Product Review: The Ipad

It’s time for another product review and this time I’m going with the Ipad.

This won’t be a technical review that you’d find on CNET, but will be a review of how you can use the Ipad to promote a healthy lifestyle.  There are dozens of apps that will help you reach your fitness and nutrition goals.

I know the Ipad isn’t cheap, I bought mine for $500 on Amazon.com.  I went with the lower memory, WIFI version because I didn’t think I’d need too much space and I knew I’d be using it mostly at home, where I have wireless.  Besides, the monthly fee for 3g didn’t appeal much to me at all. :)  Despite the upfront cost, I have to say it was worth every penny, I use mine every single day.

Many of my clients have Ipads as well and I’m learning that it has been a real tool for them to stay on course with their diet and exercise.  Following are some uses/apps that have proven beneficial.

Keeping Track Of Your Lifestyle

Record keeping is huge if you are trying to change your diet and exercise habits.  The research bears this out and I’ve definitely noticed this throughout my years of experience working with weight loss clients.  Here are some of the ways you can use your Ipad for record keeping.

1) Recording your weight each week

2) Recording your cardio minutes each week

3) Recording your daily food intake

You can get specialized apps for each of these or simply use a note app like Sticky Notes (which has a free version).

4) Streaks Motivational Calendar- is an App for the Ipad.  It was created by Fantzer, Inc and costs just 1.99 to download and use.  It is an extremely simple concept but it is also extremely effective.   Streaks allows you to create a calendar with a goal in mind.  Every day that you are successful in obtaining your goal, you mark it down on your calendar for that day.  Streaks will keep track of your consecutive days of success.  It also will record your longest streak so you have something to shoot for.  If you are trying to give up sugar, do your cardio everyday, stop eating after 8:00 PM or anything else, you set up a calendar and keep track.  If you mess up, start over again and try to break your longest streak.  Before you know it, you are hitting your goal for increasing lengths of time. 

Cardio Distraction

We all know that to lose weight and stay in shape, cardio has to be a just about daily occurrence.  While there are people out there, such as myself, that actually enjoy doing cardio, (my clients have called me a “freak” because of this) for most people it is something they have to do.  Using your Ipad to either distract you or to be productive during your session makes cardio a lot more pleasant for these people.

1) Ipod- Your Ipad comes with an Ipod app built in, so you can listen to your music while working out.

2) Movies-You can buy and rent movies and TV shows from Itunes and watch them on the Ipad.

3) Netflix App- For $7 a month you can sign up for Netflix and watch unlimited movies that are streamed instantly to your Ipad.  I’m currently watching a 14 hour documentary on World War 2 by Ken Burns while working out and it is awesome!

4) Kindle App- With the free kindle app, you can turn your Ipad into a Kindle and read books.

5) Skype- With the free skype app you can talk for free to anyone else in the world who has skype.  This is a great way to pass the time while getting in your cardio.

6) Safari-Use the built in web browser to check your emails, read the paper online or surf the net.

These are just some of the ways you can use the Ipad to enhance your health and fitness.  Although it is definitely a little pricey, you’ll fall in love with your Ipad immediately.  I know I have.

Research Update: Individual Foods And Weight Gain

Changes In Diet And Lifestyle And Long-Term Weight Gain In Women And Men

New England Journal Of Medicine 2011; 36:2392-404.

Objective: To examine the impact of individual foods on weight gain over 20 years.

Study Population: 120,877 U.S. men and women from 3 separate cohorts, The Nurses’ Health Study, The Health Professional Follow-up Study and The Nurses’ Health Study II.

Methods:  Subjects were followed for approximately 20 years (20 years for the Health Professional Follow-up subjects and Nurses’ Health cohort and 12 years for the Nurses’ Health II cohort).  The impact of different foods and lifestyle factors on long term body weight was computed statistically.

Results:  Subjects gained an average of 3.35 pounds every 4 years for a total of 16.8 pounds over 20 years.  Weight gain was most associated with consumption of potato chips (1.69 pounds over 4 years for each daily serving), potatoes (1.28 pounds over 4 years for each daily serving), sugar sweetened beverages (1.0 pound per daily serving), red meat (.95 pound per daily serving) and processed red meat like bacon, pepperoni, etc (.93 pound per daily serving).

Conversely, weight loss was most associated with yogurt consumption (-0.82 lbs over 4 years per daily serving), nuts (-.57 pound per daily serving), fruits (-.49 pound per daily serving), whole grains (-.37 pounds per daily serving), and vegetables (-.22 pounds per daily serving).

Results were also reported for lifestyle factors: physical activity was associated with weight loss, while alcohol consumption, watching too much TV and sleeping more than 8 hours and less than 6 hours were all associated with weight gain.

Discussion: This is a very well designed study.  If you need evidence of this, you just have to look at the journal that it appears in.  The New England Journal of Medicine is the holy grail of medical research. 

Just about all of the foods that promoted weight gain were high glycemic load, refined carbohydrates and just about all the foods that promoted weight loss were low glycemic load foods.  I have found this to be absolutely true in my weight loss practice.  High glycemic load carbs cause a reactive hypoglycemia in most people that dramatically increases hunger a few hours after consumption.  The high insulin levels these foods promote may also favor fat storage.

Another thing that jumped out at me while reading this paper is the idea that even tiny changes in our diet can have dramatic impacts on our long term weight.  If you have an additional 75 calorie snack each day, this will actually add up to a gain of almost 8 pounds per year and over 23 pounds in 3 years!  This is a big reason why I have my clients eliminate snacking and, of course, strictly limit the high glycemic load carbs.

Take Home Message: If weight loss is your goal, you need to understand the concept of glycemic load.  This study provides even more evidence of the weight gaining effects of high glycemic carbs. 

Top 10 List: Sources Of Sodium In The American Diet

The impact of sodium on health has received a lot of attention in the field of nutrition lately.  Countless public health initiatives designed to reduce sodium consumption in the U.S. are currently underway.  The bottom line is that we eat way too much sodium and it is having a negative effect on our health.

Most of us know that high salt consumption is associated with high blood pressure and risk of heart disease and stroke.  While this is the major issue with over consumption of salt, sodium has also been associated with stomach cancer and osteoporosis.  It used to be that if you were free of hypertension, you wouldn’t have to worry about sodium.  Those days are over.  It is now clear that everyone should take steps to reduce sodium in their diet. 

This Top 10 List is devoted to the biggest sources of sodium in the American diet.  This list is based on a combination of the amount of salt found in the food and the frequency of consumption.  It is based on data from the Grocery Manufacturer’s Association (Reference 1).  You may be surprised at some of the sources, I sure was.  Stay tuned for a more extensive post on the health effects of sodium in the next few weeks.  In the meantime, we can all start by limiting consumption of these foods.  My private clients and readers of my book should be well on their way to getting this stuff out of their diet anyway. :)

Top 10 Sources of Sodium In The American Diet

1) Meat Pizza

2) White bread

3) Processed Cheese

4) Hot Dogs

5) Spaghetti With Sauce

6) Ham

7) Ketchup

8) Cooked Rice

9) White Rolls

10) Flour Tortillas

References

1) Grocery Manufacturers Association.  Sodium and salt: a guide for consumers, policymakers and the media. Washington, D.C. 2008.

Feature Article: Saturated Fats: Harmless After All?

The impact of saturated fat on health is a controversy that has been brewing for some time in the field of nutrition. Early research based on animal investigations, ecological observations and controlled feeding studies looking at serum cholesterol supported a major, negative effect of saturated fat on risk of coronary heart disease. 

More recently, there has been some research that may call this into question.  For example, certain classes of saturated fats have been shown to have different effects on our health than others. Furthermore, saturated fat has been shown to be more or less harmful depending on what you eat in its place.  For years, proponents of low carb and paleo diets have been saying that saturated fat is mostly harmless and that the real enemy is carbohydrates.  Some people even take coconut oil (which is a saturated fat) as a health supplement.  So what’s the story here?  Is saturated fat as bad for you as we thought or can you feel free to load up on butter and steaks without risking your heart?  Let’s clear the air.

What Are Saturated Fats?

Saturated fats are fats that contain no double bonds.  All of their carbons are saturated with hydrogen.  They are found, for the most part, in animal products.  Sources of saturated fat include butter, cheese, whole milk, steak, bacon, hamburgers, pepperoni and other fatty meats.  There are also a couple of vegetable sources of saturated fats, most notably coconut oil and palm oil. 

Symposium On Health Effects Of Saturated Fat

In light of the recent questions concerning saturated fats, an expert panel was put together to weight the evidence.  There were some pretty impressive researchers on this panel, including Harvard’s Dr. Walter Willett and Dr. Frank Hu.  The members of the panel reviewed the literature and came up with a consensus opinion on the health effects of saturated fat.  They published their findings in the American Journal of Clinical Nutrition (Reference 1).

Here are some of the key findings:

1) The risk of heart disease is decreased when polyunsaturated fats replace saturated fat in the diet.  For every 1% of energy from saturated fats that are replaced with polyunsaturated fat, the risk of heart disease is reduced by 2-3%.  This is mostly due to the lowering of LDL cholesterol.

2) No clear benefit has been shown for substituting carbohydrates for saturated fat.  However, this may be due to the fact that so much of the carbohydrate consumed in the US is refined and high glyemic load.  These types of carbs tend to lower HDL cholesterol and raise triglycerides.  Evidence is suggestive that replacing saturated fat with low glycemic load carbohydrates significantly reduces risk of heart disease.

3) Replacing saturated fat with refined carbohydrates decreases HDL and LDL particle size (smaller LDL particles are more atherogenic than larger ones) and increases triglycerides.  These changes are quite harmful when it comes to risk of heart disease.

4) It is difficult to tell the effects of monounsaturated fats because in the US, a large percentage of monounsaturated fat is consumed in the form of beef and dairy.   Having said this, the research is suggestive that replacing saturated fat with monounsaturated fat will reduce risk of heart disease.

5) Individual saturated fats have different physiological effects.  Stearic acid tends to be less harmful than other types of saturated fat.   Regarding cholesterol raising effects, stearic acid appears to be neutral where other saturated fats (12:0, 14:0 and 16:0) raise LDL and HDL cholesterol.  C-14 appears to have the most negative effect.

6) There is not enough evidence to judge if short and medium chain saturated fats are harmful.

Take Home Message

So, at the end of the day, saturated fat is still pretty bad for you and it's a good idea to limit it in your diet.  If you replace saturated fat with polyunsaturated fats or monounsaturated fats your risk of heart disease is reduced significantly.  You’ll find these types of fats in vegetable oils, nuts, seeds and avocados.  If you replace saturated fat with low glycemic carbohydrates, it looks like you will also reduce your risk of heart disease.  On the other hand, if you replace saturated fats with the wrong type of carbs like white bread, pasta, white rice and sugar, you may actually be worse off.   The take home message is that the wrong type of dietary carbohydrate is as harmful as the wrong type of dietary fat.  If you’ve read my book or work with me privately, this is old news to you!

Reference

1) The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: Where does the evidence stand in 2010? The American Journal Of Clinical Nutrition 2011;93:684-88.

Research Update: Mediterranean Diet Vs Low Fat Diet For Weight Loss

A Randomized Controlled Trial Of A Moderate Fat, Low Energy Diet Compared With A Low Fat, Low Energy Diet For Weight Loss In Overweight Adults
McManus K, et al.
International Journal of Obesity 2001 25:1503-11.

Objective: To compare the efficacy of a low fat diet and a moderate fat diet for long term weight loss.

Study Population: 101 overweight men and women (BMI between 26.5 and 46).

Methods: Subjects were randomized to one of two weight loss interventions.  Both diets had a goal of 1200 calories per day for women and 1500 calories for men.  Both diets provided 15-20% of calories as protein.  The low fat diet provided 20% of calories as fat and 60-65% of calories from carbohydrate.  The moderate fat diet provided 35% fat and 45-50% carbohydrate.

Everything else about the interventions was identical, including physical activity recommendations, behavior modification advice, weekly nutrition counseling sessions and the recording of food to gauge compliance.  Measurements included body weight, BMI, waist and hip circumference, physical activity and nutrient intake.  These were taken at baseline, 6, 12 and 18 months.

Results: 1) After 18 months, the moderate fat group had lost 9.2 pounds, decreased their BMI by 1.6 points and decreased their waist circumference by 2.7 inches.        2) During this same period, the low fat group gained 6.4 pounds, increased their BMI by 1.4 points and increased their waist circumference by 1 inch.  3) After 18 months, only 20% of the low fat group was actively participating in the weight loss program while 54% of the moderate fat dieters were sticking with their plan.

Discussion: This is a beautifully designed study.  First of all, it was 18 months long so you can assess both weight loss and maintenance of lost weight.  All elements of the weight loss interventions were identical, including total calories, total protein, physical activity and the dietary counseling component.  The only difference between the two interventions is that one was low fat, high carb and the other was moderate fat, moderate carb.

The results are striking.  After 18 months, the moderate fat group was 15.6 pounds lighter than the low fat, high carb group.  It is also notable that only 20% of the low fat dieters were able to stick to their program long term, while over 50% of the moderate fat dieters were able to stick to their program.  This is the knock on low fat diets in general.  Early on, you can lose some weight with them, but it appears that most weight is regained fairly quickly.  It seems that people have a hard time sticking to the low fat plans.  This is most likely due to the increased hunger caused by the dramatic swings in blood sugar on these diets.

Take Home Message: Fat is not the enemy, people.  When chosen wisely with vegetable source of fat, a moderate fat diet (35% of calories) can help reduce the risk of heart disease and diabetes and even help you maintain your weight.  Losing weight is great, but keeping it off is better.  The research is beginning to mount that a moderate fat diet gives you a better chance of keeping your weight off than a low fat diet.

Questions And Answers: Running

I always get a lot of questions on cardio in general and running in particular, so I thought running would make a great topic for my next Q and A.  As always, if you are initiating an exercise program, check with your doctor to make sure it is safe to do so.

Is running a good exercise for weight loss?

Yes and no.  As far as its effectiveness, running is great for weight loss.  You burn a ton of calories.  However, it is high impact and over time can be very tough on the body.  When we run, we put up to 6 times our body weight on our joints.  I’m about 190 lbs, so when I run, I’m pounding my knees, hips, back and ankles with the equivalent of over 1100 pounds of joint stress!  I don’t think our bodies were designed to deal with this level of impact, particularly if you run long distances multiple times per week.  I have found if someone runs long enough and far enough, year after year, they will surely have to deal with some major overuse injuries that can have a negative impact on their ability to engage in physical activity as they age.

I think I want to run a marathon, should I?

I always try to talk my clients out of running marathons.  I get the challenge and sense of accomplishment that goes with running one, but I just don’t think it’s safe.  I’ve already covered the joint stress issue.  Another issue is the effect of that amount of exercise on immune function.  The graph of exercise and immune function is J-shaped.  Your immune system starts to improve with increasing exercise.   However, after a point, immune function starts to decline with increasing exercise.  It even gets to a point below the baseline.  What that means is exercising too much can be worse for your immune system than not exercising at all.  Ever notice how most marathon runners get an upper respiratory infection after the race?  I’m not a fan of any activity that depresses immune function. 

What if I just love to run?

I’ve worked with enough clients over the years to know that running is really addicting and many people will do it despite my recommendation not to.  In this case I would suggest a modified run/walk program.  What I have them do is run for 2 minutes at a pace a little faster than normal and then follow this with 3 minutes of brisk walking.  This interval is repeated throughout the cardio session.  With this strategy, you get the increased calorie burn of running but also break up the impact of continuous running.

Do you advise your clients to run?

Never, I always try to talk them out of it.  If they persist I suggest the run/walk program described above.  I also let them know about lower impact forms of exercise like elliptical training.  This form of exercise will give you a similar calorie burn while protecting the joints. 

Book Review: The China Study

The China Study by Dr. T. Collin Campbell is next up for review.  Dr. Campbell is an accomplished researcher who is a Professor in Nutritional Biochemistry at Cornell University.  Dr. Campbell has published a ton of research papers and has served as a member on a number of government nutrition and health committees.  He is probably most well known for his work on the China Study, which is an ecological study of nutrition and disease among 6,500 people across China.  The focus of this book is what Dr. Campbell learned from the China Study.

Introduction

Dr. Campbell strongly believes that we should eat a very low fat, low protein diet devoid of all animal products.  If you read this blog regularly or have read my book, you know I am not a low fat or vegetarian guy.  In fact, I feel that low fat diets can have a negative impact on our health due to their resulting high glycemic load.  However, in the young field of nutritional epidemiology, I believe it is important to read work that goes against your own personal views to further understand the controversies that make this field so interesting and thought provoking.  The book presents a lot of Dr. Campbell’s research on nutrition and disease.  He then tells you what foods to eat, and goes into a detailed explanation of the problems with nutrition research and policy at both the academic and government level.  Overall the book was well written and an interesting read.

5 Things I Liked About The China Study

1) Points out the dangers of red meat and saturated fat.  One thing we have all learned from low fat diet advocates is that saturated fat and lots of red meat can be harmful.  This book is no exception.

2) Emphasis on fruits and vegetables.  Fruits and vegetables are the best things we can eat to improve our health.  This is stressed throughout the book.

3) Emphasis on whole grain foods.  While I’m not a high carb guy by any stretch, I realize the importance of whole grains in our diet.  The literature is teeming with evidence that whole grains improve our health and reduce risk of heart disease, stroke, diabetes and certain cancers.

4) De-empahsizes dairy products.  Those of you who know my writing know that I’m not a huge fan of dairy. 

5) Nutrition policy section  As a member of a number of government committees on nutrition policy, Dr. Campbell can relate his first hand experience on the competing interests of academia, the food industry, research science and the government’s influence on our food policy recommendations.  I found this section a very interesting read.

What I didn’t agree with in The China Study

1) This books groups all fats as unhealthy.  While certain fats are unhealthy (saturated fat and Trans fat) other fats like mono-unsaturated fat, poly-unsaturated fat and omega 3 fatty acids are extremely health promoting.  I don’t know why he didn’t differentiate the different classes of fats.

2) This book groups all animal proteins as unhealthy.  There is a very big difference in how chicken, salmon, turkey and egg whites treat our bodies when compared to steak, bacon and hot dogs.  Some animal proteins are bad for you and some are not.

3) Very high carbohydrate diets have recently been shown to have a negative impact on HDL cholesterol and triglycerides when compared to more Mediterranean style diets.  This isn’t mentioned anywhere in the book.

4) Very high carbohydrate diets result in a high dietary glycemic load.  The glycemic load has been associated with a variety of diseases in the past 10 years.  There was no mention of this anywhere in the book or even of the glycemic load as a concept.

5) His criticism of the Nurse’s Health Study was baffling.  He feels that NONE of the research out of Harvard tells us anything because of flaws in the design of the study.  I had a hard time understanding this argument.  His study is ecological in nature, follows 6,500 Chinese citizens and measures diet one time via a 3 day food record and he has total confidence in the results.  The Nurses’ Health Study is a prospective cohort study, follows 120,000 American nurses for over 30 years and measures diet by means of a validated food frequency questionnaire that is updated every 4 years to reflect changes in diet.  Every aspect of the Nurses’ Health Study is superior to the China study yet it is given no respect in this book. 

Is The China Study Worth Reading?

Absolutely.  I enjoyed the book and learned a lot.  At the end of the day, low fat diet advocates taught us a lot about a healthy diet: the dangers of saturated fat, red meat and dietary cholesterol as well as the benefits of fruits, vegetables and whole grains.  However, well designed research has added a lot to our understanding about the benefits of healthy fats, lean animal proteins, fish and other sources of omega 3’s and most importantly, a low glycemic load diet.