Tuesday, January 12, 2016

How much weight do we really gain during the holidays?

I have been reading for years that the typical American gains 7-10 lbs. between the holiday season of Thanksgiving and New Year’s Day. However, the sources were never research based, so I have always wondered if this is really true. 

So, I decided to do a scan of the nutrition research literature to see what I could find. I was surprised that there is almost no research in this area. I found one well designed study on holiday weight gain from the New England Journal of Medicine, but it was published way back in March of 2000.

This was a simple study conducted at the National Institutes of Health in Bethesda, Maryland. In this investigation, 195 adults were weighed 4 times throughout the year: Before Thanksgiving, right after the holidays in early January, a bit after the holidays, in late February/early March and the following September.

At first I was surprised by the results, and then they made more sense. The average weight gain between Thanksgiving and New Year’s Day was about 1 pound, which was the surprising part. However, 10% of the subjects gained 5 or more pounds. As the subject’s starting weight increased, there was a trend of an increased risk of gaining at least 5 lbs. In other words, if you were overweight at the start of the study, your risk of gaining 5 lbs was higher than those with a normal weight, and if you were obese, the risk was even higher than that. 

A disturbing finding was that by the following September, the one pound weight gain remained. So, if you gain a pound every holiday season and don’t lose it, you’re looking at 5 lbs. every 5 years. This, obviously, can really add up and become a problem.

While this is just one study, it was very well done. It appears that most of us don’t gain much weight at all during the holidays, but we never seem to lose the pound or so that we do gain. The overweight and obese have a higher risk of gaining significant weight.  Generally, we don’t average the commonly referenced 7-10 pound holiday weight gain, but we do add a little and all need to be especially vigilant now that January is here!

New England Journal of Medicine 2000; 342:861-67

Animal protein vs. vegetable protein for heart health

The Study
The metabolic syndrome is a cluster of symptoms that is strongly associated with risk of heart disease, stroke, type 2 diabetes, and all cause mortality. It is diagnosed when at least three of the following are present: 1) A Waist circumference higher than 40 inches in men and 35 inches in women. 2) Blood glucose higher than 100 mg/dl. 3) Triglycerides higher than 150 mg/dl. 4) HDL cholesterol below 40 mg/dl in men and 50 mg/dl in women. 5) Hypertension. 

The researchers of this investigation wanted to see if the type and amount of protein in the diet influences symptoms of the metabolic syndrome. Sixty-two overweight men and women with metabolic syndrome were randomized into one of 3 heart healthy DASH (Dietary Approach to Stop Hypertension) diets: 1) 18% protein with two-thirds of the protein coming from plant sources. 2) 18% protein with two-thirds of the protein coming from animal sources, including lean beef. 3) 27% protein with two-thirds of the protein coming from animal sources, including lean beef. The initial goal of this 6 month intervention was weight loss followed by weight maintenance.

The results were interesting. All groups lost similar amounts of weight (about 5% of initial weight). All metabolic syndrome criteria decreased similarly independent of protein type and amount. American Journal of Clinical Nutrition 2015; 102:757-70.

Take Home Message
Many authors of diet books claim that animal protein increases risk of heart disease, and that a vegetarian diet is the only way to heart health. This study provides strong evidence against this theory. According to this study, if you choose animal proteins that are low in saturated fat, like chicken, turkey, fish, and even lean beef now and again, your ability to reduce symptoms of the metabolic syndrome are similar to eating a diet high in plant proteins. It appears that weight loss was the big driver of metabolic syndrome symptom reduction in this study.

So do not be afraid of lean animal proteins. They certainly have a place in a heart healthy diet. The big take home message here is to get your weight down to a healthy level.

Sugar and the metabolic syndrome

The Study
In this investigation, 43 overweight adolescents reduced the sugar in their diet from 28% of calories to 10% of calories for a period of nine days. The sugar was replaced with fruit, bread, pasta and cereal grains. The subjects all had at least one risk factor for cardiovascular disease at the start of the study.

The researchers wanted to study the effects of sugar on risk of heart disease, not weight loss, so they did their best to keep the participants weight stable throughout the study. The subjects were given all of their food for the 9 days and had risk factors for heart disease measured both before and after the intervention. 

The results were shocking. After just 9 days of consuming less sugar, the subjects had a statistically significant decrease in their blood pressure, triglycerides, LDL cholesterol, and had improvements in glucose tolerance. Obesity 2015: doi:10.1002/oby.21371

Take Home Message
This is a really important study. For decades, nutritionists thought of sugar as largely empty calories and only a problem if it caused weight gain. This article shows that sugar can impact risk of heart disease independent of any effect it has on body weight. 

Even though these adolescents had no appreciable change in their weight (they lost on average just 2 lbs.), there were dramatic reductions in blood pressure, blood lipids and glucose tolerance in just 9 days. And they were still consuming 10% of calories as sugar, which in my opinion, is a ton of sugar!

The message is now crystal clear. Sugar is not just empty calories, it has the potential to make you very sick. Do your best to strictly limit sugar, or even better, swear it off altogether.

Book Review: The 10 Day Sugar Detox

Next up for review is The 10 Day Sugar Detox. The author, Dana White, is a Registered Dietitian.

As the title suggest, this book is about eliminating sugar from your diet. The 10 Day Sugar Detox provides 4 diets plans to help you do this: The Orange Plan is designed for vegetarians. The Yellow Plan is for omnivores. The Green Plan is grain free and legume free. The Blue Plan is grain, legume and dairy free. The book is broken down into 3 sections. The first discusses the health effects of sugar, the second presents the meal plans and the third section presents over 100 recipes. The book is 295 pages. It is well written and I truly enjoyed reading it.

5 Things I Really Liked About The 10 Day Sugar Detox
1) I totally agree with the authors take on the negative health effects of sugar and the need to eliminate it from the diet. The recent research literature really supports this view. I have found over the years that sugar is highly addictive, and even small amounts can deeply impact one’s ability to eat healthy and hit weight loss goals. 

2) I like that there are 4 different plans. This is relevant if you suffer from allergies, digestive orders or just don’t want to be too restrictive.

3) The recipes are really creative. 

4) The author gives a very nice explanation of the impact of added sugars on blood glucose levels. Dramatic swings in blood sugar adversely affect a large number of systems in the body with very serious consequences.

5) The author also gives a really nice explanation of sugar withdrawal. I have seen this for years in my clients and certainly in myself, when I gave up sugar almost 20 years ago. It is important to expect this reaction to occur and to know that it is totally temporary.

5 Things I Didn’t Agree With In The 10 Day Sugar Detox
1) The author mentions that legumes should be avoided because they cause inflammation. I have never seen this in the research literature. As a low glycemic carbohydrate that is high in fiber, I would make the argument that legumes help to reduce inflammation in the body. I was surprised that they were restricted in 2 of the 4 meal plans.

2) The author has an unusual method of citing references that was a bit confusing. For example, she would write; “A study in the American Journal of Clinical Nutrition shows...” but there would be no corresponding number for the reference. At the back of the book, all of the references are listed alphabetically, not even by chapter. This makes it time consuming, if not impossible, to find the particular reference to which she was referring.

3) The book restricts lactose, which is the sugar found in milk. Lactose has a very mild impact on blood sugar and, in my experience, is not at all addictive like higher glycemic forms of sugar. I’m not sure why she would group it with the other added sugars.

4) After the detox, the book recommends reintroducing sugar, but at half the rate that it was originally consumed. I found this a bit surprising. The author does a very nice job explaining how sugar is just as addictive as alcohol or cocaine, but allows it to be added back to the diet after the 10 day detox. Can you imagine telling an alcoholic that after treatment it is OK to drink again, just half as much?

5) The recipes include a bunch of foods that I have my clients strictly limit. For example, the recipes consistently call for: coconut milk (which has 8 grams of sugar per serving), coconut oil, full fat cheese, full fat yogurt, bacon, prosciutto, pasta and other red meats. Most of these foods are either high glycemic load or high in saturated fat, which has the potential to raise LDL cholesterol and increase risk of heart disease and stroke.

Is The 10 Day Sugar Detox Worth Reading?
Absolutely! I enjoyed this book. Sugar is probably the most unhealthy thing in the American diet today, and we eat a ton of it. Sugar not only has a negative impact on our physical health, it is also highly addictive. This book presents some nice plans to help the reader get off the sugar roller coaster. I would just get a little tighter on the saturated fat and red meat in the recipes and would recommend that once you are off sugar, stay off. After 2 weeks or so of minor withdrawal symptoms, it is not nearly as hard to do as you may think. 


Thursday, November 12, 2015

Drinking Juice Is An Easy Way To Eat More Fruit, Right?

The answer is no, and let’s start with some background.

Fruit in its whole form is one of the very best things that you can eat. It is high in vitamins, fiber, low glycemic load carbohydrate, and phytochemicals. In the research literature, fruit consumption has been associated with a lower risk of heart disease, stroke, hypertension, and certain types of cancers.

The sugar in fruit in its natural form is surrounded by a helix of fiber. Your digestive system has to break through this fiber in order to digest the sugar. This takes time, so fruit in its whole form has a very easy impact on your blood sugar.

When you juice a fruit, you are separating the sugar from the fiber. What you are left with is pure sugar. This will cause a spike in your blood glucose and insulin levels, which is not a good state for the body. Over the short term, these spikes in blood sugar will leave you hungry a few hours later, so you tend to eat more at the next meal, which can add to weight gain. Blood sugar spikes also can negatively impact your energy and focus. Over the long term, diets with a high glycemic load have been associated with a number of diseases, including heart disease and diabetes.

Juicing a fruit or vegetable takes a seriously healthy food and turns it into the equivalent of a soft drink with a few vitamins. Eat your fruits and vegetables in their whole and natural form and keep your blood sugar on an even keel.

Weight Lifting And Metabolic Rate

The Study
Ninety four women were put on an 800 calorie per day weight loss diet and placed into one of 3 intervention groups: 1) Aerobic training 3 days per week for 40 minutes, 2) Resistance training 3 times per week, or 3) A control group. Fat free mass and resting energy expenditure were measured both before and after the intervention. Fat free mass is basically your muscle mass, and resting energy expenditure is the amount of calories each day your body needs to perform basic functions.  

At the end of the 6 month follow up, all of the women lost similar amounts of weight. However, the resistance training group maintained muscle mass during the weight loss period, while the aerobic exercise group and the control group lost muscle mass while losing weight. Consequently, the resistance training group had a much lower drop in resting energy expenditure after weight loss (44 calories per day) compared to the aerobic group (76 calories per day) and the control group (103 calories per day). Obesity 2008; 16:1045-51

Take Home Message
The majority of people who lose weight, eventually gain it back. A drop in resting energy expenditure is a big reason why this is the case. This study shows that a reduction in muscle mass is very likely the culprit. Muscle is a very active tissue. Each pound burns roughly 50 calories each day, whether you exercise or not. When you lose weight without weight lifting, a lot of the weight you lose is muscle and your metabolism drops. When you lift weights, you maintain the muscle and your metabolism drops much less, making it easier to keep the weight off.

If long term weight management is your goal, it is essential to hit the weights at least twice per week. You don’t need to spend hours in the gym to do this. Just do one exercise for each of the major body parts: your chest, back, shoulders, biceps, triceps, abs, and legs. The whole routine should take about 20 minutes and you can do it at home. All you need is an exercise mat and some dumbbells. Resistance training absolutely has to happen if you want to keep the weight off long term. In my opinion, it is the most overlooked aspect of weight loss programs.

Carbohydrate Quality and Depression

The Study
Almost 70,000 subjects from the Women’s Health Initiative had their diet and incidence of depression monitored for a period of 3 years. Diet was assessed at baseline by a 145 question food frequency questionnaire. Depression was assessed by means of the Burman 8 Item Scale for Depressive Disorders at baseline and at the end of the three year follow up.

Women with the highest glycemic index had a 22% increased risk of depression when compared to women with the lowest glycemic index. Similarly, women with the highest consumption of added sugars (79.2 grams per day) had a 23% higher risk of depression when compared to women with the lowest consumption of added sugars (17.8 grams per day). In other findings, dietary fiber, fruit, and vegetable consumption were each associated with a lower risk of depression, while refined grain consumption was associated with a higher risk of depression. American Journal of Clinical Nutrition 2015; 102:454-63.

Take Home Message
For many years, I have noticed that the mood of my clients improves when their blood sugar stabilizes. This investigation is the first well designed research article that backs up this theory up with good hard science.

The authors of this paper listed several possible mechanisms by which a higher glycemic index may increase risk of depression: 1) An increase in body wide inflammation. 2) Increased insulin resistance, which is associated with a pattern of cognitive deficit very similar to depression. 3) Peaks and valleys in blood sugar themselves may increase depression. 4) The counter-regulatory hormones to glucose are released in abundance with a high glycemic diet. They are cortisol, glucagon, epinephrine and growth hormone, and are associated with anxiety and depression. In order to keep a lower dietary glycemic index, choose fruits, vegetables, legumes, and whole grains over refined grains and added sugars.