1. The need for a holistic approach
Dr Susan Mitmesser, VP of science and technology for Pharmavite kicked off the Workshop by explaining that we have over- and under-nutrition in the same population, combined with lower nutrient values in our food supply. “We need a holistic approach to nutrition, and we need to think about early life programming, microbiome ecology, and sleep health,” she told attendees.
2. “There isn’t a lot of quality data from NHANES on our youngest infants”
The importance of nutrition and access to adequate intakes during the first 1,000 days is gaining increasing attention, but there isn’t much data on what nutritional requirements are for infants and toddlers, explained Dr Regan Bailey, associate professor in the Department of Nutrition Science at Purdue University.
3. Nutrients of concern
Dr Bailey presented data from the Feeding Infants and Toddlers Study (FITS), including the interesting finding that 1 in 5 infants and toddlers are not meeting the recommendations for iron. This is of concern in infants aged 6-12 months when iron stores start to deplete. Iron inadequacy increases during this period, and FITS data showed that not only is the use of iron supplements low, but the consumption of iron-fortified infant cereal has decreased.
On the other hand, there is a risk of getting too much zinc and vitamin A, she said. “Dietary supplements are often blamed, but US kids are exceeding this from their food alone,” she said.
Dr Bailey also told attendees that the use of dietary supplements has increased among infants and toddlers, but this is almost exclusively vitamin D drops. The most common supplements taken by infants (younger than 12 months) are vitamin D and multivitamin drops, and for toddlers (12-23.9 months) it is chewable multivitamin products.
4. The critical importance of choline for development during early life
Leading choline expert, Steven Ziesel, professor in the Department of Nutrition at the University of North Carolina, explained that there is a very small window where choline is needed – miss it and you cannot fix it later.
[According to National Health and Nutrition Examination Survey (NHANES) data, 90% of children, adults and pregnant women are not getting enough. On average, pregnant women actually consume 319 mg of choline per day, which is just 70% of the adequate intake.]
5. The power of the microbiome
The Workshop then transitioned to presentations about the microbiome, with Sean Adams, PhD, professor and section chief of developmental nutrition at the University of Arkansas for Medical Sciences, first up.
“One cannot optimize personalized nutrition, supplementation or food patterns without considering the gut microbiome,” he noted.
Dr Adams explained how his group applies metabolomics to gut microbiome metabolism, which they call xenometabolomics. “Host metabolic health is a major factor driving microbiota ecology and xenometabolism,” he said.
6. Probiotics and the microbiome – What we know and don’t know
Donald Brown, ND, managing director of Natural Product Research Consultants, urged caution around probiotics. “This area has exploded commercially, but there have been some shots across the bow,” said Dr Brown, noting the recent studies published in Cell and the viewpoint penned by industry critic Dr Pieter Cohen in JAMA Internal Medicine.
“The cart is way out in front of the horse when it comes to the microbiome,” he said, calling this microbiomania.
7. “If you’re promoting healthy sleep then you’re also promoting overall health”
“We’re at the point where we’re recognizing the importance of sleep, but we’re not quite at the point where we’re doing something about it,” explained Dr Michael Grandner, director of the sleep & health research program at the University of Arizona College of Medicine.
Dr Grandner explained that sleep is a biological requirement for human life, yet our society sees sleep as unproductive time. “This has led to incentives from many sources for sleeping as little as possible. Not only this is an incorrect perspective, it is also a potentially damaging one,” he said. “If you’re promoting healthy sleep then you’re also promoting overall health.”
Poor sleep has been linked to a number of adverse health outcomes, including weight gain, diabetes, CVD. It can impair the immune system and lead to inflammation, illness, and longer recovery. A lack of sleep can also reduce performance, including focus, attention, decision-making, learning and memory, and cognition, he said.
“You can take stimulants like caffeine to boost focus and attention but you cannot caffeinate away productivity loss and poor decision making.”
8. The third pillar of health
Dr Grandner added that sleep is easier to change than diet or exercise, and we can use sleep to get people to change other behaviors.
On the potential of supplements to benefit sleep, Dr Grandner said that looking to nutrition for a “herbal ambien” is impractical.
“A big problem is that people who take sleep supplements to “treat” insomnia are doomed to fail,” he said. “This is not the goal of these products.” But that is only a small portion of the population. Most people do not need a prescription sleep aid. “There are also opportunities for using sleep to improve the ability of nutrition to support health,” he noted.
9. The impact of sleep health on dietary patterns and caloric intake
Next up, Marie-Pierre St-Onge, PhD, associate professor in the Institute of Human Nutrition at Columbia University, revealed how sleep restriction can increases appetite. Published data shows that sleep restriction is associated with increases in ghrelin (the hunger hormone) and hunger and appetite, while leptin decreases (Leptin is the long-term regulator of energy balance).
There is also data to show how sleep restriction reduces satiety in women and increases food intake.
10. Using botanicals to manage stress and improve sleep
Dr Tieraona Low Dog, was the last expert to take the stage, and led attendees on an extensive review of botanicals for the management of stress, which in turn can improve sleep.
Valerian plus lemon balm were two of the botanicals that she recommends to her patients. Dr Low Dog cited science to support the potential of valerian plus lemon balm to relieve anxiety in healthy volunteers, while other studies show that the combination may improve sleep in children
Valerian by itself may lead to sleep benefits, according to a review of 16 studies which found that patients taking valerian had an 80% greater chance of reporting improved sleep compared to placebo, she said. The European Medicines Agency notes that valerian does not work acutely, and that effects really start to be seen over 4 weeks or more. “There is a gradual onset of efficacy,” she said.
Other botanicals with considerable benefits include California Poppy Herb (An EU monograph recognizes relief of mild symptoms of mental stress and to aid sleep, she said), Chamomile (Phytomedicine, 2016, 23 (4) 1735-1742), Holy Basil, and adaptogens like ashwagandha.