Monday, July 13, 2015

What are good snack ideas if I am trying to lose weight?

If weight loss is your goal, the best snack for you is the one you don’t eat!

Here are the reasons:
1) You shouldn’t need one. If you are eating a diet that promotes a stable blood sugar, you will not be hungry. Most hunger in between meals is due to blood sugar drops which can be totally prevented by eating the right foods in the right combinations.

2) Very small amounts of food eaten consistently can cause serious damage to your waistline. If you have 100 more calories a day than your body needs, after a year, those calories add up to 10.4 pounds. And let me tell you that 100 calories is not a lot of food. It is way too easy to get too many calories when you snack.

3) My most successful weight loss clients are consistently those that don’t snack.

Eliminate snacking entirely and you will have a much easier time losing the weight and keeping it off.


Metabolic adaptations to extreme weight loss

The Study
Your resting metabolic rate is the number of calories your body burns each day to perform its basic metabolic functioning. The higher your resting metabolic rate, the easier it is to manage your weight. It has been known for some time that resting metabolic rate decreases with weight loss. Prevailing wisdom was that this drop was due to the loss of metabolically active muscle tissue during the weight loss process. This may not be the whole story.

A study conducted by the Pennington research group tested this theory. They measured the resting metabolic rate of 16 Biggest Loser contestants before, during, and after the 30 week competition. In order to reduce the loss of muscle during the weight loss process, the contestants on this show engaged in a lot of resistance training exercise. They were successful in sparing their muscle. The average weight loss after the 30 weeks was 30% of initial body weight. Of this weight loss, 83% was fat and only 17% was muscle. After adjusting for the losses in fat and muscle mass at the end of the 30 weeks, resting metabolism in these contestants decreased by a stunning 504 calories per day. Journal of Clinical Endocrinology and Metabolism 2012; 97:2489-96.

Take Home Message
This study tells us a few important things. The first is that resistance training prevents the loss of muscle mass with weight loss, which is really important. The second is that despite the preservation of muscle, metabolism drops a lot after extreme weight loss. A drop of 504 calories per day is no joke. The question that I don’t have the answer to, is whether this decrease in metabolism happens all the time, or is due to the very extreme nature of the weight loss in this study. The contestants on this show lost an average of 5 lbs. a week. I am wondering if this severe drop in metabolism would occur in those who lose weight more slowly. 

No one really knows why resting metabolism drops so much after weight loss when accounting for lost muscle. The authors of this study believe that the drop in metabolism may be due to changes in leptin and thyroid hormones or perhaps a reduction in the size of very metabolically active organs like the heart, brain, kidney and liver. One thing is certain, when you lose a lot of weight quickly, your body fights very hard to put it back on.

We need to learn more about this phenomenon. Many people who lose weight gain it back within a short period of time, and this drop in resting metabolic rate could be a big reason why.


Are restaurants making it impossible for you to lose weight?

The Study
Most people know that eating out at restaurants is not a good strategy when trying to lose weight, but it may be worse than you think. Researchers from Tufts University purchased the 42 most commonly ordered meals in the Boston area from 9 categories of restaurants: Mexican, American, Chinese, Italian, Japanese, Thai, Indian, Greek and Vietnamese. They then measured the calorie content of the meals by bomb calorimetry. The average calorie content was a stunning 1,327 calories. This amount is more than twice the amount of calories necessary for weight maintenance. The scary thing about this study is that the researchers did not include appetizers, bread or drinks in the calorie analysis! JAMA Internal Medicine 2013;173:1292-99.

Take Home Message
Women looking to lose weight should be hitting about 1200-1300 calories per day. Men looking to lose weight should shoot for 1500-1600 calories per day. One meal out in your typical restaurant will make it impossible to hit these goals. To lose weight, eat at home the majority of the time and save restaurant meals for the couple of times a week you are allowed to cheat. The authors argue that mandatory calorie listing on menus would promote lower calorie meals by restaurants and better choices by customers. I am beginning to think that this is a good idea.


Sunday, July 12, 2015

Book Review: The Hunger Fix

Next up for review is The Hunger Fix. The author, Dr. Pam Peeke, is a medical doctor specializing in nutrition and lifestyle medicine.

The major focus of The Hunger Fix is food addiction. The author believes that overeating is dependent on the neurotransmitter dopamine and our brain’s reward system. The book explains, in great detail, the relationship between dopamine and body weight, and then presents a 3 stage recovery program to “rewire” the brain to overpower the addiction. The book is 302 pages long. The Hunger Fix is very well written and I truly enjoyed reading it.

5 Things I Really Liked About The Hunger Fix
1) I really liked learning about the science behind reward and food addiction. Many argue that food addiction is not real, and that overweight people simply lack willpower. When it comes to sugars and refined carbs, I would totally disagree. I have seen for years the powerful pull that sugar can have on the overweight and medical research is beginning to compare sugar addiction to alcohol or drug addiction.

2) I thought that the dietary approach was strong. Dr. Peeke recommends a balance of 20-30% protein, 25%-35% fat, and 30-35% carbohydrate. While I would generally recommend a bit less protein (20%) and a bit more carb (45%), this is very close to what I tell my own clients.

3) The importance of resistance training and cardiovascular exercise is stressed throughout The Hunger Fix. Not many weight loss books mention enough about exercise.

4) The section on meditation was compelling. Stress reduction can have a powerful impact on our ability to make positive lifestyle changes and sharpens focus. This is an often completely overlooked component of weight loss programs.

5) The meal plan and recipe sections were really well done. 

5 Things I Didn’t Agree With In The Hunger Fix
1) Dr. Peeke recommends eating every 3 hours. I have found that it is way too easy to overeat when you do so. My most successful clients eat 3 meals per day and don’t snack at all. If your blood sugar is stable, you will have absolutely no need to snack anyway. Keep in mind that eating just 70 more calories than your body needs per day will result in a 7 lbs. weight gain over a year.    

2) The references in this book were interesting. At certain times, the references cited were from really reputable journals, like The American Journal of Clinical Nutrition and The New England Journal of Medicine. The rest of the time, the book cited very unusual and obscure journals, links to websites, YouTube videos, newspaper articles, and magazine articles. Several times Dr. Peeke wrote “Science shows that…” and didn’t list any references at all.

3) The cardio recommendations are a bit low. Dr. Peeke recommends cardiovascular exercise 5 times per week for 20 minutes. This is well less than optimal for weight loss. In my experience, women need to hit at least 250 minutes/week and men need to hit 150 minutes/week if they want to get the scale moving.

4) One recommendation that I didn’t agree with was that for sugar consumption. Dr. Peeke does an impressive job explaining the addictive properties of added sugar. She uses compelling research to present her case. After all this, she quotes the American Heart Association recommendations on sugar, that allow women 6 teaspoons of sugar per day, and men 9 teaspoons of sugar a day. In my opinion, this is way too much! For someone addicted to sugar, complete avoidance is the only way. To me, this is similar to telling an alcoholic that one or 2 drinks a day is OK. 

5) Similar to the last point, I was surprised at some of the foods I found in the meal plan and recipes. Many of these were high glycemic load or contained a lot of sugar. Examples include: white potatoes, smoothies, balsamic vinegar, popcorn, bread, honey, brown sugar, candy, juices, rice cakes, etc. These foods can cause a reactive hypoglycemia that increases hunger and make it really hard to keep calories in the weight loss range.

Is The Hunger Fix Worth Reading?
Absolutely! I enjoyed this book. You’ll learn a lot about how our brain is hard-wired to seek rewards, and how the food industry takes full advantage of this fact when creating products. The Hunger Fix really comes from a different perspective than other weight loss books that I have read.

Overall, The Hunger Fix program is very sound. To make it complete, I would add a bunch more cardio, get a little stricter on some of the carbs allowed, and limit eating to 3 meals per day. 


Tuesday, May 12, 2015

Which Cardio Machine Should I Buy?

Getting to the gym on a daily basis doesn’t really work long term. We are all just too busy. Having the ability to do cardio at home is pivotal to generating the type of consistency necessary to make lasting changes to your weight.

A question I always get is; “What cardio machine should I buy?” My answer, in every case, is an elliptical trainer.

1) Elliptical trainers are low impact. Many modes of cardio that burn a lot of calories are tough on your joints. High impact cardio classes and running are two examples. Elliptical trainers are much easier on your joints. My client’s that use elliptical trainers have far fewer injuries than those that engage in more impactful forms of exercise.

2) You burn a lot of calories. Since elliptical trainers are an upright form of exercise, you lift your full body weight with each repetition. This makes the elliptical machine an efficient calorie burner.

3) Elliptical trainers are appropriate for all fitness levels. If you are young, fit, and work out with a bit more intensity, you can get a high-end, gym quality elliptical trainer like a Life Fitness model. These will have all sorts of variety in resistance, fitness programs, and other bells and whistles. If you are older or a little less fit, you can get a glider like the Gazelle Edge, which has no resistance and simulates walking.

4) Elliptical trainers can fit any budget. If you want to spend several thousand dollars on a gym quality machine for your home gym, there are lots of options that are worth every penny. If money is tight, you can get a glider, like the Gazelle Edge, for $130, which will do the job nicely.

Beverages and Weight Gain

The Study
The long term association beverage choice and weight gain was examined in a combined cohort of the Nurses’ Health Study, The Nurses’ Health Study II, and the Health Professional Follow-up Study. In total, there were 124,988 subjects included in this investigation that were followed for approximately 20 years. Participants reported their beverage consumption and their weight every 4 years throughout the study period. The researchers then calculated how 1 daily cup of a given beverage would impact weight each 4 year period. 

Here are the results:
1 cup of water resulted in .3 lbs. of weight loss

1 cup of sugar sweetened beverages resulted in a .8 lbs. weight gain

1 cup of fruit juice resulted in a .5 lbs. weight gain

1 cup of diet soda resulted in .2 lbs. of weight loss

1 cup of coffee resulted in .3 lbs. of weight loss

1 cup of tea resulted in .1 lbs. of weight loss

Substituting 1 cup of water per day for 1 cup of sugar sweetened beverages resulted in a weight loss of 1.1 lbs. over 4 years.
International Journal of Obesity 2013; 37:1378-85.

Take Home Message
At first glance these numbers seem kind of small. However, it is important to realize that these results are for just one cup. Many of us drink 20 ounce sodas and coffees. If you drink 8 glasses of water per day, 8 x .3 = 2.4 lbs. of weight loss over 4 years, 4.8 lbs. over 8 years, 7.2 over 12 years and 9.6 over 16. My point is that these numbers can add up over time to have a powerful impact on your weight.

It is becoming evident that the body does not fully recognize calories in liquid form. In other words, if you have a snack before dinner, most of us will eat a bit less at that dinner to compensate. Studies show that if you drink a soda before dinner, you won’t eat any less at the meal. Liquid calories don’t seem to register with our body the way solid food does.

Stay away from calorie containing beverages like soda and fruit juice, and instead go for water, club soda, coffee, tea and the occasional diet soda. Over time, these choices can have a really nice impact on your weight and your health.


Can you be obese, yet totally healthy?

The Study
The idea that it is possible to be obese yet healthy has been bounced around for some time. This hypothesis was tested in an investigation of the Whitehall II cohort of British government workers. In this cohort of 2,521 men and women, 66 met the criteria for being obese (BMI ≥30) and healthy (<2 of the following metabolic symptoms: low HDL cholesterol, high blood pressure, high fasting glucose, high triglycerides, insulin resistance). After 20 years of follow up, more than half of the healthy obese subjects progressed to unhealthy obesity. Furthermore, after 20 years, the healthy obese in this cohort were nearly 8 times more likely to progress to an unhealthy obese state than the healthy non-obese adults. Journal of the American College of Cardiology 2015; 65:101-02.

Take Home Message
This study presents convincing evidence that if you are obese but currently healthy, there is a good chance that you won’t be for long. If your BMI is 30 or greater, get it below 25, even if you are free of metabolic symptoms.