Tuesday, January 13, 2015

Questions And Answers: Should I Join A Gym?

Whenever I meet a new client, they often wonder if it is necessary to join a gym in order to attain their weight loss and fitness goals.   

The answer is no, there really is no good reason to join a gym. For the vast majority of my clients, working out at home makes a lot more sense. Here are some of the biggest reasons why:

1) Working out at home saves you time. Driving to the gym, parking your car, changing your clothes in the locker room and then doing the reverse after your workout can take up a lot of time. I, personally, can get half of my workout done by the time it would take me to get on the gym floor. When you are really busy, that extra 20 minutes can be the difference between getting your workout in and having to skip it.

2) Working out at home saves you money. Gyms are not cheap, especially the nice ones. You can take one year’s worth of gym fees and set yourself up with equipment that will last you a decade or longer.

3) Working out at home will make you more consistent. It is virtually impossible to get to the gym every day. Having equipment at home will allow you to work out more regularly, or at least get half a workout in when time is tight. In 15 years as a trainer, I have had exactly one client who was able to get all of her cardio done at a gym with consistency. I can’t even count the number who hit their cardio goals while exercising at home.

4) Working out at home will make you more efficient. Combining your cardio with something you already do is a great idea. Watching the news or other taped shows, returning phone calls, and checking your email are all things you can do while working out. It is not easy to multitask at a gym.

So what will you need? Not much, really. A set of dumbbells, an exercise mat, and a piece of cardio equipment will do the job amazingly well. I am a big fan of elliptical trainers for cardio, they are efficient calorie burners and create minimal joint stress. If you want to go the more thrifty route, a Gazelle Edge ($113 on Amazon.com) is all you’ll need. If you want to spend a bit more money on the bells and whistles, a Life Fitness elliptical is a great choice.


Mediterranean Diet And Telomere Length

The Study
A telomere is a DNA structure on a cell that shortens each time the cell divides. Telomere length is considered a biomarker for aging, because shorter telomeres have been associated with a decreased life expectancy and an increased risk of major chronic disease. In this investigation of 4,676 women from the Nurses’ Health Study, the impact of a Mediterranean diet on telomere length was examined. 

A score was created for each participant that gauged adherence to a Mediterranean diet. The score had 9 components: vegetables, fruits, nuts, whole grains, legumes, fish, monounsaturated fat:saturated fat ratio, red and processed meat, and alcohol. Women with higher scores had significantly longer telomeres after adjusting for confounders. These results provide further evidence that adherence to a Mediterranean diet promotes greater health and longevity. British Medical Journal 2014:349:g6674.

Take Home Message
In the last decade, there has been a tremendous amount of research showing a real benefit to the Mediterranean style of eating. This study is unique because it uses a biomarker for aging, which has been associated with longevity and chronic disease incidence in the research literature. 

The results of this study were pretty impressive. The difference in telomere length for each 1 point change in the Mediterranean diet score corresponded to 1.5 years of aging. A three point change in score was equivalent to 4.5 years of aging, which is comparable to the difference between smokers and non-smokers. This study provides further evidence that a Mediterranean diet is the way to go if you are looking to reduce your risk of chronic disease and increase longevity. For those of you that work with me or have read my book, congratulations, you are already consuming a Mediterranean diet!


Soda Consumption And Rheumatoid Arthritis

The Study
79,570 women from The Nurses’ Health Study and 107,330 women from the Nurses’ Health Study II cohort were divided into groups according to their consumption of soda and followed for over 20 years. The number of new diagnoses of rheumatoid arthritis (RA) in each group was compared at the end of follow-up. Women who consumed 1 or more sodas per day had a 63% increased risk of developing seropositive RA (the most common form) when compared to those consuming less than 1 serving of soda per month. Diet soda was not associated with risk of RA. The American Journal of Clinical Nutrition 2014; 100:959-67.

Take Home Message
This study provides further evidence that sugar sweetened beverages, like soda, can have a powerful impact on our health. Soda may increase inflammation and reduce insulin sensitivity, which the authors believe explains the increase in RA among the soda drinkers. Strictly limit consumption of sugar sweetened beverages, and all added sugars for that matter.

Monday, January 12, 2015

Book Review: The Forks Over Knives Plan

Next up for review is The Forks Over Knives Plan. The authors, Dr. Alona Pulde and Dr. Matthew Lederman, are both medical doctors specializing in nutrition and lifestyle medicine.

Forks Over Knives essentially has one central theme; the path to optimal health and longevity is to eat a plant based diet with absolutely no animal products. The book is broken down into 3 sections: 1) The science part: this section covers the scientific rationale behind the recommendations.  2) The lifestyle part: this section covers the 4 week transition to going vegan.  3) The recipe section.  The book is 285 pages long and is well written. I truly enjoyed reading it.

5 Things I Really Liked About The Forks Over Knives Plan
1) The foundation of this diet is fruits, vegetables, whole grains, and legumes. In my opinion, this should be a primary recommendation for every healthy diet.

2) This style of eating strictly limits red meat, processed meats, and saturated fat.  I’m in full agreement here.

3) I am really in sync with their “food dictates health” philosophy.  As a nation, we all need to understand how our diet and exercise habits can impact our health. We need to stop relying on medicine to fix us after years of abusing our bodies.

4) The section on meal planning, meal prepping, and grocery shopping is really well done and provides great tips on how to incorporate these changes into your life. 

5) The recipe section is great.  The authors include over 100 recipes that range from quick and easy to gourmet.

5 Things I Didn’t Agree With In The Forks Over Knives Plan
1) This program is heavy on the carbs at 80% of calories and includes a lot of very rapidly absorbed carbohydrates.  The glycemic index/glycemic load of this style of eating is really high and in my opinion, not a good idea if you are trying to lose weight or reduce your risk of chronic disease.  I was also a bit surprised at how much sugar was in the recipes, some of which called for ¾ cup of maple syrup!

2) This program is quite low in protein, with 10% of calories as the goal.  Recent research suggests that a bit more protein is necessary to reduce the loss of muscle that naturally occurs with aging.  The recommendations are now closer to .5 grams of protein per pound of body weight, which is about 20% of calories for most people.

3) The author’s choice of research to back up the recommendations was a bit curious.  They cited a lot of less methodologically sound research, like ecological studies, cross sectional studies, and correlational studies to prove their points, while ignoring more carefully designed randomized trials and prospective cohort studies that showed the opposite of what they recommend.  Whole areas of research were completely ignored, such as glycemic load and health, the benefits of mono and polyunsaturated fats, the benefits of consuming fish, et al.

4) The authors are very deliberate in recommending a B-12 supplement when going vegan.  B-12 is only found in animal products and B12 deficiency is no joke.  It can cause the following symptoms: numbness in hands, legs, or feet, difficulty walking, balance problems, anemia, swollen tongue, jaundice, difficulty thinking or reasoning, memory loss, paranoia or hallucinations, depression and weakness.  Many of these symptoms are irreversible if the deficiency goes on for too long. In my opinion, any diet that can make you this sick without taking a supplement pill is not a natural way of eating for humans.  

5) There were some statements made by the authors that were real head scratchers.  These statements are not in any way supported by the current nutrition research literature.  Here is a small sample:

Oil based salad dressings are unhealthy (Page 77).
Dairy can promote premature aging (Page 88).

Salmon contains harmful levels of fat (Page 103).

Fish contains heart unhealthy cholesterol and leads to bone loss (Page 103).

All vegetable oils promote heart disease (Page 107).

Vegetable oils have a negative effect on lung function (Page 107).

There is nothing health promoting about alcohol (Page 126).

And, as a glycemic load researcher, my absolute favorite: “We prefer not to talk about the glycemic index because it is a measure of something that has nothing to do with good health” (Page 123).

Is The Forks Over Knives Plan Worth Reading?
Absolutely! I enjoyed this book. You’ll learn a lot about the benefits of fruits, vegetables, whole grains and legumes.  These foods form the foundation of any healthy diet.  You will also get some great tips on meal planning, meal prep and grocery shopping. However, the very low levels of protein and healthy vegetable fats are recommendations that simply are not consistent with the current nutrition research literature.

Wednesday, November 12, 2014

Questions and Answers

Can I use Splenda/Equal everyday?

When my clients learn that eliminating sugar is an absolute key to losing weight, this question naturally follows. Unfortunately, the answer is no, you cannot use non-nutritive sweeteners like Splenda and Equal on a daily basis.

Contrary to popular opinion, non-nutritive sweeteners, like Splenda and Equal, are very well tested and safe to consume in moderation. However, there are 2 problems with them that prevents me from recommending them for everyday use.

Problem #1: They perpetuate cravings for refined carbohydrates. When you eliminate sugar and strictly limit refined carbs like bread, pasta, and white rice, it is typical to go through a withdrawal for a few weeks where you really miss them. After this period, your desire for these foods drops almost to zero. It really is miraculous how you stop craving the wrong carbs when your blood sugar stabilizes. This is a big reason why my clients lose so much weight, they just aren’t nearly as hungry. However, I have found that daily use of the non-nutritive sweeteners perpetuates cravings for sugars and refined carbs. This is problematic because any diet where you are fighting hunger and cravings is destined to fail long term.

Problem #2: The cephalic response. If I was to put your favorite food in front of you, your nose would smell it, your eyes would see it, and you actually release digestive enzymes before you even put a bite into your mouth. This phenomenon is called the cephalic response.  There is some evidence that this response is recruited when consuming non-nutritive sweeteners. Your body senses the sweet taste and releases insulin anyway. This release of insulin can lead to an unstable blood sugar.

In light of these two issues, I only recommend the use of Splenda and other non-nutritive sweeteners twice per week on cheat meals.


Low fat vs low carb for weight loss

The Study
148 obese men and women were randomized to a low fat (<30% of calories) or a low carbohydrate diet (<40 grams per day) for 12 months. By the end of follow up, participants on the low carb diet lost significantly more weight (8 pounds), lost significantly more fat mass, had significantly lower total:HDL cholesterol ratios, had significantly lower triglycerides, and significantly higher HDL cholesterol. Annals of Internal Medicine 2014; 161:309-18.

Take Home Message
This study showed that a lower carb/moderate fat diet not only enhanced weight loss, but also improved risk factors for coronary heart disease. The design of this study was exceptional, with low drop-out rates and high compliance. The only problem I have is with the title: “Effects of low carbohydrate and low fat diets”. By the end of the study, the participants were not really following a traditional low carb diet.

When I think of a low carb diet, I think Atkins, with very little carbohydrate, tons of steak, bacon, cheese and very little fiber. However, the low carb diet in this study was quite different. By the end of the 12 months, the low carb dieters were not consuming the recommended 11% of calories as carbohydrate, but fully 34% of their calories were carbohydrate. They also had very similar amounts of fiber as the low fat group. Although they did include a bit more saturated fat than the low fat group, the majority of their fat consumption (about 70%) was healthy monounsaturated or polyunsaturated fat. Indeed, what they were consuming by the end of follow-up was much more of a Mediterranean diet than a low carb diet.  Either way, this is still a well-designed study showing that a low fat diet is not the way to go for weight loss or improved health.


Tuesday, November 11, 2014

Does a low glycemic eating pattern enhance weight loss?

The Study
Several weight loss diets were compared in a randomized trial of 122 overweight men and women. One of the diets was a moderate carbohydrate, low glycemic index diet and another was a low fat diet. After six months, the subjects consuming the low glycemic index diet had a significantly greater reduction in BMI than the low fat group (-2.45 BMI units for low GI vs. -1.43 for low fat).  Measures of fasting insulin and insulin resistance were also significantly improved for the low GI group. The researchers believed that the increased weight loss with a low glycemic approach may be due to a beneficial impact on glucose and insulin levels and an increased satiety. American Journal of Clinical Nutrition 2014; 100:27-35

Take Home Message
This study provides further evidence that glycemic index is highly relevant for those looking to manage their weight. It also provides further evidence that low fat diets are not the most effective for weight loss or health promotion. In no way should any of this be a surprise to those that work with me or have read my books!