Questions And Answers: Trans Fat

What are trans fats?

Trans fats are man made fats.  They are produced through the commercial hydrogenation of unsaturated oils.  Hydrogen is bubbled through the oil at high pressure in the presence of a nickel catalyst to change the structure of the chemical bonds in the oil from cis to trans.

Why do food manufacturers do this?

Hydrogenation removes essential fatty acids such as linoleic acid and alpha linolenic acid.

These fatty acids tend to oxidize over time, which can turn the fat rancid.  Therefore, a big reason why oils are hydrogenated is to increase the shelf life of the food product.  Hydrogenation also increases the melting point of oil so that the product is solid at 25° Celsius.  This acts to improve the texture and consistency of many commercially prepared foods.  Finally, using this type of oil is cheaper for the manufacturer. 

Where are trans fats found?

Trans fats are generally found in fried foods, margarines and commercially prepared baked goods like cookies, candies and cakes.   Thankfully, recent legislation has banned the use of trans fat in restaurants in many states.  It is getting harder and harder to find them, even in food products that used to contain them a few years ago.  However, they are still used and you need to become aware of which manufacturers continue to use them in their products.

What are the health effects of trans fats?

Trans fats have been shown in the research literature to have a number of negative health effects.  They raise LDL cholesterol and lower HDL cholesterol levels, which can have a devastating impact on risk of heart disease.  Trans fats have also been associated with an increased risk of type 2 diabetes and possibly some cancers.

How do you know if a food contains trans fats?

Labeling laws now require the listing of trans fats on all food products.  This is great, not only because you can readily identify trans fat content, but because many manufacturers are now eliminating trans fat from their products so that they will not be perceived as unhealthy.  However, if a food contains less than 0.5 grams of trans fat in a serving, the manufacturer is legally allowed to list trans fats as zero grams.  This is problematic because even tiny amounts of trans fat are really harmful.  So, after checking the food label under trans fat for zero grams, you’ll also need to check the ingredient list as well.  If you see “partially hydrogenated” before any oil (IE, partially hydrogenated soybean oil) the product contains trans fat.

What are you recommendations for trans fat?

Avoid it 100%.  Treat it as if it will make you sick and shorten your life, because that is exactly what it has the potential to do.  If I was asked what is the bottom line worst thing that you can eat for your health, I would not hesitate to identify trans fat.

Book Review: Eat To Live

Eat To Live is next up for review.  The author, Dr. Joel Fuhrman, is a Medical Doctor who is board certified as a family physician and has also published some nutrition research. 

Introduction

            The Eat To Live program is based on several premises:

            1) The concept of nutrient density, which in simplest terms, is a foods ratio of nutrients to calories.  If a food delivers a lot of nutrients per serving, it is considered high nutrient density.  If it delivers a small amount of nutrients in a serving, it is low nutrient density.  The focus of Eat To Live is to eat only high nutrient density foods.

            2) All animal products will make you sick.

            3) All sources of dietary fat will make you sick and overweight.

            The book spends a lot of time discussing how nutrition impacts health and disease risk.  The food guidelines are then presented with a couple of 7 day meal plans and a large number of recipes.  The book is well written and an easy read. 

5 Things I Liked About Eat To Live

1) The concept of nutrient density- Eating nutrient dense foods means more fruits and vegetables and less processed junk food.  I’m all for that.

2) Strongly against sugar and refined carbohydrates- I couldn’t agree more.

3) Strongly in favor of fruits and vegetables- Fruits and vegetables are probably the best things you can eat to improve your health and the more the merrier.

4) Against dairy- I’m not convinced that dairy is a natural food for humans.  Those of you who work with me or read my book know this.  I don’t think there is a need for total elimination, but I feel that dairy intake should be now and again rather than a dietary staple.

5) Against snacking- I’ve been telling my clients not to snack for years.  If you are eating a blood sugar stabilizing diet, you should not be hungry in between meals.  Also, keep in mind that if you eat 70 more calories a day than your body needs, you’ll put on 8 pounds in a year and 23 pounds in 3 years.  Snack calories can add up like crazy over time.

What I didn’t agree with in Eat To Live

1) Very little attention was paid to exercise- I am more than convinced that for long term weight loss, cardiovascular exercise and resistance training are pivotal.   The research bears this out, as does my 15 years of working with weight loss clients.  Exercise was barely mentioned in this book and almost seemed to be an optional part of the program.

2) Unrealistic weight loss goals- Several testimonials were presented throughout the book that showed dramatic weight loss.  Some of these cases lost up to 19 pounds in 2 weeks.  Dr. Fuhrman says you should expect to lose 14 pounds in the first 14 days.  I think this is an unrealistic goal.  A pound of fat is 3500 calories.  To lose even 1 pound a week you have to create a caloric/exercise deficit of 500 calories per day.  This is not easy.  If you are losing a pound a week you are doing great.  Going into a program expecting to lose a pound a day will only set you up for failure and disappointment.  Realistic expectations can be the difference between staying with your program and giving up because “it’s not working”.

3) Incomplete evaluation of the current research- Many parts of this book are really well researched.  When describing the dangers of refined carbohydrates, saturated fats, Tran’s fats, etc, excellent research is presented.  The Nurses’ Health Study and the Health Professional Follow-up Study are mentioned several times in these sections.  These are Harvard cohorts and although I’m biased, I believe they represent the very best in epidemiological study design.

However, when Dr Fuhrman starts to mention that all animal protein promotes disease (even lean sources like chicken and fish) and all fat makes you fat (including healthy vegetable oils like olive oil and canola oil), he leaves out results from these cohorts that prove otherwise.  Research in the Nurses’ Health Study and Health Professional Study show that total fat is not associated with weight gain, that vegetable sources of fat reduce risk of disease and that lean sources of protein (including fish, chicken and turkey) are health promoting, particularly when they replace refined carbohydrate in the diet. 

4) Inclusion of many high glycemic load foods.   One of the goals of any healthy diet is to limit high glycemic load foods.  There is no mention of the concept of glycemic load in this book and the meal plans allows for daily consumption of white potatoes, fruit juice, dried fruit and you are even allowed 100 calories of cookies or candy each day if you want.  These high glyemic load carbs would be particularly damaging to the blood sugar since this diet is so low in fat and protein, which act to attenuate the glycemic response.

5) Overgeneralization of the macronutrients. Dr. Furman says that all fats and all animal protein are unhealthy and will lead to disease and overweight.  I beg to differ.  Some fats are bad for you and some are actually quite good for you.  Trans fat and saturated fat should be avoided while poly- and monounsaturated fat have been shown to reduce risk of chronic disease.  They also serve to lower the glyemic load of the diet when they replace refined carbohydrate foods and can improve health in this way as well. 

Fatty sources of animal protein like steak, sausage, hot dogs and bacon are indeed unhealthy choices and should be strictly limited.  However, fish, chicken, eggs and turkey are great choices that can actually reduce your risk of disease when they replace refined carbohydrate foods in the diet and thus act to lower the overall glycemic load of the diet.  Eating lean protein also promotes satiety, which is a big reason why my weight loss clients are not hungry between meals.

Is Eat To Live Worth Reading?

Absolutely.  If you are interested in nutrition as a profession or for your own personal health, read as many books as you can.   I think it is important to get as many different perspectives as possible.  In Eat To Live you will learn a lot of great things about the benefits of fruits, vegetables, whole grains and legumes.  You’ll also learn a lot about the dangers of refined carbohydrates, saturated fat and Trans fat. 

Will you lose weight?  I think you will, at least in the short term.  This is a really low calorie diet.  However, low fat diets are just too hard to stay on for any length of time and the research shows that most weight lost on low fat diets is regained after about a year.  Just keep in mind as you read this that a healthy diet also includes a bit more protein (even some lean animal protein like chicken, eggs, fish and turkey) and a lot more healthy fat (like olive oil, canola oil, nuts, avocado, etc).  Also keep in mind that if you truly want to lose weight and keep it off, exercise is a huge part of the equation.  We all collectively must learn to accept this basic truth.

Research Update: Green Tea And Serum Cholesterol

Green tea intake lowers fasting serum total and LDL cholesterol in adults: A meta-analysis of 14 randomized clinical trials.

The American Journal of Clinical Nutrition 2011; 94:601-10.

Objective: To examine the association between green tea consumption and serum cholesterol.

Methods:  This article is a meta-analysis.  The literature was extensively searched for all research on the affects of green tea on serum cholesterol.  The analysis included 14 studies and a summary estimate was calculated.  There were a total of 1,136 subjects from the 14 studies included in this meta-analysis.

Results: Green tea significantly lowered total cholesterol by 7.2 mg/dl and significantly lowered LDL cholesterol by 2.2 mg/dl.  There was no association between green tea consumption and HDL cholesterol.

Discussion:  This is a pretty impressive finding that could have a nice effect on your risk of coronary heart disease, the number one killer in the U.S.  It is hypothesized that every 1% drop in serum cholesterol lowers risk of coronary heart disease by 3%.  Green tea is produce from the leaves of the plant Camellia Sinensis.  Green tea leaves contain antioxidants, vitamins, minerals and polyphenols.   The researchers believed that substances in green tea lower serum cholesterol by inhibiting key enzymes involved in cholesterol synthesis and by reducing intestinal absorption of cholesterol.   About half of the 14 studies used green tea beverages as the intervention and the other half used green tea dietary supplements in pill form.  No major adverse health effects were reported in any of the studies.

Take Home Message: If you are trying to reduce your total and LDL cholesterol, green tea may be another simple yet effective strategy.  The studies included in this meta-analysis used a variety of doses and the authors didn’t have recommendations regarding the amounts necessary to produce the desired effect.  There were no major adverse health effects reported, so it looks like a cup or 2 a day of green tea may be a safe and effective way to lower cholesterol.

Product Review: Bowflex SelectTech 552 Dumbbells

It’s time for another product review and this time I’m going with Bowflex Selecttech 552 Dumbbells.  In a rough economy, many people have cancelled their gym memberships and started working out at home.  This is not a bad idea.  You can take one year’s worth of gym dues and make a really nice little home gym that will last you for decades.  When deciding on the type of weights to include in your home gym, there is a lot to think about: the price of the system, the space you have available, what exercises you want to be able to do, etc. 

Bowflex Selecttech Dumbbells are a great choice for any home gym.  These are dumbbells that have a dial on the side that allows you to change the weight from 5 to 50 pounds in 5 pound increments.  If you want them to be 20 lbs, you simply turn the dials to 20 and you’re all set.  I’ve had a set of these for about 6 months and have been really happy with them.  Following are some of the pro’s and con’s of these dumbbells.

Pro’s

1) Very easy to change the weight load.  If you have plate loaded weights with collars, it can take you a few minutes between exercises to adjust the weights.  This can disrupt your work/rest interval.  With the Bowflex weights, the change is instantaneous.

2) Bowflex Selecttech’s look and act like regular dumbbells.  Other adjustable dumbbell systems like Powerblocks have an unusual shape with a handle in the middle of the dumbbell.  This makes it hard to do exercises like overhead back or triceps presses.  The Bowflex system can be held like a regular dumbbell so you can do anything with them.

3) Space Saver.  These adjustable dumbbells can take the place of an entire wall of individual dumbbells.  This is great if you are in an apartment or only have a small amount of space to devote to your home gym.

4) Very Well Made.  These dumbbells are very well made and durable.  I’ve had mine for about 6 months and they look like they just came out of the box.  There are no signs of wear and tear at all.

5) Don’t roll when you place them on the floor or bench.  This may be a minor issue for some, but there is nothing worse to me than laying down your dumbbells in between sets and having to chase them around the room.  The Bowflex dumbbells lay flat and don’t roll around.  

Cons

1) The only con I can come up with is the price.  They are about $350 for the set that goes from 5 to 52 lbs.  There used to be a set that went from 5 to 25 lbs as well, but I think they may have discontinued those.  Now, if you bought pairs of 5, 10, 15, 20, 25, 30, 35, 40, 45 and 50 lb dumbbells individually, you’d spend a lot more than $350.  However, if you bought plate loaded dumbbells with collars you’d spend a lot less.

Would I Recommend The Bowflex Selecttech Dumbbell System?

Absolutely.  They are a bit pricey but they have really changed the way I can workout at home.  I can switch weights in between exercises and even in between sets with ease.  My workouts are now more fluid and I have more options than I used to regarding exercises.  I love the space saving aspect as well.  I recommend them highly.

If you are interested in picking these up, I researched a bunch of different ways to buy them and was surprised to find out that the best deal came from the Bowflex website (http://www.bowflex.com/ ).  When I got mine they threw in a free stand.  They are also available on Amazon.com and at home gym equipment stores.

The Top 15 Foods To Always Keep In Stock

Eating healthy used to be completely normal and very easy for human beings.  While evolving, the right foods were readily available and there was no such thing as junk food.  My, how things have changed!  The norm now is to eat unhealthy.  Everywhere we go: restaurants, ball games, the movies, coffee shops, airports, rest stops, etc, there are tons of unhealthy food choices and very few healthy ones.

Your home has to become your oasis for healthy eating.  A huge part of this is doing your own grocery shopping and cooking your meals the majority of the time.  Therefore, I thought I’d use this blog post to list out the Top 15 food items to always keep in your pantry/refrigerator.  If you have these tried and true, nutrient packed foods ready to go, you are never more than a few minutes away from a healthy, blood sugar stabilizing meal.

#1) Vegetables: Variety is the key here, and the more the merrier.  Include salad vegetables, sweet potatoes, broccoli, cauliflower, spinach; you get the idea.

#2) Fruits: Again, variety is the key.  Make sure to get a bunch of fruits that travel well, such as apples and pears.  You can throw these in a backpack or purse and they are always ready for you no matter what your day brings.

#3) Nuts: An excellent source of healthy fat that travels well.

#4) Nut Butters: We’re all familiar with peanut butter, but you can also find almond butter, cashew butter, macadamia nut butter and pistachio butter.   They are all really good.

#5) Olive Oil: Great for salads and to sauté vegetables.

#6) Old Fashioned Slow Cooked Oatmeal: A nice, lower glycemic whole grain packed with fiber.  Don’t get instant or quick cooking as these are higher glyemic.  Focus on the “Old Fashioned” slow cooking variety.

#7) Black Beans: Great in a salad, taco or even on their own.  A great source of low glycemic carb and vegetable protein loaded with fiber, vitamins and minerals.

#8) Quinoa: An awesome whole grain that is high in fiber and protein.  This is relatively new here in America but can be found in most grocery stores.  We cook ours in low sodium chicken broth and it’s a great dinner side dish.

#9) Tuna Pouches: These are relatively new.  They are tuna fish in a pouch that you can tear open and eat without having to drain or open with a can opener.  Highly portable, these are great on the road or even on a plane.

#10) Chicken Breast: Buy in bulk at Costco or BJ’s and keep in your freezer.  When combined with the George Foreman Grill, you’ve got a beautifully grilled chicken breast in about 6 minutes.

#11) Eggs: An excellent source of fat and protein.  They take about 2 minutes to prepare when cooking or even less if you hard boil them before hand and have them ready to go.

#12) Olivio or Smart Balance:  These are butter substitutes made from olive and canola oil.  Use any time you’d use butter.  They taste really good and are so much better for you than butter.

#13) Brown Rice: A great lower glyemic whole grain that is loaded with fiber.  Make sure you get the slow cooked variety and not instant or quick cooking as these are higher glycemic.

#14) Sliced Turkey Breast: A low fat, convenient source of protein.  Try to get it freshly sliced off a bird and not the pre-packaged variety that is filled with nitrates and other preservatives.

#15) Frozen Shrimp: A delicious source of protein that is surprisingly reasonable when bought frozen in bulk at Costco’s or BJ’s.

Research Update: Are Organic Foods Healthier For You?

Nutrition Related Health Effects Of Organic Foods: A Systematic Review

The American Journal of Clinical Nutrition 2010; 92:203-10.

Objective: To conduct an exhaustive review of the current literature on the subject of organically grown food and health.

Methods:  This article is a review paper.  The literature was extensively searched for any research on the affects of organic foods on health.  The authors initially identified 98,727 articles, but surprisingly, only 12 articles met their inclusion criterion.  The studies included hypothesized that organically grown foods would have a positive impact on health when compared to conventionally grown food.

Results:  The studies looked at a variety of outcomes, including antioxidant content, LDL oxidation, phenol content, effects on serum glucose and triglycerides, immune function, flavinoid content and antioxidant capability.  The authors concluded that evidence was lacking for any nutrition related health effects of organically grown food.   All they mentioned was a significantly reduced risk of eczema in infants fed organic milk when compared to infants drinking regular milk.  The authors also cited a recent systematic review of the past 50 years that showed that organically and conventionally grown foods are highly comparable in their nutrient content.

Discussion:  This study may be a bit surprising to many and certainly a bit controversial.  In general, organic produce and meats are much more expensive than conventionally grown.  Most buyers of organically produced foods spend this extra money for one of 2 reasons:

1) They think that there are more nutrients in organic foods.

2) They think that organic food will have a more positive impact on their health than conventionally grown food.

According to the research, neither appears to be true.  Furthermore, this is not the first time I’ve seen this in the literature.

Take Home Message: If you like to buy organic produce and meats and can easily afford to do so, by all means continue.  Some people feel that organic foods are “greener” for the environment and that animals that are organically raised are treated more humanely.  This very well may be true.  However, if you are buying organic produce because you think it is more nutritious or will result in improved health, there is very little evidence up to this point in time that this is true.

Feature Article: Understanding Nutrition Research

           Let’s face it, research can be confusing. When a major new study in the field of nutrition is released to the media, I hear the same questions all the time.

1) Why do they say that this is unhealthy now, ten years ago they said this was good for me?

2) Why do they say this is healthy now, 10 years ago they said this was bad for me?

3) Should I listen to these results and change my diet?

3) Was this a well designed study?

4) Two different newspapers reported the results differently, what is going on?

5) The government health websites tells us to do one thing, my doctor another and the media has it’s own ideas.  Who should I listen to?

            I figured I’d use this post to explain a bit about the research process and hopefully give you a better understanding of nutrition research in general.

The Scientific Method

            In reality, one study does not tell you much, even if it is well designed.  In order to change nutrition policy with confidence, you really want to see agreement among different types of research.  For example, population studies, cohort studies, randomized controlled trials, animal studies and biomarker studies are all different types of research each with their own strengths and weaknesses.  You’d really like to see most, if not all of these lines of research pointing in the direction of the hypothesis before making or changing nutrition recommendations. 

            It is also important to realize that it is totally normal to have studies that contradict each other.  Each study has its own unique methods, including different subject characteristics, different doses of the nutrient or supplement and different duration of follow up.  The way Dr. Willett at Harvard used to talk about it was very helpful.  He used to say that coming up with nutrition policy was like having a big scale with lots of stones.  The stones represent research studies.  Each time a study shows an association between a nutrient and disease, you put a stone on one side of the scale.  When a study does not support the association, you put a stone on the other side.  If a study is really well designed, it’s a big stone.  If the study has design flaws, it’s a tiny stone.  Over years, and even decades, as the research begins to mount, the scale tips to one side.  That is when the recommendations are made.

            If you think about it this way, you’ll expect to see studies that go against a recommendation now and again and you also won’t put too much weight on a single study.  It’s the accumulation of research from many different areas that leads us to make a recommendation, and this takes time.

The Media’s Play In This

            The media is a big reason why people are confused by nutrition research.  When a study comes out, they are very quick to over-inflate the importance with catchy, dramatic headlines and over-generalized stories.  I understand that they are trying to sell newspapers, but they are definitely adding to the confusion by sending the message that one study can overturn years and even decades of research.  Always take the media’s stories on nutrition research with a grain of salt.

Nutrition Science Is A Young Science

            The truth of the matter is that we have only been studying nutrition and disease in large numbers of subjects for a few decades.  Nutrition science is a young science and we are still perfecting our research methodology.  Therefore, understand that sometimes recommendations that were made 20 years ago may not turn out to be true once we look at the problem with better and more modern methods.  This may also be true 20 years from now.   Trans fat is a great example.  Decades ago, it was thought that trans fat was a better option than saturated fat to reduce risk of heart disease.  Now we know that it is far worse for you.  Our methods evolved and our studies taught us the error of the early recommendation.  As of right now I can say this with confidence; research methods have dramatically improved in the last few years and we are now beginning to understand a lot about how nutrition can affect our health. 

Publishing an article

When researchers want to publish a scientific paper, they will submit to the most prestigious journals first and then if they get rejected, submit to lesser journals with more relaxed acceptance standards.  Therefore, if an article appears in a less competitive journal, it has likely been rejected by several journals already.  Usually it will have been rejected for design flaws or because it doesn’t really add much to our current understanding of that particular nutrition and health topic.  So I always tell people to find out where the article was published.  If it was in one of the big 3 journals for nutrition literature, definitely give it more weight, if not give it a little bit less weight.  The top 3 journals for nutrition research are:

#1) The New England Journal of Medicine

#2) The Journal of the American Medical Association

#3) The American Journal of Clinical Nutrition.

Some Final Tips

So the next time you see a big nutrition study in the newspaper or TV news, consider the following.

1) This is just one study.  How does this fit into the context of the rest of the research on this subject?

2) If it goes against what we have been recommended, this is to be expected from time to time.

3) The media is probably making a bigger deal of this than it should.

4) If this was published in one of the big 3 nutrition research journals, pay attention to it a bit more.  If not, pay attention to it a bit less.

5) Always keep in mind that nutrition science is a young science and there will be some contradictions from time to time, which is true for all evolving, researched based science.  The good news is that our methods are getting pretty good and these should be fewer and fewer as time goes on.