Research Update: Beverages And Weight Loss

Replacing caloric beverages with water or diet beverages for weight loss in adults: Main results of the Choose Healthy Options Consciously Everyday randomized clinical trial.  American Journal of Clinical Nutrition 2012: 95:555-63.

Objective:  The objective of this study was to examine the effects of replacing caloric beverages with water or diet beverages as a method of weight loss over a 6 month study period.

Methods: 318 overweight and obese men and women who consumed at least 280 daily calories in beverage form were recruited for this study.  Subjects were placed into one of three groups:

Group 1 replaced 2 servings of soda per day with water.
Group 2 replaced 2 servings of soda per day with diet soda.
Group 3 was a control group that received general weight loss advice but no specific instructions on beverages.

The intervention lasted for 6 months and then weight was measured.  Replacement beverages were provided to all study participants in replacement groups.

Results: At the end of the 6 months, all three groups had lost weight.  However, participants assigned to beverage replacement were two times as likely to have achieved a 5% weight loss when compared to the control group.

Discussion: It appears that our body is not very good at registering calories in liquid form.  Studies show that when we snack on solid food, most people will generally compensate by eating fewer calories the rest of the day.  This does not seem to happen with liquid calories.  When the same people received snacks in liquid form, they did not eat any less throughout the rest of the day.  This study provides further evidence that liquid calories are usually just added to what we would normally eat in a day. 

Take Home Message: If you are trying to lose weight, dump the liquid calories.  Stick with water, decaf coffee/tea or naturally flavored sparkling water.  Don’t go too crazy with the diet sodas-- they have some issues of their own.  (To learn more about non-nutritive sweeteners, check out this post)

Book Review: The Fertility Diet

The Fertility Diet is next up for review.  Many of my clients and blog readers are at the age where they are thinking of starting a family.  Problems with conception are common and can be very difficult to deal with.  It turns out that the lifestyle habits of the mother and father have much more to do with the ability to conceive than previously thought. The book is co-authored by Dr. Walter Willett and Dr Jorge Chavarro.  Dr Willett is the Department Chair at the Harvard School of Public Health Department of Nutrition.   Dr. Chavarro is a research fellow there as well.  Full disclosure:  I know both of the authors: Dr Willett was my Department Chair while at Harvard and Jorge and I were both getting our doctorate at the same time.  Trust me when I say that my familiarity with these two amazing researchers will not bias this review.  My high opinion of this book is based solely on the fact that the book is truly well done.

Introduction

The Nurses’ Health Study has produced an impressive array of research on the subject of diet and fertility.  The Fertility Diet presents this research in an easy to understand format.  The basic premise of the book is that there are 10 diet and lifestyle strategies that will improve a couple’s chances of conception.  In the first chapter, all 10 strategies are briefly presented.  The remaining chapters of the book each cover one of these strategies in depth, and the supporting research to back up the claim is presented and analyzed.  The last part of the book features a 7 day meal plan that includes several recipes.  The book is extremely well written and converts a lot of complicated research into simple lay terms that are easy to understand to those unfamiliar with scientific research design.

5 Things I Liked About The Fertility Diet

1) It Is Research Based: Far too many nutrition books present opinion and not research based hypothesis, adding to the generalized confusion on how nutrition impacts health.  The Fertility Diet basis all recommendations on current, well designed research.  If the research isn’t definitive on a topic, the authors have the courage to say “we don’t know about this yet”.

2) It Is Comprehensive: The Fertility Diet is not just about nutrition, it covers all aspects of lifestyle that may impact the ability to conceive, including: weight, exercise, and stress.

3) Glycemic Index And Glycemic Load Are Very Well Explained:  There is a comprehensive discussion of glycemic index and glycemic load that is one of the best I have ever seen.

4) Interesting Section On Dairy:  The chapter on dairy is fascinating.  You’ll learn a lot about the difference between low fat and high fat dairy products and how they may impact the ability to conceive.  You’ll definitely be surprised by some of the research in this area.

5) Review Of Popular Diets:  In the chapter on maintaining a healthy weight, the authors present a really well done, research based review of popular weight loss diets.

Do I Recommend Reading The Fertility Diet?

Absolutely and strongly!  This book is great.  Research is becoming clear that the lifestyle habits of mother and father can not only influence the ability to conceive, but the long term health of the child.  I also think there is tremendous value in reading this book if you’re not trying to conceive.  Most of the recommendations that promote conception also promote general health as well.  In fact, the book spends a lot of time explaining how each strategy impacts health and risk of disease before getting into the impact on conception.  At times, the book had the feeling of being an updated version of Dr. Willett’s Eat Drink And Be Healthy, which, in my opinion, is one of the best nutrition books ever written.

Product Review: Fitbit Ultra

If you are interested in losing weight or improving your health, cardiovascular exercise is extremely important.  Most people are really busy, and I’ve found over the years that an inadequate level of cardio is one of the biggest obstacles to weight loss success.  Any tool that can help in this area is worth its weight in gold.  The Fitbit Ultra is one such tool.

The Fitbit is like a pedometer on steroids.  It’s a tiny gadget that you can put in your pocket or clip on your waist.  It contains a 3D motion sensor that allows you to record every aspect of your daily physical activity, including:

1) Step taken

2) Miles walked
3) Stairs climbed
4) Hours slept

You can cycle through all of these measurements on the Fitbit itself.  It also wirelessly loads them onto your computer, so you can graph and keep track of all of your activities. 

The Fitbit is a great tool to keep you aware of your physical activity and has a lot of great features. I picked one of these up a few months ago and have used it a ton. 

Fitbit Pro’s

1) Small and easy to wear, you don’t even notice it’s on you.

2) Great features: including measurement of steps, miles, stairs climbed, and sleep.

3) Free access to the Fitbit website where you can keep track of your activity, set up goals, and much more.  Many other lifestyle monitors charge you a monthly fee for access to such a site.

4) Helps you accurately gauge your level of physical activity.  I was amazed at how much my level of activity varied from day to day, depending on my schedule.

5) Provides accountability.

6) Motivates you to become more active.

Con’s
1) The only con I can come up with is that compared to other pedometers it is a bit pricey at $99.  However, this is a one time outlay with no other fees to use the website.  You also get a bunch more features than you do with everyday pedometers.

Would I recommend the Fitbit Ultra?

Absolutely.  The Fitbit Ultra is a great tool to help you assess your activity levels.  You’ll actually become competitive with yourself.  If you set a goal of 10,000 steps and your looking short one day, you may find yourself looking for excuses to walk a bit more.  It is also great for when you travel and are not sure of your physical activity levels.

Monitoring your diet and exercise is a huge part of making lifestyle changes stick.  Fitbit allows you keep track of your physical activity in a simple and highly motivating way.  

The Fitbit retails for $99 and is shipped for free.  For more information or to pick one up, check out their website at www.fitbit.com

Research Update: Red Meat And Risk Of Stroke

Red meat consumption and risk of stroke in Swedish men.  American Journal of Clinical Nutrition 2011: 94:417-21.

Objective:  The objective of this study was to examine the association between red meat consumption and risk of stroke in 40,291 Swedish men over a 10 year follow-up period.

Methods: All men filled out a 96 item food frequency questionnaire that assessed usual diet.  This enabled the researchers to compute total red meat, fresh red meat, and processed red meat consumption for the analysis.  Fresh red meat was considered minced pork, beef, or veal.  Processed red meat was considered sausage, hot dogs, salami, ham, and processed cold cuts.  Total red meat was the sum of fresh red meat and processed red meat.

Results: After 10 years of follow up, there were 2,409 new cases of stroke among these men.  Men who consumed more than 2 ounces of processed red meat per day had a 23% increased risk of stroke when compared to men consuming less than ¾ ounce of processed red meat per day. Fresh red meat was not associated with risk of stroke.  Total red meat was associated with a borderline significant 15% increased risk of stroke when comparing men who consumed the most red meat (greater than 5 ounces per day) to men who consumed the least (less than 2 ounces per day).

Discussion: A number of studies have recently shown that fresh red meat is not as strongly associated with risk of cardiovascular disease as once thought.  Processed red meat, on the other hand, is strongly associated with risk of heart disease and stroke.  It is believed that the high levels of nitrates and sodium in the processed red meat are the mechanism behind the increased risk. 

Take Home Message:  It seems like the problem with red meat largely lies in the processing.  I tell my clients to limit portions of red meat to once per week.  Choosing lean and fresh sources of red meat like filet mignon and lean hamburger is a good idea.   Strictly limit the processed red meats like bacon, sausage, hot dogs and fatty deli meats.  Keep in mind that red meat has also been associated with colon cancer incidence so don’t go overboard with the red meat consumption.

Top 5 Strategies To Reduce Your Sodium Consumption

           The impact of sodium on health has been a very hot topic in the nutritional literature of late.  Public health efforts to reduce sodium in our foods are becoming more and more focused.  In years past, sodium restriction was only recommended for those with hypertension.  It is now becoming clear that we all should be limiting our sodium intake.  High sodium diets have been associated with hypertension, stroke, heart disease, osteoporosis and even gastric cancer.  A good goal is 1500 mg of sodium per day.  The typical American gets 3400 mg.  We’ve clearly got some work to do.  Here are the top 5 strategies to reduce your sodium consumption.

1) Limit Processed Food 

The vast majority of the sodium that we consume comes from processed, pre-packaged food.  If you eat most of your food in its natural form, you’ll be reducing your sodium dramatically.  Focus on fresh fruits and vegetables, lean protein sources, vegetable fats like oils and nuts, legumes and whole grains for the majority of your calories and you will significantly reduce your sodium levels.

2) Eat Out Less

            One thing that I always stress to my clients is that when they are deciding on what to eat, the main goal is to pick foods that are healthy for them.  When you eat out at a restaurant, the main goal of the chef is to make the food taste as good as possible, so you’ll want to come back for another visit.  This means you are getting much higher levels of flavor enhancing sugar, salt and fat when you eat out.  Eat as many meals in your home as possible and your salt consumption will plummet.

3) Choose Low Sodium Versions Of Foods When You Can

            Low sodium versions of many foods are available and you can find more and more of them in grocery stores every day.  Admittedly, it does take a little while to get used to the lower sodium level, but after a short period of time you don’t even really notice the difference.  Look for low sodium black beans, soups, turkey breast, turkey bacon, nuts, nut butters, etc.  You can reduce your sodium levels drastically by just making a few changes when low sodium options present themselves.

4) Don’t Add Any Salt To Your Food At The Table

            Even better, don’t even have a salt shaker on your table.

5) Limit Fast Food

            Fast food restaurants are a major source of sodium in the American diet.  Limit fast food to an occasional treat and you’ll reduce your sodium intake dramatically.

Feature Article: Multivitamins: Healthy Or Deadly?

A controversial study by Mursu, et al was published recently in the Archives of Internal Medicine showing that women who took a multivitamin each day had an increased risk of mortality when compared to women who did not.  The results of this investigation ignited a media firestorm, to say the least.  Since then, I have been getting a ton of questions from my clients on whether or not it is safe to take a multivitamin.  I thought I’d use this blog post to examine the study and give a general, research based recommendation regarding multivitamin use.

The Study
The study in question took a look at risk of multivitamin use and mortality in 38,772 women from the Iowa Women’s Health Study (1).  Women were asked via questionnaire if they were using any supplements and if they were to describe what they were taking and how often.  This question was asked 3 different times over a mean follow-up of 19 years.  This was done to reflect changes in supplement use over the years.  Women taking a multivitamin had a 6% increased risk of mortality when compared to women who did not take a multivitamin.  Here are some of the other interesting findings of this investigation:

B6 supplements were associated with a 10% increased risk of death.
Folic acid supplements were associated with a 15% increased risk of death.
Iron supplements were associated with a 10% increased risk of death.
Magnesium supplements were associated with an 8% increased risk of death.
Zinc supplements were associated with an 8% increased risk of death.
Copper supplements were associated with a 45% increased risk of death.

Calcium supplements were associated with an 8% decreased risk of death.

Was this study methodologically sound?
Overall, this study had a sound methodology.  There was a very large sample size, updated measures of supplement use to reflect changes over time, an adequate follow-up and good control of potential confounders.   However, this study had one major flaw: the researchers didn’t exclude sick women.  This is a major problem because someone who gets diagnosed with a serious medical condition is much more likely to initiate multivitamin use.  God forbid you were diagnosed with cancer today; wouldn’t you want to load up on vitamins and supplements to help treat your disease? 

This oversight is problematic because many of those who are diagnosed with these serious diseases will die from them.  This makes it look like people who are supplementing are dying at a higher rate when in fact, they were sicker from the start.  You can eliminate this problem by excluding people who sick at the beginning of your study.

Previous Research

There are a number of well designed studies in recent years that have shown a benefit with multivitamin supplementation.  These studies show that multivitamins help reduce the risk of coronary heart disease, colon cancer and breast cancer.  Vitamin D supplementation is showing a lot of promise and folate supplementation has done much to reduce the incidence of neural tube defect in pregnant women.  We can’t forget these positive outcomes when assessing the benefits and risks of multivitamin supplementation.

So What’s The Bottom Line?

There has been a good amount of research that shows a benefit to multivitamin supplementation and just a few studies that show potential harm.  Considering that there were methodological flaws in some of the research that showed harm, I feel that the benefits of multivitamin supplementation outweigh the risks for most people.  However, to hedge your bets, I recommend taking a good multivitamin (which includes vitamin D) every other day.  This way you are minimizing the risk while retaining the benefit. This is what I do myself and what I recommend to my clients.  Always keep in mind that any kind of supplement will never replace a healthy diet.

References

1) Mursu J, Robien K, Harnack LJ, et at. Dietary supplements and mortality rate in older women.  Archives of Internal Medicine 2011; 171(18):1625-1633.

Research Update: Sugar Consumption And Heart Disease

Low to moderate sugar-sweetened beverage consumption impairs glucose and lipid metabolism and promotes inflammation in healthy young men: A randomized controlled trial. The American Journal of Clinical Nutrition 2011; 94:479-85.

Objective: To examine the association between low to moderate sugar consumption and risk factors for coronary heart disease in 29 healthy young men.

Methods:  This investigation was a crossover trial.  What this means is that the 29 men in this study were put through 6 separate 3 week interventions.  During each 3 week intervention, a 600 ml soft drink beverage was consumed daily with varying sugar content.  Here are the soft drink interventions:

Intervention 1- 40 grams of fructose per day (moderate fructose)

Intervention 2- 80 grams of fructose per day (high fructose)

Intervention 3- 40 grams of glucose per day (moderate glucose)

Intervention 4- 80 grams of glucose per day (high glucose)

Intervention 5- 80 grams of sucrose per day (high sucrose)

Intervention 6- dietary advice to strictly limit fructose.

After each intervention a variety of blood tests were taken, including LDL particle size, LDL subclass, fasting glucose and high sensitivity C-reactive protein.

Results: The results of this investigation were fascinating:

1) LDL particle size was significantly reduced after both the high fructose and high sucrose intervention.  The smaller the LDL particle, the more likely it is to promote atherosclerosis, which in turn increases the risk of heart disease.

2) A more atherogenic LDL subclass distribution was seen with all of the fructose interventions.  This means that the LDL particles became more likely to promote heart disease.

3) Fasting glucose and high sensitivity C-reactive protein increased significantly after all interventions.  C-reactive protein is a measure of body wide inflammation and has been associated with a variety of diseases, including heart disease.

Discussion:  This is an amazing paper that shows that even a moderate consumption of sugar has the potential to increase risk of heart disease.  LDL particle size, subclass distribution, fasting glucose and high sensitivity C-reactive protein all changed for the worse when consuming even moderate amounts of sugar consistently for only 3 weeks.  These are powerful markers for risk of heart disease.

Take Home Message: Drinking sugar sweetened beverages like soda is not a good idea.  It has been known for years that they provide nothing but empty calories and promote weight gain.  Now the research is beginning to mount that they can cause disease as well.  Sugar sweetened beverages are the largest contributor of sugar in the American diet.  Giving them up entirely is a good first step to improving your health.

If you work with me privately or have read my book, you know how I feel about sugar.  After trans fat, I believe it is the most harmful thing one can eat.  It is a difficult concept to accept, but at the end of the day, humans were never designed to eat sugar.  Cutting down on it, or better yet, eliminating sugar entirely, will cause far reaching and dramatic positive changes in your life that I guarantee will surprise you.