Questions And Answers: Vitamin D

Where do we get vitamin D? 

Vitamin D is both a vitamin that we can eat and a hormone that our body can produce.  Some foods high in vitamin D include fatty fish like tuna and salmon and dairy products.  Many foods are fortified with vitamin D.  The sun’s ultra violet B (UVB) rays trigger production of vitamin D.  Spending just a few minutes in the sun during the summer months can produce many thousands of IU’s of Vitamin D.

Why is vitamin D so important?

Vitamin D is important for 2 reasons.

1) It has a major influence on our health.  Deficiency of vitamin D has been associated with an increased risk of osteoporosis, heart disease, certain cancers, multiple sclerosis and infectious diseases.

2) Deficiency is really common.  It’s hard to get enough vitamin D from your diet.  We can make it from the sun, but in the fall and winter the UVB rays that stimulate production of D are weaker, especially if you live North of the line that connects Philadelphia and San Francisco.  Deficiency of vitamin D is really common in these people as well as African Americans, the overweight and older individuals.  Sunblock also prevents production of vitamin D from the sun almost completely.

3) How can I tell if I’m deficient? 

You can ask your doctor to do a blood test on your vitamin D levels.  A level of 30 ng/ml seems to be considered by most research sources to be ideal. 

4) How much vitamin D should I be getting each day? 

This is a bit of a controversial question.  The Institute of Medicine recently came out with a report that updated their recommendations for vitamin D.  They say that for those between the ages of 1-70, 600 IU’s of vitamin D is more than enough.  For those greater than 70, they recommend 800 IU’s.

At Harvard, they think this is a bit too low.  They generally taught us that 800-1000 IU’s was really optimal.  This goes up to 2000 IU’s each day if you are at a high risk of deficiency (darker skin, obese or older). 

Despite the lower recommendations, the Institute of Medicine stated that 4000 IU’s of vitamin D each day is a safe level.

5) What is the best form of vitamin D when supplementing?

There are generally 2 forms of vitamin D that you’ll find in supplements.  Vitamin D2, also known as ergocalciferol and vitamin D3, also known as cholecalciferol.  Vitamin D2 is more of a precursor to vitamin D, while D3 is chemically the same as vitamin D.   There is some evidence that D3 is better at raising vitamin D levels so I’d recommend that over D2.

6) So, should I supplement with vitamin D?

If you’ve read my book, read this blog or work with me privately, you know I’m not a huge fan of supplementation in general.  I strongly believe that in most cases, we should get our nutrients from our food, as nature intended.  However, vitamin D is a rare exception to this philosophy.

Throughout a good deal of our evolutionary period, humans lived at a latitude south of Florida and ran around naked.  We got a lot of sun, made a lot of vitamin D and had high blood levels of vitamin D.  Now, a huge percentage of the Earth’s population does not live in such a warm client.  Not only do we wear clothes, we wear sunblock to reduce our risk of skin cancer (which is a good thing).  Therefore, supplementing with D is probably a good idea for most of us.

I recommend a multi-vitamin by Cooper Concepts that includes 2000 IU of Vitamin D in each capsule.  I take this every other day, so I’m supplementing with about 860 IU’s each day on average.  I recommend a similar protocol for my clients.  Here’s a link to this vitamin if you are interested in ordering it or learning more about it.  (http://www.coopercomplete.com/)

Research Update: Macronutrient Trends In The U.S. And Omega 3's Impact On Weight Loss

Trends in carbohydrate, fat and protein intakes and association with energy intake in normal weight, overweight and obese individuals: 1971-2006.

American Journal of Clinical Nutrition 2011; 92:836-43.

This study looked at the changes in fat, protein and carbohydrate consumption in the U.S. between the years of 1971 and 2006.  The two population samples compared were the NHANES in 1971 and the NHANES in 2006.  NHANES stands for National Health And Nutrition Examination Survey.  It is a large study conducted every 2 years to examine the health and nutrition status of non-institutionalized U.S. civilian adults and children.  Physical exams were performed in mobile units and diet was assessed by means of 24 hours dietary recalls.

The results were striking. Between 1971 and 2006 the prevalence of obesity in men increased from 11.9% to 33.4%.  In women, obesity increased from 16.6% to 36.5%.  During this time, carbohydrate consumption increased from 44% of calories to 48.7%.  Fat consumption decreased from 36.6% to 33.7%.  Protein consumption decreased from 16.5% to 15.7%.  During this period the typical man consumed an additional 179 calories per day and women consumed an additional 199 calories per day.

Take Home Message:  This study tells us 2 things: #1) As a country, we’ve bought into the whole low fat, high carb message over the past few decades.  #2) It’s not working.  As carbs go up and fat goes down, we are eating more calories and gaining more weight.   Many government and health agencies are still promoting low fat, high carb diets as a weight management strategy.  It’s time for a fundamental change in this philosophy.

Effects of omega-3 supplementation in combination with diet and exercise on weight loss and body composition.

American Journal of Clinical Nutrition 2011; 93:455-62.

The goal of this study was to determine if omega-3 supplementation can enhance weight loss when combined with diet and exercise.  Subjects were randomized to two groups.  64 subjects received 15 grams of omega-3 supplements per day with an EPA:DHA ratio of 5 to 1.  The other group of 64 received placebo pills.  Both groups received diet advice as well as resistance training and cardiovascular exercise programs.  After 6 months, the total amount of weight lost was compared.  Both groups lost greater than 5% of their initial body weight.  There was no difference in weight loss between the two groups.

Take Home Message: Despite preliminary research in animals suggesting that omega-3 supplements enhanced weight loss, it doesn’t look like it will do much in humans.  Add omega 3 to the large and forever growing list of weight loss supplements that don’t really work.

Book Review: The Dukan Diet

           The Dukan Diet is next up for review.  The author, Dr. Pierre Dukan, is a French Medical Doctor that has been specializing in human nutrition since 1973.  This book was a blockbuster in Europe and the fact that Prince William’s bride used it to get ready for her wedding did not hurt sales! From a nutritional standpoint, this book has received a lot of criticism. 

Introduction

            The diet is composed of 4 phases.  The first 2 phases are supposed to help you lose weight and the last 2 help keep it off.  Phase 1 is called the Attack Phase and consists of eating nothing but pure protein, not an ounce of fat or carbohydrate.  This phase lasts for about a week.  Phase 2 is called the Cruise Phase and consists of alternating pure protein days with protein plus low carb vegetable days.  You stay on this phase until you hit your goal weight.  Phase 3 is called the Consolidation Phase and during this phase you can eat all the protein and Phase 2 vegetables you want, 2 slices of whole wheat bread, a portion of fruit and cheese, 2 starchy carbs and 2 celebration meals per week.  You stay in this phase 5 days for every pound lost.   Phase 4 is the Permanent Phase.  Here you can eat exactly as you did on Phase 3 but you must add a pure protein day every Thursday, a 20 minute walk each day, 3 daily tablespoons of oat bran and you must pledge to use no elevators or escalators.  Overall the book was well written and an easy read.  It translates well from its native French to English.

           

5 Things I Liked About The Dukan Diet

1) Dukan is strongly against refined carbohydrate foods.  I couldn’t agree more.

2) From Phrase 3 on, the program includes 2 cheat meals.  I have found this to be extremely helpful for my weight loss clients.  You don’t need to be 100% with your diet to hit your weight loss goals and it’s not realistic to never eat for fun.

3) Exercise gets a fair amount of attention and this is quite rare for diet books.

4) The recipe chapter in the book details some creative ways to eat low carb. 

5) His theory that humans are biologically designed to be meat eaters is right on.

What I didn’t agree with in The Dukan Diet

1) The majority of the phases of this program are nutritionally unbalanced.  Extremely healthy categories of foods are eliminated or strictly limited for the majority of this dietary plan.  Examples include: vegetable oils, nuts, fruits, many vegetables, whole grains and legumes, among others.

2) It is a bit heavy on the red meat.  Steak, bacon, hot dogs, etc are allowed in unlimited quantities.  This is not a good idea.  Cooking red meat forms carcinogenic heterocyclic amines, which have the potential to increase risk of colon and other digestive cancers.  This is made worse by his recommendation to overcook red meat in order to reduce the fat content.  The more you cook red meat, the higher the formation of heterocyclic amines and the higher the carcinogenic potential.

3) Advocates taking a diuretic when you hit a tough weight loss plateau.  I had to read that one again to make sure I got it right.

4) Made some very interesting and very unscientific claims throughout the book.  Here’s an example:

            -Sucking on 5 ice cubes per day will burn off 6 pounds of fat in a year.

            -A 2 minute cold shower burns as many calories as walking 2 miles.

            -The combination of water and dietary protein melts cellulite.

5) Advocates drinking as much diet soda as you want throughout the program.  Dukan mentions that it reduces cravings for carbs.  Both current research and my experience with clients have taught me that diet soda has the potential to increase cravings for refined carbs, not decrease them.

Is The Dukan Diet 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.  Will this diet work short term? I’m sure it will, it has sold a lot of books for a good reason.  Will it work for the long term? Unlikely. The literature shows us that most can’t stay on restrictive low carb diets for very long.  Is it a healthy way to eat?  In my opinion, no.  You are strictly limiting foods we know are healthy for you and eating a lot of foods that are not.

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.