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Nutridate Volume 18 • Number 2 • May 2007 Spotting the Problem—Does Diet Play a Role in Acne? by Dr Neil Mann1 and Robyn Smith2 (1Associate Professor of Human Nutrition, 2PhD research student) School of Applied Sciences, RMIT University, Melbourne Acne is a common skin problem which affects 85 per cent of Australians at some stage of their lives. It begins during puberty, peaks at about 18 years and generally fades by the mid-twenties. In some cases it can persist into middle age, with 12 per cent of women over 25 years being affected. Although acne is not life-threatening, it can have long-term ramifications for sufferers, including diminished selfesteem, social withdrawal and emotional distress. What is acne? Acne is a complex disorder of sebaceous (oil-producing) hair follicles of the skin, particularly on the face and upper torso. These follicles consist of a sebaceous (oil-secreting) gland, a hair duct and a hair strand. The final outcome of this disorder is blockage of the duct, thus trapping oily sebum under the skin, where it allows bacteria to breed resulting in infection and inflammation. There are four distinct phases of acne development, which can be summarized as indicated (see Figure 1): • increased production of keratin (a fibrous protein) which blocks the follicle opening, • a rise in hormones (especially androgens) which stimulates the sebaceous glands to produce more of the skin oil known as sebum, Figure 1: F ormation of an acne lesion in the sebaceous follicle. Blockage of the duct by keratinised cells due to certain growth hormones stimulated by over production of insulin, followed by excess sebum production and bacterial multiplication. • increased number of bacteria in the follicle, and • inflammation caused by the follicle rupturing under the skin due to the build up of infection rich sebum. These events lead to the formation of non-inflamed comedones (commonly known as black heads and whiteheads) and inflamed papules, pustules and nodules (otherwise known as pimples). STUDENT ACTIVITIES 1. What is acne? Refer to Figure 1 and the text preceding it to complete the following sentences: • Hair follicle is blocked by . . . • Sebaceous glands produce increased sebum due to . . . • Bacteria within the hair follicle . . . • The follicle ruptures under the skin due to build up of infected sebum leading to the formation of . . . 2. Use a dictionary or the article to define each of the follow terms: sebaceous, sebum, keratin, androgens, comedones. Does chocolate or any one food cause acne? For many years people have blamed chocolate for causing pimples and a study performed in 1969 set out to test this widely held view (Fulton, Plewig et al 1969). Sixty-five acne sufferers ate either a chocolate bar or an identicalappearing (placebo) bar and had their acne assessed. The researchers found that chocolate had a similar effect on acne as a placebo bar. Therefore, they concluded that chocolate cannot be blamed for causing acne. However, other researchers, who later examined this work found that the sugar and fat contents of the placebo bar were virtually identical to that found in the chocolate (Mackie and Mackie 1974). This is a lesson important in all fields of scientific investigation. Make sure you have a clear understanding of the study control/placebo and its relevance. In this case it raises the important question: if the ingredients NUTRIdate is published and distributed by: Warringal Publications PO Box 336 Fitzroy VIC 3065 • Telephone (03) 9416 0200 • Facsimile (03) 9416 0402 GPO Box 4611 Sydney NSW 1043 • Telephone toll free 1800 334 641 • Facsimile toll free 1800 629 559 • Website www.edassist.com.au Subscription information: Full-rate subscription $60.00 per annum • ISSN 1320-9701 • Copyright 2007 of the two bars were similar, why would chocolate be expected to aggravate acne more than the comparison (the placebo) food? Despite its obvious flaws this study is frequently cited as evidence that diet plays no role in the development of acne. case of acne. Since acne is highly prevalent in western countries, the authors proposed that a western diet may be a contributing factor. The diets of the two acne-free societies consisted mainly of low glycemic index (GI) foods, such as tubers, vegetables, fruits and wild forms of maize and rice (which contain slowly digested and absorbed carbohydrates) as well as hunted game. In contrast, western teenagers typically eat a diet high in refined, high GI foods, such as white bread, rice, potatoes, soft drinks, sugar-rich foods and processed cereals and snacks, which cause a rapid rise in blood glucose level after consumption. The researchers proposed that the difference in the GI of foods may provide the link between diet and acne. STUDENT ACTIVITIES 3a.Describe the obvious flaw identified in the 1969 study to determine if chocolate caused pimples? b.What is the implication that can be drawn from this for future studies involving placebos? No one food has ever been found to be the single cause of a specific disease, such as, heart disease and diabetes, which are undeniably accepted as nutritionally-related disorders that are multifactorial and involve the whole diet. So why should we expect one food item to be responsible for acne? In the case of heart disease, we know that several aspects of nutrition contribute to heart health, eg. saturated fat, fibre, fish, antioxidants, etc. It is also more than likely that a complex interplay of dietary factors present in many foods contribute to acne. The question is what are those factors and what are the main foods that contribute these factors in the diet? Modern man has tipped the glycemic index scales In westernised societies, large scale food processing, such as (the refinement of flour, has been detrimental to the nutritional quality of food. When grain is refined into flour, dietary fibre, essential vitamins (particularly B vitamins) and minerals are removed and the starch present in the grain is made more accessible to intestinal enzymes for digestion. This process of refining grains impacts enormously on blood glucose level, in that the starch (made of glucose molecules) is readily available for absorption as minimal digestion is needed. A perfect example of this is white bread and even wholemeal bread. Similarly, root vegetables such as potatoes, and grains such as rice and wheat have been selectively bred over generations to be high in a certain type of starch that is rapidly digested by humans (amylopectin starch). All of these suspect foods have a common feature, that is a high glycemic index. The glycemic index (GI) is a system of classifying the blood glucose-raising potential of carbohydrates. On a scale of 0–100, foods are ranked according to their ability to raise blood glucose and the higher the number, the greater the blood glucose response. High GI foods (GI>70) are rapidly digested and produce high blood glucose responses. In contrast, low GI foods (GI<55) are more slowly digested and produce only a small rise in blood glucose. See information below measuring GI of foods. Differences in acne prevalence worldwide The reason that we began to suspect a diet acne connection was the observation that the prevalence of acne is much lower in rural, non-industrialised societies than in modernised western populations. Although ethnic/racial genetic differences may play a role in acne, we also observed that people of similar ethnic backgrounds exhibit different rates of acne when living different lifestyles. For example, acne prevalence in indigenous South American Indians is similar to that of people of European decent when consuming a western diet. But no acne is observed when these Indians consume their natural historical diet, lacking refined processed food staples. Thus genetic/racial difference can be ruled out as a main affect in acne prevalence (Cordain, Lindeberg et al. 2002). Further support for a role of diet in the development of acne can be found from observational reports of the Inuit (Eskimo) people of North America (Schaefer 1971, Bendiner 1974). Acne only emerged in the Inuit population after the adoption of a western lifestyle. Acne was nonexistent among Inuit teens in earlier times when they maintained their hunter-gatherer lifestyle. During this time their diet was based almost entirely (80–100 per cent) on meat and fish. However, when they adopted a western lifestyle and were exposed to a diet high in bread, cereals, confectionaries and soft drinks, acne became a common and sometimes severe problem. Although the exact reason for the development of acne is unclear, the Inuits blamed the change in their diet. Interestingly, along with acne came many other diseases already common in the West, such as dental caries, obesity, diabetes and heart disease. A more recent study suggested that presence of acne was related to the type of carbohydrate in the diet (Cordain, Lindeberg et al. 2002). Researchers observed more than 1,300 teenagers from two non-westernised societies (Kitavan islanders of Papua New Guinea and the Ache hunter-gatherers of Paraguay) and found not a single How is the GI of a food measured? To measure the GI of a food it must be done in at least 10 human subjects and the mean result reported. The subjects consume a drink containing exactly 50.0 gram of glucose powder and their blood glucose level is monitored every 15 minutes for two hours after this. Measurement is done using a glucose meter to test glucose level in a drop of blood from a prick on the subject’s finger. On another day the subjects eat a serving of the food to be tested, that also contains exactly 50.0 gram carbohydrate and the blood tests are repeated for two hours. These glucose levels are plotted on a graph as shown and the area under each graph calculated. The ‘area under the curve’ (AUC) for the food is divided by the AUC for glucose and multiplied by 100—this is termed the glycaemic index (GI). Glycaemic Index (GI) = AUC (test food) x 100 AUC (glucose) ~~ Young males with acne were split into two groups and prescribed a diet for three months. One group followed the typical western diet of highly processed foods, such as white bread, potatoes and snacks such as biscuits and chips and soft drinks. The other group mirrored the diets of non-westernised societies, including lots of fresh and natural foods. The group that ate the diet which mimicked the non-western diet was called the experimental group and the group that ate the comparison diet was called the control group. 1. Control group—this group was supplied with foods with moderate-high GI values, which was typical of their normal diet. 2. Experimental group—this group was provided with foods higher in protein (eg. lean meat, fish, eggs etc) and low GI carbohydrate type foods (e.g. whole grains, nuts, basmati rice, etc). The aim of the study was to compare the effects of the two diets on acne symptoms and hormones related to acne. All participants were supplied with the same facial wash/lotion (no other creams or medications were allowed) to ensure that diet was the only difference between the two groups. The participants attended RMIT University each month to have their acne measured by a dermatologist. At the beginning and end of the diet period, blood levels of hormones that play a role in acne were also measured. Figure 2: Blood sugar levels over a 2 hour period following consumption of either 50g pure glucose (red), or a test food containing 50g carbohydrate (orange). STUDENT ACTIVITIES 4. Name and describe the two case studies cited that link lifestyle with acne. 5. Make a list of the low GI foods and the high GI foods mentioned. 6. What does the study by Gordain, Lindberg et al 2002 propose about the link between diet and acne? 7. Refer to figure 2 and the text in the article to describe the difference between low GI and high GI foods and their relationship to blood glucose levels. Study results Blood sugar levels and insulin response Both groups showed improvements in their acne during the 12-week study. However, the reduction in acne was significantly greater in the experimental group. At 12weeks, there was a 51 per cent improvement in acne in the experimental group compared to a 31 per cent improvement in the control group (see Figure 3). The experimental group also reported improvements in their self esteem, their social life and their emotional wellbeing. The small improvement in the control group (a phenomena often observed called the placebo effect) has been put down to natural improvement with approaching summer, a tendency for some control subjects to improve their diet unintentionally and the common skin wash used being superior to their previous cleaning habits. Sugar glucose is the body’s basic energy source and is present in the blood, so it is readily available to all body tissues continuously. This glucose mainly comes from digestion of carbohydrate containing foods in the small intestine. Both starchy foods and sugary foods contain glucose. Once digested the glucose moves rapidly from the intestines into the blood. As the blood glucose level rises the pancreas produces a hormone called insulin whose job it is to make cells throughout the body absorb this glucose from the blood and use it for energy metabolism (or storage as fat) in the cells. If blood glucose levels are continuously and rapidly rising following the consumption of high GI foods, then large quantities of insulin are constantly being released into the blood. This over-production of insulin is believed to affect many other hormones and processes in the body, some of which are linked to acne. For example, high levels of insulin may cause androgens (the male hormones) to become more active in both males and females. Androgens are known regulators of sebum (skin oil) production. Insulin can also promote growth of keratin in skin cells, which can cause the follicles to become blocked. With a blocked duct the excess oily sebum cannot escape onto the skin surface as it should. It builds up in the duct and skin and bacteria multiply rapidly in the duct using the sebum as food. This is infection and leads to redness and swelling called inflammation. Figure 3: Percentage change in the number of acne lesions at each visit according to dietary group. The solid line represents the decrease in acne lesions in the experimental group and the dashed line represents the control group. Researching the diet and acne link Nutrition researchers from RMIT University and dermatologists from the Royal Melbourne Hospital recently investigated the link between diet and acne. ~~ Figures 4a–d: Photographs showing improvement in acne following the experimental diet. Photos 4a and 4c were taken before the diet and photos 4b and 4d were taken after 12 weeks of the diet. In each case some redness is still evident, as inflammation resolves slowly. However infectious lesions are gone and no new comedones have formed. a. b. c. d. In summary This research showed that eating a healthy, well-balanced diet with minimum amounts of processed foods helped improve acne symptoms and reduce the psychological impact of acne. The improvement in acne was also associated with changes in hormones, providing further support for the dietary connection. These results provide, for the first time, evidence that diet may play a role in acne. Hopefully, this study (and future studies like it) will provide a clearer understanding on a topic that has been surrounded by much controversy. An added bonus of this type of dietary approach to acne is that the diet itself has many other health benefits. It is an excellent way to control weight as appetite is partially suppressed, risk factors for heart disease including cholesterol are lowered, and potential for later diabetes are reduced, as fat is lost from the body and insulin sensitivity improves. In many ways this type of diet is similar to the now-proven weight loss diet developed by CSIRO scientists, ‘The Total WellBeing Diet’ and should not be confused with the many unscientific fad-type diets promoted in the media. Finally, this type of diet provides all necessary vitamins and minerals needed for good health at levels above those accepted as standard for teenagers in the Australian Nutrient Reference Values. STUDENT ACTIVITIES 8. How does blood glucose level effect insulin levels and, in turn, the effect of insulin on hormones linked to acne? 9. After reading about the RMIT study and other case studies mentioned in this article respond to the following: a. Describe the diet you would recommend to people wishing to reduce their incidence of acne. b. State the facts from the RMIT study on which you have based your recommendations. • acne lesions • insulin levels • self esteem • androgen • social life • keratin production 10.Describe the health benefits other than the reduced incidence of acne, that a diet high in low GI foods and low in high GI foods might deliver. Figure 5: Percentage change in hormones at 12-weeks according to dietary group. Fasting insulin and adrenal androgen DHEA-S and FAI, the measure of androgenic hormone activity have all significantly decreased in the experimental group. These changes are associated with decreased follicle blockage and less sebum production. 30 Percentage Change 25 20 15 10 5 0 -5 -10 Insulin Testosterone Experimental group (n = 23) Adrenal Androgen (DHEA-S) F u r t h e r activities Free Androgen Index 11.Investigate the GI index of some popular food products. Make a list of food products which you can commonly eat with a GI of 55 or less. These foods have low GIs and should be eaten more frequently than foods with a high GI. 12.Investigate the CSIRO ‘Total Well Being Diet’ and explain why it has delivered proven health benefits to its users. Control group (n = 20) With regards to the hormonal changes (see Figure 5), the experimental group showed a slight reduction in insulin levels, whereas the control group showed a significant increase in insulin levels. The diets also had an affect on androgen (male hormones) levels. The experimental group showed a reduction in levels of an androgen produced by the adrenal gland (DHEA-S), which is known to be active in sebum production. The free androgen index, a measure of androgen activity, also decreased in the experimental group, whereas the control group showed an increase. Growth factor activity also declined in the experimental group, lowering the potential for keratin production in the cells lining the duct, hence decreasing duct blockage. References Bendiner, E. (1974). ‘Disastrous trade-off: Eskimo health for white civilization.’ Hospital Practice 9: 156–189. Cordain, L., S. Lindeberg, et al. (2002). ‘Acne Vulgaris—A disease of Western civilization.’ Arch Dermatol 138: 1584–1590. Fulton, J., G. Plewig, et al. (1969). ‘Effect of Chocolate on Acne Vulgaris.’ JAMA 210(11): 2071–2074. Mackie, B. and L. Mackie (1974). ‘Chocolate and Acne.’ Aust J Dermatol 15: 103–109. Schaefer, O. (1971). ‘When the Eskimo comes to town.’ Nutrition Today 6: 8–16 ~~ Falling in Love With Food . . . Valuing the ‘Health’ Of Food, Families and Friendships by Aloysa Hourigan Senior Nutritionist, Nutrition Australia (Qld) Take a moment to think about eating your favourite food. Think of the aroma, the taste and texture, and what event or person you connect that food with . . . it could be icecream with friends, fresh bread when you pass the local bakery, the roast dinner your grandmother cooks or the family barbeque. Why do we eat? Is it only to keep our bodies physically healthy? Think about all the reasons why you eat food. It might be that we feel hungry but it could also be the sight, smell or remembered taste of a food that influences what we choose to eat. From early in childhood we are left with memories and experiences that relate to particular foods. As we move on through life those memories can still trigger certain emotions and feelings. When these feelings occur we seek out the food that we associate with that emotion. This can be part of what Dr. Rick Kausman, author of ‘If not dieting, then what?’, describes as ‘non-hungry eating’—and the good news is that there is no need to feel this type of eating is wrong. Instead, Dr. Kausman suggests it is a good practice to sometimes embrace the idea of eating our favourite foods, for reasons other than hunger. He suggests we choose just a small amount and eat it very slowly, appreciating all its wonderful taste, smell and texture and the memories that go with it. When we take our time with food our senses are more satisfied and the need for ‘more’ is less likely to be there. A suggestion from Dr. Kausman is to try this the next time you are looking for that ‘chocolate fix’—take just two small squares of chocolate, eat one at a time, and keep each square in your mouth for about a minute or two. Your senses will be satisfied and it is unlikely that you will need to reach for more. What happens when we eat? We smell and we taste, we share a meal with family and friends, we stop and relax, we respond to emotions and sometimes we celebrate a special event. Our senses, our need to communicate with family and friends and our emotions are all involved in the act of eating. When we eat on the run, grab convenience food and make all our food choices based on what is on the food label we might be setting ourselves up to break our social bond with the act of eating and to fall ‘out of love’ with food. Throughout history the connection between food and our happiness in life has gained a place in the writings of philosophers, scientists and other historical figures. A quote from the times of ancient Persia: ‘Pleasures may be divided into six classes, to wit, food, drink, clothes, sex, scent and sound. Of these the noblest and most consequential is food.’ (Muhammad IBN Al-Hasan Al-Katib Al-Baghadi). This quote reflects the importance and high value that was placed on food and the way it contributes to our enjoyment of life. Today, this connection is being overshadowed by the intense concern about the nutrient content of food and its relationship to physical health. Scientists and consumers alike continue to put all their energy into the search for the ultimate diet. The search is for a diet that offers ‘superfoods’ to boost our health and prevent ageing, quick fixes for problems of overweight, and restriction of the variety of fresh healthy foods we can eat. Most of this is based on very little scientific evidence and the food industry and the media pick up the ‘cure all’ and ‘quick-fix’ messages to sell less healthy processed foods and expensive food supplements. We are often throwing away the benefits that savouring food and preparing it and sharing it with others can bring. Nutrition Australia’s theme for 2007 is ‘Falling in Love with Food—value yourself and your health’. It offers a message about repairing the relationship between ourselves and our food. At a time when we eat food mostly for its suggested nutritional value, for the promise of a successful change in body shape, or because it might be a magical ‘cure all’ we might be forgetting about some of the other qualities of food. Sharing meals can contribute to helping our life and bodies to stay in balance. STUDENT ACTIVITIES 1. Make a list using the information from this article and add some thoughts of your own. a. Why do we eat food? b. When do we eat food? c. What influences the type of food we eat? Add to these lists as you work through the article. 2. Savouring favourite foods slowly is to be encouraged. Explain why. Even when we have been able to work out how to satisfy our senses with food, we still have to deal with the influence of our eating environment. What food is available, the time we have for eating and social factors such as who we will share the food with, can all affect our food choice. You might be able to think of times when your family and friends have celebrated special events like birthdays and anniversaries. There are often many food memories that go with these occasions. Other factors include the abundance of food, the attraction of ~~ immediate convenience foods, advertising messages, the cost of food and the memories we have about enjoying certain foods. From when we are babies, the relationship between food and the act of caring for those we love becomes established. Babies often seek to be fed for comfort rather than only hunger. Preparing food for families and friends can be a way of expressing our care and love for them. The pace of life today with respect to work, school and family commitments often means people are left with less time to do simple everyday things such as preparing a meal, shopping for food and sitting down together to eat. Advertising and the media encourage us to seek out the ‘quick’ and ‘instant’ things in life—and one of these is food. Another strong message is to ‘eat more’. Far less value is now placed on the benefits of preparing and cooking food at home. The skills of cooking are more at risk of being lost with parents now less likely to pass on these skills to their children. It is odd that while we are all worrying about overweight and obesity, we forget that we can have a say about how much and what we eat if we prepare food ourselves. Family mealtimes can have another useful role to play in establishing and maintaining communication in families. When we eat together we are more likely to communicate and enjoy a more ‘connected’ feeling. Some studies in the United States have identified that families who eat together at least 3–5 times per week are less likely to see their teenagers troubled by alcohol, drug abuse and depression. other things, been exploring this bond between food and families. The data has shown a strong association between families who watch television while eating the evening meal and the level of overweight in their children. Other findings from the data suggest a link between the amount of time mothers spend watching television with their children and their children’s snacking habits. More hours spent by the mother watching television seem to encourage more snacking in children. These findings highlight the importance of how we eat and the eating environment. Eating meals together has a greater positive impact on health when the television is turned off and families talk to each other. In another study in Colac, Victoria, researchers showed a relationship between excessive snacking, television viewing time and the number of televisions in the house. Making eating an event of its own, where we are conscious of the taste of food and when we take time with its preparation can influence how much we eat and our satisfaction with the meal. Much previous research has indicated that taking longer over meals (at least 15 to 20 minutes) and not having other distractions such as television, while eating, allows us to feel more satisfied at the end of a meal. This can help us not to overeat. What all the above information suggests is that there is value in taking time to prepare meals from fresh ingredients and in sharing these meals with friends and family. The value is not just for our physical health but can also benefit our emotional and mental health. The World Health Organization (WHO) defines health to include emotional, social and mental health along with our physical wellbeing. So the next time you eat, aim to look after your total health, not just the physical aspects. Let yourself enjoy the taste and texture of the food, and let yourself benefit from the act of preparing and sharing food with your families and friends. Allow yourself to be ‘Falling in Love with Food’—and value yourself and your health. STUDENT ACTIVITIES 3. What is the value to health and wellbeing of taking time to prepare and have meals with the family? 4. What is the link between watching television and: a. incidence of overweight in children? b. snacking habits of children? 5. Explain why the age-old rituals of preparing and sharing meals together are under threat today. 6. Develop a set of ‘golden rules’ or ‘guiding principles’ for today’s society to ensure that the 2007 theme for Nutrition Australia, ‘Falling in Love with Food—value yourself and your health’ can be achieved. Even if teenage children do not exchange many deep inner thoughts with their parents over the evening meal, the preparation and sharing of that meal gives parents an opportunity to express some level of care and support to their child. Providing food is an act of nurturing and caring. The mealtime gives both parents and children the opportunity to at least observe each other’s mood, whether you are happy or distressed. Family discussions over meals, even if heated at times, provide an opportunity for children to give their opinions. Adolescence is a time when it is important for young people to be more responsible for themselves and express their thoughts and feelings as individuals, even if at times their views might be different from of their parents. The Nepean Longitudinal Study of Young People at the Children’s Hospital, Westmead (NSW) has, among References Fletcher, N., ‘Charlemagne’s Tablecloth’, Weidenfeld & Nicolson. 2004. Garnett, S., ‘Findings of The Nepean Longitudinal Study of Young People’ Paper presented at the Nutrition Australia AGM, 2005, Canberra. Proceedings of the National Dietitians’ Association of Australia Conference, 2006 Kausman, R., ‘If not dieting, then what?’, Allen & Unwin. 1998. ~~ Media Watch by Dorothy Carey meals, not just one token meal. Peter Bush said the chain had made changes over the past few years to try to offer healthier options, including the introduction of salads and recently starting to use oil that is virtually free of trans fats. $330,000 Buys Maccas The Tick Of Approval The cynics might call it nothing more than a public relations exercise, but the fast-food giant that has repeatedly been chided for contributing to the obesity epidemic now says it wants to be part of the solution. It has also reduced the sugar in its buns by 50 per cent, participated in obesity summits around the country and introduced nutrition labeling. That, says McDonald’s, is the rationale behind coming up with nine meals that have, for the first time, been given the tick by the National Heart Foundation. ‘Our mantra has been that we want to be part of the solution to the obesity problem.’ Mr Bush said. ‘This is really a consistent part of the journey that we’ve been on.’ The meals include salads, McNuggets, even a burger or two. But no, you can’t get fries with that. Deakin University professor in population health, Boyd Swinburn, a former medical director of the Heart Foundation in New Zealand, said the situation was a ‘clear win-win’. VicHealth chief executive Rob Moodie questioned whether the program was a marketing ploy that would help McDonald’s sell more Big Macs by simply getting more people through the golden arches. If that were the case, he said, the Heart Foundation should feel ‘duped’. ‘It potentially has significant public health interests and it potentially has commercial interests,’ he said. ‘McDonald’s has come under a fairly intense amount of fire around childhood obesity . . . but it sees a commercial opportunity in trying to have healthier options, it sees that that will help its bottom line. Beyond the PR, this has much more substance to it than a lot of other things they have announced.’ ‘If, on the other hand, this actually led to changing of consumption patterns, then hooray!’ he said. ‘If there’s any sense that they’re going to simply sell more junk food on the basis of improving their market-ability and reputation and using it as a smokescreen, then I would be very concerned.’ Carol Nader—The Age, 6 February 2007. The meals will be available from February 28 in 747 McDonald’s restaurants across Australia. STUDENT ACTIVITIES 1. Read The article. Make a list of all the positive points raised to support McDonald’s getting the Heart Foundation’s tick of approval. Beside each point made, see if you can provide a counter argument. 2. How much does McDonald’s pay to the Heart Foundation for the right to use the tick of approval? 3. Explain what costs are involved for McDonald’s and for the Heart Foundation. 4. What changes have McDonald’s made over the past few years to offer more healthy food choices? The fast-food chain has had to make significant changes to its recipes and is paying $330,000 a year to earn the Heart Foundation’s tick of approval. The foundation, a not-for-profit organisation, says the money goes towards the cost of testing the meals to make sure they meet standards and auditing the restaurants. The national manager of the Heart Foundation’s tick program, Susan Anderson, said it was a world first for McDonald’s to change its recipes to meet tough nutrition standards. She said the meals would keep the tick only if the new food combinations were not changed. For instance, salads had to be included in most meals to meet the required vegetable intake. Going further 5. Carry out an inquiry activity in your class or school to see how acceptable the approved McDonald’s meals are for students. Which of the meal choices would students select. What percentage of students would still choose the standard meal with fries? 6. For discussion. Should fast food companies be required to meet nutritional standards? 7. Given the increasing health problems associated with overweight and obesity in childhood, suggest other initiatives that could be implemented in fast food restaurants to improve the nutritive value of the foods. 8. There have been a lot of articles in the media about fast food restaurants changing to trans fats for cooking. Find out why the change will be a healthier option for consumers. ‘The key thing here is we know that 2.7 million meals are sold at fast-food restaurants every day. It’s been right on our radar to make sure that we’re trying to improve the meal offerings in these outlets,’ she said. Ms Anderson said the Heart Foundation wanted McDonald’s to offer lots of options for healthier ~~ Media Watch by Dorothy Carey Are Vitamin Pills Really As Healthy As The Claims? The arguments against using supplements such as vitamins, minerals and anti-oxidants used to go something like this: they were unnecessary, they preyed upon people’s fear of getting sick and, at the end of the day, they amounted to little more than expensive urine. Most skeptics saw them as innocuous enough because people were not doing themselves any harm, other than lightening their wallet. However, concerns that some supplements may be dangerous were fuelled last week when Danish researchers warned that too much of vitamins A and E and beta-carotene could increase the risk of death, possibly by interfering with the body’s essential defensive mechanisms. ‘There are a lot of concerns now with these supplements about what we consider is safe. We assume that because vitamins and minerals are found in food, they must always be safe—but that may not be the case,’ he said. But the alternative medicine industry believes the findings from the Danish study are alarmist and based on high doses not marketed in Australia. One of the biggest manufacturers of vitamins, Blackmores, said people who took anti-oxidants should dismiss the flawed research. The Australian Self-Medication Industry labeled the findings dubious and based on products that were controlled by US regulators who had different rules to the Therapeutic Goods Administration. Cathy O’Leary—The West Australian, 6 March 2007. STUDENT ACTIVITIES 1. List the ‘old’ arguments that are stated in the article against using dietary supplements. 2. Give reasons why these old arguments are being challenged. It raised an emerging theory that far from helping rid the body of dangerous free radicals, anti-oxidant supplements may be unwanted interlopers. It is not the first time researchers have suggested that natural remedies—like prescription drugs—can have side-effects. Last year, an elderly man died from acute selenium poisoning after reading on the internet it could treat his prostate cancer. Other studies have also identified risks, including high doses of vitamin A supplements increasing a pregnant women’s chances of having a baby with a birth defect, and large doses of vitamin C tablets increasing the risk of developing kidney stones. The Australian Medical Association WA’s vicepresident Richard Choong said most people have a reasonable diet and did not need vitamin supplements. 3. Explain the ‘new’ information relating to the action of antioxidants. 4. Is it reasonable to assume that because minerals and vitamins are found in food, they must always be safe? Justify your response. 5. What is the response to this research from the alternative medicine industry? Going further 6 a. What are the functions of vitamins A, E and betacarotene in the body? Use texts to assist you with this. b. Explain the relationship between beta-carotene and vitamin A. c. List the foods with the highest concentrations of each of these vitamins. d. Use tables of nutrient composition of foods to identify the best sources of these vitamins in your diet. 7. Discuss reasons why the manufacturers of dietary supplements may not want to accept the results of the Danish study. General Editor: Dorothy Carey, Nutrition Consultant and Writer Student activities prepared by: Peter Wright, Assistant Principal, Koonung Secondary College Editorial Board: Dorothy Carey, Colin Hobbs