Thursday, November 12, 2015

Drinking Juice Is An Easy Way To Eat More Fruit, Right?

The answer is no, and let’s start with some background.

Fruit in its whole form is one of the very best things that you can eat. It is high in vitamins, fiber, low glycemic load carbohydrate, and phytochemicals. In the research literature, fruit consumption has been associated with a lower risk of heart disease, stroke, hypertension, and certain types of cancers.

The sugar in fruit in its natural form is surrounded by a helix of fiber. Your digestive system has to break through this fiber in order to digest the sugar. This takes time, so fruit in its whole form has a very easy impact on your blood sugar.

When you juice a fruit, you are separating the sugar from the fiber. What you are left with is pure sugar. This will cause a spike in your blood glucose and insulin levels, which is not a good state for the body. Over the short term, these spikes in blood sugar will leave you hungry a few hours later, so you tend to eat more at the next meal, which can add to weight gain. Blood sugar spikes also can negatively impact your energy and focus. Over the long term, diets with a high glycemic load have been associated with a number of diseases, including heart disease and diabetes.

Juicing a fruit or vegetable takes a seriously healthy food and turns it into the equivalent of a soft drink with a few vitamins. Eat your fruits and vegetables in their whole and natural form and keep your blood sugar on an even keel.

Weight Lifting And Metabolic Rate

The Study
Ninety four women were put on an 800 calorie per day weight loss diet and placed into one of 3 intervention groups: 1) Aerobic training 3 days per week for 40 minutes, 2) Resistance training 3 times per week, or 3) A control group. Fat free mass and resting energy expenditure were measured both before and after the intervention. Fat free mass is basically your muscle mass, and resting energy expenditure is the amount of calories each day your body needs to perform basic functions.  

At the end of the 6 month follow up, all of the women lost similar amounts of weight. However, the resistance training group maintained muscle mass during the weight loss period, while the aerobic exercise group and the control group lost muscle mass while losing weight. Consequently, the resistance training group had a much lower drop in resting energy expenditure after weight loss (44 calories per day) compared to the aerobic group (76 calories per day) and the control group (103 calories per day). Obesity 2008; 16:1045-51

Take Home Message
The majority of people who lose weight, eventually gain it back. A drop in resting energy expenditure is a big reason why this is the case. This study shows that a reduction in muscle mass is very likely the culprit. Muscle is a very active tissue. Each pound burns roughly 50 calories each day, whether you exercise or not. When you lose weight without weight lifting, a lot of the weight you lose is muscle and your metabolism drops. When you lift weights, you maintain the muscle and your metabolism drops much less, making it easier to keep the weight off.

If long term weight management is your goal, it is essential to hit the weights at least twice per week. You don’t need to spend hours in the gym to do this. Just do one exercise for each of the major body parts: your chest, back, shoulders, biceps, triceps, abs, and legs. The whole routine should take about 20 minutes and you can do it at home. All you need is an exercise mat and some dumbbells. Resistance training absolutely has to happen if you want to keep the weight off long term. In my opinion, it is the most overlooked aspect of weight loss programs.

Carbohydrate Quality and Depression

The Study
Almost 70,000 subjects from the Women’s Health Initiative had their diet and incidence of depression monitored for a period of 3 years. Diet was assessed at baseline by a 145 question food frequency questionnaire. Depression was assessed by means of the Burman 8 Item Scale for Depressive Disorders at baseline and at the end of the three year follow up.

Women with the highest glycemic index had a 22% increased risk of depression when compared to women with the lowest glycemic index. Similarly, women with the highest consumption of added sugars (79.2 grams per day) had a 23% higher risk of depression when compared to women with the lowest consumption of added sugars (17.8 grams per day). In other findings, dietary fiber, fruit, and vegetable consumption were each associated with a lower risk of depression, while refined grain consumption was associated with a higher risk of depression. American Journal of Clinical Nutrition 2015; 102:454-63.

Take Home Message
For many years, I have noticed that the mood of my clients improves when their blood sugar stabilizes. This investigation is the first well designed research article that backs up this theory up with good hard science.

The authors of this paper listed several possible mechanisms by which a higher glycemic index may increase risk of depression: 1) An increase in body wide inflammation. 2) Increased insulin resistance, which is associated with a pattern of cognitive deficit very similar to depression. 3) Peaks and valleys in blood sugar themselves may increase depression. 4) The counter-regulatory hormones to glucose are released in abundance with a high glycemic diet. They are cortisol, glucagon, epinephrine and growth hormone, and are associated with anxiety and depression. In order to keep a lower dietary glycemic index, choose fruits, vegetables, legumes, and whole grains over refined grains and added sugars.


Wednesday, November 11, 2015

Feature Article: Does drinking water really help you lose weight?

We have all heard that drinking a lot of water helps you lose weight. But is this just another weight loss myth that has no scientific basis, or is it really true? According to the research literature, drinking water really can make it easier to lose weight. This post will summarize some of the important research in this field of study.

Research Evidence
1) In an investigation by the Harvard School of Public Health, the long term association between water consumption and weight was examined in a combined cohort of the Nurses’ Health Study, The Nurses’ Health Study II, and the Health Professional Follow-up Study (Reference 1). In total, there were 124,988 subjects included in this investigation that were followed for approximately 20 years. Participants reported their water consumption and their weight every 4 years throughout the study period. The researchers then calculated how 1 daily cup of water would impact weight each 4 year period. 

Here are the results:
1 cup of water resulted in .3 lbs. of weight loss over 4 years.

Substituting 1 cup of water per day for 1 cup of sugar sweetened beverages resulted in a weight loss of 1.1 lbs. over 4 years.

Although the results appear modest, they do offer evidence that by increasing water consumption, you can increase your rate of weight loss. This was particularly true if the water was substituted for more calorie heavy beverages, like soda.

2) Forty-eight adults were assigned to one of two diet groups for 12 weeks (Reference 2).  The first group was assigned a low calorie diet. The second was assigned the same diet, but was instructed to drink 16 oz. of water right before each meal. At the end of the 12 weeks, the group drinking the water prior to each meal lost an additional 4.5 pounds.

3) The Stanford University A to Z weight loss trial also examined water intake and weight loss (Reference 3). This trial was designed to compare the weight loss efficacy of 4 popular diets over a year in 173 young women. In a secondary analysis, they found that women who drank more than a liter of water each day (a little more than 4 cups) lost an additional 5 lbs. after a year.

Why Does Drinking Water Increase Rate Of Weight Loss?
While we don’t know for sure, there are several potential mechanisms by which water consumption increases the rate of weight loss:

1) Increased metabolic rate. Drinking water appears to increase sympathetic nervous system activity, which increases metabolism. Calories are also utilized to warm the water to body temperature. In the research literature, drinking 16 oz of water increased metabolic rate 30% in normal weight subjects (Reference 4) and 24% in overweight subjects (Reference 5).

2) Gastric distension. Water may also increase gastric distension, which has the potential to decrease hunger and subsequent energy intake. Fifty subjects participated in a trial that compared energy intake after consuming a water preload (Reference 6).  All subjects had access to an all you can eat lunch both with and without drinking 16 oz. of water, 30 minutes before the meal. Energy consumption at the lunches were compared. The subjects over 60 years of age consumed a statistically significant 58 fewer calories after drinking the water preload. Interestingly, this was not seen in the younger subjects.

3) Water replaces beverages containing calories. If you are drinking a lot of water, then you are probably not drinking a lot of soda or juice. The elimination of these calories over time can positively impact weight.

It is clear that drinking water can have a significant influence on ability to lose weight. I have my clients shoot for 8 cups of water each day. What counts? Filtered tap water, bottled water, hot or iced decaf coffee or tea, and flavored club soda from companies like Polar, and Poland Spring.

Any beverage that is high in caffeine does not count, since caffeine is a diuretic and may cause the body to excrete water.

1) Pan A et al. Changes in water and beverage intake and long term weight changes: results from 3 prospective cohort studies. International Journal of Obesity 2013; 37:1378-85.

2) Dennis EA, et al. Water consumption increases weight loss during a hypocaloric diet intervention in middle aged and older adults. Obesity 2010; 18:300-307.

3) Stookey JD, et al. Drinking water is associated with weight loss in overweight dieting women independent of diet and activity. Obesity 2008; 16:2481-88.

4) Boschmann M, et al. Water induced thermogenesis. Journal of Clinical Endocrinology and Metabolism 2003; 88:6015-19.

5) Boschmann M, et al. Water drinking induces thermogenesis through osmosensitive mechanisms. Journal of Clinical Endocrinology and Metabolism 2007; 92:3334-37.

6) Van Wallenghen EL, et al. Pre-meal water consumption reduces meal energy intake in older but not younger subjects. Obesity 2007;93-99.


Friday, September 11, 2015

I should be using fat free salad dressings, right?

Actually, no, and for two reasons:
1) When chosen wisely, fat is a very important part of your diet. Healthy vegetable fats, like olive oil and canola oil found in salad dressings, have been associated with a reduced risk of heart disease, stroke and type 2 diabetes.

Fats also help to stabilize the blood sugar. A stable blood sugar will reduce hunger and make it much easier to lose/maintain your weight.

2) Low fat dressings are notoriously high in sugar.  In an effort to improve the taste of a dressing without fat, manufacturers add in sugar. If weight loss is your goal, sugar in your diet will spike your blood glucose and insulin levels, which promotes hunger and fat storage.

Here are some recommendations on salad dressing:
1) Skip the low fat dressings; you want a healthy fat as part of your meal.

2) Go for oil based dressings like Italian, olive oil and vinegar, or olive oil and lemon juice.

3) Avoid creamy dressing like Ranch, French, Thousand Island, Russian, etc.  These are high in saturated fat and have the potential to raise LDL cholesterol.

4) Avoid dressings like Honey Mustard and sweet vinaigrettes which are loaded with sugar.

5) Keep portions reasonable.  Oils are high in calories and it is easy to go overboard. I have my female clients shoot for 1 tablespoon of oil at a meal, which would be 2 tablespoons of oil and vinegar or Italian dressing. Men can do 1½ tablespoons of oil per meal.

Sugar sweetened beverage consumption and risk of heart disease

The Study
A randomized trial was recently published that tested whether drinking sugar sweetened beverages increases risk of heart disease. In this investigation, 85 subjects were given either 0%, 10%, 17% or 25% of energy requirements as sugar sweetened beverages for a period of two weeks. The researchers measured risk factors for heart disease both before and after the intervention. After the two weeks were over, the subjects consuming the sugar sweetened beverages had significant, linear, and dose response increases in triglycerides, LDL cholesterol, and uric acid concentrations. Subjects consuming the two higher doses of sugar also showed increases in non-HDL cholesterol, Apo lipoprotein B, and Apo lipoprotein CIII. American Journal of Clinical Nutrition 2015; 101:1144-54

Take Home Message
Years ago, sugar was considered “empty calories” that didn’t do much good, but also didn’t do much harm. That idea is changing fast. This study, and others like it, are beginning to offer proof that sugar consumption in and of itself can cause disease. The take home message here is to get sugar out of your diet entirely. If you can’t or won’t do this, do your best to strictly limit consumption. Incidentally and not surprisingly, subjects consuming the two highest doses of sugar gained weight after the two week intervention.

Carbohydrate quality and long term weight gain

The Study
The glycemic load is a measure of how quickly and how severely the carbohydrate containing foods in your diet elevate your blood sugar. An interesting study was recently published that measured the impact of glycemic load on long term weight gain. Over 120,700 men and women from the Nurses’ Health Study, the Nurses’ Health Study II, and the Health Professional Follow-up Study were followed for 16-24 years. Changes in glycemic load and body weight were measured every 4 years throughout follow-up. 

There were 2 relevant findings: 1) Dietary glycemic load was independently associated with weight gain. Every four years, body weight increased .93 pounds for every 50 unit increase in glycemic load. 2) The glycemic load had a strong interaction with other foods. If a food was associated with weight gain, like red meat was in these cohorts, eating that food with high glycemic load carbs increased weight gain, while eating that food with low GL carbs decreased weight gain. The same was true for foods that were associated with reducing body weight, like plain yogurt. If high GL foods were consumed with the yogurt, the weight loss was attenuated.  If low GL foods were consumed with the yogurt, the weight loss was augmented. The American Journal of Clinical Nutrition 2015; 101:1216-24

Take Home Message
If weight loss is your goal, it is a good idea to pay attention to the glycemic load of your diet. Mechanisms by which a lower glycemic load diet promotes weight loss were discussed by the authors of this study. A higher resting energy expenditure, increased satiety, and reduced cravings with a low GL diet are all possibilities. If you want to lower the glycemic load of your diet, substitute fruits, vegetables, legumes and whole grains for bread, pasta, white rice and sugar. It is also a good idea to keep carbohydrates in the range of 45-50% of calories.

Product Review: Tanita Ironman Scale

When deciding on which products to review for this newsletter, I always ask myself two questions: 1) Will this product make it easier for my clients to succeed in attaining their health and fitness goals?  2) Am I asked about this type of product on a regular basis? An accurate, reliable scale answers both of these questions with a resounding “Yes”. Therefore, it is time to review the Tanita Ironman BC554.

Basic principles of weight loss are the same for everyone and can get you pretty far on your weight loss journey. However, to get those last few pounds off, I have found that the strategy becomes highly individualized. Some people will need to apply additional focus to their cardio to get there. Others need to look more closely at their total calories. For others, it may be lifestyle factors like alcohol consumption, snacking, or late night eating. The last few months of the weight loss journey very much boils down to trial and error. You make a change and see if you lose weight, if not, you try something else the next week.

In order to find out what will work for you, you need to weigh yourself properly and consistently. To do this, you need an accurate and reliable scale. I have been a huge fan of Tanita Ironman scales for years. I currently have the Ironman BC554.

1) Accuracy. I consider the Tanita Ironman line research quality. Knowing you have an accurate measurement is, for obvious reasons, pivotal.

2) Durability. My last model lasted me for almost 10 years.

3) Long battery life. I am amazed at how long the batteries last in these scales. You go years without having to replace them.

4) Measures body fat. If you are lifting weights while you are losing weight, a time may come where you will be building muscle and losing body fat at largely the same rate. This can become a bit frustrating as the number on the scale stops going down. At this point, your percent body fat is a better indicator of progress than your weight. Tanita Ironman scales come with a bioelectrical impedance analyzer to measure body fat. When used correctly, these scales provide an accurate measure of body composition which can become a very useful measure of progress toward your goals. 

1) A bit pricey. The BC554 currently lists on Amazon for $147.99. This is a lot for a scale. Other models in the Ironman family range from $99.99 up to $239.99, depending on features.

Would I Recommend Tanita Ironman Scales?
Without a doubt. These scales can be a bit on the pricey side, but they last forever, are highly accurate, and allow you to measure your body fat. Overall, they are a great investment in your health. 

To learn more about Tanita scales, visit If you want to buy one, you can pick it up on 

Monday, July 13, 2015

What are good snack ideas if I am trying to lose weight?

If weight loss is your goal, the best snack for you is the one you don’t eat!

Here are the reasons:
1) You shouldn’t need one. If you are eating a diet that promotes a stable blood sugar, you will not be hungry. Most hunger in between meals is due to blood sugar drops which can be totally prevented by eating the right foods in the right combinations.

2) Very small amounts of food eaten consistently can cause serious damage to your waistline. If you have 100 more calories a day than your body needs, after a year, those calories add up to 10.4 pounds. And let me tell you that 100 calories is not a lot of food. It is way too easy to get too many calories when you snack.

3) My most successful weight loss clients are consistently those that don’t snack.

Eliminate snacking entirely and you will have a much easier time losing the weight and keeping it off.


Metabolic adaptations to extreme weight loss

The Study
Your resting metabolic rate is the number of calories your body burns each day to perform its basic metabolic functioning. The higher your resting metabolic rate, the easier it is to manage your weight. It has been known for some time that resting metabolic rate decreases with weight loss. Prevailing wisdom was that this drop was due to the loss of metabolically active muscle tissue during the weight loss process. This may not be the whole story.

A study conducted by the Pennington research group tested this theory. They measured the resting metabolic rate of 16 Biggest Loser contestants before, during, and after the 30 week competition. In order to reduce the loss of muscle during the weight loss process, the contestants on this show engaged in a lot of resistance training exercise. They were successful in sparing their muscle. The average weight loss after the 30 weeks was 30% of initial body weight. Of this weight loss, 83% was fat and only 17% was muscle. After adjusting for the losses in fat and muscle mass at the end of the 30 weeks, resting metabolism in these contestants decreased by a stunning 504 calories per day. Journal of Clinical Endocrinology and Metabolism 2012; 97:2489-96.

Take Home Message
This study tells us a few important things. The first is that resistance training prevents the loss of muscle mass with weight loss, which is really important. The second is that despite the preservation of muscle, metabolism drops a lot after extreme weight loss. A drop of 504 calories per day is no joke. The question that I don’t have the answer to, is whether this decrease in metabolism happens all the time, or is due to the very extreme nature of the weight loss in this study. The contestants on this show lost an average of 5 lbs. a week. I am wondering if this severe drop in metabolism would occur in those who lose weight more slowly. 

No one really knows why resting metabolism drops so much after weight loss when accounting for lost muscle. The authors of this study believe that the drop in metabolism may be due to changes in leptin and thyroid hormones or perhaps a reduction in the size of very metabolically active organs like the heart, brain, kidney and liver. One thing is certain, when you lose a lot of weight quickly, your body fights very hard to put it back on.

We need to learn more about this phenomenon. Many people who lose weight gain it back within a short period of time, and this drop in resting metabolic rate could be a big reason why.


Are restaurants making it impossible for you to lose weight?

The Study
Most people know that eating out at restaurants is not a good strategy when trying to lose weight, but it may be worse than you think. Researchers from Tufts University purchased the 42 most commonly ordered meals in the Boston area from 9 categories of restaurants: Mexican, American, Chinese, Italian, Japanese, Thai, Indian, Greek and Vietnamese. They then measured the calorie content of the meals by bomb calorimetry. The average calorie content was a stunning 1,327 calories. This amount is more than twice the amount of calories necessary for weight maintenance. The scary thing about this study is that the researchers did not include appetizers, bread or drinks in the calorie analysis! JAMA Internal Medicine 2013;173:1292-99.

Take Home Message
Women looking to lose weight should be hitting about 1200-1300 calories per day. Men looking to lose weight should shoot for 1500-1600 calories per day. One meal out in your typical restaurant will make it impossible to hit these goals. To lose weight, eat at home the majority of the time and save restaurant meals for the couple of times a week you are allowed to cheat. The authors argue that mandatory calorie listing on menus would promote lower calorie meals by restaurants and better choices by customers. I am beginning to think that this is a good idea.


Sunday, July 12, 2015

Book Review: The Hunger Fix

Next up for review is The Hunger Fix. The author, Dr. Pam Peeke, is a medical doctor specializing in nutrition and lifestyle medicine.

The major focus of The Hunger Fix is food addiction. The author believes that overeating is dependent on the neurotransmitter dopamine and our brain’s reward system. The book explains, in great detail, the relationship between dopamine and body weight, and then presents a 3 stage recovery program to “rewire” the brain to overpower the addiction. The book is 302 pages long. The Hunger Fix is very well written and I truly enjoyed reading it.

5 Things I Really Liked About The Hunger Fix
1) I really liked learning about the science behind reward and food addiction. Many argue that food addiction is not real, and that overweight people simply lack willpower. When it comes to sugars and refined carbs, I would totally disagree. I have seen for years the powerful pull that sugar can have on the overweight and medical research is beginning to compare sugar addiction to alcohol or drug addiction.

2) I thought that the dietary approach was strong. Dr. Peeke recommends a balance of 20-30% protein, 25%-35% fat, and 30-35% carbohydrate. While I would generally recommend a bit less protein (20%) and a bit more carb (45%), this is very close to what I tell my own clients.

3) The importance of resistance training and cardiovascular exercise is stressed throughout The Hunger Fix. Not many weight loss books mention enough about exercise.

4) The section on meditation was compelling. Stress reduction can have a powerful impact on our ability to make positive lifestyle changes and sharpens focus. This is an often completely overlooked component of weight loss programs.

5) The meal plan and recipe sections were really well done. 

5 Things I Didn’t Agree With In The Hunger Fix
1) Dr. Peeke recommends eating every 3 hours. I have found that it is way too easy to overeat when you do so. My most successful clients eat 3 meals per day and don’t snack at all. If your blood sugar is stable, you will have absolutely no need to snack anyway. Keep in mind that eating just 70 more calories than your body needs per day will result in a 7 lbs. weight gain over a year.    

2) The references in this book were interesting. At certain times, the references cited were from really reputable journals, like The American Journal of Clinical Nutrition and The New England Journal of Medicine. The rest of the time, the book cited very unusual and obscure journals, links to websites, YouTube videos, newspaper articles, and magazine articles. Several times Dr. Peeke wrote “Science shows that…” and didn’t list any references at all.

3) The cardio recommendations are a bit low. Dr. Peeke recommends cardiovascular exercise 5 times per week for 20 minutes. This is well less than optimal for weight loss. In my experience, women need to hit at least 250 minutes/week and men need to hit 150 minutes/week if they want to get the scale moving.

4) One recommendation that I didn’t agree with was that for sugar consumption. Dr. Peeke does an impressive job explaining the addictive properties of added sugar. She uses compelling research to present her case. After all this, she quotes the American Heart Association recommendations on sugar, that allow women 6 teaspoons of sugar per day, and men 9 teaspoons of sugar a day. In my opinion, this is way too much! For someone addicted to sugar, complete avoidance is the only way. To me, this is similar to telling an alcoholic that one or 2 drinks a day is OK. 

5) Similar to the last point, I was surprised at some of the foods I found in the meal plan and recipes. Many of these were high glycemic load or contained a lot of sugar. Examples include: white potatoes, smoothies, balsamic vinegar, popcorn, bread, honey, brown sugar, candy, juices, rice cakes, etc. These foods can cause a reactive hypoglycemia that increases hunger and make it really hard to keep calories in the weight loss range.

Is The Hunger Fix Worth Reading?
Absolutely! I enjoyed this book. You’ll learn a lot about how our brain is hard-wired to seek rewards, and how the food industry takes full advantage of this fact when creating products. The Hunger Fix really comes from a different perspective than other weight loss books that I have read.

Overall, The Hunger Fix program is very sound. To make it complete, I would add a bunch more cardio, get a little stricter on some of the carbs allowed, and limit eating to 3 meals per day. 


Tuesday, May 12, 2015

Which Cardio Machine Should I Buy?

Getting to the gym on a daily basis doesn’t really work long term. We are all just too busy. Having the ability to do cardio at home is pivotal to generating the type of consistency necessary to make lasting changes to your weight.

A question I always get is; “What cardio machine should I buy?” My answer, in every case, is an elliptical trainer.

1) Elliptical trainers are low impact. Many modes of cardio that burn a lot of calories are tough on your joints. High impact cardio classes and running are two examples. Elliptical trainers are much easier on your joints. My client’s that use elliptical trainers have far fewer injuries than those that engage in more impactful forms of exercise.

2) You burn a lot of calories. Since elliptical trainers are an upright form of exercise, you lift your full body weight with each repetition. This makes the elliptical machine an efficient calorie burner.

3) Elliptical trainers are appropriate for all fitness levels. If you are young, fit, and work out with a bit more intensity, you can get a high-end, gym quality elliptical trainer like a Life Fitness model. These will have all sorts of variety in resistance, fitness programs, and other bells and whistles. If you are older or a little less fit, you can get a glider like the Gazelle Edge, which has no resistance and simulates walking.

4) Elliptical trainers can fit any budget. If you want to spend several thousand dollars on a gym quality machine for your home gym, there are lots of options that are worth every penny. If money is tight, you can get a glider, like the Gazelle Edge, for $130, which will do the job nicely.

Beverages and Weight Gain

The Study
The long term association beverage choice and weight gain was examined in a combined cohort of the Nurses’ Health Study, The Nurses’ Health Study II, and the Health Professional Follow-up Study. In total, there were 124,988 subjects included in this investigation that were followed for approximately 20 years. Participants reported their beverage consumption and their weight every 4 years throughout the study period. The researchers then calculated how 1 daily cup of a given beverage would impact weight each 4 year period. 

Here are the results:
1 cup of water resulted in .3 lbs. of weight loss

1 cup of sugar sweetened beverages resulted in a .8 lbs. weight gain

1 cup of fruit juice resulted in a .5 lbs. weight gain

1 cup of diet soda resulted in .2 lbs. of weight loss

1 cup of coffee resulted in .3 lbs. of weight loss

1 cup of tea resulted in .1 lbs. of weight loss

Substituting 1 cup of water per day for 1 cup of sugar sweetened beverages resulted in a weight loss of 1.1 lbs. over 4 years.
International Journal of Obesity 2013; 37:1378-85.

Take Home Message
At first glance these numbers seem kind of small. However, it is important to realize that these results are for just one cup. Many of us drink 20 ounce sodas and coffees. If you drink 8 glasses of water per day, 8 x .3 = 2.4 lbs. of weight loss over 4 years, 4.8 lbs. over 8 years, 7.2 over 12 years and 9.6 over 16. My point is that these numbers can add up over time to have a powerful impact on your weight.

It is becoming evident that the body does not fully recognize calories in liquid form. In other words, if you have a snack before dinner, most of us will eat a bit less at that dinner to compensate. Studies show that if you drink a soda before dinner, you won’t eat any less at the meal. Liquid calories don’t seem to register with our body the way solid food does.

Stay away from calorie containing beverages like soda and fruit juice, and instead go for water, club soda, coffee, tea and the occasional diet soda. Over time, these choices can have a really nice impact on your weight and your health.


Can you be obese, yet totally healthy?

The Study
The idea that it is possible to be obese yet healthy has been bounced around for some time. This hypothesis was tested in an investigation of the Whitehall II cohort of British government workers. In this cohort of 2,521 men and women, 66 met the criteria for being obese (BMI ≥30) and healthy (<2 of the following metabolic symptoms: low HDL cholesterol, high blood pressure, high fasting glucose, high triglycerides, insulin resistance). After 20 years of follow up, more than half of the healthy obese subjects progressed to unhealthy obesity. Furthermore, after 20 years, the healthy obese in this cohort were nearly 8 times more likely to progress to an unhealthy obese state than the healthy non-obese adults. Journal of the American College of Cardiology 2015; 65:101-02.

Take Home Message
This study presents convincing evidence that if you are obese but currently healthy, there is a good chance that you won’t be for long. If your BMI is 30 or greater, get it below 25, even if you are free of metabolic symptoms.

Feature Article: Can you exercise too much?

There has been a major push in the last few years towards extreme fitness. The trend right now is to exercise to the absolute limit of your abilities. People are flocking to boot camps and intense interval cardio classes. Every year, more people run marathons and take part in other extreme endurance events like bike races and “survival” obstacle course races. 

I am generally a big fan of fitness fads. Anything that gets people excited to work out is cool with me. However, this really high intensity training trend has always made me a bit nervous. I learned about overtraining when I was getting my Masters in Exercise Science. The American College of Sports Medicine has published a comment on overtraining, citing that excessive exercise can cause a variety of symptoms, including fatigue, depression, sensitivity to stress and impaired immune system function (Reference 1). 

The prevailing wisdom was that overtraining was not such a big deal and these symptoms were generally self-limiting and benign. Recently however, a new area of research suggests that this may not be the case. I read a newly published article in the Journal of the American College of Cardiology that was eye opening and prompted me to dig deeper into this question.

The Study
In this investigation of the Copenhagen City Heart Study cohort, 1,098 healthy joggers and 3,950 healthy non-joggers were followed for 10 years (Reference 2). The exercise habits of the runners were measured and the impact of these habits on long term risk of death were examined. The results were shocking.

Based on the reported intensity, frequency, and duration of training, runners were broken up into 3 categories; light joggers, moderate joggers, and strenuous joggers. The light joggers had a statistically significant 78% lower risk of dying when compared to sedentary subjects. The moderate joggers had a nonsignificant 34% lower risk of dying, while the strenuous joggers had a nonsignificant 197% increased risk of dying.

Subjects that ran the hardest and longest had no benefit to longevity when compared to those that didn’t exercise at all! 

Why Didn’t The Strenuous Exercisers Live Longer?
This is the million dollar question. The authors of the study offered several possibilities with plenty of references. Most of the proposed mechanisms dealt with damage to the heart. I picked up the relevant articles and looked at them in detail. Here is what I found as far as potential problems with very intense exercise:

1) Pathological restructuring of the heart and large arteries (Reference 3).

2) Elevations in troponin after intense exercise, which is a highly specific marker of myocardial cell damage (Reference 4).

3) Premature aging of the heart (Reference 5).

4) Increased risk of myocardial fibrosis, which increases risk of arrhythmia (Reference 3).

5) Increased coronary artery calcification (Reference 3).

6) Large artery wall stiffening (Reference 3).

7) Increased oxidative stress (Reference 3).

8) Renal dysfunction (Reference 3).

9) Increased risk of atrial fibrillation (Reference 3).

10) Immune system dysfunction (Reference 3).

The research here is in a relatively early stage and there is clearly more work to be done. However, after going through these studies in detail, I think there is something to the idea that very long and/or very intense exercise may be more harmful than beneficial to health and longevity.

This in no way lessens the astronomically positive impact of physical activity on health. Even in this study, those considered “light joggers” had a stunning 78% lower risk of dying during the follow up period. It’s just that as intensity goes up, health benefits may go down. 

As far as recommendations, here is what I tell my clients:
1) Limit total exercise to 45-60 minutes per day max and don’t go crazy with the intensity. Think of a time when you were late to an appointment and you were walking as fast as possible to get there without running. That is the level of cardio intensity I have my clients shoot for. If you are young, healthy and in good shape, a few intervals of increased speed for 30 seconds thrown in are probably OK.

2) Avoid marathons, long bike races, and “survival” races. They are not necessary for weight loss/health promotion and may be damaging to your health.

3) As far as weight training, keep the intensity moderate. Most of the studies I looked at were about cardiovascular exercise, but there is some evidence that any really intense exercise, even if it is of short duration, may cause issues. I always tell my clients that when they finish their cardio or weight training, they should feel like they could do a bit more.

It may just be that when it comes to exercise, the goals of health promotion and longevity may differ radically from the goals of maximizing strength, speed, and physical performance. It also may be that a program designed to reach one of those goals excludes you from reaching the other.


2) Schnor P, et al. Dose of jogging and long term mortality. Journal of the American College of Cardiology 2015; 65:411-19.

3) O’Keefe JH, et al. Potential adverse cardiovascular effects from excessive endurance exercise. Mayo Clinic Proceedings 2012; 87:587-95.

4) Shave R, et al. Exercise-induced cardiac troponin elevation. Journal of the American College of Cardiology 2010; 56:169-76.

5) O’Keefe JH, et al. Exercise for health and longevity vs peak performance: Different regimens for different goals. Mayo Clinic Proceedings 2014; 89:1171-75.


Thursday, March 12, 2015

Is It OK To Drink Coffee?

Many consider coffee drinking an unhealthy habit. However, for the vast majority of people, drinking coffee is not associated with negative health outcomes and may actually reduce the risk of chronic disease.

Although by far the biggest ingredient in coffee is water, it also contains an abundance of antioxidants, flavonoids, and other biologically active substances. These compounds can have a powerful impact on our health. In the large cohort studies at Harvard University, coffee drinking has been associated with a lower risk of coronary heart disease, stroke, type 2 diabetes, gallstones, and even Parkinson’s disease. 

So, while coffee drinking is fine, here are a few points to consider:

1) It appears that up to 6 cups per day have no negative impact on health (Reference 1). Keep in mind that a cup is 8 ounces, so if you are having a large, or extra large, you are really having 3 or 4 cups.

2) Adding cream and sugar can turn a healthy drink into a decidedly unhealthy drink. The additional calories, saturated fat, and sugar can add up quickly and negatively impact both your weight and your health. This is especially true if you are having multiple cups per day. Stick to skim or 1% milk and avoid sweeteners.

3) Coffee contains a fair amount of caffeine. In small amounts, this is not a problem for most of us. However, for certain populations, like pregnant women and those with hypertension, decaf is probably a better choice. If you have any health issues at all, check with your doctor about your recommended caffeine intake.

4) If possible, use a paper filter when brewing your coffee. There is evidence that a compound found in coffee, called cafestol, may increase LDL cholesterol. Using a paper filter greatly reduces the amount of cafestol in your coffee (Reference 2).

1) Lopez-Garcia et al. Relationship of coffee consumption with mortality. Annals of Internal Medicine 2008; 148:904-14.

2) Urgent R, et al. Separate effects of the coffee diterpenes cafestrol and kahweol on serum lipids and liver aminotransferases. American Journal of Clinical Nutrition 1997; 65:519-24.

Whole Grains And Mortality

The Study
74,341 women from The Nurses’ Health Study and 43,744 men from the Health Professionals Follow-up Study had their whole grain consumption measured repeatedly and were followed for 24 years. Rates of mortality were then compared. Participants who consumed the most whole grains had a statistically significant 9% lower risk of mortality when compared to those who consumed the least. Adding one serving of whole grains per day (28 grams) was associated with a 5% lower total mortality in this cohort.        
JAMA Internal Medicine doi:10.1001/jamainternmed.2014.6283

Take Home Message
Proponents of paleo and low carb diets claim that whole grains have a negative impact on health and need to be completely avoided. This statement is not supported by the current research literature. The authors of this study feel the benefits of whole grains come from their high levels of fiber, B vitamins, vitamin E, magnesium, antioxidants and numerous other beneficial phytochemicals.  These substances combine to have a powerful impact on our health. The authors also mentioned that whole grains have been shown to have a favorable impact on blood pressure, insulin sensitivity, as well as cardiovascular health in general. This could account for the decreases in mortality among the participants consuming high amounts of whole grains. I have my clients shoot for 2 servings of whole grains per day. Good examples of whole grains are old fashioned oatmeal, brown rice, quinoa, and corn.

Wednesday, March 11, 2015

Weight Training And Abdominal Obesity

The Study
Waist circumference and physical activity were measured in 10,500 men from the Health Professional Follow-up Study in 1996 and 2008. The goal was to see which activities caused the greatest reduction in abdominal fat over the 12 year study period. In a somewhat surprising finding, resistance training had the strongest association with lower abdominal fat. Adding 20 minutes per day of weight training resulted in a .67 cm reduction in weight circumference. Adding 20 minutes per day of cardiovascular exercise resulted in a .33 cm reduction in waist circumference. The authors believed that the metabolic boost from weight training was the likely reason for the difference. Obesity 2014 doi:10.1002/oby.20949

Take Home Message
Resistance training is often completely ignored by those trying to lose weight. This is a real shame, because there is no better way to increase your metabolism, and therefore, the number of calories you burn each day.

In this investigation, resistance training resulted in twice the reduction in waist circumference over 12 years when compared to cardiovascular exercise. Does this mean that you should you stop doing your cardio and focus just on the weights? Absolutely not! The combination of cardio, weight lifting, and the right diet are pivotal to improving your health and losing weight. This study just highlights the importance of including resistance training in your program.

Product Review: MyFitnessPal Smartphone App

If you are looking to improve your diet to lose weight or reduce your risk of chronic disease, writing down what you eat is critical to your success. Food logging provides a higher level of accountability and helps you uncover the days/times/situations that are giving you the most trouble. When these situations are properly identified, a strategy can be created to deal with them effectively.  

The My Fitness Pal app is a powerful tool to help you do this. You can easily record your food, and more importantly, this app allows you to keep track of critical aspects of your diet like total calories, fiber, sodium and percent fat, protein, and carbohydrate. While this app is not the first or only app that allows you to record you food, it is the ease of use that makes this such a home run.

1) My Fitness Pal is free, which is awesome.

2) The number of foods in the My Fitness Pal database is mind-numbing at 5 million. You can search for brand names as well as food names. For example, if you get your almond butter freshly ground at Whole Foods, you can find it specifically in the database, instead of just looking up generic “almond butter”.

3) You can scan barcodes with your smart phone to identify a food.

4) Tutorial videos are provided that explain each and every feature in detail.

5) Once you are done logging your food, you can get nutrition summaries of your day, including your calories, fiber, sugar, and sodium consumption. You can also quickly view a pie chart of your fat, protein, and carb distribution. This is my favorite feature and provides a great summary of how you did that day.

6) You can save meals and import them on another day. This is a great feature, because most of us rotate a few different breakfasts and lunches the majority of the time. Logging these meals is instantaneous when you can just call them in.

7) There is a friend feature that allows you to share your food logs with others.  This is useful if you want to show your nutritionist, trainer, or doctor what you are doing.

8) You can import whole recipes from popular sites like The app will scan in the ingredients, fill out the nutrition data, and assign you totals per serving. I haven’t used this feature, but it seems pretty handy for those that cook a lot.

Would I Recommend My Fitness Pal?
Absolutely! This is particularly valuable for my clients that are just starting out. It is also useful for those that have been successful in losing the majority of their weight and are now trying to lose that last couple of pounds, which can require a bit more focus on their diet.

So what should you shoot for? Although these recommendations are highly dependent on activity level, I have my female weight loss clients shoot for about 1200-1300 calories per day, and my men f0r 1500-1600 calories per day. As far as fat, protein, and carbohydrate as a percentage of calories, I look for 20% of calories as lean protein, 30-35% of calories as healthy vegetable fat, and 45-50% of calories as low glycemic load carbohydrate.

Pick up this free app on your android or IPhone. You’ll be glad you did.


Tuesday, January 13, 2015

Questions And Answers: Should I Join A Gym?

Whenever I meet a new client, they often wonder if it is necessary to join a gym in order to attain their weight loss and fitness goals.   

The answer is no, there really is no good reason to join a gym. For the vast majority of my clients, working out at home makes a lot more sense. Here are some of the biggest reasons why:

1) Working out at home saves you time. Driving to the gym, parking your car, changing your clothes in the locker room and then doing the reverse after your workout can take up a lot of time. I, personally, can get half of my workout done by the time it would take me to get on the gym floor. When you are really busy, that extra 20 minutes can be the difference between getting your workout in and having to skip it.

2) Working out at home saves you money. Gyms are not cheap, especially the nice ones. You can take one year’s worth of gym fees and set yourself up with equipment that will last you a decade or longer.

3) Working out at home will make you more consistent. It is virtually impossible to get to the gym every day. Having equipment at home will allow you to work out more regularly, or at least get half a workout in when time is tight. In 15 years as a trainer, I have had exactly one client who was able to get all of her cardio done at a gym with consistency. I can’t even count the number who hit their cardio goals while exercising at home.

4) Working out at home will make you more efficient. Combining your cardio with something you already do is a great idea. Watching the news or other taped shows, returning phone calls, and checking your email are all things you can do while working out. It is not easy to multitask at a gym.

So what will you need? Not much, really. A set of dumbbells, an exercise mat, and a piece of cardio equipment will do the job amazingly well. I am a big fan of elliptical trainers for cardio, they are efficient calorie burners and create minimal joint stress. If you want to go the more thrifty route, a Gazelle Edge ($113 on is all you’ll need. If you want to spend a bit more money on the bells and whistles, a Life Fitness elliptical is a great choice.


Mediterranean Diet And Telomere Length

The Study
A telomere is a DNA structure on a cell that shortens each time the cell divides. Telomere length is considered a biomarker for aging, because shorter telomeres have been associated with a decreased life expectancy and an increased risk of major chronic disease. In this investigation of 4,676 women from the Nurses’ Health Study, the impact of a Mediterranean diet on telomere length was examined. 

A score was created for each participant that gauged adherence to a Mediterranean diet. The score had 9 components: vegetables, fruits, nuts, whole grains, legumes, fish, monounsaturated fat:saturated fat ratio, red and processed meat, and alcohol. Women with higher scores had significantly longer telomeres after adjusting for confounders. These results provide further evidence that adherence to a Mediterranean diet promotes greater health and longevity. British Medical Journal 2014:349:g6674.

Take Home Message
In the last decade, there has been a tremendous amount of research showing a real benefit to the Mediterranean style of eating. This study is unique because it uses a biomarker for aging, which has been associated with longevity and chronic disease incidence in the research literature. 

The results of this study were pretty impressive. The difference in telomere length for each 1 point change in the Mediterranean diet score corresponded to 1.5 years of aging. A three point change in score was equivalent to 4.5 years of aging, which is comparable to the difference between smokers and non-smokers. This study provides further evidence that a Mediterranean diet is the way to go if you are looking to reduce your risk of chronic disease and increase longevity. For those of you that work with me or have read my book, congratulations, you are already consuming a Mediterranean diet!