Wednesday, November 12, 2014

Questions and Answers

Can I use Splenda/Equal everyday?

When my clients learn that eliminating sugar is an absolute key to losing weight, this question naturally follows. Unfortunately, the answer is no, you cannot use non-nutritive sweeteners like Splenda and Equal on a daily basis.

Contrary to popular opinion, non-nutritive sweeteners, like Splenda and Equal, are very well tested and safe to consume in moderation. However, there are 2 problems with them that prevents me from recommending them for everyday use.

Problem #1: They perpetuate cravings for refined carbohydrates. When you eliminate sugar and strictly limit refined carbs like bread, pasta, and white rice, it is typical to go through a withdrawal for a few weeks where you really miss them. After this period, your desire for these foods drops almost to zero. It really is miraculous how you stop craving the wrong carbs when your blood sugar stabilizes. This is a big reason why my clients lose so much weight, they just aren’t nearly as hungry. However, I have found that daily use of the non-nutritive sweeteners perpetuates cravings for sugars and refined carbs. This is problematic because any diet where you are fighting hunger and cravings is destined to fail long term.

Problem #2: The cephalic response. If I was to put your favorite food in front of you, your nose would smell it, your eyes would see it, and you actually release digestive enzymes before you even put a bite into your mouth. This phenomenon is called the cephalic response.  There is some evidence that this response is recruited when consuming non-nutritive sweeteners. Your body senses the sweet taste and releases insulin anyway. This release of insulin can lead to an unstable blood sugar.

In light of these two issues, I only recommend the use of Splenda and other non-nutritive sweeteners twice per week on cheat meals.


Low fat vs low carb for weight loss

The Study
148 obese men and women were randomized to a low fat (<30% of calories) or a low carbohydrate diet (<40 grams per day) for 12 months. By the end of follow up, participants on the low carb diet lost significantly more weight (8 pounds), lost significantly more fat mass, had significantly lower total:HDL cholesterol ratios, had significantly lower triglycerides, and significantly higher HDL cholesterol. Annals of Internal Medicine 2014; 161:309-18.

Take Home Message
This study showed that a lower carb/moderate fat diet not only enhanced weight loss, but also improved risk factors for coronary heart disease. The design of this study was exceptional, with low drop-out rates and high compliance. The only problem I have is with the title: “Effects of low carbohydrate and low fat diets”. By the end of the study, the participants were not really following a traditional low carb diet.

When I think of a low carb diet, I think Atkins, with very little carbohydrate, tons of steak, bacon, cheese and very little fiber. However, the low carb diet in this study was quite different. By the end of the 12 months, the low carb dieters were not consuming the recommended 11% of calories as carbohydrate, but fully 34% of their calories were carbohydrate. They also had very similar amounts of fiber as the low fat group. Although they did include a bit more saturated fat than the low fat group, the majority of their fat consumption (about 70%) was healthy monounsaturated or polyunsaturated fat. Indeed, what they were consuming by the end of follow-up was much more of a Mediterranean diet than a low carb diet.  Either way, this is still a well-designed study showing that a low fat diet is not the way to go for weight loss or improved health.


Tuesday, November 11, 2014

Does a low glycemic eating pattern enhance weight loss?

The Study
Several weight loss diets were compared in a randomized trial of 122 overweight men and women. One of the diets was a moderate carbohydrate, low glycemic index diet and another was a low fat diet. After six months, the subjects consuming the low glycemic index diet had a significantly greater reduction in BMI than the low fat group (-2.45 BMI units for low GI vs. -1.43 for low fat).  Measures of fasting insulin and insulin resistance were also significantly improved for the low GI group. The researchers believed that the increased weight loss with a low glycemic approach may be due to a beneficial impact on glucose and insulin levels and an increased satiety. American Journal of Clinical Nutrition 2014; 100:27-35

Take Home Message
This study provides further evidence that glycemic index is highly relevant for those looking to manage their weight. It also provides further evidence that low fat diets are not the most effective for weight loss or health promotion. In no way should any of this be a surprise to those that work with me or have read my books!

Monday, November 10, 2014

Is Butter Really Back?

Saturated fat has been in the news quite a bit lately. A recently published study has sparked quite the controversy. The study in question appeared in the journal, Annals of Internal Medicine, in March of this year (1). This study was a systematic review and meta-analysis of the research on saturated fat and risk of coronary heart disease. The primary conclusion was that saturated fat has no relationship with risk of heart disease, and that the recommendation to limit saturated fat consumption is not at all scientifically justified.

As usual, the media went overboard with this headline, proclaiming that nutrition scientists have been wrong all along and don’t know what they are talking about.  My two favorite headlines were the Time Magazine article entitled “Eat Butter” (2), and the New York Times piece entitled “Butter Is Back” (3). So, what is going on here? Is butter really back?

The Study
The Annals of Internal Medicine study identified 49 observational studies and 27 randomized controlled trials that investigated the association between saturated fat consumption and risk of coronary heart disease. The data from these studies were combined and a summary risk was computed. When comparing the top third of saturated fat consumers to the bottom third, there was a non-significant 3% increase in risk for coronary heart disease.

Problems With The Annals Study
A good number of nutrition scientists disagreed with the study’s methods and conclusions. Dr. Walter Willett, the chair of the Nutrition Department at the Harvard School of Public health, was among them. He published a comment in Annals concerning the article just a few months after it was published (4). Here is a quick summary of some of the problems he listed: 1) There were gross errors in data extraction. In other words, the researchers didn’t use the most relevant risk estimates from the studies that they included. 2) The omission of important studies. The researchers did not include a number of important investigations, particularly those showing a benefit of polyunsaturated fat consumption on risk of heart disease.

Harvard also sponsored a special teaching session on saturated fat where Dr. Willett mentioned another really important problem with the Annals study: 3) The saturated fat variable was tested in isolation. In other words, saturated fat was investigated on its own, not in comparison to other nutrients.

This third point bears some explaining. When you just look at saturated fat as a variable on its own, it is like comparing it to the rest of the American diet, which is generally unhealthy. So if you are comparing 2 things that aren’t super healthy, one doesn’t look worse for you than the other. 

What is far more useful, is to compare saturated fat to another nutrient in a substitution model. Our total caloric consumption is pretty stable. If we eat less of something, we tend to eat more of something else to replace it. For example, when we reduced our fat consumption in the 1990’s and 2000’s, we replaced it with refined carbohydrate foods, which wasn’t good for our weight or our health. 

A beautifully designed study was published in the American Journal of Clinical Nutrition in 2009 using saturated fat in substitution models (5). This study was a pooled analysis of 11 American and European cohort studies that included a total of 344,696 subjects. When saturated fat was replaced with carbohydrate, there was no association with risk of heart disease. However, when saturated fat was replaced with polyunsaturated fat, there was a 26% lower risk of coronary death and a 13% lower risk of cardiovascular events. Strangely, this study was left out of the Annals review.

In summary, reducing saturated fat is still a good idea. Eating less butter, cream, cheese, and animal fat is still a good recommendation. Replacing those calories with healthy sources of fat, like nuts, vegetable oils, and avocados, is associated with a reduced risk of heart disease. Replacing those calories with carbs, is not associated with risk of heart disease.

Saturated fat may not be as harmful as originally thought, but it is not quite out of jail. Let’s say it is on probation. I still have my clients shoot for a maximum of 7% of their calories as saturated fat, but to include an abundance of healthy vegetable fats in their diet.

1) Chowdhury R, et al. Association of dietary, circulating, and supplement fatty acids with coronary risk. Annals of Internal Medicine 2014; 160:398-406.

2) Walsh, B. Eat butter. Time Magazine 6/23/14 pp. 28-35.

4) Willett WC, et al. Letter in response to: Association of dietary, circulating, and supplement fatty acids with coronary risk. Annals of Internal Medicine 2014; 161:453.

5) Jakobsen MU, et al. Major types of dietary fat and risk of coronary heart disease: A pooled analysis of 11 cohort studies. American Journal of Clinical Nutrition 2009; 89:1425-32.

Friday, September 12, 2014

Are Fruit Smoothies A Good Choice For Breakfast?

Life is pretty busy for most of us. We are all looking for quick and easy meals that will save us time. This seems to be especially true for breakfast. At first glance, a fruit smoothie seems like an awesome choice. It has fruit, yogurt or milk, maybe some flax seed, and some ice. These are all healthy ingredients.

However, fruit smoothies are definitely not a good choice for breakfast, especially if you are trying to lose weight. It all has to do with blending the fruit.

Whole fruits are one of the healthiest things that you can eat. They are loaded with vitamins, minerals, fiber, antioxidants and other biologically active phytochemicals. They are easy on the blood sugar because each sugar molecule is surrounded by a helix of fiber. This takes time for your digestive system to break down and results in an easy, gradual rise in blood sugar and a small release of insulin. 

When you blend fruit, you upset this healthy, natural package. Blending fruit separates the fiber from the sugar. This results in a higher spike in blood sugar and insulin, which has the potential to increase fat storage, decrease fat burning at the muscular level, and increase hunger a few hours later, which leads to snacking.

If weight loss is your goal, eat your fruit in its whole, natural form and never blend it.

Does Vitamin D Supplementation Enhance Weight Loss?

The Study
218 overweight women were randomly assigned to 2,000 IU of vitamin D or placebo for 12 months. Both groups received the same weight loss advice, which included comprehensive dietary change and 225 minutes of cardiovascular exercise per week. After 12 months, there was no significant difference in weight loss between the two groups. The vitamin D group lost 8.2% of their baseline body weight, while the placebo group lost 8.4% of their baseline weight. American Journal of Clinical Nutrition 2014; 99:1015-25.

Take Home Message
In some cross-sectional studies, vitamin D levels have been inversely associated with obesity. However, it appears that vitamin D supplementation does not increase weight loss. This was a very well designed study with good adherence and a long duration. Once again, another promising weight loss supplement fails to live up to the rigors of a randomized trial. I guess there is just no substitute for proper diet and exercise if weight loss is your goal.


Does Protein Really Help You Eat Less?

The Study
In a randomized trial with a crossover design, 30 men and 28 women consumed three different diets for 12 days on separate occasions: 5% of energy from protein, 15% of energy from protein, and 30% of energy from protein. The diets and exercise habits were identical in all three conditions with the exception of the amount of protein consumed.  All meals were consumed at the University that was conducting the study and food consumption was ad lib, subjects could eat as much as they wanted at a meal. When consuming the 5% energy diet, subjects averaged 2,264 calories per day.  When consuming the 15% protein diet, subjects consumed 2,221 calories per day.  When consuming the 30% protein diet, subjects consumed 2,085 calories per day. American Journal of Clinical Nutrition 2014; 99:1397-406.

Take Home Message
This study provides further evidence that higher protein consumption reduces energy intake.  Researchers are not quite sure why protein increases satiety, but it sure seems to in trials.  The difference in calories consumed between the high and low protein diets was 180 calories per day.  This has the potential to have a profound impact on body weight over time.  I have my clients shoot for about 20% of calories as protein, which is a safe level and can really have a positive impact on hunger and subsequent energy intake.

Thursday, September 11, 2014

Product Review: Nike Fuelband

If your goal is weight loss, the ability to measure your total physical activity is a powerful tool.

As a trainer, my client’s exercise activities are easy to track. I will issue a cardio goal, like 250 minutes of elliptical training per week, my client will keep a record of minutes completed, and we both know exactly what is going on.

What I have learned in the last few years, with the help of the technology that is described below, is that the amount of non-exercise physical activity varies wildly from person to person.

I have clients in the medical field that walk so much during their work day that they hit 9,000 steps from work alone. I have other clients who have more sedentary office based jobs that barely hit 2,000 steps during a workday. The Nike Fuelband is a simple tool that measures your entire physical activity, both your exercise activity and your activities of daily living.

The Nike Fuelband is a tiny device that you wear around your wrist like a watch. It contains a sports tested accelerometer that measures all varieties of physical activity. It gives you a number of useful measures: including the number of steps you walk per day, the number of calories you have burned from physical activity, and most importantly, your Nike Fuel for that day. 

Nike Fuel is a universal metric of physical activity. You set a goal for Nike Fuel points in a day, mine is 3000. Your Fuelband converts all of your physical activity into Nike Fuel points, including walking, running, weight lifting, basketball, and all other sports and activities. The band has a series of LED lights that turn from red to yellow and then to green as you progress toward your Nike Fuel goal for the day. When you hit your goal, the band lets you know.

1) This device measures all of your physical activity, not just your steps.

2) You wear the Fuelband like a watch. This is a huge upgrade over most pedometers that you have to clip onto your belt. I can’t tell you how many of my clients have lost their pedometer because it has fallen off of their waist at some point in the day. In most cases, it is never found.

3) The Fuelband plugs directly into your computer’s USB port to recharge and upload data.

4) You have free access to the Nike Fuel website, which keeps track of your activity and allows you to set goals. The website is awesome.

5) Very good battery life. In my experience, it lasts 5 or more days without a charge and once plugged in, recharges very quickly. 

6) It can store multiple day’s worth of data and then uploads automatically while charging. Therefore, you don’t have to connect it to your computer every day. Just charge it every week or so and your data will be uploaded.

7) It also tells the time.

8) It comes with a one year warranty. If it breaks, Nike is very good about sending you a new one within the warranty period. 

Would I Recommend the Nike Fuelband?
Absolutely! Many of my clients have picked one up and they all love it as much as I do. It will teach you a ton about your activity level. You will start to understand your patterns. You’ll be able to see which days of the week you consistently hit your goals, and which days you don’t. When you come up with a plan to improve on the days that you miss, you can easily measure your progress.

It is very motivating as well. Recently I set a goal of 100 days of 3000 fuel points, which I’m proud to say that I hit! More than once, I was doing a few minutes of jumping jacks before I went to bed to make sure I hit my goal for the day. My wife thought I was nuts, but once I set that goal; I wouldn’t go to bed until I hit it.

For my weight loss clients, I have them set a goal of 3,000 fuel points and a minimum of 7,500 steps per day.

The Nike Fuelband retails for $99 and you can pick it up on the website.

Click here for more information or to pick one up.

Friday, July 11, 2014

Questions and Answers

What weight loss supplement do you recommend?

The short answer: absolutely none!

The long answer requires a bit of a background. In October 1994, the Dietary Supplement Health and Education Act was signed into law by President Clinton. After this law was in place, manufacturers of dietary supplements did not need approval from the FDA to begin marketing and selling their supplement products. 

This is in direct contrast to pharmaceutical drugs which need to prove that they are both safe and effective before they can be brought to market. 

Following are some of the problems that this law created:
1) Nobody is checking up on the ingredients in these supplements. Often they don’t contain what they say they do, or contain little to none of the advertised active ingredients. 

2) For the same reason, sometimes they contain harmful ingredients like pharmaceutical drugs or even banned substances.  There is really no regulation until there is a report of illness or injury, then the FDA will look into it.  It is up to the FDA to prove that these substances are not safe and they don’t have the resources to test all of the tens of thousands of products on the market.   

3) They never stand up to scientific scrutiny. I read the nutrition literature every month, and whenever an independent university or research institution tests these weight loss supplements, they don’t increase weight loss when compared to a placebo in well-designed randomized controlled trials.

Stay away from weight loss supplements.  At best they are ineffective, at worst they can make you sick.  If weight loss is your goal, there is no substitute for a good diet, the right cardiovascular exercise program and a well-designed strength training routine. 


Research Update

Mediterranean Diet And Diabetes

The Study
In this randomized trial, 3,541 men and women aged 55-80 at high risk of cardiovascular disease were put on one of three diets: a Mediterranean diet supplemented with olive oil, a Mediterranean diet supplemented with nuts, or a low fat control diet. After 4.1 years of follow up, the pooled Mediterranean group had a 30% lower risk of type 2 diabetes when compared to the low fat control group. The authors believed that the Mediterranean diet contains components that decrease inflammation, oxidative stress, and insulin resistance. Annals of Internal Medicine 2014; 160:1-10.

Take Home Message                    
Yet again, the Mediterranean diet is shown to be extraordinarily health promoting.  It is a diet that is 35-40% healthy fat, high in nuts, fruits, vegetables, legumes and fish, and low in butter, sugars, and refined carbohydrate. This study also provides further evidence that a low fat diet is not the way to go.

Glycemic Load And Inflammation

The Study
This paper is a systematic review of the literature on the association between dietary glycemic index/load and markers of inflammation. Nine observational studies and 13 intervention studies were identified for this review. Markers of inflammation in these studies were C-reactive protein (CRP) and Interleukin 6 (IL-6). The researchers found that the majority of studies found a significant association between glycemic index/load and higher levels of inflammation. The authors of the study believe that higher glycemic load diets increase oxidative stress which leads to an inflammatory response by the body. American Journal of Clinical Nutrition 2014; 99:813-33.

Take Home Message
It appears that inflammation is very important in the development of a variety of chronic diseases, such as: type 2 diabetes, heart disease, stroke, dementia, and even some cancers. Swings in blood sugar can have a really powerful impact on our health. Do your best to keep your glycemic load low by substituting fruits, vegetables, legumes, and whole grains for refined grains like bread, pasta, white rice, and sugar.

Research Update: Are nuts health promoting or just fattening?

Association of nut consumption with total and cause specific mortality. New England Journal of Medicine 2013; 369:2001-11.

To examine the association between nut consumption and all-cause mortality.

76,464 women from the Nurses’ Health Study and 42,498 men from the Health Professional Follow up study were followed for 30 years. Nut consumption was measured every 4 years by means of a validated food frequency questionnaire. Risk of death was computed for increasing levels of nut consumption, while statistically controlling for potential confounding variables.

By the end of follow up, there were 16,200 deaths in the Nurses’ Health Study and 11,229 deaths in the Health Professional Follow-up Study. When compared to subjects who never consumed nuts, subjects consuming 7 or more servings of nuts per week had a 20% lower risk of dying. A serving of nuts was considered to be 1 ounce.

There was a statistically significant inverse association between nut consumption and death due to cancer, heart disease, and respiratory disease. The association between nut consumption and a lower risk of morality was actually stronger for subjects that were overweight or obese.

Nuts have long been vilified for their high fat content. Those looking to improve their health or lose weight were told to strictly limit consumption. This was the wrong advice. First of all, nut consumption does not have a major impact on body weight. In both the Nurses’ Health and Health Professional cohorts, less weight gain was seen among subjects with more frequent nut consumption.

Nuts are also an extremely healthy food. They contain unsaturated fatty acids, fiber, vitamins, minerals, antioxidants, protein, and other beneficial phytochemicals. The authors noted that the combination of these components has been shown to be cardio-protective, anti-carcinogenic, and anti-inflammatory.  That is likely why those who consume nuts frequently have a lower risk of dying.

Take Home Message
Nuts are a very important part of a healthy diet. Do not fear them, but appreciate them and enjoy them on a daily basis.

Book Review: Grain Brain

Next up for review is Grain Brain. The author, Dr. David Perlmutter, is a Board Certified Neurologist and president of the Perlmutter Health Center in Naples, Florida.

Grain Brain really has one central theme; that the wrong type of carbohydrate can destroy the human brain. The book is broken down into 3 sections: 1) The science part: this section covers how the brain works, all about gluten, and how the wrong type of carbs can cause problems. 2) The lifestyle part: this section covers the proper diet and exercise program to optimize brain function. 3) Meal plans and recipes. The book is 285 pages and is very well written. I truly enjoyed reading it.

5 Things I Really Liked About Grain Brain
1) I really enjoyed learning about the human brain. While I have studied anatomy and physiology in the past, this book really gets into the inner working of the brain and how our lifestyle can help it to flourish or slowly destroy it. It really is a miracle organ.

2) The part of the book that discusses the link between blood sugar and brain function was fascinating. As the research begins to pile up in this area, it was really nice to get a detailed explanation of the potential mechanisms that may be at play here. Very few people truly understand the importance of maintaining a stable blood sugar, as nature intended. It makes me sad when I think of how our country is eating right now.

3) The section on sleep was really interesting. Sleep deprivation will adversely affect just about every part of your body, especially your brain. Seven hours per night should be your absolute minimum goal.

4) As an exercise physiologist, the chapter on physical activity and optimal brain function was fascinating. I knew that exercise is important for brain health, but I was surprised that it was the most important factor. When speaking of preventing brain shrinking and cognitive flexibility, Perlmutter notes that there is no better tool than physical activity. 

5) In Grain Brain, a good amount of time is spent discussing the problems with a low fat, high carbohydrate diet. The author strongly feels that this style of eating is not the path to weight loss or improved health. I couldn’t agree more.

5 Things I Didn’t Agree With In Grain Brain
1) When covering carbohydrate containing foods, the author utilizes the glycemic index, a standardized measure of how a carbohydrate food will influence blood sugar. However, he completely ignores the concept of glycemic load. This measure takes into account both the glycemic index and the amount of carbohydrate in a serving. The glycemic load will give you a much more practical look at how a food will impact blood sugar and insulin levels and it should have been discussed.

2) Grain Brain recommends only 60 grams of carbs per day. This is only 12% of calories on a 2000 calorie diet. Since 20% of protein is about as high the body will let you go, this diet breaks down to 12% Carb, 20% Protein, and 68% Fat. This is a ton of fat, and as mentioned later, much of the fat that he recommends is saturated fat. This level of carb restriction has also been demonstrated in the literature to be very hard to sustain.

3) Grain Brain includes a liberal consumption of saturated fats. Coconut oil, beef tallow, butter, and cheese are all allowed on a daily basis. I don’t think this much saturated fat is a good idea.

4) Grain Brain strictly limits other foods that are health promoting such as whole grains, fruits, and legumes. 

5) I was a bit confused by the references. The book had a ton of references and some were from very reputable journals, like the Journal of the American Medical Association and The New England Journal of Medicine. However, a significant percentage of his references were from quite unscientific sources, such as YouTube videos, blogs, Dr. Oz’s website, New York Times science writers, etc. These references do not prove much scientifically, they are just the opinion of the author. In most cases, the author was not a researcher or educated in the research sciences in any way.

Is Grain Brain Worth Reading?
Absolutely! I really enjoyed this book. You’ll learn a lot about the human brain and how to take care of it. While I don’t agree with many of the dietary recommendations, this much is clear; the proper diet, plenty of exercise, and the right amount of sleep can help keep your brain working until a ripe old age. This is of the utmost importance, because at the end of the day, if your brain isn’t working, what kind of life can you have, really?


Monday, May 12, 2014

Ask Dr. Halton

When is the best time to do my cardio?

I get this question all the time from new clients. The short answer is: anytime you want. I have successful clients who exercise in the mornings and I have successful clients who exercise in the evenings. I have even had a few who worked out at 10:00 PM!

Having said this, I have read research that showed early morning exercisers were more likely to stick to their routine. The reason for this is simple and makes a lot of sense. If you reserve time to work out in the early morning, very few unexpected life issues will pop up and cause you to miss the session. If you wait until the evening, any number of work or family “emergencies” can keep you from exercising.

It also depends on if you are a morning person or not. I, for one, love doing cardio in the mornings but don’t enjoy weight training in the AM. I just don’t feel as strong first thing in the morning and always save my weights for later in the day if possible.

So, in summary, do your cardio anytime that you want as long as you are doing it consistently. If you are an evening exerciser and you find you keep missing sessions because of interruptions, consider switching to the AM to improve your consistency.

Research Update

Should fruit juice be a part of your weight loss plan?

The Study
In this randomized crossover trial, 34 subjects consumed a 400 calorie preload that was either whole fruit or fruit juice. Immediately after consuming the preload, subjects were then presented with a lunch of macaroni and cheese and allowed to eat as much as they wanted. Energy intake and satiety were measured by visual analogue scale. The results were fascinating: 1) Overweight/obese subjects were significantly more hungry after the fruit juice than the solid fruit preload. 2) Subjects consumed significantly less of the macaroni and cheese lunch after ingestion of the solid fruit. 3) Total daily energy intake was significantly higher when obese participants consumed the fruit juice when compared to the solid fruit preload. International Journal of Obesity 2013; 37:1109-14

Take Home Message
Avoid fruit juice if weight loss is your goal and instead focus on whole fruit in its natural form. When you juice a fruit, you concentrate the sugar and eliminate the fiber. This process turns a food that is easy on the blood sugar to one that will cause a rapid spike in blood sugar and then a reactive hypoglycemia that will leave you feeling hungry. In this study, this effect was even more pronounced in those that were overweight or obese.

How does exercise influence hunger?

The Study
15 lean and healthy young men completed two 60 minute trials on separate occasions. Trial #1 was a treadmill run of 60 minutes at 70% of maximum aerobic capacity. Trial #2 consisted of 60 minutes of rest. After each trial, the men were shown images of high and low calorie foods while an MRI of brain activity was taken. Hunger was measured by visual analogue scale and appetite hormones were measured in the blood. The exercise session significantly decreased hunger. The exercise session significantly increased responses in reward related regions of the brain when shown images of low calorie foods and this activation was suppressed when shown images of high calorie food. Levels of ghrelin, a hormone that increases appetite, were significantly reduced after the exercise session. American Journal of Clinical Nutrition 2014; 99:258-67.

Take Home Message
For years, I have noticed anecdotally, that when a new client initiates an exercise program, their diet seems to immediately improve. I thought this was psychological, but it may just be physiological. Although more research is needed in this area, it seems that acutely after exercise, we are less interested in unhealthy food and more interested in healthy food. Consider this just one more reason to include exercise in your weight loss program.

Research Update: Sugar Consumption And Cardiovascular Disease

Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Internal Medicine 2014; 174:516-24.

To investigate the association between sugar consumption and risk of cardiovascular disease.

1988-94 National Health and Nutrition Examination Survey (NHANES) data was used for this investigation. NHANES is a nationally representative sample of the U.S. population. Each participant completed a household interview and a physical examination at a mobile examination center. Diet was measured by means of a 24 hour dietary recall that was conducted through a personal interview. Sugar consumption was measured, and subjects were followed for 14 years for incidence of cardiovascular disease.

In this cohort, 71.4 percent of subjects consumed more than 10% of their calories as sugar. The average sugar consumption was 15.7% of calories. When compared to subjects consuming the lowest amount of sugar (7.4% of calories), subjects consuming the most sugar (25.2% of calories) had more than double the risk of cardiovascular disease. This was after controlling for all known risk factors for cardiovascular disease, and even after controlling for overall diet quality.

Studies showing the risk of a high sugar diet are really starting to mount. There have been reported associations between sugar and risk of obesity, type 2 diabetes, hypertension, dyslipidemia, and now even stronger evidence that sugar consumption is associated with cardiovascular disease.

What makes this study interesting is that it controlled for the Healthy Eating Index score in the statistical modelling. This score measures overall diet quality. It is easy to argue in an epidemiological study such as this, that sugar is simply a marker for an unhealthy diet, so of course it will be associated with cardiovascular disease. Since this study controlled for overall diet quality, it focuses in a bit more on sugar as the culprit.

As for the mechanisms, the authors propose several possibilities:

1) Sugar has been shown in animal studies to increase hypertension.

2) Excess sugar has been shown to increase triglycerides and LDL cholesterol while lowering HDL cholesterol.

3) Sugar has been shown to increase inflammation, which is a big part of developing cardiovascular disease.

Take Home Message
If you work with me or have read any of my books you already know I am an anti-sugar guy. Sugar is everywhere and the percentages can creep up on you quickly. One soda has 35 grams of sugar, and at 140 calories, makes up 7% of total calories on a 2000 calorie diet.

Strictly limiting sugar, or better yet completely avoided it, should be a high priority for anyone who is looking to manage their weight or reduce their risk of chronic disease. The most common sources of sugar in this cohort were sugar sweetened beverages, grain based desserts (like cookies and cakes), fruit drinks, dairy based desserts (like ice cream), and candy.  Limiting these foods is an awesome place to start.  

Saturday, May 10, 2014

Feature Article: Are your sleeping habits affecting your weight?

There is strong evidence that sleep plays an important role in our health. Short sleep duration has been shown to increase risk of coronary heart disease (1), type 2 diabetes (2), hypertension (3), and even early death (4). It is now clear that we can add weight gain to this list.  

Why sleep deprivation is associated with weight gain is not yet understood. There are several hypotheses that are supported by the literature. In this feature article, we’ll take a look at some of the research and make some recommendations, so that you can be sure that your sleeping habits are bringing you closer to your weight loss goals and not further away.

Sleep And Weight Gain
The association between sleep and weight gain was examined in 68,183 women in Harvard’s Nurses’ Health Study (5). After 16 years of follow up, women who slept 5 hours per night had a 32% increased chance of gaining 15 or more kg (32 pounds) when compared to women sleeping 7 hours per night. Women sleeping 7-8 hours per night had the lowest risk of major weight gain.

Sleep And Subsequent Energy Intake
Thirty men and women were studied under both short sleep duration (4 hours per night) and habitual sleep (9 hours per night) for 5 nights (6). On the 5th day, they were given unlimited access to food and consumption was closely monitored. When subjects were sleep deprived, they consumed 295 more calories per day than when they had a full nights sleep.

Sleep And Metabolism
Fourteen normal weight males had their energy expenditure measured by indirect calorimetry on 2 separate occasions; after 8 hours of sleep and after complete sleep deprivation (7). When compared to a normal night’s sleep, energy expenditure was reduced by 5% following sleep deprivation.

Mechanisms Of Action
It is not entirely clear why sleep deprivation promotes weight gain. Several mechanisms have been supported by the research literature:

1) Sleep deprivation may alter neuronal pathways that regulate reward behaviors.

2) Sleep deprivation may increase levels of ghrelin, a hormone produced in the stomach which has been shown to increase hunger.

3) Sleep deprivation may decrease levels of leptin, a hormone which influences metabolism and satiety.

4) Fatigue resulting from sleep deprivation may reduce physical activity.

5) Sleep deprivation may decrease thermogenesis.

It is likely that several of these proposed mechanisms are working in concert.

I have my clients shoot for a minimum of 7 hours of sleep per night. Those that fall short do so for one of 2 reasons:

They are too busy to get a full night’s sleep. 
The answer to this is simply to make sleep a priority. Arrange your schedule to get to bed 7 hours before you need to wake up, no excuses. If you are watching a game or an awesome TV show, DVR it and watch the rest the next day.

They can’t fall or stay asleep.

This can be for a variety of reasons. Here are some potential solutions:

 1) Meditate for 10 minutes before you go to bed. This will get your body and mind prepared for sleep. To learn how to do this, pick up The Relaxation Response by Herbert Benson, MD.

2) White noise can be useful, particularly if you live in a city. We use an air purifier that drowns out extraneous noise 100%.

3) Make it really dark in your bedroom. Early morning light may be creeping in and waking you up. Really good blinds or a sleep mask takes care of this.

4) Don’t drink anything after 8:00 PM. Sometimes a midnight bathroom break disrupts your rhythm and then you can’t get back to sleep.

5) Limit caffeine, particularly in the late afternoon and early evening.

1) Ayas NT, et al. A prospective study of sleep duration and coronary heart disease in women. Archives of Internal Medicine 2003; 163 (2):205-209.

2) Ayas NT, et al. A prospective study of self-reported sleep duration and incident diabetes in women. Diabetes Care 2003; 26:380-84.

3) Tochikubo O, et al. Effects of insufficient sleep on blood pressure monitored by a new multibiomedical recorder. Hypertension 1996; 27:1318-24.

4) Wingard DL, et al. Mortality risk associated with sleeping patterns among adults. Sleep 1983; 6:102-07.

5) Patel SR, et al. Association between reduced sleep and weight gain in women. American Journal of Epidemiology 2006; 164:947-54.

6) St-Onge MP, et al. Short sleep duration increases energy intakes but does not change energy expenditure in normal weight individuals. American Journal of Clinical Nutrition 2011; 94:410-16.

7) Benedict C, et al. Acute sleep deprivation reduces energy expenditure in healthy men. American Journal of Clinical Nutrition 2011; 93:1229-36.

Wednesday, March 12, 2014

What is considered a good rate of weight loss?

This is a really important question that I hear from just about every client that I work with. Having reasonable and realistic expectations of your weight loss effort can be the difference between hitting your goal, and giving up prematurely because the program “Isn’t working fast enough!”

Ideal weight loss is ¾ of a pound per week for the ladies and 1 pound a week for the men. I know this 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. This is the rate of weight loss for those that are successful at losing weight and keeping it off long term.

Why is this the case?
1) A pound of fat is 3500 calories. This means that there are 500 calories per day that you have to eliminate by either eating less or exercising more. Even this is not easy to do with consistency.

2) Resistance training will add small amounts of muscle to your body. This is pivotal to maintaining metabolic rate and ensuring that you’re losing body fat and not muscle mass. This additional muscle weight will show up on the scale and will slow down the overall rate of weight loss. Trust me when I say this is a very good trade-off. Maintaining muscle mass throughout the weight loss process is the only way to permanently change your body.

3) The human body has a number of defense mechanisms to weight loss that are recruited when body fat starts to drop. This will naturally slow down the rate of weight loss as time goes on.

4) It is far better to make smaller changes to your diet and exercise program that are sustainable long term, than major changes that you can only keep up for a short time.

Popular TV shows and fad diets will promise that you can lose 5, 10, or 15 pounds in a week. Don’t believe the hype. Slow and steady wins the race when it comes to weight loss. Keep your eye on the goal long term and take it nice and slow!




Tuesday, March 11, 2014

Research Update

Is your breakfast making you hungry?

The Study
48 subjects consumed Quaker Old Fashioned Oatmeal and Honey Nut Cheerios for breakfast on 2 separate occasions in a randomized crossover trial. Both meals contained 363 calories; 250 for the cereal and 113 for the fat free milk. Visual analogue scales measuring hunger and satiety were completed throughout the morning of each test. When the subjects consumed the oatmeal, they reported significantly higher levels of fullness and significantly lower levels of hunger, desire to eat, and prospective food intake than when eating the Honey Nut Cheerios. The oatmeal breakfast was lower in sugar, had a lower glycemic index, and had higher amounts of protein, total fiber, soluble fiber, and beta glucan than the Cheerios. These are all potential mechanisms for the increased satiety. Journal of the American College of Nutrition 2013; 32:272-79.

Take Home Message
When it comes to weight loss, a calorie is not a calorie! Some foods increase hunger and subsequent energy intake, and some don’t. The glycemic load is a powerful concept that must be understood if you want to lose weight and keep it off.

What’s more important, the number of fruits and vegetables consumed or the variety?

The Study
71,141 women from the Nurses’ Health Study and 42,135 men from the Health Professional Follow-up Study had their quantity and variety of fruit and vegetable consumption measured for a period of 22 years. Subjects consuming 8 or more servings of fruits and vegetables per day had a 17% lower risk of heart disease compared to those consuming 2 or fewer servings of fruits and vegetables per day. Variety, which was measured as the total number of unique fruits and vegetables consumed at least once per week, was not associated with risk of coronary heart disease. The authors believed the reduction in risk of heart disease was due to the presence of carotenoids, vitamin C, fiber, magnesium, potassium, and/or antioxidants in the fruits and vegetables. American Journal of Clinical Nutrition 2013; 98:1514-23.

Take Home Message
While it is always good advice to include a variety of fruits and vegetables in your diet, it may not be as important as the number of servings, at least when it comes to risk of heart disease. One last note: white potatoes and fruit juices were not considered as servings of fruits and vegetables by the researchers, most likely due to their higher glycemic load.

Groundbreaking New Research On Blood Sugar And Dementia

Glucose levels and risk of dementia. New England Journal of Medicine 2013; 369:540-48

Previous research has shown that diabetics have an increased risk of dementia.  This study examines the association between high blood glucose levels and risk of dementia in those without diabetes.

2,067 older men and women free of dementia and diabetes, were recruited from Group Health Cooperative, which is a health care system in Washington State. Over 7 years of follow up, blood glucose was measured repeatedly with a fasting blood glucose test.  Risk of dementia was measured by means of the Cognitive Abilities Screening Instrument. By the end of follow up, researchers had collected 35,264 measures of blood glucose in these subjects. The association between glucose levels and incidence of dementia were calculated.

By the end of follow-up, there were 524 new cases of dementia in this cohort.  Blood glucose levels were linearly and significantly associated with an increased risk of dementia, starting at fasting concentrations of 105 mg/dl. Following are the increases in risk of dementia with the corresponding average blood glucose readings:

105 mg/dl: 10% increased risk of dementia
110 mg/dl: 15% increased risk of dementia
115 mg/dl: 18% increased risk of dementia
It is also important to note that those with an average glucose reading of 95 had a 14% reduced risk of dementia.

Previous research has shown that diabetics have an increased risk of dementia.  Therefore, it is known that very high levels of blood glucose have a negative impact on the aging brain. This is the first study to show significant increases in risk of dementia with blood glucose levels well below that of diabetics.  

A fasting blood glucose reading below 100 is considered normal.  A fasting blood glucose above 125 is considered definitive for a diagnosis of diabetes.  If you fall in between (101-125) you are considered pre-diabetic.  This study showed that even a tiny increase in fasting blood glucose above normal will increase risk of dementia.  This is frightening because a huge number of American fall into this prediabetic category.  The authors felt that the increased risk of dementia was due to acute and chronic hyperglycemia, insulin resistance, and microvascular disease of the central nervous system.

Take Home Message
This is a really well designed study published in the #1 journal that will initiate more research in this area.  In the meantime, do your best to keep your fasting blood glucose levels in the normal range (even a bit lower as those with a reading of 95 mg/dl had a reduced risk of dementia). The best way to do this is to exercise daily, keep your weight in a healthy range, and eat a low glycemic load diet.

Monday, March 10, 2014

Product Review: Gazelle Edge

If you work with me or have read any of my books, you already know that cardio is essential to weight loss, fitness, and chronic disease prevention. Research is now telling us that we need to do a lot more of it than any of us originally thought. If weight loss in particular is your goal, cardio simply has to be a daily part of your routine. 

Going to the gym sounds great, but I can’t say that I have seen it work long term. In fact, in 15 years of working with weight loss clients, I can name one client who consistently got to the gym every single day to hit her cardio goal. Life just seems to get in the way. The only answer is to have a piece of cardio equipment in your home.

Enter the Gazelle Edge. This is a glider, which is very similar to an elliptical trainer, and is sold on I can’t say enough about it. Here are some of the great features:

1) It is low impact and very easy on the joints. 

2) It is light and folds up for easy storage against a wall or even under a bed. This makes it perfect for those in apartments or for those that don’t want a piece of gym equipment prominently displayed in their home.

3) It is inexpensive. Amazon sells it for about $120 with free shipping.

4) Having the Gazelle at home makes getting your cardio minutes a snap. Put it in front of your flat screen, and TV time becomes exercise time. You can talk on the phone while on the Gazelle. When your balance gets really good, you can even read on the Gazelle. 

5) It works! The majority of my clients use it as their primary source of cardio (as do I) with amazing weight loss results.

*Always remember that whenever you are starting or changing your exercise program, it is important to talk to your doctor first to get medical clearance.

Over the years I have gotten a lot of questions from my clients on how to best use the Gazelle Edge. In this next section, I’ll answer them for you.

Should I use the arms?

No! In fact, I recommend taking the arms off altogether. I want you to focus on the larger muscles of the lower body and not your arms. Also, with the arms off, you will be free to hold the TV remote, a book, or your tablet. If you need to hold on for balance in the beginning, you can keep your hands on the side of the machine.

How can I prevent the Gazelle from sliding around while I’m working out?

If you place the Gazelle on a hardwood floor, it can move around a bit during your workout. To prevent this, use the Gazelle in a carpeted room. If this isn’t an option, a thin yoga mat underneath it will help a lot. I actually use a yoga mat on top of the carpet to keep the machine from leaving indentations on the carpet.  This combination reduces movement 100%.

Initially, I feel like I’m not working out hard enough, am I doing something wrong?

When you first start using the Gazelle, you will not be entirely balanced and comfortable. This tends to slow down your pace. It is common to feel like you are not getting a great workout at this time. After a couple of weeks, your balance will improve and you will be able to greatly pick up the pace. The key is to take long, fluid strides, kind of like cross country skiing on one of those Nordic Track’s from years ago. Also, swing your arms as if you were running quickly.

Can I do anything else to pick up the intensity?

For most people, following the above recommendations will get their intensity to the proper level to improve fitness and lose weight. However, if I have a client that is a bit younger and healthy, I’ll recommend interval training to ramp up the intensity. 

I’ll have them start out their cardio at the normal intensity for 4½ minutes, and then sprint for 30 seconds. I’ll have them repeat this 4 or 5 times during their workout. This is a great way to increase intensity and burn more calories. The sprint does not have to be maximal, just a clear increase in speed for 30 seconds. If a client is overweight or has cardio-metabolic risk factors, such as hypertension or high cholesterol, I don’t recommend interval training, since the increased intensity can spike heart rate and blood pressure.

So there you have it. If attaining your cardio goals has been a problem for you, the Gazelle Edge is a low cost and effective solution.

To learn more about the Gazelle or to pick one up: click here.