK Rude, FR Singer, and HE Gruber
Skeletal and Hormonal Effects of Magnesium Deficiency
J Am Coll Nutr 2009; 28(2):131 - 141.
Abstract

FA Tylavsky, LA Spence and L Harkness
The Importance of Calcium, Potassium, and Acid-Base Homeostasis in Bone Health and Osteoporosis Prevention
J Nutr 2008;138(1):164S - 165S.
Full article (PDF)

SA Lanham-New
The Balance of Bone Health: Tipping the Scales in Favor of Potassium-Rich, Bicarbonate-Rich Foods
J Nutr 2008;138(1):172S - 177S.
Abstract
Full article (PDF)

Because of my practice area (neuroscience), I've been focused on brains and neglecting bones -- at least in terms of the evidence for best practice. Collecting these resources wasn't too difficult (thank you, OVIDSP databases and Google Scholar) and reading them has been very interesting, informative and even surprising. I hope you find some of these resources helpful, too.

In my next post (currently in draft stage) I'll be sharing evidence and practical guidelines on how a plant-based diet can build and maintain healthy bones.

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Other Greens & Berries posts on nutrition and bone health:

Nutrition in Bone Fracture Prevention & Healing: Part 1
Nutrition in Bone Fracture Prevention & Healing: Part 2
Nutrition in Bone Fracture Prevention & Healing: Part 3

New resource: stroke & transient ischemic attack - management & prevention

A new provincial clinical practice guideline for stroke/tia prevention and management has now been approved and released:

Stroke and Transient Ischemic Attack – Management and Prevention

Notes:

This guideline is based on scientific evidence current as of the Effective Date [April 29, 2009].

It was developed by the Guidelines and Protocols Advisory Committee, approved by the British Columbia Medical Association and adopted by the Medical Services Commission.

It comes in a variety of formats including the full guideline, an executive summary, and resources which are contained in the appendices

 I've quickly scanned the full guideline and noted nutrition is included in these sections:

IV. Management: TIA and Stroke

Prevention of medical complications of stroke is an important aspect of patient care. There are multiple complications post-stroke, and the following list addresses some of the most serious or common complications. Early mobilization and appropriate positioning within 24 hours are associated with improved outcomes. Assess swallowing and refer to SLP/OT as appropriate

• • Serious cardiac complications - common in the first three months post-stroke
  • Depression – estimated to affect up to 1/3 of patients; assess and treat individually
  • Dysphagia/malnutrition/dehydration – optimize positioning (sitting upright in chair unless contraindicated) for meals etc.; consider enteral feeding if no oral intake for >48hrs; there is a reduction in risk of aspiration pneumonia when swallowing is managed early by a speech therapist

Appendix F: A Guide for Patients

 For additional evidence and resources on the important role of nutrition in acute stroke recovery when nutrition support is needed to prevent or correct malnutrition), please see these older posts and links to resources:

• • Research article: undernutrition & stroke outcome
  • Weight Loss After Stroke
  • Canadian Best Practice Recommendations for Stroke Care: Summary (2008)