Friday, September 28, 2012

Thoughts from Beyond the Zion Curtain

Part of my training as a Registered Dietitian was to learn about different cultural/ethnic/religious food practices.  When I was an intern this involved a whirlwind tour through a variety of neighborhoods in Chicago ("Look, a Caribbean grocer, now back on the bus!"), and in practice I have found that sometimes a person just needs to live in a different county to have developed different food habits.  Since this part of our trip has taken us through Utah and now Idaho I have been thinking a lot about the dietary/lifestyle habits of those who are part of the Mormon religion.  Or, as a friend who grew up Mormon calls it, those who live "Beyond the Zion Curtain."

The assumptions that I had made from what I heard on the news was that Mormons didn't smoke/chew tobacco, consume alcohol, or consume caffeine.  Since my boyfriend and I haven't had any trouble finding decent iced tea or (for him) diet soda while traveling through hear, I decided to do a little digging like a Skeptic should.

Turns out that one of the things I was mistaken about was the caffeine.  Apparently the Mormon Word of Wisdom forbids "hot drinks" which apparently word-of-mouth somehow translated as "no caffeine" but it just means--"no hot drinks like tea and coffee as these were the only hot drinks known to the settlers in 1831."  As a matter of fact, within the past few weeks the Mormon church has actually released a statement clarifying the church's position on caffeine.  So even though they are not saying cola drinks are healthy, they are not forbidden. 

So other hot drinks like hot chocolate and hot cider are apparently OK because they weren't known in 1831 by the Mormon settlers, and herbal tea is OK because "the Lord" allows for use of herbs, and chocolate is OK in general even though it contains caffeine.  Confused yet?  I am too, probably because these laws are not based on evidence.

Take home message--never assume someone's cultural food practices; always ask and do research yourself.  And always be skeptical of dietary advice based on the dictates of a few people without evidence to back it up.

Wednesday, September 26, 2012

Travel Time and Food Machines

Explanation for blog neglecting:  I've been busy helping Boyfriend of SkepticRD move his parents cross county.  His dad has Amyotrophic lateral sclerosis (ALS), otherwise known as Lou Gehrig's disease, so while I'm getting to see a large part of beautiful country, it's been kind of exhausting since we have to stop more frequently so he can receive help to do things that the rest of take for granted, like coughing.  But, he is an amazing man and scientist who still wants to work, and he has plenty of ideas that he wants to put out there, and I am honored to be helping him out even if my major role is to help his son not get Road Trip Rage.

One of his ideas, relevant to a nutrition blog, is his creation of something simply called the Food Machine.  I will let the video do the explaining, but suffice to say it's a machine that uses highly oxygenated water to create a mini-mixed farm of vegetables and fish to help feed hungry people using a minimum of space.  If you are part of an organization like a school and/or university that can supply the human power to have your own system, you can get involved here.

The next couple days are not to be as travel heavy.  You're probably expecting me to write about eating on the road aren't you?  Maybe I can oblige.

Friday, September 21, 2012

So, how do I do this again?

While researching another topic I came across this blog post from Skeptoid entitled How Does a Skpetic Lose Weight.  I'll admit I agree with a lot of what he said and implied, including how some diets seem more like a religion than they do actual science, how you can't ignore the First law of thermodynamics, how keeping a log is vital for increasing your awareness of what and how much you're eating, and how people fail to lose weight by overestimating the calories burned during exercise.  I did, however, take issue with a few things he said, or rather, maybe it was the way he said it.

1) He mentions calculating your basal metabolic rate (BMR) and then links to a site that has you calculating your BMR using the Harris Benedict Equation, which was discovered in 1919.  Not a bad place to start, as all equations are just estimates, but this has been supplanted by the Mifflin St. Jeor equation, especially for those who are very overweight or obese. (Link)  Unless you have access to a machine that performs indirect calorimetry, if you want to know what your caloric restriction should be, you probably want a more up to date formula.

2)  Then there's this statement: "I’m someone who believes there is no such thing as “junk food” or “health food”. While there are no “healthy” or “unhealthy” foods, there are plenty of healthy and unhealthy diets. Any food is good for you if you eat the right amount, and bad for you if you eat the wrong amount."
Technically, he's right, and I think in the comments section he uses one of my favorite quotes regarding the dose determining the poison.  I also disagree with a lot of the terminology/tone used in many diet books that basically says "If you eat this food you are going to die right now!"  (I once was reading a blog post where the author had devised a quite tasty recipe in which she suggested the use of grapeseed oil.  Yes, that oil is heavier on the omega-6, but most of the commenters, instead of acknowledging that, essentially accused her of telling them to kick puppies). Also "healthy/unhealthy" are very vague terms, and I think could be replaced with more specific terms like "calorically dense" or "this elevates my blood glucose to an unacceptable level" which describes a food rather than make a judgement on it.  But, from a practical standpoint, I do think that there are some foods that are so calorically dense, or that raise the blood glucose level to high, that they are just too hard to fit in to a weight loss plan (or plan for Type 2 diabetes) and each person should develop a list of things for themselves that they have to avoid.  This writer has obviously achieved a level of rationality that allows him to eat a donut and not sit there and think obsessively about donuts the rest of the day, and I think that's great.  I personally, however, have not achieved that level of self control, so I am not ashamed to say "If I bring that bag of tortilla chips home I will want to eat them all, therefore, this is not on the plan to bring home!" and still consider myself a good skeptic when it comes to evaluation diet info.

3) On a related note, I also got a little cranky when I read this statement, "But, when I reached the end of each day's calorie budget, I stopped eating.  That's really all there is too it."
Once again, good for him for reaching the level of rationality and self control that it takes to do that, as well as keeping close track of his calorie intake!  However, I'm sure I'm not the only one who has ever reached the end of my calorie budget (after allowing myself to have tortilla chips, chocolate, or whatever it was) and couldn't concentrate or sleep because I was so goddam hungry I wouldn't be satisfied until I had something to eat and subsequently went way over my calorie budget.  I'm sure there are plenty of internet bullies that would be happy to accuse me of having the self control of a teenager (usually meant to say--not much), but given my knowledge of biochemistry, I would say that I may have eaten in such a way or arranged my food supply in such a way that I promoted my natural desire to consume food, and I need to not do that again any time soon.  So, yes, I have actually set myself up on a plan, based on the best research that we have available for now, that restricts my consumption of carbohydrate so that I don't promote elevated insulin levels and subsequent hunger.  And since I actually want to get some nutrition out of my food that I eat (in appropriate portions), I actually do choose to forgo the donuts/pecan pancakes/twinkies on a regular basis.  I don't claim anything magical about it, I know that I control my weight by not taking in more calories than I burn.  How I help myself stay within that calorie budget, however, might actually involve forbidding myself to eat certain foods and concentrating on enjoying the things I do eat.

Now I think both the author of this blog post and I would both agree that each of us found what works for us, and that anecdotes/personal stories/n=1 studies are not evidence.  What I did think he forgot to point out though, is that what works for him may not exactly work for the rest of us, particularly since he didn't seem to use any of the "tricks" that I have mentioned before, like not shopping while hungry, that will help you stay within your calorie budget.  Maybe he thinks such psychological "tricks" are too much of a soft science to be used, but I don't know without asking.  I take a different approach in that said "tricks" are worth using as long as you know what you are doing and don't consider them to be "magical."

Take home message--you lose weight by taking in less calories.  If in your quest to achieve that, however, you do feel like you have to avoid certain foods, you can still restrict yourself and still be a good skeptic.

Tuesday, September 18, 2012

First Subway, Now Starbucks

I'm sure some of you have come across this little gem about the women who lost 85 pounds by eating at Starbucks.  Of course most of us remember Jared Fogle who lost weight by eating "healthier" Subway sandwiches as well.   Was there anything magic about Subway or Starbucks or any other restaurant that starts with the letter S that caused people to lose wt?  Of course not!  People lost weight because they dramatically reduced their calorie intake and got some exercise in too, but they also had "help" by sticking with foods that were already portioned and not diverting from it.  This reminds me of the many questions that I have received over the years about pre-packaged food programs like Nutri-system and Medifast, etc.  Let's take a look at the pro's and con's of these shall we?

The advantages:
1) They are useful for people who need to lose weight but have limited cooking skills.   My dad is one of those people;  he can fry eggs and that is pretty much the extent of his cooking skills.  His significant other has much better cooking skills, but because of some health complications that she has she can't stand long enough to cook; as a result they both ate out for most of their meals and were significantly overweight.  My dad knew he needed to lose weight because he was diagnosed with Type 2 diabetes, and he wanted to try Medifast because he knew someone else that had lost weight on it.  By using the food items in that plan and by eating lean protein and vegetables in the evening (at a restaurant) he was able to lose quite a bit of weight, not have to struggle with learning to cook, and actually have food he enjoyed. 
2) These programs can be useful for people with limited cognitive ability.  As I mentioned before I do work with people who might have impaired judgement related to a stroke or another type of medical condition.  Using the pre-packaged foods takes a lot of the guesswork out of the meal planning and they have less to remember.  Also, heating up a pre-packaged dinner might be safer for someone who might forget that they left the stove on.
3) They can be useful as a training tool for eating smaller portions.  Some people eat large portions or take seconds out of habit, and said habits can be hard to break.  You might start out by cooking a meal, putting a certain amount on your plate, enjoying what you eat...and then the remainder on the stove smells so good that you just want to have a little bit more....and soon you are way over the limit.  If all you have a packaged dinners or shakes, you don't have any leftovers to temp you, and you learn you can actually be quite content with less food.  You might only use the packaged food for a short time period until you are used to eating smaller portions.
4) Some people really, really, for whatever reason, do not want to think about what they are eating and want something easy and requiring of little preparation.  A pre-packaged plan that includes whole meals might actually help this individual eat more healthy than he/she would otherwise, especially if he/she normally does a lot of eating on the run.  For example, many people just eat a bowl of cereal for breakfast if they are in a hurry; if they ate the oatmeal supplied by medifast they would actually get more protein than than if they just ate regular cereal/oatmeal.
5) Sometimes a person might need to lose weight quickly for a surgical procedure.  Where I work, if people elect to have weight loss surgery they must lose a certain amount of weight beforehand to hopefully decrease fatty deposits in the liver so the surgeon can have an easier time during the surgery and they recovery will hopefully be smoother and free of complications.

The disadvantages:
1) If you are using pre-packaged foods that come straight out of the fast food restaurant or straight out of the freezer case; you might wind up deficient in protein or other nutrients that you need.  For example, at the age of 66 a person really should be eating protein at every meal so that your body can absorb it better.  Eating Starbucks oatmeal probably isn't going to help with that.  Once again on average an adult is going to need 20-30 grams of protein per meal, and a lot of the frozen dinners maybe only provide about 14 grams.
2) Some of the programs out there, including Nutri-System, might have a higher sodium content than some people can handle.  I work with a lot of people that have congestive heart failure or chronic kidney disease and they have to watch their sodium intake or else they will retain fluid. (And not just in a "I hate my puffy ankles" way, but in a "I can't even breathe because of the extra fluid" way).  I have had a few people who decided to try programs like Nutri-System and had to quit because of the fluid retention they were experiencing.
3) These type of programs often don't teach people to think critically about what you're eating.  My patients with cognitive impairment are probably not going to be able to develop critical thinking skills about their food intake, but what about the rest of us?   If you stop the program (likely because of one of the other disadvantages I'm going to cover), chances are you are going to resume your former poor eating habits and gain the weight right back.  And if you a person who eats when you are experiencing stress, or eats a lot on the run, this type of program didn't help you deal with any of the "non-hunger" reasons that people eat or overeat.  And that weight cycling can be pretty discouraging when it comes to future attempts to lose weight.
4) On a related note, these type of programs don't encourage cooking skills.  What if you want to go off the program some day?  Once again, you may find yourself back with your former bad eating habits or relying on the old high calorie favorites because you are not sure what to do.
5)These type of programs can be expensive.  Some people don't mind paying for the extra labor involved for the sake of convenience, and of course everyone can decide how to spend their own money.  I personally, however, would rather cook healthy meals at home as much as possible and put the money I save towards one of my interests.  I remember when I first looked at some of the Nutri-System meals and looked at the prices; I knew I could easily make some of those same entrees in bulk and portion out and freeze those meals for later.  In other words, I could make multiple entrees for the price of that one Nutri-System meal.
6) Some people just need more variety than what these programs have to offer.  Once again, some people (like my dad) are content to just eat the same type of food over and over again and it doesn't bother them.  That would drive me crazy, but then I love to experiment with different seasonings and different ways of preparing food.  I find that people tend to stick to a plan better if they are not bored and have some flexibility too.
7) Some people just don't like the food.  If you are on a plan where all you can dream about is eating "real" food again than you are probably not on the right plan for you.  A good plan is something that you can live with and hopefully enjoy most of the time.

Take home message--some pre-packaged plans can be advantageous for people to use in the short term or if the ability to make good choices or cook is impaired for some reason.  Overall, however, you will save money, improve your knowledge of nutrition and how your body works, and improve your cooking skills by learning to make healthy food at home.

Monday, September 17, 2012

Clinicians Behaving Badly: Dietitian Version

It's bad enough when you hear lousy information and poor science being perpetuated by the general public.  It's even worse when someone who is supposed to have education and experience in a science related field does the same thing.  On today's edition of "Clinicians Behaving Badly" I want to discuss this little article that I came across last week: Dietitian Names Five Foods That Help Fight Fat.

Now, I will be the first to admit that it is entirely possible that she was misquoted or that her words were taken out of context.  I have had a conversation with patients before where what I said and what they heard/remembered later were very different things.  Since there is no by line--it is also possible that she talked to someone who works for a large news service and that she talked to someone in another state over the phone who in turn gave the info to someone else to be typed, resulting in a poorly written article.  But if these words were pretty close to what she said, then the bad science award is definitely going to her today.

Problem number one:  "Berries stimulate a hormone that burns fat."  First of all, I would never word a statement that way, because I know that when I am dealing with the public I am often dealing with people who don't always have the best idea of how their body really works.  A statement like that can conjure up images of a person dropping weight in a short period of time, or "all I changed was I added berries and the weight just started dropping off!"  Typically our bodies are much more complex than that; the addition of one food does not change our metabolism.  Since she is not available for interview at the writing of this blog, I assume she is talking about the hormone adiponectin which does help us break down fat.  Unfortunately, so far this is only seems to be true if you are a rat fed raspberry ketones, and remember, humans are not rats (in case you had forgotten!), and there haven't been any human studies on these, yet.  There was one small study done in Europe that indicated people fed berries did have smaller waist circumference measures, but levels of adiponectin were not measured that I could see (Link).

Problem number two: "Berries stablize blood sugar."  This is another statement I hear all the time and I wish I could find a way to make it go away.  It still has the connotation, in my mind, that if your blood glucose is high or low the addition of berries will "magically" bring your glucose levels to an appropriate level.  Once again, it's more complicated than that.  Now, are there advantages to eating berries if a person has Type 2 diabetes or some other insulin-resistant related condition?  From a practical standpoint, yes, but it has to do with the volume that you eat.  Let's say you had a choice between eating a cup of berries or 12-15 small grapes (both of these have roughly the same amount of carbohydrate and calories FOR THAT PORTION SIZE).  Chances are if you eat the cup of berries, you will eat more by volume, and you will feel fuller, and be less likely to oversnack or overeat in general.  And by keeping your carbohydrate intake under control, your blood sugar will hopefully not elevate if you have and your body will not have to produce excess insulin to keep your blood sugar under control (or cause your blood sugar to drop later because you produced excess insulin).  See the difference in what I said there?  Oh, and by the way, if you eat half a flat of strawberries in about a day, like some of my patient's have done, it's probably not going to help you.

Problem number three: "Researchers found eating in-shell pistachios helps trick the brain into thinking you have eaten more than you have." I assume she is talking about this particular study.  Now, there is some evidence that setting up your meals and/or snacks in such a way so that they take longer to eat may help you feel satisfied with less, which is a tenant of a program called mindful eating.  One of the red flags for me, however, is that once again a specific food was held up as having "magical properties" when there are plenty of other "nuts in the shell" that could be substituted and she neglected to talk about how it was likely the process of having to shell nuts that caused people to slow down and let the satiety hormones kick in.  The other red flag for me is that I had a hard time finding the original study that wasn't part of a "Nut health" website and other studies that I found were also funded by organizations like the "Western Pistachio Association."  Confirmation bias anyone?

Problem number four: "Schwabenbauer suggests including an egg in your breakfast to avoid cravings later in the day."  She's right in that people who make a point of including protein (and healthy fats) at their meals do feel less hungry later on, but I really have a problem with the wording here.  If you are just adding an egg to your large bagel, or you eat a boiled egg with a gigantic bowl of cereal, then you are probably going way over your calorie/carb limit.  I would have (hopefully) said something like "Have a breakfast that includes a source of protein, like eggs, and leave the bagels and the cereal alone" if I was trying to fit that into a soundbite.

Problem number five: "The caffeine combined with a unique type of antioxidant help rev up your metabolism and boost fat burning."  She is probably referring to this study done in 2008: Efficacy of a green tea extract rich in catechin polyphenols and caffeine in increasing 24-h energy expenditure and fat oxidation in humans.  Before we jump to the conclusion, let's look at the study.  First of all it was done using a very small sample size, only ten people.  Second of all, all the participants were adult men, we don't know if this would apply to women or not.  Third, the increase in metabolism would mean that these men would have burned an extra 50-100 calories a day; would could easily be made up for by eating 1 piece of fruit, 1 cookie, 1 slice of bread, etc.  I would hardly think that constitutes a huge increase.

Take home message--while there may be aother dvantages to consuming a variety of protein foods, berries, vegetables, and nuts, there is no one particular food that is going to help you lose weight.  And if you are a clinician who is being interviewed, if you have enough warning try writing out your answers ahead of time or even ask if you can see the article before it goes to print to make sure you come across correctly.  And remember, look for a health care person with a good grounding in science before taking their advice.

Sunday, September 16, 2012

It's almost State Fair Time

About a year ago I got an e-mail from my boss, stating that our new Public Relations person wanted someone to write a short post for Facebook on eating healthier at the State Fair.  Apparently she was a transplant to the area and had received quite a shock when she saw the amount of deep fried products available for consumption.  I, of course, volunteered after collapsing in helpless laughter, because, who really does expect to find something healthy at any state fair?  But obviously there are some people who do wish to do as much damage control as possible, so here is a copy of what I wrote:

5 Tips for Healthier State Fair Eating

The State Fair opens this weekend, and many people are ready to indulge in their favorite Fair foods and try some new ones.   People who are nutrition-conscious, however, sometimes feel they have to avoid the Fair altogether or go hungry while watching others enjoy themselves.  If you don’t want to deprive yourself but not completely fall off the nutrition wagon, you can follow these tips:
  1. Plan what you are going to indulge in before you go.  Visit the State Fair website to help determine which foods are your “must haves” and “I-can-do –with outs.”  For example, you might “have” to eat a corny dog because it reminds you of fond childhood memories, but you don’t have the same warm-fuzzy feelings about Blooming Onions.  Forgo the calories of one so you can enjoy the other.
  2. Eat a light meal before you go.  Let’s face it, if you go to the Fair hungry it will be harder to stick to your plan.  A simple meal of protein with vegetables and a piece of fruit is quick to prepare, well balanced, and satisfying enough to hold you over until you arrive at the Fair.
  3. Share items with a friend or family member.  Obviously, eating only half the funnel cake will give you half the calories and you can save money also.  
  4. Look for items that are grilled or rotisseried.  Yes, there are some non-fried items at the Fair!  Once you arrive at the Fair you can walk around the food booths to see what is offered and then make your choices.
  5. Limit liquid calories.  Reach for bottled water more than you do soft drinks or alcoholic beverages.  Sometimes the weather can still be quite warm during the Fair and this will also help you stay hydrated.
Remember too that the State Fair (and Fair foods!) only comes once a year, so you know you can go back to your usual plan after enjoying yourself for a day.  

A few other tips I would add:
  1. Ask yourself if it's really worth it to experience any side effects you might have.  If you are a person who is used to eating much healthier, you might feel quite sick after indulging in certain foods.  Nausea, vomiting, and diarrhea are not on my top ten list of fun things to do, but you have to decide where your limit is.
  2. Make it clear to your Fair companions what you are and aren't going to eat ahead of time, and choose your companions wisely.  Some people feel guilty about their own food choices and might try to give you a hard time; you might not want to eat around that type of person at all, let alone at the Fair!
  3. Get to know some of the farmer's that bring animals there; some of them might sell range fed chickens, grass fed beef, etc during other parts of the year.  You can find healthier sources of meat from a trusted source and support a smaller farmer. 
And I'll repeat what I said above--you don't need to feel guilty about something you eat once a year, just be careful that you stay well enough to enjoy it.

Wednesday, September 12, 2012

Opinion: Don't mess with chocolate, or any other food for that matter

First Oreos, then chocolate and stroke risk, and now an alert reader has sent me another chocolate related article from the UK: Fruit Juice Infused Chocolate to Reduce Fat Consumption.  One of my first thoughts is "This isn't going to end well."  And I, of course, will tell you why.

First of all I need to state that from the perspective of a person with food intolerances I am fascinated by people who have the food chemistry knowledge to actually create a product that has a similar mouth feel and flavor to the original.  I've written before about how in many cases substitutes are not always a good idea but sometimes I just want to eat a piece of pizza, dammit, and I am happy that someone has come up with a recipe where I can have a decent crust.  When someone starts talking about removing something from a particular food, however, that's where I start to get even more skeptical about the supposed benefits.

In this particular case they are trying to remove the fat from the product, and I assume it's because they think the fat content is a bad thing.  When we look at the breakdown of the types of fats that are in cocoa butter, and therefore in a chocolate bar, you will find that the main type of fat is something called stearic acid.  So far the evidence points to this type of fat having either a neutral impact on the concentration of LDL cholesterol (often called "the bad cholesterol") in the blood or might even lower it slightly (Link).  The second type of fat found in chocolate is oleic acid, and this type of fat also seems to either be neutral or quite possibly raise HDL ("good cholesterol") levels. (1, 2) although.  So, since there isn't really any solid evidence that the fat in chocolate might impact lipid levels and/or risk of cardiovascular disease, it doesn't seem to me that removing something that gives chocolate it's unique texture isn't really worth it.

On a related note, some will point out that fat has more calories per gram than protein or carbohydrate, so it could be that they are trying to lower the calorie content of the chocolate?  This hasn't always worked out to well when it comes to food manufacturing.  Some products like "low fat" cookies, chips, frozen desserts, etc have almost the same amount of calories per serving, or there may be only a 20-30 calorie different.  Usually when you remove fat from a product you have to replace it with something, and that something is more carbohydrate in some form usually.  So, depending on the type of fruit juice used in this product you may wind up with more carbohydrate than before, and if you have diabetes/pre-diabetes or some other type of insulin resistant problem you certainly won't be able to work that product in too often and still stay within your carbohydrate limit.

One other problem that I still see a lot is that when some people see a product is "low fat," or "sugar-free" or "low carb" (or whatever apellation it's given) their ability to look at portion sizes and control how much they're eating goes out the window.  As a result, they actually wind up taking in more calories or carbohydrate than they did before, and possibly doing more harm to their efforts to lose weight, etc, than before.  Now, one of the versions of the chocolate bar that was mentioned, the one with vitamin C/citric acid and water, might have significantly less calories/carbs per serving--but if your double/triple/quadruple your  Anytime an advertisement catches your eye, try to up your scrutinization of the label a little more; in other words, up your skeptical quotient even more when you see any of these "special" products.  I also happen to think that the use of some of these items creates a type of "tunnel vision" where we only focus on one food or one nutrient as being "bad" and we cease to look at our diet as a whole.  For example, I've had some patients over the years who were very, very careful with their fat and cholesterol intake, but they were completely ignorant of how much added sugar they were taking in.  Even pointing out to them that their "fat-free yogurt" with fruit had a lot more calories than plain yogurt or even a glass of whole would still result in "why can't I lose weight?"

The other problem I have with foods that are manipulated to be "healthier" is I always fear that we might wind up with the "McDonald's problem."  At one time the popular fast food chain used beef tallow to cook its french fries, but by 1990 they had switched to vegetable based oil/shortening in order to lower the saturated fat content of its foods.  Unfortunately, it turns out the new oil was worse in that it contained more trans-fatty acids, meaning that you now were eating something that could increase insulin resistance, inflammation, and lower your good cholesterol on top of getting a load of low nutrition carbohydrates that you didn't need.  McDonalds is back to using oil with less trans fat, but couldn't we have save some time and effort by just saying "Look, french fries are a carbohydrate/calorie load however you look at it, nobody eats them for health reasons, and they need to be a treat" instead of trying to mess with the original product?  (I know, I know.  It wouldn't have been good for advertising, which is once again why no-one wants me to work in marketing).

And then there are other consequences that ripple through the food production world that we may not see.  I still remember the days, and I regret it now, when we as dietitians used to be so picky about telling our patients/clients to eat "white meat" over "dark meat."  At the time I didn't know that chickens were being bred to have breasts so large they would in horrible pain if they lived to long, and I also wasn't thinking about how wasteful that was.  I should have been encouraging people to buy whole chickens or whole chicken parts and use up the leftovers for the week.  Here's a post with video about this, be careful as there is video footage of what I consider animal cruelty: Big Breasts Sell on Chickens Too.

So back to the end of this past Monday's post I talked about how to best enjoy chocolate and maybe get a few health benefits out of it too.  So your take home message for today is--know your limits and enjoy foods in the most natural state possible.

Monday, September 10, 2012

Before you fall into the chocolate river

Everyone can be vulnerable to confirmation bias at some point, and I think people are more vulnerable when they hear "good news" about a favorite food of theirs.  If you are one of those people whose favorite food happens to be chocolate, then you were probably happy to see this headline or one of it's permutations: "Stroke Prevention: More Sweet News for Chocolate Lovers."  I'll bet many of you were tempted to avoid the advice from a previous post about ignoring the headline, weren't you?

Well, fortunately for science, if not chocolate lovers, the folks over a Medline Plus aren't going to let you get away with it.  They bring up several good points which I will expound upon in today's post.

1) This study was observational, so they could notice a correlation between chocolate consumption and stroke risk, but correlation does not equal causation!  The only way you might get closer to "proving" cause and effect would be to do a double blind randomized study where some ate chocolate for several years and other people wouldn't be allowed to.  So, you can't justify your chocolate purchase on an observation.

2) The researchers, once again, allowed people to self report on their chocolate consumption, so the actual average consumption might be much higher or lower than what was reported.  Do any of you remember to the ounce or gram how much chocolate you consumed yesterday?  Last week?  In the past ten years?  Would you be willing to admit it if you did?  So, we can't justify a chocolate purchase on someone's faulty human memory either.

3) If you live anywhere other than Sweden, where this particular study was done, you probably have a very different diet.  Are you eating gravlax, or ligonberry jam, or artsoppa on a regular basis (or do you have to Google those terms?) along with your chocolate?  Did this study account for the complexities of a varied diet on our bodies?   And it also says in the study that most of the chocolate consumed in Sweden is milk chocolate, and most other studies look at the impact of dark chocolate, so where does that lead us.  So, we can't justify a chocolate purchase based on someone else's diet either.

4) What about the amounts/portion size?  Let's, for just a minute, pretend that everyone remembered how much chocolate they consumed for the past ten years or so.  The amount was the equivalent of one quarter cup of chocolate chips PER WEEK.  Now, unless you are a professionally trained chef, you are most likely going to have to go to your kitchen and look at your quarter-cup dry measure.  Not very big is it?  And remember it was only that amount PER WEEK and not per day.  And if I did my math correctly, that would be roughly four squares of Ghirardelli squares PER WEEK.  Anybody else have trouble staying at that amount?  More is not necessarily better, so unless you plan on being very strict with your allowance, you probably can't use "Four squares of this per week and I won't have a stroke!" as justification either.

5) This study was done in men aged 49-75, so we don't know if it helps to start eating chocolate earlier, or if it applies to women at all.  So ladies, you definitely can't justify your chocolate purchase on this study either.

I know, I know, some of you are thinking, "Well is chocolate ok if it's consumed in moderation?"  For those of you who are just tuning in to this blog, let me remind you about how much the term "moderation" drives me crazy because if you ask ten different people what "consuming chocolate in moderation" means you will get about ten different answers.  So a better question would be "would it hurt me to eat chocolate if I stay within my calorie/carbohydrate limit and might it help me?" 

First of all, you have to know what your carbohydrate/calorie limits are, and figure out how many calories/carbohydrates are in a serving, and then you have to figure out what that serving is!  I have found that 85% cocoa has the least amount of added sugar/carbohydrate (when I'm looking for a chocolate bar/chocolate squares to eat), and a tablespoon of cocoa powder only has ~1 gram of net carbohydrates and about 12 calories.  So if you can work a few squares of 85-90% chocolate in, or use unsweetened cocoa powder to make your own sugar-free hot chocolate mix or sugar-free pudding, you might actually be able to get your chocolate fix and still stay within your limits.  I personally find that I am still better off buying the individually wrapped squares, which means I pay more, but it means I also won't have the other section of the chocolate bar tempting me.  Remember what I said before about the evidence pointing toward sugar having addictive qualities?  You might want to think about whether or not you resemble that remark before you start in on the chocolate.   And of course, if you are adding cocoa powder to your smoothies or making pudding out of it, think about other sources of carbohydrate that you might be getting as well.

Would the chocolate help you if you are able to keep the amount under control?  Interestingly enough, when you start looking at double-blinded studies, there are some positive results as in this study here and here.  But even the study authors trying to remind people of portion sizes, sugar content, etc.

Take home message--If you like chocolate and feel that you can keep your amounts under control, there might be some benefit.  Find the kind with the least amount of sugar that you can tolerate.

Friday, September 7, 2012

Are you trying a new diet or a new religion?

The other day one of my friends declared on Facebook that he was going to start living this "Paleo lifestyle" that he had heard so much about; he had already started eating the bugs and animals he found in the park and was running around his yard un-showered and unclothed.  I requested that he at least wear a loincloth at our next community outreach event, and then started thinking about the many different diet plans that are out there that start out with good principles and then the people that claim to follow the plan take it off the rails at some point.  I will review three plans in this post and briefly discuss the positive aspects of each plan, where people tend to stray from a healthy plan, and how to avoid going off the rails if you do choose to follow a similar plan.

The Atkin's Diet
The good:

  • Gives an excellent review in lay person terms about hormones such as insulin that play a role in appetite regulation, blood glucose regulation, heart disease, etc.
  •  One of many carb restricted plans that have been validated by evidence as a way to help people with metabolic syndrome/pre-diabetes/Type 2 diabetes lose weight and gain better control of their blood glucose levels and lipid levels (Link)
  •  People do experience an appetite suppression when they are producing ketones—basically when you don't eat carbohydrate and have glucose as a readily available fuel your body will start "breaking down" fat for fuel and ketones are the result.
  • Allows you to have certain kinds fat, which, let's face it, tastes good; fat also provides satiety to prevent overeating.
  •  Makes it easy for you to meet your daily protein requirements.
  •  Vegetable intake is encouraged and so are certain fruits after the first two weeks.
  • Helps people avoid foods empty of nutrition like white bread, pasta, white rice, etc.
  • Exercise is encouraged.

Where I've seen it go bad:

  •  Those who purchased the 1972 edition might not realize that certain fats really are better for us than others.  If they wind up using a lot of seed oils they might go too heavy on the omega-6 which is not so good for preventing inflammation, and there is evidence that eating a lot of deep fried food may influence the development of atherosclerosis (Link).  Those who purchase the latest version may not have the same pitfalls.
  • Some people start spending a lot of money on "low carb" substitutes and their shopping cart is full of "low carb" bagels, tortillas, pasta, brownies, meal replacement bars, chocolate sauce, etc.  These items are often high in cost but low in nutrition as far as vitamins and minerals go.  I personally haven't found a lot of the commercially produced items to be very tasty or filling either, but everybody's a little different.
  • Some people seem to think that calories no longer matter when following a plan like this, but that's not true.  You still have to take in fewer calories that what you were before to lose weight.  Granted, the ketosis can help you from consuming extra calories, and there is some evidence that you burn more calories on the low carb plan, but it is still possible to consume too much. (Link)
  • There's a tendency to forget that how much and what type of animal protein you consume has an impact on the environment around you.  Does your consumption support local farms that raise the animals humanely or are you feeding into the factory farm industry?

Avoiding the pitfalls

  • Figure out what substitutes you might actually want to spend money on and which you can do without (or you don't really care for the taste anyway).
  •  Check the calorie and carbohydrate count of any "low carb" foods you might buy against the original product.  Don’t be a victim to advertising and spend more money on something that’s not really that different.
  •  Cook from scratch more to avoid purchasing a lot of processed food.  You will enjoy the taste and the savings a lot more
  • Make sure your substitutes have some nutritional value to them.  Use lettuce leaves for tortillas, cut up zucchini for "spaghetti," use almond flour/chopped nuts to make quiche crusts, etc.
  •  Allow for "the real thing" as a treat every once in a while.
  •  Use pasture-raised butter, coconut oil, avocado oil/avocadoes, olive oil for your fats and avoid the deep fryer.

The Paleo Diet and the Paleo Diet Solution
The good:

  •  Gives a good overview of the role of diet in our evolutionary history.
  • Also gives a good review of various hormones and how they regulate appetite.
  •  Encourages people to intentionally create "scarcity," if you don't have it available then you can't eat it.
  • Encourages people to avoid processed food of all types.
  • Encourages the purchasing of animal protein from humane sources.
  •  Encourages people to cook more from scratch.
  •  Suitable for people with many food intolerances and gastro-intestinal problems.
  • Exercise is an integral part of the plan.

Where I've seen it go bad:

  • Tendency to fall for "ancient wisdom" fallacies (more details at Rationalwiki).  Paleolithic people did not evolve TO eat their diet; they evolved BECAUSE of their diet.  They ate what was around them (opportunistic omnivores) and what was around them was plant matter, insects, and animals.   They had no "special wisdom" about what to eat and not to eat (although plenty of myths later evolved around this later).  I've also seen some practitioners advocating other forms of woo such as acupuncture, use of "chew sticks" for cleaning teeth (which can cause unnecessary abrasions), and even people who claim to heal cavities using certain foods.
  • Yes, there is money to be made from making a new snack product and labeling it "paleo." I decided to try some "paleo snacks" just to see what they had, and one of the products they had was a brownie made of almond flour, coconut oil, etc that was at least 280 calories.  If you are a competitive athlete you might be able to handle that for a snack, but those of us just exercising to be healthy really couldn't spare that.  If you ate an ounce of nuts you would still get fewer calories.
  • The asking of the question "Is this paleo?" instead of "Is this going to help me meet my health goals?"  Guess what, even your certified humane pork is probably very different than the wild animal a paleolithic person would have eaten.  Your coconut pudding with honey would not have been consumed by a paleo person because there would have been no reason to combine the two, and she certainly wouldn't have eaten that honey on a regular basis either.
  • Some people have not figured out the difference between being skeptical of medicine and being plain old paranoid.  If your doctor wants to put you on a medicine for blood pressure, for example, without talking about lifestyle changes you should be skeptical.  But it also helps to have your tetanus shot up to date if you are going to be out in the woods hunting, and if you have a severe infection you might need to take antibiotics, and herd immunity for your kids is a good thing too!
  •  Even though the consumption of grains and legumes takes up a small part of our evolutionary history, some people have apparently adapted to be able to consume dairy and grains without suffering negative consequences.  As they say over at the evolutionary blog Nothing in Biology Makes Sense:  If we are going to use evolution to justify our dietary choices, why throw out the last 10,000 years of it? (Link)

Avoiding the pitfalls:

  •  Learn more about evolutionary biology and how it relates to our food intake beyond what it is explored in the diet books.  Catching Fire: How Cooking Made us Human ( link) is one good place to start, and Richard Dawkins’ The Greatest Show on Earth ( link) is a general book on evolution that is quite readable.
  •  Keep in mind that natural is not always better, and that just because something was done one way several thousand years ago doesn't mean its ok to do now.
  • Be appreciative of the aspects of modern medicine that have enriched our lives.
  •  Ask "Does this help me meet my health goals?" as opposed to "Is this paleo?"
  • Portion sizes/calories still count.  Sure nuts are included, but it won’t help you if you eat the whole bag at one sitting. Use nut flours sparingly as well.
  • Be very careful of people using "Paleo/Primal" to sell their snacks.  You might wind up with a much higher calorie item than what you thought.
  • Some people do fine with dairy, others don't.  Some people avoid grains most of the time to limit calories but do allow for a treat sometimes, figure out what you personally can handle.

Vegetarian/Vegan Diets
The good:

  •  Encourage the eating of nutrient dense plant foods.
  • Encourages eating a variety of vegetables and usually promotes creative ways to improve them.
  • Encourages humane treatment of animals.
  • Encourages good stewardship of environmental resources.
  • Encourages good stewardship of financial resources.
  • Sometimes encourages the use of unprocessed foods.

Where I've seen it go bad:

  •  Some people eliminate animal foods only, but do not make a point of eating nutrient dense plant foods
  • Some people merely ask "is it vegan?" not "Does this help me meet my health goals?"  See my post about Oreos, which are vegan.
  •  People avoid factory farms, but they buy items "Big Agriculture" has produced and therefore are not good stewards of arable land.
  • Some people purchase a lot of processed meat substitutes made from isolated soy protein or snack foods that are labeled organic.  This is not good stewardship of finances, in my opinion, and you are likely taking in foods that are empty of nutrition.
  • Some people aren't careful with how much carbohydrate they are consuming and this can be problematic if you have diabetes or another insulin resistant problem.
  •  Some people play a weird numbers game which makes some foods look like they contain more of a nutrient than they really do.  One I’ve seen frequently is “broccoli contains more protein per 100 calories than beef,” which is technically true, but you also have to consume about 4 cups of raw broccoli to get the 20-30 grams of protein needed at a meal.

How to avoid the pitfalls:

  • As stated in a previous post, eat your vegetables, avoid processed snack foods and processed meat substitutes as much as possible.
  • Be careful with your portion sizes when it comes to grains and limit added sugars and carbs that are empty of nutrition.
  • By from local farms as much as possible, particularly if they are mixed farms.
  • Ask "Does this help me meet my health goals" as well as "Is it vegan?"
  • Make sure that the food you are eating contains a decent amount of protein for the portion size that you are consuming, in other words, that portion should be the equivalent of 1 ounce of meat.

Other considerations for EVERYBODY!

  • Make sure you are not being, well, annoying.  Do you give advice on what people should eat when they haven't even asked?  Do you walk into someone's home and tell them they are eating the wrong kind of bread or that they shouldn't even eat bread at all without them asking?  Do you complain loudly in the restaurant that there's "nothing" for you to eat?  Do you wonder why you are not invited to parties?  There is nothing wrong with speaking up for yourself (e.g. telling a host ahead of time that you have food allergies), but you can do it in a nice way, and even offer to bring a particular dish that’s “safe” for you.  And if you are reading this blog, you probably have access to the internet, so look up restaurant menus ahead of time and call ahead to ask about ingredients whenever possible.  Maybe people will see you eating a certain way and ask you about it, but if they don’t, as an adult they probably don't want to hear advice they didn't ask for.
  • Listen yourself when you talk about your diet.  Do you back up your claims with evidence?  Or do you sound like an overenthusiastic cult member?  If you sound like the latter, you better do some more research.
  • Keep in mind what's right for you might not exactly fit the bill for someone else.  The person with the hereditary blood disorder is probably eating meat for a reason.   The person who doesn't always buy grass fed beef may not have found a way to budget for the other.  Try not to make any snap judgments before you've walked in that person's shoes.
  • Your new diet probably won't make you live any longer than what your genetics want you to live.  Live healthier, yes, live longer, not necessarily.