Citicoline and Brain Health

My husband is concerned about his brain. He exercises, is lean, and eats right, but increasingly he says he has a hard time remembering the right word or clearly articulating his thoughts. So, when I attended a lecture by Drs. Deborah Yurgelun-Todd and Perry Renshaw from The Brain Institute of the University of Utah on the brain health benefits of the dietary supplement, CognizinÒ citicoline, I was intrigued. (The session was sponsored by Kyowa Hakko, USA (http://kyowa-usa.com/), a global manufacturer of compounds used in dietary supplements and CognizinÒ brand citicoline).

After the conference I did some research by starting with Natural Medicines and then doing a literature search through Pub Med (http://www.ncbi.nlm.nih.gov/pubmed) to learn more about citicoline. I also contacted Dr. Yurgelun-Todd about her research on citicoline, as she has been studying it for over a decade. I found that citicoline was originally used as a treatment for individuals who had a stroke.  It is estimated that 2 million brain cells die every minute after a stroke so early treatment is essential to preserve the brain and maintain normal function. In a recent review of citicoline used in stroke patients, it was found that citicoline was safe to use and had beneficial effects on recovery, especially in older patients (>70 yrs) who had no other treatments. One study found that when citicoline was given to stroke patients within 3 hours, they were more likely to have complete recovery compared to those who got a placebo. Not all studies find such great results, but overall the evidence of a positive improvement in brain function after a stroke is well founded.

Food is not a good source of citicoline; only a small amount is found in organ meats. When citicoline is taken orally (in a pill) it is broken down into a B-vitamin, choline, and cytidine which is further metabolized into a compound called uridine. Both choline and uridine can cross the blood brain barrier and once in the brain, they can be converted back to citicoline, sometimes referred to as CDP-choline. Within the brain citicoline has several actions. First, it helps stimulate the production of cell membranes. Second, citicoline increases the production of the neurotransmitters which have been shown to increase attention, focus and memory.

Research on citicoline for other disorders where cognitive abilities are affected is scant, but promising. Researchers can’t yet say that citicoline will improve memory or cognition in individuals with Alzheimer’s disease, Bipolar disorder, Parkinson’s disease or traumatic brain injury, but stay tuned as more research is conducted in these areas.

I asked Dr. Yurgelun-Todd what she would say about healthy 50+ adults taking citicoline and she said that there is some good evidence to support the use of the supplement on improved focus and sustained attention. Her studies have used doses ranging from 250-4000 mg/day but she says a dose of 250-500 mg/day is effective and well-tolerated.

What about my husband? He has been taking citicoline for a couple of months (250 mg twice a day) and notices an improvement in word finding and clarity in conversations. He said he sometimes had to “think in pictures” when telling a story, but now he thinks he has better mental clarity. Of course, this is anecdotal. As for his memory, well, he still leaves the house without his wallet and phone and can’t find the milk in the refrigerator, but he feels it has helped him and that is a good thing.

 

Guilt-free snacks?

The email caught my eye..."guilt-free snacks for healthy habits." Sounded like something I would be interested in and it had all of the buzz words for today's consumer: "pure, natural, real, organic, gluten-free, and straight from nature."  Well, that last one is a lie because no processed snack food comes "straight from nature." I've never seen a chocolate hazelnut brownie coconut butter tree or a dark chocolate Brazil nut bush.

Never mind that, snacking is big business and many of us graze all day long, forgoing meals for snacks. So, how did these 3 "guilt-free" snacks fare on closer look? Spoiler alert....not so good.

For those of us 50+ adults, snacks should be nutrient-rich but not calorie-rich. Even for the most active among us, calories count and I've seen many older adults sabotage their weight and fitness goals by consuming too many "healthy" snacks. Snacks have calories and to avoid the weight creep of aging we have to be mindful of calories from all snacks. Let's take a closer look at these so-called "guilt-free snacks."

• Dark chocolate Brazil nuts. A 4-oz bag sells for $6.00 with 5 servings/bag. Each serving has 230 calories, 18 g fat, 7 g saturated fat, 12 g sugar, and 3 g protein. Let's face it, how many of you can stop at one serving? A pretty pricey snack, loaded with calories, fat and sugar and not much protein to promote satiety...that feeling of fullness that keeps you from eating more a few hours later.
• Chocolate hazelnut brownie coconut butter. This one costs $13.33 for a 12-oz jar. Two tablespoons comes with 220 calories, 20g fat and 3 g protein. Coconut butter is all the rage and we can debate the health aspects of it another time, but as a snack it packs a calorie and fat wallop.
• Crunch cluster almonds. A one-oz serving will set you back 160 calories and 13 g fat with only 5 g protein. And, a 9-oz bag costs $6.32.

To me, a guilt-free snack is affordable and delivers on nutrition and taste. Snacks that are much (much!) less expensive and more (more!) nutrient-rich include plain Greek yogurt (100 calories and 18 g protein) mixed with your favorite seasonal fruit or try cottage cheese (1/2 cup has 90 calories and 13 g protein) with a few whole grain crackers. If you like a creamy, cheesy snack, try a portion-controlled wedge (like The Laughing Cow spreadable cheese wedges with only 35 calories per wedge) on crisp apple slices.

Don't be fooled by the health-halo surrounding "guilt-free" snacks. Eat nourishing, healthy snacks without the high price tag. I'll bet you have some in your fridge right now!










Is Sugar the New Fat?

After a morning aerobics class at the local YMCA, I was catching my breath in the locker room and chatting to two women from the class. They know I am a registered dietitian nutritionist so the conversation turned from our hard workout to what else....food. One of the women asked me about calcium and what were the best sources. She said she gave up drinking milk because it had too much sugar....11 grams of sugar in a cup of milk and didn't I think that was outrageous?!  Before I could answer the other woman chimed in and started talking about the World Health Organization's (WHO) recommendation that sugar intake should be halved to 5% of total calories or about 6 teaspoons or 25 grams a day for an average person.


So, back to the calcium question. I suggested a glass of 100% orange juice fortified with calcium as a good way to start the day. Fortified orange juice contains needed nutrients (130% of the daily value for vitamin C, 25% of the daily value for vitamin D, and 35% (or 350 milligrams) of the calcium daily value); that goes a long way in helping women meet the 1200 milligrams of calcium recommended for women of our age. Both women were surprised (shocked?) that a dietitian would suggest drinking fruit juice. "What about all that sugar?" was the reply. I wish I had my carton of OJ to show them that 1 cup of 100% orange juice has 22 grams of sugar and that the sugar is naturally occurring in fruit and fruit juice. These are same women who were sipping on post-exercise recovery drinks that were "all natural." One had a Snapple Cranberry Raspberry (16 ounces = 51 grams of sugar) and Odwalla Mango Tango (16 ounces= 44 grams of sugar).


Sugar is becoming the new fat. Remember when we abhorred fat and removed fat from our favorite foods? That brought us such interesting foods as fat-free cookies (loaded with sugar and refined carbohydrates), fat-free cheese (scary stuff that tasted like plastic), and fat-free coffee cakes (remember Entenmann's? Fat-free goodies but often with more calories than the original coffee cake). Now, sugar has taken fat's placed as the new nutrient to be vilified.


Yes, we can all afford to decrease our sugar intake, but why eliminate healthy foods, like orange juice or pineapple juice or milk or yogurt that contain naturally occurring sugars? I work with athletes who are trying to gain weight and I recommended low-fat chocolate milk and 100% fruit juices like grape and orange and apple to boost calories while getting needed nutrients. I think it is better to get real foods with real nutrients than taking protein powdered drinks.


The WHO recommendation is meant to help curb obesity and reduce dental cavities but there are unintended consequences when we demonize one nutrient and try to find a replacement for it. The woman who questioned the sugar in low-fat milk said she read online that almond milk was lower in sugar. True, but did she also notice that almond milk is lower in protein? A cup of almond milk has 1-2 grams of protein yet a glass of low-fat milk has 8 grams of protein. We need the protein in the low-fat milk more than we need fewer sugar calories in almond milk.


So, if you want to reduce sugar intake (and, we all should), start reading labels and look for the hidden sugars in your favorite foods. Check out your brand of peanut butter, catsup, soup, and pasta sauce and see how much sugar is lurking in those foods. Find alternatives (take your reading glasses to the grocery store) but don't give up healthy, nutritious foods just because there is some naturally-occurring sugars in them. I am not giving up my OJ despite the WHO recommendation.

Tomaotes...in winter?

 

I had the good fortune to be an invited guest at The Culinary Institute of America's yearly conference, World of Healthy Flavors in January. World of Healthy Flavors is a collaboration between the CIA and Harvard School of Public Health. It brings chefs, food service operators, growers, and suppliers together to marry nutrition science with delicious food. From quick service restaurants to campus dining, innovations in food preparation and flavor is the outcome of this conference, now in it's 10th year.

 

After the conference, there is a day added to celebrate "Produce First." This is where the real fun begins. Teams are established that include chefs, nutritionists, and produce representatives to come up with several dishes showcasing one produce ingredient. I was on the "Tomato" team, sponsored by NatureSweet tomatoes. (Disclosure, I have no financial relationship to the company to promote the product.) We had three types of tomatoes from NatureSweet...."Glorys" (cherry tomatoes, )"Cherubs" (grape tomatoes), and "SunBursts" (yellow tomatoes). All of these fully vine-ripened tomatoes are produced in greenhouses under controlled environmental conditions; everything from the seeds to soil to water is controlled. The result is a delicious, juicy tomato that tastes good all year long. When I first discovered NatureSweet tomatoes at my local discount shopping club, I was excited because, (1) they taste great and I love them as a snack with only 27 calories per cup, (2) they are great roasted and used to top fish, chicken, or pasta. To roast, heat the oven to 450 degrees F. and drizzle olive oil on a baking sheet. Add a carton or two of tomatoes, swirl them around the pan to coat in olive oil and sprinkle with salt and pepper. Roast in oven for 15 minutes and then turn them. Continue roasting for another 10 to 15 minutes until they begin to split open. I use them on pasta for a much tastier and nutrient-rich topping than jarred marinara sauce, or over grilled fish or chicken breast for a quick dinner.

 

Tomatoes, raw or cooked, are a tasty, healthy food. Tomatoes are anti-inflammatory foods and are loaded with anti-oxidants of the carotenoid family. One carotenoid that has gotten a lot of media attend for it's role in prostate health is lycopene. This compound in tomatoes is associated with lower risk of prostate cancer and stroke. Cooking the tomatoes breaks down the cells, releasing the lycopene making it more readily absorbed. Lycopene is also fat-soluble so eating tomatoes with some fat will also help it be better absorbed. Eighty percent of lycopene in the U.S. diet comes from tomatoes, so start roasting tomatoes in a bit of olive oil to get even more health benefits.

 

Back to my "team." The creative chefs came up with many dishes but the highlight was our "Tomato Cod with Smoked Roasted eggplant, Fried Citrus Rind, and Pickled Roasted Tomatoes." A dish that begins and ends with tomatoes...what could be better?

 

 

For more recipes, check out www.naturesweet.com

 

 

362 Exhibitors and So Little Time!

Every year I attend the Food and Nutrition Conference & Expo of the Academy of Nutrition and Dietetics and like a kid in a video game store, I love the exhibit hall. This year 362 exhibitors were doling out food and beverage samples in Houston and as I walked through the aisles of vendors I thought about what might appeal to the 50+ audience. So, here are some of my favorites that can help improve your health and taste great at the same time. (I have no financial interest nor have I done any consulting with these companies or products.)

The Mushroom Council, representing fresh mushroom producers or importers, was preparing samples of turkey-mushroom burgers. The smell drew me in but the taste made me a true believer. Paring mushrooms and meat to make healthier burgers, meatballs, tacos...or any recipe that calls for ground beef or turkey... can reduce the fat, sodium and calories of a dish while increasing vitamins, minerals and fiber. And, let's not forget the cost. One study showed a 27% reduction in cost when using mushrooms for part of the ground meat. Recently, research sponsored by the Mushroom Council was highlighted on NPR at http://www.npr.org/blogs/thesalt/2013/11/05/243218136/make-room-for-mushrooms-fungi-compete-with-meat-in-burgers. So, next time you are using ground meat in a favorite dish, finely chop mushrooms and mix into the meat and be prepared to be surprised at the flavor punch.

The Almond Board of California was handing out a dietitian's favorite snack...a tin filled with natural whole almonds. The tin holds the "perfect portion" of 1-ounce or 23 almonds. Almonds make a great a snack for those of us 50+ as a serving has 6 grams of protein, 3.5 grams of fiber, and 35% of the daily value for vitamin E. A 2013 study from Purdue University with 137 participants who were given 1.5 ounces of almonds (about 35 whole almonds) every day for a snack showed that hunger levels were decreased, vitamin E and "good" fats were increased without weight gain. So, when the mid-morning or afternoon hunger hits, grab a handful of nutrient-rich almonds.

The Cherry Marketing Institute was serving refreshing tart cherry juice. While I don't like the term "super food," cherries are making a pitch for that title. Some studies using tart cherry juice (about 10-ounces a day) have shown anti-inflammatory effects in those with arthritis and gout. Athletes are getting in the cherry juice cheering section, too, as a recovery drink. Some college and professional athletes are drinking cherry juice after a hard workout or during injury rehab to reduce inflammation and promote healing. Cherry juice is a nutritious beverage that might be worth a try for active older adults who experience muscle soreness after a tough workout.

The Canola Info/Canola of Canada booth caught my eye because in Georgia I've noticed the beautiful fields of canola plants in the early spring. Fields of yellow flowering canola plants are quite a sight to see. Canola oil has the least saturated fat of all the oils (even olive oil) and it also contains alpha-linolenic acid, an omega-3-fat, associated with fatty fish or flaxseed. It is about 60% oleic acid (the kind of fat in olive oil) and 21% polyunsaturated fat. All of those numbers give canola oil a heart healthy profile for those who want the lowest saturated fat oil and don't always like the taste of olive oil.

Last, I was happy to see Flatout at the expo. I've been using these flatbreads as a bread substitute for about a year because they are higher in protein and fiber with half the calories of sliced bread. This Chicago-based company was sampling a new product, a rosemary and olive oil "fold it" flatbread. Great taste for 100 calories and I bought a package when I got home (found in the deli/bakery section of most grocery stores) and it will be a staple in my house. The flatbreads are also great for quick pizzas on a busy night...top with mushrooms, of course!

Can't wait for next year's expo to see what else I can taste...and enjoy!

What is junk food?

Last week a study in Pediatrics (Athlete Endorsements in Food Marketing, October 7, 2013) made headlines. Almost without fail the headlines used the word "junk" food to describe athletes' endorsements and one headline went so far to say, "Yes, Peyton Manning is making you fat."

When I read the study, it got me thinking about what is a "junk" food and who defines the parameters of what is and is not considered a "junk" food. As a registered dietitian nutritionist, I am not so sure what a "junk" food is....is it a side of pork belly or a soft drink or cheese puffs?  Usually, a junk food describes one that is calorie-rich without providing nutrients. Does a sports drink fit that definition? Some would say yes, and athletes have been endorsing sports drinks for decades. While a sports drink might be a junk food to a sedentary person who never breaks a sweat, to an athlete a sports drink is a proven hydration beverage. The joint position paper of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine states that "beverages containing 6-8% carbohydrate are recommended for exercise events lasting longer than 1 hour." The Evidence Analysis Library of the Academy of Nutrition and Dietetics goes on to say that " current research supports the benefit of carbohydrate consumption in amounts typically found in sport drinks (6-8%) to endurance performance in events lasting 1 hour or more."  Anyone who watches Peyton Manning or Serena Williams or LeBron James (all called out in the media reports for endorsing "junk" foods) knows they perform at a high intensity and duration and can benefit from the carbs and electrolytes in sports drinks. So, to a competitive athlete a sports drink is not a "junk" food so why shouldn't football, basketball or tennis players endorse sports drinks?

Quick service restaurants were also on the hook for "junk" food and athletes' endorsements. McDonald's is often picked on as a provider of  "junk" food but did you know that 80% of McDonald's menu items are under 400 calories? And, that in 2012 the default in the new happy meal is a side of fruit, a kid's size fry, and a fat-free milk? McDonald's has served 530 million packs of apple slices to kids in a one year period from 2012-2013. Of course, there are high calorie and high fat and high sodium items in any restaurant, but we often forget that there are healthy choices in every restaurant if one chooses to look for them.

And, of course we mustn't forget the fry...a real junk food that is making us all fat, right? On average, Americans get about 1.5% of their calories from French fries. Potatoes are an excellent source of potassium, a nutrient identified by the 2010 Dietary Guidelines Advisory Committee as a shortfall nutrient. Only 2-3% of Americans had adequate intakes of this important mineral. And, frying of potatoes does not destroy the potassium as some people believe.

A further look at the Pediatrics article showed that famous athletes endorse more sports goods and apparel than foods and beverages. Yet, I didn't hear anyone complain about sneakers made in less than desirable conditions in developing countries and sold for a tidy profit by U.S. companies.

I would like to see the media stop demonizing foods and instead help people enjoy their favorite foods in moderation (another word some people don't like), but I like it just fine.

Should you avoid white vegetables?

Last Saturday I was at a rural Georgia Farm Festival and I bought a bag of potatoes from a local farmer (photo of my purchase to the left). As I carried the 5-pound bag to my car, a stranger approached me wagging her finger at me. She said, "You shouldn't eat those. I stopped eating potatoes years ago because white vegetables are horrible and you might as well pour sugar down your throat."  I was stunned by her comment on many levels. First, when did it become acceptable for a stranger to give out nutrition advice? Second, she was just plain wrong.

A recent paper (executive summary available for free at http://advances.nutrition.org/content/4/3/318S.full.pdf) published a roundtable discussion convened on the campus of Purdue with leading nutrition experts. The topic of the roundtable and the summary was, "White vegetables: A forgotten sources of nutrients."  As nutritionists, we often tell our clients to choose a colorful diet but maybe we should have emphasized that white vegetables are healthy, too, and certainly are not devoid of nutrients. One of the experts cited in the paper reminded us that white vegetables contain important nutrients like vitamins C and D, potassium, calcium, and dietary fiber, and color is not an accurate indicator of these nutrients. In addition to potatoes, other white vegetables include onions, cauliflower, mushrooms, and turnips and if we only used color as a guide to choosing our veggies we would miss some key nutrients.

Only 2-3% of Americans get the recommended intake of potassium and potatoes are one of our best sources of this important mineral. Higher potassium intakes are associated with lower blood pressure and the DASH diet, a meal plan designed to lower blood pressure, contains many potassium-rich foods, including potatoes. Potatoes are naturally low in sodium and high in potassium; a healthy combination.

Potatoes are also a good source of dietary fiber and not just in the skin. The flesh of the potato has soluble fiber, the kind of fiber that helps to lower blood cholesterol levels.

As for the comment that potatoes=sugar, well, that is a reference to the glycemic index; a measure of how a fixed amount of a carbohydrate in a food affects blood sugar. Potatoes have a higher glycemic index than other vegetables but that doesn't mean they are the same as eating sugar. Most of use eat potatoes as part of a meal and the other foods in the meal can alter or lower the glycemic response of a single food.

I am going to prepare my potatoes by roasting them with a drizzle of olive oil and dried rosemary for a delicious side dish. Oh, and by the way, I saw the woman who admonished me later on at the festival eating hot dogs and, you guessed it, a bag of potato chips!