Appetite Short News: Pavlovian Conditioning at Work in the Obese | Polydextrose as a Satiety Promoter | Parents, Just Like Their Kids, Fall for All the Tricks of the Food Industry

Too lean for Pavlovian Conditioning.

In today's "appetizing" installment of the short news, I have picked three of the latest publications from the scientific journal Appetite, of which I thought that they were newsworthy. In that, I cover the Pavlovian Conditioning of overweight individuals, the benefits of polydextrose on appetite control and the way product labels fool parents and children into buying unhealthy foods.

I have to admit: It's not all practically applicable, but who knows maybe you can use it to smart-ass during the holidays. Or maybe you bake some polydextrose enhanced super-satiating cookies for your family, ha?

More facts for your smart-ass sessions on the holidays ;-)

Bugs Dictate What You Crave

Sweeteners & Your Gut

Foods, Not Ma- cros for the Gut

Lactulose For Gut & Health

Probiotics Don't Cut Body Fat

The Macrobiotic MaPi2.0 Diet

• Hedonic food cue conditioning in the obese: You know the story about Pavlov's dog starting to salivate, when the bell rang that would usually accompany his next feeding?
  
  Well, a recent study confirms that something very similar is at work in obese, but not lean subjects. While the former remain calm and cool to a visual cue that had previously been given alongside some tasty chocolate milk, the latter began to swallow, a reliable sign of increased salivation. As the scientists from the Allaint International University in San Diego say, these "
  

  are the first results to show differential acquisition of Pavlovian conditioned responding in overweight individuals compared to lean individuals" (Meyer. 2014)

  The fact that the conditioning worked was yet not the only significant finding, Meyer et al. made. They also observed that hedonic food stimuli were significantly more effective 'conditioners' in the obese than neutral stimuli.
  
  Practically speaking the observations the researchers from the Allaint International University in San Diego made, may partly explain the difficulties obese individuals who may have been conditioned / conditioned themselves to hedonic food stimuli for their whole lives have when it comes to controlling their energy intake.
• Polydextrose as a satiety promoter: In their meta-analysis of the current literature on the effects of polydextrose on energy intake, researchers from the US and Finland found that...
  
  • polydextrose consumed with a mid-morning snack reduces energy intake (EI) at lunch time.
  • this reduction in EI at lunch time occurs in a dose-dependent manner.
  • but the energy intake during the rest of the day did not show any difference
  Now this probably wouldn't be newsworthy, then, if a a regression model had not been able to confirm a dose-dependent effect on the reduction of daily energy intake.

Added polydextrose reduces the insulin response to milk (Lummela. 2009)

What exactly is polydextrose? Polydextrose is a glucose polymer that is completely soluble in water. As a food additive it offers the texture of sucrose but provides only 25% of the equivalent energy, or 4 kJ/g. It has been approved for use in foods in over 60 nations and is recognized as a dietary fiber in more than 20 countries (FAO/WHO, 2009). Next to the reduced energy content it has another benefits of the fibrous substance is that its addition to foods like milk can reduce the insulinogenic response to this meals significantly - even in healthy individuals (Lummela. 2009).

• More specifically, the meta-analysis was able to show that the dose of polydextrose consumed correlated significantly with the reduction of nergy intake at lunch (−0.67 Polydextrose (g/day) | 80% correlation; P < 0.01), due to which the energy intake was reduced by 1% per 2.86g of polydextrose per day.
  
  As Ibarra et al. point out, the sex-specific results are consistent with results for the whole group - the effect is thus similarly pronounced in both men and women. Accordingly, the meta-analysis "supports the notion that the consumption of polydextrose reduces voluntary energy intake at a subsequent meal" and that "this reduction in energy intake occurs in a dose-dependent manner" (Ibarra. 2014).
• Parents of preschool children make (non-)sense of front-of-package visuals and claims on food - A recent study from the Colorado State University and the University of Illinois at Urbana-Champaign investigated what parents make of the colorful packaging of foods their kids like to buy and found that most of them tend to "accept misleading front-of-package claims when making quick food decisions" (Abrams. 2014).
  
  

  

  Parents fall for unwarranted claims, and misleading images children for cartoons.

  While playful visuals appeal to children, parents associate them with junk food. That does yet not mean that they would not fall for health claims, realistic graphics, and natural claims which make them classify the junkfoods that were investigated in the study at hand as healthier.
  
  Fruit graphics in particular were misunderstood to indicate that the respective foods actually contained fruit, when they were simply meant to communicate flavors, instead. Against that background it's not surprising that the unsettling result of this study in 28 women and 2 men revealed that "[parents may make unhealthy food choices as a result of front-of-package information" (Abrams. 2014).

Intensity is key to reduce the exercise induced increase in appetite | more

Bottom line: I understand very well that for most of you only news item #2 is of practical value. Item #1, on the other hand, is rather a description of the misery than a solution and #3 is something that you as a SuppVersity reader probably knew, already... that being said, simply adding more polydextrose to the foods dumb parents buy for their kids because there are fruits on the packaging is not going to help their kids becoming overweight adults who begin to salivate, whenever they see the right food cues. A long-term solution to the problem would thus have to start with the production of healthier foods by the food industry and the education of the public who would then no longer fall for the unwarranted health claims on the packaging of children and adult food products | Comment on Facebook!

References:

• Abrams, Katie M., Caitlin Evans, and Brittany RL Duff. "Ignorance is bliss: how parents of preschool children make sense of front-of-package visuals and claims on food." Appetite (2014).
• Ibarra, Alvin, et al. "Effects of polydextrose on different levels of energy intake: a systematic review and meta-analysis." Appetite (2014).
• Lummela, Netta, et al. "Effects of a fibre-enriched milk drink on insulin and glucose levels in healthy subjects." Nutrition journal 8.1 (2009): 45.
• Meyer, Monica D., et al. "Pavlovian conditioning to hedonic food cues in overweight and lean individuals." Appetite (2014).

43% More Protein 10x Higher 24h Net Protein Retention: It Takes 0.32g/kg Whey + Casein Post Workout to Establish a Positive Nitrogen Balance After Running + Cycling Ex.

The kids who were the subjects in the study at hand didn't lift. They ran and cycled and still ended up in a positive nitrogen balance - thanks to post-workout protein supplementation.

As a SuppVersity reader you are familiar with the results of previous studies investigating the effects of post-workout protein ingestion. Studies that revealed that it takes ~20-30g of whey protein to maximize acute protein synthesis in adults.

In an upcoming issue of the Journal of Applied Physiology researchers from the Nestle Research Center are now about to publish what I believe is a unique study investigating the net protein balance (=synthesis minus breakdown) over 8h and 24h after the workout in response to the ingestion of different amounts of whey + casein (at a 1:4 ratio) immediately after a standardized running and cycling intervention (Moore. 2014)

You can learn more about protein intake at the SuppVersity

Protein Timing DOES Matter!

5x More Than the FDA Allows!

Protein requ. of athletes

High EAA protein for fat loss

Fast vs. slow protein

Less Fat, More Muscle!

In contrast to "the average" protein synthesis study, the study at hand didn't just use an unusual subject group consisting of 6 female and 7 male kids (mean age 11.7 years), the type of exercise and the method the scientists used to determine the usefulness of the low (0.75g/100ml) and high (1.5g/100ml) protein beverages were different as well.

Figure 1: Graphical overview of the study design (Moore. 2014)

In view of the recently flaring doubts about the significance of post-exercise acute net protein synthesis as a predictor of training-induced muscle synthesis and the existing evidence that there is no reliable association between the wto (Mitchell. 2014), it is particularly interesting that the team Swiss US, and Canadian researchers measured both, protein breakdown and synthesis, which were calculated by measuring the concentration of the major nitrogen-containing metabolites urea and  creatinine were determined in the urine of the subjects, to determine the net protein retention, i.e. the amount of protein that actually remained in the system for 8h and 24h, respectively.

Overview of the total energy and macronutrient intake (Moore. 2014)

Strict dietary control is another strength of the study at hand, which was part of a larger investigation the data of which has not yet been published: Participants were provided with a controlled diet for the 24h period during which protein metabolism measures were performed. Resting energy requirements were estimated using standard equations and were corrected with an activity factor of 1.5.

Aside from the energy and macronutrient profiles of the test beverages, the 24h controlled diets were supplied as isoenergetic breakfast and lunch meals (consumed within the laboratory providing ~11 and 40% of 24h energy intake, respectively) and dinner meals (consumed outside the laboratory providing ~35% of 24h energy intake) with the remaining ~14% of energy coming from the test beverages. The breakfast, lunch, and dinner meals were also isoprotein and provided ~15, 45, and 40% of the 24h food protein intake, respectively, with the test beverages providing a variable amount of protein in addition to the meal protein intake.

As you can see in Figure 2 the results were not extremely different from what we already saw in the previously mentioned acute protein synthesis studies. Only the high dose protein supplementation that contained 12.8 ± 3.6 g protein (i.e. 0.32 ± 0.07 g/kg and thus ~25.6g for a 80g human being) supplement established a significantly increase in net protein balance.

Figure 2: Protein breakdown, synthesis and net protein balance over 24h (Moore. 2014)

If you take a close look at the left columns of Figure 2 you will even see that the 24h net protein metabolism was in fact slightly negative. Moreover, the study confirms what you've previously read here at the SuppVersity an increase in protein availability is - specifically at stable total energy intakes - always associated with an increase in protein breakdown.

Last but not least it may be important to mention that the total protein intake was (a) not extremely different between the three groups (see figure in "tight dietary control" box) and that (b) it was actually below the kids habitual protein intake of 1.56g/kg which would suggest that it is unlikely that some sort of accommodation effect may occur over time.

Nice, but what are the implications? Stick to your 30g post-workout whey protein shake. It's unlikely that this is less effective than a whey + casein combination as it was used in the study at hand if you make sure to follow your PWO shake up with a high protein meal (at least 10g of EAAs) within 2h after your workout. If you can't do that, I would rather add another 10g of casein on top of the 30g of whey - it's after all the leucine in whey that triggers the additional increase in protein synthesis after a workout.

Speaking of protein intake: Eventually we cannot say, though, what kind of protein we are talking about, here. As limited as the direct quantification of acute myofibrilar (or sarcoplasmic) protein synthesis may be, it has one major advantage over the method that was used in the study at hand: it is muscle specific.

In contrast, measuring the nitrogen metabolites in the urine, which was the method of choice in the study at hand is not muscle-specific. If it wasn't for previous evidence from the previously criticized, but by no means useless studies that investigated the acute myofibrilar protein synthesis in response to exercise we could thus argue that the difference in net protein balance is due to the exercise induced protein loss in the liver (Millward. 1982) or the gastrointestinal tract (de Oliveira. 2009). The way it is, we can yet be more or less sure that most of the protein will have ended up in the muscle | Comment on Facebook!

Reference:

• de Oliveira, Erick Prado, and Roberto Carlos Burini. "The impact of physical exercise on the gastrointestinal tract." Current Opinion in Clinical Nutrition & Metabolic Care 12.5 (2009): 533-538. 
• Millward, DAVID J., et al. "Effect of exercise on protein metabolism in humans as explored with stable isotopes." Federation proceedings. Vol. 41. No. 10. 1982.
• Mitchell, Cameron J., et al. "Acute Post-Exercise Myofibrillar Protein Synthesis Is Not Correlated with Resistance Training-Induced Muscle Hypertrophy in Young Men." PloS one 9.2 (2014): e89431.
• Moore et al. "Post-exercise protein ingestion increases whole body net protein balance in healthy children." J Appl Physiol (October 23, 2014). Article in press.

Childhood Asthma: Children Born to Mothers Who Consume Semi-Skimmed Milk 8% More Likely, Kids of Whole Milk Drinking Mothers 15% Less Likely to Develop Asthma

Image 1: Better make sure your "mother's milk" (the milk you drink while you or your significant other are pregnant) is full fat!

I don't know if you have listened to my "brother" Carl Lanore's Super Human Radio interview with Boyd Eaton, yesterday, but if you did, you will probably remember that the two also broached the issue of dairy consumption on a paleo diet. And while many of you may have been surprised to hear that Eaton does consume milk products on a regular basis, it is probably even more intriguing that the show came full-circle only a couple of minutes later, when Carl who had just addressed the issue of iron-overload and how that relates to the relative abundance of meat in an ancestral diet, read my facebook message about the beneficial effects of milk proteins, Zunquin et al. observed in a 2006 trial rodent trial intended to simulate the potential side effects of high dose iron supplementation to replete iron stores in iron-depleted athletes (Zunquin. 2006).

Milk allergy or allergy due to the lack of full-fat milk - is that the question?

Yet while the Zunquin study is by no means the only scientific evidence that nature's original meal replacement, irrespective of whether or not it may be "intended for human consumption" can exert potent health effects (cf. Barfray. 2003), the pros and cons of a high(er) intake of dairy is still a matter of constant debate. Other than within the paleosphere, the public and scientific debate does yet usually revolve around the notion of low- vs. high fat dairy, with the common recommendation to "choose low fat dairy in order to avoid the unhealthy saturated fats that come with the full-fat variety".

Figure 1: Associations between mothers' consumption of milk and dairy during pregnancy and incidence of early childhood asthma (18 months) in children from the Danish national Birth Cohort; data expressed as differences to no-consumption (data based on Masolva. 2012)

Aside from the downside of non-existent yet potentially healthy levels of certain fatty acids, such as conjugated linolic acid (yeah, the one that can kill empty fat cells, cf. "Nasty Insights into the Yo-Yo-Effect: Lower Body Fat Sticks and From Fit2Fat There's no Easy Way Back!"), the reduced absorption and presence of fat-soluble nutrients and the necessity to add sugar or artificial flavors, as well as chemicals to modify the taste and mouth-feel of those watery low-fat dairy products, a recent study from Department of Nutrition at the Harvard School of Public Health in Boston does now provide compelling evidence that either one or all of the former aspects, or a hitherto not elucidated difference between skim and full-fat dairy products increases children who are born to mothers who consume >5 portions of semi-skimmed milk per week during their pregnancy have an 8% increased risk of developing childhood asthma and a 40% increase in risk of developing allergic rhinitis later in life (Maslova. 2012).

Table 1: If you are interested in other sources of CLA (and omega-3), in general, and the difference between grass- and grainfed beef, in particular, check out this table from a Daley et al. (Daily. 2012)

What's even more intriguing, though, is that the consumption of equal amounts of full fat milk was associated with a statistically significant 25%(!) reduction in asthma-risk (and recurrent wheeze symptoms) in the ~60,000 children / mother pairs from the dataset of the Danish National Birth Cohort the US scientists analyzed. Similarly, there was a

"dose–response was present for semiskimmed milk intake, while any intake of full-fat yoghurt appeared to be protective of child asthma" (Maslova. 2012)

that did, just as the aforementioned results, remain significant, even when the data was adjusted for the intake of other allegedly beneficial foods (fruit and vegetables) and nutrients (vitamin E, vitamin D, Se, Zn from diet and supplements).

So are those the CLAs and other ruminant trans-fats?

While Malsova et al. fail to give a clearcut answer on what the underlying reasons for these observations are, their detailed analysis of the data does yield some evidence that CLAs and other ruminant trans-fatty acids cannot explain the differences, as they showed similar correlations with both full-fat and semi-skimmed milk intake and were "not associated with either the early or later childhood outcomes" (Maslova. 2012).

Image 2: Not, not all full-fat milk drinkers worked on a farm ;-)

An analysis of other potentially confounding lifestyle factors yielded similarly inconclusive results so that this leaves us without a causal explanation for either the protective effect of whole milk and full-fat yogurt intake on early childhood asthma or the increased risk to develop wheeze at 18 months in children born to high consumers of semi-skimmed milk. In the absence of any information of what happened in the course of the following 7-years it appears futile come up with any hypothesis that would explain the direct associations of maternal low-fat yoghurt consumption with child asthma and allergic rhinitis and the "suggestive" relationship of the latter with total milk intake, anyways. And as the scientists say:

The diversity and complexity of our results make it difficult to interpret and propose a single agent mechanism, yet the consistent associations with low-fat yoghurt for later childhood outcomes suggest that compounds specific to this food, such as artificial sweeteners, may play a role.

Interestingly, they specifically refer to the use of aspartame as the "primary" artificial sweetener in the Danish food supply since the 1980s, but cite a - at least in my humble opinion - highly biased source (Gideon. 2010) on that issue without even providing a single scientific study that would implicate aspartame as a factor involved in the etiology of asthma (+my brief research shows, there is none).

Image 3: Too much statistical shenanigan involved in the ER data for my liking.

A note on additional data evaluated in the study: The scientists make use of the actual hospital admissions due to asthmatic reactions as another source for their study data. Unfortunately, those only contribute to the already confusing results, because they suggest that despite the fact that the incidence of early childhood asthma is lower (other data), the chance to end up in hospital, as assessed by data from the Danish National Patient Registry appears to be higher in children born to mothers with a high full fat milk intake (+30%), and minimally reduced for children whose mothers consumed the same amount of skimmed dairy - it is however questionable how reliable this 3rd hand data which had to be linked back to the central person registry first and ran through multiple processing steps actually is (same for data from the Register of Medicinal Product Statistics).

As far as the underlying mechanisms are concerned this leaves us with but one relatively certain conclusion: The scientists' initial hypothesis that ruminant trans-fatty acids could play a causal role in the development of allergic disease development cannot be upheld in view of the inverse associations Maslova et al. found between the CLA content and the risk to develop asthma and/or allergic rhinitis across products with different fat content.

Suggested reading:

• Ask Dr. Andro: Are Colostrum and Milk Products in General Healthy Muscle Builders, a Waste of Money or Toxic Waste? 
• Whey and Casein Work Hand in Hand for Protein Anabolism, but Scientists Overlook Fat, When They Reassemble Milk  
• Coke vs. Diet Coke vs. Milk - The "Unhealthy Beverage Shoot-Out": Milk Reduces, Coke Increases Visceral Fat. Dreaded Diet Coke on Par With Plain Water  
• The Fat Truth Behind the Dairy Weight Loss Miracle: MUFA and PUFA Impair, Saturated Fat and Plenty of Micronutrients Drive Full-Fat Dairy-Powered Fat Loss. 
• Want B12, But Hate Meat? Drink Milk! SNAC-Fortified Cyanocobalamin 136% More Bioavailable Than Standard B12 - Still Less Effective Than B12 From Cow's Milk

References:

1. Bartfay WJ, Davis MT, Medves JM, Lugowski S. Milk whey protein decreases oxygen free radical production in a murine model of chronic iron-overload cardiomyopathy. Can J Cardiol. 2003 Sep;19(10):1163-8. 
2. Daley CA, Abbott A, Doyle PS, Nader GA, Larson S. A review of fatty acid profiles and antioxidant content in grass-fed and grain-fed beef. Nutr J. 2010 Mar 10;9:10.
3. Gideon B (2010) Aspartam: Nu også i ikke ‘Light’ produkter. < http://infowars.dk/content/aspartam-nu-ogs%C3% A5-i-ikke-light-produkter > last accessed on July 10, 2012
4. Maslova E, Halldorsson TI, Strøm M, Olsen SF. Low-fat yoghurt intake in pregnancy associated with increased child asthma and allergic rhinitis risk: a prospective cohort study. Journal of Nutritional Science (2012), vol. 1, e5.
5. Zunquin G, Rouleau V, Bouhallab S, Bureau F, Theunynck D, Rousselot P, Arhan P, Bougle D. Iron and exercise induced alterations in antioxidant status. Protection by dietary milk proteins. Free Radic Res. 2006 May;40(5):535-42.

The Soy Formula: Pregnant or Lactating Mother + Soy = Metabolically Deranged Male Offspring

Image 1: Newsweek title from the
year 2000 - "Fat for Life?"; did his
mother love her soy protein more
than her son's health?

Those of you who listened to my dissertations on yesterday's fourth installment of the Amino Acid Series on Carl Lenore's Super Human Radio will probably remember the lack of carnitine in the not-yet-enriched soy based baby-formula of the late 1970s. Now, a recently published rodent study suggests that the negative effects of soy may well begin before the offspring is even born: Exposure of pregnant and lactating rats to a soy (vs. a casein) based diet "increased the presence of the characteristics of the metabolic syndrome in the offspring" (Jahan-mihan. 2011).

In the course of their study, the results which was published in the latest issue of the British Journal of Nutrition, the scientists randomly assigned pregnant rats (at day 3 of gestation) to one out of two calorically identical diets, which different only with regard to the source of their protein content. While half of the rats were fed a soy based formula, the other half received a casein based diet.

Figure 1: Amino acid composition of the cystein- (C) and cystein+methionine (S) fortified (indicated by the asterisk) casein (C) and soy-based (S) diets rat dams and their offspring were fed in the course of pregnancy and lactation and weening, respectively (data adapted from Jahan-mihan. 2011).

The whole study consisted of two almost identical test series, which lasted 9 (Exp. 1) and 15 weeks (Exp. 2) and provided unambiguously detrimental results for the male pups :

In Expt 1, pups born to S-fed dams had higher fasting blood glucose (BG), systolic blood pressure (SBP) and diastolic blood pressure (DBP) at week 4, higher blood glucose (BG) response to a glucose administration (P,0·001) and higher body weight (BW) at week 8 (P,0·05). In Expt 2, consumption of the S diet throughout gestation and lactation resulted in higher BW (P,0·05), DBP (P,0·005) and SBP (P,0·005) in the offspring. They also had higher homeostasis model assessment of insulin resistance (HOMA-IR; P,0·05) and plasma homocysteine (P,0·05) at weaning, higher fasting BG and glucose response to glucose administration (P,0·005) at week 12 and higher HOMA-IR (P,0·01) at week 15.

It goes without saying that in absence of other variables, either the amino acid composition or the genistein, daidzein and glycitein content of the soy diet must have been responsible for the metabolic priming towards high blood pressure, obesity and diabetes.

Figure 2: Relative elevation of glucose, insulin, HOMA-IR (marker of insulin resistance) and corticosteroids (stress hormones) in offspring of soy-fed rats compared to pups of casein-fed mothers at different time-points in their lives (data adapted from Jahan-mihan. 2011).

In that it is worth mentioning that the extension of the duration of the soy feeding from gestation in experiment 1 to gestation + lactation in experiment "resulted in a more robust effect of the S diet on BW, body composition and glucose metabolism in the offspring". These results contradict the hypothesis "that offspring weaned to similar diets as their mothers will adapt more appropriately to their postnatal environment"; an observation a cynic may comment with the words: 'I guess, they did not have enough time for genetic adaption'.

As far as the underlying reasons for these detrimental effects of a soy-based pregnancy and lactation diet go, the scientists argue that bioactive peptides such as valine–proline–proline and isoleucine–proline–proline, which are present in casein, but are not contained in soy proteins, may play a factor. On the other hand, Jahan-mihan et al. discount the isoflavone content of the soy protein (36.1, 31.3 and 4.4µg/g for Genistein, daidzein and glycitein, respectively) as potential cause of the metabolic derangement, because "the genistein content of the S diet was 36 µg/g of the diets, well below that reported (250 mg/g diet) in the maternal diet to affect epigenetic and phenotypic changes in mice". The latter, however, makes me question the reasons, the researchers had to chose exclusively male pubs in their study!? What if not the phytoestrogens in soy would whack up the male pups endocrine system? Be that as it may, if you are a mother to be, you better not make soy protein your no.1 source of dietary protein, in order not to set your children up for high blood pressure, obesity and diabetes in their later lives.

Baby Weight and Depression? It Doesn't Have to be the Treadmill: 11% and 8% Less Body Fat with Resistance and Flexibility Training Within 4 Months Postpartum

Image 1 (ezineMarks.com): Heidi Klum certainly deserves respect to go from left to right within 5 weeks, but not every woman has a fitness trainers and chefs to make that possible.

I know, this may not be a "regular" SuppVersity post; and no, I am not becoming a father, but I still found that the results of a recently conducted trial by J. D. LeCheminant et al. from the Brigham Young University in Provo, Utah, deserved some attention. After all you will usually be confronted with the notion that those celebrity moms run around for (or four?) hours every day to starve themselves back into their size zero jeans within possibly record-braking time (see "The German Fräuleinwunder", Heid Klum in image 1). In fact, breastfeeding alone is associated with a ~618 kcal increase in energy expenditure per day alone would be way above my usual recommendation not to go below a -20% reduction in calorie intake, when you are dieting in order to preserve precious muscle tissue, and should thus well suffice to get you my dear mothers back in shape in no time, even if you did not work out, at all (Thomson. 1970).

Do it like Heidi: Breastfeed and lift weights, as long your baby is still too light to be lifted ;-)

Six weeks after they had given birth and thus way later than Heidi Klum, for example, the young mothers (mean age: 26 years) who had been recruited by LeCheminat and his colleagues from the local community were randomized to one out of two study groups:

Does resistance training increase fertility I guess, this has little to no statistical significance, but upon reviewing the 'collateral' data from the study, I realized that 10% of the women in the RT group withdrew from the study due to another pregnancy. In the FT group, on the other hand it was not a single one. Probably just coincidence (or a side effect of feeling strong and sex?), but interesting, nonetheless ;-)
1. resistance training (RT) - nine exercises (leg extension, seated leg curl, leg press, biceps curl, shoulder press, chest press, lat pull-down, seated row, and abdominal curl-ups) for all major muscle groups, 1–3 sets per exercise (increasing from month 1-4), 90-s rest interval between sets, and 8–12 repetitions per set performed on 2 nonconsecutive
   days per week at a local physical therapy
2. flexibility training (FT) - the protocol was based on the recommendations from the American College of Sports Medicine Position Stand (1998) and included static stretching, four stretches (sets) per major muscle group, and holding each stretch for 10–30s; participation in group stretching once per week was optional

At baseline, 2 months, and 4 months, all participants were tested for strength, flexibility, exercise self-efficacy, depressive symptoms, and objectively measured PA. Body composition (DXA) was assessed at baseline and 4 months. Another parameter that may well be of interest yet was not included in the later  statistical analysis is the breast feeding rate, of which the scientists state that despite the fact that "most" (95%) were breastfeeding, only...

56% were breastfeeding exclusively, 33% combined infant formula with breastfeeding, and 7% combined some solids with breastfeeding. The remaining two participants did not report the extent of breastfeeding combined with formula or solids.

Obviously the statistical power would have been too low for significant results here, anyway, but I would still have been interested if there was - as I would speculate a certain trend for "exclusive breast feeders" to lose their 16kg of pregnancy weight faster than their "formula assisted" peers.

Figure 1: Changes in body composition from begin to the end of the study period (based on LeCheminan. 2012)

Apropos losing weight, as the data in figure 1 clearly indicates that worked almost magically for women in both groups.Although the changes are obviously slightly more pronounced and despite the fact that the women in the RT group quadrupled (+300%!) the amount of vigorous activity they performed on a weekly basis while the women in the FT group increased their vigorous activity levels by "only" 50%, these differences did not reach statistical significance. This does yet not mean that someone who strength trains cannot see better results (especially in the mirror) compared to someone who is just doing some stretches, it does however underline how returning to normal eating habits staying generally active and not sitting depressed next to your child and in front of the television all day long alone, can already help you, your wife, friend or relative get rid of much (~60%) of the 6.5kg the women in the stud had retained of their 16kg of pregnancy weight even postpartum in only 4 months.

Image 2 (TopNews.in): Light resistance training is good for mothers to be and  has no detrimental effects on unborn children.

Working out during pregnancy? Contrary to common believe, a light to moderate strength training workout (35-40min) performed three times per week over the second and third trimester of pregnancy does not have a negative impact on the newborn's body size or overall health (Barakat. 2009). On the contrary, it could help "attenuate the adverse consequences of maternal body weight gain" (Barakat. 2009) and "eliminate or significantly reduce the need for insulin in women with GDM [gestational diabetes]" (Brankston. 2003) - prepartum obesity prevention for you and your child, what more can you ask for, ladies?

Moreover, the women in the RT group however had so profound strength increases, especially in the midsection, that they probably could not only keep pace with, but have probably easy surpassed the weight development of their infants.

Figure 2: Strength development (rel. change vs. baselin) during the 4-months study period (based on LeCheminan. 2012)

What's the use of that? Well aside from probably being stronger (and sexier) than before the pregnancy the fortified midsection, will safeguard these mothers from the dreaded backaches, many of them develop as a consequence of carrying their increasingly heavier toddlers around. Against that a couple of pounds of body fat less may eventually reveal a set of chiseled abs is nothing but a welcome side effect of which I personally feel that it is not absolutely necessary for a woman.

Bottom line: If you want to get in shape after a pregnancy,...

Image 3 (MusclePharm): Regardless of what you think about their products. MusclePharm's advertising guys certainly have their finger on the pulse of the time: A time, where the previous perception of skinny women = sexy women begins to tumble - if you asked me, I'd say it was about time for that to happen! Strong is the new sexy (baby?)!

It is not necessary to starve yourself and your baby (you can hardly expect to have enough breast milk on a low-fat 800kcal diet, can you?) hand it over to granny and do 4h on the treadmill every day. You better get yourself a gym membership, find new friends and train your whole body at least two times a week. That will not only make your mother (or mother-in-law) your toddler and husband happy it will also help you to come to terms with your new self, which - if you do it correctly - will be stronger, healthier, sexier and happier than before, as a side-finding of the study was that the "sedentary time and light-intensity PA time improved to a greater extent in the RT group than the FT group" indicating that resistance training, but not flexibility training "would result in improved confidence to perform PA following childbirth and perhaps facilitate behavioral change toward a sustained increase in spontaneous PA" (LeCheminant. 2012) as it was proposed by Schmitz et al in another context (Schmitz. 2003) and could thus have exponentiated the direct effects of strength training by indirect / downstream effects which counteract the general tendency towards a sedentary, non-active lifestyle in our society.

References:

1. Barakat R, Lucia A, Ruiz JR. Resistance exercise training during pregnancy and newborn's birth size: a randomised controlled trial. Int J Obes (Lond). 2009 Sep;33(9):1048-57. Epub 2009 Jul 28.
2. Brankston GN, Mitchell BF, Ryan EA, Okun NB. Resistance exercise decreases the need for insulin in overweight women with gestational diabetes mellitus. Am J Obstet Gynecol. 2004 Jan;190(1):188-93.
3. Lecheminant JD, Hinman T, Pratt KB, Earl N, Bailey BW, Thackeray R, Tucker LA. Effect of resistance training on body composition, self-efficacy, depression, and activity in postpartum women. Scand J Med Sci Sports. 2012 Jun 28.
4. Schmitz KH, Jensen MD, Kugler KC, Jeffery RW, Leon AS. Strength training for obesity prevention in midlife women. Int J Obes Relat Metab Disord. 2003 Mar;27(3):326-33.
5. Thomson AM, Hytten FE, Billewicz WZ. The energy cost of human lactation. Br J Nutr. 1970 Jun;24(2):565-72.

Ketogenic Dieting and Vitamin & Mineral Imbalances!? Differential Effects of Classical Ketogenic and Medium Chain Triglyceride Ketogenic Diet on Vitamin and Mineral Status in Children

"Keto diets are unhealthy! You simply do not get enough quality nutrients if you do not eat your healthy pasta, bread and other starchy carbs." I suppose many of you - just like me - cannot tolerate the black-and-white thinking of either of the two, the high or the low/no carb camp and are thus as interested in the recently published results from a 12 month dietary intervention using either a classical ketogenic diet (Christodoulides. 2011), which uses long chain triglycerides as its primary source of fatty acids, or a medium chain triglyceride ketogenic diet, where the majority of fatty acids came from MCT oils [unfortunately the scientists used Liquigen or MCT oil (both SHS International) instead of a natural source of MCTs, like coconut oil] on vitamin and mineral status of 49 children (age 2-16 years).

Although the results are somewhat skewed due to the extensive use of supplements - apart from the MCT oil in the MCT group, all children received an additional mulit vitamin [either Forceval Junior capsules (Unigreg, Morden, UK) or Phlexy-vits powder sachets (SHS International)], the results (cf. figure 1) suggest that, after all, ketogenic dieting cannot be that detrimental to you vitamin and mineral status as one might expect.

Figure 1: Effects of 12 month on classical or MCT based ketogenic diet on vitamin and mineral status in 49 children.
(data adapted from Christodoulides. 2011)

It is particularly interesting that while vitamin E increased dramatically in the long-chain fatty acid fed "classical keto" group (no wonder in view of the amount of vitamin E present in most long-chain seed oils), the vitamin A level in that group dropped similarly dramatically.

In comparison, the changes in Zinc, Selenium and Magnesium appear to be negligible. In the case of magnesium the observation that

the pairwise comparison with baseline in children who provided data at both time points showed a significant decrease at 3 and 6 months and a highly significant decrease [of magnesium levels] at 12 months

especially in the classical diet is a cause of concern for "those using the diet to treat children with intractable epilepsy", where low(er) magnesium levels appear to correlate with seizures and magnesium supplementation is used as part of the common treatment strategy.

I leave it up to you to decide, whether your think that either a classical or, let alone, a MCT based (with MCTs from supplements instead of whole food sources) diet can be more than a temporary intervention or treatment strategy. Despite the positive evidence that you won't die from mineral insufficiencies or vitamin deficiencies within 12 month of vitamin and mineral supplemented (I assume every keto dieter will take a good multi vitamin anyway) ketogenic dieting, I am still not even remotely considering this to be an option for me.

Sunlight, L-Tryptophan & Vitamin B6 With Breakfast Increase Serotonin and Wakefulness During the Day and Melatonin and Restful Sleep at Night

Image 1: For these kids the high tryptophan + B6 breakfast would be useless unless they already got their 10min+ of direct sun exposure this morning

A recently published study that was conducted by a team of international researchers led by Miyo Nakade from the Gakuen University in Nagoya, Japan (Nakade. 2012), concludes that sunlight exposure and vitamin B6 and l-tryptophan intake with breakfast could be profound modulators of circadian rhytmicity in young children (N=816, age = 2-6 years). The results the researchers published in the latest issue of the Journal of Physiological Anthropology clearly suggest that the increased production of serotonin from l-tryptophan and the vitamin B6 metabolite pyridoxal 5’-phosphate (also known as PLP or p5p) exerts beneficial effects on the morningness-eveningness (M-E) score - a measure for the natural and highly desirable difference in wakefulness in the morning and sleepiness in the evening, the disturbance of which is among the emerging correlates of metabolic diseases, such as diabetes, obesity and abnormal lipid metabolism.

[C]hildren showed a tendency to be more morning-typed if they ate breakfast with
a high estimated Trp content. This study also confirmed a similar trend with estimated Vi-B6
content. Among essential amino acids, the Trp content in food is quite small, and thus it is
necessary to make a special effort to consume a sufficient amount in one’s diet.

That those foods with specifically high tryptophan content are, as so often, eggs, meats, and fish is something I probably don't have to tell you - just as I don't have to tell you that soybeans, and other soy products, which also contain significant amounts of tryptophan should not constitute a major part of your diet; regardless of whether you are a man or a woman.

Sunlight must not be hidden behind curtains or seen just through the windows your car

Interestingly, all the vitamin B6 and tryptophan in the world appears to be of little use, if you get too little sun-exposure (Rosenthal. 1997). And, now listen up!, they can become disturbed when you sleep with black out curtains and use an alarm clock to wake you up (Harada. 2003) - in how far these effects are mitigated, or even reversed (i.e. using black-out curtains = beneficial) in people who would otherwise be constantly exposed to unnatural light-exposure (e.g. a street lantern right before your window) would require further investigation, though.

Figure 1: Distribution of early birds (low M-E score on the x-axes) and late risers (high M-E score) among the study population (data calculated based on Nakade. 2012).

Anyways, as you can see in figure 1 the effect of the curtains was statistically significant, but not as pronounced as the scientists' emphasis in their report would have it. There are tendencies for more morning types (lower M-E scores) in the children sleeping without blackout curtains, yes. And there are no real evening types in the children sleeping without blackout curtains, but the broad majority falls into the same 18-23 M-E score range on the 7-28 early bird to long sleeper scale Nakade et al. employed.

Vitamin B6 and inflammation: Although this is only indirectly related to the topic of circadian rythmicity and wake-sleep patterns, it is quite intriguing that vitamin B6 is still touted as an anti-inflammatory agent. And though even very recent population based studies confirm that there is in fact an inverse relation of low plasma vitamin B6 and its active metabolite pyridoxal-5-phosphate (PLP) are inversely associated with the "overall inflammation" score in the US population (Sakakeeny. 2012), another recent study by Ulvik et al. clearly suggests that these associations are corollary, at best (Ulvik. 2012). In their trial, the results of which have been published in the May issue of the American Journal of Clinical Nutrition, Ulvik et al. administered 40 mg pyridoxine hydrochloride per day to patients with stable angina pectoris. Contrary to their expectations, this practice did neither replete the low vitamin B6 levels, nor sooth the inflammation. On the contrary, the rapidly metabolized vitamin B6 appeared to preserve or even increased the expression of inflammatory markers.

What's good in the morning won't hurt at night

With tryptophan being a serotonine precursor and vitamin B6 a necessary co-factor in its synthesis, it may come as a surprise that both, and the sunlight induced serotonin synthesis boost can boost "morningness" and make you more alert. After all, you will probably have read on the label of various dietary supplements that tryptophan is supposed to make you sleepy, right? What those labels don't tell you is that the exposure to sunlight and not the shear availability of precursors and co-factors, let alone the position of the hands on your clock modulate its destiny. And determine whether the tryptophan will get you going, as it obviously does in the children with the highest breakfast intake of tryptophan and vitamin B6 (cf. figure 2), or helps you fall and stay asleep at night.

Figure 2: M-E index relative to group mean in high / low tryptophan & vitamin B6 breakfast intake groups (data calculated based on Nakade. 2012)

That both is possible and obviously works quite fine, is thus the main message of this study, the results of which Nakade et al. interpret as direct evidence for the potential usefulness of

[...] a higher Trp and Vi-B6 intake [to] promote the synthesis of serotonin via light stimulation in the morning and have a natural sleep-inducing effect when converted to melatonin at night [and thus] help prevent a phase delay in young children’s circadian clocks and promote their morningness against the effects of the 24-h commercialization of society.

Against the background, that similar improvements have been observed in 35 middle-aged/elderly (aged 55-75 year) volunteers who consumed a tryptophan enriched  (+30mg per serving) cereal at breakfast and dinner for three weeks by Bravo et al. (Bravo. 2012). And since there is no effect without "side effects", I guess I better mention that the Spanish researchers also observed significant increases in

Table 1: Tryptophan content of various foods (in g per 100g, 2nd column), ordered by tryptophan per protein content (3rd column; data based on Wikipedia)

• sleeping time,
• sleep efficiency, and
• immobile time

as well as concomitant decreases in

• sleep latency (almost 25%!),
• wake bouts,
• total activity, and
• sleep fragmentation index

If you take into consideration that their subjects' total antioxidant capacity levels and mood improved, as well and that the treatment elicited a -50% decrease in state anxiety and a significant drop on Beck's Depression Inventory Index, both of which returned to their initial value, when the treatment was seized, it should be obvious that you better make get out in the sun, immediately after you made the right food choices (and no, I am not talking about tryptophan-enriched breakfast cerals, here) at breakfast and watch the sunset after dinner ;-)

References:

1. Bravo R, Matito S, Cubero J, Paredes SD, Franco L, Rivero M, Rodríguez AB, Barriga C. Tryptophan-enriched cereal intake improves nocturnal sleep, melatonin, serotonin, and total antioxidant capacity levels and mood in elderly humans. Age (Dordr). 2012 May 24.
2. Harada T, Matsumura A, Takeuchi H: Effects of the usage of a blacked-out curtain on the sleep-wake rhythm of Japanese University students. Sleep Biol Rhythms 2003, 1:179–181
3. Nakade M, Takeuchi H, Taniwaki N, Noji T, Harada T. An integrated effect of protein intake at breakfast and morning exposure to sunlight on the circadian typology in Japanese infants aged 2-6 years. J Physiol Anthropol. 2009 Sep;28(5):239-45. 
4. Nakade M, et al. Can breakfast Tryptophan and Vitamin B6 intake and morning exposure to
   sunlight promote morning-typology in young children aged 2-6 years? Journal of Physiological Anthropology 2012, 31:11
5. Sakakeeny L, Roubenoff R, Obin M, Fontes JD, Benjamin EJ, Bujanover Y, Jacques  PF, Selhub J. Plasma Pyridoxal-5-Phosphate Is Inversely Associated with Systemic Markers of Inflammation in a Population of U.S. Adults. J Nutr. 2012 May 23.
6. Rosenthal N, Schwartz P, Tumer E, Nalm S, Matthews J, Hardin T, Barnett R, Wehr T:
   The psychobiology of SAD and the mechanism of action of light therapy. Biol Psychiatry
   1997, 42:57S.
7. Ulvik A, Midttun O, Ringdal Pedersen E, Nygård O, Ueland PM. Association of plasma B-6 vitamers with systemic markers of inflammation before and after pyridoxine treatment in patients with stable angina pectoris. Am J Clin Nutr. 2012 May;95(5):1072-8. 
8. Wikipedia contributors. Tryptophan. Wikipedia, The Free Encyclopedia; 2012 May 26, 00:42 UTC [cited 2012 May 27]

Does the Optimal Meal Frequency Depend on Age? Study Suggests: Kids Better Eat Often, Adolescents Rather Step Away From Their Sugary Sins - Quality Counts!

Frequent Meals Are a Good Thing For Young Kids But Not For Older Ones Who Will Self-Select Their Snacks

My recently published article "Many Small Meals Suck! Especially For Diabetics. Human Study Shows 6 Small Meals Mess W/ Blood Sugar Control, Make You Hungry and Decrease The Metabolic Rate" (read more) has caused quite a stir in the comment section on the article page, as well as on Facebook.

Obviously, we are not all the same, and I did never imply that one or another of the the extra-ordinary SuppVersity readers will thrive on a six+ meal a day regimen. What most people who freaked out totally forgot, though, is that said article was not about a study in which the subjects eat as much as they wanted. It was a study with restricted energy intake.

What I really wanted to highlight is thus, that with any diet that delivers less nutrients than you would need in given time period, even a non-significantly higher decrease in basal energy expenditure in response to an increase in meal frequencies is significant! It's significant with respect to the longstanding claim that "eating frequently will keep your metablism running, when you're dieting"... a claim the study by Kahleova et al. would clearly refute.

But enough of these dict chestnuts. Let's take at the latest contribution researchers from the , University of Ulster have recently made to the never-ending debate about the  "optimal" meal frequency (Murakami. 2014; Note: If there is one thing, I can tell you for sure, it's that there is no one-size fits it all optimum!)In contrast to the previously cited study, the study Kentaro Murakami and M. Barbara E. Livingstone published in the 111th issue of the British Journal of Nutrition is based on epidemiological data from British children aged 4 –10 years (n=818) and adolescents aged 11– 18 years (n=818).

You can learn more about meal frequency at the SuppVersity

Grazin' Bad For the Obese!

Breakfast Keeps You Lean?!

Frequent Protein Consumption

Myth: Few Meals More Bodyfat

8 Meals = Stable, But High Insulin

Int. Fasting & Exercise

The scientists assesssed the dietary intake was assessed using a 7 d weighed dietary record. The exact meal / eating frequency (EF) was calculated based on all eating occasions, except for those providing, 210 kJ (57.3kcal) of energy. Based on the available data on metabolic risk factors (i.e. total, HDL-cholesterol and LDL-cholesterol concentrations, TAG concentration, BMI z-score, waist:height ratio, and systolic and diastolic blood pressures), Murakami & Livingstone eventually calculated the age, sex, social class, physical activity, levels, protein, fat, total sugar and dietary fibre intake, as well as ratio of reported energy intake to estimated energy requirement (EI:EER) adjusted adiposity, high blood pressure and cardiovascular disease (CVD) risks for the kids and adolescents.

"Subjects with a higher EF were more likely to be boys (only adolescents), be in nonmanual social class and be physically active (only children). Additionally, EF was positively associated with EI:EER, EI and energy-adjusted intakes of carbohydrate and total sugar and inversely associated with energy-adjusted intakes of protein, fat (only adolescents), starch and dietary fibre." (Murakami. 2014)

What? Well, ok, let's make it easier: The well-off kids ate more frequently and were more active. Boys who were more active ate more frequently.

Figure 1: Difference in macronutrient and total sugar intake between kids and adolescents who eat 3-4 meals per day and those who consume 6 meals or more, i.e. the first and third tertile of eating frequencies (Murakami. 2014)

And, a a closer analysis of the data and the differences in macronutrient composition between the first (3-4 meals per day) and the third (6+ meals per day) tertile in Figure 1 clearly indicate, the frequent eaters consumed...

• significantly more energy (relative to their needs),
• significantly more carbs, and total sugar, as well as
• less protein, starch and dietary fibre

I guess by now you are not surprise to hear that the number of "meals" per day was independently and positively associated with BMIz-score in the adolescent study participants. What may come as a surprise, is the reduced blood pressure in the young(er) frequent eaters - the children (age 4-10), of which the smartest among you will by now already have gathered that it's not the result of frequent eating, but a confounding factor which is like the frequent meals contingent with the increased physical activity ... Yes, right: The athletic kids! I am referring to this ever-shrinking minority of 4-10 years who are actually engaging in physical activity.

Figure 2: Physical activity according to age and meal frequency (Murakami. 2014)

So is inactivity the thing to blame? Probably not! It's not as if the adolescents were less active - on the contrary, the number of very active adolescents is even 11.4% higher than that of the 4-10 year-olds (see Figure 2). It's rather their "advantage" of being old enough to go and buy their own snacks which appears to haunt them. I mean, we all know that many parents have no clue what they are doing, but the obesity-triggering increase in total sugar and total energy intake in adolescents is unlikely that this is exclusively their parents' fault.

Practically speaking have thus arrived at one of the ever-recurring principle of sensible nutrition, here at the SuppVersity: In an unrestricted diet scenario, food quality is the major determinant of health and disease, leanness and obesity.

Reference:

• Kahleova, et al. "Eating two larger meals a day (breakfast and lunch) is more effective than six smaller meals in a reduced-energy regimen for patients with type 2 diabetes: a randomised crossover study." Diabetologia (2014). Ahead of print.
• Murakami, Kentaro, and M. Barbara E. Livingstone. "Associations of eating frequency with adiposity measures, blood lipid profiles and blood pressure in British children and adolescents." British Journal of Nutrition 111.12 (2014): 2176-2183.

Mother's Day Special: 13+ Things Science Has To Tell Us About the First "VIP" in Our Lives

Tell me that's not you! (img. Geeks.Pirillo.com)

While the risk of birth has decreased by 99% in the course of the 20th century, from approximately 850 maternal deaths per 100,000 live births in 1900 to 7.5 in 1982, it is - at least in the US - stagnating ever since (2002 data from the CDC; cf. Chang. 2002). This does not just mean that the Healthy People 2000 objective for maternal mortality of no more than 3.3 maternal deaths per 100,000 live births was not achieved during the twentieth century; it does also mean that your mother - irrespective of your and her age risked her life for you, the very moment you were born. And I am pretty sure that regardless of whether she's had the chance to do just that again, she'd be willing to sacrifice her life, if that would save yours. This alone would be worth cherishing what she has done and hopefully is and will be doing for you on at least one day of the year!

Now, science is a pretty impersonal business and using questionnaires and score-boards to quantify emotions is probably not the appropriate thing to do on Mother's Day. Against that background I have broadened the scoop of today's SuppVersity Mother's Day Special to "all things mother and child" and compiled a potpourri of the very latest and selected older studies on the physical and psychological bond between mother an child and the burdens and rewards of motherhood.

• Married mothers receive the greatest social support, but mothers don't complain (Flowers. 1996) -- As a 1996 paper in the Journal of Divorce & Remarriage reports that the social support in the lives of single, divorced, and married mothers differs significantly.
  
  According to the qualitative and quantitative measures Anita F. Flowers and her colleagues evaluated, the social support network which was defined as the number of people available to the mother for social support and her own perception of the quantity and quality of social support, married mothers differed significantly from single and divorced mothers in both qualitative and quantitative measures of support.
  

  "Married mothers appeared to fare best, reporting larger social support networks and more perceived support, as well as less depression and anxiety." (Flowers. 1996)

  But single and divorced mothers don't complain: All reported similar patterns of emotional support. The patterns of instrumental support, however, varied significantly between married and single mother and those who were divorced, with the latter reporting that they receiving significantly less instrumental support than than the former.
  
  Contrary to the emotional support, which correlated "moderately" with the rates of depression among all mothers, the instrumental support was not significantly correlated with either depression, anxiety, or adjustment to parenthood and lend support to the initially raised notion that the words "Mom, I love you! Thanks for all you're doing for me" are worth more than all the toasters, vacuum cleaners and flowers you may have bought for your mothers in the past ;-)

• A History of Mother's Day: The first celebrations in honor of mothers were held in the spring time in ancient Greece. In the course of the festivities, the Greeks paid tribute to Rhea, the Mother of the Gods. Later, during the 17th century, England honored mothers on "Mothering Sunday," celebrated on the fourth Sunday of Lent. In the United States, Julia Ward Howe is said to have suggested the idea of Mother's Day in 1872. Howe, who wrote the words to the Battle Hymn of the Republic, saw Mother's Day as being dedicated to peace. It is yet Anna Jarvis of Philadelphia who is officially credited with turning this day into an "official" holiday. 
  What children write in their letters on Mother's Day changes with age (Weisz. 1980) -- According to an analysis of the Mother's Day letters from 249  children,  aged  7-17 "references to being granted autonomy and control declined with age"; an observation the scientists interpreted as a sign of a developing understanding for the intent underlying parental behavior.
  

  "She  cooks  the  best  chili  and  she  kisses me every  day on  the  nose."  (April, age 7)

  The same maturation process is probably behind the decline in references to the way mother provide food and physical support to the authors of the analyzed Mother's Day letters.
  

  "She  teaches  me right from wrong, even though it may hurt.  She very heart warming when your down  in  the  blues  [sic]."  (Bill, age  15)

  The references to just  "being there", on the other hand are consistent with person-perception literature "on age increases  in  the use of abstract, covert, and psychological  categories." 

• Iodine is an indispensable nutrient for mothers-to-be and the developing brain of their kids (Hynes. 2013) -- Even a mild iodine deficiency during pregnancy is associated with reduced educational outcomes in the offspring.
  

  "These associations remained significant after adjustment for a range of biological factors (maternal age at birth of child, gestational length at time of birth, gestational age at time of urinary iodine collection, birth weight, and sex). Differences in spelling remained significant after further adjustment for socioeconomic factors (maternal occupation and education)." (Hynes. 2013)

  The data Hynes et al. evaluated was based on the results of a 9-year follow-up of the Gestational Iodine Cohort. According to the detailed analysis, kids that had been born to mother who had urine iodine concentrations (UIC) that were lower than 150µg/l  scored 10.0% worse on spelling, 7.6% worse on grammar, and 5.7% in English-literacy performance tests compared with children whose mothers' UICs were =150 µg/L.

While Crohn's disease, just as a leaky gut and other intestinal disturbances appear to contribute to overall inflammation and consequent visceral fat gain (learn more), Crohn's does not influence the mortality rate of the patients offspring.

• Children born to mothers with Crohn's disease don't have a higher mortality rates (Zugna. 2013) -- While you may get the impression that each and every minimal impairment of maternal health will have highly detrimental effects on the offspring, the effects of Crohn's disease are at least not life-threatening: With 60 deaths per 100,000 person-years in children of mothers with CD, vs. 54 in controls, "[p]arental CD does not seem to influence mortality rate in offspring, which suggests that neither genetic influences of CD nor intrauterine conditions have adverse effects on offspring mortality rate."

• Children born to vaccinated mothers have higher risk of being infected with measles and, possibly, rubella (Waajenborg. 2013) -- What may sound counter-intuitive is actually a pretty logical reaction to the modifying effects of vaccination on the original immune defenses.
  
  Compared to mothers who had not been vaccinated, the "estimated duration of protection by maternal antibodies" among infants in the general population was short: 3.3 months for measles, 2.7 months for mumps, 3.9 months for rubella, and 3.4 months for varicella and thus on average 2 months less than for women from orthodox and unvaccinated communities in the Netherlands.

• Relationship to parents changes with age, but other factors have a greater influence (Kaufman. 1998) -- Gayle Kaufman and Peter Uhlenberg from the The University Of North Carolina At Chapel Hill analyzed the "Effects of Life Course Transitions on the Quality of Relationships between Adult Children and Their Parents" in an eponymous paper from 1998 and observed, that approximately one fifth of relation ships deteriorated with time.

  

  Figure 1: OLS regression of relationship quality with parent at national survey of families and households (Kaufman. 1998)

  A larger baseline effect on the benefial (positive) or negative (negative values) of the mother-son/daughter and father-son/daughter relationship was yet observed the number of siblings and at first maybe surprisingly and not necessarily statistically significant the (partial-) employment status of the parents (see figure 1). Furthermore divorce and declines in parental health lead to deteriorating child-parent relationships and the mother-daughter relationship was significantly better in African American women than in any other ethnicity (0.422 vs. 0.172-0.173 in hispanic and others).

• Mothers who return to work early are more likely to develop depression (Chatterji. 2013) -- According to the results of a recent study from the University of Albany. Specifically,...
  

  "Among mothers of 6-month-old infants, maternal work hours are positively associated with depressive symptoms and parenting stress and negatively associated with self-rated overall health." (Chatterji. 2013)

  As you would expect, this does yet not have negative effects on the mothers' "quality of parenting" - that's how mothers operate: Everything for the kids, nothing for themselves and that's why we are celebrating their day today ;-)

• Kids' inappropriate food intake is mainly a function of "maladaptive parenting practices in mothers" (Moens. 2013) -- I know it's not fair to blame mothers for the obesity of their children, I can hardly think of any mother who does not want only the very best for her kids. Nevertheless, the net outcome of what mothers do and don't do at the dinner table can contribute to children's eating- and weightproblems.
  
  In a pertinent study, researchers from the Department of Developmental, Personality and Social Psychology at the Ghent University. The scientists invited 36 mothers with two children (4-12 y) of which 10 sibling-pairs were discordant for weight status (healthy weight - overweight) to the lab and observed the maternal response and controlling behavior during the meal. Their results showed that the mothers' authariation / permissive behavior had direct influence on the amount the children ate. In particular, ...
  • authoritarian behavior control on part of the mother and higher food intakes (0.51)
  • permissive behavior control on part of the mother and lower food intake (0.52)
  • authoritarian behavior control on part of the mother and less restraint eating (0.66)
  • permissive behavior control on part of the mother and higher dietary restraint (0.65)
  showed statistically significant correlations (corresponding values in brackets). In other words: The harder the mothers pushed, the more the children ate and the less controlled were their eating habits.

• 

  Although ketogenic diets may not be 100% save for pregnant women, many of the fatty staple foods of ketogenic dieters are abundant in choline, a nutrient 25% of the women from high and almost all women from low income countries are deficient. Potential consequences? Birth defects, hampered brain development & more (cf. Zeisel. 2013; learn more about choline)

  Ketogenic diets ain't for mother's to be (Sussmann. 2013) -- Preliminary evidence from rodent studies would suggest that the consumption of a ketogenic diet during pregnancy could result in organ dysfunction and behavioral changes in postnatal life.
  • larger body size early in pregnancy,
  • smaller brain size,
  • smaller body volume later in pregnancy
  • reduced heart sizes
  • smaller thymus
  • enlarged spines, thalamus and midbrain
  I guess most of you will yet be lucky enough to have been born before the keto-hype, anyway. In case you are planning to have a baby though, I personally would not recommend you rely on the stupid saying "mice are no little men".

• Breast-feeding is heart-healthy for mothers (Groer. 2013) -- While you have read numerous times about the superior health effects of breast feeding on the health of your offspring, there is more an more evidence that breastfeeding is also important for the mother's health. While it is obvious that it helps them shed pregnancy weight, a recent from the University of South Florida Colleges of Nursing and Medicine clearly suggests that breastfeading is also good for the heart of the mothers.
  
  Even after adjustment for BMI, the systolic blood pressure (SBP) and heart rate decline in the postpartum period was significantly greater in breastfeeding women compared to matched controls in the who were feeding formula (p<0.05). Other covariates, the scientists evaluated, e.g. family income, stress, marital status, and ethnicity were" not significantly associated with these variables over time." The latter did however influence the stress levels, which were likewise lower in the breast feeding women, but highly depended on the aforementioned confounding factors.

• Children born to better educated mothers have lower risks of depression (Park. 2013) -- While it has long been known that "early-life low socioeconomic position (SEP) increases the risk of adult major depression", the role of maternal eduction is often a better predictor of the offspring's physiological and psychological well-being.
  
  Scientific support for this hitherto non-validated hypothesis comes from a group of researchers who conducted a longitudinal analysis of data from the Canadian National Population Health Survey from 1994/1995 to 2006/2007. In the corresponding paper that's about to be published in an upcoming issue of Social Psychiatry and Psychiatric Epidemiology the authors report that children who are born to mothers with less than secondary school education had a +104% risk of major depressive episodes (MDE) compared to those whose mothers had more education.
  
  Paternal education, on the other hand, was not associated with MDE, at all. Even more astounding is yet that neither adult income, student status, psychosocial stress, and selected common early-life adversities did not influence the association between major depressive episodes and the estimate for maternal education. 

• Transfer of H. pylori from mother to child could be one of the downsides of natural child-birth (Siavoshi. 2013) -- While recent studies did eventually lend credible support to the notion that the bacterial composition of children who are born by Caesarian appear to be less favorable (Turroni. 2012) and could partly explain the higher incidence of type I diabetes (Stene. 2013), a recent study from the University College of Sciences at the  University of Tehran, suggests that natural (=vaginal) child birth entails a greater risk of early colonization with H. pylori.
  

  

  Certain lactobacillus strains can help eridacte H. pylori infections (learn more)

  "A significant correlation was found between the occurrence of H.pylori genes in vaginal yeasts and that in neonates' oral yeasts, occurrence of H.pylori genes in mothers' vaginal yeasts or neonates' oral yeasts, and UBT+ [urea breath test] results in mothers." (Siavoshi. 2013)

  Currently, there is yet a paucicity of evidence suggesting that the higher risk of H.pylori infection entails any future health risks. Nevertheless, a 2009 study from the Peking University Third Hospital is not the only study reporting greater rates of gastric cancer in areas with higher H. pylori prevalence among children in their early teens (Zhang. 2009).  

• "Can you sooth your baby, when he/she is crying"?  (Radesky. 2013) As innocuous as the question may sound, it could be the most important question for a doctor to ask the mother of newborn child. After all, the latest data from a Boston Medical Center and Boston University study clearly shows that inconsolable infant crying quadruples the risk of postpartum depression.
  
  Thus, 5 to 6 weeks postpartum, more than 20 minutes of inconsolable crying per day have more detrimental effects on a mother's psyche than the dreaded infant colics (+100% risk in postpartum depression).

• Well-known / celebrity older mums: Cherie Blair (baby at 45), Madonna (baby at 41), Sarah Brown (wife of Gordon Brown - baby at 40 and 42), J K Rowling (baby at 37 and 39), Emma Thompson (baby at 40), Liz Hurley (baby at 36), Susan Sarandon (baby at 46), Mimi Rogers (baby at 45), Iman (baby at 44), Jerry Hall (baby at 41), Annette Bening (baby at 41), Brooke Shields (baby at 37 and 40),  Geena Davis (baby at 46), Courtney Cox Arquette (baby at almost 40), Helen Hunt (baby at 40), Helen Fielding (baby at 46 and 48), Lowri Turner (baby at 42), Meera Syal (baby at 43), Holly Hunter (twins at 47), Sarah Jessica Parker (baby at 37), Elle Macpherson (baby at 39), Anna Nichol Smith (baby at 38), Salma Hayek (baby at 41), Nicole Kidman (baby at 41), Gwen Stefani (baby at 38), Lisa Marie Presley (twins at 40), Gillian Anderson (baby at 40), Dannii Minogue (baby at 38), Celine Dion (twins at 42), Mariah Carey (baby at 41), complete list at pregnancyover35.
  A mother's age at birth is a significant risk factor for type I diabetes in the offspring (Flood. 1982; Bingley. 2000) -- While the risk for children of older mothers to be born with type I diabetes appears to be particularly pronounced for (late) first-borns, Flood et al. observed in 1982, already, that it type I diabetes was also ore prevalent in late-birth-order siblings.
  
  According to a study by Bingley et al., the risk of type I diabetes increases by 25% (95% confidence interval 17% to 34%) for each five year band of maternal age, so that maternal age at delivery of 45 years or more was associated with a relative risk increase of +211% compared with a maternal age of less than 20 years.

  

  Figure 2: Women by Number of Children Ever Born (US data from the CDC based on stats from 2010)

  The study from the University of Bristol did yet also reveal that paternal age was also associated with a +9% increase for each five year increase in paternal age. Similar to Flood et al. Bingley et al. did also observe a trend for decreasing diabetes risk, for children who came late in the birth order compared to children who were firts-borns to parents in the same age (-15% risk reduction per child born.

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That's it for Mother's Day: Now that you even had a serving of Mother's day gossip, I hope that all of you have something to talk about at the afternoon coffee party at your mother's or your mother-in-law's Mother's Day table. And before I do forget to mention that all the best to all the mother's out there, you are the bests! All of you ;-)

References:

• Chang J, Elam-Evans LD, Berg CJ, Herndon J, Flowers L, Seed KA, Syverson CJ. Pregnancy-related mortality surveillance--United States, 1991--1999. MMWR Surveill Summ. 2003 Feb 21;52(2):1-8.  
• Chatterji P, Markowitz S, Brooks-Gunn J. Effects of early maternal employment on maternal health and well-being. J Popul Econ. 2013 Jan 1;26(1):285-301. 
• Flood TM, Brink SJ, Gleason RE. Increased incidence of type I diabetes in children of older mothers. Diabetes Care. 1982 Nov-Dec;5(6):571-3.
• Flowers AF, Schneider HG, Ludtke HA. Social Support and Adjustment in Mothers with Young Children, Journal of Divorce & Remarriage. 1996. 25:3-4, 69-84
• Groer MW, Jevitt CM, Sahebzamani F, Beckstead JW, Keefe DL. Breastfeeding status and maternal cardiovascular variables across the postpartum. J Womens Health (Larchmt). 2013 May;22(5):453-9. 
• Hynes KL, Otahal P, Hay I, Burgess JR. Mild Iodine Deficiency During Pregnancy Is Associated With Reduced Educational Outcomes in the Offspring: 9-Year Follow-up of the Gestational Iodine Cohort. J Clin Endocrinol Metab. 2013 May;98(5):1954-62. 
• Kaufman G, Uhlenberg P. Effects of Life Course Transitions on the Quality of Relationships between Adult Children and Their Parents. Journal of Marriage and Family. 1998; 60(4): 924-938. 
• Moens E, Braet C, Vandewalle J. Observation of parental functioning at mealtime using a sibling design. Appetite. 2013 Apr 30.  
• Park AL, Fuhrer R, Quesnel-Vallée A. Parents' education and the risk of major depression in early adulthood. Soc Psychiatry Psychiatr Epidemiol. 2013 May 10. 
• Radesky JS, Zuckerman B, Silverstein M, Rivara FP, Barr M, Taylor JA, Lengua LJ, Barr RG. Inconsolable Infant Crying and Maternal Postpartum Depressive Symptoms. Pediatrics. 2013 May 6. 
• Siavoshi F, Taghikhani A, Malekzadeh R, Sarrafnejad A, Kashanian M, Jamal AS, Saniee P, Sadeghi S, Sharifi AH. The Role of Mother's Oral and Vaginal Yeasts in Transmission of Helicobacter Pylori to Neonates. Arch Iran Med. 2013 May;16(5):288-94. 
• Sussman D, van Eede M, Wong MD, Adamson SL, Henkelman M. Effects of a ketogenic diet during pregnancy on embryonic growth in the mouse. BMC Pregnancy Childbirth. 2013 May 8;13(1):109. 
• Stene LC, Gale EA. The prenatal environment and type 1 diabetes. Diabetologia. 2013 May 10.
• Turroni F, Peano C, Pass DA, Foroni E, Severgnini M, Claesson MJ, Kerr C, Hourihane J, Murray D, Fuligni F, Gueimonde M, Margolles A, De Bellis G, O'Toole PW, van Sinderen D, Marchesi JR, Ventura M. Diversity of bifidobacteria within the infant gut microbiota. PLoS One. 2012;7(5):e36957.
• Waaijenborg S, Hahné SJ, Mollema L, Smits GP, Berbers GA, van der Klis FR, de Melker HE, Wallinga J. Waning of Maternal Antibodies Against Measles, Mumps, Rubella, and Varicella in Communities With Contrasting Vaccination Coverage. J Infect Dis. 2013 May 8. 
• Weisz JR. Autonomy, Control, and Other Reasons Why "Mom Is the Greatest": A Content Analysis of Children's Mother's Day Letters. Child Development. 1980; 51(3): 801-807 .
• Zeisel SH. Nutrition in pregnancy: the argument for including a source of choline. Int J Womens Health. 2013 Apr 22;5:193-9. doi: 10.2147/IJWH.S36610. Print 2013.
• Zhang DH, Zhou LY, Lin SR, Ding SG, Huang YH, Gu F, Zhang L, Li Y, Cui RL, Meng LM, Yan XE, Zhang J. Recent changes in the prevalence of Helicobacter pylori infection among children and adults in high- or low-incidence regions of gastric cancer in China. Chin Med J (Engl). 2009 Aug 5;122(15):1759-63.
• Zugna D, Richiardi L, Stephansson O, Cnattingius S, Ludvigsson JF. Mortality Rate in Children Born to Mothers and Fathers With Celiac Disease: A Nationwide Cohort Study. Am J Epidemiol. 2013 Apr 25.