Research Update

Do we eat more when we drink alcohol?

The Study

1,864 men and women were selected from the National Health and Nutrition Examination Survey who reported drinking alcohol on one of their 24 hour dietary recalls and not the other. The amount of calories consumed on drinking versus nondrinking days were compared. When drinking alcoholic beverages, men consumed an extra 168 non-alcohol calories with increases in saturated fat, sodium, meat, and potatoes. Women consumed a nonsignificant 93 more calories on days when they drank alcohol and consumed a higher amount of saturated fat.  The authors noted that alcohol has been shown in the research literature to influence food related hormones. American Journal of Clinical Nutrition 2013; 97:1068-75.

Take Home Message

If weight loss is your goal, you need to limit the alcohol. Alcohol is calorie dense at 7 calories per gram, and does tend to increase food intake. I have my weight loss clients shoot for no more than 4 drinks per week.

Soda and heart disease in kids

The Study

Everyone knows that sugar sweetened beverages, like soda and fruit drinks, are not the healthiest choice, but a recently published study in adolescents is truly eye-opening. 1,433 Australian teens had their sugar sweetened beverage consumption measured by a food frequency questionnaire at age 14 and 17. Girls who consumed the most sugar based beverages (greater than 1.3 servings per day) had a 3.8% increase in their BMI, a 5 times greater risk of overweight or obesity, and a 3 times greater prevalence of risk factors for heart disease. Girls who consumed the most of these beverages also had a significant increase in triglycerides, systolic blood pressure, waist circumference, and a decrease in HDL cholesterol. Boys who consumed the most sugar sweetened beverages had a significant decrease in HDL cholesterol and significant increases in triglycerides and waist circumference. American Journal of Clinical Nutrition 2013; 98:327-34.

Take Home Message

We have known for some time that soda and fruit drinks are associated with weight gain. The increases in risk factors for heart disease in the children in this study are alarming, to say the least. Soda’s and fruit drinks need to be strictly limited, or better yet, completely avoided.

Can You Be Overweight Yet Totally Healthy?

Are metabolically healthy overweight and obesity benign conditions? Annals of Internal Medicine 2013;159:758-69.

Objective

A recent study suggested that the overweight have a lower risk of mortality than those that are at a normal weight. A minority subgroup of obese individuals on the surface seem to be completely healthy. They have no negative metabolic consequences that are normally associated with weight gain, such as high blood pressure, insulin resistance, high cholesterol, etc. This investigation examines whether there is a class of “benign” obesity that does not increase risk of disease.

Methods

This paper is a meta-analysis of 8 studies that compare risk of all-cause mortality and/or cardiovascular events in 5 categories of individuals:

1) Normal weight and healthy

2) Normal weight and unhealthy
3) Overweight and healthy
4) Overweight and unhealthy
5) Obese and healthy
6) Obese and unhealthy 

Healthy individuals lacked any of the normal risk factors for heart disease such as: high triglycerides, low HDL, high blood pressure, high blood glucose, etc. Normal weight is considered a BMI under 25. Overweight is considered a BMI of 25.1-29.9. Obese is considered a BMI greater than 30.

Results

Those that were of normal weight and healthy were considered the reference group. Compared to these subjects, those that were unhealthy and obese had a 265% increased risk of death or cardiovascular events. Those that were overweight and unhealthy had a 270% increased risk of death or cardiovascular disease. Those that were normal weight and unhealthy had a 314% increased risk of death or cardiovascular events. Those that were overweight and healthy had a non-significant 21% increased risk, while those that were obese and healthy had a 25% increased risk.

Comment
Studying the effects of weight on mortality is really challenging. People who smoke are thinner than average and die younger than nonsmokers. People who are sick often lose weight for years before they die. So, sometimes it looks like thinner people die younger than those who are a bit heavier. However, when these issues are properly controlled for, the research literature shows a strong association between overweight, obesity, and early mortality. This study confirms this idea. Subjects who were obese but otherwise healthy had a significant increase in risk of early death or cardiovascular events. 

Take Home Message

Despite recent headlines to the contrary, being overweight is unhealthy. If your BMI is above 25, work to get it lower. If it is below 25, do your very best to keep it there.

Book Review: Salt, Sugar, Fat

Next up for review is Salt, Sugar, Fat: How The Food Giants Hooked Us. The Author, Michael Moss, is a Pulitzer Prize Award winning investigative reporter for the New York Times.

Introduction

Salt, Sugar, Fat is an inside look at everything the food companies have done to addict us to their products and the role this has played in the obesity epidemic. The writer, Michael Moss, interviewed dozens of food scientists, marketing directors, and executives from the processed food industry. What he learned was staggering. The book, obviously enough, is broken down into 3 sections: salt, sugar, and fat.  The roles that each of these ingredients play in the addictive nature of processed foods is described in detail. The book is a bit long at 347 pages, but is very well written and researched. I truly enjoyed reading it.

5 Things I Really Liked About Salt, Sugar, Fat

1) I was stunned to learn about the complexity of “bliss point” research. The bliss point is the exact combination of fat, sugar, and salt that makes processed snack treats irresistible and highly addictive. Nothing is by accident, the research is conducted by PhD scientists who fully understand the addictive properties of these ingredients. The origins of this research is fascinating. In the 1960’s, a graduate student was trying to fatten up some lab rats for a study on the metabolic effects of obesity. No matter how much of their natural food the student fed to the rats, they wouldn’t gain weight. Their body shut down their hunger when they had enough. One day as a treat, he dropped in a couple of fruit loops and the rats went nuts! They couldn’t get enough. He found the answer to his problem. By feeding the rats sweets like chocolate and cookies, they would keep eating until they became obese. The sugar overwhelmed the rat’s natural defense mechanisms to weight control. It was not long until the food companies caught on.

2) It was really interesting that most of the executives interviewed completely avoided their company’s products and ate quite prudently. Many of these executives regret their role in formulating and marketing products that have contributed to the obesity epidemic.

3) I love how the book examines the controversial issues of this topic. For example:               1) Corporate profit vs. consumer health. 2) The consumer’s personal choice to pick unhealthy foods vs. the expertly designed bliss point research that may take that choice away because of the addictive nature of those foods. 3) Are the food companies just giving consumers what they want or are they driving them to eat more of the wrong food with scientific research. There are no easy answers to these questions but we need to think about them.

4) The salt chapter was really well done. I found the case study of Finland to be fascinating. In the late 1970’s, Finland was consuming huge amounts of salt and had epidemics of hypertension, heart disease, and stroke. In fact, men from Finland had the highest rates of cardiovascular disease in the world. Finland’s public health authorities took action by going after the manufacturers. Any food item that exceeded a certain amount of salt was stamped with the words “High Salt Content”. They also began a public health education campaign to reduce salt consumption. The results were striking. By 2007, salt consumption in Finland had been reduced by one-third and deaths from heart disease and stroke were cut by 80%! Why aren’t we doing this?

5) Another thing I learned is that sugar, salt, and fat add a lot more to a product than just taste. For example, salt adds color, aroma, texture, consistency, and mouth feel to a processed food. Another example is that when fat is reduced in a food, sugar is added to reduce bacterial growth. I did not know this. The truth of the matter is that fat, sugar, and salt preform other duties in these processed foods. Reducing them by a significant amount can really change a product. The book details several producers that reduced levels of these additives and sales dropped significantly because the product looked or tasted funny. This adds another level to this complex problem.

Is Salt, Sugar, Fat Worth Reading?

Absolutely! I really enjoyed this book.  It takes a very thorough look at how the food companies have contributed to the obesity epidemic. This is a tough problem to solve, but it needs to be figured out. This book affirms 2 things I have been telling my clients for the past 15 years:

1) Any time you eat a processed food, or at a restaurant, keep in mind that the goal of the creator of that food is to make it taste good. Sugar, salt, and fat is how they do it.

2) To truly be successful in changing your diet, you have to eat the vast majority of your meals at home with fresh, home-made ingredients. Save your restaurant and fast food meals for the few times a week where you allow yourself to cheat.

Research Update

Do Fruits And Vegetables Help You Live Longer?

The Study

In a Swedish Cohort study, 71,706 men and women aged 45-83 were followed for 13 years to examine the effect of fruit and vegetable consumption on mortality. When compared to subjects consuming 5 servings of fruits and vegetables per day, subjects who never ate fruits and vegetables lived 3 years shorter and had a 53% increased risk of mortality. The authors believed the difference in mortality was due to the fruit and vegetable consumer’s lower rates of cardiovascular disease and cancer. American Journal of Clinical Nutrition 2013; 98:454-9.

Take Home Message

Fruits and vegetables are the healthiest things you can eat, aim for a minimum of 5 servings per day, more is better.

 

Do Nuts Make You Fat?

The Study

Although nuts are an extremely healthy food, many avoid them because they fear their high fat content will cause weight gain. A recently published meta-analysis examined this question. Thirty-three randomized controlled trials were included in this meta-analysis. The results were very interesting. When comparing diets that included nuts to diets that did not, researchers found no increases in body weight, BMI, or waist circumference. In fact, all three were lower in the nut groups, although these differences did not reach statistical significance. The authors believed that the protein and fiber in nuts increase satiety, and that is why they were not associated with weight gain. American Journal of Clinical Nutrition 2013; 97:1346-55.

Take Home Message

Nuts are an awesome food. They are high in healthy fats, protein, fiber, minerals, and phytochemicals. Feel free to include nuts in your diet without fear of them tipping the scale in the wrong direction. Just be reasonable with your portions.

 

 

What Should I Weigh?

When I meet a new weight loss client, one of the first questions I ask is, “How much weight would you ideally like to lose?” Usually they turn around and ask me, “Well, how much do I need to lose?”

My primary goal is to get my clients down to a point where their weight will no longer increase their risk of chronic diseases like heart disease, stroke, type 2 diabetes, and cancer. A simple and powerful measure of how your weight will affect your risk of disease is the Body Mass Index.

Your body mass index is your weight in kilograms divided by your height in meters squared. If your body mass index is 25 or lower, your weight is considered normal. If it falls between 25.1 and 29.9, you are considered overweight. If it is 30 or more, you are considered obese.

Risk of chronic disease begins to increase with BMI’s over 25 and rises sharply with BMI’s over 30. I always have my clients shoot for a BMI under 25. While the BMI measure isn’t perfect, there is a ton of solid research behind the numbers, so I always have my clients start there.  

The Center for Disease Control has a free BMI calculator (click here). You can use this calculator to figure out your BMI today and also what weight you need to reach to get it under 25. There are also a variety of BMI calculator apps for your Smartphone. Just go to your app store and type in “BMI calculator” and you’ll get a number of options to download, many of which are free.

 

 

 

 

 

Research Update: High Glycemic Carbs And Your Brain

Effects of dietary glycemic index on brain regions related to reward and craving in men. American Journal of Clinical Nutrition 2013; 98(3):641-47.

Objective

The goal of this investigation was to examine the effect of glycemic index on brain function during the late post-prandial period (4-5 hours after eating a meal).

Methods

Twelve overweight men consumed two liquid meals on separate occasions. The meals were identical in calories, macronutrients, and palatability. The only difference between the meals was that one had a glycemic index of 84, and the other had a GI of 37. Brain activity was then measured by MRI four hours after consumption of each meal. Blood glucose, insulin, and hunger were also measured repeatedly during the post-prandial period.

Results

Plasma glucose was significantly lower and hunger was significantly greater four hours after the high glycemic meal when compared to the low glycemic meal. The high glycemic preload also elicited a greater brain activity centered in the right nucleus accumbens. This area of the brain is associated with reward and food craving.

Comment

This is a fascinating study! We’ve known for years that high glycemic carbs promote a post-prandial dip in blood sugar that leads to an increase in hunger. I always thought that this was governed solely by the endocrine system. This is the first study to show that high glycemic carbs actually change brain activity, particularly in areas that control reward and craving. While this is just one study, it was very well designed.

Take Home Message

If you work with me or have read my books, you know that a low glycemic approach is the key to losing weight and improving health. This study provides even more reason to strictly limit high glycemic carbs like bread, pasta, white rice and sugar. Instead, focus on lower glycemic carbs like fruits, vegetables, legumes, and whole grains.

 

Should eggs be a part of your regular diet?

The controversy surrounding the egg is a great example of the divide between popular opinion and well-designed research in the field of nutrition. Eggs have been vilified for decades because of their high cholesterol content. Many doctors and nutritionists advocate complete avoidance of egg yolks. I recently read a well written review of the current literature on eggs and health in The American Journal of Clinical Nutrition (1). I definitely learned a few new things.  Therefore, I thought that an update on the research concerning eggs and our health would be a great feature article for the 1^st edition of this newsletter.

Why Have Eggs Been Vilified?

Eggs are considered unhealthy for one basic reason: they are high in cholesterol. A single egg has 213 milligrams. The daily recommended intake for dietary cholesterol is 300 mg. per day. Therefore, by consuming 2 eggs at breakfast, you exceed your daily recommendation for cholesterol. The theory behind the advice to avoid eggs is that consuming too much dietary cholesterol will increase risk of heart disease and stroke.

Research On Eggs And Disease

The article I mentioned earlier is a comprehensive review and meta-analysis of all research to date on the association between eggs and our health (1). In a meta-analysis, researchers combine data from many different studies in order to calculate a statistical summary of all published research. It is kind of like dumping all of the subjects from all of the studies into one population and then analyzing the data.

When this was done for eggs, the researchers found no increased risk of heart disease, stroke, or total cardiovascular disease when comparing those consuming one or more eggs per day to those eating less than one egg per week. This is not new or surprising. Past research has shown that dietary cholesterol is only weakly associated with serum cholesterol. In the Nurses’ Health Study, the Health Professional Follow-up Study, and the Framingham Heart Study, there was no association between egg consumption and risk of heart disease (2,3).

However, the meta-analysis found a 42% increased risk of type 2 diabetes when comparing those consuming one or more eggs per day to those consuming less than one egg per week. This was news to me and I found it a bit disturbing. Therefore, I went out and retrieved all of the major studies on eggs and type 2 diabetes and read them for myself.

I found 5 studies, 3 prospective cohort studies (4-6) and 2 randomized controlled trials (7,8). One of the prospective cohort studies showed a 58% increased risk of type 2 diabetes when comparing subjects consuming 1 or more eggs per day to those consuming less than one egg per week (4). The other 2 cohort studies showed no association (5,6).

The 2 randomized trials were of similar design and were conducted by the same research group (7,8). These trials found that consuming 3 eggs per day for 12 weeks did not raise fasting glucose or insulin resistance.

After reviewing the studies, I came to the conclusion that there is far more evidence that eggs do not increase the risk of type 2 diabetes than that they do. However, the study that showed an association was well designed, so we will keep our eyes on this area of investigation.

What Else Is In Eggs Besides Cholesterol?

An egg yolk is very much like a multivitamin supplement. It contains vitamin D, folate, vitamin E, vitamin A, monounsaturated fat, vitamin B12, vitamin B2, essential amino acids, linoleic acid, calcium, and vitamin B1. Egg yolks are, in fact, one of the most nutrient dense foods that you can eat.

Recommendation

I tell my clients to enjoy up to 6 egg yolks per week. This amount does not have any negative impact on cardiovascular disease and will absolutely pack their breakfast with protein and essential nutrients. There are 2 populations that I would alter this recommendation for:

1) Diabetics: There is evidence of an increased risk of heart disease in diabetics that consumed 1 egg per day (2). Therefore, if you are diabetic, I would limit egg yolks to 3 per week.

2) Older men with a diagnosis of prostate cancer: There is some preliminary evidence of an association between consuming 6 or more eggs per week and an increased risk of progression from more benign prostate cancer to a more deadly form (9). There is no evidence of this association for men consuming up to 3 yolks per week. While this area of research is not yet definitive, I’d play it safe and limit myself to 3 eggs per week if I was diagnosed with prostate cancer.

References

1) Shin, et al. Egg consumption in relation to risk of cardiovascular disease and diabetes: A systematic review and meta-analysis. American Journal of Clinical Nutrition 2013; 98:146-59.

2) Hu, et al. A prospective study of egg consumption and risk of cardiovascular disease in men and women. Journal of the American Medical Association 1999; 281:1387-94.

3) Daubes, et al. Eggs, serum cholesterol and coronary heart disease. American Journal of Clinical Nutrition 1982; 36:617-25.

4) Djousse, et al. Egg consumption and risk of type 2 diabetes in men and women. Diabetes Care 2009; 32:295-300.

5) Djousse, et al. Egg consumption and risk of type 2 diabetes in older adults. American Journal of Clinical Nutrition 2010; 92:422-27.

6) Vang, et al. Meats, processed meats, obesity, weight gain and occurrence of diabetes among adults: Findings from Advent Health Studies. Annals of Nutrition and Metabolism 2008; 52:96-104.

7) Mutungi, et al. Dietary cholesterol from eggs increases plasma HDL cholesterol in overweight men consuming a carbohydrate restricted diet. Journal of Nutrition 2008; 138:272-76.

8) Ratliff, et al. Carbohydrate restriction reduces insulin resistance and plasma leptin without modifying appetite hormones in adult men. Nutrition Research 2009; 29:262-68.

9) Richman, et al. Intake of meat, fish, poultry, and eggs and risk of prostate cancer progression. American Journal of Clinical Nutrition 2010; 91:712-21.