True or false: Identifying and removing certain trigger foods from your diet is always the best treatment for digestive symptoms.
FALSE. While some people have food allergies or autoimmune conditions (like celiac disease) where certain foods are always the culprit, many digestive symptoms have more complex causes. In some cases, patients will eliminate more and more foods from their diet because they believe the foods are responsible for their symptoms when the real culprit is not the type of food itself, but the digestive tract's response to eating in general.
In what we call "disorders of gut-brain interaction," abnormal nervous system function in the GI tract causes patients to feel abnormal sensations even when digestion is seemingly working normally. Targeting these abnormal nervous system responses may be a better goal of treatment than identifying and eliminating foods from the diet.
Kyle Staller, MD, MPH
Director of the Gastrointestinal Motility Laboratory
Massachusetts General Hospital
True or false: Where food is located in the grocery store has no impact on what you decide to buy.
FALSE. The “choice architecture” of the grocery store, or any food environment, strongly influences what we purchase. Healthy choice architecture (i.e., when healthy items are placed in highly visible or convenient locations) increases the likelihood of making a healthier choice.
We have demonstrated this effect in the Mass General Hospital cafeteria, where food and beverages are labeled as red (least healthy options), yellow, and green (the healthiest). When the healthiest items were placed at eye level or in convenient locations (e.g., water bottles in baskets at food stations), employees were more likely to make those healthier choices.
We also demonstrated the same effect in corner stores in Chelsea, when we placed fresh produce at the front of the stores and near checkout counters.
Unfortunately, the food industry has leveraged "unhealthy" choice architecture for many decades to tempt us into impulse purchases by placing foods high in sugar, salt, or unhealthy fats on supermarket endcaps, checkout lanes, or at the front of the store.
Anne Thorndike, MD, MPH
Associate Professor of Medicine, Primary Care Physician
Massachusetts General Hospital
True or false: Early introduction to foods such as peanut butter can help prevent the development of allergies.
TRUE. The strongest evidence to date comes from the LEAP Trial (Learning Early About Peanut Allergy), where Gideon Lack and colleagues demonstrated that introducing developmentally appropriate forms of peanuts between four and six months of age can result in an 80% reduction of peanut allergy in high-risk children.
We collaborated with Corinne Keet, MD, PhD, at Johns Hopkins University on a study which demonstrated that in kids with severe eczema, the chance of peanut allergy significantly increases with time. While less than a fifth of children younger than six months were already allergic to peanuts, about half of children over eight months were allergic to them. These findings highlight the importance of not delaying the introduction of developmentally appropriate forms of peanuts.
Michael Pistiner, MD, MMSc
Director of Food Allergy Advocacy, Education and Prevention
Mass General Hospital for Children
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