Research Update: The Right Rice And Surprising News About Milk

White rice, brown rice and risk of type 2 diabetes

Archives of Internal Medicine 2010 170:961-69

This study was by my former research group at Harvard headed by Dr. Frank Hu, an absolute nutrition all star.  This is a prospective cohort study on 157,463 women and 39,765 men from the Health Professional Follow up study and the Nurses’ Health Study I and II that were followed for about 20 years.   Participants with the highest intake of white rice (≥5 servings per week) had a 17% increased risk of type 2 diabetes compared to those with the lowest consumption of white rice (<1 serving per month).  In contrast, participants with the highest consumption of brown rice (≥2 servings per week) had an 11% lower risk of type 2 diabetes when compared to those with the lowest consumption (<1 serving per month).

Take Home Message:  Switching from white rice to brown rice is an easy thing we can all do to reduce our risk of type 2 diabetes.  Possible mechanisms presented by the authors were the higher glycemic index and the lower fiber content of white rice compared to brown rice.  The increased risk of 17% for white rice is a high number considering that this is just one food.  I actually like the taste of brown rice better anyway J

Milk and hip fractures

Journal of Bone and Mineral Research 2010 Accepted article (to be published shortly)

This is a meta-analysis that was undertaken by Harvard’s Department of Nutrition in collaboration with some European research groups.  A meta-analysis is a type of study where a researcher searches the literature for all of the relevant studies on a subject and combines them statistically to come up with a summary measure of association.  For women, 6 studies were combined (195,102 women and 3,574 hip fractures) and they found no protective effect whatsoever for milk and hip fracture.  In men, 3 studies were combined (75,149 men and 195 hip fractures) and again they found no significant protective effect of milk on risk of hip fracture.

Take Home Message: This may come as a huge surprise to a lot of people, but milk may not be a big player at all if your goal is to reduce risk of hip or other fractures.  This is not the first meta-analysis to find a neutral effect of milk on risk of hip fracture.  In fact, from an ecological perspective, the countries with the highest dairy intake (Northern European countries) have the highest risk of fracture while the countries with the lowest intake of dairy (African countries) have the lowest risk of fracture.

If you’ve read my book or work with me privately, you already know that I’m not a big fan of dairy products to start.  #1) We are the only species to drink another species milk.  #2) Most adults are unable to digest the protein in milk. #3) Dairy was designed for the cow and they have 4 stomachs.   So how do you protect your bones?  Make sure you are getting enough vitamin D, get enough physical activity (both cardio and strength training) and be sure to get calcium from your diet independent of milk.  You can find it in dark green, leafy vegetables like lettuce, spinach and kale, beans, legumes, salmon, oranges and almonds.

Top 5 Traits Of Successful Weight Loss Clients

Losing weight and keeping it off is not an easy thing to do.  For over 15 years, I’ve been studying weight loss both academically, in graduate school and clinically, working with weight loss clients.  In that time I’ve found that successful losers tend to share common traits.   Conversely, these traits are lacking in those that are not successful.  I thought I’d use this post to list the top 5 traits and explain a bit why they are so important.

Trait #5 Ability to do cardio at home

If you are serious about losing weight, cardiovascular exercise needs to be a just about daily activity for you.  The research literature is beginning to paint a very clear picture of this fact.  If you need to go to the gym to do your cardio, it just doesn’t happen with enough consistency.   I always strongly recommend that my clients have a piece of cardio at home to help them get their minutes.   If you missed my previous post on the Gazelle Edge, here is the link.  This provides a low impact, portable, inexpensive solution to this problem.

Trait #4 Resiliency

Just about every aspect of our lives now distracts us from a healthy lifestyle.  The wrong food is just about everywhere, our schedules are getting busier and busier and physical activity is no longer built into our day.  You will get off track from time to time with your diet and exercise habits.  Count on it.  It happens to all of us.  Holidays, vacations, birthdays, stressful periods at work/home all contribute to this.  The key is to get back as soon as possible.  Some people let a bad meal choice become a bad day, then a bad weekend, then a bad week and then a bad month.   Those who are successful don’t think like that.  They get back right away, I mean the next day!  I played a lot of hockey growing up and the best goalies had a very short memory.  In other words, they may let in a really bad goal but they quickly forgot about it.  They focus on the next shot like the last one never happened.  Have a short memory when it comes to your dietary and exercise indiscretions.

Trait #3 Plans ahead

My clients that are most likely to hit their weight loss goals are quite organized and plan ahead.  Here are some examples:  1) Doing grocery shopping early in the week and making sure they have what they need to prepare healthy meals when they are home. 2) When going out to eat, suggesting restaurants where they know they can make good choices. 3) When traveling, making sure that they will have access to the type of foods they need to stay on plan even if it means bringing non-perishable food items with them on their trip.  We all run into trouble when we find ourselves in situations with tempting foods and no healthy alternatives.  Minimize these situations by planning ahead whenever possible.

Trait #2 A realistic attitude about what it will take to lose weight.

Lose 30 pounds in one month eating your favorite foods and doing no exercise!  Claims like these sell a ton of books and supplements but what they don’t do is help you lose weight.  One of my old professors you to say “The only way to lose 20 lbs instantly is to cut off a leg!”.  My most successful clients don’t fall for these claims.  They know that weight loss will take a lot of effort.  They know they need to eat right, they know they need to do just about daily cardio and they know they have to hit the weights at least twice a week.  They accept the facts and go about making their changes.  They know there will be struggles but they accept them and work to overcome them.

Trait #1 They seek out the research based science of weight loss.

The individuals I work with who do the best with their weight loss realize that there is a science to it all.  They don’t care to learn about how to eat from a famous celebrity or actress who never even cracked a book on nutrition.  More than half of the weight loss best sellers on Amazon.com are written by authors that have literally never even studied college level nutrition.  They are either actors, look really good or are amazing marketers fooling consumers.   The people who buy these books would never go to a doctor that didn’t go to med school or go to a tax accountant that had never studied accounting.  People that are truly successful losing weight get the facts from the experts and are immune to all the nonsense.

Feature Article: Alcohol

            A topic that comes up every time I give a nutrition lecture, start with a private client or meet a doctor’s referral is alcohol.   Here are some of the most typical questions:

Is alcohol good for you or bad for you?

What is considered a drink?

Can I drink alcohol if I want to lose weight?

Does it have to be red wine only?

            I figured I’d use this post to answer these questions and more.  Alcohol continues to be an interesting and controversial subject.   However, current research has taught us much about the effects of alcohol consumption on our health.

Basic Information On Alcohol

            Humans have been drinking some form of a fermented beverage for over 10,000 years.   The main active substance in alcohol containing drinks is ethanol.  Ethanol exerts a direct influence on the stomach, brain, heart, gallbladder as well as the liver.  It has an effect on inflammation, blood coagulation, insulin sensitivity, serum cholesterol and triglycerides.  As many of us know, it also has a direct effect on mood, concentration, coordination and most definitely, judgment.  

Alcohol contains 7 calories per gram.  As a reference, carbohydrate and protein have 4 calories per gram while fat contains 9 calories per gram.  A drink generally contains 12-14 grams of alcohol which equates to 12 ounces of beer, 5 ounces of wine and 1.5 ounces of hard liquor. 

Health Effects

            Alcohol’s impact on human health is a rather complicated issue.  Depending on the dose, alcohol is either extremely healthful or quite literally a poison.  Heavy drinking causes severe damage to the liver and heart, increases risk of a number of cancers and is involved in roughly half of all fatal traffic accidents.    For those individuals prone to alcoholism, excessive drinking can destroy virtually every aspect of their life.

            However, the health benefits of a moderate consumption of alcohol are undeniable.   Let’s start with the heart.   There is strong evidence that alcohol increases HDL cholesterol which is probably why it is associated with a reduced risk of coronary heart disease. (1)  Alcohol also improves the factors that influence clotting which is probably why it is associated with a reduced risk of stroke. (1) Finally alcohol tends to improve insulin sensitivity and there is evidence that it reduces the risk of type 2 diabetes. (2)

            Many wrongly feel that the benefits are only from red wine due to the antioxidants in the grapes.  This is not the case.  In our cohorts at Harvard, similar benefits were found for wine, beer and hard liquor, so feel free to drink what you like.

            So what is considered moderate consumption?  1-2 drinks per day for men and 1 drink per day for women.  You need consistent intake here, you can’t save all 7 of your drinks for Saturday night at the bar, you have to drink on a just about daily basis to get these benefits.  One other thing to mention is that even a moderate consumption of alcohol has been associated with an increase risk of breast cancer in women, about 40% increased risk with 2 drinks per day (3).  However, getting enough folate seems to minimize this risk.

Alcohol And Weight

            I hate to complicate things further but I have found that alcohol can have a profound influence on your ability to lose weight.  Alcohol provides 7 calories per gram and if you have 1-2 drinks every day, trust me, the calories begin to add up.  I have read that alcohol also slows down your metabolism but I haven’t really seen a lot of hard evidence that this is true.  What I can say is true, in my experience and others, is that after a few drinks we all develop a kind of “You only live once” mentality and the late night fast food stop or trip to the diner becomes all but inevitable.  

            If you work with me privately or read my book on weight loss, you know that to limit alcohols affect on weight, I restrict my clients to 4 alcohol containing drinks per week.  This way you get some of the benefits of drinking without the negative effect on your weight.

Take Home Message

            At the end of the day, the recommendation for alcohol use depends on the individual.  Drinking in moderation (1-2 drinks for men per day and one drink for women per day) has definite health benefits.  If you have a family history of alcoholism, it’s probably a good idea not to start drinking if you currently aren’t.  If you are a female, make sure you get adequate folate if you drink even moderately to help reduce any increased risk of breast cancer.  If you want to lose weight, limit yourself to a maximum of 4 drinks per week.  This way you are obtaining some of the benefits without sabotaging your weight loss efforts.

References

1) Annals of Epidemiology 2007 175:24-31.

2) Diabetes Care 2005 28:719-25.

3) Journal of the American Medical Association 1998 279:535-40.

Research Update: Carbohydrates And Inflammation

Carbohydrate Nutrition And Inflammatory Disease Mortality In Older Adults

Buyken, AE et al.

American Journal of Clinical Nutrition 92:634-43 2010.

Objective: To examine whether dietary glycemic index, dietary fiber, and carbohydrate containing food groups were associated with mortality attributable to inflammatory disease.  These diseases include diabetes, Alzheimer’s, Parkinson’s, infectious disease, respiratory diseases, immunologic diseases, digestive diseases and others.

Study Population: 1,400 postmenopausal women and 1,245 men aged 49 or older.  This was an Australian cohort that was followed for 13 years.  By the end of follow up, 84 women had died and 86 men had died.

Results:  Women with the highest dietary glycemic index had a 2.9 fold increased risk of death from inflammatory diseases.  Increasing intake of foods high in sugar or refined starches also independently predicted a greater risk of death from inflammatory diseases.

In men, increasing consumption of fruit and fruit fiber decreased risk of death from inflammatory disease.

Comment:  This study is interesting for a variety of reasons:

#1- I’ve seen literature suggesting that a diet rich in high glycemic carbohydrates increases C - reactive protein (a marker of body wide inflammation), but this is the first study I’ve seen that looks at death caused by inflammation.

#2- A tripling of the risk of death in a 13 year period for women with the highest glycemic index is a very significant finding with a huge public health relevance considering the high glycemic nature of the current American diet. 

#3- The fact that the results were not the same for men was interesting.  It’s not the first time that I’ve seen the effects of glycemic index attenuated in men.  The authors mention that the reason for this may be that men have a higher antioxidant status than women until age 75.

Take Home Message:  The explanation for these results may stem from the hyperglycemia (high blood sugar) that results from chronic consumption of high glycemic carbohydrates.   This may result in an overproduction of free radicals and a greater release of inflammatory cytokines.  

If you read my book or work with me privately, you already know how heavily influenced my nutritional recommendations are by the glycemic index and glycemic load.  This is further evidence to avoid refined carbohydrate containing foods such as white bread, pasta, white rice and most importantly, sugar.

Question And Answer: Breakfast

          I’ve been working in the fields of exercise and nutrition for over 15 years.  I see many of my own private clients each day and a number of doctors in Boston send me out to meet with their patients for weight loss and disease risk reduction.  I’ve noticed that certain questions tend to come up time and time again and I thought it would be a nice feature to answer some of them for you on this Blog.  Today’s topic is breakfast.

Question:  Skipping breakfast is a good way to decrease the day’s calories and lose weight, right?

Answer: Absolutely not!  When you skip breakfast you switch on a mechanism that will increase weight gain, not weight loss.    You must remember that we evolved in times of famine and food scarcity.  To survive, humans had to develop ways around these tough times in our evolution.  If you finish dinner at 7:00 PM and then wake up, skip breakfast and eat lunch at noon, you have gone 17 hours without eating.  This tells the body that there is a lack of food around and the body makes 2 relevant adjustments.  1) It slows down your metabolism. 2) It preserves your body fat and will burn muscle for energy.  Neither of these will help you lose weight.  Eat a nice sized breakfast every single day.

Question: I’m just not hungry in the morning, doesn’t that mean that I don’t need to eat?

Answer: Not at all.  You will develop a hunger for breakfast once you get into the routine.  If you have to force yourself at first, so be it.

Question: Is it alright to drink coffee in the morning?

Answer: Absolutely.  Feel free to drink a cup or 2 of coffee each day, regular or decaf.  Recent research suggests that coffee drinkers have a slightly reduced risk of cardiovascular disease and type 2 diabetes, so it may actually be good for you.   However, make sure you don’t add sugar or artificial sweetener to your coffee (a little milk or cream is ok).

Question: Can I do smoothies for breakfast?

Answer: I’m not a huge fan.  #1) I like real food in general, I don’t like powders or supplements for protein.  #2) Most smoothies include adding whole fruits and blending them to a puree.  This separates the sugar in the fruit from the fiber and will cause a greater spike in blood sugar and insulin than if you ate the whole fruit as nature intended.  This will have a negative effect on subsequent hunger and body weight.  A simple breakfast like nuts, fruit and a few slices of turkey breast takes no more time to make than a smoothie and will better stabilize your blood sugar.

Question: I do my cardio in the morning, should I eat before or after?

Answer:  This depends entirely on you.  Some people can workout on an empty stomach and feel fine (like me).  I don’t eat before my cardio if I do it first thing in the morning.  If you feel really hungry and weak without breakfast, I would suggest splitting your breakfast in two parts and eat half before your workout and the other half after.  I don’t think it is a good idea to workout on a full stomach.

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Book Review: The Paleo Solution by Rob Wolf

           Another regular feature of my Blog will be book reviews.  I’ll take a look at popular books on Diet, Exercise, Weight Loss and Health and let you know what I think.  I have only 2 criteria for reviewing a book.

1) It must be a Nutrition/Weight loss top 20 best seller on Amazon.  I want to review books that you all have heard of and may like to read.

2) The author must have credentials.  I need to see some level of education.  In other words, I need to see proof that the author has at least a peripheral understanding of nutrition science and research.  I am more than tired of celebrities who are selling diet and weight loss books without ever opening a book on the subject.

            The Paleo Solution by Robb Wolf meets both criteria nicely.   It is a best seller on amazon.com in the category of weight loss and the author has a degree in biochemistry, a field closely correlated with nutrition.

Introduction

            The book is based on the theory that the diet we ate during the Paleolithic or “hunter-gatherer” era of our evolution is the most health promoting.  The book is really well written and quite humorous at times.  The author and I have a lot in common.  In our youth we were both trying to be healthy and followed a low fat, high carb diet that made us sick.  We eventually learned about the right way to eat, fell in love with the field of nutrition and got a degree in the field.  The book spends a lot of time going over the biochemistry of digestion, presents a detailed 30 day meal plan and spends a good amount of time discussing exercise.   It’s a fairly long book (320 pages) but it reads quick because it is interesting and well written.

5 Things I really like about The Paleo Solution

1) The idea of studying human evolution to figure out what we should eat.  Anyone who has worked with me or read my book knows that my nutrition philosophy is heavily influenced by studying the original human diet.

2) The emphasis on the biochemistry of digestion.  The author does a great job explaining the hormonal consequences of eating different foods.  This is very important information if you want to truly understand the health effects of the foods we eat.

3) Emphasizes the importance of adequate sleep.  This is huge for both general health as well as weight loss.

4) Stresses that exercising too much is not good for you.  I like the moderate approach he takes to increasing physical activity.

5) Focuses on just 3 meals a day.  I totally agree with this philosophy.  With a stable blood sugar, there is no need to graze.

5 Things I disagreed with in The Paleo Solution

1) One thing that I found a bit tough to take is how the author kept blasting the nutritional research as quackery and non-scientific.   I feel that the research we do at Harvard is extremely relevant and our methods are tried and true.  There are a lot of problems with nutrition science for sure but to make such a blank statement was a bit rough.

2) The author believes that all grains are unhealthy.  I don’t agree with this.  There is very well designed research that points to the beneficial effects of whole grains on risk of heart disease, diabetes and even some cancers. 

3) The author also doesn’t differentiate cereal fiber from other forms of fiber.  He mentions that you get lots of fiber on his diet, which is true, but none of it is cereal fiber.  In our research at Harvard, cereal fiber had the most protective effects regarding disease risk reduction.

4) The meal plan was a little heavy on the red meat.  One of his sample days had red meat at all 3 meals and even for the snack.   This is not a good idea.

5) The nutrient composition of a sample day on his plan was: Fat 39%, Carb 23%, Protein 38% and cholesterol 461 mg.  This is a bit high on the protein.  I did a review paper on high protein diets and I feel this amount of protein may put a stress on the kidneys of sensitive individuals.  I’m also not crazy about the amount of cholesterol ingested on this day.

Is it worth reading?

        I think The Paleo Solution is definitely worth reading.  I learned a lot about how our early ancestors lived and ate and this is extremely relevant when asking questions about the lifestyle we were designed to live.   However, I think to follow the diet literally isn’t the best idea.   There is a lot of really good research out there that has improved our knowledge of the health effects of our food and that must be taken into account in addition to our native diet. 

        One last thought: Our early ancestors lived for only 30-35 years.  Who knows what long term health affects this native diet would have had on risk of heart disease, stroke, diabetes and cancer if they lived to their mid 70’s like we do?

Research Update

As many of you may already know, I read the nutrition literature monthly to keep up to date on the latest research.  I will regularly post summaries of some of the studies that I find particularly relevant.  Here is the latest:

Red Meat And All Cause Mortality

Archives of Internal Medicine vol 169, pp 562-71, 2009

These results came from the National Institutes of Health-AARP Study and included approximately 500,000 participants.  Those who ate the most red meat (5 oz per day) were 30% more likely to die over the next ten years than those that ate the least (2/3 oz per day).  For the purposes of this study, red meat included beef, veal, lamb and pork products.

Take Home Message: This is not the first time we’ve seen such results regarding red meat consumption.  It is high in saturated fat, often contains nitrates and sulfates, and when cooked converts carcinogenic heterocyclic amines.  Focus on chicken, turkey, fish, eggs and legumes for your protein choices and let red meat be an occasional treat.

Micronutrients And Fad Diets

American Journal of Clinical Nutrition vol 92, pp 304-12, 2010

This study looked at 4 distinct dietary approaches to weight loss and measured their nutrient quality.  73 overweight or obese women were put on each diet for a period of 8 weeks.   The diets tested were the Atkin diet (extremely low carb), the Zone (moderate carb, Mediterranean), Ornish (extremely low fat) and LEARN (based on the US Food Pyramid).   The results were very interesting.  The Atkins group was deficient in Thiamin, Folate, Vitamin C, Iron and Magnesium.  The Ornish group was deficient in Vitamin E, B-12 and Zinc.  The Learn group was deficient in Vitamin E, Thiamin and Magnesium.  The Zone intervention resulted in no deficiencies and in fact was associated with a significantly decreased risk of deficiency for Vitamins A, E, K and C.

Take Home Message: This study provides more evidence of the healthful nature of a Mediterranean style of eating.  Moderate low glycemic carbs, a good amount of healthy fats and lean sources of protein are the hallmarks of this dietary strategy.  If you’ve read my book, worked with me or read this Blog this is old news for you!!! :)

Omega 3 And Fish Consumption And Risk Of Age Related Hearing Loss

American Journal of Clinical Nutrition Vol 92, pp 416-21, 2010

This was a cohort study of 2,956 men and women in Australia.  Diet was measured by means of a food frequency questionnaire and then hearing was measured at 5 and 10 year follow-up visits.   Subjects that consumed fish greater than or equal to twice a week had a 42% reduced risk of age related hearing loss compared to those that ate fish less than once a week.

Take home message:  This study provides even more evidence of the benefits of fish consumption.  Make sure you include seafood in your protein choices at least twice a week but limit consumption of the high mercury varieties- including Swordfish, King Mackerel and Tilefish.