Archive for June, 2005
Only if you’re willing to keep your calories restricted – to about 1400 a day!
According to an article at ABC-News detailing the results from the National Weight Control Registry, a database of people who have lost atleast 30-pounds and maintained their weight-loss for at least one year, that’s how many calories they eat on average to maintain their weight.
This most recent look at a sampling of 2,700 people in the database, most of whom were women, found that all reported eating about 1,400 calories per day. The number of registrants following a low-carb diet (<90g carbs) rose between 1995 to 2003, from 6% to 17%, and the percentage of calories from fat also rose from 24% to 29%.
What is troubling, at least to me, is the severely restricted calorie load eaten to maintain the weight loss.
A calorie intake of just 1,400-calories per day is starvation. Such a low intake of calories will not provide adequate levels of essential nutrients for the long-term. If you recall, I wrote recently about a study that showed an increased risk of death following weight loss, [Can Losing Weight Kill You?] and pondered about what could be the reasons for the increased risk.
Since the researchers did not track the type of diet used to lose weight, the nutrient-density of the weight-loss diet or the quality of the maintenance diet in that study, it is impossible to conclude that weight-loss, in and of itself, increases risk of early death. However, as I pointed out, loss of lean body mass may be a risky problem with losing weight – and some dietary approaches actually rob the body of high amounts of lean body mass along with fat loss, namely low-fat, very low calorie diets.
For years the National Weight Control Registry has been used to highlight how a low-fat diet and exercise helps one maintain their weight loss. It is often touted as the “proof” that a low-fat diet works in the long-term. But, and this is where the problem is, the focus is on the percentage of fat in the diet and the amount of exercise, not the nutritional quality or quality of life and health of those being followed. Until we shift our focus, and look at the quality of the diet in terms other than calories (hint, hint – nutrient-density) in the short and long-term, we are not going to solve the obesity trends in the US.
As the ABC-News article painfully shows, no one seems worried about the effect of what is chronic starvation for these people – they’re concerned over a rise in the percentage of fat in the diets of those in the registry!
You may remember when I wrote about Basal Metabolic Rate in my previous commentary – very few adults have a basal metabolism of just 1,400 calories, and if they’re exercising [that is “active”], 1,400 calories is most definitely not enough calories to meet Active Metabolic Rate [the amount of calories to maintain weight].
With that low an intake of calories, the body is fighting for survival, making all sorts of metabolic compromises through homeostasis, to just survive. Long-term that cannot be viewed as a “good” way to lose weight or proof of “success” for maintaining weight loss.
No one should be expected to starve themselves to reach a healthy weight and no one should be expected to become chronically deficient in essential nutrients because they’re not eating enough calories each day to maintain that weight loss.
If you’re considering a weight-loss plan, think long and hard about what is expected in the long-term….think about how you’ll have to eat once you reach your goal weight….think about the importance of meeting or exceeding your nutrient requirements, even in the weight loss period.
And then consider a controlled-carbohydrate approach – an approach that, when done properly, allows adequate calories, is nutrient-dense, spares lean-body mass and allows you to eat well once you’re at your goal weight to maintain not only your new weight, but also your long-term health.
This year has brought more evidence about the importance and role of adequate intake of Vitamin D – and not just on the health of our bones!
Since the beginning of the year, Vitamin D deficiency has been linked to:
- Skin Cancer [ironic, isn’t it?]
- Heart Disease
- Fetal development problems [Maternal deficiency]
- Learning and Memory dysfunction
- Bone deformity
- Low Bone Mineral Density
- Seizures in Newborns [Maternal deficiency]
- Muscle Weakness
- Chronic Autoimmune Disease
- Hip Fractures in the elderly
- Nutritional Rickets
How are we, in the United States, doing when it comes to adequate Vitamin D levels?
Back in February, researchers from Canada published Vitamin D insufficiency in North America in the Journal of Nutrition [J Nutr. 2005 Feb;135(2):332-7]. Among their conclusions – we’re not getting enough Vitamin D and that the response to vitamin D supplementation in clinical trials suggests current recommendations for dietary intake of this vitamin are too low and that a higher adequate intake should be recommended.
Throughout the spring many articles appeared in the media suggesting that our phobia of the sun and our obession with liberal use of sunscreens may be contributing to our Vitamin D deficiency. Sunshine is, afterall, the primary source of Vitamin D for the body. By screening out the sun’s UV rays, sunscreens are robbing our bodies the ability to manufacture Vitamin D, so without intake from food or supplements, we risk deficiency in this essential Vitamin.
In the last week, a number of articles have once again sounded the warning that any exposure to the sun’s ultraviolet rays is damaging, so lather up with that sunscreen – and be sure it’s also full-spectrum for UVA and UVB. These warnings are being issued by the American Academy of Dermatology and the Food and Drug Administration (FDA). Have they not read the over 100 studies published since January 1st? Have they missed the almost 10,000 abstracts specifically looking at Vitamin D deficiency?
Now, I’m not suggesting wanton exposure to the sun with no thought to the potential for damage to your skin – that can happen with too much exposure, especially if your skin burns.
What I am suggesting is providing your body with one of the essential Vitamins it needs to function properly – and this time of the year, you can do that with moderate time in the sun, about 10-20 minutes, without sunscreen on.
Not convinced that exposing your skin to moderate amounts of sunshine is a good thing?
Don’t worry – there are other things you can do instead, and these things should be considered during the winter months in northern latitudes!
- 1 teaspoon of cod liver oil daily provides all the Vitamin D you need, and it’s in its natural food form, not a synthetic
- Vitamin D is also present in some foods, most notably in Shrimp, a 4-ounce serving of boiled shrimp provides 40.6% of the DV; Salmon, 1 4-ounce cooked serving provides 95% of the DV; Tuna (canned in oil), a 3-ounce serving provides 50% of the DV; Sardines (canned in oil), a 1.75-ounce serving provides 70% of the DV; and Mackerel, a 4-ounce cooked serving provides 95% of the DV.
- Other foods that are good sources of Vitamin D include: Large whole Eggs – one egg provides 5.7% of the DV; 8-ounces of whole Cow’s Milk provides 25% of the DV; and 4-ounces of baked Pacific Cod provides 15.9% of the DV.
- Fortified food sources can also be used, although the Vitamin D within them is synthetic
- Supplements can also be used, but again the form of Vitamin D is synthetic
Earlier today (see blog entry below) I wrote about a study which found that losing weight may pose a risk in the long-term. While the study was limited in its ability to determine causation, it does pose questions – most notably ‘does the type of diet used to lose weight affect health in the long-term?’
I included the importance of nutrient-density in the equation of risk-benefit and now another study published in the American Journal of Clinical Nutrition (2005 81: 1253-1254), suggests that a controlled-carb approach offers:
- A metabolic advantage
- A nutritional advantage
- A greater improvement in levels of triglycerides
An energy-restricted, high-protein, low-fat diet provides nutritional and metabolic benefits that are equal to and sometimes greater than those observed with a high-carbohydrate diet,” concluded the researchers.
For this study, researchers randomly assigned 100 overweight or obese women aged 40 to 58 years, with a body mass index of between 28 and 38, to one of two isocaloric 5600kJ diets for a 12-week period. Participants – 100 middle-aged, moderately obese women – were placed on a 12 week of diet with either of two isocaloric, restricted diets, each with similar fat content (20% of calories) but varied protein and carbohydrate content. The high-protein (HP) diet contained 34% of calories as protein with 46% of calories from carbohydrate, and the high-carbohydrate (HC) diet contained 16% of calories from protein with 64% of calories from carbohydrate.
- Both groups had similar weight-loss ~ about 16-pounds
- When the results were further evaluated according to initial serum triacylglycerol concentrations, patients with high triacylglycerol who consumed the HP diet lost 25% more weight and had greater reductions in body fat mass and serum triacylglycerol concentrations than did those with high triacylglycerol who consumed the HC diet
- Serum vitamin B-12 levels increased 9 percent with the high-protein diet and decreased 13 percent with the high-carbohydrate diet
- Folate and vitamin B-6 levels increased with both diets
- Both groups also experienced a decrease in LDL-cholesterol, HDL-cholesterol, glucose, insulin, free fatty acid, and C-reactive protein concentrations with weight loss
The authors conclude that HP diets are of particular benefit in patients with high circulating triacylglycerol concentrations.
In today’s Guardian (UK) an article caught my attention – Overweight who diet risk dying earlier, says study. You can find the abstract on PubMed.
The first sentence of the article, Overweight people who diet to reach a healthier weight are more likely to die young than those who remain fat, according to a study, opens the door to a number of intriguing questions.
- Did the researchers investigate enough factors to reach their conclusions, or is this merely a correlation and not causation?
- Does the type of diet followed to lose weight influence the risk of losing weight?
- How do we determine if/when the risk of losing weight outweighs the benefits?
What the researchers found was that in an 18-year follow-up of 2,957 overweight or obese people, data showed that those who wanted to lose weight and succeeded were significantly more likely to die young than those who stayed fat. Those who participated had been screened to ensure they had no underlying illnesses. Those who gained weight also had a greater risk of dying young.
So, the first of my questions, did the weight-loss cause more deaths or did something else increase the risk of early death?
That’s a difficult question to answer since the researchers only looked at intention to lose weight, weight-loss, weight stability and weight-gain and did not investigate other issues related to health such as smoking habits, type of diet used for weight-loss, exercise habits, prescription and/or illicit drug use, or a host of other risks to long-term health.
“It seems as if the long-term effect of the weight loss is a general weakening of the body that leads to an increased risk of dying from several different causes,” said Dr Sorensen. “The adverse effects of losing lean body mass may overrule the beneficial effects of losing fat mass when dieting,” he added.
Ah, now there is something interesting – the loss of lean body mass as a factor that may increase risk! Which brings me to my second question – the type of diet used to lose weight. Again, the data is lacking here since the researchers didn’t investigate the type of diets used to lose weight, so the nutritional quality of the diets used cannot be determined.
For years I’ve held the belief that the nutrient-density in the diet is of utmost importance when one is trying to lose weight. Dieting – that is creating a calorie deficiet to lose weight – is placing a strain on the body which has evolved with one primary function – survival. Choose a diet that is nutritionally bankrupt and the strain on the body is greater than when the body receives the nutrients it requires to function.
When one purposely creates a calorie deficit the potential for a nutrient deficit is higher. That is why it is critical to ensure you’re body is meeting or exceeding nutrient requirements (vitamins, minerals, essential fatty acids, essential amino acids) while you are losing weight. These critical nutrients help the body “survive the famine” of calories.
The foods eaten (macronutrients – carbohydrate, fats, proteins) must be nutrient-dense. The evidence we have that has actually measured lean body mass loss compared to fat loss shows that a carbohydrate restricted approach with adequate protein intake is more protective to lean body mass than a fat restricted approach.
Which brings me to my last question – how do we determine if/when the risk of losing weight outweighs the benefit?
The authors stressed that very overweight people and those with weight-related illnesses should not be deterred from dieting, but added that researchers should in future consider the short-term advantages of weight loss against the potential long-term risks.
Losing lean body mass is potentially detrimental to overall health in the long-term. The key is to find a weight-loss diet that will help protect lean body mass and allow the body to shed fat stores. To date, the data supports a controlled-carbohydrate approach to lose weight while preserving more lean body mass when compared with other dietary approaches.
The caveat? Well, there a few…
Nutrient-density – if you choose a low-carb diet or a controlled-carb diet you must be vigilant about ensuring you eat nutrient-dense selections to meet or exceed the RDA’s as you lose weight. Many find it helpful to track their eating in software that calculates nutrient intake along with calories, fats, carbohydrates and protein intake. Online there is a free service from FitDay.com that I highly recommend.
Calorie deficit – it is critically important that you do not send your body into a metabolic state of starvation while you’re losing weight. If you restrict your calorie intake too much, your body can perceive the calorie deficit as “famine” and actually reduce your metabolism – slow down how quickly you use stored calories from fat and lean body mass – and be counter-productive to weight loss while also increasing the strain on the whole body to survive.
So how much of a deficit is too much?
A good rule of thumb is to ensure you’re eating enough calories each day to meet your Basal Metabolic Rate (BMR) – that is how many calories your body requires just to function before any movement or activity is considered. The BMR is the calories required for body temperature regulation, blood flow, heart beat, breathing, etc. To find your BMR, you can use an online calculator that determines your BMR based on your current weight, height and gender. Be sure to re-calculate with each 10-pound loss since your BMR is closely tied to your current weight.
Activity – It’s important to overall health that you’re active. You don’t need to go crazy, but you do need to get yourself moving. A good online calculator can help you determine how many calories you’re using for a variety of activities – and it’s based on how much you weigh and how many minutes you did the activity! If you’re currently leading a “sedentary” lifestyle, start slowly and add more activity over time and as you lose weight.
Earlier this week I wrote about the Pennsylvania House passing a bill to protect the food industry from obesity-related lawsuits. In Maine, as reported in MaineToday.com, Governor John Baldacci signed a bills Friday to shield restaurants from litigation filed by customers who blame the establishments for their weight problems.
As in Pennsylvania, the Restaurant Association in Maine is just thrilled with the passage of the law that now protects them from lawsuits. Richard Grotton of the Maine Restaurant Association said he supports a new law that prevents what he called “frivolous obesity lawsuits.”
Except in instances of deception, restaurants in Maine will become immune from lawsuits in which people claim that food sold by the restaurant made them fat. “There has to be some personal responsibility here,” he said.
Given the emerging evidence that many ingredients in various foods are potentially harmful, and even “addictive,” why are we allowing state legislatures to act in what may not be our best-interest?
To give you some examples…
1) On June 10th, I wrote about HNE creation in fried foods. The toxin in question — 4-hydroxy-trans-2-nonenal (HNE) — collects in high amounts in polyunsaturated oils that have linoleic acid, which include canola, corn, soybean and sunflower. The International Herald Tribune reported on a study that revealed the risks associated with re-heating vegetable oils in cooking. The findings, the researchers say, highlight the risk of reheating the oils or reusing them, since the amount of the compound, known as HNE, increases with each heating.
Restaurants use oil again and again – how much HNE are you being exposed to when you choose foods fried in that oil? There are no warnings to alert you to the potential danger, yet we know the danger and so does the restaurant industry!
2) I wrote about McDonalds bringing back their Super-Size, 42-ounce soda. And they didn’t just bring it back – they’re giving it away FREE with a Big Mac and Fries. With such a promotion, you’re now exposed to HNE’s AND excess calories, and let’s not forget, trans-fats.
3) That’s right, they’re still serving up french fries and other foods riddled with trans-fats. As reported by the Center for Science in the Public Interest, McDonald’s recently settled a lawsuit started because they had promised to reduce trans-fats in their foods and then they didn’t. When McDonald’s announced that it was reformulating its frying oil to contain less trans fat, the company told the public that its fried foods would be healthier. By retracting its promise as quietly as it did, McDonald’s purposefully deceived its customers.
As noted by CSPI, [w]hile this settlement will help undo some of the damage, McDonald’s should keep its promise and change its frying oil, as it already has in Denmark and Australia. All restaurants of any kind should immediately switch to healthier oils for the sake of their customers’ health.
4) Let’s not forget to mention High-Fructose Corn Syrup (HFCS), the ingredient of choice in many foods and beverages today. Jimmy Moore [Livin’ La Vida Low-Carb] has taken on this issue with a level of passion that has even the Corn Refiners Association taking notice! The evidence to date shows that HFCS isn’t as beneign as we’ve been led to believe and may be detrimental to health in the long-term. In an upcoming article here, I’ll be reviewing the evidence for my readers.
These are just four examples that highlight the issues related to obesity in the United States. To claim it is soley “personal responsibility” belies the fact that 2 out of every 3 Americans are overweight, with 1 of the 2 obese. If we look at statistics from other countries, they’re either a heck of a lot more responsible than Americans or they’re not being fed a steady diet of foods that stimulate weight gain, all the while being told just eat in “moderation” and exercise – limit your calories – added sugar can be up to 25% of your total calories – eat more grains – eat more whole grains – make better choices.
Where are the messages that state simply – stop eating junk food – and a demand for better, healthier foods?
Need another reason to eat your vegetables?
Here’s one – Dutch researchers at a meeting of Alzheimer’s researchers, unveiled evidence on Monday that a diet higher in folate is important for a variety of health effects. It’s already proven to reduce birth defects, and research suggests it helps ward off heart disease and strokes, and now might help slow the cognitive decline of aging.
In a Yahoo! News article, Study: Extra Folic Acid May Help Memory, the details of the study involving 818 cognitively healthy people ages 50 to 75, had participants divided into two groups – one swallowed either folic acid supplements or a dummy pill for three years while continuing to eat their normal diet.
At the end of the trial, in memory tests, the supplement users had scores comparable to people 5.5 years younger; in tests of cognitive speed, the folic acid helped users perform as well as people 1.9 years younger.
That’s significant brain protection, with a supplement that’s already well-known to be safe, said Johns Hopkins University neuroscientist Marilyn Albert, who chairs the Alzheimer’s Association’s science advisory council.
Previous studies have shown that people with low folate levels in their blood are more at risk for both heart disease and diminished cognitive function.
While the study looked at the effects of using a supplement, Folate is found in high levels in many foods. The RDA in the United States is 400mcg per day and women of child-bearing years and/or who are pregnant are encouraged to take a supplement to ensure adequate intake to reduce the risk of spina-bifida. The Dutch study used an 800mcg supplement – this is the level that was investigated and found to slow the “brain drain.”
Getting in folate from food has a distinct advantage over the use of supplements or enrichment in foods that are not typically high in folate – homocystine. Too many people are not including enough vegetables in their diet and have an elevated homocystine level, which causes inflammation which leads to health problems.
Of course you can supplement for folate if you need to, but if you’re eating a diet rich with non-starchy vegetables and a good selection of fruits, legumes, whole grains and animal proteins like eggs, poultry and fish, you can reach an 800mcg a day level with food alone.
The best foods to get folate from are – surprise, surprise – favorites among those who follow a controlled-carb lifestyle!
- Romaine or Cos Lettuce = 152mcg per 2 cups shredded
- Spinach = 262mcg per 1 cup cooked
- Asparagus = 262mcg per 1 cup cooked
- Calf Liver = 860mcg per 4-ounce
- Broccoli = 93.9mcg per 1 cup cooked
- Peanuts = 87.5mcg per 1/4 cup
- Sunflower seeds = 81.8mcg per 1/4 cup dried
- Avocado = 90.4mcg per 1 cup
- Cauliflower = 54.5mcg per 1 cup cooked
- Brussel Sprouts = 93.6mcg per 1 cup boiled
- Beans/Legumes = 200-300mcg per 1 cup cooked
- Flax Seeds = 53.8mcg per 2-TBS
- Strawberries = 25.5mcg per 1 cup raw
- Raspberries = 31.9mcg per 1 cup raw
- Tomatoes = 27mcg per 1 cup raw
- Cucumber = 13.5mcg per 1 cup raw
- Egg = 24mcg per large egg
Being a new mom, my concern for children’s nutrition has increased exponentially since the birth of my son last August. So my interest was peaked yesterday when a friend emailed me about an article in the New York Times, Bananas, Maybe. Peas and Kale? Dream On.
In it, Laurie Tarkan laments that parents are surrendering to picky-eating habits, “Across the country, other parents of young children are also surrendering, serving macaroni and cheese, chicken nuggets, grilled cheese, pasta and hot dogs rather than endure the mealtime stress of having their children eat well-balanced meals.”
What caught my eye was this – “Experts have a smorgasbord of answers, a theory to support every point of view – and surprisingly little research.”
Quite frankly we don’t need research to communicate to parents that macaroni and cheese, chicken nuggets, grilled cheese, pasta and hot dogs shouldn’t be daily fare in a child’s diet.
But she contines, “Many nutritionists and public health scientists say eating a high-fiber diet rich in fruits and vegetables in childhood is important in preventing diseases like cancer, diabetes, heart disease, obesity and osteoporosis, a position that other experts question. The research on the developmental and long-term health effects of poor diet in young children is scant.”
Actually a quick search through PubMed shows that there is an abundance of data available that highlights the detrimental effect of a poor diet – a nutrient deficient diet – not only from infancy and childhood but also from before birth! Mom’s eating habits have an effect on a child’s development in the womb, potentially influence what they’ll like as solids are introduced and, lest we forget, what the child is fed from the introduction of solids matters.
The research available isn’t in the context of “picky eaters” or “poor eating habits” – it’s in the context of inadequate essential nutrients, malnutrition and/or poor diet – keywords I’m sure were not searched looking for evidence….but it is exactly what picky eating is and the effect in the short and long-term is well documented.
It isn’t rocket science to understand that chronic deprivation of essential nutrients leads to health problems. Children are not cognizant of the risk to their health – that is the responsibility of the parents. As noted in the article, the surrender of parents to their child’s picky eating habits leads to “Picky eaters who only eat high-fat high-sugar foods may also be at higher risk for obesity.”
The available evidence suggests it isn’t only obesity these children are at risk for – chronic nutrient deprivation also is implicated in heart disease, high cholesterol, diabetes, cancer, osteoporosis, arthritis, and a host of other maladies.
Instead of these scattered bits of “don’t worry, be happy”, the article would have benefited from an in-depth look at the advertising that urges young children to eat high-sugar or high-calorie processed foods — or one on poorer parents in America who have little choice but to feed their kids such foods on a regular basis.
Instead the article qualifies as one more piece of fluff enabling parents to continue fostering poor eating habits – afterall, why fight it when you can find some “expert” who will coddle the idea that it’s okay to avoid stressing yourself to feed your children well.
In our fast-paced world, where we’re constantly looking for more convenient, time-saving foods, we’re doing our children a disservice for the long-term when we create the bad eating habits that are called “picky.”
Introducing children to fast food that is cheap, quick and packaged for convenience starts the slipperly slope toward “picky eating” – once you’re sliding along, going back is a scary thought. Here’s a thought – make the time commitment while your child is an infant – make the time to prepare wholesome foods and only serve simple basics – at least one non-starchy vegetable, perhaps fruit, a protein. No small child “needs” cookies, cake, ice cream, soda or other empty calorie items.
If you’re already well into toddlerhood or beyond and fighting the battle for healthy eating – know it’s worth the effort! You are the parent and you have total control of what you purchase for your family to eat in your home or when you eat out – don’t buy junk – your children will be exposed to enough of it outside your home and when they are spending time with others without you also contributing to poor eating habits too. Prepare simple meals that are made from whole foods and limit snacks – teach your children that “goodies” are only for special occasions, as a treat, and not something they’re “entitled” to every day. Your children may not appreciate it now, but they’ll be thanking you when they’re healthy adults!