Sunday, September 13, 2020

Changing carb quality improves risk factors for heart disease

The Study 

The quality of carbohydrates we eat has been a very hot topic in nutrition research for some time. In this fascinating study, over 5,000 overweight Spanish adults worked to improve their carbohydrate choices from less healthy sources (such as refined cereals, sugar and soda) to more healthy sources (such as fruits, vegetables, legumes and whole grains). The results were impressive. After 6 months of these changes, body weight, waist circumference, blood pressure, fasting glucose, glycated hemoglobin, and triglyceride levels all improved significantly. After 12 months, HDL cholesterol also improved. American Journal of Clinical Nutrition 2020; 111:291-306. 

Take Home Message

The carbohydrates you choose can have a major impact on your weight, energy, mood and health. Shoot for healthy sources like fruits, vegetables, whole grains, beans and other legumes. Limit bread, pasta, white rice and sugar. It is also a good idea to have a moderate percentage of carbs in your diet. Somewhere around 40-50% is a nice goal, especially if you round out the difference with 20-25% lean proteins and 30-35% healthy vegetable based fats.

Three Popular Diets Compared

The Study

This interesting study examined adherence, dietary composition, weight loss and health effects for three popular weight loss diets: intermittent fasting, paleo and Mediterranean. A total of 250 overweight adults were allowed to choose which diet they wanted to try and were followed for 1 year. Here are some of the results:

-Weight loss was slightly higher on the Intermittent Fasting diet at 8.8 lbs. by the end of the year. The Mediterranean diet was a close second at 6.2 lbs. The Paleo group only lost 4 pounds by the end of follow up. However, the Mediterranean group lost more body fat, visceral fat and had a greater drop in waist circumference than the other groups.

-The Mediterranean diet was the easiest to stick to with 57% of subjects sticking with the diet by the end of 1 year. The Intermittent fasting group was a close second with 54% of subjects staying on the diet by the end of 1 year. Only 35% of the Paleo subjects were still on their diet by the end of the year.

-The Mediterranean group had a significantly lower blood pressure and HbA1c compared to the other groups and also ended up with a lower c-reactive protein, which is a measure of body wide inflammation.

-The intermittent fasting subjects had the highest consumption of processed foods and lowest fiber and calcium intakes by the end of 12 months. American Journal of Clinical Nutrition 2020; 111:503-14.

Take Home Message

This is a really interesting study. When you are choosing a weight loss diet, you need to look at the whole picture. Will the diet work? Can you stay on it? How will it impact your long-term health? For me, the Mediterranean diet is the clear winner here. It provides the right combination of helping you lose weight, being the easiest to stay on and it has the best impact on your health. I have been recommending this type of diet for over 20 years with amazing results. If you want to learn more about it, check out the Healthy Eating Pyramid from the Harvard School of Public Health here.

Book Review: The Weight Loss Triad, 2nd Edition

As many of my blog and newsletter readers know, I like to review books from time to time. Well today it is my pleasure to introduce my own new book, The Weight Loss Triad, 2nd Edition. Many of you may be familiar with my first book, The Weight Loss Triad, which was published in 2009. I can’t believe it was over 10 years ago! There are a few reasons why I figured it was time to update this book:

-There has been a lot of new nutrition and weight loss research in the past 10 years that has influenced my recommendations. While the majority of my program is exactly the same as it was 10 years ago, there have been a few important changes that needed attention.

-I have had 10 more years of experience working with clients, which has taught me a lot about how to make this program work for people regardless of any obstacles they may be facing.

-The 1st Edition was written for the general population. I didn’t include a lot of the research that guides my recommendations because I did not want to make things too complicated. In the 2nd Edition, I want to let the reader know where they can find the studies that I have used to formulate my recommendations and to provide a summary of this research.

My new book, similar to the 1st Edition, presents a comprehensive weight loss strategy broken down into 3 key areas: Diet, Cardiovascular Exercise and Resistance Training. It also includes chapters on lifestyle factors and frequently asked questions to help the reader incorporate the principles of this program into their daily routine no matter what life throws their way.

In these crazy and stressful times, we all need to do what we can to take care of ourselves. If your diet and exercise programs need a little tweaking and you want to drop a couple of pounds, this book could be a great help to you.

You can pick it up on Amazon.com in either a print or kindle version. 
(Click Here)

Tuesday, July 14, 2020

Diet And Arthritis


The Study
The relationship between diet and arthritis progression was examined in 2,757 subjects with existing knee arthritis. Subjects in this study tended to eat two different types of diets. The Western Dietary pattern was high in French fries, red and processed meats, sugar, refined grains and pizza. The Prudent Dietary pattern was high in fruits, vegetables, legumes, fish and whole grains. After 6 years of follow-up, subjects consuming the Western diet had a significant progression of their arthritis. Subjects consuming the Prudent diet had a significant decreased progression of knee arthritis. American Journal of Clinical Nutrition 2020; 111:667-676.  

Take Home Message
This is a fascinating study. The idea that your diet can impact something like arthritis progression is powerful stuff. There are two potential mechanisms. One is that eating the unhealthy Western diet promoted weight gain, which speeds up arthritis progression. This is not the only mechanism because when body weight was controlled for, the relationships persisted. It is also possible that the Western diet promoted inflammation while the Prudent diet decreased it. There are about 1,000 reasons to eat a healthy diet. It looks like we can add improving orthopedic health to the list.


Muscle Loss And Weight Regain


The Study
In this interesting trial, 209 subjects went on an 8-week low calorie diet and lost at least 8% of their initial body weight. At the end of their weight loss, body composition was measured via DEXA scan. Over 30% of lost weight was muscle in these subjects. The amount of muscle lost was a borderline significant predictor of weight regain (p-value of .055). American Journal of Clinical Nutrition 2020; 111:536-44.

Take Home Message
It is very common to regain lost weight. A big reason why this happens is that we lose muscle when we lose weight without resistance training. Muscle burns 3 times as many calories as fat and muscle loss can have a negative and significant impact on metabolic rate. 

This study shows that the amount of muscle lost during the weight loss process tended to predict weight regain. The good news is that there is a highly effective way to limit the amount of muscle lost as you lose weight. You simply lift weights 2-3 times a week. Weight lifting is often overlooked by those attempting to lose weight but is essential if you want to keep the weight you lose off for good.


Monday, July 13, 2020

Are You Weighing Yourself Correctly?


If you are trying to lose weight, it is imperative that you weigh yourself consistently and with accuracy. Since I often get questions from clients about the best way to do this, I thought it would make a nice feature article for readers of my blog and newsletter.

Why is it so important to weigh yourself each week?
There are two reasons why it is critically important to weigh yourself each and every week:

-The first reason is simply to find out what is going on. Bad habits can sneak in quietly and if you think you are getting away with them, you won’t be able to stop them. A weekly weight reading keeps you aware of where things are going.

-The second reason is to help you identify patterns. When you lose weight, study what you did right. When you gain weight, study what you did wrong. Assigning a consequence to a behavior is critical to learning whether or not you should continue or avoid that behavior. Over a period of months, you will learn exactly what you must do to lose weight and exactly what causes you to gain weight. Consider your weigh in a data point to help you gauge your program and make any necessary adjustments.

How to weigh yourself accurately and consistently
1) It all starts with an accurate scale. I am a big fan of Tanita Iron man scales. These are research quality scales that also let you measure your body fat. They are a bit more expensive than your typical scale but last for years and years. You can pick these up on Amazon.com and learn more about them at Tanita.com. I have been using one of the IronMan series for years and love it.

2) Weigh yourself one time a week, first thing in the morning, in your underwear, before you eat or drink anything. If you had a cheat meal with refined carbohydrates like bread, pasta or white rice, a particularly salty meal or a few drinks containing alcohol, it is perfectly normal to retain a few pounds of water. This can impact your weigh in, so find a day to weigh yourself when you have been eating clean for at least 2 full days. Most of my clients splurge on Wednesday and Saturday nights, so a Wednesday morning or Saturday morning weigh in is perfect. Record your weight in a log to make it easy to keep track of trends.

3) Lastly, keep the right mental attitude when weighing yourself. A lot of my clients got very nervous about their weekly scale reading at first. If they did not lose weight, they would get upset and feel like they failed. It is totally normal to have weeks where you don’t drop weight and weeks where you even gain weight along the way. Don’t freak out if this happens here and there. Look at the weigh in for what it is, a weekly data point to help you gauge your progress, keep you focused and make any necessary adjustments to your program.


Thursday, May 14, 2020

How Can I Optimize My Immune System?

Given the Covid-19 epidemic, many people are wondering what they can do to keep their immune system running at peak efficiency. I have fielded this question from clients for many years. Here is how I answer them:

To keep your immune system in great shape, you need to focus on 4 areas:
1) Eat healthy. Follow a low glycemic load Mediterranean diet. This includes:
-Lean and healthy protein sources like beans, nuts, chicken and fish. 
-Low glycemic carbohydrates like fruits, vegetables, legumes and whole grains.
-Healthy vegetable fats like olive oil, canola oil, nuts and avocados.

2) Exercise. Cardiovascular exercise should be in the range of 150-180 minutes per week. Also be sure to hit the weights at least twice per week. Keep exercise intensity moderate. Too much exercise can result in overtraining which will actually impair immune function.

3) Get at least 7 hours of sleep each night.

4) Engage in some type of stress reducing program each and every day. This can be meditation, progressive muscle relaxation, deep breathing or yoga. Shoot for at least 10 minutes of focused stress reduction per day.

Carbohydrate Quality And Insomnia

The Study
The relationship between diet and sleep is an area of increasing interest in nutrition research. In this recent study, the impact of carbohydrate quality on risk of incident insomnia was examined in over 50,000 subjects from the Women’s Health Initiative Observational Study. After 3 years of follow-up, women with the highest dietary glycemic index had a statistically significant 16% higher risk of insomnia when compared to women with the lowest glycemic index. Added sugar and refined grain consumption were each independently associated with insomnia while fruits and vegetables were associated with a reduced risk of insomnia. American Journal of Clinical Nutrition 2020; 111:429-39.  

Take Home Message
This is a really interesting study. We all know how important sleep is for our physical and mental health. The idea that what we eat influences how we sleep is not new. However, this is the first study that I have seen that links high glycemic carbs to insomnia. Here is what the researchers think happens: You eat a high glycemic carbohydrate and your blood sugar spikes. Your body releases the counterregulatory hormones adrenaline, cortisol, glucagon and growth hormone to bring your blood sugar back up. Side effects of the counterregulatory hormones released include heart palpitations, tremor, anxiety, irritability and hunger. These can keep you up at night.

This makes a lot of sense and is yet another reason to avoid carbohydrates that spike your blood sugar. Limit high glycemic carbs like bread, pasta, white rice and sugar and focus on low glycemic carbs like fruits, vegetables, whole grains and legumes.

Is Coconut Oil Healthy?

The Study
The health effects of coconut oil is a controversial topic in the field of nutrition. Proponents of certain fad diets claim that coconut oil is good for your heart and aids in weight loss. A recent meta-analysis published in the journal Circulation sheds some light on this controversy. Sixteen articles were included in the meta-analysis and the summary results showed that:

LDL Cholesterol increased by 10.47 mg/dl after coconut oil feeding.

HDL Cholesterol increased by 4.00 mg/dl after coconut oil feeding.

Coconut oil had no impact on body weight.

https://doi.org/10.1161/CIRCULATIONAHA.119.043052

Take Home Message
I was not particularly surprised by these results. Coconut oil is not a healthy fat. While it may slightly increase HDL (the healthy) cholesterol, it can dramatically increase LDL cholesterol, which increases risk of heart attack and stroke. It has also been shown to have no impact on body weight. Stick with healthy, non-tropical vegetable oils like olive oil or canola oil for your cooking. These oils are high in unsaturated fatty acids, which have been shown in the research literature to improve serum cholesterol levels, improve inflammation and stabilize heart rhythms.

MyPlate Versus The Harvard Healthy Eating Plate

In 2011, the USDA published its latest nutrition recommendations with My Plate. My Plate consists of a simple picture of a plate that visually illustrates what we should be eating at each meal. 



The plate has 4 segments, one for fruits, vegetables, protein and whole grains and a glass of milk on the side. While this was definitely a step forward from the Food Guide Pyramids that preceded My Plate, the recommendations were not based entirely on the latest nutrition research.

In response, Harvard University’s Department of Nutrition published their own healthy eating plate that does a much better job of providing nutrition recommendations. The Harvard version is based on the current research in the field of nutrition and is not subjects to lobbying or political pressures of any kind.



As you can see, the Harvard plate has more detailed recommendations. Let’s take a look at how the two compare:

-Fruits and Vegetables: The MyPlate graphic simply shows that half of your plate should be fruits and vegetables. While this is a great start, the Harvard Healthy Eating Plate goes a step further to mention that variety is important and that potatoes and French fries don’t count as vegetables. These are 2 important distinctions.

-Grains: The MyPlate graphic simply shows that ¼ of your plate should include grains. The Harvard Healthy Eating Plate gives a lot more information here. It recommends to focus on whole grains such as brown rice and to limit refined grains, such as white bread. This is a much better recommendation since distinct types of grains can have very different impacts on health.

-Proteins: The MyPlate graphic simply shows that ¼ of your plate should be filled with protein. The Harvard Healthy Eating Plate provides more detailed instructions to choose fish, poultry, beans and nuts and to limit red meat and cheese and to avoid bacon, cold cuts and other processed meats. These recommendations much better reflect current research evidence on the health effects of protein.

-Milk: The MyPlate graphic shows a glass of milk off to one side of the plate. It recommends dairy at every meal. The Harvard Healthy Eating Plate has a glass of water with the recommendation to drink water, tea or coffee, limit dairy to 1-2 servings per day and to avoid juice and sugary drinks. We don’t need large amounts of dairy in our diet. There is little evidence that a high dairy consumption decreases risk of osteoporosis and very high intakes of dairy can actually be harmful, raising the risk of prostate and ovarian cancer.

Dietary Fat: MyPlate offers no guidance on the consumption of dietary fats. Harvard’s Healthy Eating Plate recommends consuming healthy vegetable oils such as olive oil and canola oil and to limit butter and trans fat. These are important recommendations to include.

Physical Activity: MyPlate offers no message about physical activity. The Harvard Healthy Eating Plate has a little stick figure running in the bottom left with the reminder to stay active. This is a simple yet relevant message about the importance of physical activity in weight maintenance as well as general good health.

Conclusions And Recommendations
Although USDA’s MyPlate is a step forward, the recommendations do not reflect the latest research evidence in the field of nutrition. The Harvard Healthy Eating Plate is a much better guide and should be the reference for those looking to improve their diet and reduce their risk of chronic disease.


Saturday, March 14, 2020

Does weight gain change your brain’s response to high sugar/high fat foods?


The Study
In this fascinating study, 67 subjects were given milkshakes containing varying amounts of fat and sugar while undergoing a brain MRI. Thirty-six of these subjects had a 10% or greater increase in their BMI in the previous 2 years. Thirty-one of these subjects were weight stable in the previous 2 years. The subjects who had gained weight showed a decreased responsivity in brain regions associated with taste and reward processing when consuming milkshakes high in fat and sugar. This would make them more likely to want to keep eating these unhealthy foods. American Journal of Clinical Nutrition 2019; 110:1275-86.  

Take Home Message
This study provides further evidence that there is an addictive component to eating unhealthy foods. I have noticed this with my clients for years. Although the mechanisms are not quite clear, it appears that the more high sugar and high fat food you eat, the more you want.

Egg consumption and dementia


The Study
Moderate egg consumption has been associated with improved cognitive function in the research literature. This may be due to the high content of phosphatidylcholine in eggs. This study examined the association between phosphatidylcholine and risk of dementia in 2,497 middle-aged men from Finland. After 21 years of follow-up, men who consumed the most phosphatidylcholine had a 28% lower risk of dementia when compared to men who consumed the least. Even more impressive was that in a subset of the study, men who consumed the most phosphatidylcholine performed significantly better in tests of memory and verbal fluency. American Journal of Clinical Nutrition 2019;110:1416-1423.

Take Home Message
This is a very interesting study. For years, eggs were vilified because of their high cholesterol content. While you don’t want to go overboard with eggs, I tell my clients that up to 6 yolks a week are fine. Eggs yolks contain a lot of healthy nutrients. This study adds to that list of healthy nutrients. Just one note- if you have diabetes, it is a good idea to limit egg yolk consumption. Some research has shown an increased risk of heart disease in diabetics who consumed a lot of egg yolks.

Friday, March 13, 2020

Is intermittent fasting the best way to eat for our weight and health?


Intermittent fasting has been the subject of a lot of research and intense conversation of late. A recent review article in The New England Journal of Medicine adds fuel to the debate. What are the pro’s and con’s of intermittent fasting? Is it the easiest way to lose weight? Is it the best strategy for health and longevity? I don’t know if we totally have the answers to these questions just yet, but some conclusions can be drawn from the data we have so far.

The Article 
The article was published in late December in The New England Journal of Medicine by two researchers from John’s Hopkins University School of Medicine (Reference 1). The main thrust of the article is to present the health benefits of intermittent fasting. The authors argue that fasting turns on adaptive cellular responses that improve glucose regulation, increases stress resistance and suppresses inflammation. 

The article discusses the three most studied fasting protocols:
-Alternate day fasting.

-5:2 intermittent fasting, where you fast for 2 days each week.

-Daily time restricted feeding.

The article goes on to describe research that found benefits of intermittent fasting on aging and a wide variety of disease processes, including: cognitive function, obesity, diabetes, cardiovascular disease and cancer.

Conclusions And Recommendations
1) This article presents some very interesting research concerning the health effects of intermittent fasting. This is a well written and well researched article published in the top medical journal in the world. The researchers make some compelling arguments about how fasting can improve health. I think the research in this area is in a really early stage and we need to do a lot more before we have any definitive answers.

2) Having said that, most of the research has been on animals. This can be a problem because animals have a very different physiology compared to humans and many times animal research does not translate to humans much at all. The authors mention this in the conclusion: “Animal models show that intermittent fasting improves health throughout the life span, whereas clinical studies have mainly involved relatively short-term interventions, over a period of months. It remains to be determined whether people can maintain intermittent fasting for years and potentially accrue the benefits seen in animal models” (Reference 1).

3) When it comes to weight loss strategies, I am not at all convinced that intermittent fasting is the way to go. I feel this way for several reasons:

-In most of the studies that I have seen, there is no greater weight loss when comparing fasting and a more standard continuous calories restriction. I researched two of the weight loss studies cited in this review (References 2 and 3). These studies compared continuous calorie restriction to intermittent fasting. In both of these investigations, the amount of weight loss was the same whether fasting was used or continuous calorie restriction was used as a method of weight loss. 

-While there were some benefits to those who fasted, including improved fasting insulin and insulin resistance, there were some negatives as well. Several other research investigations that I have covered in my blog showed negative outcomes with diets using intermittent fasting. These include: an increased LDL cholesterol, glucose dysregulation, increased inflammation, increased hunger, a decreased physical activity level and a decreased energy expenditure. If you want to reference these studies, please refer to this older blog post (click here).

-There can be some real side effects to intermittent fasting. This was apparent in both of the weight loss studies that I downloaded from the review. In the British Journal of Nutrition article, subjects in the intermittent fasting group were more likely to report constipation, headache, feeling light-headed and being preoccupied with food as side effects (Reference 2). Furthermore, the subjects fasting were more likely to have deficiencies in important nutrients such as magnesium, zinc, selenium and fiber.
In the International Journal of Obesity article, subjects fasting were more likely to report negative side effects such as lack of energy, headache, constipation, lack of concentration and hunger (Reference 3).

-Another major issue for me is the nutritional composition of the diet. If you are seriously restricting your food intake several days each week, there is no way that you will be getting enough vitamins, minerals, fiber, antioxidants, fruits, vegetables, etc. Supplementing with vitamins is just not the same.

In conclusion, this article on fasting in The New England Journal of Medicine is very interesting.  There appears to be some real health benefits for animals. It remains to be seen if these benefits translate to humans over the long term. As a weight loss strategy, it is my opinion that fasting is not the easiest or most effective strategy.

References
1) de Cabo R, et al. Effects of intermittent fasting on health, aging and disease. New England Journal of Medicine 2019; 381:2541-51.

2) Harvie M, et al. The effect of intermittent energy and carbohydrate restriction v daily energy restriction on weight loss and metabolic disease risk markers in overweight women. British Journal of Nutrition 2013; 110:1534-47.

3) Harvie M, et al. The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers: a randomized trial in young overweight women. International Journal of Obesity 2011; 35:714-27.

Monday, January 13, 2020

Glycemic load and inflammatory metabolites


The Study
The glycemic load is a measure of how your diet impacts your blood sugar. A high glycemic load diet causes a lot of dramatic spikes in blood sugar, while a low glycemic load diet has a much easier effect on blood sugar. In this study, 80 subjects consumed a high glycemic load diet for 28 days followed by a low glycemic load diet for 28 days. A variety of metabolic functions were tested after both dietary periods. After the low glycemic load diet, subjects had a significant improvement in metabolites involved with inflammation. American Journal of Clinical Nutrition 2019; 110:984-92.

Take Home Message
This study provides further evidence that dramatic swings in blood sugar can be harmful to our health. Focus on low glycemic load sources of carbohydrate such as fruits, vegetables, legumes and whole grains and be sure to strictly limit refined carbohydrate foods such as bread, pasta, white rice and sugar.

Mediterranean diet and risk of skin cancer


The Study
In this French study, 98,995 women had their diet monitored for a period of 15 years. Each subject was given a score that reflected how well they followed a Mediterranean diet. The score was based on intakes of fruits, vegetables, legumes, cereal products, olive oil, fish, dairy products, meat products and alcohol. Women who most closely followed a Mediterranean diet had a 17% lower risk of skin cancer when compared to women who did not follow a Mediterranean diet. American Journal of Clinical Nutrition 2019;110:993-1002. 

Take Home Message
This is a really interesting study. It is the first I have seen that links a healthy diet to a reduced risk of skin cancer. One potential mechanism is that the Mediterranean diet contains high levels of antioxidant nutrients like beta carotene, retinol, vitamin C and E, folate and vitamin D. These antioxidants may act to reduce damage to DNA. Another potential mechanism is that subjects consuming a Mediterranean diet consume healthier fats like omega 3 fatty acids and monounsaturated fat. These fats may reduce inflammation and in turn, reduce risk of skin cancer. Either way, this study provides more evidence that a Mediterranean diet is a very healthy way to eat.

Akonza Lat Machine Review


Working out at home is a great strategy for anyone who is too busy to get to the gym consistently. You don’t really need all that much equipment, as most body parts can be worked well with a simple pair of adjustable dumbbells. The back is the one body part that is a bit harder to target at home. A machine that focuses on the back is a great idea for any home gym.

That is why the Akonza lat machine is next up for review. This is a lat pull down machine designed for the home gym that has both a high and low pulley. It is available on Amazon.com with free delivery for Prime Members.

Pros
1) This machine is very well built: I have had mine for over 3 years and it looks and works like it did when it was brand new.

2) Not too tall: This is important as some of the machines I looked at were too big for my basement. The Akonza Lat pull down machine is 6 feet, 4.5 inches tall and will fit in most any room in your home.

3) Inexpensive: Currently this machine is on sale at Amazon.com at the very attractive price of $149.97, which includes shipping for Prime Members.

4) Versatile: The machine comes with both a high and low pulley and two attachments. This allows you to add a bunch of exercises for your back, triceps, shoulders and biceps. You can do even more if you add other attachments, which are quite inexpensive.

5) You can put it together by yourself. The directions were not at all complicated, it just took a little time.

Cons
1) The seat is a bit on the small side. This is not a major problem, it just could have been a little bigger.

2) When using the lower pulley for upright rows or bicep curls, the machine is not quite stable and seems like it could tilt backward. This is easily fixed by simply putting one foot on the base of the machine during the upward phase of the exercise. Admittedly, the machine is not designed for these types of exercises, I just like to do them. When using the high and low pulley as intended, the machine is completely stable. 

Do I Recommend the Akonza Lat Machine?
Absolutely. This little gem will turn your basement weight room into a bona fide home gym. The price is right, it is versatile and is built very well. If you are busy, working out at home is critical to working out consistently. Adding just a few pieces of equipment, such as this lat machine, will allow you to replicate the gym experience in the comfort of your own home.

Disclosure: I am not affiliated with the company that makes the Akonza Lat Machine and make no money if you buy it.