Understanding Your Food and Biotechnology (Part 3)

Posted on November 13, 2015 by gutsandgrowth

This is the last of my blog posts on the topic of biotechnology and foods from Ronald Kleinman’s lecture: Biotechnology, Nutrition, and Agriculture: A Perspective and Implications for Child Health. The posts over the past 4 days describe in detail why the hysteria over genetically modified foods/genetically modified organisms (GMOs) is detrimental. Unfortunately, the lack of understanding has led to widespread adoption of “GMO-free” labeling by food manufacturers which perpetuates the misplaced idea that these foods may not be safe. The slides and lecture will be available at the Nutrition4Kids website.

This mother’s blog: “I don’t feed them organic food and I’m not a bad Mom.” It is a sad commentary that someone needs to write this.

Humans, unlike plants, do not have the enzyme that Roundup (glyposate) targets –so it is safe. By targeting this enzyme, genetic engineering can allow the crop to be herbicide resistant, making it fairly easy to kill off weeds without hurting crop. With biotechnology, we can kill weeds without killing plants. Thus, no till farming is needed. Current herbicides are much safer than prior agents. Roundup (glyphosate) is water-soluble; it is not stored in fat. There is a 30 yr hx/o safe use. There is no data indicating cancer risk in humans or fertility risk.

In the past, testing breastmilk for roundup used a flawed methodology. F/u study by McGuire M (sponsored by US govt) showed no Roundup (glyphosate) in breastmilk.

Drought-resistant crops are becoming increasingly important. Meeting global food production will require more ‘crop per drop’ due to increasing population and less lands available for farming. Not just 3rd World –look at California. There are low crop yields in areas without biotech (Subsaharan Africa) and higher mortality.

Key points:

Genetically Modified Foods/Genetically modified organisms (GMO). These foods are safer and better than foods that are not genetically modified.
Roundup is not dangerous for humans.
Attacks on GMOs are part of a larger “War on Science.” As with vaccinations, there is a great deal of misleading and exaggerated information.
Biotechnology can help solve food crisis, improve the lives of small farmers, and reduce malnutrition. Genetically modified food reduces the needs for chemicals and can improve health.

Understanding Your Food and Biotechnology (Part 2)

Posted on November 12, 2015 by gutsandgrowth

This blog continues on the issue of genetic engineering and how it affects your food. The information was presented in a lecture by Ronald Kleinman (see the posts from the last two days): Biotechnology, Nutrition, and Agriculture: A Perspective and Implications for Child Health. The slides and lecture will be posted on Nutrition4Kids website.

Biotechnology/genetic engineering is more precise in selecting desirable crop traits

Why Newer Techniques (Genetic Engineering) Are Safer: Fewer Genes Affected Than Traditional Breeding and Mutagenesis along with Required Safety Testing

In the slide above, the first column shows traditional breeding of crops and how this can introduce thousands of changes into the crop. The second column illustrates the use of chemicals and radiation (mutagenesis) to change crops; this type of crop engineering preceded genetic engineering and has not required the rigorous testing of the final two columns which depict modern biotechnology with either RNA interference of transgenetics. Both of the later two methods are precise and undergo ~6-10 years of testing before introduction.

The above slide is one example of the safety of genetically modified tomatoes.

BT Corn (insect resistant) is Safer with Less Liver Cancer and Fewer Birth Defects

Key points:

Genetic change in foods is as old as agriculture. Lots of vegetables/crops were not found in nature, including corn and wheat.
Why is it false to talk about genetic modification as a special category? It’s all DNA which is undergoing constant change. Traditional breeding allows selection of random multiple genes and then selecting plant we like. Biotechnology is more precise and safer (eg. only the gene for sweetness for corn is transferred).
240 Agencies from across the globe have confirmed that biotechnology is safe because of the extensive testing that show these agents are at least as safe as ‘natural’ products. 2500 studies of GMO products from across the globe (not just Monsanto!) have proven the safety of these products.
Other examples of beneficial biotechnology: a) BT Corn — safer, less liver cancer, less birth defects (myelomeningocele) b) Golden Rice –can solve iron & vitamin A deficiency. Vitamin A deficiency contributes >1 million deaths/yr due to increased susceptibility to infections. Golden Rice in normal quantities provides RDA of Vit A. This is a lot more effective and less expensive than a supplement.

More tomorrow…

Understanding Your Food and Biotechnology (Part 1)

Posted on November 11, 2015 by gutsandgrowth

Yesterday’s blog post summarized a recent talk by Ronald Kleinman, MD: Biotechnology, Nutrition, and Agriculture: A Perspective and Implications for Child Health. Given the prevalence of misinformation on this topic, I am spending the next few days elaborating on this lecture. The full lecture (video and slides) will be available on the Nutrition4Kids website.

Genetic Engineering Has Allowed Development of Vaccines

Biotechnology in Our Foods is Ubiquitous

Biotechnology Has Reduced Mortality Dramatically

Genetic Change in Crops is as Old as Agriculture. There would not be corn as we know it without crop breeding.

Key points:

Genetic engineering has not only improved our food supply but has been essential in innovations like vaccines and insulin.
Biotechnology is ubiquitous. It’s not just crops, but cheese, wine, etc. Biotechnology has led 16,000 fewer children dying each day compared to 1995; this is largely due to biotechnology. Improved food security and less malnutrition results in fewer secondary complications (eg pneumonia, diarrhea).
Genetic change in foods is as old as agriculture. Lots of vegetables/crops were not found in nature, including corn and wheat. Cross-breeding allowed development of modern corn and wheat.

More tomorrow…

War on Science and Genetically-Modified Food

Posted on November 10, 2015 by gutsandgrowth

In the battlefield of ideas, science is losing badly. The problem with science is that many concepts are complex and sometimes difficult to communicate. For anyone interested in the science of food, and not the hysteria, a great lecture on this topic was presented by Ronald Kleinman, MD: Biotechnology, Nutrition, and Agriculture: A Perspective and Implications for Child Health

Stanley Cohen, Jeff Lewis, Evelyn Johnson (Georgia AAP President), Ronald Kleinman, and Jay Hochman at the Georgia AAP Nutrition Symposium.

I had the opportunity to participate and moderate a nutrition symposium at the Georgia American Academy of Pediatrics (AAP) pediatric meeting. This symposium was sponsored by Nutrition4Kids and funded by an educational grant from Nutricia. The first lecture was given by Dr. Kleinman. He is Chief of the Department of Pediatrics at Massachusetts General Hospital and Physician-in-Chief at MassGeneral Hospital for Children (MGHfC) and Partners Pediatrics. This was a fabulous talk and will be available at the Nutrition4Kids website. This blog post is a summary of the talk. Over the next few days, a couple of these ideas will be discussed further. Key points:

Genetically Modified Foods/Genetically modified organisms (GMO). These foods are safer and better than foods that are not genetically modified.
Roundup is not dangerous for humans. With biotechnology, we can kill weeds without killing plants. Thus no till farming is needed. Current herbicides are much safer than prior agents. Humans, unlike plants, do not have the enzyme that roundup targets –so it is safe. Roundup is water-soluble; it is not stored in fat. There is a 30 yr hx/o safe use. There is no data indicating cancer risk in humans or fertility risk. In the past, testing breastmilk for roundup used a flawed methodology. F/u study by McGuire M (sponsored by US govt) showed no roundup in breastmilk.
GMOs are part of a larger “War on Science.” As with vaccinations, there is a great deal of misleading and exaggerated information.
Genetic engineering has not only improved our food supply but has been essential in innovations like vaccines and insulin.
Biotechnology is ubiquitous. It’s not just crops, but cheese, wine, etc. Biotechnology has led 16,000 fewer children dying each day compared to 1990; this is largely due to biotechnology. Improved food security and less malnutrition results in fewer secondary complications (eg pneumonia, diarrhea).
Genetic change in foods is as old as agriculture. Lots of vegetables/crops were not found in nature, including corn and wheat. Cross-breeding allowed development of modern corn and wheat.
Why is it false to talk about genetic modification as a special category? It’s all DNA which is undergoing constant change. Traditional breeding allows selection of random multiple genes and then selecting plant we like. Biotechnology is more precise and safer (eg. only the gene for sweetness for corn is transferred, so can be more safe).
240 Agencies have confirmed that biotechnology is safe because of the testing that shows these agents are at least as safe as ‘natural’ products. 2500 studies of GMO products from across the globe (not just Monsanto!) have proven the safety of these products.
Most of GMO-farming occurs with small farmers (90% in developing world) who are not rich; these products result in income gains of greater than 30%.
Why is there such widespread adoption of GMO products by farmers? They are better: insect resistance, herbicide resistance, viral resistance, and drought/salt resistance
Other examples of beneficial biotechnology: a) BT Corn — safer, less liver cancer, less birth defects (eg. myelomeningocele) b) Golden Rice –can solve iron & vitamin A deficiency. Vitamin A deficiency contributes >1 million deaths/yr due to increased susceptibility to infections. Golden Rice in normal quantities provides RDA of Vit A. This is a lot more effective and less expensive than a supplement. These products are not commercially available even though nonprofits willing to give seeds for free –due to hysteria, politics. Greenpeace has actually burned Golden Rice rice fields.
Drought-resistant crops are becoming increasingly important. Meeting global food production will require more ‘crop per drop’ due to increasing population and less lands available for farming. Not just 3^rd World –look at California. There are low crop yields in areas without biotech (Subsaharan Africa) and higher mortality.

Unfortunately, shortly after hearing this lecture explain in great detail why GMO-containing products should be praised and not shunned, I picked up a drink. Here’s the label:

Bottomline: The science is sound. Biotechnology and GMOs/genetically modified foods are making are food better, safer and reducing mortality. If only we could communicate this fact effectively.

Related blog posts:

Hyperoxaluria due to Excessive Almond Milk

Posted on November 9, 2015 by gutsandgrowth

A recent report (Ellis D, Lieb J. J Pediatr 2015; 167:1155-8) highlights the high content of oxalate in almond milk products which led to hyperoxaluria and hematuria in three children.

Key points:

“A tendency to low fluid intake and a hereditary predisposition to calcium-based nephrolithiasis may have been contributing factors.”
“Mammals lack oxalic decarboxylase and other enzymes that can degrade oxalic acid…oxalate homeostasis depends on” ..1) dietary intake, 2) endogenous synthesis of oxalate, 3) GI flora degradation and limiting of absorption, and 4) renal processing/excretion of oxalate

My take: In patients with oxalate kidney stones or microscopic hematuria, limiting almond milk and increasing fluid intake would be beneficial.

Gabi

Changing Narrative on Affordability of HCV Treatments

Posted on November 8, 2015 by gutsandgrowth

A recent commentary (J Chhatwal et al. Clin Gastroenterol 2015; 13: 1711-13) makes the point that HCV treatment is looking a lot better lately with regard to cost.

Key points:

“Sofosbuvir-based treatment in 2015, on average, costs 54% of the wholesale acquisition cost”
When considering the recent discounts, “the cost of treatment decreased to $56,000…and the cost per SVR decreased to $58,000.” The cost of an SVR with the first generation protease inhibitors, boceprevir and teleprevir, has been estimated to have been $213,000.
“The discounted cost of treating 1 person with HIV in the United States is $315,000 in 2014 US dollars.” Thus, curing HCV which is more deadly, at 18% of the cost, looks more favorable.
More discounts and more competition are expected.

Bottomline: Based on these cost considerations, the authors state that HCV treatment should be used broadly and not solely in those with advanced fibrosis.

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Down Syndrome -Updated Growth Curves

Posted on November 7, 2015 by gutsandgrowth

Full link to Pediatrics article (www.pediatrics.org/cgi/doi/10.1542/peds.2015-1652 DOI: 10.1542/peds.2015-1652): Growth Charts for Children with Down Syndrome in U.S. (Reference from Kipp Ellsworth)

Excerpt:

New DSGS growth charts were developed by using 1520 measurements on
637 participants. DSGS growth charts for children ,36 months of age showed marked improvements in weight compared with older US charts. DSGS charts for 2- to 20-year-olds showed that contemporary males are taller than previous charts showed. Generally, the DSGS growth charts are similar to the UK charts.

Fecal Diversion for Perianal Crohn’s Disease

Posted on November 6, 2015 by gutsandgrowth

A recent study (S Singh et al. Alimentary Pharmacology & Therapeutics; 2015: 42: 783-92; article first published online: 11 AUG 2015. DOI: 10.1111/apt.13356) gives more specific data regarded the outcomes of fecal diversion for perianal Crohn’s disease. While diversion can be helpful, the meta-analysis indicates that only one-sixth of patients were able to achieve successful bowel continuity/reconnection. The authors did not note a significant improvement in successful bowel continuity restoration in the era of biologics compared with prebiologic era (17.6% vs13.7%).

An excerpt of a summary of this study from Gastroenterology & Hepatology (September 2015)

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Stranger than fiction?

Is Autoimmunity Associated with Nonceliac Wheat Sensitivity?

Posted on November 5, 2015 by gutsandgrowth

According to a recent study (A Carroccio, et al. Gastroenterol 2015; 149: 596-603), patients with nonceliac wheat sensitivity (NCWS) (aka. nonceliac gluten sensitivity or wheat intolerance syndrome) are more prone to developing autoimmune disorders compared with patients with irritable bowel syndrome.

Given the difficulty identifying NCWS, the findings must be viewed cautiously; in addition, much of this study was a retrospective study.

Background: The authors identified 131 patients diagnosed with NCWS (121 female) with a mean age of 29 years. They compared these individuals to control groups of patients with either celiac disease (CD) or irritable bowel syndrome (IBS). In addition to the retrospective study, the authors prospectively examined 42 patients diagnosed with NCWS (2011-2014). These diagnoses were established by double-blind placebo-controlled wheat challenge.

Key findings:

In the retrospective analysis, 29% of NCWS patients and 29% of CD developed autoimmune diseases (mainly Hashimoto’s thyroiditis, 29 cases) compared with a smaller proportion of subjects with IBS (4%) (P<.001).
In the retrospective analysis, 46% of NCWS, 24% of CD and 2% of IBS developed ANA antibodies (median titer 1:80).
In the prospective arm, 24% of NCWS, 20% of CD, and 2% of IBS subjects developed autoimmune disease.
Similarly, in the prospective arm, 28% of NCWS, 7.5% of CD and 6% of U+IBS developed ANA antibodies (median titer 1:80).
ANA positivity was associated with the presence of HLA DQ2/DQ8 haplotypes (P<.001). ANA positivity, to a lesser extent, was associated with the presence of duodenal lymphocytosis (grade A histology).

The authors note that “these associations strongly suggest a celiac condition, but it must be emphasized that all the patients we included were negative for CD-specific antibodies and showed normal intestinal villi” with a gluten challenge.

Potential limitations included a selection bias of patients referred to this tertiary center.

My take: This study suggests significant overlap between CD and NCWS. The real frequency of autoimmunity in NCWS is unclear as this study population is not likely representative of most patients who go gluten-free.

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“Men Sometimes See Exactly What They Wish To See” and Gluten Sensitivity

Posted on November 4, 2015 by gutsandgrowth

For me, a recent study (AD Sabatino et al. Clin Gastroenterol Hepatol 2015; 13: 1604-12, editorial 1613-15) was particularly interesting. While it had “positive results,” these findings were based almost entirely on the results of three patients.

In brief, this study examined 61 adults (w/o celiac disease) who believed that gluten induced intestinal and extraintestinal symptoms. These individuals were randomized to receive either 4.375 g/day of gluten or rice starch via capsules. This amount of gluten is equivalent to 1 sandwich or 2 slices of bread.

Findings:

Overall, intake of gluten significantly increased symptoms compared to placebo (P=.034), including bloating, pain, foggy mind, depression, and aphthous stomatitis.
Looking at a scatterplot (Figure 4), it is abundantly clear that all of these findings are driven by 3 patients.
“In the vast majority of patients the clinical weight of gluten-dependent symptoms was irrelevant in light of the comparable degree of symptoms experienced with placebo”
“Our study did not provide any progress in identifying possible biomarkers of NCGS [non-celiac gluten sensitivity]”

This type of study, with mixed conclusions, led the editorialists to quote Spock (from Star Trek):

“In critical moments, men sometimes see exactly what they wish to see.”

Then, the editorial provides a historical context of NCGS with a review of the relevant prior studies. Other comments:

“These findings can be a Rorschach test of sorts, in which the viewer draws interpretations that are based on his or her prior beliefs about NCGS.”
The authors note that both the gluten and the control arm likely had a significant nocebo effect (negative placebo effect),
“This trial, like its predecessors, seems only to contribute to the uncertainty about NCGS.”

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