Dear Tom Brady: You Won, Your Nutrition “Beliefs” Don’t

Tom Brady is a multiple Super Bowl winner.  He’s also a businessman, and he’s glommed onto the formula for marketing a diet regimen:

  • Be a celebrity, preferably a sports celebrity, because they’re instantly believable.  Not credible, but no one cares about credibility or facts, just that you’re believable.
  • Look good, have a killer bod.  People will think your diet is the reason. Hey, sexy sells.
  • Have an equally hot spouse or significant other who can endorse you. And when you say you get to bed early every night, no one would doubt you. 
  • Talk about nutrition “beliefs” and “philosophy”.  Facts aren’t good for business.
  • Exclude all the standard food commodities. They’re not elite enough (see below).
  • Have all the trendy “free-froms”:
    • No gluten.
    • No red meat.
    • No dairy.  
    • No white potatoes or any other nightshade vegetables either, like peppers, eggplant, or tomatoes.  They’re “inflammatory”. 
    • No GMOs.
  • Keep it as green as possible.  Heavy on leafy foods, but he also includes beans – I do like this part.
  • Go against the grains – at least the common ones, like wheat and corn – again, those commodity foods the masses eat, because you aren’t most people.
  • Have expensive “uniquely formulated” products to sell – only available from your web site.  It’s critical to eat like a wealthy, elite athlete, not a commoner.
  • ELECTROLYTES!  The ones he sells in particular — the TB12 electrolytes.  They’re part of his “alkalinizing” the body, a must for health in his book.  (NO science supporting this – none).  A 20-serving, 1.7-ounce bottle sells for $15 (plus shipping).  That’s 71 cents per serving.  A serving of milk gives you three times more potassium, plus protein, sodium, calcium, and other nutrients you  need after a workout, for one-third the price. This from someone who chastises food companies about “brainwashing” consumers.  Shame on you, Tom. 
  • WHEY PROTEIN POWDER?!  This dairy food is OK – IF it’s TB’s specially formulated one.  It’s $50 for 21 servings, or $2.38 per serving.  To get the same amount of protein from real milk would set you back only about 65 cents, and you’d get all the other nutrients in milk to boot. 

Keep Edgy: Diss the Mediterranean Diet!

Sweet red pepper: One of many superfoods
NOT allowed on TB’s diet!

No cooking with olive oil!  Swap it for coconut oil.  No scientific basis for this – coconut oil is way more saturated than any animal fat.

No yogurt, eggplant, tomatoes, or peppers!  No cheese!  Nutrient-rich foods that have fed and sustained Italians and Greeks for thousands of years have no place in this winner’s diet.  Fish only if it’s wild-caught.  Farmed salmon, while quite healthy and affordable, but probably not exclusive, elite, or expensive enough.

You’re Busted, Tom. Ditching Dairy Is Dumb.

Dairy foods – from milk to yogurt to cheese – have unparalleled qualities.  If you know your nutrition, this isn’t debatable.  It might be boring, but facts often are. 

He writes, “When I was a kid, the dairy industry rolled out lots of campaigns urging people to drink lots of milk.  But research today is pretty clear that we should consume dairy in more limited amounts. Our belief [there’s that word again] at TB12 is that dairy products are high in calories and lower in nutritional value than other foods.”

I don’t know what “research” he’s talking about (I’d bet he doesn’t either), but there is no drink that can match a glass of milk for nutritional value and affordability.  None.  Furthermore, a mountain of solid science verifies the benefits of dairy foods, including that a glass of low-fat chocolate milk after a workout is BETTER than sports drinks for repairing muscle mass and improving endurance in subsequent workouts.   Why? Probably a great carb-to-protein ratio and a great electrolyte balance, plus vitamins and minerals.  Of course, milk is a commodity, so it has to be out. 

No GMOs?

Tom seems to disagree with over 100 Nobel prize winning scientists who have attested to the safety and nutritional value of foods produced with genetic engineering. I wonder what he knows?

Cut-To-The-Chase-Advice

Nutrition advice should be grounded in science and facts, not beliefs or philosophies.  Using the word “belief” shouldn’t give you a pass to propagate nutrition myths and misinformation. 

Most of us don’t have personal chefs to cook our meals (and clean up afterwards).  Tom’s diet may not be harmful to the average person, but the DASH and the Mediterranean diets have far more science behind them and are solid, affordable, and sustainable paths up the mountain towards good health.  They don’t require expensive “website” foods and supplements or forbid foods either – it’s a matter of how much and how often.  Not sexy, just solid.  For my health, I’ll go there.  Sorry, TB.

For 2019: Beets Go Big Keto’s “King” & “Ya Gotta Have A Gimmick!”

What kinds of diets do consumers want?  My previous post noted the top 3 diets – from a scientific standpoint – but nutritionists say consumers swap what’s safe and sound for what’s fast and flawed, preferring trendy diets like keto and intermittent fasting. 

Pollock Communications and Today’s Dietitian just released their annual survey of registered dietitian nutritionists (RDNs), this year totaling 1,342 respondents, who give their views of what’s tops to consumers. 

,Consumers’ fondness for flashy diets, like keto, is disappointing to RDNs like Dr. Joan Salge Blake, Associate Professor at Boston University and author of the textbook Nutrition and You.  She even says keto will have similar results in the marketplace with the drastic fat-free diets of the 90’s.  Back then, “We saw a plethora of non-fat cookies, (remember Snackwells??), ice cream, and candy products bulging in the supermarket aisles.”  Salge Blake predicts, “We are going to see Keto cookies, ice cream, and candy muscling out low-fat goodies down the supermarket aisles.” She reminds us that fat-free doesn’t mean calorie-free and too many calories of any type won’t help America’s waistline.  

Salge Blake concluded, “Haven’t we seen this movie before?   I think I know the ending.”

Consumers get it right – sometimes

You’ll see from the graphic above that consumers are liking some great foods!  Fermented foods are tops – again.  Good news for yogurt, kefir, kimchi (pictured), tempeh, and other foods that have the great anti-inflammatory properties fermentation often brings.

Other veterans to the list are:

Kimchi: a fermented food that’s tops for 2019
  • Avocados
  • Seeds
  • Nuts
  • Coconut products
  • Ancient grains (think farro and amaranth, among many others)
  • Exotic fruits (like lychees, horned melons, and dragon fruits)

The Newbies

Consumers are “beet”-ing a path to this delicious veggie and high time.  Beets are packed with both nutrients and flavor.  They’re also naturally high in nitrates, which can give a little boost  to exercise endurance. 

Blueberries, a newcomer?  Who’d have thought they’d ever been off the list?  Low in calories and among the best sources of antioxidants, I’d like to see people popping these somewhere into a meal or snack as often as possible.  Fresh or frozen, they’re fantastic. 

Disappointingly, kale got bumped from the #10 spot and replaced by plant-based “milks”.  The “halo” these beverages have is unfounded and kind of ironic, given that there is also consumer preference for “clean eating”, yet these beverages are pretty low in nutritional content, usually have little or no protein, none of the bevy of nutrients natural to real milk, and the only nutrients they do have are usually added. 

Ironically, there is very little of the identifying food in these drinks.  Only 3 or 4 almonds, for instance, are in a glass of almond milk.  Pretty expensive!  The foods these beverages are derived from are fantastic.  Eat almonds, rice, oats, and walnuts.  But milk is a far better beverage for nutrition.  One exception: soy beverages.  Soybeans are high in protein and for my patients who are allergic to milk or are vegan, it’s the closest equivalent.

Amy Myrdal Miller, RDN, president of Farmer’s Daughter Consulting and a member of the elite food organization Les Dames d’Escoffier, has mixed feelings about the survey’s results.  “I love seeing fermented foods at the top of the list. Fermentation creates so many powerful flavor molecules, which can lead to greater enjoyment of foods. But I hate seeing non-dairy milks. Cow’s milk provides so many essential nutrients in a natural, delicious form.”    

Keep in mind, this survey is what RDNs see as the top trends for 2019. Trends aren’t always positive! Facts aren’t always driving consumers’ decisions. Perceived truths are often the drivers, and there is no shortage of myths and misinformation about food and nutrition in the popular media.  

As for that other trendy diet consumers liked, intermittent fasting, isn’t that just a formal way of what we used to call, skipping a meal?

To sum up, here’s the complete list of

  1. Fermented foods, like yogurt
  2. Avocado
  3. Seeds
  4. Ancient Grains
  5. Exotic fruit, like acai, golden berries
  6. Blueberries
  7. Beets
  8. Nuts
  9. Coconut products

Now, make your 2019 about #factsnotfears!

The Top 3 Diets: Why Do They Always Win?

WINNERS AGAIN – according to US News’ annual ranking of diets, the Mediterranean diet, the DASH diet, and the Flexitarian diet were the best diets of 2018. They’re likely top be the best of 2019, too, since they’ve been tops forsome time now.  This is NOT news to thoseof us in the field – they’re widely accepted as terrific examples of healthfuleating styles.

These diets are notable for two things:

  • The science about their healthfulness, and
  • They all push plant foods: fruits, veggies, whole grains, nuts

What else I love about them?  They don’t push out any foods.   You can include anything; the only issue is how much and how often.  My kind of eating style, because it’s realistic. 

DASH to delicious!

DASH details:

So, what’s different about them? 

-Low-fat and fat-free dairy are featured

-Add AT LEAST one fruit or vegetable to each meal, but preferably more.

-WALK!  Just a little, about 15 minutes after lunch or dinner (do it anytime you can, but aim for at least 30 minutes a day).

Mmmmediterranean!

Mediterranean Momentum:

  • Olive oil is the fat for cooking and salads.  Canola is also good, but butter is rare. 
  • It’s nuts. Almonds, hazelnuts, pistachios are typical.  An ounce several times a week.  What’s an ounce?  Small handful – think “nibble” not ”shovel”. 
  • Something fishy? Yup.  Twice a week, and make it fatty – think salmon more than sole. (Hint for economy: canned salmon is a superfood and by comparison to fresh, it’s super-economical). 
  • Low in red meat – BUT, for red meat lovers, you CAN eat red meat on this diet and there’s good research to say so.  I have the details here.
Approaches vegetarian, but room for all

Flexitarian Features: 

  • Includes more vegetarian meals, especially plant-based proteins. 
  • Dairy and eggs? Both OK!  The diet just emphasizes including the plant-proteins, as well.
  • Meat?  Nota feature, but more of an, “it’s OK sometimes, too” approach. 
  • It’s not about strict anything, or it wouldn’t be “flex”.  You’re in charge about how far to take it.

Together is better

If there’s a downside to the Med diet, it’s the low-calcium content.  The 2015 US Dietary Guidelinesfor Americans endorsed both the Med diet and the DASH diet as excellent eatingstyles, but they acknowledged that the Med diet didn’t fully meet calcium needs.  The majority of people have diets deficientin calcium – the reason calcium is a “nutrient of concern”.  What to do?

Breaking New Research: The “MedDairy Diet.” 

An Australian study, just published, looked at the cardiovascular health markers of a Med diet, supplemented with four servings of dairy — one serving of low-fat milk; 40-120 grams hard or semisoft cheese; 200 grams low-fat Greek yogurt or 200 grams tzatziki dip.  Here’s what they discovered about the Med-Dairy diet’s effects:

The Med-Dairy diet improved cardiovascular health markers:

  • LOWERED blood pressure (both the top and bottom numbers)
  • LOWERED triglycerides
  • RAISED HDL-cholesterol levels (the good kind of cholesterol)

Talk about an example of “We’re better when we work together”! 

What I especially liked about this study was that it included full-fat cheese, a favorite of many, and it actually included a fair amount of it – about 1.5 to 4 ounces daily, depending on calorie needs. 

But RED meat…?

Yes, you can still have lean, unprocessed red meat on a MedDiet.  Indeed, this Purdue University study, blinded to even the investigators, found that eating up to 18 ounces of leanred meat was not only OK, but it was MORE effective than a Med diet thatlimited lean red meat to only 7 ounces per week.  Red meat lover?  You’re OK, within the context of a Med diet.

As for the WORST-rated diets?  Those that are super-trendy, alsosuper-restrictive (Keto, Dukan, and Whole-30 lead this pack).  Entire food groups excluded, rigid rules, demonizedfoods, and little science to support them – a red flag.  Don’t hate them, but give them a big hug andlet them go. 

Yes, Virginia: There Are 10 Ways to Have Holidays Without Weight Gain

So many people, clients, patients, co-workers over the years, have told me they’ve just given up trying to lose weight during the holidays – that food-festival parties, get-togethers, celebrations and general mayhem that spans the period between Thanksgiving and New Year’s Day.

What is about holidays that cause weight gain? If you know the contributing factors, you can make a plan. Here’s what you’re likely to deal with until New Years:

Workplace food court: The constant brigade of popcorn bins, chocolates, homemade cookies, cakes and sweets, all available all day long.

Drinking: We love eggnog, but it’s the most calorie-laden drink of any year – about 330 calories in a cup. Over-boozing has calories, too – and leads to mindless eating.

Stress-eating: time is short, obligations are long, stress triggers eating whatever is within arm’s reach!

More fooding, less moving: whenever you need a little more time to get things done, it’s easy to borrow from your workouts and walks. It’s also just when you need to burn some extra calories. Ow.

Happiness can be depressing! Everyone seems to be happy but you’re so-so. You’re not alone, either. It’s easy to think food is your BFF during the holidays, and it can be – if you choose the right friends.

Good News

You probably won’t gain much weight during the holidays! This review published last year found that average holiday weight gain in adults ranged from about 1-2 pounds in various studies, not the 5-7 pounds you may have heard about.
But what about you? If holiday weight gain has been YOUR typical, changing that is easier than you think. Take it on as a project and like every project, it needs a good plan. Plans may take some of the spontaneity out of eating, but you’re trading up – for peace of mind and body. That’s totally worth it.

Planning means that you start every day assessing the meals and eating occasions you’ll have and the foods you’re likely to encounter. What does the “no holiday weight gain” plan look like? Here are 10 strategies that put you on a path to enjoying holidays without weight gain:

1. Eat modestly, but don’t skip meals. You’ll just end up being hungry and over-scarfing.

2. Weave in some fiber: Aim for 3 pieces of fresh fruit daily. Aim for 2 cups of veggies, raw or cooked. Think you can’t?  You can – fill up one of those plastic take-out soup containers with cut veggies and it’s two cups right there.

3. Discriminate! Is it a regular store-bought something-or-other that’s loaded with empty calories or is it really tasty? Hold out for something really special. You’re worth it.

4. Never arrive hungry to a party:Eat some raw veggies or a piece of fruit before going to a party or social function. When the edge is off hunger, your focus is on social fun.

5. Go pro: Lean protein keeps you feeling satisfied, and helps prevent blood glucose levels from spiking then plummeting later. About 100-150 calories invested in options like turkey roll-ups, beef jerky, fat-free Greek yogurt, even a fat-free latte will pay off later.

6. Get functional: it’s a social function, so keep the priority on socializing rather than eating.

7. Be the last man (or woman) standing…in line: Always be among the last ones in line for the food. It’ll look a little less appetizing (probably a good thing) and there’s less time to have second portions.

8. Get out of Dodge: Lingering to the end encourages more nibbling.  Be social, sample what you want, then move along.

9. ONE – a singular sensation!  When you see something you want, have it. But one portion. One is the magic number, not a lonely number.  But read #10.

10. Get “hospital-sized”:  Not to eat, just to look at portion sizes. When you’re thinking of a high-calorie food, whether it’s mac and cheese or the Buche de Noel pictured at the top, it’s one “hospital-sized” portion. Keep it there and enjoy it. There will be another treat another day.

Family Meals: You Don’t Have To Go Big, Just Go Home

Eating together as a family – however you define your family – has always been a good thing, but now it’s been shown to be a healthier thing, too. This September marks the 4th National Family Meals Month ™, a campaign started in 2015 by the non-profit Food Marketing Institute Foundation to encourage families to eat together more often.

And The Survey Says…

Here’s what a Nielson Harris poll, conducted last year, found about the campaign’s impact among consumers who saw it:

• 4 in 10 (42%) said they were cooking more meals at home.

• More than 3 in 10 are:

    • Making healthier food choices
    • Eating more fruits and vegetables
    • Eating together more as a family

As a nutrition professional, these are big wins. But the bennies don’t stop there. Read on.

This publication from the University of Florida reviewed the benefits of family meals and found:

• Family meals are happening more often. Now 7 in 10 kids eat with their families at least four times a week.

• Family meals strengthen family bonds and teach an appreciation of cultural, ethnic, and religious heritage.

• Teens said that talking/catching up, and spending time with family members was the BEST PART of family meals. Huge win for families and a huge opportunity.

Something that’s better for nutritional, physical, and mental health, improves social behaviors, and contributes to a family’s overall feeling of happiness is as close to a “magic bullet” as you’re going to find. They’re certainly cheaper than eating out or getting take-out. Do they take a little time to prepare? Yes, but show me something, ANYTHING, that does a better job of helping you and your family be healthier and happier and save you money. There isn’t anything better for a family than a meal eaten together. Period.

So What Are the Barriers To More Family Meals?

Despite all these benefits from family meals, they aren’t happening often enough. The top obstacles cited in the FMI survey:

• Scheduling issues – everyone is in different places at meal times.

• Too tired to cook. Takeout or eating out seems easier.

• Too time-consuming to make meals.

• Too many distractions: social media, TV, homework.

But… What’s For Dinner?

Have you noticed that this nutritionist has mentioned very little about things like calories, fats, and added sugars in this post? I’m actually less interested in what you serve than the fact that you’re eating together.

Get the family meal ritual down first. The research has shown that once more family meals start happening, the quality of the meal starts advancing: more fruits and vegetables, fewer empty calories, less sugar and saturated fat. Eat together at home and you’re probably on your way to a better meal.

One rule though: No technology at the table. Each member has a place at the table because they matter. Yes, family meals can be part of esteem-building also

Getting Help: A Few Tips

• Delegate: Older kids an share some meal prep duties. It’s good for initiate communication without being “face-to-face”. Make sure to thank them for their help, too. It reinforces that they’re appreciated.

• Convenience if OK: Bagged greens, frozen veggies, and yes, canned foods like beans and tomato sauce are nutritious and save time. I encourage them.

• Set it up: before work, set the table, get out any pots or pans you’ll need, and anything non-perishable. It really shaves valuable time later.

Dinner IN 30 Minutes? Try Dinner FOR 30 Minutes

Eat more slowly, do more talking. The food won’t go away and you’ll enjoy it more. If the kids are done eating sooner, then have them stay for the full 30 minutes to make conversation. Make it a family tradition and try doing it as often as you can, because #FamilyMealsMonth matters, and it matters all year long.

Could Losing Weight Make You Richer?

Well, yes and no. It won’t automatically add to your bank account, but according to this study you’ll probably spend less on health care. Reducing weight reduces health risks – and what they cost you.

The authors studied data between years 2001-2015 from the Medical Expenditure Panel Survey (MEPS), an annual survey that uses a nationally representative sample of adult civilians. They looked at the additional cost of being obese, compared to a non-obese person with the same condition.

They combined the costs for obesity-related illness from all “third-party payers”, including Medicare, Medicaid, private insurance plans, and patient “out-of-pocket” spending, other than for over-the-counter medicines. The results are worrisome – and costly.

Price Per Pound

Out of the 334,000 adults surveyed, 30%, or 99,000, had a body mass index (BMI) over 30, indicating obesity. This is no surprise, as other national surveys have shown similar percentages. This percentage would double if they had included people who were merely overweight, with BMI values between 25-29.9.

After adjusting for inflation to 2015 dollars, here’s the change in the percentage of medical costs associated with obesity:

• 2001: 6.13% of medical expenditures
• 2015: 7.91% of medical expenditures

That might not seem like a huge change, but it amounts to a 29% increase, compared to someone with the same condition who is not obese. Some states, such as Ohio and Wisconsin, fared even worse, with increases over 40%.
The cost of obesity isn’t just born by third-party payers. Consumers often have plans with high deductibles. If your visits require a co-pay, the more visits you need, the more money out-of-pocket costs you have. Consumers now average nearly 5% of their own medical costs to treat obesity, with consumers in many states far exceeding this percentage. The study also noted that 13% of prescription drug costs are to treat obesity

Weighing Down Your Earnings?

The authors quoted several studies that suggest associated a higher BMI with lower wages, but for women only, not men. Weight-related discrimination in the workplace has also been documented. Indeed, there is less chance of being hired because of weight. Then there are the issues of obesity-related health problems causing more missed days due to illness, more physician visits, more medication costs.

When you add it all up, shedding a few pounds starts to make financial sense, not just healthy sense. Who wouldn’t rather put that money to better use if they could – and you can.

Going Positive – a 5% solution

This study showed national averages but you’re not a population, you’re you. Everyone is different. You can’t change national numbers but you can impact your own. Losing 100 pounds is not necessary to be healthier and reduce obesity-related risks. This review of weight research studies documented that even losing 5% of your body weight will produce health benefits. Weigh 200 pounds? That means if you release 10 pounds you’re healthier. Hold that for a year and I’m your biggest cheerleader.

Take It Easy To Save More

I wouldn’t care if you made one small positive change to your diet or lifestyle each month. Just do what you can commit to and know it’s moving you in the right direction, health-wise, and money-wise. In fact, if you’re making changes you notice quickly, you’re probably making too drastic a change. OK to slow down, take a year to lose 12 pounds – a pound a month. If that gets you to the 5% solution, you’re already saving money on health care costs.

BTW — This is a pic of a huge California peach on a “smiling” dessert plate.  It WAS dessert, amazingly delicious all on its own.  

Direct & “Indirect” Food Additives: Issues Or Non-Issues?

The American Academy of Pediatrics recently released a policy statement on food additives — the direct food additives like nitrates, and indirect ones, like plastic containers that come into contact with food. Their bottom line is that the FDA’s regulatory process doesn’t properly vet food additives and cannot assure us that all of these 10,000 “chemicals” [emphasis mine] are 100% safe.

I like the AAP – really I do – but in this case I wonder if they’re presenting a balanced view of the total body of science on food additives. For example, the statement references studies where additives are “linked” to conditions like impaired thyroid function and immune responses to vaccines, even increased risk for obesity. Yet, many of the referenced studies also admit that such “link” may not be one of cause-and-effect. Moreover, numerous studies not referenced validate the safety of these additives. Getting approval of a new food additive just isn’t easy – nor should it be.

Is ANYTHING 100% Safe?

Not likely, and that includes prescribed medications, but that doesn’t mean we shouldn’t use them when necessary. It would be easy to get suspicious of everything we eat: Are healthy foods like beans 100% safe for everyone?

It’s more useful to me and my patients to put this issue perspective, and to that end I think the AAP statement could have done that better. We DO have the most advanced food delivery system in the world and our FDA is a guide post for similar organizations in other countries.

The AAP’s issue with nitrates is one I don’t get, for example. Nitrates and “processed meats” are buzz words, true. But a food label saying “no nitrates added” doesn’t mean the meat has no nitrates. Celery powder is often a substitute, because celery is a source of natural nitrate, along with green beans, carrots, spinach and collards. Of course, celery powder is also a “food additive.”

If someone is eating processed meat frequently, I’d be more concerned with what it’s replacing in the diet, rather than nitrates per se. Let’s balance the diet and the nitrates become a non-issue.

The Big Picture

As a pediatric nutritionist for over 30 years, I’d love it if we lived in a world without a need for anything “additive”. But we don’t, and in some cases that’s a good thing. After all, food additives have provided some of the best public health interventions. I’m glad I don’t have to see children with neural tube defects anymore, now that folic acid – a food additive – is added to enriched grains. My own mother remembers her grandmother having a goiter and to this day she will only use iodized salt. No fancy sea salt, not even Kosher salt, for her. “You never had to see anyone with a goiter,” she says.

The AAP calls for the FDA to re-examine the regulatory process for approval of food additives, including those additives on the “GRAS” (generally regarded as safe) list. They also note that low-income children are at increased risk, as higher consumers of packaged foods.

Food Additives & Food Budgets

As for affordability, I like that the AAP recommends practitioners “develop a list of low-cost sources of fruits and vegetables.” I’ve worked my entire career with low income patients and helping patients stretch their food dollars goes hand-in-hand with good medical nutrition therapy. Nothing is nutritious until people eat it.

I don’t have the luxury of telling parents that their family’s health is at risk until the feds beef up their regulatory process. I also think there’s a lot that you can do at ANY income level to reduce exposure to additives. The AAP does give some recommendations in the interim, but frankly, they’re the same ones I’ve been giving to my patients on for years, just for general health:

• Make fresh fruits and veggies a big priority in the home eating environment. (Uh, it helps if parents eat them, too, and in front of the kids).

• When microwaving food, put it onto a plate or in a glass container instead of plastic. It just saves worrying about whether the container is microwave-safe to begin with. Also, no plastic wrap when microwaving. Too hot and the stuff melts. Ick.

• Forget the dishwasher for plastic containers. Just wash them by hand. Done.
Finally, if you’re doing these things anyway, then you’re also already minimizing your exposure to food additives. Then the feds can take all the time they want. You’re doing your job and that’s plenty safe.

 

 

 

Dark Chocolate: Does More = Less for BMI & Waist?

Readers of this column know I’m a lover of good dark chocolate. I make no secret of my interest in finding out all that’s good about the stuff. Here’s the latest:

This recent meta-analysis looked at the effects of eating dark chocolate on body weight, body mass index (BMI) and waist circumference.

Why I Like This Study

• It included randomized controlled trials (RCTs) only. That means “cause-and-effect” results of an intervention. Large population studies can’t do that (no matter what the headlines imply).

• The studies in this meta-analysis all had to investigate cocoa’s or dark chocolate’s (DC) effect on body weight, body mass index (BMI) and waist circumference .

• DC had to be specifically prescribed and compared with a placebo group that did not consume cocoa or DC

• Neatness counted. The authors of this meta-analysis looked only at studies with adults. No animals.

First the bad news: Glass half empty?

There was no significant effect of dark chocolate/cocoa supplementation on BMI, weight, or waist circumference. Bummer. Some studies found a difference, some did not, but when you pool all the studies together and treat them as one huge study, which is what a meta-analysis does, no significant difference in these parameters could be found.

If you’re a glass-half-empty kind of person, this sounds bad, but it really isn’t. DC hasn’t traditionally been known to be a weight-loss aide. Then again, read on…

Saving the best for last…

In studies that lasted longer, 4 to 8 weeks, and that included at least 30 grams of dark chocolate daily:

• There was a significant reduction in BMI and body weight.

• Waist circumference was reduced but only in doses of 45-60 grams daily.

Personally, 30-60 grams of dark chocolate daily would not pose difficulty for me, especially if I knew it would help my waist circumference. It’s means budgeting in about 150-300 calories, but it’s nice to know that there might be justification for moving dark chocolate from the “once-in-a-while treat” to “healthful way to spend discretionary calories.” If it motivates you to get on the treadmill for 30 minutes daily, so you can balance out that extra ounce of DC, so much the better. Hey, #Commitmentiseverything 😉

Here are a few of my latest fave bars.  They’re pricey, but good chocolate isn’t for gulping.  Learning to savor our food just adds to the enjoyment.

Lean Red Meat in a Mediterranean Diet? Oh, Yes You Can!

This post is a collaboration with Beef. It’s What’s for Dinner., on behalf of the Beef Checkoff, as part of my role as a member of the Beef Expert Bureau.

In my previous EdibleRx column, I discussed the PREDIMED study, a 2013 landmark multi-center trial that showed how following a Mediterranean diet could reduce the risk of heart attack, stroke, and cardiovascular disease, but that was recently retracted due to flawed methodology. The re-analyzed and republished data showed good, but less dramatic results, than when first published.

Among the hallmarks of a traditional Med diet, one that the typical Greek farmer ate, are the inclusion of olive oil as the preferred fat in cooking, lots of fish, fruits, vegetables, and minimal red meat. Oh, and the glass of red wine.
Red meat? That Mediterranean farmer didn’t eat much because not much was available. Cows were expensive and sheep worked better on the arid land, plus they gave wool and milk to make feta. All based on pragmatism, not fashion. Red meat (usually lamb) was a celebratory dish. My Greek grandfather loved roasting the lamb heads at Easter (knock it, but farmers waste nothing).

Better Med With Red

A new study asks the question: What would happen to cardiovascular risk factors if you ate a Med diet but compensated/replaced some (up to 18 oz/week) of the poultry with lean red meat, keeping consumption of fish, extra-virgin olive oil (EVOO), nuts, and the rest of the Med diet the same?

This study, in the American Journal of Clinical Nutrition, has some credibility.  It’s small, but well done, and it’s a “cross-over” design, so that every participant followed both the Med diet limited in red meat and the Med diet that included red meat (i.e. Med-Red) for 5 weeks each, with about a month in between each phase.
Following both Mediterranean-style diets produced lower total cholesterol levels, but here’s the difference:

• The Med-Red diet lowered total cholesterol significantly more than the Med diet limited in red meat.

• The Med-Red diet lowered LDL-cholesterol, but the Med diet limited in red meat did not.

Blood pressure improved in both groups, regardless of red meat intake. HDL-cholesterol, glucose levels, and insulin were similar and unchanged for both groups.

Revised Results = New Questions

• Is the advice to reduce red meat intake in a Med diet misguided?

• What about lean forms of deli meat (beef and pork)?

From this study, the answer would be “yes” to the first question, but the second cannot yet be answered because it hasn’t yet been tested. It’s possible that processed, lean deli meats (beef and pork) may be able to be included with similar results to the Med-Red diet. “To be continued…”

Interestingly, when I looked at the revised PREDIMED data, specifically the questionnaire that scored the adherence to the Med and control diets, at the 1-year, 3-year, and 5-year follow-up marks, there were no differences in consumption of red or processed meats between the Med diet groups and the control groups, even though the Med diet groups had a lower risk of stroke. Maybe it’s not the red meat that makes the difference here.

Limitations? ALL studies have them. This study was smaller and didn’t last as long as the PREDIMED study, which had a 5-year follow-up.

The study was funded partially by the Beef Checkoff and the Pork Checkoff, but before you make pre-judgements, it was also funded by the National Institute of Health’s Ingestive Behavior Research Center at Purdue University and NIH’s Institute of Health’s Indiana Clinical and Translational Sciences Institute, all reputable organizations. Regardless, the funding organizations had “no role in the design or conduct of the study; collection, analysis, or interpretation of the data; or writing of the manuscript.” The study was fully peer-reviewed.

Cut-To-The-Chase Recommendations

• Stop worrying about “red meat” and focus more on leanness and freshness (i.e. unprocessed).

• Beef in particular has a lot to offer nutritionally, especially nutrients like zinc and iron, but also conjugated linoleic acid, B-vitamins, and more.

• Keep meat lean, keep portions real (4 or 5 ounces are enough, downing a 12-oz. portion doesn’t prove masculinity and your body can’t use all that protein at one meal anyway. Good news is that this study showed you can enjoy up to 18 ounces of lean red meat per week as part of this eating pattern and still see a positive impact on heart health)

• Make sure you have it with plenty of veggies and some whole grains, dressed with a drizzle of EVOO.

If you want a great lean beef recipe I made, check out my recipe for an easy, lean, tasty pot roast here, or for many more check out Beef-It’s What’s for Dinner and this infographic on the Med Diet. The site is loaded with great, heart-healthy recipes.

Is the Med Diet a Dead Diet? No – Despite Retractions

But the Mediterranean diet did get a kick in the keester. The New England Journal of Medicine just published a retraction of the 2013 PREDIMED study because of flaws discovered in the randomization methodology. Basically, it found that about a fifth of the 7447 trial subjects weren’t randomized properly, which could have allowed bias to creep into the data.

PREDIMED was a study on the Mediterranean diet and its impact on cardiovascular disease, specifically heart attack, stroke, and cardiovascular-related death. The study was intended to go on for 7 years but was stopped after about 4 years because the results were so dramatic that it was considered unethical to prevent the participants on the control diet from benefitting from the Med diet.

Subjects were supposed to have been randomly assigned to one of three groups:

• Instruction on the Med diet and provided free extra-virgin olive oil (EVOO);

• Instruction on the Med diet and provided free nuts (about 30 grams daily of a mix of almonds, hazelnuts, and walnuts);

• General advice on a low-fat diet. After 3 years, this group would also have additional dietary instruction.

Where did things go awry?

For about a fifth of the 7447 participants, randomization didn’t happen. They point out several ways the randomization failed for these participants, and these failures didn’t seem intentional or malicious. Probably due to site technicians who were poorly trained, poorly supervised, or sites that just weren’t run efficiently.

The authors completely re-analyzed the results of the study and published them here.

Did the corrected analysis change the results?

Yes. The results are still good, but not as dramatic. The Med Diet with either nuts or EVOO showed benefits only for reducing the risk of stroke, but not heart attack or other cardiovascular event.

We shouldn’t dismiss the Med diet though.  Although the PREDIMED study had flaws, other Med diet studies have shown positive results.

What holds true about the Med diet

• It’s simple and sustainable.

• It uses easily obtainable foods.

• It doesn’t require major dietary changes, yet still has at least some cardiovascular benefits.

As a clinician who has spent years helping people change their eating behaviors, a diet with these attributes hits the tri-fecta.

Where the Med diet could improve

A 14-item questionnaire was used in the PREDIMED study to determine a “MedDiet Score” of adherence to the diet. Some of the questions are a bit odd, if not troubling:

• Why are homemade pastries OK but “commercial bakery” items discouraged?

• Why are “red and processed meats” grouped together? More to the point, why is lean red meat in the same category as fatty, salty sausage?

• There is absolutely no mention at all of dairy foods, milk, yogurt, or cheese, either low-fat or regular? Yogurt and cheese are nutrient-rich and present in a Med Diet, even if not adequately so.

Solution: A “MediterDASHean Diet”

It combines the best of the Med Diet with the DASH (Dietary Approaches to Stop Hypertension) diet. Both emphasize lots of fruits, vegetables, legumes, but DASH makes up for what’s missing from the Med Diet and the diets of most people: dairy nutrition.

The Med Diet, for all it’s advantages, is low in calcium. Even the 2015 US Dietary Guidelines for Americans, which praises the Med Diet, acknowledges the likely lack of adequate calcium in the Med Diet.

A calcium supplement alone cannot replace the nutrition-rich package in dairy foods.  With a MediterDASHean Diet, you just do the Med diet but include at least 2 servings of dairy foods daily – full-fat, low-fat, or non-fat, whatever your calorie needs allow. Personally, I get three servings and happily so.

The Med diet discourages “red and processed meat” but it’s not clear why. It’s even less clear with a new dynamite study that looks at what happens when a Med Diet swaps out lean poultry for lean beef and pork. It’s my next post, so watch this space!

Photo credits: Penne: Petar Milošević – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=59899700  Caprese salad: Jessica Rossi, https://www.flickr.com/photos/jesswebb/3797226962