Wednesday, December 28, 2011

Questions And Answers: Trans Fat

What are trans fats?

Trans fats are man made fats.  They are produced through the commercial hydrogenation of unsaturated oils.  Hydrogen is bubbled through the oil at high pressure in the presence of a nickel catalyst to change the structure of the chemical bonds in the oil from cis to trans.

Why do food manufacturers do this?

Hydrogenation removes essential fatty acids such as linoleic acid and alpha linolenic acid.
These fatty acids tend to oxidize over time, which can turn the fat rancid.  Therefore, a big reason why oils are hydrogenated is to increase the shelf life of the food product.  Hydrogenation also increases the melting point of oil so that the product is solid at 25° Celsius.  This acts to improve the texture and consistency of many commercially prepared foods.  Finally, using this type of oil is cheaper for the manufacturer. 

Where are trans fats found?

Trans fats are generally found in fried foods, margarines and commercially prepared baked goods like cookies, candies and cakes.   Thankfully, recent legislation has banned the use of trans fat in restaurants in many states.  It is getting harder and harder to find them, even in food products that used to contain them a few years ago.  However, they are still used and you need to become aware of which manufacturers continue to use them in their products.

What are the health effects of trans fats?

Trans fats have been shown in the research literature to have a number of negative health effects.  They raise LDL cholesterol and lower HDL cholesterol levels, which can have a devastating impact on risk of heart disease.  Trans fats have also been associated with an increased risk of type 2 diabetes and possibly some cancers.

How do you know if a food contains trans fats?

Labeling laws now require the listing of trans fats on all food products.  This is great, not only because you can readily identify trans fat content, but because many manufacturers are now eliminating trans fat from their products so that they will not be perceived as unhealthy.  However, if a food contains less than 0.5 grams of trans fat in a serving, the manufacturer is legally allowed to list trans fats as zero grams.  This is problematic because even tiny amounts of trans fat are really harmful.  So, after checking the food label under trans fat for zero grams, you’ll also need to check the ingredient list as well.  If you see “partially hydrogenated” before any oil (IE, partially hydrogenated soybean oil) the product contains trans fat.

What are you recommendations for trans fat?

Avoid it 100%.  Treat it as if it will make you sick and shorten your life, because that is exactly what it has the potential to do.  If I was asked what is the bottom line worst thing that you can eat for your health, I would not hesitate to identify trans fat.

Wednesday, December 14, 2011

Book Review: Eat To Live

Eat To Live is next up for review.  The author, Dr. Joel Fuhrman, is a Medical Doctor who is board certified as a family physician and has also published some nutrition research. 

            The Eat To Live program is based on several premises:
            1) The concept of nutrient density, which in simplest terms, is a foods ratio of nutrients to calories.  If a food delivers a lot of nutrients per serving, it is considered high nutrient density.  If it delivers a small amount of nutrients in a serving, it is low nutrient density.  The focus of Eat To Live is to eat only high nutrient density foods.

            2) All animal products will make you sick.

            3) All sources of dietary fat will make you sick and overweight.

            The book spends a lot of time discussing how nutrition impacts health and disease risk.  The food guidelines are then presented with a couple of 7 day meal plans and a large number of recipes.  The book is well written and an easy read. 

5 Things I Liked About Eat To Live
1) The concept of nutrient density- Eating nutrient dense foods means more fruits and vegetables and less processed junk food.  I’m all for that.

2) Strongly against sugar and refined carbohydrates- I couldn’t agree more.

3) Strongly in favor of fruits and vegetables- Fruits and vegetables are probably the best things you can eat to improve your health and the more the merrier.

4) Against dairy- I’m not convinced that dairy is a natural food for humans.  Those of you who work with me or read my book know this.  I don’t think there is a need for total elimination, but I feel that dairy intake should be now and again rather than a dietary staple.

5) Against snacking- I’ve been telling my clients not to snack for years.  If you are eating a blood sugar stabilizing diet, you should not be hungry in between meals.  Also, keep in mind that if you eat 70 more calories a day than your body needs, you’ll put on 8 pounds in a year and 23 pounds in 3 years.  Snack calories can add up like crazy over time.

What I didn’t agree with in Eat To Live
1) Very little attention was paid to exercise- I am more than convinced that for long term weight loss, cardiovascular exercise and resistance training are pivotal.   The research bears this out, as does my 15 years of working with weight loss clients.  Exercise was barely mentioned in this book and almost seemed to be an optional part of the program.

2) Unrealistic weight loss goals- Several testimonials were presented throughout the book that showed dramatic weight loss.  Some of these cases lost up to 19 pounds in 2 weeks.  Dr. Fuhrman says you should expect to lose 14 pounds in the first 14 days.  I think this is an unrealistic goal.  A pound of fat is 3500 calories.  To lose even 1 pound a week you have to create a caloric/exercise deficit of 500 calories per day.  This is not easy.  If you are losing a pound a week you are doing great.  Going into a program expecting to lose a pound a day will only set you up for failure and disappointment.  Realistic expectations can be the difference between staying with your program and giving up because “it’s not working”.

3) Incomplete evaluation of the current research- Many parts of this book are really well researched.  When describing the dangers of refined carbohydrates, saturated fats, Tran’s fats, etc, excellent research is presented.  The Nurses’ Health Study and the Health Professional Follow-up Study are mentioned several times in these sections.  These are Harvard cohorts and although I’m biased, I believe they represent the very best in epidemiological study design.

However, when Dr Fuhrman starts to mention that all animal protein promotes disease (even lean sources like chicken and fish) and all fat makes you fat (including healthy vegetable oils like olive oil and canola oil), he leaves out results from these cohorts that prove otherwise.  Research in the Nurses’ Health Study and Health Professional Study show that total fat is not associated with weight gain, that vegetable sources of fat reduce risk of disease and that lean sources of protein (including fish, chicken and turkey) are health promoting, particularly when they replace refined carbohydrate in the diet. 

4) Inclusion of many high glycemic load foods.   One of the goals of any healthy diet is to limit high glycemic load foods.  There is no mention of the concept of glycemic load in this book and the meal plans allows for daily consumption of white potatoes, fruit juice, dried fruit and you are even allowed 100 calories of cookies or candy each day if you want.  These high glyemic load carbs would be particularly damaging to the blood sugar since this diet is so low in fat and protein, which act to attenuate the glycemic response.

5) Overgeneralization of the macronutrients. Dr. Furman says that all fats and all animal protein are unhealthy and will lead to disease and overweight.  I beg to differ.  Some fats are bad for you and some are actually quite good for you.  Trans fat and saturated fat should be avoided while poly- and monounsaturated fat have been shown to reduce risk of chronic disease.  They also serve to lower the glyemic load of the diet when they replace refined carbohydrate foods and can improve health in this way as well. 

Fatty sources of animal protein like steak, sausage, hot dogs and bacon are indeed unhealthy choices and should be strictly limited.  However, fish, chicken, eggs and turkey are great choices that can actually reduce your risk of disease when they replace refined carbohydrate foods in the diet and thus act to lower the overall glycemic load of the diet.  Eating lean protein also promotes satiety, which is a big reason why my weight loss clients are not hungry between meals.

Is Eat To Live Worth Reading?
Absolutely.  If you are interested in nutrition as a profession or for your own personal health, read as many books as you can.   I think it is important to get as many different perspectives as possible.  In Eat To Live you will learn a lot of great things about the benefits of fruits, vegetables, whole grains and legumes.  You’ll also learn a lot about the dangers of refined carbohydrates, saturated fat and Trans fat. 

Will you lose weight?  I think you will, at least in the short term.  This is a really low calorie diet.  However, low fat diets are just too hard to stay on for any length of time and the research shows that most weight lost on low fat diets is regained after about a year.  Just keep in mind as you read this that a healthy diet also includes a bit more protein (even some lean animal protein like chicken, eggs, fish and turkey) and a lot more healthy fat (like olive oil, canola oil, nuts, avocado, etc).  Also keep in mind that if you truly want to lose weight and keep it off, exercise is a huge part of the equation.  We all collectively must learn to accept this basic truth.

Monday, November 28, 2011

Research Update: Green Tea And Serum Cholesterol

Green tea intake lowers fasting serum total and LDL cholesterol in adults: A meta-analysis of 14 randomized clinical trials.
The American Journal of Clinical Nutrition 2011; 94:601-10.

Objective: To examine the association between green tea consumption and serum cholesterol.

Methods:  This article is a meta-analysis.  The literature was extensively searched for all research on the affects of green tea on serum cholesterol.  The analysis included 14 studies and a summary estimate was calculated.  There were a total of 1,136 subjects from the 14 studies included in this meta-analysis.

Results: Green tea significantly lowered total cholesterol by 7.2 mg/dl and significantly lowered LDL cholesterol by 2.2 mg/dl.  There was no association between green tea consumption and HDL cholesterol.

Discussion:  This is a pretty impressive finding that could have a nice effect on your risk of coronary heart disease, the number one killer in the U.S.  It is hypothesized that every 1% drop in serum cholesterol lowers risk of coronary heart disease by 3%.  Green tea is produce from the leaves of the plant Camellia Sinensis.  Green tea leaves contain antioxidants, vitamins, minerals and polyphenols.   The researchers believed that substances in green tea lower serum cholesterol by inhibiting key enzymes involved in cholesterol synthesis and by reducing intestinal absorption of cholesterol.   About half of the 14 studies used green tea beverages as the intervention and the other half used green tea dietary supplements in pill form.  No major adverse health effects were reported in any of the studies.

Take Home Message: If you are trying to reduce your total and LDL cholesterol, green tea may be another simple yet effective strategy.  The studies included in this meta-analysis used a variety of doses and the authors didn’t have recommendations regarding the amounts necessary to produce the desired effect.  There were no major adverse health effects reported, so it looks like a cup or 2 a day of green tea may be a safe and effective way to lower cholesterol.

Monday, November 14, 2011

Product Review: Bowflex SelectTech 552 Dumbbells

It’s time for another product review and this time I’m going with Bowflex Selecttech 552 Dumbbells.  In a rough economy, many people have cancelled their gym memberships and started working out at home.  This is not a bad idea.  You can take one year’s worth of gym dues and make a really nice little home gym that will last you for decades.  When deciding on the type of weights to include in your home gym, there is a lot to think about: the price of the system, the space you have available, what exercises you want to be able to do, etc. 

Bowflex Selecttech Dumbbells are a great choice for any home gym.  These are dumbbells that have a dial on the side that allows you to change the weight from 5 to 50 pounds in 5 pound increments.  If you want them to be 20 lbs, you simply turn the dials to 20 and you’re all set.  I’ve had a set of these for about 6 months and have been really happy with them.  Following are some of the pro’s and con’s of these dumbbells.

1) Very easy to change the weight load.  If you have plate loaded weights with collars, it can take you a few minutes between exercises to adjust the weights.  This can disrupt your work/rest interval.  With the Bowflex weights, the change is instantaneous.

2) Bowflex Selecttech’s look and act like regular dumbbells.  Other adjustable dumbbell systems like Powerblocks have an unusual shape with a handle in the middle of the dumbbell.  This makes it hard to do exercises like overhead back or triceps presses.  The Bowflex system can be held like a regular dumbbell so you can do anything with them.

3) Space Saver.  These adjustable dumbbells can take the place of an entire wall of individual dumbbells.  This is great if you are in an apartment or only have a small amount of space to devote to your home gym.

4) Very Well Made.  These dumbbells are very well made and durable.  I’ve had mine for about 6 months and they look like they just came out of the box.  There are no signs of wear and tear at all.

5) Don’t roll when you place them on the floor or bench.  This may be a minor issue for some, but there is nothing worse to me than laying down your dumbbells in between sets and having to chase them around the room.  The Bowflex dumbbells lay flat and don’t roll around.  

1) The only con I can come up with is the price.  They are about $350 for the set that goes from 5 to 52 lbs.  There used to be a set that went from 5 to 25 lbs as well, but I think they may have discontinued those.  Now, if you bought pairs of 5, 10, 15, 20, 25, 30, 35, 40, 45 and 50 lb dumbbells individually, you’d spend a lot more than $350.  However, if you bought plate loaded dumbbells with collars you’d spend a lot less.

Would I Recommend The Bowflex Selecttech Dumbbell System?
Absolutely.  They are a bit pricey but they have really changed the way I can workout at home.  I can switch weights in between exercises and even in between sets with ease.  My workouts are now more fluid and I have more options than I used to regarding exercises.  I love the space saving aspect as well.  I recommend them highly.

If you are interested in picking these up, I researched a bunch of different ways to buy them and was surprised to find out that the best deal came from the Bowflex website ( ).  When I got mine they threw in a free stand.  They are also available on and at home gym equipment stores.

Friday, October 28, 2011

The Top 15 Foods To Always Keep In Stock

Eating healthy used to be completely normal and very easy for human beings.  While evolving, the right foods were readily available and there was no such thing as junk food.  My, how things have changed!  The norm now is to eat unhealthy.  Everywhere we go: restaurants, ball games, the movies, coffee shops, airports, rest stops, etc, there are tons of unhealthy food choices and very few healthy ones.

Your home has to become your oasis for healthy eating.  A huge part of this is doing your own grocery shopping and cooking your meals the majority of the time.  Therefore, I thought I’d use this blog post to list out the Top 15 food items to always keep in your pantry/refrigerator.  If you have these tried and true, nutrient packed foods ready to go, you are never more than a few minutes away from a healthy, blood sugar stabilizing meal.

#1) Vegetables: Variety is the key here, and the more the merrier.  Include salad vegetables, sweet potatoes, broccoli, cauliflower, spinach; you get the idea.

#2) Fruits: Again, variety is the key.  Make sure to get a bunch of fruits that travel well, such as apples and pears.  You can throw these in a backpack or purse and they are always ready for you no matter what your day brings.

#3) Nuts: An excellent source of healthy fat that travels well.

#4) Nut Butters: We’re all familiar with peanut butter, but you can also find almond butter, cashew butter, macadamia nut butter and pistachio butter.   They are all really good.

#5) Olive Oil: Great for salads and to sauté vegetables.

#6) Old Fashioned Slow Cooked Oatmeal: A nice, lower glycemic whole grain packed with fiber.  Don’t get instant or quick cooking as these are higher glyemic.  Focus on the “Old Fashioned” slow cooking variety.

#7) Black Beans: Great in a salad, taco or even on their own.  A great source of low glycemic carb and vegetable protein loaded with fiber, vitamins and minerals.

#8) Quinoa: An awesome whole grain that is high in fiber and protein.  This is relatively new here in America but can be found in most grocery stores.  We cook ours in low sodium chicken broth and it’s a great dinner side dish.

#9) Tuna Pouches: These are relatively new.  They are tuna fish in a pouch that you can tear open and eat without having to drain or open with a can opener.  Highly portable, these are great on the road or even on a plane.

#10) Chicken Breast: Buy in bulk at Costco or BJ’s and keep in your freezer.  When combined with the George Foreman Grill, you’ve got a beautifully grilled chicken breast in about 6 minutes.

#11) Eggs: An excellent source of fat and protein.  They take about 2 minutes to prepare when cooking or even less if you hard boil them before hand and have them ready to go.

#12) Olivio or Smart Balance:  These are butter substitutes made from olive and canola oil.  Use any time you’d use butter.  They taste really good and are so much better for you than butter.

#13) Brown Rice: A great lower glyemic whole grain that is loaded with fiber.  Make sure you get the slow cooked variety and not instant or quick cooking as these are higher glycemic.

#14) Sliced Turkey Breast: A low fat, convenient source of protein.  Try to get it freshly sliced off a bird and not the pre-packaged variety that is filled with nitrates and other preservatives.

#15) Frozen Shrimp: A delicious source of protein that is surprisingly reasonable when bought frozen in bulk at Costco’s or BJ’s.

Friday, October 14, 2011

Research Update: Are Organic Foods Healthier For You?

Nutrition Related Health Effects Of Organic Foods: A Systematic Review
The American Journal of Clinical Nutrition 2010; 92:203-10.

Objective: To conduct an exhaustive review of the current literature on the subject of organically grown food and health.

Methods:  This article is a review paper.  The literature was extensively searched for any research on the affects of organic foods on health.  The authors initially identified 98,727 articles, but surprisingly, only 12 articles met their inclusion criterion.  The studies included hypothesized that organically grown foods would have a positive impact on health when compared to conventionally grown food.

Results:  The studies looked at a variety of outcomes, including antioxidant content, LDL oxidation, phenol content, effects on serum glucose and triglycerides, immune function, flavinoid content and antioxidant capability.  The authors concluded that evidence was lacking for any nutrition related health effects of organically grown food.   All they mentioned was a significantly reduced risk of eczema in infants fed organic milk when compared to infants drinking regular milk.  The authors also cited a recent systematic review of the past 50 years that showed that organically and conventionally grown foods are highly comparable in their nutrient content.

Discussion:  This study may be a bit surprising to many and certainly a bit controversial.  In general, organic produce and meats are much more expensive than conventionally grown.  Most buyers of organically produced foods spend this extra money for one of 2 reasons:

1) They think that there are more nutrients in organic foods.
2) They think that organic food will have a more positive impact on their health than conventionally grown food.

According to the research, neither appears to be true.  Furthermore, this is not the first time I’ve seen this in the literature.

Take Home Message: If you like to buy organic produce and meats and can easily afford to do so, by all means continue.  Some people feel that organic foods are “greener” for the environment and that animals that are organically raised are treated more humanely.  This very well may be true.  However, if you are buying organic produce because you think it is more nutritious or will result in improved health, there is very little evidence up to this point in time that this is true.

Wednesday, September 28, 2011

Feature Article: Understanding Nutrition Research

           Let’s face it, research can be confusing. When a major new study in the field of nutrition is released to the media, I hear the same questions all the time.

1) Why do they say that this is unhealthy now, ten years ago they said this was good for me?

2) Why do they say this is healthy now, 10 years ago they said this was bad for me?

3) Should I listen to these results and change my diet?

3) Was this a well designed study?

4) Two different newspapers reported the results differently, what is going on?

5) The government health websites tells us to do one thing, my doctor another and the media has it’s own ideas.  Who should I listen to?

            I figured I’d use this post to explain a bit about the research process and hopefully give you a better understanding of nutrition research in general.

The Scientific Method
            In reality, one study does not tell you much, even if it is well designed.  In order to change nutrition policy with confidence, you really want to see agreement among different types of research.  For example, population studies, cohort studies, randomized controlled trials, animal studies and biomarker studies are all different types of research each with their own strengths and weaknesses.  You’d really like to see most, if not all of these lines of research pointing in the direction of the hypothesis before making or changing nutrition recommendations. 
            It is also important to realize that it is totally normal to have studies that contradict each other.  Each study has its own unique methods, including different subject characteristics, different doses of the nutrient or supplement and different duration of follow up.  The way Dr. Willett at Harvard used to talk about it was very helpful.  He used to say that coming up with nutrition policy was like having a big scale with lots of stones.  The stones represent research studies.  Each time a study shows an association between a nutrient and disease, you put a stone on one side of the scale.  When a study does not support the association, you put a stone on the other side.  If a study is really well designed, it’s a big stone.  If the study has design flaws, it’s a tiny stone.  Over years, and even decades, as the research begins to mount, the scale tips to one side.  That is when the recommendations are made.
            If you think about it this way, you’ll expect to see studies that go against a recommendation now and again and you also won’t put too much weight on a single study.  It’s the accumulation of research from many different areas that leads us to make a recommendation, and this takes time.

The Media’s Play In This
            The media is a big reason why people are confused by nutrition research.  When a study comes out, they are very quick to over-inflate the importance with catchy, dramatic headlines and over-generalized stories.  I understand that they are trying to sell newspapers, but they are definitely adding to the confusion by sending the message that one study can overturn years and even decades of research.  Always take the media’s stories on nutrition research with a grain of salt.

Nutrition Science Is A Young Science
            The truth of the matter is that we have only been studying nutrition and disease in large numbers of subjects for a few decades.  Nutrition science is a young science and we are still perfecting our research methodology.  Therefore, understand that sometimes recommendations that were made 20 years ago may not turn out to be true once we look at the problem with better and more modern methods.  This may also be true 20 years from now.   Trans fat is a great example.  Decades ago, it was thought that trans fat was a better option than saturated fat to reduce risk of heart disease.  Now we know that it is far worse for you.  Our methods evolved and our studies taught us the error of the early recommendation.  As of right now I can say this with confidence; research methods have dramatically improved in the last few years and we are now beginning to understand a lot about how nutrition can affect our health. 

Publishing an article
When researchers want to publish a scientific paper, they will submit to the most prestigious journals first and then if they get rejected, submit to lesser journals with more relaxed acceptance standards.  Therefore, if an article appears in a less competitive journal, it has likely been rejected by several journals already.  Usually it will have been rejected for design flaws or because it doesn’t really add much to our current understanding of that particular nutrition and health topic.  So I always tell people to find out where the article was published.  If it was in one of the big 3 journals for nutrition literature, definitely give it more weight, if not give it a little bit less weight.  The top 3 journals for nutrition research are:

#1) The New England Journal of Medicine
#2) The Journal of the American Medical Association
#3) The American Journal of Clinical Nutrition.

Some Final Tips
So the next time you see a big nutrition study in the newspaper or TV news, consider the following.

1) This is just one study.  How does this fit into the context of the rest of the research on this subject?

2) If it goes against what we have been recommended, this is to be expected from time to time.

3) The media is probably making a bigger deal of this than it should.

4) If this was published in one of the big 3 nutrition research journals, pay attention to it a bit more.  If not, pay attention to it a bit less.

5) Always keep in mind that nutrition science is a young science and there will be some contradictions from time to time, which is true for all evolving, researched based science.  The good news is that our methods are getting pretty good and these should be fewer and fewer as time goes on.

Wednesday, September 14, 2011

Questions And Answers: Vitamin D

Where do we get vitamin D? 
Vitamin D is both a vitamin that we can eat and a hormone that our body can produce.  Some foods high in vitamin D include fatty fish like tuna and salmon and dairy products.  Many foods are fortified with vitamin D.  The sun’s ultra violet B (UVB) rays trigger production of vitamin D.  Spending just a few minutes in the sun during the summer months can produce many thousands of IU’s of Vitamin D.

Why is vitamin D so important?
Vitamin D is important for 2 reasons.
1) It has a major influence on our health.  Deficiency of vitamin D has been associated with an increased risk of osteoporosis, heart disease, certain cancers, multiple sclerosis and infectious diseases.

2) Deficiency is really common.  It’s hard to get enough vitamin D from your diet.  We can make it from the sun, but in the fall and winter the UVB rays that stimulate production of D are weaker, especially if you live North of the line that connects Philadelphia and San FranciscoDeficiency of vitamin D is really common in these people as well as African Americans, the overweight and older individuals.  Sunblock also prevents production of vitamin D from the sun almost completely.

3) How can I tell if I’m deficient? 
You can ask your doctor to do a blood test on your vitamin D levels.  A level of 30 ng/ml seems to be considered by most research sources to be ideal. 

4) How much vitamin D should I be getting each day? 
This is a bit of a controversial question.  The Institute of Medicine recently came out with a report that updated their recommendations for vitamin D.  They say that for those between the ages of 1-70, 600 IU’s of vitamin D is more than enough.  For those greater than 70, they recommend 800 IU’s.

At Harvard, they think this is a bit too low.  They generally taught us that 800-1000 IU’s was really optimal.  This goes up to 2000 IU’s each day if you are at a high risk of deficiency (darker skin, obese or older). 

Despite the lower recommendations, the Institute of Medicine stated that 4000 IU’s of vitamin D each day is a safe level.

5) What is the best form of vitamin D when supplementing?
There are generally 2 forms of vitamin D that you’ll find in supplements.  Vitamin D2, also known as ergocalciferol and vitamin D3, also known as cholecalciferol.  Vitamin D2 is more of a precursor to vitamin D, while D3 is chemically the same as vitamin D.   There is some evidence that D3 is better at raising vitamin D levels so I’d recommend that over D2.

6) So, should I supplement with vitamin D?
If you’ve read my book, read this blog or work with me privately, you know I’m not a huge fan of supplementation in general.  I strongly believe that in most cases, we should get our nutrients from our food, as nature intended.  However, vitamin D is a rare exception to this philosophy.

Throughout a good deal of our evolutionary period, humans lived at a latitude south of Florida and ran around naked.  We got a lot of sun, made a lot of vitamin D and had high blood levels of vitamin D.  Now, a huge percentage of the Earth’s population does not live in such a warm client.  Not only do we wear clothes, we wear sunblock to reduce our risk of skin cancer (which is a good thing).  Therefore, supplementing with D is probably a good idea for most of us.

I recommend a multi-vitamin by Cooper Concepts that includes 2000 IU of Vitamin D in each capsule.  I take this every other day, so I’m supplementing with about 860 IU’s each day on average.  I recommend a similar protocol for my clients.  Here’s a link to this vitamin if you are interested in ordering it or learning more about it.  (

Monday, August 29, 2011

Research Update: Macronutrient Trends In The U.S. And Omega 3's Impact On Weight Loss

Trends in carbohydrate, fat and protein intakes and association with energy intake in normal weight, overweight and obese individuals: 1971-2006.
American Journal of Clinical Nutrition 2011; 92:836-43.

This study looked at the changes in fat, protein and carbohydrate consumption in the U.S. between the years of 1971 and 2006.  The two population samples compared were the NHANES in 1971 and the NHANES in 2006.  NHANES stands for National Health And Nutrition Examination Survey.  It is a large study conducted every 2 years to examine the health and nutrition status of non-institutionalized U.S. civilian adults and children.  Physical exams were performed in mobile units and diet was assessed by means of 24 hours dietary recalls.

The results were striking. Between 1971 and 2006 the prevalence of obesity in men increased from 11.9% to 33.4%.  In women, obesity increased from 16.6% to 36.5%.  During this time, carbohydrate consumption increased from 44% of calories to 48.7%.  Fat consumption decreased from 36.6% to 33.7%.  Protein consumption decreased from 16.5% to 15.7%.  During this period the typical man consumed an additional 179 calories per day and women consumed an additional 199 calories per day.

Take Home Message:  This study tells us 2 things: #1) As a country, we’ve bought into the whole low fat, high carb message over the past few decades.  #2) It’s not working.  As carbs go up and fat goes down, we are eating more calories and gaining more weight.   Many government and health agencies are still promoting low fat, high carb diets as a weight management strategy.  It’s time for a fundamental change in this philosophy.

Effects of omega-3 supplementation in combination with diet and exercise on weight loss and body composition.
American Journal of Clinical Nutrition 2011; 93:455-62.

The goal of this study was to determine if omega-3 supplementation can enhance weight loss when combined with diet and exercise.  Subjects were randomized to two groups.  64 subjects received 15 grams of omega-3 supplements per day with an EPA:DHA ratio of 5 to 1.  The other group of 64 received placebo pills.  Both groups received diet advice as well as resistance training and cardiovascular exercise programs.  After 6 months, the total amount of weight lost was compared.  Both groups lost greater than 5% of their initial body weight.  There was no difference in weight loss between the two groups.

Take Home Message: Despite preliminary research in animals suggesting that omega-3 supplements enhanced weight loss, it doesn’t look like it will do much in humans.  Add omega 3 to the large and forever growing list of weight loss supplements that don’t really work.

Monday, August 15, 2011

Book Review: The Dukan Diet

           The Dukan Diet is next up for review.  The author, Dr. Pierre Dukan, is a French Medical Doctor that has been specializing in human nutrition since 1973.  This book was a blockbuster in Europe and the fact that Prince William’s bride used it to get ready for her wedding did not hurt sales! From a nutritional standpoint, this book has received a lot of criticism. 

            The diet is composed of 4 phases.  The first 2 phases are supposed to help you lose weight and the last 2 help keep it off.  Phase 1 is called the Attack Phase and consists of eating nothing but pure protein, not an ounce of fat or carbohydrate.  This phase lasts for about a week.  Phase 2 is called the Cruise Phase and consists of alternating pure protein days with protein plus low carb vegetable days.  You stay on this phase until you hit your goal weight.  Phase 3 is called the Consolidation Phase and during this phase you can eat all the protein and Phase 2 vegetables you want, 2 slices of whole wheat bread, a portion of fruit and cheese, 2 starchy carbs and 2 celebration meals per week.  You stay in this phase 5 days for every pound lost.   Phase 4 is the Permanent Phase.  Here you can eat exactly as you did on Phase 3 but you must add a pure protein day every Thursday, a 20 minute walk each day, 3 daily tablespoons of oat bran and you must pledge to use no elevators or escalators.  Overall the book was well written and an easy read.  It translates well from its native French to English.
5 Things I Liked About The Dukan Diet
1) Dukan is strongly against refined carbohydrate foods.  I couldn’t agree more.

2) From Phrase 3 on, the program includes 2 cheat meals.  I have found this to be extremely helpful for my weight loss clients.  You don’t need to be 100% with your diet to hit your weight loss goals and it’s not realistic to never eat for fun.

3) Exercise gets a fair amount of attention and this is quite rare for diet books.

4) The recipe chapter in the book details some creative ways to eat low carb. 

5) His theory that humans are biologically designed to be meat eaters is right on.

What I didn’t agree with in The Dukan Diet
1) The majority of the phases of this program are nutritionally unbalanced.  Extremely healthy categories of foods are eliminated or strictly limited for the majority of this dietary plan.  Examples include: vegetable oils, nuts, fruits, many vegetables, whole grains and legumes, among others.

2) It is a bit heavy on the red meat.  Steak, bacon, hot dogs, etc are allowed in unlimited quantities.  This is not a good idea.  Cooking red meat forms carcinogenic heterocyclic amines, which have the potential to increase risk of colon and other digestive cancers.  This is made worse by his recommendation to overcook red meat in order to reduce the fat content.  The more you cook red meat, the higher the formation of heterocyclic amines and the higher the carcinogenic potential.

3) Advocates taking a diuretic when you hit a tough weight loss plateau.  I had to read that one again to make sure I got it right.

4) Made some very interesting and very unscientific claims throughout the book.  Here’s an example:
            -Sucking on 5 ice cubes per day will burn off 6 pounds of fat in a year.
            -A 2 minute cold shower burns as many calories as walking 2 miles.
            -The combination of water and dietary protein melts cellulite.

5) Advocates drinking as much diet soda as you want throughout the program.  Dukan mentions that it reduces cravings for carbs.  Both current research and my experience with clients have taught me that diet soda has the potential to increase cravings for refined carbs, not decrease them.

Is The Dukan Diet Worth Reading?
Absolutely.  If you are interested in nutrition as a profession or for your own personal health, read as many books as you can.   I think it is important to get as many different perspectives as possible.  Will this diet work short term? I’m sure it will, it has sold a lot of books for a good reason.  Will it work for the long term? Unlikely. The literature shows us that most can’t stay on restrictive low carb diets for very long.  Is it a healthy way to eat?  In my opinion, no.  You are strictly limiting foods we know are healthy for you and eating a lot of foods that are not.

Thursday, July 28, 2011

Product Review: The Ipad

It’s time for another product review and this time I’m going with the Ipad.
This won’t be a technical review that you’d find on CNET, but will be a review of how you can use the Ipad to promote a healthy lifestyle.  There are dozens of apps that will help you reach your fitness and nutrition goals.

I know the Ipad isn’t cheap, I bought mine for $500 on  I went with the lower memory, WIFI version because I didn’t think I’d need too much space and I knew I’d be using it mostly at home, where I have wireless.  Besides, the monthly fee for 3g didn’t appeal much to me at all. :)  Despite the upfront cost, I have to say it was worth every penny, I use mine every single day.

Many of my clients have Ipads as well and I’m learning that it has been a real tool for them to stay on course with their diet and exercise.  Following are some uses/apps that have proven beneficial.

Keeping Track Of Your Lifestyle
Record keeping is huge if you are trying to change your diet and exercise habits.  The research bears this out and I’ve definitely noticed this throughout my years of experience working with weight loss clients.  Here are some of the ways you can use your Ipad for record keeping.

1) Recording your weight each week
2) Recording your cardio minutes each week
3) Recording your daily food intake

You can get specialized apps for each of these or simply use a note app like Sticky Notes (which has a free version).

4) Streaks Motivational Calendar- is an App for the Ipad.  It was created by Fantzer, Inc and costs just 1.99 to download and use.  It is an extremely simple concept but it is also extremely effective.   Streaks allows you to create a calendar with a goal in mind.  Every day that you are successful in obtaining your goal, you mark it down on your calendar for that day.  Streaks will keep track of your consecutive days of success.  It also will record your longest streak so you have something to shoot for.  If you are trying to give up sugar, do your cardio everyday, stop eating after 8:00 PM or anything else, you set up a calendar and keep track.  If you mess up, start over again and try to break your longest streak.  Before you know it, you are hitting your goal for increasing lengths of time. 

Cardio Distraction
We all know that to lose weight and stay in shape, cardio has to be a just about daily occurrence.  While there are people out there, such as myself, that actually enjoy doing cardio, (my clients have called me a “freak” because of this) for most people it is something they have to do.  Using your Ipad to either distract you or to be productive during your session makes cardio a lot more pleasant for these people.

1) Ipod- Your Ipad comes with an Ipod app built in, so you can listen to your music while working out.
2) Movies-You can buy and rent movies and TV shows from Itunes and watch them on the Ipad.
3) Netflix App- For $7 a month you can sign up for Netflix and watch unlimited movies that are streamed instantly to your Ipad.  I’m currently watching a 14 hour documentary on World War 2 by Ken Burns while working out and it is awesome!
4) Kindle App- With the free kindle app, you can turn your Ipad into a Kindle and read books.
5) Skype- With the free skype app you can talk for free to anyone else in the world who has skype.  This is a great way to pass the time while getting in your cardio.
6) Safari-Use the built in web browser to check your emails, read the paper online or surf the net.

These are just some of the ways you can use the Ipad to enhance your health and fitness.  Although it is definitely a little pricey, you’ll fall in love with your Ipad immediately.  I know I have.

Thursday, July 14, 2011

Research Update: Individual Foods And Weight Gain

Changes In Diet And Lifestyle And Long-Term Weight Gain In Women And Men
New England Journal Of Medicine 2011; 36:2392-404.

Objective: To examine the impact of individual foods on weight gain over 20 years.

Study Population: 120,877 U.S. men and women from 3 separate cohorts, The Nurses’ Health Study, The Health Professional Follow-up Study and The Nurses’ Health Study II.

Methods:  Subjects were followed for approximately 20 years (20 years for the Health Professional Follow-up subjects and Nurses’ Health cohort and 12 years for the Nurses’ Health II cohort).  The impact of different foods and lifestyle factors on long term body weight was computed statistically.
Results:  Subjects gained an average of 3.35 pounds every 4 years for a total of 16.8 pounds over 20 years.  Weight gain was most associated with consumption of potato chips (1.69 pounds over 4 years for each daily serving), potatoes (1.28 pounds over 4 years for each daily serving), sugar sweetened beverages (1.0 pound per daily serving), red meat (.95 pound per daily serving) and processed red meat like bacon, pepperoni, etc (.93 pound per daily serving).
Conversely, weight loss was most associated with yogurt consumption (-0.82 lbs over 4 years per daily serving), nuts (-.57 pound per daily serving), fruits (-.49 pound per daily serving), whole grains (-.37 pounds per daily serving), and vegetables (-.22 pounds per daily serving).
Results were also reported for lifestyle factors: physical activity was associated with weight loss, while alcohol consumption, watching too much TV and sleeping more than 8 hours and less than 6 hours were all associated with weight gain.
Discussion: This is a very well designed study.  If you need evidence of this, you just have to look at the journal that it appears in.  The New England Journal of Medicine is the holy grail of medical research. 
Just about all of the foods that promoted weight gain were high glycemic load, refined carbohydrates and just about all the foods that promoted weight loss were low glycemic load foods.  I have found this to be absolutely true in my weight loss practice.  High glycemic load carbs cause a reactive hypoglycemia in most people that dramatically increases hunger a few hours after consumption.  The high insulin levels these foods promote may also favor fat storage.

Another thing that jumped out at me while reading this paper is the idea that even tiny changes in our diet can have dramatic impacts on our long term weight.  If you have an additional 75 calorie snack each day, this will actually add up to a gain of almost 8 pounds per year and over 23 pounds in 3 years!  This is a big reason why I have my clients eliminate snacking and, of course, strictly limit the high glycemic load carbs.

Take Home Message: If weight loss is your goal, you need to understand the concept of glycemic load.  This study provides even more evidence of the weight gaining effects of high glycemic carbs. 

Tuesday, June 28, 2011

Top 10 List: Sources Of Sodium In The American Diet

The impact of sodium on health has received a lot of attention in the field of nutrition lately.  Countless public health initiatives designed to reduce sodium consumption in the U.S. are currently underway.  The bottom line is that we eat way too much sodium and it is having a negative effect on our health.

Most of us know that high salt consumption is associated with high blood pressure and risk of heart disease and stroke.  While this is the major issue with over consumption of salt, sodium has also been associated with stomach cancer and osteoporosis.  It used to be that if you were free of hypertension, you wouldn’t have to worry about sodium.  Those days are over.  It is now clear that everyone should take steps to reduce sodium in their diet. 

This Top 10 List is devoted to the biggest sources of sodium in the American diet.  This list is based on a combination of the amount of salt found in the food and the frequency of consumption.  It is based on data from the Grocery Manufacturer’s Association (Reference 1).  You may be surprised at some of the sources, I sure was.  Stay tuned for a more extensive post on the health effects of sodium in the next few weeks.  In the meantime, we can all start by limiting consumption of these foods.  My private clients and readers of my book should be well on their way to getting this stuff out of their diet anyway. :)

Top 10 Sources of Sodium In The American Diet
1) Meat Pizza
2) White bread
3) Processed Cheese
4) Hot Dogs
5) Spaghetti With Sauce
6) Ham
7) Ketchup
8) Cooked Rice
9) White Rolls
10) Flour Tortillas

1) Grocery Manufacturers Association.  Sodium and salt: a guide for consumers, policymakers and the media. Washington, D.C. 2008.