Diet Pattern from Another Perspective

The Economic Research Service of the USDA released food consumption data that provided the following in the overview, "In 2002, total meat consumption (red meat, poultry, and fish) amounted to 200 pounds per person, 23 pounds above the level in 1970. Americans consumed, on average, 18 pounds less red meat (mostly less beef) than in 1970, 37 pounds more poultry, and 4 pounds more fish. The types and amounts of food an individual chooses to eat not only affect his or her well-being, but also have implications for society as a whole."

In the spreadsheets online, the ERS data for 2000 includes calorie consumption of 2,739-calories each day (not including alcohol). Because the data is presented differently than the FAO data I used in a previous post, it's not an easy cut & paste into a spreadsheet to see where the calorie differences are found. After reviewing both sets of data however, the ERS data shows consumption of significantly less calories than FAO data for these items:

Added sugars ERS = 502-calories - FAO = 666-calories
Cereal GrainsERS = 635-calories - FAO = 869-calories
DairyERS = 285-calories - FAO = 387-calories

Other food consumption differences are minor, like butter is listed in the FAO data as 55-calories per day and 32-calories in the ERS data; FAO says fish in the US is 30-calories a day, the ERS says 16-calories a day.

The discrepancy is due to the calculation methods - the FAO calculates consumption based on production, imports, exports, wholesale waste and clearance from supply chain; the ERS takes that a step further and calculates estimated plate/kitchen waste along with surveys from eating habits (like what percentage of the population is known to toss egg yolks before making an omelet). In addition, unlike the FAO data which assumes, for example, "dairy is dairy" globally, the ERS bases the consumption estimate on type of dairy consumed (whole, low-fat, skim, etc.), so it more refined than the FAO data.

So, before I continue, I'm also going to present a quick scenario of a day of eating created from the ERS data since it also works out to 73% of calories from plant-based sources and 27% of calories from animal foods. Interestingly, if we use the ERS data, the calories from added sugars, cereal grains and vegetable oils now exceeds 60% of total calories per day.

So, based on the ERS dataset, the menu for a day might look like this:

Breakfast
1 serving frozen waffles
Pancake syrup
2-oz pork sausage
Coffee with sugar and non-dairy creamer
1 cup orange juice

Snack
Low-fat fruit yogurt
Bottled water

Lunch
1 cup mixed salad greens, tomatoes, slice onion, salad dressing (composite to type)
Roast beef (3-oz) sandwich with mayonnaise, 1 slice nonfat american cheese
1 cup potato salad
1 can regular soda

Snacks/Beverages
1 apple
8 reduced fat Wheat Thins
1.5 tablespooon peanut butter

Dinner
2.5-oz chicken breast, skinless, sauted in vegetable oil (soybean)
1 cup broccoli with margarine
1 cup brown rice (long grain)
1 cup lemonade (from powder mix)

Total Calories = 2738
Fat = 102g (34%)
Carbohydrate = 370g; Fiber = 23g; Net = 347g (51%)
Protein = 99g (15%)

The above menu is off by 3-calories, and like the FAO data menu is exact for meat, poultry, eggs, etc.

Like the previous menu, it is startlingly "healthy" if we measure healthfulness based on dietary guidelines in America - it contains low-fat dairy, reduced fat crackers, lean meats and favors margarine and vegetable oil for cooking.

Yet, it too is a nutritional nightmare - deficient now in Potassium, Vitamin D, and Vitamin K; with excessive intake of sodium (63% more than recommended) and contains less fiber than recommended.

It also contains an unacceptably high 7.48g of trans-fatty acid - but hey, saturated fat only provides 8% of total calories.

I've added this post to add to our understanding of how we eat in the United States and to begin the next step of analysis of why this type of eating pattern may be directly related to our obesity epidemic and exploding prevalence of metabolic syndrome and diabetes.

We'll begin to tackle that issue next week!

What Does our Diet Look Like?

On Wednesday I ended my post with:

The changes in our diet over the last forty years begs an important question - how are we able to consume copious and increasing amounts of sugar, vegetable oils and cereal grains while continuing to eat a similar level of animal foods?

Just what is going on in our metabolism that even makes that possible?

That was written after detailing how our diet changed between 1961 and 2000 - changes that included an increase of 934-calories; 80% of them from increased consumption of added sugars, cereal grains and vegetable oils; all while we ate less red meat, butter, and eggs.

The shocker - as a nation we consumed an average 3,817-calories per person each day in 2000.

So, I had to wonder, what does 3,817-calories in a day look like?

Using the FAO data for each food group and type, I pulled a menu together in an attempt to reach 3,817-calories with, as per the consumption data, 156g of fat, 115g of protein, 20g of alcohol and 450g of carbohydrate.

In the process I had to choose foods rich with soybean oil, added sugars and include an adequate level of cereal grains to try to match the consumption pattern suggested in the data; I also limited animal fats and proteins to align with the data to reach the dietary pattern the FAO data suggests we consumed each day in 2000.

Lastly, I attempted to make this menu as realistic as possible, where an individual might think they're eating healthy since recent surveys show the majority of people - 75% - actually do think they're eating healthy.

What does such a day of eating potentially look like if we create a menu based on the consumption data from 2000?

Breakfast
1 serving frozen pancakes, microwaved
2.5 small brown-and-serve pork sausage links
Pancake syrup
Coffee with sugar and non-dairy creamer
1/2 cup orange juice

Morning Snack & beverage
Low-fat Fruit Yogurt
Lemonade

Lunch
1 cup mixed greens salad, 1/2 cup diced tomatoes, 1 medium slice onion
2 TBS salad dressing (composite to type, soybean oil based)
2-oz lean roast beef, 1 slice american cheese (plastic wrap type), 2 regular slices rye bread, mayonnaise
3/4 cup potato salad
1 small apple
Lemonade (made from powdered mix)

Afternoon Snack(s) & beverages
1-ounce tuna in water mixed with mayonnaise
6 reduced fat Wheat Thins
1 can regular soda
1 peanut butter cookie (packaged, soft style)
Lemonade
Bottle of water

Dinner
3.9-oz chicken, white meat, skinless (vegetable oil, soybean, used in pan to saute chicken)
1 cup noodles, 1 tsp butter
1 cup green beans with onions, from frozen, margarine in ingredients
7.5 ounces red or white wine

After Dinner Snack
1 cup skim milk
Pretzels, reduced fat dip

Total Calories = 3,830
Fat = 152g
Carbohydrate = 472g; Fiber 21g; Net 451g
Protein = 125g
Alcohol = 20g

Just a bit over the estimated calorie intake (+13 calories), but the menu is exact for intake of beef, fish, poultry, pork, butter and eggs; notable is that there isn't an egg on the menu, it's in the prepared foods.

In this menu, the cereal grains, added sugars and soybean oil is very very close to the consumption estimate from the FAO.

Overall, in the above menu, almost 57% of the calories come from three things - cereal grains, vegetable oils and added sugars.

Yet it doesn't look like there are 4.5-tablespoons of soybean oil or a bit more than 3/4 of a cup of added sugars and with seven servings of grains, it's well within the dietary recommendation of six to ten servings each day.

It's also within the recommendation to keep saturated fat intake at or below 10% of calories, coming in with just 9% of calories from saturated fat.

But consider this - even with this level of calorie intake, the above menu does not meet the recommended intake for Potassium, Vitamin A, Vitamin D, Magnesium or Fiber! All those calories and anyone eating it is still deficient for essential nutrients, and even would consume 2.75-times the sodium without adding one shake of salt at the table!

And, while this menu contained just 9% of calories from saturated fat - a target most agree is desirable, no one would say the almost 12g (11.58g) of trans-fatty acids are acceptable, yet the above menu contains that much trans-fat!

This is but one scenario of a typical day's menu that might align with the consumption data for the United States in 2000; few eat all types of meat and fish in one day; the FAO data and ERS data is based on consumption averages - so while in the real world one day may be chicken and fish and another day beef or pork, over a week or month we consume an average number of calories from those foods.

The scary thing is the above menu isn't unreasonable for an average person to consume throughout the day, and many of the items I selected are considered "healthier" choices as per the dietary recommendations - the lowfat yogurt, wheat thins, tuna, rye bread, pretzels, skinless chicken breast, salad and green beans with onions, non-dairy creamer, skim milk, lean roast beef, and an apple - yet this menu is a nutritional nightmare - is it any wonder What We Eat in America, a report compiled using NHANES data, found chronic population-wide nutrient deficiency when published in 2005?

Which brings us to the second question asked above - just what is happening in our metabolism that allows us to eat that many calories?

We'll explore that question next week...

Time Crunch...

Yesterday I wrote that I'd continue with a follow-up to my post - for those awaiting that post, please forgive my delay, an unanticipated schedule change here means I won't be able to complete the post until later tonight!

Thanks for your patience!

Do we need more plant-based calories in our diet?

Eat a plant-based diet.

It's a message we're bombarded with almost daily in the media and from health experts.

Carefully packaged within the message are subtle cautions about our omnivore ways - meat is loaded with "artery clogging" saturated fat, so are dairy products; eggs are rich with that deadly stuff called cholesterol; and, my favorite, we eat too much protein anyway, so limiting or eliminating animal foods will somehow resolve this problem in our diet.

A recent article in Pipe Dream, sums up our wayward diet nicely, "we are here to tell you to relax and put down the t-bone, as you're probably getting enough protein to feed a small family...of lions.

[...]

Although protein is an essential macronutrient which plays many key roles in the way our bodies function, we do not need huge quantities of it...Given the content of a Western diet, getting enough protein is no challenge. Unlike carbohydrate centered diets of China and Italy, protein is a huge part of our diet. From pork chops to hamburgers to filet mignon, meat is everywhere...You don't have to become a vegetarian to combat the protein craze, but consider rethinking the amount of animal protein you ingest."

Another site, The Body Fat Guide, explains that "Looking first at the role of animal fat in producing disease, one comes across a contradiction to the conventional wisdom: the French Paradox. If eating animal fat produces heart disease, why do the French, who eat plenty of saturated animal fat, have lower rates of heart disease?

The explanation that is consistent with the research on animal protein is that the French consume animal fat largely in the form of butter and cream, which is very low in animal protein. When considering the overall diet of the French, one sees that it is much lower in total animal protein then the Western diet, even though it is higher in animal fat."

Articles like these try convince you that the problem in our diet is animal foods - and that if we eliminate or limit animal foods, we'll see better health because we'll be eating less animal protein and animal fat.

The question then is, are we really eating too much animal protein and fat?

In order to answer that question, we need to first look at our dietary habits before the "diet-heart theory" (aka the lipid hypothesis) took off in the popular media; before the messages to eat less fat really took hold in the minds of the American public; to a time when people just ate their food and didn't think much of it other than did it taste good?

To do that we'll look back at data from the 1960's - the period right before health organizations and the government sought to modify our eating habits toward a plant-based diet....so let's look at the year, 1961 - the earliest date available for complete data from the Food and Agriculture Organization (FAO) of the UN.

From the food balance sheets (which calculates production, exports, imports, waste, spoilage and other factors that determine final consumption of a given population) we find that in 1961 the calories in our diet came from mostly plant-based foods; 65% of total calories were plant-based and 35% were animal-based sources.

Of the 2882.50-calories each day, we consumed 13.2% of our calories from protein, 34.4% from fat, 48.7% from carbohydrates and 3.7% from alcohol.

Of those calories, animal protein accounted for 8.7% of our total calories and also accounted for 66.1% of our total protein intake.

Animal fats provided 21.7% of our total calories, and also accounted for 66% of our total fat consumed.

Pretty shocking, isn't it?

By today's dietary standards, that's a diet that's going to kill you - and given the level of noise about our "poor diet" these days, we must be eating more animal fat and protein - so you'd think?

Well, we're most definitely eating more calories - in 2000 we consumed an average of 3816.71-calories each day; an increase of 934.21 calories over 40-years.

Where things get interesting though, is how our diet has changed in those years.

By 2000, however, our diet looked very different from the sixties; in fact, our dietary intake from plant-based foods increased to account for 73% of our calories each day, animal food sources provided just 27% of our calories.

Must make the "plant-based diet is all that" crowd pretty darn happy - we've most definitely migrated toward eating more calories from plant-based foods than animal foods!

But, in 2000 we did eat more calories - we consumed just 12% of our calories from protein, 36.7% from fat, 47.3% from carbohydrate and 4% from alcohol.

Shifts in protein consumption also are found in the data - where before 8.7% of our total calories were from animal proteins, in 2000, just 7.6% of calories came from animal protein; and animal protein now accounted for 63% of our total protein versus 66% previously.

So while we're told we're in the middle of an obesity epidemic, an explosion of diabetes and a healthcare crisis - remember this fact: while the powers that be are trying desperately to convince you to restrict or eliminate animal foods - today we're eating less protein as part of our total diet than other countries with less heart disease - including Japan!

In countries with enviable low mortality rates from heart disease, protein accounts for

• 13.2% of calories in Japan
• 13.2% of calories in Sweden
• 13.1% of calories in France
• 12.5% of calories in Italy
• 13.1% of calories in Spain
• 13.5% of calories in Greece

We consume just 12% of our calories each day from protein - and here's an interesting fact: we're not eating more red meat or eggs.

In fact, consumption of both red meat and eggs has decreased over 40-years, along with consumption of butter.

In 1961 red meat (beef, lamb, and goat) provided about 140-calories each day; in 2000 these same foods now provided an average of 123-calories a day. Pork consumption didn't change much, but poultry consumption increased significantly - in 1961 poultry accounted for an average 64-calories a day; by 2000 it accounted for 186-calories a day.

So, while we're eating less red meat and about the same amount of pork, we're eating a heck of a lot more poultry!

Eggs used to provide an average 67-calories a day (about six eggs a week on average per person); in 2000 that had declined to 55-calories a day (less than five eggs a week on average per person).

And, butter - that "bad boy" everyone keeps insisting we must eat less of - well, we are...a lot less. In 1961 we averaged 65-calories a day from butter (about 4.5 tablespoons a week) - in 2000 that was down to just 40-calories a day (about 2.8 tablespoons a week).

So, while we're eating the same calories from animal fat - most of it today is from poultry, not butter, eggs and red meat - and 36 more calories from animal protein, is again from increased consumption of poultry, not red meat or eggs.

But still, if you're advocating a plant-based diet, that's not much of an "advance" toward a "healthier" diet is it?

And, well, we are eating 934 more calories a day! That can't be a good thing.

So, if just 36 of those calories are from animal foods, what the heck explains the other 898-calorie increase?

Sugar, vegetable oils and cereal grains.

Yes, a full 80% of our calorie increase - 750.48 calories - comes from just three sources: sugar, vegetable oils and cereal grains.

Over the period of 40-years, we've increased our added sugars by about 30%, adding 150-calories a day (from 515.75 calories to 665.82 calories); increased our consumption of vegetable oils almost two-fold, adding 358.78-calories a day (from 276.15 calories to 634.93 calories); and increased our consumption of cereal grains by 38%, adding 241.7-calories a day (from 627.32 calories to 869.05 calories).

Sugar, vegetable oil and cereal grains - the base ingredients of many packaged, processed foods in America.

The changes in our diet over the last forty years begs an important question - how are we able to consume copious and increasing amounts of sugar, vegetable oils and cereal grains while continuing to eat a similar level of animal foods?

Just what is going on in our metabolism that even makes that possible?

Those questions will be explored tomorrow!

Adaptive Thermogenesis Can Impede Weight Loss

A calorie is a calorie is a calorie; so we're told.

Calories in - calories out matter when it comes to our weight; so we're told.

Eat less and move more, reduce calories and increase calories used, the secret to weight loss; so we're told.

Back in 2004, Drs. Feinman and Fine offered up a paper, published in Nutrition & Metabolism, "A calorie is a calorie" violates the second law of thermodynamics.

Within that paper, it was noted that, "A review of simple thermodynamic principles shows that weight change on isocaloric diets is not expected to be independent of path (metabolism of macronutrients) and indeed such a general principle would be a violation of the second law. Homeostatic mechanisms are able to insure that, a good deal of the time, weight does not fluctuate much with changes in diet – this might be said to be the true "miraculous metabolic effect" – but it is subject to many exceptions. The idea that this is theoretically required in all cases is mistakenly based on equilibrium, reversible conditions that do not hold for living organisms and an insufficient appreciation of the second law. The second law of thermodynamics says that variation of efficiency for different metabolic pathways is to be expected. Thus, ironically the dictum that a "calorie is a calorie" violates the second law of thermodynamics, as a matter of principle."

While the paper has been cited a number of times over the years, no other major study or paper has challenged the idea that weight loss is mostly dependent on "calories in calories out" - so lacking is any question of this belief that many continue to hold the not-so-subtle idea that if someone isn't losing weight on a calorie restricted diet, then they are not restricting calories enough or they're cheating and just won't admit it.

Well folks, get ready to read an eye-popping study published this month in the International Journal of Obesity, Clinical significance of adaptive thermogenesis. (full text)

The conclusion?

In conclusion, based on studies that have shown a greater than predicted decrease in EE under energy restriction circumstances, this review presented arguments in support of the potential of adaptive thermogenesis to impede obesity treatment on a short- and long-term basis, at least in some individuals. In some cases, the adaptive decrease in thermogenesis was shown to be significantly related to a single cycle of body weight loss and regain, an increase in plasma organochlorine concentration following weight loss, and a lower than predicted EE was also shown to be associated with severe nocturnal oxygen desaturations in OSAS. This suggests that energy metabolism might be sensitive to stimuli of different physiological nature and that adaptive thermogenesis could be quantitatively more important than what is generally perceived by health professionals and nutrition specialists. However, from a clinical point of view, several issues remain to be investigated in order to more clearly identify adaptive thermogenesis determining factors and to develop strategies to cope with them. Along these lines, it is concluded that unsuccessful weight loss interventions and reduced body weight maintenance could be partly due, in some vulnerable individuals, to the adaptive thermogenesis, which is multicausal, quantitatively significant, and has the capacity to compensate for a given prescribed energy deficit, possibly going beyond any good compliance of some patients. [emphasis mine]

Weight loss impeded, even with restricting calories and good compliance?

Who'da thunk it possible?

Gluten-Free Labeling, Proposed Rules, Open Comment Period

On January 23, 2007 the FDA opened a comment period on proposed rules for labeling products 'gluten-free'. The agency accepting comments and feedback from consumers on several issues relating to a gluten-free diet and how individuals make choices about gluten-free products.

If you would like to comment, the page is HERE.

The proposed rule summary was published as follows:
2005N-0279 - Food Labeling; Gluten-Free Labeling of Foods
FR Type: Proposed Rules
Action: Other
RIN Number: 0910-ZA26

SUMMARY: The Food and Drug Administration (FDA) is proposing to define the term "gluten-free" for voluntary use in the labeling of foods, to mean that the food does not contain any of the following: (1) an ingredient that is any species of the grains wheat, rye, barley, or a crossbred hybrid of these grains (all noted grains are collectively referred to as "prohibited grains"); (2) an ingredient that is derived from an prohibited grain and that has been processed to remove gluten (e.g., wheat flour); (3) an ingredient that is derived from a prohibited grain and that has been processed to remove gluten (e.g., wheat wheat starch), if the use of that ingredients result in the presence of 20 parts per million (ppm) or more gluten in the food; or (4) 20 ppm or more gluten. A food that bears the claim "gluten free" or similar claim in its labeling and fails to meet the conditions specified in the proposed definition of "gluten free" would be deemed misbranded. FDA also is proposing to deem misbrand

In Brief...

Discover Magazine
The Ancient Atkins Diet

Because European settlements from around 10,000 B.C. are primarily found along coasts and rivers, archaeologists assumed their inhabitants survived mostly on fish and plants. The latest look at Mesolithic menus suggests, however, that people back then were a lot more interested in steak than salad niçoise. Archaeologist Glyn Davies of the University of Sheffield in England recently performed a detailed chemical and physical analysis on an 8,000-year-old thighbone unearthed along a river in central England. He focused on patterns of nitrogen and carbon isotopes that can distinguish plant eaters from meat eaters. "We know the bone belonged to a woman who ate an almost exclusively carnivorous diet, only occasionally supplemented with berries or plants," Davies says. Cut marks seen on the bones of wild cattle, aurochs, and deer found nearby corroborate that view. The research raises new questions about Europe's inhabitants after the last ice age. "Everything we know from that period suggests that this woman probably lived in a small family group that traveled seasonally between inland hills and the coast," Davies says. "But no fish and plant remains suggests she stayed put, doing more hunting than gathering."

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FREE eBookNutrition & Physical Degeneration, Weston A. Price

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FREE full-text of the original 1930 publication of the Steffanson & Andersen Bellevue Experiment

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New York Times
One in Eight Adults in NYC has Diabetes
"One in eight adults in New York City has diabetes, and nearly twice as many appear to be developing it — a picture even grimmer than that of the nation as a whole, according to the city’s first attempt to definitively measure the rate of the disease."

Metabolic Syndrome Doubles Risk - Now What?

A study, Metabolic Syndrome and Risk of Incident Cardiovascular Events and DeathA Systematic Review and Meta-Analysis of Longitudinal Studies, was recently published in the Journal of the American College of Cardiology. Researchers evaluated the findings of thirty-seven studies which evaluated associations between MetS and cardiovascular events or mortality and concluded "the best available evidence suggests that people with MetSyn are at increased risk of cardiovascular events. These results can help clinicians counsel patients to consider lifestyle interventions, and should fuel research of other preventive interventions."

Metabolic syndrome isn't a disease per se; rather it is a clustering of multiple metabolic abnormalities - abnormal cholesterol (elevated triglycerides, low HDL), central adiposity, high blood sugar, and high blood pressure - that when occuring together increase the risk of cardiovascular disease and death.

Some background first - in recent years the diagnosis of MetS has been under fire since two major health organizations - the American Diabetes Association (ADA) and the American Heart Association (AHA) - disagreed about the clinical utility of the diagnosis. The ADA issued a joint statement with the European Association for the Study of Diabetes (EASD) that the syndrome should not be considered a separate disease; the AHA followed up with a statement that it should.

As I wrote back in August 2005, the major sticking points addressed in the ADA statement included: there was no agreement for definition of the syndrome, a lack of understanding of the pathogenesis of MetS, no agreement about course of treatment for those diagnosed, no agreed upon standards of care for those diagnosed, and no agreed upon strategies to help prevent MetS. The AHA shot back with a statement in September 2005 to clarify and justify the diagnosis.

In June 2006, the two organizations seemed to harmonize their positions when they issued a joint statement that emphasized agreement between the organizations. It placed an emphasis on treating "a core set of risk factors (pre-diabetes, hypertension, dyslipidemia, and obesity)" as well as smoking. The statement sidestepped the genesis of the still-simmering disagreement—a dispute that neither group tried to hide—the definition of metabolic syndrome.

Why this background is important is because while the two organizations squabbled, a number of papers were published that shed light on preventing and reversing Metabolic Syndrome. The most important of these was in December 2005; when a study published in Nutrition and Metabolism, Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction, connected the dots between diet and development of Metabolic Syndrome.

As Jeff Volek, PhD, RD, lead researcher from the University of Connecticut, Storrs said, "Make a list of the features of metabolic syndrome, then, make a list of the things that carbohydrate restriction is good at fixing. They're the same list. Somehow, we never really noticed that. We know the cause of metabolic syndrome is often linked to disruption of insulin. Thus, the key to treating metabolic syndrome is to control insulin, and carbohydrates are the major stimulus for insulin."

So while HeartWire summed up the findings from the paper in the Journal of the American College of Cardiology, as "new meta-analysis show that the syndrome is more than the sum of its risk factors - and that it may pose a higher risk to women than to men...[m]etabolic syndrome...nearly doubled a person's risk of developing CVD...[t]he overall relative risk for cardiovascular events and death for people with the metabolic syndrome was 1.78 (95% CI 1.58-2.00), the study found. Cardiovascular events were about 33% higher for women than men;" and noted that the "findings are applicable to clinical practice: clinicians can use this evidence to motivate patients when counseling them to reduce risk factors;" we still find nothing but a big question mark when it comes to prevention and treatment!

Basically, the paper quantifies the risk of Metabolic Syndrome and the AHA notes that until its publication "clinicians were getting a mixed message about the utility of making the diagnosis."

So now we have jusification to diagnosis Metabolic Syndrome, but the question remains - what is a clinician to do with the data? The meta-analysis found a significant increase in risk - but what exactly are physicians to do with that knowledge when they have a real live patient standing before them and a diagnosis of metabolic syndrome?

Well if they look to the AHA for guidance they'll find the TLC (Therapeutic Lifestyle Changes) diet is recommended and is as follows:

TLC Diet in ATP III
Total Fat 25–35%
Saturated Less than 7%
Polyunsaturated Up to 10%
Monounsaturated Up to 20%
Carbohydrate 50–60% of total calories
Protein Approximately 15%
Cholesterol Less than 200 mg per day
Total Calories Balance energy intake and expenditure to maintain desirable body weight and prevent weight gain

These guidelines ignore Level 1 evidence that points to a more effective dietary approach and dismisses the importance of the paper Carbohydrate restriction improves the features of Metabolic Syndrome.

They also ignore, from the AHA journal Circulation, a paper published four years ago - Diets and Clinical Coronary Events: The Truth Is Out There

As the researchers noted in that paper, everything is "bad" according to the recommendations, "[f]ats are considered "bad" because they lead to cardiovascular events. However, one of the alternative energy sources, carbohydrates, is "bad" because it increases the risk of diabetes, and the other, protein, is "bad" because of increased burdens on the liver and kidneys."

So they asked, What, then, can be done to give patients a simple answer to their most frequent question: "What can I eat that will keep me from dying, having a heart attack, or having a stroke?"

After reviewing the evidence they concluded that "The time has come to apply to diet research the same level of evidence required for other interventions. We believe that indications or claims made for weight loss or health improvement via diet—whether made by authors, the government, or associations—must be supported by 3 types of evidence: proof that the diet provides essential nutrients in actual patients, efficacy studies, and randomized, controlled trials with clinical events as end points....Until then, the public will continue to be subject to speculation and potentially hazardous extrapolation from putative biological surrogates to clinical outcomes."

Remarkably, four years later, we still have a lack of convincing evidence to eat a low-fat, mostly plant-based diet; but that hasn't stopped the AHA from revising their recommendations late last year, nor stopped them from recommending the TLC diet for those at risk.

In an editorial I featured here, Dr. Gil Wilshire, MD, FACOG expressed his outrage over the lack of "gold standard" evidence to support the revisions in the AHA dietary recommendations. In part, his words parallel those of the researchers back in 2003:

Show me some high-quality data. Show me that someone has bothered to properly test the 50 year-old hypothesis.

In the absence of this information, I would like to make the following recommendation:

AN IMMEDIATE MORATORIUM ON ALL POPULATION-WIDE DIETARY RECOMMENDATIONS THAT LACK SUPPORT FROM WELL-PERFORMED, PROSPECTIVE, EVIDENCE-BASED HUMAN STUDIES.

Sanity in this field will only come out of a complete overhaul. We need to tear down the current edifice of confusion to its most basic foundations, and rebuild it from the bedrock up.

...

While today we now have a meta-analysis to point to that finds a significant increase in risk for cardiovascular disease and death in those with Metabolic Syndrome, thus a justification to utilize it as a diagnosis; we still do not have dietary recommendations based on evidence to help those at risk for or diagnosed with Metabolic Syndrome!

I consider this a national shame, especially when you consider that one-third of our population is believed to have or are developing features of Metabolic Syndrome.

The American Heart Association is failing us and it's time we speak up and hold them accountable for their continued dismissal of evidence that clearly points to carbohydrate restriction as a scientifically supported, valid dietary approach to treat those with Metabolic Syndrome!

If you've seen improvements from a controlled-carb diet or feel the AHA must review the data available for carbohydrate restricted diets - tell the AHA here!

Eat Right, Get Sick?

When you're doing everything "right", you expect results, right?

An interesting study, Nutrient Intake, Body Composition, Blood Cholesterol and Glucose Levels among Adult Asian Indians in the United States, published in this month's Journal of Immigrant and Minority Health, found that "[d]espite having a dietary intake that meets the National Cholesterol Education Program, Adult Treatment Panel III recommendations, this group [adult Asian Indians] was at a higher risk for chronic disease, by virtue of increased BMI and % BF along with an altered metabolic profile (high BP and TC and low HDL-C)."

Their dietary habits were impressive and much better compared with the Standard American Diet - fat intake was just 25% of calories, protein 14% and carbohydrates provided 64% of calories. Their BMI was an average 25.5, just a tad "overweight" for the group as a whole.

Alarming however were findings that body fat percentage was higher than desired (20% men, 36% women); Total Cholesterol-to-HDL ratios were high (4.86 men, 4.11 women), blood glucose was elevated (122mg/dL men, 105mg/dL women), and their blood pressure was high.

This was, again as the researchers concluded "depite having a dietary intake that meets the National Cholesterol Education Program, Adult Treatment Panel III recommendations."

The researchers couldn't bring themselves to connect-the-dots to their subjects' diet contributing to - even causing - the metabolic disturbance; of course it has to be something else, it couldn't be their diet; afterall, their diet met the NCEP-ATPIII recommendations!

Down the Rabbit Hole of WLS for Children

Get ready for our adventure down the rabbit-hole today as we explore the solution to childhood obesity in Wonderland.

The Chicago Tribune reported yesterday, [a]s the popularity of stomach surgery has skyrocketed among obese adults, a growing number of doctors are looking at children as possible candidates.

A group of four hospitals...are starting a large-scale study this spring examining how children respond to various types of weight-loss surgery. They include gastric bypass, in which a pouch is stapled off from the rest of the stomach and connected to the small intestine...[and]...a procedure called laparoscopic gastric banding, where an elastic collar installed around the stomach limits how much someone can eat.

The study was approved by the FDA after surgeons at New York University Medical Center published findings in the Journal of Pediatric Surgery this month. In that study, 53-children, aged 13 to 17, underwent bariatric surgery; they lost nearly half their excess weight over 18-months post-op.

The Chicago Tribune highlighted the "success" of one teen, Crystal Kasprowicz, who shed 100-pounds after the surgery, but didn't mention any of the teens who faced additional surgery or other complications after their surgery.

In the abstract of the study we find some numbers to give us an idea of the complications:

• 2 patients had band slips that required laparoscopic repositioning
• 2 patients developed a symptomatic hiatal hernia that required laparoscopic repair
• 1 patient developed a wound infection requiring incision and drainage
• So, of 53 subjects, 10% required additional surgery

• 5 patients experienced hair loss
• 4 patients experienced iron deficiency
• 1 patient developed nephrolithiasis and cholelithiasis (kidney stones and gallstones)
• 1 patient develpped gastroesophageal reflux
• So, of 53 subjects, 21% experienced a complication that didn't require additional surgery

In total, 30% of all the patients experienced a complication. Funny how the media fails to report that, huh?

When Britain recently approved weight loss surgery for children, I included a list of complications we know happen in adults in UK Solution to Childhood Obesity - Surgery & Drugs:

Short Term Complications (in the first 3 to 14 days)

• Bleeding Leak
• Abscess and Infection
• Pulmonary Embolus Death
• Severe Nausea and Vomiting
• Narrowing or ulceration of the connection between the stomach and the small bowel has been reported in one series in about 20% of all patients undergoing gastric bypass
• Bile Reflux Gastritis occurs when bile flows back into the stomach
• Fistulas, (an abnormal passage leading from one hollow organ to another) abscess and infection have been seen in gastric bypass operations
• Dumping Syndrome
• Gallstones
• Adhesions, scar tissue caused by healing after surgery
• Diarrhea

Long Term Complications

• Vitamin and Mineral Deficiencies - Decreases in iron, vitamin B12, and/or Folate levels were detected eight months to eight years (median, two years) after the operation
• Peripheral neuropathy (disorders resulting from injury to the peripheral nerves) has been reported after operation
• Osteoporosis and Bone Loss
• Gastric bypass procedures carry the highest risk of multiple micronutrient deficiencies, that may supervene despite close medical follow-up
• Patients with a gastric bypass have a greater frequency of microcytosis and anemia, more frequent subnormal serum levels of vitamin B12, and impressive failure to absorb food vitamin B12
• Gastrointestinal bleeding from a duodenal ulcer four years after having a gastric bypass procedure for obesity
• Symptomatic gallstones requiring cholecystectomy
• Abdominal Wall Hernia
• Pregnancy Complications

But let's set aside the complications for a moment and read what one surgeon tells his patients (adults) before surgery:

The “two by two” lecture is legendary. After prepping more than 900 patients for bariatric procedures since 1998, Gus Slotman, MD, a School of Osteopathic Medicine (SOM) professor of surgery, can move through his advance warnings for obese patients with lightening speed. “I say this all day long,” he laughs, joking that as a baby boomer himself, his mantra might just be helping him stay as thin as he was back in school.

Without pausing for a single breath, he can rattle off the dietary rules for life after surgery: “Two ounces of protein every two hours, or eight times a day. That’s two by two and take 15 minutes to finish. I tell them they have to commit themselves to eating no more than two ounces at a time. And there will be no room for anything but meat, fish, chicken, vegetables, fruit, dairy products, eggs and other proteins. Say goodbye to bread, potatoes, rice, pasta, noodles, pretzels, chips, cheez doodles, crackers, junk cereal and all those starch-carbs.”

Yes, you've just stumbled down the rabbit hole.

In the real world, pre-surgery, we're told repeatedly a carbohydrate restricted diet is dangerous and no one wants to eat that way anyway; in Wonderland, post-op, a carbohydrate restricted diet is mandatory for success and maintaining health.

So after you pony up $25,000 to have your surgery, face the very real (and often expensive) risk of complications, it's not only safe, but necessary to follow a carbohydrate restricted diet.

Funny, but the media doesn't seem too keen on reporting this either. What they are keen on is selling us the idea that weight loss surgery is the answer to the growing problem of childhood obesity.

I don't buy it, and neither should you.

Statin Briefs

Lancet, Jan 20, 2007
Are Lipid-Lowering Guidelines Evidence-Based?
To sum it up: No studies have shown statin cholesterol-lowering drugs to be effective for women at any age, nor for men 69 years of age or older, who do not already have heart disease or diabetes. More than 50 adults have to take a statin drug for 1 patient to avoid a fatal heart attack, and that figure only applies to high-risk patients. Cholesterol treatment guidelines need to be revised.

This is London, UK, Jan 23, 2007
To sum it up: Dr. Malcolm Kendrick has published a book, The Great Cholesterol Lie; who likens the lipid-hypothesis and heart disease to an amazing beast. "The closer you look the more you find that the cholestrol hypothesis is an amazing beast. It is in a process of constant adaptation in order to encompass all contradictory data without keeling over and expiring."

HeartWire Jan. 27, 2007
Dr. James M Wright of the University of British Columbia, Vancouver
"If you take a male who is 50 years old, a smoker, with high blood pressure, who eats the worst diet in the world . . . then if I were an honest physician, I would tell him that maybe he should be taking a statin. And if he asked how much would that reduce his risk, I would have to tell him that it would only reduce his risk by 2% over the next five years. If he understood that information, he would say, You're expecting me to take a pill everyday for five years? And it's going to cost me two dollars a day? You're crazy! I'm not going to do it."

So, if physicians were truly honest with their patients, the doctor says, "I think there probably would be very few people being treated for primary prevention with a statin drug."

World Review Nutrition Dietetics, 96: 1–17, 2007
To sum it up: Dr. Harumi Okuyama says the direction of modern medicine needs to move away from the lipid-hypothesis of coronary heart disease. Once cases of genetic/familial high cholesterol are removed from population statistics, he claims that high cholesterol is not found to be a causal factor for coronary heart disease. High total cholesterol is not positively associated with high coronary heart disease mortality rates among general populations more than 40–50 years of age. He notes that the rate of heart attacks differs by approximately 4 to 8-fold at the same total cholesterol level in some populations.

He continues that while Western countries have accepted the lipid-hypothesis of heart disease and the use of statin drugs, "little benefit seems to result from efforts to limit dietary cholesterol intake or to total cholesterol values to less than approximately 260 mg/dL." He believes it is urgent we change the direction of current medical practice away from statins.

When is a Child Too Fat?

A recent Diet Blog entry, Fat Kid Phobia: A Personal Rant, has provoked an interesting discussion in the comments section.

The center of the debate is the recent finding, published in the October 2006 issue of Public Health Nutrition, that 90% of parents of 5 to 6-year olds did not recognize their child was overweight. As Yahoo News brutally headlined it, Parents Blind to Fat Children, Study.

Jim (author of Diet Blog) wrote, "When my daughter looks up at me with her concerned eyes and asks "Daddy is my tummy too big?" - my answer is - "You are just beautiful the way you are".

Or I could glare at her with stern eyes. I could inform her that she is in the grip of an obesity epidemic. That she had better start eating less. That I would be watching everything she puts in her mouth. That she isn't quite good enough.

I have no doubt that I could annihilate her fragile self-esteem in a few minutes with such careless words.

I'm not ignoring the fact that there is an obesity problem and that there are many very real health consequences -- but who gets to decide my child is overweight -- and by what definition? Certainly parents and families can be educated about healthier lifestyles - but is fear-mongering and guilt a good way to do this?

Do I tell my daughters that they are not allowed to have round tummies or big thighs? Because if they do it might mean they are overweight. And if they are overweight then they are... what...? Sick? Unhealthy? Lazy? Unacceptable?"

Considering the full-court-press the issue of childhood obesity is getting in the media, schools measuring the BMI of children and sending home BMI report cards, public service messages targeting parents of overweight children, mandates for wellness programs in schools, and a plethora of other initiatives to reduce the indidence of childhood obesity, Jim's question and underlying concern is valid - it isn't only adults whom are hearing and seeing the messages that children are in trouble, kids are hearing and seeing those messages each day too.

And here we have a survey confirming what many have been saying for years - parents are blind to their childrens weight problem.

I wondered, just how is it possible not to recognize a child is overweight or obese?

For that answer I had to go to the full-text to read everything rather than depend on the short abstract, which didn't provide enough information to understand the protocol of the survey or how the research team crunched the numbers to reach their conclusions.

An interesting thing emerged in the full-text - the researchers used an international set of cut-offs for overweight and obese in children, first proposed in May 2000 in the British Medical Journal; so the CDC's calculator for children and teens is not useful here. In the BMJ article we find the standard used for this survey in Table 4 which provides the BMI points of overweight and obese:

Five year old boys:
BMI of 17.41 or less = normal/healthy weight
BMI of 17.42 to 19.29 = overweight
BMI of 19.3 or more = obese

Five year old girls:
BMI of 17.14 or less = normal/healthy weight
BMI of 17.15 to 19.16 = overweight
BMI of 19.17 or more = obese

For simplicity here, let's work with girls since one fear many parents have with daughters is the worry about creating eating disorders in their future if they send the wrong messages about weight and body image.

So let's use an example of a five-year old girl who is 3' 8" - 44" tall.

At what weight does she transition from normal to overweight? At what weight does she transition from overweight to obese?

Using the CDC BMI Calculator, to enter height and weight and find BMI, here are the results:

47-pounds = 17.1 BMI (normal/healthy)

47.5-pounds = 17.2 BMI (overweight)

53-pounds = 19.2 BMI (overweight)

53.25-pounds = 19.3 BMI (obese)

Of the 134 five-year-old girls measured in the survey, 21 were found to be "overweight" and 5 were found to be "obese".

As we can see from above, a half-pound can have a profound difference - a child weighing 47-pounds is normal/healthy, a child weighing 47.5-pounds is overweight, and a child somewhere between 47.5-pounds and 53-pounds is overweight...a very small margin of just six pounds difference between normal/healthy and obese.

Six pounds - is it any wonder parents might not think a child classified as "overweight" by the BMI isn't overweight?

I really have to wonder how many of the 21 girls classified as overweight were within a pound of normal/healthy? How many were within two pounds? Three?

This is just one example of many potential scenarios for a little girl who is five years-old; she may or may not have more or less lean body mass (muscle) compared with her peers; may or may not be laying down fat to enable a growth spurt in her near future; and may or may not have the same stature of another girl of the same height, where one little girl may be "sturdy" another might be "dainty".

But, these are things the BMI cannot measure. And this is where adult judgement has to come into play.

It's noteworthy that the researchers didn't try to measure the perception of other adults, specifically pediatricians or family doctors who are tasked with keeping an eye out for problems. Perhaps they could have taken it a step further too and asked the parents of the children in the study - ask them if looking at child A, B, or C would they consider the child, who is not their own, normal/healthy weight, overweight or obese?

I think that type of insight would be useful - I know if I were trying to judge between a child who is 47-pounds and one who is 48-pounds, I'd probably not recognize the 48-pound child as overweight - it's simply not a big enough difference to be an overt difference between the two children. Even a few pounds probably wouldn't set off alarm bells for most people when they're looking at two or three children who are close to the same weight.

But with the BMI standard, those few pounds make all the difference.

Jim said it nicely, "I'm not ignoring the fact that there is an obesity problem and that there are many very real health consequences...but is fear-mongering and guilt a good way to do this?"

This is a question we all need to ask ourselves and consider as we continue to turn up the volume in an effort to convince parents to pay attention to their child's weight.

We also need to be aware of what messages we are unwittingly sending to children - often very young children - as we adults try to find a solution to reverse the trends of overweight and obesity affecting our children.

As a parent I know it's hard to objectively assess my child - in my eyes he's perfect in every way.

It's hard to the assess my neice and nephew, my young cousins, and my cousins' children too. But then, when I step beyond the circle of family into the circle of friends it's much easier to "see" a problem, but then again, if we're talking a pound here or there, no way! Quite frankly, unless the child is really way to heavy, or having trouble in daily activity it's a tough call to make, especially since we're talking about kids who are growing and always changing right before our eyes!

I don't have the answer to how to reverse the trend of childhood obesity - I do see it, I do recognize it....and I do worry that how we're going about the solution may do more harm than good in the coming years.

I know it pains me to hear my five year-old neice say she doesn't want to get fat - she's tall and slim, but just barely registering in the 10th percentile for BMI-for-age; just as it pains me to see a little girl struggling at the playground because she's carrying too much weight on her little body.

There are no easy answers here. But if we get this one wrong - what will we have done to our future generation?

What are your thoughts?

More Unhappy Meals

Michael Pollan's essay has certainly kindled a wide range of commentary from the blogosphere. For your reading pleasure:

Scientific American:
Hard to Swallow Some of Pollan's "Unhappy Meals"

Waisted In Wasteland (Low-Carb):
What Shall We Eat Today?

The Last Atkins Dieter (Low-Carb):
A National Experiment in Mainlining Glucose

Adam Campbell (Fitness/Controlled-Carb):
An Eating Philosophy You Can Live (Well) By

Nutrient-Rich (Vegetarian/Vegan):
NY Times: Michael Pollan on Nutritionism

seitan's delight:
Eat Food: It's like you have to spell it out for these people

It's All One Thing (Vegetarian/Vegan):
The wisest advice about eating

Marc Joseph Nutrition (general nutrition):
How Nutritional Science Has Ruined the Way We Eat - Michael Pollan

Joe Pastry (cooking/baking):
"Unhappy Meals"

So There

A doc in London sums it up nicely:

The Telegraph, London - Doctor's diary: James Le Fanu takes a look at obesity

No doubt reflecting the seasonal preoccupation with weight matters, there currently seem to be a lot of stories on this theme in the papers: fat dogs (and fat owners), fat South African lady stuck in a tunnel of love, MPs "alarmed" about an obesity epidemic in schoolchildren and, best of all, the claim that some people are now overeating so as to qualify for weight reduction surgery.

Meanwhile, back in the surgery, it has become a lot easier to turn down the customary New Year request for slimming pills by pointing to the physical transformation of several of the staff. They are all beneficiaries of the high-protein/low-carb approach.

The effectiveness of this type of diet is certainly a great embarrassment to the legion of medical experts who, over the past 20 years, have insisted that eating a lot of meat and dairy products is bad for the heart – quite wrongly, as it turns out.

Indeed, just six weeks ago, Dr Thomas Halton of Harvard reported in the New England Journal of Medicine the findings of a study showing it is women on the medically approved low-fat diet who have the higher risk of heart disease. So there.

The Dogma of Nutritionism - Eat Less Meat

The blogosphere has been buzzing the last few days over seven words:

Eat food. Not too much. Mostly plants.

Those seven little words start Michael Pollan's essay, Unhappy Meals, in the New York Times magazine (from Sunday). As Pollan sums it up at the start, "That, more or less, is the short answer to the supposedly incredibly complicated and confusing question of what we humans should eat in order to be maximally healthy."

Somehow as he meandered from his brillant assessment on the rise of "nutritionism" - "an ideology" - influencing nutrition - "the science" - he too fell for it; fell for the belief that animal protein is a dietary demon that must be limited, if not eliminated if we are to get back on track to reach an optimum diet, thus maximize our health.

Intersperced throughout the essay are a number of not-too-subtle reminders that animal protein, especially meat, is taking up too much space on our plates.

He tells us we we knew this decades ago when the McGovern Senate Subcommittee first drafted dietary guidelines that included the statement to “reduce consumption of meat," that was compromised in an effort to appease industry to read “Choose meats, poultry and fish that will reduce saturated-fat intake.”

He continues to explain to us that the Gary Taubes article, What if it's All been a Big Fat Lie, was a "revisionist" accounting of what really happened in our diet since the implementation of the compromised dietary recommendations; cites T. Colin Campbell and Walter Willet as two researchers in agreement with the view that "the culprit nutrient in meat and dairy is the animal protein itself", thus we should eat less meat.

He then ties it all neatly up with "But people worried about their health needn’t wait for scientists to settle this question before deciding that it might be wise to eat more plants and less meat. This is of course precisely what the McGovern committee was trying to tell us."

He includes a number of convincing arguements to make the case against animal protein:

We just heaped a bunch more carbs onto our plates, obscuring perhaps, but not replacing, the expanding chunk of animal protein squatting in the center.

Of course thanks to the low-fat fad (inspired by the very same reductionist fat hypothesis), it is entirely possible to reduce your intake of saturated fat without significantly reducing your consumption of animal protein: just drink the low-fat milk and order the skinless chicken breast or the turkey bacon.

Thomas Jefferson was on to something when he advised treating meat more as a flavoring than a food.

Even the beginner student of nutritionism will immediately spot several flaws: the focus was on “fat,” rather than on any particular food, like meat or dairy. So women could comply simply by switching to lower-fat animal products.

And then, in a plea to convince us to return to our ecological and cultural relationship with food and eating, and reduce our consumption of meat, Pollan suggests we "Eat more like the French. Or the Japanese. Or the Italians. Or the Greeks. Confounding factors aside, people who eat according to the rules of a traditional food culture are generally healthier than we are. Any traditional diet will do: if it weren’t a healthy diet, the people who follow it wouldn’t still be around. True, food cultures are embedded in societies and economies and ecologies, and some of them travel better than others: Inuit not so well as Italian. In borrowing from a food culture, pay attention to how a culture eats, as well as to what it eats... Let culture be your guide, not science."

With all of this taken together then, it's difficult to wrap my head around his advice to "Eat more like the French. Or the Japanese. Or the Italians. Or the Greeks... Let culture be your guide, not science;" especially when he takes a huge leap of faith to explain the French Paradox by suggesting, "it may not be the dietary nutrients that keep the French healthy (lots of saturated fat and alcohol?!) so much as the dietary habits: small portions, no seconds or snacking, communal meals — and the serious pleasure taken in eating. (Worrying about diet can’t possibly be good for you.)"

So while I agree with his recommendations to eat real food (not processed, packaged, unknown generations ago foodstuff) and not too much, I'm baffled by his indictment of animal foods and his strong words against eating meat - especially when he then holds up four countries as somehow traditionally superior to our own because their dietary pattern is real food, not too much and mostly plant-based food.

The problem with that is the data doesn't align with the dogma which holds the traditional dietary patterns in Japan and the Mediterranean are plant-based, rich with "good fats," and naturally limits consumption of meat and animal foods.

What does the data tell us? Let's use the data from a source considered accurate for worldwide production and consumption data - the Food and Agriculture Organization (FAO) of the United Nations. Let's start with some basics:

United States 77.85-years Obesity 33% Smokers 17%
France 79.73-years Obesity 9.4% Smokers 27%
Italy 79.81-years Obesity 8.5% Smokers 24%
Greece 79.24-years Obesity 22% Smokers 35%
Japan 81.25-years Obesity 3.2% Smokers 30%

Gosh, maybe staying thin and smoking makes you live longer?

No, I don't think that's what Pollan was thinking when he suggested we eat like any of the above countries! No, the implication is they consume a healthier diet - specifically with more plant foods and less animal protein and animal fat.

The big question is, do they?

Well, not exactly.

Of all the countries, we actually eat the least amount of protein as a percentage of calories with 12.2% of our total calories provided by protein. Italy consumes 12.4% of their calories from protein; Greece 12.7%; France 12.9%; and Japan 13.2%.

But wait, percentage of calories is often misleading since it doesn't tell us the absolute gram intake and if they're eating less calories than we are, then even with higher percentage of protein, they're likely eating less protein....right?

Wrong.

With the exception of Japan, who consumes 92g protein daily, with a total calorie intake of 2768-calories daily (2003), here is how the absolute intake stacks up for the countries Pollan implies eat less animal protein and therefore infers is the reason they have less heart disease (2003 data):

United States - Protein 115g daily, 3754-calories/day
Italy - Protein 115g daily, 3675-calories/day
France - Protein 117g daily, 3623-calories/day
Greece - Protein 117g daily, 3666-calories/day

Wait, wait, wait - that's total protein! What about animal protein? Surely if these countries consume plant-based diets, the majority of their protein will be from plant-based sources and little will come from animal foods, right?

Well, let's look at that data:

United States - animal protein 66g daily (57% of total protein)
Italy - animal protein 62g daily (54% of total protein)
France - animal protein 76g daily (65% of total protein)
Greece - animal protein 63g daily (54% of total protein)
Japan - animal protein 52g daily (57% of total protein)

So, from our country to each Pollan asserts has a better dietary pattern, we find adequate intake of protein and a majority of that protein is from animal foods.

Something then is making us fatter than them - could it really be that we're eating too much fat?

Probably not:

United States - total fat 155g daily - 37% of calories
Italy - total fat 156g daily - 38.2% of calories
France - total fat 168g daily - 42% of calories
Greece - total fat 145g daily - 35.5% of calories
Japan - total fat 86g daily - 28% of calories

OK, so with the exception of Japan, these countries consume a "high fat" diet, not the mythical "low-fat" diet we're told they eat.

Perhaps then, the problem with our diet goes a bit deeper - maybe it really is the animal fats, the "bad" saturated fats we're told we should limit and avoid if possible.

Oops, there goes another assumption...

United States - animal fat 72g daily, 46% of fat calories
Italy - animal fat 71g daily, 46% of fat calories
France - animal fat 106g daily, 63% of fat calories
Greece - animal fat 57g daily, 40% of fat calories
Japan - animal fat 35g daily, 40% of fat calories

Surely death from heart disease must be highly correlated with their protein or fat consumption?

It has to be there somewhere - we're told repeatedly if we eat too much animal foods we're going to increase our risk for heart disease! So, again, what does the data say?

I'll let the numbers speak:

United States - 106.5/100,000 die from heart disease each year
Italy - 65.2/100,000
France - 39.8/100,000
Greece - 68.8/100,000
Japan - 30/100,000

So it seems if we're looking to reduce the risk of heart disease, it's an all-or-nothing proposition when it comes to protein and fat - France and Japan are very similar for rates of death from heart disease, but their diets are radically different; France consumes a high fat, high saturated fat diet, rich with protein and animal protein; Japan consumes a lower fat diet, lower in saturated fat, but still 40% of their fat calories from animal source, and their diet is rich with protein and animal protein as a percentage of their calories.

Hey, let's add to the confusion - both countries also have the highest percentage of the population that smokes - in France 27% smoke, in Japan 30.3% smoke!

So is the best advice to take up smoking and eat eather a low-fat with less than 30% total fat or eat a high-fat diet withmore than 40% of calories from fat and eat lots of animal protein while you're at it?

No, but unlike Pollan's subtle and not-so-subtle implication that the diets he suggests we follow do not include much meat or animal protein, the data clearly shows that protein is an essential part of these diets; the Japanese consume 57% of their total protein from animal protein sources, the French consume 65% of their total protein from animal protein sources.

Surely something is protecting these populations for heart disease; surely it's something we or they eat or do that the other doesn't.

What can start to explain how these countries eat better, live longer and die less from heart disease?

It's not the fat, it's not the protein, it's not the animal fat and it's not the animal protein.

Heck, it's not even their smoking or drinking habits.

What is it then?

I don't know - but the one glaring difference in our diets isn't our protein or fat - it's our consumption of sugar.

As a nation, we consume almost twice as much added sugars - 657-calories a day, 17.5% of total calories - than the next closest country, France (383-calories/day 10.5% of calories).

Our sugar consumption is significantly higher than all the countries - Italy 302-calories/day 8.2% of calories; Greece 332-calories/day 9% of calories; Japan 271-caloires/day 9.8% of calories.

Pollan got sucked into the dogmatic belief that meat is the problem in our diet because he didn't do his homework - he accepted the version of the "healthy diet" as espoused by those trying, desperately, to convince us to eat less meat and animal foods and adopt a plant-based diet; accepted a "healthy diet" means eating less meat and animal foods.

Problem is, the data tells us something different - it tells us the real, tangible, measurable difference between us and them is our consumption of added sugars.

Eat real food, not too much, limit the added sugars!

Bon Appetit!

Study: Children Need More Dietary Fats

An email this morning provided a link to a recently published paper at the Göteborg University Library, Nutrition and health in 4-year-olds in a Swedish well-educated urban community. It is the dissertation of PhD candidate Malin H. Garemo, designed to "analyze nutrition in healthy 4-year-olds´ in a Western urban community in Sweden in relation to socio-economy, life style and different aspects of health in order to improve the understanding of possible associations."

As reported in The Local, an english language newspaper in Sweden, the study showed "that one in five four-year-olds have a body mass index (BMI) that is considered too high, while 2 percent are obese. But children who regularly eat fatty foods are not the ones with a high BMI. It was instead found that a third of the children need to consume more saturated fat." [emphasis mine]

From the abstract, we learn the children were also deficient for essential nutrients, vitmain D, omega-3 fatty acids and iron; we also learn that "higher BMI was associated with lower fat and higher sucrose intake;" and these children were not consuming more calories than required for their energy needs.

Even more alarming in the findings, "girls had significantly higher metabolic markers than the boys. In girls, the HOMA ß-cell function was negatively associated with the intake of fat and positively with the intake of carbohydrates."

Folks, these were four-year-olds - not teens, not adults - but very young children!

The summary says it all "A lower fat intake was associated with higher BMI and higher HOMA ß-cell function. fS-insulin and insulin resistance were associated to increased growth rate from birth to the age of 4 (upward centile crossing). Risk factors for the metabolic syndrome can be identified already in healthy 4-year olds, especially in girls."

How can that be?

When children are found deficient in vitamin D, the first things that comes to mind is the diet; it may be lacking enough eggs, butter, cream, fish, liver and/or whole milk and dairy foods like yogurt. That, and depending upon the time of the year, inadequate exposure to sunlight.

When children are found deficient in n-3 fatty acids, the first things that come to mind is the diet may be lacking enough eggs, alpine cheese, fish, oil-packed fish, nuts, but butters/oils and vegetables like squash.

And when children are deficient in iron, the first things that come to mind is the diet may be lacking enough eggs, green vegetables, meats, liver, and.or beans.

In this review, the children were lacking all three of the above and lower fat intake was inversely associated with higher BMI too.

If we review these major deficiencies in the diet of these children, and consider the conclusion they need more dietary fat and less carbohydrates (specifically sugar), it's easier to understand the importance dietary fats have in growth and development for children.

Their little bodies are akin to perpetual energy, and constantly needing a much higher level of calories than just looking at them would suggest. Honestly, who would think a little 3-or-4-foot kid would need as much as 1,500-calories a day?

That's because they're constantly in a state of growth - whether it be physically growing taller, physically laying down muscle or fat stores, or internally growing nerves or blood vessels - they're always growing something, and that requires not only calories for energy, but specific building blocks to make it happen properly - vitamins, minerals, trace elements, amino acids, and fatty acids.

In previous generations the focus was mainly on getting and providing enough food to meet these energy needs; today we've modified our view and extrapolated our notions about a "healthy diet" - carbohydrate-rich, low-fat - to our children. Not a day goes by that there isn't an article or segment in the news that we need to feed our kids less fat and more "good" carbohydrates.

But, as this study found - lower fat, calorie compensated with more carbohydrates; that is an energy balanced diet - is inadequate for essential nutrients and is leading to profound metabolic consequences, especially in girls. The changes noted for girls are those that lead to PCOS, infertility, diabetes and a host of other health ailments later in life including cardiovascular disease and some cancer.

But Im pretty darn sure we're going to continue to read and hear we need to cut fat out of our children's diets and feed them more carbohydrate; afterall, a proper diet is plant-based, low-fat, with limited artery-clogging animal-based foods.

Or is it?

Please don't eat the Squirrels

Officals in New Jersey are advising residents in Ringwood not to eat the squirrels; or at least limit consumption!

Oh dear....it seems the little critters are contaiminated with lead.

Read more here...

Childhood Obesity: Asking the Tough Questions

In today's Telegraph an article asks - what can be done to tackle the obesity epidemic?

An "alarming" obesity epidemic is condemning an entire generation of British children now at primary school to increased rates of serious health problems, a committee of MPs has warned.

The report criticised the Government for doing little to curb the problem, which already costs Britain £3.5 billion, and argued that schools should tell parents when their children are overweight or obese.

What do you think can be done to tackle Britain's obesity epidemic? Who or what is to blame? Should parents be taken to task if their offspring are overweight? Or would that risk stigmatising the children in question?

If you have children, how do you encourage them to be fit and healthy? Why do you think British - and American - children are generally more prone to obesity than their European peers?

Not a day goes by in the US that we're not reminded, by the media and policy makers, that childhood obesity is rampant, our children at risk for a host of ailments in their future if we do nothing to stop this crisis, and they may even have a shorter life expectacny if we don't do something to reverse the trend.

Go to any mall, playground, school, or other place children are and it's obvious that many more children are overweight than in previous generations; where previously one or two might have stood out in a crowd as heavier than the others; today it seems the thin children stand out from the crowd. Simple observation tells us that there are more children who are overweight today than in years past.

One question asked in the above article, "If you have children, how do you encourage them to be fit and healthy?" provides me an opportunity to share my strategies.

1 - Buy, prepare and serve quality food at home

2 - Encourage active play - climbing, exploring, running, jumping, skipping; provide adequate downtime to relax and rest; engage son in daily activites as part of his routine each day (help carry in groceries, help carry folded laundry to room, etc.)

That's it.

We often hear that children, especially toddlers and pre-schoolers, are picky eaters. While that may be true, that doesn't mean we should feed them anything just to get them to eat something.

Often I see parents offer really great options only to cave in to whining for something else; it's easier to give the child what they want because it's often uncomfortable to think we're making our child(ren) unhappy or distresed; so the french fries or chicken nuggets are rationalized as acceptable because at least the child is eating something and is happy. Then some parents seem to go out of their way to provide whatever the something else is; at a recent holiday party we attended, a mom I know actually brought McDonald's for her children because that's what they wanted; never mind the incredible spread provided by the hostess, the kids wanted burgers and fries, what can you do?

Needless to say, thus far, my stategy to provide quality food, the majority prepared at home, is working. If my son doesn't want to eat something offered, that's okay; if something else is readily available as a choice, he's can have that to eat if he'd like. What he isn't given is the opportunity to whine his way to junk foods or a separate meal prepared just for him; our family meals offer enough variety that we'll each find things we like - if we don't like something, no biggie, don't eat it, pick something from what else is prepared.

My husband and I do take an "all bets are off" attitude when we're eating outside our home, where our son is likely to be offered foods we don't typically have at home. We've been pleasantly surprised that the habits he's developed at home continue (on his own) when he's allowed to choose and eat whatever he wants from what's being served.

A quick story that illustrates what I'm talking about.

We recently visited family and he had an incredible time with his cousins. Dinner was an delicious spread of Middle-eastern foods along with a pot of blue-box macaroni and cheese prepared for the kids since the food was spicy. Plated for him, by his aunt, was the mac & cheese, some vegetables, and the lamb and chicken.

What did he eat? The chicken, lamb and vegetables. He did take a bite of the mac & cheese, chewed it a bit and then asked to spit it out, he didn't like it. I wasn't surprised, he doesn't like pasta. I chalk his dislike of pasta up to it being pastey and bland compared with what he normally eats.

So what does he normally eat?

Instead of just telling you his menu, let me show you his typical day of eating - the foods prepared for him on an average day at home. Let me also say he's in the 95th percentile for height; 50th percentile for weight; and 20th percentile for weight-to-height ratio. Oh, and he doesn't eat off the china - I've plated the food before serving it to him on regular plates for the picture taking, so the foods aren't lost in the patterns on the plastic plates for kids!

Breakfast - broccoli and cheese omelet; yougurt with blueberries and strawberries.



What he actually ate - the yogurt and berries and about half the omelet, picking out all the broccoli to eat it; he also had some whole milk.

Lunch - cheeseburger, ketchup (no HFCS type), grapes, spinach



What he actually ate - about 2/3 of the burger, all the spinach, most of the grapes; he also had some whole milk and cod liver oil.

Dinner - chicken curry, basmati rice, green & yellow string beans with carrots, kiwi and sliced tomato with ranch



What he actually ate - the chicken, kiwi, most of the string beans and carrots, whatever rice stuck to his chicken, tomatoes and ranch; he also had some whole milk.

Snacks - sliced apple, cashews, raisins, whole wheat pita triangles, hummus



What he actually ate - apple with skin removed, cashews, three of the raisins, and he used the pita triangles as a means to scoop up the hummus, ate one bite from the pita and left the rest; he also had some juice heavily diluted with water.

I've had some criticize his eating, suggesting that he's being deprived of nutrients because he's not eating enough grains or starches.

If this is your first reaction to his day of eating, you can relax - after accounting for what he actually ate, his day provided every last vitamin, mineral, trace element, amino acid and fatty acid he needs.

In this day he ate about 1265-calories; of which 63g was protein.

His typical day of eating provides all essential micronutrients; yet it does not conform to the dietary recommendations that insist specific macronutrient ratios - 55% carbohydrate, 15% protein, 30% fat - as necessary to meet nutritional requirements; that encourage copious consumption of grain products; that suggest reducing fat after two is critical to avoid chronic disease later in life; and that minimize the effect of added sugar in the diet.

We're often told that if we'd only feed our children according to the recommendations and encouraged more phyiscial activity, we'd not see obesity in children.

What the experts fail to consider is this - the diet they're recommending is short-circuiting our children's natural satiety signals because it is challenging the metabolic pathways and failing to meet all nutrient requirements beyond the macronutrient level (carbs, protein, fat) to the micronutrient level (essential fatty acids, amino acids, vitamins, minerals and trace elements).

Children have much smaller stomachs than adults, thus can't eat nearly the same volume as adults, yet require more calories per pound because of energy expenditure and growth. Their diet needs to be energy-dense and nutrient-dense in less volume than an adult.

So what are we told to feed them once they turn two?

We're specifically told to eliminate or strictly limit the nutrient-dense, calorie-dense foods and feed them more foods that are low in fat to keep dietary fat and cholesterol within limits; provide them a diet rich with carbohydrates from grains, cereals, sugar, fruits and vegetables; limit meats to those that are lean; switch to low-fat/skim dairy products or dairy replacements like soy milk; and be mindful to include snacks and variety in the diet.

Here is a sample menu, from the American Academy of Pediatrics (AAP), that illustrates the standard recommendations today; it is designed for a child weighing 21-pounds:

BREAKFAST
1/2 cup iron-fortified breakfast cereal or 1 cooked egg (not more than 3 eggs per week)
1/4 cup whole milk (with cereal)
1/2 cup juice
Add to cereal one of the following:
1/2 banana, sliced
2-3 large sliced strawberries

SNACK
1 slice toast or whole wheat muffin
1-2 tablespoons cream cheese or peanut butter (spread)
1 cup whole milk

LUNCH
1/2 sandwich-tuna, egg salad, peanut butter, or cold cuts
1/2 cup cooked green vegetables
1/2 cup juice

SNACK
1-2 ounces cubed cheese, or 2-3 tablespoons pitted and diced dates
1 cup whole milk

DINNER
2-3 ounces cooked meat, ground or diced
1/2 cup cooked yellow or orange vegetables
1/2 cup pasta, rice, or potato
1/2 cup whole milk

While I commend whomever designed this menu for using only whole foods, with no packaged snacks, I cannot find much else to praise; namely because, while it provides adequate amino acids, the menu fails to provide adequate intake of Vitamin E, Vitamin K, Copper, Selenium, Potassium and omega-3 fatty acids.

While it provides a similar amount of protein (60g) as what I prepared for my son (63g), and doesn't contain much added sugars, it does pack a potential punch to blood sugars and insulin with 154g of carbohydrate and less fiber (10g versus 15g). Add to this, that even though volume weight is virturally identical to the diet consumed by my son (1367g versus 1368g), it provides 100 more calories than his; if the higher amounts of food suggested as snacks are included, it could provide 400 calories more.

The recommended diet offers more calories, a high level of carbohydrate to be metabolized as glucose in the body, less fiber and inadequate levels of many essential nutrients.

Why are we making recommendations that are nutritionally inadequate and a metabolic challenge?

We seriously need to start re-thinking our dietary recommendations for children; right now our dietary recommendations and policy are failing them because our phobias about dietary fats have seeped into their lives as we've modified their diet to limit fat and include an abundance of carbohydrate-rich foods that does not, at the end of the day, have the desired effect.

Our children are gaining weight because the diet we're recommending they eat is higher in calories without providing all essential nutrients (even with all the fortification of foods) and is a burden on their metabolism.

As a parent I can only do what I believe is best for my child; and when it comes to food, the best for my child is a nutrient-dense diet that targets essential nutrients, not a specific ratio of carbohydrate, protein and fat; nor a specific number of servings of grains, beans, meats/fish/poultry, milk, fruits, nuts, seeds or vegetables each day.

As a member of a larger community, I can only share my experience and results.

The rest is up to you.

Child Abuse Ad Stirs Controversy

It seems the folks at PETA have no limits to which they'll go to promote a vegan diet to the population at large. Their latest propoganda - the above poster "advertisement" in Britian - which says that feeding children meat is child abuse.

As reported by the BBC, even with 67 complaints about the poster, directed to the Advertising Standards Authority (ASA), the advertisement is allowed to remain prominently displayed throughout the country. The ASA did not feel the poster trivialized child abuse, was misleading, or had the potential to harm children if parents removed meat from their child's diet.

In their defense, PETA argued that "[i]t believed it was acceptable to say giving youngsters food that some scientific research stated was more harmful than a vegetarian diet was "tantamount to abuse."

What do you think?

National Retailer Advising Nutritionally Bankrupt Diet Advice

What happens when you mix a national retailer with advice to lose weight? You wind up with the latest and greatest marketing campaign to sell goods to consumers through a program encouraging you to "Get Fit. Get Rewards." for signing up to lose weight with KMart's website, New Day Your Way.

The lead-in page is convincing! Heck, if you sign-up you can get coupons to go shopping and buy products sold by KMart! Yippie!

Join thousands of other weight loss heroes along the path to the life you've always wanted. It's a simple, fun, and supportive way to shed those pounds and find a healthier, happier you. We supply you with:

• a weight loss program that allows you to set your own goals and track your weekly progress
• expert advice on how to eat healthier and become happier
• exciting new exercise techniques
• motivational emails
• and articles coupon rewards when you succeed

What exactly is the weight loss program they're providing online? Well, over at the site's "Food School" we find an area sponsored by the American Diabetes Association and an At-a-Glance Food Guide with the following recommendations for women: Protein 45g; Carbohydrate 55% of calories; Fat 30% of calories.

If fat and carbohydrate make up 85% of the total calories, and 45g of protein is the remaining 15% of calories, they're endorsing and recommending a 1225-calorie a day diet for women without actually saying it.

Let's be honest here, for the vast majority of overweight women trying to lose weight, this is simply not enough calories to meet basal metabolic requirements - the energy needed for basic functions like heart beat, body temperature and blood flow. For example, a 30-year old woman, 5'6" tall, weighing 175-lbs (BMI 28.2), requires a minimum of 1578-calories each day to meet basal metabolic energy requirements. If she weighs more, she requires more calories just to meet basic needs.

Putting aside the calorie recommendation, more disturbing is the recommended intake for vitamins, minerals and trace elements - those provided will lead to significant nutrient deficiency if followed. With just 45g of protein each day, a woman who might weigh 175-lbs is also going to fail to meet minimum requirements for amino acids; protein requirements are agreed to be 0.8g/kg of body weight - at 175-lbs a woman would require a minimum of 64g of complete protein to meet her minimum needs each day.

Now, imagine this - a young woman, overweight at 175-lbs, following the advice to consume just 150mcg of folate each day who then gets pregnant. Can you say high risk of neural tube defects? Higher risk of anemia?

Imagine now she's also followed the advice to consume just 500mg of calcium each day, just 2.5mcg of vitamin D, and just 200mg of magnesium. Can you say high risk of bone fracture?

In both of the above examples, the site recommends micronutrient intake far below the Daily Recommended Intake (DRI) published by the National Academy of Sciences, Institutes of Medicine. In fact, the site's recommendation for Folate is just 37.5% of the DRI - the IOM recommends women consume at least 400mcg each day of folate!

The site recommends intake for sixteen different micronutrients - vitamin A, thiamin, riboflavin, niacin, patheotenic acid, vitamin B-6, vitamin B-12, vitamin C, vitamin E, vitamin K, vitamin D, folate, calcium, iron, magnesium and zinc.

Of these, six are accurate (based on the IOM's established standards); eleven fail to meet DRI, and even the lower Estimated Average Requirement (EAR); and one, vitamin A, actually exceeds the upper tolerable limit established by the IOM.

So not only will your average overweight woman be eating too few calories, she'll also be consuming a diet that's nutritionally bankrupt.

All brought to you by the American Diabetes Association and KMart.

But hey, you can get some coupons to go shopping!