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* Gluten-No Effect on Gastrointestinal Symptoms in Healthy People


* Very Low-Calorie Meal Replacement Brings Rapid Weight Loss But Also Bone Loss in Postmenopausal Women


* Ultraprocessed Foods and Associations With Type 2 Diabetes



Eating gluten-containing foods does not cause gastrointestinal symptoms in people without a gluten-related disorder, reports a double-blind, randomized controlled trial.


Although gluten is safe to eat for people without a gluten sensitivity, endorsements from some celebrities and athletes have "cultivated" the perception that a gluten-free diet (GFD) is healthier. Indeed, the researchers say that market research shows that 44% of Americans buy gluten-free food for reasons other than gluten sensitivity, and 65% believe that a GFD is healthier.


Because of the need to differentiate people who benefit from a GFD from those who do not, this study investigated how gluten affects healthy volunteers. It included 28 participants, of whom 75%, or 21, were female. Participants had a mean age of 38 years, and all had undergone serological testing to detect the absence of celiac disease. They attended 2 study sessions at a community venue and received education from a dietitian about a GFD. They were then asked to undergo a GFD for 2 weeks and complete a Gastrointestinal Symptom Rating Scale to measure baseline abdominal pain, reflux, indigestion, diarrhea, and constipation. A visual analog scale was also used to measure "global fatigue."


Next, the researchers randomly assigned participants to add sachets of either a gluten-containing or gluten-free flour to their food twice daily for 2 weeks. Those in the gluten group received 14 g of gluten protein daily. Participants in both groups continued their GFD during this time. Participants completed the Gastrointestinal Symptom Rating Scale again at the end of the trial. Mean symptom scores decreased in the gluten group at the end of the trial, suggesting symptomatic improvement. Only 1 participant in the gluten group reported a worsening of some symptoms without improvement in others during that time. There was no significant difference between the groups with respect to changes in any of the symptoms (abdominal pain: treatment/control mean [SD], -0.36 [1.95]/-0.29 [1.49]; P = .914) However, the Gastrointestinal Symptom Rating Scale's diarrhea score significantly decreased in participants in the gluten group (baseline/follow-up mean [SD], 2.71 [1.94]/1.64 [0.92]; P = .033). This was probably an anomalous result, the authors note. No other within-group analyses were significant. The limitations of their study included its short duration and the possibility that the trial may have unintentionally attracted participants with nonceliac gluten sensitivity or irritable bowel syndrome. The lack of effect of gluten on these participants suggests that gluten does not cause gastrointestinal symptoms in most people. While some people who do not have celiac disease and yet report symptoms after eating gluten may have nonceliac gluten sensitivity; some possibly have an irritable bowel syndrome that responds to gluten restriction, and in others, it is simply due to a chance relationship that is not durable in the long term.


Source: Croall ID, Aziz I, Trott N, et al. Gluten does not induce gastrointestinal symptoms in healthy volunteers: a double-blind randomized placebo trial. Gastroenterology 2019;157:881-883.



Obese postmenopausal women lost significantly more weight on a severely calorie-restricted diet than those on a more moderate diet, but the former also lost more bone mineral density (BMD), Australian clinical trial investigators reported. The trial included 101 obese postmenopausal women with a mean age of 58 years and mean body mass index of 34.4 kg/m2. They were randomized to either a moderately energy-restrictive diet (25%-35% reduction) based on the Australian Guide to Healthy Eating or the severely energy-restricted diet (65%-75% reduction) that included meal-replacement soups and shakes and a protein bar. The moderate intervention continued for 12 months, whereas the severe intervention lasted only 4 months, after which participants switched to the moderate diet for 8 months. The severe diet provided 1200 mg of calcium and 15 [mu]g of vitamin D daily. Both diets had a prescribed protein intake of 1 g/kg of body weight per day. Physical activity was encouraged for both groups but was not supervised.


Compared with the moderate diet group, the severely restricted diet group lost more overall body weight (effect size, -6.6 kg; 95% confidence interval [CI], -8.2 to -5.1 kg) and whole-body fat mass (effect size, -5.5 kg; 95% CI, -7.1 to -3.9 kg). The group on the severely restricted diet also lost more total hip BMD over the course of the 12-month intervention (effect size, -0.017 g/cm; 95% CI, -0.029 to -0.005 g/cm). The severe dieters also lost more whole-body lean mass and thigh muscle mass, but these were proportional to their total weight loss. Muscle strength as measured by handgrip did not differ between the 2 groups.


Participants on the severe diet were only a third as likely to discontinue the trial compared with those on the moderate diet. This may be because the substantial and rapid weight loss was encouraging, and the total meal replacement program was simple and convenient to use. A 3% to 5% loss of body weight has generally been accepted as clinically significant, and recent research has shown that greater weight loss improves health outcomes in a dose-dependent manner. However, the consequences of accelerated BMD loss with a severely energy-restricted dietary obesity treatment were clinically concerning, especially if BMD loss continued beyond the 12-month intervention, because loss has been linked to an increased risk of osteoporosis and fragility fracture. The bone loss was clearly an adverse effect. An accompanying editorial agreed with the researchers that the loss of BMD should be considered in light of the benefits of weight loss. They noted that the findings need to be considered in the context of an ever-increasing obesity epidemic and the various obesity-related adverse health outcomes, including type 2 diabetes, cardiovascular diseases, and all-cause mortality.


Two key limitations of the study were that data on participants' physical activity and actual dietary intake were not reported, raising questions about adherence to the intervention diets and how nutrient intake levels compared between groups. Additionally, biomarker data, such as circulating 25-hydroxyvitamin D levels, were not measured. They could have provided valuable information about effects on nutritional status. The bottom line is that the researchers say caution is warranted when implementing severely restrictive diets in postmenopausal women, "especially in those with osteopenia or osteoporosis, for whom concurrent bone-strengthening treatments (eg, muscle strengthening exercises) are recommended."


Sources: Seimon RV, et al. JAMA Network Open 2019;2(10):e1913733; Steur M. JAMA Network Open 2019;2(10):e1913752.



The US Department of Agriculture has announced $23.5 million in grant funding awards through the Farmers Market Promotion Program and Local Food Promotion Program. The programs, part of the Local Agricultural Marketing Program authorized by the 2018 Farm Bill, each distributes approximately $11.75 million, and both require 25% applicant matching funds. The USDA said the Farmers Market Promotion Program received 183 applications, of which 49 projects were funded. For the Local Food Promotion Program, the USDA received 215 applications and funded 42 projects.


A few of the projects funded by Farmers Market Promotion Programs include the following:


* Sustainable Economic Enterprises of Los Angeles will launch the first mobile farmers' market app and delivery service in Southern California.


* Farmshare Fresh for Less Mobile Markets project in Austin, Texas, connects consumers to local producers by sourcing, aggregating, and marketing local produce, along with healthy grocery staples, directly to customers. The markets currently operate 7 sites and will expand to 14, in 2020.


* Global Garden Refugee Training farm in Montgomery, Illinois, proposes to improve food safety practices and increase earnings from direct-to-consumer produce sales for 6 displaced refugee farmers who have established incubator plots at the program farm



A few of the projects funded by the Local Food Promotion Program Project include the following:


* Davis, California, Community Alliance With Family Farmers will build farmer capacity; increase market access and supply; build food hub viability via training, purchasing planning, new sales, and food safety support; and support more institutions to purchase local foods through technical assistance and brokered connections


* Colorado Springs, Colorado, Bytable, Inc, will refine a scalable infrastructure model for online sales for regional and local food businesses; and


* Fort Pierce, Florida-based Treasure Coast Food Bank will utilize its Florida Agriculture and Nutrition Collaborative Food Production Facility to provide small-scale local and regional farmers and growers with new and strengthened market opportunities by increasing regional consumption of and access to 5 million pounds of locally and regionally grown produce.