Tuesday, May 14, 2019

Can I drink alcohol if I am trying to lose weight?

This is a question I get all the time from new clients.  The answer is yes you can, but in moderation. Alcohol has been associated with weight gain in the research literature. Scientists from Harvard combined subjects from 3 separate cohorts into a giant study on individual foods and weight gain (1). Over 120,000 men and women were followed for up to 20 years. Increases in alcohol, even just one drink a day, were significantly and consistently associated with modest weight gain. There are several reasons why this may be true:

-Alcohol is calorie dense, it contains 7 calories per gram. A typical beer has 150 calories, a glass of wine has 85 calories and 1.5 ounces of hard liquor generally has 100 calories. Have 2 or 3 of these a day and trust me, the calories begin to add up.

- Liquid calories generally don’t register with the body. In other words, if you eat a solid food snack in the late afternoon, you would compensate by eating a little less at dinner. The body does not seem to recognize liquid calories in the same way. So, if you have a drink or two before dinner, you don’t eat any less food. In this way, alcohol calories are simply added on rather than substituted.

               - Alcohol can’t be stored in the body, so it becomes a priority for oxidation. Because of this fact, alcohol consumption suppresses fat oxidation. Therefore, you are burning less of your body fat when you drink.

               - In my experience and that of my clients, when you have a few drinks and start to get a bit of a buzz, your discipline goes out the window. After 3 or 4 drinks, the dessert menu becomes harder to resist and the late night fast food/diner stop seems to become all but inevitable!

You don’t necessarily have to give up alcohol here. If you have a few drinks a week, say four or less, you’ll be fine. If you’re drinking every day, this can really slow your rate of weight loss. A good strategy that several of my successful clients have used is to drink only on the weekends and avoid alcohol completely during the week.

1) Mozaffarian D, et al. Changes in diet and lifestyle and long-term weight gain in women and men. New England Journal of Medicine 2011; 364:2392-404.

Multivitamin use and your health

The Study
The health benefits of multivitamin use remain controversial. In this recent investigation, 30,899 adults identified through the National Health and Nutrition Examination Survey (NHANES) had their multivitamin use measured and then were followed for over 6 years. Multivitamin use had no association with risk of mortality in either direction. A few other interesting findings:

-Adequate intake of Vitamin A, K, magnesium, zinc and copper were associated with a reduce risk of all cause mortality. However, this was only true when these nutrients were obtained from foods, not from supplements.

-Excess intake of calcium was associated with an increased risk of cancer death. This association was mostly from supplemental calcium, not calcium obtained from food.

Annals of Internal Medicine doi:10.7326/M18-2478

Take Home Message
It appears that multivitamins don’t do much harm or much good. There really is no reason to take them. I always recommend getting your vitamins and minerals from your food. Make sure to include a variety of fruits and vegetables, whole grains, and nuts each day. The findings concerning calcium are disturbing. If you are taking a high dose of calcium, you may want to talk to your doctor about the pro’s and con’s of doing so.

Monday, May 13, 2019

Fruits And Vegetables And Your Health

The Study
Blood levels of vitamin C, carotenoids and alpha-tocopherol are biomarkers for fruit and vegetable consumption. In a meta-analysis of 69 prospective cohort studies, the association between these biomarkers and health were examined. In addition to blood levels, this study also examined dietary intake of these nutrients. The results were impressive. Blood levels/and or dietary intake of these nutrients were associated with a statistically significant lower risk of coronary heart disease, stroke, cardiovascular disease, cancer and all-cause mortality. American Journal of Clinical Nutrition 2018: 108: 1069-91.

Take Home Message
We have all heard it many times before- fruits and vegetables are good for you. Well, they still are. Fruits and vegetables are among the most healthy things that we can eat. Load up on them. I have my clients shoot for at least 5 servings per day of fruits and vegetables. More is better. 

Just a few notes:

-Limit dried fruits, like raisins and dried cranberries. These are higher glycemic can spike your blood sugar.

-Limit fruit and vegetable juices. These are also high glycemic.

-Try to vary your sources of fruits and vegetables. Get as many colors on your plate as possible.

Product Review: Lose it! Food Tracking App

If you are trying to drop a few pounds, keeping track of what you are eating is essential. It provides accountability and gives you a sense of control over the healthy changes you are trying to make. I always have a new client write down their food for the critical first few weeks of our work together. 

That is why the Lose it! app is next up for review. This is an app for your smart phone that allows you to track your food. It is available for both Android and iPhones.

1) The lite version is free, which is great. 

2) It is really easy to use. It takes about 2 minutes to get comfortable with how it works.

3) There are 7 million foods in the database. Every single food I tried to look up was there.

4) It is convenient. Being able to log your food on your phone makes it really easy.

5) There is a macronutrient breakdown that shows you the percentage of your diet that is fat, protein and carbohydrate. This is very useful.

6) You can scan the bar code of a food item in the app to add it to your meal. This really increases the accuracy of your logging.

1) There are constant reminders to upgrade to the premium version. I don’t begrudge anyone trying to make money, but it does get a little annoying.

2) There is not a lot of nutrition information available in the lite version. Nutrients such as saturated fat, grams of sugar, sodium, etc, are not available.

3) There are lots of links to other things you don’t really need that clutter up the interface.

Do I Recommend the Lose it! food tracking app?
Absolutely. This is a great app that will help you keep track of your diet. It is convenient, free, easy to use and has a comprehensive food database. Lose it! makes logging your diet a snap. I do not know if upgrading to the premium version is a good value as I, personally, did not see the need to do that. Give this one a try. It is available at the Google Play Store or the App Store for Apple products.

Disclosure: I am not affiliated with the company that makes the Lose it! food tracking app and make no money if you use it.

Wednesday, March 13, 2019

Exercise and inflammation

The Study
In this investigation, 10 subjects who exercised regularly for up to 5 hours per week added 17.5 miles of running to their weekly fitness routine. The researchers were trying to see the impact of intense exercise on the subject’s ability to absorb dietary iron. By the end of follow-up, the subjects had a significant increase in Interleukin-6 levels, which is a biomarker of inflammation. American Journal of Clinical Nutrition 2018;108:1324-1333.

Take Home Message
Inflammation plays a central role in the progression of many chronic diseases, including heart disease, cancer, type 2 diabetes and Alzheimer’s disease. This study is interesting because it provides further evidence that too much exercise is not great for our body. In this investigation, adding 17.5 miles of running to a moderate fitness routine significantly increased body wide inflammation. Moderate exercise has been shown to decrease inflammation, which is one of the many reasons why it is good for you. However, this study shows us that if you do too much, exercise can actually have the opposite effect.

Don’t go overboard with your cardio. Thirty to forty minutes of moderate intensity cardiovascular exercise each day is about as high as I would go. This is the perfect amount to maintain your weight, improve your energy, improve your mood and strengthen your immune system. This amount will also help decrease your risk of today’s most deadly diseases. When it comes to exercise, more is not necessarily better.

Carbohydrate intake and energy expenditure after weight loss

The Study
Following weight loss, resting energy expenditure drops significantly. This is a big reason why so many dieters quickly regain their lost weight. A recently published randomized trial examined if the ratio of carbohydrate to fat impacts resting energy expenditure post weight loss. After a 12% weight loss, 164 overweight subjects were randomized to one of three diets for a period of 20 weeks:

-High Carbohydrate: 60% carbohydrate, 20% fat, 20% protein.

-Moderate Carbohydrate: 40% carbohydrate, 40% fat, 20% protein.

-Low Carbohydrate: 20% carbohydrate, 60% fat, 20% protein.

The primary outcome was total energy expenditure, which was measured by doubly labeled water. The results were fascinating. Subjects consuming the higher levels of carbohydrates had greater decreases in total energy expenditure. Subjects on the moderate carbohydrate diet burned 91 more calories per day when compared to subjects on the high carbohydrate diet. Subjects on the low carbohydrate diet burned 209 more calories per day when compared to the high carbohydrate diet. British Medical Journal 2018;363:k4583.

Take Home Message
This is a really interesting study. The differences in energy expenditure found in this study are highly relevant. Compared to the high carb diet, the extra calories burned in the moderate and low carb diets could prevent 10-20 lbs. of weight regain in a year. 

The researchers believed that the differences in energy expenditure could be due to a lower glycemic index, a lower glycemic load, thermic effects, brown adipose activity, autonomic tone, nutrient cycling, changes in ghrelin levels and/or changes in leptin sensitivity.  

The low carb subjects were found to have lower levels of ghrelin. Ghrelin has been shown to lower energy expenditure and promote fat deposition. The low carb group also had lower levels of leptin. Previous research has shown that lower levels of leptin after weight loss predict less weight regain.

Although more research is needed in this area, going lower carb may make it a lot easier to keep lost weight off permanently. This study provides further evidence that low-fat high carbohydrate diets do not seem to be the path to permanent weight loss.

Does intermittent fasting improve rate of weight loss?

Intermittent fasting has become a popular weight loss strategy in recent years. Many best-selling diet books advocate intermittent fasting as an efficient and natural way to lose weight that is more effective than conventional methods. A randomized controlled trial was recently published that compared an intermittent fasting protocol to a standard weight loss diet where calories where slightly reduced on a daily basis.

The Article
This randomized trial was conducted in Germany and was recently published in The American Journal of Clinical Nutrition (Reference 1). In this investigation, 150 overweight and obese men and women were randomized to one of two weight loss diet groups. The intermittent calorie restriction group (ICR) had a weekly schedule of 5 days without energy restriction and 2 days with an energy restriction that was 75% of usual calories. The goal of the continuous calorie restriction group (CCR) was to reduce calories by 20% each day.

There was a 12 week intervention phase, a 12 week weight maintenance phase, and an additional 26 week follow period for a total of 50 weeks of follow-up. By the end of the 12 week intervention, there was no significant difference in weight loss between the two groups. By the end of the 50 week follow-up, there was still no significant difference between groups in the amount of weight lost.

There were a few other notable findings:
-Physical activity was measured by means of an accelerometer at the start of the study and in Week 12. Levels of physical activity increased by .2% in the continuous calorie restriction group but decreased by 13.4% in the intermittent calorie restriction group.

-By the end of Week 12, fasting glucose had been reduced more in the continuous calorie restriction group than in the intermittent calorie restriction group (-7.6% vs. -2.9%). This difference was statistically significant.

-Five times as many subjects reported uncomfortable side effects in the fasting group compared to the daily calorie restriction group.

Other Research
Several other research publications I have covered in my blog showed negative outcomes with diets using intermittent fasting. These include: an increased LDL cholesterol, glucose dysregulation, increased inflammation, increased hunger and a decreased energy expenditure. If you want to reference these studies, please refer to my review of the Obesity Code (click here).

Conclusions And Recommendations
Despite its recent popularity, intermittent fasting does not appear to be a better weight loss strategy than moderate daily calorie restriction. In fact, it appears to have some real negatives. There is no reason to starve yourself in order to lose weight. I have found that the combination of a blood sugar stabilizing low glycemic load Mediterranean diet, adequate cardiovascular exercise and resistance training is absolutely the way to go if you want to lose weight, feel great and reduce your risk of today’s most deadly diseases.

1) Schubel R, et al. Effects of intermittent and continuous calorie restriction on body weight and metabolism over 50 weeks: A randomized controlled trial. American Journal of Clinical Nutrition 2018; 108:933-45.