Got a Salty Tongue? New Study Says It’s Not So Bad!

Hypertension and “low-sodium diet” seem to go together like two peas in an unsalted pod.  Salt, has been one of the “eat less of” ingredients that dietary guidelines and health organizations have warned us about forever.  We’ve been told of the risks to our blood pressure and heart health in particular.

In the US, we get about 3,500-4000 mg of sodium daily, according to the Centers for Disease Control   (women tend to be on the lower end of this range).  You may exceed these levels if you eat out a lot, as restaurant chefs are known for their generosity with salt.  US Dietary Guidelines recommend a max of 2,300 milligrams, and if you’re at risk for cardiovascular disease, it’s only 1,500 mg.  Even at 2,300 mg, it means cutting out a third of the sodium we eat.

Kimchi: Yes, it’s salty, but it’s OK,
just don’t binge!

The problem?  People HATE low-salt diets and they love salty food!   Even excluding French fries, these foods also figure into our love of salty savories:

  • Grandma’s chicken soup (and most canned or homemade soups)
  • Cured meat, fish (smoked salmon!) and cold cuts
  • Most condiments, from Worcestershire sauce to anchovy paste
  • Most ethnic dishes and restaurant meals
  • Almost everything savory that‘s canned or jarred (pasta sauces, tomato sauce, baked beans, and on)

S.O.S.: Save Our Sodium?

This study looked at just how bad the present intake of sodium is for our health and it turns out sodium may be a minor player. 

The study estimated sodium intake by assessing sodium in the urine (where 90% of our sodium ends up) and divided the groups into low, medium, and high excretion groups and followed them for about 8 years, looking at risk for cardiovascular events and death.

Interestingly, the groups at the most risk had both the highest and the LOWEST intakes of sodium, but only when they also had a low intake of potassium. 

The group with the LOWEST risk for death and cardiovascular events?  They had a moderate sodium diet (3.000-5,000 mg/day) but diets that were highest in potassium. 

D.A.S.H.-ing Through the Clutter

A diet that’s moderate in sodium but high in potassium.  That’s pretty much the DASH diet: “Dietary Approaches to Stop Hypertension”.  It works and it’s simple.  Just eating more fruits, vegetables, and low-fat and fat-free dairy foods (milk is an astoundingly good source of potassium) does the trick, and it’s what most people’s diets need more of anyway.  Here’s why I like the DASH approach:

  • It’s not regimented or prescriptive. It’s an eating style that works with all cuisines.
  • Plenty of delicious foods are also loaded with potassium. Eat your favorites and eat them daily. 
  • Bonus: eating more fruits, veggies and low-fat dairy foods will probably push out some of the higher-salt foods people eat now, especially for snacks.

ALL fruits and vegetables are good sources of potassium, but here are some superstars:

  • All melons and berries
  • All citrus fruits and juices (100% juice, please)
  • All potatoes, squash, pumpkin
  • All leafy greens (lettuce, spinach, kale, the whole lot)
  • Beets (don’t laugh – beets are the new “in” veggie for 2019!)
  • MILK!  Whole, 2%, 1% and fat-free, also yogurt are the top non-plant sources of potassium – and calcium.

Reality: It Doesn’t Have to Bite

High-potassium foods are a “must-have.” More important than “low-sodium”!

People in the free-living world aren’t going to stop eating their favorite savory foods and they shouldn’t have to.  It’s time we accepted that and focused on encouraging everyone to eat more high-potassium foods. This latest study suggests it may be more effective anyway.

While the research continues, make sure your favorite savories keep better company:

  • Ham sandwich?  Instead of the chips and soda, try an apple or banana and some iced tea.
  • Going out to dinner?  Start with a salad – dressing on the side so you stay in charge.  Have a nice baked potato – sour cream has no sodium! 
  • Soup’s on?  Add some beans and greens for good measure.
  • Bacon and eggs?  Lox and bagels?  Have a fruit and yogurt parfait along with it.  Or at least a glass of OJ or a banana.
  • Get the herbs and spices into everything: soups, salads, meat, fish, even yogurt!  Dried or fresh, herbs and spices are loaded with antioxidants and replace the need for some of the salt.

There’s no requirement for a specific fruit or veggie to be healthy.  Just eating more fruits, veggies and dairy foods is a start and a good one.  It’s a super-tasty way to get healthier all-around – and just by eating, because these foods also fill nutrient gaps.  The benefits go way past getting more potassium. 

Your Headphones Won’t Mask the “Noise” In New Egg-Heart Disease Study

For years, all you heard about eggs was that they were “linked with” heart disease.  Keep consumption to a few eggs per week and dietary cholesterol to less than 300 mg. per day. Since one egg has about 185 mg of cholesterol, you really had to be careful how you spent those 300 mg. 

Then, research found saturated fat to be riskier for heart disease than dietary cholesterol, but the egg damage was done.  Finally, the 2015 US Dietary Guideline for Americans finally dropped it’s 300 mg/day cholesterol limit.   

Eureka!  Progress!  Eggs Are Back!

Give up omelets? Say it ain’t so!

Just when consumers were getting comfortable having an omelet again, here comes a new study in the Journal of the American Medical Association that claims an “association” between egg consumption and heart disease.  At first glance, the study seems impressive:

  • They looked at 6 different populations or “cohorts”, covering a 17-year period, on average.
  • They calculated hazard ratios (HR) and absolute risk difference (ARD) for cardiovascular-related deaths and all-cause mortality.
  • They adjusted for “demographic, socioeconomic, and behavioral factors.”

Here’s what they concluded

“Among US adults, higher consumption of dietary cholesterol or eggs was significantly associated with higher risk of incident CVD and all-cause mortality in a dose-response manner.”

They say that, for every 300 mg of cholesterol you eat, your chances of dying from heart disease in 17 years (assuming you’re over 50) are increased by about 17% and your chances of dying of anything at all are increased by about 18%.

But the average consumption of both eggs and dietary cholesterol was modest.  Even the cohort with the highest consumption of eggs ate only 0.42 eggs/day – less than 3 eggs per week!  Average dietary cholesterol intake was: 240 mg/day – well under the previously recommended 300 mg/day.

Turns out that, in this study, cholesterol become the issue, not eggs, but even when you just look at cholesterol, it’s important to hear the study’s “noise”.

The “Noise”, a.k.a. Weaknesses & Limitations 

It’s problems, plural, and the authors acknowledged some of them, but still felt entitled to make some strong conclusions (and I feel entitled to strongly disagree with them):

  • “Associations” and “linked-to” don’t CAUSE anything.  Anytime, and I mean ANYTIME you hear about a study that shows a food is “linked to” or “associated with” a disease or condition, it does NOT indicate the food CAUSES that condition, yet journalists often don’t get this concept.  These “Observational” studies are incapable of doing anything more than generating a hypothesis.
  • All the dietary data came from a SINGLE dietary report, and a self-report at that.  That’s like asking thousands of people about their diets on one day, and track how many die in 17 years.  Then draw conclusions about their deaths based on what they ate on that single day.  
  • Different dietary survey methods were used, so there was no uniformity of measurement.  To deal with that, the authors use a lot of statistical methods that “harmonize” the data and supposedly give you a better picture.  All methods still involved self-reports however.
  • Poorly surveying a large number of people doesn’t make data more reliable, no matter how you “harmonize” the data.  In this study, it still means 29,000 people were poorly surveyed.    
  • This study assumes a stable diet and lifestyle for 17 years, and that’s unrealistic.  No matter how many statistical tests you do, or how much “statistical significance” you find, no one – but no one – has that kind of stability for 17 years. 

Who knows what other lifestyle factors that evolved during the 17-years after the original dietary data were taken?  The authors do not, and the study cannot tell anything about what influence such factors might have had.

Yes, they’re STILL incredible…
….even for your heart!

Cut-To-The-Chase-Nutrition Reality Check

The egg has nourished people for thousands of years.  It has the highest quality protein of any food (it’s neck-and-neck with dairy), and critical, hard-to-get nutrients like vitamin D and choline.  Eggs also have the antioxidants lutein and zeaxanthin, known to help reduce the risk of age-related macular degeneration.  And they’re actually low in saturated fat. 

  • Pair your eggs with other good foods.  Scramble or fry them in olive oil, have them with fresh fruit and whole-grain toast.  It’s breakfast, but also lunch or dinner.
  • Balance it!  Greek yogurt with that fruit will round out the meal, or combine them in a smoothie as a beverage with those eggs.   
  • I keep hard-cooked eggs in my fridge as a high-protein snack.  Spread them with some Dijon mustard or hummus and keep hunger pangs away. 

The Easter bunny can rest easily.

Wanna Eat Healthy? Get Your Nitrates!

Think nitrates in your food and eating healthy don’t go together? What’s this gorgeous spinach salad have to do with nitrates? Read on, but let’s start at the beginning.

You’re not going vegan but you want to eat better and you’ll start with baby steps, like I talked about in my previous post.  OK, and here are some popular intentions:

  • Try and eat more leafy green stuff.
  • Definitely cut the hot dogs, ham, bacon, the deli stuff, and “processed” meat, even if it’s lean.  Everyone knows that stuff is “bad” because it has nitrates, right?

Swapping out hot dogs and ham for spinach and beets (the new “in” veggie for 2019, as I mentioned here) would at least cut back on the nitrates, right?  Wrong. 

Where the Real Nitrates Are

Indeed, a bunch of healthy, nutrient-rich veggies like beets, spinach, celery, even iceberg lettuce and broccoli, have more nitrates than that hot dog you snuck in for lunch last week.  Check out this chart from a 2012 report of the nitrate content in foods.  Amounts are in “parts per million” (ppm):

This image has an empty alt attribute; its file name is mushrooms-417101_1280-2.jpg
More nitrates than a hot dog — & it’s healthy food!
  • Beets: 2797 ppm
  • Spinach: 2333 ppm
  • Celery: 1496
  • Mushrooms: 590 ppm
  • Broccoli: 394 ppm
  • Strawberries: 173 ppm
  • Cured sausage (hot dog), cooked: 32 ppm

Are Nitrates in Fruits and Veggies a Problem?

No, and not in other foods either, according to Melissa Joy Dobbins MS, RDN, CDE and known as The Guilt-Free® RD.   “This is a great example of how misinformation can create a “fear factor” when it comes to food. I think most people who are concerned about nitrates/nitrites would be surprised to learn that the majority of these nutrients in our diet are not from cured meats, but from plant foods, namely a variety of vegetables.”

Dobbins’ statement is evidence-based and reflects the conclusion of this 2015 meta-analysis of many studies on dietary nitrates, nitrites, and nitrosamines, which found nitrates associated with a decreased risk of gastric cancer.  The slight increased risk associated with increased nitrite intake was considered weak, and tended to come from weak or poorly-designed studies, which muddied their findings.  Even then, spinach still has more nitrites than cured sausage.

Nitrates & Their Cousins: Nitrites and Nitrosamines

Here are the basics you need to know about these:

  • Nitrates are naturally present in lots of different foods. 
  • Nitrites are also naturally present in foods but most are formed when bacteria in your saliva convert nitrates to nitrites. 
  • Nitrosamines are not naturally present in food but can form in food through several pathways.  Cooking at a high temperature, such as frying cured meat, or when an acid (like stomach acid) is present.  If there’s any concern, it’s with the formation of nitrosamines.  Even then, conversion from nitrite to nitrosamine can be inhibited or stopped by the addition of compounds like ascorbic acid, or “vitamin C”.  Seriously – check the ingredient label of many cured foods like hot dogs and you’ll find “ascorbic acid” is often present. 

“Nitrate-Free” Cured Meat?

There are cured meats labeled “no added nitrates.”  What they add instead is celery powder.  As you’ll see from the table above, celery is loaded with natural nitrate.  There’s no evidence that there’s any difference between the nitrate in celery powder and the nitrate added to “nitrated” cured meat. 

Celery: Fine wherever you find it

Nitrates: The Boil-Down

It’s ironic to know that someone eating a spinach salad is probably getting 10 times more nitrates than the person eating the ham sandwich, but Dobbins noted, “Does that mean we should be afraid of eating vegetables? No. It means we should look at the overall nutrients a food provides and try to consume more nutrient-rich foods and fewer empty-calorie foods.”

It may be that the folks who eat lots of cured meat may also have a less-healthy lifestyle overall.  They may be less likely to engage in regular physical activity, and less likely to eat a lot of veggies and fruits, and may drink more soda or eat more junk snacks.

Cut-To-The-Chase-Advice

Eat all the spinach, beets, mushrooms, celery and broccoli you can fit into your diet.  As for cured meat, I like Dobbins’ approach. Nitrates may not be an issue but balance still is, so don’t go crazy at a cold-cut buffet.  If you like cured meats, make them leaner cuts, like ham, instead of sausage.  And have that ham with lots of veggies – even high-nitrate ones like spinach and broccoli.  A meal loaded with nitrates can, and should, still be healthy.  0000000000000

Learn From a Baby About New Year’s Resolutions

Even a baby who hasn’t seen his/her first New Year can teach us something about making resolutions.  Babies may not think about their health, but this poll done in the UK found the top 3 resolutions for adults:

  1. Lose weight
  2. Get fitter
  3. Eat more healthy

Wisely, the poll also followed up with these people.  Nearly two out of three who made resolutions keep them and more than 4 in 10 broke a resolution within the first month.  Only 1 in 3 kept going for more than a month. 

Resolutions: They’re FOR the Year, so TAKE All Year

Imagine if a baby stopped trying to walk after falling?  Every single human would be immobile.  A broken resolution isn’t a failed resolution!  I wouldn’t even call it broken – just “in progress.”  The flip side is to expect 100% perfection 100% of the time, right from the start.  Ridiculous.  You get up, look at where you tripped up, and move on. 

This study found successful “resolvers” used more behavioral strategies, which, by nature, require more time, because behaviors change slowly.  Every road has a pothole or two, so if you encounter one on your journey, you’re typical and on schedule.  Keep it moving.

Ready, S.M.A.R.T., Go!  –Anytime

Learn from these guys

Never mind January 1, whenever you’re ready, the calendar will support it.  Just see a resolution as its own project.  Give it priority and treaty it with some respect.  This is you, after all.

S.M.A.R.T. is just an acronym for the components of successful goals and objectives, whether in the workplace or your personal space.   The letters have stood for different things over the years, but here’s where they stand now:

  • Specific: keep it simple, something you KNOW you can achieve. “I’m going to eat healthier” isn’t specific.  “I’m going to eat 1 cup of fruit and a cup of vegetables at least 3 days a week” is more specific.
  • Measurable: Note how far you walked, how many vegetables you ate, or whatever your specific objective is. Forget obsessing about every detail.  Again, simple is key here.
  • Achievable: Specific and achievable are two sides of the same coin.  THINK LIKE A BABY here.  Take baby steps!  Set a goal you think is achievable and then reduce the goal by 50% or more.    You can inch up later. 
  • Realistic: Meet yourself where you live.  If you can’t spare a whole hour a day for exercise – or if you’re not in shape yet for that – it’s OK.  I don’t care if you start walking for 5 minutes a day.  You’ll be at this the whole year and you’ll get where you need to go.  An easy goal is the best kind when you’re starting out. If you want to lose 10 pounds of body fat in 3 days, that’s specific but not realistic. 
  • Time-bound: TAKE THE WHOLE YEAR but set small time goals for the baby steps.  You’re building a habit here, and habits take time to become established. 

We want everything done immediately and easily sustained forever.  Let that concept go, because it’ll never happen – for anyone.  Most importantly, THAT’S OK. 

Baby steps & persistence!

Babies Have Vitamin “P”

Back to babies.  They’re loaded with vitamin P – persistence and patience!  Even better – they LOVE the journey and what they accomplish along the way!  Have you ever seen a baby’s expression when they crawl farther, learn to hold a spoon, or stand for the first time?   Give yourself a little credit for taking those baby steps.  They’re the best kind!

Believing Junk Is Even Worse Than Eating Junk

If you’re of a “certain age” you’ll remember “Vacupants.” You hook up a vacuum to the hole in the special “pants” and the fat melts off.  The idea was that it somehow “vacuumed” away the extra weight.

You might think this could never happen in the age of digital media but you’d be wrong.  It happens plenty, just differently.

The food, nutrition, and diet world is loaded with sensational and extreme headlines and promises.  We gravitate towards the sensational. The promise of a quick fix has a magical way of grabbing your attention and won’t let go.

It’s the modern-day version of the “snake-oil” sales pitch.  You’ve probably seen headlines touting:

• “Lose 10 pounds in 3 days without doing exercise or changing your diet!” (Similar to the Vacupants claim — see how much things have changed?)

• “Lose all the weight you want eating junk food!”

• “This miracle food speeds up metabolism!”

Most common now are diets that spout the total avoidance of a food or even entire food groups. Think about carb- and sugar-phobia that lumps empty-calorie foods together with great foods like beans and fresh fruit. Or the keto diets that demonize most carbs, including whole grains and most fruits and vegetables, and hold the state of ketosis on a pedestal. In truth, ketosis is something that should generally be prevented, not promoted.

Then there’s the scare-tactic approach:

  • “10 Foods You Should Never Eat”
  • “Your Body Can’t Process These 3 Foods”
  • “5 Foods That Cause Belly Fat”

“Absolute” Exploitation

These sensational promises, extreme claims, and headline-grabbers exploit people who are vulnerable, undereducated or just misinformed. Someone with a health issue, including someone trying to lose weight, is vulnerable, even desperate for a solution, making them easy prey for junk science purveyors.  Health issues are sensitive, lots of emotions are involved, making them vulnerable to quick-fixes, magic bullets, and instant cures – just the type of stuff that makes up fad dieting.

Educated people aren’t insulated either. “Vacupants” was marketed as a quick weight loss method.  Laugh if you must, I once had a patient, an educated woman, who admitted she’d bought this gizmo. No, they didn’t work. She’d have been better of if she’d put on some actual sweats and gone walking for half an hour a day instead.

We all like being told something that fits with our values or what we’d LIKE to be true.  Eating junk can be over in a flash but believing junk can continue for years.

10 Red Flags of Junk Science

Tufts University does a nice job of explaining these in detail, but this is the Cuttothechase version:
1. Promises of a quick fix. File “miracle foods” under this one, too.
2. Danger warnings of a single food.
3. Claims that sound to good to be true. Hint: they are too good to be true.
4. Simple conclusions from a complex study. Oversimplifying often indicates taking results out of context or omitting caveats.
5. Recommendations based on a single study. If it cannot be replicated, it’s probably bogus or at least cherry-picked. Pass.
6. Statements refuted by reputable health organizations. If they’re reputable, they require solid evidence. Key word: solid. If they pass on the claim, you should, too.
7. Lists of “good” and “bad” foods. #ridiculous
8. Recommendations made to help sell a product or supplement. This doesn’t mean it’s junk, but if it’s good, check for lots of evidence and organizations that agree.
9. Research that is not peer reviewed. Big red flag for research that’s badly done.
10. Recommendations from studies that ignore differences among individuals or groups. There can be differences between genders, smokers vs. non-smokers, young and old age groups, the works.

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.  

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.

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

Can You Be Fit But Fat? New Study Has Some Answers

And can you reduce your risk of a heart attack? That’s what a new study asked, and the results were recently presented at the annual meeting of the American Academy of Sports Medicine (abstract 366, specifically).

It’s the question everyone wants answered, given that nearly 2 out of 3 people in the US are overweight or obese. (The photos on this post are of military personnel. Even they struggle with weight and fitness!) The idea being, do we have to be focused on weight if we’re willing to do our aerobic thing, or strength training, or just leading an active lifestyle, with things like regular biking, tennis, and recreational sports and activities?

New Findings

This research, known as Tromsø Study, was carried out over 34 years, from 1979 through 2013. When you look at heart attack risk, long-term data studies are preferred, but by their nature, it takes a oong time to learn the results. That’s what makes this study more significant. Participants were grouped based on the activity levels they reported:

Low activity – walking, gardening, etc. less than 4 hours per week.
Moderate activity: walking or gardening at least 4 hours per week.
High activity: running, biking or similar things that get the heart rate up, at least 4 hours per week.
Vigorous activity: engaging in competitive sports regularly.

Being active at any weight helps

This is the good news. Highly active people at any weight cut their risk of heart attack by about 12% versus those in the low-activity group.

Those engaging in regular “vigorous activity” cut their risk by 37% overall. Among those who were overweight or obese, the more active they were, the lower their risk of a heart attack.

Being overweight or obese mattered more

Even after adjusting for age, gender, smoking, and activity level, the overweight and obese people had much higher risk for a heart attack than normal weight people. Even active obese people were more than twice as likely as inactive normal weight participants to have a heart attack.

HOLD ON! – This Study Wasn’t Perfect

No study is, and the researchers call out this study’s weaknesses and limitations:

• Heart attack was the only health issue studied. Being active DOES benefit other chronic conditions like hypertension and type 2 diabetes, to name only two, but these weren’t addressed by this study.

• Activity levels were self-reported. Sorry – but people are known to report higher levels of activity than they really engage in.

• Body composition wasn’t studied. The researchers used the body mass index (BMI) to classify people as normal weight, overweight, or obese. It’s possible to be overweight but not overfat, especially if you engage in lots of strength training and are thus very muscular, although this is not as common as you might think. Flipping this around – you can be normal weight and still have too much body fat.

Cut-to-the-Chase Advice

1. Do what you can do. Being active at any weight is better than being inactive. Check with your doctor to see what activities are right for you. Running and high-impact stuff just isn’t right for everyone.  I don’t like “perfect”.  I like “better.”  My colleague Liz Ward’s mantra is, “Better is the new perfect.”  Way to go, Liz!

2. Consistency is everything. Aim to be active every day in some capacity – even if you’re normal weight.

3. Forget trying to be a “perfect” weight. Pick a weight you can maintain. Work on holding it there for a few months, then re-evaluate. Maybe that’s where you’ll stay, maybe you’ll take it down a bit. If you do go for less weight, take it five pounds at a time.

4. For activity: DO WHAT YOU LOVE. Then love that you can do it. I’ve worked for many years with people who have physical disabilities. They’d give anything to have the option to take the stairs or just go for a walk. Embrace the gift of your abilities.