Monday, November 14, 2016

Raisins are a convenient and portable way to get my fruit, right?

As a derivative of fruit, it makes sense that most people think of raisins as a healthy food. My clients are usually quite surprised when I tell them that dried fruit needs to be strictly limited.

The problem with raisins arises during the drying process. Drying a fruit increases the sugar content dramatically and decreases the fiber. 

As you probably know, raisins are dried grapes. A serving of grapes (4 ounces) has a glycemic index of 43 and a glycemic load of 7, both of which are on the lower end (Reference 1). However, a serving of raisins (2 ounces) has a glycemic index of 64 and a glycemic load of 28, both on the high end (Reference 1).

The key to eating for weight loss is to maintain a stable blood sugar. This strategy helps to keep insulin at a reasonable level and significantly reduces hunger and subsequent energy intake.

Despite having some nutritional upside, eating raisins is very similar to eating candy when it comes to your blood sugar. If you are trying to lose weight, a much better choice is to go for fruit in its whole and natural form.


Religious service attendance and mortality

The Study
Over 74,000 women in the Nurses’ Health Study had their religious service attendance assessed repeatedly by questionnaire and were followed for 20 years. By the end of follow-up, women who attended religious services more than once per week had a statistically significant 33% lower rate of mortality when compared to women who did not attend religious services. The association held after controlling for all known predictors of death in this cohort. JAMA Internal Medicine 2016; 176:777-85

Take Home Message
This is a fascinating study to me. You don’t see a lot of literature on the subject of religious beliefs and health outcomes, but the reduction in risk of mortality in this investigation is strong and impressive.   

The mechanism for the reduction in risk of death in the religious is not known. However, the authors suggest several possibilities:

 1) Increased social support

2) Lower levels of depression

3) Higher levels of optimism

4) Religious coping mechanisms

5) More purpose in life

6) More self discipline

7) Higher psycho-social resilience

It is certainly beyond the scope of this blog to make recommendations of a religious nature. However, I just wanted all of my readers to be aware of this association, because it appears to be a very important predictor of long-term health.

Can lifting light weights effectively build muscle?

The Study
In this study, 49 men that lifted weights regularly performed 12 weeks of resistance training. The men were randomly allocated to one of two training groups; the first group used very heavy weights (75-90% of 1 rep max) for 8-12 repetitions per set, the second group used much lighter weights (30-50% of 1 rep max) for 20-25 repetitions per set. Each group lifted weights 4 times per week. At the end of follow-up, there were significant increases in muscle mass in both groups with no difference between groups. Journal of Applied Physiology 2016; 121:129-138.

Take Home Message
This study shows that you don’t have to lift very heavy weights in order to build muscle. You can get similar increases in muscle mass with lighter weights and higher repetitions. I use lighter loads with most of my clients, for a bunch of reasons: 1) I find there is a lower risk of injury. 2) It is my opinion that it is safer (lower spikes in blood pressure and heart rate) than using much heavier weights. 3) I find there is a lower risk of overtraining with lighter weights. 4) Generally, it is more enjoyable. Experienced weight lifters actually enjoy the fatigue and “burn” that comes with lifting heavy weights. Most people that are new to weight lifting and that are deconditioned do not. 

This study shows us that you can build muscle quite well with lighter loads, as long as you increase your repetitions.

Product Review: PT Pro Fitness Bench

As a trainer and nutritionist working with weight loss clients, I have noticed for years that clients who exercise at home get much better results than those that go to a gym.

If you want to stay in shape and at a healthy weight as you get older, exercise has to be a daily event. Most of my clients do cardio every day and hit the weights at least two or three times per week. Given our busy lives, is it realistic to expect to get to the gym every day? For just about everyone, the answer is no.

There are several reasons why working out at home is better than joining a gym:

1) It takes much less time to workout at home. If you have to get in your car, drive to the gym, get changed in the locker room and then do the same thing in reverse, you have just turned your 40 minute workout into an hour and 20 minute ordeal. It’s just too easy to blow off. 

Furthermore, at a gym you may have to wait for someone to finish using the cardio or weight training equipment you want to use. This adds even more time.

2) It is just more convenient. If I am watching my kids, I can take them downstairs to play while I hit the weights for 20 minutes. I can’t bring them to the gym. I can also combine my exercise with something I need to do if I workout at home. I can return phone calls, check my email, read the paper, watch the news, etc, all while doing cardio. When I was in grad school, I even used to study while doing my cardio. It is hard, if not impossible, to do these things at the gym.

3) It is much cheaper over the long term. Gyms can be quite expensive. The cheaper $10 a month gyms that are popping up are great, but they may not be convenient to you. Say your gym costs $70 per month, or $840 per year. In 5 years, you have spent $4,200. You can set yourself up with a really nice home gym for a fraction of that amount that will last you for decades.

A great place to start for any home gym is a set of dumbbells and an exercise bench. Enter the PT Pro Portable Fitness Bench. This bench is perfect for people that don’t have a lot of space and/or don’t want to look at their exercise equipment on a regular basis.

Here are some of the benefits of this bench:
#1) It folds up for storage. The legs of this bench fold up so you can store it in a closet or under your bed. This is a great feature if you live in an apartment and don’t want your bench taking up valuable space. For most of my time in Boston, I had a tiny apartment and this feature was critical.

#2) For fitness professionals; this bench is light weight and portable. You can bring it to a client’s home if you are an in-home trainer.

#3) The bench has both incline and decline capabilities, so you can add a lot more variety than you can with a simple flat bench.

#4) It is very well made. I’ve had mine for years and it is holding up extremely well. In fact, it looks and works as well today as the day I got it, which was 7 years ago.

Cost: It is not cheap at $299, but it is a one time expense. You will likely never have to buy another bench. It’s also a cost saver if it allows you to cancel your gym membership. 

For more information, here’s the manufacturer’s website:

Note: I have no relationship with this company and do not make any money for promoting their products. I just have been really happy with my PT Pro and recommend it highly.

Tuesday, September 13, 2016

Is a low fat diet the path to weight loss?

It is completely understandable how low fat diets came to be popular. Before we had the tools to really study diet in large populations, it made a lot of sense. After all, fat contains 9 calories per gram, compared to 4 calories per gram for protein and carbohydrate. It seems logical that limiting the most calorie dense food would help one to lose weight. Now that our research methods are more advanced, we have had the opportunity to study the efficacy of low fat diets. It turns out that they really don’t work so well over the long term.

In a summary of the research literature, replacing 10-15% of dietary fat with carbohydrate results in a modest weight loss of 2-9 lbs. over the short term (6 months). However, over the long term (1 or more years) this weight is regained and there is no association between percent of dietary fat and body weight (Reference 1).

Why is this the case? For two reasons actually:

1) Dietary fat promotes satiety. It helps you feel full. Most people get really hungry a few hours after eating a low fat meal, particularly if it is high in carbohydrate and low in protein.

2) Dietary fat helps to stabilize blood sugar. Swings in blood sugar common with low fat, high carbohydrate eating patterns result in a reactive hypoglycemia that drives down blood sugar and increases insulin levels. For most people, this will result in increased hunger and overeating. 

Incidentally, these hormonal changes in blood sugar and insulin levels may also promote fat storage independent of caloric intake.

The most convincing evidence that low fat diets do not result in long term weight loss has been indirectly conducted right here in America over the past few decades. Our percent of calories from fat has steadily dropped from 40% of calories to 34% in the last 30 or so years. Have we gotten thinner? Not at all, obesity rates have skyrocketed in this time period.

1) Willett WC. Dietary fat plays a major role in obesity: no. Obesity Reviews 2002; 3:59-68.

A completely new way of thinking about weight loss

The Study
The prevailing wisdom about how to lose weight is to decrease calories and increase physical activity. This theory was put to the test in a very interesting study. One hundred and fifty four adolescents and 75 college age women underwent a two week baseline measure of their resting metabolic rate, energy intake, and body composition. Researchers created a variable for each subject called energy flux, which was calculated by adding energy intake and energy expenditure for each person. Subjects were then followed for 2 years to see who gained or lost the most weight.

The subjects with low energy flux were more likely to gain weight, while the subjects with high energy flux were more likely to lose weight. In other words, eating more calories and exercising a lot reduced the risk of gaining weight, while eating fewer calories and exercising very little increased the risk of gaining weight. American Journal of Clinical Nutrition 2016; 103:1389-96.

Take Home Message
This is a fascinating study that tells us 2 two things:

1) Exercise is extremely important for long term weight maintenance, which most of us already know.

2) Cutting calories a lot may not facilitate long term weight loss. This is a relatively new concept. 

Our body fights back really hard when we cut calories. Very few people can keep weight off long term when they lose it solely by reducing energy intake. The researchers believed that the reason the low energy flux group gained weight was largely due to significant decreases in resting metabolic rate as a response to the lower calorie intake.

Although this is just one study and more research is needed, it is becoming clear that weight loss is much more than just calories in versus calories out. The human body has awesome defense mechanisms to keep its body fat at what it considers to be a safe level. We have much to learn about these mechanisms.

I tell my weight loss clients to cut their calories slightly, not severely, and to make cardio and strength training a very consistent habit.

What influences appetite more, cutting calories through dietary restriction or through exercise?

The Study
In this randomized trial, 10 young men completed 2 separate interventions that created a 25% deficit of their energy requirements. This was done first by reducing calories by 25%, and later by exercising 25% of their calories away. Appetite and energy intake were measured after each condition. The results were a bit surprising. Despite the deficit being 25% in both interventions, subjects were significantly more hungry and ate more calories after reducing their food intake. American Journal of Clinical Nutrition 2016; 103:1008-16.

Take Home Message
For most people, losing weight over the short term is not that difficult. Keeping it off is the real challenge. We evolved in times of famine, drought and food scarcity. Our body developed some very good defense mechanisms to help keep our body fat at a safe level, including lowering metabolic rate and increasing hunger when faced with weight loss.

This study provides evidence that reducing calories creates more of this fight back response than exercise. This makes sense to me. I have noticed for years that drastic caloric restriction and rapid weight loss almost always results in an equally rapid regain of lost weight. I have found that the quicker the weight comes off, the quicker it comes back on. A more slow and steady approach to weight loss is imperative. Reducing calories moderately, but consistently, is the key. A well organized exercise program is the other part of the equation.


Is Cancer Preventable?

Most of the major chronic diseases, like heart disease and type 2 diabetes, are easy to study. Since they occur often, cohort studies have enough power to provide very useful information. Since they have intermediate endpoints (HDL, LDL, triglycerides, insulin resistance, etc), more short term study designs like randomized trials have been extremely important. As research methods have become more advanced, we have learned a great deal about heart disease, type 2 diabetes and how to prevent them both.

Cancer is something of a different story. It is not just one disease but 100 different diseases. Lung cancer has a very different story than skin cancer when it comes to causes, prevention and effective treatments. This is true for most cancers. This is what makes cancer so very hard to study. Cohort studies generally won’t have enough cases of distinct cancers to perform meaningful analysis for decades, if ever. Randomized trials are not really effective because cancer takes years to develop and doesn’t have hard and fast identifiable intermediates to study. 

For these reasons, we don’t know nearly as much about preventing cancer as we do about most other diseases. Since cancer is the 2nd leading cause of death in the U.S., it is imperative to learn as much as we can about its prevention. In the last year or so, some very influential studies were published. I thought I would summarize this research for readers of my newsletter.

Tomasetti, et al.

This study was published a year and a half ago and was quite controversial (Reference 1). It proposes that the majority of cancers have nothing to do with genetics or lifestyle factors. They are simply a function of the number of times a tissue’s cells divide. The more divisions, the more likely a random act of mutation will occur.

The authors of this study theorize that one third of cancer risk is lifestyle or genetic and that two-thirds is simply the bad luck of random cell division. What this study is basically saying is that almost 70% of your risk of cancer has nothing to do with how you live your life.

Song, et al.

This was a very large study that combined both the Nurses’ Health Cohort with the Health Professional Follow-up Study (Reference 2). Over 135,000 men and women were included in this investigation. Subjects were considered to have a healthy lifestyle pattern if they met the following 4 criteria:

1) Nonsmoker.

2) Moderate alcohol consumption (≤1 drink per day for women, ≤2 drinks per day for men).

3) A BMI between 18.5 and 27.5.

4) Weekly aerobic exercise totaling 75 minutes/week of vigorous cardio or 150 minutes/week of moderate cardio.

Rates of death due to cancer were compared between those with a healthy lifestyle and those without a healthy lifestyle. The population attributable risk for the healthy lifestyle score was 48% of cancer deaths for women and 44% in men. What this means is that if everyone in the cohort adopted these 5 habits, roughly half of all cancer deaths would be prevented.

These 2 cohorts, made up of mostly doctors and nurses, are generally more healthy than the average American. When they extrapolated the score to the U.S. population as a whole, these 5 factors would prevent 59% of cancer deaths in women and 67% of cancers deaths in men.

This study shows that lifestyle is very important when it comes to reducing the risk of cancer mortality and contradicts the first study presented. Two other interesting notes: 1) This study did not include dietary variables and 2) Some of the factors were a little relaxed. For example, a BMI of 27 or less was considered a healthy range where a BMI or 25 would have been a bit more strict. Therefore, the results from this study may actually underestimate the protective effects of a healthy lifestyle.

Moore, et al.

In this large study, 12 separate cohorts were combined to investigate the association between self reported physical activity and incidence of 26 different types of cancer (Reference 3). When all of the cohorts were combined, there were 186,932 cancers reported. The combination of the sample size and number of cancers reported provided a very unique research opportunity.

High versus low levels of physical activity were associated with significantly lower risk of 13 different cancers, including: esophageal, liver, lung, kidney, gastric, endometrial, leukemia, myeloma, colon, head and neck, rectal, bladder and breast.

Three other types of cancer were borderline significant: gall bladder, small intestine and non-Hodgkin’s lymphoma.

There was actually a slight increase in melanoma among those more physically active, so be sure to use sunscreen if exercising outdoors.

Previously, physical activity was thought to reduce risk of just a handful of cancers. This study showed that it does a lot more to protect us than originally thought.

Cancer is difficult to study. There is a lot of inconsistency in the literature due to methodological issues. I would say that there is definitely an element of bad luck with cancer that you don’t see in other diseases. However, it appears that a large percentage of cancers are preventable.

Here is what I recommend:
#1 Don’t smoke.
#2 Maintain a healthy weight.
#3 Exercise regularly, every day even.
#4 Eat a healthy Mediterranean style diet, limiting red meat and processed meats.

These 4 areas are a very good place to start if you are trying to reduce your risk of not only cancer, but other major chronic disease as well.

1) Tomasetti, et al. Variation in cancer risk among tissues can be explained by the number of stem cell divisions. Science 2015; 347:79-81.

2) Song, et al. Preventable incidence and mortality of carcinoma associated with lifestyle factors among white adults in the United States. JAMA Oncology. doi:10.1001/jamaoncol.2016.0843.

3) Moore, et al. Association of leisure time physical activity with risk of 26 types of cancer in 1.44 million adults. JAMA Internal Medicine. doi:10.1001/jamainternmed.2016.1548.

Wednesday, July 13, 2016

How often should I be changing my sneakers?

Although this is something that most of us don’t think about, this is actually a really important question. If you are doing cardio on a daily basis, or close to it, you really need to pay close attention to your footwear.

Most people think to change their sneakers when they look old and beat up and the tread is starting to wear down. By the time these signs of wear and tear are apparent, you are well passed the time you should have retired them.

The issue is the midsole, which lies between the rubber bottom of your sneaker and where your foot sits. The midsole provides the majority of the cushioning for your shoe, and is therefore vital to the protection of your joints from the impact of your exercise. 

The midsole wears out way before the other parts of the shoe do. So I tell all of my clients that no matter how new the rest of the sneaker looks, replace them after 6 months. 

You don’t have to throw them out. You can certainly wear them around the house or to go shopping or whatever, just not for your cardio.

If you have knee, hip or back issues, changing your sneakers consistently can be a simple way to reduce your pain and discomfort.

Effects of a low glycemic index, low glycemic load diet

The Study
Twenty six overweight women were randomized to a low glycemic index, low glycemic load diet or their usual diet for 12 weeks. All of the subjects were infertile at the time of this investigation and were on a waiting list for IVF treatment. By the end of follow-up, the women in the low glycemic group lost 10 lbs, reduced their BMI by 2 units and reduced their body fat by almost 4%. The women in the usual diet group had slight increases in all of these variables. The low glycemic group had 85.4% more oocytes retrieved than the control group and had 3 spontaneous pregnancies resulting in 3 live births. American Journal of Clinical Nutrition 2015; 102:1365-72.

Take Home Message
This is an interesting study for a couple of reasons:

1) It shows the efficacy of the low glycemic diet for weight loss. To lose 4% of your body fat and 2 BMI units in 12 weeks is extraordinary weight loss. I am not at all surprised, as I have been using this approach with my own clients for decades and have had great success with it.

2) The changes in oocyte retrieval and the 3 spontaneous pregnancies in the low glycemic group just goes to show you how the stabilization of blood sugar can benefit hormone levels and body systems in surprising and unforeseen ways. 


Legumes and weight loss

The Study
A meta-analysis was recently published that compared the weight loss impact of diets containing legumes to diets without them. Data from 21 trials were included. For those of you not familiar with them, examples of legumes are black beans, pink beans, pinto beans, lentils and hummus. Diets containing legumes reduced weight by .75 lbs.  The average duration of the trials was 6 weeks. American Journal of Clinical Nutrition 2016; 103:1213-23.

Take Home Message
Legumes are an extremely healthy dietary choice and it looks like they may be particularly good for your waistline. An extra three-quarters of a pound lost in 6 weeks may not sound like much, but if you kept it up for a year, this little habit can have a very nice impact on your weight.

Legumes are high in protein and fiber, which tend to promote satiety. They are also low glycemic and tend to promote a stable blood sugar. This may also act to decrease hunger and food intake.  The subjects in the studies included in this analysis averaged one serving of legumes per day.  Black beans, pink beans, pinto beans, lentil soup, and hummus are just a few ways to get legumes into your diet, which is a great idea if you are looking to improve your health and your weight.


Book Review: Always Hungry

Next up for review is Always Hungry. The author, Dr. David Ludwig, is an endocrinologist, researcher and professor at Harvard Medical School and the Harvard School of Public Health. I met him a few times when I was getting my Doctorate and I am a very big fan of his research. 

This interesting book presents a weight loss strategy based on blood sugar stabilization. Dr. Ludwig uses his vast research experience to argue that refined carbohydrate foods, and the subsequent swings in blood sugar following their consumption, have much to do with the increases in obesity in the last 30 years. The book is broken down into 2 sections. The first section covers the research in the area of glycemic load/glycemic index in a truly impressive fashion. The second part presents the weight loss program, which includes 3 different phases, meal plans and recipes. The book is 384 pages long. The first section of this book was the best I have read since Dr. Walter Willett’s Eat, Drink and Be Healthy (a must read for those who have not read it yet). 

5 Things I Really Liked About Always Hungry
1) I really liked how Dr. Ludwig explains the hormonal consequences of the foods we eat. He presents a beautiful summary of the research to date on glycemic index and glycemic load and puts a serious hole in the theory that a calorie is a calorie. 

2) Finally, a popular weight loss book that talks about reasonable weight loss. Dr. Ludwig explains that good and steady weight loss is ½ pound to 2 pounds per week. So many people think that their weight loss plan is failing if they don’t lose 5 pounds a week and it is a shame. Slow and steady wins the race with weight loss. You need to give your body time to adjust to the weight you lose. In my opinion, this minimizes the level of “fight back” your body will give in terms of increased hunger and decreased metabolism.

3) I really agree with Dr. Ludwig when he says that refined carbohydrate and sugar consumption are the critical components of weight gain and need to be the focus of weight loss efforts. 

4) Dr. Ludwig recommends the reader consume a source of protein, fat, and low glycemic carb at each and every meal. The addition of the protein and fat attenuates the glycemic response. This will sound familiar to those who have read my book. This is probably because both Dr. Ludwig and I used the same research to formulate our weight loss strategies. This method of macronutrient combination just flat out works if you are trying to lose weight.

5) I also really like how Dr. Ludwig incorporates sleep and stress reduction into his program. These are two critical areas for those looking to lose weight that do not get nearly enough attention.

5 Things I Didn’t Agree With In Always Hungry
1) The book really didn’t stress the importance of resistance training, which I feel is mandatory if long term weight loss is your goal. Resistance training both increases metabolism and spares lean body mass during the weight loss process. 

2) I thought the cardio recommendations were a little on the light side. I have found that women in particular need to do a lot more cardio than Dr. Ludwig recommends in order to achieve and maintain their weight loss goals.

3) The program allows 2 alcohol containing drinks per day. While I can’t deny the health benefits of moderate alcohol consumption, in my clinical experience, this amount of alcohol will dramatically slow down the weight loss process.

4) In the food lists, there is no limit whatsoever on saturated fat and red meat. Foods like beef, full fat cheese, butter, sour cream, and heavy cream can be included at every meal if you want. I found this surprising. Many of these foods have been associated with an increased risk of heart disease, stroke and certain cancers and I don’t know why you would not want to focus on more healthful choices of protein and vegetable based fats.

5) The addition of up to 6 teaspoons of sugar each day and an ounce of 70% cocoa dark chocolate (which adds another 2 teaspoons) was surprising to me. The research Dr. Ludwig presents on the dangers of sugar and its addictive properties is very compelling in the first section. In my experience, the vast majority of those with a weight problem have uncontrollable cravings when consuming sugars and refined grains and they will not stop at just a few servings of these foods. The more sugar they have, the more they want. 

I do believe that there are people who are not addicted to sugar and refined carbs and can have just 1 cookie and stop there. These people are few in number and almost never have a problem with their weight. To me, the only answer is complete sugar restriction. After a 2 week withdrawal period, it is amazing how you won’t care that you are not eating sugar. I can’t think of a single client of mine that has attained their weight loss goal who ate sugar regularly. 

Is Always Hungry Worth Reading?
100% yes! I truly enjoyed this book. Many of my recommendations came from the same research that Dr. Ludwig covers in the first section of this great book. Our approach is very similar and we differ in just a few areas. I believe exercise should get a bit more attention. I believe that saturated fat and red meat should be limited. I believe sugar should be avoided 100%. Lastly, I believe that alcohol consumption should be a bit more controlled. This is an excellent book and a must read for anyone interested in how the food we eat can impact our weight and our health.


Friday, May 13, 2016

How much sleep do I need?

In the last few years, it has become evident that sleep deprivation has a negative impact on ability to lose weight. Although there is much left to learn about the mechanisms involved, it appears that at least 2 things happen to you when you do not get enough sleep:

1) Leptin levels drop. Leptin is a hormone that influences your metabolism. When leptin levels drop, you burn fewer calories.

2) Ghrelin levels increase. Ghrelin is a hormone that influences appetite. The higher the ghrelin, the more hungry you will be.

For obvious reasons, the combination of burning fewer calories and eating more because you are hungry makes it tough to lose weight.

Many studies over the last 10 years have shown a decreased metabolism and/or increased energy intake with sleep deprivation.

So, how much sleep do you need? Most studies show that 7 hours or more are what you are looking for. I have also found this to be true with my own clients.

Take a good look at your sleeping habits. Sleep deprivation can often be a little thought of, but very important component of your weight loss program.

Energy and macronutrient intake after gastric bypass surgery

The Study
Gastric bypass surgery is an effective strategy for weight loss in the severely obese when diet and exercise has not been effective. However, in most cases, 40-50% of lost weight is regained after several years and it is not clear why this is the case.

In this study, 16 women were followed for 3 years after bypass surgery. Total energy, lean body mass, and basal metabolic rate were measured at regular intervals during the follow-up. By the end of 12 months, the women had lost an average of 87 lbs.

At baseline, calorie consumption was 2,072 per day.

At 1 month post surgery, it dropped down to 681 calories.

At 12 months post surgery, it increased to 1240.

At 36 months, it increased to 1,448 calories.

As far as basal metabolic rate:

At baseline, it was 1.1 kcal/minute.

At 3 months it was .93 kcal/minute.

At 12 months it was .86 kcal/minute.

At 36 months is was .85 kcal/minute.

By the end of 1 month, 51.6% of weight lost was lean body mass. By the end of one year, 24.5% of weight lost was lean body mass. By the end of 36 months, 30% of weight lost was lean body mass. American Journal of Clinical Nutrition 2016; 103:18-24.

Take Home Message
This is a really important study, not just for those who have bypass surgery, but for everyone looking to keep lost weight off for good. Over the 3 years of this study, we saw a gradual increase in caloric consumption, a gradual decrease in basal metabolic rate, and a very significant loss in lean body mass.

Remember, lean body mass burns calories and is highly related to metabolism. You lose muscle, your metabolism drops and weight regain is far more likely. 

This study shows why a lot of people who get gastric bypass surgery regain their weight. They are the same reasons why the rest of us regain our weight; calories shoot back up and metabolism drops. 

The body may lower metabolism in response to weight loss. There is not much we can do about that. However, we can minimize loss of muscle mass by lifting weights consistently throughout the weight loss process and during weight maintenance. Keeping a close eye on caloric consumption is also essential to keeping the weight off.

This study would have been perfect if half the women were randomized to a weight lifting routine post surgery to compare basal metabolic rates and percent lean body mass lost.

Thursday, May 12, 2016

Probiotics and Weight Loss

The Study
Probiotics are live micro-organisms that have been shown to improve varying aspects of health when consumed in the proper quantities. It has been hypothesized that they increase rate of weight loss. In this randomized controlled trial, 89 overweight and obese women consumed a standard low fat yogurt, or a probiotic yogurt, for 12 weeks while following the same comprehensive weight loss program.

At the end of follow-up, women in both groups lost similar amounts of weight. However, the women consuming the probiotic yogurt had a 13.9 mg/dl drop in total cholesterol and a 13.5 mg/dl drop in LDL cholesterol when compared to the standard low fat yogurt group. They also had significant improvements in blood glucose and insulin levels. American Journal of Clinical Nutrition 2016; 103:323-29.

Take Home Message
This is a very nicely designed trial with a simple message. Probiotics can definitely improve certain health parameters but do not appear to increase the rate of weight loss. We are just beginning to learn about the health effects of the gut microbiota, but it appears to be an extremely important and complex element of good health. Unfortunately, it does not look like a quick fix for weight loss.


Feature Article: Do vegetarians live longer than meat eaters?

Vegetarians tend to avoid meat for one of 2 reasons, they think it is unhealthy to eat meat or they have an ethical issue with doing so. If they are motivated by ethical factors, that question is beyond the scope of this newsletter. If they are motivated by improved health, we can ask the question; Are vegetarians healthier than meat eaters? Do they live longer?

I recently came across a study that attempts to answer this question.

Mortality in vegetarians and comparable nonvegetarians in the United Kingdom. American Journal of Clinical Nutrition 2016;103:218-230.

This study was a pooled analysis of 2 prospective cohort studies in the UK that totaled 60,310 subjects: 

18,431 were regular meat eaters who ate meat 5 or more times per week.

13,039 were less frequent meat eaters.

8,516 were fish eaters who ate fish but not meat.

20,324 were vegetarians including 2,228 vegans who did not eat any animal foods.

Diet was assessed by means of a food frequency questionnaire. After over a million person years of follow-up time, there were 5,294 deaths before the age of 90. By the end of follow-up, there was no significant difference in total mortality among the 5 groups.

In other words, vegetarians and vegans did not live any longer than those that ate meat or fish.

I was not really surprised by the findings of this study. The idea that meat eaters are unhealthy while vegetarians are healthy is far too simplistic. There is a whole lot more to the story.

#1) Protein itself is not really the issue. It is what comes along with the protein package that will determine a food’s impact on health.

Healthy sources of protein will be low in saturated fat, unprocessed, low in sodium, and not red in color.

Examples of healthy protein sources would be lean meats like chicken and turkey, low fat dairy products, legumes, nuts, fish and seafood. You can see that some of these are animal sources and some are not.

Proteins you want to go a bit easier on include red meat, processed meats (like bacon, sausage, pepperoni, and hot dogs) and full fat dairy products like cheese. Again, some of these are animal sources and some are not.

2) When evaluating the health impact of a diet, you have to look at more than just the source of protein. For example, what is the quality of carbohydrate consumed? What type of fat is being consumed? If you are eating a ton of saturated fat, sugar and high glycemic load carbs, you are not going to be healthy no matter what protein sources you are focusing on.

For example a meat eater and a vegetarian can go out to a restaurant for lunch and order the following:

1) Meat eater: A garden salad with grilled chicken and olive oil and vinegar dressing, a glass of club soda with lime and a bowl of strawberries for dessert.

2) Vegetarian: Pasta Alfredo with two big pieces of bread, 2 sugary sodas and an ice cream sundae for desert.

Who did a better job, the vegetarian or the meat eater?

So, the take home messages from this study are the following:
1) Lean sources of animal protein like chicken, turkey, fish, and seafood are not bad for your health. There is no reason to avoid them.

2) The protein sources to strictly limit include processed meats like bacon, salami and hot dogs, red meat, dairy products like cheese, yogurt and milk that are full fat.

3) There are other important factors besides the source of protein in your diet that will impact your risk of chronic disease. Make sure you are paying good attention to your sources of fat and carbohydrate. Other important areas that need attention are your weight, exercise habits, sleep and stress levels.

Sunday, March 13, 2016

If I Am Not Hungry, Is It OK To Skip Breakfast?

It has been a really big surprise to me as a nutritionist to learn just how many people don’t eat breakfast in the morning.  I, for one, am starving when I wake up and have been ever since I have been a little kid. I don’t know how anyone can wait until lunch for their first calories of the day. Either way, I am often asked if it is OK to skip breakfast, particularly by those looking to lose weight.

Will skipping breakfast impact one’s ability to lose weight?
The research goes back and forth on this one and I don’t think we really do know for sure. I have seen evidence of a decreased weight loss in breakfast skippers and I have seen evidence that there is no difference in weight loss when comparing breakfast eaters to those who skip breakfast.

I can tell you this anecdotally, in the last 15 years, every one of my clients who hits their goal weight eats breakfast. Here is my theory as to why it is important:

Since humans evolved in times of famine and food scarcity, I feel that over the years our bodies developed defense mechanisms to protect us from these events.

When food starts to get in short supply, I believe that our body tries to prevent fat stores from dropping too low. This is accomplished 2 ways. #1) Our metabolism slows down so it takes fewer calories to get through a day. #2) In an effort to preserve fat stores, we start to burn muscle for energy. There is evidence of this in the research literature. When people lose weight by really restricting their calories, you start to see a lower metabolic rate and a significant loss of lean body mass.

Say you eat dinner at 6:30 PM, go to bed, skip breakfast and eat at noon the next day. You have gone 17½ hours without eating food, almost a full day. I believe that this does bad things to your metabolism and makes it harder to lose weight. It is also my opinion that when the body notices a steady and consistent supply of calories every few hours, it is more likely to release its fat stores, and that is why I don’t like my clients to skip breakfast. Again this is my theory, I don’t think there has been enough research on these defense mechanisms to prove or disprove them.

Some other reasons to eat breakfast:
1) It will help keep your blood sugar stable, which has a very nice impact on your energy, mood and ability to focus.

2) When you skip breakfast, you tend to make up the calories by snacking. In general, snack foods aren’t as healthy as planned meals.

3) I don’t think it is possible to get all of the good nutrition your body needs in a day in just two meals. Eating three meals makes it much easier to hit goals for fruits, vegetables, protein, vitamins, minerals, fiber, anti-oxidants, etc.

So in conclusion, everyone should eat a healthy breakfast. This is especially important if you are trying to drop a few pounds.


Prebiotic Consumption And Risk Of Weight Gain

The Study
Prebiotics are fermentable carbohydrates that our body can’t digest. They have the ability to alter the composition of our gut microbiota and are thought to confer a number of health benefits. However, most studies on prebiotics have been on animals and research in humans is sparse.

In this investigation, 8,569 normal weight subjects from the Spanish Sun Project cohort had their diet measured by a food frequency questionnaire and self reported their weight every two years. The subjects were split up into 4 groups according to their consumption of prebiotics. After 9 years of follow-up, the group consuming the most prebiotics had a 13% lower risk of becoming overweight when compared to those consuming the least. American Journal of Clinical Nutrition 2015; 102:1554-62.

Take Home Message
The connection between our gut bacteria and our weight is fascinating and is still in the process of being elucidated. There really does seem to be a connection. Prebiotics are used as an energy substrate by healthy bacteria in the gut that convert them into short chain fatty acids. These short chain fatty acids are thought to influence levels of certain hormones, like peptide YY and glucagons-like peptide 1, that may influence satiety and decrease food consumption. 

In this cohort, most of the prebiotics that were consumed came from fruits, vegetables, legumes and whole grains. If you need yet another reason to eat these healthy foods with regularity, here you have it.

Diet Soda Vs. Water For Weight Loss

The Study
Sixty-two obese and overweight women initiated the same weight loss plan, which included a low calorie diet and 300 minutes of moderate exercise per week.  Half of the women were told to drink at least one diet beverage after lunch and the other half were told to eliminate diet beverages and drink only water. Body weight and several metabolic indicators were measured both before and after the 24 week intervention. Both groups lost a significant amount of weight. The diet soda drinkers lost an average of 16.7 lbs., while the water drinkers lost 19.4 lbs. Furthermore, the women drinking the water had a statistically significant improvement in insulin sensitivity when compared to the diet soda drinkers. American Journal of Clinical Nutrition 2015; 102:1305-12.

Take Home Message
This was a very well designed trial that taught us a few things: 1) Water is, far and away, the beverage of choice for weight loss. 2) Drinking diet soda regularly does not prevent weight loss, if the diet and exercise program is strong. A couple of studies I have read in the past few years hypothesized that consistent diet soda consumption interfered with the ability to lose weight. This study shows evidence that this is not true. However, the water drinkers lost more weight over the 24 weeks and had an improvement in insulin sensitivity, which translates to a lower risk of type 2 diabetes.

If weight loss is your goal, make water your primary beverage. If you love diet soda, have a couple a week as a treat.  If you are drinking a lot of regular soda now, switching to diet can be a nice and easy option to start the scale moving in the right direction as you transition yourself to water as your go to beverage.


Product Review: Bowflex SelectTech Dumbbells

Working out at home makes a lot of sense. Most of us are busy, and not having to drive to a gym, park the car and get changed can save us some serious time. Exercising at home can also can save you a lot of money. You can take one year’s worth of gym dues and make a really nice little home gym that will last you a decade or longer. When deciding on the type of weights to include in your home gym, there is a lot to think about, including; the price of the system, the space you have available, and what exercises you want to be able to do. 

Bowflex SelecTtech Dumbbells are a great choice for any home gym. These are dumbbells that have a dial on the side that allow you to change the resistance from 5 to 50 pounds in 5 pound increments (and even 2½ lbs. increments for the first 20 lbs.). If you want them to be 20 lbs, you simply turn the dials to 20 and you’re ready to go. I’ve had a set of these for years and have been really happy with them. Following are some of the pro’s and con’s of these dumbbells.

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

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

3) A Serious space saver. This adjustable dumbbell set takes the place of an entire wall of individual dumbbells. This is important if you are in an apartment or only have a small amount of space to devote to your home gym.

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

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

6) You can increase the weight by 2.5 lbs. increments all they way up to 22.5 lbs. with these dumbbells. Sometimes an increase from 10 lbs. to 12.5 lbs., rather than to 15 lbs. is appropriate and this is a nice option to have.

1) The only con I can come up with is the price. Right now on Amazon, they are $290.67 for the set that goes from 5 to 52 lbs. Now, if you bought pairs of 5, 10, 15, 20, 25, 30, 35, 40, 45 and 50 lb dumbbells individually, you’d spend a lot more than $290. However, if you bought plate loaded dumbbells with collars, you’d spend a lot less.

Would I Recommend the Bowflex SelectTech dumbbell system?
Absolutely. They are a bit on the pricey side, but they have really changed the way I can workout at home. I can switch weights in between exercises and even in between sets, with ease. My workouts are now more fluid and overall quicker to get through. I love the space saving aspect as well. I recommend them highly. Several of my clients over the years have purchased these and they have all been just as happy with them.

If you are interested in picking these up, they are available all over, but currently has the best price and free Prime shipping.


Tuesday, January 12, 2016

How much weight do we really gain during the holidays?

I have been reading for years that the typical American gains 7-10 lbs. between the holiday season of Thanksgiving and New Year’s Day. However, the sources were never research based, so I have always wondered if this is really true. 

So, I decided to do a scan of the nutrition research literature to see what I could find. I was surprised that there is almost no research in this area. I found one well designed study on holiday weight gain from the New England Journal of Medicine, but it was published way back in March of 2000.

This was a simple study conducted at the National Institutes of Health in Bethesda, Maryland. In this investigation, 195 adults were weighed 4 times throughout the year: Before Thanksgiving, right after the holidays in early January, a bit after the holidays, in late February/early March and the following September.

At first I was surprised by the results, and then they made more sense. The average weight gain between Thanksgiving and New Year’s Day was about 1 pound, which was the surprising part. However, 10% of the subjects gained 5 or more pounds. As the subject’s starting weight increased, there was a trend of an increased risk of gaining at least 5 lbs. In other words, if you were overweight at the start of the study, your risk of gaining 5 lbs was higher than those with a normal weight, and if you were obese, the risk was even higher than that. 

A disturbing finding was that by the following September, the one pound weight gain remained. So, if you gain a pound every holiday season and don’t lose it, you’re looking at 5 lbs. every 5 years. This, obviously, can really add up and become a problem.

While this is just one study, it was very well done. It appears that most of us don’t gain much weight at all during the holidays, but we never seem to lose the pound or so that we do gain. The overweight and obese have a higher risk of gaining significant weight.  Generally, we don’t average the commonly referenced 7-10 pound holiday weight gain, but we do add a little and all need to be especially vigilant now that January is here!

New England Journal of Medicine 2000; 342:861-67

Animal protein vs. vegetable protein for heart health

The Study
The metabolic syndrome is a cluster of symptoms that is strongly associated with risk of heart disease, stroke, type 2 diabetes, and all cause mortality. It is diagnosed when at least three of the following are present: 1) A Waist circumference higher than 40 inches in men and 35 inches in women. 2) Blood glucose higher than 100 mg/dl. 3) Triglycerides higher than 150 mg/dl. 4) HDL cholesterol below 40 mg/dl in men and 50 mg/dl in women. 5) Hypertension. 

The researchers of this investigation wanted to see if the type and amount of protein in the diet influences symptoms of the metabolic syndrome. Sixty-two overweight men and women with metabolic syndrome were randomized into one of 3 heart healthy DASH (Dietary Approach to Stop Hypertension) diets: 1) 18% protein with two-thirds of the protein coming from plant sources. 2) 18% protein with two-thirds of the protein coming from animal sources, including lean beef. 3) 27% protein with two-thirds of the protein coming from animal sources, including lean beef. The initial goal of this 6 month intervention was weight loss followed by weight maintenance.

The results were interesting. All groups lost similar amounts of weight (about 5% of initial weight). All metabolic syndrome criteria decreased similarly independent of protein type and amount. American Journal of Clinical Nutrition 2015; 102:757-70.

Take Home Message
Many authors of diet books claim that animal protein increases risk of heart disease, and that a vegetarian diet is the only way to heart health. This study provides strong evidence against this theory. According to this study, if you choose animal proteins that are low in saturated fat, like chicken, turkey, fish, and even lean beef now and again, your ability to reduce symptoms of the metabolic syndrome are similar to eating a diet high in plant proteins. It appears that weight loss was the big driver of metabolic syndrome symptom reduction in this study.

So do not be afraid of lean animal proteins. They certainly have a place in a heart healthy diet. The big take home message here is to get your weight down to a healthy level.