Research Update: Protein Consumption and Subsequent Energy Intake

Protein leverage affects energy intakes of high protein diets in humans. American Journal of Clinical Nutrition 2013; 97:86-93.

Objective: To examine the association between protein consumption and subsequent energy intake.

Methods: This study was a 12 day randomized crossover trial of 40 men and 39 women.  Subjects visited a university cafeteria for breakfast, lunch, and dinner. The foods offered were similar for each of the three 12 day intervention periods, but varied in protein content (5% of calories, 15% of calories, and 30% of calories).  Fat was kept constant at 35% of calories, so the protein was substituted for carbohydrate.  Subjects could eat as much at a meal as they wanted.

The researchers measured total daily caloric consumption for each subject when they were eating low, moderate, and high amounts of protein.  They also measured subjective ratings of hunger and satiety in each of these three conditions.

Results: The results were striking.  When the subjects were eating 5% of calories as protein, they averaged 2,228 calories per day.  When they were eating 15% of calories as protein, they averaged 2,298 calories per day.  When they were eating 30% of calories as protein, they averaged only 1,722 calories per day!  Fluctuations in hunger and desire to eat were attenuated in the high protein group as well.

Discussion: This is a beautifully designed study.  I love crossover trials, because you are using the same subjects for each of the conditions being tested, which all but eliminates sampling error.  The difference between the moderate and high protein groups was 576 calories per day.  This is a dramatic difference that would have a major impact on body weight. 

The research is really beginning to mount on how dietary protein promotes satiety and decreases subsequent energy intake.  The mechanisms aren’t quite clear, but it may have to do with the high nitrogen content of protein foods.  Nitrogen is difficult for our body to process ,so the theory is that when we eat a lot of protein, our body shuts down hunger in order to prevent nitrogen levels from getting too high.

Take Home Message:  If you are looking to lose weight and decrease your hunger throughout the day, add a bit more protein to each meal.  I have my clients shoot for 20-25% of total calories as protein.  I have found this level to be safe and highly effective for weight loss.

Book Review: Fat Chance

Fat Chance is next up for review. The author, Dr. Robert Lustig, is a medical doctor and the Director of the University of California San Francisco Weight Assessment For Teen And Child Health Program.  You may remember him from his Youtube video, “Sugar: The Bitter Truth”, which was viewed over 3 million times.

Introduction

The basic premise of Fat Chance is that a calorie is not always a calorie.  In other words, there are hormonal consequences to the foods we eat that tend to promote fat storage or fat burning.  The book cites our increased sugar consumption as the driving force behind the obesity epidemic.  The book focuses a lot on the hormonal consequences of our food, how these hormones influence our health, ways to change our diet to improve our health, as well as a section on public health policy solutions to the obesity epidemic.  The book was extremely well written and well referenced.  I really enjoyed reading it and learned a lot.

Five Things I Really Liked About Fat Chance

1) The idea that a calorie is not necessarily a calorie.  For years, the prevailing wisdom was that if you burn more calories than you take in, you’ll lose weight, no matter what you eat.  We are now learning that this is not always true.  Certain foods start a hormonal sequence that actually promotes fat storage while other foods do not.  The book nicely explains this.

2) The section on the hormonal consequences of our food.  This was very well done.  Lustig explains what happens biochemically when we eat different types of fat, protein, and carbohydrate foods. This knowledge is absolutely essential if you want to lose weight.

3) The toxicity of sugar.  If you work with me or read any of my books, you know how I feel about sugar.  After trans fat, I believe it is the worst thing you can eat. The section on sugar nicely explains why this is so.

4) The section on visceral vs. subcutaneous fat.  This was a great explanation of the difference between these 2 types of fat.  All body fat is not created equal!  Visceral fat (found inside the abdomen and organs) is far more damaging to our health than subcutaneous.

5) His proposed policy changes to control the obesity epidemic. This section is definitely a bit controversial.  Policies such as soda taxes, placing limits on advertising for unhealthy foods, and banning sugar in schools tend to raise as many political conversations as public health conversations.  However, this section brings up some pretty interesting ways to help curb the obesity epidemic and I found it a very interesting read.

Five Things I Didn’t Agree With In Fat Chance
1) Lustig repeatedly mentions that weight loss through diet and exercise is impossible to maintain long term.  I couldn’t disagree more.  With the right combination of diet, cardiovascular exercise and resistance training, long term weight loss is absolutely possible.  I’ve seen it hundreds of times with my own clients over the past 15 years.  Just because it is not easy and most people don’t know what to do, does not mean that it is impossible.

2) Lustig goes on to mention that being a little overweight is actually good for your health. He cites studies that found those with a BMI between 25 and 30 have the longest life span.  These studies were methodologically flawed by including smokers and sick subjects.  Since most diseases cause weight loss before death, and because smokers are thinner and ultimately less healthy than non-smokers, including these subjects in statistical analyses makes it look like thin people are less healthy.  In the Harvard cohorts, when these methodological flaws were controlled for, there was strong evidence that being overweight significantly increased risk of disease and early death.

3) Lustig didn’t really go over what you should eat to lose weight and be healthy.  There were no sample meal plans, just a shopping list.  I thought there could have been a bit more guidance here.

4) That leads me to the shopping lists.  Lustig spends most of the book explaining the hormonal consequences of eating too much sugar.  He is so right, and this was my favorite part of the book. However, I was a bit confused when he presented his shopping guide.  Foods were divided into 3 categories: 1) Green light foods can be eaten anytime.  2) Yellow light foods can be eaten 3-5 times a week. 3) Red light foods can be eaten once per week.  There were a lot of high sugar yellow light foods!  For example, a bunch of high sugar breakfast cereals were in the yellow category.  Some had up to 19 grams of sugar per serving, which is almost 5 teaspoons.  These were allowed up to 5 times per week.  This amount of sugar will increase hunger and cravings for more sugar.  I’ve found 100% sugar avoidance is the only way to go.  If you have a little sugar every day, you’ll want more and never get over your cravings.

5) Very little mention of resistance training.  In my opinion, building calorie burning muscle through resistance training is an essential component of long term weight loss.  Fat chance didn’t really spend any time on this at all.

Is Fat Chance Worth Reading?

Absolutely!  This book is a must read for anyone concerned about how our diet affects our weight and our health, which should be all of us!  Dr Lustig is a smart guy who is passionate about reducing the suffering caused by the obesity epidemic.  Just about anyone who reads this book will think twice next time they are in front of a cookie or brownie.  Life without sugar is admittedly very difficult at first, but after a couple of weeks you truly won’t miss it and your health will improve in ways you won’t believe.

Product Review: Nike Fuel Band

The ability to measure your progress toward a fitness goal is pivotal.  Today, I’ll review a product that can help you do this in a big way; the Nike Fuel Band.

The Nike Fuel Band is a tiny device that you wear around your wrist like a watch.  It contains a sports tested accelerometer that measures your physical activity.  It gives you a number of useful measures: including the number of steps you walk per day, the number of calories you have burned from physical activity, and most importantly, your Nike Fuel for that day. 

Nike Fuel is a universal metric of physical activity.  You set a goal for Nike Fuel points in a day, mine is 3000.  Your Fuel Band converts all of your physical activity into Nike Fuel points, including walking, running, weight lifting, basketball, and all other sports and activities.  The band has a series of LED light that turn from red to yellow and then to green as you progress toward your Nike Fuel goal for the day.  When you hit your goal, it lets you know.

Pros
1) This device measures all of your physical activity, not just your steps. This gives you a much better idea of your total activity.

2) You wear the Fuel Band like a watch.  This is a huge upgrade over most pedometers that you have to clip onto your belt.  I can’t tell you how many of my clients have lost their pedometer because it has fallen off of their waist at some point in the day.  In most cases, it is never found.

3) The Fuel Band plugs directly into your computer’s USB port to recharge and upload data.

4) You have free access to the Nike Fuel website, which keeps track of your activity and allows you to set goals.  The website is awesome.

5) Very good battery life.  In my experience, it lasts 5 or more days without a charge and once plugged in, recharges very quickly. 

6) It can store multiple day’s worth of data and then uploads automatically while charging.  Therefore, you don’t have to connect it to your computer every day.  Just charge it every week or so and your data will be uploaded.

7) It also tells the time.

Cons

1) The only con I can think of is that at $150, it is a bit more expensive than some of the other products on the market.

Would I Recommend the Nike Fuel Band?

Absolutely! Many of my clients have picked one up and they all love it as much as I do.  It will teach you a ton about your activity level.  You start to understand your patterns of physical activity.  You’ll be able to see which days of the week you consistently hit your goals, and which days you don’t.  When you come up with a plan to improve on the days that you miss, you can easily measure your progress.

It is very motivating as well.  I set a goal of 100 days of 3000 fuel points, which I’m proud to say that I hit! More than once, I was doing a few minutes of jumping jacks before I went to bed to make sure I hit my goal for the day.  My wife thought I was nuts, but once I set that goal; I wouldn’t go to bed until I hit it.

For my weight loss clients, I have them set a goal of 3000 Fuel points and 10,000 steps per day.

The Nike Fuel Band retails for $150 and you can pick it up on the Nike.com website.

Click here for more information or to pick one up.

Research Update: Mediterranean Diet and Cardiovascular Disease

Primary prevention of cardiovascular disease with a Mediterranean diet. New England Journal of Medicine 2013 DOI: 10.1056/NEJMoa1200303

Objective:  The objective of this trial was to compare the effects of a Mediterranean diet and a low fat diet on risk of cardiovascular disease in subjects over 5 years.

Methods: 7,447 subjects at high risk of developing cardiovascular disease were randomized into one of 3 diet groups: A Mediterranean diet supplemented with olive oil, a Mediterranean diet supplemented with nuts, and a low fat diet. The subjects were followed for 4.8 years and the primary endpoints were myocardial infarction, stroke, or death from cardiovascular causes.

Results: The Mediterranean group supplemented with nuts had a 30% lower risk of cardiovascular disease when compared to the low fat group.  The Mediterranean group supplemented with olive oil had a 28% lower risk of cardiovascular disease when compared to the low fat group.  The trial was stopped early because it was no longer considered ethical to keep the low fat group on a diet that could be increasing their risk of cardiovascular disease.

Discussion: This is a beautifully designed study in an elite research journal.  A 30% reduction in risk of cardiovascular disease in only 5 years is an impressive difference.  The authors believed that the benefit of the Mediterranean diet was due to favorable changes in blood lipids, insulin sensitivity, and resistance to oxidation, inflammation, and vasoreactivity.

Take Home Message:  This study provides further evidence that a low fat diet is not the way to go.  In fact, this study is so big and so well done, that it very well may be the final nail in the coffin for low fat diet proponents.  If you want to reduce your risk of cardiovascular disease, the number one killer in the U.S., follow a Mediterranean approach; which features olive oil, nuts, fruits and vegetables, legumes, lean protein and limits sugar sweetened beverages, breads, sweets, butter, and red meat.

Top 10 Sources Of Hidden Sugar In The American Diet

In my opinion, sugar is the most serious problem with the American diet. As a nation, we consume a ton of it!  It has been shown in the research literature to increase the risk of obesity, heart disease, and type 2 diabetes.  What makes sugar so dangerous is its addictive quality.  The more you have, the more you want.  It is very hard to do sugar part time.  In 15 years of working with clients, I have found that the only way to deal with sugar is to avoid it 100%.  Once you are off of it for a period of 2 weeks, you honestly won’t even miss it.  But if you have it now and again, your cravings for it will be a daily battle.

Most sources of sugar are quite obvious to my clients: soda, cookies, cake, ice cream, etc.  However, there are a lot of hidden sources of sugar in the American diet.  I thought I’d use this post to list out the top 10.

10) Barbecue Sauce: Most brands have 2½ teaspoons of sugar in a 2 tablespoon serving. Many have even more than this.

 

9) Jelly And Jam: A 2 tablespoon serving provides a startling 6½ teaspoons of sugar.

8) Energy Bars: These are marketed as healthy, workout friendly snacks or meal replacements, but in most cases they are nutritionally equivalent to candy bars.  Most leading brands have over 6 teaspoons of sugar per bar.

7) Dried Fruit: Long considered healthy, raisins and other dried fruits are a huge source of hidden sugar in our diets.  A quarter cup serving of raisins has 7½ teaspoons of sugar.

6) Ketchup: A 2 tablespoon serving has 2 teaspoons of sugar. 

5) Low Fat Salad Dressing: When manufacturers reduce the fat in a product, they almost always add more sugar to improve the taste.  Most commercial low fat dressings pack 1½ to 2 teaspoons of sugar in a 2 tablespoon portion.  Since most people use more than this to dress their salad, the sugar can add up fast.

4) Vegetable Juice: When you separate the fiber from the sugar in a fruit or vegetable, you are left with a very high glycemic load beverage.  There are almost 2 teaspoons of sugar in an 8 oz glass of tomato-based vegetable juice.

3) Flavored Yogurts: These are perceived as a healthy choice for breakfast or for a high protein snack.  However, the typical flavored yogurt has 3¼ teaspoons of added sugars in a 6 ounce serving.

2) Balsamic Vinegar: This one is usually a shocker to my clients.  Balsamic vinegar can have a ton of sugar.  It really depends on the brand.  Check your labels.  I’ve seen balsamic vinegar that has 5 teaspoons of sugar in a 2 tablespoon serving! Make sure the one you use has a lot less.

1) Orange Juice: Long considered a healthy start to your day, orange juice is loaded with sugar.  While it is naturally occurring sugar, it is separated from the fiber in the orange, so it's impact on your blood sugar is dramatic.  You’ll find 5½ teaspoons of sugar in a typical 8 ounce glass of orange juice.

Feature Article: New Research On Diet Soda

Consumption of artificial sweetener and sugar containing soda and risk of lymphoma and leukemia in men and women. 
American Journal of Clinical Nutrition 2012; 96:1419-28.

Last month, a very interesting article was published examining diet soda consumption and risk of certain cancers.  The results were a bit surprising and a bit disturbing.  I thought I’d use this post to explain the ramifications of this investigation. 

Summary Of Findings

The objective of this study was to examine the association between diet soda consumption and risk of 3 cancers: non-Hodgkin’s lymphoma, multiple myeloma, and leukemia.  The study included 47,810 men from the Health Professional Follow-up Study and 77,218 women from the Nurses’ Health Study.  Participants were followed for 22 years.  Here are the main findings:

-When the 2 cohorts were combined, there was no significant association between diet soda consumption and risk of these cancers.

-Men consuming the most diet soda had a 31% increased risk of non-Hodgkin’s lymphoma and a 102% increased risk of multiple myeloma.

-This association was not seen in women.

-Men consuming the most regular soda (not diet) had a 66% increased risk of non-Hodgkin’s lymphoma.

Why You Should Be Concerned

1) This is a very well designed study.  Harvard’s Nurses’ Health Study and Health Professional Follow-up Study are two of the best cohort studies in the whole world. 

2) A recent very large study in rats saw increases in risk of these cancers with a high consumption of aspartame, which is the sweetener used in diet soda.

3) This association is biologically plausible.  Aspartame in liquid breaks down to its 3 ingredients; methanol, aspartic acid, and phenylalanine.  Formaldehyde is metabolized from methanol and is a documented carcinogen.

Why You Should Not Freak Out Entirely

1) There is a lot of previous research on the health effects of aspartame, I mean a lot.  It is arguably the most tested food substance in the history of the world.  The results of this research in both humans and animals is that it is safe.

2) When the cohorts were combined, there was no association between diet soda and these cancers.  Also when women were analyzed separately, there was no association between diet soda and these cancers.

3) The men showing an increased risk of cancer were drinking a lot of diet soda, an average of 11 servings per week.  A serving is considered 12 ounces.  Men with lower consumption, even up to 6 servings per week, saw no increased risk of these cancers.

4) It may not even have been the aspartame that caused the problem.  Because there was an increased risk in non-Hodgkin’s lymphoma in men drinking a lot of regular soda, the researchers theorized that it may be something else in soda in general, perhaps another ingredient common to both diet and regular soda (such as the caramel coloring) or a substance used in the packaging.

5) There is really no reason that there should be a sex difference in risk of cancer with this exposure.  The sex difference in risk combined with the fact that risk was elevated in regular soda drinkers as well means the results could have been due to chance.  In fact, the researchers mention as much in their own conclusions.

Recommendations

As the first study to show harm with high levels of diet soda consumption, this will no doubt spur new research in this field.  We should all keep our eye on it. 

My clients and readers of my books know that I advocate 100% sugar avoidance and, instead, occasional non-nutritive sweetener use twice a week on splurge meals.   It is my opinion that this level of consumption is safe, even after reading this study.  Two or three diet cokes a week have never been shown to cause any problem, including in this investigation.  If you are drinking tons of diet soda every day, is this study enough to make you stop?  It probably would be for me. 

However, my clients and readers of my books already know that daily consumption of diet soda is a bad idea for a number of reasons.  But that is a whole other story and this post is long enough already!

Although this study is the first to suggest a potential negative health effect of diet soda, keep in mind that lots of research has found an association between regular soda and risk of obesity, diabetes, and even heart disease.  Artificial sweeteners, although far from perfect, when consumed in moderation, are still the lesser of two evils.

Before I read this study, I had aspartame in the “occasional use” category.  In other words, I looked at it as I did red meat.  Now and again consumption is not likely to cause a problem, but daily consumption may.  After reading this article and considering all previous literature, I still look at it this way.

One last note: both this study, and the study in rats focused on aspartame, also known as Equal.  Sucralose, also known as Splenda, has not been shown to have any negative health effects.  Therefore, when you do occasionally use an artificial sweetener, it may be a good idea to go for products made with Splenda instead of Equal just to be on the safe side.

Introducing Life On The Triad and Maximize Your Health

Today is a very exciting day for me.  I’m officially launching 2 new books!  I thought I’d use this post to tell you a little about them.

Life On The Triad

I published my first book, The Weight Loss Triad, almost 4 years ago. This book presented a comprehensive weight loss program divided into 3 key areas: Diet, Cardiovascular Exercise, and Resistance Training.  It has done far better than I ever would have imagined. 

Life On The Triad is a meal plan and recipe companion to The Weight Loss Triad.  It includes 28 days of breakfasts, lunches, and dinners that comply 100% with The Triad principles.  For this project, I teamed up with my sister, Diana Halton, who is a graduate of New York City’s prestigious Institute of Culinary Education.  She is an absolutely awesome chef.  With her help, we created 28 recipes ranging from quick and easy to gourmet.  Again, all of these recipes comply 100% with the principles of The Weight Loss Triad to keep you moving steadily toward your weight loss goals.

Life On The Triad also includes chapters on eating out, traveling, sugar free living, and a shopper’s guide.  For those who have not read my first book, I’ve also included a brief summary of The Weight Loss Triad program.

To learn more about Life On The Triad or to pick up a copy, please click here.

Maximize Your Health

Maximize Your Health is a simple, yet powerful top 10 list of the most important things that you can do to reduce your risk of chronic diseases like heart disease, stroke, diabetes, and cancer.

We are bombarded with health advice on a daily basis from newspapers, TV, our government, medical societies, doctors, and of course books on diet and fitness.  Much of this advice is conflicting.  It has become very difficult for people to separate the good information from the bad. The key to making the right decisions for your health is to separate sound research hypothesis from personal opinion.

There is a huge and remarkable body of research literature that has been published in the past 30 years that shows just how the right combination of diet, exercise, and lifestyle habits can promote robust health and dramatically reduce risk of chronic disease.  Sadly, most Americans don’t even know that this research exists or how to separate the good studies from the bad.

I have yet to see a simple, easy to read summary of this research. 

That is why I wrote Maximize Your Health.  The book lists out the 10 most important and modifiable lifestyle factors to improve your health and reduce your risk of chronic disease.  All of the claims are backed by the latest research.  The book also includes detailed action steps to help you improve your adherence to these health promoting strategies.

To learn more about Maximize Your Health or to pick up a copy, click here.