Is a Low-Fat Diet Better Long-term?

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.

2005: The Year of Vitamin D

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
• Cancer
• Diabetes
• Myelofibrosis
• Fetal development problems [Maternal deficiency]
• Learning and Memory dysfunction
• Tuberculosis
• 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

Metabolic Benefits of Controlled-Carb Nutrition

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.

Can Losing Weight Kill You?

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.

Maine also to Protect Food Industry

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?

Avoiding Brain Drain

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

Turning Picky Eaters Around...

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!

Food Industry Seeks Lawsuit Protection

Apparently the food industry lobby in Pennsylvania is seeking protection from future lawsuits. A bill was passed, according to an article in today's Patriot News, in the Pennsylvania House to provide immunity against obesity related lawsuits to food producers, processors, sellers and servers as long as their goods are sold in accord with other relevant laws and regulations.

Interestingly there have been no lawsuits filed in Pennsylvania - what prompted the bill was lawsuits in other states. The bill passed the state House 191-7 and is now going to the state Senate for consideration.

Food industry groups have sought such protection across the country since a 2002 lawsuit against McDonald's by two New York teens who said their golden arches diet made them fat. The case is pending. The Pennsylvania Trial Lawyers Association opposed the bill as unnecessary because no such lawsuits have been filed in Pennsylvania.

In a related story, the sponsor of the bill, Rep. Doug Reichley (R-Lehigh) said, "My legislation is an attempt to make sure food does not become the tobacco of the new millennium."

I wonder if Representative Reichley understands his implicit admission that the food companies his legislation is protecting are indeed guilty of producing nutrient-poor foods?

Think about it - he's comparing food with tobacco and the tobacco lawsuits that continued even with successful jury determinations that tobacco companies were not responsible for the product they manufactured, marketed and sold to American consumers. Over time, juries were given more evidence, from scores of researchers, that showed the detriments of tobacco use, the marketing of such products and the manipulation of such products by manufacturers to increase use by consumers. In time, and with the weight of the evidence, juries started to hold the tobacco companies responsible. Tobacco use is still highly viewed as as a personal choice and one who uses tobacco held to the "personal responsibility" standard - however, tobacco companies are also now held responsible for their marketing, manufacture and messages to the public.

Now think about food. And consider how the legislation is being viewed by those in the food industry:

• The bill is favored by the Pennsylvania Restaurant Association. "We think it's a pre-emptive strike, and something that will protect the industry here from something that's just unreasonable," Patrick Conway, president of the restaurant association, said after yesterday's vote.
  .
• Ed Herr, president of Herr Foods Inc., expressed delight at the margin of the vote. "What that vote tells me is people agree obesity is a personal responsibility and not the responsibility of a food processor or a restaurateur. ... It's really a lifestyle problem."

My goodness, more of the "blame game" to assign the epidemic of overweight/obesity squarely on the individual. The message is clear: the food industry has no responsibilty, needs no responsibility, and will do whatever it can to avoid any responsibility. Why?

And why are legislatures even considering protecting the food industry when our experience with big tobacco provides us with insight that full disclosure isn't a given or to be taken for granted when it comes to information about both risk and benefit regarding the healthfulness of something?

What exactly is the industry afraid of in the future?

Food Writers and Missed Opportunities

Many of the major newspapers have food writers who focus on providing recommendations about "healthy eating." The New York Times has Jane Brody and her Personal Health column. The Washington Post has Sally Squires and her Lean Plate Club column which is also published in the LA Times. Since I live in the DC-Metro area, I follow the articles published in the Washington Post and am routinely dismayed by the nutrient-deficient recommendations made by Sally Squires.

Today's article, To Cut Fat, Eat Less Meat, is just another example of how dangerous it may be to follow the recommendations of food writers with an agenda to promote only low-fat options rather than nutrient-density. But, I'll get to that in a minute.

Her evidence today was...[a] new study of some 55,000 healthy, middle-aged Swedish women finds that those who ate little or no meat weighed significantly less than their more carnivorous counterparts. The findings are some of the first to show a direct link between a plant-based diet and a lower body mass index, or BMI.

Curious, I wanted to look at the data myself and found it online - Risk of overweight and obesity among semivegetarian, lactovegetarian, and vegan women.

Data analyzed in this cross-sectional study were from 55459 healthy women participating in the Swedish Mammography Cohort. Women were asked whether they considered themselves to be omnivores, semivegetarians , lactovegetarians, or vegans, and this question was the main exposure variable in this study. In secondary analyses, some women were reclassified as lactovegetarians on the basis of food intakes reported on the food-frequency questionnaire.

Sounds like a large number of women were followed, doesn't it? Just how many from each category though? This is where the numbers get interesting...

• omnivores - 54257
• semivegetarians - 960
• lactovegetarians - 159
• vegans - 83

The findings showed that in the above categories, the incidence of overweight or obesity was:

• omnivores = 40%
• semivegetarians = 29%
• lactovegetarians = 25%
• vegans = 29%

Personally, I'm not surprised by the findings when the numbers show that the vast majority included are in just one category - omnivores. Every group, including the vegans, actually reported that they include animal products from time to time - so none of the groups were truly eating an exclusive "plant based" diet.

The study looked at BMI. What it did not look at is important - nutrient-density and overall health. While the data can support a finding that those eating a diet that is rich with plant foods weighed less and had a lower BMI, it cannot extend to a finding of better overall health because no one looked at cholesterol, bone density, blood pressure, nutrient intake or other health markers in the women followed.

Yet, Sally Squires jumped on the data as "proof" that eating a lower fat diet is healthy and even offered up a recommendation on how to eat "semi-vegetarian" sometimes.

Go semi-vegetarian sometimes . You may be doing it already. Breakfast on shredded wheat with berries, slivered almonds and skim milk. Have a large Greek salad with feta cheese and a crusty bread for lunch. Snack on fruit and yogurt and eat a couple of bean burritos with a little low-fat cheese and some rice for dinner. Have fruit for dessert and you've had a semi-vegetarian day.

What's wrong with such a recommendation?

It's painfully inadequate for essential nutrients - those vitamins and minerals considered critical for long-term health!

By inputing her recommendations into FitDay.com and using 1/2 cup of blueberries as the fruit in the morning, 2-medium slices of Greek/Armenian bread and 4-tbs of low-fat dressing in the lunch, a peach and 8-ounces of low-fat fruit yogurt as the snack and a medium apple for dessert, the calorie load worked out to 2016-calories for the day - right on target for the 2000-calorie RDA recommendations.

So how did her recommendations fare for nutrients?

At the high-level - that is the percentage of calories from each macronutrient (fat, carbohydrate and protein) the day looks spectacular! Fat accounted for just 25% of calories, with just 9% from saturated fats; carbohydrate provided 60% of calories and protein accounted for 15% of calories. All well within the US Dietary Guidelines.

The question begs - how did the recommendation fare for nutrient-density?

In a word - miserably!

Based on the 2000-calorie RDA's

• Sodium intake was high - 2876mg - 476mg over the 2400mg limit
• Vitamin A fell short, with just 618mcg of the 800mcg RDA
• Vitamin C RDA was almost met with 59mg of the 60mg RDA
• Iron fell short of the 18mg RDA with just 15.8mg
• Vitamin D was lacking with just 2.46mg of the 5mg RDA
• Niacin was lacking with just 13.9mg of the 20mg RDA
• Vitamin B-6 fell short with just 1.2mg of the 2mg RDA
• Vitamin B-12 fell short with just 3mcg of the 6mcg RDA
• Magnesium was lacking with just 358mg of the 400mg RDA
• Zinc fell short of the 15mg RDA with just 10.4mg in the day
• Copper was lacking with just 1.75mg of the 2mg RDA
• Vitamin K was painfully lacking with just 3.6mcg of the 80mcg RDA

Failing to provide adequate levels of 11 essential nutrients is not a "healthy" recommendation!

Honestly, what is more important - maintaining "acceptable" macronutrient percentages of calories OR actually eating a nutrient-dense diet that meets or exceeds RDA's?

In your quest to find a dietary approach that works for you, remember, it's not just the macronutrient percentages that matter - in fact they matter little at the end of the day if you're leaving your body malnourished for essential nutrients it needs to function and thrive! Next time you see a food writer providing a sample menu, take the time to really look at it carefully - look beyond the ratio of fat:carbs:protein and see if it really is providing nutrient-density!

How Do You Create a Quandry?

Have a television show follow 300 dieters for six months with those following an Atkins diet pitted against those following Weight Watchers, Slimfast and Rosemary Conley (a British plan) and then watch as the Atkins low-carb dieters win!

That's what recently happened in Wales, during the BBC's television series, Diet Trials. The results were reported in the ICWales article, Experts in quandary over effects of Atkins diet.

The television show, Diet Trials, followed 300 people on four different diets - Atkins, WeightWatchers, Slim Fast and Rosemary Conley - in a bid to discover which was the best.

The group on the Atkins diet experienced initially high weight loss which soon plateaued and, after six months, was comparable to loss on the three other diets.

After six months the dieters had lost:

• about 11% of their initial body weight on Atkins
• about 10% of their initial body weight on WeightWatchers and Rosemary Conley
• about 8% of their initial body weight on Slim Fast

Dr Truby, who has analysed the results of all the Diet Trials volunteers, said results showed Atkins dieters did not suffer a negative impact on cholesterol levels and other risk factors associated with cardiovascular disease. In particular those people on Atkins had significant drops in their triglyceride levels. But it is unclear whether the effect was directly linked to the diet itself or the fact that the volunteers were losing weight, which in turn reduces the risk factors.

Does it really matter why the triglycerides dropped significantly? I don't think so. The fact that there was a significant reduction adds to the evidence that low-carb diets can reduce cholesterol and triglycerides in most individuals.

The very public results have left the medical community in a quandry though - at the British Dietetic Association conference in Cardiff attendees debated what to recommend to individuals needing to lose weight. It is estimated that three million people in the UK were following the low-carbohydrate regime last year, but those numbers fell amid concerns the diet was associated with an increase in heart disease risk factors and kidney problems.

Now, those on the Atkins diet clearly lost weight and experienced improvements in their lipid profiles - and they did lose the most weight of all the plans followed on the television show.

So what's the problem? Again, it's the long-term effects.

Dr Truby, a senior lecturer in nutrition and dietetics at the University of Surrey, said "We don't know the long-term effects of restricting carbohydrates and the impact of a relatively low-fibre intake. We also don't know what impact a fairly acidic diet, like Atkins, will have on bone health. The Atkins diet was no better or worse in terms of weight and fat loss and there were some beneficial lipid profiles achieved."

The concern over long-term effects is nothing new. It is only in the last few years that scientists have undertaken the time-consuming controlled research to find out the long-term implications of eating a very low-carb diet. In the meantime, recommending a very low-carb program for weight-loss remains questionable for many within the medical community.

In my opinion it is short-sighted to limit options to those who are overweight and obese today while waiting for research data that both clinical case studies and anecdotal evidence suggests is safe and effective. Barring any major metabolic issues, the vast majority of individuals will not need to remain at very limited carbohydrate levels for the long-term.

In fact, most plans recommend reintroducing a broad spectrum of carbohydrate foods - nuts, seeds, fruits, legumes, and whole grains - after an initial period of restriction to provide more nutrient-density in the overall diet. Over time, for most people, a low-carb diet becomes a controlled-carb lifestyle with restrictions on added sugar, refined grains and empty calorie processed foods.

With this in mind, and data from one-year trials available, I think doctors owe their patients information about low-carb diets as an option to consider where, for the individual, it may be an appropriate option. With obesity continuing to rise in the US and in the UK, it is time to take every option and put it on the table for those who are overweight or obese today - provide them with the tools to use low-carb to lose the weight and provide them real help in learning new eating patterns for the long-term. Ultimately controlled-carb nutrition is the goal - where added sugars, highly processed foods and refined/enriched grains are shunned in favor of real whole foods!

Tell me again how that is not healthy in the long-term?

Let them Drink....Chocolate Milk?

Palm Beach Country schools have decided to eliminate whole milk from their offerings next year.

Why?

According to an article in the Sun-Sentinel [Palm Beach County schools will only offer fat-free and skim milk next year] a number of reasons are given:

• Whole milk has more fat in it - at least 3.25% in whole milk versus 2% or less in reduced fat varieties
• Whole milk only makes up 25% of the sales versus 41% of sales for low-fat chocolate milk
• Whole milk has more calories than other varieties

Its elimination is part of a gradual withdrawal of unhealthy foods from school menus.

Let me see if I have this right...whole, plain milk is unhealthy, so it's being eliminated...and chocolate milk is going to still be offered - does that mean it's "healthy?"

What other "heathly" options are listed among those foods available to schoolchildren?

• Fat-free or skim regular milk
• Fat-free or skim chocolate milk
• Fat-free or skim strawberry milk
• Reduced selection of sodas in vending machines (they're not eliminated?)
• Baked potato chips

Get this...The sugar in the sweetened milks is less of a concern than the cholesterol-inducing fat of whole milk, nutritionists say.

Are they kidding?

An 8-ounce serving of whole milk has less calories (156-calories) than an 8-ounce serving of reduced-fat chocolate milk (180-calories) according to the USDA Nutrient Database, and has much less carbohydrate (sugars, both naturally occuring and added) 11g in whole milk versus 26g in low-fat chocolate milk! The whole milk and reduced-fat chocolate milk both have about 8g of protein; the whole milk 8.9g of fat and the reduced-fat chocolate milk 5g of fat.

Are we really that obessed with fat content that we're willing to eliminate whole milk in favor of reduced-fat chocolate milk with 15g more sugar - added-sugar - or almost 4-teaspoons of additional sugar....and call it healthy? Think about that for a moment - would you, as a parent, add four teaspoons of sugar to your child's glass of milk?

Cited in the article is a study from the University of Vermont that found that that children who drank flavored, low-fat milks increased their calcium consumption and drank fewer sodas and fruit juices.

I doubt they've considered the weight of the evidence - other studies contradict the notion that fat calories are the main culprit in childhood obesity; raise concerns about not only the type of milk consumption itself, but how much milk is consumed in childhood as a predictor of overweight and obesity; and question the role of even diet sodas in rising obesity rates.

Schools do need to be more accountable for the foods they allow served in the cafeteria and on school grounds.

Eliminating whole milk while keeping low-fat, sugar-added, flavored milk is just setting children up for lifetime eating habits that are unacceptable - not only are these beverages less nutrient-dense, they also have added-sugar - empty calories - something we should be trying to restrict in a child's diet so as to not crowd out nutrient-dense foods with sugar-laden options.

Here's a thought - why not offer water?

Mixed McMessages

We have a love-hate relationship with fast food in the US. We hate that it isn't the best food we can choose to eat, but we love the convenience. We hate that it comes jam-packed with more calories than we need, but we love the convenience. We hate that it isn't nutrient-dense, but we love the convenience.

See a theme there? It's a love-relationship built on convenience.

At what price though, long-term? And why our fascination with fast food?

Part of the problem, I think, is the mixed messages we receive from fast food companies. On the one hand they agree we should eat healthful foods, while on the other they tantalize us with slick marketing to divert attention from the fact that eating lots of fast food isn't really healthy.

Case in point: Today two articles are out about McDonald's - one is touting the company's efforts to promote exercise; the other highlighting the re-introduction of the Super-Size, 42-ounce soda.

Wow.

In the new promotion, "McKids", McDonald's is introducing a line of skateboards and bikes donning the golden arch to aid kids in burning off the calories of french fries and burgers. McDonald's Global Chief Marketing Officer Larry Light said in a statement earlier this week that the skateboards and bikes are "designed to help make fitness fun."

The "McKids" line is just another step in McDonald's recent attempts for a healthier, positive food service - in light of criticisms that they promote unhealthy lifestyles and contribute to the increasing obesity in American society.

So far so good, although I really don't think that kids need to be used to advertise McDonald's on their bikes and skateboards - which is what happens when a child rides a bike with the golden arches on it. But, that's another issue.

Same day, different paper, we find that McDonald's is also re-introducing their 42-ounce Super-Size sodas. At 410-calories - empty calories - the Super-Size sodas are back as part of a summer promotion in the Chicago area where outlets will be giving them away free with the purchase of a Big Mac and fries.

Getting rid of 42-ounce drinks was a key part of McDonald's highly touted March 2004 rollback of super-sizing. The Oak Brook-based company depicted it as an effort to simplify its menu, but the move followed stepped-up criticism by health advocates who charged the fast-food giant with contributing to the nation's obesity problem. It also coincided with the release of "Super Size Me," a documentary alleging bad health effects from an all-McDonald's diet.

Free 42-ounce, 410-calorie sodas and kids' bikes and skateboards sporting the golden arches...what's next? Glucose monitors with a smiling Ronald? Insulin pumps donning the golden arches?

Portion Size for Kids Matters

Researchers at Cornell University published findings of a study exploring children's eating habits in the June issue of the journal Appetite, and found that the most powerful predictor for how much children eat is how much food is put on their plate.

For years many have held the idea that children self-regulate appetite and will not eat more than they require. Research is showing that this is simply not true and David Levitsky, professor of nutritional sciences and of psychology at Cornell said, "These findings suggest that both the onus of controlling children’s weight -- both in causing overweight in children as well as in its prevention -- must rest squarely in the hands of parents and other caregivers."

Touché!

The study was led by Levitsky and Gordana Mrdjenovic, who monitored the food intake of 16 preschool children, ages 4-6, for five to seven consecutive days in day-care centers, and parents kept a food diary of what their children ate in the evenings and weekends. Where previous studies were conducted in laboratories, this one was in a natural settings where environmental factors can play a very powerful role in determining a child’s food intake.

"We found that the more food children are served, the more they eat, regardless of what they’ve eaten previously in the day, including how big their breakfast was," said Levitsky. "We also found that the more snacks children are offered, the greater their total daily food and calorie intake."

This study adds to a previous study at Cornell that reported that children do not adjust for the amount of food they eat to compensate for how many sweetened drinks they have either at meals or between meals. And another study that Levitsky was part of that reported that the more food young adults are served, the more they eat.

According to the National Institutes of Health, the number of children who are overweight has doubled in the last two to three decades;

• currently 1 child in 5 is overweight

The increase is in both children and adolescents, and in all age, race and gender groups. Obese children are now developing diseases;

• Type 2 diabetes, that used to occur only in adults
• greater risk for heart disease, high blood pressure and stroke in adulthood

Overweight children not only suffer more health problems but also,

• social discrimination
• low self-esteem
• and depression

Parents, you have the greatest influence on not only how your children eat and what your children eat, but also how much your children eat.

• Be sure you're serving nutrient-dense, quality foods!
• Start your child's meal with a child's portion of food - don't load up their plate!
• Choose snacks wisely - don't offer junk foods!
• Choose beverages carefully - no soda or sugar-sweetened beverages!
• Limit snack times - children don't necessarily "need" a snack to make it to the next meal - allow snacks only when the child cannot make it until the next meal or offer only a small "nibble" or "taste" of something light to satisfy without adding too many calories

Nature and Obesity

Researchers at the Leeds Institute of Genetics, Health and Therapeutics (LIGHT), at the University of Leeds in the UK, are exploring the relationship between obesity in humans and our departure from our relationship with the environment, or nature.

Professor Grant, director of the Institute believes the human body wouldn't become resistant to insulin action and hoard fat in the way we are seeing today without a reason.

“It's a physiological process so there must be some kind of benefit,” he said. “The question is, under what circumstances?” When the body's fat cells - or adipocytes - become full, they send messages to the brain to slow down and conserve energy. There is one circumstance where these responses are vital - animal hibernation.

Humans don't hibernate, but what has changed in our environment that would lead us to continue to gain weight and, as some suggest, lose our ability to regulate our weight?

Grant suggests that animals have a basic metabolic response that stores energy and develops insulin resistance in preparation for deprivation, usually during long winter months. In hibernating animals, this response is accompanied by prolonged periods of torpor, but in humans and other animals seasonal variations in light and food are critical in regulating energy utilisation, even though man probably never formally hibernated.

In our progress, we (humans) have lost touch with our traditional environment...throughout the year we have abundant food supplies and ambiant light sources whenever it is dark outside, thus we no longer respond to the seasons around us. As Grant puts it, "We have fractured our relationship with our environment - we no longer respond to seasons and we don't have a fluctuating food supply. As a result we get obese and what should be a short term protective response to help us over winter becomes chronic, harmful and leads to diabetes and cardiovascular disease.”

This theory is being tested at the Institute and may provide insights into how to reverse or prevent obesity in the future.

Personally, I think the theory makes a lot sense and I also think that many of the foods we now eat in abundance are also damaging our metabolism and our health.

While researchers continue to study the relationship between us and nature, and how it relates to our body weight, there are things to do now...

• Make the majority of your diet whole foods (organic as much as possible)
• Eat fruits and vegetables that are in-season (locally grown as much as possible)
• Drink lots of spring water
• Pay attention to your sleep - sleep helps rejuvenate the body
• Go for "fresh" over frozen, processed, jarred or canned whenever possible

Obese Teens: Diet or Drugs?

In the June 15, 2005 edition of JAMA (as reported by the Sacramento Bee) a new study was published reporting the data from a study in which 539 obese adolescents ages 12 to 16 were randomized into a double-blind, controlled study for 54-weeks to see the weight-loss with and without the weight-loss drug Orlistat, sold under the brand name Xenical.

The study found that more than one-quarter (25%) of the Xenical patients, compared with 15% of the group getting a placebo, had a 5% or higher decrease in their body mass index (BMI). Similarly, while both groups regained weight lost during the first four weeks of the study, the Xenical group had gained less weight than the control group by the end of the trial. The Xenical patients also experienced a reduction in their hip and waist circumference, while those on a placebo saw an increase.

Xenical, first approved for adults in 1999, works by decreasing the intestines' ability to absorb fat. It does that by inhibiting an enzyme called lipase, which normally cuts the fat into small pieces so it can be absorbed. The study, completed in 2002, was key in the Food and Drug Administration's approval in 2003 of Xenical for use in children 12 and older.

Because Xenical's action is in the gut, the drug is considered safer than others designed to aid weight loss. But it is not without side effects. As with adults, the drug triggered gastrointestinal problems in many study participants. Half of them (50%) complained of having fatty or oily stools and nearly 30% reported oily spotting.

The research also raises concerns that doctors may be tempted to prescribe the drug without a program to teach and monitor behavior changes. Because the drug is often used indefinitely in adults, childhood obesity experts wonder whether Xenical would prove safe and effective if used for a long time.

In my opinion, this is another example of the disturbing trend today to seek a "magic bullet" for the obesity epidemic. No one wants to be told they have to work hard to lose weight, make permanent changes in their eating habits - that there is no "magic bullet" out there that will make it go away. But that is the brutal truth - you simply cannot lose weight and keep it off unless you modify your eating habits and lifestyle permanently!

The differences in weight reduction between the two groups (15% versus 25% losing 5% of their BMI) is not, in my opinon, impressive. Especially when you take into consideration the high incidence of side-effects in the trial group. Add to that the need to remain on the drug over the long-term and it is simply a problem, not a solution. We need solutions!

As a society, do we really want to be teaching our youth that popping a pill for the rest of their life is the answer to their weight problem?

Or do we want to instill in them a sense of confidence in their own ability to make the commitment to themselves that they can take control of their eating habits and lifestyle and enable them with accurate information and knowledge about nutrition and health to eat right and be active?

Low GI - Lower Cardiovascular Disease Risk

Reuters ran an article last week, Low-Glycemic May be Better than Low-Fat, highlighting the findings of a study published in the American Journal of Clinical Nutrition, May 2005 titled, "Effects of an ad libitum low-glycemic load diet on cardiovascular disease risk factors in obese young adults."

The media, it seems, is always searching for the "next big thing" and these days it's anything that isn't "low-carb" - or at least isn't named low-carb! Funny thing - low-glycemic diets are controlled-carb and very often even low-carb. But let's not call it that, OK?

Back to the study data...

This was a nicely done study - controlled and randomized and even ad libidum (eat whatever and however much you want) for the low-glycemic participants. Researchers randomized participants into two groups:

• Low-Glycemic Group (LG) - allowed to eat anything they wanted from the low-glycemic foods list (energy intake averaged 40-45% of calories but was not specifically restricted from the start) along with 30-35% of energy from fat with the remaining calories fulfilled with protein, 20-30%.
• Low-Fat Group (LF) - calorie restricted to maintain a calorie deficit (200-500 calorie per day deficit), with no more than 30% of calories from fat, 55-60% of calories from carbohydrate and the remaining calorie requirements fulfilled with protein, 10-15%.

Do I need to tell you who did better?

The findings included:

• At 6-months the LG group lost 8.4% of their body weight; the LF group lost 7.8%
• At one-year, the LG group had maintained a loss of 7.8% of body weight; the LF group 6.1%
• The LG group showed significantly greater (P=0.005) mean decline in plasma triacylglycerols than did the conventional diet group (LG -37.2%; LF -19.1%)
• Mean plasminogen activator inhibitor 1 concentrations decreased (–39.0%) in the LG group but increased (33.1%) in the LF group (P = 0.004).
• Changes in cholesterol concentrations, blood pressure, and insulin sensitivity did not differ significantly between the groups.

So what does this mean?

The researchers concluded that the low-glycemic approach, in an ad libidum setting, "may be more efficacious than a conventional, energy-restricted, low-fat diet in reducing cardiovascular disease risk. "

As more evidence continues to mount, it is going to be harder and harder to ignore the efficacy of controlled-carb nutrition, which includes low-carb diets as an effective weight-loss tool.

Cataracts and Carbohydrates

There was an interesting study published this month in the American Journal of Clinical Nutrition regarding carbohydrate intake and the development of cataracts. The study found that the quantity of carbohydrate in the diet - not the quality - increased the risk of developing early cortical cataracts (the second most common kind).

Researchers reviewed dietary date on 417 participants in the Boston area included in the Nurses' Health Study and found that those who ate the most carbohydrates (>200g per day) were 2.5 times more likely to have cortical cataracts when compared with those eating the least carbohydrates (<185g per day) each day. A high carbohydrate intake was not, however, associated with the most common cataracts - nuclear cataracts. Interestingly, the glycemic index of the carbohydrates eaten were not associated with the development of either type of cataracts.

The evidence already shows that controlling your carbohydrate intake - specifically eating whole foods instead of processed foods - helps to control weight and maintain health. This new research adds to what we already know and reveals how important it is to eat right. Controlling your carbohydrate intake to levels below 185g per day isn't low-carb - it's controlled-carb. And, it's healthy for you if you avoid the added sugars, refined grains and other processed foods that are all too available in our diet today.

The Gene Hunters

In the July Issue of the MIT Enterprise Technology Review, an interesting article, "Wired to Eat," explores the theory that body weight is determined by genetics.

I'll warn you in advance, the article is long - but it is worth the read!

And, of course, here's the cliff note's version...

Researchers from Rockefeller University in New York have been studying the residents of the tiny island, Kosrae, since 1994. The research team chose Kosrae for its isolation, and because most of its people are descended from just a few families. Since the end of WWII, the residents of this island have gone from being mostly trim and fit, to mostly out-of-shape and overweight/obese.

What's also changed significantly are their eating habits and lifestyle. Before the US took over the island, the residents ate fish, bananas, coconut and taro. In the years since the US started shipping in canned and processed foods, the islanders have gained weight.

The Rockefeller team suspects that the proclivity of a person's body to approach a certain weight is determined far more by genes than was previously thought--specifically, genes that control the impulse to eat. Growing evidence indicates that an individual's weight is 40 to 70 percent decided by genes, which makes it about as heritable as height.

Not everyone agrees though - "There are too many cases where people have willed themselves to lose substantial amounts of weight and keep it off," says nutrition expert Marion Nestle of New York University. Teasing out which perspective is right--or whether, as seems likely, obesity is a complex interaction of both genetics and lifestyle--will help determine our attitudes not only toward fat people but toward the effectiveness of dieting.

On Kosrae...

• 88% of adults are overweight or obese
• 50% of adults are obese
• Diabetes afflicts 1 in 8 adults

Are many of the islanders genetically predisposed to large appetites, which, once food was plentiful, they were suddenly able to satisfy? Or as New York University's Marion Nestle and Kosrae health officials maintain, is it simply a case of a population's sudden shift to an unhealthy lifestyle, which might be corrected by cutting down on frosted flakes and Spam?

The "blame the genes" hypothesis flies in the face of arguments mounted by nutritionists and the diet industry, and of the popular belief that eating habits can be controlled through willpower. "We have some control over eating from our reasoning centers of our brain," says the lead researcher Friedman, "but this seldom overrides our basic instinct to eat when we're hungry."

Friedman contends that exercise and better eating will make Kosraeans healthier but probably will not solve the obesity problem.

What really intrigues Friedman is why everyone doesn't get chubby when there is plenty to eat. Analyses show that the number of lean people has remained steady for the past 30 years, he says. "One's size is not an environmental effect. Nor is it a matter of willpower."

Friedman acknowledges that what he suggests is counterintuitive, since people can resist jelly beans up to a point. But he insists that, for the majority of the obese, free will in weight control is an illusion.

I think it's safe to say that both genetics and lifestyle play a role. We didn't suvive evolutionary forces because we were dieting - we ate when food was plentiful, stored body fat, and survived during lean times and even famines because we had body fat to get us through. Today, especially in the United States, food is available in abundance - and not just good food, but any food, including nutritionally-void, empty calorie foods.

Genetically we're pre-programmed for survival. Our bodies work to primarily ensure our survival and does this on a very primal level - we don't think about it. Over the years as our understanding of food and nutrients has grown, so has our ability to mass produce food. The more we move away from our traditional diet, the fatter we get.

The islanders of Kosrae are living proof of this - by abandoning their traditional diet and adopting one littered with processed foods, they've grown fat. They are not the only population in the world where this is evident - in fact, every population that has abandon their traditional diet for one heavy with processed foods gets fat - the Canadian Inuit, the Pima Indians, or Japanese moving to the United States and adopting the Standard American Diet (SAD).

I don't think we need to spend millions studying the genetics of this phemomenon.

Honestly, what's the purpose of such study? Is it to develop drugs to shut-off genes so we can eat unhealthy foods and not suffer the weight-consequences? Is it to coddle those who continue to eat unhealthy foods, to somehow assure them it's not their fault and give them peace-of-mind as they eat another donut?

How about this - how about we be honest - eating the wrong foods makes you fat, leaves you malnourished, increases your hunger as the body tries in vein to get the nutrients it does need, and causes your body to revolt with the emergence of disease and degeneration. It is a vicious cycle that you can stop.

Make the commitment to your health and well-being...stop eating the wrong foods and adopt a healthy eating lifestyle! Eat whole foods instead of processed foods. Drink water instead of sodas, juices and other beverages loaded with sugar or chemicals. And get out and walk, ride a bike or hike in a nearby park - just get yourself moving more!

Obesity Adds Nine Years

A team of researchers from the United States and Britain found that the more people weigh, the older their cells appear on a molecular level, with obesity adding the equivalent of nearly nine years of age to a person's body.

As reported in the Washington Post, this is the first direct evidence that fat accelerates aging, possibly speeding the unraveling of crucial genetic structures inside cells that wither with age. The findings suggest that many health problems associated with being overweight -- heart disease, cancer, diabetes, arthritis -- may result from fat cells hastening the natural aging process.

Tim Spector of St. Thomas Hospital in London, who led the study, which was published online yesterday by the Lancet medical journal noted, "This may not be apparent because these people may not have as many wrinkles. But underneath it looks like they are aging at a faster rate."

This accelerated cellular aging may explain why an alarming number of obese children are developing the most common form of diabetes - prior to the increase of obesity among the young, it almost invariably was seen only in adults. Young children today are also showing signs of cardiovascular disease and degenerative diseases once only seen in aging adults.

Ask yourself - do you want to shorten your life expectacy? Do you want to accelerate the aging process in your children?

If you don't, now is the time to stop eating poorly and get yourself back on track by eating well and healing your body with good nutrition. Role model for your children and make available to them only healthy foods in your home. When you eat out or with family and friends, help them make good choices from the selections that are available. And, yes, you can even learn to have an occassional treat too!

Evidence suggests that damage from poor eating habits is reversible - you can heal your body by eating right and ensuring your body gets the nutrients it needs for well-being. Start by returning to the basics - whole foods, organic when possible, and lots of water. Become active, get out in the sunshine and enjoy walking, riding a bike or exploring nature with your family! No one can do this for you or your family - only you can take control of what you eat, what your family eats and the lifestyle you create for your loved ones.

Diet Soda Linked to Obesity

In the years I've been advocating healthy eating habits, one thing I've repeatedly recommended was to avoid replacing regular soda with diet soda - and even if you already drink only diet soda, just break the soda habit - regular or diet - and don't look back!

Well, now it seems that the research is showing that diet soda consumption is linked to obesity. The findings come from the San Antinio Heart Study and were reported in AZCentral.com earlier today.

A review of 26 years of patient data found that people who drink diet soft drinks were more likely to become overweight. Not only that, but the more diet sodas they drank, the higher their risk of later becoming overweight or obese - 65 percent more likely for each diet drink per day.

However, the idea that diet sodas can lead to weight gain isn't new. Last year, a group from Purdue University found that when rats were fed the equivalent of diet soda, they ate more high-calorie food afterwards than did rats fed the same amount of a drink sweetened with high-calorie sweetener.

The group hypothesized that the body regulates its energy needs through appetite and that it learns to associate sweetness with a lot of calories. But when fed artificially sweetened foods and drinks on a regular basis, the body figures it can no longer use taste to estimate calorie consumption. It assumes that it can eat all the sweets it wants, without consequences.

Let me give it to you straight - anytime you're drinking soda - diet or regular - you're not drinking something better for your body....water! Water is calorie-free and comes with a host of essential minerals too - things your body needs.

So next time you're thirsty, pass on the soda and grab a nice bottle of spring water or mineral water - hey even add some fresh lemon or lime too - your body will thank you!

Study: Pediatricians Lack Confidence

A recently released study in the Journal of Ambulatory Pediatrics, as reported by RedNova, found that only 12% of pediatricians surveyed were confident about their ability to treat overweight children. Add to that, only 11% of pediatricians are even using BMI charts to evaluate and determine if their patients are a healthy weight or not and a full third reported they hadn't even considered using the BMI charts!

A number of obstacles were cited by the doctors as barriers to reducing obesity in a pediatric clinical setting...

• Easy availability of fast foods and sweetened soft drinks
• Questionable school food practices
• Limited physical activity in schools
• Lack of reimbursement for health-care professionals other than doctors
• Lack of printed materials for patients
• Adults not perceiving obesity as a health hazard
• And fear of offending children and their families

To me the above is simply a laundry list of excuses not to encourage patients and their families to take control of their health which starts with eating right.

Do children want to hear they're overweight? Of course not - but it is the responsibility of the adults in a child's life - and that includes their pediatrician - to ensure they're learning good eating habits and are on the road to lifelong health. By ignoring an overweight condition and hoping for the best simply isn't good enough.

Physicians have a responsibility to the child and the parents to provide them with information and tools to lead a healthy life.

Is it so hard to sit with a parent and child and say "you can only have a fast food meal, as a treat, once a week," or "drinking soda is not only bad for your teeth, but can also make you gain weight if you drink it everyday."

Is it so difficult to suggest to a parent that they make their child's lunch each day rather than rely on the school lunch program?

Is it really that hard to tell parents that their children need to be doing physical activity each day and if the school isn't providing a formal physical education program and recess, get your kids outside and running around after school?

And, lastly, just how challenging is it to have someone in the practice type up a "Fact Sheet" and "Eating Right" guidelines - or for that matter going online and downloading any number of pamphlets that are available - and printing them up for patients?

If nothing else, this survey shows that you're really on your own when it comes to your health and well-being. You have to take the initiative yourself to educate yourself, become informed and take control of your eating and life...thinking that your doctor, or your child's doctor is going to point out there's a problem is a risky proposition if your doctor is among the 88% who lack the confidence to bring up the obvious!

Control Glucose, Lower Risk of Heart Disease

My headline seems like a 'no-brainer' to those following a controlled-carb lifestyle. For those attending the American Diabetes Association's Scientific Sessions in San Diego, such a concept was "pretty astounding," according to the ADA Scientific Director, Richard Kahn.

In the clinical trial of 1,375 diabetics, early, intensive treatment to keep blood sugar levels close to normal in people with diabetes can cut their risk of cardiovascular disease by about 50% and the risk of heart attack and stroke by 57%. Both of these are much better results than those achieved by any cholesterol or blood pressure drug, researchers reported.

The study was conducted on those with Type I diabetes, but "There is no reason to think tight glucose control might not be of benefit to the type 2 population," says study co-chair David Nathan, director of clinical research at Massachusetts General Hospital, but that has not been shown in this study.

In the real world, what does this mean?

For anyone who is pre-diabetic or already diagnoised with diabetes, it means you must take control of your blood sugar levels NOW and do so diligently for the rest of your life. Work carefully with your doctor, educate yourself and eat right.

Eating right, in a way that offers a self-controlled approach, means paying attention to your diet - restrict or completely eliminate added sugars, avoid high fructose corn syrup, eliminate any sources of trans-fats, limit starches and eat a lot more non-starchy vegetables. There are a number of controlled-carbohydrate nutritional approaches available to you, including low-glycemic approaches, low-carb approaches and sugar-free or gluten-free plans. Find one that works for you, your taste preferences and your lifestyle.

Danger Lurking in Fried Foods

The International Herald Tribune reported recently 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.

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. However, HNE doesn't form in saturated oils coming from animal fat.

Although you may not have heard of it before, HNE has quite toxic as a health threat documented in studies two decades old, according to the lead researcher.

Some of the diseases associated with exposure to HNE:

• Cardiovascular disease
• Stroke
• Parkinson's
• Alzheimer's
• Huntington's disease
• Liver ailments
• Cancer

Liquid oils are at risk for oxidative damage when heated - high polyunsaturated oils and even highly monounsaturated oils like olive oil.

Knowing the risk means you can do something about reducing your own risk.

• Avoid eating foods fried in restaurants since oil is heated, heat is maintained at a high temperature and then the oil is often re-heated for use again until it degrades beyond use.
  
• For foods that are sauteed, ask what the oil used is and be sure the chef is sauteeing at a low-to-moderate temperature.
  
• Avoid packaged foods that are fried in suseptible oils - potato chips, corn dogs, etc.
  
• When you choose liquid oils to purchase in the supermarket, choose ones that have not been "heat processed" or "refined" - choose cold pressed oils only.
  
• At home, use liquid oils only once and then discard. Do not heat the oil to an extremely high temperature and do not use if it's been kept at a high temperature longer than 30-minutes.
  
• At home, use highly stable oils for cooking - cocunut oil is one of the best "high heat" oils to use and comes packed with nutrients and antimicrobial properties.

Low-Fat Milk and Childhood Obesity

We hear the advice again and again - have your children drink more low-fat or skim milk!

A study out this month in the Archives of Pedeatrics & Adolescent Medicine found the more milk kids drank, the faster they gained weight. In fact, kids who drank more than three glasses of milk a day increased their odds of becoming overweight by some 35 percent.

The study looked at the milk consumption of 12,000 children (ages 9-14) participating in the Growing Up Today Study (an ongoing project examining the relationship between diet, exercise and other lifestyle factors, and an array of health issues) to uncover any links between milk consumption and weight over 12 months. Even though most kids tracked in the study were drinking low-fat milk, those who drank more than three glasses daily gained the most weight.

In the conclusions, the researchers stated that "Contrary to our hypotheses, dietary calcium and skim and 1% milk were associated with weight gain, but dairy fat was not. Drinking large amounts of milk may provide excess energy to some children."

Where's the Evidence?

This morning's headline in the Diabetes section of About.com screamed for attention: Best of Low-Carb and Low-Fat Diets for Weight Control. It seems the experts on the European Congress on Obesity have come up with a new idea about losing weight - combine the ideas of low-carb diets with the ideas of low-fat diets and *poof* you'll have healthy weight-loss.

Just ignore the fact that there is no scientific evidence to support such ideas.

With no clear "one-size-fits-all" approach to weight-loss this new theory smacks of yet another attempt to create one out of thin air. For decades we have heard that a low-carb approach is unhealthy, potentially dangerous and restricting too many foods. We've been told again and again that the side-effects may be undesirable and that the approach is lacking nutrients.

Yet, in the last three years, reams of data has been published on low-carb diets. And the evidence is truly compelling - low-carb diets work. They help individuals lose more weight, more body fat and spare more lean body mass than low-fat diets. For the vast majority of those who follow a low-carb diet properly, the satiety factor is high and individual satisfaction with food choices is high. And, for the vast majority [70-90%], the major health risk factors we all recognize - blood pressure, cholesterol, triglycerides, and metabolic markers - all improve!

From the data available, we know that a low-fat diet may work for some individuals - and may even be a better option for some; we also know that a low-carb diet works for others; and we know various other approaches work too. What we don't have is any data to suggest that combining a low-carb diet with a low-fat diet is safe, effective or just wishful thinking.

But that's what happens when the experts simply cannot let go of dogma that is firmly rooted. To consider the idea of recommending a higher intake of fat than the current established limit of 25-35% of calories just isn't acceptable. It doesn't matter than the evidence to-date shows a higher level of fat intake is safe on a low-carb diet; it doesn't matter than those following a low-carb diet are satisfied with their food choices; and it doesn't matter than risk factors are greatly improved with a low-carb diet. The fat content is just too high regardless of the evidence.

And the very thing they found unacceptable about low-carb diets pre-2001 - cries about a lack of supporting evidence - is exactly what they are now doing by putting forward the idea of combining low-carb with low-fat.

Where is their evidence?

Kids Suffering Middle-Age Health Problems

Obesity, Type-II Diabetes, High Cholesterol, Atherosclerosis, Metabolic Syndrome, High Blood Pressure, Coronary Heart Disease.....in children!

The European Health Congress on Obesity met in Athens, Greece last week and the statistics they released should alarm every parent around the world - 20-36% of children in the US and Europe are OBESE with many already suffering the ailings of middle-age adults.

By the numbers, obesity rates reported at the congress:

• England = 20 percent
• Spain = 30 percent
• United States = 30 percent
• Italy = 36 percent

Is it any wonder when various studies show that children are consuming more than 33% of their calories from pizza, snacks and desserts? That their main source of calories is from sodas and sweet beverages? With too many "empty calories" each day, obesity is inevitable. And with it comes all the trappings of such indulgence - degeneration, inflammation and disease.

Can we reverse this trend?

Of course we can.

But first we must acknowledge the problem isn't the child's fault - they learn their eating habits from the adults around them. Every adult who interacts with a child has a responsibility to that child to guide them and teach them good eating habits. This includes parents, grandparents, aunts, uncles, caregivers, teachers, coaches and family friends.

Ten Steps to Better Nutrition for Children...

1. Turn off the TV, the computer and the video games and send the kids outside to play in the fresh air and sunshine as they wait for dinner to be ready.

2. Get active as a family - take a walk after dinner, play in the yard, build sandcastles on the beach together, go hiking in the woods, window shop without buying anything on a rainy day, go to the playground, wrestle in the family room or just play simon says. It doesn't matter what you do as long as it's activity and it's together!

3. Eliminate junk food from your home. No more buying sodas, chips, candy, donuts, cake, cookies each week. These are now "special treats" that are allowed occassionally at birthday parties, family gatherings or special holidays. Special treats should not be allowed more than once a week.

4. Establish a definition of what a "healthy snack" is for your kids - fruits, cut veggies with a dip, nuts, seeds, string cheese are all acceptable types of snacks that provide both energy for your child and nutrients too. Healthy snacks should not be a large amount of food or high in calories - just enough to satisfy a taste of something while holding off hunger until the next meal.

5. Establish limits to snack times in a day. Snacking shouldn't be an "anytime" occassion but available when a child is truly hungry and will not make it to the next meal without a nibble of something small. One or two snacks a day should be enough when you consider the next full meal is just an hour or so away.

6. Sit down as a family to eat. Research shows that families that eat together regularly are in better health and have less weight problems.

7. Learn to cook if you depend on convenience foods, restaurant meals and take out more than twice a week. Yes, it's more time consuming, but isn't your family worth it? In countries where obesity rates are lowest, the data shows that 75% of meals are consumed at home and are prepared with fresh ingredients.

8. If you're a short-order cook in the kitchen each day - stop now. Make one meal for the family and if the child decides they do not like what you have prepared, they can wait until the next meal or eat from those selections they do like at the meal. When you focus on just one meal, you can better balance the nutritional value of the foods you make and better ensure your child is eating a healthy balance of foods.

9. Offer variety at each meal - with vegetables (potatoes don't count) at center stage. There is no reason to eliminate any one food group (unless there are allergies) from your child's repetoire, but do be sure you serve balanced meals - vegetable, protein, quality oils/fats, and one starchy item. For example, spaghetti with tomato sauce and bread isn't balanced - it's too starchy. Balance such a meal with some meatballs or sausage (nitrite free) for complete protein, make the sauce a "garden style" sauce rich with vegetables, serve a side of fresh green beans and a salad with olive oil (quality oil) and vinegar and skip the bread. By doing this, the portion of spaghetti is smaller and the family is eating more vegetables, that provide more nutrients, than they would have!

10. Be the role model your child needs you to be. Don't eat in the car, watching television, in bed or anywhere else that is teaching your child that eating is an "anytime, anywhere" affair. In countries with the lowest obesity rates, another clear difference is found in their eating habits when compared with ours - they eat at the table in the kitchen or dining room for the vast majority of meals and snacks and enforce the rule with their children to do the same. If you yourself want to eat foods that are less than "healthy" that's OK - but do it when your child is not around to watch and learn!

Who's Impressed?

In the June issue of Pediatrics, researchers praise educational intervention as an effective way to modify eating habits for the better based on results from the NHLBI-sponsored DISC study, part of the "We Can" initiative (Ways to Enhance Children's Activity and Nutrition).

Researcher showed that eight- to 10-year-olds could be persuaded to increase their intake of "go foods" and decrease their intake of "whoa foods." At the start of the study (baseline) two groups of children were evaluated and both groups ate approximately 43% of their calories each day from snacks, pizza and desserts with 57% of their calories from those foods designated as "Go Foods".

The intervention group, which included parents, received nutrition education which included a "Go Guide" to help select foods throughout the study. The control group only received pamphlets on heart-healthy eating that are available to the public.

At the end of the study, the control group's eating habits were similar to when they started - 57% from "Go Foods"; the intervention group had modified their eating habits and consumed 67% of their calories from "Go Foods."

Sounds impressive, doesn't it?

Well, I for one am not impressed. Especially when I consider the foods that were included in the "Go Foods" list and the alarming 33% of calories from desserts, pizza and snacks the intervention group still consumed!

First let me tackle the "Go Foods" list. It reads like a "diet mentality" primer for kids. If you want to read it yourself, it's here online in PDF format. The focus is not on nutrition or nutrient-density, it's on "energy balance" and "portion size." Now don't get me wrong, these are important features of a healthy diet...but nutritional quality of foods eaten is more important.

Just how poor are some of the options on the "Go Foods" list, which are described as "almost anytime foods"? Angel food cake, ginger snaps, baked chips, low-fat frozen yogurt, ice milk bars, egg substitutes, and diet sodas, diet iced tea and diet lemonade! In addition, the page following the list cautions that one should try to avoid added sugar in their foods, while many of the "Go Foods" are loaded with added sugars to maintain "mouth feel" after reducing or removing the fat! Talk about sending contradictory messages!

More disturbing is the implication (found at the top of the list) that the "Go Foods" are nutrient-dense, whereas the "Whoa Foods" are calorie-dense. I really would like to know exactly what nutrients my child would be getting from angel food cake or pretzels!

What message do we really want to send to children? Is it that they can eat salty snacks (pretzels), cake (angel food cake) and cookies (ginger snaps) each day if they want to? That is the message we are sending and in doing so we're setting up an "entitlement" mentality that these children are going to take with them into adulthood - a mindset that snacks, sweets and desserts are daily fare instead of occassional treats.

The intervention group still ate 33% of their calories from pure JUNK - nutrient-poor foods that should be limited in a child's diet - and did not increase their intake of fruits or vegetables. That's success?

My other concern is with the focus on calories (energy balance) and portion control. The nutritional value of many foods in the "Whoa Foods" are ignored with highly processed, refined foods recommended in their place. Children are growing at a rapid pace throughout childhood and require nutrient-dense foods to ensure they meet their nutrient requirements within their calorie requirements.

Let me give you an example. In the "Slow Foods" list are whole eggs but in the "Go Foods" list are egg substitutes or egg whites. Whole eggs provide significantly more nutrients than just egg whites and are a whole food instead of a processed product like egg substitutes.

Which do you think is better for a growing child?

How about we compare the nutritional value of just egg whites to a whole egg?

	Large Egg	Egg Whites
Calories	74	34
Fat	4.9g	0
Carb	0.6g	0.5g
Protein	6.3g	7.4g
Calcium	26mg	5mg
Iron	1mg	0
Sodium	70mg	110mg
Vitamin B-12	0.7mg	0
Vitamin E	0.5mg	0
Vitamin D	17.3mg	0
Vitamin A	244mg	0
Vitamin K	0.1mg	0
Riboflavin	0.3mg	0

Again, which do you think provides more nutrients for a child?

In our obession with low-fat foods and enforcing a strict adherance to eating the right number of portions from each food group we've lost sight of, not only the critical importance of nutrients, but also the satiety value of many of the natural, whole foods we're being told to avoid or limit. I personally would rather see my child eat an egg (or two, depending on his age) for breakfast with some sliced strawberries instead of a bowl of highly processed cold cereal topped with fat free milk.

I for one am committed to teaching my child that fruits, nuts and natural cheeses are acceptable for snacks - not angel food cake, ice milk bars and ginger snap cookies....those foods are on our "Whoa Foods" list!