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Food at the Heart of the Matter

In the world of nutrition science, Dr. Penny Kris-Etherton is a heavy hitter. A Distinguished Professor of Nutrition at Penn State University (for nearly 40 years), she has authored or co-authored over 370 research papers. She is Chair of the American Heart Association’s Council on Lifestyle and Cardiometabolic Health and served on the President’s Council on Fitness, Sports and Nutrition Science Board from 2014 to 2016.

Yet when we open the email from her that should have been a photo of herself, we find a photo of a young boy in class reading a book titled, Adventures in Cholesterol. “That’s my grandson, Oscar,” says a proud Dr. Kris-Etherton. “He’s a budding scientist.” As a professor, she shares her wealth of knowledge easily, as if giving it away makes it more valuable.

She trusts science and won’t be swayed from her ideals. She is someone you want in your corner and lucky for you, she’s in your corner — your wellbeing drives her work. A gentle contentment radiates from her along with an easy laugh. She is authentic, with a genuine commitment to improving individual and population health with good nutrition practices.

We spoke to Dr. Kris-Etherton about her work from her office at Penn State, where she was wrapping up the semester before a two-week vacation.

How do you describe your work to the everyday person?

I study how diet affects cardiovascular health. We know that heart disease is the leading cause of death in the US and the world. Nutrition plays a key role in affecting the risk for cardiovascular disease. Dietary patterns, individual foods and bioactive nutrients — nutrients that cause a biological response — are a large part of my work. Examples are polyphenols in vegetables or high quality protein in meat or fish. I study how they affect important risk factors for cardiovascular health.

What drew you to this field?

Growing up, my father and uncle had a restaurant which was handed down to them from their father (my grandfather). I worked in the restaurant and got to see first-hand the eating habits and food choices of restaurant patrons and this intrigued me. In high school I became interested in biology and became more fascinated by the strong connection between food, nutrition, biology and health.

That fascination only grew in college and grad school, especially with the publication of the Seven Countries Study, a study that began in 1958 of the dietary habits and heart disease rates in the US, Finland, the former Yugoslavia, Greece, Italy, Japan and The Netherlands. This study associated saturated fats in the diet with high blood cholesterol levels and heart disease. We had evidence that nutrition affected heart disease!  With heart disease being a leading cause of death in affluent societies,  I thought, “Look what nutrition can do!” Now, heart disease is the leading cause of death worldwide. And if good nutrition practices were followed by people around the world, many nutrition-related diseases, including heart disease would be drastically reduced.

It used to be that only wealthy countries suffered most from cholesterol-related cardiovascular disease. Over time, poorer countries entered that realm. Affluent people in developing countries started smoking, developed poor eating habits and became sedentary. Previously, developing nations suffered primarily from communicable and infectious diseases. Now poor nutrition practices have taken the lead.

So, I saw nutrition was a way of benefiting the public health of society and making a positive impact. Sharing my knowledge about good nutrition practices to improve the health of our nation has been the motivating factor for me. I went on to study nutrition at Rochester Institute of Technology and Case Western Reserve University. I earned my doctorate at University of University of Minnesota in 1978.  I love sharing what I’ve learned with others. I want to be part of the solution.

What is a problem that you wanted to solve?

I wanted to decrease the prevalence of cardiovascular disease with good nutrition practices on a population-wide basis. I asked the question, “What can we do in terms of getting people motivated?” Education and knowledge are both motivators. At a certain point in life we have responsibilities, relationships and families. We don’t want to die early or even die young or even suffer with heart disease for twenty years or longer. When we are twenty we think we will live forever. That’s when we think we’re invincible. In truth, that’s an important time to start making conscious choices about what we put in our bodies. We can set ourselves up for success with a healthy lifestyle the younger we start.

Why is your research important?

We’ve learned so much about the role of diet in preventing and treating heart disease. This research has a big impact on helping people make informed choices about nutrition. We can arm individuals with the knowledge that eating habits, dietary patterns and specific foods contribute to loss of heart health which may lead to heart attack or heart failure. A person can survive these events but will most likely have a diminished quality of life.

Research helps people create a solution before the problem arises, empowering them to achieve their life potential. This research can change lives. That feels pretty important.

What other achievements are you proud of?

I assumed the role of Chair of the Council on Lifestyle and Cardiometabolic Health at AHA on July 1, 2018.  The Council on Lifestyle and Cardiometabolic Health promotes the expansion and exchange of knowledge with the ultimate goal of improving cardiovascular health across the lifespan. The Council promotes basic, clinical, epidemiological and translational science related to nutrition, lipids, obesity, diabetes, physical activity and behavior change. I was very excited to step into this role.

I’m also proud of my work with the President’s Council on Fitness, Sports and Nutrition (PCSFN) from 2014 to 2016. This appointment was an interesting professional experience for me. PCSFN engages, educates, and empowers all Americans to adopt a healthy lifestyle that includes regular physical activity and good nutrition. Since 1956, the Council has created and promoted programs and initiatives that motivate people of all ages, backgrounds, and abilities to be active and eat healthy.

Of the papers you’ve authored, are there any personal favorites?

I’m especially proud of two papers on fish oil consumption and the connection to cardiovascular disease. Fish Consumption, Fish Oil, Omega-3 Fatty Acids, and Cardiovascular Disease, from 2002, has been cited over four thousand times! This paper paved the way for recommendations on fish consumption and omega-3 fatty acid intake. In 2010, the Dietary Guidelines for Americans made recommendations for the first time for fish consumption — two servings per week.

Determinants of Erythrocyte Omega-3 Fatty Acid Content in Response to Fish Oil Supplementation, published in 2013, identified the predictors that explained factors that contributed to the response to dietary omega-3 fatty acids. Factors that improved the responsiveness to dietary omega-3 fatty acids were baseline omega-3 fatty acid intakes, age, sex, and physical activity. Individuals who had a lower baseline intake of omega-3 fatty acids had a greater response than individuals with a higher habitual intake. Women had a greater response than men.  Older individuals had a greater response than younger individuals.  And physical activity had a positive effect and resulted in an even greater response. Mike Flock, a doctoral student in my lab, co-authored this paper with me. This one is pretty special.

What is a discovery you’ve been really excited about?

I am very excited about all of the research that has been done to date demonstrating a key role of nutrients, foods and healthy dietary patterns in managing blood pressure and maintaining vascular health. A healthy dietary pattern emphasizes fruits, vegetables, whole grains, low-fat dairy, lean proteins (including legumes), nuts & seeds and liquid vegetable oil. It is low in sodium, saturated & trans fats and added sugars.

The new American Heart Association & American College of Cardiology Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults recommends that systolic blood pressure be <120 mmHg and diastolic blood pressure be <80mmHg. Almost 50% of the US population has blood pressure levels that exceed these recommendations.

A healthy dietary pattern can play a very important role in helping achieve these blood pressure recommendations and decrease the prevalence of heart disease and stroke in the US.

Has your research ever had an outcome that was not what you expected?

We did a study on soy protein and vascular health that didn’t show any benefits of soy.  This was really disappointing to us. We were hoping for good news about soy’s benefits on blood pressure, but our study results turned out to be negative. From a different nutrition topic standpoint, however, for a long time we thought low-fat diets were good for heart health before research demonstrated they were not so good, in terms of lipids and lipoprotein responses. This led to a research focus by the academic community on the cardiovascular health effects of moderate-fat diets. Collectively this research demonstrated many health benefits of good fats. All of the research that has been done with health moderate fat diets has changed our thinking about fats in a very big way. Now, dietary guidance recommends that good fats (not refined and simple carbohydrates) replace “bad” fats.  Thus, a moderate fat diet, and not a low-fat diet is recommended. Also, a moderate fat diet versus a low-fat diet is easier to follow.

Have there been any key reversals of research in your career?

Fish oil and omega-3 fats in the prevention and treatment of heart attack and cardiovascular disease lost a lot of steam — specifically, fish oil supplements. The benefits of fish consumption didn’t translate to fish oil supplements. More and more recent studies showed that the supplements didn’t have the cardiovascular health benefits we expected from early studies that showed that fish oil supplements significantly decreased cardiovascular disease in persons with heart disease. The bottom fell out on this one. The early studies demonstrated benefits of fish oil supplements when used immediately post-heart attack at a time when medical practice was less intensive for cardiac patients.

Today’s standard of care for heart attack calls for immediate, rigorous ‘ABC’ treatment — aspirin and antianginal medications, beta-blockers and cholesterol-lowering medications. Although this clinical practice regimen is of the utmost importance (ie, it is now the standard of care in medicine), when given in conjunction with fish oil, there are not additional benefits in heart attack patients. However, there is some very new research in healthy people without heart disease who are low fish consumers that has shown cardiovascular benefits from omega-3 fatty acids.  Recent research has also shown similar of omega-3 fatty acids in individuals with diabetes who are at increased risk of heart disease.  Yet another study reported benefits of a prescription form of a fatty acid in fish oil in people with high blood triglycerides who were also taking a statin drug. So, the tide is turning again and we are seeing some benefits of omega-3 fatty acids for the prevention of heart disease.  There is also more research showing many benefits of fish consumption in addition to the long chain omega-3 fatty acids found in fish.  On the basis of all of this research, consumers are encourage to consume about 2 fish meals (preferably fatty fish) weekly as a source of omega-3 fatty acids as well as many other nutrients.

What frustrates you about heart health and public perception?

I find it frustrating when dietary guidelines are misunderstood. People think they are following a healthy diet but really aren’t. The messages are being lost in translation. People are not implementing food-based dietary recommendations accurately.  A perfect example is the message to consume more plant proteins instead of animal proteins that are high in saturated fat. Many consumers and health professionals have decided to avoid all animal products.

I find it frustrating when dietary guidelines are misunderstood. People think they are following a healthy diet but really aren’t. The messages are being lost in translation.

This can be done well, but it means knowing how to plan a healthy vegan diet that does not have any animal foods.  So many plant based diets that are being implemented by well meaning, but uninformed individuals, fall short of meeting all nutrient needs which can have long-term serious health consequences. The science of nutrition changes frequently with new findings and this can cause consumer confusion resulting in the lack of public trust in nutrition recommendations.

What are some misconceptions you want to clarify about diet and heart health?

First, that fat is bad. There are good fats — people simply have to pay attention to the amount they eat (and the type, too). Not all fats are bad.

Second, eating a nutritious diet but topping it off with sugar-sweetened drinks, frappes, fancy lattes, and smoothies is not healthy. These drinks are loaded with refined, low-fiber carbs and simple sugars. I also want to point out the “all natural” perception. Burgers and fries can be misinterpreted as healthy because they are all natural. Sugar is a prime example of all natural but not being healthy.

Finally, there are a lot of misconceptions around nitrates. Many people hear about nitrates in relation to meats, but nitrates are primarily found in fruits and vegetables. Nitrates are bioactives that play a key role in the production of nitric oxide, which promotes good vascular health. This is a reaction in the body that is happening. Fruits and vegetables vary a great deal in their content of nitrate. Spinach, collard greens and beets are high in nitrates.

We want nitrates from healthy foods like fruits and vegetables.  Americans fall way short of meeting current recommendations for fruits and vegetables.

What revision to health guidelines do you predict in the future?

I think the new Dietary Guidelines will address the topic of behavior change and make recommendations about how people can change their “bad” dietary habits in favor of achieving a healthy dietary pattern by making recommended food choices. Also, the new Dietary Guidelines will most likely address a new age group, specifically the birth to two-year age range. All previous editions of the Dietary Guidelines have only made recommendations for individuals older than two.

The current Dietary Guidelines have recommended three healthy eating patterns — a healthy US-style eating pattern, a healthy Mediterranean-style eating pattern and a healthy vegetarian or vegan eating pattern.  Now people will have more choices with an eating pattern that best fits their lifestyle. I think we’ll also refine our current messages. We’ve already come a long way by recommending specific colors of veggies and making specific recommendations around fish, seafood and nuts. With further research, we may make more specific recommendations about which fruits, vegetables, fish and nuts to eat.

If you were in charge of educating Americans on diet and nutrition, how would you go about it?

Post it on signs. Write it on blimps. Put the message everywhere, especially on all types of social media. Even restrooms are a possible target for posted messages! Also, we need to fill a huge gap by educating physicians and other health care professionals on nutrition. People listen to their doctors. We need to empower them to spread the right message. Many doctors pick up the prescription pad for medication first, but there is a movement among doctors to write an actual prescription for a healthy diet and physical activity. That’s the kind of action we want to cure the nutrition problems of today.

What’s your take on diet trends?

Keto, Atkins, Whole30, Body Reset, Dukan diets — you name it. Most diet trends today sound scientific and good, but many restrict entire food groups. When you start doing that you compromise the nutritional quality of the diet. For example, excluding grains and starchy vegetables can cut out great sources of fiber. When you go to extremes you are limiting many good options, making it hard to obtain adequate vitamins, minerals and bioactives and also making it almost impossible to follow the diet for any period of time. People looking to lose weight on these diets frequently do lose weight but often regain the weight and then some. An overly-restricted diet is not healthy or sustainable for a lifetime.

Where do you stand on organic versus non-organic foods?

Organic foods are widely deemed to be healthier than non-organic foods, but research is showing us that there is no clear benefit in organic vs. non-organic foods. Even the most educated consumers need to be aware of perception marketing when it comes to organic foods. Does the science back it up? Is it better to be safe rather than sorry and buy organic? Consumers need to be aware that organic foods often sit on grocery store shelves longer causing nutrients to be adversely impacted. And although there are rules on the types of pesticides farmers can use, organic foods are typically grown with natural pesticides and additives. It’s so important to educate ourselves.  The scientific literature indicates that from a safety and nutrition perspective, organic and conventionally produced foods are essentially the same.

We are so lucky to have you on our science advisory board! Why did you choose to be on HumanN’s advisory board?

I believe in HumanN’s products. They are very exciting to me because they are science-based. There is a lot of evidence that backs the benefits of all their products – especially beets. The values that HumanN stands for are also commendable. Joel wants to do something significant and make a difference in peoples’ lives. His business model prioritizes the greater good over self-interests. His goal is to make a positive impact on people everywhere.

What’s a book you’ve given most as a gift and why?

Not just one book – two books: Ready Player One by Ernest Cline and The Heart by Maylis de Kerangal. I have gifted these books and recommend them highly.

If you could have a gigantic billboard anywhere, what would it say?

My billboard would quote Michael Pollan, author of Food Rules and In Defense of Food. “Eat food. Not too much. Mostly plants.”

If you weren’t doing what you’re currently doing what would you do?

Something needs to be done about the problem of childhood hunger. That’s where I’d be putting my efforts. It’s important to fight childhood hunger and malnutrition through good nutrition programs, education and public policy. Here in State College, the Y has a backpack program. Every Friday, volunteers pack over a thousand backpacks that go home with children in need of foods over the weekend. On Monday, these kids return the backpacks empty to be filled again next weekend. They have food to eat on the weekends, when school lunches aren’t available. This is a noble cause.

I see myself being actively involved with a nonprofit or organization dedicated to education in nutrition, even at the grassroots level. From there I might be able to get involved more deeply. USDA statistics tell us that in 2017, 15.7% of households with children were food-insecure. Typically, when there are hungry children in a household, there are also hungry adults. I believe the number of hungry children is closer to 20%. Some children don’t eat anything for an entire day. This typically happens over a weekend as children in school often have access to school lunch programs. How can a child reach their potential if they are hungry?

Do you think farming techniques will change in the future?

My husband, Dr. Terry Etherton, is Department Head of Animal Science at Penn State. We talk about this a lot. Over the next 40 years, the global village will need to produce a quantity of food that approximates food produced over all of humankind’s history on the planet.  We need to do this on a land base that is available — and suitable — for agriculture. That land base is decreasing. To reach this goal, we have to vastly improve productive efficiency of plant and animal agriculture.  Science is one way we can help with this looming challenge. It’s imperative that new science-based innovations are developed to feed a continually-growing world population.

What’s the most worthwhile investment you’ve made?

The best investment I ever made was in my family. I’ve tried to put them first whenever possible. My husband and I had opportunities to leave State College but for many reasons (personal and professional) decided to “stay put”. Penn State is a world-class university and we have valued all that it has offered for so many years. Also, State College is a wonderful place to raise a family. We both are thankful that we built our home and careers in State College and at Penn State. Our two sons graduated from Penn State.  And now we have three fantastic grandkids (that we are trying to recruit to Penn State!). Raising a family in State College and working at Penn State have proved to be two great investments that have yielded many benefits. Going forward I hope to “give back” as much as I can to help the next generations live a long, healthy and meaningful life!

Author Penny Kris-Etherton

Penny Kris-Etherton, PhD RD

Dr. Penny Kris-Etherton is a Distinguished Professor of Nutrition at Penn State University, the current Chair of the AHA Council on Lifestyle and Cardiometabolic Health, past Chair of the American Heart Association (AHA) Nutrition Committee, and past President of the National Lipid Association.  With a research program focused on exploring how nutrients and other bioactive constituents affect established and emerging risk factors for cardiovascular disease, her connection to HumanN is apparent. Dr. Kris-Etherton has published over 350 scientific papers, 10 book chapters and co-authored four books. Her research program has been funded by the National Institutes of Health, USDA and the private sector. She has also served on many national committees and review panels including the 2005 Dietary Guidelines for Americans Advisory Committee, the 2002 National Academy of Sciences Panel on Macronutrients, the National Lipid Association's Patient Centered Management of Dyslipidemia Panel, NIH’s Nutrition Study Section, and the National Cholesterol Education Program Second Adult Treatment Panel.

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