Hey, welcome, everybody back to the Clear Hell podcast.
Today I have a very special cast.
Her name is Dr. Lorena Pacheco, and she's a nutritional epidemiologist that combines her passion and interest in public health, community nutrition, clinical trials, health disparities, and chronic disease prevention to develop scalable and culturally appropriate interventions, like teaching kensions to prevent carditabolic disease in Hispanic, Latinos and other minority populations.
She is a research scientist in the department of Nutrition at the Harvard TH Chan, School of Public Health, and an adject professor at Simmons University in the Department of Nutrition.
She has over 25 publications, including one featured in the Harvard News.
And she has a paper that're going to talk about today that discusses avocado intervention that improves physical activity in Hispanic and Latino families.
And this is a very elegant study.
I highly recommend everyone check it out.
Dr. Pacheco, welcome to the podcast.
Thank you, Tom.
It's a pleasure to be here.
Thank you for the invitation.
I'm excited for our conversation today and thank you for having me.
I do before we get started, though, want to mention one nutritional epidemiology is for those audience members that are not real acquainted with that term, basically is the field that studies the role of diet and nutrition in relation to diseased occurrence at a population level.
And like you mentioned, I'm particularly focused on cardome metabolic disease, but this can be in any outcome that the researcher is interested in.
Yeah, that's fantastic because a lot of people who don't know, they don't know what epidemiology might mean in the context of nutrition.
But I think you're kind of well positioned because you come from a culturally diverse background.
You had said that your grandparents owned a restaurant in Tijuana that served Chinese food.
Yes.
And did you notice, do you notice any differences between that kind of food and then the food that you are able to get over here?
Right.
Yeah, thank you for the question.
Yes, they own a Chinese food restaurant in Tijuana, which is in the state of Baja California in Mexico.
And that was my playground.
I think truly I believe that having that very unique experience of being brought up in such an environment hustle bustle of a kitchen and food everywhere. And that was your language.
That was the inception for my love for food, cooking and nutrition, and I think in many instances why I became a registered dietitian and that pursued, you know, a higher education, but that that was the main focus.
And in terms of of differences regarding, you know, customer preferences south of the border or the U clientele, and generally, I think if people tend to like their what they like.
And even as counseling patients as a dietician, I think something to consider in this conversation.
And I don't know if you've seen in your practice, but the repetitive selection of certain foods or dishes that when you go to takeout or you go to a specific restaurant that you like, you're always ordering the same thing.
Like it takes a lot of you to explore other things on the menu and you've seen, I think and maybe some of your listeners, they they know that they and especially in a Chinese food restaurant, there's a vast number of options.
It's not going to be limited to a certain f few handful, at least in my experience.
We usually, right?
But we usually tend to, I don't know, always order the same things.
And I think it goes back to comfort foods, right?
It goes back maybe core memories that you made with your family and maybe at that restaurant or certain connotations that you have with certain foods.
But in the short answer, no, usually people gravitate toward fried foods, mostly.
That's great.
Yeah.
You know, I noticed that one of the things I actually found in in Mexico was the simple, they call them street tacos over here, but it was just, you know, this simple straightforward chicken, some, uh, you know, maybe just a little bit of vegetables on it, maybe none at all. And then just some sauce on it.
And then that was it.
And that to me was, I don't know, it was just so simple and nice to have that instead of, you know, everything that they sometimes include on on the other dishes.
It was just an interesting find for me to see that simplicity there.
Exactly.
Exactly.
And I think in many instances, it mimics what also, you know, happens initional Chinese homes.
I mean, I certainly the things that I would see in the restaurant were not dishes that I would consume at home if my my grandfather was actually the chef at both home and at the restaurant or he led, you know, the entire team.
And something to to note, he was very much an advocate of fresh and local ingredients. And before the term, you know, the coin phrase like farm to table, he was already doing it.
And I think that's where many of, you know, to your point, having that simplistic number of ingredients, that was to me how I would see food preparation, right?
Because we don't have to dabble and all these mechanistic things or other methodologies or preparing meals.
But I mean, it's great that people do, but I I think coming from that perspective or these these two sides or these two cultures, Chinese and and Mexican, I tend to navigate more toward that simplistic view of preparing food, you know, a simple bowl of steam rice, brown rice these days, and a quick, maybe, you know, stir fry of veggies or in if I'm wanting Mexican food, very much so, like the tacos that you describe, just a basic cornrortilla and then some lean protein and maybe some avocado.
Yeah, it makes it almost easier and almost like tastier to me. Um it definitely does. Um Yeah, and I think, you know, me and my wife, we try and cook the stir fry as well.
And it's such an easy meal.
The prep is sometimes a little long, but overall, the meal itself turns out it's, you know, pretty straightforward and pretty easy to cook, in other words.
But you're right, like that that farm to table, that that term, I think, you know, people have been using it for years, and I think it may have been a little bit overrun by the adoption of processed foods. . And, you know, the availability and the advertising and sometimes even people who are just stressed at work and they don't feel they have time to cook.
I think that it definitely lends to not eating um, you know, whole foods, in other words.
Right.
And and I I do see that and that's something that we we also try and provide evidence for.
I think that is definitely growing, even andain's data shows that, right?
That even during the pandemic, we were cooking more.
So it's exciting to that I do want to mention I will be leading that type of analyses for the next set of studies coming from the Channing cohorts, which are long- lasting epidemiological studies.
I think we have more interesting questions about cooking and preparing meals at home or even the consumption of fried food, right?
Both inside the home or outside the home.
I think it's important to to share it with with folks.
However, we we do need the time to accrue that data, right?
Accordingly, and make sure that is, you know, really measured and all of that.
But I think that's something coming, because we do have data.
I mean, there is data out there.
I think is always important to provide more evidence on that on the fact.
And hopefully we get more folks trying to prepare meals at home as much as possible.
That's a new line of research that I'm currently working on and providing or hopefully providing effective interventions for Hispanics or other minority groups.
And that that they feel that it's also culturally validated, right?
Using ingredients that their grandparents would have done, maybe, that would ab use in their own recipes at home.
Because I think there's a disconnect and I don't know if you seen that in in your practice, Tom, but the more and more that I see younger generations, they don't know what original recipes look for, you know, or like how what ingredients are used to prepare which type of dish.
And that is something that it also helps in your identity as an individual, right, as part of that specific culture.
And I think it feeds off in itself and it's definitely a worthy cause to pursue if we can find a way of engaging with one's own culture and and making delightful delicious dishes that are just as healthy. And if not more, right?
Because we don't want everyone just to eat chicken or salmon and broccoli and rice, I think it's the typical example of a I think they'd start to run away if I kept telling them to do that.
And I understand.
It's it's great and it's great, you know, we've used it, but if we can diversify that, it'll be great.
Yeah, is that is that kind of one of the the main goals in your your teaching kitchens?
Yeah, well, right now there's this um multitrial, a multictit trial, and I'm I'm going to be using that curriculum per se, right?
And building of from really, you know, put on the ground kind of like of data gathering to see if what we think that it's an effective in this part of the multicompent intervention will be accessible and will it work with this sense, with Hispanic, uh which is the population that I initially worked with.
This is going to be the first ever teaching kitchen.
Pilot study, we're studying small, but just to see that effective it is for the Hispanic population, you know, what works and what doesn't?
And based on that, we can modify it and then take it up to the next level.
So really is the combination of that effort that is being put through through the multide of the teaching kitchen and then refining, you know, further that curriculum and valating it for a Hispanic population and be able to say, oh, wow, maybe this type of recipes were better than the others, maybe this uh these suggestions about exercise are better for our population . I do know that we enjoy Latinos is soon by classes.
So maybe that is kind of like our recommendation, right, for exercise versus just simply walking.
It just depends.
And so there are these are the things that we're trying to decipher at this stage of this project.
And hopefully I can come back and share more about how the intervention is going.
And yeah, it's exciting work is really rewarding work because at the end of the day, you want to set an investigator as a scientist to bring forth something that people can use, right?
And they take it up to to practice and something that feels like them because they comes from them and it needs to feel that is built for them specifically.
And when you have that, I think it's really a win win win situation.
You know, you win as an investigator, the public wins and then your entire community wins at the as a productive of that because you want individuals to be healthy to enjoy their, you know, well in his journey and more so, you can do it in a culturally appropriate way.
Yeah, I think that's really important in in it's almost like the movie Inception almost, where you're like, it's it's a line between you teaching them something and then they adopting it within their mind.
And they their persona, you know?
Because if you can't achieve that, then they will not.
Like they will not adopt it.
And and what you've done is just kind of basically lecture to them instead of help them along in the journey.
Right.
Would you mind just giving us like a short overview of the the teaching kitchen kind of the curriculum just a little bit?
Right.
Yeah.
So it's multicomponent.
And I think really the key other than the fact of um providing that nutrition education, which we know, that evidence tells us it works up to a point, right?
And then, because basically people are not going to do that all the time.
It has I think most of my friends's dieticians the default, right?
Is you're grabbing something, you know, a package of food or maybe physicians that says yourself and you're like immediately looking at the ingredients this and immediately looking at the nutrition facts.
But for the normal population, they might not do that.
So giving them a good idea of what that looks like, what portions look like serving sizes have at home looks like, things like that, but also teaching about real food.
I think that's something that we've gone away from and not to say that processed foods have a place, you know, they find in certain respects and we can have a whole conversation about, you know, what even that means.
But I think for for us for the teaching kitchen concept, what really is making the dent is that we're providing that culinary instruction.
So it's the culinary instruction tied with the n utrition education by a dietitian tied with exercise recommendations by an exercise physiologist, you have encounters with the chef, right, on that weekly basis.
And you having that economy sense of economy that you can't accomplish that at home, right?
Because ultimately we want that to be replicated in your home.
And and then you have motivational interviewing or that coaching, you know, coming from the scientists or that PI or whomever is delivering it in this case it will be me doing that.
I'm going to be certified in MI, which is going to be wonderful because you you sort of do it, right, with concentations, but this is stick it up a notch.
And then the rest is mindfulness.
And that's another thing that I think for for most folks, it's not it's a default, you know, to have that mindfulness component per se in our daily activities and just think about it. If we were a little bit more aware, right, self-aware of what we're doing on a daily basis of our getting up from bed in the morning a certain way, being aware of even the type of steps that we're taking.
I mean, there, we just finished our at the Harbor School Public Health, um a seminar and a conference about mindfulness and really, it's called the Tnahan Center for mindfulness.
We practiced even walking meditation, you know, at the retreat.
And and this is just being yourself and making sure that each step, you know, that you're taking, your understanding that you are taking it.
So and I think this is something very important to mention in this very fast life that we are living.
And everyone is go, go, go.
Everyone is having to arrive at a certain place, but then we're not really there.
We're checking the phone and checking or the watch and saying, oh, I have to be here.
I have to be somewhere else and another in an hour, sorry.
And then that finishes and then you're already thinking, I have to get to the car or whatever means of transportation.
You have to get home to do this in this and that.
So it feels almost that we're always in a rush and trying to get somewhere.
But then do we really get somewhere, Tom?
I mean, do we really, you know, what what's the outcome?
And so this is just another part of this multicomponent intervention that hopefully, as these five parts, you know, combine will help individuals take a step back and really focus on on their health.
And hopefully we do see these changes in cardio metabolic factors, which, you know, are the main, you know, risk factors for not only heart disease, but even weight control, weight management, outcomes of that nature.
Yeah, I think you're really covering like all your bases there, especially with the mindfulness thing because many people , they were built to have self-doubt, self-criticism, anxiety, and worry, simply because of our need to survive.
And a lot of people walk around with this and one of the other things that I've run into is that unfortunately, mindfulness has somewhat been used as a scapegoat in order to say that, oh, you're not performing well because you're not doing mindfulness training.
But in reality, when you use that mindfulness training, you can actually accomplish a lot of personal change.
And so it can be it can be very, very helpful.
And I know especially not not only nutritional side, but also the fitness and kind of bodybuilding side.
It comes into a huge amount of play. And I just don't think that that many people discuss it.
You know, many people don't say, oh, well, this is what I've done.
I've done introspection.
I've done journaling, I've done meditation.
And I think that it's a very, very, very big, big part.
And I'll I'll be interested to hear how that actually turns out there.
Yes.
And and just for for your sake and for your audience members, if you want to learn more the Ticknohan center from my ownfulness in public health, it is housed within the department of nutrition at the school of public health.
And so just, you know, at any search engine, just, you know, type that in and it'll show up.
And so we're we're trying to to build that that evidence there within the department.
I think it's huge because it it's such an important topic as as you mention.
And I I really think that it will make the difference and we we just need to provide that, you know, evidence.
And yeah, when it when the pilot study is done, I would be happy to come back and and share the the final findings what we saw that worked didn't work and even refine it further before we we launch it as a single site, you know, RCT.
Yeah, yeah, yeah, yeah, randomized control trial.
Yeah, that'd be yeah, that'd be great.
And so in some of your studies, you use the food frequency questionnaire.
Yes, which is which is fantastic.
It's a great questionnaire.
And but I know sometimes there are concerns with things like recallias, where we can't always, we're just human and we just can't always recall the things we've eaten.
And so do you have ways that you have learned, you know, to to kind of decrease that recall bias?
Right.
Yes, there the short answer is, yes, there there are ways.
And and this is, I mean, I can that's the short answer, but I think there's so much more to discuss about the FFQ if I if I may, just because of, thank you because of that, you know, bad rep Usually that that it gets.
It, you know, that is just another tool and I'll go into the definition right now, but we need to take it for what it is and what what's its intention, right?
And I think if we understand what it was used for, the criticism might be somewhat reduced because it fits in a specific place for science, for specific methodology, that it might not answer the question that you want, but that is just, maybe that's not your tool, right?
So I'll share with that.
It is a dietary assessment tool, okay, used the nutritional research and mostly an epidemiological studies, meaning these in min our situation at Harvard bunchit cohorts.
So we have the nurses health study and the health professionals follow-up study that have focused on food intake over the previous year.
That is how we frame it.
And for the majority of these things in my experience with other cohorts, that is usually what it is getting to the FFQ.
It's an average intake about a specific list of foods that you have?
Okay, based on the previous year.
But historically, um what I think most people don't know is that we want to understand in epidemiology, you know, whether folks were exposed or not exposed to something, because we want to understand if whatever they were exposed or not exposed is affecting their health, right?
And into the future.
And usually for diet is going to be a little bit more complex just because we don't eat things in isolation, right?
So you eat a certain pattern. And you read a certain way.
And really one of the pioneers in understanding this and not so much in that there weren't others, but Dr. Walter Willard with that if the cue that he developed for the nurse's health study, it was answering that specific question for that period of time through that population, because initially they wanted to understand cancer risk, right?
And so I'm saying that there's not going to be a single FFQ out there, Tom.
And I think this is really important for the audience to know that it's going to be validated for everyone, for like all the populations.
That that's just a fact, because it's very population specific, your research questions specific, your hypotheses fried goes into play and over a specific period of time, because whatever you list there, whatever foods, and beverages are going to be tied up to a nutrition data said, that in itself is going to be limited to that specific time frame, right?
So let's say more foods now are available.
Now we have to update it.
That is why you see, especially with the nurses cell study and the professionals follow-up study such valuable cohorts, because those nutrition databases get updated, right?
And this is the value and the beauty of having repeated measurements because you're addressing also that in a within person variability that you might see across time.
So these are great dietary assessment tool, but this is mostly used to see that distribution of that exposer not exposed, you know, in this case, dietary factors in this population.
And maybe another researcher would want to do that, but it's the specific to that population.
Something else that I wanted to mention, I think they they also, you know, we've heard criticism of people that say that we place people in certain categories and that's just the nature.
So initially, and I can send you a copies of, you know, our FFQs, but we provide the list of the foods, right?
And then we you have a a set of potential answers from never or less than once per month to up to six times per day or whatever that range.
So really what we're focusing on is having an average of their intake over that specific time frame.
So we're not, if you're going to have, let's say your question has to be very precise and you want really precise nutrition measurements, that's not going to be the tool for you.
So this is just to understand that ranking of folks or that distribution of that potential average intake over time for this specific population.
And to answer your question about the Ral bias, I I've seen it in the various FFQs that I have the privilege of working with with different cohorts.
But you see there are very, well, at least they attempt to provide a clear description of what they are asking.
Okay.
And for example, for the nurses's health studies, you have an instruction of the very top top of the page, quote, unquote, for each listed fill in the circle indicating how often an average you have used the amount specified during the past year.
And then you have next to that food item, the serving size so that participant can visualize the portion of that food or that beverage.
Okay.
And then, as well, there are statements to help clarify frequency, especially with seasonal foods.
For instance, please try to average your seasonal use of foods over the entire year and they provide an example . I think we in in our covert is like Canada though just because it might be seasonal in this area or certain specific areas of the US. If you use, you, you know, you eat it four times.
So weig during the approximate three months and the average use would be once per week.
You know, so we do provide clear examples so that people are situated.
Okay, in that sense.
And also descriptions are very specific descriptions for beverages.
And I think those probably are the most clear or the folks get just because it's one glass bottle or can of carbonated beverages, which it' very simple to understand.
And I a last thing about FFQ is because if not, we can be here until, you know, tomorrow, probably.
They're the ideal choice for logic scale, epidemological studies, and considering fre living populations, right?
So these in this case, are nurses that when they started in the cohort, you know, they had a lot of things going on.
You know, they had work, they had a family, they had all these things.
Now the cor courts started in 1976.
So things have changed, right?
But for the most part, we are cognizant of that.
So these are for free living populations.
They're relatively inexpensive, right, you send them in the mail or they can do it online now.
There is it to administer by mail, like I said, online. Low participant burden for the most part, and this is again in comparison to other measures that you're demanding too much of the person, right?
They have to scale everything, they have to measure everything.
But again, that is what if your study or that research question, you want that precision, then you're going to go ahead and demand that, right?
From the participant in a way.
But here really, it's not that tool for you if that is what you're asking.
And if you can have periodic assessments, that's even, you know, better for you and in the long run, just because you have that additional repeated measurement and potentially seeing that change, if any, right?
In in that intake of that specific food or food group that you're interested or even group of food.
So maybe like SSVs, youed barriages, you know.
Yeah.
I think that that kind of bears repeating a little bit because it's so important.
If you are trying to measure a free living population, you can't have as much, I guess, precision on the metrics because they will not tolerate it.
In other words, They may say, you know, they may drop out because you're asking them.
Like if you ask them to report once a day for an entire year, then they're going to be like, no way, I can't.
It's it's literally impossible.
Exactly.
So I think that's a very, very good point that if you, you know, in that instance, yeah, you you could maybe cut down on on recall bias.
But yet now you're you're driving the study to be more of a more clinical, more controlled, and probably shorter with with less with less participants, because there's no way you could do that in the in the real world.
Exactly.
Exactly.
And I think this is something that gets muddled right?
Out in in just just out, I want to say, because I can't really say for one specific arena or the other, but I think folks might get confused in that that everyone thinks, oh, they used an FFQ and it's the same FFQ for for everyone.
And no, I mean, it takes a lot of thought to design an FFQ.
And it might be the case that even what you first started with might not be used for another research question because that is not what you intend to capture, right?
If I'm looking for cancer, then I'm going to go ahead and look for specific things that might trigger that for me, right?
You're not going to be asking about others that might not be irrelevant because that is going to get you nowhere.
You know, I'm sure you've heard in in your statistics says trash in trash out, you know, it's not even if you have the most wonderful model and it's beautifully designed, but if your data is not really fitting into what your model or what you're asking that your model gets you, it's it's not going to be worth it at the end of the day.
Yeah, yeah, that's a very, very good point.
Yes.
So let's say, for example, if we go back to teaching kitchen intervention, I'm not going to be using an FFQ for that, right?
I might do a shorter version of that if I want to capture diet, but I think is mostly going to be the quality of that diet, you know, to understand how many fruits and vegetables are we doing, how many?
And there are other ways of deriving that versus me and is really not purposeful, right?
Of going through this thing that's say the FFQ of the Nurse' health study for my intervention.
And so I I think it just merits to say it just depends on your intention and your question and what you ultimately want to answer, that it'll reflect on the methodology.
And the specific tool that you want to use and apply.
Yeah, yeah, that's that's very that's a very good point because sometimes you have to piggyback off a studies that have been started simply because the funding, the organization of it, you kind of have to go along with that study and look at what, you know, kind of results it may may have brought and and kind of go from there, just because it's the only available study that may might be out there.
Right, exactly.
And we we sure know that that has happened, right?
And but if you are a strict shooter, you'd say, you know, a scientist, you're going to say, well, this these are our limitations.
And I think this is what you get with really good scientific papers that, especially from from renown groups, right?
Like you you understand that these are folks that have paid attention that whatever it is, you know, printed on the paper, that there were many discussions to get to that point.
And really the interpretation must be read with a certain degree of interest and also caution, right?
Whenever you're picking up a paper, you know, what exactly, I mean, did they measure what they intend to do and then what was their interpretation?
So I think you you just have to be really conscious of, you know, you conscientious about whether you're picking up a specific paper that um it's it's not um providing any value to you as an audience member or a reader on your readership and just looking for that, um, particular groups of folks that you do know do work well.
Right.
Yeah.
Yeah, exactly.
Yeah.
And and I mean, that's a whole, you know, also that brings up the causation versus correlation, um kind of, you know, understanding there.
And I think people, if you see something in the social media or something like that, it's very good practice to drill down and and find out where that data came from.
Yeah, and go back to the source.
That's what I tell my students, right?
Even if they are, let's say, they're doing a lit review or even going through systematic reviews and you get all sorts of folks sometimes publishing things that they're saying something, but that that's not what they did, right?
So Right.
I'm the type of person that is going to go back to the reference that you mentioned and then read that paper to see if and to see if that's true.
And maybe I'm just nerd, you know, with an exclamation point at the end of that word, but I think you need to demand that from the scientific community.
You you have to hold people accountable and that sense.
And if you did do a mistake, then just correct it.
I mean, I myself have that.
We made a mistake in one of our papers with the units and it went to print and we made that, you know, correction immediately in so it's not we're human and we're prone to error, right?
Things happen.
But I think if we are a little bit more aware of that and that perspective of let's just have a conversation about whatever that was brought up or that potential error, it'll be we're better, well off.
But going back to the correlation and caation issue, that is also something that, as you mentioned, it comes immediately, right?
And in social media or many influencers are things that are trending And again, just for the sake of definition, correlation, you know, it can tell us that two things are related, but it does not mean that it costs, you know, one costes the other.ustation does mean that one factor directly influences another and it demonstrates that costs and affect relationship.
But I think an example that we always provide an epidemiology and maybe you yourself have heard it is that uh ice cream cells and the drowning incidents, you know, how they still are.
I mean yeah, I'm sure it's aboutt, right?
So this is a very common example.
So it's true that both tend to increase during the summer months, right?
Ice cream cells increases well drowning incidents, but it does not mean that ice cream consumption causes people to drown, right?
Instead is being influenced by the third factor, which is the warm weather.
It's just, you know, part of it.
We're incing.
Everyone in the summer is eating ice cream and we're also swimming more, right?
So we might have those instances happen at the same time.
Yes.
Now, I have to say, if I tell my son he can't have ice cream, he may act like he's drowning.
That's how it comes up.
So that I think is causation on that part.
Yeah, yeah, yeah.
And then for especially for for nutrition, right?
There's so many things that we need to consider in order to say, yeah, this is this is the X factor is costing by outcome.
We have we need to have multiple lines of research, you know, explaining things from let's say observational studies, from much perspective studies, from as well as intervention trials, that we have RCT saying the same thing.
And if not, how well can we decipher this?
Maybe we don't have enough data in our lunch to cohorts to see that as of yet of what the RCTs are picking up and maybe we just need to wait a little bit longer.
Maybe we also need other type of methods, like mechanistic studies, right?
Examining more to that food and gene expression component to build the stronger case for caation.
So it's not something taken lightly, but I do know that people will, you know, ultimately do it unconsciously.
Oh, yeah, these two things are related, but it takes more than that, just the ice cream and the drowning to see that or determine that.
So, and again, that's something that it is part of the daily conversation in the department and doing studies and with colleagues because we just have to be patient enough to get that data, right, accrru and an ice and before we start saying that in and I think you probably seen it with the language that we used in most of our papers that we, you know, we see this, these are the strengths and these are the limitations, because even if they are well-digned experiments, you also have, you know, a certain degree of disadvantages, right?
That's just what we deal with.
And again, if we are super straightforward scientists, we wouldn't matter.
It's like, well, this this is the nature of the data and then we'll work it for the next time.
We'll work on something else.
Yeah, yeah.
And that's a it's a really fascinating read to get to the end of a study and see what how they're kind of, you're almost calling out yourself, you know?
You're like, we do not either, maybe we don't understand this enough, or we need something else done further to understand it.
And it's very interesting because it's almost like you're you're teasing out parts of life that many people may not see.
Like, like it just kind of life is happening around you, but when you get in the research world, you get to tease out those parts and it can be very interesting to read how, you know, at the end of a study, like, well, how are they thinking about this now?
Or what did they think that was not strong about this?
And how does that look, you know, in my own daily activities?
So I I think that's a that's a really good point there.
I kind of wanted to get to, I don't know, if we're doing okay on time. Um.
Okay, okay, good.
I wanted to get into avocados because I a day doesn't go by, maybe two days, maybe three, but avocado will be there on my plate.
It's for breakfast.
It's there for dinner or lunch.
It's there probably about every three days.
And when I was reading through your studies, you had some very nice, very cool studies on avocados. And it's especially specifically, there was one that was like on avocados and the increase in physical activity in Hispanic families.
And I was wondering if you can maybe talk about that a little bit because it's such a it's such a cool little thing.
I't I don't know.
It's just very, very interesting to read.
Yeah, this was part of our avocado trial and this was some of the subsequent studies that came out of the trial and basically we partnered with sesthedal health before you to be called s Sanhedral Health Center in South San Diego and with the partner with the community from Motoras, who were trained community health care advocates or workers, they know the community.
This is how we engage with the families who are all Hispanics and we randomized them into two groups.
So the one of the groups received 14 avocados per family per week and the our controller, the lower intake received about three avocados per family in our preliminary work.
That is how we determine kind of like that habitual intake, right?
Because we didn't want folks to tend having this is another thing of intervention trials in the diet uh or nutrition arena because it's um isn't that we can't really hide that, right?
We cannot, it's not like a placebo and we can give someone a pill and especially if you're recruiting individuals to a study called avocado studies, I think, you know, they're going to expect that at some degree.
And also because this is part of, you know, their daily intake, right, as part of their culture, also removing that, we didn't think it would have been a, you know, a great way of us to really capture adherence, really to the trials.
Again, this these are the things that you talk about in in that preparation, right, stage and how are we going to go about it?
And basically we had to at least tackle habitual intig.
So this is why we have a lower intake group of families and then a higher intake group of families.
And the intervention was about six months in addition to the avocados the were delivered to their home.
We also did nutrition education, which was done by the promotoras.
And adherence, you know, was good throughout the study, and we did, for the most part, we saw benefits in cardiometabolic health factors as well as nutritional intake.
That was the main goal of the study.
But what one of our, I believe at the time, she was a post-doctoral fellow, Dr. Tara Schroud at UCSD, and she wanted to understand more about that physical activity.
So we measured physical activity using the global physical activity questionnaire, which was still reported, but we've used it in the past and these type, you know, in the similar populations and it it was validated.
It worked well.
And there's so many prompts in this global physical activity assessment that you get and it's facilitated, right?
So we have the RA asked the questions and then the individual is answering them.
So we really good about our measurement of physical activity.
But we what we saw is that the there was improvement in physical activity with avocados.
So it might have been that intentional sense of eating something that is nutritious that is it was making them feel good, that, you know, all the connotations about having healthy diets or following a healthier regimen and engaging in more physical activity.
It was pretty cool to see that because it was unexpected.
Yeah.
And I remember there's like a, I think it was 26 or 27%, like total physical like increase in total physical activity.
Yeah, and the intervention group, which is it's pretty cool because you're saying like you're kind of looking at you going, okay, if I give them healthy food, I guess they'll they'll get more exercise or the more get more physical activity.
And I think we also need to account an ormention, right, that when there's some type of nutrition education that is affecting that, right?
Because we are giving them not only the delivery of the avocados, but that engagement with the promotota.
And we didn't really mention anything about physical activity, Tom during the nutrition education.
We were just focusing on my plate, you know, lessons that we can everyone is have access to. And the we provided both families with a recipe book with avocado recipe book.
But for some reason, that having seems to be the case that having those extra abocados, right?
So having that surplus for their family with that high, you know, high intake of avocados did a really good job into wanting folks to engage in another healthy behavior.
And right?
So we we felt really happy with those findings because it was definitely unexpected.
Maybe it's also the case of us as investigators, not that we per se, you know, talked about the potential positive, you know, influences or benefits of avocado.
But I think they're pretty well known, especially in a population that has consumed that fruit, right?
For a while.
And so maybe that also, uh, you know, was at play there, but for us as someone who who wanted at least in a population that we know need more, you know, everyone is a home, needs more physical activity.
Why why not attributed to eating avocado?
Come on.
Right.
Right.
Yeah, that that's that's that's really cool.
So, yeah, I mean, avocado has tons of tons of benefits, so we know now. Um I mean, especially likeardiovascular health and and I think yeah, and you did another paper on on that, on the consumption and risk of cardiovasor'sase, right?
Like with the avocado?
Yes, that that is when I started at Harvard and again, taking advantage, right, of that grade two set, three sets cohort studies of epidemiological studies that are there.
And before I answer that question Tom, do you mind if I tell the audience a little bit about what are bunchitudal studies and or beological?
Yes, yeah, let's definitely talk about that.
So, um and maybe they've heard inner health study or the health professionals and we throw all these names and it's kind of like normal for us to hear them.
But these are what they call prospective cohort studies and it's a type of observational study or a type of epidemiological study.
And there are basically three main types, cohort studies, which are these that I just mentioned, case control studies and cross-sectional studies.
And cohort studies are the ones that are going to, you know, father group of individuals over time to see if they develop disease,ase control studies usually compare a group of folks with with a condition with a group without it, right?
And that has their own sets of analysis and then cross-sectional studies examine data at a single point in time.
So think about it, what we do with and Haynes and it's just at that point in time we like a survey and it's not going to happen again.
So that's a cross-sectional study.
So with the nurse cell study and the health professionals, you start with folks that are free of that de cease in question, right?
Because you want folks that are, let's say with a clean bill at the beginning or as much as as you can, depending on what you're studying.
And you build as an investigator, you establish your cohort.
Maybe you have a specific set of characteristics like age, location, exposure to something that, again, it goes back to your research question or a common characteristic.
And the goal is that you want to follow these folks through the time over time and back that data and exposure or that factor of interest.
In our case, it would be, you know, diet dietary factors and track them whether they develop the health outcome again, of interest for your specific research question or not.
And one of the advantages is that you can assess risk because whenever because your baseline, you're excluding people with, you know, that outcome of interest, and you have, let's say, maybe 10, 15, 20 years into the future to examine whether who got or not that outcome, you can assess it, which is super important, you know, having to us as that new case or that new event.
It might be cardiac disease.
It might be cancer.
It might be something else.
And so for temporarily, tempor realities are, meaning the event or that event an effect relationship, since the exposure to the factor in question precedes, right the outcome.
Also, there's less recal biased in the exposure happens before the outcome, not to say that there are other other, you know, types were sources.
Again, we move back to our initial conversation about the FFQs andals.
So that's another type of potential for the most part as far as how we can assess that exposure.
It's, you know, it happened before the outcome.
And then, of course, I think we also must, you know, talk about the disadvantages.
We usually need a large, you know, sample size to to get that, especially when the outcome is rare, right?
Because we are not going to get as many events or cases, right?
It can be expensive and time consuming.
I mean, how many years and does the nurses health study in the health professionals have been active.
It's been it's been a lot of work by so many researchers because they they believe in this and why not?
It's one of those tre stresss that and also other cohorts, right?
Like the women's health study, initiative, sorry, and, you know, other cohorts that we've, this is how we dis you know, disentangled all these issues with potential risk factors and disease.
So I just wanted to clear that for your audience just to, so they know what, what exactly is a longudome cohort study.
And I' going back to Yeah.
Going to avocado, are you referring to the paper, right, with avocado intake, right?
And CVD?
Yes, uh-huh.
Yeah, and the Journal of American Heart Association.
Right.
So we found a lower risk of total CVD and hard disease with the intake of half a cup of avocado.
And again, many iterations went in many discussions to discuss what could be something interpretable, right?
Because that we go back to original question about the FFQ, we we rank people, right?
It's a distribution of intake.
And so for us to make it something interpretable and easy to understand for folks, we needed to make those conversions.
Again, this is something that it was simple enough to do with avocado because people can look at it.
And it's it's easy enough to scoop a certain, you know, that half a cup serving, right?
It's a little bit more visually, um, I don't know, interpretable that something else.
And again, we we did stipulate our specific serving as this and you have many sizes of avocados out there in the market.
We also must consider, let's say, for the avocados that we use for the avocado tr trial, where the physical activity outcome, those wereas avocados, right?
And we understand that in some instances, we don't, not everyone gets that avocado, even though it's the number one most, you know, widely used in the US or the consumers consume.
But we understand that it might not might not be everywhere.
We were just discussing a potential of a study in Puerto Rico and but they have, you know, very specific avocados on the island, right?
So that that kind of introduction of a new variety might not go well, right?
So in in this paper, we wanted to make sure that whatever unit, right, we would represent and make the analysis with might be something representative for the majority of folks.
And with the an average, right, of the potential variety used in the US, which would be a host of, at least domestically.
Yes, exactly.
Yeah.
That's a good point, because you're right.
You know, you could grow a different avocado and the makeup of it, the amount of fiber, you know, potassium in it, it could be different.
It could definitely be different.
Right.
And I think if we go back to the specifics of the paper, I think it was, what, 20, 21 percent lower risk of cornery heart disease and 16 percent lower risk, of total cardiovascular disease.
So that that's pretty good.
I mean, that in in itself, I remember doing a presentation for like a seminar for our school, our department.
And I compared to in the cohor what we've seen with other m moffas, right?
Monoon saturated fatty asses.
And we see the similar effect with almonds and all the oil.
So it as a whole, right, as a mono unsaturated food, I think it's important and also a great takeaway from that paper tom, I must say is what we do with the substitutions, right ? Because I think most people just add on and I don't know about you in practice, but as a dietician, I focus with that replacement, right?
You always want people to make better choices and not to just pile them on because that's just adding more calories, right?
So you want individuals to understand, okay, well, if I'm going to be doing avocados today and that is going to be my source of fad, something else must go.
So that's why I think the n nitty gritty of that paper and we when we mention you know replacing of half a serving a day of margarine or butter or egg and yogurt.
And we, you know, those were really thought out, even processed meats, because those are things you might use and placed with the avocado, you know, as other fatty foods, not to say that you can't have avocado toast with some eggs is just a potential, right?
Maybe lower that.
Just, you know, you might have folks that have other dietary restrictions.
So we gave you a potential list of replacement foods.
And I think that's also the takeaway because you would find that if you replace the avocado with the list of foods, you get 16% to 22% lower risk of CVD, just by making those small adjustments.
And it, you know, I think it goes to show that really, if we are paying attention to that change in our in our fatty acids, right?
Which is something that you suffician, know, the American heart association and all these other entities really rally behind focusing on those unstaturated fatty acids, right?
And especially something that is so ubiquitous like g avocado.
I mean, there was the time, it wasn't that in your face, but everyone knows what I remember.
All of a sudden it came up.
Yeah, Wakamole, you know, everyone understands that for the number one sales, I think is for the Super Bowl Sunday.
I mean, that's the one. Sale of avocado and everything related to that nature.
So why not have it in various times of the week, right, especially it can support beneficial aspects of your diet and for your health instead of other types of fatty foods that you might intake and that same, you know, week.
I think avocado was of a better choice.
Yeah, and I just wanted to point out the the primary outcome measure of the study was the composit, of fatal CHD, nonfatal myocardium function and fatal non-fatal stroke.
So when we talk about cardioascular disease, we're really talking about avoiding these major complications of, you know, having a heart attack and having a stroke.
And so I think it's a very good, you know it's a very very good thing to replace these foods that you, you know, you kind of list in this study there with the avocado.
One of the one of the problems that you ultimately run into when talking about nutrition with patients is, you know, what else they'll say, well, Doc, if I'm not eating this, what am I actually going to eat?
And if you don't, if you're a, you know, a physician who doesn't really know about nutrition, it becomes very difficult.
And sometimes also people may not have access to a nutritionist.
It can be hard in that in that instance.
But I think avocado also plays a role in like satiety, like sustaining their satciety really well.
So instead of pancakes, you may want to eat, you know, which will may run out on you throughout the day as far as, you know, energy and satiety goes, if you switch to the avocado, it can hold you out for a lot longer. The potential biological mechanisms that are in place here, not only there are cardiorotective, but definitely the fiber intake, the contents are that it has that'll help you with satiety, the plant steriles, you know, all these things that are really favorable for liid profile, right?
And I think as something a simple as this, I think this web steam, you know, a superf food.member those days that certain foods were d superf food because of all these great benefits that not only, although you do see folks, I'm sure you have seen them in your practice that are don't like avocados, right?
They have the texture or something like that.
I do look at them strangely, but I say, okay.
Yeah, right.
And also, not that it happens often, but I think some so many people don't think about the potential allergic reaction that you might have.
I don't know if you were aware of the lat latics g allergies and I was going to that.
Yeah.
So when if you see something it was less common now, right?
But in my olden day, you know, I needed to to know that because if you had someone, a patient primarily that was allergic to latex, kiwi banana, avocado or a no-no.
So they from the same family and they that protein is triggering to them.
And so that's something that we needed to be really considerate about with the trial, actually, because you don't want to induce anotheric reaction, right?
To folks.
So sometimes it's an aversion.
Sometimes it is an allergic reaction, like they they are legitimately allergic to it, but they sometimes folks don't why.
They just tell you, I get, you know, an effect, but it's probably due because they it's related to the latics, you know, L. But yeah, but that's something.. Thank you for that.
That's.
You're welcome search for it and it yeah, it's not very common.
I think it was common, you know, before when we had moral basics allergies and I remember like in my training in the hospital, it was just something so aware.
But since we sort of got away from that in the use of latics in our products, is it's just not so relevant.
But um, yeah, you still see them once in a while.
Yeah, that's interesting.
I was wondering, so yeah, thank you for going over that that study with me.
I was wondering, does Harvard offer, do they offer any like nutritional or healthy eating courses for the public?
I think um there was a time that maybe, and this is a big maybe because um I don't know if course Sarah had some Free Harvard classes.
Do you know that our en let me just check on the name so that I don't give you a wrong name.
I believe is called the professional site?
Yeah,essional and lifelong learning Harvard University and there are a bunch of online courses that anyone is open to the public, and I believe they're very cost effective, maybe like $20, $15.
And they are a certain course of subnutrition or nutrition for diabetes, um health, and they can go up to six weeks.
I mean, it's a really, and that talk.
It's not like a one hour thing in your done, right?
So it it so I think for me, I would definitely suggest that to folks if they're interested because you know that the information, even if you are paying those twenty bucks, $15, it it goes back to that same, you know, the running of the website, the making sure that the evidence is up to date because someone is doing that, right?
It's not not not for free.
Someone has to to make sure that everything is up and running and it so and everything, I must say, um, Tom, anything from the nutrition stores, which is the website for the department of nutrition, anything that we put out there is free for the audience and you can definitely make sure that it's it's up to par with the evidence and we not only share evidence from our studies, but what others have been doing, but it's called the nutrition stores.
And so between the nutrition stores and the professional and life fun learning side at Harvard, I think the audience can get really good information and resources for free.
We also do many interviews there.
Any mention of a new paper or a publication, something of interest as far or the arena of nutrition, that is the first place that you will get to see it.
And it also comes to, you know, with a great section on recipes.
So maybe , you know, you want to try something out of the ordinary and I am, you know, here knocking on the door. All of the folks that again, do the same order of takeout. And I get to see them with the same thing.
So maybe doing something and exploring and expanding their pallet in and you can do it at home, you know, just get the ingredients, but you know that these are well research and tested recipes.. You're not a yeah, it comes out back. Doesn't work and you brought it to a party and now, you you're like, I got this off of Harvard.
Yeah, exactly.
Yeah, yeah, I'm looking at it's very fantastic, yeah, healthy eating plates, all kinds of things. Food features, nutritions source update and protein.
This is a very good resource here.
Yeah, that's fantastic.
I'm going to put that in the show notes for sure.
Cool.
Yeah, and it keeps growing, right?
I mean, whenever we have something of interest or that people, uh, we definitely want to hear back from folks or any interests, then we can highlight certain things.
I remember when the avocado and the CVD, you know, paper came out from from Yahad that do we just discussed?
Then we did a whole feature in avocados, you know, for that month or so. And different recipes that you can use avocados in avocado smoothie, avocado brownies.
So so it's it's neat.
And especially if I think it prevents it from getting us as, you know, as consumers, right?
Bored.
Because, again, I go back to my basics and I am habitual in that sense and I get stuck considering recipes, even me who was brought up in a restaurant, right?
And you're like, well, I'm not, you know, feeling too too adventurous in the kitchen.
I'll I'll go with something that I know it's going to not take that long or like you mentioned the stir fry.
This is really again for me as well, go to. But I I things like this make me want to be a little bit more adventurous and say, okay, well, if they already tested it, I know it's going to be at least somewhat good, right?
Maybe I can drink it as to what I enjoy.
Maybe I I enjoy more like spicy foods, then I'll add a little someball to it.
Yes, yeah.
Yeah.
Uh-huh.
Yeah, exactly.
So is there are there any other things you wanted to talk about?
Because I know we're coming up a little bit on an hour here or so.
Is there anything else you wanted to mention?
Well, I think another area that we can maybe tackle for next time would be sugar student beverages, or even amplifying our discussion on moofas and seed oils.
I think that's something that a lot of people get confused on.
And definitely I would love to come back and and chat about those things.
But I think we tackled so many different topics, right?
In nutrition research that are somewhat the basics.
Yeah, we we did talk about the um certain studies, but I really enjoyed addressing the FFQ and like the nature of studies and why we do what we do and nutrition, you know, research.
It's it's just important.
The more that we talk about these, the more that we, as researchers are open about, you know, what we do and just be not on about it, I think it's way better and we get to connect with the audience.
Yeah, I think that we did cover some really important topics that are not necessarily out there in the public.
So I really appreciate you you talking with me and we're going to definitely have more episodes with you on and talking about interesting topics.
Thank you again, for the invitation and please let your audience members know that um feel free to reach out if they have any questions or topics that they might want us to discuss in the future.
Definitely.
Thank you so much.
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