Monday, October 31, 2005

Weight Loss Stalled by Low Calorie Diets

Often in my blog I write about the importance of losing weight while eating an adequate calorie intake - that is enough calories to support basal metabolic rate (BMR) to thwart the body's reduction (conservation) in energy requirements to just function. I also repeatedly warn it is critical while losing weight to do everything possible to ensure an adequate intake of essential nutrients too!

We're bombarded with advice to restrict calories - too often to starvation levels - and then blame the dieter if they complain about hunger, find it difficult to continue the starvation voluntarily, or - heaven forbid - lose the weight and then resume eating what should be a normal intake of calories and gain weight!

In today's Statesman Journal, an interesting article is found, "You can't measure self against TV show dieters," that discusses the reality of weight loss in the real world versus what we see on television shows like NBC's The Biggest Loser.

Within the article is the truth - if you reduce calories too much, your "metabolism will slow to a screeching halt!" With the end result being that "...when you try to eat normal again, you will gain more weight than you lose because your metabolism won't be able to handle it."

Missed was the opportunity to provide good advice to someone losing weight.

Once the author stated that too few calories spell disaster, no other advice was forthcoming to help someone figure out how many calories they should eat while trying to lose weight!

So, here it is - you have to eat enough calories to support your body's basic calorie requirements to just function - that is to just "be" before you include any activity in your day, before you do anything as simple as get out of bed.

I recently found a good online calculator - Diet Calculator - that uses a number of criteria to estimate your calorie requirements when losing weight: current weight, height, gender, measurements to neck, waist and hips, along with activity level. The results include BMI, a weight-to-height ratio, ans estimates of body fat percentage and lean body mass percentage. What I really like about this calculator is that it also provides estimates of calorie requirements to include as a MINIMUM when you're trying to lose weight. The estimate is based on the calculated Basal Metabolic Rate, which is what your body absolutely needs to avoid starvation mode. The other nice thing with this calculator is that it's free to use and includes an explanation of each result and recommendation provided.

While calories are indeed part of the equation to weight loss, it is also critical to ensure that you are providing your body with the essential nutrients it requires each day too! Without adequate intake of the fundamental vitamins, minerals, trace elements, essential fatty acids and essential amino acids (protein) each day, your body cannot work at an optimal level. Missing key nutrients is like trying to build a house without enough supplies or the right tools. It is for this reason I strongly encourage designing your weight loss diet with whole foods that are nutrient-dense. As a "safety net" a good multi-vitamin and essential oils can be included - but first and foremost must be the quality of foods you eat - whole foods that are rich with nutrients.

Lose Weight, Reverse Heart Disease?

That's a question that researchers at Royal Adelaide Hospital and University of Adelaide in Australia want to know. As reported in The Advertiser, "Weight loss may reverse heart damage" researchers are exploring the theory that losing weight will reverse heart damage in those who have neglected their cardiovascular health.

While I applaude the researchers to consider such a study, I am disappointed that only one dietary approach is under investigation - a very low calorie diet (VLCD) that requires the use of meal replacment shakes, along with exercise...basically, starvation.

The meal replacement shakes are a product called KicStart, manufactured in Australia. A quick review of the ingredients and nutritional content shows that they are highly processed and of, in my opinion, questionable nutrient value. The omega-3 and omega-6 fatty acids are delivered in the shake by powders, not oils, and thus one must question the true quality of essential fatty acids this product may or may not deliver. There is also no disclosure in the product information about the quality or quantity of essential amino acids in the shakes.

The bigger question though is this - are researchers really unable to design a study that explores different dietary approaches? According to the article, the researchers have 80 men participating - so why only one design protocol? With an opportunity to investigate how diet influences cardiovascular health over two years, why are the researchers only really looking at what a starvation diet will do to cardiovascular health?

If we really want to reverse heart disease we must begin to ask the hard questions! Not only that, but we must demand researchers explore all scientifically supported avenues and not just stick with the same old stale theories that obviously do not work.

In my opinion, this study is an absolute waste of time and resources.

If the researchers really want to know if and how diet can be used to reverse heart disease, they will include a calorie adequate, nutrient-dense dietary approach as one of the groups studied - and they'll have a group of "controls" to compare the different study groups to also to see if dietary intervention versus doing nothing really does provide a benefit or not.

Sunday, October 30, 2005

Party Pooper

The education section of the Washington Post today carried an article about the demise of the school party in "At Many Elementary Schools, the Party's Over." The reason for limiting, or eliminating, the cupcakes, candies and other junk food is due to the rise in childhood obesity.

Schools, where many children eat two of their day's meals, are being pushed to the front lines of the battle against kiddie bulge. A federal law requires schools to create wellness policies that encourage students to be more active and eat more healthfully. Some schools in Virginia have started exercise clubs. In Maryland, schools are cracking down on vending-machine junk food.

Now, there is a focus on school parties, said Margo Wootan, a policy director at the Center for Science in the Public Interest, a Washington-based nutrition advocacy group. The birthday party, the Halloween party, the Valentine's Day party, the end-of-the-year party -- all are centered on junk food, according to the advocacy group.

The article cites the grave statistics which show that in the period from 1980 through 2002, the incidence of overweight children has skyrocketed from 7% to 16% for kids aged 6 to 11. More alarming is the number of tweens and teens who are classified as obese - up from 5% in 1980 to 16% in 2002.

One really does have to think about what is driving this trend in childhood obesity.

Is it children viewing Cookie Monster eating cookies, pre-schoolers playing Candyland and children indulging in cupcakes at class birthday parties, or something else? Are we, as a nation, over-reacting when we no longer want to allow children to celebrate a birthday or holiday with a treat - especially the 84% who are "normal" weight?

My readers know I am all about good nutrition and eating well. I'm also realistic and understand the value of teaching children how to actually live in this world - a world littered with poor food choices, junk food and outright garbage promoted as "food" for the masses.

Somehow, eliminating cupcakes at the class birthday party, in my mind, seems just a tad hypocritical when the "healthier" option included in the article were apple slices with caramel. A small cupcake (frosted) has about the same calories and sugar - so what's the point in eliminating the cupcake?

What? Does it make the parents and policy makers somehow feel better? Do they think they've done something to reduce the risk of obesity if the kids are eating apple slices and caramel instead of cupcakes? If it's the same calorie and sugar-load, nothing has changed except the "package" it is delivered to the metabolism - it is still a sugary treat that will have the same result.

And, the real deal is this - it isn't the cupcakes per se, it's the health damaging ingredients they're made with - the trans-fats, the refined white flour, the processed sugar - all adding to the metabolic burden the body, a child's body, must work to counter after eaten.

Add to that the poor diet too many children are eating daily - packaged, processed foods; fast foods; too few vegetables; too much junk and way too much soda - with much less physicial activity each day...and is it any wonder obesity is a growing problem?

The solution isn't to eliminate the very things that make childhood so memorable, like your special day at school when it's your eighth birthday and everyone in your class gets to celebrate with you. The solution simply isn't that simple - banning cupcakes or other treats will not stop children from eating poorly - not when that's exactly how their parents allow them to eat each day!

We are fooling ourselves if we think apple slices with caramel are "healthier." Oh, yes, they do sound better - after all, it is a treat with apples now, isn't it?

Hey, why not apple-spice cupcakes with cream cheese frosting instead? When made using healthful ingredients, such an option can not only reduce the sugar to about 12g per cupcake (down from 24g), but can also deliver fresh apples, nuts, cheese and spices (which are rich in essential nutrients) and eliminate the trans-fats and processed/refined ingredients too! But, ya know what - that takes time - and it's simply easier to just ban the cupcakes than to invest the time to make a treat that is healthy, isn't it?

Saturday, October 29, 2005

PBS: Rx for Survival

This week PBS is airing a series titled "Rx for Survial" which explores numerous health issues around the globe.

Episode Six: Back to Basics looks to be very interesting.

The segement description

Ever since sailors noticed that scurvy could be prevented with citrus fruits, it has been clear that illness could be caused by a lack of certain nutrients. While nutrient-enriched products have reduced diseases caused by vitamin deficiency in the developed countries, the problem continues to plague the developing world. And many in poorer countries suffer from the twin problems of poor nutrition and unsafe water, which create a disease burden that is almost unbearable. Back to the Basics explores the connection between health and the essential requirements that so many people take for granted. It also examines how an overabundance of nutrition — in the form of over-consumption — is causing an epidemic of obesity that is spreading across the globe.

Check your local PBS listing to see when it will air in your area!

Cholesterol: The Missing Information

Millions of people rely on various websites for accurate, sound information. One such site is which recently released an online guide, How to Lower Blood Cholesterol. For anyone interested, is a New York Times company. On their main website, New York Times Company: Our Company, they state that the "core purpose is to enhance society by creating, collecting and distributing high-quality news, information and entertainment."

The article in question left me wondering, where exactly was the "high-quality" aspect to the information presented? The highly visible banner at the top of the page encouraged readers to "learn more" about Vytorin, a statin drug, while the information itself was scant and offered little options to dietary intervention, with only the AHA Step 2 Diet suggested before starting stain drug therapy.

A review of the evidence shows that other dietary approaches may actually be more effective to not only lower total cholesterol, but to improve cholesterol ratios of HDL, LDL and triglycerides. It is the ratio of these components of total cholesterol that are much more important to weighing risk than total cholesterol alone or any one single component of your cholesterol panel viewed in isolation! Yet, nowhere in the article is such detail provided.

Statins are indeed effective, but they do carry some significant risks - risks that can be avoided if one explores other options and tries these other options before throwing their hands up in the air after just one dietary approach that doesn't work for them. Specifically - a controlled-carb approach!

A diet that restricts carbohydrate intake has been shown to be highly effective with cholesterol improvements in the majority (70-90%) who can maintain a controlled-carb lifestyle. Such an approach isn't for everyone - there does exist a small population of people who are "responders" and will see no benefit from carbohydrate restriction. But, if you work with your doctor, it is worth the effort to see if this alternative dietary approach is appropriate for you.

The article should have noted the data that shows controlling carbohydrate is an effective approach - but I can only conclude that such information was missing because the section about cholesterol is sponsored by a pharmaceutical company. Every last page I clicked on throughout the section kept coming up with banners to Vytorin - learn more, learn more, learn more - about Vytorin! Maybe needs to change their name to!

Thursday, October 27, 2005

Where's the Real Food?

Can you imagine feeding a toddler a full day of only packaged, processed foods? Well, it seems Gerber has no problem making such a recommendation to parents who visit their website seeking information about feeding a toddler!

The graphic heading of the Menu 1 page makes the implicit claim that the menus are designed to be a "Start Healthy Stay Healthy" feeding plan.

So, what's on the menu for Day 1?

Ready for this?

Breastmilk, formula or whole milk
1/3 cup Gerber Rice Cereal with Ingredients of Formula

Breastmilk, formula or whole milk
1 Gerber 3rd FOODS™ Lil' EntrĂ©es Macaroni and Cheese Dinner with Apples & Chicken

Breastmilk, formula or whole milk
6 ounces Gerber 3rd FOODS™ Green Beans with Rice

4 ounces Gerber Apple Plum Juice
3 ounces Gerber Blueberry Buckle Dessert

This is a "Stay Healthy" feeding plan?

Good grief, is it any wonder our children are growing fatter each year?

Not only is the above menu ALL processed foods if one is using formula - it's severely deficient for essential nutrients when analyzed against the Institute of Medicine (IOM) micronutrient RDA's for a toddler!

It missed the following critical vitamins and minerals:
  • Sodium
  • Potassium
  • Fiber (just 3g all day)
  • Vitamin D
  • Vitamin B-6
  • Folate
  • Phosphorus
  • Magnesium
  • Vitamin K
  • Selenium
  • Calories

The above menu (using 32-ounces of formula in the day) also exceeded the upper limit for Vitamin A (added vitamin A) for toddlers with 617mcg - the upper limit is 600mcg, and the upper limit for iron (from added iron) with 21.25mg of iron, and the upper limit from iron is 10mg.

And it only had 11mg of cholesterol - and cholesterol is critical to brain development! Oh, and don't get me started on how much sugar was in this menu...the total carbohydrate for the day was 158-grams - all of it, with the exception of the 3g of fiber, turning into glucose in the metabolism.

Keep in mind too, this menu provides 41g of total fat - 34% of calories which is actually a bit low for fat for a toddler, but that isn't my concern concern is how much of that is trans-fats? According to the FitDay analysis, of those 41g of fat, 13g were saturated fat, 7g were polyunsaturated fat, and 13g were monounsaturated fat. If you add those up, that accounts for 33g of the fat grams - leaving potentially 8g of trans-fats! Eight grams of trans-fats potentially in a menu designed to feed a toddler?

How in the world does Gerber get away with claiming such a nutritionally bankrupt and potentially "health damaging" (from the level of trans-fats) menu is "healthy"?

If you're a parent, I urge you to start reading labels carefully and stop looking to food manufacturer's on guidance about what is "healthy" for your children's diet. Feed your children real, whole foods - not this packaged, processed food that leaves them starving for critical, essential nutrients!

Get Smart about Food Labels!

Today the Center for Science in the Public Interest (CSPI) called for the FDA to enforce labeling guideline rules on manufacturers that label foods in a misleading way.

In a letter to acting FDA commissioner Andrew von Eschenbach, CSPI said that FDA's Office of Nutritional Products, Labeling, and Dietary Supplements (ONPLDS), does not have any plan to identify and remedy misleading labeling.

In their press release, Crackdown on Fraudulent Food Labels Urged, CSPI highlighted how many food manufacturers create labels that "exaggerate the presence of healthful ingredients" and the Food and Drug Administration (FDA) doesn't have "the will to stop deceptive labeling and typically does nothing even when flagrantly fraudulent labels are brought to its attention."

This is an issue I myself have written about here at Weight of the Evidence when I've found labels that are misleading or deceptive. Many may recall my disgust at the finger-food, Gerber Veggie Wagon Wheels Carrot, that I pointed out in Infant Feeding Myths that are mostly refined corn, contain trans-fats from partially hydrogenated oils, and have no carrots listed in the ingredients! Yet this is a product touted by Gerber, on their website, as "puffed grains made with real fruits or vegetables," and a "good source of iron and zinc" along with "no artificial colors." And take a look at that picture...Yup, real carrots are included in the graphic marketing online!

Here are the ingredients:
Corn Flour, Sunflower Oil, Cheese Seasoning (Whey, Nonfat Milk, Partially Hydrogenated Soybean Oil, Cheddar Cheese {Cultured Milk, Salt, Enzymes}, Buttermilk, Maltodextrin, Salt, Lactose, Sodium Caseinate, Sodium Phosphates, Butterfat, Dipotassium Phosphate, Natural Flavor, Lactic Acid, Sunflower Oil), Carrot Powder, Dicalcium Phosphate, Salt, Tocopherols (Vitamin E), Zinc Sulfate and Electrolytic Iron.

So, "carrot powder" counts as "real vegetables"?

You couldn't pay me to feed these to my child....he can have some real carrots instead.

CSPI points to a number of products to illustrate how pervasive the problem with labeling really is:
  • Gerber Graduates for Toddlers Fruit Juice Snacks -- the package is decorated with pictures of oranges, cherries, and strawberries, but the leading ingredients are corn syrup and sugar. "You can guess why Gerber doesn't call these things Corn Syrup Snacks-no parent would buy them," says Silverglade. "This is candy, not fruit juice."
  • Betty Crocker Super Moist Carrot Cake Mix -- the box depicts what appear to be pieces of carrot, but the only carrot ingredient is "carrot powder," which is the 19th ingredient listed, behind artificial color, salt, and dicalcium phosphate.
  • Smucker's Simply 100% Fruit -- the strawberry version of this "100% fruit" spread contains 30 percent strawberries; the blueberry version contains only 43 percent blueberries. Both have more fruit syrup than fruit-syrup that comes not from berries but from less-expensive apple, pineapple, or pear juice concentrate.
  • Kellogg's Eggo Nutri-Grain Pancakes -- the label boasts that these pancakes are "Made with Whole Wheat and Whole Grain," but the pancakes are made primarily with white flour and have more high-fructose corn syrup than whole wheat or other whole grain. CSPI says that foods labeled "whole grain" should have whole grain flour as their flour constituent, as is the requirement for whole wheat bread.
  • General Mills' Yoplait Light Fat Free Yogurt -- the label claims to "burn more fat" and help dieters lose weight if they consume three servings of milk, cheese, or yogurt daily. However, the U.S. government's Dietary Guidelines Advisory Committee has called the evidence on dairy products and weight loss inconclusive.
  • Quaker Oats Pasta Roni -- the label boasts White Cheddar & Broccoli in large letters and displays a picture of pasta with pieces of broccoli. Although broccoli appears on the fourth line of a 14-line ingredient list, there are only small specks of broccoli in the actual package.
Each of these products are highly processed and things you really don't need in your diet. Your best defense is to be vigilant in reading labels - not just the package claims on the front, but the back of the package where you'll find the ingredients and nutrition facts panel. In both the nutrition facts panel and the ingredients, manufactures are strictly regulated by law to be straight forward and without claims.

A good rule of thumb if you are looking at packaged foods is this - if it contains ingredients you cannot readily purchase yourself, or ingredients that you do not use to prepare your food, skip it and make it yourself with real, whole ingredients instead.

Think about it - do you want to eat or give your children "carrot powder" or carrots?

Wednesday, October 26, 2005

Going Against the Grain

We read and hear almost daily about the importance of eating whole grain foods. The most often promoted among those available include 100% whole wheat (or other grain) bread and 100% whole grain cereals. We're told these foods are rich with nutrients and are a good source of fiber.

For those following a low-carb diet, one that is limiting total carbohydrates each day, including whole grains is almost impossible in the first weeks after starting many of the low-carb diets. Are these folks running the risk of nutrient deficiency without including grains?

Surprisingly the answer is "no" if they choose and include their vegetables wisely!

A few years ago, I wrote an article titled "No Potatoes? No Bread? Oh My!" that detailed how vegetables - that is non-starchy vegetables - actually offer a higher level of nutrients and fiber when compared with whole grain breads or potatoes (another highly promoted starchy vegetable).

Two regular slices of 100% whole wheat bread comes in at 137-calories, with 4g of fiber, 2.4g of fat, 25.8g of carbohydrate (total) and 5.4g of protein.

The bread choice also offers 4% of daily calcium, 10% of iron, 10% of thiamin, 6% of riboflavin, 11% of niacin, 7% of folate, 5% of B-6, 13% of phosphorus, 12% of magnesium, 7% of zinc and 8% of copper.

Pretty impressive, isn't it?

What if, instead, you chose a cup of cooked spinach?

Well, that's just 41-calories, with 4.3g of fiber, 0.46g of fat, 6.75g of carbohydrate (total) and 5.4g of protein. So, with the spinach option, you're saving yourself fat and calories with similar protein and fiber intake.

What about the vitamins and minerals?

The spinach is actually more nutrient-dense, providing 295% of vitamin A, 29% of Vitamin C, 24% of calcium, 36% of iron, 4% of Vitamin E, 9% of thiamin, 21% of riboflavin, 4% of niacin, 66% of folate, 22% of B-6, 10% of phosphorus, 39% of magnesium, 9% of zinc and 16% of copper.

Tell me again why grains are a "must have" in our diet?

While whole grains are significantly better than refined grains, they are not necessary in the diet. Yes, you can have some when you are controlling your carbohydrate intake, but it is not true you have to eat grains to get your fiber and nutrient requirements met!

Is Candyland Making Kids Fat?

Should Children Play Candyland?

That's the question Megan Romer asked in her headline this week in her gaming editorial at

She first makes the case that the pre-school boardgame offers no educational benefit and continues with "the game is based on a fictional land which is made completely of candy. Right now, over half of American children are considered obese. Should we really be subjecting our children to subliminal messages that candy is fun and wonderful and magical?"

This type of thinking reminds me of the decision by Sesame Street to take away Cookie Monster's cookies and change his tune from "C is for Cookie" to "Cookie is a Sometimes Snack." Yeah, yeah, blasphemous, I know!

I don't know about you, but the idea that the 55-year old board game, Candyland, is "subjecting" children to sublimal messages that are making them eat more candy is silly. How did children in the first 30-years of the games history manage to stay trim?

Oh, that's right - they didn't eat gobs of candy, junk food and sodas each day; they actually played outside regularly and their schools offered recess and phys-ed; their parents saved treats for special occassions and their daily diet was mostly home prepared foods with very limited occassions for a fast food meal.

Let's not forget, until the 1980's there were probably, at best, only nine to twelve television stations to choose from for the majority of people in the US, home computers didn't exist in any significant number, nor did home video game players.

But, ya know, it's Candyland that's making kids think that candy is fun, wonderful and magic and causing them to eat too much of it. Please! Give me a break!

For a child, candy is wonderful and fun, and who knows, maybe even magical ---- that is not the problem.

The problem is giving them too much of it.

I for one, who totally believes that added sugars are part of the problem in the obesity epidemic, recognize how important childhood is and how influential we adults are in the lives of children.

It is we - the parents and adults around children each day - who set the stage for what is "normal" for diet and who set the limits on things like candy.

What happened to the common sense of simply keeping things like candy as an occassional "treat," like it used to be considered years ago?

Ms. Romer is taking comments on her article - Forums!

Weight Loss: Glycemic Index (GI) and Glycemic Load (GL)

If you read the headline today, Reducing GI does not boost effects of low-calorie diet, you might be left with the impression that reducing the glycemic load in your weight loss diet will have no benefit. Think again!

As I read through the article, I wanted to see the data, so I headed over to the American Society for Nutrition to read the paper in their journal, the Journal of Nutrition. The abstract was freely available, but didn't add any more information from the article about the study, so I ponied up the $8.00 for access to the full-text titled, Reduced Glycemic Index and Glycemic Load Diets Do Not Increase the Effects of Energy Restriction on Weight Loss and Insulin Sensitivity in Obese Men and Women.

The reason I wanted to see the full paper is because, to-date, the research that is published shows there are a number of benefits to reducing the glycemic load in your diet and this study seemed to counter the evidence we already have supporting reduced glycemic load.

Specifically the benefits shown in various studies include:
  • Increased insulin sensitivity
  • Greater losses of body fat on a low GI/GL calorie restricted diet
  • Significantly improved measure of triglycerides
  • Increased HDL coupled with lowered LDL cholesterol
  • Higher levels of satiety reported by those following a lower GI/GL diet

Personally, I think the GI/GL is a bit too complicated for practical use by the general public. Too many things confound the usefulness of the GI/GL in an everyday free-living setting - mixed meals simply register all over the place on the GI/GL scale, making it difficult to accurately assess how a meal is really going to affect you.

That said, the research into the why and how of the GI/GL is beneficial to our understanding of how different foods - specifically carbohydrate foods and mixed meals - affect our metabolism. This particular study asserts that low glycemic index and load diets have no differing effect on weight loss or insulin sensitivity when compared with a high glycemic index/load diet - the abstract makes that assertion clear: Weight loss and improved insulin sensitivity scores were independent of diet composition. In summary, lowering the glycemic load and glycemic index of weight reduction diets does not provide any added benefit to energy restriction in promoting weight loss in obese subjects.

So, what did the full-text say?

  • Each diet group lost body weight during the 12-wk feeding phase of the study but the amount lost did not differ among the groups.
  • At 12-weeks the HF and LGI groups tended to maintain their lean body mass (LBM).
  • The calculated HOMA scores were significantly improved at 12 wk compared with baseline in all 3 groups. The improvement in the LGI group was significantly greater than the improvement in the HF group at wk 12.

This was the first phase of the study. Let's look at the results in some real numbers, rather than general statements, shall we?

At 12-weeks, the real pounds lost by each group were calculated as:

  • High-GI lost 9.3kg average, or 20.5-pounds
  • High-Fat lost 8.4kg on average, or 18.5-pounds
  • Low-GI lost 9.95kg on average, or 21.9-pounds

At twelve-weeks, which group had a greater weight loss? The Low-GI group lost 1.4-pounds MORE than the High-GI group. Statistically this is not considered "significant," but if you were the individual trying to lose weight, which approach would you consider better?

So far as lean body mass losses, how did each group do? (Remember, LOSING lean body mass is BAD)

  • High-GI lost 4.8kg on average, or 10.6-pounds of LBM
  • High-Fat lost 2.6kg on average, or 5.7-pounds of LBM
  • Low-GI lost 3.04kg on average, or 6.7-pounds of LBM

Still with me? Good...

When you look at both total weight lost and the loss of lean body mass, here is how each group did for FAT LOSS:

  • High-GI lost a total of 20.5-pounds, with 10.6-pounds of LBM, for a fat loss of 9.9-pounds
  • High-Fat lost a total of 18.7-pounds, with 5.7-pounds LBM, for a fat loss of 12.8-pounds
  • Low-GI lost a total of 21.9-pounds, with 6.7-pounds of LBM, for a fat loss of 15.2-pounds

Now which dietary approach would you want to follow?

Can it even get any better? How did the various groups do with insulin as measured by serum insulin?

  • High-GI at 12-weeks had a reduction of 20.1 pmol/L
  • High-Fat at 12-weeks had a reduction of 6.3 pmol/L
  • Low-GI at 12-weeks had a reduction of 28.5 pmol/L

But, the study was 36-weeks, wasn't it?

What happened in the 24-weeks following the initial 12-weeks?

Well, researchers set the participants out into "free-living" conditions and instructed them to continue to follow their group diet. How did that go? Ummm....all groups lowered their glycemic load by choosing foods that were low glycemic index, thus confounding the final results!

All 3 groups, despite receiving dietary instruction for their specific assignment, consumed diets of relatively low glycemic index and low glycemic load when making their own food selections. The glycemic indices of the diets at 24 wk differed (P = 0.014), with subjects in the LGI group initially consuming a lower glycemic index diet than the other 2 groups; however, at 36 wk, diet glycemic indices did not differ among the 3 groups (P = 0.14). The 5-d food record review showed that subjects in the LGI group tended to choose lower glycemic index foods but members of the other 2 groups simply increased dietary fat.

Basically this tells us that the final 24-weeks of this study are useless to measure if there does exist a benefit for weight loss OR improvements in other health risk markers since everyone in the study was eating a diet that was low glycemic index.

How the researchers had the gall to assert this data shows that the glycemic index/load offers no benefit is beyond me.

The data from the time participants were within controlled conditions - 12-weeks - is very compelling - especially for lean body mass preservation while losing weight.

Yes, the total weight lost between the groups is not "statistically significant," but the data clearly shows when you assess both total weight lost and lean body mass lost, the low glycemic index/load approach was significantly better with more body fat lost and more lean body mass maintained!

The fact that the last 24-weeks of the study were corrupted by all groups eating a lower glycemic index/load and higher fat diet should have been stated as a confounder in the abstract and abstract results with the researchers being open about how and why their final results are confounded and that reaching a conclusion is impossible due to the confounding factors!

If nothing else this study speaks volumes about how important it is to go to the data - the primary source - and see what happened, do the math and make an evaluation for yourself about what the study found. While the headline today is screaming that a low glycemic index/load offers no benefit for weight loss - this data shows the opposite - those on the low GI/GL diet lost more pounds, more body fat and preserved more lean body mass!

Tuesday, October 25, 2005

Move in the Right Direction

We hear a lot about how exercise or general activity is important in our health and well-being. The government recommends 60-90 minutes each day and other experts contend even 30-minutes a day is good. The research available shows that physical activity reduces risks and improves health.

So, what stops so people from starting an exercise routine or just being more active?

You guessed it - time!

But, consider this - simply walking each day can be your first step to better health! All you need is a good pair of walking shoes and you're all set to step out and get moving in the right direction!

If you want to enhance the benefit, research shows that listening to music while you walk actually increases your pace - which increases the calories burned and weight lost!

Researchers at Fairleigh Dickinson University in Teaneck, N.J., asked 41 women, who weighed an average of 192 pounds, to follow a program that included limiting calories, walking and attending weekly group meetings. The sessions were followed by a group walk. Half of the women were given portable CD players with headsets and told to listen to the music of their choice every time they walked. The other group did so with no music.

After six months, the results were:
  • The music-listening group adhered more closely to the walking program than the non-music group. Its members lost an average of 16 pounds and 4% of their body fat.
  • The non-music group dropped an average 8 pounds and 2% body fat.

If you feel you don't have time to start a formal walking program, consider getting yourself a pedometer - for a week, track how many steps you take each day and then find ways to add more steps each day into your daily routine. Most agree that 10,000 steps each day is a good target to shoot for over time - that is 5-miles of walking each day.

You may be surprised by your results - many people only take between 2,000 and 5,000 steps each day. If you're one of them, increasing that to 10,000 steps may feel overwhelming, but can be done slowly over time.

Simple changes in your daily routine can add steps very quickly without taking a lot more time - parking further from the entrance, taking the elevator instead of the stairs, even just walking to the mailbox instead of parking the car and getting the mail as you arrive home all make a difference at the end of the day. Over time small changes add up and soon you can be taking 10,000 steps each day while enhancing your health!

Parents Recognize Childhood Obesity Issues

The Associated Press (AP) and Kids Online (KOL), the child focused section of America Online, recently polled 961 parents of children aged 6 to 17 about childhood obesity, Poll: Parents point to lack of exercise as the major factor in childhood obesity. The results were really just confirmation of the many reasons we already know are contributing to the problem of childhood obesity and showed that parents are aware of the problems.

Overall the reasons for obesity cited by parents included:
  • Lack of exercise
  • Easy access to junk food
  • Poor eating habits
  • Television commercials
  • Food packaging
  • School lunches
  • Cost of healthy food, especially for families with less than $25,000 annual income

Sadly the poll offered a laundry list of reasons with few solutions. After reviewing the responses, many clearly believe that lack of time is an issue. When exactly did we run out of time to do those things that are important?

Many will find the time to stand in line, idle parked in the "take away" spots or wait at the drive-thru window for dinner without realizing that such time could be spent preparing a healthy meal.

Think about that for a moment - how long do you wait for that "convenient" meal? Not only that, how much more are you going to pay for that meal?

As an example, if I call Outback Steakhouse to order dinner, I'm going to use up about 45-minutes of time to wait for that meal when I consider the time to call, order, drive to the restaurant, wait in the carry-out parking spot, have someone bring my food to me and then drive back home. A dinner for two adults will cost anywhere from $25 to $40. Not only have I burned through almost an hour I could have used to make the meal, I've spent more than twice what it would cost me to make it - and I could have made it with much better ingredients if I'd done it myself!

Now don't get me wrong here - I too enjoy the "take-out night" as much as anyone else. In fact, my husband and I have a take-out night a couple of times a month- it's a nice break from cooking each night. But, the problem I see is that we've been led to believe, through careful marketing over the years, that we simply don't have time anymore, or that endeavors such as cooking meals are a waste of our precious time.

I don't know about you, but the way I see it, we parents are given one opportunity to raise our children, once they're grown there is no going back to try again. The most precious gift any parent can give their child is time - time with them and time spent ensuring their health and well-being...and that includes ensuring they eat a healthful diet! Make the time!

One other problem cited in the survey was the lack of access to safe play space. I recently finished reading Last Child in the Woods, by Richard Louv - a book that addresses the problem of children increasingly disconnected from nature and free play outside.

Getting active doesn't have to mean joining a ball team. "One of the strongest correlates of how overall active a child is, is how much time they spend outdoors,'' said Dr. Nancy Krebs, who co-chairs an American Academy of Pediatrics' obesity panel. "Nature takes over from there.''

While many parents offer many reasons for less outdoor time, research shows that children need time outside and need free play, which bolsters creativity, learning, problem solving, critical thinking and decision making. Add to that, research shows that reducing time in front of the television, video game player and computer actually hinders weight gain in children!

Here again though we find some parents making excuses - "We as parents need to do more,'' said Elena Penson, a sales clerk from Lufkin, Texas, whose family makes a point of going to a park twice a week to play catch. "But when we get home, we're tired, too. We've gotten lazy.''

And again I contend as parents we must make the time and encourage - no insist - our children to play outside. As Louv points out in his book - free play in a natural setting is often better than organized play (which is still good).

You don't have to spend a lot of money to get your kids outside and active - the park, walking trails, even your own backyard, the school yard after hours or an empty lot (free of litter, of course) can provide space that allows free play where children can explore and learn about their home environment and create their own play.

Think you just don't have the time? Get together with friends and neighbors and start a play-group round-robin arrangement where parents trade-off time each day to bring together a group of children to play freely. If you bring together just three parents, you have just created three days of outdoor play for your child and committed to one day where you make the time for your child and two others! Not only are your children getting more time outside, you're also now part of building community for your children - they'll learn about cooperation, commitment and time management from you and your neighbors!

The bottom line is this - our children are facing an obesity epidemic that is already taking its toll on their health and will continue to if we - parents - do not do something about it. We can lament the problem all we want, but unless we step up and start to make the time to do something about it, the problem will only get worse. We cannot sit back and wait for someone else to "solve" the problem - wait and it will be too late.

Make the time now - you won't have anymore time later than you do now, so just do it!

Friday, October 21, 2005

Tripping over Trans-Fats

Good Grief!

Do you have any idea how much of the edible oils in the United States are rich with trans-fats?

According to a Time article, "Target: Trans Fats," some 10-billion (yes, with a "B") pounds per year are consumed in the United States.

Some 85% of the roughly 19 billion lbs. of edible oils Americans consume each year comes from soy. About 10 billion lbs. of that soy oil gets hydrogenated, according to Mark Matlock, senior vice president of food research at Archer Daniels Midland (ADM).

What's more disturbing, at least in my mind, is the small number of people who try to avoid them in their diet - The Hartman Group, a Bellevue, Wash., consultancy, has found that although a majority of consumers have heard about trans fats--mainly because of Joseph's Oreo lawsuit--only about 14% are likely to actively avoid them.

Considering how prevalent they really are in our food supply, many do perceive it to be difficult to avoid them - but isn't your health worth it?

And, avoiding them certainly does not leave you with a spartan diet with limited options as the article suggested!

Charlie Lousignont, an executive at Fazoli's restaurant chain, based in Lexington, Ky., which cut trans fats from most of its menu last April, points out that consumers tend to make choices based on taste, not virtue. "The ultimate food product," he says, "is low in calories, carbohydrates and sodium and has no trans fats. That leaves you with only a handful of things--like a carrot."

The first step to avoiding man-made trans-fats in your diet is simple - stop buying packaged processed foods that have
  • partially hydrogenated oils
  • margarine
  • shortening
  • mono-glycerides and di-glycerides (potential sources of trans-fatty acids) the list of ingredients! And do not use shortening made from partially hydrogenated oils or margarine in your cooking.

The next step is more difficult - avoid ordering or buying meals or side items that may be prepared with offending man-made trans-fats. Ask about how these foods are prepared and if there is an ingredients list you can review. The foods most often prepared with man-made trans-fats include:

  • Deep fried foods
  • Baked goods including breads
  • Cookies, cakes and pasteries - especially those with frosting
  • Vegetables and other sides that may have been prepared with stick margarine
  • Foods that rely on packaged ingredients that contain man-made trans-fats
  • Even sauteed foods like fish and chicken - ask, ask, ask what they use to sautee!

Thursday, October 20, 2005

The New Math of Weight Loss

Ahhh, I love it when researchers publish data that highlights the flaws in the calorie theory and then they conveniently revert to the use of statistics to avoid the obvious!

Want to see the latest shenanigans with statistics?

Check out the data presented at the North American Association for the Study of Obesity (NAASO) conference this past weekend - as reported by Fox News in their online article, "How Much Exercise Sparks Weight Loss?" - presented by Dr. John Jakicic, a Professor of Health and Physical Activity at the University of Pittsburgh.

For two years, Dr. Jakicic has followed more than 200-obese women (average age 37, average BMI 32 at the start) on a calorie-restricted diet and varying exercise routines:
  • average calorie intake = 1,200 - 1,500 calories per day
  • Fat intake restricted to 20-30% of calories
  • moderate amount/moderate intensity
  • moderate amount/vigorous intensity
  • longer amount/moderate intensity
  • longer amount/vigorous intensity
  • those following the "moderate" regiments burned about 1,000 calories per week from exercise
  • those following the "longer" regiments burned about 2,000 calories per week from exercise

Now the findings were interesting, body fat percentage lost:

  • longer amount/vigorous intensity = 7.2%
  • longer amount/moderate intensity = 6.5%
  • moderate amount/moderate intensity = 4.9%
  • moderate amount/vigorous intensity =3.7%

But, what's wrong with this picture?

After two years these women only managed to lose between 3.7% and 7.2% of their body fat? How is that even possible given the calorie restriction and calories burned in exercise?

It's not!

If the calorie theory is applied, these women should have lost a lot more weight over two years.

Forget the statistics - Just do the math!

We know the average age was 37....we know the average BMI was 32....let's assign a height of 5'7" as our baseline here, which means a body weight of 204.5-pounds at the start of the study for a "pretend" participant we can use as our baseline to do the math. You can double-check my assumptions with an online BMI calculator at the CDC website.

We do need to know something else though - what is the calorie intake at the start to maintain body weight of, let's just say, a completely sedentary person of this height and weight? For this number, we need a Basal Metabolism Calculator, which can be found online at Room 42's website. Here we find a "couch potato" needs 1,865-calories per day just to maintain her weight.

So, we have some good numbers to start with.

Now let's do the math. Let's assume she eats the higher calorie average - 1,500 per day. And, also let's assume she wound up in the group burning just 1,000 calories a week for her exercise. How much weight should she have lost if we apply the calorie theory?

Oh.....92.28-pounds in two years!

That's right - 92.28-pounds!

Remember, the calorie theory is all about "calories in, calorie out."

Calories in = average 1,500 per day...this represents a calorie deficit of 365-calories each day. But, let's call it 300-calories just in case she under-reported her food intake.

300-calories per day X 365-days = 109,500 calories x 2 years = 219,000 calories

219,000 calories divided by 3500-calories per pound = 62.57-pounds

Now we have to factor in the exercise calories burned each week.

1,000 calories per week x 52 weeks = 52,000 calories x 2 years = 104,000 calories

104,000 calories divided by 3,500-calories per pound = 29.71-pounds

Add them up...

62.57-pounds + 29.71-pounds = 92.28-pounds theoretically lost if the calorie theory holds true.

What happened? Where's the expected weight loss?

Yup - another hole shot right into the Calorie Theory - and no one is paying attention since the "stats" used look good enough.

Well, "good enough" here simply isn't good enough. When you see statistics thrown around like this, without real pounds and hard numbers assigned to fat pounds lost - do the math!

Silencing the Critics of Splenda

Most of my readers already know my position on artificial sweeteners - avoid using them if you can.

My reasons are pretty simple - the use of artificial sweeteners in place of natural sweeteners never helps you really break the "sweet habit" so many have developed over the years and there is no way around the fact that artificial sweeteners are not natural in our diet - they are chemical compounds one would not find naturally within their diet without technological advances to create them.

That said, my position has remained somewhat flexible to the extent that if one simply cannot find the power within to simply abandon that sweet tooth altogether, then restrict your intake of artificial sweeteners to no more than 3-servings per day to limit your exposure to the chemicals these products are.

Now there are others who feel differently. That's one of the things that makes our lives so interesting - good people often have differing opinions and life is often riddled with grey areas when it comes to who is "right."

On one side of the artificial sweetener debate are those who are strongly opposed to any use; on the other are those who see no harm in using artificial sweeteners, even a high intake on a daily basis. Both sides seem to have evidence to support their position. Those in favor point to research that shows no negative effects, those opposed point to research that shows negative effects.

So what is the lay person to do?

The answer is often to seek out the information for yourself, evaluate it, look at both sides and come to a decision for yourself whether you feel ingesting artificial sweeteners is safe for you or not.

What happens though when one side of the debate is silenced? What if your access to the negative opinions and/or potentially negative health data from research is restricted? Think it can't happen? Think again!

September's Ecologist Online has a chilling article titled "Life After Aspartame" which details the ongoing effort to silence Dr. Joseph Mercola, DO from providing access to his articles about Splenda to any visitor of his website ( from England.

Details in the article include:

  • Recently, the publisher of the local newspaper the Brighton Argus considered it prudent to publish an apology composed by Tate & Lyle (or their lawyers) or face a legal action for defamation and loss of sales after printing an article suggesting that sucralose was harmful to humans.
  • Tate & Lyle's first high-profile victim, however, was - one of the world's most visited internet health sites. Run by Dr Joseph Mercola, the site has been a vocal critic of sucralose for years. Instead of carrying freely available information on sucralose that might stimulate spirited public debate, it now carries the following message: 'Attorneys acting on behalf of the manufacturers of sucralose, Tate & Lyle Plc, based in London, England, have requested that the information contained on this page not be made available to internet users in England.'
The article ends with some pointed questions...

If sucralose is safe beyond any reasonable doubt, why is there such a fervent need to suppress any criticism of it?

...Whom do such tactics really serve?

Do they serve the consumer and the principles of choice, information, safety and redress?

Or do they serve the corporate machine and its need to keep generating profits without taking responsibility for the human cost of doing so?

My question is - how do you feel about supporting a company, by purchasing its products or products containing their ingredient, when you now know what they're doing behind the scenes to censor public access to negative opinions of their product?

Wednesday, October 19, 2005

Dying to be Slim

If you're considering gastric bypass surgery, consider this - within the year following surgery, 3% of women and 5% of men who were aged 30-44 died.

That's 3 women out of every 100 and 5 men out of every 100 who had the procedure.

It's worse if you're older. For those who were aged 65-74 at the time of surgery, 13% of the men died and 6% of the women died within the year following the procedure.

No matter how you slice it, this is significantly higher than the oft quoted 2% risk of death claimed by bariatric surgeons.

Early Mortality Among Medicare Beneficiaries Undergoing Bariatric Surgical Procedures

Ten Ways to Boost Vegetable Intake

1. Add vegetables (onions, peppers, spinach, broccoli, etc.) to your eggs in the morning in an omelet or frittata!

2. Have a small salad each night as the start to your dinner - be sure to use dark green leafy lettuce and add some additional veggies beside just tomatoes and cucumber - add in any combo of broccoli florets, celery, peppers, shredded red cabbage, shredded carrots, etc.

3. Cut raw vegetables make a great snack! Broccoli florets, carrot sticks, celery, peppers, etc. all taste great raw with some dip.

4. Chilly night? Skip the salad and make a vegetable-rich soup to start dinner with!

5. Add vegetables in unlikely places - zucchini and summer squash and/or eggplant can be added as a layer to lasagna, reducing one layer of pasta; adding fresh spinach to sauces boosts vegetable intake without changing the flavor of the sauce while also adding color and texture!

6. Skip the potatoes, rice and pasta and serve two vegetable side dishes instead! You'll pack in more essential nutrients - vitamins and minerals - per ounce with the vegetables!

7. Instead of serving traditional bread, make a vegetable-based bread like zucchini bread or pumpkin bread.

8. Who says cookies can't be good for you? Drop shredded carrots into nutrient-dense (occassional treat) oatmeal raisin cookies without altering the flavor or texture!

9. Make it slaw! Cole slaw, broccoli-slaw and other veggie slaws all can be added to your lunch and pack in more nutrients from vegetables in a tangy side dish!

10. Vegetables for dessert? While technically a fruit, many consider pumpkin a vegetable - Whip up a sugar-free pumpkin mousse, crustless pumpkin pie or pumpkin custard. Try substituting spaghetti squash or even riced cauliflower for rice in a rice pudding/custard.

Have more ideas? Email me at

From the Mailbox: Economics of Obesity Follow-up

After yesterday's Economics of Obesity - Part 2 - my e-mailbox quickly filled with letters that both thanked me and chastised me. The praise and criticism was split about 50/50 with some telling insight into what folks think is important in their daily life.

I'll start with some of the praise:
  • You're dead on when you advise reading through the circular and planning the meats first. One step I'd add, which I do, is to see what meats are on sale and decide meals for the week based on what I can buy on sale. I try to buy enough meats to use leftovers for lunch the following day or as a leftover meal smorgasborg later in the week. And, great advice to use leftover veggies in omletes in the morning! Often we have just a small amount of vegetable left and it often gets I'll toss it into our omletes instead!
  • I have a very small budget for groceries each week and one thing I do is try to consolidate much of my shopping into some items on a monthly basis. I have just $250 a month for food and that's less than the amount you used and we do manage to eat mostly fresh foods. It is really hard though. Instead of shopping each week for everything I need that week, I take my monthly budget at the start of the month and stockpile things when they are on sale that can be used all month, like canned tuna, when it is on sale. When meat is on sale I'll buy a lot of it and freeze it. Just last week our grocery store had ground beef on sale for 99-cents a pound and I bought 10-pounds and froze most of it for using it all month. I can't do that with the fruits and vegetables, but for anything that can be frozen, this saves a lot of money.
  • Frozen vegetables are just as good as fresh and are almost always much cheaper, especially if you buy the store brands in the bigger bags. When there are coupons for the name brands, don't buy them the week the coupon is out though, the sale price isn't really a good deal that week and will get better when it's almost expired. I've seen this again and again and now just put the coupon aside and wait.
  • I think people wind up eating unhealthy because they think they're getting a good bargain with the boxed or pre-made foods. Years ago I realized that something convenient like the pre-made roasted chicken is more expensive than making it myself. The roast chicken by Tyson's is $5.99 for less than two pounds chicken cooked and that includes the bones and stuff you waste too! When whole chicken is on sale I can buy one for 99-cents a pound and get a 5-pound chicken for $4.95 and a packet of seasoning for $1.00...more than twice the chicken for the same money!

Then, of course, were the critics:

  • Do you really think people will only drink water all week? Your shopping list completely failed in reality since most people want to have something to drink other than water and milk!
    My reply: You're probably right, and that is something I acknowledged in my article. One thing folks can do is make their beverages rather than buy them. Make room in the budget for a box of tea bags and some lemons and make iced tea. This is much more economical than buying iced tea mix or bottled teas and you can control the amount of sugar added (or completely leave it out). One could also use lemons and limes to flavor water too!
  • Your shopping list had no snacks! There is no way that kids are going to like having apples and peanut butter for a snack, not in this world anyway. And kids need some juice too to drink.
    My Reply: Let's pretend you're right - that kids don't want to have apples and peanut butter for a snack. So, we should feed them what? Chips? Donuts? Since you didn't state what you'd suggest, I can only assume that you're talking about the very things that are contributing to the childhood obesity we're seeing today. There are ways a parent can get creative and offer more "traditional" snacks while still offering nutrient-density in their child's diet. For example, if oatmeal is one of the things on the shopping list in the week, make some oatmeal cookies with the kids. Not only are they going to be a better alternative to the packaged cookies with questionable ingredients, you'll also have an activity you can share with your children! Oh, and kids don't *need* juice...try whole fruit, it's better for them!
  • Meals can be stretched more if you buy pasta, rice, beans and bread and don't eat so much meat. You don't have enough of any of these things in the pretend shopping list and these items are lifesavers for those of us on a tight budget.
    My Reply: Sally, the point of my exercise in trying to put together a week of shopping on a tight budget was as much nutrient-density with mostly fresh whole foods. While rice, pasta, beans and bread may make it appear you're stretching the meal out, you're decreasing the nutrients in the meal overall, especially if you skimp on the sources of whole proteins to buy more rice, pasta, beans and bread. On a limited budget it really is a balancing act and, in my opinion, the most important mutrients - those that are classed "essential" - must be the items you consider first in putting together your list. Pasta, rice, beans and bread are not rich in "essentials," that is, quality protein and fats. While you certainly can include pasta, rice, beans and bread - these should be accompaniments to a meal, not the foundation of a meal, from my perspective. These should be secondary to meat, poultry, fish and the fresh/frozen fruits and vegetables which are more nutrient-dense per ounce.
  • Tuna in oil? Are you nuts? Tuna in water is better for you and has the same protein as tuna in oil with less fat!
    My Reply: Ahhh, the calorie issue! You may remember I noted the reason for choosing the tuna in oil was both calorie density and nutrient-density. Tuna in oil has a much higher level of fat soluble vitamins than that packed in water. Specifically, tuna (light) in oil has 201IU of Vitamin D, packed in water - zero. For Vitamins A, E and K the tuna in oil again has higher levels of each! Add to that the minor difference in calories - tuna in oil is 168 calories for 3-ounces and tuna in water is 99-calories - the nutrient-density makes the tuna in oil a much better choice since you'd be hard pressed to find the same vitamins in a source for just 69-calories! And, just to be clear, the tuna in oil has more protein too - 24.76g in 3-ounces compared with 21.68g in the tuna packed in water.

Keep the mail coming - the ideas and suggestions you all have are great and as I get more good ideas in my email, I'll update in the future!

Tuesday, October 18, 2005

Economics of Obesity - Part 2

Last week, in my Economics of Obesity entry, I asked my readers "Is it really more expensive to eat healthful food or not?"

My question was prompted by an article in the Houston Chronicle that asserted that the cost of fresh food and the time crunch felt by the working poor conspire to cause poor eating habits, less activity and thus obesity.

The reader response was overwhelming and the vast majority strongly felt that eating well - that is fresh foods instead of packaged, processed foods - costs more money and requires more time to prepare.

The response did not deter me from trying to evaluate the truth of these notions from a real world experience - trying to plan a menu for one week, for a family of four, that was mostly fresh, whole foods within a tight budget. I honestly did not know however, what is considered a "tight budget" for grocery shopping. I know what I spend and I know I consider it a tight budget - but for those who live as the "working poor" what does that budget really look like?

I'd like to thank Jessica R. Dreistadt, the Coordinator of Advocacy and Outreach at Second Harvest Food Bank of Lehigh Valley and Northeast Pennsylvania for her email that provided a link to the "Frugal Food Challenge," an experiement with 21-adults participating and challenged to purchase all food eaten in one week based on the average food stamp allocation - 89-cents per meal - with three meals a day as a foundation, that's just $2.67 per day!

Noteworthy of the challenge - the participants had never experienced poverty or the real issue of food insecurity and the results were telling. I strongly encourage my readers to take a few minutes to read through the report - it is an eye-opener!

That said, I had my budget - for a family of four, eating three meals a day, each meal limited to an 89-cent budget, I had to create a menu that would feed this family for just $74.76 for the week! [The math = 4 people x 3 meals per day = 12 meals per day; 12 meals per day x 7 days a week = 84 meals; 84 meals x 0.89 = $74.76]

Is it even possible to feed a family of four on just $74.76 a week? Can it even be done with packaged, processed foods - let alone the vast majority being whole fresh foods?

Well, it is definitely not easy...but, with some time and planning, it is doable - barely - and it does require some compromise.

First armed with the local grocery store circular I looked over the specials and sales for the week and decided the first items to include were the proteins. Protein and fat are essential in the human diet and for this reason, protein foods were to be the critical items determined first before any other selections. Animal proteins already come packed with fats, so this allowed me to concentrate on the fruits and vegetables after the meat, poultry and fish.

On sale this week, a 10-pound turkey for $4.90, 3-pounds of lean ground beef for $5.64, two 1-pound keilbasa for $3.00, a 3-pound chicken sample pack for $2.97 and lastly, a pound of salmon for $4.99. I'd quickly burned through $21.50 of the budget just with the meats, poultry and fish - would the remaining $53.26 provide enough fruits, vegetables, nuts & seeds, whole grains and even some snacks for this mock family of four?

Staple items for some breakfasts, lunches, and cooking were next - 3 dozen eggs ($2.37), three 6-ounce cans of chunk light tuna in oil ($2.01), a 32-ounce jar of store brand real mayonnaise ($1.89), name-brand 16-ounce jar of natural peanut butter ($1.99), store brand bread crumbs - italian seasoned ($1.29), 24-ounce jar of name-brand spaghetti sauce ($1.79), two cans of tomato sauce plain generic ($0.99), a one-pound container of generic ricotta whole milk ($1.99) and name-brand lasagna noodles, whole wheat ($1.29). Another $16.61 spent from this limited budget, leaving just $37.65 for the remaining foods needed.

Fresh fruits and vegetables proved to be the most challenging to the budget, and this is where some compromise had to be made.

While ideally all the fruits and vegetables should be fresh, I had to compromise and include some frozen selections which proved less expensive than the fresh. For example, one-pound of fresh strawberries were available for $3.99, the frozen one-pound bag of strawberries (no sugar added) was just $1.50. The same proved true with some of the vegetables - fresh broccoli was on sale for $1.29 a pound, but the frozen one-pound bag of chopped broccoli was just $1.00....with less waste, the frozen broccoli had better bang for the buck.

So, fresh fruits and vegetables did include - 2-pounds of medium apples ($1.98), 2-pounds of baby carrots ($3.00), 2 Haas avocados ($3.00), 3-pounds of russet potatoes ($2.37), 2-pounds of yellow summer squash and zucchini ($2.58), a three-pack of romaine hearts ($1.99), a container of cherry tomatoes ($1.99), three cucumbers ($0.99), 2-pounds of green peppers ($1.58) and 1-pound of red peppers ($1.99). Another $22.47 from the budget, leaving just $15.18 for the rest of the fruits and vegetables and basics needed for the week.

Frozen selections included, 1-pound bag of broccoli ($1.00), 1-pound bag chopped spinach ($1.00), 1-pound bag of mixed vegetables ($1.00), a 1-pound bag of strawberries ($1.50)....budget remaining is just $11.68.

A loaf of store brand 100% whole wheat bread ($1.50), 1-pound generic butter ($1.99), ranch salad dressing ($1.79), two onions ($0.66), one 16-ounce cans of kidney beans ($0.69), a gallon of generic whole milk ($2.03) and packets of chili seasoning, meatloaf seasoning and chicken dinner seasoning ($2.97) exhausted the budget, leaving only $0.05 left, and I still had not gotten cheese into the menu!

I'm not sure I could do this each week and yet know that there are millions of Americans out there who must not only try, but actually live on such a budget. If you're interested in what the above foods make for meals, here is a quick overview:

Breakfasts included eggs with leftover vegetables to make omelets each morning. This was less expensive and more nutrient-dense than cold or hot cereal with milk to start the day.

Lunches included leftovers and sandwiches made from leftover meats and poultry, egg or tuna salad along with some fresh cut vegetables or the baby carrots.

Dinners included meat lasagna, chili, meatloaf, baked chicken, salmon and roasted turkey. Each dinner included lots of vegetables and a small salad each night. The turkey proved to be the biggest bargain of the week at just 0.49-cents per pound, providing nutrient-density and high quality protein in a number of potential meal occassions.

Snacks were limited to fresh and frozen fruits, the apples topped with peanut butter as a treat, perhaps even milk-based smoothies made with the strawberries.

The only beverage affordable was tap water - free - and one gallon of whole milk for the week. The budget simply did not allow soda, juice or coffee or tea.

In many instances I chose the whole milk variety of a food (milk, ricotta cheese) or the tuna in oil over the tuna in water for both calories and nutrient-profile. When you're hoping to feed a family of four on a tight budget, every calorie counts and every last nutrient is critical - and whole milk varieties offer better nutrient profiles for vitamins and minerals than do processed, low-fat varieties along with more calories to sate appetite; the same hold true for tuna in oil.

With very few exceptions, the use of coupons would be useless - the fresh and even frozen foods included in this budget are usually not discounted with coupons. This isn't to say I wouldn't recommend keeping your eye open to coupons available - the seasoning packets, salad dressing, keilbasa, peanut butter, tuna and some other items all potentially could have coupons available to save money and allow for more food to be included with the savings.

I often advise trying to find savings at a warehouse club. But, honestly, with a budget of just %$74.76 for a week, I'm not sure how a virtual family of four could afford the $45 membership fee. Over the course of the year, I'm not convinced that the family would realize a $45 savings from their food bill when you consider the limited availability of fresh foods at the wholesale clubs and the large packages that must be purchased for the savings. The potential for waste and limitation on variety due to the actual cost of the larger packs may be greater than the savings at the end of the day. This is something that should be investigated and some time spent before one invests in the membership fee - will you use it often enough, have the ability to buy the fresh foods and not see more waste with larger packs, and still have a good variety in your menu - with the membership or not?

One big discrepancy in prices was between the fresh and frozen vegetables and fruits. It is important for anyone on a strict budget to comparison shop the produce section and the frozen section before making their final purchases! While the fresh strawberries were on sale for $3.99 a pound, this was more than twice as expensive as the frozen strawberries. While the fresh broccoli was $1.29 a pound, a minor difference from the frozen chopped broccoli for $1.00 - it was with the long stems which would have resulted in more waste per pound, so the frozen broccoli was still a much better bargain.

Lastly is the very real limitation of the social aspect of sharing a meal with family and friends that is strictly curtailed on such a tight budget. Eating out is next to impossible and buying enough food to entertain at home is also limited. Here is where I think some creativity can help - perhaps family and friends can plan to get together once a week and share the costs without stating it as such? Potluck dinners, picnics, tapas parties, etc. can all help bring together friends and family to share a meal and everyone brings something to contribute to the meal and that may help keep a budget while allowing for that precious together-time we all need with those close to us.

By no means is the menu I put together to be considered nutritionally complete. I have not run the items through software to determine the nutrient profile - but would guess it is adequate in most nutrients, although I am sure it is most likely deficient in at least one essential nutrient. My goal wasn't, unfortunately a nutrient-dense menu on a budget, but a menu that was mostly fresh, whole foods.

That said, with good planning, I will assert that it is possible to put together a nutritionally-dense menu - time is the key along with selecting nutrient-dense foods that are mostly whole foods. As one of my readers emailed, "we don't live in a perfect world" - and I agree...striving for the best you can afford, with most food being fresh, whole food is about as perfect as we can get!

Healthy Aging - Nutrition, Lifestyle and Activity

Time magazine in its October 17, 2005 issue has Dr. Andrew Weil, MD on its cover to promote his new book, "Healthy Aging: A Lifelong Guide to Your Physical and Spiritual Well Being" and provide readers with an exclusive excerpt from the book.

In the excerpt he provides insight into the aging process after noting differences among the aging of his former classmates at a school reunion, "Why are some individuals so outwardly altered by time and others not? Or, in other words, why is there often a discrepancy between chronological age and biological age? I believe the answer has to do with complex interactions of genetics and environment. I also believe, on the basis of evidence I have reviewed, we actually have control over some of those factors."

On these points, I am in total agreement with Dr. Weil. I also agree with him that aging is a process - a natural process - and fighting it rather than doing all you can to be healthy as you age is a losing proposition. Bottom line - if you do everything you can to mask aging and do things that keep the outside looking good, like plastic surgery, that still may not be mean you're not falling apart on the inside! Aging well, with health, requires a total approach to your well-being inside and out.

That said, my disagreements with Dr. Weil are found mostly in his recommendations for diet. The only thing I find agreement with is his statement that "It should be obvious by now that diets don't work, except in the short term. By definition, diets are regimens that eventually end, and when people go off them the weight that was lost is almost always regained."

He continues to explain his dietary philosophy as an "anti-inflammatory" dietary approach. Sounds good since we know that inflammation, especially chronic low-level inflammation, is deadly. "I believe without question that diet influences inflammation. The food choices we make can determine whether we are in a proinflammatory state or in an anti-inflammatory one. The anti-inflammatory diet on these pages offers specific recommendations for foods to include and foods to avoid."

It is in his recommendations that I depart from agreement. Dr. Weil has long been an advocate of a low-fat diet - and he continues to be.

He recommends complex carbohydrates, but at intake levels that still are going to wreck havoc on insulin and blood sugar, because even though complex, they're still converted to blood glucose, albeit slower than refined carbohydrates, but blood glucose nonetheless. And this is the trap that many well intentioned physicians find themselves stuck in - carbohydrate, refined or complex, is metabolized to glucose in the body.

This doesn't mean you shouldn't eat any carbohydrates - what it does mean is that you should be choosy about your carbohydrates and control how many you do include each day to support insulin and blood sugar stability. Your best bets are non-starchy vegetables, which are rich in nutrients, fiber and relatively low in carbohydrate per serving. Good options also include nuts and seeds, rich in essential fatty acids, fiber and protein, while again low in carbohydrate per serving. And let's not forget the lower glycemic load fruits, like berries and melons - these are rich with vitamins and minerals, fiber and offer that sweetness we enjoy without spiking blood sugar or insulin!

The carbohydrates to carefully consider include your starchy vegetables, grains and high GI fruits, like bananas. These do not need to be eliminated, but limiting portion size and including protein and fat within a meal where a smaller portion of these is eaten will help to limit insulin and blood sugar spikes.

Then, of course, there are the "no-no" carbohydrates - refined grains, refined processed, packaged foods and any highly processed food with a high carbohydrate or added sugar count in the nutrition facts panel. These are best viewed as anti-nutrients that offer your body nothing more than empty calories and quick fat storage.

And your long-term dietary approach isn't just about carbohydrates. You require essential amino acids (EAAs) each day from high quality protein sources and essential fatty acids (EFAs) from high quality fat sources. Unlike carbohydrate, both protein and fat are essential in your diet - that is critical to include each day, for without adequate intake you will deprive your body of what it requires to function properly!

So, while Dr. Weil's book makes good points about lifestyle - exercise, stress reduction, rest and sleep - in the aging process and overall health, he misses the boat in his nutritional advice by continuing with his low-fat diet philosophy, which continues to be unsupported by the scientific evidence as the end-all-be-all dietary approach for the general population.

The Deception of Statistics

In a review study in the July 2005 British Journal of Medicine: Changes in dietary fat and declining coronary heart disease in Poland: population based study, Zatonski and Willett explore the impact of dietary changes in Poland on coronary heart disease.

They suggest that the reduction of over a third of coronary heart disease in Poland between 1990 and 2002 is attributed to increased consumption of polyunsaturated fats, with a reduction in saturated fats. They conclude this after accounting for and including estimates that show a small reduction in smoking and an increase in the intake of imported fruit, neither of which they believe were large enough to have made the impact on the significant declines in cardiovascular disease seen.

Before I continue, let's be clear here - the reserachers concluded it was a decrease in saturated fat intake and an increase in polyunsaturated fat intake that was the reason for the decrease in cardiovascular disease in men (38%) and women (42%) in Poland.

So how much of a decrease in saturated fat are we talking about here?

What the researchers found was that a decrease in saturated fat, coupled with an increase in polyunsaturated fat (which changed the ratio of the two combined by 70%) was the main reason for the improvements in cardiovascular health.

The researchers build their case to reduce saturated fat by pointing out that statistically saturated fat intake decreased by 7% in the time period investigated. Statistically, 7% seems like a significant amount, however, in real grams of saturated fat intake this was a very minor decrease from an average of 44.8g per day to 41.5g per day, or 30 less calories from saturated fat per day.

They continue to build their case by showing that the statistical increase in consumption of polyunsaturated fat intake happened at the same time - it rose 57% in the time period, but in real terms was an increase from 14.89g per day to 23.3g per day, or an additional 75 calories from polyunsaturated fats.

Now here is where things get a bit interesting.

The data isn't "consumption data" from what people actually eat, but "availability data" on what foods are available to eat. And, even with what is best a "minor" decrease in saturated fat intake, at the lowered intake of 41.5g per day, such an intake of saturated fat is still HIGH compared with our dietary guideline of less than 10% of calories from saturated fat.

Within our own guidelines we have maximum levels of saturated fat intake provided at various calorie intake to use as a guide to meal planning - for example, at 2000-calories, 10% or less saturated fat is 20g or less in a day; at 2500-calories, 10% or less saturated fat is 25g or less. Unless these folks were eating more than 3735-calories per day, they were consuming more than 10% of their calories from saturated fat if they're eating 41.5g a day!

In this study, the researchers never tell us what the percentage of calories are from total or saturated fat, but based on how many calories must be eaten to maintain less than 10% of calories from saturated fat as is recommended in the United States, it's easy to calculate that this population is eating more than 10% of their calories from saturated fat due to the high calorie intake that must be eaten to eat less than 10% of calories from saturated fat.

So, even though it is unstated by the researchers, this population is eating a high fat diet. There is just no way around it when you do the math.

Now, even with the minor decrease in saturated fat, the actual fat intake from saturated fat and polyunsaturated fat increased when the two sources are taken together. In fact, the increase is from 59.6g per day from saturated and polyunsaturated to 64.8g per day from both. So this population increased their intake of fat from saturated and polyunsaturated fats combined.

The researchers do not reveal what the monounsaturated fat intake is, so we have no way of knowing if total fat increased or not. What we do know however, is that generally monounsaturated fat intake is usually almost twice that of polyunsaturated due to the monounsaturated fats in oils typically higher in polyunsaturated fats.

In this study, the researchers noted that the increased oils eaten were rapeseed (canola) and soya (soybean) oils and a quick look at the fatty acid profile of these oils shows that 100g of these oils contain 55.3g of monounsaturated fat and 32.4g of polyunsaturated fat along with 7.8g of saturated fat. So if the population consumed 23.3g of polyunsaturated fat, it is safe to assume they consumed at least 39g of monounsaturated fats in their overall dietary intake of fats if we use the canola and soybean oil profile.

Let's do some quick math...

  • 41.5g known from saturated fat
  • 23.3g known from polyunsaturated fat
  • approximately 39g of monounsaturated fat
  • Total = 103.8g of fat in a day, or 934.2 calories from fat.

The researchers stated in their conclusion, "The experience of Poland is consistent with epidemiological and clinical evidence(4) indicating that mortality due to coronary heart disease can be reduced by partly replacing dietary saturated fats with polyunsaturated fats while maintaining a low intake of trans fatty acids."

Oh really?

If this population is indeed eating 2,500-calories each day on average for both men and women, approximately 934 from fat represents 37.3% of calories from fat and 15% of calories from saturated fat.

Now some may say, but you simply don't know the calories or the monounsaturated fat intake. Well, guess what? The researchers don't know either - they used food availability data to build their case, not actual food consumption data, so my guess here is as good as theirs is! And no matter how you slice it, 41.5g from saturated fat per day is (when compared with our dietary guidelines) a high intake of saturated fat!

I wondered how far off I might be in declaring this a high-fat diet and looked to see if any other studies are available based on consumption data and that give some hard percentage of calories from fat(s) in the diet. Sure enough, in a Polish medical journal (Zaklad Epidemiologii) data was published in 2003 that looked at dietary habits during the period of 1993-2001.

The findings support my assertions:

  • Total fat intake 37.8% in men 2001
  • Total fat intake 35.9% in women 2001

If anything, the data here supports eating a nutrient-dense diet, rich with animal fats and fruits and vegetables.

The data is best viewed by what is not explored - total fruit consumption (the researchers looked only at imported fruits), vegetable consumption, reduction in stress levels over the period of time due to governmental policy changes, living standard changes, etc. - each of these is a confounding factor that remains unexplored and each of these confounding factors has indeed been highlighted in critical citations of this review study.

In this month's journal, Uffe Ravnskov states in his letter, "Zatonski's and Willett's statement that their finding is supported by epidemiological and clinical evidence is not true either. In a review of all cohort and case-control studies, heart patients had eaten more saturated fat than had healthy controls in three cohorts, but in one cohort they had eaten less, and in 22 cohorts and in six case-control studies no difference was found."

In July's journal, another letter pointed to the economic changes not included in the review data, "Lock and McKee challenge these claims and discuss the likelihood of Europe's agricultural policy damaging the progress achieved between 1991 and 2002. "

In July's journal, a commentary stated that the braod range of fruits and vegetables consumed must be accounted for - "The paper clearly shows that dietary change had a major impact on cardiovascular mortality, but the authors, by considering changes in the intake of imported fruit only, have underestimated changes in consumption of the full range of fruits and vegetables known to have significant cardioprotective effects. The introduction of a market economy had major consequences for domestic production and the retail sector. There has been large investment in agriculture, with central European producers now integrated with wider European agricultural production. Much non-traditional produce is now grown locally, and fruits and vegetables are available to consumers throughout the year. Consequently, to capture the full impact of changing availability of food since the 1990s, the changes in both the total and the seasonal consumption of all fruits and vegetables need to be taken into account."

So, while some researchers continue to insist that saturated fats are a villan in our diet and will grasp at straws for some way to prove that reducing saturated fat is cadioprotective, this particular study is no more than data manipulation and statistical deception. 41.5g of saturated fat consumed daily is not low-fat and is not 10% or less calories each day from saturated fat. In this paper saying such is avoided by sticking with the statistics rather than the cold hard real numbers in grams and calories each day.

Who are they trying to kid? Are we really supposed to believe that reducing saturated fat intake by a mere 3.3g per day is going to lead to a decline in heart disease by 38-42%? This reduction while still consuming what could well be 15% of total calories from saturated fat?

I don't know about you, but this data strongly suggests that a change in the quality of the diet and imporvements in living standard - even with a high intake of saturated fat - is cardioprotective! This populations diet is not low-fat, is not low in saturated fat - so, don't let the statistics blind you into thinking it is!

Monday, October 17, 2005

Protein and Satiety

As a nation, we seem to always be seeking the "easy fix" or the "next big thing" when it comes to losing weight, so I wasn't surprised by the headline "Protein is the new diet hook" in yesterday's USA Today.

The article reviewed recent data from a study out of Australia that was presented this weekend at the North American Association for the Study of Obesity (NAASO) conference. The study was published in the Journal of Clinical Endocrinology & Metabolism in September and found that higher protein intake increased satiety in those on a weight-loss diet.

So, let's take a look at the study.

The researchers followed 57 overweight/obese, hyperinsulinemic individuals (25-men and 32-women) for 12-weeks of weight loss and 4-weeks of weight maintenance. They were randomized into two groups and each group was given a 1,400-calorie-per-day diet to follow that was either "high protein" or "high fat."

It is here that it is important to understand the macronutrient mix they were allowed:
  • Group 1 - High-Protein - 1400 Calories per Day
    29% Fat, 34% Protein, 37% Carbohydrate
    406 fat calories, 476 protein calories, 518 carbohydrate calories
    45g fat, 119g protein, 129.5g carbohydrate
  • Group 2 - High Fat - 1400 Calories per Day
    45% Fat, 18% Protein, 37% Carbohydrate
    630 fat calories, 252 protein calories, 518 carbohydrate calories
    70g of fat, 63g protein, 129.5g carbohydrate

Both groups lost about the same amount of weight and improvements in fasting and postprandial insulin and glucose occurred independently of diet composition. The big difference between the two groups was the decreased hunger reported by those on the "high protein" diet.

While the results are indeed interesting and show that protein is a factor in satiety, the researchers missed opportunities to explore how macronutrient mix does affect appetite, weight loss and markers like insulin and glucose. The researchers also failed to provide adequate nutrients to the participants.

In this study, one of the two groups was protein deficient.

Yes, I said it - 63g of protein each day is simply not enough protein intake for an obese individual and that is what the "high fat" group had for their protein intake. In fact, it is barely enough protein for a normal weight, average height woman....for an obese male or female this amount of protein is deficient - there's no way around it.

In this study, the other group was fat deficient.

Yes, I really said that too - in the group eating 29% fat calories, their fat intake was restricted to just 45g per day at 1400 calories per day. It is safe to assume that this level of fat intake failed to meet or exceed their essential fatty acid requirements for each day.

So what we really have here in this study is a comparison of two nutritional deficiency diets. Neither is healthy or should be recommended.

I've said it before and I'll say it again - the key to weight management and health is nutrient-density and adequate calories to support basal metabolism during weight loss. Until researchers shift their focus from percentage of calories in the diet of macronutrients - fat, protein and carbohydrate - we will continue to fail in our dietary recommendations and fail to provide the general public with usable information to not only lose weight but maintain their weight loss and optimize their health in the long-term. Until researchers address the real calorie needs for the overweight or obese and stop placing these individuals on hypocaloric starvation level diets, weight gain after weight loss is inevitable and the obesity epidemic will continue to be problematic in our country.

I would bet money that every last person in this study gained back the weight they lost within the 90-days following the study end date. Why? They weren't given the tools to eat a nutrient-dense diet for the short or long-term.

Friday, October 14, 2005

Economics of Obesity

We read a lot about how eating well costs more money; how fresh foods like produce and poultry are more expensive than packaged, processed foods. Take for example a recent quote in the Houston Chronicle article, "Eating healthy harder for poor":

"Energy-dense foods rich in starch, sugar or fat are the cheapest option for the consumer," said Adam Drewnowski, director of the Center for Public Health Nutrition at the University of Washington. "As long as the healthier lean meats, fish and fresh produce are more expensive, obesity will continue to be a problem for the working poor."

The article also added that, "Many parents, sometimes working two jobs, don't have the time to cook healthy meals. And fresh food is more costly."

So, the conventional wisdom asserts that two issues are undermining the working poor's ability to eat well:
  • Time crunch
  • Fresh food is more expensive

I've been wondering how true these notions really are. Is it really more expensive to eat healthful food or not?

So, over the next week I'm taking your emails at to get your insights and ideas, while I work on investigating (non-scientific to be clear) on whether it is possible to eat better, healthier foods for the same or less budget, and what it takes to do that. In a blog entry next week, I'll write about if it can be done and share with you how to do it if it is indeed possible!

In the meantime, send me your emails with your ideas and tips on eating well on a budget and I'll share the best ones in the blog entry too!