Monday, November 13, 2017

Is It Ever OK To Cheat On My Diet?

This is a question I get quite often from my weight loss clients. Not only is it OK to splurge now and again, I actually insist on it!

There are lots of reasons why it is perfectly fine to go off your diet a few times each week:

1) You don’t need to be perfect on your diet to attain your weight loss and health improvement goals. If you are good 90% of the time, you will do awesome. If you eat 21 meals a week, being good 90% of the time leaves 2 meals a week to have some fun.

2) There are times in your life where eating junk food is just fun and appropriate. When I am at a Jets or Islanders game, I am not eating a can of black beans with nuts and a piece of fruit. It is just not going to happen.

3) It is not realistic to be perfect on your diet, so why set yourself up for failure? A big part of my weight loss program is strictly limiting refined carbohydrates like bread, white rice, pasta and desserts. If I told a client that they could never, ever eat any of these foods again, even the most motivated of them would last a few weeks or at most a few months. However, knowing you can have these foods a few times a week makes it much easier to stay on the program long term, which is necessary if you want to hit your goals. At the end of the day, being able to go off your diet twice a week significantly improves long-term adherence.

4) Having the ability to go off your diet gives you options when you are not in control of your food choices. For example, being invited to a wedding or a dinner party can be a big problem if you are trying to be tight with your diet. You don’t really know what you are going to be served. Using one of your splurge meals at the event will allow you to eat whatever is there and not worry about going off your plan.

5) It may even help you to lose weight to overeat a bit twice a week. While I have seen no hard research data on this at all, I feel that overeating a few times a week may relax your body’s natural defense mechanism to a chronic decrease in calories.

I do have just a couple of rules for my clients when it comes to splurging:

1) These are splurge meals, not splurge days. In other words, these are not 10 hour affairs, just 1 meal.

2) No back to back splurges. Keeping a stable blood sugar is the key to long-term calorie reduction. Splurging two days in a row can really throw off your blood sugar and kick start hunger and cravings. I have my clients have a splurge meal midweek on Wednesday and another on Saturday.

3) I have my clients avoid sugar even on splurge meals. It is just too addictive for most people who are trying to lose weight. However, sugar free desserts are permitted on splurge meals for those who have a sweet tooth.

Protein Supplements And Weight Maintenance

The Study
Increasing dietary protein has been shown to improve satiety and decrease subsequent energy intake. Some studies have shown that increasing protein as a percent of calories results in more weight loss when compared to lower protein diets. However, the role of protein supplementation in weight maintenance is not known. After an eight-week weight loss period, 220 subjects consumed a supplement of 45 grams per day of whey protein, whey protein plus calcium, soy protein or maltodextrin (which served as the control group). Subjects were followed for weight regain for a period of 24 weeks. By the end of follow-up, there were no significant differences in weight regain among the 4 groups. American Journal of Clinical Nutrition 2017; 106:684-97.

Take Home Message
Protein serves a lot of really important functions and it is important to include a lean source of it at every meal.  However, it looks like aiding in weight maintenance is not one of these functions. There is no need to supplement with protein shakes. Just get your protein from whole food sources, as nature intended.

Glycemic Index, Satiety And Subsequent Energy Intake

The Study
Thirty-seven children between the ages of 9 and 12 were given a variety of different breakfasts for 3 consecutive days on separate occasions. One of these was a low glycemic index breakfast and another was a high glycemic index breakfast. After each meal, satiety was measured and the students had access to an all you can eat lunch buffet. The results were fascinating. Compared to the low glycemic index breakfast, subjects consumed 145 more calories at lunch when they ate the high glycemic index breakfast. Hunger was significantly greater after the high glycemic breakfast on 2 of the 3 days measured. Pediatrics 2003; 112:e414-19.

Take Home Message
This is an older study that I came across while researching my 4th book and it is a powerful one. What is really interesting to me is that both the high and low glycemic index breakfasts that they served these kids had the same number of calories. The fact that the students ate that much more after the high GI meal is a powerful example of how important carbohydrate quality is to subsequent energy intake.

In my opinion, a low GI approach to weight loss is by far the most effective strategy. I have been using it successfully with clients for almost 2 decades. A one meal difference of 145 calories is absolutely huge. If this happened 3 times a day for a month, you’ve got an excess of over 13,000 calories, which theoretically would result in a 3.7 pound weight gain, each and every month. 

Keeping your blood sugar stable with a low glycemic load diet is essential if weight loss is your goal. To do this, focus on fruits, vegetables, legumes and whole grains for your carbohydrates while limiting bread, pasta, white rice and sugar. Also make sure to add in healthy sources of protein and fat at every meal. You’ll be amazed at how much less hungry you are in between meals.

Product Review: Stamina 1690 Power Tower

Most of us are too busy to get to the gym every day, so working out at home is the key to working out consistently. You don’t need a lot of equipment or space to set up a serviceable home gym. When I was in grad school in Boston, I had a foldable bench, a Bowflex adjustable dumbbell system and a Gazelle Edge elliptical trainer. All of this equipment could be stored in the closet of my studio apartment.

However, if you have a basement or a garage as a dedicated workout space, you have the luxury of adding a few pieces of equipment that can really add variety to your at-home workout. Now that I live in a house in the suburbs, I have a nice sized basement with plenty of room for fitness equipment.

Today I’d like to review a great piece of equipment for those that have a little more space to dedicate to their home gym. It is called the Stamina 1690 Power Tower. This is a simply designed multi-station home gym that allows you to perform a variety of body weight exercises.

1) Inexpensive. The Power Tower is currently available on Amazon for $89.99. This is an amazing value.

2) Easy to put together. I put this together myself in a short amount of time and without any help. 

3) Versatile. You can perform a lot of different exercises with this system, including; pull-ups, chin-ups, dips, neutral grip push-ups, and a number of ab exercises.

4) Very sturdy.

5) Looks sharp

1) The only con I can come up with is that it takes up a fair amount of space. You have to make sure your ceiling is high enough to accommodate the 81 inches from ceiling to floor. I could do this comfortably in my basement, but I had to measure first.

Do I Recommend The Stamina 1690 Power Tower?
Absolutely. If you have the space, the Stamina 1690 Power Tower will make your home gym feel a lot more like an actual gym. Muscle confusion is key to a proper resistance training program. The more exercises that you have to choose from, the better your results are going to be.
If you want to pick up the Power Tower, it is available on, here is the link

Disclosure: I am not affiliated with the company that makes the Stamina 1690 Power Tower and make no money if you buy it.

Thursday, September 14, 2017

Individual foods and risk of mortality

The Study
We have known for decades that our dietary choices can positively or negatively impact our long-term risk of chronic disease.  A recently published meta-analysis summarizes the results from hundreds of studies that investigated the association between different food groups and all-cause mortality. The results were interesting:

Foods that reduced risk of mortality
1 serving per day of nuts reduced risk of mortality by 15%
1 serving per day of legumes reduced risk of mortality by 10%
1 serving per day of whole grains reduced risk of mortality by 9%
1 serving per day of fish reduced risk of mortality by 7%
1 serving per day of vegetables reduced risk of mortality by 6%
1 serving per day of fruits reduced risk of mortality by 6%

Foods that increased risk of mortality
1 serving per day of red meat increased risk of mortality by 16%
1 serving per day of processed meat increased risk of mortality by 12%
1 serving per day of sugar sweetened beverages increased risk of mortality by 7%
1 serving per day of eggs increased risk of mortality by 7%
American Journal of Clinical Nutrition 2017; 105:1462-73.

Take Home Message
The take home message here is pretty simple: eat more of the foods that decrease mortality risk and less of the foods that increase it.  It is easy to focus solely on results when you are trying to lose weight and lose sight of the long-term health consequences of your dietary choices.  Many popular fad diets are guilty of this.  The goal is to eat in a way that helps you lose weight and reduces your long-term risk of chronic disease. This way you’ll have a lot longer to enjoy your fit new body!

Wednesday, September 13, 2017

Is intermittent fasting healthy?

The Study
Fasting or skipping meals has become a popular strategy for losing weight. However, the long-term health effects of this practice are not known. A recently published investigation in the American Journal of Clinical Nutrition looked into this question. In this crossover trial, 17 normal weight subjects underwent 3 separate 24-hour interventions: a day that they skipped breakfast, a day that they skipped dinner and a day that they ate three conventional meals.  Energy was measured in a respiration chamber and calories were kept constant on each of the three days. Blood glucose, insulin and inflammatory factors were measured throughout the study protocol. The results were quite interesting. Compared to 3 normal meals per day, when subjects skipped breakfast, they showed signs of disturbed glucose homeostasis and increased inflammation. American Journal of Clinical Nutrition 2017; 105:1351-61.

Take Home Message
This is the second recent publication that has shown a disturbed glucose homeostasis with meal skipping or fasting. Disturbed glucose homeostasis has the potential to increase risk of type 2 diabetes. The increased inflammation found in this investigation with breakfast skipping is also problematic as inflammation has been associated with many chronic diseases. 

I don’t recommend meal skipping or fasting as a weight loss strategy to my clients. Besides the negative health consequences outlined in this study and others, it has also been shown to slow down metabolism in a recent investigation. When metabolism slows down, the risk of weight gain increases because you are burning fewer calories each and every day. 

If weight loss is your goal, eat 3 nutritious meals each day. In addition, hit your cardio goals and lift weights at least twice per week. Be patient with your rate of weight loss, there are no quick fixes.

Diet soda and risk of stroke

The Controversy
A few weeks back, just about every major newspaper ran a headline that diet soda consumption causes stroke and dementia. The papers were referring to an investigation that was recently published in the journal Stroke.

The Study
In this study, 2,888 older men and women from the Framingham Heart Study Offspring cohort were followed for 10 years (Reference 1). Beverage intake was measured by means of a food frequency questionnaire that was filled out 3 times during the 10 year follow-up. When compared to subjects that never drank diet soda, subjects that had one or more diet sodas daily had a 296% greater risk of ischemic stroke and a 289% greater risk of Alzheimer’s disease. These are very big increases and the media went crazy with the headlines. But in typical fashion, the newspapers did not tell the whole story here. 

There are some pretty big problems with the methods in this study and a far better designed study performed the same analysis and came up with very different results.

Let’s start with some of the problems with the methods in the Framingham investigation:
1) For a prospective cohort study, this was a pretty small investigation that included only 2,888 subjects and 97 cases in the stroke analysis. The dementia analysis included 1,484 subjects and only 81 cases.

2) There was significant loss to follow-up. Only 72% of subjects completed all 3 food frequency questionnaires.

3) The subjects who drank a lot of diet soda were not nearly as healthy as those that did not. They had a higher waist to hip ratio, body mass index, had more hypertension, lower HDL cholesterol, more diabetes, atrial fibrillation and cardiovascular disease, exercised less and consumed more saturated fat. This would not be a problem if confounders were well measured and adequately controlled for. In my opinion, they were not, which brings us to points 4 and 5.

4) There was an incomplete measurement of confounders, particularly those related to diet. 

5) I believe there were some problems with the modeling in this investigation.

For me, these 5 factors really hurt the generalizability of this study. Harvard University published a study on diet soda consumption and risk of stroke that was much better designed and came up with a very different result (Reference 2). Let’s see some of the ways that this second study was better designed.

1) The Harvard study included 84,085 women from the Nurses Health Study for 28 years of follow-up and 43,371 men from the Health Professional Follow-up Study for 22 years of follow-up. This is compared to only to 2,888 subjects in the Framingham study. The Harvard study included 4,354 strokes while the Framingham study had only 97.

2) Follow-up rates for the Harvard Study were 96% in men and 97% in women. In the Framingham cohort, only 72% of subjects completed all food frequency questionnaires.

3) The Harvard study measured and controlled for many more confounders than the Framingham study. Here is a list of confounders that the Harvard group included that the Framingham group left out of their study: consumption of red meat, poultry, fish, nuts, whole and low fat dairy, fruits and vegetables, cereal fiber, alcohol, parental history of myocardial infarction, trans fat, multivitamin use, aspirin use, vitamin E use, and menopausal status. The Framingham study controlled for diet by including a variable that measured how closely subjects followed the 2005 dietary guidelines. To me, this is inadequate because the guidelines from 2005 don’t really reflect all that can be healthy about one’s diet.

4) The Harvard study included every possible variable in the final model. In other words, they controlled for every potential confounder in the statistical model that they presented in their final results. In the Framingham study, the researchers did not include waist to hip ratio in their final model. This is a major confounder of the relationship between diet soda consumption and risk of stroke because people who are overweight have a much higher risk of stroke and people that are overweight are often more likely to drink diet soda (in an effort to lose weight). I’m not quite sure why this was left out, but the fact that they did not measure for all potential confounders and did not include weight in their final model leaves open the strong possibility of residual confounding in this study.

The Harvard study found a 16% increased risk of stroke for those that consumed 1 or more diet sodas per day when compared to those that did not drink diet soda. This is a far cry from the 296% increased risk found in Framingham. In my opinion, the Harvard results are much more in line with the true association between diet soda consumption and risk of stroke. 

Conclusions And Recommendations
I apologize if this post is a little long or technical. The media has a way of just running with a headline without really understanding the methods or limitations of the study in question. This causes a lot of confusion in my field.

Let me get one thing straight, I am not an advocate for diet soda. It is much better to drink water than any type of soda. I view diet soda the same way as I think of foods like bacon, butter, steak or cheese:  If you eat a ton of these foods, they can cause problems for you. If you have them only occasionally, they are not a major problem. For those that don’t eat sugar at all, an occasional diet soda once or twice a week can be a real treat. 

Incidentally, this level of consumption was not associated with stroke in the better designed Harvard study. In fact, in the discussion section of the Harvard study, the authors mention that the slight increase in risk of stroke with daily diet soda consumption should be interpreted with caution. They mention that there is no known mechanism between diet soda and incident stroke and that in previous analyses in the Harvard cohorts, diet soda has not been associated with weight gain, heart disease, or type 2 diabetes.

1) Pase MP, Himali JJ, Beiser AS, et al. Sugar and artificially sweetened beverages and the risks of incident stroke and dementia. Stroke 2017 DOI: 10.1161/STROKEAHA.116.016027.

2) Bernstein AM, de Koning L, Flint AJ, et al. Soda consumption and the risk of stroke in men and women. American Journal of Clinical Nutrition 2012; 95:1190-9.

Thursday, July 13, 2017

Is Coconut Oil Healthy?

This subject perfectly illustrates the deep chasm between nutrition research and the general public’s views of nutrition. They are very often not aligned. I’m not sure when or how it started, but a few years back, the idea that coconut oil was health promoting began to build momentum.

The answer is no, coconut oil is not the best oil to use. It is not even close to being the best oil to use. In fact, it is probably the one you most want to avoid using.

Coconut oil is extremely high in saturated fat. Almost 90% of the fat in coconut oil is saturated. For comparisons sake, butter contains 64% saturated fat and beef contains 40% saturated fat. 

The saturated fat in coconut oil raises LDL cholesterol, which increases risk of heart disease and stroke. In fact, the American Heart Association recently released a report advising against use of coconut oil, citing a review of 7 randomized trials showing that coconut oil increased LDL cholesterol in all 7 studies!

Oils with high amounts of mono and polyunsaturated fats, such as olive oil and canola oil, have the exact opposite effect. They lower LDL cholesterol and have been associated with reduced risk of heart disease and stroke. These are the oils you should be using.

Prebiotic supplementation and weight loss in children

The Study
Prebiotics are a non-digestible carbohydrate that promote the growth of healthy bacteria in the gut. The role of prebiotic supplementation in weight loss is controversial. In this randomized trial, 42 overweight boys and girls between the ages of 7-12 were assigned 8 grams of oligofructose-enriched inulin (a prebiotic) each day or placebo for 16 weeks. After the intervention, a variety of measures were taken and an all you can eat breakfast buffet was offered to the subjects. 

After 16 weeks of supplementation, there were no significant differences in the amount of food the subjects were consuming on a daily basis. There were no significant differences in body mass index between the two groups. When all subjects were included, there were no significant differences in the amount of food consumed at the all you can eat breakfast buffet. American Journal of Clinical Nutrition 2017; 105:790-99.

Take Home Message
It appears that prebiotic supplementation is not effective as a weight loss strategy. It is interesting to note that when the analysis was restricted to just 11-12 year old subjects, there was a significantly lower consumption of food at the breakfast buffet at the end of the intervention for those in the prebiotic group. 

However, when all of the data was looked at together, there was no significant difference in daily energy consumption or BMI after 16 weeks of supplementation. It will take some more research to fully answer this question, but right now it does not look like prebiotics will do much to aid in the weight loss process.  

Can whole grains increase metabolism?

The Study
The impact of whole grains on body weight remains a controversial topic. In this randomized controlled trial, 81 men and women were put on a 6 week diet. The diets were identical except for the fact that one group received 207 grams of whole grain and 40 grams of fiber each day, while the other received refined grains and only 21 grams of fiber. The goal of this intervention was to maintain weight and observe any metabolic differences between the two groups. By the end of follow-up, the whole grain group had a significant increase in resting metabolic rate and a higher stool energy content than the refined grain group. The combined difference between the two groups amounted to 92 calories per day. American Journal of Clinical Nutrition 2017; 105:589-99.

Take Home Message
In the last few years, several fad diets have attempted to demonize whole grains as unhealthy and an obstacle to weight loss. The research does not support this view. The literature is replete with studies associating whole grains with a reduced risk of heart disease, stroke, diabetes, inflammatory disease and cancer. This study is a great example of some emerging evidence that it can help maintain body weight as well.

There are several potential mechanisms to explain the relationship between whole grains and a lower weight. Whole grains are thought to suppress appetite, improve glycemic control, improve insulin sensitivity and are also thought to positively alter gut-microbiota. The 92 calorie per day difference found in this study does not sound like a lot but it adds up. In a year’s time, this difference equates to a weight loss of about 6 pounds. 

Don’t listen to those that tell you to avoid whole grains. They are a very important part of a healthy diet and may actually help you lose weight. Shoot for 1-2 servings per day. Great choices are oatmeal, brown rice, and quinoa.

Book Review: Blast The Sugar Out

Next up for review is Blast the Sugar Out. The author, Dr. Ian Smith, is a medical doctor who used to be a co-host of the television show, The Doctors. He has written several other bestselling health, fitness and weight loss books.

This book presents a 5 week weight loss strategy packed with recipes, meal plans and snack ideas. It has a particular focus on reducing blood sugar levels for those who are diabetic or prediabetic. The author mentions that the book was also written for anyone who wants to lose weight or reduce their sugar consumption. The book is 240 pages long. It is well written and I truly enjoyed reading it.

5 Things I Really Liked About Blast the Sugar Out
1) I like how the primary focus of this book is to reduce refined sugar consumption. After trans fat, I rate sugar as the worst thing that we can eat. The number of problems that refined sugar causes is staggering. I treat it like a drug, because to me that is what it is. 

2) I really like that the book emphasizes cardiovascular exercise as a big part of the program. It needs to be a major focus if weight loss is your goal.

3) I like the recommendation to drink a lot of water. It is essential not only for weight loss, but for overall health and quality of life.

4) The recipes and meal plans are well organized and very well done.

5) I really liked the Sugar Swap in the back of the book (Appendix 1). In this section, the author lists a much healthier alternative for every kind of sugary treat that you may be tempted by. This is a very practical little section.

5 Things I Didn’t Agree With In Blast the Sugar Out
1) A lot of high glycemic load carbs are allowed on this program. All of the following are regulars in the meal plans: cold cereals, dried fruit, smoothies, French toast with maple syrup, French fries, lots of bread (even whole grain bread can spike blood sugar), onion rings, pizza, popcorn, fruit juice, pancakes, crackers, rice cakes, pita bread, animal crackers, vanilla wafers, pretzels, etc.  When it comes to spikes in blood sugar, increased hunger and cravings, many of these foods are as damaging as sugar.

2) This book is very big on snacking. In addition to 3 meals, the plan calls for 2 or even 3 snacks per day. In my experience, this can lead to overeating and really slow down rate of weight loss. If the average woman needs to be close to 1,200 calories/day to effectively lose weight, each meal/snack needs to be around 200 calories. This is not a lot of food! If she goes over by even 50 calories per meal or snack, she is looking at 300 extra calories per day or 9,000 extra calories per month. Further, if you are eating in a way that stabilizes blood sugar, you will not need to eat every 2 or 3 hours. You simply won’t be hungry.

3) Allows late night snacking. In the section on snacking, the book mentions that it is OK to have a snack at 8:30 PM or later. I have found that late night eating is a really bad idea for those trying to lose weight. I have seen it completely prevent weight loss in past clients and I actually use it as a strategy to gain weight for the rare client that works with me in an effort to increase their weight.

4) A lot of the meals are really low in fat. Fat is actually a very good thing in your diet, if you choose it carefully. Vegetable based fats like olive oil, canola oil, nuts, and avocados have a positive impact on risk of chronic disease. They also help to stabilize the blood sugar, decrease insulin spikes and keep you full longer than meals without fat. The research literature has also shown that low fat diets are not effective for long term weight loss.

5) The book could focus a bit more on resistance training. While a good amount of time is spent on cardio, strength training is mentioned only briefly. I believe that weight training is the secret ingredient to lasting weight loss. Sparing lean tissue during the weight loss process is the absolute key to keeping the weight off.

Is Blast the Sugar Out Worth Reading?
Absolutely. This book gets a lot right. As a nation, we all need to be eating a lot less sugar. It is far more damaging to our health than most people realize. This book will help you to do that. I would just make a few additions to this program. I would be a little stricter with the high glycemic carbs, cut down on the snacking (especially at night), add in a bit more healthy vegetable fat and add a whole bunch of strength training.

Saturday, May 13, 2017

Visual cues and subsequent energy intake

The Study
Larger portion sizes have been shown to increase energy intake in the research literature. A recently published study attempts to explain why. Thirty-six children between the ages of 7 and 10 were shown a variety of pictures while undergoing a brain MRI scan. Some of the pictures were of large portion sizes, some were of small portion sizes. Some of the pictures where of high energy density junk foods (like chicken nuggets, French fries and cookies) and some were of low energy density healthy foods (like grilled chicken, green beans and blueberries).

The results were fascinating. When the children were shown pictures of foods with large portion sizes, there was a decrease in activity in the region of the brain called the inferior frontal gyrus. This region is important for inhibition. When the children were shown pictures of the high energy density junk food, there was an increased activation in the insula, caudate and cingulate. These parts of the brain deal with reward and taste processing. American Journal of Clinical Nutrition 2017; 105:295-305.

Take Home Message
This is a really interesting study. Just seeing pictures of foods that were large in portions or energy dense changed the brain in a way that increased the desire to overeat. When I first started studying nutrition and weight loss in the early 2000’s, the prevailing wisdom was that losing weight was simply about eating less and exercising more. 

It is now clear that there is a lot more going on. There are a multitude of factors that impact our food choices and cravings. The results of this study add simple visual cues to the growing and complex list of body systems that impact what we eat and how much we eat. We are learning a lot but still have a ways to go. If you find yourself in the presence of tempting foods that you do not want to eat, look away! J

Changes in skeletal muscle and organ size after weight loss

The Study
Most people who lose weight have a really hard time keeping it off. This is largely due to a drop in resting energy expenditure after weight loss. The goal of this study was to learn more about the root cause of the metabolic decrease that accompanies weight loss. For this investigation, 53 men and 39 women with type 2 diabetes were randomly assigned to one of two groups. The first group had an intensive diet and exercise intervention to help them lose weight. The second group had diabetes support and education, but did not lose weight. MRI scans were performed on all subjects at the end of one year and then again at the end of the second year.

The results were very interesting. By the end of 1 year, only the diet and exercise group lost weight (14.5 pounds on average). The diet and exercise group lost a bit more muscle during the first year (about ½ a pound), but also had significant reductions in the size of their spleen and liver when compared to the control group. American Journal of Clinical Nutrition 2017; 105:78-84.

Take Home Message
This is a pretty cool study. The intervention that helped these subjects lose weight was really heavy on exercise, which is why they maintained a lot of their muscle. The fact that their organs decreased in size is fascinating. Organs like the liver, spleen, heart, and kidneys burn a lot of calories. The fact that they may get smaller after weight loss may explain a lot of the decrease in metabolic rate seen after weight loss. 

The take home message is the following: lift weights at least twice per week when trying to lose weight. This will minimize the loss of lean muscle tissue and make it much easier to keep the weight you lose off permanently. We need to learn more about the decrease in organ size and how this may impact our ability to keep weight off. Stay tuned.

Product Review: Bodylastics Resistance Bands

When I was in college and even grad school, there always seemed to be plenty of time to get to the gym and enjoy a leisurely workout. Now that I’m older, time is definitely more limited. I’ve noticed the same thing with the majority of my clients over the years. At the end of the day, it is just not realistic for most people to get the gym on a daily basis. It is for this reason that I am a huge proponent of working out at home.

You do not need a lot of space or equipment to successfully exercise at home. An inexpensive piece of cardio equipment (such as the Gazelle Edge), a flat bench and some dumbbells will get the job done quite well for most people. However, working out your back can be a bit more challenging in the home environment. There are a few dumbbell exercises that focus on the back, but to really get the variety you want, you’ll need to bring in some other equipment. I figured I’d use this post to introduce one such piece of equipment: Bodylastics Resistance Bands.  

Bodylastics Resistance Bands are a stackable and adjustable resistance system. The version that I purchased has 96 pounds of resistance, but they also sell versions with more or less resistance. The system comes with 4 different colored bands of varying thickness that you can combine to produce the exact resistance you need for any exercise.

In addition to the stackable resistance bands, the system comes with hand and ankle handles, as well as a door anchor. The door anchor is the absolute key. It allows you to attach the system to any door that closes in your home. If you put it up high, you can simulate high pulley exercises, like lat pull downs. If you keep the anchor a bit lower, you can simulate low pulley exercises, like seated rows. This adds a completely new element to how you can work your back at home. Let’s take a quick look at the pros and cons of the Bodylastics system.

1) Extremely Well Made And Durable: I’ve had my bands for 6 years and they are showing no signs of wear and tear.

2) Serious Resistance: I’ve historically been a bit down on resistance bands in general. I never felt like I was getting the type of resistance that I needed. Not so with the Bodylastics system. These feel a lot tighter than other bands I’ve used. I get a great workout with these.

3) Comes With A Door Anchor: Great for working the back with simulated high and low pulley exercises.

4) Very Portable: The system comes with a carrying case that can easily fit in your luggage for when you need to bring your workout on the road.

5) Very Secure Door Anchor: Door anchors tend to make me nervous. Not this one. It is solid and it’s going no where, so feel free to workout with confidence.

1) The only con that I can come up with is the price. They are a bit more expensive than other resistance bands. They retail for $54.95, but as of this writing, has them on sale for $29.95, which is a great price while it lasts.

Do I Recommend Bodylastics Resistance Bands?
Absolutely. These are a great addition to any home gym and will allow you to be much more creative with your workouts. While they cost a bit more than other bands on the market, the quality of this product easily makes it worth the extra investment. To learn more about these bands or to pick them up, check out their amazon page (here).

Disclosure: I am not affiliated with the company that makes these bands and make no money if you buy them.  I just think they are great and want to let you know.

Tuesday, March 14, 2017

Is Intermittent Fasting A Good Way To Lose Weight?

The Study
Intermittent fasting has been proposed as a method of weight loss in recent years. However, questions remain as to whether it is an effective and safe strategy to manage body weight. A recently published investigation attempts to answer this question. Eighteen men and women completed two three day trials in a crossover design. On the first day, subjects consumed 100% of their energy needs. On the second day, a standardized breakfast was consumed, hormones and appetite were measured and an all you can eat breakfast and lunch was served to all subjects. On day three, an all you can eat breakfast was offered. The second trial started with subjects consuming only 25% of energy needs. Days 2 and 3 in the second trial were identical to the first trial.

There were several important results reported:
1) When subjects restricted their energy intake on day 1, they consumed 7% more energy on day 2. By day 3, they consumed no more calories than they did when they did not fast.

2) Appetite was higher on day 2 when subjects fasted, but not different on day 3.

3) Blood glucose was significantly higher after energy restriction.

4) Energy expenditure was significantly lower on the morning of day 2 after fasting. American Journal of Clinical Nutrition 2016; 104:1545-53.

Take Home Message
This is a fascinating study to me. I have never recommended fasting as a method of weight loss. Is it effective? In the short term, probably. I would argue that it is not in the long term. I think you win the battle but lose the war by fasting. While you will certainly lose some weight, it is my opinion that starving yourself  recruits some of our body’s most effective defense mechanisms. Specifically, metabolic rate is slowed and we start to burn muscle in an effort to spare body fat. This combination makes long term weight loss virtually impossible.

A lot of my concerns about fasting were validated by this study:

1) Subjects were very hungry the day of the fast and even the second day as well. This makes compliance tough because most people are pretty miserable when they are hungry and won’t let themselves stay hungry for long.

2) Subjects consumed more calories the next day than if they had eaten normally.

3) Their energy expenditure was lower the next day. In other words, the fasting seemed to slow down their metabolism. Not good.

4) Most concerning was that their blood sugar and insulin levels were significantly greater when they fasted. This indicates impaired glycemic control, which is not a good thing at all.

5) On a side note, if you are cutting your calories by 75% up to 4 days per week, it is going to be impossible to get enough vitamins, minerals, antioxidants, fiber, etc on those days. These nutrients are hugely important for our health and for chronic disease risk reduction.

In conclusion, there are no shortcuts to losing weight. It takes a lot of work, but the path to a healthy weight and a healthy body is a combination of a balanced diet, a good cardiovascular exercise program and consistent resistance training.

Is Dairy Fat Harmful?

The Study
There has been some question lately as to whether dairy should be consumed in its full fat form or the currently recommended low fat/fat free versions. A very well designed study was recently published that attempts to answer this question using 3 of Harvard University’s most well known cohort studies. 

This was a massive study including 43,652 men from the Health Professional Follow-up Study, 87,907 women from the Nurses Health Study and 90,675 women from the Nurses’ Health Study II cohort. Subjects had their dairy fat consumption measured repeatedly and were followed for over 20 years for incidence of cardiovascular disease (which includes both heart disease and stroke). When dairy fat was compared to a similar amount of carbohydrate (not including fruits and vegetables) there was no difference in risk of cardiovascular disease. However, replacing 5% of energy from dairy fat with:

-polyunsaturated fat resulted in a 24% lower risk of cardiovascular disease.
-vegetable fat resulted in a 10% lower risk of cardiovascular disease.
-whole grains resulted in a 28% lower risk of cardiovascular disease.
American Journal of Clinical Nutrition 2016; 104:1209-17.

Take Home Message
This study is another example of the chasm between well designed nutrition research and popular, internet based fad diet nutrition recommendations. The research literature has consistently shown that high saturated fat consumption is associated with higher risk of heart disease and stroke. Dairy fat is no exception. Low fat/fat free dairy is the way to go. Get your fat from healthy vegetable sources, such as olive oil, canola oil, nuts, seeds, avocados and nut butters.

The Truth About Saturated Fat

The Controversy
When I was studying nutrition in the late 90’s and early 2000’s, it was widely accepted that saturated fat had a negative impact on serum cholesterol and would increase risk of heart disease when consumed in large amounts. In the past few years, there has been some question as to whether or not this is true.

There are several reasons why this doubt has crept into the minds of the public:
1) Several popular diets actively promote the consumption of saturated fats.

2) The idea that coconut oil is a healthy food has really taken off. Proponents of coconut oil argue that different saturated fatty acids will impact health in distinct ways. They argue that coconut oil is high in the type of saturated fats that are health promoting.

3) Several research studies have come out in the past few years suggesting that saturated fat does not increase risk of heart disease.

So is it true, are saturated fats harmless even when consumed in large amounts? Could some types of saturated fats even be good for you?

Saturated Fats
Let’s start from the top. Just what is a saturated fat? 

There are 4 basic types of fats; saturated fat, trans fat, polyunsaturated fats and monounsaturated fats. These different types of fats have very different impacts on our health.

Let’s focus on saturated fats. Saturated fats are fats that contain no double bonds. All of their carbons are saturated by hydrogens. They are found, for the most part, in animal products.

There are several different classes of saturated fatty acids, identified by the number of carbons in their chain length:

Lauric acid: has a 12 carbon chain and is found in coconut oil.
Myristic acid: has a 14 carbon chain and is found in palm and coconut oil.
Palmitic acid: has a 16 carbon chain and is found in palm oil, butter, and beef tallow.
Stearic acid: has an 18 carbon chain and is found in cocoa butter, chocolate and beef.

A study was published recently in The British Medical Journal that sheds a lot of light on this controversial topic.

The Study
The study in question was conducted by Zong et. al. and utilized both of Harvard University’s Nurses’ Health Cohort and Health Professional Follow-up Study (Reference 1). Over 73,000 women and over 42,000 men were followed for 20+ years. Subjects were categorized by saturated fat consumption and monitored for risk of heart disease. What makes this study different is that the researchers didn’t focus exclusively on saturated fat, but also on the individual subtypes of saturated fat most commonly consumed by these subjects. Results were presented for total saturated fat, as well as lauric acid, myristic acid, palmitic acid and stearic acid.

The results were convincing:
-For total saturated fat, there was a statistically significant 18% higher risk of coronary heart disease when comparing subjects consuming the highest amounts of saturated fat to those consuming the lowest amounts.

-When comparing subjects who consumed the most stearic acid to those who consumed the least, there was a statistically significant 18% higher risk of coronary heart disease.

-When comparing subjects who consumed the most palmitic acid to those who consumed the least, there was a statistically significant 18% higher risk of coronary heart disease.

-When comparing subjects who consumed the most myristic acid to those who consumed the least, there was a statistically significant 13% higher risk of coronary heart disease.

-When comparing subjects who consumed the most lauric acid to those who consumed the least, there was a borderline significant 7% higher risk of coronary heart disease.

-Replacing 1% of energy from saturated fat with 1% of energy from:
            Polyunsaturated fat- resulted in an 8% reduction in risk of heart disease.
            Whole grains- resulted in a 6% reduction in risk of heart disease.
            Plant protein- resulted in a 7% reduction in risk of heart disease.

This study tells us several things:
1) Saturated fat, in all of its forms, has the potential to increase risk of heart disease. The increases in risk were statistically significant for total saturated fat, stearic acid, myristic acid and palmitic acid. The only fatty acid that did not reach statistical significance was lauric acid. This relationship was very close to being significant as well (those consuming the most lauric acid had a 7% increased risk of heart disease and the p-value for trend was .05).

2) Replacing saturated fats with healthier foods (polyunsaturated fat, whole grains, plant protein) reduced risk of heart disease in these cohorts.

So, with such strong evidence of harm, why the controversy?
1) Much of the information floating around about saturated fat and coconut oil is not based on research science but on opinion.

2) The few studies that showed no increased risk in heart disease from saturated fat generally used statistical models that replaced saturated fat with carbohydrate. Since most of the carbohydrate that we consume in the U.S. is processed, it is not surprising that replacing one unhealthy food for another does not materially change risk of heart disease. Well designed studies like the one presented here use models that replace saturated fats with more healthful options, such a vegetable based oils, healthy protein and whole grains. These studies show consistent benefit to doing so.

My recommendations to my clients regarding saturated fats are not new. Saturated fat is still associated with an increased in risk of heart disease, regardless of the subtype. It is important to limit consumption to about 7% of calories. When you do substitute the sources of saturated fat in your diet, make sure it is not with refined carbohydrate, but with nuts, avocado, healthy vegetable oils high in poly- and monounsaturated fats, fruits, vegetables, whole grains and vegetable sources of protein.


1) Zong G, Yanping L, Wanders A, et al. Intake of individual saturated fatty acids and risk of coronary heart disease in U.S. men and women. British Medical Journal 2016 355:i5796.

Friday, January 13, 2017

What are some tips to get back on track with my diet after the holidays?

The time between Thanksgiving and New Years day presents some real challenges for those trying to eat healthy and lose weight. The holidays are great and it is a lot of fun celebrating with friends, families and coworkers. Just about everyone puts on a few pounds during this time and that is OK.

However, for many of us, the unhealthy eating continues well into January and even February. This is mostly due to swings in blood sugar that result in increased hunger and cravings for refined carbohydrates, which were likely consumed in large amounts over the last several weeks. The more we eat bread, pasta, white rice and sugar, the more we want these foods.

A couple of extra cheat meals and a few pounds gained during the holiday season are not much of a problem. But if the disordered eating lasts for months, you will put on some serious weight. Even my most successful and dedicated clients will struggle during and after the holidays. Here are a few strategies that help them get back on track:

1) If you have eaten more refined carbohydrates during the holiday season, you will have an increase in cravings for them. You will also be more hungry in general. Step one is to mentally realize this. Tell yourself that you will be hungry for the wrong foods, but will not give into them. Getting your head right and understanding the origin of the cravings is very helpful.

2) Write down your food for 2 weeks. It adds a layer of accountability that gets you back on the right track.

3) Go to the grocery store and load up on all of the right foods. Make it easy to eat healthy. 

4) Plan your meals ahead of time. Think about what you will eat for breakfast, lunch and dinner for the next few days or even a week.

5) Try to limit eating out at restaurants for the first week or two. The warm bread at the table and the menu with a million unhealthy options can be too much when you are craving the wrong foods. 

After a week or two of eating right, you will find that your blood sugar has stabilized and the hunger and cravings for the wrong foods will start to calm down.


Are low fat diets the best option for sustained weight loss?

The Study
Some of the most accomplished professors at Harvard University’s Department of Nutrition conducted a systematic review of weight loss trials to determine if low fat diets increased rate of weight loss compared to other approaches. After comprehensively evaluating the literature, 53 studies were identified that included over 68,000 participants. The findings were very interesting:

-In weight loss trials, low carbohydrate interventions led to significantly greater weight loss than low fat interventions (a difference of about 2.5 lbs.).

-Low fat diets did not lead to a difference in weight change when compared to higher fat weight loss approaches.

-In weight loss trials, higher fat diets led to significantly greater weight loss than low fat diets when groups differed by more than 5% of calories obtained from fat at follow-up (a difference of about 2.5 lbs). The Lancet 2015; 12:968-79.

Take Home Message
Despite decades of advice to the contrary, low fat diets really are not the best strategy for weight loss. There are a few reasons why dieters struggle with a low fat approach:

1) Since protein tends to stay relatively constant in most dieters, when they decrease fat, they increase carbohydrate consumption. In the American diet, this usually means more refined carbohydrates. Since fat acts to stabilize the blood sugar, the low fat, high carbohydrate pattern of eating causes a reactive hypoglycemia in many people that leaves them hungry. Over time, this hunger wins out and the dieter ends up snacking and overeating.

2) These swings in blood sugar also promote higher than normal insulin levels. There is evidence that higher insulin levels promote fat storage through a variety of mechanisms. 

Therefore, for many who attempt a low fat approach to weight loss, they are hungry, eating more, and storing fat at a higher rate. Not a good combination!

While there are certainly people that will do very well on a low fat diet, the research shows that for the typical person trying to lose weight, there are better options.

In both my analysis of the literature and my clinical practice, I have found the Mediterranean approach to be much more effective. This is a moderate fat, moderate carb, low glycemic load diet that stabilizes blood sugar and dramatically decreases hunger. My clients do amazingly well with this approach to weight loss.

Does exercising in the fasted state prevent weight gain?

The Study
Twenty-seven healthy male volunteers were overfed 30% of their body’s calorie needs for 6 weeks. During this overfeeding period, the men were randomized into one of three groups. Group #1 exercised early in the morning, before eating any breakfast. Group #2 ingested carbohydrate before and during their morning exercise. Group #3 was a control group that did not exercise. The two groups that exercised trained with identical programs (360 minutes of cycling and running per week). At the end of the 6 weeks, the control group gained 6.6 lbs. The group that exercised after breakfast gained 3.1 lbs. The group that exercised in the fasting state gained only 1.5 lbs. Journal of Physiology 2010; 588.21: 4289-4302.

Take Home Message
This is a very interesting study suggesting that exercising on an empty stomach may somehow protect us from weight gain. However, there is a major problem with this study that prevents us from drawing this conclusion with confidence. The study does not accurately measure, and does not provide for the reader, the number of calories these subjects consumed each day. The text of the article mentions that the energy intake in all groups was similar. This statement simply means that they were not significantly different statistically. It does not mean they were identical.

The difference in weight gain between the two groups was 1.6 pounds over 6 weeks, which equates to 133 calories per day. It may just be that the fasting group ate a tiny bit less than the breakfast group. The problem is that we don’t know what the difference was in calories per day. Therefore, it is impossible to conclude that exercising on an empty stomach has an impact on weight gain. However, this study has certainly generated an interesting hypothesis that should be tested with an intervention more sensitive to the caloric consumption of the participants. At the very least, this study shows us that exercising for an hour a day helps to prevent weight gain when overeating.

Book Review: Dr. Gundry's Diet Evolution

Next up for review is Dr. Gundry’s Diet Evolution. The author, Dr. Stephen Gundry, is a heart surgeon who has pioneered the development of several surgical devices and techniques. He is a very accomplished physician.

This interesting book presents a weight loss strategy based on an understanding of how our genes work. Dr. Gundry believes that over many thousands of years, our genes have developed defense mechanisms that are now working against us when it comes to our weight and our health. His theory is that by adopting certain dietary and lifestyle habits, we can make these genes work for us instead of against us, resulting in weight loss and improved health. The book is 304 pages long. It is well written and I enjoyed reading it.

5 Things I Really Liked About Diet Evolution
1) It strictly limits sugar and refined carbohydrates like white bread, white rice and pasta. In my opinion, limiting these foods and stabilizing your blood sugar are pivotal to improving your weight and your health.

2) It allows cheat meals. This is a huge part of my recommendations as well. I find regular cheat meals to be essential for several reasons: 1) You don’t have to be perfect to get really good results. 2) The idea of never having a piece of bread, a slice of pizza or a burger again in your life is not at all realistic. 3) Sometimes it is just fun and appropriate to eat junk food. If I am at a Jets or Islanders game, it just does not feel right to be eating a salad or a bowl of black beans.

3) I really like how Dr. Gundry promotes slow and steady weight loss. A huge problem with most weight loss books is that they promise a ridiculous, unsustainable rate of weight loss. A pound a week is what you are looking for. It may not be fast, but it is sustainable and realistic. It is also my opinion that losing weight slowly gives you a much better chance of keeping it off.

4) I like that Dr. Gundry recommends resistance training for weight loss. It is always surprising to me how many weight loss books do not include this essential component.

5) The book contains a large number of well put together recipes.

5 Things I Didn’t Agree With In Diet Evolution
1) This book has a lot of restrictions on what I consider to be very healthy foods. For example, all of the following are considered “Unfriendly” foods and are restricted to some degree: carrots, peas, sweet potatoes, squash, mangos, pineapple, pears, legumes, oatmeal, quinoa, etc. These are all healthy foods I recommend to my clients and I’m not quite sure why they are considered so bad for you on this program.

2) Diet Evolution makes a number of claims that are not supported by the research literature: Here is a small sample:

Eating legumes will slow the rate of weight loss.

Eating whole grains will slow the rate of weight loss.

Milk causes cancer.

Low fat diets have shown to be the most successful for weight loss.

3) The book spends a good amount of time explaining why non-nutritive sweeteners are to be avoided, but includes them in a very large percentage of the recipes.

4) I was really surprised that Dr. Gundry dispels all prospective cohort studies as “silly observations”. I understand that only randomized trials can prove cause and effect. However, they have some very serious limitations when it comes to diet and lifestyle research. For example, ethical issues, short length of follow-up, high drop out rates and low compliance plague most trials concerning our diet and lifestyle. 

In most cases of lifestyle research, longer term cohort studies will give us our best chance of answering our research question. Here is an example; there has never been a single randomized trial to test if cigarette smoking causes lung cancer. Ethical considerations rightfully prevent any such trial from being conducted. However, observational research has consistently shown that smoking causes lung cancer. This is not a silly observation to me! I also found it ironic that later in the book, when discussing the benefits of moderate alcohol consumption, Gundry backs up his claim by citing a reference on alcohol consumption and risk of coronary heart disease in the Health Professional Follow-up study, which happens to be a prospective cohort study.

5) This book is very heavy on vitamin and mineral supplementation. In my opinion, the research has not shown such supplementation to be beneficial and in some cases, it can even cause harm. It never makes sense to me when a dietary program strips a lot of healthy foods out of the diet (such as fruits, legumes, whole grains, etc) and then suggests vitamin and mineral supplementation to fill in the nutritional gaps. Why not just leave the nutrient packed foods in the diet? To me, any diet that we need to supplement with pills to balance our nutrient needs is not a natural diet for humans to consume.

Is Diet Evolution Worth Reading?
Absolutely. This book gets a lot right and the theory of how our genes impact our food choices is a unique take and quite interesting. I would just ease the restrictions on what I consider to be healthy foods such as fruits, vegetables, legumes, whole grains, lean sources of protein and healthy fats.