weight loss

600th Issue Celebration

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Nutrition Advances Over The Last Two Years

Author: Dr. Stephen Chaney 

celebrationIn the nearly twelve years that I have been publishing “Health Tips From The Professor”, I have tried to go behind the headlines to provide you with accurate, unbiased health information that you can trust and apply to your everyday life.

The 600th issue of any publication is a major cause for celebration and reflection – and “Health Tips From The Professor” is no different.

I am dedicating this issue to reviewing some of the major stories I have covered in the past 100 issues. There are lots of topics I could have covered, but I have chosen to focus on three types of articles:

  • Articles that have debunked long-standing myths about nutrition and health.
  • Articles that have corrected some of the misinformation that seems to show up on the internet on an almost daily basis.
  • Articles about the issues that most directly affect your health.

Here are my picks from the last two years:

Weight Loss Diets

weight lossSince it is almost January, let’s start with a couple of articles about diet and weight loss (or weight gain). I have covered the effectiveness of the Paleo, Keto, Mediterranean, DASH, vegetarian, and Vegan diets for both short and long-term weight loss in my book “Slaying The Food Myths”, so I won’t repeat that information here. Instead, I will share a few updates from the past 100 issues.

Is Time-Restricted Eating Better Than Other Diets? Time-restricted eating is one of the latest fads. But is it really better than other diets for weight loss and improved health? In this article I reviewed two studies that compare time-restricted eating with diets that do not restrict time of eating but cut calories to the same extent. You may be surprised at the results.

Can You Lose Weight Without Dieting? In this article I share 8 tips for losing weight without going on a diet. The article is based on research by Dr. Brian Wansink, a behavioral psychologist who specializes in studying how external clues influence our eating patterns. As you might suspect his 8 tips for losing weight have nothing to do with counting calories or going on restrictive diets.

Healthy Diets

dairy foodsIs Whole Fat Dairy Healthy? For years dietary guidelines have been telling us to select low fat dairy foods. But some health gurus are telling you that isn’t true. They claim whole fat dairy is healthy. So, you are probably wondering, “What is the scoop (as in ice cream) on whole fat dairy?” In this article I look at the study behind the headlines and answer that question. But the answer is not a simple “Yes” or “No”. The answer is more nuanced. It turns out that whole fat dairy is healthier in some diets than in others. 

Are Low Carb Diets Healthy? Are low carb diets good for you or bad for you? It depends on which study you quote. Two major studies in recent years have come to opposite conclusions. In this article I help you sort through the conflicting studies and rephrase the question. Instead of, “Are low carb diets healthy”, the question should be, “Which low carb diets are healthy?”

Are All Plant-Based Diets Healthy? Plant-based diets have acquired a “health halo” in recent years. Your mama told you to eat your fruits and vegetables. And many health gurus have been telling you not to neglect your grains, legumes, nuts, and seeds as well. But some of these foods require a lot of food preparation.

Never fear! The food industry has come to your rescue with a wide variety of processed plant-based foods. No need for food prep. But are they as good for you as the unprocessed plant foods they replace? In this article I review a study that answers that question.

You probably know what that answer is, but the article is worth a read anyway. That is because the study also asks whether vegan and vegetarian diets are healthier than other primarily plant-based diets. And you may not know the answer to that question.

Diet And Heart Disease

egg confusionAre Eggs Bad For You? For years we were told that eggs are bad for us because they contain cholesterol. Then we were told that eggs in moderation may not increase our risk of heart disease. And recently studies have appeared claiming eggs may be good for our hearts. What is the truth about eggs and heart disease? In this article I review a recent study claiming eggs are bad for our heart and put that study into the context of other recent studies to clear up the “eggfusion”.

Which Diets Are Heart Healthy? Every popular diet claims to help you lose weight, reduce your risk of diabetes, and reduce your risk of heart disease. All these claims can’t be true. Which diets deliver on their promises, and which are just pretenders? In this article I review a recent study that answered that question for heart disease.

This study was a very large metanalysis of over 40 studies with 35,548 participants that looked at the effect of different diets on heart disease outcomes. The study identified two diets that significantly reduced the risk of heart disease. There are other diets that might reduce the risk of heart disease, but their benefits have not been proven by high quality clinical studies. They are merely pretenders.

The Dangers Of Processed Foods 

In previous issues of “Health Tips From the Professor” I have shared articles showing that diets high in processed foods are associated with an increased risk of obesity, diabetes, and heart disease. But the story keeps getting worse. Here are two articles on recent studies about processed foods that appeared in “Health Tips From The Professor” in the last two years.

Why Does Processed Food Make You Fat? We already know that eating a lot of highly processed food is likely to make us fat. But what is it about processed food that makes us fat? In this article I review a recent study that answers that question.

This study is interesting for two reasons.

  • It identifies the characteristics of processed foods that make us want to eat more.
  • It identifies some minimally processed foods that have the same characteristics and suggests we should choose minimally processed foods wisely. Simply put, knowledge is power. We may want to avoid minimally processed foods that have the same obesity-inducing characteristics as processed foods.

Do Processed Foods Cause Cancer? Previous studies have shown that processed food consumption is associated with a higher risk of obesity, diabetes, and heart disease. Can it get any worse? In this article I review a recent study that shows processed food consumption is associated with an increased risk of several kinds of cancer.

Maintaining Muscle Mass As We Age

As we age, we begin to lose muscle mass, a process called sarcopenia. Unless we actively resist loss of muscle mass it will eventually impact our quality of life and our health.

We can prevent this loss of muscle mass with resistance exercise, adequate protein intake, and adequate intake of the amino acid leucine. Previous studies have shown people over 50 need more of each of these to maintain muscle mass, but the amount they need has been uncertain until now. Three recent studies have given seniors better guidelines for maintaining muscle mass.

Can You Build Muscle In Your 80s? In this article I review a recent study that enrolled a group of octogenarians in a high-intensity exercise program to see if they could gain muscle mass. They were able to increase their muscle mass, but the intensity of the exercise required may surprise you.

Optimizing Protein Intake For Seniors. In this article I review two recent studies that looked at the amount, timing, and kind of protein needed for seniors in their 60s and 70s to maximize gain in muscle mass.

How Much Leucine Do Seniors Need? In this article I review a recent study that determined the amount of leucine seniors in their 70s need to optimize gains in muscle mass and strength.

The Benefits And Risks Of Supplementation

Omega-3s And Heart DiseaseIf you listen to Big Pharma or the medical profession, you hear a lot about the “risks” of supplementation and very little about the benefits. In “Health Tips From the Professor” I try to present a more balanced view of supplementation by sharing high-quality studies showing benefit from supplementation and studies that put the supposed risks into perspective.

The Good News About Omega-3s and Stroke. Multiple studies have shown that omega-3 supplementation reduces the risk of ischemic strokes (strokes caused by a blood clot). But it has been widely assumed they might increase the risk of hemorrhagic strokes (strokes caused by bleeding). In this article I review a meta-analysis of 29 clinical studies with 183,000 participants that tested that assumption.

How Much Omega-3s Are Best For Blood Pressure? Multiple studies have shown that omega-3 supplementation can reduce high blood pressure. But the doses used vary widely from one study to the next. In this article I review a meta-analysis of 71 double-blind, placebo-controlled clinical studies that determined the optimal dose of omega-3s for controlling blood pressure.

Omega-3 Supplements Are Safe. As I said above, it has been widely assumed that omega-3 supplementation increases the risk of bleeding and hemorrhagic stroke. In this article I review the definitive study on this topic. More importantly, it reveals which omega-3 supplements might increase bleeding risk and which do not.

Are Calcium Supplements Safe? Big Pharma and the medical profession have been warning us that calcium supplements may increase heart disease risk. In this article I review the definitive study on this topic.

Prenatal Supplements

prenatal dha supplementIf you are pregnant or thinking of becoming pregnant, your health professional has likely recommended a prenatal supplement. You probably assume that prenatal supplements provide everything you need for a healthy pregnancy. Unfortunately, recent research has shown that assumption is not correct.

Is Your Prenatal Supplement Adequate? In this article I review a study that should serve as a wakeup call for every expectant mother. It showed that most prenatal supplements were woefully inadequate for a healthy pregnancy.

What Nutrients Are Missing In Prenatal Supplements? In this article I review a study that identified additional nutrients that are missing in most prenatal supplements.

Prenatal Supplements Strike Out Again. In this article I review a study that looked at the diet of pregnant women to determine their needs and compared that to the nutrients found in prenatal supplements. Once again, most prenatal supplements were woefully inadequate. Is it, “Three strikes and you are out”?

Exercise

Walking FastWalking Your Way To Health. We have been told that walking is good for our health. But how many steps should you take, how fast should you walk, and does it matter whether these steps are part of your daily routine or on long hikes? In this article I review a study that answers all these questions.

Which Exercise Is Best For Reducing Blood Pressure? If you have high blood pressure, you have probably been told to exercise more. But which exercise is best? In this article I review a study that answers that question. And the answer may surprise you.

Did You Know? 

Question MarkIf you have been reading “Health Tips From the Professor” for a while, you probably know that I enjoy poking holes in popular myths. Here are two new ones I deflated in past two years.

Is Low Alcohol Consumption Healthy? You have probably heard that low alcohol intake (that proverbial glass of red wine) is good for you. But is that true? In this article I review a recent study that shows that myth was based on faulty interpretation of the data and provides a more nuanced interpretation of the data.

Is HDL Good For Your Heart? You have been told that increasing your HDL levels reduces your risk of heart disease so many times it must be true. But is it? In this article I review HDL metabolism and a recent study to provide a more nuanced interpretation of the relationship between HDL and heart disease risk.

How To Talk With Your Doctor About Cancer 

Because of my years in cancer research, I am often asked whether someone should follow their oncologist’s advice and go on a recommended chemotherapy or radiation regimen. Of course, it would be unethical for me to provide that kind of advice.

In this article I tell you the questions to ask your oncologist about the prescribed treatment regimen, so you can make an informed decision. However, I also recommend you only ask these questions if you can handle the answers.

The Bottom Line

I have just touched on a few of my most popular articles above. You may want to scroll through these articles to find ones of interest to you that you might have missed over the last two years. If you don’t see topics that you are looking for, just go to https://chaneyhealth.com/healthtips/ and type the appropriate term in the search box.

In the coming years, you can look for more articles debunking myths, exposing lies and providing balance to the debate about the health topics that affect you directly. As always, I pledge to provide you with scientifically accurate, balanced information that you can trust. I will continue to do my best to present this information in a clear and concise manner so that you can understand it and apply it to your life.

Final Comment: You may wish to share the valuable resources in this article with others. If you do, then copy the link at the top and bottom of this page into your email. If you just forward this email and the recipient unsubscribes, it will unsubscribe you as well.

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.

_______________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

 _______________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.  Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com/lifestylechange/.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Do GLP-1 Drugs Increase Suicide Risk?

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The Pros and Cons Of GLP-1 Drugs 

Author: Dr. Stephen Chaney 

MagicYou’ve seen the ads. You just inject these “miracle” drugs into your thigh once a week, and your excess weight magically disappears. They look like the simple solution for weight loss everyone has been looking for.

More about that in a minute. Let’s first talk about what these drugs are how they work.

What GLP-1 Drugs Are: These drugs are commonly referred to as GLP-1 drugs. But their full name is GLP-1-like receptor agonists. That’s a mouthful, so let me break it down for you.

GLP-1 stands for glucagon-like peptide-1. Glucagon-like peptide-1 is produced by the stomach whenever we eat a meal. It is a hormone that binds to receptors in key organs and reduces appetite and lowers blood sugar (more about this in a minute).

GLP-1-like drugs are peptides designed to resemble the portion of the glucagon-like peptide that binds to GLP-1 receptor. The term agonist means that these drugs have the same effect as the naturally occurring GLP-1 peptide.

The difference is that the naturally occurring GLP-1 peptide hormone is rapidly degraded, so it stays in the bloodstream for a very short time after each meal. In contrast, the GLP-1-like receptor agonist drugs are designed to be much more stable, remaining in the bloodstream for a week or more. That’s why these drugs only need to be injected on a weekly basis.

How GLP-1 Drugs Work: GLP-1 drugs:

  • Bind to GLP-1 receptors on the pancreas and stimulate insulin release. This can help type 2 diabetics control their blood sugar levels.
  • Bind to GLP-1 receptors on the stomach and reduce the rate of gastric emptying. This prolongs the feeling of fullness after each meal.
  • Bind to GLP-1 receptors on the small intestine and reduce gut motility, which increases transit time through the small intestine. This also prolongs the feeling of fullness. But it can also lead to gastrointestinal side effects.
  • Bind to GLP-1 receptors on the brain and turn down your “appestat”. This reduces feelings of hunger between meals.

A Brief History Of GLP-1 Drugs

ProfessorGLP-1 drugs have been around since 2005.But the newest and most successful class of GLP-1 drugs (e.g., Ozempic) was developed in 2017 by a Danish pharmaceutical company called Novo Nordisk to help type 2 diabetics control their blood sugar levels.

However, once it became apparent that patients on Ozempic achieved significant weight loss, doctors started prescribing it for weight loss even though it had only been approved for controlling blood sugar. This is a practice described as “off label” use. It became so popular for weight loss that diabetics started to have trouble getting their prescriptions filled.

Novo Nordisk ramped up their production of Ozempic and introduced a second, higher potency drug, Wegovy, that is marketed primarily for weight loss. And, of course, where there is money to be made other companies have introduced their own GLP-1-like receptor agonists for both controlling blood sugar and weight loss.

The popularity of these drugs can only be described as a tsunami. To help you put it into perspective:

  • Novo Nordisk’s market value is currently over $500 billion. That is larger than the GDP of Denmark where it is located.
  • One in eight adults in the United States are either taking or have taken a GLP-1 drug.
  • GLP-1 drugs have had 1.2 billion Tik Tok views since 2021.

The Pros And Cons Of GLP-1 Drugs

pros and consLet me be clear. These drugs work. For people with poorly controlled type 2 diabetes or severe obesity-related health issues, they can be a godsend. But like any “quick fix” weight loss drugs they are overprescribed.

The reality is that unless people on the drugs make healthy lifestyle changes, the weight comes back as soon as they quit using the drugs. So, for most people these drugs are not a short-term weight loss solution. They are a long-term necessity if they want to keep the weight off.

And whenever we are thinking about long-term drug use, we need to ask whether they are safe for long-term use.

That brings me to a story. When I was still teaching medical students, the co-director of the first-year course we ran was a medical geneticist. In his introductory lecture to the medical students he made the comment, “The only safe drug is a new drug”. After a dramatic pause he completed the statement with, “That’s because they haven’t discovered all the side effects yet.”

Let me elaborate. Before a drug can be approved by the FDA it must be proven safe and effective in a series of clinical trials. But those clinical trials have their drawbacks. They are relatively short and include a relatively small group of patients.

Sometimes it is only after a drug has been used by millions of patients for several years that we know of some of their most dangerous side-effects. For that reason, the FDA and regulatory agencies in other countries have a monitoring system for detecting “adverse drug reactions” (side-effects) after the drug has been approved.

Simply put, doctors report adverse drug reactions to a central agency. When enough adverse events of a particular type have been detected, clinical studies are initiated to determine how significant that side effect is.

Medical history is littered with drugs that passed the initial company-run clinical studies with flying colors and were introduced to the general public with great fanfare – only to be withdrawn a few years later once serious side-effects had been discovered. One might ask whether GLP-1 drugs may be in the same category.

When you look at the official Ozempic and Wegovy websites they say that the most common adverse reactions, reported in ≥5% of patients in their clinical trials, were nausea, vomiting, diarrhea, abdominal pain, and constipation. These side effects are fully predictable for drugs that inhibit gastric emptying and reduce gut motility. They are also easy to detect in short term clinical studies.

More recently, several reports have suggested that these drugs reduce muscle mass. This is not life-threatening, but it is concerning for older patients trying to maintain muscle mass and for anyone trying to lose weight.

That’s because your muscles are among the most metabolically active tissues in your body. When muscle mass decreases, basal metabolic rate (the rate at which you burn calories 24 hours per day) also decreases. With that in mind, you don’t need to be a genius to understand why loss of muscle mass is a concern for anyone trying to lose weight.

However, more troubling reports have recently surfaced about increases in suicidal behavior in people using GLP-1 drugs. During the company-run clinical trials only 0.27% of drug users reported an increase in suicidal thoughts or behavior, so the drug companies are saying, “Nothing to see here”. However, those clinical trials excluded patients with suicidal tendencies from their analysis, while no such exclusion is recommended for prescribing these drugs.

The authors of the study (G Schoretsanitis et al, JAMA Network Open, 7(8):e2423385, 2024) I will describe today decided to take a closer look at the association of suicidal behavior with GLP-1 drug use.

How Was This Study Done?

clinical studyThe authors obtained their data from the WHO Individual Case Safety Reports database. It is the largest database of its kind in the world, with over 28 million reports of suspected adverse drug reports from 140 member countries.

From this database they identified 107 reports of suicidal and/or self-injurious adverse drug reactions associated with the class of GLP-1 drugs that include Ozempic and Wegovy between July 2011 and August 2023. Key characteristics from these 107 reports were:

  • Median age = 48 years.
  • Percentage of female patients = 55%.
  • Length of GLP-1 use before symptoms were reported = 80 days.
  • Other medications used were primarily medications for diabetes (15.9%), depression (13.1%), and anxiety (4.7%).
  • The suicide was successful in 6.5% of the reports.
  • Suicidal thoughts and/or behaviors disappeared in 62% of the cases after discontinuing the drug.

The authors performed a statistical method known as a disproportionality analysis of suicidal thoughts and behaviors in this group of GLP-1 users. Simply put, they asked whether the frequency of suicidal thoughts or behaviors was disproportionally high for patients using GLP-1 drugs compared to all other drugs in the database for which suicidal tendencies have been reported.

In case you are thinking this is a strange comparison, let me explain why it was chosen.

  • The WHO Individual Case Safety Reports database (and similar databases maintained by the FDA and other national health organizations) only contains reports of adverse drug reactions. There is no way of comparing the number of adverse drug reactions with the number of people taking the drug. So, you cannot use the database to estimate the percentage of people using GLP-1 drugs who develop suicidal thoughts or behaviors.
  • Even if it were possible to estimate the percentage of GLP-1 users who develop suicidal tendencies, databases like this significantly undercount the percentage of adverse drug reactions. That’s because if the symptoms are mild, patients often do not report them to their doctors. And busy doctors don’t always report them to the FDA or WHO. It is primarily the cases that result in hospitalization that get reported.

Do GLP-1 Drugs Increase Suicide Risk?

For simplicity, I am restricting myself to the data in this paper related to the Ozempic and Wegovy class of GLP-1 drugs. The results with other classes of GLP-1 drugs were not as clear.

The authors reported:

  • The Ozemic/Wegovy class of GLP-1 drugs were associated with a disproportionately higher risk of suicidal thoughts and behaviors compared with other drugs in the WHO database.
  • The disproportionately higher risk remained significant when the authors looked at patients who were using the GLP-1 drugs with either antidepressants or anxiety medications.
    • The authors interpreted this as suggesting that people with anxiety or depression may be at higher risk of suicidal thoughts and behaviors when taking this class of GLP-1 drugs.

The authors concluded, “This study using the WHO database found a signal of semaglutide [the class of GLP-1 drugs that includes Ozempic and Wegovy] associated suicidal ideation [suicidal thoughts and behaviors], which requires urgent clarification.”

What Does This Study Mean For You?

Question MarkI don’t want to overemphasize the significance of this study.

  • It does not prove an association of this class of GLP-1 drugs with suicidal thoughts and behaviors.
  • It does not provide definitive information about other classes of GLP-1 drugs. There appeared to be an increased risk, but the data were not statistically significant.
  • However, it is the first study to show there might be an association with GLP-1 drugs and suicidal behavior.
    • Suicide is not a trivial side-effect, which is why the authors said it “requires urgent clarification” by future clinical studies designed specifically to address this possibility. For example, the premarketing clinical trials by the drug companies excluded patients with depression, anxiety, or suicidal tendencies. Since these are likely to be the most vulnerable group, future clinical studies should perhaps focus on this group.

As I said at the beginning of this article, we often don’t know about the most serious side effects of new drugs until they have been on the market for a few years. And it is studies like this one that are often the first indication of serious side effects.

So, here are my recommendations for you:

  • We don’t yet know for sure whether suicidal tendencies are a side-effect of GLP-1 drugs, but you need to be aware that this is a possibility.
  • If you suffer from depression, anxiety, or suicidal thoughts GLP-1 drugs may not be the best choice for you. At the very least you should discuss the risks and benefits with your doctor before using them.
  • If you are using GLP-1 drugs and experience an increase in depression, anxiety, or suicidal tendencies you should discontinue the drug immediately and report your side effects with your doctor.

My most important recommendation is that unless you are dangerously obese, you should consider healthier, drug-free approaches to losing weight. Simple changes in diet and lifestyle can give you gradual weight loss. More importantly, diet and lifestyle change can lead to permanent weight loss. And you will experience side benefits rather than side effects

The Bottom Line

GLP-1 drugs have become immensely popular for weight loss. If you believe the ads, all you need to do is to inject yourself with the drug and those excess pounds will magically appear.

However, we often don’t know about the most serious side effects of new drugs until they have been on the market for a few years. And there have been reports of increased suicide risk associated with the use of GLP-1 drugs.

A recent study looked the increased risk of suicidal thoughts and behaviors associated with the use of GLP-1 drugs. If found:

  • GLP-1 drugs were associated with a disproportionately higher risk of suicidal thoughts and behaviors compared with other drugs.
  • The disproportionately higher risk remained significant when the authors looked at patients who were using the GLP-1 drugs along with either antidepressants or anxiety medications.
    • The authors interpreted this as suggesting that people with anxiety or depression may be at higher risk of suicidal thoughts and behaviors when taking GLP-1 drugs.

For more details on this 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.

______________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

________________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.

Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”.

Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

What Can Twins Tell Us About Diet?

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What Are The Pros And Cons Of Twin Studies? 

Author: Dr. Stephen Chaney 

Why is the advice on healthy diets so confusing? One blog claims the vegan diet is best. Another says it is the keto diet is best. The Mediterranean diet is popular, but other experts claim the DASH or MIND diet might be better. Blogs champion diets ranging from the familiar to downright weird.

If you try to keep up with the science, it seems like the science is constantly changing. Each week you see headlines saying the latest study shows diet “X” is best – and “X” keeps changing. Why is that? Why do studies on healthy diets keep coming up with conflicting conclusions?

I have discussed the strengths and weaknesses of clinical studies and why they provide conflicting results in detail in previous issues of “Health Tips From the Professor”. However, one factor I have not discussed in detail is the effect of genetics on how we utilize foods, something called nutrigenomics.

Simply put, we are all genetically different. The way we utilize foods is different. The effect that foods have on our bodies is different. I have touched on that briefly in a previous article discussing individual difference in blood sugar response to various foods. But that is just one of many examples.

We do not yet know enough about gene-nutrient interactions to use genomic data to accurately predict which diets are best. Again, I have covered that topic in a previous issue of “Health Tips From the Professor”. However, we do know that genetic differences have a big influence on which diet is best for us. And most clinical studies on diets do not even attempt to take genetic differences into account.

That is where twin studies come in. Identical twins (monozygotic twins) have an identical genetic makeup and usually have an identical environment until they become adults. So, when I saw an identical twin study (MJ Landry et al, JAMA Network Open, 6(11):e2344457, 2023) comparing a vegan diet (only plant foods) with an omnivorous diet (both animal and plant foods), I wanted to review it and share it with you.

How Was The Study Done? 

Clinical StudyIdentical twins were recruited from the Stanford Twin Registry. Twenty-two identical twin pairs were chosen for this study. Their characteristics were average age = 40, BMI = 26% (moderately overweight), sex = 77% female, ethnicity = 73% white, followed by an approximately equal representation of Asian, black, multiracial, and Pacific Islander.

One unanticipated characteristic of this group of twins was that 70% of them still lived together and cooked together, so their environment was also very similar.

One twin of each pair was put on a healthy vegan diet and the other on a healthy omnivorous diet for 8 weeks. Both diets were designed by dietitians. The diets emphasized fruits, vegetables, and whole grains while limiting added sugars and refined grains.

Both diets were healthier than the diets the twins were eating prior to the study. Finally, the participants were not told how much to eat, and were not instructed to lose weight.

For the first four weeks the participants were provided with all their meals by a nationwide food delivery company. The participants were also provided with training on purchasing and preparing healthy foods for their diet. This prepared them for the last 4 weeks of the study in which they purchased and prepared their own meals.

Participants visited the Stanford Clinical and Translational Science Research Unit at the beginning of the study and at the end of weeks 4 and 8 for weight measurement and a fasting blood draw.

Adherence to the diets was measured by a series of unannounced interviews to administer a 24-hour dietary recall questionnaire. These were scheduled for the weeks they visited the clinic.

What Can Twins Tell Us About Diet? 

TwinsEven though the sample size was small, there were three statistically significant results.

  • LDL-cholesterol was reduced by 12% for the twin on the vegan diet, while it remained unchanged for the twin on the omnivorous diet.
  • The fasting insulin level was reduced by 21% for the twin on the vegan diet, while it remained unchanged for the twin on the omnivorous diet. This suggests the twin on the vegan diet was experiencing improved blood sugar control after just 8 weeks.
  • The twin on the vegan diet lost 4 pounds in 8 weeks, while weight remained the same for the twin on the omnivorous diet. This occurred even though neither twin was instructed to eat less nor to lose weight. It is most likely a consequence of the lower caloric density of the vegan diet (See my discussion of caloric density in last week’s issue of “Health Tips From the Professor”.
  • The changes in LDL-cholesterol and fasting insulin were remarkable because none of the twins in this study had elevated LDL-cholesterol or problems with blood sugar control at the beginning of the study.

The authors of this study concluded, “In this randomized clinical trial of the cardiometabolic effects of omnivorous vs vegan diets in identical twins, the healthy vegan diet led to improved cardiometabolic outcomes compared with a healthy omnivorous diet. Clinicians can consider this dietary approach as a healthy alternative for their patients.”

[Let me decipher the term cardiometabolic for you. The decrease in LDL-cholesterol is associated with heart health – the cardio portion of the term. The decrease in fasting insulin is associated with decreased risk of diabetes. Since diabetes is considered a metabolic disease, this is the metabolic portion of the term.]

Were There Any Downsides To The Vegan Diet? 

thumbs down symbolThis study also highlighted two well-known limitations of vegan diets.

  • Although the differences were not statistically significant, the authors expressed concern that vitamin B12 intake was less for twins on the vegan diet than twins on the omnivorous diet even though the vegan diet was designed by dietitians.

The authors noted that B12 deficiency among vegans is well known, and said, “Long-term vegans are typically encouraged to take a cyanocobalamin (vitamin B12) supplement.

  • Although both groups had excellent adherence to their assigned diets, those assigned to the vegan diet expressed a lower satisfaction with the diet, which suggests long-term adherence to the diet after the study ended was unlikely.

The authors said, “Although our findings suggest that vegan diets offer a protective cardiometabolic advantage compared with a healthy omnivorous diet, excluding all meats and/or dairy products may not be necessary because research suggests that cardiometabolic benefits can be achieved with modest reduction in animal foods and increases in healthy plant-based foods compared with typical diets.”

“We believe that lower dietary satisfaction in the vegan group may have been attributable to the strictness of the vegan diet…Some people may find a less restrictive diet preferable for LDL-cholesterol-lowering effects.”

I concur.

What Are The Pros And Cons Of Twin Studies? 

pros and consThe Pros are obvious. Most dietary studies cannot take genetic differences into account and have difficulty accounting for environmental differences. In this study genetics was identical for each twin pair and their environment was very similar. It offers a unique advantage over other studies.

But the strength of this study is also its greatest weakness. Because the general population is genetically and environmentally diverse, it is difficult to extrapolate the results to the general population.

If this were the only study to show cardiometabolic benefits of a plant-based diet, it would simply be an interesting observation.

  • But there are several studies showing that the vegan diet is associated with lower weight and reduced risk of heart disease and diabetes.
  • And there are dozens of studies showing that primarily plant-based omnivorous diets reduce the risk of heart disease and diabetes.

This study is fully consistent with those studies.

The Bottom Line 

A recent study put identical twins on either a healthy vegan diet (only plant foods) or a healthy omnivorous diet (both animal and plant foods) for 8 weeks. At the end of 8 weeks:

  • LDL-cholesterol was reduced by 12% for the twin on the vegan diet, while it remained unchanged for the twin on the omnivorous diet.
  • The fasting insulin level was reduced by 21% for the twin on the vegan diet, while it remained unchanged for the twin on the omnivorous diet. This suggests the twin on the vegan diet was experiencing improved blood sugar control after just 8 weeks.
  • The twin on the vegan diet lost 4 pounds in 8 weeks, while weight remained the same for the twin on the omnivorous diet. This occurred even though neither twin was instructed to eat less or to lose weight. It is most likely a consequence of the lower caloric density of the vegan diet.
  • The changes in LDL-cholesterol and fasting insulin were remarkable because none of the twins in this study had elevated LDL-cholesterol or problems with blood sugar control at the beginning of the study.

The authors of this study concluded, “In this randomized clinical trial of the cardiometabolic effects of omnivorous vs vegan diets in identical twins, the healthy vegan diet led to improved cardiometabolic outcomes compared with a healthy omnivorous diet. Clinicians can consider this dietary approach as a healthy alternative for their patients.”

For more information on the pros and cons of this 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.

 _____________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

_______________________________________________________________________

 About The Author

Dr. Steve ChaneyDr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.  Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

For the past 35 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Why Does Processed Food Make You Fat?

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How Can You Enjoy Eating Without Getting Fat? 

Author: Dr. Stephen Chaney 

You are probably tired of hearing about how bad processed foods are for you. If you have been following the headlines, you probably already know that diets high in processed foods are linked to obesity, type 2 diabetes, heart disease, some forms of cancer, memory loss, liver disease, kidney disease, depression, risk of dying from any cause, and much more.

And this is a serious problem because 60-70% of the American diet comes from processed foods.

In fact, you may have seen these headlines so frequently that your eyes glaze over, and your mind shuts down any time you see the words “processed foods” in the title.

This week I will be sharing the latest studies on why processed foods make us fat. Stick with me on this. This is not just another article on processed foods. While the focus of the article is on processed foods, the studies it covers are valuable because they also identify some unprocessed foods that can make us fat.

Spoiler alert! Today’s “Health Tip” is important because it teaches us that weight control is not as simple as eliminating processed foods from our diet. We also need to know which unprocessed or minimally processed foods to eat less of.

Before I proceed, I should give you a brief review of how processed foods are defined because that definition has changed in recent years.

What Are Processed Foods? 

ScientistEveryone used to have a good understanding of which foods were processed. But several years ago, the scientific community introduced a new food classification system called “The NOVA food classification system” and introduced a new category – ultra-processed foods. I have covered this classification system in previous “Health Tips From the Professor” articles, but I will review it here.

The NOVA system categorizes foods into four groups according to the extent of processing they have undergone:

  1.  Unprocessed foods.
    • This category includes foods like fruit, vegetables, milk, eggs, and meat.

2) Processed culinary ingredients.

    • This category includes foods you might find in restaurants or prepare yourself to which things like salt, sugar, vegetable oils, butter, or cream were added in the preparation.

3) Minimally processed foods.

    • This category includes foods like canned vegetables, freshly made breads, and cheeses.

4) Ultra-processed foods.

    • This category includes foods like soft drinks, chips, packaged snacks, most breakfast cereals, chicken nuggets & fish sticks, fast food burgers, hot dogs, and other processed meats.

The actual list is much longer, but you get the idea. What we call processed foods, scientists now call ultra-processed foods. The article I am discussing used the term “ultra-processed foods” in the title.

But, since the term “ultra-processed foods” has not yet entered the popular vocabulary, I will use the term “processed foods” in this article because it is more understandable to the average reader.

Does Processed Food Make You Fat? 

clinical studyI shared a study in a previous issue of “Health Tips From the Professor” that suggested that the answer was yes, but did not answer the question of why. That’s because of the way the experiment was designed.

The ultra-processed diet and unprocessed diets were matched with respect to:

  • Total calories in the food portions given to the subjects.
  • Caloric density (calories per serving size). That’s because caloric density has been linked to overeating (I’ll discuss that in more detail below.) The authors of the study eliminated that variable.
  • Macronutrients (carbohydrate, fat, & protein). I’m sure you’ve seen blogs suggesting that carbohydrates or fat cause weight gain. And you’ve probably seen blogs suggesting that high protein diets cause weight loss. The authors eliminated these variables.
  • Total sugar, fiber, and sodium. That’s because the sugar, fat, and sodium content of foods increase their tastiness (palatability), which has been linked to overeating (more below). The authors eliminated this variable.

In short, this study compared a tasty, healthy ultra-processed food diet with a tasty, healthy unprocessed food diet. [Note: This does not represent the real world. In the real world the ultra-processed foods eaten by most Americans are higher in caloric density, sugar, fat, and sodium and lower in fiber than unprocessed foods.]

However, in the scientific world, this was an excellent study design. By eliminating variables thought to explain the correlation between ultra-processed food consumption and obesity, the study was able to focus on two questions:

#1: With those variables eliminated, do ultra-processed foods still lead to overeating? Here the answer was a clear, yes.

  • The study participants eating ultra-processed foods ate 500 more calories per day than those eating unprocessed foods. (Both groups were presented with meals and snacks containing the same number of calories and told to eat as much as they wanted.)
  • Participants eating ultra-processed foods gained 2 pounds in just two weeks, while those eating unprocessed foods lost 2 pounds.

#2: If so, what else about ultra-processed foods leads to overeating? One popular theory of why ultra-processed foods lead to overeating is that they cause large blood sugar spikes and crashes, which stimulates appetite. But the authors of the study were disappointed to find no large blood sugar spikes following consumption of ultra-processed food meals.

However, I don’t think their data disproves the blood sugar spike theory. Remember that this was a “healthy ultra-processed food diet”. The amount of sugar and fiber was identical in the ultra-processed and unprocessed food diets. More importantly, when I looked at the sample menus provided by authors as supplementary information, each meal contained a significant percent of whole, low-glycemic foods. This was a “healthy ultra-processed food” diet designed by a dietitian, not what the typical American eats.

So, why did the ultra-processed food group eat more in this study? This study did not provide an answer to that question, but other studies (described below) have provided probable answers to that question.

Why Does Processed Food Make You Fat? 

What do other studies tell us about why processed foods make us overeat and gain weight? Here are the top 7 mechanisms that have been suggested and what they mean for us.

candy bar#1: Caloric Density: Simply put, caloric density is the number of calories in a serving of food. When you consume foods with a high caloric density, you are more likely to consume excess calories without even thinking about it.

When I was still teaching medical students, I used this example to illustrate the effect of caloric density on calories consumed. “There are the same number of calories in a 2-ounce candy bar and a pound of apples. You can eat a 2-ounce candy bar and be ready to eat more. If you eat a pound of apples, you are done for a while”.

Since most processed foods have a higher caloric density than unprocessed foods, the simplest solution to weight control is to limit processed foods in your diet.

However, how you or your favorite restaurant prepares unprocessed foods is important as well. For example, the addition of cheese or cream sauces can significantly increase the caloric density of the food. This is why the NOVA food classification system I described above created a new category of “culinary foods” to describe these kinds of foods.

#2: Hyper-palatability: In prehistoric times foods that were sweet, salty, and fatty were essential for survival, so we are hardwired to desire those foods. Here is why:

  • We need a certain amount of sugar for our brain, red blood cells, and a few other tissues to function. Wild game provides almost no carbohydrate. Fruits were the best source of sugar, but fruits were scarce prior to farming. The craving for sweetness drove us to forage far and wide to find fruits and other plant sources of sugar and carbohydrate.
  • Sodium is essential for survival, but unprocessed plant and animal foods provide very little. That’s why even in Biblical times, salt was worth its weight in gold.
  • In prehistoric times, food was sometimes scarce, especially in winter. It might be a week or more between meals. Fat stores got prehistoric man through these times of scarcity, so it was important to eat fatty meals in times of plenty. [Note: We no longer live in times of scarcity, and those fat stores have gone from being an asset to being a health concern.]

Unfortunately, “Big Food, Inc” has weaponized these hardwired desires for sweet, salty, and fatty foods. Simply put, processed foods taste good because they fulfil our hardwired taste desires. Scientists call it “hyper-palatability”. But whatever you call it, we want to eat more, and that leads to overeating.

And again, the way we prepare the foods we eat also matters. It’s only natural to add extra salt, sugar, and/or fat to the foods we prepare so they taste better. And if we add too much, we make the healthy foods we eat hyper-palatable, and we are tempted to overeat.

On a personal note, I never knew you might want to add sugar and fat to the vegetables you cook before my family moved to the south. On the other hand, I had never eaten collard greens before either.

#3: Food Consistency: When you look at studies on the effect of food consistency on calories consumed, you find that there are several different ways of defining food consistency, but they are all looking at the same thing from a different perspective – like the fable of the 6 blind men trying to describe an elephant.

applesauce
  • Food Structure: The classic study, published in 2009, compared the effect of sliced apples, applesauce, and apple juice eaten shortly before a meal on the number of calories consumed at the meal. In terms of calories consumed during the meal, the results were clear. It was apple juice > applesauce > apple slices.

This drew attention to the effect of food structure on calories consumed. Apples are a whole food with cellular structure intact. Applesauce contains all the nutrients, phytonutrients, and fiber of whole apples, but the cellular structure has been lost. Apple juice contains most of the nutrients and phytonutrients of applesauce, but the fiber has been lost.

Why does the structure of whole foods matter?

    • Cell structure must be destroyed before digestion can occur, the release of sugar and carbohydrates from the food is delayed. This reduces the spikes and valleys of blood sugar that can increase appetite.
    • Transit time of the food through the intestine is also delayed. Thus, the feeling of fulness persists longer, which reduces appetite.

There are two takeaway lessons from this study that may not be so obvious:

    • Neither applesauce nor apple juice meet the NOVA definition of an ultra-processed food. So, simply removing processed foods from your diet may not be enough to reduce your appetite and, therefore, your caloric intake.
    • In addition, adding fiber back to apple juice did not make it equivalent to applesauce in reducing appetite. So, despite what Big Food Inc tells you, adding fiber to processed foods does not turn them into health foods.
  • Soft Versus Hard Foods: Many processed foods are soft, and most unprocessed foods are hard. So, you could think of this as a description that separates processed foods from unprocessed foods.

But, if you consider the apples versus applesauce comparison I described above, it is obvious that soft versus hard description also pertains to minimally processed foods such as applesauce and whole, unprocessed foods such as apples. 

For example, one recent study comparing soft versus hard foods found it didn’t matter whether the soft foods were processed or unprocessed. People in the study ate more calories from all soft foods than from hard, unprocessed foods such as raw fruits and vegetables.

  • Fast Versus Slow Foods: This description separates foods based on the speed at which they are digested and pass through the intestine. Once again, you might think of this as a description that separates processed and unprocessed foods until you think about applesauce versus apples comparison.

And, as you might expect, a recent study comparing “fast” versus “slow” foods found it didn’t matter whether the fast and slow foods were processed or unprocessed. People in the study ate more calories from fast foods than from slow foods.

[Note: This study defined “slow” foods as harder, chunkier, more solid, and more viscous. While the first three adjectives describe what other scientists also refer to as “hard” foods, the final adjective broadens the category to include “soft” foods like oatmeal.]

How Can You Enjoy Eating Without Getting Fat? 

For most Americans, weight is a constant uphill battle. Their weight increases by a few pounds every year, and over time that continuing weight gain adds up. Diets are never enjoyable, which is part of the reason they almost always fail in the long term. You want to control your weight, but you also want to enjoy what you eat. Why is that so hard?

The secret to a healthy weight is to find foods you enjoy that don’t increase your appetite –  foods that fill you up, so you eat less naturally. Here are my 4 tips for eating foods you enjoy without getting fat.

Tip #1: Limit processed foods. Processed foods tend to have a high caloric density; are hyper-palatable, soft, and fast; and lack the intact cellular structure of whole, unprocessed foods. And multiple studies, such as the one I cited above, agree that processed foods cause us to eat more and to gain weight. So, the single most important step you can take to control your weight is to limit your intake of processed foods.

Tip #2: Choose minimally processed foods wisely. The studies I shared above suggest that avoiding processed foods may not be enough. We also need to look at the minimally processed foods we eat (applesauce, for example). These studies suggest we should also favor whole, unprocessed foods over minimally processed foods that are softer and faster (more quickly digested).

By now, you might be saying, “Wait a minute. I thought you said I could enjoy eating without getting fat. How can I enjoy eating if I have to give up my favorite processed and minimally processed foods?”

My short answer would be, “No. But you might want to broaden your horizons”. We all tend to be creatures of habit. We eat a relatively small variety of foods on a regular basis. When my wife and I decided to eat healthier, we kept trying new foods until we found new, healthier foods we loved.

The category of whole unprocessed foods offers many options. There are fruits, vegetables, many varieties of 100% whole grains, beans, nus, seeds, eggs, and meats. And we are blessed to live in a country with abundant choices. When you walk into your local supermarket you will find dozens of foods in each of these categories that you have never tried before. Be daring. Keep trying new foods until you find new favorite foods you love.

Tip #3: Be aware of how foods are prepared. The studies described above also suggest how we prepare the food is important. We can start out with a whole unprocessed food and end up with something no better than processed food if we prepare it incorrectly. If we add lots of cream, cheese, butter, and/or sugar, we increase the caloric density. And this can lead to us consuming more calories without even thinking about it.Throw in some salt and we have also made the food hyper-palatable, which makes us want to eat more.

Now you might be saying, “But I grew up with my food being cooked this way. This is my comfort zone. Do I have to completely change the way I cook my food, and the items I choose at my favorite restaurant?”

Again, my short answer would be, “No, but you might want to try new recipes.” I am not a cooking guru. That would be my wife. But I do know there are lots of books and web sites featuring healthy recipes. Once again, be bold. Try new recipes until you find new favorites. Try new items on your favorite restaurant’s menu or try new restaurants until you find healthier, restaurant foods you love.

Tip #4: Never say never. This is perhaps the most important tip. Whenever we tell ourselves we can never eat a food again, it becomes irresistible. We are setting ourselves up for failure. The goal should be to change unhealthy foods and unhealthy recipes from an everyday occurrence to an occasional pleasure.

The Bottom Line 

Multiple studies show that eating processed foods leads to weight gain. It may be no coincidence that 60-70% of the foods Americans eat is highly processed and 60-70% of us are overweight or obese.

In the article above, I summarize recent studies asking why processed foods make us fat. If you think these studies are only of interest to scientists, you would be wrong. These studies also help us to identify unprocessed and minimally processed foods in our diet that can make us fat.

For more information on these studies, and 4 tips on how you can enjoy eating without getting fat, 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.

 _____________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

 

Is HDL Good For Your Heart?

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Is Everything You Knew About HDL Wrong?

Author: Dr. Stephen Chaney 

HDL CHolesterolIn last week’s “Health Tips From the Professor” I talked about one of the greatest strengths of the scientific method – namely that investigators constantly challenge, and occasionally disprove, existing paradigms. That allows us to discard old models of how things work and replace them with better ones.

Last week I shared a study that disproved the paradigm that low to moderate alcohol consumption is healthier than total abstinence. This week I share several studies that challenge the belief that HDL cholesterol is good for your heart.

The belief that HDL is good for your heart has all the hallmarks of a classic paradigm.

  • It is supported by multiple clinical studies.
  • Elaborate metabolic explanations have been proposed to support the paradigm.
  • It is the official position of most medical societies, scientific organizations, and health information sites on the web.
  • It is the recommendation of most health professionals.
  • It has been repeated so often by so many trusted sources that everyone assumes it must be true.

Once we accept the HDL/heart health paradigm as true, we can construct other hypotheses on that foundation. For example:

  • Raising your HDL levels naturally takes effort. Pharmaceutical companies have been pursuing the “magic pill” that raises HDL levels without any effort on your part.
  • Low carb diets like the Keto and Paleo diets are high in saturated fat. The low carb enthusiasts claim this is a good thing because saturated fat raises HDL levels, and HDL is good for your heart.

But what if the underlying HDL/heart health paradigm weren’t true? These hypotheses would be like the parable of a house built on a foundation of sand. The paradigm will be washed away as soon as it is critically tested.

So, let’s look at experiments that have challenged the HDL/heart health paradigm.

Do Drugs That Increase HDL Levels Work?

The first hint that the HDL/heart health paradigm might be faulty happened when a pharmaceutical company developed a drug that selectively increased HDL levels.

The drug company thought they had found the goose that laid golden eggs. Just imagine. People wouldn’t have to lose weight, exercise, or change their diet. They could simply take a pill and dramatically decrease their heart disease risk. A drug like that would be worth $billions.

The problem was that when they tested their drug (torcetrapib) in clinical trials, it had absolutely no effect on heart disease outcomes (AR Tall et al, Atherosclerosis, Thrombosis, and Vascular Biology 27:257-260, 2007).

The pharmaceutical company couldn’t believe it. Raising HDL levels just had to reduce heart disease risk. They concluded they didn’t have the right drug, and they continued to work on developing new drugs.

That was 16 years ago, and no HDL-increasing drug has made it to market. Have they just not found the right drug, or does this mean the HDL/heart health paradigm is incorrect?

Does Saturated Fat Decrease Heart Disease Risk?

Now let’s turn to two claims of low carb enthusiasts.

#1: Saturated fats decrease your risk of heart disease in the context of a low carb diet. I have debunked that claim in several previous issues of “Health Tips From The Professor”. But let me refer you to two articles here – one on saturated fat and heart disease risk and one on low-carb diets.

#2: Saturated fats decrease heart disease risk because they raise HDL levels. This is the one I will address today.

The idea that saturated fats decrease heart disease risk because they raise HDL levels is based on a simplistic concept of HDL particles. The reality is more complex. Several clinical studies have shown:

  • The type of fat determines the property of the HDL particles.
    • When polyunsaturated fats predominate, the HDL particles have an anti-inflammatory effect. When saturated fats predominate, the HDL particles have a pro-inflammatory effect.
  • Anti-inflammatory HDL particles relax the endothelial cells lining our blood vessels. That makes the lining of our blood vessels more pliable, which improves blood flow and reduces blood pressure.
    • Anti-inflammatory HDL particles also help reduce inflammation of the endothelial lining. This is important because an inflamed endothelial lining is more likely to accumulate fatty plaques and to trigger blood clot formation that can lead to heart attacks and strokes.

So, the question becomes, “What good is it to raise HDL levels if you are producing an unhealthy, pro-inflammatory HDL particle that may increase the risk of high blood pressure, heart attacks, and strokes?”

In short, these studies suggest it isn’t enough to just focus on HDL levels. You need to ask what kind of HDL particles you are creating.

Is HDL Good For Your Heart?

strong heartOnce the studies were published showing that…

  • Drug-induced increase of HDL levels without any change in health habits is not sufficient to decrease heart attack risk, and…
  • Not all HDL particles are healthy. There are anti-inflammatory or pro-inflammatory HDL particles, which likely have opposite effects on heart attack risk…

…some people started to question the HDL/heart health paradigm. And one group came up with the perfect study to test the paradigm.

But before I describe the study, I need to review the term “confounding variables”. I described the term and how it affects clinical studies in last week’s article. Here is a brief synopsis:

  • The studies supporting the HDL/heart health paradigm are association studies. Association studies measure the association between a single variable (in this case, increase in HDL levels) and an outcome (in this case, heart disease events, heart disease deaths, and total deaths).
  • Associations need to be corrected for other variables known to affect the same outcome (things like age, gender, smoking, and diabetes would be examples in this case).
  • Confounding variables are variables that also affect the outcome but are unknown or ignored. Thus, they are not used to correct the associations, which can bias the results.

The authors of this study (M Briel et al, BMJ 2009:338.b92) observed that most interventions that increase HDL levels also lower LDL levels. Lowering LDL is known to decrease the risk of heart disease deaths. But this effect had been ignored in most studies looking at the association between HDL and heart disease deaths.

They hypothesized that the change in LDL levels was a confounding variable that had been ignored in previous studies and may have biased the results.Heart Disease Study

To test this hypothesis the authors searched the literature and identified 108 studies with 299,310 participants that:

  • Compared the effect of drugs, omega-3 fatty acids, or diet with either a placebo or usual care.
  • Measured both HDL and LDL levels.
  • Measured reduction in cardiovascular risk.
  • Had a randomized control design.
  • Lasted at least 6 months.

They found that every 10 mg/dl decrease in LDL levels in these studies was responsible for a:

  • 7.1% reduction in heart disease events (both heart disease deaths and non-fatal heart attacks).
  • 7.2% reduction in heart disease deaths.
  • 4.4% reduction in total deaths.

After correcting for the effect of decreased LDL levels on these heart disease outcomes, the increase in HDL levels had no statistically significant effect on any of the outcomes.

The authors concluded, “Available data suggest that simply increasing the amount of circulating HDL cholesterol does not reduce the risk of coronary heart disease events, coronary heart disease deaths, or total deaths. The results support reduction in LDL cholesterol as the primary goal for lipid modifying interventions.”

In other words, this study:

  • Supports the author’s hypothesis that LDL levels were a confounding variable that biased the studies supporting the HDL/heart health paradigm.
  • Concludes that increasing HDL levels has no effect on heart disease outcomes, thus invalidating the HDL/heart health paradigm.

Is Everything You Knew About HDL Wrong?

Peek Behind The CurtainDoes that mean that everything you knew about HDL is wrong? Not exactly. It just means that you need to change your perspective.

Don’t focus on HDL levels. Peek behind the curtain and focus on what’s behind the HDL levels. For example:

  • Losing weight when overweight increases HDL levels. But the decrease in heart disease outcomes is more likely due to weight loss than to the increase in HDL levels.
  • Exercise increases HDL levels. But the decrease in heart disease outcomes is more likely due to exercise than to the increase in HDL levels.
  • Reversing pre-diabetes or type 2 diabetes increases HDL levels. But the decrease in heart disease outcomes is more likely due to the reversal of diabetes than to the increase in HDL levels.
  • High-dose omega-3 fatty acids increase HDL levels. But the decrease in heart disease outcomes is more likely due to the omega-3 fatty acids than to the increase in HDL levels.
  • The Mediterranean diet increases HDL levels. But the decrease in heart disease outcomes is more likely due to the diet than to the increase in HDL levels.

And if you want to go the drug route:

  • Statins and some other heart drugs increase HDL levels, but the reduction in heart disease outcomes is probably due to their effect on LDL levels rather than their effect on HDL levels.

On the other hand:

  • Saturated fats increase HDL levels. But saturated fats increase heart disease risk and create pro-inflammatory HDL particles. So, in this case the increase in HDL levels is not a good omen for your heart.
  • Drugs have been discovered that selectively increase HDL levels. However, there is nothing of value behind this increase in HDL levels, so the drugs have no effect on heart disease outcomes.

The Bottom Line 

In this article I discuss several studies that have challenged the HDL/heart health paradigm – the belief that HDL is good for your heart.

For example, one group of investigators analyzed the studies underlying the HDL/heart health paradigm. They hypothesized that these studies were inaccurate because they failed to account for the effects of LDL levels on heart disease outcomes.

After correcting for the effect of decreased LDL levels on heart disease outcomes in the previous studies, the authors showed that increases in HDL levels had no significant effect on any heart disease outcome.

The authors concluded, “Available data suggest that simply increasing the amount of circulating HDL cholesterol does not reduce the risk of coronary heart disease events, coronary heart disease deaths, or total deaths. The results support reduction in LDL cholesterol as the primary goal for lipid modifying interventions.”

In other words, this study:

  • Supports the author’s hypothesis that LDL levels were a confounding variable that biased the studies supporting the HDL/heart health paradigm.
  • Concludes that increasing HDL levels has no effect on heart disease outcomes, thus invalidating the HDL/heart health paradigm.

Does that mean that everything you knew about HDL is wrong? Not exactly. It just means that you need to change your perspective. Don’t focus on HDL levels. Focus on what’s behind the HDL levels. For more information on that, read the article above.

For more information on this 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.

____________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

Which Diets Are Best In 2023?

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Which Diet Should You Choose?

Author: Dr. Stephen Chaney

Emoticon-BadMany of you started 2023 with goals of losing weight and/or improving your health. In many cases, that involved choosing a new diet. That was only 6 weeks ago, but it probably feels like an eternity.

For many of you the “bloom” has gone off the new diet you started so enthusiastically in January.

  • Perhaps the diet isn’t working as well as advertised…
  • Perhaps the diet is too restrictive. You are finding it hard to stick with…
  • Perhaps you are always hungry or constantly fighting food cravings…
  • Perhaps you are starting to wonder whether there is a better diet than the one you chose in January…
  • Perhaps you are wondering whether the diet you chose is the wrong one for you…

If you are rethinking your diet, you might want to know which diets the experts recommend. Unfortunately, that’s not as easy as it sounds. The diet world has become just as divided as the political world.

Fortunately, you have an impartial resource. Each year US News & World Report invites a panel of experts with different points of view to evaluate popular diets. They then combine the input from all the experts into rankings of the diets in various categories.

If you are still searching for your ideal diet, I will summarize the US News & World Report’s “Best Diets In 2023”. For the full report, click on this link.

How Was This Report Created?

Expert PanelUS News & World Report recruited a panel of 30 nationally recognized experts in diet, nutrition, obesity, food psychology, diabetes, and heart disease to review the 24 most popular diets.

The diets evaluated are not the same each year. Last year they evaluated the top 40 most popular diets. This year they only reviewed the top 24.

That means some good diets were left off the list. For example, the vegan diet is very healthy, but it is also very restrictive. Very few people follow a pure vegan diet, so it didn’t make the top 24 most popular. However, this year’s list did include several primarily plant-based diets that are more popular with the general public.

The panel is also not the same each year. Some experts are rotated off the panel, and others are added. The experts rate each diet in seven categories:

  • How easy it is to follow.
  • Its ability to produce short-term weight loss.
  • Its ability to produce long-term weight loss.
  • its nutritional completeness.
  • Its safety.
  • Its potential for preventing and managing diabetes.
  • Its potential for preventing and managing heart disease.

They converted the experts’ ratings to scores 5 (highest) to 1 (lowest). They then used these scores to construct eleven sets of Best Diets rankings:

  • Best Diets Overall ranks diets on several different parameters, including whether all food groups are included in the diet, the availability of the foods needed to be on the diet and the use of additional vitamins or supplements. They considered if the diet was evidence-based and adaptable to meet cultural, religious, or other personal preferences. In addition, the criteria also included evaluation of the prep and planning time required for the diet and the effectiveness of the diet for someone who wants to get and stay healthy.
  • Best Plant-Based Diets used the same approach as Best Diets Overall to rank the eight plans emphasizing minimally processed foods from plants that were included in this year’s ratings.
  • Best Commercial Diet ratings used the same approach to rank 15 commercial diet programs that require a participation fee or promote the use of branded food or nutritional products.
  • Best Long-Term Weight-Loss Diet ratings were generated by combining the safety of the rate of weight loss promoted and the likelihood of the plan to result in successful long-term weight loss and maintenance of weight loss.
  • Best Fast Weight-Loss Diets were scored on their effectiveness for someone who wants to lose weight in three months or less.
  • Best Diabetes Diet ratings were calculated equally from the effectiveness of the diet for someone who wants to lower risk factors for diabetes, the nutritional quality of the diet, and research evidence-based support for the diet.
  • Best Heart-Healthy Diet ratings were calculated equally from the effectiveness of the diet for someone who wants to lower risk factors for hypertension and other forms of heart disease, the nutritional quality of the diet, and evidence-based support for the diet.
  • Best Diets for Bone and Joint Health were calculated equally on the effectiveness of the diet for someone who wants to lower their risk factors for inflammation and improve bone and joint health, as well as the nutritional quality and research evidence-based support for the diet.
  • Best Diets for Healthy Eating combines nutritional completeness and safety ratings, giving twice the weight to safety. A healthy diet should provide sufficient calories and not fall seriously short on important nutrients or entire food groups.
  • Easiest Diets to Follow represents panelists’ averaged scores for the relevant lifestyle questions, including whether all food groups are included and if the recommended foods are readily available at the average supermarket.
  • Best Family-Friendly Diets were calculated equally on their adaptability for the whole family, including cultural, religious, and personal preferences, the time required to plan and prep, nutritional value and access to food at any supermarket.

Which Diets Are Best In 2023?

Are you ready? If this were an awards program, I would be saying “Envelop please” and would open the envelop slowly to build suspense.

However, I am not going to do that. Here are the top 3 and bottom 3 diets in each category (If you would like to see where your favorite diet ranked, click on this link.

[Note: I excluded commercial diets from this review. (I have a brief discussion of commercial diets below). If you notice a number missing in my summaries, it is because I eliminated one or more commercial diet from my summary.]

Best Diets Overall 

The Top 3: 

#1: Mediterranean Diet. The Mediterranean diet has been ranked #1 for 6 consecutive years.

#2 (tie): DASH Diet (This diet was designed to keep blood pressure under control, but you can also think of it as an Americanized version of the Mediterranean diet.)

#2 (tie): Flexitarian Diet (A flexible semi-vegetarian diet).

The Bottom 3: 

#20: Keto Diet (A high protein, high fat, very low carb diet designed to achieve ketosis).

#21: Atkins Diet (The granddaddy of the high animal protein, low carb, high fat diets).

#24: Raw Food Diet (A diet based on eating foods that have not been cooked or processed).

Best Plant-Based Diets Overall 

The Top 3: 

#1: Mediterranean Diet.

#2: Flexitarian Diet.

#3: MIND Diet (This diet is a combination of Mediterranean and DASH but is specifically designed to reduce cognitive decline as we age.)

The Bottom 3: 

Since only 8 diets were included in this category, even the bottom 3 are pretty good diets, so I did not include a “list of shame” in this category.

Best Long-Term Weight-Loss DietsWeight Loss

The Top 3: 

#1: DASH Diet

#2 (tie): Volumetrics Diet (A diet based on the caloric density of foods).

#2 (tie): Mayo Clinic Diet (A diet designed to establish lifelong healthy eating habits).

The Bottom 3: 

#22 (tie): Keto Diet.

#22 (tie): Atkins Diet.

#24: Raw Food Diet.

Best Fast Weight-Loss Diets

The Top 3: 

#1: Keto Diet

#2: Atkins Diet

#7 (tie): Mayo Clinic Diet

#7 (tie): South Beach Diet

#7 (tie): Volumetrics Diet

The Bottom 3: 

The diets at the bottom of this list were designed for health and weight maintenance rather than rapid weight loss, so I did not include a “list of shame” in this category.

Best Diabetes Diets

The Top 3: 

#1: DASH Diet

#2: Mediterranean Diet

#3: Flexitarian Diet

The Bottom 3: 

#20: Atkins Diet

#21: Paleo Diet (A diet based on what our paleolithic ancestors presumably ate. It restricts grains and dairy and is heavily meat-based).

#22: Raw Food Diet.

Best Heart-Healthy Diets

Healthy HeartThe Top 3: 

#1: DASH Diet

#2: Mediterranean Diet

#3 (tie): Ornish Diet (A whole food, semi-vegetarian diet designed to promote heart health).

#3 (tie): Flexitarian Diet

The Bottom 3: 

#22 (tie): Raw Foods Diet

#22 (tie): Paleo Diet

#24: Keto Diet

Best Diets for Bone and Joint Health 

The Top 3: 

#1 (tie): DASH Diet

#1 (tie): Mediterranean Diet

#3: Flexitarian Diet

The Bottom 3: 

#21 (tie): Raw Foods Diet

#21 (tie): Paleo Diet

#22: Atkins Diet 

#23: Keto Diet 

Best Diets for Healthy Eating

The Top 3: 

#1: Mediterranean Diet

#2: DASH Diet

#3: Flexitarian Diet

The Bottom 3: 

#22: Keto Diet

#23: Atkins Diet

#24: Raw Foods Diet

Easiest Diets to FollowEasy

The Top 3: 

#1 (tie): Flexitarian Diet

#1 (tie): TLC Diet (This diet was designed by the NIH to reduce cholesterol levels and promote heart health.)

#3 (tie): Mediterranean Diet

#3 (tie): DASH Diet

The Bottom 3: 

#19: Atkins Diet

#20: Keto Diet

#22: Raw Foods Diet

Which Diets Are Best For Rapid Weight Loss?

Happy woman on scaleThere are 2 take-home lessons from the rapid weight loss category:

  1. If you are looking for rapid weight loss, any whole food restrictive diet will do.
    • Last year’s diet analysis included the vegan diet, and both vegan and keto diets ranked near the top of the rapid weight loss category. Keto and vegan diets are both very restrictive, but they are polar opposites in terms of the foods they allow and restrict.
      • The keto diet is a meat heavy, very low carb diet. It restricts fruits, some vegetables, grains, and most legumes.
      • The vegan diet is a very low-fat diet that eliminates meat, dairy, eggs, and animal fats.
    • The Atkins and keto diets toppled this year’s rapid weight loss list, but they were joined by the Mayo Clinic, South Beach, and volumetrics diets. Those diets are also restrictive, but, like the vegan diet, they are very different from the Atkins and keto diets.
    • I did not include commercial diets that rated high on this list, but they are all restrictive in one way or another.

2) Whole food, very low carb diets like Atkins and keto are good for rapid weight loss, but they rank near the bottom of the list for every healthy diet category.

    • If you choose to lose weight on the Atkins or keto diets, switch to a healthier diet once you reach your desired weight loss.

Which Diet Should You Choose?

Food ChoicesWith rapid weight loss out of the way, let’s get back to the question, “Which Diet Should You Choose?” My recommendations are:

1) Choose a diet that fits your needs. That is one of the things I like best about the US News & World Report ratings. The diets are categorized. If your main concern is diabetes, choose one of the top diets in that category. If your main concern is heart health… You get the point.

2) Choose diets that are healthy and associated with long term weight loss. If that is your goal, you will notice that primarily plant-based diets top these lists. Meat-based, low carb diets like Atkins and keto are near the bottom of the lists.

  • “Why is that?”, you might ask? The answer is simple. And it’s not that all 30 experts were prejudiced against low carb diets. It’s that the major primarily plant-based diets like Mediterranean, DASH, and flexitarian are backed by long-term clinical studies showing they are healthy and significantly reduce the risk of diabetes, heart disease, and other chronic diseases.
  • On the other hand, there are no long-term studies showing the Atkins and keto diets are healthy long term. And since the Atkins diet has been around for more than 50 years, the lack of clinical evidence that it is healthy long term is damming.

3) Choose diets that are easy to follow. The less-restrictive primarily plant-based diets top this list – diets like Mediterranean, DASH, MIND, and flexitarian. They are also at or near the top of almost every diet category.

4) Choose diets that fit your lifestyle and dietary preferences. For example, if you don’t like fish and olive oil, you will probably do much better with the DASH or flexitarian diet than with the Mediterranean diet.

5) Finally, focus on what you have to gain, rather than on foods you have to give up.

  • On the minus side, none of the diets include sodas, junk foods, and highly processed foods. These foods should go on your “No-No” list. Sweets should be occasional treats and only as part of a healthy meal. Meat, especially red meat, should become a garnish rather than a main course.
  • On the plus side, primarily plant-based diets offer a cornucopia of delicious plant foods you probably didn’t even know existed. Plus, for any of the top-rated plant-based diets, there are websites and books full of mouth-watering recipes. Be adventurous.

What About Commercial Diets?

I chose not to review commercial diets by name, but let me make a few observations.

  • If you look at the gaps in my lists, it should be apparent that several commercial diets rank near the top for fast weight loss, but near the bottom on most healthy diet lists.
  • I do not recommend commercial diets that rely on ready-to-eat, low-calorie, highly processed versions “of your favorite foods”.
    • These pre-packaged meals are expensive. Unless you are a millionaire, you won’t be able to afford these meals for the rest of your life.
    • These pre-packaged meals are not teaching you healthy eating habits that will allow you to keep the weight off.
  • If you wish to spend your hard-earned dollars on a commercial diet, choose a diet that:
    • Relies on whole foods from all 5 food groups.
    • Teaches and provides support for the type of lifestyle change that leads to permanent weight loss.
  • Meal replacement shakes can play a role in healthy weight loss if:
    • They are high quality and use natural ingredients as much as possible.
    • They are part of a holistic lifestyle change program.

The Bottom Line 

For many of you the “bloom” has gone off the new diet you started so enthusiastically in January. If you are rethinking your diet, you might want to know which diets the experts recommend. Unfortunately, that’s not as easy as it sounds. The diet world has become just as divided as the political world.

Fortunately, you have an impartial resource. Each year US News & World Report invites a panel of experts with different points of view to evaluate popular diets. They then combine the input from all the experts into rankings of the diets in various categories. In the article above I summarize the US News & World Report’s “Best Diets In 2023”.

There are probably two questions at the top of your list.

#1: Which diets are best for rapid weight loss? Here are 2 general principles:

  1. If you are looking for rapid weight loss, any whole food restrictive diet will do.

2) If you choose to lose weight on the Atkins or keto diets, switch to a healthier diet once you reach your desired weight loss. Atkins and keto diets are good for rapid weight loss, but they rank near the bottom of the list for every healthy diet category.

#2: Which diet should you choose? Here the principles are:

  1. Choose a diet that fits your needs.

2) Choose diets that are healthy and associated with long term weight loss.

3) Choose diets that are easy to follow.

4) Choose diets that fit your lifestyle and dietary preferences.

5) Finally, focus on what you have to gain, rather than on foods you have to give up.

For more details on the diet that is best for you and my thoughts on commercial diets, read the article above.

Tips For Successful Weight Loss

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Which Diet Is Best?

Author: Dr. Stephen Chaney

It’s the beginning of January. Weight loss season has just launched again. Like millions of Americans, you have probably set a goal to eat healthier, lose weight, or both. But which diet is best? Vegan, Paleo, Keto, 360, Intermittent Fasting, low-carb, low fat – the list is endless.

And then there are the commercial diets: Meal replacements, low calorie processed foods, prepared meals delivered to your door – just to name a few of the categories.

You can choose to count calories, focus on portion sizes, or keep a food journal.

And, if you really want to live dangerously, you can try the latest diet pills that claim to curb your appetite and rev up your metabolism.

The advertisements for all these diets sound so convincing. They give you scientific-sounding mumbo jumbo to explain why they work. Then they talk about clinical studies they say prove their diet works.

If you are like most Americans, you have already tried several of these diets. They worked for a while, but the pounds came back – and brought their friends with them.

But, as the saying goes, “Hope springs eternal in the human breast”. Surely some diet you haven’t tried yet will work for you.

There are such diets. But they will require effort. They will require a change of mindset. There is no magic wand that will chase the extra pounds away forever.

If you are searching for the perfect diet to start the new year, let me be your guide. Here are:

  • 4 tips on mistakes to avoid and…
  • 6 tips on what to look for…
  • 7 tips for making weight loss permanent…

…when you are choosing the best diet for you.

Mistakes To Avoid When Choosing The Best Diet

Avoid1. Endorsements

Endorsements by your favorite athlete or public person are paid for. They don’t necessarily represent their opinion. Nor do they assure you that they follow that diet or use that diet supplement.

Endorsements by Dr. Strangelove and his buddies can be equally misleading. They usually tell you that the medical establishment has been lying to you, and they have discovered the “secret” to permanent weight loss and the “Fountain of Youth”.

Recommendations of the medical and scientific communities usually represent a consensus statement by the top experts in their field. I would choose their advice over Dr. Strangelove’s opinion any day.

2) Testimonials

Most of the testimonials you see online or in print are either paid for or are fake.

Testimonials by your friends can be equally misleading. We are all different. What works for your friend or for your trainer may not work for you.

For example, some of us do better on low-carb diets, and others do better on low fat diets.

[Note: Some DNA testing companies claim they can sequence your DNA and tell you which diet is best. However, as I reported in a recent article in “Health Tips From The Professor”, independent studies show that DNA testing is of no use in predicting whether low-carb or low-fat diets are better for you.]

3) Diets Based on “Magic” Or “Forbidden” Foods or Food Groups.

I have often said we have 5 food groups for a reason. Each food group provides a unique blend of nutrients and phytonutrients. And each plant food group provides a unique blend of fibers that support the growth of different types of friendly gut bacteria.

The bottom line is that each of us does better with some foods than others, but there are no “magic” or “forbidden” foods that apply to everyone.

Magic4) “Magic” Diets.

I have written perhaps the first diet book, “Slaying The Food Myths”, that doesn’t feature a “magic” diet that is going to make the pounds melt away and allow you to live to 100. Instead, I recommend a variety of healthy diets and suggest you choose the one that fits you best.

However, I understand the allure of “magic” diets. Dr. Strangelove claims the diet will be effortless. He gives you some scientific-sounding mumbo-jumbo to convince you the diet is scientifically sound. Then he cites some clinical studies showing the diet will cause you to lose weight and will improve your health parameters (things like cholesterol, triglycerides, blood sugar, and blood pressure). It sounds so convincing.

Before you fall for Dr. Strangelove’s latest “magic” diet, let me share two things that may blow your mind:

  • The studies are all short-term (usually 3 months or less).
  • When you rely on short-term studies, the very low-fat Vegan diet and very low-carb Keto diet give you virtually identical weight loss and improvement in health parameters!

Those two diets are as different as any two diets could be. That means we can forget all the scientific-sounding mumbo-jumbo as to why each of those diets work. Instead, we should ask what these two diets have in common.

The answer is simple:

#1: The clinical studies are comparing “magic” diets to the typical American diet. Anything is better than the typical American diet! It is high in sugar, refined carbohydrates, saturated fat, and highly processed foods. No wonder the “magic” diets look so good.

#2: The diets are whole food diets. Anytime you eliminate sodas, fast foods, and highly processed foods, you will lose weight.

#3: The diets eliminate one or more food groups. Whenever you eliminate some of your favorite foods from your diet, you tend to lose weight without thinking about it. I call this the cream cheese and bagel phenomenon.

  • If you are following a low-fat diet, it sounds great to say you can eat all the bagels you want. But without cream cheese to go with the bagels, you tend to eat fewer bagels.
  • If you are following a low-carb diet, it sounds great to say you can eat as much cream cheese as you want, but without bagels to go with your cream cheese, you tend to eat less cream cheese.

#4: Because they eliminate many of your favorite foods, “magic” diets make you focus on what you eat. Whenever you focus on what you eat, you tend to lose weight. That is why food journals and calorie counters are effective.

#5: Finally, whenever you lose weight, your health parameters (cholesterol, triglycerides, blood sugar, and blood pressure) improve.

Tips For Successful Weight Loss

SkepticWhat should you look for in choosing a healthy weight loss diet? Here are my top 6 tips.

1. Choose whole food diets. Avoid sodas, fast foods, and highly processed foods.

2) Choose primarily plant-based diets. These can range from Vegan through semi-vegetarian, Mediterranean, DASH, and Nordic. All are healthy diets. I have discussed the evidence for this recommendation in my book “Slaying The Food Myths”. Here is a brief summary.

When we look at long term (10-20 year) studies:

  • Vegetarians weigh less and are healthier than people consuming the typical American diet.
  • People consuming semi-vegetarian, Mediterranean, and DASH diets are healthier than people consuming the typical American diet.

When we look at low-carb diets:

  • People consuming plant-based low-carb diets weigh less and are healthier than people consuming the typical American diet.
  • People consuming meat-based low-carb diets are just as fat and unhealthy as people consuming the typical American diet.
  • The Atkins low-carb diet has been around for more than 50 years, and there is no evidence it is healthy long-term.

3) Choose diets that include a variety of foods from all 5 food groups. I have discussed the rationale for that recommendation above.

4) Choose diets that consider meat as a garnish, not a main course.

5) Choose diets that feature healthy carbs and healthy fats rather than low-carb or low-fat diets.

6) Think lifestyle, not diet. If you choose a restrictive diet so you can achieve quick weight loss, you will probably be just as fat and unhealthy next December 31st as you are this year. Instead, choose diets that teach healthy eating and lifestyle changes that you can make a permanent part of your life.

Tips For Keeping The Weight Off

You know the brutal truth. Around 95% of dieters regain everything they lost and then some within a few years. You have probably gone through one or more cycles of weight loss and regain yourself – something called “yo-yo dieting”. You may even be asking yourself if it is worth bothering to try to lose weight this year.

Rather focusing on the negative statistics of weight loss, let’s look at the good news. There are people who lose the weight and keep it off. What do they do?

There is an organization called the National Weight Control Registry that has enrolled more than 10,000 people who have lost weight and kept it off. The people in this group lost weight on almost every diet imaginable. However, here is the important statistic: On average people in this group have lost 66 pounds and kept it off for at least 5 years.

The National Weight Control Registry has kept track of what they have done to keep the weight off. Here is what they do that you may not be doing:

1. They consume a reduced calorie, whole food diet.

2) They get lots of exercise (around 1 hour/day).

3) They have internalized their eating patterns. In short, this is no longer a diet. It has become a permanent part of their lifestyle. This is the way they eat without even thinking about it.

4) They monitor their weight regularly. When they gain a few pounds, they modify their diet until they are back at their target weight.

5) They eat breakfast on a regular basis.

6) They watch less than 10 hours of TV/week.

7) They are consistent (no planned cheat days).

Which Diet Is Best?

Now it is time to get back to the question you are asking right now, “Which diet is best?” I have covered a lot of ground in this article. Let me summarize it for you.

If you are thinking about popular diets:

  • Primarily plant-based diets ranging from Vegan to Mediterranean and Dash are associated with a healthier weight and better health long term.
    • If want to lose weight quickly, you may want to start with the more restrictive plant-based diets, like Vegan, Ornish, Pritikin or semi-vegetarian.
    • If you do better with a low-carb diet, my recommendation is the lower-carb version of the Mediterranean diet called Med-Plus. It is a whole food version of the Mediterranean diet that minimizes added sugar and refined grains (I will be talking more about it in next week’s “Health Tips From the Professor”).
    • If your primary goal is rapid weight loss, you could also start with one of the healthier of the restrictive low-carb diets, like the Paleo or the 360 diet. I do not recommend the Keto diet.
  • No matter what diet you start with, plan to transition to the primarily plant-based diet that best fits your lifestyle and food preferences. This is the diet you will want to stick with to maintain your weight loss and achieve better health long term.
  • Plan on permanent lifestyle change rather than a short-term diet. Otherwise, you are just wasting your time.
  • Eat whole foods. Big Food keeps up with America’s favorite diets and is only too happy to sell you highly processed foods that match your favorite diet. Avoid those like the plague.

If you are thinking about commercial diets featuring meal replacement products:

  • Look for meal replacement products that:
    • Do not contain artificial sweeteners, flavors, or preservatives.
    • Use non-GMO protein. A non-GMO certification for the other ingredients is not necessary. For a more detailed explanation of when non-GMO certification is important and when it is unnecessary, see my article in “Health Tips From the Professor”.
    • Have stringent quality controls in place to assure purity. “Organic” and/or “non-GMO” on the label do not assure purity.
  • Look for programs that can provide clinical studies showing their diet plan is effective for weight loss and for keeping the weight off. Many programs have short-term clinical studies showing they are effective for weight loss, but very few have longer-term studies showing the weight stays off.
  • Finally, look for programs that teach permanent lifestyle change. This should include guidance on exercise and healthy eating.

I do not recommend most commercial diets that feature prepared low-calorie foods “shipped right to your door” as a major part of their program. The foods are highly processed. Plus, they include all your favorite unhealthy foods as part of the program. Even if they include lifestyle change as part of their program, they are undermining their message with the foods they are providing you.

I would be remiss if I didn’t mention that Weight Watchers is highly recommended by most experts in the field. Weight Watchers emphasizes journaling and counting calories, which is a plus because it makes you focus on what you are eating. They also have a good lifestyle program and support that can help you transition to permanent lifestyle change if you are willing to put in the effort. However, I don’t recommend their prepared low-calorie foods. They are no better than foods provided by the other commercial diet programs.

The Bottom Line 

Weight loss season is upon us. If you plan to lose weight and/or adopt a healthier diet this year, you are probably asking, “Which Diet Is Best?” In this issue of “Health Tips From The Professor” I give you:

  • 4 tips on mistakes to avoid when selecting the diet that is best for you.
  • 6 tips on how to choose the best diet.
  • 5 tips on what to look for when selecting a diet featuring meal replacement products.
  • 7 tips on how to keep the weight off.

Then I put all this information together to help you choose the best diet, the best meal replacement product, and/or the best commercial diet program.

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.

500th Issue Celebration

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Nutrition Breakthroughs Over The Last Two Years

Author: Dr. Stephen Chaney 

celebrationIn the nearly ten years that I have been publishing “Health Tips From The Professor”, I have tried to go behind the headlines to provide you with accurate, unbiased health information that you can trust and apply to your everyday life.

The 500th issue of any publication is a major cause for celebration and reflection – and “Health Tips From The Professor” is no different.

I am dedicating this issue to reviewing some of the major stories I have covered in the past 100 issues. There are lots of topics I could have covered, but I have chosen to focus on three types of articles:

  • Articles that have debunked long-standing myths about nutrition and health.
  • Articles that have corrected some of the misinformation that seems to show up on the internet on an almost daily basis.
  • Articles about the issues that most directly affect your health.

Best Ways To Lose Weight

weight lossSince it is almost January, let’s start with a couple of articles about diet and weight loss (or weight gain). I have covered the effectiveness of the Paleo, Keto, Mediterranean, DASH, vegetarian, and Vegan diets for both short and long-term weight loss in my book “Slaying The Food Myths”, so I won’t repeat that information here. Instead, I will share a few updates from the past 100 issues.

My Tips On The Best Approach For Losing Weight: Every health guru has a favorite diet they like to promote. I am different. My book, Slaying the Food Myths, is probably the first “anti-diet” diet book ever written. Based on my years of research I can tell you that we are all different. There is no single diet that is best for everyone. In this article I have summarized my tips for selecting the weight loss diet that is best for you.

The US News & World Report’s Recommendation For the Best Diets: Each year US News & World Report assembles some of the top nutrition experts in the country and asks them to review popular diets and rank them for effectiveness and safety. In this article I summarize their ratings for 2022.

Does Intermittent Fasting Have A Downside? In previous articles in “Health Tips From the Professor” I have reported on studies showing that intermittent fasting is no more effective for weight loss than any other diet that restricts calories to the same extent. But does intermittent fasting have a downside? In this article I reported on a study that suggests it does.

Can A Healthy Diet Help You Lose Weight? Most investigators simply compare their favorite diet to the standard American diet. And any diet looks good compared to the standard American diet. In this article I reported on a study that compared two whole food diets that restricted calories by 25% to the standard American diet. One calorie-restricted diet was more plant-based and the other more meat-based. You may be surprised at the results.

Omega-3s

Omega-3s continue to be an active area of research. Here are just a few of the top studies over the past two years.omega3s

Do Omega-3s Oil Your Joints? In this article I reviewed the latest information on omega-3s and arthritis.

Do Omega-3s Add Years To Your Life? In this article I discussed a study that looks at the effect of omega-3s on longevity.

The Omega-3 Pendulum: In this article I discuss why omega-3 studies are so confusing. One day the headlines say they are miracle cures. A few weeks later the headlines say they are worthless. I discuss the flaws in many omega-3 studies and how to identify the high-quality omega-3 studies you can believe.

Do Omega-3s Reduce Congestive Heart Failure? In this article I review a recent study on omega-3s and congestive heart failure and discuss who is most likely to benefit from omega-3 supplementation.

Plant-Based Diets

Vegan FoodsWill Plant-Based Proteins Help You Live Longer? In this article  I review a study that looks at the effect of swapping plant proteins for animal proteins on longevity.

Can Diet Add Years To Your Life? In this article  I review a study that takes a broader view and asks which foods add years to your life.

Is A Vegan Diet The Secret To Weight Loss? This is an update of my previous articles on vegan diets. This article asked whether simply changing from a typical American diet to a vegan diet could influence weight loss and health parameters in as little as 16 weeks. The answer may surprise you.

Is A Vegan Diet Bad For Your Bones? No diet is perfect. This article looks at one of the possible downsides to a vegan diet. I also discuss how you can follow a vegan diet AND have strong bones. It’s not that difficult.

Anti-Inflammatory Diets

What Is An Anti-Inflammatory Diet? In this article  I discuss the science behind anti-inflammatory diets Inflammationand what an anti-inflammatory diet looks like.

Can Diet Cause You To Lose Your Mind? In this article  I discuss a study looking at the effect of an inflammatory diet on dementia. The study also looks at which foods protect your mind and which ones attack your mind.

Do Whole Grains Reduce Inflammation? You have been told that grains cause inflammation. Refined grains might, but this study shows that whole grains reduce inflammation.

Nutrition And Pregnancy

pregnant women taking vitaminsHere are the latest advances in nutrition for a healthy pregnancy.

The Perils Of Iodine Deficiency For Women. In this article I reviewed the latest data showing that iodine is essential for a healthy pregnancy and discuss where you can get the iodine you need.

Do Omega-3s Reduce The Risk Of Pre-Term Births? You seldom hear experts saying that the data are so definitive that no further studies are needed. In this article I reviewed a study that said just that about omega-3s and pre-term births.

Does Maternal Vitamin D Affect ADHD? In this article I reviewed the evidence that adequate vitamin D status during pregnancy may reduce the risk of ADHD in the offspring.

How Much DHA Should You Take During Pregnancy? In this article I reviewed current guidelines for DHA intake during pregnancy and a recent study suggesting even higher levels might be optimal.

Is Your Prenatal Supplement Adequate? In this article I reviewed two studies that found most prenatal supplements on the market are not adequate for pregnant women or their unborn babies.

Children’s Nutrition

Here are the latest insights into children’s nutrition.Obese Child

Are We Killing Our Children With Kindness? In this article I reviewed a recent study documenting the increase in ultra-processed food consumption by American children and the effect it is having on their health. I then ask, is it really kindness when we let our children eat all the sugar and ultra-processed food they want?

Is Diabetes Increasing In Our Children? In this article I reviewed a study documenting the dramatic increase in diabetes among American children and its relationship to ultra-processed food consumption and lack of exercise.

How Much Omega-3s Do Children Need? In this article I reviewed an study that attempts to define how much omega-3s are optimal for cognition (ability to learn) in our children.

Diabetes

diabetesHere are some insights into nutrition and diabetes that may cause you to rethink your diet.

Does An Apple A Day Keep Diabetes Away? You may have been told to avoid fruits if you are diabetic. In this article I reviewed a study showing that fruit consumption actually decreases your risk of diabetes. Of course, we are all different. If you have diabetes you need to figure out which fruits are your friends and which are your foes.

Do Whole Grains Keep Diabetes Away? You may have also been told to avoid grains if you are diabetic. In this article I reviewed a study showing that whole grain consumption actually decreases your risk of diabetes. Once again, we are all different. If you have diabetes you need to figure out which grains are your friends and which are your foes.

Heart Disease

Here is an interesting insight into nutrition and heart disease that may cause you to rethink your diet.

Is Dairy Bad For Your Heart? You have been told that dairy is bad for your heart AND that it is good for your heart. Which is correct? In this article I discuss some recent studies on the topic and conclude the answer is, “It depends”. It depends on your overall diet, your weight, your lifestyle, and your overall health.

Breast Cancer

Here are some facts about breast cancer every woman should know.breast cancer

The Best Way To Reduce Your Risk Of Breast Cancer In this article I review two major studies and the American Cancer Guidelines to give you 6 tips for reducing your risk of breast cancer.

The Truth About Soy And Breast Cancer You have been told that soy causes breast cancer, and you should avoid it. In this article I review the science and tell you the truth about soy and breast cancer.

Supplementation

Vitamin SupplementsSome “experts” claim everyone should take almost every supplement on the market. Others claim supplementation is worthless. What is the truth about supplementation?

What Do The 2020-2025 Dietary Guidelines Say About Supplements? Every 5 years the USDA updates their Dietary Guidelines for foods and supplements. In this article I discuss what the 2020-2025 Dietary Guidelines say about supplements. Yes, the USDA does recommend supplements for some people.

Who Benefits Most From Supplementation? Not everyone benefits equally from supplementation. In this article I discuss who benefits the most from supplementation.

Should Cancer Patients Take Supplements? Doctors routinely tell their cancer patients not to take supplements. Is that the best advice? In this article I review a study that answers that question.

Can You Trust Supplements Marketed on Amazon? Amazon’s business model is to sell products at the lowest possible price. But do they check the quality of the products marketed on their site? In this article  I review a study that answers that question.

Is Your Prenatal Supplement Adequate? In this article I reviewed two studies that found most prenatal supplements on the market are not adequate for pregnant women or their unborn babies.

The Bottom Line 

I have just touched on a few of my most popular articles above. You may want to scroll through these articles to find ones of interest to you that you might have missed over the last two years. If you don’t see topics that you are looking for, just go to https://www.chaneyhealth.com/healthtips/ and type the appropriate term in the search box.

In the coming years, you can look for more articles debunking myths, exposing lies and providing balance to the debate about the health topics that affect you directly. As always, I pledge to provide you with scientifically accurate, balanced information that you can trust. I will continue to do my best to present this information in a clear and concise manner so that you can understand it and apply it to your life.

Final Comment: You may wish to share the valuable resources in this article with others. If you do, then copy the link at the top and bottom of this page into your email. If you just forward this email and the recipient unsubscribes, it will unsubscribe you as well.

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.

 

Can Healthy Eating Help You Lose Weight?

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Who Benefits Most From A Healthy Diet?

Author: Dr. Stephen Chaney 

fad dietsFad diets abound. High protein, low carb, low fat, vegan, keto, paleo – the list is endless. They all claim to be backed by scientific studies showing that you lose weight, lower your cholesterol and triglycerides, lower your blood pressure, and smooth out your blood sugar swings.

They all claim to be the best. But any reasonable person knows they can’t all be the best. Someone must be lying.

My take on this is that fad diet proponents are relying on “smoke and mirrors” to make their diet look like the best. I have written about this before, but here is a brief synopsis:

  • They compare their diet with the typical American diet.
    • Anything looks good compared to the typical American diet.
    • Instead, they should be comparing their diet with other weight loss diets. That is the only way we can learn which diet is best.
  • They are all restrictive diets.
    • Any restrictive diet will cause you to eat fewer calories and to lose weight.
    • As little as 5% weight loss results in lower cholesterol & triglycerides, lower blood pressure, and better control of blood sugar levels.

Simply put, any restrictive diet will give you short-term weight loss and improvement in blood parameters linked to heart disease, stroke, and diabetes. But are these diets healthy long term? For some of them, the answer is a clear no. Others are unlikely to be healthy but have not been studied long term. So, we don’t know whether they are healthy or not.

What if you started from the opposite perspective? Instead of asking, “Is a diet that helps you lose weight healthy long term?”, what if you asked, “Can healthy eating help you lose weight?” The study (S Schutte et al, American Journal of Clinical Nutrition, 115: 1-18, 2022) I will review this week asked that question.

More importantly, it was an excellent study. It compared a healthy diet to an unhealthy diet with exactly the same degree of caloric restriction. And it compared both diets to the habitual diet of people in that area. This study was performed in the Netherlands, so both weight loss diets were compared to the habitual Dutch diet.

How Was The Study Done?

clinical studyThis was a randomized controlled trial, the gold standard of clinical studies. The investigators recruited 100 healthy, abdominally obese men and women aged 40-70. At the time of entry into the study none of the participants:

  • Had diabetes.
  • Smoked
  • Had a diagnosed medical condition.
  • Were on a medication that interfered with blood sugar control.
  • Were on a vegetarian diet.

The participants were randomly assigned to:

  • A high-nutrient quality diet that restricted calories by 25%.
  • A low-nutrient-quality diet that restricted calories by 25%.
  • Continue with their habitual diet.

The study lasted 12 weeks. The participants met with a dietitian on a weekly basis. The dietitian gave them the foods for the next week and monitored their adherence to their assigned diet. They were advised not to change their exercise regimen during the study.

At the beginning and end of the study the participants were weighed, and cholesterol, triglycerides, and blood pressure were measured.

Can Healthy Eating Help You Lose Weight?

Vegetarian DietTo put this study into context, these were not healthy and unhealthy diets in the traditional sense.

  • Both were whole food diets.
  • Both included fruits, vegetables, low-fat dairy, and lean meats.
  • Both restricted calories by 25%.

The diets were designed so that the “high-nutrient quality” diet had significantly more plant protein (in the form of soy protein), fiber, healthy fats (monounsaturated and omega-3 fats), and significantly less fructose and other simple sugars than the “low-nutrient-quality” diet.

At the end of 12 weeks:

  • Participants lost significant weight on both calorie-restricted diets compared to the group that continued to eat their habitual diet.
    • That is not surprising. Any diet that successfully restricts calories will result in weight loss.
  • Participants on the high-nutrient quality diet lost 33% more weight than participants on the low-nutrient-quality diet (18.5 pounds compared to 13.9 pounds).
  • Participants on the high-nutrient quality diet lost 50% more inches in waist circumference than participants on the low-nutrient-quality diet (1.8 inches compared to 1.2 inches).
    • This is a direct measure of abdominal obesity.

When the investigators measured blood pressure, fasting total cholesterol levels, and triglyceride levels:Heart Healthy Diet

  • These cardiovascular risk factors were significantly improved on both diets.
    • Again, this would be expected. Any diet that causes weight loss results in an improvement in these parameters.
  • The reduction in total serum cholesterol was 2.5-fold greater and the reduction in triglycerides was 2-fold greater in the high-nutrient quality diet group than in the low-nutrient-quality diet group.
  • The reduction in systolic blood pressure was 2-fold greater and the reduction in diastolic blood pressure was 1.67-fold greater in the high-nutrient quality diet group than in the low-nutrient-quality diet group.

The authors concluded, “Our results demonstrate that the nutrient composition of an energy-restricted diet is of great importance for improvements of metabolic health in an overweight, middle-aged population. A high-nutrient quality energy-restricted diet enriched with soy protein, fiber, monounsaturated fats, omega-3 fats, and reduced in fructose provided additional health benefits over a low-nutrient quality energy-restricted diet, resulting in greater weight loss…and promoting an antiatherogenic blood lipid profile.”

In short, participants in this study lost more weight and had a better improvement in risk factors for heart disease on a high-nutrient-quality diet than on a low-nutrient-quality diet. Put another way, healthy eating helped them lose weight and improved their health.

Who Benefits Most From A Healthy Diet?

None of the participants in this study had been diagnosed with diabetes when the study began. However, all of them were middle-aged, overweight, and had abdominal obesity. That means many of them likely had some degree of insulin resistance.

Because of some complex metabolic studies that I did not describe, the investigators suspected that insulin resistance might influence the relative effectiveness of the two energy-restricted diets.

To test this hypothesis, they used an assay called HOMA-IR (homeostatic model assessment of insulin resistance). Simply put, this assay measures how much insulin is required to keep your blood sugar under control.

They used a HOMA-IR score of 2.5 to categorize insulin resistance among the participants.

  • Participants with a HOMA-IR score >2.5 were categorized as insulin-resistant. This was 55% of the participants.
  • Participants with a HOMA-IR score ≤2.5 were categorized as insulin-sensitive. This was 45% of the participants.

When they used this method to categorize participants they found:

  • Insulin-resistant individual lost about the same amount of weight on both diets.
  • Insulin-sensitive individuals lost 66% more weight on the high-nutrient-quality diet than the low-nutrient-quality diet (21.6 pounds compared to 13.0 pounds).

The investigators concluded, “Overweight, insulin-sensitive subjects may benefit more from a high- than a low-nutrient-quality energy-restricted diet with respect to weight loss…”

What Does This Study Mean For You?

Questioning WomanSimply put this study confirms that:

  • Caloric restriction leads to weight loss, and…
  • Weight loss leads to improvement in cardiovascular risk factors like total cholesterol, triglycerides, and blood pressure.
    • This is not new.
    • This is true for any diet that results in caloric restriction.

This study breaks new ground in that a high-nutrient quality diet results in significantly better:

  • Weight loss and…
  • Reduction in cardiovascular risk factors…

…than a low-nutrient quality diet. As I said above, the distinction between a “high-nutrient-quality” diet and a “low-nutrient-quality” diet may not be what you might have expected.

  • Both diets were whole food diets. Neither diet allowed sodas, sweets, and highly processed foods.
  • Both included fruits, vegetables, grains, and lean meats.
  • Both reduced caloric intake by 25%.
    • If you want to get the most out of your weight loss diet, this is a good place to start.

In this study the investigators designed their “high-nutrient-quality” diet so that it contained:

  • More plant protein in the form of soy protein.
    • In this study they did not reduce the amount of animal protein in the “high-nutrient-quality” diet. They simply added soy protein foods to the diet. I would recommend substituting soy protein for some of the animal protein in the diet.
  • More fiber.
    • The additional fiber came from substituting whole grain breads and brown rice for refined grain breads and white rice, adding soy protein foods, and adding an additional serving of fruit.
  • More healthy fats (monounsaturated and omega-3 fats).
    • The additional omega-3s came from adding a fish oil capsule providing 700mg of EPA and DHA.
  • Less simple sugars. While this study focused on fructose, their high-nutrient-quality diet was lower in all simple sugars.

ProfessorAll these changes make great sense if you are trying to lose weight. I would distill them into these 7 recommendations.

  • Follow a whole food diet. Avoid sodas, sweets, and highly processed foods.
  • Include all 5 food groups in your weight loss diet. Fruits, vegetables, whole grains, dairy, and lean proteins all play an important role in your long-term health.
  • Eat a primarily plant-based diet. My recommendation is to substitute plant proteins for at least half of your high-fat animal proteins. And this study reminds us that soy protein foods are a convenient and effective way to achieve this goal.
  • Eat a diet high in natural fibers. Including fruits, vegetables, whole grains, beans, nuts, seeds, and soy foods in your diet is the best way to achieve this goal.
  • Substitute healthy fats (monounsaturated and omega-3 fats) for unhealthy fats (saturated and trans fats) in your diet. And this study reminds us that it is hard to get enough omega-3s in your diet without an omega-3 supplement.
  • Reduce the amount of added sugar, especially fructose, from your diet. That is best achieved by eliminating sodas, sweets, and highly processed foods from the diet. I should add that fructose in fruits and some healthy foods is not a problem. For more information on that topic, I refer you to a previous “Health Tips” article .
  • Finally, I would like to remind you of the obvious. No diet, no matter how healthy, will help you lose weight unless you cut back on calories. Fad diets achieve that by restricting the foods you can eat. In the case of a healthy diet, the best way to do it is to cut back on portion sizes and choose foods with low caloric density.

I should touch briefly on the third major conclusion of this study, namely that the “high-nutrient quality diet” was not more effective than the “low-nutrient-quality” diet for people who were insulin resistant. In one sense, this was not news. Previous studies have suggested that insulin-resistant individuals have more difficulty losing weight. That’s the bad news.

However, there was a silver lining to this finding as well:

  • Only around half of the overweight, abdominally obese adults in this study were highly insulin resistant.
    • That means there is a ~50% chance that you will lose more weight on a healthy diet.
  • Because both diets restricted calories by 25%, insulin-resistant individuals lost weight on both diets.
    • That means you can lose weight on any diet that successfully reduces your caloric intake. That’s the good news.
    • However, my recommendation would still be to choose a high-nutrient quality diet that is designed to reduce caloric intake, because that diet is more likely to be healthy long term.

The Bottom Line 

A recent study asked, “Can healthy eating help you lose weight?” This study was a randomized controlled study, the gold standard of clinical studies. The participants were randomly assigned to:

  • A high-nutrient quality diet that restricted calories by 25%.
  • A low-nutrient-quality diet that restricted calories by 25%.
  • Continue with their habitual diet.

These were not healthy and unhealthy diets in the traditional sense.

  • Both were whole food diets.
  • Both included fruits, vegetables, low-fat dairy, and lean meats.
  • Both restricted calories by 25%.

The diets were designed so that the “high-nutrient quality” diet had significantly more plant protein (in the form of soy protein), fiber, healthy fats (monounsaturated and omega-3 fats), and significantly less fructose and other simple sugars than the “low-nutrient-quality” diet.

At the end of 12 weeks:

  • Participants on the high-nutrient quality diet lost 33% more weight than participants on the low-nutrient-quality diet (18.5 pounds compared to 13.9 pounds).

When the investigators measured cardiovascular risk factors at the end of 12 weeks:

  • The reduction in total serum cholesterol was 2.5-fold greater and the reduction in triglycerides was 2-fold greater in the high-nutrient quality diet group than in the low-nutrient-quality diet group.
  • The reduction in systolic blood pressure was 2-fold greater and the reduction in diastolic blood pressure was 1.67-fold greater in the high-nutrient quality diet group than in the low-nutrient-quality diet group.

The authors concluded, “Our results demonstrate that the nutrient composition of an energy-restricted diet is of great importance for improvements of metabolic health in an overweight, middle-aged population. A high-nutrient quality energy-restricted diet enriched with soy protein, fiber, monounsaturated fats, omega-3 fats, and reduced in fructose provided additional health benefits over a low-nutrient quality energy-restricted diet, resulting in greater weight loss…and promoting an antiatherogenic blood lipid profile.”

In short, participants in this study lost more weight and had a better improvement in risk factors for heart disease on a high-nutrient-quality diet than on a low-nutrient-quality diet. Put another way, healthy eating helped them lose weight and improved their health.

For more details on this study, what this study means for you, and my 7 recommendations for a healthy weight loss 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.

Does Time-Restricted Eating Have A Downside?

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Are The Benefits Of Time-Restricted Eating An Illusion?

 Author: Dr. Stephen Chaney

intermittent fastingWeight loss is difficult. If you are like most American adults, you have tried at least 5 or 6 diets by the time you are 50, and all of them have failed. Or maybe you have found a diet that works reasonably well at helping you lose weight, but it’s difficult to stick with. And you worry that it may not be healthy long-term.

But hope springs eternal, and there are always new diets to try. One of the newer diet fads is something called intermittent fasting. The most popular form of intermittent fasting (because it is the easiest to follow) is something called time-restricted eating.

The concept is simple. You don’t change what you are eating. Instead, you restrict the time during which you are eating those foods. Typically, you restrict your time of eating to 8 hours a day and abstain from all food the rest of the day. Hence, the term “time-restricted eating”.

I won’t go into the supposed benefits of time-restricted eating. You have probably heard those already from advocates of this form of eating. But you may be wondering if those benefits are true and whether time-restricted eating has any drawbacks.

Fortunately, a recent study (T Moro et al, Medicine and Science In Sports & Exercise, 53, 2577-2585, 2021) answers those questions. It put a group of athletes on either a control diet or a time-restricted diet for an entire year and looked at the relative benefits and drawbacks of both diets.

How Was This Study Done?

Clinical StudyThis study recruited 19 healthy, resistance-trained males (average age = 29, average weight = 185 pounds) for the study. All the subjects had at least 5 continuous years of resistance training, no steroid use, and no known medical conditions.

The subjects completed a 7-day food diary prior to the study, at the end of 2 months, and at the end of 12 months. The participants were instructed not to change their usual caloric intake or diet composition. In addition, each participant received a personalized diet protocol based on the analysis of their food diary at baseline.

The results from the first two months have previously been reported (T Moro et al, Journal of Translational Research, 14: 290, 2016). This report covers the subsequent 10 months.

During the first two months, the participants were contacted weekly by a dietitian to ensure adherence to the diet. During the interviews, the dietitian asked questions about meal timing and composition, appetite, and any difficulties in maintaining the diet protocol. When necessary, the dietitian gave advice to improve adherence to the diet. During the subsequent 10 months, the participants were contacted less frequently, and the interviews were shorter.

The participants were divided into two groups. The selection was random except that the two groups were matched with respect to caloric intake at baseline (~2,900 calories/day).

The ND (normal meal distribution) group ate their meals over a 12-hour period, with meals at ~8AM, 1 PM, and 8 PM. The distribution of calories for this group was 25%, 40%, and 35% over the three meals.

The TRE (time-restricted eating) group ate their meals over an 8-hour period, with meals at ~1PM, 4 PM, and 8 PM. The distribution of calories for this group was 40%, 25%, and 35% over the three meals.

The training regimen consisted of strength training specifically designed to increase muscle mass. A standardized 3-times per week training regimen was established during the first two months of supervised training. The participants continued the same training regimen on their own for the next 10 months. Workouts were performed between 4 and 6 PM to fall within the eating window for both groups.

Finally, tests for inflammatory markers, cholesterol & other blood lipids, blood sugar control, hormones, body composition, and strength were performed before the program started, at 2 months, and again at 12 months.

What Are The Benefits Of Time Restricted Eating?

thumbs upWhen the investigators looked at health outcomes at the end of 12 months:

  • Inflammatory markers were significantly reduced in the TRE (time-restricted eating) group compared to the ND (normal meal distribution) group.
  • Blood sugar control was significantly improved in the TRE group compared to the ND group.
  • Lipid profiles were significantly improved in the TRE group compared to the ND group.

These results are consistent with the findings of earlier short-term studies on the benefits of time restricted eating.

The authors concluded. “Our results suggest that long-term time-restricted eating in combination with a resistance training program is feasible, safe, and effective in reducing inflammatory markers and risk factors.”

At this point you are probably thinking, “It sounds like everything I have heard about time-restricted eating is true. I can’t wait to get started.”

What Causes The Benefits Of Time-Restricted Eating?

SkepticBefore you jump on the time restricted eating bandwagon, let’s look more closely and ask what caused these apparent health benefits.

When the investigators looked at changes in caloric intake over the 12-month period:

  • The TRE group spontaneously decreased their total caloric intake by 6.4% in spite of being told not to change their diet.
    • The decrease in caloric intake was driven by a decrease in both carbohydrate and fat intake, while protein intake remained constant.
    • Most of this change occurred between 2 and 12 months when they were no longer being closely supervised by dietitians.
  • In contrast, caloric intake and macronutrient intake did not change significantly for the ND group.

The reason for the decrease in caloric intake is not known.

  • If you follow social media or blogs about time-restricted eating, you have been given some scientific-sounding mumbo-jumbo about how the 16 hours of fasting changes your metabolism and/or reduces your appetite. However, this is speculation. There is scant evidence for it.
  • A more likely explanation is that when you restrict the time you allow yourself to eat, you naturally eat less without thinking about it. You are simply less hungry when the second and third meals roll around. [This may explain why even these highly disciplined athletes required weekly coaching by dietitians to keep their caloric intake constant.]

And when the investigators looked at changes in body weight over the 12-month period:

  • The TRE group lost 3.4% of their body weight.
    • Most of that weight loss was due to a decrease in fat mass, but there was also a loss of muscle mass.
  • In contrast the ND group increased their total body weight by 3.4%.
    • In other words, at the end of 12 months the difference between the TRE and ND groups amounted to almost 7% of their body weight. This difference was highly significant.
    • Most of the increase in body weight in the ND group was due to a 2.9% increase in muscle mass.

These results are also consistent with the findings of earlier studies of time-restricted eating.

The observed decrease in body weight and fat mass is important because whenever you decrease body weight and fat mass, you:

  • Reduce inflammatory markers.
  • Improve blood sugar control.
  • Improve lipid profiles.

In the words of the authors, “…it is plausible that the caloric reduction observed in the TRE group may have contributed to the reductions in body mass and additional health benefits…”

Of course, that still sounds pretty good. Who wouldn’t want to lose weight and get healthier? But are the weight reduction and health benefits unique to time-restricted eating? That is the claim of those who promote this diet.

But is it true? To answer that question, we need to take a broader view of popular diets. We need to ask, “Is something special about time-restricted eating, or would other restrictive diets give similar results?”

Are The Benefits Of Time-Restricted Eating An Illusion?

The TruthThere are two diet truths that nobody is talking about:

1) Forget the metabolic mumbo-jumbo. The primary reason restrictive diets cause you to lose weight is that you unconsciously eat less while you are on these diets.

For time-restricted eating, you eat less because you have restricted the time when you can eat. With other restrictive diets, you have restricted the foods you can eat. The reason why that causes you to eat less is more subtle. I call it the “Bagels and Cream Cheese Effect”.

    • When you go on a low-fat diet, it sounds great to say you can eat all the bagels you want. But without the cream cheese, bagels become boring, and you eat less.
    • When you go on a low-carb diet, it sounds great to say you can eat all the cream cheese you want. But without the bagels, cream cheese becomes boring, and you eat less.

2) The proponents of fad diets make them look good by comparing them to the typical American diet. Anything is better than the American diet. However, when you make the comparisons based on the reduction in caloric intake or the amount of weight lost, the health benefits of popular diets are virtually identical. For example:

    • When you compare the Atkins diet and other low carb diets with the typical American diet, inflammation is lower on the low carb diets. However, one recent study compared people on the Atkins diet with people who had lost an equal amount of weight on a balanced diet that included all food groups. Guess what? Inflammation is much higher on the Atkins diet when you compare it to a healthy diet that gives equal weight loss.
    • This study reported that the time-restricted eating group ate less, lost more weight, and had better health parameters than the control group. However, previous studies that compared time-restricted eating with groups that reduced caloric intake to the same extent by simply counting calories have found the two groups had identical weight loss and improvement in health parameters.

In other words, there is nothing magical about time-restricted eating. Any diet that causes you to eat less will give identical results. There are only two questions left:

  1. Can you stick with time-restricted eating long term?

Time-restricted eating is not everyone’s cup of tea. But this study suggests that if you can stick with it better than with other restrictive diets, you are likely to lose weight and reap some health benefits.

2) Should you stick with time-restricted eating long term?

To answer this question, you need to know whether there are any downsides to time-restricted eating.

Does Time-Restricted Eating Have A Downside?

thumbs down symbolOf course, most people would consider weight loss and an improvement in health parameters as a definite plus. It’s all good. Or is it? Does time-restricted eating have any downsides? This study identified two potential downsides:

1) Decreased anabolic hormones.

    • Anabolic hormones (hormones that stimulate an increase in muscle mass) were decreased in the TRE group. Specifically:
      • Testosterone was decreased by 17% at the end of 12 months in the TRE group.
      • Insulin-like growth factor-1 (IGF-1) was decreased by 14% in the TRE group.
    • Both anabolic hormone levels were unchanged in the ND group.

2) Decreased muscle mass. Between months 2 and 12:

    • Muscle mass was decreased by 2.3% in TRE group and increased by 2.9% in the ND group.
    • The cross-sectional area of arm and thigh muscles was decreased by an average of 4.3% in the TRE group and increased by an average of 8.5% in the ND group.

In the words of the authors, “With our results, we confirmed that a long-term TRE protocol could impair the ability of maintaining muscle mass, possibly because of a reduction in caloric intake and a direct effect of fasting on the production of anabolic hormones.”

That is putting it mildly. The participants in this study were engaged in a rigorous 3-times/week strength training program specifically designed to increase muscle mass and were consuming over 100 grams of protein a day. So, a continuous increase in muscle mass and cross-sectional area would be expected. This was seen in the ND group but not in the TRE group, which actually lost muscle mass. The average “Joe” or “Jane” would likely lose even more muscle on this diet.

And continuous, long-term loss of muscle mass has significant health consequences including:

  • Decreased metabolic rate, which makes it more difficult to maintain a healthy weight.
  • Decreased insulin sensitivity, which increases the risk of diabetes.
  • Increased risk of osteoporosis.
  • Muscle weakness, which increases the risk of falling.

Dr. Paoli, the lead scientist on this study, was quoted as saying, “The main take home message is that there are pros and cons to prolonged time-restricted eating. Although time-restricted eating may produce some physiological advantages, it is not a miracle as often suggested in social media posts.”

The Bottom Line 

A recent study looked at the pros and cons of following a time-restricted eating (TRE) diet compared to a diet with normal meal distribution (ND) for 12 months.

  • The TRE group had reduced inflammation, better blood sugar control, and better lipid profiles than the ND group.

However, the improved health parameters were not caused by some magical metabolic changes due to fasting.

  • The TRE group unconsciously reduced their caloric intake and lost weight compared to the ND group. And any time you lose weight, you get reduced inflammation, better blood sugar control, and better lipid profiles.

In the words of the authors, “…it is plausible that the caloric reduction observed in the TRE group may have contributed to the reductions in body mass and additional health benefits…”

And there is nothing unique about time-restricted eating.

  • Any restrictive diet is likely to give similar results. (For more details, read the article above.)

Finally, there were some significant downsides to time-restricted eating.

  • The TRE group had a reduction in anabolic hormones and lost muscle mass.

In the words of the authors, “With our results, we confirmed that a long-term TRE protocol could impair the ability of maintaining muscle mass, possibly because of a reduction in caloric intake and a direct effect of fasting on the production of anabolic hormones.”

This is putting it mildly. The participants in this study were engaged in a rigorous 3-times/week strength training program specifically designed to increase muscle mass and were consuming over 100 grams of protein a day. They should have gained muscle mass. Instead, they lost it.

Continuous, long-term loss of muscle mass has significant health consequences including:

  • Decreased metabolic rate, which makes it more difficult to maintain a healthy weight.
  • Decreased insulin sensitivity, which increases the risk of diabetes.
  • Increased risk of osteoporosis.
  • Muscle weakness, which increases the risk of falling.

Dr. Paoli, the lead scientist on this study, was quoted as saying, “The main take home message is that there are pros and cons to prolonged time-restricted eating. Although time-restricted eating may produce some physiological advantages, it is not a miracle as often suggested in social media posts.”

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.

Health Tips From The Professor