Wednesday, March 12, 2014

What is considered a good rate of weight loss?

This is a really important question that I hear from just about every client that I work with. Having reasonable and realistic expectations of your weight loss effort can be the difference between hitting your goal, and giving up prematurely because the program “Isn’t working fast enough!”

Ideal weight loss is ¾ of a pound per week for the ladies and 1 pound a week for the men. I know this doesn’t sound like much, but it adds up to 3 pounds in a month, 18 pounds in 6 months, and 36 pounds in a year. This is the rate of weight loss for those that are successful at losing weight and keeping it off long term.

Why is this the case?
1) A pound of fat is 3500 calories. This means that there are 500 calories per day that you have to eliminate by either eating less or exercising more. Even this is not easy to do with consistency.

2) Resistance training will add small amounts of muscle to your body. This is pivotal to maintaining metabolic rate and ensuring that you’re losing body fat and not muscle mass. This additional muscle weight will show up on the scale and will slow down the overall rate of weight loss. Trust me when I say this is a very good trade-off. Maintaining muscle mass throughout the weight loss process is the only way to permanently change your body.

3) The human body has a number of defense mechanisms to weight loss that are recruited when body fat starts to drop. This will naturally slow down the rate of weight loss as time goes on.

4) It is far better to make smaller changes to your diet and exercise program that are sustainable long term, than major changes that you can only keep up for a short time.

Popular TV shows and fad diets will promise that you can lose 5, 10, or 15 pounds in a week. Don’t believe the hype. Slow and steady wins the race when it comes to weight loss. Keep your eye on the goal long term and take it nice and slow!




Tuesday, March 11, 2014

Research Update

Is your breakfast making you hungry?

The Study
48 subjects consumed Quaker Old Fashioned Oatmeal and Honey Nut Cheerios for breakfast on 2 separate occasions in a randomized crossover trial. Both meals contained 363 calories; 250 for the cereal and 113 for the fat free milk. Visual analogue scales measuring hunger and satiety were completed throughout the morning of each test. When the subjects consumed the oatmeal, they reported significantly higher levels of fullness and significantly lower levels of hunger, desire to eat, and prospective food intake than when eating the Honey Nut Cheerios. The oatmeal breakfast was lower in sugar, had a lower glycemic index, and had higher amounts of protein, total fiber, soluble fiber, and beta glucan than the Cheerios. These are all potential mechanisms for the increased satiety. Journal of the American College of Nutrition 2013; 32:272-79.

Take Home Message
When it comes to weight loss, a calorie is not a calorie! Some foods increase hunger and subsequent energy intake, and some don’t. The glycemic load is a powerful concept that must be understood if you want to lose weight and keep it off.

What’s more important, the number of fruits and vegetables consumed or the variety?

The Study
71,141 women from the Nurses’ Health Study and 42,135 men from the Health Professional Follow-up Study had their quantity and variety of fruit and vegetable consumption measured for a period of 22 years. Subjects consuming 8 or more servings of fruits and vegetables per day had a 17% lower risk of heart disease compared to those consuming 2 or fewer servings of fruits and vegetables per day. Variety, which was measured as the total number of unique fruits and vegetables consumed at least once per week, was not associated with risk of coronary heart disease. The authors believed the reduction in risk of heart disease was due to the presence of carotenoids, vitamin C, fiber, magnesium, potassium, and/or antioxidants in the fruits and vegetables. American Journal of Clinical Nutrition 2013; 98:1514-23.

Take Home Message
While it is always good advice to include a variety of fruits and vegetables in your diet, it may not be as important as the number of servings, at least when it comes to risk of heart disease. One last note: white potatoes and fruit juices were not considered as servings of fruits and vegetables by the researchers, most likely due to their higher glycemic load.

Groundbreaking New Research On Blood Sugar And Dementia

Glucose levels and risk of dementia. New England Journal of Medicine 2013; 369:540-48

Previous research has shown that diabetics have an increased risk of dementia.  This study examines the association between high blood glucose levels and risk of dementia in those without diabetes.

2,067 older men and women free of dementia and diabetes, were recruited from Group Health Cooperative, which is a health care system in Washington State. Over 7 years of follow up, blood glucose was measured repeatedly with a fasting blood glucose test.  Risk of dementia was measured by means of the Cognitive Abilities Screening Instrument. By the end of follow up, researchers had collected 35,264 measures of blood glucose in these subjects. The association between glucose levels and incidence of dementia were calculated.

By the end of follow-up, there were 524 new cases of dementia in this cohort.  Blood glucose levels were linearly and significantly associated with an increased risk of dementia, starting at fasting concentrations of 105 mg/dl. Following are the increases in risk of dementia with the corresponding average blood glucose readings:

105 mg/dl: 10% increased risk of dementia
110 mg/dl: 15% increased risk of dementia
115 mg/dl: 18% increased risk of dementia
It is also important to note that those with an average glucose reading of 95 had a 14% reduced risk of dementia.

Previous research has shown that diabetics have an increased risk of dementia.  Therefore, it is known that very high levels of blood glucose have a negative impact on the aging brain. This is the first study to show significant increases in risk of dementia with blood glucose levels well below that of diabetics.  

A fasting blood glucose reading below 100 is considered normal.  A fasting blood glucose above 125 is considered definitive for a diagnosis of diabetes.  If you fall in between (101-125) you are considered pre-diabetic.  This study showed that even a tiny increase in fasting blood glucose above normal will increase risk of dementia.  This is frightening because a huge number of American fall into this prediabetic category.  The authors felt that the increased risk of dementia was due to acute and chronic hyperglycemia, insulin resistance, and microvascular disease of the central nervous system.

Take Home Message
This is a really well designed study published in the #1 journal that will initiate more research in this area.  In the meantime, do your best to keep your fasting blood glucose levels in the normal range (even a bit lower as those with a reading of 95 mg/dl had a reduced risk of dementia). The best way to do this is to exercise daily, keep your weight in a healthy range, and eat a low glycemic load diet.

Monday, March 10, 2014

Product Review: Gazelle Edge

If you work with me or have read any of my books, you already know that cardio is essential to weight loss, fitness, and chronic disease prevention. Research is now telling us that we need to do a lot more of it than any of us originally thought. If weight loss in particular is your goal, cardio simply has to be a daily part of your routine. 

Going to the gym sounds great, but I can’t say that I have seen it work long term. In fact, in 15 years of working with weight loss clients, I can name one client who consistently got to the gym every single day to hit her cardio goal. Life just seems to get in the way. The only answer is to have a piece of cardio equipment in your home.

Enter the Gazelle Edge. This is a glider, which is very similar to an elliptical trainer, and is sold on I can’t say enough about it. Here are some of the great features:

1) It is low impact and very easy on the joints. 

2) It is light and folds up for easy storage against a wall or even under a bed. This makes it perfect for those in apartments or for those that don’t want a piece of gym equipment prominently displayed in their home.

3) It is inexpensive. Amazon sells it for about $120 with free shipping.

4) Having the Gazelle at home makes getting your cardio minutes a snap. Put it in front of your flat screen, and TV time becomes exercise time. You can talk on the phone while on the Gazelle. When your balance gets really good, you can even read on the Gazelle. 

5) It works! The majority of my clients use it as their primary source of cardio (as do I) with amazing weight loss results.

*Always remember that whenever you are starting or changing your exercise program, it is important to talk to your doctor first to get medical clearance.

Over the years I have gotten a lot of questions from my clients on how to best use the Gazelle Edge. In this next section, I’ll answer them for you.

Should I use the arms?

No! In fact, I recommend taking the arms off altogether. I want you to focus on the larger muscles of the lower body and not your arms. Also, with the arms off, you will be free to hold the TV remote, a book, or your tablet. If you need to hold on for balance in the beginning, you can keep your hands on the side of the machine.

How can I prevent the Gazelle from sliding around while I’m working out?

If you place the Gazelle on a hardwood floor, it can move around a bit during your workout. To prevent this, use the Gazelle in a carpeted room. If this isn’t an option, a thin yoga mat underneath it will help a lot. I actually use a yoga mat on top of the carpet to keep the machine from leaving indentations on the carpet.  This combination reduces movement 100%.

Initially, I feel like I’m not working out hard enough, am I doing something wrong?

When you first start using the Gazelle, you will not be entirely balanced and comfortable. This tends to slow down your pace. It is common to feel like you are not getting a great workout at this time. After a couple of weeks, your balance will improve and you will be able to greatly pick up the pace. The key is to take long, fluid strides, kind of like cross country skiing on one of those Nordic Track’s from years ago. Also, swing your arms as if you were running quickly.

Can I do anything else to pick up the intensity?

For most people, following the above recommendations will get their intensity to the proper level to improve fitness and lose weight. However, if I have a client that is a bit younger and healthy, I’ll recommend interval training to ramp up the intensity. 

I’ll have them start out their cardio at the normal intensity for 4½ minutes, and then sprint for 30 seconds. I’ll have them repeat this 4 or 5 times during their workout. This is a great way to increase intensity and burn more calories. The sprint does not have to be maximal, just a clear increase in speed for 30 seconds. If a client is overweight or has cardio-metabolic risk factors, such as hypertension or high cholesterol, I don’t recommend interval training, since the increased intensity can spike heart rate and blood pressure.

So there you have it. If attaining your cardio goals has been a problem for you, the Gazelle Edge is a low cost and effective solution.

To learn more about the Gazelle or to pick one up: click here.


Friday, January 10, 2014

How Often Should I Weigh Myself?

Weighing yourself regularly and properly is an important component of any weight loss program. It serves 3 purposes:

1) To measure your progress. If you are losing weight, you’ll know your program is working. If not, you’ll know that it is time to make some changes.

2) To learn about your personal metabolic physiology. No 2 people lose weight the same way. It is a highly subjective process. When you weigh yourself weekly, you’ll start to see certain patterns. You’ll study what you did when you lost weight, and you’ll study what you did when you didn’t. After several months, you’ll refine your program with laser-like focus, knowing exactly what you have to do to achieve your goals.

3) Weight Maintenance. Once you hit your goal weight, weighing yourself weekly will keep you focused. Old habits will tend to creep back in. If you see small increases in your weight, you can make the necessary adjustments.

Weighing yourself correctly is a bit more complicated than you may think. Here’s how I have my clients do it:

1) Make sure you have a research quality scale. I’m a big fan of the Tanita Iron Man (  These are digital scales that are highly accurate and can even measure your body fat. They run around $100, but last forever.

2) Pick a day of the week that will be your regular weigh in day. Alcohol, salt, and refined carbohydrates make you retain water like crazy for up to 2 days after consumption. Some of my clients will go up 3-4 pounds after a splurge meal! This is not body fat, just water retention that goes away after a couple of days.

For this reason, you want to eat very clean for 2 days before your weigh in day. That means no splurges, alcohol, or restaurant meals. Since most of my clients splurge on the weekends and get back on track Monday and Tuesday, Wednesday is a natural weigh in day. Personally, I like Saturday morning. I’m very tight with my diet on Thursday and Friday, so Saturday is my day.

3) Weigh yourself first thing in the morning, before you eat or drink anything, in your underwear. You wake up in a dehydrated state, which will help control for level of hydration which is a natural confounder for accurate weight readings.

4) Record your weight so you can measure your progress and search for patterns.

Weighing yourself regularly and accurately is a vital tool in your arsenal when trying to lose or maintain your weight. Make sure you use it properly!

Research Update

Do we eat more when we drink alcohol?

The Study
1,864 men and women were selected from the National Health and Nutrition Examination Survey who reported drinking alcohol on one of their 24 hour dietary recalls and not the other. The amount of calories consumed on drinking versus nondrinking days were compared. When drinking alcoholic beverages, men consumed an extra 168 non-alcohol calories with increases in saturated fat, sodium, meat, and potatoes. Women consumed a nonsignificant 93 more calories on days when they drank alcohol and consumed a higher amount of saturated fat.  The authors noted that alcohol has been shown in the research literature to influence food related hormones. American Journal of Clinical Nutrition 2013; 97:1086-75.

Take Home Message
If weight loss is your goal, you need to limit the alcohol. Alcohol is calorie dense at 7 calories per gram, and does tend to increase food intake. I have my weight loss clients shoot for no more than 4 drinks per week.

Soda and heart disease in kids

The Study
Everyone knows that sugar sweetened beverages, like soda and fruit drinks, are not the healthiest choice, but a recently published study in adolescents is truly eye-opening. 1,433 Australian teens had their sugar sweetened beverage consumption measured by a food frequency questionnaire at age 14 and 17. Girls who consumed the most sugar based beverages (greater than 1.3 servings per day) had a 3.8% increase in their BMI, a 5 times greater risk of overweight or obesity, and a 3 times greater prevalence of risk factors for heart disease. Girls who consumed the most of these beverages also had a significant increase in triglycerides, systolic blood pressure, waist circumference, and a decrease in HDL cholesterol. Boys who consumed the most sugar sweetened beverages had a significant decrease in HDL cholesterol and significant increases in triglycerides and waist circumference. American Journal of Clinical Nutrition 2013; 98:327-34.

Take Home Message
We have known for some time that soda and fruit drinks are associated with weight gain. The increases in risk factors for heart disease in the children in this study are alarming, to say the least. Soda’s and fruit drinks need to be strictly limited, or better yet, completely avoided.


Can You Be Overweight Yet Totally Healthy?

Are metabolically healthy overweight and obesity benign conditions? Annals of Internal Medicine 2013;159:758-69.

A recent study suggested that the overweight have a lower risk of mortality than those that are at a normal weight. A minority subgroup of obese individuals on the surface seem to be completely healthy. They have no negative metabolic consequences that are normally associated with weight gain, such as high blood pressure, insulin resistance, high cholesterol, etc. This investigation examines whether there is a class of “benign” obesity that does not increase risk of disease.

This paper is a meta-analysis of 8 studies that compare risk of all-cause mortality and/or cardiovascular events in 5 categories of individuals:

1) Normal weight and healthy
2) Normal weight and unhealthy
3) Overweight and healthy
4) Overweight and unhealthy
5) Obese and healthy
6) Obese and unhealthy 

Healthy individuals lacked any of the normal risk factors for heart disease such as: high triglycerides, low HDL, high blood pressure, high blood glucose, etc. Normal weight is considered a BMI under 25. Overweight is considered a BMI of 25.1-29.9. Obese is considered a BMI greater than 30.

Those that were of normal weight and healthy were considered the reference group. Compared to these subjects, those that were unhealthy and obese had a 265% increased risk of death or cardiovascular events. Those that were overweight and unhealthy had a 270% increased risk of death or cardiovascular disease. Those that were normal weight and unhealthy had a 314% increased risk of death or cardiovascular events. Those that were overweight and healthy had a non-significant 21% increased risk, while those that were obese and healthy had a 25% increased risk.

Studying the effects of weight on mortality is really challenging. People who smoke are thinner than average and die younger than nonsmokers. People who are sick often lose weight for years before they die. So, sometimes it looks like thinner people die younger than those who are a bit heavier. However, when these issues are properly controlled for, the research literature shows a strong association between overweight, obesity, and early mortality. This study confirms this idea. Subjects who were obese but otherwise healthy had a significant increase in risk of early death or cardiovascular events. 

Take Home Message
Despite recent headlines to the contrary, being overweight is unhealthy. If your BMI is above 25, work to get it lower. If it is below 25, do your very best to keep it there.