5 Questions This RD Wants You to Ask About Nutrition News

I think we can all agree, nutrition is the most relevant yet most confusing science. Everybody eats, but in the 19 years I’ve been an RD, I’ve seen complete 180-degree shifts in what we know. And trust me, I’ve been as frustrated as the average person. Even knowing that nutrition is a relatively new science that is constantly evolving, I have wondered what to eat and what to feed my family.

Further complicating matters, nutrition science isn’t just about the foods we eat. It’s about so much more–our genetics, our emotional relationship with food, and our social connections with each other, to name a few. Actually, many of the things that confound our understanding of nutrition are the things that fascinate me the most!

But frankly, nutrition is also about the politics and economics of those invested in it–and it this fact that most makes me critically (sometimes cynically!) question all health-related information I come across.

We can’t change any of these factors, try as we might. But what we can do is approach each piece of nutrition news with a plan to get to the real bottom line–and I do not mean the economic one.

To do this, we should ask ourselves questions that analyze the news and help us make the most sense out of it. It is my goal to do that through my blog posts, but in case you are wondering how I approach nutrition news, here are the very questions I ask myself. I hope you will ask these same questions the next time you hear some nutrition news, whether it’s from government sources, the media, or even your multi-level-marketing friend. And when still in doubt, feel free to contact me at dianenorwood@thewanderingrd.com!

5 Questions This RD Wants You To Ask About Nutrition News:

1. What is the primary source of the information?

Knowing the source is important because you can consider bias when assessing new information and comparing it with other sources of related information.  The information’s source is only one piece of the puzzle to assessing the validity of the information because you cannot eliminate bias, only minimize it.

Is the information coming from a company who stands to benefit financially? Or conversely, is it coming from a researcher at an institution who stands to lose a lot (for example, funding or their job) if the research doesn’t support their life’s work? Is it coming from an organization with a political and economic agenda (for example, the USDA with agricultural ties)?  Is it coming from a blogger who is paid to promote a product?

But even when there is not an obvious economic or political investment, sometimes the source’s preconceived notions are a form of bias. I frequently find that many RDs have a judgmental almost angry tone when presenting information from their “soap box” and this is a bias that I really try to keep in check.

 

2. Is it a quick fix or does it sound too good to be true?

If it sounds easy, look deeper. Particularly in the case of weight loss, I’m sorry to say there is no easy fix. In fact, many proprietary herbal blend supplements can actually be dangerous, especially because many companies don’t list the amounts consumed of each ingredient, but rather lump them all together as a blend.

But even if a product doesn’t contain questionably harmful ingredients, there’s the very real possibility it is a waste of money. One reason is that dietary supplements are not regulated well (thanks to the Dietary Supplements and Health Education Act of 1994), so companies don’t always include the ingredients or full amounts that are listed on their labels because no one is checking up on them.

Plus many people experience a “placebo effect” when they begin using dietary products; that is, they unknowingly (or even knowingly) change how they are eating and experience desired results that can’t be attributed solely to the product they are taking. If you’re like me, you may even see this with your own friends; your Facebook feed may be full of  pictures of really healthy meals your friends are eating while they are taking one dietary supplement or another. If you eat real, lower sugar, lower refined-carb food that replaces processed foods, you can lose weight without expensive products.

 

3. Do you need a subscription, membership or salesperson “dealer” as a gateway to the product, information or service?

If and when there is a truly effective weight loss supplement, there will be no more overweight people and no weight-loss industry. Until then, most companies are trying to make money, not trying to help you lose weight safely and permanently.

When multi-level marketing companies use social networks to sell nutrition-related products among friends, I find it particularly scary because you are more likely to try a potentially harmful or wasteful product just because your trusted friend is swearing its safety and efficacy to you. And sometimes you are even made to feel unsupportive if you don’t buy it.

But fundamentally, I’d stand firm if I were you. There is no way to extract all the compounds that work together in real, whole food to make it the most nourishing to our bodies and as a result, there is no proprietary product on the market that will revolutionize your nutrition. And don’t forget to consider what will happen when you stop taking the product. You may be worse off than before you started.

 

4. Is there scientific, peer-reviewed, journal-published data to review?

This is the gold standard of scientific data: scientific articles published in a well-respected journal that is reviewed by experts in the field. In particular, the only way to prove causation is the randomized controlled clinical trial, although it’s difficult to do these studies when it comes to nutrition. You have to force people to eat a certain way and it’s hard to be sure they are doing so unless in a lab, and if they’re in a lab, it’s not “real life.”

So, observational studies are frequently done to look for associations to provide hypotheses to be further tested; however, they only show correlation not causation. Unfortunately, most people forget this, including many study authors. And the media is notorious for publishing stories stating results of observational studies as fact. If it’s an observational study, or a short clinical trial, take the results with a big grain of salt.

In addition, scientific articles are not free of bias. Only certain articles are selected for publication. Even the ones that are published can be poorly designed with confounding factors. Review articles can creatively select certain studies to include and others to leave out, which influences the conclusions.

And if the research available is only done by the company itself and reported on their own website, do they give you access to read beyond the abstract? Frequently scientific language is used to make claims that are not supported by the study’s actual design. Scientific-sounding information may sound convincing, but it’s important to look at the study details to determine the methods used and whether the conclusions are reasonable.

 

5. What Should I Do With This Information?

This is the most important question to ask yourself. When a headline suggests a particular food has health benefit, many Americans tend to run out and add it to their usual diet. But in most cases, you have to analyze your overall diet and see how the food can fit in and make adjustments to the foods you already eat.

For example, olive oil is a very heart-healthy monounsaturated fat. But if you simply start adding it to your diet, without giving up anything else, such as sugar and refined carbs that contribute to obesity and heart disease, you will not see the health benefits and may actually end up worse off. Radical changes to your diet based on one new study are likely to leave you even more frustrated–and potentially unhealthier–than ever.

Final Words

When reading about nutrition news, remember to have respect for your body. It is an incredible, complicated machine that is capable of far more than we may ever know. There is no need to detox or cleanse your body. The best thing you can do for your health is to eat easy, real foods and avoid processed foods as much as possible. Please, consider this if you consider nothing else when you read nutrition news.

Sugar: What You Should Know

Sugar is always making it into the news—and into products on grocery store shelves.  It, apparently like sex, sells. As a result, we are bombarded with conflicting and even controversial information about sugar every day. We love it, and at the same time, we hate it. One minute dietitians (RDs) are telling us “everything in moderation.”  How can we not love that–permission to eat what tastes good? The next minute, we hear how Americans should banish sugar from our lives forever.  And oh, how we hate that! Sugar is the ultimate love-hate relationship! What gives? Sugar tastes so good. How could it be so bad?

Well, let’s discuss all things sugar. In this post, I will do the following:

We Are Simply Eating Too Much Sugar
American women eat an average of 15 teaspoons of sugar each day, while men eat 21 teaspoons (it likely differs because men eat more, in general).1 Children eat an even higher percentage of added sugar than adults each day, and surprisingly, the majority of sugar is coming from store-bought foods eaten at home.2 These numbers are likely significantly lower than actual intakes, because they are estimates from 24 hr recalls, which are notoriously unreliable. Yet, even these numbers far surpass any current recommended limits (see chart), which I believe could even be falsely high due to sugar industry lobbyists influencing them. After all, a 20-ounce soda alone provides a day’s worth of sugar (about 15 teaspoons of sugar) according to all these current guidelines. I’d say soda companies have a vested interest in the science and policies of sugar, wouldn’t you?

Most concerning is the fact that people haven’t always eaten sugar in these proportions. In fact, for the great majority of human history, before sugar and flour became easily refined and cheap during the industrial revolution, we ate far less sugar and carbohydrate.  Americans have increased our sugar intake more than 40-fold since the American Revolution!6

Not everyone agrees on the cause, but all researchers agree that people grow fatter and sicker after adopting the “Western” diet and/or lifestyle. This has occurred in many populations around the globe, and it seems to happen within only two generations. Many argue that we grow fatter and sicker because of increased total calories, which have no doubt increased over time. But even if refined sugar and flour aren’t specifically to blame  (although many experts, including me, would argue that they are), it’s hard to argue that these excess calories are coming from anything other than refined sugar and flour. Yes, some increased calories are coming from the fat in our ice cream and other processed foods, but we probably wouldn’t be eating these foods if they didn’t have the added sugar.

Since the beginning of the low-fat diet craze that started in the early 1980’s, added sugar, and carbohydrate intake in general, has dramatically increased (food companies had to replace the fat with something) and so have many diseases.32  It appears that many chronic diseases such as obesity, diabetes, metabolic syndrome, heart disease, Alzheimer’s, and cancer are negatively associated with sugar intake.6-31

Soda often takes the brunt of the blame for added sugar intake because 1) Americans drink a lot of it, and 2) there are very few foods that are pure sugar like soda is, which makes it easier to identify and study than the various types of sugar in other mixed-nutrient foods. 6-31   I’m not a soda fan, but soda does not appear to be any worse than any other source of added sugar. The problem is it all adds up. Sometimes certain sugars are described as “better” than others. Particularly, there has been a lot of misguided focus on high fructose corn syrup (HFCS) as the “worst” added sugar, and honey, agave or maple syrup are often described as “better.” The bottom line is this: existing research shows (and in my opinion future research will continue to show) excess sugar of any kind appears to be harmful to your health—which is the first compelling reason we should limit all types of sugar–and FYI, sugar has 50+ names.

  1.  Sugar is Linked to Many Diseases

This is my first point deliberately—it’s actually many related points. Just look at this long list of diseases associated with sugar. It’s shocking, and I promise I don’t mean to scare you as much as educate you. But frankly, I find it a little scary. The good news: eating less sugar may improve your health!

  • Sugar provides excess calories and increases levels of the hormone insulin, which promotes fat storage and leads to obesity.
  • Chronically elevated levels of insulin are linked to insulin resistance, type 2 diabetes, and metabolic syndrome, all of which increase your risk for heart disease.
  • Sugar contributes to increases in blood levels of circulating fatty acids (dyslipidemia), which increases your risk for fatty liver disease and heart disease.
  • Sugar also contributes to hypertension, which may increase your risk of heart disease, stroke, and renal failure.
  • Chronically elevated levels of blood glucose and insulin levels are linked to cancer, including endometrial, esophageal, pancreatic, kidney, gallbladder, breast and colon cancer.
  • Chronically elevated levels of blood glucose and insulin levels are also linked to Alzheimer’s disease.

Further, there is research linking nearly all of these “Western” diseases with each other. Obese people are more likely to develop diabetes. People with diabetes are at higher risk for heart disease. Cancer occurs more frequently in people who have diabetes and obesity.  Alzheimer’s has been dubbed “type 3 diabetes” by many researchers.30  Is sugar part of the connection? It is not completely clear. It is very complicated and difficult to study to be sure what is causing the associations. And your genetics most certainly play a part. But let’s discuss what happens in your body when you eat sugar.

Of course, as you know, there are different types of sugar. But when they are metabolized, many break down into varying amounts of glucose and fructose in the body. The body handles both of of these differently.

Glucose enters the blood stream, increases your blood sugar, and your pancreas pumps out the hormone insulin to escort the glucose into the cells, where it can be used for energy. To be clear, insulin itself is not the problem. In fact, you can’t live without insulin; it is just the catalyst for increased fat storage in response to excess sugar intake.  Some glucose is used directly for energy, some  is stored as glycogen in the muscles and liver, and some is converted and stored as fat. So, a high sugar diet may lead to obesity, which then puts you at increased risk for metabolic syndrome, diabetes, heart disease and some cancers.

Many types of added sugar, including HFCS, white table sugar (sucrose), honey, maple syrup and agave also break down into about half fructose and half glucose. Fructose is the natural sugar found in fruits, and it should be noted it would be difficult to get too much by eating fruit alone.  But when you eat unnatural amounts of fructose from various sources of added sugar, fructose can be converted into fat directly in the liver, and this process also produces uric acid, which can lead to gout and possibly hypertension. So, a high sugar diet may also increase your risk of gout,  hypertension, and dyslipidemia, which further contributes to metabolic syndrome, obesity, diabetes, and fatty liver disease.

The metabolic pathways that occur when we eat various types of sugar are also thought to cause inflammation, especially when you have abdominal fat, which may be part of the process by which sugar is linked to certain diseases, especially cardiovascular disease.31 More research is needed, but the arrow is pointing in the right direction: cutting out all forms of added sugar and refined grains (which break down and are metabolized much like sugar) and eating mostly easy, real food can only help.

  1. Sugar Provides No Essential Nutrients

Excuse me for restating the obvious—but you do not need sugar, and it takes the place of more nutritious real foods.  This is the second reason I urge you to limit your sugar intake. It provides energy (that is, calories, usually in excess of what you need), but no other nutrients. That’s what we RDs mean by “empty calories.” Yes, we have been saying this for yeeeeears. But please don’t gloss over it—it’s what I like to call a “common sense verification of science.”  In other words, does the science make sense?  Well, yes, indeed, it does. There’s never been a research study or a dietary guideline that has suggested we need to eat any amount of refined sugar regularly. (I know, right? Duh. And it’s crazy to say “never” and “research” in the same sentence.)

If you want to get even more technical, carbohydrates from foods are not exactly necessary either. There are “essential amino acids” (protein) and “essential fatty acids” (fats) that our bodies cannot make, so we need to eat them from foods. But your body is technically able to make the carbohydrate it needs, specifically glucose from protein or even from glycerol, which is released in fatty acid metabolism.33 And your brain is able to function quite well on mostly ketones, which are produced when you burn fat for energy (hence, the popular “keto” diet.)  Of course, that’s another post…or several!  But I digress. For most people, this discussion is moot because our food supply provides more than enough carbohydrates for our bodies…even if you’re eating mostly real foods, which is the best way to get your carbohydrates because then you also get beneficial nutrients and phytochemicals that only whole foods provide.

Are you with me so far? We are eating too much sugar, it negatively affects your health, and it provides nothing your body needs. Still need another reason to lower your sugar intake?

  1. Sugar May Be Addictive

It is not my intent to minimize how hard it is to cut out sugar—it does take some getting used to. It even requires some will power.  But that might be putting it mildly, for some people. Although it’s controversial, some scientists suggest sugar may be addictive.34-36 Addiction or not, the jury is out, but sugar tends to lead to continued cravings for some people. If you’re one of them and you’ve ever tried cutting it out, you know the feeling. Sugar hovers in your forethought, almost haunting you, even after you’ve eaten a meal and should feel satiated. Maybe you need that piece of chocolate after your meal? You’re used to that feeling of satisfaction that serotonin triggers in your brain after you eat sugar.  We are learning more and more that our gut hormones are also intricately involved in appetite, satiety and sugar metabolism. Some people can have a little sugar and be fine. Some people can even have a lot. Some people find it easier to try to avoid sugar because even having a little leaves them wanting more and more. I suspect there’s something in that, beyond just will power.

However, as hard as it is to avoid sugar—both due to its prevalence in our food supply and the possibility it may be addictive—the cravings can be overcome with time, the right mindset—and by sticking with real foods. The body is able to adjust to lower sugar intake in a few weeks, and it gets easier, so don’t give up and give it enough time!

Sugar: Putting the Science into Real-Life Perspective

To summarize this evidence-based perspective and put it into practical terms, I will ask you the very questions I consider when deciding what to eat and feed my family:

  1. What if you have genes that are prone to obesity? Or diabetes? Or heart disease? Or cancer? Or Alzheimer’s? In other words, you may not know you have these genes, but what if these health problems run in your family, and therefore, you might also be more susceptible to them?

and

  1. What if our food supply is providing too much refined carbohydrate and sugar, often in hidden places, so that it’s nearly impossible to eat within the recommended guidelines (if you’re not purposely trying to avoid sugar and refined carbohydrates)? (Or worse still, what if the guidelines aren’t low enough for optimal health, even if you are eating within the recommendations?)

and

  1. What if sugar and/or refined carbohydrates may be addictive?

Add together these very real (evidence-based, although not all conclusive as of yet) possibilities and ask yourself this final question:

Do you want to be a slave to the high-sugar, highly-refined processed foods you eat, so that eating them makes you crave more and sabotages your health?

I, for one, don’t. So, I choose easy, real food. Every. Single. Day. And I personally find that once you limit sugar, it’s easier to eat for your health and most surprisingly, it’s equally satisfying. Do I deviate sometimes? Yes. I just got back from a week at Walt Disney World. I still tried to limit my carbohydrates to mostly real foods, but I had some dessert foods. You know how moderation makes me cringe, but that’s my kind of moderation–a very small portion of one or two of my favorites when I’m on vacation once or twice a year!

Real Food: a Work Around?

You know how I love simplicity. And real food. And most importantly–life itself (hence the extreme value I place on health.) So, while we are continually waiting for more conclusive research, I do not believe you need to count grams of sugar or carbohydrates. The simplest way to limit sugar is to choose real, unprocessed, whole foods.  Added sugars are not going away from our food supply. And public health policies or guidelines are not going to dramatically change anytime soon either. (Well, the Nutrition Facts Label is, but you can read what I think about that here.)  Rather, I see it as a “work around” to these fundamental problems if you choose to be mindful of your body and intentional with real-food fuel.  The quantity and the quality of the carbohydrates you eat will be vastly improved when you choose real, whole foods and you will drastically cut added sugars.

You might worry it will take lot of time looking for sugar in products, researching healthier options, and cooking from scratch. But I would argue lowering my sugar intake has even simplified my life. I share here How Slashing Sugar Can Simplify Life.

Final Thoughts

Slashing sugar (and refined carbohydrates) in your diet can be a big adjustment, I realize. We are surrounded by foods not fit for healthy lifestyles. But choosing better food doesn’t have to be complicated or a negative experience of deprivation. You are changing your health for the better, going back to the basics and simplifying your life, and enjoying foods as nature intended them. With the right mindset about food (which science shows you have control over, so think positively…more on that later), I believe it can be a very rewarding experience. Don’t aim for perfection, but aim for improvement with consistent healthy habits. You can retrain your brain and your body. You have nothing to lose–except possibly some excess weight and/or some health risk–giving it a try.

Start with these Tips for Slashing Sugar. I’d love to hear how it goes for you…please share your comments and tips if you’ve been trying to cut out sugar!

References

Preventing Diabetes (and Obesity): We Can Do Better with Real Food

I was at a diabetes conference last week and it was eye-opening, but maybe not in the way you are thinking. (Get ready to wander with me…) As a certified diabetes educator (CDE), I am all too familiar, as maybe you are too, with type 2 diabetes and its disease process, progression, and complications. And while I did learn several new and fascinating treatment options from the conference, the most important thing I took away is much more of a practical revelation.

These well-respected medical professionals were presenting valuable information on how to manage the “train wreck” that is full-blown diabetes, but we are still largely ignoring (thanks mostly to a lack of insurance coverage) the prevention of diabetes in the whopping 86 million Americans who have prediabetes.(1)  What struck me is that while I have not been working with patients as a CDE for more than 10 years, there have been many advances in medication and technology, but not much has changed in our efforts to prevent people from getting this terrible obesity-related disease.

There are 29 million people who already have diabetes, 8 million of whom are undiagnosed. (1) What if we could also help them reduce the number of medications they are taking (and paying for), prevent complications, and improve their quality of life? It’s not just prevention, but better management we could help people attain with practical lifestyle interventions–involving easy, real food, of course.

In general, would you agree that it’s easier to prevent problems than to deal with them after the fact? It’s better to have money in the bank before you shop. It’s better to have insurance before you need it. It’s better to have a will or trust before you die. Well, I strongly believe it’s better to delay or prevent diabetes than to treat it.

Research shows lifestyle interventions, which often result in weight loss, are able to drastically slow the progression of diabetes and prevent it in many people. In the landmark study, Diabetes Prevention Program, the lifestyle therapy resulted in a 58% lower incidence of diabetes than the control. (2) Other studies have shown similarly beneficial results from lifestyle interventions. (3) I feel excited to be in a profession in which I can help people prevent diabetes. But I’m frustrated because I have encountered health professionals (not necessarily at the conference!) who seem either unaware, complacent, disillusioned–or even self-righteous at times–when dealing with people already in the throes of diabetes. Then there are food bloggers (not necessarily RDs) in the Internet realm who may seem extremist, fanatical and maybe even on the fringes of nutrition. And there seems to be no platform in between to reach the 86 million Americans with prediabetes…or the two-thirds of Americans who are overweight or obese and may develop diabetes if they haven’t already.(4)

Further, it has never been more obvious to me that there is stark division between this RD’s idea of optimal nutrition and what most Americans are eating. But of course most RDs have to negotiate and compromise and teach whatever the patient is willing to learn. I get that there are stages of change and we need to be sensitive to a patient’s needs, but couldn’t we do better? We can and need to do better. I can say this because the number of people with diabetes is expected to double by 2050 (5) and this epidemic isn’t going to stop with advances in medications and technology alone. Indeed, they are vital for the management of diabetes, but they are like Band-aids on the symptoms (and metabolic dysfunctions) of diabetes, not solutions to the underlying problem.

I believe RDs could be a much bigger part of the solution to the problem of diabetes (and obesity). What if we were relentless in expressing our empathy and passion for helping our patients understand they have more control over their health than they may feel they do? What if the foods they are eating and their hormones are making it harder to stick with healthy changes? What if we gave them support to change how they are eating and stick with it along the way?  I believe that we all have the power to change our health habits and want to help people understand that. But I believe most health professionals working in health care institutions are limited by guidelines (and insurance policies) that are not serving their patients well.

For example, at the conference the RD presented how the 2015 Dietary Guidelines for Americans (6) recommends a limit of 10% calories from added sugar (50 grams for a 2000 calorie diet, or about 13 teaspoons of sugar), and how the new Nutrition Facts label (7) will include added sugars. This is factual information the RD was probably asked to cover. But here are my concerns: all carbohydrates affect your blood sugar, natural or added. So, 1) that is too much added sugar and it’s taking the place of more nutritious sources of carbohydrate from real foods, and 2) having added sugar on the label is not at all helpful to someone with diabetes. It’s the total carbohydrate that matters when controlling their blood sugar or dosing insulin.

As hopeless as this may sound, we will never have completely conclusive research in nutrition. That’s the nature of the beast (nutrition science). You can’t always put people in randomized controlled trials to test what you want to test. And even when you can, you can’t expect the results to apply perfectly to everyday life. But to help people prevent diabetes (and obesity), we must do better than simply relying on guidelines (that of course are influenced by all sorts of bias) and not applying whatever new research we have as it becomes available. At the conference, for example, I was hoping to hear more about the newer, very relevant evidence supporting low-carb diets as not only a viable, safe option for someone with diabetes, but as an optimal treatment. (8,9) And I was hoping to hear less about dietary fat (and especially the very outdated concern about dietary cholesterol, which even the Dietary Guidelines downplays)(6), because the evidence is mounting that we need to be less concerned about fat and salt and much more concerned about sugar. (10-15)

In all honesty, I used to believe low-carb diets were potentially harmful and inadequate in nutrition, and that they were hard to stick with. But more and more research is showing low carb diets are not harmful, people can indeed function well on fewer than 130 grams of carbohydrate each day, and they can stick with this low-carb lifestyle and reap many benefits. So, who are we as health professionals to keep this evidence-based option from people if it may help them? Low carb diets may not help everyone, but in my opinion, they are worth a try with patients who are willing (and it’s worth trying to convince those who are not willing initially) because getting diabetes has the potential to be far more harmful than any effort to follow a relatively simple, low-cost, low-carb, real-food approach.

If you’re still with me…thank you!  Please share your comments or questions. Why are low carb diets so controversial? What’s your take or experience? And always feel free to share special requests for nutrition topics you’d like to explore!

References:
  1. American Diabetes Association. Statistics About Diabetes. Overall Numbers, Diabetes and Prediabetes. Accessed 3/25/2017.
  2. National Institutes of Health. National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes Prevention Program. Accessed 3/25/2017.
  3. Chen L. et al. Effect of lifestyle intervention in patients with type 2 diabetes: a meta-analysis. Metabolism. 2015; 64(2): 338-347. 
  4. National Institutes of Health. National Institute of Diabetes and Digestive and Kidney Diseases. Overweight and Obesity Statistics. Accessed 3/25/2017. 
  5. Matvienko OA. et al. A Lifestyle Intervention Study in Patients with Diabetes or Impaired Glucose Tolerance: Translation of a Research Intervention into Practice. J of Amer Board of Fam Med. 2009;22(5): 535-543.
  6. US Department of Health and Human Services and US Department of Agriculture. Dietary Guidelines for Americans 2015-2020. Eighth Edition. Accessed 3/25/2017.
  7. US Food and Drug Administration. Changes to the Nutrition Facts Label. Accessed 3/25/2017.
  8. Feinman RD et al. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition 31 (2015)1-13.
  9. Noakes TD, et al. Evidence that supports the prescription of low-carbohydrate high-fat diets: a narrative review. Br J Sports Med. 2017;51:133-139.
  10. DiNicolantonio JJ, Lucan SC. The wrong white crystals: not salt but sugar as aetiological in hypertension and cardiometabolic disease. Open Heart 2014;1:e000167.
  11. Johnson RJ, Segal MS, Sautin Y, Nakagawa T, Feig DI, Kang DH, Gersch MS, Benner S, Sánchez-Lozada LG. Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease. Am J Clin Nutr. 2007 Oct;86(4):899-906.
  12. Te Morenga LA, Howatson AJ, Jones RM1, Mann J. Dietary sugars and cardiometabolic risk: systematic review and meta-analyses of randomized controlled trials of the effects on blood pressure and lipids. Am J Clin Nutr. 2014 Jul;100(1):65-79.
  13. Gardner CD, Kiazand A, Alhassan S, Kim S, Stafford RS, Balise RR, Kraemer HC, King AC. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. JAMA. 2007 Mar 7;297(9):969-77.
  14. Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, Golan R, Fraser D, Bolotin A, Vardi H, Tangi-Rozental O, Zuk-Ramot R, Sarusi B, Brickner D, Schwartz Z, Sheiner E, Marko R, Katorza E, Thiery J, Fiedler GM, Blüher M, Stumvoll M, Stampfer MJ; Dietary Intervention Randomized Controlled Trial (DIRECT) Group. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008 Jul 17;359(3):229-41.
  15. Krauss RM, Blanche PJ, Rawlings RS, Fernstrom HS, Williams PT. Separate effects of reduced carbohydrate intake and weight loss on atherogenic dyslipidemia. Am J Clin Nutr. 2006;83:1025-1031.

 

 

 

 

“Moderation” Makes Me Cringe

A while ago now, I read yet another nutrition-related news article that stated “moderation” was key–and I cringed. Then it hit me, I am a moderation-hating registered dietitian (RD). You will no longer hear me use the word “moderation” or worse, the phrase “everything in moderation.” You heard that right. Hear me out…

I used to preach “everything in moderation” as much as the next nutritionist. Especially when friends or acquaintances asked me on the fly for nutrition advice. Or when I addressed a group of people and couldn’t delve into individual specifics. I walked a line; I wanted to promote a balanced and sustainable way of eating, while not giving too much bad news. And I also towed the line with my fellow RDs; moderation was our mantra. However, recently I have become frustrated with the ambiguity and the political correctness of the “moderation” philosophy, which is geared toward the masses and therefore, grossly oversimplified.

I can see how this phrase came to be. Unfortunately, I think nutrition experts (like me), food industry, government, and consumers are all partly responsible for this ill-defined, mass-communicated, often ineffective approach to eating. But the fact that moderation has gotten out of hand as a philosophy is as much my fault as anyone else’s. As a nutrition expert, I now believe it is negligent telling people they can eat everything in “moderation” knowing it’s likely not specific enough to help them improve their health.

But in all honestly, one of the reasons I haven’t been posting (besides a busy life) is because I have been hesitant to say it. Afraid of turning people off immediately and not getting through to help them. Afraid of taking a stand when science may disprove me in the future. And I honestly think even our political climate lately has affected me so very personally, so that I have been generally afraid of voicing an opinion. Eeek. How meek of me…

Am I a middle-child peace keeper having a mild mid-life crisis? Maybe, but the bottom line is this: I’m over it. (Until the next one.) And recipe posts are not all I have to share (although it is my pleasure to offer this practical information since I’m doing it for my family anyway). That said, I can’t make any promises about posting a certain number of times a week, although more frequently than once every five months should be doable. Ha. Blogging on my own terms…ah.

Back to my main point…in our defense, sometimes we nutrition experts have engaged in the moderation conversation when it’s not the right time or place (in a group or in public), when what we really need is more time together to make individualized changes that you can live with to improve your health. But I now think it’s more harmful than helpful to give a cursory spiel of moderation even in these situations.

The way I see it, suggesting moderation for the masses can actually hinder individual behavior change. For example, sometimes during an individual counseling session— just when I think we have made progress together, forming some specific behavior change goals—I hear my moderation philosophy echoed back to me. At this point, it is as clear as a door slamming in my face that the conversation is being shut down. (We all do that sometimes, don’t we? Sabotage ourselves before we begin when we are not ready to make changes.) But when this happens, I am only half as frustrated as the people who later realize that eating in moderation hasn’t helped them achieve their food-related goals. I can only imagine how devastated they must feel, blaming me or themselves, or both. And the viscous cycle of weight-loss efforts and failures continues…

Just look around to see how moderation fails us with weight loss. Some people eat moderately and are not overweight. Some people eat moderately and are overweight. Some people do not eat moderately, and are not overweight. And yes, some people do not eat moderately and are overweight. Clearly, “eating in moderation” isn’t effective for everyone. It’s not simply a matter of increasing physical activity. There are many overweight marathon runners. And I strongly believe achieving a healthy weight is not only a matter of will power either. Obese people have different genes that are making it harder to be thin than people who are not obese. Weight control for overweight or obese people is an uphill battle that is definitely an injustice, yet deserves no judgment—only useful tools. And “eating in moderation” is simply not specific enough to be one of them.

I think the moderation philosophy also came into being because we haven’t wanted to negatively talk about certain foods. We don’t want to take away your eating pleasure by stigmatizing “bad” foods. Eating should be enjoyable! But what you may not realize (I didn’t for a while) is that certain food industry lobbyists go to great lengths to make sure government directed guidelines don’t identify and/or quantify “bad” foods. You could say I’m cynical (BTW, I think that’s when you know you’re getting old, when everything is a conspiracy!) but this really happens. So, we nutrition experts have been left frequently hoping we all have a “sixth sense” that helps us figure out how to balance mostly healthy foods with a few treats now and then, because that seemed reasonable. But it’s not reasonable or helpful.

Much as I hate to be the bearer of bad news, I care enough to spend my priceless free time saying this (among other things): there are indeed “bad” foods. While we might disagree on some, most unbiased experts can’t deny sugar-containing foods are among the worst. So, we’ll start there. Foods containing the refined white stuff we know as sucrose, the syrups (corn syrup and high fructose corn syrup) and all of the 50+ other names for sugar (cane sugar, brown sugar, and even honey, maple syrup, agave, etc.) are not healthy when eaten in excessand they almost always are eaten in excess if you’re not purposefully avoiding them.

Sorry, but there’s no sugar-coating it. And even though it may make me a nutrition extremist, I have to take a strong stance against sugar (all types)—and even a high carbohydrate diet (more on that later)—because I feel you should know it’s a serious health hazard. And it’s not just in regards to people who are overweight or obese. Sugar is linked to many different diseases—which means you might want to read on whether your weight is in a healthy range or not.

To be clear, I am not trying to take away your eating pleasure. Anyone who knows me knows I believe eating should be truly enjoyable! But I also firmly believe eating whatever your body craves is not the only way to enjoy eating.  Changing your mindset, “resetting your body” with easy, real foods, and focusing on many positive and social eating behaviors (shopping at local farmers’ markets, cooking with friends, eating as a family, etc.) will allow you to enjoy foods in a simpler, more meaningful way. I passionately believe (and there is some evidence to support this belief) “there is something in” these social connections we make while eating. And living overseas, especially in Italy, made it even more apparent that we are often lacking those connections in our American culture.

Who doesn’t crave simplicity and meaningful social connections in this often crazy, fast-paced, disconnected lifestyle we live? I think it’s a great start to eat easy, real food at your next snack or meal. Stay tuned for more on all of these themes, starting with more thoughts and data on sugar.

 

New “Nutrition Facts” Label, New You?

I read this New York Times article yesterday (March 20, 2016) about the newly approved Nutrition Facts Label, which will be required on most products by July 2018. Here’s the gist (and a picture, below) from the article:

  • the new labels will show updated serving sizes, to reflect more accurately the portions Americans are actually eating,
  • the calories will be listed in big print, and
  • there will be an “added sugars” line listed under carbohydrates.

new nutrition facts label 2016Hmmm…how do I feel about this? Well, I agree we eat bigger portions, and too many calories. We definitely eat way too much sugar. And I believe looking for added sugars is a big step in the right direction. But I think there’s a better, easier way to eat less and avoid sugar. Avoid most foods with labels whenever possible! Eat real, whole foods and eat more simply. I know it’s not always that simple for many people. But changing the Nutrition Facts label does nothing to make it easier, in my opinion.

I can see why they are increasing the serving sizes on labels, but I’m just not sure it will help anything. Americans eat bigger portions than the serving sizes currently reflect, so as it stands on the current Nutrition Facts label, we have to do math to figure out calories and all the other nutrients for the amount we eat. But are we going to eat less if the only thing that’s changed is we don’t have to do the math? (Actually, isn’t it possible if we don’t have to spend time on the math, we might spend the time we saved eating more?) Yes, we can see how much we are eating at a glance, but even without the math, the numbers are meaningless or easy to avoid for most people, aren’t they? I mean, who wants to worry about the math and the numbers anyway??? Sometimes I eat a handful of pita chips (one of my weaknesses) and I never even look at the label. Gasp. And I call myself a dietitian. If the numbers won’t stop me, who will they stop?

I actually found myself sympathizing with the soda industry camp when they said the rule to add the “added sugar” line lacks scientific evidence. Now, hear me out…there is plenty of evidence that sugar sweetened beverages are associated with obesity. I’m not saying you should drink soda by any means. (And BTW, who doesn’t know soda has a ton of sugar in it??? How is this label going to make a difference when people already know that and drink it anyway?) The main problem I see is that replacing products containing “added sugars” with products containing other forms of carbohydrate could be just as unhealthy as the foods containing added sugars. That is, the soda industry representatives are right in that the science does not support the idea that an excess of other sugars (or any carbohydrates for that matter) are any better for you than soda. For example, choosing a product full of “natural sugars” like 100% fruit juice and drinking too much of it is not a healthy choice. Choosing a highly refined white flour product, like bread or pasta, that has “no added sugars” is definitely not a healthy choice. And what about honey, maple syrup, and agave? The science doesn’t support choosing them more frequently than any other form of sugar. Focusing on “added sugars” completely misses the mark and doesn’t tell the complete story: that excess carbohydrates of any kind are likely to be bad for your health.

Well, the Nutrition Facts label is merely a tool, not an education in nutrition. If you have a drill, you won’t necessarily know how to hang a picture. If you have a better Nutrition Facts label, you won’t necessarily know how to eat well for better health. So, I hope to help your understanding of nutrition more than a Nutrition Facts label alone ever could. Yes, there are times when you can’t or don’t want to eat whole, easy real foods. I get that. But I also get–and I’m sure you do, too–that changing the Nutrition Facts label is not enough to change the health of Americans.

The good news is we have all the information we need on the Nutrition Facts label as it stands. When I do buy products with labels, I skip over the calories on the label. Because if you are choosing the right foods (real, whole foods and fewer refined carbohydrates and sugar), you will automatically lower your calorie intake and feel satiated, without counting calories. I do linger at total carbohydrates, and fiber and sugars for a minute to assess the quantity and quality of carbohydrates, but I would argue the ingredient list is the most useful part of the whole label.

  • If a product has many ingredients (say more than about five, according to Mark Bittman in Food Matters: A Guide to Conscious Eating), I avoid it.
  • If it has products that I feel are harmful, I avoid it. For example, any sources of trans fat.
  • If a product has ingredients I feel are unnecessary like food coloring or preservatives (especially if I can’t pronounce them) or if there’s an alternate fresh version that eliminates those ingredients, I avoid the product and choose the fresh version. For example, I never buy bottled lemon or lime juice; it takes only a minute to squeeze a lemon or lime with my handy citrus squeezer gadget, and it tastes better.
  • If a product has any of the 50+ names sugar goes by, I generally avoid it or when necessary only eat it once a month (or even less frequently). For example, my kids love baked beans, so if I don’t have time to make them from scratch, I buy one can and add a can of drained and rinsed pinto beans to them to make it go further. But again, it’s very seldom that we have baked beans. Ketchup and mayo are the condiment exceptions, I could try making my own, but until then, we don’t use enough ketchup or mayo to worry too much about the sugar they contain.

So, the bottom line is this: I wouldn’t wait with bated breath until July 2018; you can start now choosing whole, real foods and using the ingredient list to make better choices in the grocery store.

Obesity and My Musings on What We Know For Sure

“It ain’t what you don’t know that gets you into trouble; it’s what you know for sure that does.  –Mark Twain”

This is such a popular quote, you may have heard it. I love how it succinctly summarizes my beefs with nutrition. I mean, how would you feel if your mommy brain (or daddy brain, Google says that’s a real thing) realized one day, after spending 7 years of your life on higher education, that everything you learned “for sure” is fundamentally wrong? And, oh by the way, you are still paying for that higher education? (The only bright side is consolidation at an extremely low rate…but I digress.)

Well, I can tell you how I felt. Somewhat stupid. In trouble even. But only at first, because I realized for a moment I fell into the very nutrition trap non-experts can get sucked into—taking everything at face value and not digging deeper. Well, if I believe it’s not the destination, but the wandering journey that’s important, I can at least find some peace (i.e., forgiveness for my moments of professional weakness) and resolve to make things better for myself and anyone who will listen. The fact is, my education (both in school and in life since) has given me all the skills I need to analyze nutrition science and its many influences, i.e., politics, economics, society, etc. And in so doing, I like to think I’m able to provide information you don’t often find on the Internet. (And so, to B, I say: really, it’s priceless, this “negative dowry” I brought to our marriage. That’s my story and I’m sticking to it this time.)

So, in this first “overview” post, let’s consider this morsel: why do we get fat? I thought we knew the answer 20 years ago when I started my career: we get fat because we eat too much, or exercise too little, or both. Calories in exceed calories out, so we store them as fat. End of story, right?

Well, as sure as we were, it appears that is not true. After decades of being urged by the USDA to eat more carbohydrates (mainly grains, breads and starches) and fewer fats (particularly saturated fat from meats, eggs and dairy products) and proteins (meats and eggs, for example),1,2 the obesity epidemic has steadily increased,3 and diabetes along with it.4 Researchers have learned diet affects many systems in the body (see Figure 15), so that they now realize we have grossly oversimplified weight gain. In fact, we have been looking at it all wrong.

Dieteffects copy

We don’t eat too much to get fat.  Getting fat makes us eat too much.6

What exactly does that mean? Obesity is considered a disease condition, which occurs in some people who have the genetic metabolic misfortune that causes their body’s hormones (namely insulin, and others) to drive them to overeat the wrong type of foods, thereby causing weight gain.5,6

Another way to say it is this: a calorie is not a calorie. That is, if you are prone to obesity your body handles carbohydrates (especially refined carbohydrates and sugar) differently than protein and fat.7,8 This may not sound like that big of a deal, especially if you are thin as you read this, but the implications are indeed huge (pun intended):

  1. Being overweight or obese is considered a medical condition—not simply gluttony and a lack of willpower. Some people have genes that make them more susceptible to obesity. That, coupled with the poor quality of food (rich in refined carbohydrates) that has become our culture, creates a serious medical problem. When we consider studies in which thin people try like crazy to gain weight and can’t no matter how much they eat or how little they exercise, the theory of gluttony falls apart.9 In short, some people have thin genes and stay thin no matter what they eat, some people have obesity genes and can keep weight off by choosing better foods, and a small percentage of people have obesity genes that are expressed regardless of what they eat. But I am ashamed to say in the past I have judged patients who have not been successful with the “simple” advice I have given them. If you’re honest, you have probably done the same, sizing up strangers at the grocery store or out at a restaurant when they choose unhealthy foods. Still worse, if you’re like most people, you have probably felt ashamed of yourself for not being able to get to or stay at a healthy weight. I’d love for us all, individually and as a society, to leave the shame out of it and instead focus on figuring out what to do next.
  2. If you are overweight or obese, you can change how you eat and still feel satisfied. Most people who are overweight have tried many diets. Most of these leave you feeling hungry and deprived. You do have a choice to make—to change how you eat—but you don’t have to starve yourself when you are choosing the healthiest foods for your body. Real, whole foods as part of a diet that is lower in carbohydrates (especially refined ones) and processed foods will leave you feeling satisfied, improve your health, and help you lose inches and/or weight…but I’ll elaborate much more on that soon and over time!
  3. You do not need to count calories to eat for better health and lose weight. I have always hated calories. Calorie counting is a lot of work, takes the fun out of eating, and usually towards the end of the day, leaves you feeling short-changed. If you’re eating the healthiest foods for your body, they will satisfy you and you will be able to stop eating when you feel full.  When some people eat too many carbohydrates and highly refined carbohydrates, it can cause a cyclical hormonal response that causes frequent hunger and subsequent overeating.6 Side note: have you ever wondered why we even use calories to measure the energy food provides? Burning foods in a laboratory to obtain their caloric value makes no sense when that’s not what happens when we eat them. Let’s forget about calories and commit to choosing better quality foods and see what happens
  4. You don’t even need to exercise to lose weight. Don’t get me wrong, it is very important to exercise for many health benefits, such as heart health, stress relief and mood, improved sleep, and maintaining muscular and bone strength, especially as we age. And exercise also helps people with diabetes or impaired glucose metabolism use carbohydrates better, which indirectly may make weight loss more achievable. But studies show when we exercise in an attempt to lose weight, we compensate with an increase in appetite and intake of food.10 We also may unknowingly compensate by decreasing activity later in the day after we’ve exercised.11 So, the effects are balanced pretty evenly by the body. Think of all the people who run marathons but are not extremely thin. The take home point is this: weight control in overweight people is more about changing how you eat than changing how much you exercise.
  5. Even if you’re not overweight, this information still applies to you. I hear many people tell me they never had a problem with obesity, until suddenly they did in middle age. So, you never know if you might have to deal with obesity yourself and it’s easier to prevent weight gain than it is to lose weight. At the very least, it is possible you know people who are overweight or obese and knowing this information can modify your perceptions—and society itself over time—to become more accepting and helpful to those plagued with obesity and all that goes along with it. But even if you could guarantee obesity would never be a problem for you, there are many other diseases such as diabetes, Alzheimer’s, and cancer that may possibly be prevented by eating a healthier lower carbohydrate, low sugar diet. Diabetes, Alzheimer’s and cancer have been shown to be related to obesity.12,13,14  Alzheimer’s has even been dubbed “type 3 diabetes.”15,16 The research linking obesity to refined carbohydrates and sugar is mounting.17,18,19 And inflammation may be part of the process by which certain diseases are precipitated by dietary factors.20,21 It is altogether possible these other diseases are related to refined carbohydrates and sugar intake even in the absence of obesity. Although there is research about decreasing risk of type 2 diabetes with lifestyle approaches including decreased refined carbohydrates,22 much more research is needed in other areas. But to this self-diagnosed “control freak,” it’s fascinating to think that through our nutrition we might have this much natural control over many aspects of our health.

Are you with me so far? I’m cruising through topics because this is a “big picture” of where we are headed, together I hope. I will conclude with this for now: sometimes, as in the case of obesity, we think we know something for sure. But if we let bias get in the way and are not diligent in considering the old and new evidence fully, we get into trouble and may even have to retract our words…I hate it when that happens! There is always going to be a tremendous amount of misinformation about nutrition and your health circulating the Internet. I can’t change that. But I can sift through it carefully and share fascinating topics, elaborating on what I’ve started to explain here, and how it’s made my family change the way we eat on a daily basis. Although if you’re looking for perfection, you won’t find it here. But we are redefining our taste buds and keeping things healthy, simple and tasty. And yes, I’m working on recipes!

For the record, misinformation isn’t just the case with science; although Mark Twain is usually referenced as the author to the quote above, there is actually no record he said it. But even film makers (The Big Short) have credited him for it. Even though I expect movies to take creative liberties, I was nonetheless disillusioned to find out the quote was erroneous. Checking the facts—scientific or otherwise—is labor-intensive, but because I believe we are better off for it, I am happy to do it for you whenever I can. Thanks for waiting for my posts and reading! Please ask questions or share your comments if I have piqued your interest…or even made you feel uncomfortable.

References