Fine-Tuning the Front End

Grocery shopping. Love it or hate it, one aspect of shopping that few people relish is waiting in line to pay. But change could be coming to the checkout experience, making stores' "front end" more enjoyable for shoppers and profitable for retailers — and a prime opportunity to promote good nutrition.

According to industry experts, several factors converge at the front end that cause consumers distress: After browsing the aisles and selecting their items, shoppers head to the checkout area to unload groceries onto a conveyer belt and part with their money — stressful tasks for some shoppers. A long line can foster feelings of boredom and frustration.

"Checkout is the most dreaded part of the shopping trip, and waiting simply exacerbates the problem," says Steve Zoellner, director of Shopper Merchandising Solutions at Mondelēz International. When there's a wait, shoppers go into "coping mode," often choosing to distract themselves with their mobile phones, for example.

Adding to shoppers' already negative feelings are cluttered displays of product selections they don't need or that aren't complementary. (Have you ever wondered why the lint rollers are hanging between the pantyhose and flashlight keychains?)

The checkout area is the retailer's last chance to make one more sale, so it's to their advantage for the front end to be inviting and encourage "impulse purchases." But only 18 percent of shoppers purchase an item from the checkout area, according to the 2014 Front-End Focus research study. Rather, 84 percent of consumers say looking at products at the checkout counter just gives them something to do while waiting in line, and 66 percent believe items at checkout are unnecessary purchases.

With the right product selection, the checkout area could be a significant source of impulse purchases — perhaps as a little treat for completing a shopping trip. Beverages, confectionery (such as candy, gum and mints) and magazines are considered "power categories" because they generate more than 90 percent of impulse sales at checkout.

They may be small-ticket items, but increasing checkout purchases by just 1 percent could boost a store's average front-end sales by nearly $300 per week, or about $15,350 annually. This sales lift is no small increase in an industry with razor-thin profit margins: In 2013, the average net profit for supermarkets was just 1.3 percent, according to the Food Marketing Institute.

Understanding that power categories dominate at checkout, some supermarkets are devoting lanes to health-focused items. An example is Hy-Vee, which operates more than 230 retail stores in the Midwest. Most stores feature at least one "Healthy Bites" checkout lane with a wide selection of "better-for-you" impulse items.

The Sycamore, Ill., location has two Healthy Bites lanes, says Hy-Vee dietitian Lisa Brandt, RDN, LDN. The lanes are stocked with fresh apples and bananas, fruit-and-nut bars, small packages of nuts and trail mix, fruit leather and "all-natural" peanut butter, and single-serving bags of multigrain chips, popcorn and crackers. Healthy Bites coolers are stocked with plain, sparkling and coconut waters, unsweetened teas and 100-percent fruit juice boxes.

"Moms especially like giving their kids a treat they can feel good about," says Brandt, adding that Hy-Vee shoppers appreciate the convenience and wholesomeness of Healthy Bites offerings.

Earlier this year, Elisabeth D'Alto, RD, LDN, a dietitian with East Coast retailer ShopRite, began pilot-testing more nutritious offerings at two checkout lanes at her store in Lutherville-Timonium, Md. The lanes are stocked with fresh fruit, nuts, bars, baked chips and popcorn, plus an endcap cooler with plain bottled water. More offbeat offerings include dry-roasted edamame with goji berries, single-serving packages of water-packed tuna with crackers, and dark chocolate-covered berries. D'Alto makes sure the lanes feature gluten-free, dairy-free, reduced-sodium and reduced-sugar selections, as well.

The pilot test came about after talking with shoppers and store associates during tours and nutrition consultations. "I see a lot of seniors, millennials and moms with kids who need or want to get healthier," D'Alto says. "I wanted to see how we might generate buzz around checkout with these offerings." She is encouraged by positive feedback, and if the lanes become permanent, D'Alto hopes to add non-food items such as exercise bands, water bottles and containers for packing nutritious lunches.

Meanwhile, innovations and new offerings may make checking out the most fun part of a shopping trip. Research that observes shopper behavior suggests several tactics to enhance the experience:

• Look for opportunities to go high-tech, such as engaging shoppers through touchscreens to interact with product-related content.
• Remove extra displays that block shoppers' movements and clutter their views of prime impulse products.
• Create a cohesive experience with harmonious signs and product assortments.

"We need to improve the traffic flow and make it easier for shoppers to navigate the checkout area," says Zoellner. "The front end can be a unique and inviting shopping destination."

Is Gluten-Sensitivity Real? New Research Causes New Thinking

Gluten-free diets have become one of the hottest approaches to a long list of health ailments and weight loss. An ongoing debate asks whether gluten sensitivity truly exists or if it is a media-driven fad, pandering to hypochondriacs and dieters, and boosting sales of gluten-free products.

The answers may not be so clear-cut. Historically, gluten was thought to pose problems only for the 1 percent to 2 percent of the population who suffer from autoimmune celiac disease, for which the cornerstone of treatment is a strict gluten-free diet. But emerging research suggests there is a spectrum of non-celiac gluten-related disorders that improve when gluten is removed from the diet.

"Celiac-Lite"
For years, gastroenterologists and researchers have been trying to understand the role of gluten in non-celiac conditions. In 2012, celiac researchers coined the term "non-celiac gluten sensitivity," or NCGS, for individuals who present with symptoms similar to celiac disease and say they feel better on a gluten-free diet. "Roughly 6 percent of the population suffers from NCGS, which pre NCGS, which presents as a trigger to gluten with a possible presence of gluten immune-reaction," says Alessio Fassano, MD, director of the Center for Celiac Research at MassGeneral Hospital for Children in Boston.

Sometimes referred to as "celiac-lite," NCGS is a form of gluten intolerance that does not meet diagnostic criteria for celiac disease or other related conditions, such as wheat allergy, and does not cause inflammation or damage to the small intestine. NCGS is a rapidly growing diagnosis, despite not having an established definition and being a controversial topic that is not well-understood.

"Gluten sensitivity is an understudied area that appears to be a gluten-induced activation of an innate, rather than adaptive, immune-mediated reaction to gluten that does not always occur in the same way when eating gluten," Fassano says.

Variability among patients, the lack of definitive biomarkers and inconclusive studies have hindered progress in identifying NCGS. However, a few studies have offered some insight into the condition. A small Australian study published in 2011 was among the first to show gluten could induce symptoms in non-celiac patients. A well-conducted study using a double-blind, placebo-controlled design found NCGS exists in specific clinical conditions, including 5 percent to 20 percent due to irritable bowel syndrome.

Researchers at the National Institutes of Health recently published a study corroborating these findings. The study population consisted of a group of 59 participants who believed they suffered from NCGS. They were given less than 5 grams of gluten or a placebo in pill form for one week. Participants taking the gluten pills reported a significant difference in symptoms compared to those taking placebo pills after just one week.

However, research published in 2013 suggests that gluten alone may not be responsible for the symptoms. The same Australian researchers conducted a follow-up study that challenged the findings of their earlier study. Only 8 percent of the participants improved on gluten-free diets, yet all of the participants had significant improvements on a low fermentable oligosaccharides, disaccharides, monosaccharides and polyols, or FODMAP, diet. These results indicate the possibility that the positive effect was due to removing FODMAPs — not gluten.

Detecting Gluten Sensitivity
Sensitivity to gluten appears to occur at any age and to people who have previously tolerated gluten. "Gluten triggers a biological response in everyone, yet not everyone gets sick when eating gluten," Fassano says. Without biomarkers to confirm NCGS, it is considered a diagnosis of exclusion. The only way to identify NCGS is to rule out other related conditions and demonstrate both improvement when gluten is removed and recurrence of symptoms when gluten is reintroduced.

Celiac disease is a serious condition that must be ruled out first, after which other potential causes within the spectrum of gluten-related disorders should be considered. A diagnosis of NCGS can only be made when celiac disease and other related conditions are adequately excluded. Testing for celiac disease requires a celiac blood test and biopsy samples from multiple areas of the intestine, including the duodenal bulb. Consumption of gluten is essential for accurate results. Going on a gluten-free diet beforehand can mask the results of the tests and result in an inaccurate diagnosis, which many experts suspect is why celiac disease is dramatically underdiagnosed.

NCGS is a condition typically characterized by gastrointestinal symptoms (diarrhea, abdominal discomfort, pain, bloating and flatulence) or extraintestinal symptoms (fatigue, headache, brain fog and lethargy) that occur after gluten ingestion and improve after gluten is removed from the diet. Undigested gluten can act like a foreign invader, irritating the gut and the microvilli within the intestine, leading to decreased absorption of nutrients.

“Celiac disease can be a challenge to diagnose, with up to 50 percent of people presenting without any gastroenterology symptoms,” says Shelley Case, RD, author of Gluten-Free Diet: A Comprehensive Resource Guide (9th edition due in fall 2015, self-published). Many patients present with anemia due to reduced iron absorption.”

Non-Celiac Gluten-Related Disorders
Only a fraction of the patients who report NCGS have a gluten-related condition. When it is not celiac disease or NCGS, experts consider FODMAP intolerance. Fermentable sugars may be poorly digested in some people, causing discomfort, gas and bloating — symptoms similar to those of NCGS and other gastrointestinal conditions. Food intolerance occurs either when the body lacks a particular enzyme needed to digest nutrients, nutrients are too abundant to be completely digested or a particular nutrient cannot be properly digested.

Following a low-FODMAP diet can be more challenging than a gluten-free diet and requires the guidance of a registered dietitian nutritionist. The elimination diet limits fructose (fruits and vegetables), lactose (dairy), fructans (wheat, rye barley, onions, garlic and leeks, for example), galactans (some legumes, broccoli and cabbage) and polyols (types of sugars). Most people with a FODMAP intolerance are able to identify which foods are problematic and gradually add back the ones that are well-tolerated.

Since fructans include the gluten-containing grains wheat, rye and barley, people intolerant to FODMAPs show some signs of improvement on a gluten-free diet, but it may only be temporary. A hydrogen breath test is an effective diagnostic tool used to help distinguish food intolerances from NCGS.

A wheat allergy, which affects less than 1 percent of adults in the U.S., is another cause of these problematic symptoms. Food allergies are very specific immune system responses involving either the immunoglobulin E, or IgE, antibody or T-cells reacting to a particular food protein. Wheat allergy differs from celiac disease and NCGS, and therefore the body reacts differently.

An allergic immune response to wheat can lead to a variety of symptoms, including swelling, itching, skin rash, nasal congestion and tingling or burning of the mouth. People with wheat allergies are allergic to a wheat protein, not necessarily gluten, and can tolerate gluten-containing barley and rye.

Many people feel better when they remove gluten, but it may not be due to a specific food allergy or intolerance. "The number of people going gluten-free vastly outnumbers the number of people who truly have a biological problem tolerating gluten,” says Mayo Clinic gastroenterologist Joseph Murray, MD. “Some people feel better when gluten is eliminated for many reasons — including the placebo effect, they eat less, their diet is healthier, they believe it is better for them — and when they return to their old diets, they start feeling bad.”

Potential Causes for Gluten Sensitivity
There is no evidence indicating an increase in gluten sensitivity over the last 35 years, but rather a lot of media attention, Murray says. The prevalence of NCGS in the general population is unknown, largely because many people are self-diagnosing and adopting a gluten-free diet without medical advice or consultation. NCGS does not appear to be genetically based, unlike celiac disease, which has a fairly well-established pathogenesis. The cause of NCGS is not well-understood and may be different for individual patients. It has been hypothesized that symptoms may be a result of impaired intestinal mucosa barrier function or related to an innate immune response to gluten. Whether it is actually the gluten or a component in the grain that is responsible for the symptoms remains under scrutiny.

“New varieties of wheat, wheat hybridization and quality of grains that have been introduced over the past 40 years have been ruled out as causing an increase in the condition,” Fassano says. “Individuals may be predisposed to NCGS. It does not appear to be related to the timing of introduction of grains, nor does breastfeeding appear to be protective.”

In an attempt to unscramble the gluten puzzle, emerging research takes a closer look at how the microbiome may be affected by genetics, the environment and the immune system. The microbiome, a community of microorganisms in the human digestive tract housing good and bad bacteria, has been of particular interest in recent research. (Even Hippocrates believed that all diseases begin in the gut.) The microbiome is inherited from the mother, is extremely dynamic, varies among individuals and changes in the same individual over time.

Beyond genetics, nutrition is one of the most influential factors in the microbiome that may offer protection. “Babies born vaginally, consuming balanced diets and with minimal infections and antibiotics in the first few years of life establish a healthy gut and microbiome that is protective and likely lowers risk for developing diseases,” Fassano says. “On the other hand, when the microbiome is trained inappropriately, the risk for disease is greater and may be a secondary factor explaining NCGS.”

Why RDNs Are Fundamental to Success
NCGS is a growing problem encountered in clinical practice, yet is difficult to diagnosis and a challenge to manage in the absence of diagnostic markers. Whether gluten removal, wheat exclusion or a low-FODMAP diet, a carefully executed process of trial and error is required with elimination diet plans. Food diaries, in which clients record everything they eat and drink and any symptoms that follow, are especially helpful.

However, relying on what people report or anecdotal observations are subjective and open to misinterpretation. “Double-blind food challenges are the most accurate way to determine NCGS,” Murray says. No evidence-based guidelines exist for reintroduction of gluten-containing foods; it is dependent upon the level of sensitivity. Reintroducing gluten is best done when the patient feels better and with simple foods, such as matzo or soda crackers, which are pure wheat.

Gluten reintroduction is a risk-versus-benefit decision and should be highly individualized to the patient. “Unlike celiac disease, there is no damage to the small intestine, so consuming small amounts of gluten goes without incident,” Murray says. When removing gluten is effective, there could be a threshold of tolerance that allows some gluten in the diet. When it is ineffective, Case recommends trying a low-FODMAP diet.

RDNs may have been skeptical about NCGS initially, but it has proven to be an excellent opportunity to assume a leadership role in the diagnosis and care of patients. “Asking the right questions, doing a detailed diet history and overseeing gluten elimination and challenges are where dietitians can play an essential role,” Case says. “Dietitians are having great success treating NCGS patients, and unless we embrace and treat these conditions, patients will seek alternative practitioners.”

What Exactly Is Yacón Syrup?

The South American yacón plant is often cultivated for its edible root, which can be juiced and evaporated to produce a syrup. The high fructooligosaccharide content of yacón root has drawn recent attention. A type of soluble fiber, fructooligosaccharide functions as a prebiotic, feeding beneficial bacteria in the gut.

Research has found that it may improve blood lipids, prevent constipation and improve absorption of minerals, such as calcium and magnesium. Fructooligosaccharide has potential to regulate blood glucose levels, especially for individuals with diabetes.

However, few studies have examined the effects of yacón syrup on humans. One study on obese women without diabetes found that when consuming yacón syrup before meals for 120 days, participants experienced a significant reduction in body weight, BMI, waist circumference, serum insulin and LDL cholesterol, and a significant increase in frequency of defecation. Glucose levels did not change significantly. More research is needed on yacón syrup as a supplement for individuals with diabetes, and currently, there is insufficient evidence to promote its use as a weight-loss aid.

A Global Mission for Nutrition Education

From emergency relief posts to missions organized by faith-based organizations, the dietetics community is no stranger to international volunteerism — and the expertise and skill sets of registered dietitian nutritionists often make them unique assets on these initiatives. Yet RDNs and other practitioners face a major challenge working in developing nations: a lack of appropriate nutrition education aids.

"In searching through catalogues of nutrition education materials, I found they depicted foods, people and settings that these [overseas communities] have never seen," says Dixie Havlak, RD, who has worked in rural Nicaragua and Honduras. "It takes months to put together information, and that makes people think twice about going overseas and doing work."

In countries where people may not have a very sophisticated understanding of science and most local community nutrition workers have little training or poor access to education materials, health practitioners must go back to basics. Visual aids that meet the needs of minimally literate people are especially important, Havlak stresses.

"In the U.S., most people know we get nutrients from food. But some cultures may not even have a word for that," she says. "We have to go back to the very fundamentals of nutrition, health care and how the body works."

Culturally appropriate and effective education aids not only support volunteers, but also the efforts of practitioners whose careers are with government agencies, NGOs or military services. "Before and after my journeys in Central America, I often met other people going down there — dietitians, nurses and medical teams who commonly teach about nutrition and health issues — who had to throw together health education materials at the last minute," Havlak says. "That seems really inefficient."

To help close the gap and support international nutrition education, the Academy of Nutrition and Dietetics has launched a pilot project to develop a collection of free resources for health practitioners working in developing countries. Made possible through funding from the Academy Foundation through the Wimpfheimer-Guggenheim Fund for International Exchange in Nutrition, Dietetics and Management, the first phase of the collection will focus on Central America.

All RDNs, registered nurses, pediatricians, family practitioners, physician assistants and other public health workers with field experience in this region are invited to take an online survey to assess needs for materials and tools that could aid in international medical missions and humanitarian assistance efforts. Respondents also can submit examples of materials (handouts, posters, visual aids) they have developed or used in nutrition education efforts.

"When we can share materials, we improve our ability to serve the developing world and make it easier for more practitioners to volunteer," Havlak says. "Many people on the ground are desperate for material, and we can help them facilitate understanding of health issues and improve the ability to communicate that with the people they serve."

To share your ideas and experiences, visit sm.foodnutrimag.org/intsurvey or email IRproject@eatright.org. Resources will be available mid-2016 on eatrightPRO.org.

How the Latest Research May Shed Light on Serum Cholesterol

It was such a simple sound bite: Know your number and know your risk. When research emerged in the 1980s implicating dietary and serum cholesterol in the development of heart disease, cholesterol became the nutrient that everybody loved to hate.

Over time, science slowly moved the needle away from this mindset. “Good” and “bad” serum cholesterol were delineated, and more recently, studies determined that eating cholesterol-rich foods didn’t actually increase serum cholesterol like we once thought. And while some still maintain that lower total serum cholesterol is always best, more recent research challenges the validity of measuring cholesterol as a singular marker of cardiovascular health. So where does the medical community stand now on serum cholesterol?

What is Cholesterol?
First, a refresher. Manufactured by the liver, cholesterol’s functions extend well beyond the cardiovascular system. It’s the structural backbone to sex hormones, including testosterone, estrogen and progesterone (in addition to the adrenal hormone cortisol), and is crucial to brain function, both as part of myelin sheath structure and its role in nerve impulse conductivity. Because it is required to synthesize vitamin D from sun exposure, cholesterol is relevant to the immune and skeletal systems. And in cell membranes, cholesterol provides structural support and may also act as an antioxidant.

There’s even evidence that cholesterol may play a role in protecting against bacterial and parasitic infection.

Serum cholesterol travels through the blood stream within lipoproteins, of which the two most abundant are low-density lipoprotein and high-density lipoprotein. LDL carries cholesterol from the liver to peripheral tissues, while HDL carries cholesterol back to the liver for excretion or recycling. Routine cholesterol panels typically include total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides. LDL and HDL cholesterol levels measure the amount of cholesterol carried in these lipoproteins, and many health professionals rely on these figures to gauge risk for cardiovascular and coronary artery disease.

What if "Normal" Does Not Equal "Healthy"?
This is where it gets interesting. Studies have found that up to 75 percent of patients hospitalized for heart attacks had normal to optimal serum LDL levels, and in 2013, revised guidelines from the American Heart Association and American College of Cardiology removed LDL cholesterol target levels and recommended that doctors not prescribe cholesterol-lowering medication based on cholesterol levels alone — a significant departure from long-held advice.

The key to understanding LDL cholesterol’s risks and rewards may lie in the size and density of its particles, which range from large, buoyant, cholesterol-rich particles to small, dense particles low in lipids. Since everyone has a mix of different types of LDL particles at any given time, some practitioners are testing for serum cholesterol “phenotype” patterns to discern composition (see sidebar).

Pattern A describes having mostly large, more buoyant LDL particles and is linked with good cardiovascular health, while pattern B refers to having mostly smaller, more dense LDL particles that are more prone to oxidation — and therefore associated with greater risk of atherosclerosis and higher overall cardiovascular disease risk. So whereas a person with low triglycerides, high HDL cholesterol and slightly elevated total and LDL cholesterol with pattern A phenotype (big, buoyant particles) may not be at increased risk for atherosclerosis or cardiovascular disease, a person with low to normal HDL cholesterol and normal total and LDL cholesterol levels with pattern B phenotype (small, dense particles) may indeed be at increased risk.

LDL particle size and density are influenced by genetics, diet and body weight — and dietary interventions have demonstrated measurable effects. More long-term studies are needed to help shape recommendations, but some researchers are exploring the effect of diet and weight loss on LDL patterns.

While the mechanisms are not yet understood, they include:

Higher intakes of saturated fat may increase large, buoyant LDL particles.
Reducing carbohydrates may reduce small, dense LDL particles.
Reducing dietary fat may reduce total LDL cholesterol, but specifically lowers large, buoyant particles.
Weight loss has been shown to improve LDL patterns in overweight men.
A high-carbohydrate, low-fat diet has been shown to shift study participants from pattern A to pattern B.
Study participants who started out as pattern B on a high-fat diet remained pattern B on a low-fat diet.
Although the clinical value of measuring LDL patterns remains hotly debated, many agree that more research is warranted since findings potentially could change the landscape surrounding serum cholesterol. In the meantime, staying up to date on emerging research and new practices is advice that any practitioner can get behind.

Why the Low-FODMAP Diet Is a Growing Dietitian-Led Treatment for People with IBS

Irritable bowel syndrome is a complex digestive condition that interferes with the daily lives of millions of people worldwide. Typically occurring in episodes, the condition is characterized by symptoms such as moderate to intense abdominal pain, bloating and gas. This set of digestive symptoms is not unique to IBS; therefore, to accurately diagnose the condition, health care professionals must rule out other issues such as celiac disease, small intestinal bacterial overgrowth and food allergies.

While diet does not cause IBS, individualized nutrition therapy can significantly lessen symptoms Tweet this through identification and restriction of trigger foods. Fermentable oligosaccharides, disaccharides, monosaccharides and polyols, or FODMAPs, have been identified as a group of short-chain carbohydrates that are rapidly digested and poorly absorbed in the gut, thus provoking excess fluid and gas in the bowels of many people with IBS. FODMAPs are naturally occurring carbohydrates found in foods such as apples, watermelon, asparagus, broccoli, milk and beans and are sometimes added to food as sweeteners.

Although some carbohydrates under the FODMAP umbrella, such as lactose and fructose, have been targeted in IBS therapy in the past, research on diet therapy addressing all FODMAPs as a group only began within the last decade. Research started in Australia in 2006, and subsequent studies have occurred elsewhere, including the United Kingdom, New Zealand, Scandinavia and the U.S. The results have been clear: When people with IBS consumed high amounts of FODMAPs, their symptoms got worse; when they restricted FODMAPS, their symptoms improved.

Now with enough evidence to support its use, a low-FODMAP diet is recommended as a nutrition prescription for patients with IBS in the Academy of Nutrition and Dietitics' Nutrition Care Manual. Client education materials for a low-FODMAP diet will be available in the NCM later this year.

Nonetheless, doctors caution that low-FODMAP diet therapy is not a cure for patients with IBS. Individual response to the diet varies, and some people with IBS experience little relief from following a low-FODMAP diet. And while a low-

FODMAP diet produces significant results in most IBS patients, it doesn't always eliminate all symptoms. For instance, some patients may experience relief from gas and bloating, but their irregular bowel patterns remain.

FODMAP expert Patsy Catsos, MS, RDN, LD, began using low-FODMAP diet therapy in her private practice almost a decade ago. To date, she has helped thousands of patients through the diet and says that "the FODMAP elimination diet is more than just a list of foods — it's a process. To get the best outcomes, patients need a strategic plan, and that's where the dietitian comes in."

One concern about following a low-FODMAP diet is the effect it may have on a patient's gut microbiota. Evidence shows IBS patients have different gut microbiomes compared to the healthy population. Preliminary research suggests taking a probiotic supplement during low-FODMAP diet therapy can prevent the washout of beneficial gut bacteria, leading some FODMAP experts to recommend this type of supplement to people with IBS on the diet.

In addition to IBS, limited evidence shows promise of a low-FODMAP diet for people with inflammatory bowel disease, which is a separate medical condition (an autoimmune disease characterized by chronic inflammation; includes Crohn's disease and ulcerative colitis). Some researchers suspect a low-FODMAP diet may help alleviate digestive symptoms in people with non-celiac wheat sensitivity, but the diet has not been validated in this population.

Not all FODMAP-containing foods worsen IBS symptoms for all patients, which is why the diet therapy is conducted in two phases. To identify specific foods that trigger symptoms in a patient, phase 1 restricts all high-FODMAP foods and phase 2 gradually reintroduces them.

Phase 1 typically lasts up to eight weeks and is when patients feel most challenged by the restrictiveness of the diet. Elimination and reintroduction of FODMAP-containing foods is the only effective strategy to identify trigger foods in patients with IBS. Reliable assessment methods such as hydrogen breath tests are available to detect some, but not all, FODMAP malabsorption, but these tests are capable of false positives and are not perfect. Because long-term evidence is not available and there is a risk of nutritional inadequacy if the diet is poorly planned, restricting high-FODMAP foods should be temporary and reintroduction should be as quick as possible in accordance with the patient's symptoms.

Patients and physicians should work with an RDN who is trained in administering a low-FODMAP diet to ensure the success of the nutritional therapy. According to low-FODMAP diet educator Kate Scarlata, RDN, LDN, "The low-FODMAP diet has many nuances, and online resources are often outdated, making the IBS patient confused and frustrated. The role of the dietitian is to be well-prepared with the latest and most accurate low-FODMAP diet research to successfully guide the patient with this effective nutrition intervention." While research shows good patient compliance of about 75 percent following the diet, it is restrictive by nature.

Barriers include expense of low-FODMAP specialty foods, dislike for the taste, unwillingness to follow the diet and the challenge of identifying and selecting low-FODMAP foods when eating away from home. Additional challenges are the lack of defined cutoff values for high- and low-FODMAP foods and shortage of FODMAP content on food packaging.

Two voluntary certifications for low-FODMAP food products are available, one from Monash University and the other from FODMAP Friendly, both of which have access to FODMAP laboratories to conduct food testing. These seals are on few products in grocery stores today, but likely will increase as the diet gains popularity. Dietitians interested in learning more about FODMAP diet therapy are encouraged to read books by reputable FODMAP experts, seek continuing education opportunities such as workshops and trainings led by FODMAP experts and use the Monash University low-FODMAP diet app.

The Power of Virtual Reality Comes to FNCE

 if you've been on social media, watched the news or been anywhere near a videogamer in the last year, you've heard about virtual reality. But what is it? Tweet this

In simplest terms, it's a video — only instead of the camera recording that which is in its field of view (i.e. what the camera is pointed at), virtual reality cameras record in all directions simultaneously. The result is a 360-degree immersive experience that allows viewers to see everything around them, as if they were right there themselves.

While everyone from business and media to educators and tech leaders are calling virtual reality a game changer, two industries in particular have been driving its development: videogames and pornography.

But the applications of virtual reality extend far beyond entertainment. In 2014, Volvo® used virtual reality to let users "test drive" one of its new car models. In February 2015, Merrell® took users on a dangerous mountain hike to support the launch of a new boot.

Last November, The New York Times invited its subscribers to experience "The Displaced," an 11-minute VR video from the perspectives of four children in war-torn countries. That same month, YouTube® announced that it would start supporting virtual reality on its platform. And earlier this year, Excedrin® launched a VR migraine simulator to help medical and caregiver communities understand the experience of migraine sufferers.

We here at Food & Nutrition think the applications for the dietetics community are endless: from global education and training simulations to culinary demos and virtual reality tours of farms and food processors. There are several ways to view virtual reality videos: on a desktop, on certain mobile devices or through VR viewers, which can range from a $600 gaming headset to a $25 cardboard viewer, each offering slightly different features and experiences.

Last fall, California-based VR technology company Oculus®, in collaboration with Samsung®, released the Gear VR. This high-end headset at a consumer-friendly price point (or in some cases, completely free with the purchase of a Samsung smartphone) is helping to usher VR to mainstream audiences.

For organizations interested in producing virtual reality experiences, the expense associated with creating content has been prohibitive for smaller budgets. After all, the highest-end cameras cost about $60,000, the postproduction requires hundreds of hours of stitching multi-angle footage, and the delivery to viewers often requires specialty apps.

But newer technology (driven by amateur video enthusiasts as well as communities in the adventure sports and media industries) is focused on bringing VR cameras and editing software to businesses and consumers alike. The technology behind virtual reality is unfolding — and we want our readers at the forefront! We'll be at the Food & Nutrition Conference & Expo™ with headsets and videos for attendees to try, including featured videos from the Almond Board of California®. We also supplied two Stone Soup bloggers with VR cameras so they could film their own adventures — and share their tips with attendees interested in creating virtual reality content.

Visit us at the Food & Nutrition VR Video Booth on the 2016 FNCE Expo Floor (Booth #2565, right next to the Culinary Demo Theater) for your own mind-blowing VR experience!

Growth of Discount Grocers

Successful global giants in the grocery market, including the European companies ALDI and Lidl, continue to emerge in America, bringing with them lower prices, more jobs and stiff competition. While it may seem like a new trend, discount retailing has been in practice for centuries. Dating back to the early 1900s, “undersellers” sold merchandise such as apparel at a lower cost than mainstream stores. After the Great Depression, discount operations opened more frequently, selling a wider variety of goods.

But it wasn’t until the end of World War II when discount merchandising truly took off, fueled largely by consumers seeking bargains in the face of rising prices and demand for goods after wartime shortages. In the 1960s, four major players entered the space and would continue to dominate for decades: Kmart, Woolco, Target and Walmart.

While these discount retailers are viewed more as department stores, food-specific discount operations have emerged and generally fall into two categories: box stores, which sell few perishables and a limited amount of brands and product lines; and warehouse, which sell the manufacturer’s brands at discount wholesale, a moderate amount of product lines but few assortments of goods. Both of these models offer very low prices,few services and a bare-bones atmosphere.

Today, many communities have a mix of grocery store models, from upscale establishments with onsite bars, cafes and restaurants to deeply discounted retailers from all over the world. With all these retailers selling similar foods, more or less, competition is fierce.

According to a 2015 Retail Industry Report by Mazzone & Associates, supercenters, dollar stores and warehouse clubs gained a greater share of the food retailing market as consumers sought out convenience, lower cost and the ability to buy in bulk. In addition, lower-income consumers are forgoing premium goods and stock up on discounted foods instead.

Another way discount retailers win over shoppers is by offering store brands, aka private labels, which help keep cost down. German retailer Lidl found a way to also satisfy consumer demand for healthful, fresh foods, organic produce and all-natural products; its private-label items are free from MSG, trans fat and synthetic colors, and it includes a variety of organic and gluten-free options, such as produce, meat, dairy and packaged goods.

How Supermarkets are Competing

In an attempt to attract new customers, retain existing customers and foster loyalty, many supermarket chains offer discounts and promotions, such as coupons and weekly sales. Some also offer on-site amenities, such as cash machines, movie rentals and coffee shops. However, these tactics may ultimately cause profits to idle or fall.

Generic or off-brand products that were once seen as subpar by some now present an opportunity for retailers to provide value and quality at a lower cost. In 2016, the retailers Costco, Kroger and Trader Joe’s were among the top five vendors of private-label food and beverages in the United States. Customers view these “store brands” as valuable and trusted alternatives to more expensive national brands.

Another attempt to compete is through mergers and acquisitions. Top retail operators buy smaller competitors or merge with larger supermarket chains, which allows the companies to maintain profitability while lowering per-unit costs. On June 16, 2017, Amazon made headlines around the world for its $13.7 billion purchase of Whole Foods Market, an acquisition that caused other grocery chains’ stocks to plunge as much as 17 percent that day.

In the increasingly cutthroat grocery industry, some retailers have saved money and cut costs by keeping employee wages low through salary freezing. Other vendors have implemented self-checkout aisles to reduce their number of employees altogether.

The Future Landscape of Grocery Shopping

Discount retail locations may be smaller than traditional grocery stores, with fewer aisles and a more minimal design, but their competitive edge and consumer appeal are undeniable. Mainstream supermarkets may need to close stores, restructure, cut costs and reallocate dollars to remain viable.

In addition, the world continues to shift to a more technological society, with robust e-commerce and digital grocery stores like AmazonFresh. Online grocery sales are estimated to reach $100 billion by 2025, so innovation is necessary. Supermarkets may introduce mobile apps and advanced point of sale systems, such as self-checkout kiosks, to replace workers and cut wage costs.

Despite the fact that only 40 percent of households shopped at deep-discount retailers in 2016, which is much lower than supermarkets and mass merchandisers, the amount of trips to these retailers rose by 2.8 percent. This indicates there are significant opportunities for discount retailing to continue growing in years to come.

Why Does Nutrition Advice Contradict Itself?

One day coconut oil is a cure-all, the next it will kill you. Coffee is good! No, it’s bad. Carbs are evil and then they are a necessity. Why is there so much contradiction when it comes to nutrition advice? It often results in confusion and mistrust, so I thought I would address why these contradictions occur and what you can do to make sure you are getting the most accurate information possible.

The Media

Most people obtain their nutrition information from a media source. When it comes to getting views and clicks, the more sensational the headline, the better. The media is prone to use hyperbole when reporting on scientific studies. For example, when a study found that butter had a neutral effect on cardiovascular disease risk when compared to other foods, the TIME magazine headline read, “Butter is Back!”

When the media overstates results of studies, this lends to the confusion that consumers experience. One day butter will kill you, and the next day it will save you. When you read the actual studies behind the headlines, the authors are much more reserved in their analyses.

The Nature of Evidence-Based Advice

Often the media will take one small study and run the result as if it is absolute fact. However, the way that good evidence-based advice is formed takes time and a multitude of studies. In this way, a good case can be built for giving a nutrition recommendation.

The types of studies also matter. There is a “hierarchy of scientific evidence” that classifies which study designs are strongest. For example, a randomized clinical trial holds much more weight than a case study. Unfortunately, study design is not always considered.

Finally, recognize that nutritional science is constantly evolving. Evidence builds upon itself and nutrition advice sometimes needs to be clarified, modified or completely changed based on the progression of evidence.

When taking nutrition advice, whether it be from a professional or a media outlet, be sure that it is built on sound scientific evidence. Confirm that supporting references point to peer-reviewed literature. Ask critical questions about supporting studies, including their type and reproducibility.

Bias

Bias exists in most all situations. To arrive at good nutrition advice, all of us must do our best to eliminate as much bias as possible. For example, good scientific studies try their best to eliminate bias on the part of the researchers. Researchers are human, after all, and can be biased toward a particular result or perhaps influenced by a funding source.

In addition, most of us have some level of “confirmation bias.” This means that we tend to favor evidence that upholds our pre-existing beliefs and ignore evidence that contradicts them. When we become aware of this quality of human nature, we can approach life with a more open mind. Be aware that your own bias affects your ability to accept and process nutrition advice as well. This goes for RDNs, too — we also can get entrenched in some rigid views of food, weight and health.

Source

It can be difficult to discern which news sources to trust. Almost anyone can label themselves a nutrition expert and share advice. It’s pretty easy for anyone to start a blog, Facebook page or Twitter account and start handing out advice.

Be wary if the source of the information also is trying to sell you something, even if they are a professional. For example, one well known TV doctor dishes out advice that is credible on one segment and out of left field on the next. Even though he is an MD, he is in entertainment and the producers of his show are looking for content that will sell.

Seek out nutrition information from sources that strive to be unbiased and based on scientific evidence. One example is the Academy of Nutrition and Dietetics. Academic institutions usually are reliable sources as well.

Conclusion

4 Tips to Beat the Post FNCE Blues

By now, you’ve probably come off the FNCE adrenaline rush, having been surrounded by motivating peers in the nutrition field, and are now eating your post-FNCE blues away with the free samples you received. However, now is the time to put your new skills and connections to work!

FNCE is the Food & Nutrition Conference & Expo that occurs annually across the country bringing dietetic and nutrition professionals together around the world. This is a time to be surrounded by the coolest people (no bias here) and greatly expand your network by interacting in various capacities at the expo, sessions or events. FNCE allows attendees to gain knowledge and skills that will improve interventions, patient participation and results, as well as build upon existing knowledge with emerging research and innovative tips and tricks of the trade.

Following FNCE be sure to:

Start Sending Those E-mails!

Send e-mails and follow up with those you met. Fostering relationships is key to having a successful career. Thank the people you interacted with for sharing their advice, tips and research with you.

Put the New Information into Play

Use the newly acquired skills and information gained by modifying interventions, adjusting research questions or starting new projects after being inspired by the experts you met.

Remember: Follow Your Passions

Say yes to things that excite you, take hold of opportunities that come your way and be patient!

Take Care of YOU

Being involved in multiple projects and various sectors within the nutrition field is great, but to optimally perform we need to get adequate sleep, fuel ourselves properly and maintain our social health. Although most RDNs or future RDNs are Type A and want everything to be perfect, the most important thing you can do for yourself is to take care of you.

And now you can look forward to entering the next 100 years of the Academy of Nutrition and Dietetics with your robust network and newly acquired skills!

See you next year at FNCE in the nation’s capital where after the conference we will storm the Hill to advocate for the profession.

How to Throw a Party for All Dietary Preferences

My gluten-free, dairy-free aunt and dairy-free cousin recently threw me the most spectacular baby shower. They thought of every detail — including how to please the more than 30 guests with various dietary preferences.

First, they had a “mom-osa” bar, which I appreciated greatly since alcohol is a thing of the past for me right now. I enjoyed sipping my sparking water with a splash of pineapple juice and fresh berries. Champagne was available for those who wanted to imbibe.

They also had a buffet of Greek food including hummus, baba ganoush, tzatziki sauce, pita bread, fresh cut vegetables, tabbouleh and stuffed grape leaves. It was the perfect light meal for a shower and the buffet-style service allowed people to pick and choose the foods that were appropriate for them.

My aunt made two desserts. A scrumptious zucchini spice layered cake with traditional buttercream frosting and a platter of gluten-free white champagne cupcakes, which meant everyone could enjoy a celebratory treat.

If hosting a party — and this is the time of year when many of us do — you are likely to have guests with dietary restrictions or food allergies, and the last thing you want is for them to be left out of the food festivities. At the same time, trying to please everyone can be exhausting.

Follow these four tips to help you throw a party for all your guests, no matter their dietary preferences:

Get the Details

RSVPs aren’t just for confirming attendance. They also are important to gather insight on any special dietary needs. Whether guests call, text or email their response to your invitation, be sure to have them include any food allergies or preferences so you can plan accordingly.

Explore Your Options

Once you know the dietary needs you’ll need to consider when creating a menu for your party, it’s time to jump on the computer and find recipes that will work. Find collections of recipes online that are devoted to dietary preferences and also explore cookbooks designed for specific diets.

Allow Guests to Customize Their Plates

If you have guests with various dietary needs, it may be easier to offer a deconstructed menu and let guests build their own plates with foods they prefer. The key is to provide a variety of add-ins, condiments and toppings. For example, you could have a build-your-own yogurt parfait bar with various fresh berries and fruit, regular Greek yogurt, coconut yogurt, nuts, gluten-free and regular granola, honey and cinnamon. A salad bar or taco bar also are easy meal options that give guests options.

Offer Two Variations of the Same Meal

You also can create two variations of one meal to please all your guests, such as a regular and a vegetarian chili. It may be more work for you, but your guests will appreciate the time and effort you put into making sure their needs were met. This also is a good option if the party calls for a specific or traditional meal.

Your pregnancy and baby guide

Am I pregnant? What should I be eating? Is it normal to be this tired? How can I help my partner during labour?
Whatever you want to know about getting pregnant, being pregnant or caring for your new baby, you should find it here.
You'll find detailed week-by-week guides and lots of expert videos, parents' tips and interactive tools to explore.
Before you start, why not:
work out when your baby is due with our due date calculator 
log in to create your own personalised birth plan
Want to know if you're really pregnant?

Got any of the signs and symptoms of pregnancy? Read our guide on finding out if you're pregnant.
Find out about pregnancy tests, or your next steps if you've had a positive pregnancy test.
Also, find out more about getting help if you're not getting pregnant.
Keeping well in pregnancy

everything you need to know about a healthy pregnancy diet and supplements in pregnancy
smoking and drinking can harm an unborn baby – read our stop smoking and alcohol pages for help trying to quit
Antenatal care and the baby's development
find out as much as you can about what's happening inside you in the first few weeks of pregnancy
how to cope with all those common pregnancy problems, like morning sickness, tiredness and headaches
find out all about the ultrasound scans and checks and tests you'll be offered as part of your antenatal care, including screening for Down's syndrome
Vaccinations in pregnancy
Why it's recommended that women have the flu vaccine in pregnancy and whooping cough vaccine in pregnancy.
Labour and birth

Find out all you need to know about labour and birth, including where you can have your baby – for example, either in a hospital, midwife-led unit, or at home – and what pain relief is available, such as gas and air (entonox) and epidural.
Your new baby

When your baby arrives, you can find advice on all the essentials of baby care, including breastfeeding, bottle feeding, changing nappies, and washing your baby. Plus:
find out how to cope with a crying baby and get tips on settling them into a good sleep routine
as a new mum, find out about the possible changes to your body and your relationships, and know how to spot the symptoms of postnatal depression
if you have twins or multiples, find out about feeding, getting out and about, and sleep issues
Feeding, teething and tantrums
find out about all aspects of parenting, including support and services, keeping fit, and going back to work
know the signs of serious illness in babies and the symptoms of infectious illnesses such as chickenpox
find out how to keep your baby safe and what to do if they have an accident
at six months old your baby will need to start solid foods, so be prepared with our weaning tips and first food ideas
as your baby becomes a toddler, get tips on teething, the importance of play, temper tantrums and potty training
Want to share your pregnancy and baby experiences?

Connect with others who can offer practical and emotional support about any pregnancy and baby issues on the HealthUnlocked NCT forum.

Going dry for a month boosted my health

Joanna Munro describes herself as the typical mother who enjoys a well-earned glass of her favourite tipple at the end of a trying day.

As someone who drank no more than a couple of glasses of wine a day, Joanna, 45, was by no means a heavy drinker. But one day, she realised that "wine o'clock" had become more of a habit than a pleasure.

She gave up alcohol for a month for Dry January to prove to herself she was still in control but she tells how she soon started noticing unexpected health benefits.  

Pleasure or habit?

"Back in December, I was a typical example of the mother who reaches for her first glass of rosé while simultaneously burning dinner, tripping over the dog, emptying the washing machine and resolving conflicts between the kids. Then I realized that "wine o'clock" had become an automatic reflex that wasn’t so much a pleasure as a habit. 

"I didn’t find an answer to my question on the internet, but I did find Alcohol Concern’s website and a challenge called Dry January. I liked the idea – an opportunity to prove to myself that I had more self-control than a four-year-old who’d been left alone in a Cadbury’s warehouse. If I was hooked, I’d be clawing my way up the curtains in despair within days.

"So I signed up. Over the month, my resolve was considerably strengthened by Dry January’s Facebook page and the determination and solidarity of those taking part. The challenge worked a charm because people can encourage each other and be accountable to each other.

"The aim was simple on paper: give up alcohol for one month. As I’m an eternal optimist, I added an hour of exercise every day for good measure. I quickly worked out a circuit through my local village. When attempting abstinence for the first time in 12 years, sunshine and great countryside proved ideal to lift this trainee teetotaler’s spirits."

Health benefits

"The first week, I rode the virtuosity wave. I was a disdainful diva, even declining champagne on the beach to toast in the New Year. By the middle of the second week, however, the queen of self-control and restraint was glowering, Gollum-like, over her glass of Perrier and lime as hubby savoured his beer.

"After two weeks the cold turkey wore off, and the first benefits kicked in. I was in bed snoring shamelessly before 10 and was awake before the alarm at 6.15am. My skin was looking better. I had more energy, and was proud of myself for sticking at it.

"Although weight loss wasn’t a decisive factor for me, I lost 5lbs (2.3kg) in the first month and I have now lost nearly 10lbs and banished three inches (7.5cm) of muffin top from my waistline. Like many other people on Dry January’s page, my problem was the inexplicable desire to replace my evening dose of wine with snacks in front of the TV.

"Yet in the long run, less wine meant less nibbles. I realised how alcohol opened up my appetite and made me reach for those salty nibbles.

"Less nibbles meant less weight. Not exactly rocket science, but a winning equation nevertheless."

Five hacks for a good work-life balance

In today's often intense work culture, it can be difficult to strike and successfully maintain a good balance between work and our personal lives. This, in many cases, can cause burnout. Here, we provide for some tips on how to keep this balance and avoid self-sabotage.

Reportedly, people in the United States work more than any other population, and data provided by the Organisation for Economic Cooperation and Development indicate that the average U.S. employee put in a total of 1,783 working hours during 2016.

Some surveys suggest that U.S. workers stay connected with job-related issues in their spare time, including at weekends and when on vacation. Overwork can lead to what is often referred to as "burnout," which is a state of feeling mentally and physically exhausted, devoid of motivation, and without much to offer.

So, what are some things that you can do to avoid your work and personal lives blending into each other? How can you maintain a sense of balance that allows you to harvest your full potential in both areas of your life? We offer you a few tips that might help you to regain - or maintain - equilibrium.

Essentially, if you want to strike that often elusive work-life balance, it is important to fully separate the two and ensure that you do not allow them to mix with each other. Setting boundaries is crucial, but what is perhaps most difficult is to set mental boundaries between your work and private life to avoid cross-spillage.

1. Dismiss the smartphone

In order to avoid getting tangled up in work during your free time, it might be a good idea to make it clear that you will not respond to work e-mails or take work-related calls outside of business hours.

If you are self-employed or work from home, try to schedule a cluster of hours each day and declare those as your "office hours."

Research has shown, time and again, that the state of being permanently connected - always inspecting your electronic devices to check your e-mails, calls, and messages - is linked to significantly higher stress levels.

So, make sure to put your phone away after work. It may be better still if you leave it in a completely different room, a study suggests.

Prof. Adrian Ward, from the University of Texas in Austin, explains that our phones can act as "brain drains," and that constantly worrying about our phone notifications uses up important - and limited - mental resources.

2. Don't let job worries hijack private time

This is a tricky one, since it can be hard to dismiss work-related issues that have been on your mind for the entire day, and there is no magic switch to allow you to achieve that instantly. However, several recent studies have shown that stress weighs down relationships.

So, if you want to maintain good-quality relationships with your family, partner, or friends, try your best to keep work-related stress away from the dinner table, and do not let it monopolize conversations and "family time."

Medical News Today have recently reported on research suggesting that practicing meditation and yoga can improve the individual sense of well-being. Another study also explains how these mind-body practices can reduce stress at a physiological level.

Meditating your way out of a work "mindset" at the end of a long day might allow you to set aside any work-related worries and instead focus on spending quality time with your loved ones, or even just with yourself.

3. Consider having a 'work uniform'

If you don't already have a job that requires you to wear some kind of uniform, such as protective equipment, on a regular basis, then perhaps you should consider coming up with your own dress code for work.

One study suggests that there is such a thing as "enclothed cognition," meaning that what you wear can influence how you think about yourself and others. Different clothes have different meanings for different people, so this is an individual mental experience.

Thus, picking a particular set of clothes to serve as your "work uniform" might boost your confidence and allow you to perform better while in a work environment.

At the same time, having different kinds of clothes and accessories for work and for activities outside of work could help you to draw a mental line between one context and another.

4. 'Bookend' your commute with a good read

Existing research shows that reading can improve your life in more ways than one, and one of these ways is by significantly reducing stress levels.

In a study covered by MNT, Dr. David Lewis - who conducted the research at the University of Sussex in Brighton, United Kingdom - noted that books "cause you to enter what is essentially an altered state of consciousness."

So why not bookend your commute to work - or your self-set business hours, if you work on a freelance basis, for instance - with a good story, or some inspiring poetry?

Reading might help to dissipate potential anticipatory stress before work and ease the way into a more relaxed headspace after.

5. Delegate chores to indulge in 'you time'

New research suggests that delegating, or "outsourcing," responsibilities such as house chores can greatly improve life satisfaction. If you leave work to return to a sink chock-full with dirty dishes, that will not do much to alleviate stress and will instead contribute to your physical state of exhaustion.

Instead, try to delegate chores where possible, or consider hiring someone to help you. That way, you can free up time to do what really counts: engaging in activities that improve your mental and physical well-being, such as hobbies.

One U.K.-based campaign suggests that leisure activities not only decrease stress levels but can also have a beneficial effect on your work by improving your creativity and making you more mentally "flexible."

Life outside of work, says Prof. Robert Lechler - who is the president of the U.K. Academy of Medical Sciences - "is not an added extra - it is integral to who we are and the skills we must develop to be successful."

All jobs are different, so not all of the tips given above may fit your current situation. The key is to do what's best for you and your well-being.

Do you have a personalized strategy for maintaining work-life balance? If so, what does it entail? We look forward to reading your opinions.

Prenatal acetaminophen may affect masculinity

When we have a headache or a cold, many of us pop a Tylenol without a second thought. But acetaminophen - the active analgesic ingredient in the drug - is also commonly used to ease pain during pregnancy. A new study suggests that this could be a major problem.

The new research suggests that taking the common analgesic acetaminophen during pregnancy is not a good idea, especially for mothers expecting male babies.

The study, published in the journal Reproduction, examines the effects of acetaminophen in mouse fetuses and finds adverse effects on the masculinization of the mouse brain, extending all the way into adulthood.

Previous research has already indicated that acetaminophen can suppress the development of testosterone in male fetuses, potentially leading to developmental changes in the reproductive system and the brain.

Testosterone is a male sex hormone that drives the growth and development of the male body, as well as the "male programming" of the brain. In men, testosterone controls sex drive, bone and muscle mass, fat distribution, and the production of sperm and red blood cells.

In the previous studies in rodents, inhibited levels of testosterone in the fetuses were shown to raise the risk of testicular malformation in newborns.

But there are other health risks posed by inhibited levels of testosterone, and many of them manifest in the behavior of adult males, suggests the new research.

The first author of the study is Prof. Anders Hay-Schmidt, who, at the time of the study, was part of the Department of Neuroscience and Pharmacology at the University of Copenhagen in Denmark.

Acetaminophen inhibits bmasculinization

Prof. Hay-Schmidt and colleagues gave mice a dose of acetaminophen almost equivalent to that which pregnant women are usually recommended.

The researchers evaluated the male rodents' behavior, looking at their aggressiveness toward other males and their ability to mark their territory, as well as their ability to mate.

As adults, the mice whose mothers had received acetaminophen performed significantly worse across all of the three criteria.

Prenatal exposure to acetaminophen resulted in alterations in the adults' urinary marking behavior. The rodents were also less aggressive toward males invading their territory. The mice also had "reduced intromissions and ejaculations" during mating.

The behavioral changes noticed by the researchers were also backed up by investigations into the mice's brains. The researchers found that the number of neurons had significantly decreased in the brain region that controls sex drive.

Specifically, in the acetaminophen-exposed male mice, the brain area called the "sexually dimorphic nucleus" in the anterior hypothalamus had "half as many neurons as the control mice."

The corresponding author of the study, Dr. David Møbjerg Kristensen - of the Department of Biomedical Sciences and the Novo Nordisk Foundation Center for Protein Research at the Faculty of Health and Medical Sciences - comments on the findings.

He says, "We have demonstrated that a reduced level of testosterone means that male characteristics do not develop as they should. This also affects sex drive."

"In a trial, mice exposed to paracetamol at the fetal stage were simply unable to copulate in the same way as our control animals. Male programming had not been properly established during their fetal development, and this could be seen long afterwards in their adult life. It is very worrying."

Dr. David Møbjerg Kristensen

He recommends taking the painkiller with caution and also reminds future mothers to consult their physician if they are unsure about the medication they wish to take.

"I personally think that people should think carefully before taking medicine. These days it has become so common to take paracetamol that we forget it is a medicine, and all medicine has side effects. If you are ill, you should naturally take the medicine you need. After all, having a sick mother is more harmful for the fetus," says Dr. Kristensen.