Research Update

Is your breakfast making you hungry?

The Study

48 subjects consumed Quaker Old Fashioned Oatmeal and Honey Nut Cheerios for breakfast on 2 separate occasions in a randomized crossover trial. Both meals contained 363 calories; 250 for the cereal and 113 for the fat free milk. Visual analogue scales measuring hunger and satiety were completed throughout the morning of each test. When the subjects consumed the oatmeal, they reported significantly higher levels of fullness and significantly lower levels of hunger, desire to eat, and prospective food intake than when eating the Honey Nut Cheerios. The oatmeal breakfast was lower in sugar, had a lower glycemic index, and had higher amounts of protein, total fiber, soluble fiber, and beta glucan than the Cheerios. These are all potential mechanisms for the increased satiety. Journal of the American College of Nutrition 2013; 32:272-79.

Take Home Message

When it comes to weight loss, a calorie is not a calorie! Some foods increase hunger and subsequent energy intake, and some don’t. The glycemic load is a powerful concept that must be understood if you want to lose weight and keep it off.

What’s more important, the number of fruits and vegetables consumed or the variety?

The Study

71,141 women from the Nurses’ Health Study and 42,135 men from the Health Professional Follow-up Study had their quantity and variety of fruit and vegetable consumption measured for a period of 22 years. Subjects consuming 8 or more servings of fruits and vegetables per day had a 17% lower risk of heart disease compared to those consuming 2 or fewer servings of fruits and vegetables per day. Variety, which was measured as the total number of unique fruits and vegetables consumed at least once per week, was not associated with risk of coronary heart disease. The authors believed the reduction in risk of heart disease was due to the presence of carotenoids, vitamin C, fiber, magnesium, potassium, and/or antioxidants in the fruits and vegetables. American Journal of Clinical Nutrition 2013; 98:1514-23.

Take Home Message

While it is always good advice to include a variety of fruits and vegetables in your diet, it may not be as important as the number of servings, at least when it comes to risk of heart disease. One last note: white potatoes and fruit juices were not considered as servings of fruits and vegetables by the researchers, most likely due to their higher glycemic load.

Groundbreaking New Research On Blood Sugar And Dementia

Glucose levels and risk of dementia. New England Journal of Medicine 2013; 369:540-48

Objective

Previous research has shown that diabetics have an increased risk of dementia.  This study examines the association between high blood glucose levels and risk of dementia in those without diabetes.

Methods

2,067 older men and women free of dementia and diabetes, were recruited from Group Health Cooperative, which is a health care system in Washington State. Over 7 years of follow up, blood glucose was measured repeatedly with a fasting blood glucose test.  Risk of dementia was measured by means of the Cognitive Abilities Screening Instrument. By the end of follow up, researchers had collected 35,264 measures of blood glucose in these subjects. The association between glucose levels and incidence of dementia were calculated.

Results

By the end of follow-up, there were 524 new cases of dementia in this cohort.  Blood glucose levels were linearly and significantly associated with an increased risk of dementia, starting at fasting concentrations of 105 mg/dl. Following are the increases in risk of dementia with the corresponding average blood glucose readings:

105 mg/dl: 10% increased risk of dementia

110 mg/dl: 15% increased risk of dementia

115 mg/dl: 18% increased risk of dementia

 
It is also important to note that those with an average glucose reading of 95 had a 14% reduced risk of dementia.

Comment

Previous research has shown that diabetics have an increased risk of dementia.  Therefore, it is known that very high levels of blood glucose have a negative impact on the aging brain. This is the first study to show significant increases in risk of dementia with blood glucose levels well below that of diabetics.  

A fasting blood glucose reading below 100 is considered normal.  A fasting blood glucose above 125 is considered definitive for a diagnosis of diabetes.  If you fall in between (101-125) you are considered pre-diabetic.  This study showed that even a tiny increase in fasting blood glucose above normal will increase risk of dementia.  This is frightening because a huge number of American fall into this prediabetic category.  The authors felt that the increased risk of dementia was due to acute and chronic hyperglycemia, insulin resistance, and microvascular disease of the central nervous system.

Take Home Message

This is a really well designed study published in the #1 journal that will initiate more research in this area.  In the meantime, do your best to keep your fasting blood glucose levels in the normal range (even a bit lower as those with a reading of 95 mg/dl had a reduced risk of dementia). The best way to do this is to exercise daily, keep your weight in a healthy range, and eat a low glycemic load diet.

Product Review: Gazelle Edge

If you work with me or have read any of my books, you already know that cardio is essential to weight loss, fitness, and chronic disease prevention. Research is now telling us that we need to do a lot more of it than any of us originally thought. If weight loss in particular is your goal, cardio simply has to be a daily part of your routine. 

Going to the gym sounds great, but I can’t say that I have seen it work long term. In fact, in 15 years of working with weight loss clients, I can name one client who consistently got to the gym every single day to hit her cardio goal. Life just seems to get in the way. The only answer is to have a piece of cardio equipment in your home.

Enter the Gazelle Edge. This is a glider, which is very similar to an elliptical trainer, and is sold on amazon.com. I can’t say enough about it. Here are some of the great features:

1) It is low impact and very easy on the joints. 

2) It is light and folds up for easy storage against a wall or even under a bed. This makes it perfect for those in apartments or for those that don’t want a piece of gym equipment prominently displayed in their home.

3) It is inexpensive. Amazon sells it for about $120 with free shipping.

4) Having the Gazelle at home makes getting your cardio minutes a snap. Put it in front of your flat screen, and TV time becomes exercise time. You can talk on the phone while on the Gazelle. When your balance gets really good, you can even read on the Gazelle. 

5) It works! The majority of my clients use it as their primary source of cardio (as do I) with amazing weight loss results.

*Always remember that whenever you are starting or changing your exercise program, it is important to talk to your doctor first to get medical clearance.

Over the years I have gotten a lot of questions from my clients on how to best use the Gazelle Edge. In this next section, I’ll answer them for you.

Should I use the arms?

No! In fact, I recommend taking the arms off altogether. I want you to focus on the larger muscles of the lower body and not your arms. Also, with the arms off, you will be free to hold the TV remote, a book, or your tablet. If you need to hold on for balance in the beginning, you can keep your hands on the side of the machine.

How can I prevent the Gazelle from sliding around while I’m working out?

If you place the Gazelle on a hardwood floor, it can move around a bit during your workout. To prevent this, use the Gazelle in a carpeted room. If this isn’t an option, a thin yoga mat underneath it will help a lot. I actually use a yoga mat on top of the carpet to keep the machine from leaving indentations on the carpet.  This combination reduces movement 100%.

Initially, I feel like I’m not working out hard enough, am I doing something wrong?

When you first start using the Gazelle, you will not be entirely balanced and comfortable. This tends to slow down your pace. It is common to feel like you are not getting a great workout at this time. After a couple of weeks, your balance will improve and you will be able to greatly pick up the pace. The key is to take long, fluid strides, kind of like cross country skiing on one of those Nordic Track’s from years ago. Also, swing your arms as if you were running quickly.

Can I do anything else to pick up the intensity?

For most people, following the above recommendations will get their intensity to the proper level to improve fitness and lose weight. However, if I have a client that is a bit younger and healthy, I’ll recommend interval training to ramp up the intensity. 

I’ll have them start out their cardio at the normal intensity for 4½ minutes, and then sprint for 30 seconds. I’ll have them repeat this 4 or 5 times during their workout. This is a great way to increase intensity and burn more calories. The sprint does not have to be maximal, just a clear increase in speed for 30 seconds. If a client is overweight or has cardio-metabolic risk factors, such as hypertension or high cholesterol, I don’t recommend interval training, since the increased intensity can spike heart rate and blood pressure.

So there you have it. If attaining your cardio goals has been a problem for you, the Gazelle Edge is a low cost and effective solution.

To learn more about the Gazelle or to pick one up: click here.

 

How Often Should I Weigh Myself?

Weighing yourself regularly and properly is an important component of any weight loss program. It serves 3 purposes:

1) To measure your progress. If you are losing weight, you’ll know your program is working. If not, you’ll know that it is time to make some changes.

2) To learn about your personal metabolic physiology. No 2 people lose weight the same way. It is a highly subjective process. When you weigh yourself weekly, you’ll start to see certain patterns. You’ll study what you did when you lost weight, and you’ll study what you did when you didn’t. After several months, you’ll refine your program with laser-like focus, knowing exactly what you have to do to achieve your goals.

3) Weight Maintenance. Once you hit your goal weight, weighing yourself weekly will keep you focused. Old habits will tend to creep back in. If you see small increases in your weight, you can make the necessary adjustments.

Weighing yourself correctly is a bit more complicated than you may think. Here’s how I have my clients do it:

1) Make sure you have a research quality scale. I’m a big fan of the Tanita Iron Man (www.tanita.com).  These are digital scales that are highly accurate and can even measure your body fat. They run around $100, but last forever.

2) Pick a day of the week that will be your regular weigh in day. Alcohol, salt, and refined carbohydrates make you retain water like crazy for up to 2 days after consumption. Some of my clients will go up 3-4 pounds after a splurge meal! This is not body fat, just water retention that goes away after a couple of days.

For this reason, you want to eat very clean for 2 days before your weigh in day. That means no splurges, alcohol, or restaurant meals. Since most of my clients splurge on the weekends and get back on track Monday and Tuesday, Wednesday is a natural weigh in day. Personally, I like Saturday morning. I’m very tight with my diet on Thursday and Friday, so Saturday is my day.

3) Weigh yourself first thing in the morning, before you eat or drink anything, in your underwear. You wake up in a dehydrated state, which will help control for level of hydration which is a natural confounder for accurate weight readings.

4) Record your weight so you can measure your progress and search for patterns.

Weighing yourself regularly and accurately is a vital tool in your arsenal when trying to lose or maintain your weight. Make sure you use it properly!

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.