Halloween’s Over, Holidays Are Coming: Need to Curb Sugar Cravings?

Sugar seems to have become the new trans fat: the thing everyone feels entitled to bash.  Not just added sugar, but even sugar naturally present in food is suspect.  See my previous column on “Paleo-inspired baby food”, made without any grains, dairy, even fruit, to avoid babies having a “sugar crash”.  Seriously?

Surprisingly, we’re eating LESS sugar now, with intake going from 109 grams/day in 2000 to 92 grams/day in 2016, according to USDA data. Still, people still get too much sugar and many say they crave it.

Cook County, that includes Chicago, recently defeated a referendum that would have levied a “soda tax”.  Get my take on this issue here.

What is a sugar craving?

A craving is an intense desire for any food that that goes above and beyond biological need.  It’s not the same as hunger, which is more physiologically based (think hunger “pangs” and stomach growling).  And a craving doesn’t necessarily indicate a dietary deficiency of something.

You were born liking sugar

Mother Nature didn’t set you up, we all evolved to prefer the taste of sweet things.  Infants only days old will suckle more strongly on liquids that are sweeter.  Indeed, breast milk actually has more natural sugar (lactose) than cow’s milk – if it didn’t, infants may not be as motivated to suckle, putting their very survival at risk.  Since sugar also helps stimulate fat synthesis in the body, eating more of it than you need when it’s available would help you out during periods of food scarcity.  Throughout nature, most naturally sweet foods, such as fruit and honey, are also safe to eat, so sweetness of a food may have also been our clue about its safety.

Do you want sugar when you’re stressed?

Anything stressful: family matters, time crunches at work or home, relationship issues, can all increase sugar cravings.  Indeed, holidays bring up all of the above, along with the pressure to be “happy” when indeed, you just aren’t feeling it.  Add in a lack of sleep because of all the increased demands on time and you have a perfect storm for stress-eating whatever your comfort food is.

When you’re stressed, your body screams for relief, and sweets are a quick fix.  Not the best one, just the quickest.  Sugar also stimulates the brain to make serotonin, which helps calm you down, at least temporarily.  And, like just about every other thing today, sweets are around everywhere, even more so during the holidays.  All those baked goods that aren’t around at any other time of year make us feel entitled to “get while the getting is good”.

Beating sugar cravings

Sugar isn’t angel food, but it’s not devil’s food either, so no need to avoid sugar, just make things manageable.  Here are easy action steps that keep sugar in the sweet spot – where it makes you happy AND still healthy:

  1. GO PRO EVERY MORNING: A nice protein load early in the day cuts those hunger pangs that can trigger sugar cravings later, but most people don’t get much protein in the morning.  Cereal and milk are a great start, but go further.  Have at least a 5-oz. cup of fat-free Greek yogurt or a hard-cooked egg (or two), some string cheese, or a piece of last night’s beef or chicken.
  2. SPEND SUGAR CALORIES WISELY: Sugary soft drinks are wasted calories, but low-fat chocolate milk or sweetened Greek yogurt (tip: a teaspoon of honey tastes like more) give you of something rich with flavor that fills some real dietary gaps at the same time.  That’s making sugar work harder for you.
  3. SUGAR SUBSTITUTES? Calm down about the prevailing culture. The science on their safety is solid as a rock.    Evidence shows they can actually be useful tools.  More about this in a FUTURE column, so watch this space.  For now, resist the mob mentality about these and use them as tools to help cut dietary sugar.
  4. PUSH YOUR SWEET BUTTON WITHOUT SETTING OFF ALARMS: When eating out with people, instead of dessert, order a cappuccino.  It’ll only be about 100 calories, even with whole milk and some sugar, and you’ll keep occupied while everyone else has dessert.  If they offer you a bite or two, take it.  You’ll visit your happy place but leave happy, too.
  5. SEE IF YOUR TASTE BUDS NEED A RE-SET: Is a fruit salad sweet enough without having to add sugar?  If not, your taste buds may have become “dumbed down” from eating too many sweets.  A few weeks where the sweetest thing in your diet is fresh fruit and flavored yogurt re-sensitizes exhausted taste buds so you can eat the occasional sweet but enjoy it even more.

MEAT AND TYPE 2 DIABETES? CALM DOWN — LET’S BOIL IT DOWN

Just when people are at feeling (justifiably) entitled to feel OK about eating meat again, out comes a study that “associates” consumption of meat with type 2 diabetes.  It was published in the American Journal of Epidemiology and was part of the Singapore Chinese Health Study.  Here’s the gist:

Over 63,000 Chinese adults, ages 45-74 years

There were two interviews during follow-up of just under 11 years to determine type 2 diabetes

Dietary pattern determined only once – at the start, by a food-frequency questionnaire

The variables: intake of poultry, red meat, seafood and incidence of type 2 diabetes upon follow-up.

They divided the subjects into four groups based on intake of shellfish, poultry, and red meat.  Then they compared the groups with the lowest intake of meat/poultry/shellfish with groups that had the highest intakes.

Here’s where things get interesting, but first:

Iron 101

There are two ways iron exists in food.  Iron is either part of hemoglobin (called “heme iron”), as in the case of animals, or it’s bound to other compounds (called “non-heme iron”), as with plants.  Compounds like phytates in plants bind to iron to make it less absorbable.  Eating plant iron with an acid, like having spinach with a vinaigrette dressing, will help liberate some of the iron, but in general, heme iron is more available to the body.

How much iron do we need each day?  Adults need 12 mg/day and women of child-bearing age need 18 mg/day, because they lose iron each month they menstruate.

The study data are “noisy”

This means the study has limitations that prevent drawing strong conclusions. To be fair, he study’s authors were pretty responsible in pointing out some of the limitations of their study. Most notably:

  • Dietary pattern was taken at the beginning and never again. So, what you had for dinner on a  Tuesday night 11 years ago predicts your health now?  You might be able to get statistics from this data, but drawing any realistic conclusions is making a Grand Canyon leap.  People’s diets change over 11 years!
  • Activity patterns were also assessed only once, at the beginning of the study.
  • Those who ate the most red meat ate averaged only about 53 grams daily – less than two ounces! And they still ate more seafood than meat.
  • Those who ate the most seafood also averaged about 33 grams of red meat daily — a little over an ounce! So differences between the HIGHEST and LOWEST consumption of red meat was only 20 grams – about 2/3 of an ounce.
  • Different meat types were assessed (beef, pork, lamb, etc.), but not cuts of meat, or parts of poultry (legs have more heme iron than breast) or dietary fat.  Pork belly has lots more fat than pork loin, for instance.

With the difference between the highest fish-eaters and the highest meat eaters being only 20 grams of meat, the difference may be statistically significant but not clinically (“real life”) significant.  The “associations” these studies talk about don’t mean “cause-and-effect” but consumers don’t often understand that. and the headlines don’t help much. To get the facts you usually have to read beyond headlines.

My take-away from this study? Not a whole lot.    

And the authors pretty much agree with me, noting, “We do not perceive any reason for meat intake to be related to the likelihood of disease diagnosis in our study population.”  Simply put, this study failed to connect meat intake with type 2 diabetes.  Game over.

Seafood absolutely is great food, but meat and poultry are also nutrient-rich.  Some tips for eating meat and poultry well:

  • Go leaner whenever possible.
  • Keep portions real. Even 4 ounces of lean meat is going to be loaded with enough protein for your meal.
  • Keep half your plate veggies and fruits.
  • Include a whole grain or a starchy vegetable.
  • Keep added fat reasonable. Olive oil or canola are good choices, rather than butter or coconut oil.

 

Paleo-Inspired Baby Food? Sorry, They Need ALL Food Groups

In the EdibleRx, I like to keep things informative and simple.  I’m not a fan of demonizing foods or food groups.  Balance is key, and I believe in making recommendations based on sound evidence – as good as it exists.

Food trends come and go – witness the plethora of extreme diet books that have populated bookshelves (maybe even your own) and spurred endless conversations and discussions.  When a trend becomes potentially harmful to a vulnerable group, however, I cannot let that slip by.  Having spent most of my career working with children and families with special needs, it makes my blood boil when food trends and fads get visited on vulnerable groups.

Case in point: Back around 2004 I was called to testify before the House Energy & Commerce Committee, which was examining two companies in particular that were marketing diet pills and supplements for children.  One supplement actually used herbs that were contraindicated in anyone under age twelve years.  I pulled no punches and spoke the science, the facts, and also my outrage.  When you get the ear of Congress people, believe me, it’s not about keeping quiet.  It’s about using a professional voice to speak the truth, and making sure it is heard by those who can make changes.  That supplement website was shut down, fortunately.

I was interviewed September 18th for an ABC News story about a company making Paleo-inspired baby food: free from grains, dairy, and fruit, centered around meat and vegetables.  Beef, chicken and veggies are great foods and fine for a meal, but promoting a diet free from dairy, grains, and fruit for infants and toddlers is not. Young children this age need balance and variety from all five food groups.  Simple, basic foods from these groups are a nutrient-rich package and round out a balanced diet.

Their reasoning?  From their website:

“We were shocked by the amount of sugar in most baby foods, because sugar (even from fruit) creates inflammation which leads to health problems and can make a baby fussy from the blood sugar crash.”

In 30+ years as a pediatric nutritionist/dietitian working with children with special needs of all forms, I have yet to see an infant/toddler who had a “sugar crash” from eating strained pears.  Period. 

As for their food, it comes in three different flavors, “free-range chicken, “all grass-fed beef” or “uncured bacon”, each mixed with vegetables and each with either 4 or 5 grams of protein – less than what you’d get from about an ounce of edible beef or chicken (both typically contain about 7 grams of protein per ounce).   Squeeze pouches only, sold online in 6-packs.  Each pouch is 4-oz. or ½ cup.

Baby Nutrition 101: Mixed dishes are not first foods

They call these products “first foods to feel good about” but these are all mixed dishes.    You never want to introduce more than one new food at a time.  If there’s an allergic reaction, you won’t know which food is causing it.

Meat and vegetables are great foods for babies – but not JUST meat and vegetables.  While they shun dairy, I hope they’re OK with breast milk – it has even more “sugar” than cow’s milk.  (For the record, cow’s milk doesn’t replace breast milk or formula until at least 12 months.)

“Ridiculous” Costs

Cost per 6-pack: $26.95, or about $4.50 PER SERVING!  For $26.95 you can buy enough healthful beef, chicken and veggies – and grains, fruit, and dairy – and feed your toddler for days, or even buy wholesome prepared baby food.  An infant/toddler diet that excludes grains, dairy, and fruit isn’t serenity.  It’s insanity.  And $26.95 for 3 cups of meat and veggies?  Unnecessary food elitism.  Good baby food — store-bought or homemade — should be, and IS, far more affordable than this.

And even if you buy baby food in pouches, feed it to baby with a spoon.  Stay involved.  It’s the start of having family meals — one of the BEST ways to feed kids of all ages.  Hey, it’s Family Meals Month.  Make it happen in your family. THAT make healthier kids.

FAMILY MEALS: ESSENTIAL TO FAMILY HEALTH

September is National Family Meals Month, and it couldn’t come at a more appropriate time than right now, when kids are back at school, yet for many families affected by weather, a family meal can be the most comforting thing ever.  For all families, re-committing to having family meals together is one of the most beneficial things parents can do for their kids and for family life.

The practice of having family meals isn’t dead, but there are signs it’s ailing.   Families still eat together, but according to a Harris poll cited in a 2015 study on family meals, only 3 in 10 families eat together every night.  There’s room for improvement here and there are many reasons to make the effort.

Family Meals: It’s About the ACT As Much As the Meal

A quick research rundown on benefits of frequent family meals:

  • Kids are 12% LESS likely to be overweight
  • Kids are 24% MORE likely to eat healthier foods (and 20% LESS likely to eat unhealthy foods!)
  • Kids are 35% LESS likely to have eating disorders (e.g. have a healthier RELATIONSHIP with food)
  • A separate study found that eating home-cooked meals most often (even if using some frozen or packaged convenience foods) resulted in eating about 130 FEWER calories for the day, compared to people who cook at home less often or not at all. Those families also ate less fat and sugar.

The benefits go beyond nutrition.  Better mental health, social skills and even higher grades In addition to the dietary benefits, research has shown advantages to eating meals together that go beyond nutrients and nutrition but that are every bit as important:

  • A 2015 study: Kids who grow up having regular family meals are more likely to have more desirable social behaviors (such as sharing, respect, fairness) as adults.
  • A 2014 study: have fewer signs of depression, less likely to abuse drugs, less likely to engage in delinquent acts.
  • Strong association between family meals and higher grades, higher self-esteem, less risky behavior.

So…What’s the Barrier to Family Meals?

Check the “Life Happens” folder.  There’s more demanded of everyone today.  Jobs aren’t 9 to 5 anymore.  Technology allows (and encourages) us to check work-related messages outside of typical workday hours.  Pile on the demands of the kids, their academic, extracurricular, and social schedules, plus the demands of just running a household, and family meal seems like an unnecessary expenditure of time.

It’s necessary. As often as you can have it and really make it a priority.   It sends important messages to your kids:

  • A little time spent together every day is important, and
  • You kids are worth my time every day.
  • I want to know what’s happening with you, and

Is there a downside to family meals?  Only if the family relationship isn’t strong.  It’s also another reason to establish the family table early on as a totally neutral zone for parents and kids alike.

How To Enjoy, Not Endure, Family Meals

  • No technology.   If kids – or patents can’t disconnect for the 20-30 minutes it takes for the family meal, then family meals aren’t the problem, family standards are, and it’s time for a reset.  They’ll miss a few texts and posts and they’ll learn the world still spins.
  • Switzerland. The family meal table is a fully demilitarized zone.  No fights, no bickering, no lectures.  Keep it positive.  If social skills need some work, this is the place.  Give some guidance, but always with encouragement, not judgement.  And ALWAYS give some positive feedback.  Kids (and adults) love to be told they’re doing a good job.
  • Table it. Research has associated eating together around the family table, not in front of the TV or in other rooms, with lower body mass index (BMI – a measure of weight-for-height) for kids AND parents. Keep them engaged until everyone is finished – that’s also associated with lower BMIs.
  • Everyone’s an owner. Parents are hungry for prep help! No matter the menu, give age-appropriate tasks for prep and clean-up.  Everyone gets dinner sooner and enjoys it more because they have a personal stake in its prep.  Big note: tell the kids you appreciate their help.  Positive feedback is the ultimate motivator.

Fave Family Meal Story

My friend, Marylou, told me about her former next-door neighbor, a widow with six kids and a huge house to care for.  Marylou visited one Saturday morning to find the widow with a huge pile of laundry to do, yet she was prepping to take all her kids on a picnic.  Marylou was aghast and said, What about all this laundry?!”  The woman said, “I know, but in ten years they won’t remember the laundry.  They’ll remember the picnic we had.”

I love that mom.  And thanks to my own mom, for making great family meals — including breakfasts!

CAN COCOA & CHOCOLATE HELP METABOLIC SYNDROME?

 Cocoa flavanols – those phenom compounds in cocoa that seem to have great health benefits, such as improving blood flow and helping manage blood glucose levels, but some recent research pulls together just how they may be useful in metabolic syndrome.

Let me get through the basics so we can talk about the good stuff.  Metabolic Syndrome constitutes a group of conditions:

  • High triglyceride levels
  • High fasting blood sugar
  • Large waist circumference
  • Low HDL cholesterol (the good type of cholesterol)
  • At least borderline high blood pressure

If you have any three of these, or if you’re taking medication to control three of these, you probably have metabolic syndrome.  You also have lots of company, since 1 in 3 Americans has it, too, according to a 2015 study, although many don’t know it.  Having even one of these conditions increases your risk for common but serious chronic diseases, such as heart disease, type 2 diabetes, and stroke.  These are impacted by diet, so having metabolic syndrome usually means your diet and eating style needs a closer look.  Sounds awful, but it isn’t, and you may get some help where you never expected any.

Cocoa flavanols to the rescue

Not everyone is aware that cocoa is one of the most, if not the most, concentrated sources of antioxidants in the diets.  We may get a larger quantity of antioxidants from other foods, like tea, coffee, fruits and vegetables, but that’s because we eat larger amounts of them and on a daily basis.

A recent review in the highly respected Journal of Nutritional Biochemistry looked at the ways cocoa may act to be healthful and it may be different than you thought (for those of us “chocolate-science nerds” who even thought about such things).   After looking at over 244 published papers, here’s what the authors concluded about cocoa flavanols and how they lessen metabolic syndrome:

  • Cocoa flavanols appear to slow down the action of digestive enzymes, delaying spikes in blood glucose levels, possibly by limiting or delaying the digestion of starches, and encouraging better insulin response. Nice news: a larger dose seems to be most effective, but it’s way too early to suggest any “more is better” recommendations.
  • Regular cocoa consumption seems to have “pre-biotic” effects, e.g. regularly exposing the gut environment to cocoa flavanols encourages growth of good bacteria that in turn helps the lining of the colon function more effectively. How so? It seems to reduce the absorption of endotoxins (the stuff that’s released when bacteria disintegrate).  Endotoxins that get absorbed into the bloodstream can cause things like plaque buildup and disruption of insulin regulation.  Less of these is better.
  • Cocoa flavanols also help insulin sensitivity in muscles and peripheral tissue. However, they’re not well absorbed. They get broken down by the gut bacteria, but the resulting metabolites (products of the breakdown) do get absorbed and are likely what is doing the good work in the peripheral tissues.

It’s not over

Metabolic syndrome, and especially type 2 diabetes, are associated with chronic low-grade inflammation.  Through a variety of mechanisms, the powerful antioxidant activity of cocoa flavanols may also help reduce this inflammation, and in an enjoyable way.

As a clinician, this is music to my ears: something my patients like hearing and that I like explaining.  Chocolate and cocoa flavanols are a win-win and make me love the power of food.

There’s still much more to know, however.  Many of the studies in humans were of short duration, so it’s not known if observed benefits fade after a few weeks or months.  Dark chocolate is where the flavanols reside, (aim for cocoa powder — the most concentrated source, or 70% bars) but specific doses of cocoa for each condition and best ways to administer cocoa for maximum effect are also unknown.

Cut-to-the-chase

  • There’s excellent news on potential benefits of cocoa and its flavanol compounds, and their potential impact on metabolic syndrome, diabetes, blood glucose control, and other chronic health risks.
  • We still need to remember that the ways in which we consume cocoa – bars, truffles, hot chocolate, etc. provide calories. Too many of those – from ANY source — will contribute to weight gain, one of the hallmark hazards of metabolic syndrome.
  • So it is with chocolate and cocoa as it is with alcohol: eat with your head, not over it. An ounce a day of the darker stuff, or a good scoop of cocoa powder in a drink, is just fine.  NOTE: If the ingredient label says the chocolate is “processed with alkali” or “Dutched”,  the flavanols have been removed. Skip this stuff if you want the benefits.

[Personal note to researchers: please try to avoid concluding that a pill is the best way to get cocoa flavanols!  We’re real people and would be far more likely to get recommended “doses” if they were in the form of edible chocolate and cocoa. Just saying.]

ARE SMARTPHONES HELPING OR HURTING TEENS’ LIFESTYLES

A recent article in The Atlantic, written by Jean M. Twenge, a professor of psychology at San Diego State University, painted a bleak statistical picture of the “iPhone” generation – basically pre-teens and teens, as does her recent book on the subject.  Here’s a snapshot of what’s happening with kids today since the debut of the iPhone, much of which is drawn from data collected by Monitoring the Future:

  • Less going out without their parents.
  • Less likely to get at least 7 hours of sleep: By 2015, 41% of teens failed to get at least 7 hours of sleep nightly, up from 34% in 2007.
  • Nearly 1 in 4 teens admits to being online “almost constantly”.
  • More likely to feel lonely: In 2015 nearly 1 in 3 teens said they felt lonely, up from 1 in 5 in 2007.

Almost 9 in 10 teens have smartphones now, and they use them.  According to a study by the Pew research center, the typical teen in 2015 sent and received about 30 texts per day, versus none in 2007.  More than 7 in 10 teens use multiple social network platforms.

What’s the addiction to smartphones?

All humans learned to survive by monitoring any changes in their environment.  Social networks change every second of every day.  It’s easy to see how teens (and adults, let’s face it) can’t help feeling that they’re missing out if not constantly monitoring various social platforms.

Teens may be “super-connected” but are they “communicating”?  Their increasing feelings of loneliness suggest that they’re not.

Disturbing thought: kids can now be “socially” active without leaving their homes, without leaving their rooms, and even without leaving their beds.  Nothing physical required for this “social activity” except thumbs in motion. Even if they do physical activity in school, the more they’re using their smartphones, the more they’re essentially at bedrest.

What does this have to do with health?

A lot.  Staying at home more, going out less, feeling lonely, and getting less sleep, are all negative trends for developing teens. Add that to the lack of physical activity that’s enabled by this online, sedentary life, and it doesn’t bode well for their health.

According to the Centers for Disease Control, all kids ages 6-17 years should get at least 60 minutes of physical activity daily. Nationally, only 1 in 4 said they met this goal in 2015, according to CDC statistics.  Nearly 3 in 10 did as recently as 2011.  That also means 75% of teens are not active enough.

Former Surgeon General David Satcher, in his 2001 landmark “Call to Action to Prevent and Decrease Overweight And Obesity”, emphasized more physical activity, but also “fewer sedentary activities.”  That means an hour of exercise followed by 23 hours of laying around, doesn’t cut it.

Back to school is a perfect time to build a better routine, one that gives teens a lifestyle that’s not only healthier, but happier.  If feelings of loneliness are increasing, they often go hand-in-hand with low self-esteem, already too common in teens.  Behavior changes that help shift self-esteem positively deserve some attention.

Calories and Social Media Time: 2 Things to Spend Wisely

Here are three big triggers for mindless eating: feeling lonely, being tired, and staring at any screen.  If your teen thinks a smartphone is an umbilical cord to the world, cutting it off seems tyrannical and isn’t necessary.  Still, these tips can help them towards healthier behaviors, positive attitudes, and lead them to healthier eating:

  • Media diet: NEVER at the table and insist the meal last 30 minutes. Family dinners aren’t just about food, they’re about communicating and connecting.  If this requires some getting used to, it’s a red flag that it’s overdue.
  • Kitchen help. Assign them some part of the meal prep – it builds responsibility but it also keeps them off the smartphone a little longer.  If it’s preparing part of the meal, give them some freedom to make decisions about what vegetable to cook or what ingredients to include in the salad.
  • TELL THEM YOU APPRECIATE WHAT THEY DID and mean it. There’s never been a better motivator than that.
  • Keep ALL “screen time” to a max of 2 hours daily, but also support non-screen activities that interest them.
  • Shut down all media (and snacking) at least an hour before bedtime. Two hours is even better.

Silver lining: by 2015 teens were also far less likely to have a driver’s license and have sex than were teens in 2007 – but there have to be better ways to prevent driving accidents and teen sex than keeping them home, hypnotized by a screen!

Show Me LESS Money — I’ll Show You a Healthy Mediterranean Diet

A recently published study suggested there were “socioeconomic status (SES) inequities in the cardiovascular protection associated with the traditional Mediterranean Diet.”  Simply put, the Mediterranean diet reduced cardiovascular risk but only in higher socioeconomic groups.  The best benefits came among those who were well educated and had better incomes.  It also suggested that the better health outcome of this richer and more educated bunch happened because they were able to buy higher quality, healthier food.

This may make for great headlines: low-income, less educated people are victims of a cruel society that keeps them powerless and less healthy.  It also bugs me to no end.  I have spent most of my career working with primarily low- and moderate-income populations.  My patients read a headline that says only the wealthy and educated can benefit from a Mediterranean diet and conclude things are just stacked against them because they aren’t wealthy or upper-income people and may never be.

What’s in The Study but Not the Headlines:

Whenever I see conclusions like these I know it’s time to dig in a little deeper. There are other conclusions, perhaps more realistic ones, that could be drawn from this study, even if they wouldn’t grab headlines.

All studies have weakness and limitations.  Many never make it into the press releases and news articles, however, and that just adds to all the nutrition confusion out there.  This study’s authors acknowledged some of the study’s weaknesses, but there were others that weren’t considered.

  • The authors acknowledged the study’s somewhat short duration, only 4.3 years of follow-up. Fair enough — it is what it is.
  • They noted that dietary information was self-reported and taken only once and only at baseline. A lot can change over 4 years that could impact the value of the study’s findings and conclusions.
  • Average age of the subjects was mid-50’s.  There is no record of their dietary history up to this point.  It’s one of the problems with this type of research – current dietary pattern doesn’t indicate your lifetime dietary history, when many of your health risks were likely determined.
  • Differences in health outcomes were attributed to dietary disparities. That’s a leap.  The outcomes may have had more to do with health care disparities throughout the years prior to the study, rather than whether or not they ate a green vegetable the day before they were interviewed.
  • The study noted that higher SES groups “are more likely to get in line with dietary recommendations”. Very likely, but such groups may also be more likely to afford and seek medical attention, take prescribed medication, follow physician recommendations, and make other positive lifestyle modifications.  This is a huge piece of the puzzle.

Rich and Educated Didn’t Always Do the Smart Thing

Higher income participants actually ate a narrower variety of vegetables than the lower income group and practiced LESS healthful cooking methods for beef, such as grilling and frying.   Does that mean also that eating fewer types of vegetables and doing more frying and grilling of beef is “linked” to a better outcome?  Not likely, although, to be fair and balanced, that’s what the data show, and it’s just as statistically accurate to make such a statement from these data.  This is why describing a behavior as “linked” or “associated” to an outcome doesn’t always tell us much and should certainly never be considered equivalent to “cause-and-effect.”

Observational studies make it easy to cherry-pick what you want to conclude.  All they are really designed to do however, is generate a hypothesis, not a conclusion.

We should be empowering and motivating lower-income people, not treating them as victims.  I don’t have the luxury of telling my low-income patients sorry, but eating better and being healthier are a rich man’s game.  Hello?  They need and deserve help, motivation, and sound nutrition advice, not to hear their health is at risk because they didn’t go to college or make a lot of money.

A Healthy, Economical Mediterranean Diet

Your Mediterranean diet doesn’t have to be populated with lobster and shrimp and washed down with an expensive chardonnay.  For the rest of us, more reasonable options are the way to go, and they can be just as tasty and healthful.  After all, the original Mediterranean diet wasn’t about indulgence, it was about making the best from what was available.

Try these tips for eating a delicious Mediterranean diet.  They’re budget-friendly but they’re smart for any budget:

  • Canned salmon – a treasure. It’s my own go-to for omega-3 fats. Surprise: it’s almost always wild, but without the wild price of the fresh stuff. The edible bones are loaded with calcium and vitamin D, too.
  • Beans, any kind, canned, fresh, or dry: Hummus anyone? Canned kidney or garbanzo beans are great topped with some pasta sauce.
  • Eat in the “C-suite”. Super-nutritious affordable fave veggies: carrots, cabbage, collards, cauliflower, celery. All great choices any time of year.
  • Frozen: peas, green beans are awesome and just as nutritious as fresh, with no prep or waste.
  • Fruits: eat the best of each season. It’ll taste better and be more affordable.  Let it be your sweet treat instead of junk sweets.
  • Extra-virgin Olive oil: You only need a little.  Buy what you can afford and use it where you’ll really taste it — on salads, bread, even on hummus.
  • Dessert, anyone? Try Greek yogurt with fruit, nuts, and a teaspoon of honey. Great for protein when it’s a meatless meal, too.
  • Nuts in bags, not jars. You get more for the money. An ounce a day is enough for benefits.

IT’S HOT OUT THERE! ARE YOU EATING ENOUGH WATER?

 

It’s summer, the hottest time of year, and everywhere you turn you’re hearing about the importance of drinking enough water and fluids.

But how much should we be drinking?  The daily water intake recommendations by the Food and Nutrition Board of the National Academies of Sciences are 13 cups (3.7 liters or about 125 ounces)daily for men, and 10 cups (2.7 liters or about 91 ounces) for women.  These are very general though, as a single recommendation is impossible.  A lot depends on factors like these:

Weight. If you weight more, you usually need to drink more, but it’s not a linear progression.  That is, a 200-lb. person doesn’t need twice the fluid of a 100-lb. person.  The smaller person is more vulnerable to dehydration and overheating because they have a high “surface-to-volume ratio,” the same reason a small child is more vulnerable to overheating.

Gender. Men tend to need more fluid than women.  They tend to weigh more but also have more muscle, which is metabolically active and requires more water to stay hydrated and function properly.

Activity level. But the more active you are in any season, the more you sweat and thus need to rehydrate.

It doesn’t all have to be water and the IOM is clear that all beverages , including coffee, tea, milk, and even juice, so getting those 9 to 13 cups is easier than you think. Liquids aren’t the only place to get water.  You can easily amp up your take from food if you include plenty of high-water fruits and veggies, and there are real advantages to doing this:

  • Flavor! Chilled summer fruits and vegetables are taste powerhouses.
  • Rehydration nutrition: high-water fruits and veggies are loaded with hydrating nutrients like potassium and magnesium. Count milk in here, too.

For highest water content, go for fresh versiuons.  Here’s a list of some of the most common high-water fruits and vegetables (by % weight):

FRUITS

% water

VEGETABLES % water
Watermelon

92

Cucumber, lettuce (iceberg)

96

Strawberries

92

Zucchini, radish, celery

95

Grapefruit

91

Tomato (red)

94

Cantaloupe

90

Tomato (green), cabbage (green)

93

Peach

88

Cabbage (red) cauliflower, eggplant peppers (sweet) spinach 92
Raspberries, pineapple, orange

87

Broccoli 91

Many are more than 90% water, so they really contribute to your total fluid intake for the day.  Plus, they do what a glass of water simply can’t: help you get enough fruits and vegetables for a healthy diet.

Personal fave: watermelon.  I love this stuff.  I have loved watermelon since I was a kid and waited for it to come into season so I could gorge myself on it.  Even now, when I come home on a steamy, sweltering day there is absolutely nothing better to cool me down and get my taste buds dancing than a huge chunk of ice-cold watermelon.  I’m hardcore, too.  I cut off only the outer skin because I love the white part of the rind as well.  It’s not as sweet but that’s OK and it’s still good, kind of like a semi-sweet cucumber.

MORE: Can you be a health-freak AND a smoker?  Get my take in this New York Post article here.

BEEF EARNS ITS PLACE AT THE WEIGHT LOSS TABLE

A solid clinical study by a well-respected team, just published in the July issue of Obesity Science and Practice, showed that eating lean beef, at least four times per week, produced weight loss just as effectively as a non-beef diet.  Even better: there was no negative impact on heart health indicators, like total cholesterol, LDL “bad” cholesterol, or blood pressure.

This research, called the Beef W.I.S.E. Study (Weight Improvement, Satisfaction, Energy) followed 99 overweight and obese adults for 16 weeks.  Everyone did moderate-intensity exercise regularly and ate a higher protein diet, either with beef or without beef.  The beef eating dieters ate beef about 4 times per week, not every day, and they ate plenty of other lean protein foods, like nonfat Greek yogurt, fish, chicken breast, etc. Indeed, some type of lean protein happened at each meal and snack.

The beef-eaters lose just as much weight, preserved just as much lean muscle mass as the non-beef group. “A key finding of this study is that 90 to 95 percent of the weight lost came from fat, not muscle,” said Dr. Drew Sayer, PhD, a co-author of the study. “This shows that lean beef doesn’t have to be restricted in a higher-protein diet and is just as effective as other protein choices in supporting healthy weight loss and leaner bodies.”

And I’d bet they also liked their diet more, because they didn’t have to omit food they liked.  Anytime you have to omit a food on a diet, it can become the one food you want.  According to the Consumer Beef Index, a survey of attitudes about beef, 3 out of 4 people DO like beef as a favorite or a top meal choice.  The dieters in the Beef WISE didn’t eat beef daily, but about five times weekly.  No deprivation there.

That’s exactly why I like this study: no feelings of deprivation.  To be fair, there was no particular advantage to including lean beef, but the W.I.S.E. factors of satisfaction and energy are key to EVERY successful diet, and to maintaining both the lost weight and a healthful eating style.  Whether you’re trying to lose weight or keep it off, YOUR eating style should help you feel energized and satisfied.  The researchers will be following these dieters longer term and satisfaction data is also being analyzed, but the high retention rate suggests the participants liked whichever diet they were eating.

These beef-eaters ate lean beef, but that’s pretty easy.  There are 29 cuts of beef that qualify as lean, meaning they have less than 10 grams of fat per serving and less than 4 ½ grams of saturated fat per 3-oz. cooked serving.  Check out this chart listing 19 popular lean cuts of beef.

CutToTheChase: If you like lean beef, it’s be W.I.S.E. to include it while losing weight. It’s produces the same benefits as a non-beef diet.  Liking your diet is key to staying one it!  Try this lean beef recipe for Grilled Southwestern Steak with Colorful Vegetables (pictured at top).  It’s quick, delicious, and loaded with lean protein.

Note: this study was funded partially by the Beef Checkoff, but also by many additional federal agencies, like the National Heart Lung and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases.  It was registered at https://clinicaltrials.gov. It’s sound science and highly credible. It’s sound science and highly credible. It’s one of the reasons I partnered with the Beef Checkoff program, established by the federal government in 1985. Participation by beef producers is mandatory.

How YOU View Food & Health: “And the Survey Says…”

 

…you’re confused!

The International Food Information Council (IFIC) recently released its 2017 “Food & Health Survey: A Healthy Perspective: Understanding American Food Values” all about consumers’ beliefs and behaviors around food.

To “cut-to-the-chase,” consumers are confused!  How confused are they?  Here are some highlights:

  • 4 in 5 admit finding conflicting information about food and nutrition.
  • Over half say this confusion gives them doubts about their food choices (maybe agita, too?)
  • 24 out of 25 people do seek out health benefits form the foods they choose, but less than half of those people could identify even one food or nutrient linked to those benefits!

Friends & Family: The New “Nutritionists”

More than 3 in 4 consumers actually rely on the people closest to them for at least some of their nutrition advice.  They’re skeptical about it, though.  About 7 in 10 don’t exactly have high trust in these folks for nutrition and food safety info.   Friends and family mean well and don’t speak “nutrition-ese”, so they’re easy to listen to.  Things change however, according to Tony Flood, senior director of food safety at IFIC, who noted, “For concerns such as foodborne illness and chemicals in food, news articles tend to be the top source to influence consumer opinion.”

Smart, because the “hallway advice” from friend and family, has a downside: inaccurate or incomplete information fuels food and nutrition myths.  No one wants to make food decisions and purchases based on flawed assumptions.  Here’s what the IFIC survey had to say about that:

  • If a food costs $2, you are more likely to think it’s healthier than an IDENTICAL food that costs 99 cents.
  • You’re four times as likely to think fresh food is healthier than frozen
  • You’re five times as likely to think fresh is healthier than canned

Let’s at least clear some confusion about the above points:

  • Higher price – for the exact same item – is no indication of healthfulness.
  • Frozen can actually be higher in nutrients. Nowadays, frozen produce is quick frozen right on the field as it’s harvested.  That helps it retain nutrients that can be lost during the time it takes for the fresh version to go from farm to store, to your refrigerator – where you may wait a few days to prepare and eat it.
  • Canned foods vs. fresh? It depends.  Canned garbanzo and kidney beans?  Super nutritious.  I always keep them around.  Canned tomato paste is just condensed, concentrated tomatoes, and cooking tomatoes makes more of the antioxidant lycopene available.  Two thumbs up.  Canned fruit with lots of syrup?  Fresh or frozen fruit is a better choice most of the time, and it does have more fiber. Of course, context is everything: a canned peach with some vanilla Greek yogurt will have way fewer calories and more protein than a slice of cheesecake.

Let’s Clear the Air

As a clinician of over 30 years, I try every which way to make certain that a patient in my office leaves with clarity, not confusion.  Why? Because a confident patient/consumer is motivated to make positive changes!  A confused consumer says, “no” and stays put.  Exactly what I don’t want. Eating is more than just nutrition.  It’s about enjoyment.  If you’re confused or conflicted, where’s the fun?

Resolving conflict

Consumers said they trusted health professionals, especially registered dietitian/nutritionists (RDN), the most, even if they didn’t go to them as often as other sources.  It might be worth it to have a chat with an RDN.  It’ll help stop your confusion about food and get you more confident about the choices you make. As my colleague Carolyn O’Neil says, “The more you know, the more you can eat.”

Another way to clear the confusion? Sign up for my newsletter.  That’s an easy, positive change right there.