Does Maternal Vitamin D Affect Childhood ADHD?

Can ADHD Be Prevented?

vitamin dIf you are pregnant, or of childbearing age, should you be supplementing with vitamin D? Increasingly, the answer appears to be yes.

1) Based on blood 25-hydroxy vitamin D levels (considered the most accurate marker of vitamin D status):

    • 8-11% of pregnant women in the US are deficient in vitamin D (<30 nmol/L).
    • 25% of pregnant women have insufficient vitamin D status (30-49 nmol/L).

In short, that means around 1/3 of pregnant women in the US have insufficient or deficient levels of vitamin D. The effect of inadequate vitamin D during pregnancy is not just an academic question.

2) The Cochrane Collaboration (considered the gold standard for evidence-based medicine) has recently concluded that supplementation with vitamin D reduces the risk of significant complications during pregnancy.

3) Another recent study found that inadequate vitamin D status during pregnancy delayed several neurodevelopmental milestones in early childhood, including gross motor skills, fine motor skills, and social development.

If neurodevelopmental milestones are affected, what about ADHD? Here the evidence is not as clear. Some studies have concluded that vitamin D deficiency during pregnancy increases the risk of ADHD in the offspring. Other studies have concluded there is no effect of vitamin D deficiency on ADHD.

Why the discrepancy between studies?

  • Most of the previous studies have been small. Simply put, there were too few children in the study to make statistically reliable conclusions.
  • Most of the studies measured maternal 25-hydroxyvitamin D levels in the third trimester or in chord blood at birth. However, it is during early pregnancy that critical steps in the development of the nervous system take place.

Thus, there is a critical need for larger studies that measure maternal vitamin D status in the first trimester of pregnancy. This study (M Sucksdorff et al, Journal of the American Academy of Child & Adolescent Psychiatry, 2020, in press) was designed to fill that need.

How Was The Study Done?

Clinical StudyThis study compared 1,067 Finnish children born between 1998 and 1999 who were subsequently diagnosed with ADHD and 1,067 matched controls without ADHD. There were several reasons for choosing this experimental group.

  • Finland is among the northernmost European countries, so sun exposure during the winter is significantly less than for the United States and most other European countries. This time period also preceded the universal supplementation with vitamin D for pregnant women that was instituted in 2004.

Consequently, maternal 25-hydroxyvitamin D levels were significantly lower than in most other countries. This means that a significant percentage of pregnant women were deficient in vitamin D, something not seen in most other studies. For example:

    • 49% of pregnant women in Finland were deficient in vitamin D (25-hydoxyvitamin D <30 nmol/L) compared to 8-11% in the United States.
    • 33% of pregnant women in Finland had insufficient vitamin D status (25-hydroxyvitamin D 30-49.9 nmol/L) compared to 25% in the United States.
  • Finland, like many European countries, keeps detailed health records on its citizens. For example:
    • The Finnish Prenatal Study collected data, including maternal 25-hydroxyvitamin D levels during the first trimester), for all live births between 1991 and 2005.
    • The Care Register for Health Care recorded, among other things, all diagnoses of ADHD through 2011.

Thus, this study was ideally positioned to compare maternal 25-hydroxyvitamin D levels during the first trimester of pregnancy with a subsequent diagnosis of ADHD in the offspring. The long-term follow-up was important to this study because the average age of ADHD diagnosis was 7 years (range = 2-14 years).

Does Maternal Vitamin D Affect Childhood ADHD?

Child With ADHDThe answer to this question appears to be a clear, yes.

If you divide maternal vitamin D levels into quintiles:

  • Offspring of mothers in the lowest vitamin D quintile (25-hydroxyvitamin D of 7.5-21.9 nmol/L) were 53% more likely to develop ADHD than offspring of mothers in the highest vitamin D quintile (49.5-132.5 nmol/L).

When you divide maternal vitamin D levels by the standard designations of deficient (<30 nmol/L), insufficient (30-49.9 nmol/L), and sufficient (≥50 nmol/L):

  • Offspring of mothers who were deficient in vitamin D were 34% more likely to develop ADHD than children of mothers with sufficient vitamin D status.

The authors concluded: “This is the first population-based study to demonstrate an association between low maternal vitamin D during the first trimester of pregnancy and an elevated risk for ADHD diagnosis in offspring. If these findings are replicated, they may have public health implications for vitamin D supplementation and perhaps changing lifestyle behaviors during pregnancy to ensure optimal maternal vitamin D levels.”

Can ADHD Be Prevented?

Child Raising HandI realize that this is an emotionally charged title. If you have a child with ADHD, the last thing I want is for you to feel guilty about something you may not have done. So, let me start by acknowledging that there are genetic and environmental risk factors for ADHD that you cannot control. That means you could have done everything right during pregnancy and still have a child who develops ADHD.

Having said that, let’s examine things that can be done to reduce the risk of giving birth to a child who will develop ADHD, starting with vitamin D. There are two aspects of this study that are important to keep in mind.

#1: The increased risk of giving birth to a child who develops ADHD was only seen for women who were vitamin D deficient. While vitamin D deficiency is only found in 8-11% of pregnant mothers in the United States, that is an average number. It is more useful to ask who is most likely to be vitamin D deficient in this country. For example:

  • Fatty fish and vitamin D-fortified dairy products are the most important food sources of vitamin D. Fatty fish are not everyone’s favorite and may be too expensive for those on a tight budget. Many people are lactose intolerant or avoid milk for other reasons. If you are not eating these foods, you may not be getting enough vitamin D from your diet. This is particularly true for vegans.
  • If you have darker colored skin, you may have trouble making enough vitamin D from sunlight. If you are also lactose intolerant, you are in double trouble with respect to vitamin D sufficiency.
  • Obesity affects the distribution of vitamin D in the body. So, if you are overweight, you may have low 25-hydroxyvitamin D levels in your blood.
  • The vitamin D RDA for pregnant and lactating women is 600 IU, but many multivitamin and prenatal supplements only provide 400 IU. If you are pregnant or of childbearing age, it is a good idea to look for a multivitamin or prenatal supplement that provides at least 600 IU, especially if you are in one of the high risk groups listed above.
  • Some experts recommend 2,000 to 4,000 IU of supplemental vitamin D. I would not recommend exceeding that amount without discussing it with your health care provider first.
  • Finally, for reasons we do not understand, some people have a difficult time converting vitamin D to the active 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D in their bodies. If you are pregnant or of childbearing age, it is a good idea to have your blood 25-hydroxyvitamin D levels determined and discuss with your health care provider how much vitamin D you should be taking. Many people need more than 600 IU to reach vitamin D sufficiency status.

#2: Maternal vitamin D deficiency has a relatively small effect (34%) on the risk of the offspring developing ADHD. That means assuring adequate vitamin D status during pregnancy should be part of a holistic approach for reducing ADHD risk. Other factors to consider are:

  • Low maternal folate and omega-3 status.
  • Smoking, drug, and alcohol use.
  • Obesity.
  • Sodas and highly processed foods.

Alone, each of these factors has a small and uncertain influence on the risk of your child developing ADHD. Together, they may play a significant role in determining your child’s risk of developing ADHD.

In closing, there are three take-home lessons I want to leave you with:

1) The first is that there is no “magic bullet”. There is no single action you can take during pregnancy that will dramatically reduce your risk of giving birth to a child who will develop ADHD. Improving your vitamin D, folate, and omega-3 status; avoiding cigarettes, drugs, and alcohol; achieving a healthy weight; and eating a healthy diet are all part of a holistic approach for reducing the risk of your child developing ADHD.

2) The second is that we should not think of these actions solely in terms of reducing ADHD risk. Each of these actions will lead to a healthier pregnancy and a healthier child in many other ways.

3) Finally, if you have a child with ADHD and would like to reduce the symptoms without drugs, I recommend this article.

The Bottom Line

A recent study looked at the correlation between maternal vitamin D status during the first trimester of pregnancy and the risk of ADHD in the offspring. The study found:

  • Offspring of mothers who were deficient in vitamin D were 34% more likely to develop ADHD than children of mothers with sufficient vitamin D status.

The authors concluded: “This is the first population-based study to demonstrate an association between low maternal vitamin D during the first trimester of pregnancy and an elevated risk for ADHD diagnosis in offspring. If these findings are replicated, they may have public health implications for vitamin D supplementation and perhaps changing lifestyle behaviors during pregnancy to ensure optimal maternal vitamin D levels.”

In the article above I discuss what this study means for you and other factors that increase the risk of giving birth to a child who will develop ADHD.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

 

Preparing For The New Normal

Can Supplements Strengthen My Immune System?

COVID-19The United States and the rest of the world are facing the biggest challenge of our lifetimes. COVID-19 has killed hundreds of thousands of people and decimated economies around the world.

As of the publication date of this article we have no vaccine and only one treatment option that appears to be about 30% effective in a preliminary clinical trial. People are scared.

The question I get asked most often is: “Can supplements protect me from COVID-19”. That’s not a question I can answer with confidence. The few studies we have are small and preliminary. Plus, there is too much we still do not know about COVID-19.

However, there are studies about how diet and supplements affect the immune system. I can answer the question, “Can Supplements Strengthen My Immune System”, with confidence. That will be the focus of this article.

However, before covering that, let me take an objective look at what our “New Normal” will be like and how we can prepare for it.

Preparing For The New Normal

ProfessorAs a scientist I am appalled by the divisive and hyper-partisan arguments about how we should be handling the COVID-19 pandemic. This is a time when our country should be united against a common enemy. Instead I see myths and lies propagated on both sides of this important issue.

The press only magnifies the problem by repeating the myths without fact checking. Whether they are on the left or the right, the media only repeats myths that fit their narrative. As a result, people like you are confused and scared.

Let me try to give you a more objective and scientific view of what the “New Normal” will look like, and how we can prepare for it.

Let’s start with one of the biggest arguments over the past few weeks – when should we reopen our country. This argument is based on the myth that if we wait long enough, the virus will be gone, and life can return to normal.

Nothing could be further from the truth. In reality viruses don’t work that way. They continue to circulate through the population at low levels. Whenever we emerge from our homes and resume our daily lives, the virus will be lurking. There will be flare-ups. There will be hot spots. There will be deaths. And the press will report every one.

So, the question should not be when we emerge. It should be how we emerge. We should emerge cautiously. We should continue to take appropriate precautions. These precautions will become our “New Normal” until we have an effective vaccine. By now, you probably have the CDC precautions memorized, but let me repeat them here:

  • If you are sick, stay home until you recover. If your symptoms worsen, contact your doctor right away.
  • If you are exposed, get tested right away and self-quarantine for 14 days if you test positive.
  • When you go out, wear a face mask and practice social distancing. When you get home, wash your hands in soap and water for 20”.
  • For now, we will need to avoid the customary handshake (and if you are from the South like me, the customary hug).
  • If you are very old or very sick, you should stay home as much as possible. If you have a loved one in this category, you should do everything in your power to protect them from exposure.
  • The guideline that is hardest to project into the future is the one on crowd size. It is hard to predict what the CDC will recommend about crowd size as part of our “New Normal” a few months from now. However, because this virus is extremely contagious, it may be risky to attend any gatherings where there are large, tightly packed crowds for the foreseeable future. This could include some of our favorite things – like movies, live theater, night clubs, and sporting events.Myth Versus Facts

Finally, there is another big myth, namely that the virus will simply disappear once we have a vaccine. Vaccines reduce your risk of exposure because fewer people are carriers of the virus. However, coronaviruses never disappear. They continue to circulate in the population for decades.

Even after we have a vaccine, people will still get sick from COVID-19. People will still die from COVID-19. The difference is that we will no longer hear about COVID-19 cases and deaths on the nightly news. Those cases and deaths will just become part of the statistics that the CDC collects on flu-like illnesses each year – and everyone ignores.

Now that I have discussed what the “New Normal” will look like and summarized the CDC guidelines for reducing your exposure to COVID-19 as the lockdown eases, let me add another guideline of my own:

  • Keep your immune system as strong as possible.

Why Is Keeping Your Immune System Strong Important?

strong immune systemIt is no secret that the media likes to focus on bad news. It is the bad news that draws people in and keeps them coming back for more.

Pandemics are no different. It doesn’t matter whether we are talking about the Spanish flu, SARS, MERS, or COVID-19. We focus on cases and deaths – the bad news. We ignore the good news – there are millions of people who were infected and had no symptoms.

However, if you have been listening closely to what the experts have been saying rather than relying on the media for your information, the good news is obvious.

  • 80-85% of people who have tested positive for COVID-19 have mild or moderate symptoms. Their symptoms are no worse than they experience with the seasonal flu.
  • Preliminary antibody tests suggest that the number of people infected with COVID-19 who experience no symptoms may be 10 to 40 times higher than reported cases.
  • The experts say that the difference is a strong immune system. They tell us that it is people with weakened immune systems that suffer and die from COVID-19.

So, how do you keep your immune system strong? Let’s start by looking at the role of supplementation.

Can Supplements Strengthen My Immune System?

MultivitaminsThose of you who follow me know that I consider supplementation as just one aspect of a holistic approach to health. However, I am starting with supplements because the question I am often asked these days is: “Can supplements protect me from COVID-19”.

As I said at the beginning of this article, that is not a question I can answer with confidence. Instead, the question you should be asking is, “Can Supplements Strengthen My Immune System?”

As I mentioned above, the experts are telling us that it is people with weakened immune systems who suffer and die from COVID-19. That means it is important to keep our immune system as strong as possible.

How do we do that? Here is what an international group of experts said in a recent review (PC Calder et al, Nutrients, 12, 1181-1200, 2020).

1) “A wealth of mechanistic and clinical data show that vitamins A, B6, B12, C, D, E, and folate; trace elements zinc, iron, selenium, magnesium, and copper; and omega-3 fatty acids EPA and DHA play important and complementary roles in supporting the immune system.”

2) “Inadequate intake and status of these nutrients are widespread, leading to a decrease in resistance to infections, and an increase in disease burden.”

They then made the following recommendations:

1) Supplementation with the above micronutrients and omega-3 fatty acids is a safe, effective, and low-cost strategy to help support optimal immune function.

    • They recommended 100% of the RDA for vitamins A, B6, B12, C, D, E, and folate and minerals zinc, iron, selenium, magnesium, and copper in addition to the consumption of a well-balanced diet.
    • They recommended 250 mg/day of EPA + DHA.

2) Supplementation above the RDA for vitamins C and D is warranted.

    • They recommend 200 mg/day of vitamin C for healthy individuals and 1-2 g/day for individuals who are sick.
    • They recommend 2000 IU/day (50 ug/day) for vitamin D.

3) Public health officials are encouraged to include nutritional strategies in their recommendations to improve public health.

Their recommendations could be met by a multivitamin that provides all the micronutrients they recommend, an omega-3 supplement, and extra vitamins C and D.

What Else Should I Do To Strengthen My Immune System?

healthy foodsAs I said above, supplementation is only one part of a holistic approach to a strong immune system. Here are the other components of a holistic approach:

1) It starts with a healthy diet.

    • Eat foods from all 5 food groups.
    • Eat plenty of fruits and vegetables. They provide antioxidants and phytonutrients that are important for our immune system.
    • Eat plenty of high fiber foods. Include whole grains and beans in addition to fruits and vegetables. That’s because the friendly gut bacteria that strengthen our immune system need a variety of fibers from different food sources to feed on.
    • Eat oily fish on a regular basis.
    • Avoid sodas, sugary foods, and highly processed foods.
    • Avoid high fat diets

2) Get adequate sleep. For most of us, that means 7-8 hours of sleep a night.

3) Maintain a healthy weight.

4) Get adequate exercise. Aim for a minimum of 150 minutes of moderate intensity exercise each week.

5) Manage stress and anxiety in healthy ways. Yes, that means if you let the news about COVID-19 cause anxiety, you are weakening your immune system. You may want to turn off the news and try prayer, meditation, yoga, or whatever relieves stress for you.

The Bottom Line

In this article, I summarized the “New Normal” we face as we emerge from lockdown and how to navigate the new normal as safely as possible. If I were to summarize this article in a few short sentences, this is what I would say:

Until we have an effective vaccine the “New Normal” is a world in which a dangerous virus is lurking in the community, waiting to strike the unprepared.

Forget all the angry rhetoric about when we should emerge from lockdown. The important question is not when we emerge. It is how we emerge.

We don’t need to stay huddled in our homes, fearful to leave, unless we are very old or very sick.

We do need to take appropriate precautions when we leave home based on the recommendations of the CDC. None of us are invincible as far as this virus is concerned. More importantly, if we bring the virus home, we may kill the very people we love the most. We need to follow the guidelines.

We should also make sure that our immune system is as strong as possible through a holistic combination of diet, supplementation, adequate sleep, exercise, weight management, and stress reduction.

For more information on CDC COVID-19 Guidelines, click here.

For more details about preparing for the new normal and diet & supplementation recommendations, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Does Diet Affect Sperm Quality?

Do Real Men Eat Meat?

Enjoying Red MeatMeat has a certain mystique among some men. They believe real men eat meat, especially red meat. The belief is that eating red meat makes them bigger, stronger, and more virile. In that world view, vegetarianism is effeminate.

How much of that is true? Let’s start by looking at the bigger and stronger part:

  • Animal proteins are higher in the branched chain amino acids, especially leucine, which help drive the increase in muscle mass associated with exercise. However, meat protein is digested slowly.
  • Milk protein is also high in branched chain amino acids and is digested more quickly. That’s why many body building supplements are whey protein based.
  • In addition, leucine is now being added to some of the plant protein supplements. Those supplements are often as effective as whey protein supplements at driving the increase in muscle mass associated with exercise

But what about virility? Does meat make men more virile? Fortunately, we now have an answer to these questions. A recent study (L Nassan et al., JAMA Network Open, 2020; 3(2) :e1921610) has looked at the effect of diet on sperm count and sperm quality.

How Was The Study Done?

Clinical StudyIn Denmark, all men are required to undergo a physical examination around age 18 to determine their fitness for military service. Research staff at the University Department of Growth and Reproduction at Rigshospitalet in Copenhagen approached young men undergoing their physical exams and invited them to participate in this study.

The men filled in a food frequency questionnaire, answered questions about their lifestyle and medical history and provided semen and blood samples for the study prior to undergoing their physical exam. 2935 men who were unaware of their fertility status and not using anabolic steroids were included in the data analysis.

The average age of participants in the study was 19 and 78% of them were of normal body weight.

The participants were divided into four groups based on their diet:

1.     Western Diet characterized by a higher intake of pizza, French fries, processed and red meats, snacks, refined grains, sugary beverages and sweets.

2.     Danish Diet characterized by a higher intake of cold processed meats, whole grains, fruits, mayonnaise, cold fish, condiments, and dairy.

3.     Vegetarian Diet characterized by a higher intake of vegetables, soymilk, and eggs, without red meat or chicken.

4.     Prudent (Healthy) Diet characterized by a higher intake of fish, chicken, vegetables, fruit, nuts, and water.

The effect of these diets on sperm count and sperm quality were compared.

Does Diet Affect Sperm Quality?

SpermWhen the authors measured sperm counts in the study participants, the results were as follows:

  • Greatest adherence to a prudent diet resulted in a sperm count of 167 million.
  • Greatest adherence to a vegetarian diet resulted in a sperm count of 151 million.
  • Greatest adherence to a Danish diet resulted in a sperm count of 146 million.
  • Greatest adherence to a Western diet resulted in a sperm count of only 122 million -27% lower than for men eating a prudent diet.
  • Similar results were reported for measure of sperm quality, such as sperm motility (how fast the sperm can swim) and normal sperm morphology (sperm without visible defects).
  • These results are similar to several earlier studies showing that men eating a healthy diet have greater sperm count and sperm quality.

The authors concluded: “Our findings support the evidence that adhering to generally healthy diet patterns is associated with better semen quality and more favorable markers of testicular function. Because diet is modifiable, these results suggest the possibility of using dietary intervention as a potential approach to improving testicular function in men of reproductive age.”

Do Real Men Eat Meat?

SteakNow it is time to come back to the original question, “Do real men eat meat”. Or more specifically, does red meat consumption increase virility? Of course, the whole question of whether a single food affects virility, or any other aspect of manliness, is bogus.

Individual foods don’t affect our health. Diets do. So, let’s review how diets affect men’s sperm count and sperm quality.

  • The highest sperm count and sperm quality was associated with the prudent diet. This diet relied primarily on fish and chicken as protein sources but did not exclude red meat. It was also a diet high in vegetables, fruits, nuts, and water (in place of sugary beverages).
  • The second highest sperm count and sperm quality was associated with the vegetarian diet. This diet relied on beans and eggs as the primary protein sources. It specifically excluded red meat and chicken but did not exclude fish. It was also high in fruits and nuts. Soy milk, tea, and coffee were the main beverages.
  • The third highest sperm count and sperm quality was associated with the Danish diet. This diet relied on cold processed meats (some of which were red meats), cold fish, and dairy for protein. However, it also was rich in whole grains and fruits. Water and sugary beverages were consumed in equal proportions.
  • The lowest sperm count and sperm quality was associated with the Western diet. This diet relied on red and processed meats as the primary protein source. However, it was also high in refined grains, snacks, sugary beverages, sweets, and junk foods.

So, if we are using sperm count and sperm quality as a measure of virility, it is clear that real men don’t eat red meat. Or put another way, a diet rich in red meat is more likely to reduce sperm count and sperm quality than it is to increase it.

However, a small amount of red meat as part of an overall healthy diet can be consistent with good sperm count and quality.

In short, diet does affect sperm quality. For example, based on this study:

  • An 8-ounce steak with French fries, cherry pie, and a soft drink (or, in our part of the country, sweet tea) may not be good for your sex life.
  • If you don’t want to give up red meat, a better choice might be 3-ounces of steak in a vegetable stir fry, fruit for dessert, and water or tea as your beverage.
  • If you want to maximize sperm count and sperm quality, an even better choice would be chicken, fish, or beans with vegetables, fruit for dessert, and water or tea as your beverage.

The Bottom Line

Meat has a certain mystique among some men. They believe real men eat meat, especially red meat. The belief is that eating red meat makes them bigger, stronger, and more virile.

How much of that is true. We already know that meat has no magical power to make men bigger and stronger. But what about virility? Does meat make men more virile? Fortunately, we now have an answer to that question. A recent study has looked at the effect of diet on sperm count and sperm quality.

  • The highest sperm count and quality was associated with a prudent diet. This diet relied primarily on fish and chicken as protein sources but did not exclude red meat. It was also a diet rich in vegetables, fruits, nuts, and water (in place of sugary beverages). In other words, it was a healthy diet.
  • The lowest sperm count and quality was associated with the Western diet. This is a diet that relies on red and processed meats as the primary protein source. However, it is also high in refined grains, snacks, sugary beverages, sweets, and junk foods.

So, if we are using sperm count and sperm quality as a measure of virility, it is clear that real men don’t eat red meat. Or put another way, a diet rich in red meat is more likely to reduce sperm count and quality than it is to increase it.

However, a small amount of red meat as part of an overall healthy diet can be consistent with good sperm count and sperm quality.

In short, it appears that diet does affect sperm quality:

  • An 8-ounce steak with French fries, cherry pie, and a soft drink (or, in our part of the country, sweet tea) may not be good for your sex life.
  • If you don’t want to give up red meat, a better choice might be 3-ounces of steak in a vegetable stir fry, fruit for dessert, and water or tea as your beverage.
  • If you want to maximize sperm count and sperm quality, an even better choice would be chicken, fish, or beans with vegetables, fruit for dessert, and water or tea as your beverage.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Why Do Most Diets Fail?

How To Lose Weight And Keep It Off

New Year DietTomorrow is the official start of another dieting season. Millions of Americans will be making a New Year’s Resolution to lose weight. The top three reasons for these weight loss resolutions are:

1)    Reduce disease risk (73%). After all, we are being told those excess pounds increase our risk of diabetes, heart disease, cancer, and just about every other disease known to man.

2)    Improve self-esteem (61%). Some of this may be due to the social stigma associated with obesity, but many people simply want to improve the image they see in the mirror every morning when they get out of the shower.

3)    Boost energy (49%).

Those are all good reasons for losing weight. But before you make your New Year’s resolution to embark on another weight loss journey, you should ask yourself “Do weight loss diets work?” If you look at the statistics, they aren’t very encouraging:

1)    45 million Americans go on a weight loss diet every year.

·       50% go on fad diets.

·       They spend $33 billion on weight loss products.

·       90% regain almost all the weight. That’s called the yo-yo effect.

·       On average, Americans gain 11 pounds on every diet yo-yo.

o   They might as well have thrown that $33 billion to the wind.

2)    228,000 Americans get gastric bypass surgery.

·       80% regain almost all the weight.

o   Their digestion and their health will never be the same.

As if those statistics weren’t bad enough, the obesity epidemic gets worse year after year (see the graphic on the Obesity Epidemicright). Americans keep getting fatter. What we are doing clearly isn’t working.

You are probably saying to yourself: “I know that, but this year I’m going to try a new diet.” As the saying goes “Hope springs eternal in the human breast”, but is it realistic to think this time will be different?

Let me share a quote from a book and TV series called “The Weight Of the Nation” by John Hoffman & Dr. Judith Salerno”:

“First we blamed fat – low fat diets didn’t work! Then we blamed carbs, eggs, red meat, dairy, white flour, sugar, juices, sodas, high-fructose corn syrup, & partially hydrogenated fats. One by one, we replaced the evil food du jour…and watched our collective waistlines grow.”

In other words, they are saying it’s not just low-fat diets that don’t work. None of the popular diets work long term. I come across lots of people who tell me the Atkins weight-loss diet works best for them. That would be convincing if they were slender, but they aren’t! They gained it all back and then some. Now that the keto diet has been around for a few years, I am starting to see the same pattern there as well.

Clearly, the problem isn’t losing the weight. Any diet can help you lose weight. The problem is keeping the weight off. Let’s look at why this is.

Why Do Most Diets Fail?

WhyTo understand the answer to this question, let’s start with another quote from “The Weight Of the Nation”: “Our bodies were designed to store fat in times of plenty and retain fat in times of famine”

Essentially, the authors were saying when our ancestors were hunters and gatherers, there were times when food was abundant, and times when food was scarce. In order to survive, our bodies had to store energy in its most efficient form when food was abundant and hold on to those energy stores as long as possible when food was scarce.

Fat provides more than twice as many calories per gram as either carbohydrate or protein. Additionally, our ability to store carbohydrate is limited. And we don’t really have protein stores. All the proteins in our body have essential functions. However, our ability to store fat is unlimited. Now you understand why fat is the preferred energy store in times of plenty and our bodies try to hold on to it as long as possible in times of famine.

With that perspective in mind, there are three reasons why most diets fail:

1)    Most dieters are looking for rapid weight loss (at least 2-5 pounds/week). That is a problem because “Our bodies were designed to…retain fat in times of famine”. When we lose weight quickly, our bodies interpret that as famine. Our bodies respond by decreasing our metabolic rate so we can hold on to those fat stores.

The solution to this problem is to set more reasonable weight loss goals. If we keep the rate of weight loss in the 1-2 pound/week range (0.5-1 pounds/week is even better), we can largely avoid this famine response. You should ask yourself, “What’s the rush?” After all, the average American only gains 1-2 pounds/year. Why do we need to get rid of that excess weight in just a few weeks?

2)    Most dieters are looking for significant weight loss (more than 20 pounds). That is a problem because our bodies are designed to retain fat stores, not protein stores. When our bodies sense a famine they burn our protein stores (lean muscle mass) to spare as much of our fat stores as possible. The longer the diet (famine) lasts, the more muscle mass we lose.

That’s a problem because muscle burns calories much faster than fat. The more muscle we lose, the more our metabolic rate decreases. It gets harder and harder to lose weight, and eventually we reach a plateau. Most people get discouraged at that point and go off their diet.

That’s where the other part of the quote from “The Weight Of The Nation” kicks in: “Our bodies are Yo-Yo with Boydesigned to store fat in times of plenty”. Once again, it is fat we store, not protein. Most people never regain the protein stores they lost, so their metabolic rate remains low. They regain most of the weight they lost, and then some. This is the origin of the yo-yo effect.

There are two solutions to this problem:

·       Increase your resistance exercise and your intake of protein with high levels of the essential amino acid leucine. I have covered this in a previous issue of “Health Tips From The Professor”.

·       Set more reasonable weight loss goals. It is possible to lose more than 20 pounds without losing muscle mass. We just need to think in terms of reaching those weight loss goals in years rather than in months. Once again, remember it took us years to gain the weight. Why not think in terms of years to lose the weight?

3)    Most dieters think in terms of diets rather than lifestyle change. Diets have an expiration date. Then most people just drift back to “the way they really live”. Lifestyle change, on the other hand, is permanent. Once we change to a healthier lifestyle, we no longer need to focus on weight loss. The weight comes off automatically.

To better understand the power of lifestyle change let’s look at something called “The National Weight Control Registry”.

How To Lose Weight And Keep It Off

Happy woman on scaleRather than focus on the abysmal statistics for long-term weight loss, doctors Rena Hill and James O Wing decided to focus on the characteristic of people who manage to keep their weight off. They founded something called “The National Weight Control Registry” and invited people who were successful at keeping the weight off to participate in their program.

Currently, the National Weight Control Registry is tracking over 10,000 individuals who have lost 30 pounds or more and have kept it off for long periods of time. They use detailed questionnaires and annual follow-up surveys to study the behavioral and psychological characteristics and the strategies of weight loss maintainers.

When you look at how they lost weight, they are a very diverse group:

·       They lost weight on every possible diet – from vegan to keto to just plain crazy.

·       50% lost weight on commercial diet programs. 50% lost weight on their own.

·       Some lost weight quickly. Some lost weight slowly.

When you look at weight maintenance, you realize that the dismal weight maintenance statistics don’t have to apply to you. The good news is:

·       On average, people in The National Weight Control Registry have lost 66 pounds and have kept it off for 5 years or more.

·       12-14% of them have maintained a weight loss of 100 pounds or more for 5 or more years.

·       Even better, once they maintained their weight loss for 2-5 years, it became easy.

They no longer had to battle hunger and a sluggish metabolism. They no longer had to think about the lifestyle changes they were trying to maintain. Their new lifestyle became what they did automatically, without even thinking about it. Their weight loss had become permanent.

By now, you are probably wondering how they do it. Here are the top 7 characteristics of those who are successfulhealthy living at keeping the weight off:

1)    They consumed reduced calorie, low-fat, healthy diets.

2)    They had internalized their eating patterns. It had become how they ate every day without even thinking about it.

3)    They monitored their weight regularly. This allowed them to make adjustments whenever they saw their weight start to creep up.

4)    They ate breakfast on a regular basis.

5)    They got lots of exercise (on average, about 1 hour/day).

6)    They watched less than 10 hours of TV/week. If you were wondering where you would find the time to exercise an hour/day, this is probably your answer.

7)    They were consistent. They had no planned “cheat days”. This doesn’t mean they were purists. They still allowed themselves to eat some of their favorite unhealthy foods on an occasional basis. They just didn’t set aside regular times when they planned to “pig out”.

There was one other interesting observation from this study:

·       Those who used meal replacement shakes as part of their weight loss, focused more on diet and included meal replacement shakes as part of their maintenance program.

·       Those who lost weight on their own, also followed healthy eating habits, but put a bit more emphasis on exercise to keep themselves on track.

·       Both approaches were effective.

The take-home message of the National Weight Control Registry is clear. There is no magic diet that guarantees you will keep the weight off. The “secret” to keeping the weight off is a healthy eating pattern and a healthy lifestyle.

In short, if your resolution is to lose weight next year, don’t focus on the diet you will follow to lose the weight. Instead, focus on the healthy lifestyle you will follow to keep the weight off.

Of course, you will be most successful if the diet you are following to lose weight incorporates the healthy lifestyle you plan to follow to maintain your weight loss.

What Role Do Habits Play In Weight Loss?

Habits-Old-vs-NewFinally, I would like to share a recent study (G Cleo et al, International Journal of Obesity, 43: 374-383, 2019) that puts the whole issue of weight loss and weight maintenance in a different perspective. This study looked at the role that habits play in weight loss.

In short, the study enrolled 130 participants who wanted to lose weight. All the participants were told this was a weight loss study, but none of the participants were given detailed diet and exercise recommendations to follow. The study had a 12-week intervention phase followed by a 12-month follow-up phase. The participants were divided into three groups.

1)    Group 1 received no advice during the intervention phase. This was the control group.

2)    Group 2 focused on breaking old habits. During the intervention phase they were sent daily tests suggesting new habit patterns. These were suggestions like “Drive a different route to work today”. None of the texts had anything to do with diet or lifestyle.

3)    Group 3 focused on creating new healthy habits. They were given a list of 10 healthy habits. During the intervention phase they were asked to log how many of these habits they implemented each day. The 10 healthy habits were:

#1: Keep to a daily meal routine.

#2: Choose reduced fat versions of foods.

#3: Walk off the weight (aim for 10,000 steps/day).

#4: Pack a healthy snack (Choose healthy options such as fruits, nuts, or low-fat yogurt).

#5: Read labels.

#6: Be cautious with your portions.

#7: Break up your sitting time (Stand for 10 minutes every hour).

#8: Think about your drinks (Choose water instead of sodas and fruit juices).

#9: Focus on your food (Slow down. Don’t eat while watching TV).

#10: Don’t forget your 5 servings of fruits and vegetables a day.

The results were:

·       People in both habit change groups lost significantly more weight than people in the control group.

·       People in the habit change groups continued to lose weight for 12 months after the intervention ended.

·       Weight loss was essentially identical in the two habit change groups.

The last observation is particularly interesting. Remember that one of the habit change groups was simply focused on breaking old habits, yet people in this group did just as well as people who were taught healthy lifestyle habits. This implies that people already know about healthy lifestyle habits. They just don’t know how to break their old habits. Once they become comfortable breaking old habits, they find it easy to adopt healthier lifestyle habits.

In short, change your habits, change your lifestyle. Change your lifestyle, control your weight.

What Does This Mean For You?

why-do-most-dirts-failI covered a lot of information in this article. Let me sum it up by giving you my top 10 tips for losing weight and keeping it off.

1)    You don’t need to achieve your “ideal weight”. Losing 5-10% of your body weight may be enough.

2)    Ditch diets. Focus on lifestyle change.

3)    Slow and steady wins the day.

4)    Change your habits, change your weight.

5)    Long-term weight loss is possible.

6)    Low-fat, healthy eating patterns are best.

7)    Once you have internalized healthy habits, they become automatic.

8)    If you stick with a healthy lifestyle long enough, keeping the weight off becomes easy.

9)    Focus on all the healthy food choices you have, not what you have to give up. There is a cornucopia of great tasting, healthy foods to choose from.

10)  Never say never. Allow yourself to enjoy your old favorite foods on occasion. Just don’t make it a habit.

The Bottom Line

I cover a lot of information in this article. Let me sum it up by giving you my top 10 tips for losing weight and keeping it off.

1)    You don’t need to achieve your “ideal weight”. Losing 5-10% of your body weight may be enough.

2)    Ditch diets. Focus on lifestyle change.

3)    Slow and steady wins the day.

4)    Change your habits, change your weight.

5)    Long-term weight loss is possible.

6)    Low-fat, healthy eating patterns are best.

7)    Once you have internalized healthy habits, they become automatic.

8)    If you stick with a healthy lifestyle long enough, keeping the weight off becomes easy.

9)    Focus on all the healthy food choices you have, not what you have to give up. There is a cornucopia of great tasting, healthy foods to choose from.

10)  Never say never. Allow yourself to enjoy your old favorite foods on occasion. Just don’t make it a habit.

For more details on how to lose weight and keep it off, read the article above. In fact, if you plan to lose weight in the coming year, you should really read this article first.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

 

 

Do Vegetarians Have A Higher Risk Of Stroke?

What Are The Benefits And Risks Of A Vegetarian Diet?

Vegetarian FoodsVegetarian diets are thought to be very healthy. Clinical studies show that vegetarian diets are associated with decreased risk of heart disease, diabetes, cancer, Alzheimer’s disease, and much more. What’s not to like?

That’s why the recent headlines claiming that vegetarian diets may increase the risk of stroke were so surprising. Advocates of meat-heavy diets like the Paleo and Keto diets were overjoyed. These results fit in with their view that we should be eating more meat protein and less plant protein. Nutrition experts, on the other hand, were asking: “What’s going on?” “How can this be?”

Those of you who are regular readers of “Health Tips From the Professor” know that I am an advocate of primarily plant-based diets. Thus, I felt a responsibility to analyze the study (TYN Tong et al, British Medical Journal, 366: 14897, 2019) behind the headlines impartially and give you, my readers, clear guidelines for the healthiest possible diet.

How Was The Study Done?

clinical-studyLet’s start with some background:

·       A major study called the “European Prospective Investigation Into Cancer and Nutrition” (EPIC) has been underway since the early 90’s.

·       The British component of this study is known as the EPIC-Oxford study.

·       While the study has “cancer” in it’s title, it was designed to measure the impact of nutrition on many diseases. In this case, the study focused on heart disease and stroke.

·       Finally, enrollment in the EPIC-Oxford study was designed to give a high proportion of vegetarians in the study population.

The EPIC-Oxford study enrolled 48,188 participants with no previous history of heart disease, stroke, or angina between 1993 and 2001. A detailed diet analysis was performed upon enrollment and again in 2010. Based on these data, the participants were divided into three groups:

1)    Meat eaters (24,428 participants).

2)    Fish eaters (7,506 participants). This group consumed fish but no other meats. People with this eating style are often called pescatarians.

3)    Vegetarians (16, 254 participants). This group consumed dairy and eggs, but no meat. People with this eating style are often called lacto-ovo vegetarians.

4)    The diet analysis also identified participants who were vegans (no animal foods). However, this group was too small to obtain statistically significant comparisons, so they were included with the lacto-ovo vegetarians in the vegetarian group.

Data on heart disease and stroke were obtained from the UK’s health service records through March 31st, 2016. The average time of follow-up for participants in the study was 18.1 years.

Without going into greater detail, this was a very large, well-designed study.

How Did The Diets Of The Three Groups Compare?

balance scaleThe first step in analyzing this study is to ask how the diets of the three groups compared.

Compared to meat eaters, the fish eaters consumed:

·       No meat other than fish.

·       Slightly less milk and significantly more cheese.

·       Slightly more fruits & vegetables.

·       Significantly more legumes & soy foods, nuts & nut butter.

·       Slightly more carbohydrate and slightly less protein.

·       Slightly less saturated fat and slightly more polyunsaturated fat.

·       Around 260 fewer calories per day.

Compared to fish eaters, the vegetarians consumed:

·       No meat.

·       Slightly less milk & cheese.

·       About the same amount of fruits & vegetables.

·       Significantly more legumes & soy foods, nuts & nut butter.

·       Slightly more carbohydrate and slightly less protein.

·       About the same saturated and polyunsaturated fat.

·       Around 125 fewer calories per day.

On average, the vegetarians consumed about 1 cup of milk and one ounce of cheese per day. The fish eaters consumed 1.4 ounces of fish per day.

In terms of comparisons:

·       The biggest differences were between the fish eaters and the meat eaters. It would be fair to say that the fish eaters consumed a primarily plant-based diet with added fish and dairy.

·       The biggest differences between the vegetarians and fish eaters was that the fish eaters got a significant percentage of their protein from fish, while the vegetarians got a significant amount of their protein from plant sources. Otherwise, their diets were fairly comparable.

Finally, the 10-year follow-up diet analysis showed that most participants stuck with their initial diet.

Do Vegetarians Have A Higher Risk Of Stroke?

strokeNow, for the study results:

·       Compared to meat eaters, fish eaters had 13% lower risk of heart disease, and vegetarians had a 22% lower risk of heart disease.

o   For vegetarians this corresponds to 10 fewer cases of heart disease per 1,000 people over 10 years.

·       Compared to meat eaters, vegetarians had a 20% higher risk of stroke, mostly due to an increased risk for hemorrhagic stroke.

o   For vegetarians this corresponds to 3 additional cases of stroke per 1,000 people over 10 years.

·       The risk of stroke was essentially identical for fish eaters and meat eaters.

In many other aspects, vegetarians were healthier than meat-eaters. For example, they:

·       Weighed less.

·       Had lower blood pressure.

·       Had lower total and LDL cholesterol.

·       Were less likely to have developed diabetes during the study.

·       Were less likely to have required long-term treatment for other illnesses.

What Are The Strengths And Weaknesses Of The Study?

strengths-weaknessesThe strength of this study is obvious. It was a very large, well-designed study. The study also lasted a long time. Participants in the study were followed for almost 20 years.

There are two clear weaknesses, however:

1)    Numerous previous studies have confirmed that vegetarian diets decrease heart disease risk by about 20%. However, none of those previous studies have reported an increase in stroke risk. This study is an outlier.

2)    There is no clear mechanism that explains why a vegetarian diet might increase stroke risk. Based on previous observations that statin drugs increase the risk of hemorrhagic stroke, the authors suggested the increased stroke risk might be due to lowered LDL cholesterol levels.

This mechanism is speculative at present. Furthermore, if true, it would suggest that any intervention (drug or nutritional) that lowers LDL cholesterol would increase stroke risk.

In the words of the authors:

·       “The present study has shown that British adults who were fish eaters or vegetarians had lower risks of heart disease than meat eaters, but that vegetarians had higher risks of stroke.

·       Future work should include further measurements…to identify which factors may cause the observed associations. [In plain English: We need to understand how vegetarian diets might increase stroke risk before we put too much weight on the results of this study.]

·       Additional studies in other large-scale cohorts with a high proportion of non-meat eaters are needed to confirm the generalizability of these results and assess their relevance for clinical practice and general health.” [In plain English: More studies are needed to confirm this observation before we start changing our recommendations about what constitutes a healthy diet.]

What Are The Benefits And Risks Of A Vegetarian Diet?

benefits-risksLet’s assume for a minute that the results of this study are accurate and take a closer look at the benefits and risks of a vegetarian diet. Here is my assessment:

1)    This report is troubling, but it may not be correct. The association of vegetarian diets with a slight increase in stroke risk has only been seen in a single study. This study needs to be confirmed before we become too concerned about vegetarianism increasing stroke risk.

2)    On the balance, vegetarian diets should still be considered very healthy. They lower the risk of heart disease, high blood pressure, diabetes, some cancers, inflammatory diseases and possibly even Alzheimer’s disease.

3)    However, I have often said that we have 5 food groups for a reason, and it is not a good idea to eliminate whole food groups. In the past, I have used that statement to critique diets that leave out important plant food groups like fruit, whole grains, and legumes.

If the data on stroke risk in this study are true, it suggests it might also not be a good idea to leave out meat. However, you don’t need a lot of meat. The fish eaters in this study were consuming 1.4 ounces of fish per day. That was enough to eliminate the increased risk of stroke.

4)    In addition, you don’t have to be a vegan purist to enjoy the health benefits of a primarily plant-based diet. As I describe in my book, “Slaying The Food Myths”, primarily plant-based diets ranging from vegan through pescatarian and semi-vegetarian to Mediterranean and DASH are all incredibly healthy.

I personally follow a semi-vegetarian diet but often recommend Mediterranean and DASH diets to others because they are the easiest primarily plant-based diets for the average American to follow.

5)    Finally, if you have a family history, or are at high risk, of stroke, I recommend prudence until we know more. You may wish to adopt a version of primarily plant-based diets that incorporates some meat (That would be in the pescatarian to DASH range of primarily plant-based diets). Your heart will thank you, and you won’t increase your risk of stroke.

The Bottom Line

A recent study enrolled 48,188 British adults; divided them into meat eaters, fish eaters, and vegetarians; followed them for 18.1 years; and looked at their risk for heart disease and stroke. The results were:

·       Compared to meat eaters, fish eaters had 13% lower risk of heart disease, and vegetarians had a 22% lower risk of heart disease.

o   For vegetarians this corresponds to 10 fewer cases of heart disease per 1,000 people over 10 years.

·       Compared to meat eaters, vegetarians had a 20% higher risk of stroke, mostly due to an increased risk for hemorrhagic stroke.

o   For vegetarians this corresponds to 3 additional cases of stroke per 1,000 people over 10 years.

·       The risk of stroke was essentially identical for fish eaters and meat eaters.

Here is my perspective:

1)    This report is troubling, but it may not be correct. The association of vegetarian diets with a slight increase in stroke risk has only been seen in a single study. This study needs to be confirmed before we become too concerned about vegetarianism increasing stroke risk.

2)    On the balance, vegetarian diets should still be considered very healthy. They lower the risk of heart disease, high blood pressure, diabetes, some cancers, inflammatory diseases and possibly even Alzheimer’s disease.

3)    However, I have often said that we have 5 food groups for a reason, and it is not a good idea to eliminate whole food groups. In the past, I have used that statement to critique diets that leave out important plant food groups like fruit, whole grains, and legumes.

If the data on stroke risk in this study are true, it suggests it might also not be a good idea to leave out meat. However, you don’t need a lot of meat. The fish eaters in this study were consuming 1.4 ounces of fish per day. That was enough to eliminate the increased risk of stroke.

4)    In addition, you don’t have to be a vegan purist to enjoy the health benefits of a primarily plant-based diet. As I describe in my book, “Slaying The Food Myths” (https://slayingthefoodmyths.com), primarily plant-based diets ranging from vegan through pescatarian (the fish eaters in this study) and semi-vegetarian to Mediterranean and DASH are all incredibly healthy.

I personally follow a semi-vegetarian diet but often recommend Mediterranean and DASH diets to others because they are the easiest primarily plant-based diets for the average American to follow.

5)    Finally, if you have a family history, or are at high risk, of stroke, I recommend prudence until we know more. You may wish to adopt a version of primarily plant-based diets that incorporates some meat (That would be in the pescatarian to DASH range of primarily plant-based diets). Your heart will thank you, and you won’t increase your risk of stroke.

For more details on the study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Is The Paleo Diet Bad For Your Heart?

Is The Paleo Diet Bad For Your Gut?

the paleo dietThere is a lot to like about the Paleo diet:

·       It is a whole food diet. Any diet that eliminates sodas, junk foods, and highly processed foods is an improvement over the American diet.

·       It includes lots of vegetables and some fruits.

·       It helps you lose weight, and any diet that results in weight loss improves your blood work – things like cholesterol, triglycerides, blood sugar control and more.

However, there are concerns the Paleo diet may not be healthy long term.

·       In part, that is because the diet is high in meat, red meat, and saturated fat.

·       Equally important, however, is what the diet eliminates – namely whole grains, legumes (beans), and dairy.

Those of you who have read my book, “Slaying The Food Myths”, know that I say: “We have 5 food groups for a reason”. This is particularly true for the plant food groups. That’s because each plant food group provides a unique blend of:

·       Vitamins and minerals. Those can be replaced with good multivitamin/multimineral supplement.

·       Phytonutrients. You can only get the full complement of health-promoting phytonutrients from a variety of foods from all 5 food groups.

·       Fiber. There are many kinds of fiber and they each play different roles in our intestine. You can only get all the health-promoting varieties of fiber by consuming fruits, vegetables, whole grains and legumes.

·       Gut bacteria. What we call fiber, our gut bacteria call food. Each of the plant food groups supports different populations of friendly gut bacteria.

Based on this reasoning, one might suspect that the Paleo diet might alter our gut bacteria in ways that could be bad for our health. Until recently, this sort of reasoning was just a theoretical concern. That’s because:

1)    We knew far too little about the health effects of different populations of bacteria. This is rapidly changing. Several recent studies have systematically investigated the connection between gut bacteria and health outcomes.

2)    We knew our diet influenced the bacteria populations found in our gut, but we had no understanding of how these changes might influence our health. This too is changing. The study (A Genoni et al, European Journal of Nutrition, https://doi.org/10.1007/s00394-019-02036-y) I discuss this week is an excellent example of recent studies linking diet, gut bacteria, and risk factors for disease.

How Was The Study Done?

can you believe clinical studies doctorThis study recruited 91 participants from Australia and New Zealand. It was a very well designed study in that:

·       The Paleo diet group (44 participants) was recruited based on self-proclaimed adherence to the Paleo diet (< 1 serving/day of grains and dairy products) for one year or more. This is important because short term effects of switching to a new diet are confounded by weight loss and other factors.

o   After analyzing the diets of the Paleo group, the investigators found it necessary to subdivide the group into Strict Paleo (< 1 serving/day of grains and dairy products) and Pseudo-Paleo (> 1 serving/day of grains and dairy).

·       The control group (47 participants) was recruited based on self-proclaimed adherence to a “healthy diet” for 1 year or more with no change in body weight (A healthy diet was defined as a whole food diet containing a variety of foods from all 5 food groups). This is important because far too many studies compare the diet they are promoting to an unhealthy diet with a lot of sugar and highly processed junk foods. These studies provide little useful information because almost anything is better than an unhealthy diet.

·       The participants completed a diet survey based on the frequency of consumption of various foods during the previous year. However, because diet surveys based on the recollection of participants can be inaccurate, the investigators used two rigorous tests to validate the accuracy of those diet surveys.

o   The first was a 3-day weighed dietary record (WDR). Simply put, this means that participants weighed and recorded all foods and beverages before they were eaten for 3 days. Two of those days were weekdays, and one was a weekend day.

o   Secondly, the investigators used blood, urine, and metabolic measures to independently determine protein and energy intake of each participant. Participants who were identified by these means as under reporting both protein and energy were considered unreliable dietary reporters and were excluded from the analysis.

o   It is very rare to find a study that goes to this length to validate the accuracy of the dietary data used in their analysis.

The participants also provided blood, urine and stool samples and completed a physical activity assessment.

What Were The Differences Between The Paleo Diet And The Healthy Control Diet?

Paleo FoodsOnly the Strict Paleo Diet group was faithfully following the Paleo diet. In addition, most of the results with the Pseudo Paleo Diet Group were intermediate between the other two diets. Therefore, to simplify my discussion of this study I will only compare the Strict Paleo Diet group, which I refer to as the Paleo Diet group, with the Healthy Diet control group.

The Paleo diet emphasizes fresh vegetables, especially green leafy vegetables, and discourages grains. Thus, it is no surprise that:

·       The Paleo Diet group ate 74% more vegetables and 3 times more leafy green vegetables than the Healthy Diet group.

·       The Paleo Diet group ate only 3% of the grains and 3% of the whole grains compared to the Healthy Diet group.

The Paleo diet encourages consumption of meat and eggs and discourages consumption of dairy and plant proteins. Thus, it is not surprising that:

·       The Paleo Diet group ate 3 times more red meat and 5 times more eggs than the Healthy Diet group.

·       The Paleo Diet group ate 10% of dairy foods compared to the Healthy Diet group.

·       The Paleo Diet group consumed two times more saturated fat and cholesterol than the Healthy Diet group.

The most interesting comparison between the two diets was the following:

·       Intake of total fiber, insoluble fiber, and soluble fiber was comparable on the two diets.

·       However, intake of resistant starch was 50% lower in the Paleo Diet group. This is significant because:

o   Resistant starch is a type of fiber found primarily in whole grains, legumes, potatoes, and yams (Potatoes and yams are also dietary “no nos” on most low-carb diets).

o   Resistant starch is an especially good food for certain species of healthy gut bacteria.

Is The Paleo Diet Bad For Your Gut?

Bas BacteriaBecause resistant starch affects gut bacteria, the study next looked at the effect of the two diets on the populations of gut bacteria. This is where the story starts to get interesting. When they looked at different groups of gut bacteria, they discovered that:

·       Bifidobacteria were much more abundant in the Healthy Diet group than in the Paleo Diet group, and the amount of Bifidobacteria in the gut was directly proportional to the amount of whole grains in the diet.

o   This is important because previous studies have suggested Bifidobacteria help maintain intestinal barrier integrity and protect against irritable bowel syndrome and obesity.

·       Roseburia were also much more abundant in the Healthy Diet group and proportional to the amount of whole grains in the diet.

o   This is important because previous studies have suggested Roseburia protect against inflammatory bowel diseases like Crohn’s disease and ulcerative colitis.

·       Hungatella were much more abundant in the Paleo Diet group and were inversely proportional to the amount of whole grains in the diet.

o   This is important because Hungatella metabolize carnitine and choline, which are found in meats (especially red meats), egg yolks, and high fat dairy, into a compound called trimethylamine or TMA. TMA is then further metabolized in the liver to trimethylamine-N-oxide, or TMAO.

o   TMAO is a bad player. It is positively associated with heart disease, stroke, kidney disease, diabetes, and Alzheimer’s disease. However, the evidence is strongest for heart disease. TMAO has been called an independent risk factor for cardiovascular death.

Because of this, the study looked at TMAO levels in the blood of the two diet groups. These results were concerning:

·       TMAO levels were 2.5-fold higher in the Paleo Diet group than in the Healthy Diet group.

·       As might be expected, TMAO levels were positively correlated with red meat intake and inversely proportional to whole grain intake.

Is The Paleo Diet Bad For Your Heart?

heart diseaseWhen you put all the evidence together you have a compelling argument that the Paleo diet is likely to increase the risk of heart disease. Let me summarize the data briefly:

1)    The Paleo diet discourages the consumption of whole grains.

2)    Whole grains are a major source of a dietary fiber called resistant starch.

3)    Because the Paleo diet is low in resistant starch, it causes a decrease in two healthy types of gut bacteria and an increase in a type of gut bacteria called Hungatella.

4)    Hungatella metabolize compounds found in meat, eggs, and dairy to a precursor of a chemical called TMAO. This study showed that TMAO levels were 2.4-fold higher in people consuming a Paleo diet.

5)    TMAO is associated with coronary artery disease and is considered an independent risk factor for cardiovascular death.

The authors of the study concluded: “Although the Paleo diet is promoted for improved gut health, results indicate long-term adherence is associated with different gut microbiota and increased TMAO. A variety of fiber components, including whole grain sources, may be required to maintain gut and cardiovascular health.”

Of course, studies like this are looking at associations. They are not definitive. What we need are long term studies looking at the effect of the Paleo diet on heart disease outcomes like heart attack and stroke. Until we have these studies my advice is:

·       Don’t accept claims that the Paleo diet is heart healthy. There are no long-term clinical studies to back up that claim.

·       Be aware that the Paleo diet affects your gut bacteria in ways that may be bad for your heart.

The more we learn about our gut bacteria, the more we appreciate the importance of including all 5 food groups in our diet, especially all the plant food groups.

Are Low Carb Diets Healthy?

low carb dietThe Paleo diet is not the only diet that is high in red meat and low in whole grains. The same is true for virtually all the popular low-carb diets. There are studies showing other low-carb diets also alter gut bacteria and raise TMAO levels, so there is a similar concern that they may also increase the risk of heart disease.

This is in addition to concerns about the high saturated fat consumption which increases the risk of heart disease and red meat consumption, which may increase the risk of certain cancers.

Finally, there are no studies showing that any low-carb diet is healthy long term, even the Atkins diet, which has been around for more than 50 years. Until we have long-term studies about the health consequences of low-carb diets, my advice is similar to that for the Paleo diet.

·       Don’t accept claims that low-carb diets are healthy. There are no long-term clinical studies to back up that claim.

·       Be aware that low-carb diets affect your gut bacteria in ways that may be bad for your health.

The Bottom Line

A recent study looked at the effect of the Paleo diet on an important risk factor for heart disease. Here is a brief summary of the data:

1)    The Paleo diet discourages the consumption of whole grains.

2)    Whole grains are a major source of a dietary fiber called resistant starch.

3)    Because the Paleo diet is low in resistant starch, it causes a decrease in two healthy types of gut bacteria and an increase in a type of gut bacteria called Hungatella.

4)    Hungatella metabolize compounds found in meat, eggs, and dairy to a precursor of a chemical called TMAO. This study showed that TMAO levels were 2.4-fold higher in people consuming a Paleo diet.

5)    TMAO is associated with coronary artery disease and is considered an independent risk factor for cardiovascular death.

Of course, studies like this are looking at associations. They are not definitive. What we need are long term studies looking at the effect of the Paleo diet on heart disease outcomes – like heart attack and stroke. Until we have these studies my advice is:

·       Don’t accept claims that the Paleo diet is heart healthy. There are no long-term clinical studies to back up that claim.

·       Be aware that the Paleo diet affects your gut bacteria in ways that may be bad for your heart.

·       Virtually all the popular low-carb diets discourage consumption of whole grains, so my advice for them is the same as for the Paleo diet.

The more we learn about our gut bacteria, the more we appreciate the importance of including all 5 food groups in our diet, especially all the plant food groups.

For more details on the study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease

Diet and Chronic Disease: Type 2 Diabetes and Heart Disease

Can You Cut Your Risk Of Heart Disease And Diabetes In Half?

Author: Dr. Stephen Chaney

 

diet and chronic disease heart attackIt is no secret that heart disease and diabetes are among the top two causes of death in this country. They are killers. Even worse, they can affect your quality of life for years before they kill you. Finally, they are bankrupting our health care system. Anything we can do to reduce the toll of these diseases would be of great benefit.

Is there a connection between diet and chronic disease, specifically type 2 diabetes, stroke, and heart disease?

That is why recent headlines suggesting that deaths due to heart disease, stroke, and diabetes could be cut almost in half simply by changing our diet caught my attention. Of course, those headlines came as no surprise. It almost seems like the American diet is designed to make us fat and unhealthy. It seems designed to make us die prematurely from heart disease, stroke, and diabetes.

 

How Was The Study Done?

diet and chronic disease heart diseaseThis was a major study (R. Micha et al, JAMA, 317: 912-924, 2017 ). They started by using something called the National Health and Nutrition Examination Survey (NHANES). NHANES is a major survey conducted approximately every 10 years by the US government to collect data on demographics, disease, and diet from a cross section of the US population. They used this database to determine how frequently Americans consumed various heart-healthy and heart-unhealthy foods. They collected data from two surveys conducted in 1999-2002 and 2009-2012 to determine how consumption of those foods had changed over that 10-year period.

  • The heart-healthy foods they included in their study were fruits, vegetables, nuts & seeds, whole grains, and seafood omega-3s (long chain omega-3s).
  • The heart-unhealthy foods they included in their study were red meats, processed meats, sugar-sweetened beverages, and sodium.

They then did a meta-analysis of high quality clinical studies measuring the effects of those foods on deaths due to heart disease, stroke, and diabetes. They combined the data from all these studies to calculate the deaths due to all three causes combined, something they called deaths due to cardiometabolic disease.

Diet and Chronic Disease, Preventing Type 2 Diabetes and Heart Disease

diet and chronic disease lifestyleWhen the investigators combined all the data, they estimated that changing one’s diet from heart-unhealthy foods to heart-healthy foods would reduce cardiometabolic deaths (deaths due to heart disease, stroke, and diabetes) by 45.4%. That is an almost 50% reduction just by eating a healthier diet.

  • This probably underestimates the benefit of eating a healthier diet because they did not include the effects of reducing saturated fats, sweets, and refined carbohydrates on cardiometabolic deaths.
  • The reduction in cardiometabolic deaths was consistent across all demographic groups. It ranged from 40% to 60% when they considered gender, age, or ethnicity.
  • The 45.4% reduction in cardiometabolic deaths represents a holistic change to a healthier diet. When you consider the individual components of the standard American diet:
  • Decreasing sodium intake gives a 9.5% reduction in deaths.
  • Increasing intake of nuts and seeds gives an 8.5% reduction in cardiometabolic deaths.
  • Decreasing intake of processed meats gives an 8.2% reduction in cardiometabolic deaths.
  • Increasing intake of vegetables gives a 7.6% reduction in cardiometabolic deaths.
  • Increasing intake of fruits gives a 7.5% reduction in cardiometabolic deaths.
  • Decreasing intake of sugar-sweetened beverages gives a 7.4% reduction in cardiometabolic deaths.
  • Increasing intake of whole grains gives a 5.9% reduction in cardiometabolic deaths.
  • Decreasing red meat consumption gives a 4.2% decease in diabetes deaths. They did not include the effect of red meat consumption on heart disease or stroke deaths in their calculation.

diet and chronic disease heartHolistic changes are best: It would be easy to look at each of those individual changes and conclude that the change is so small that it isn’t worth the effort. That would be totally missing the point. These data clearly show a relationship between diet and chronic disease:

  • A holistic change in diet that includes all these individual changes can make a huge difference in your risk of dying from heart disease, stroke, or diabetes.
  • Even if you are not prepared to make this many changes at once, each individual change gets you one step closer to a longer, healthier life. In fact, if you make just one or two of these changes you have reduced your risk of dying more than if you were taking a statin drug – and with no side effects.

The good news is that Americans have made some positive changes in their diet between the first and second NHANES survey, and, as a result, cardiometabolic deaths declined by 26.5%. The biggest contributors to this improvement were:

  • Increased polyunsaturated fat consumption (-20.8%).
  • Increased nut and seed consumption (-18%).
  • Decreased sugar sweetened beverage consumption (-14.5%).
  • This was partially offset by increased processed meat consumption (+14.4%)

The authors concluded: “Dietary factors were estimated to be associated with a substantial proportion of deaths from heart disease, stroke, and type 2 diabetes. These results should help identify priorities, guide public health planning, and inform strategies to alter dietary habits and improve health.”  Below is a summary of the relationship between diet and chronic disease (specifically type 2 diabetes, stroke, and heart disease).

 

The Bottom Line

It almost seems like the American diet is designed to make us fat and unhealthy. It seems designed to make us die prematurely from heart disease, stroke, and diabetes. A recent study looked at the effect of a healthier diet on what they called cardiometabolic deaths (deaths due to heart disease, stroke, and diabetes). They concluded:

  • changing one’s diet from heart-unhealthy foods to heart-healthy foods would reduce cardiometabolic deaths by 45.4%. That is an almost 50% reduction just by eating a healthier diet.
  • This probably underestimates the benefit of eating a healthier diet because they did not include the effects of reducing saturated fats, sugary foods, and refined carbohydrates on cardiometabolic deaths.
  • The reduction in cardiometabolic deaths was consistent across all demographic groups. It ranged from 40% to 60% when they considered gender, age, or ethnicity.
  • The 45.4% reduction in cardiometabolic deaths represents a holistic change to a healthier diet. When you consider the individual components of the standard American diet:
    • Decreasing sodium intake gives a 9.5% reduction in deaths.
    • Increasing intake of nuts and seeds gives an 8.5% reduction in cardiometabolic deaths.
    • Decreasing intake of processed meats gives an 8.2% reduction in cardiometabolic deaths.
    • Increasing intake of vegetables gives a 7.6% reduction in cardiometabolic deaths.
    • Increasing intake of fruits gives a 7.5% reduction in cardiometabolic deaths.
    • Decreasing intake of sugar-sweetened beverages gives a 7.4% reduction in cardiometabolic deaths.
    • Increasing intake of whole grains gives a 5.9% reduction in cardiometabolic deaths.
    • Decreasing red meat consumption gives a 4.2% reduction in diabetes deaths. They did not include the effect of red meat consumption on heart disease or stroke deaths in their calculation.

It would be easy to look at each of those individual changes and conclude that the change is so small that it isn’t worth the effort. That would be totally missing the point. These data clearly show:

  • A holistic change in diet that includes all these individual changes can make a huge difference in your risk of dying from heart disease, stroke, or diabetes.
  • Even if you are not prepared to make this many changes at once, each individual change gets you one step closer to a longer, healthier life. In fact, if you make just one or two of these changes you have reduced your risk of dying more than if you were taking a statin drug – and with no side effects.

The authors concluded: “Dietary factors were estimated to be associated with a substantial proportion of deaths from heart disease, stroke, and type 2 diabetes. These results should help identify priorities, guide public health planning, and inform strategies to alter dietary habits and improve health.”

For more details, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Is The Whole 30 Diet Right For You?

Rules For Selecting A Healthy Diet

Author: Dr. Stephen Chaney

 

the whole 30 dietRecently, someone asked my opinion of the Whole 30 Diet. When you look at their web site, the claims are impressive:

  • Blood sugar swings disappear, energy levels improve, digestive issues and inflammation disappear.
  • Lose weight without counting calories.
  • Eliminate a long list of lifestyle-related diseases.

You probably want to know whether these claims are true. I do not have time to evaluate every diet, so let me evaluate the Whole 30 Diet in terms of principles you can use to evaluate any of the diets you will encounter in the new year.

What Is The Whole 30 Diet?

Basically, the Whole 30 Diet is a 30-day elimination diet designed to help you lose weight rapidly and change the way you eat.

the whole 30 diet an elimination dietThe diet allows you to eat “moderate portions of meat, seafood, and eggs; lots of vegetables; some fruit; plenty of natural fats; and herbs, spices, and seasonings.” [You are instructed to] “eat foods with very few ingredients, all pronounceable ingredients, or better yet, no ingredients listed at all because they’re whole and unprocessed.”

  • Recommended meats are grass-fed beef, organic poultry, and wild-caught fish.
  • Recommended fats are coconut oil, olive oil, and ghee (clarified butter).

The diet forbids:

  • Added sugar, real or artificial, in any form.
  • Alcohol
  • Grains
  • Legumes
  • Dairy
  • The additives carrageenan, MSG, and sulfite.
  • Baked foods, junk foods, and treats (sweets).

Although, not explicitly stated, because this diet eliminates sugar, grains, legumes, and baked goods, it is essentially a low carb diet.

This diet prescription is absolute. According to the authors of the diet: “Just a small amount of any of these [forbidden] inflammatory foods could break the healing cycle; promoting cravings, messing with blood sugar, disrupting the integrity of your digestive tract, and (most important) firing up the immune system. One bite of pizza, one spoonful of ice cream, one lick of the spoon mixing the batter within the 30-day period and you’ve broken the “reset” button, requiring you to start over again on Day 1.”

My comment: This statement is not accurate, but I understand why they say it. They are simply trying to get you to adhere strictly to the diet. After all, it is the little “modifications” we make that doom most diets to failure. It’s when we say: “Surely, one ice cream sundae can’t hurt” or “I don’t have time to fix dinner. I’ll just pick up some fried chicken on the way home.”

Finally, the Whole 30 Diet:

  • Tells you not to count calories and not to step on the scale for 30 days. I consider this a plus. Successful diets should emphasize lifestyle change, not counting calories.
  • Says nothing about exercise. This is a glaring omission.

Does The Whole 30 Diet Uphold The Rules For Selecting A Healthy Diet

 

Here are my rules for evaluating healthy diets:

First, let’s look at the initial (short-term) weight loss:

  • the whole 30 diet short term weight lossAny diet that eliminates sodas, junk foods, fast foods, and sweets will make you healthier and will help you lose weight. This is a big plus for the Whole 30 Diet.
  • Any diet that emphasizes whole foods over processed foods is likely to help you lose weight. This is also a plus for the Whole 30 Diet.
  • Both low carb and low-fat diets can help you lose weight. Let me be clear. I am talking about plant-based low-fat diets, not low-fat diets with a lot of sugars and simple carbohydrates. Low carb diets also result in water loss. This is also a plus for the Whole 30 Diet.
  • Diets that eliminate whole food groups tend to result in short-term weight loss. That’s because they eliminate some of your favorite foods, and it generally takes you a while to adjust. Since the Whole 30 Diet is focusing on the first 30 days, this is also likely to be a plus for the Whole 30 Diet.
  • Exercise is an essential component of healthy weight loss diets. The lack of a defined exercise component is a minus for the Whole 30 Diet.
  • On balance, the Whole 30 Diet is likely to be effective for short-term weight loss. However, this is true for most popular diets because they also eliminate sodas, junk foods, fast foods, and sweets. I have heard of the “Meat Lovers Diet” (which I don’t recommend), but I have never heard of a “Junk Food Lovers Diet.”  Many of the popular diets also favor whole foods and eliminate multiple food groups.
  • The main difference between the Whole 30 Diet and other popular diets is their absolute prohibition of any deviation from their diet plan. This makes the diet harder to follow, but it increases the probability of weight loss for those who do follow the plan.
  • Weight loss improves blood sugar control, energy levels, and inflammation. Thus, those claims are likely to be true, but not entirely for the reasons the diet proponents claim. The diet’s effect on digestive issues are likely to vary from one individual to another. However, if you have digestive issues to begin with, you probably have a problem with one or more of the foods you are currently eating. The elimination of multiple foods from your diet may help.
  • Weight loss can also reduce the severity of diabetes and other lifestyle diseases. This claim may also be true, but not for the reasons the diet proponents claim.

Next let’s look at long term weight loss. Here the Whole 30 Diet doesn’t look as promising. The Whole 30 Diet has only been around since 2009, so we have no long-term data comparing weight maintenance with other diets. However, here is what we do know.

Finally, let’s look at long term health. The information on the Whole 30 Diet’s web site does not make it clear what kind of diet they are recommending once you have completed your 30 days. However, if they are recommending a similar diet long-term, there are no long-term data showing it is healthy. The data we do have on that type of diet is mixed.

  • the whole 30 diet long term healthConsumption of sodas, junk foods, and fast foods is associated with an increased risk of diabetes and heart disease. Thus, elimination of these foods is a plus for the Whole 30 Diet, as is the reliance on whole, unprocessed foods.
  • However, multiple studies have shown that primarily plant-based diets are associated with significantly lower long-term risk of heart disease, diabetes, and other lifestyle diseases than meat-based diets. I have covered these studies in several recent issues of “Health Tips From the Professor.”  This is a minus for the Whole 30 Diet.
  • Diets that eliminate whole food groups are likely to result in nutritional deficiencies. For example, the Whole 30 Diet is similar to the paleo diet, and a recent study showed the paleo diet results in multiple nutritional deficiencies. This is also likely to be a minus for the Whole 30 Diet.

Other Comments:

  • All added sugar is not bad for you. I agree that added sugar in sodas, junk foods, fast foods, and sweets should be avoided. However, for other foods the glycemic index is more important than whether the food contains added sugar. I covered this topic in detail in a recent article called “Is It The Sugar, Or Is It the Food?
  • Red meat is considered a probable carcinogen. There is no evidence that grass-fed beef is any healthier with respect to cancer risk than conventionally raised meat. I covered this in detail in my recent article on the paleo diet.
  • Olive oil has been shown to be healthy in multiple studies. However, both coconut oil and ghee contain ~50% long-chain saturated fats and are problematic. I have covered this in detail in a previous article on coconut oil.
  • Whole grains and legumes are included in most anti-inflammation diets. Their exclusion from the Whole 30 Diet cannot be justified on the basis of inflammation.
  • I would be far more concerned about additives like artificial colors, flavors and preservatives than I would be about carrageenan, MSG, and sulfite. I have covered carrageenan in one recent article and MSG in a second article.

 

Is The Whole 30 Diet Right For You?

 

In summary, there is a lot to like about the Whole 30 Diet:

  • It eliminates sodas, junk foods, fast foods, and sweets.
  • It focuses on whole foods rather than processed foods.
  • If followed exactly as described for 30 days, it is likely to result in successful short-term weight loss.
  • The weight loss is likely to be associated with health benefits.
  • However, these statements are equally true for most popular diets.

The web site for the Whole 30 Diet does not indicate what diet is recommended at the end of the 30-day period. However, if the Whole 30 Diet is continued, it is not clear whether it would be ideal for weight maintenance and health long-term.

  • The elimination of sodas, junk foods, fast foods, and the reliance on whole foods is a positive.
  • It’s reliance on meat rather than legumes and other plant protein sources is a negative.
  • It’s elimination of multiple food groups is likely to lead to nutritional deficiencies.

 

The Bottom Line

 

If you are primarily interested in an evaluation of the Whole 30 Diet, here is a summary:

There is a lot to like about the Whole 30 Diet:

  • It eliminates sodas, junk foods, fast foods, and sweets.
  • It focuses on whole foods rather than processed foods.
  • If followed exactly as described for 30 days, it is likely to result in successful short-term weight loss.
  • The weight loss is likely to be associated with health benefits.
  • However, these statements are equally true for most popular diets.

The web site for the Whole 30 Diet does not indicate what diet is recommended at the end of the 30-day period. However, if the Whole 30 Diet is continued, it is not at all clear whether it is ideal for weight maintenance and health long-term.

  • The elimination of sodas, junk foods, fast foods, and the reliance on whole foods is a positive.
  • It’s reliance on meat rather than legumes and other plant protein sources is a negative.
  • It’s elimination of multiple food groups is likely to lead to nutritional deficiencies.

If you would like to know the principles used to reach these conclusions (principles you can use to evaluate any diet), read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Choosing the Best Weight Loss Diet

Calories Rule

Author: Dr. Stephen Chaney

 

weight loss dietChoosing a weight loss diet?

Next week you’ll be making your annual New Year’s resolution that this will be the year that you finally lose those extra pounds and keep them off!

The good news is that you will have lots of choices for losing that weight. The bad news is that most of those choices are bogus!

You see each diet book and Internet marketer will have a “magic formula.”

  • Sometimes it will be a “magic” diet composition – low fat diets, low carb diets, high protein diets – or don’t eat protein and carbohydrates together.
  • Sometimes it will be a “magic” food – grapefruit, cabbage soup, acai berries or chocolate.
  • Sometimes it will be a villainous food or food group to avoid – sugar, grains, or dairy.

All these diets are hyped with a lot of scientific sounding mumbo jumbo and many of them have short term studies that seem to show that they work. But whenever well designed scientific studies have been performed that compare these diets at equal calorie levels and look at weight loss over two years or more, there is not a dime’s worth of difference between them.

With Weight Loss Diets, Calories Rule

weight loss diet calories ruleDespite all the hype that you will hear, weight loss is dependent on the difference between calories in and calories out.

Don’t misunderstand me, I recognize that the calorie equation is not identical for everyone. For example, in a recent issue, “Does Genetics Determine Weight,”  of “Health Tips From The Professor” I talked about a study that put all of the subjects in a metabolic ward where every aspect of calorie intake and calorie expenditure were controlled. They then restricted calories by the same percent for everyone for 6 weeks. The subjects with “thrifty genes” lost 5% of their body weight. Subjects with “spendthrift genes” lost 12% of their body weight.

  • The good news is that everyone lost weight. Calories rule!
  • The bad news is that some people lost weight more slowly than others. Life isn’t fair.

The problem, of course, is that we don’t live in a metabolic ward. We have trouble keeping track of the calories we eat and overestimate the calories we burn. That’s why fad diets are so popular. They promise you won’t have to track calories. You don’t have to watch what you eat. You won’t need to exercise. All you need to do is eat the foods they tell you are OK and avoid the foods they tell you are bad.  This is not how to choose a weight loss diet.

I have a news bulletin: There is no “magic diet formula,” no “magic diet composition” and no “magic diet food.”  Did you really think that someone had repealed the laws of thermodynamics?

Once you understand and accept that the difference between calories in and calories out is the most important determinant of successful weight loss, you can start to understand the key principles of successful weight loss.

 

Choosing The Best Weight Loss Diet

 

choosing best weight loss dietHere is a quick guide to choosing the best diet:

Principle #1: The diet doesn’t have to be weird to be successful.

In fact, the diet is most likely to succeed if it includes foods that are familiar to you.

If you’re a “meat and potatoes” guy, a vegetarian diet is not likely to be successful for you (Some of my friends refer to that kind of diet as “rabbit food”). If you are a vegetarian, a meat-based low-carb diet is not likely to be appealing.

More importantly, we are all different. Some of us will lose weight successfully on one diet. Other people will be more successful on a different diet. That means that the diet that worked so well for your friend might not work at all for you. You will need to experiment a bit to find the best diet for you.

And, before you ask me, your body type or blood type has absolutely nothing to do with which diet is going to work best for you.

Of course, you will need to make some changes to your diet. You will want to drop unhealthy foods from your diet and include some foods that are new to you. The first foods to go should be sodas (both sugar-sweetened and diet), junk foods, and fast foods. In their place add water or herbal tea, fruits, vegetables, and whole grains. That change alone can be worth at least 2-5 pounds in your first month.

You will want to think about what you are eating and make conscious choices about which foods are helping you fulfill your goals of losing weight and which are not.

Principle #2: The diet should be one that is healthy in the long run.

I’m particularly talking about the popular high fat, low carbohydrate diets here. It is clear diets high in meat and fat – particularly saturated and trans fats – are associated with increased risk of heart disease, diabetes, cancer and inflammatory diseases.

Plus, high fat diets just don’t work well for long term weight control. Fat has more calories than carbohydrate. This is not rocket science!

Just in case you don’t believe me, you just need to consult the National Weight Control Registry. The National Weight Control Registry was established in 1994 and has tracked the weight loss strategies of over 5000 people who have been successful at keeping their weight off long term.

While those people lost weight using every diet in the books, the vast majority of them who were successful at keeping their weight off long term followed a low calorie, low-fat diet to maintain their weight loss. Of course, I am not referring to a low-fat that contains a lot of sugar and refined carbohydrates. That kind of diet is part of the problem. I am referring to a plant-based low-fat diet with lots of fruits, vegetables, legumes and whole grains.

Principle #3. Don’t forget the other part of the calorie equation. That’s right, I’m talking about exercise.

While you burn some calories every time you exercise, the real value of exercise is that it increases lean muscle mass – and lean muscle mass burns more calories than fat.

Again, if you consult the National Weight Control Registry, you will find that virtually everyone who has been successful at keeping the weight off exercises on an almost daily basis.

Helpful hint: The handy exercise monitors on your Fit Bit, smart phone, and exercise machines overestimate energy expenditure by as much as 50%. Decrease those numbers accordingly when you are estimating your calorie balance for the day.

Principle #4: Don’t start if you don’t intend to finish. Once again, the National Weight Control Registry puts that in perfect perspective.

Almost everyone who was successful at keeping the weight off long term had stopped thinking of it as a diet. It had become a way of life. It was how they ate. It was the exercise that they liked to do on a daily basis. It no longer required any conscious effort. It no longer required any will power.

This is perhaps the most important weight control principle of all:

When you make your resolutions this New Year, don’t make a resolution to change your weight. Make a resolution to change your life.

 

The Bottom Line

 

Forget the hype. There is no “magic diet formula”, no “magic diet composition” and no “magic diet food.” While the calorie equation is different for each of us (see article above for details), weight loss always requires that calories out be greater than calories in. Calories rule!

Here are four simple principles to keep in mind when selecting the best diet to lose weight next year.

#1: The diet doesn’t have to be weird to be successful.

#2: The diet should be one that is healthy in the long run.

#3: Don’t forget the other part of the calorie equation, i.e. exercise.

#4: Don’t start if you don’t intend to finish.

For more details, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

A Bad Diet as an Adult May be the Result of Poor Feeding Habits in Infancy

“As The Twig Bends…”

Author: Dr. Stephen Chaney

infant bad dietYou have probably heard the saying “As the twig bends, so grows the tree.”  The origin of that quote is lost in lore of medieval England, but the saying absolutely rings true when we are talking about infant nutrition and a bad diet as an adult.

Most moms naturally assume that a healthy diet is important for their infants, but many new moms have questions:

  • What does a healthy diet for their infant look like?
  • What should they do if their infant is a fussy eater?
  • Could what they feed their infants influence their eating patterns and their health for years to come?

Of course, there is no shortage of advice. There are the family customs handed down from generation to generation. There is lots of advice on the internet, some of it offered by people who have no knowledge of nutrition. Your pediatrician’s advice may be based on what they learned in medical school, but it is just as likely to have come from their mother.

All of that advice is well meaning, but some of it is flat out wrong!

Fortunately, the Centers for Disease Control and the US Food and Drug Administration have sponsored a major study called the longitudinal Infant Feeding Practices Study II (IFPD II) to answer these and other important questions about infant feeding practices.

How The Study Was Set Up

The initial phase of the study was performed between May 2005 and June 2007, and the study design was reported in 2008 (Fein et al., Pediatrics, 122: S28-S35, 2008). During this phase of the study, investigators simply collected information on infant feeding practices from ~2000 mothers when their infants were between 1 month and 1 year of age.

The purpose of this phase of the investigation was simply to collect baseline data so that subsequent studies could correlate infant feeding practices with diet and health outcomes as these children got older.

This was a very comprehensive survey of infant feeding practices and health status:

  • The first neonatal feeding practices survey was sent when the infant was ~ 1 month old.
  • Between ages 2 to 7 months, nine more surveys were sent out on an approximately monthly basis.  These surveys asked about infant feeding, health, care, and related issues.
  • After 7 months additional surveys were sent out every 7 weeks until the infant was 12 months old.
  • In addition, the study included two maternal dietary surveys, one during pregnancy and a second one 4 months after delivery.

A Bad Diet Can Begin in Infancy

In phase 2 of the study multiple investigators followed up with ~1,500 of these children at age 6 to find out how infant feeding practices correlated with their diet and health as they reached early childhood. These studies were all published in a special edition of the journal Pediatrics in 2014 (Pediatrics, 134: Supplement 1, September 2014).  Key findings from these studies were:

breastfeedingDuration of Breastfeeding Is Positively Correlated With A Healthier Diet At Age 6(C.G. Perrine et al, Pediatrics, 134: S50-S55, 2014). Specifically:

  • Infants who were breastfed for 12 months or longer were significantly more likely to drink water and to eat fresh fruits and vegetables at age 6 than infants who were breastfed for 6 months or less.
  • Infants who were breastfed for 12 months or longer were also significantly less likely to consume juices and sugar-sweetened beverages at age 6.
  • However, no correlation was seen between the duration of breastfeeding and consumption of milk, sweets and salty snacks in this study.

The authors of this study made the interesting comment that the taste of breast milk varies somewhat depending on what the mother has eaten that day. In contrast, commercial infant formulas taste the same every time and are often somewhat sweeter than breast milk. They hypothesized that this normal variation in the taste of breast milk may make toddlers and young children more willing to accept new foods such as fruits and vegetables.  Here, you can already start to see breastfeeding longer may help avoid a bad diet later.

Of course, the authors cannot eliminate the possibility that mothers who breastfeed longer are also choosier about what they feed their children.

Fruit and Vegetable Intake In Infancy Is Positively Correlated With Fruit and Vegetable Intake At Age 6(K.A. Grimm et al, Pediatrics, 134: S63-S69, 2014).  Specifically:

  • 33% of 6-year-olds in their survey consumed fruit less than once daily and 20% consumed vegetables less than once daily.
  • More importantly, children in their study who consumed fruits and vegetables less than once daily during late infancy (10-12 months) were ~2.5 times less likely to eat fruits and vegetables more than once daily at age 6.

The authors of the study made the interesting observation that a liking of things that are sweet or salty is hardwired into the human brain.  A single exposure to sweet and salty foods during infancy may be all that it takes to create a lifelong craving for those kinds of foods and leading to a  bad diet.

In contrast, it may take repeated exposure to fruits and vegetables during infancy to develop a familiarity and preference for those kinds of foods. One of the authors of this study reported in a previous study that infants who were offered green beans for the first time squinted and wrinkled their noses. However, many of those same infants opened their mouths to try a spoonful if parents persisted.

Once again, there are other factors to consider, such as the kind of diet parents are modeling for their children.

Consumption of Sugar-Sweetened Beverages During Infancy Doubles The Odds Of Consuming Them At Age 6(S. Park et al, Pediatrics, 134: S56-S62, 2014).  This study speaks for itself, but it is troubling.  I shudder every time I see a young mother wheeling her baby through a store with a soft drink in their baby bottle.  Is this a bad diet for an infant?

The implication of these studies and several other studies published in that issue of Pediatrics is clear.  Bad diets do begin in infancy.  However, there is a positive side to these studies.  Good diets also begin in infancy, and you are in charge of what your infant puts in their mouth.

Bad Health Begins In Infancy

These studies are critically important because bad diets are not just a victimless crime.  Bad diets affect health.  Eventually, they kill people.  Here are two examples from this set of studies that show how an infant’s diet affects their health – one positively and one negatively.

Duration of Breastfeeding Is Positively Correlated With A Healthier Immune System At Age 6(R. Li et al, Pediatrics, 134: S13-S20, 2014). This study showed that longer breastfeeding and later introduction of foods was associated with lower rates of ear, throat, and sinus infections.  This conclusion is not exactly new.  It strongly supports what a number of previous studies have shown.

bad diet childConsumption of Sugar-Sweetened Beverages During Infancy Doubles The Odds Of Obesity At Age 6(L. Pan et al, Pediatrics, 134: S29-S35, 2014).  This finding is not surprising.  The study mentioned above showed that consumption of sugar-sweetened beverages during infancy doubles the odds of consuming them at 6.  Moreover, previous studies have clearly shown that consumption of sugar-sweetened beverages is associated with obesity in children.

However, this finding is troubling because obese children often become obese adults, and obesity is associated with many serious health issues.

Again, the implication of these studies is clear.  Both bad health and good health can be strongly influenced by feeding habits established in infancy.

 

The Bottom Line

 

  • A major clinical study supported by the Centers for Disease Control and Prevention and the US Food and Drug Administration monitored infant feeding patterns during the first year and compared those patterns with diet habits and health outcomes at age 6.
  • The duration of breastfeeding was positively associated with a healthier diet and a stronger immune system at age 6. Specifically:
  • Infants who were breastfed for 12 months or longer were significantly more likely to drink water and to eat fresh fruits and vegetables at age 6 than infants who were breastfed for 6 months or less.
  • Infants who were breastfed for 12 months or longer were also significantly less likely to consume juices and sugar-sweetened beverages at age 6.
  • Infants who were breastfed for 12 months or longer were significantly less likely to suffer from of ear, throat, and sinus infections.
  • The pattern of fruit and vegetable consumption established in late infancy was maintained through at least age 6. Specifically:
  • Children who consumed fruits and vegetables less than once daily during late infancy (10-12 months) were ~2.5 times less likely to eat fruits and vegetables more than once daily at age 6.
  • Consumption of sugar-sweetened beverages during infancy has a negative impact on both diet and health through at least age 6. Specifically:
  • Consumption of sugar-sweetened drinks during infancy doubles the chances that children will still be consuming sugar-sweetened beverages and will be obese at age 6.
  • This study strongly confirms what many smaller studies have suggested for years. It reinforces the importance of breastfeeding for at least the first 12 months and slowly transitioning to healthy foods rather than sugar-sweetened beverages and junk foods. It shows that what we feed our infants may influence their diet and their health for a lifetime.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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