Protein Is Essential, But Too Much is Too Much

Why do I consider protein the important focus for the short and long-term?

In a word, it's satiety.

That and animal based protein is nutrient-dense; when in included at adequate levels in your diet, it is much easier to meet nutrient needs each day.

Most calorie restricted diets not only reduce calories, they significantly reduce protein intake. I think this is the cause of the hunger often reported once an individual is into their lower calorie diet after a few weeks. While starvation does work in the short term, long-term 95% of people who lose weight will gain it back within three years, 99% will within five.

When you do not eat enough protein, you are starving, slowly but surely; and that holds true even in a state of excess calorie consumption.

Protein is a really neat macronutrient, not only does it provide us with essential amino acids, it also is used throughout the body to repair and build muscle, cells and tissue. Amino acids are critical to maintain our health, but they're not really a great energy source - when the body's energy sources are low, it begins to degrade proteins for use as an alternative energy source. Amino acids can be classified as glucogenic or ketogenic.

Glucogenic amino acids can be degraded to pyruvate or an intermediate in the Krebs Cycle. They are named glucogenic because they can produce glucose under conditions of low glucose. This process is also known as gluconeogenesis, or the production of "new glucose." Amino acids form glucose through degradation to pyruvate or an intermediate in the Krebs Cycle. The intermediates can then be converted to oxaloacetate, the main precursor for gluconeogenesis. (glucogenic amino acids: alanine, cysteine, glycine, serine, threonine, tryptophan, asparagine, aspartate, phenylalanine, tyrosine, isoleucine, methionine, threonine, valine, arginine, glutamate, glutamine, histidine, and proline).

In contrast, ketogenic amino acids can produce ketones when energy sources are low. Some of these amino acids are degraded directly to ketone bodies such as acetoacetate (leucine, lysine, phenylalanine, tryptophan, and tyrosine). The other ketogenic amino acids can be converted to acetyl CoA. Acetyl CoA has several different fates, one of which is the conversion to acetoacetate. Although not a preferential energy source, acetoacetate can be metabolized by the brain and muscle for energy when blood glucose is low and acetoacetate cannot be used in gluconeogenesis, since acetyl CoA cannot be converted directly to oxaloacetate.

The above is what happens when you consume adequate protein each day. So, what happens if you consume too many calories and/or too much protein? Basically, when energy sources are high, both glucogenic and ketogenic amino acids are converted to fatty acids through the intermediate acetyl CoA. Other amino acids that are degraded to intermediates in the Krebs Cycle are siphoned off into the production of urea, a nitrogenous carboxyl compound that is filtered through the kidneys and secreted in the urine.

Put another way, you now have fatty acids that can store as body fat.

It is for this reason one should not consider a low-carb diet as an all-you-can-eat buffet, just hold the carbs. Whether you're new to carbohydrate restriction, or a long-term veteren, you need to know how much protein you need at minimum, and also understand where the maximum is for weight loss and weight maintenance.

How does one know how much is enough and how much is too much?

It depends largely on weight. In fact, it is really all about how much one weighs. Protein requirements are based on body weight because body weight takes into account mass, lean body tissue and structural maintenance. The more you weigh, the more protein you need; the less you weigh, the less you need.

The absolute minimum, to meet EAA requirements is considered 0.8g/kg body weight. On a low-carb or carb-controlled diet, one does require more to fuel gluconeogenesis and most agree that protein requirement ranges, from 1.0g/kg to 1.5g/kg. A good middle maximum is 1.2g/kg if someone is active. For this reason, I usually provide individuals with a minimum target for protein each day based on the EAA minimum (0.8g/kg) from animal foods, then provide a range of maximum from all sources, including the vegetables they'll consume, that ranges 1.0g/kg and 1.2g/kg. In the years I've helped people understand how much protein is enough, I've only encountered a couple who were very active and could consume 1.5g/kg.

The chart below provides protein requirement and upper protein range for those restricting carbohydrate in their diet.

WEIGHT	PROTEIN EAA MIN	PROTEIN GNG RANGE
350-plus	125g	160-190g
340	123g	154-185g
330	120g	150-180g
320	116g	145-175g
310	113g	140-170g
300	109g	136-165g
290	105g	131-160g
280	102g	127-155g
270	98g	122-150g
260	95g	118-145g
250	91g	114-140g
240	87g	110-135g
230	84g	105-130g
220	80g	100-125g
210	76g	95-120g
200	73g	90-115g
190	69g	86-110g
180	66g	86-100g
170	62g	77-95g
160	59g	72-90g
150	56g	70-85g
140	55g	70-85g
130	55g	70-85g
120-less	55g	70-80g

Do Calories Count?

We often hear, and even I've said, do not count calories on a low-carb diet. The advice, on its face, is sound because when someone starts a low-carb diet, overweight or obese, counting only grams of carbohydrate, they reduce their calorie intake even when eating ad libidum; so having to count calories over-complicates a dietary approach that already lowers calorie intake anyway.

But saying "don't count calories" does not mean that calories do not matter. I wrote about how it is a myth that calories don't count back in 2005 (here).

They do, they always have and always will - but they're not always perfectly matched to calories-in/calories-out (CICO) since nutrient-density of the food you eat also matters, along with the fact that the body compensates daily with homeostsis and how much we move, so it's not always burning exactly the same calories each day. But over a long-term average, calculated active metabolic rate (AMR) is a fairly accurate target for calories needed on average each day to maintain weight when you're meeting requirements for essential nutrients.

So, should you count calories?

Based on years of experience, my suggestion remains - when you start a low-carb diet, do not count calories.

If you stall, look at calories - you may be eating too many, or (gasp) not enough.

If you gain, look at calories - I can promise you that if you're keeping your carbohydrate restricted, gaining almost always means you're eating surplus calories from fat and protein in excess of your active metabolic rate (AMR); small fluctuations are normal, but gain on gain on gain while restricting carbohydrate is excess calories.

It is a MYTH that you cannot gain weight if you just keep your carbohydrate restricted, the fact is calories do matter. In addition,hormones, glycogen stores, and metabolic rate matter too, but if you're gaining weight while keeping carbohydrate restricted, you're not gaining in a calorie deficit, you're gaining in a calorie surplus.

Where Are We Today?

When I started this blog back in 2005, in my second post, Hunter-Gatherers, I looked at a review by Loren Cordain et al, about the maronutrient estimations in worldwide hunter-gather diets.

I noted,

Their findings included

• Most (73%) of the worldwide hunter-gatherer societies derived >50% (56–65% of energy) of their subsistence from animal foods, whereas only 14% of these societies derived >50% (56–65% of energy) of their subsistence from gathered plant foods.
  
  
• This high reliance on animal-based foods coupled with the relatively low carbohydrate content of wild plant foods produces universally characteristic macronutrient consumption ratios in which protein is elevated (19–35% of energy) at the expense of carbohydrates (22–40% of energy).
  

So, most of the hunter-gathers are eating 56-65% of their energy from animal foods, providing 19-35% of their calories as protein and just 22-40% of their calories from carbohydrate.

In a "real world" 2000-calorie a day diet, what does such a macronutrient mix look like?

19-35% of calories from protein = 380 to 700 calories or 95g to 175g of protein, with most coming from animal foods

22-40% of calories from carbohydrate = 440 to 800 calories or 110g to 200g of carbohydrate

The remaining calories, from fat = 500 to 1180 calories, or 25-59% or 55g to 131g of fat

And continued by stating that "[t]hese ratios are very much in line with controlled-carbohydrate nutrition ratios, which generally holds that carbohydrate is limited to 40% or less for daily calorie intake. The mix of fat and protein calories in a controlled-carb approach is highly individualized and the goal is to include quality protein in adequate amounts and only include quality fats and oils."

Six years later, I still hold the opinion that today, controlled-carb nutrition can model the diet of our ancestors; typically called Paleo and/or Primal eating. In fact, I'd say it would be difficult to consume a diet high in carbohydrate (greater than 40% of calories from carbohydrate) without specifically focusing on eating a high level of carbohydrate each day.

Has this become clearer in the years since I started this blog?

Not really.

In truth, time has created a variety of differing opinions that leave many confused; worse is that some seek to create divisions where none need be.

Recently Jimmy Moore posted AHS12: A Dichotomy Of Differing Interpretations Of What Paleo Is. In it, he writes, "However, when it comes to starchy carbohydrate sources of nutrition such as white potatoes, sweet potatoes or white rice (the toxin-free “safe starches” identified as such by Paul Jaminet), there’s a definite divide between those who avoid them because they raise blood sugar and insulin levels as well as lipid numbers to unhealthy levels (...) and those who believe these starches provide the adequate glucose your body needs to perform and function as it was intended to. That’s quite a division within the Paleo community that doesn’t have an easy answer to bridge the chasm."

Is this really a division within the Paleo community? Is this really a chasm that needs a bridge?

Honestly, I don't think so.

As I noted in my comments on his link to the blog on Facebook, "Paleo is a guideline to the types of foods one can eat, not the amount one *should* eat of any particular macronutrient; low-carb is one dietary approach which fits in with a paleo diet. Both focus on quality protein, good fats and nutrient dense carbohydrate. What level of carbohydrate you consume is your business, Paleo is basically just the framework for what foods to choose from. I don't think paleo has to be low-carb to be effective. It really is dependent on the individual."

One of the things I've learned over the last decade is that nothing is set in stone when it comes to macronutrients - the diets of healthy, normal weight individuals, around the globe vary greatly, what matters most is the micronutrient composition in the overall diet; it's habitually meeting or exceeding essential fatty acids (EFA), essential amino acids (EAA), essential vitamins, minerals and trace elements. The Japanese do that by consuming copious amounts of fish and pork, but their overall diet is lower in fat than those in France, who also do that with a wide variety of meat, full-fat dairy and a boatload of non-starchy vegetables and fruits. Both diets also have starchier foods too, yet these populations are not, nor have they ever been, suffering alarming rates of obesity.

Why?

If you look at diet quality, both Japan and France are eating serious quality foods, real foods, compared to the US and other nations with exploding obesity rates.

Quality matters; it is the heart-and-soul of Paleo, it is the heart-and-soul of Primal. The focus of ancestral eating (Paleo and Primal) is real food, shunning the processed and choosing quality. It defines no specific level of macronutrients by gram or percentage, but does point to nutrient density and meeting essential nutrient requirements. While one can follow a low-carb diet and eat Paleo-Primal style, that does not mean Paleo-Primal is low-carb per se; although, as noted i the paper by Cordain et al, Paleo-Primal diets are lower in carbohydrate than the Standard American Diet (SAD).

I do not think we have this deep divide, I think what we're seeing is a wide variety of approaches to reach the same goal - eating healthfully for the long-term. For some that includes soaked and fermented grains (Weston A. Price Foundation), for others eliminating grains is important, but dairy and legumes, along with other foods that are newer in our history may be included (Primal), and still there are those who hold that those foods, eaten by others in the spectrum of eating "real food", are simply unacceptable, just say no (Paleo). At the end of the day, the common theme amongst all - eat real food!

As one commenter noted on Jimmy's blog, "We do not currently understand everything about the variation in individual response to carbohydrates, such as sex differences, or dependence on history of metabolic dysfunction. We also do not completely understand how an individual’s dietary needs may change as a function of time depending on external
conditions. In addition, how much carbohydrate a person will do best on will depend on their goals (performance, longevity, reproductive health), but once again we do not understand the complete picture!"

I concur! Many things factor into weight loss and long-term health, eating real food is the one thing that continues to be the most important aspect of a healthy diet.

Chris Kresser nailed it last year, in his post Beyond Paleo: Moving from a Paleo Diet to a Paleo Template.

Review Time

Back in 2007, I did a series on the "rules" of Atkins. Here I present the links to that series and will follow-up in the coming weeks with lessons learned and a view of the long-term.

• Handing you the Keys to Success
• Establishing Good Eating Habits: Rule One
• Rule Two: Back to Basics
• Rule Three: Vegetables & Fruits are Heart of Controlled-Carb
• Rule Four: Starches, Sweets: No Longer Staples
• Rule Five: Break Free from Contradictions
• Rule Six: Empower Yourself
• Rule Seven: Use Your Smarts!
• Rule Eight: Keep it Real
• Rules to Drink it Up!
• Rules to Maintain a Balance

Babaganoush

Apologies for no picture!

Babaganoush - 8 servings

2 large eggplants (about a pound)
1 medium red tomato
1 thick slice red onion (about 1")
1 Tbs ground nutmeg
2 tsp crushed garlic
Juice from 1/2 medium lemon
2 Tbs Tahini
3 Tbs pine nuts (pignoli)
4 Tbs EVOO

Preheat oven to 400 and place eggplants on baking sheet. Bake at 400 for 35-40 minutes.

Remove from oven and allow to cool. Peel the skin and discard, cut up eggplant and place in large bowl.

In a small bowl, set aside 2 Tbs of olive oil, add the remaining olive oil to the eggplant.

Add all remaining ingredients (except the pine nuts) and blend with an immersion blender until smooth.

To serve (makes 8 servings), top on lettuce or a thick slice of tomato, top with olive oil and pine nuts.

Per Serving (8) including topped with EVOO and pine nuts: 16g fat, 12g carbohydrate, 3g protein
NOTE: Carbohydrate is net; total less fiber

Sugared Beverages

Commentary from Governor David Patterson, New York on CNN.com:

Today, we find ourselves in the midst of a new public health epidemic: childhood obesity.

What smoking was to my parents’ generation, obesity is to my children’s generation. Nearly one out of every four New Yorkers under the age of 18 is obese. In many high-poverty areas, the rate is closer to one out of three.

That is why, in the state budget I presented last Tuesday, I proposed a tax on sugared beverages like soda. Research has demonstrated that soft-drink consumption is one of the main drivers of childhood obesity.

These days I’m no longer surprised when something like an “obesity tax” is foisted upon the masses without so much as a whimper – afterall it is your fault if you’re fat, right? You should pay more, right?

Several commentators in the media applauded the move by Governor Patterson – Nicolas Kristof opined the hope that other states will follow suit because “if other states follow, [it] could help make us healthier.”

He even ties it up neatly with a bow, repeating Patterson’s parallel to smoking and cigarettes, “These days, sugary drinks are to American health roughly what tobacco was a generation ago. A tax would shift some consumers, especially kids, to diet drinks or water.”

No one likes taxes, but by golly, we must do this for the children! We must save ourselves from ourselves with this tax – save the children, save the world, reduce consumption of sugared beverages and all will be well.

What’s maddening isn’t so much the propsed tax on sugared beverages, it is what government does if they can get away with it….what’s maddening is that no one seems to notice that we are already paying taxes that enable the flood of cheap soda, fruit drinks and sugared beverages into our markets. It’s paid by our taxes in the Farm Bill, with corn being king amongst the crops subsidized by our tax dollars.

This new tax represents a double taxation to New Yorkers – taxed first from their income to subsidize corn in the Farm Bill; and now to add insult to injury, when they dare to consume products made from the corn products their tax dollars helped make cheap at the consumer level – namely high-fructose corn syrup….beverages produced that are artificially low in price at the consumer level and often cheaper than buying a bottle of water!

If the government truly wants to tackle the obesity epidemic, perhaps it’s time to revisit the Farm Bill and how it is directly creating a market flooded with cheap corn calories at the consumer level for things like high-fructose corn syrup which is used in thousands of food products in our markets!

Banning Bottled Water

They say the road to hell is paved by good intentions.

The Toronto Star recently noted the political battlelines drawn around the debate to ban bottled water in Toronto, “Environmentalists claim bottled water commercializes a public resource, undermines faith in Canadian water systems, and sends plastic bottles to the landfills. The bottled water industry counters that environmental groups rig recycling rate numbers and vilify a product that helps combat obesity.”

Last week the vote was cast and the Toronto city council voted to immediately ban the sale and/or distribution of bottled water in City Hall and the city’s civic centres where contracts permit, and ban the sale and/or distribution of bottled water in other city-owned facilities such as arenas and theatres by the end of 2011.

While it’s now illegal to not only sell bottled water, but also illegal to distribute bottled water in city-owned facilities in Toronto, it’s still perfectly legal and acceptable to sell and distribute sweetened waters (translation – soda and fruit drinks).

Afterall, isn’t that really what soda and fruit drinks are – simply sweetened water?

Let me see if I understand this.

Bottled water = bad-illegal

Bottled soda & fruit drinks = good-legal

This vote after Statistics Canada released data that found Canadians consumed more than 95 litres of soft drinks in 2007!

How much more soda and fruit drinks do you think folks will drink now that bottled water is banned?

So We Begin the Food Stamp Challenge

When I posted about this year’s Food Stamp Challenge yesterday, underway in various locations in the US, I assumed it was going to be much harder this year to stay within the allotted budget despite an almost double amount of money last year. My regular readers may recall, last year I reviewed the sales circulars online to get the best bargains, planned the week of meals before I went shopping, had to include a fairly high level of canned goods (especially beans) and barely made the budget. We did well nutritionally – with the exception of Vitamin D, we met all nutrient requirement RDA’s and managed to keep carbohydrate intake at an average 97g per day for the week; 73g net if you deduct fiber. But, as I noted, it wasn’t easy to do on a budget of just $3.00 per person per day, or $63 for the week for my family.

This year, with a nearly double budget – $123.27 for the week ($5.87 per person per day) – I changed the rules I’d follow in response to comments last year. Unlike last year, this year I’d shop in only one store, no pre-planning; instead I’d grab a sales circular on my way into the closest grocery store to my home and do my shopping for the week without any menus planned ahead of time.

Now I don’t shop for many routine items at the grocery store – most meats for us are usually ordered from a local farm, I buy a lot of produce at the local Farmer’s Market, and some things, like cheese, I usually buy at a specialty shop in town. But I do shop enough in the grocery stores to note that prices have definitely risen over the last year, with some items nearly double what I remember from last year.

When I did our grocery shopping yesterday, at HyVee (closest to my house) I was surprised that I wasn’t just within budget, but that I didn’t spend the entire budget. And, I included a number of items that were “maybe” items, held back until I could see the running total for the “must have” foods; “maybe” things like crumbled blue cheese, roasted red pepper hummus, name-brand coffee, a small container of heavy cream, a fancy brand of fajita wraps and a small pumpkin my son asked for that we aren’t going to actually eat.

That isn’t to say I didn’t make any compromises – I did buy canned green beans over the fresh, they were much less expensive in the can; I chose frozen whole strawberries over the fresh for the same reason; and frozen broccoli won over the fresh too. My cuts of meat, poultry and fish were all selected by price rather than higher priced selections. For the most part, organic foods were out….one compromise I would not make was the organic, grass-fed, VAT pasturized, non-homogenized milk for my son; that was one thing that would be included no matter how much it cost. Luck had it though that it was on sale this week!

I also decided once I saw the sale circular for the week, that I’d see if I could do a week with low-carb – basically keep carbohydrate (for my husband and I only) at or below 60g a day on average and not have to include much in the way of beans or starchy foods, although I did buy two bread items (wraps and pita) when I saw they were possible within the budget. My goal again this year is that in the week we are able to eat well and meet our nutrient requirements. I think I did fairly well too!
When all was totaled, I spent $115.55 before tax, $120.91 with tax.

What did I get for my money?

*Items with a star were “maybe” items included when I saw the total was still within budget, listed in order placed into the final order.

1-pound butter
3-quarts half & half
2 dozen large eggs
1/2 gallon organic whole milk
1 8-ounce brick store-brand mozzarella
1 8-ounce brick store-brand cheddar
1 container sour cream
1 container cottage cheese
1 package cream cheese
10 8-ounce containers assorted store-brand yogurt (including plain)

1-pound deli ham (it was a steal at $1.99 a pound!)

1-pound bag frozen broccoli
1-pound bag frozen spinach
1-pound bag frozen whole strawberries

Box of tea bags
1 can bean sprouts
2 cans green beans
Small Hellmann’s mayonnaise
2 Bottles store-brand salad dressing
1 small bottle soy sauce
2 cans mandarin oranges
1 bag dried split peas
1 packet taco seasoning
1 can tomato paste
1 can diced tomatoes
1 bag sauerkraut

5 bananas bunch
2 pears
1 head cauliflower
2 cucumbers
2 bags of store-brand mixed salad
1 head iceberg lettuce
2 kiwi fruit
1 yellow pepper
2 red peppers
2 green peppers
Yellow and green squash
1 spaghetti squash
2.5-pounds carrots
1 package Wholly guacamole
4 lemons
5 onions
1/2 cantaloupe
5 apples
2 plums

1 package Johnsonville sausage patties
1 package Oscar Mayer bacon
1 whole chicken
1 package chicken leg/thigh quarters
1 package split chicken breasts
2 pounds ground beef
1 large pork roast
1 package coconut crusted fish filets (store made; raw; frozen)
1 package eye-of-round steak
Folgers coffee* (I had a smaller, less expensive container, but added this instead)

1 package boneless skinless chicken breasts*
1/2 pint heavy cream*
1 small bottle olive oil*
1 small jar minced garlic*
Assorted bags, very small amounts, open/loose spices sold by the ounce*
1 container blue cheese crumbles*
3 small sample size cheese (butterkase, gouda, gruyere)*
1 container roasted red pepper hummus*
1 5-pack Toufayan tomato wraps*
1 package pita*
1 small pumpkin*

You’ll notice that above I don’t have any tomatoes or tomato sauce. That’s because we have a garden and right now, an excess of tomatoes that have to be eaten or made into sauce, so I’ll be using those tomatoes in some dishes this week.

As you can see, I wasn’t left with little choice – I didn’t have to buy boxes of macaroni & cheese or ramen noodles. In fact, with the higher budget this year, I was able to buy much more fresh produce and meat, along with some “goodies” to enhance the meals I’ll make, like blue cheese to top salads, assorted cheeses for snacks, and decent coffee for our morning brew.

Last night we kicked off our week with a delicious chicken & beef fajitas, complete with tomato wraps, sour cream, guacamole and cheddar cheese that I shredded from the block of cheese. Since our son isn’t too keen on spicy food, I made him some plain chicken and onion sautéed in a little butter, and with that he had some broccoli and a blueberry yogurt, and then a plum for dessert.

Food Stamp Challenge 2008

In May 2007, I decided to step up to a challenge getting a lot of press as the Congress was readying to pass a new farm bill – it was to feed my family with a budget those recieving food stamps must stay within each week.

At that time, the average per day was just $3.00 per person each day, which translated to $21 per week per person, or $63 total for all three of us to eat for one week. I chronicled my shopping, meals and my thoughts afterward between May 25 and June 5, which are still available on my blog.

Making the news this week is a new challenge as we near the holiday season and more individuals and families find themselves in need of assistance. Yesterday kicked-off the Grand Rapids for the Michigan Food Stamp Challenge where those participating try to live on $5.87 per day per person (the new, higher maximum level provided to recipients).

From news reports, “300 state and local leaders who have pledged to live on the equivalent of food stamps for five days.”

Apparently the governor of Michigan, Jennifer Granholm, is participating in the challenge. As reported by mlive.com, “The governor says she took her son shopping Sunday at a Meijer grocery store. They could only spend $5.87 per day per person. She says she bought a lot of macaroni and cheese.”

Like last year, I’m not surprised by the belief perpetuated in the media that one must eat poor quality, high carbohydrate, cheap foods to survive on a limited budget. Last year I showed that was untrue as I fed my family a high-quality, nutrient dense diet for the week on just $3.00 a day per person. This year recipients receive even more money and I have to wonder, given the current economic situation, is the increase enough or not?

So this year, once again, I’m going to see what a food stamp budget, $5.87 per person per day, buys us since food prices have steadily increased in the last year.

Can we eat as well as we did last year?

Will I need to make compromises?

Will we eat better?

Last year a number of comments criticized that I shopped in three different stores, had access to the internet to review sales circulars and plan based on sales, and had time to plan our meals before I shopped. For this challenge, I will shop in the closest grocery store to our house, will pick-up the circular when I enter the store and do my best without pre-planning the week since it was pretty clear that time and ability to plan ahead are both issues for many.

Like last year, I invite readers to step up to the challenge too and share your experience in the comments as we move forward for the week, starting tomorrow.

Here’s our rules for the October 2008 Food Stamp Challenge:

1. Maximum per person is $5.87 per person per day. For us, a family of three, this means I have to feed us with just $123.27 in the coming week. Your total budget does not include any sales tax since recipient purchases are not subject to sales tax.

2. Salt and pepper are considered in your pantry, so you do not need to buy either. But any other spices, condiments or cooking fats/oils do need to be purchased or you need to deduct a portion of your cost when you did buy the item that is in your pantry since it’s difficult to have a stocked pantry when you’re on food stamps. For example, if you do have chopped garlic in your house, you don’t have to buy another jar for the week, but should – if you use some – deduct a part of the cost. If the jar cost $5.00 and you use one serving from a 10-serving jar, take 50-cents off your budget to account for the garlic you used.

3. It’s best to plan ahead, so if you have mailed or newspaper ad circulars, review what’s on sale and make a list before you shop. This time around, I’ll personally not plan ahead like I did last year and I’ll shop in only one grocery store. You don’t have to unless you want to also.

4. If you have a child in school and they receive or buy lunch, do not deduct this from your budget. Any foods you pack for lunch or snacks does have to be part of your budget however.

5. The budget does not include paper products, cleaning supplies, over-the-counter medicines, prescription medication, or non-food items not covered by food stamps. If you do need to buy these while you’re shopping, just make them a separate order, paid for separately, so you can accurately add up what you’re spending on food only.

6. We can shop for, prepare and cook whatever we want to eat, and can eat free food at business functions, meetings, work, or other places just like anyone else; in addition we can sample from tasting stations in grocery stores, and eat at parties we attend, hosted by friends or family. We cannot take home leftovers to stretch our budget though.

7. We can also eat out – but do need to include any meals we pay for and include the tax and tip since food stamp recipients cannot pay for meals out with their debit card, but also do have the expectation that the food stamps are assistance, not their sole source of buying food…we’ll include any meals out in our total budget.

Basically, the challenge includes preparing and eating what you are able to purchase throughout the coming week, and any meals eaten out, since it’s one thing to have to shop with a limited budget and another to live with it for a week.

Who will join me this week?

Again this year, those participating in the challenge are encouraged to email me photos of their groceries for the week, along with recipes and meal ideas and insights about your experiences during the week. I’ll highlight them here on my blog next week and open discussion about the various challenges we all faced, and the things we learned along the way! As always your comments are welcome as the challenge gets underway!

A Picture Worth 1000 Words

Public Comment Open at USDA

Last week, in the Atlanta Journal Constitution, an article revealed some
shocking school breakfast and lunch options: "Pop-Tarts and doughnuts
for breakfast for 2-year-olds. Rolls, chicken nuggets and French fries for
school lunches. Brownies given the same nutritional value as a slice of
whole-wheat bread."

This struck a chord with me since I recently posted on my blog about
the dismal lunches served in the Columbia Public Schools in Missouri.
One particularly disturbing lunch option - Smucker’s PBJ Uncrustable,
Pepperidge Farms Goldfish Pretzels, Rice Krispie Treat, 1% cholocate
milk, baby carrots and a fruit - is offered daily to students throughout the
district!

With 789-calories, the school's website highlights that the lunch contains
23g of protein (92-calories) and just 24% fat (189-calories; 21g); no
mention that this means the lunch also contains 508-calories from
carbohydrate (127g), or the equivalent of 32-teaspoons of sugar in a child's metabolism...not to mention if a parent packed such a lunch for their
child each day, they'd be branded as irresponsible and lending a hand
to the epidemic of childhood obesity!

With school back in session across many states, it seems we have a
pattern that shows school lunches are not as healthful as we're led to
believe!

Senatobia, Mississippi: Chicken Nuggets or BBQ Rib Sandwich, Mashed
Potatoes w/Gravy, Cheesy Broccoli, Hot Cinnamon Apples, Fruit Juice,
Yeast Roll, Gelatin. (assorted milk)

Randolph, Massachusetts: Nachos with cheese, beef, onion, tomato and
sour cream and fruit. (assorted milk)

Roff, Oklahoma: Corndog, tator tots, black-eyed peas, chocolate pudding
and milk.

Whittier, Massachusetts: Choice of Domino's of french bread pizza, small
salad, pretzel, assorted fruit. (assorted milk)

Folsom, New Jersey: Nachos with cheese or Smucker's PB&J, vegetable,
fruit and milk.

Ada, Oklahoma: Frito chili pie with cheese, green beans, garden salad,
rosy applesauce, salad bar and milk.

Benton, Arkansas: Pizza, corn, salad, half an orange, milk

Nachos, pizza, chicken nuggets, corndogs, frito chili pie....what is frito
chili pie anyway? And why are we not disturbed by these school lunches
offered to our kids each day?

Amazingly, each and every one of these lunches meet the minimum
standards for school lunches established by the USDA.

Which begs the question - how do we go about improving the minimum
standards for school lunches?

It turns out the Child Nutrition and WIC Reauthorization Act of 2004 is
up for review and revision in 2009, and you can provide comments about
ways to improve the school lunch program by either testifying at an
upcoming USDA Listening Session, or submit written comments online
or via mail.

If you'd like to submit comments online, you may at the Public Comment and Submission page.

If for some reason the above link fails to take you to the page for public
comment, the Docket ID is FNS-2008-0011 and the Docket Title is
Request for Public Comments for Use in Preparing for 2009
Reauthorization of the Child Nutrition Programs and WIC.

Investigate the Alternate Hypothesis

Ever since the publication of Gary’s Taubes’ Good Calories, Bad Calories, folks within the low-carb community have suggested and discussed various study designs to investigate the alternate hypothesis, the “Carbohydrate Hypothesis”, explored in the book. The biggest issue isn’t so much designing a study, but funding a study large enough and controlled enough to reach valid conclusions.

With obesity considered one of the most pressing health issues of our time, wouldn’t it be great if we could find the resources necessary to investigate, in a really well done trial, that alternate hypothesis?

Enter Project 10100 - a call for ideas to change the world by helping as many people as possible.

Project 10100 is accepting submissions of ideas for projects until October 20, 2008. One hundred ideas will be selected for public review and voting to narrow the field to twenty semi-finalists. An advisory board will then select five projects to fund from a commitment by Google of $10-million dollars.

One category is “Health” and the critera provided to help those submitting ideas includes:

Criteria:

Reach: How many people would this idea affect?
Depth: How deeply are people impacted? How urgent is the need?
Attainability: Can this idea be implemented within a year or two?
Efficiency: How simple and cost-effective is your idea?
Longevity: How long will the idea’s impact last?
Project 10100 may be a way to fund a study to investigate the Carbohydrate Hypothesis!

If you’d like to submit your ideas, you can go to the Project 10100 website, or directly to the submission page.

Gary Taubes - Columbia, MO - November 2008

Gary Taubes, author of Good Calories, Bad Calories and three time winner of the National Association of Science Writers’ Science in Society award, is scheduled to present his lecture, The Quality of Calories: Big Fat Lies: The Truth About Diet, Exercise and Obesity, on November 13, 2008 in Columbia, Missouri.

The event is sponsored by the Boone County Medical Society and the Department of Nutritional Sciences at the University of Missouri. It is free and open to the public. Registration is strongly recommended as seating is limited.

The presenation will take place at the Monsanto Auditorium (University of Missouri) at 2:30pm and will be followed by a reception in the McQuinn Atrium. More details are on the flyer below. To register online, click here.

Feeding Infants Fructose

Discussion: Consuming fructose during suckling may result in lifelong changes in body weight, insulin secretion, and fatty acid transport involving CD36 in muscle and ultimately promote insulin resistance.

That was the conclusion reached by researchers who published Dietary Fructose During the Suckling Period Increases Body Weight and Fatty Acid Uptake Into Skeletal Muscle in Adult Rats, in the journal Obesity.

While the study was on rats, it’s interesting to look at the ingredients in baby formula sold in the United States (all of the below are the first few ingredients listed from peapod.com and do not include the brand name):

INGREDIENTS: Nonfat Milk, Whey Protein Concentrate, Corn Syrup Solids…

INGREDIENTS: Corn Syrup Solids, Partially Hydrolyzed Nonfat Milk and Whey Protein Concentrate Solids, Vegetable Oil…

INGREDIENTS: Corn Syrup Solids, Vegetable Oil (Palm Olein, Soy, Coconut, and High Oleic Sunflower Oils), Casein Hydrolysate …

INGREDIENTS: Corn Syrup Solids (43.2%), Soy Protein Isolate (11.5%), High-Oleic Safflower Oil (10.3%), Sugar (Sucrose) (8.4%), Soy Oil (7.7%), Coconut Oil (7.7%)….
Is there a connection with rising prevalence of childhood obesity and feeding infants corn syrup solids? Things that make you go ‘hmmmm’

My New Blog Home

Well, I decided to migrate my blog, Weight of the Evidence, to WordPress. This was due to Blogger locking my blog under the mistaken belief it was a “spam blog”. I have some minor work to do on the posts that migrated to get them properly tagged – but should have that complete by the end of next week.

For anyone who has my old blog address in their links (weightoftheevidence.blogspot.com) – please change the link to www.WeightoftheEvidence.com – Thank you!

Chew on this...

The Cochrane Database of Systematic Reviews recently withdrew a document within its collection - Advice on low-fat diets for obesity.

As we learn on The Cochrane Collection website, the editorial group responsible for this previously published document have withdrawn it from publication.

The reason cited for the withdrawal?

This review is withdrawn because it is very much out of date, as authors stated. None of the authors has any plans to update it.

Happy Trails to you....

http://www.youtube.com/watch?v=4IGtDPG4UfI

Two Year Dietary Trial Results: Low-Carb Better than Low-Fat

The study just published in the New England Journal of Medicine, Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet (free full-text), is quite a read, with lots of data and lots of findings to explore and look at!

First things first - the objective of the study was to compare the effectiveness and safety of weight loss diets over a two year period.

The dietary approaches included in the study:

• a low-carb diet, loosely based upon the Atkins diet, no calorie restriction
• a Mediterranean diet, calorie restricted, based on the recommendations of Dr. Willett & Dr. Skerrett (Eat, Drink & Be Healthy)
• a low-fat diet, calorie restricted, based on the American Heart Association guidelines

In addition to weighing participants each month and measuring waist circumference, the researchers measured at reporting invervals (6-months, 12-months and 24-months) total cholesterol, LDL, HDL, triglycerides, fasting blood glucose, fasting insulin, HbA1C, blood pressure, HOMA-IR, C-reactive protein, leptin, adiponectin, bilirubin, alkaline phosphatase, alanine aminotransferase and urinary ketones.

Enrolled in the study were 322 volunteers; they were provided their largest meal each day (lunch) at work, and given support and guideance about their diet throughout the study period. Of the 322 who started the trial, 95.4% completed one year, and 84.6% (272 participants) completed the 24-months - making this perhaps, the best adherence level in a dietary trial lasting two years!

So what happened? Let's look at the various outcome measures to see.

Weight Loss

The mean weight changes among the 272 participants who completed 24 months of intervention were:

–3.3 ±4.1 kg in the low-fat group (7.3-pounds)
–4.6 ±6.0 kg in the Mediterranean-diet group (10.1-pounds)
–5.5 ±7.0 kg in the low-carbohydrate group (12.1-pounds)
(p=0.03)

Overall, in the intent to treat data (which includes even those subjects that did not complete the study) the weight loss was reported as:

–2.9 ±4.2 kg for the low-fat group (6.4-pounds)
–4.4 ±6.0 kg for the Mediterranean-diet group (9.7-pounds)
–4.7 ±6.5 kg for the low-carbohydrate group (10.3-pounds)

The reason I note the two findings is that in the media reports, the trend appears they're reporting the intent-to-treat numbers, which are lower because they include the 50 subjects that dropped out. Those who actually completed the study are the data I prefer to look at for weight loss since it accurately presents how effective the dietary approaches are when continued for two years!

Waist Circumference

-2.8 ±4.3 cm in the low-fat group
-3.5 ±5.1 cm in the Mediterranean-diet group
-3.8 ±5.2 cm in the low-carbohydrate group

Lipid Profiles

The graph itself speaks volumes:

High-Sensitivity C-Reactive Protein, High-Molecular-Weight Adiponectin, and Leptin

The level of high-sensitivity C-reactive protein decreased significantly only in the Mediterranean-diet group (21%) and the low-carbohydrate group (29%), during both the weight-loss and the maintenance phases, with no significant differences among the groups in the amount of decrease.

During both the weight-loss and the maintenance phases, the level of high-molecular-weight adiponectin increased significantly in all diet groups, with no significant differences among the groups in the amount of increase.

Circulating leptin, which reflects body-fat mass, decreased significantly in all diet groups, with no significant differences among the groups in the amount of decrease; the decrease in leptin paralleled the decrease in body weight during the two phases.

Fasting Plasma Glucose, HOMA-IR, and Glycated Hemoglobin

Among the 36 participants with diabetes, only those in the Mediterranean-diet group had a decrease in fasting plasma glucose levels (32.8 mg per deciliter); this change was significantly different from the increase in plasma glucose levels among participants with diabetes in the low-fat group.

This is critically important to note - the low-fat group experienced a rise in fasting blood glucose over the course of the two years; this despite a greater calorie deficit than the other two diets, and a greater increase in physical activity! Yet, this type of diet is exactly how the ADA recommends people at risk for or diagnosed with diabetes eat, while expecting ever increasing doses of medication to cover their progressive decline in glycemic control.

It is also noteworthy that, "there was no significant change in plasma glucose level among the participants without diabetes." Basically those who did not have diabetes did not experience any change in their values over the period of the study.

What the researchers did not note in their written text of the results was this - the low-carb dieters had similar declines in their fasting blood glucose levels through month 12, followed by a progressive decline through month 24.

If we look at the data provided, we can see something important changed - the quality of the carbohydrate they consumed seems to have declined. If you look at the table providing details of the dietary intakes, one major change in the low-carb group between moth 12 and month 24 pops out - as the study progressed, the consumed less and less fiber on average, compared with their baseline intake. Now early on, that's to be expected. Later, as carbohydrate is increased - if quality whole foods are the choice - fiber typically increases!

In contrast, insulin levels decreased significantly in participants with diabetes and in those without diabetes in all diet groups, with no significant differences among groups in the amount of decrease.

Among the participants with diabetes, the decrease in HOMA-IR at 24 months was significantly greater in those assigned to the Mediterranean diet than in those assigned to the low-fat diet.

Again, in the text, the researchers do not note if there were changes in HOMA-IR in the low-carb group. There was - over the 24-month period, the HOMA-IR in those with diabetes, following the low-carb diet, declined by 1.0; in those with diabetes following the low-fat diet the decline was 0.3; and in those with diabetes following the Mediterranean diet the decline was 2.3.

The last item reported in the section was the HbA1C levels. Among the participants with diabetes, the proportion of glycated hemoglobin at 24 months decreased by:

0.4 ±1.3% in the low-fat group
0.5 ±1.1% in the Mediterranean-diet group
0.9 ±0.8% in the low-carbohydrate group

The changes were significant only in the low-carbohydrate group.

The lower HbA1C is perhaps one of the most important outcomes of this study. The diabetics, in the low-carb group, were able to lower their levels by 0.9 over the 24 months and this was significantly greater than those in the two other diets. Unfortunately the researchers did not include the baseline HbA1C for participants, so we do not know what the reduction really means.

Liver-Function

Tests Changes in bilirubin, alkaline phosphatase, and alanine aminotransferase levels were similar among the diet groups

Alanine aminotransferase levels were significantly reduced from baseline to 24 months in the Mediterranean-diet and the low-carbohydrate groups.

The Good, Bad, and Why oh Why?

Overall, most reporting on the study today, feel the research team did a good job designing the study and executing it, many applauding the high rate of retention in the study for two years. I too am impressed that the participants remained committed to the trial, their assigned diets, and the longer-term outcome measures!

I personally would have liked more information than was published.

Key information regarding the baseline diet was not included in the data - not published items include how many calories were consumed, on average, at baseline; nor do we know how much protein, carbohydrate, fat or fiber was in the baseline dietary habits of those participating. While obviously not critical, it is 'nice to know' data.

I also would have liked to see the researchers have the courage to actually follow the Atkins dietary approach, and not make changes based on a number of assumptions.

We do not, for example, know what the outcome would be if the participants on the low-carb dietary arm had not been told to specifically choose vegetable based fats over animal fats. Atkins does not specifically state you must eat butter, but the diet allows butter. In addition, encouraging the consumption of plant-based proteins over animal proteins is another tweak that may not have had any effect, or may have had a positive or negative one. We simply do not know because the researchers encouraged plant-based protein consumption rather than leave the dietary recommendations as they are - meats, eggs, poultry, fish, tofu and such are allowed, ad libitum. [please see update below!]

The reporting in the media, as my earlier post highlights, has been quite an eye-opener. I'm not sure if those quoted realize it or not, but their reaction to the study is quite telling, especially those with the strongest vested-interests in maintaining the status quo.

In the Wall Street Journal, Robert Eckle, the past president of the American Heart Association and a professor of medicine at the University of Colorado Health Sciences Center, said he was not ready to recommend an Atkins-type low-carb diet based on the results. People on a low-carb diet increased their consumption of saturated fat, he said, which could not be good for them in the long run.

Did he even bother to read the findings?

Or maybe he was just disappointed the AHA's recommended diet - the diet recommendations the low-fat group were instructed to follow - did so poorly compared to the other two?

Did he know that the study author, Dr. Meir Stampfer of Harvard Medical School, in the same article, said "It is time to reconsider the low-fat diet as the first choice for weight loss and for cardiovascular health, it is not the best."

I think tomorrow, we'll take a fun ride through many of the quotes and opinions offered on this study!

In the meantime, what are your thoughts? Feel free to leave comments!

UPDATE 7/18/08

I received an email today from a friend who asked one of the researchers about the reference to plant-based (vegetable) fats and proteins. Dr. Shai assured him that the low carbohydrate group was not advised to consume a vegetarian low-carb diet, nor were they specifically restricted from eggs, cheese, red meat, poultry or fish. Due to dietary restriction (religious) the group would not, for instance have a cheeseburger or butter on top of their steak. Olive oil featured prominently. The participants did read the Atkins diet book. And the examples provided of the types of meals was "For example, a plate could include : fish or fried/not bread coated chicken/or red meet, broccoli and mushrooms coated with eggs, roasted eggplants, vegetable salad (peppers, cucumber, green leaves, notlettuce) with olive oil dressing.

One Study, A Myriad of Opinions

The buzz across the internet today is the findings from the paper, Weight loss with a Low Carbohydrate, Mediterranean, or low fat diet, published in the New England Journal of Medicine.

The headlines are all over the place regarding what the results mean:

Low-Carb and Low-Fat Diets Face Off

Dr. Meir Stampfer, the study's senior author and professor of epidemiology and
nutrition at Harvard School of Public Health, told ABC News: "The low-carb diet
was the clear winner in providing the most weight loss."

The Never-Ending Diet Wars: Why Atkins Still Doesn't Beat Low-Fat Diet

"An optimal diet is one that is low in fat (because fat, whatever the type, has
9 calories per gram versus only 4 calories per gram for protein and
carbohydrates). When you eat less fat, you consume fewer calories without
having to eat less food, because the food is less dense in calories, as well as
low in refined carbohydrates."

Healthy Diets Shown to Have Benefit Despite Modest Weight Losses

In a tightly controlled dieting experiment, obese people lost an average of just
6 to 10 pounds over two years. The study, published Thursday in The New
England Journal of Medicine, was supposed to determine which of three types of
diets works best. Instead, the results highlight the difficulty of weight loss
and the fact that most diets do not work well.

More Evidence that Diets Don't Work

After two years of effort the dieters lost, on average, 6 to 10 pounds. The
study, funded in part by the Atkins Research Foundation, seemed designed to
prove that low-carb diets trump low-fat diets. But in the end, all it really
showed is that dieters can put forth tremendous effort and reap very little
benefit.

Diet Study: Hold the Carbs, Not the Fats

Low-carbohydrate and so-called Mediterranean diets may be more effective than
low-fat diets, according to a major new study published in tomorrow’s New
England Journal of Medicine.

Against the Grains

Carbohydrates have taken another hit. A new study finds that a low-carb diet
results in greater weight loss and better cholesterol readings than a low-fat
regimen that promotes a lot of grains and fruits.

Diet Plans Produce Similar Results

New research shows that Mediterranean and low-carb diets are just as good and
just as safe as the low-fat diet often prescribed by doctors, a revelation that
should give people more choices in eating well.

Unrestricted Low-Carb Diet Wins Hands Down

The similar caloric deficit achieved in all diet groups suggests that a
low-carbohydrate, non–restricted-calorie diet may be optimal for those who will
not follow a restricted-calorie dietary regimen.

Atkins Diet is Safe and Far More Effective Than a Low-Fat One, Study Says

The controversial Atkins diet is just as effective and safe as a conventional
low-fat diet, a two-year study has found. Researchers found that
overweight volunteers shed more pounds on the low carbohydrate regime than they
did on an orthodox calorie-controlled diet.

Low-Carb and Mediterranean Diets May Equal Watching Fat Intake

Explain to interested patients that the study suggested low-carbohydrate and
Mediterranean diets could be as effective as the traditionally recommended
low-fat diet for weight loss.

It's amusing that each of the above headlines are all reporting on the same study!

Later today, in another post, we'll set aside the headlines and simply look at the study itself and the results.

Shame on Missouri!

Yes this is going to be a rant!

Yesterday I was alerted to the newly proposed changes, open for public comment, in the Missouri Eat Smart Guidelines - standards for school lunches (and breakfast) in my state. When I first opened the document, I was not surprised by the incremental reduction of dietary fat and the push for more fiber, especially with whole grains.

What did surprise me was the absolute lack of attention to nutrient-density at each category level. Oh, there is a minimum which applies to each category - the minimums established by the USDA that establish minimum calories, fat not to exceed 30%, acceptable levels of protein, cholesterol, sodium and fiber, along with target minimums for calcium, iron, and vitamins A and C.

So the committee drafting the newly proposed "expemplary" category didn't think it wise to perhaps set the bar higher - ya know, establish benchmark minimum for other micronutrients...maybe the same ones identified as deficient in our children in Missouri?

Hey, the starting document to consider this could be the Missouri Department of Health & Senior Services (DHSS) recently published Dietary Intake Summary Report for school year 2000-2001 - in it the DHSS reported finding the vast majority (greater than 50%) of all children in the state fail to meet RDA requirements for vitamin A, iron, calcium, folate and zinc, and 25% fail to meet requirements for protein, vitamin B6 and vitamin C.

HELLO!

We have a serious problem with malnutrition and the best the Missouri Eat Smart Guidelines committee can come up with is stricter limits on dietary fat and increasing fiber?

Has the committee that drafted this guideline even looked at what is being served in our schools?

Columbia public schools offer this delight each day:
Smucker's PBJ Uncrustable, Pepperidge Farms Goldfish Pretzels, Rice Krispie Treat, 1% cholocate milk, baby carrots and a fruit.

Can you imagine what would be said to a parent packing such a lunch for their child?

But guess what? That lunch conforms to the standards for low-fat with just 21g of dietary fat (24% of calories) - just ignore the fact that once protein is tallied, carbohydrate accounts for 508 of the 789 calories - that's 127g of carbohydrate, or the equivalent of 32-teaspoons of sugar in a child's metabolism in one meal!

But hey, it provides 6g of fiber - above the target 5g standard, right?

The public schools have the audacity to call that abomination a nutritious lunch?

Oh, and don't get me started on the soy-based products being used in meals and that fact not being disclosed to parents, unless of course, they poke around to read the allergen lists.

Beef Tacos on the menu?

I'd expect they're made with beef, wouldn't you? Nope...they're based on an "enriched" product schools purchase - made with some beef and an ingredient listed as "VPP" - vegetable protein product - better known as soy protein.

Chicken Nuggets on the menu?

I'd expect they're breaded chicken pieces, wouldn't you? Nope...they're also based on an "enriched" product schools purchase, already prepared - made with some chicken and an ingredient listed as ISP - isolated soya protein.

Think it can't get worse?

I don't think schools do much more than open a can, heat and serve these days - just reading through the spreadsheets available online makes that pretty clear - almost everything sold in school breakfast and lunches are convenience foods, from various vendors, that are nutritionally bankrupt, but easy to heat and serve.

If a parent were to habitually feed their child that crap, at the very least they'd be chastized as irresponsible - yet this is how the schools operate each day, serving what can only be called food-garbage each day and they have audacity to label them "healthful" and nutritious.

When you have a chance, read through the proposed Missouri Eat Smart Guidelines, then let the committee know what you think in the open public comments!

If people don't start speaking up, and demanding truly nutrient-dense meals for their children, it's only going to get worse!