Friday, September 13, 2019

Can I eat raisins?

This is a question I get from new clients all the time. Since raisins are a form of fruit, it makes sense that people think that they are a good choice as a snack or as part of a meal.
While it is true that fruits in their whole and natural form are great to include in your diet in abundance, a lot changes about a grape when it is dried into a raisin. 
The drying process tends to increase the sugar in a fruit. This transformation dramatically changes the way that raisins impact our blood sugar.
Let’s compare an apple to raisins. The glycemic index of an apple is quite low at 34, while the glycemic index of a raisin is 64. The glycemic load of an apple for a 120 gram serving is 5, while the glycemic load of a 60 gram serving of raisins is 28.   
Glycemic index and glycemic load are measures of how a food impacts our blood sugar. Generally speaking, the lower this number, the easier the food will be on your blood sugar.
Whether your goal is to lose weight, improve your health or increase your energy, keeping your blood sugar stable is absolutely critical. Raisins make it difficult to do this. Limit raisins and other dried fruits and focus on whole, fresh fruits that are not processed in any way.

Portion size and caloric intake in children

The Study
Does the amount of food on your plate influence the amount of calories you ingest? A recently published study in children attempts to answer this question. Forty-six children aged 3-5 were served the same 5 day menus on two separate occasions. The first was with normal portion sizes. In the second, portions were increased by 50%.

When the children had more food on their plate, they ate an additional 167 calories, which was a statistically significant increase of 18%. Overweight children showed an especially strong response to the larger portions. American Journal of Clinical Nutrition 2019; 109:1361-72.

Take Home Message
While the results of this study are particularly important to parents of pre-school children, I believe that they apply to all of us. When there is more food on our plate, we all tend to eat more. This is a big reason why people who eat out a lot at restaurants tend to gain weight.

There are really 2 take home messages here:
-Serve a reasonable amount of food on your plate in the kitchen and bring your plate to the table. If you see a big dish of food in front of you, you will be way more likely to load up with a second portion.

-Limit eating out at restaurants to just a few times per week. Portion sizes at restaurants are almost always greater than what you would make for yourself at home.

Non-nutritive sweeteners and body weight

The Study
The impact of non-nutritive sweeteners on body weight is controversial. In this study, 154 subjects were randomized to one of 5 groups and consumed 1.5 liters per day of a beverage made with either sugar, sucrolose (Splenda), aspartame (Equal), saccharin (Sweet and Low) or rebaudioside A (another non-nutritive sweetener). The beverage was consumed daily for 12 weeks. The results were fascinating:

 -Subjects consuming the sugar sweetened beverage gained 4.1 pounds by the end of the 12 weeks.

 -Subjects consuming the saccharin (Sweet and Low) beverage gained 2.6 pounds by the end of the 12 weeks.

 -Subjects consuming the sucrolose (Splenda), aspartame (Equal) and rebaudioside A had no significant change in body weight.

-When compared to all of the other non-nutritive sweeteners, the sucrolose (Splenda) group lost a statistically significant 3 pounds. American Journal of Clinical Nutrition 2019;109:1288-1301.

Take Home Message
There are really 2 take home messages here, one is not surprising while the other is quite surprising.

-It is not surprising that drinking a sugar sweetened beverage for 12 weeks puts weight on you. That is exactly what happened in this investigation.

-The idea that different non-nutritive sweeteners have distinct impacts on our weight is completely novel. This is the first study that I have seen that shows this and I think it will initiate a lot of research on in this area. In this study, Sweet and Low resulted in significant weight gain, Splenda in significant weight loss. Equal didn’t impact weight in either direction. While this is just one study, there may be something interesting here. We’ll stay tuned for further research in this area. 

What is worse for your health: regular or diet soda?

Nobody mistakes sugar for health food, but the serious impact it has on our health is just beginning to reveal itself in the research literature. For many people, diet soda is an agreeable alternative to sugar sweetened beverages, but the question arises; is diet soda any better for you than regular soda? A fascinating new study out of Harvard University helps us answer this question.

The Article
In this investigation, 37,716 men from the Health Professional Follow-up Study and 80,647 women from the Nurses’ Health Study were followed for 28 years (Reference 1). Sugar sweetened and artificially sweetened beverages were measured repeatedly throughout the follow-up. The outcomes were risk of cardiovascular death, cancer death and death from any cause. Here are some of the more interesting findings in this important study:

 -When compared to subjects that rarely drank soda, subjects who drank 2 or more sodas a day had a 21% higher risk of mortality, a 31% higher risk of cardiovascular disease and a 16% higher risk of cancer.

 -When compared to subjects that rarely drank diet soda, subjects who drank 2 or more diet sodas a day had a 4% higher risk of mortality and a 13% higher risk of cardiovascular disease. Diet sodas were not associated with risk of cancer.

 -Substituting one diet soda per day for one regular soda per day reduced risk of total mortality by 4%, cardiovascular disease mortality by 5% and cancer mortality by 4%.

Conclusions And Recommendations
This is a very well done study that tells us a lot. The take home messages here are the following:

1) Sugar is really harmful to our health. This study shows us an increased risk of disease and mortality with even moderate consumption. A statistically significant increased risk of mortality was found with just 2-6 servings per week. Sugar is also really addictive. The best advice is just to avoid it completely.  In the context of a blood sugar stabilizing diet, after 2 weeks, you won’t even miss it. I know this last sentence sounds hard to believe, but in my own experience and that of my clients, it is absolutely true.

2) Diet soda was far less harmful to our health. This may be a surprise to a lot of people who believe that artificial sweeteners are more or less a poison. They are actually quite well tested and well-designed research studies (such as this) have shown that they are safe, especially when consumed moderately.

3) A couple of notes when comparing regular soda to diet soda:

 -When comparing extreme quintiles, regular soda had over 5 times the risk of mortality than diet soda.

 -Diet soda was not associated with risk of mortality in those that consumed it moderately, which was less than 2 servings per day.

 -There was no association between diet soda and mortality in men, regardless of how much was consumed. The association was only seen in women.

As far as recommendations, there are 2:

1) Avoid sugar sweetened beverages, they are harmful to our health and are addictive. 

2) An occasional diet soda can be a real treat. Just don’t go overboard. Diet soda can perpetuate cravings for sweet foods and due to the cephalic response, may trick the body into releasing insulin. I generally tell my clients that they can include artificial sweeteners on their cheat meals, which is 2 meals per week. The rest of the time, drink water, decaf coffee/tea and my personal favorite, flavored club soda.

1) Malik VS et al, Long term consumption of sugar sweetened and artificially sweetened beverages and risk of mortality in US adults. Circulation 2019; 139:2113-25.