Friday, December 24, 2010

Top 5 Traits Of Successful Weight Loss Clients

Losing weight and keeping it off is not an easy thing to do.  For over 15 years, I’ve been studying weight loss both academically, in graduate school and clinically, working with weight loss clients.  In that time I’ve found that successful losers tend to share common traits.   Conversely, these traits are lacking in those that are not successful.  I thought I’d use this post to list the top 5 traits and explain a bit why they are so important.

Trait #5 Ability to do cardio at home
          If you are serious about losing weight, cardiovascular exercise needs to be a just about daily activity for you.  The research literature is beginning to paint a very clear picture of this fact.  If you need to go to the gym to do your cardio, it just doesn’t happen with enough consistency.   I always strongly recommend that my clients have a piece of cardio at home to help them get their minutes.   If you missed my previous post on the Gazelle Edge, here is the link.  This provides a low impact, portable, inexpensive solution to this problem.

Trait #4 Resiliency
          Just about every aspect of our lives now distracts us from a healthy lifestyle.  The wrong food is just about everywhere, our schedules are getting busier and busier and physical activity is no longer built into our day.  You will get off track from time to time with your diet and exercise habits.  Count on it.  It happens to all of us.  Holidays, vacations, birthdays, stressful periods at work/home all contribute to this.  The key is to get back as soon as possible.  Some people let a bad meal choice become a bad day, then a bad weekend, then a bad week and then a bad month.   Those who are successful don’t think like that.  They get back right away, I mean the next day!  I played a lot of hockey growing up and the best goalies had a very short memory.  In other words, they may let in a really bad goal but they quickly forgot about it.  They focus on the next shot like the last one never happened.  Have a short memory when it comes to your dietary and exercise indiscretions.

Trait #3 Plans ahead
          My clients that are most likely to hit their weight loss goals are quite organized and plan ahead.  Here are some examples:  1) Doing grocery shopping early in the week and making sure they have what they need to prepare healthy meals when they are home. 2) When going out to eat, suggesting restaurants where they know they can make good choices. 3) When traveling, making sure that they will have access to the type of foods they need to stay on plan even if it means bringing non-perishable food items with them on their trip.  We all run into trouble when we find ourselves in situations with tempting foods and no healthy alternatives.  Minimize these situations by planning ahead whenever possible.

Trait #2 A realistic attitude about what it will take to lose weight.
          Lose 30 pounds in one month eating your favorite foods and doing no exercise!  Claims like these sell a ton of books and supplements but what they don’t do is help you lose weight.  One of my old professors you to say “The only way to lose 20 lbs instantly is to cut off a leg!”.  My most successful clients don’t fall for these claims.  They know that weight loss will take a lot of effort.  They know they need to eat right, they know they need to do just about daily cardio and they know they have to hit the weights at least twice a week.  They accept the facts and go about making their changes.  They know there will be struggles but they accept them and work to overcome them.

Trait #1 They seek out the research based science of weight loss.
          The individuals I work with who do the best with their weight loss realize that there is a science to it all.  They don’t care to learn about how to eat from a famous celebrity or actress who never even cracked a book on nutrition.  More than half of the weight loss best sellers on Amazon.com are written by authors that have literally never even studied college level nutrition.  They are either actors, look really good or are amazing marketers fooling consumers.   The people who buy these books would never go to a doctor that didn’t go to med school or go to a tax accountant that had never studied accounting.  People that are truly successful losing weight get the facts from the experts and are immune to all the nonsense.

Happy Holidays to you all and best wishes for a healthy and fit New Year!

Tuesday, December 14, 2010

Feature Article: Alcohol

            A topic that comes up every time I give a nutrition lecture, start with a private client or meet a doctor’s referral is alcohol.   Here are some of the most typical questions:

Is alcohol good for you or bad for you?
What is considered a drink?
Can I drink alcohol if I want to lose weight?
Does it have to be red wine only?

            I figured I’d use this post to answer these questions and more.  Alcohol continues to be an interesting and controversial subject.   However, current research has taught us much about the effects of alcohol consumption on our health.

Basic Information On Alcohol
            Humans have been drinking some form of a fermented beverage for over 10,000 years.   The main active substance in alcohol containing drinks is ethanol.  Ethanol exerts a direct influence on the stomach, brain, heart, gallbladder as well as the liver.  It has an effect on inflammation, blood coagulation, insulin sensitivity, serum cholesterol and triglycerides.  As many of us know, it also has a direct effect on mood, concentration, coordination and most definitely, judgment.  

Alcohol contains 7 calories per gram.  As a reference, carbohydrate and protein have 4 calories per gram while fat contains 9 calories per gram.  A drink generally contains 12-14 grams of alcohol which equates to 12 ounces of beer, 5 ounces of wine and 1.5 ounces of hard liquor. 

Health Effects
            Alcohol’s impact on human health is a rather complicated issue.  Depending on the dose, alcohol is either extremely healthful or quite literally a poison.  Heavy drinking causes severe damage to the liver and heart, increases risk of a number of cancers and is involved in roughly half of all fatal traffic accidents.    For those individuals prone to alcoholism, excessive drinking can destroy virtually every aspect of their life.

            However, the health benefits of a moderate consumption of alcohol are undeniable.   Let’s start with the heart.   There is strong evidence that alcohol increases HDL cholesterol which is probably why it is associated with a reduced risk of coronary heart disease. (1)  Alcohol also improves the factors that influence clotting which is probably why it is associated with a reduced risk of stroke. (1) Finally alcohol tends to improve insulin sensitivity and there is evidence that it reduces the risk of type 2 diabetes. (2)

            Many wrongly feel that the benefits are only from red wine due to the antioxidants in the grapes.  This is not the case.  In our cohorts at Harvard, similar benefits were found for wine, beer and hard liquor, so feel free to drink what you like.

            So what is considered moderate consumption?  1-2 drinks per day for men and 1 drink per day for women.  You need consistent intake here, you can’t save all 7 of your drinks for Saturday night at the bar, you have to drink on a just about daily basis to get these benefits.  One other thing to mention is that even a moderate consumption of alcohol has been associated with an increase risk of breast cancer in women, about 40% increased risk with 2 drinks per day (3).  However, getting enough folate seems to minimize this risk.

Alcohol And Weight
            I hate to complicate things further but I have found that alcohol can have a profound influence on your ability to lose weight.  Alcohol provides 7 calories per gram and if you have 1-2 drinks every day, trust me, the calories begin to add up.  I have read that alcohol also slows down your metabolism but I haven’t really seen a lot of hard evidence that this is true.  What I can say is true, in my experience and others, is that after a few drinks we all develop a kind of “You only live once” mentality and the late night fast food stop or trip to the diner becomes all but inevitable.  

            If you work with me privately or read my book on weight loss, you know that to limit alcohols affect on weight, I restrict my clients to 4 alcohol containing drinks per week.  This way you get some of the benefits of drinking without the negative effect on your weight.

Take Home Message
            At the end of the day, the recommendation for alcohol use depends on the individual.  Drinking in moderation (1-2 drinks for men per day and one drink for women per day) has definite health benefits.  If you have a family history of alcoholism, it’s probably a good idea not to start drinking if you currently aren’t.  If you are a female, make sure you get adequate folate if you drink even moderately to help reduce any increased risk of breast cancer.  If you want to lose weight, limit yourself to a maximum of 4 drinks per week.  This way you are obtaining some of the benefits without sabotaging your weight loss efforts.

References
1) Annals of Epidemiology 2007 175:24-31.
2) Diabetes Care 2005 28:719-25.
3) Journal of the American Medical Association 1998 279:535-40.

Saturday, December 4, 2010

Research Update: Carbohydrates And Inflammation

Carbohydrate Nutrition And Inflammatory Disease Mortality In Older Adults
Buyken, AE et al.
American Journal of Clinical Nutrition 92:634-43 2010.

Objective: To examine whether dietary glycemic index, dietary fiber, and carbohydrate containing food groups were associated with mortality attributable to inflammatory disease.  These diseases include diabetes, Alzheimer’s, Parkinson’s, infectious disease, respiratory diseases, immunologic diseases, digestive diseases and others.

Study Population: 1,400 postmenopausal women and 1,245 men aged 49 or older.  This was an Australian cohort that was followed for 13 years.  By the end of follow up, 84 women had died and 86 men had died.

Results:  Women with the highest dietary glycemic index had a 2.9 fold increased risk of death from inflammatory diseases.  Increasing intake of foods high in sugar or refined starches also independently predicted a greater risk of death from inflammatory diseases.

In men, increasing consumption of fruit and fruit fiber decreased risk of death from inflammatory disease.

Comment:  This study is interesting for a variety of reasons:

#1- I’ve seen literature suggesting that a diet rich in high glycemic carbohydrates increases C - reactive protein (a marker of body wide inflammation), but this is the first study I’ve seen that looks at death caused by inflammation.

#2- A tripling of the risk of death in a 13 year period for women with the highest glycemic index is a very significant finding with a huge public health relevance considering the high glycemic nature of the current American diet. 

#3- The fact that the results were not the same for men was interesting.  It’s not the first time that I’ve seen the effects of glycemic index attenuated in men.  The authors mention that the reason for this may be that men have a higher antioxidant status than women until age 75.

Take Home Message:  The explanation for these results may stem from the hyperglycemia (high blood sugar) that results from chronic consumption of high glycemic carbohydrates.   This may result in an overproduction of free radicals and a greater release of inflammatory cytokines.  

If you read my book or work with me privately, you already know how heavily influenced my nutritional recommendations are by the glycemic index and glycemic load.  This is further evidence to avoid refined carbohydrate containing foods such as white bread, pasta, white rice and most importantly, sugar.

Wednesday, November 24, 2010

Question And Answer: Breakfast

          I’ve been working in the fields of exercise and nutrition for over 15 years.  I see many of my own private clients each day and a number of doctors in Boston send me out to meet with their patients for weight loss and disease risk reduction.  I’ve noticed that certain questions tend to come up time and time again and I thought it would be a nice feature to answer some of them for you on this Blog.  Today’s topic is breakfast.

Question:  Skipping breakfast is a good way to decrease the day’s calories and lose weight, right?

Answer: Absolutely not!  When you skip breakfast you switch on a mechanism that will increase weight gain, not weight loss.    You must remember that we evolved in times of famine and food scarcity.  To survive, humans had to develop ways around these tough times in our evolution.  If you finish dinner at 7:00 PM and then wake up, skip breakfast and eat lunch at noon, you have gone 17 hours without eating.  This tells the body that there is a lack of food around and the body makes 2 relevant adjustments.  1) It slows down your metabolism. 2) It preserves your body fat and will burn muscle for energy.  Neither of these will help you lose weight.  Eat a nice sized breakfast every single day.

Question: I’m just not hungry in the morning, doesn’t that mean that I don’t need to eat?

Answer: Not at all.  You will develop a hunger for breakfast once you get into the routine.  If you have to force yourself at first, so be it.

Question: Is it alright to drink coffee in the morning?

Answer: Absolutely.  Feel free to drink a cup or 2 of coffee each day, regular or decaf.  Recent research suggests that coffee drinkers have a slightly reduced risk of cardiovascular disease and type 2 diabetes, so it may actually be good for you.   However, make sure you don’t add sugar or artificial sweetener to your coffee (a little milk or cream is ok).

Question: Can I do smoothies for breakfast?

Answer: I’m not a huge fan.  #1) I like real food in general, I don’t like powders or supplements for protein.  #2) Most smoothies include adding whole fruits and blending them to a puree.  This separates the sugar in the fruit from the fiber and will cause a greater spike in blood sugar and insulin than if you ate the whole fruit as nature intended.  This will have a negative effect on subsequent hunger and body weight.  A simple breakfast like nuts, fruit and a few slices of turkey breast takes no more time to make than a smoothie and will better stabilize your blood sugar.

Question: I do my cardio in the morning, should I eat before or after?

Answer:  This depends entirely on you.  Some people can workout on an empty stomach and feel fine (like me).  I don’t eat before my cardio if I do it first thing in the morning.  If you feel really hungry and weak without breakfast, I would suggest splitting your breakfast in two parts and eat half before your workout and the other half after.  I don’t think it is a good idea to workout on a full stomach.


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Sunday, November 14, 2010

Book Review: The Paleo Solution by Rob Wolf

           Another regular feature of my Blog will be book reviews.  I’ll take a look at popular books on Diet, Exercise, Weight Loss and Health and let you know what I think.  I have only 2 criteria for reviewing a book.

1) It must be a Nutrition/Weight loss top 20 best seller on Amazon.  I want to review books that you all have heard of and may like to read.

2) The author must have credentials.  I need to see some level of education.  In other words, I need to see proof that the author has at least a peripheral understanding of nutrition science and research.  I am more than tired of celebrities who are selling diet and weight loss books without ever opening a book on the subject.

            The Paleo Solution by Robb Wolf meets both criteria nicely.   It is a best seller on amazon.com in the category of weight loss and the author has a degree in biochemistry, a field closely correlated with nutrition.

Introduction
            The book is based on the theory that the diet we ate during the Paleolithic or “hunter-gatherer” era of our evolution is the most health promoting.  The book is really well written and quite humorous at times.  The author and I have a lot in common.  In our youth we were both trying to be healthy and followed a low fat, high carb diet that made us sick.  We eventually learned about the right way to eat, fell in love with the field of nutrition and got a degree in the field.  The book spends a lot of time going over the biochemistry of digestion, presents a detailed 30 day meal plan and spends a good amount of time discussing exercise.   It’s a fairly long book (320 pages) but it reads quick because it is interesting and well written.

5 Things I really like about The Paleo Solution
1) The idea of studying human evolution to figure out what we should eat.  Anyone who has worked with me or read my book knows that my nutrition philosophy is heavily influenced by studying the original human diet.

2) The emphasis on the biochemistry of digestion.  The author does a great job explaining the hormonal consequences of eating different foods.  This is very important information if you want to truly understand the health effects of the foods we eat.

3) Emphasizes the importance of adequate sleep.  This is huge for both general health as well as weight loss.

4) Stresses that exercising too much is not good for you.  I like the moderate approach he takes to increasing physical activity.

5) Focuses on just 3 meals a day.  I totally agree with this philosophy.  With a stable blood sugar, there is no need to graze.

5 Things I disagreed with in The Paleo Solution
1) One thing that I found a bit tough to take is how the author kept blasting the nutritional research as quackery and non-scientific.   I feel that the research we do at Harvard is extremely relevant and our methods are tried and true.  There are a lot of problems with nutrition science for sure but to make such a blank statement was a bit rough.

2) The author believes that all grains are unhealthy.  I don’t agree with this.  There is very well designed research that points to the beneficial effects of whole grains on risk of heart disease, diabetes and even some cancers. 

3) The author also doesn’t differentiate cereal fiber from other forms of fiber.  He mentions that you get lots of fiber on his diet, which is true, but none of it is cereal fiber.  In our research at Harvard, cereal fiber had the most protective effects regarding disease risk reduction.

4) The meal plan was a little heavy on the red meat.  One of his sample days had red meat at all 3 meals and even for the snack.   This is not a good idea.

5) The nutrient composition of a sample day on his plan was: Fat 39%, Carb 23%, Protein 38% and cholesterol 461 mg.  This is a bit high on the protein.  I did a review paper on high protein diets and I feel this amount of protein may put a stress on the kidneys of sensitive individuals.  I’m also not crazy about the amount of cholesterol ingested on this day.

Is it worth reading?
        I think The Paleo Solution is definitely worth reading.  I learned a lot about how our early ancestors lived and ate and this is extremely relevant when asking questions about the lifestyle we were designed to live.   However, I think to follow the diet literally isn’t the best idea.   There is a lot of really good research out there that has improved our knowledge of the health effects of our food and that must be taken into account in addition to our native diet. 

        One last thought: Our early ancestors lived for only 30-35 years.  Who knows what long term health affects this native diet would have had on risk of heart disease, stroke, diabetes and cancer if they lived to their mid 70’s like we do?

Thursday, November 4, 2010

Research Update

As many of you may already know, I read the nutrition literature monthly to keep up to date on the latest research.  I will regularly post summaries of some of the studies that I find particularly relevant.  Here is the latest:

Red Meat And All Cause Mortality
Archives of Internal Medicine vol 169, pp 562-71, 2009

These results came from the National Institutes of Health-AARP Study and included approximately 500,000 participants.  Those who ate the most red meat (5 oz per day) were 30% more likely to die over the next ten years than those that ate the least (2/3 oz per day).  For the purposes of this study, red meat included beef, veal, lamb and pork products.

Take Home Message: This is not the first time we’ve seen such results regarding red meat consumption.  It is high in saturated fat, often contains nitrates and sulfates, and when cooked converts carcinogenic heterocyclic amines.  Focus on chicken, turkey, fish, eggs and legumes for your protein choices and let red meat be an occasional treat.

Micronutrients And Fad Diets
American Journal of Clinical Nutrition vol 92, pp 304-12, 2010

This study looked at 4 distinct dietary approaches to weight loss and measured their nutrient quality.  73 overweight or obese women were put on each diet for a period of 8 weeks.   The diets tested were the Atkin diet (extremely low carb), the Zone (moderate carb, Mediterranean), Ornish (extremely low fat) and LEARN (based on the US Food Pyramid).   The results were very interesting.  The Atkins group was deficient in Thiamin, Folate, Vitamin C, Iron and Magnesium.  The Ornish group was deficient in Vitamin E, B-12 and Zinc.  The Learn group was deficient in Vitamin E, Thiamin and Magnesium.  The Zone intervention resulted in no deficiencies and in fact was associated with a significantly decreased risk of deficiency for Vitamins A, E, K and C.

Take Home Message: This study provides more evidence of the healthful nature of a Mediterranean style of eating.  Moderate low glycemic carbs, a good amount of healthy fats and lean sources of protein are the hallmarks of this dietary strategy.  If you’ve read my book, worked with me or read this Blog this is old news for you!!! :)

Omega 3 And Fish Consumption And Risk Of Age Related Hearing Loss
American Journal of Clinical Nutrition Vol 92, pp 416-21, 2010

This was a cohort study of 2,956 men and women in Australia.  Diet was measured by means of a food frequency questionnaire and then hearing was measured at 5 and 10 year follow-up visits.   Subjects that consumed fish greater than or equal to twice a week had a 42% reduced risk of age related hearing loss compared to those that ate fish less than once a week.

Take home message:  This study provides even more evidence of the benefits of fish consumption.  Make sure you include seafood in your protein choices at least twice a week but limit consumption of the high mercury varieties- including Swordfish, King Mackerel and Tilefish.

Sunday, October 24, 2010

Product Review: Gazelle Edge

          From time to time, I will post reviews on my Blog of products that will help you attain your health and fitness goals.   Today I want to tell you about a piece of exercise equipment that has seriously changed the health of my clients. The best thing about this machine is the level of convenience it provides at such a low cost.

          Anyone who has read my book or worked with me as a private client knows just how important cardiovascular exercise is to losing weight.  It truly needs to become a part of your daily routine.  Going to the gym is great, but I can’t say I’ve seen it work long term.  In my 15 years of helping people lose weight, I have run across exactly 1 person who was able to get to the gym on something even close to a daily basis.  You need to make your cardio sessions easy to accomplish.  One of the best ways to do so is to have a piece of equipment in your home.

          Enter the Gazelle Edge.  This is a glider (similar to an elliptical trainer) sold on Amazon.com and I can’t say enough about it.
     #1) It is low impact and very easy on the joints.
     #2) It is light and portable.  It folds up for easy storage against a wall or under your bed.
     #3) It is inexpensive.  You can get it from Amazon.com for under $100 with free shipping!
     #4) It totally works.  I can’t tell you how many of my clients have lost serious weight using nothing more than this for their cardio.  Mind you they are also following my diet and hitting the weights regularly! 
    #5) I have been using one myself for years and love it!

          If you order it from Amazon.com, it comes fast and you put it together yourself in about 15 minutes.  Put it in front of the TV and do your cardio while you are watching the news or your favorite show (A Tivo or DVR makes this even more convenient).  You can chat on the phone while on the Gazelle Edge and when your balance gets really good, you can even read while on it.  The Gazelle Edge, along with some free weights, completely eliminates the need and expense of joining a gym.

          The Gazelle Edge is a great product, for a great price that will make it easier on you to lose weight and improve your health.  What more could you ask for?

Click Here To Learn More About The Gazelle Edge

Thursday, October 14, 2010

The Top 5 Reasons People Are Unsuccessful Losing Weight

       I’ve been helping people lose weight for over 15 years.  I’ve studied Exercise Physiology at the Master’s level and Human Nutrition at both the Master’s and Doctoral level.  One thing I’ve learned over the years is that the vast majority of people who are trying to lose weight are unsuccessful.  These people know they need to lose weight in order to improve their health and appearance; they sincerely want to lose weight, but are unable to do it.  In fact, 95% of people who try to lose weight will be unable to maintain a permanent 5% weight loss. 

          Throughout my years of clinical work with weight loss clients and academic studies, I’ve learned that there are some very good reasons why people are unable to accomplish their weight loss goals.  When they figure these out, weight loss becomes not only possible, but dare I say simple.  Following are, in my opinion, the Top 5 reasons why people are unsuccessful in the weight loss game.

Reason #5: Not initiating a strength training program 
          Once we hit our 25th birthday, we start to lose our muscle mass at the rate of 1% per year.  This is a natural part of the aging process.  Each pound of muscle burns 50 calories per day, whether you exercise or not.  As we go from our 20’s to our 30’s and 40’s, it is very natural to gain weight because we are burning fewer calories each year.  A well designed resistance training program not only stops the loss of muscle, but can add to it, so you burn more calories each and every day.

          Furthermore, we have amazing defense mechanisms to prevent us from losing weight.  You must remember we evolved in times of famine and food scarcity.  Those of us who survived to pass on our genes gained body fat quickly and lost it slowly.   As a defense mechanism, when we lose weight without resistance training, half of the weight we lose is fat while the other half is muscle.  The body does not want to let its fat stores get too low, so it burns muscle to spare the fat.  This results in a lower metabolism and eventually any weight lost is regained.  When you add weight training to your plan, you preserve your lean body mass and lose almost pure fat.  This results in permanent weight loss.

Reason #4: Unrealistic expectations

          Many people have completely unrealistic expectations with regards to their weight loss.  They feel that if they are not losing 2, 3, 4, or even 5 pounds a week that their plan isn’t working and they give up.  Nonsense!  A pound of fat is 3,500 calories.  To lose a pound of fat in a week you have to create a daily deficit of 500 calories.  This is not easy to do at all.  My goal for my female clients is ¾ of a pound a week and for men it is 1 pound a week.  Three quarters of a pound doesn’t sound like much but it adds up to 3 pounds in a month, 18 pounds in 6 months and 36 pounds in a year.  People who are successful losing weight lose it at this rate.

Reason #3: Not getting enough cardiovascular exercise

          Many people who are trying to lose weight hit the treadmill for 20 minutes 2 or 3 times a week and expect to lose weight.  It won’t happen.  Both my experience working with weight loss clients and current research suggest that we need to do way more than that to lose weight.  Cardio must become a part of your daily routine if you want to lose weight and keep it off.

Reason #2: Following a low fat diet
         
          Many who are seeking to manage their weight choose a low fat dietary plan.  Unfortunately, this strategy sets them up for failure.  First of all, low fat diets simply don’t work long term.   In meta-analyses, low fat diets have been found to cause a modest initial weight loss that is completely regained after one year.  There are several reasons for this: #1) Fat provides satiety. #2) Fat helps to stabilize your blood sugar and reduces high insulin levels when consumed with carbohydrates.  Furthermore, since protein levels in our diets remain relatively stable, if you are eating low fat you are eating high carb and that is not the way to lose weight.

Reason #1: Eating the wrong type of carbohydrate

          The #1 reason why people are unsuccessful losing weight is because they are choosing the wrong carbohydrate sources.  Certain carbohydrates spike our blood sugar.  They are known as high glycemic load carbohydrates.  Other carbohydrates have a more modest effect on our blood sugar, these are called low glyemic load carbohydrates. 

          Consuming an abundance of high glycemic load carbohydrates causes a spike in blood sugar and insulin levels which can promote fat storage, decrease fat breakdown and most importantly, dramatically increase hunger and overeating.  Eating the right type of carbohydrates is pretty much the best thing you can do to aid in the weight loss process.

Monday, October 4, 2010

Feature Article: Artificial Sweeteners: A Lesser Of Two Evils?

          Artificial sweeteners, also known as non-nutritive sweeteners have been the subject of controversy since their inception in 1879.  A variety of myths and misconceptions concerning their health effects have been swirling around for decades.  The subject of this post is to answer some of the most common questions that I receive concerning non-nutritive sweeteners in my nutrition counseling practice. 

What are non-nutritive sweeteners?
            Non nutritive sweeteners are food additives that provide a sweet taste without providing caloric energy.  They have zero grams of carbohydrate, zero fat and zero protein.  The FDA has approved use of 5 non-nutritive sweeteners.
  • Aspartame- found in Equal, Nutrasweet and others.  Aspartame, gram for gram is 180 times sweeter than sugar.
  • Acesulfame-K- found in Sunett, Sweet One, is 200 times sweeter than sugar.
  • Saccharin- found in Sweet’N Low, is 300 times sweeter than sugar.
  • Sucralose- found in Splenda, is 600 times sweeter than sugar.
  • Neotame- does not have any brand names and is 7,000-13,000 times sweeter than sugar.
Are they safe?
            Despite popular belief, the FDA approved non-nutritive sweeteners are extremely well tested for safety.  These sweeteners have been tested at levels of consumption so high that a person could never attain them in everyday life, yet still produced no negative effects on health.  I recently read a review paper on all of the non-nutritive sweeteners and the summary finding was that they were not associated with any negative health outcome.  After reviewing the literature, I can say with confidence that these additives will not cause brain cancer, strokes, seizures, Alzheimer’s disease or any of the other maladies that people associate with them.

Does this mean I can use them all the time?
            This is where it gets a bit tricky.  I do not recommend the use of these sweeteners on an everyday basis.  Although they won’t cause you to die from cancer like everyone thinks, there are 2 major problems with them.

Problem #1 Non-nutritive sweeteners perpetuate cravings for sugar and refined carbohydrates.
            As any one of my clients will tell you, no matter what your health and fitness goals may be, a big part of getting there is to reduce your consumption of refined carbohydrates such as bread, pasta, white rice and sugar.  The good news is that when you limit these foods in the context of a stable blood sugar, cravings for them disappear after about 2 weeks.   If you are eating non-nutritive sweeteners on a daily basis, you’ll never get over your cravings for the refined carbs.  You will be hungry all the time.  This is a problem because any diet that involves feelings of deprivation and hunger will not work long term.

Problem #2 The Cephalic Response
            The second problem with the non-nutritive sweeteners gets a bit more technical.  We humans have something called the Cephalic Response.   If I was to put your favorite food in front of you, your eyes would see it, your nose would smell it and your body will actually release digestive enzymes before you even put a bite into your mouth!  Your body is anticipating consumption.  This is very likely happening with the non-nutritive sweeteners.  Your body thinks it’s getting something sweet so it releases insulin anyway.  This is the exact situation you are trying to avoid, since the resulting drop in blood sugar following an insulin surge will leave you hungry.  I have seen some papers that showed an association between non-nutritive sweetener use and increased hunger and food consumption.

Take Home Message
            In light of these two problems, I do not recommend non-nutritive sweeteners for everyday use.  However, once or twice a week, I believe that they are far less harmful than sugar.  At the end of the day, I can’t produce a single research paper that shows an association between non-nutritive sweeteners and any chronic disease.  On the other hand, I can produce dozens, if not hundreds of research papers that show an association between high glyemic carbohydrates such as sugar and chronic diseases such as heart disease, stroke, diabetes, cancer and possibly even Alzheimer’s disease.  In summary, non-nutritive sweeteners appear to be the lesser of two evils, but don’t go overboard.  Have a sugar free treat once or twice a week at the most.  But of course, stay away from sugar all the time!

Additional Questions
What about Stevia?
            Stevia is another non-nutritive sweetener that is produced from the leaves of a plant grown in South and Central America.   While Stevia’s producers say it is safe, the FDA has not done its own evaluation just yet.   The FDA initially agreed to the manufacturer’s safety findings and has allowed it to be used in a variety of products.  More recently, there have been some reports that Stevia may increase cancer risk, so the FDA is requiring more information on the safety of this sweetener.  Personally, I feel that Stevia has not been tested enough for me to recommend it to my clients.  I’d stay away from it until we learn more.

What about Sugar Alcohols?
            Sugar alcohols are compounds that taste sweet like sugar, but are not as easily broken down and absorbed as table sugar.  On food labels, they show up as xylitol, mannitol, erythritol, hydrogenated starch hydrolysates and sorbitol.  Sugar alcohols are found in nature in prunes and apricots.  Sugar alcohols generally have 50-70% of the sweetness of sugar.  They are cropping up in all sorts of sugar free items, particularly sugar free candy and ice cream.   The only problem I have seen regarding safety/side effects is that they will have a laxative effect when consumed in large quantities due to the fact that they are not completely absorbed.  Therefore, start with small amounts and see how you tolerate them.  Again, limit consumption of all non-nutritive sweeteners to once or twice per week.

Friday, September 24, 2010

Research Update: Waist Circumference And Mortality

Waist Circumference And All Cause Mortality In A Large US Cohort
Jacobs EJ, et al.
Archives of Internal Medicine, 2010 170:1293-1301

Objective: To study the association between waist circumference and mortality in men and women in the Cancer Prevention Study II Nutrition Cohort.

Study Population: 48,500 men and 56,343 women 50 years of age or older from the Cancer Prevention Study II Nutrition Cohort were followed from 1997-2006.  In that time 9,315 men died and 5,332 women died.

Results:  Very high levels of waist circumference were associated with a 2 fold higher risk of mortality in both men and women compared to a normal size waist.  A very large waist size was considered 120 cm or 47.2 inches for men and 110 cm or 43.3 inches in women. 

Waist circumference was associated with an increased mortality in all categories of body mass index in both men and women.  Therefore, no matter what your BMI: normal, overweight or obese, the larger the waist circumference, the higher the risk of death.

Comment:  This study is interesting for a variety of reasons:

#1- It is a very large sample size which increases the power of the study to measure what it intends to.

#2- A doubling of the risk of death in a 10 year period for those with the highest waist circumference is a very significant finding with a huge public health relevance considering that 50% of men and 70% of women between the ages of 50-79 are above the standard for waist circumference. 

#3- Even if your BMI and weight are considered normal, your waist circumference is still highly relevant to risk of death.  Most people who have a normal weight and/or BMI feel like they are off the hook regarding the health effects of their weight.  This is the first study I’ve seen that shows this may not be the case.  You need to be at a healthy weight/bmi and waist size. 

Take Home Message:  If you are at a normal weight and BMI, good for you.  Also make sure your waist circumference is below normal limits.

Measure your waist circumference at your belly button.  The cut offs for abdominal obesity is 88 cm (34.6 inches) for women and 102 (40.2 inches) for men.  Be well below this level!
 

Tuesday, September 14, 2010

Welcome To My Blog!

         Welcome to my Blog!  My name is Dr. Thomas L Halton and I want to start off by telling you a bit about myself.  As far as my background, I’m a recent graduate of Harvard University with a doctorate in Nutritional Epidemiology.  This is basically a fancy way of saying I study how nutrition affects diseases, most notably heart disease, diabetes, obesity and cancer. I also hold Masters Degrees in Human Nutrition and Exercise Physiology.  I am a Licensed Nutritionist in the State of Massachusetts, a Certified Nutrition Specialist and an ACE Certified Personal Trainer.

          I own and run Fitness Plus, a personal training and nutrition counseling company based in Boston.  In recent years I have taught grad school at Simmons College, served as a research consultant at The Cooper Institute in Dallas, Texas, launched a lecture business on health and fitness and I even have a book out on weight loss called The Weight Loss Triad.

          Helping people to live better lives through proper diet and exercise is a true passion for me.  That is the subject of my Blog.  In the future, I will update this Blog with all sorts of useful information, including:

          Research Breakthroughs- I’m constantly reviewing the latest research on diet, exercise and obesity.  When I come across an important study, I’ll summarize the results here on the Blog.

          Tips on how to lose weight and reduce your risk of today’s most deadly diseases.

          Questions And Answers- Certain questions keep coming up in my private practice and also with the patients of the medical practice that I work for.  I’ll answer some of the most common questions I receive.

          Feature Articles- These are research articles that I’ll post on a variety of topics including general nutrition, weight loss, disease prevention, supplements, etc.

          Book Reviews- When I come across a great book on health and fitness, I’ll review it here.

          Product Reviews- When I come across a great product to help you attain your health and fitness goals, I’ll review it here.

          Recipes And Shopping Tips- To help you reach your health and fitness goals.

          Thanks for stopping by and feel free to contact me with comments or questions about any of the posts. (fitnessplus14@gmail.com).

Here’s to your good health,

Dr. Thomas L Halton