Livestrong

As some of you may know, I recently was hired as a free lance writer for Livestrong.com.

Livestrong is a great site that features a ton of useful health, fitness and nutrition information.  It gets over 6 million hits a month!  I figured that I’d share my last 3 articles that were published on livestrong.com as this blog post.

#1) Why is week 2 of weight loss so hard?  In this article I detail some of the reasons that week 2 of weight loss is not as successful as week 1.

#2) The best all around exercise machine? In this article I declare one exercise machine as the king of them all.  Spoiler alert: it’s the elliptical trainer.

#3) Why aren’t I losing weight on my gazelle?  This article explores how to use the Gazelle Exercise Glider optimally for weight loss.

I hope you enjoy the articles and the site and let me know what you think!

Top 5 Items To Include In Your Home Gym

Going to the gym can be a fun and motivating way to stay in shape.  When I was a doctoral student, it was one of my favorite parts of the day because school was both demanding and sedentary and I really needed to release some stress.

Now that I’m working, getting to the gym is a lot more challenging.  I rarely have a chunk of time in my day when I can get to the gym, get changed, workout and then travel home.  The huge crowds before and after work at most gyms have always turned me off.  A great solution for me and many of my clients is to work out at home.  You don’t need to have a lot of space or spend a lot of money.  In fact, if you took 1 years worth of gym dues, you can set yourself up with a great space saving home gym that will last you a lifetime, or close to it.

By working out at home you save money and you save time and who couldn’t use more of those two things?  Therefore, I am dedicating this post to The Top 5 Items To Include In Your Home Gym.

#1) Gazelle Edge Glider: This is a portable, inexpensive glider (very similar to an elliptical trainer) that will totally take care of your cardio needs.  It folds up for easy storage, costs around $100 with free shipping from amazon.com, and is all around awesome!  I’ve been using one for my cardio for years and love it.  I’d say about 80% of my clients also pick it up and love it too.  I dedicated an entire blog post to the Gazelle.  Here it is

#2) Free weights:  Nothing beats these, period!  For the ladies, pick up a set of 5’s and 8’s.  For the guys, pick up some adjustable free weights that are plate loaded.  They sell these at sporting goods stores.  I’d say get a set that will allow you to go up to 40 pounds or so.  If you want to spend the money, you can also get the spin lock weights from Bowflex or Powerblock.  These can be a bit pricey and they don’t really do anything more for you than free weights but are definitely more convenient and take up less space.

#3) Exercise bands: The one body part that is difficult to exercise at home is your back.  While there are a variety of free weight exercises that target the back, nothing beats the pulling exercises of the lat pull down machine.  A good set of exercise bands takes care of this nicely.  I have Bodylastics bands that come with a door anchor.  This allows your bedroom door to become a high or low back machine.  They are a bargain at $45 on amazon.com. Check them out here

#4) PT Pro Portable Fitness Bench: This bench is awesome.  It pops up for incline exercises, folds down for decline exercises and the legs fold up for easy storage in a closet.  I have one and love it.  It’s a bit pricey at $299 but it is totally worth it if you are pressed for space. 

Here's the link 

#5) Door mounted chin up bar:  You’ve probably seen these on TV.  This chin up bar requires no permanent installation.  It fits on your door frame and you can take it off when your not using it.  I use it with arm slings for ab exercises and it’s also great for chin ups and pull ups.  It is also a bargain at $24 on amazon.  Here's the link

Research Update: Protein, Glycemic Index, And Maintenance Of Weight Lost

Diets With High Or Low Protein Content And Glycemic Index For Weight Loss Maintenance

Larsen TM, et al.

New England Journal Of Medicine 363:2102-13 2010.

Objective: To examine whether manipulating dietary glycemic index and protein consumption has an impact on maintaining weight loss.

Study Population: 773 men and women from 8 European countries that had lost at least 8% of their body weight on an 800 calorie diet.

Methods:  All participants were put on a low calorie diet prior to the study and had lost 8% of their initial body weight.  After this point they were randomly assigned to one of 5 diets:

1) Low protein (13% of calories) and low glycemic index

2) Low protein (13% of calories) and high glycemic index

3) High protein (25% of calories) and low glycemic index

4) High protein (25% of calories) and high glycemic index

5)  A control diet

The goal of the glycemic index variable was a difference of 15 units of dietary glycemic index.  Subjects were monitored for 26 weeks to see which group was able to keep the weight they lost off.

Results:  1) Subjects who were in the low protein, high glycemic index diet intervention were the only ones to gain a statistically significant amount of their weight back. 2) Subjects in either high protein group regained significantly less weight than subjects in either low protein group. 3) Subjects in either low glycemic group regained significantly less weight than subjects in either high glycemic group.

Take Home Message:  First of all, this was a really tightly designed study that made it into the #1 journal in the world, The New England Journal of Medicine.  That alone says a lot about the methods and overall validity of the study design.

This study shows that if you focus on lower glycemic carbohydrates and add a bit more high quality protein to your diet, you’ll have an easier time maintaining your weight loss.  If you’ve read my book or work with me privately, this is old news to you.  I have seen this for years with my own clients. 

Another really interesting finding is that the investigators also watched the subjects for additional weight loss.  Both the high protein and low glycemic groups were more likely to achieve an additional weight loss of more than 5%.  It appears that in this group of subjects, a higher protein and lower glycemic approach improved both the ability to lose weight and the ability to keep it off.

Feature Article: Eggs; Hero Or Villain?

The controversy surrounding the egg is a great example of the chasm between popular opinion and current research in the field of nutrition.  Eggs have been criticized for years because of their cholesterol content.  Many doctors and even nutritionists have people throw away their egg yolks, buy egg substitutes or avoid eggs altogether in an effort to reduce their risk of heart disease and improve their health.  Well designed research regarding eggs and our health has been conducted and it’s time to set the record straight. 

Why have eggs been vilified?

Eggs are considered an unhealthy food for one basic reason; they are high in cholesterol.  A single egg has 213 milligrams of cholesterol.  The daily recommended level of dietary cholesterol is 300 milligrams per day.  So consuming one egg comes close to the daily recommendation and consuming 2 eggs at a meal exceeds the daily recommendation for cholesterol.  The theory behind the advice to avoid eggs is that consuming a lot of dietary cholesterol will raise serum cholesterol and increase risk of heart disease and stroke.

Does the cholesterol you eat in your diet increase your risk of heart disease?

Cholesterol that you consume in your diet is only weakly associated with your serum cholesterol levels.  There is strong evidence that trans fat and saturated fat consumption have a negative impact on serum cholesterol, but this does not seem to be the case with dietary cholesterol.  In both the Nurses’ Health Study and the Framingham Heart Study (2 of the largest and most well designed cohort studies in existence) dietary cholesterol was not associated with an increased risk of coronary heart disease.  (See Reference 1, Reference 2)

Have eggs been shown to increase risk of heart disease?

Several studies have examined the association between egg consumption and risk of heart disease.  In 1999, researchers from Harvard published one such study in the Journal of the American Medical Association.  They looked at egg consumption and risk of coronary heart disease in 80,082 women from the Nurses’ Health Study and 37,851 men from the Health Professional Follow-up Study (See Reference 3). Subjects were followed for 8 years and there was no evidence of increased risk of heart disease in men or women who consumed 1 egg per day.   There was, however, an increased risk in diabetic men and women who consumed 1 egg per day.  In the Framingham Heart Study, there was also no association found between egg consumption and risk of heart disease (See Reference 2).

So what else is in an egg yolk besides cholesterol?

Egg yolks are like a multivitamin supplement.  They contain vitamin D, folate, vitamin E, vitamin A, monounsaturated fats, vitamin B12, vitamin B2, essential amino acids, linoleic acid, calcium and vitamin B1.  They are, in fact, one of the most nutrient dense foods you can eat.

So what’s the take home message on eggs?

I tell my healthy clients to enjoy up to 7 yolks a week.  This amount will not have any negative impact on cardiovascular health and will absolutely pack their breakfast with essential nutrients.  The increased risk with diabetics is definitely a cause for concern.  I advise my diabetic clients to limit themselves to 3 yolks per week.  

References

1) Hu FB, Stampfer MJ, Manson JE, et al. Dietary fat intake and risk of coronary heart disease in women. The New England Journal of Medicine 1997; 337:1491-1499.

2) Dawber TR, Nickerson RJ, Brand FN, et al. Eggs, serum cholesterol and coronary heart disease. American Journal of Clinical Nutrition 1982; 36:617-25.

3) Hu FB, Stampfer MJ, Rimm EB, et al. A prospective study of egg consumption and risk of cardiovascular disease in men and women. Journal of the American Medical Association. 1999; 281:1387-94.

Questions And Answers: Omega 3 Fatty Acids

I get a lot of questions about omega 3 fatty acids.  Many people don’t know much about what they do, but have heard they are healthy.   There is also a lot of confusion concerning the dangers of mercury consumption when eating fish.  I thought this topic would make a great post for my next Q and A, so here goes:

1) What are omega 3 fattys acids?

Omega 3 fattys acids are an essential polyunsaturated source of fat.  They are essential because our body can’t make them, we need to get them from our diet.  There are 3 subtypes of omega 3’s: 1) EPA 2) DHA 3) Alpha-linolenic acid.

2) Where are they found?

EPA and DHA are found in fish.  The fattier the fish, the higher the level of omega 3’s.  Alpha linolenic acid is found in vegetable oils like canola oil, nuts like walnuts, flaxseed, dark leafy vegetables and some animal fat, particularly if the animal was grass fed.

3) How do omega 3’s impact health?

Omega 3’s are believed to have an impact on the following: 1) The make up of cell membranes  2) Hormones that regulate clotting 3) Hormones that regulate contraction and relaxation of artery walls and 4) Inflammation.

Dietary intake of omega 3’s has been shown to decrease fatal heart arrhythmia, lower heart rate and blood pressure and improve the function of blood vessels.  At larger doses they have been shown to lower triglycerides and decrease inflammation. (See Reference 1)  These benefits appear to be strongest for EPA and DHA which are the marine sources of omega 3’s.

4) Do I need to supplement them?

Not at all.  If you work with me or have read my book, you’ll know I’m not a fan of supplementing in general.  There are several factors in whole foods that work synergistically to help nutrients work.  When you isolate a compound and put it in pill form, you lose this important aspect of nutrition.  If you get 2-3 servings of a variety of seafood such as fatty fish (tuna, salmon, sardines, mackerel) or shellfish each week you are doing great.  Vegetable sources of omega 3’s (oils, nuts, flaxseed) have generally not shown as much benefit, so try to focus on the marine sources.

Furthermore, there have been some reports of high levels of mercury in some of omega 3 supplements.  Since supplements are not regulated, you can never really be sure of the source.  This is another reason to get your omega 3’s from your food.

5) What about mercury in our fish- should I be concerned?

Yes and no.  Mercury is a compound that when ingested in large doses can damage nerves in adults and cause severe problems with the developing nervous systems of young children and fetuses. 

In general, the benefits of omega 3 consumption outweigh the risks.  I tell my client to strictly limit consumption of the 4 biggest sources of mercury in our fish: swordfish, shark, tilefish and king mackerel.   Outside of that, for adults, it appears that eating a variety of seafood will pose little problem, with the potential for serious benefit.

However, if you are pregnant or trying to become pregnant, you need to talk to your doctor about how to deal with the issue of mercury.  On the one hand, EPA and DHA from fish sources are extremely important to the neurological development of the fetus.  On the other hand, high amounts of mercury have the potential to have the opposite effect.  Your doctor will help you strike the proper balance of minimizing the risk and maximizing the benefit of fish.  Generally, the recommendation for pregnant women is to consume no more than 2 servings of seafood a week and only one of these servings should be albacore tuna.   Pregnant women are also told to avoid the 4 big sources of mercury: swordfish, shark, tilefish and king mackerel.

6) So what do you recommend?

I tell my clients to eat 2-3 servings of seafood each week and to vary the sources.  Good low mercury sources of omega 3’s are shrimp, canned light tuna, salmon, pollack and catfish.  I also have them limit the 4 big sources of mercury: swordfish, shark, tilefish and king mackerel.

I don’t have them supplement with fish oil and if they are pregnant or trying to get pregnant, I defer to the advice of their Ob/Gyn doctor.

References

Leaf A.  Prevention of sudden cardiac death by n-3 polyunsaturated fatty acids. Journal of Cardiovascular Medicine. 2007; 8 Suppl 1:S27-29.

Research Update: Low Carb Diets And All Cause Mortality

Low Carbohydrate Diets And All Cause Mortality And Cause Specific Mortality

Fung, et al.

Archives of Internal Medicine 153:289-98 2010.

Objective: To examine the relationship between a low carbohydrate diet and risk of all cause mortality over a study period of 26 years in women and 20 years in men.

Study Population: Participants in this study included 85,168 women from Harvard’s Nurses’ Health Study and 44,548 men from Harvard’s Health Professional Study. 

Results: During the period of follow-up there were 12,555 deaths in men and 8,678 deaths in women.  The researchers looked at the affect of 3 different types of low carbohydrate diets.  A general low carbohydrate diet, one based largely on animal sources of fat and protein and one based on vegetable sources of fat and protein.  The results were striking.  Those following a general low carb diet had a 12% increased risk of dying from any cause.  Those eating an animal based low carb diet had a 23% increased risk of dying from any cause.  Conversely, those following a vegetable low carb diet had a 20% lower rate of dying from any cause.

Comment:  This study is near and dear to my heart.  #1) My research group while I was at Harvard conducted it, so many of these people are my friends and colleagues. #2) They used the scoring system I helped develop for my 2006 New England Journal of Medicine article on low carb diets.  3) In many ways, this is an extension of my previous work.

These results are important for several reasons.

1) There have been a number of short term studies that have looked at the health effects of low carb diets.  The results of these studies have had mixed results.  There is some evidence that a low carb diet has a nice effect on HDL cholesterol, triglycerides and insulin sensitivity but there has also been some evidence of an increase in LDL cholesterol which may increase risk of cardiovascular disease.  This study helps to answer the question of the long term effects of these diets on health.

2) Many proponents of low carb diets theorize that red meat and saturated fats are OK in the context of a low carb diet because LDL particles become larger, more buoyant and therefore less damaging with regards to risk of heart disease.  This may not be the case.  Those who consumed animal sources of fat and protein (IE bacon, steak, cream, butter, etc) had a 23% increased risk of dying from any cause while those who consumed vegetable sources of fat and protein (legumes, nuts, olive oil, etc) had a 20% decreased rate of dying from any cause.

3) These results are consistent with some earlier research.   Among Greek participants of the European Prospective Investigation Cancer and Nutrition (EPIC) study, a low carbohydrate diet was associated with a statistically significant increased risk of death (Ref 1).

Take Home Message

The authors hypothesized that the vegetable based low carb diet was protective because it was high in unsaturated fats, dietary fiber and micronutrients such as magnesium and potassium.  The red and processed meats of the low carb diet were hypothesized to be the most harmful aspect of that dietary pattern.  Those of you who work with me privately or read my book know that I’m not an advocate of low carb diets.  However, if you plan to do one, make sure you choose predominantly vegetable sources of fats (like olive oil, nuts, avocados, etc) and lean sources of protein (fish, chicken, turkey, beans, etc.)  The idea that red meat, bacon, cheese, butter and cream are harmless in the context of a low carb diet appears to be unsubstantiated.

References

1) Trichopolou A et al. Low carbohydrate, high protein diet and long term survival in a general population cohort.  European Journal of Clinical Nutrition. 2007 61:575-81.

Book Review: The New Atkins For A New You

The New Atkins For A New You by Dr. Stephen Phinney, Dr. Jeff Volek and Dr. Eric Westman is next up for review.  This is an updated version of Dr Atkins program by three nutrition researchers.  Dr. Phinney taught at the University of Vermont, the University of Minnesota and the University of California at Davis.  Dr. Volek is a professor at the University of Connecticut and Dr. Westman is a professor at Duke.

Introduction

            This book takes a more research based approach to Atkins’ decade’s old theory of the low carbohydrate diet.  I’m quite familiar with the research of Dr Westman and Dr. Volek.  I read a lot of their work while publishing my research on low carb diets at Harvard.  The book is well written and is based on the premise that carbohydrates are to be strictly limited to lose weight and improve health.  The program itself is very similar to the old Atkins as far as going through different phases of decreasing carbohydrate restriction as you approach your goal weight.  What is different about this book is that the authors have used current research to back up a lot of their claims and even to improve the diet from a nutritional standpoint, all while maintaining severe carb restriction.

5 Things I really like about The New Atkins For The New You

1) The latest research on carbohydrate, fat and protein metabolism are presented.  Many of their claims are indeed backed by science.

2) The diet is definitely more focused on vegetables than the previous edition.

3) The consequences of refined carbohydrate metabolism are very well explained.  This is hugely important whether you want to lose weight or improve your health.

4) Research concerning saturated fat and LDL particle size is very well presented.

5) They have a really great section about how body weight will vary from day to day and you should never get too wrapped up in one or 2 bad scale readings.  This is very important and I’m always saying this to my clients.

5 Things I disagreed with in The New Atkins For The New You

1) Severe restrictions on fruits and whole grains.  Although these can be added in a bit in later phases, they are underemphasized in my opinion.  Current research is quite definitive in detailing the health benefits of these of foods.

2) The recipes were a bit heavy on the full fat dairy (like cheese and cream), red meat and saturated fat.  It is a good idea to limit consumption of these foods.

3) I don’t think this book gives exercise its fair due.  It almost seems as if exercise is optional.  You can do it if you feel like it.  Current research shows you need to do a lot if you want to maintain weight loss.

4) The fat/protein/carb percentages seem a bit unrealistic to me.  For example, if you are a tall man you are instructed to eat 8 oz of protein at each meal.  Not including snacks that is 168 grams of protein a day.  When you are restricting your carbs to 30 grams a day on a 1500 calorie diet here are the percentages:

Protein 45% of calories, Carb 8% of calories and Fat 53%.  This seems unsustainable to me.

5) Non nutritive sweeteners are allowed on a consistent basis, up to 3 packets per day.  I have found that they definitely stimulate carb cravings and tend to undermine weight loss efforts when used on a daily basis.

Is The New Atkins For A New You worth reading?

            Absolutely!  This book is a big step forward when it comes to the low carb lifestyle.  While I don’t agree with a large percentage of the dietary recommendations, the book takes a nice look at how we metabolize fats, proteins and carbs and brings the latest research into the forum.  I wish more weight loss books did this!  I remember reading Atkins when I was a young nutrition student.  While I never fully bought into the program hook, line and sinker, Atkins was one of the first to note the dangers of sugars and refined carbs both for weight gain and health.  My current nutritional recommendations are indeed shaped by this knowledge.