Diet Or Exercise: What Matters More For Weight Loss?

“Exercise doesn’t matter. You just have to eat less” 

“Diet doesn’t matter much, as long as you exercise.”

A new study in the Journal of Nutrition says being more active not only won’t help you lose weight, it won’t even burn extra calories overall, at least in kids. The authors found that active kids and sedentary kids burned the same amount of calories, just doing different things. The active kids – rural Ecuadorian children who did a lot of subsistence farming activity – burned fewer calories when active, compared with the sedentary kids from “peri-urban” Ecuador.

Conversely, when the active kids were at rest, they burned more calories than the city kids did, so over the course of the day, they all burned about the same number of calories.

There were no differences between the two groups of kids with respect to height, weight, or BMI, but here’s where they did differ:

  • Active kids had less total body fat and percent body fat.
  • Active kids also had significantly more “fat-free mass” (read: muscle)

Hmmm, doing more laborious activity, they had more muscle and less body fat than their sedentary counterparts, but still didn’t burn any more calories at the end of the day? Seems odd?

I’m not surprised, and here’s why:

The kids doing the farm labor every day are in better physical condition. Their greater muscle mass and lower fat percent attest to this. Their bodies have adjusted to doing more physical activity by becoming more efficient with how they spend calories. The result: less difference between the energy needed for their activity and what they burn when they’re sitting.

Take an extreme example: a 150-pound runner who runs 10 miles a day, and a 150-pound sedentary guy who never exercises. Who is going to exert more effort on a 10-mile run? The sedentary guy of course, because his body isn’t conditioned for it. The runner’s body just sees it as another typical day, whereas the sedentary guy is gasping for air after a half-mile. The runner still burns calories while running, to be sure, but the sedentary guy burns more.

On the other hand, the runner may also burn a few more calories when at rest, because his metabolism doesn’t slow down to the degree the sedentary guy’s does. The runner’s body is anticipating getting back to physical work before long.

Is exercise useless?

Hardly – and we shouldn’t entertain that thought. Being physically active has endless benefits, and the study’s authors say so. However, their suggestion that overweight and obesity are driven primarily by diet, with a minor – if any – role played by physical activity, is not shared universally, and definitely not by me. I CANNOT separate the two.

Diet & activity changes often happen simultaneously, making it difficult to know which one has more influence. When kids (and adults) move to urban centers and do less physical activity, their diets typically also change to include more refined grains, and added sugar and fat, and fewer fruits and vegetables. They also snack more. They also do far less physical activity.

Instead of thinking it’s “either/or”, let’s try a different approach: Look at how people successfully lost weight and kept it off.

Enter the National Weight Control Registry (NWCR)

The NWCR, started in 1994 by James Hill and Rena Wing, has amassed a database of over 10,000 people. To qualify for inclusion, you must have lost at least 30 pounds and maintained the loss for at least a year, all objectively documented, so no fakes here. The NWCR has published many research papers about the results, finding that people lost weight in a wide variety of ways, yet there were surprisingly common factors about how weight loss was maintained. Just a few:

  • 47 out of 50 have increased their physical activity, most commonly by walking.
  • 9 in 10 exercise an average of 1 hour a day.
  • 49 out of 50 did modify their food intake in some fashion.
  • They’re doing fewer sedentary activities: 6 in 10 watch less than 10 hours of TV per week(!)

Cut-To-The-Chase Takeaway

Diet and physical activity: we all need to be mindful of both – for our health, our weight, and our enjoyment of life. Let’s make a point of enjoying the benefits of each, and be glad we can.


**NEWSFLASH**  I’ve joined the website The Chocolate Life, as author and contributor.  Check out my posts here

It’s nearing Valentine’s Day, a.k.a., The Big Chocolate Holiday, and fine chocolate is top of mind for many. (It’s on my mind 365 days a year.) Describing chocolate as “fine” however, may not mean what you think.

The National Confectioner’s Association has their own way of distinguishing “fine” chocolate from what they call “premium” and “mainstream” chocolate. I’ll “cut-to-the-chase”:

  • Mainstream: This is your widely distributed, familiar-to-everyone chocolate you see in the supermarket, convenience stores, newsstands, airports, etc. Hershey’s, Nestle, and Mars are some of the largest companies in the US making mainstream chocolate. Typically less than $8/pound.
  • Premium: You’ll find it in supermarkets, on the “higher-end” shelf.  Think Lindt, Green and Black, Ghirardelli, Ferrero, and the like. Some of these companies also operate their own boutiques, with varieties or flavors that may not be available in mainstream chocolate. Typically at least $11/pound.
  • Fine: Here we get into the “craft” and artisan chocolate. Usually the makers are smaller companies that source their cocoa beans from specific nations, regions, or directly from the cacao farmer him/herself. Sometimes they do “varietal” bars using only cacao beans from a particular nation or region of a nation. They often tell you on the wrapper the process they go through to make the bar, and some tasting notes to look for, similar to a label on fine wine. Price? High and higher. I’ve seen bars that might be $9 but are tiny, only 25 GRAMS (less than an ounce!). That translates to over $150/pound.  See below for an explanation.

The Cocoa Beans

Cocoa beans come in many varieties, but the three main ones are:

  • Forastero: grown in all cacao-growing regions but most comes from West Africa. It’s the heartiest and the easiest cocoa bean to grow, and makes up about 80% of global production. Flavor-wise, it has a reputation for having a less complex flavor profile, but there are some exceptions, noted below.
  • Criollo: the finest variety without question, prized for its nuanced flavor, dependent on the “terroir”, soil conditions, and of course, how the farmer handles it. It brings the highest price, so all fine chocolatiers want it, but it’s also finicky to grow. Most is grown in South America and it makes up only 5% of the global supply of cacao. A sub-category is the Porcelana cocoa. Absolutely fabulous, and the “Tiffany” of chocolate. Melts in your mouth and melts your credit card.
  • Trinitario: this is a hybrid of the first two, first developed in Trinidad but now grown in other regions. It has some of the fabulous flavor nuances of the Criollo bean but also some of the heartiness of Forastero, so it’s a lot easier to grow than Criollo beans.
  • Heirloom: these are varieties – often of Forastero beans – that are not widely grown and usually native to a particular region. Best known is the Arriba Nacional bean from Ecuador. It has a designated origin, meaning that no bean can be so named unless it’s from this varietal grown in this region.

Why’s The Price So High?

Fine chocolate — especially “craft” or artisan chocolate — isn’t cheap. It just isn’t. Small craft chocolatiers can’t buy in bulk, and the best cocoa beans are produced in relatively small quantities. At every point on the road from bean to bar, it’s labor-intensive work.

Be sure what you’re paying for, though. Elaborately decorated boxes and packaging, especially around special holidays, make a great gifts, but when buying for myself, I skip it. If it’s truly fine chocolate, I also shy away from bars that have lots of “bulk items” added. When bars are loaded with whole hazelnuts, macadamias or dried cranberries, they bring curb appeal but also add non-chocolate weight. If I’m paying $10 or $12 for a 75-gram bar of artisan chocolate, I don’t want cheaper add-ons taking up space!  Flavorings, OK. Groceries, no. Just a personal preference. 

Mindful Enjoyment!

I liken a high-quality craft chocolate bar to good wine. I don’t gulp either one. Just savor, enjoy, and don’t rush it.

Final word: The above is my take on fine chocolate.  You deserve your own preferences so eat the chocolate YOU enjoy!  


COVID-19 Sheltering: The “Big Pause” Is Cleaning Our Air

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.  This post was reviewed for accuracy by USDA.

Staying home has made us all a little grumpy and impatient.  I love banana bread, but if I see one more recipe for it, I think I’ll explode. 

Take note of how drastically “The Big Pause” has changed how we live:

  • We’re driving less, if at all. “Rush hour?”  Almost a memory.  
  • Air travel has ground to a near halt. There are 40% fewer flights worldwide, according to Forbes.
  • Business “travel”? That involves walking from your bed to your laptop.  A couple of clicks and you’re in your meeting room.  Dress code: “way casual.”
  • Leisure travel? A dream. The summer vacay you work 50 weeks a year for will probably look a little different.  Even if you can get a flight or are willing to drive or ride a train, you’ll be extremely limited once you arrive.  Even the New York Hilton locked its doors! 

Global Sheltering: An Environmental Experiment That Could Never Have Been Done

We’re subjects in an environmental research study that would ordinarily be impossible to do.  Believe it or not, there IS something good about staying home.  The good in the air is the air itself. A new report from IQAir, a Swiss-based air tech company, found an unprecedented improvement in air quality since the world started to shelter in place.

This report looked at levels of “PM2.5”, which stands for “particulate matter with a diameter of 2.5 micrometers or less”, in 10 cities around the world during a 3-week lockdown period, and compared them to the same periods in 2019.   Of all air pollutants, the PM2.5 category is considered the most hazardous to our health.  A detailed explanation is available here

Lockdowns in each nation started at different times, but most of the 3-week time periods ended on April 13, 2020.  Some examples of the PM2.5 reductions:

  • Delhi, India: ¯60%
  • Wuhan, China: ¯44%
  • Seoul, South Korea: ¯54%
  • Los Angeles: ¯31%
  • New York City: ¯25%

Peer-reviewed publications have also weighed in.  This recent study on air quality in India echoes the IQAir report. It looked at changes using the Air Quality Index, which measures greenhouse gases (GHG) and particulates in the air, using a scale from 0-500 with 0 being healthiest levels and 500 being unhealthiest levels.  In Delhi, the Air Quality Index (AQI) averages around 175 (“unhealthy”).  At the end of the 3-week period, it fell within the “good” to “moderate” range, levels that have seldom been seen – or inhaled – more than a few times in the past several years. 

Where Do Methane                                            & Animal Agriculture Fit In?

Prior to COVID-19, if anyone had asked the question, “What’s the biggest contributor to greenhouse gas (GHG) emissions, a likely response, albeit incorrect, might have been, “all the methane from animals, especially from beef and dairy.”  However, the transportation sector is consistently the largest contributor of greenhouse gas emissions.

The better air quality since the lockdown, however, occurred with stable livestock levels, evidence that this huge improvement in air quality was not agriculture-related. Indeed, India is nearly 38% vegetarian, so beef consumption per capita is low, yet it saw some of the most significant reductions in GHG emissions during the periods studied.  

In the United States, ALL of agriculture, plants and livestock combined, contributes only about 10% to total GHG emissions.  Livestock accounts for 3.9%, with beef contributing a mere 1.9% of total GHG emissions. 

GHG From Agriculture: More Positive News

According to a 2005 report issued by the Intergovernmental Panel on Climate Change, issued (doc page 46, PDF page 63), “Since 2000, GHG emissions have been growing in all sectors, except in agriculture, forestry and other land use.”  Indeed, global GHG emissions from agriculture have DECLINED since 2000, likely owing to advances in agricultural science, better farming technology and animal science practices, given that production has improved and the human population has increased during this period. 

I cannot speak to farming and livestock practices everywhere in the world. I do know, however, that livestock raised in the US, particularly beef and dairy cows, are raised much more efficiently, with better land stewardship and modern practices, than elsewhere in the world.

Cut-To-The-Chase-Nutrition Take-Away

I support whatever eating style you choose, provided it’s balanced, healthful and enjoyable for you.  But first get all the accurate facts and credible evidence available to you.  Then, you know you’re making an informed choice.

My “Improv” Beef Salad: Absolutely Plant-Based

Whenever I notice lots of odds and ends in the fridge, (think half can of kidney beans, a small hunk of cheese, leftover veggie stir-fry from two nights ago), I improvise a dinner from them all, plus some fresh ingredients to round it out.

Today was one of those days: too hot to want the oven on and a lot of leftover goodies that deserved attention. We eat a very plant-based diet, but I also had about half a pound of lean top round steak that I knew would cook quickly. Done.

I just rubbed the steak with garlic powder, oregano, dried Italian herbs, and Old Bay seasoning (this stuff isn’t just for shellfish!). Into the cast-iron pan for few minutes on each side and the cooking was done – almost. To the beef bits at the bottom of the pan I added just a little EVOO and caramelized half a sliced onion slowly.

Here’s the “improv” part: greens of choice but basically anything edible you have on hand that can be eaten chilled or at room temperature. Here’s what happened tonight:

Farmer’s market stuff:

• Golden beets, just steamed
• Radish greens and beet greens that I had stir-fried yesterday.
• Tomatoes
• Fresh corn, removed from the cob after cooking

Other odds and ends:

• Celery stalks and leaves
• Garbanzo beans
• Bean salad (made with elephant, or “gigante” beans) from the Greek deli
• Greek feta (not local but the Greek deli sells the best), used up what was left
• Black olives from the deli bar

It was delicious and plant-based, but included every food group:

• Lean meat: the top round has 200 calories in 4-oz and that includes 29 grams of protein. If I’d had a smaller steak, I’d have used less.
• Dairy: love the tang from the feta
• Legumes: two types of beans – garbanzos and giant elephant beans, all told about half a cup per serving.
• Veggies: loaded. Absolutely loaded. The corn? It’s a whole grain, even if it’s often considered a “starchy vegetable”.
• Fruit? I suppose you can count the tomato. Sometimes I add an apple, cut into chunks, but I had so much stuff to use up it wasn’t necessary.

• Legumes: two types of beans – garbanzos and giant elephant beans, all told about half a cup per serving.
• Veggies: loaded. Absolutely loaded.
• Fruit? I suppose you can count the tomato. Sometimes I add an apple, cut into chunks, but I had so much stuff to use up it wasn’t necessary.

I’ve often included some dried cranberries and walnuts or pecans, if there were small amounts left in bags. After all, this is a meal to tidy up the fridge and the pantry.

Top round steak is a lean cut and 4-oz. is plenty, especially with all the other ingredients. You can dress this platter with oil and vinegar, but I just used some balsamic.

Note: this platter had only 4-oz. of beef. The salad was large but a lot of it was airy greens at the bottom. I made 2 platters – my other half enjoyed the other one!

Champagne steak salad

You can get a lot of delicious, lean, and professionally tested recipes, like this champagne steak salad, at beefitswhatsfordinner, or you can use the beef you have on hand and “improv” your way to a terrific, plant-based beef dinner on your own.

Food Fashions: Full-Frontal & Fickle!

It’s coming up on Fashion Week in New York and while that’s all about styles of clothes, foods come into – and go out of – fashion, too.  A previous post dealt with foods that nutritionists never thought would become popular, yet they did just that. 

Now think of the foods that were “in” — for a while.  I actually heard or read these comments recently:

  • “I’m so over kale, already.”  I read this comment by a former editor of a prominent food magazine. (Cauliflower is the new kale, if you’re wondering, but beets are gaining.)  
  • “Cottage cheese? What are you, like, 80?”  (This was said to me and no, I’m not 80 — but hey, nothing wrong with 80!)
  • “A baked potato?  A white one? Are you serious?”
  • “I don’t’ do bread.  All that gluten.  Quinoa is my thing.”
  • “She wants a Cosmo? No one drinks those anymore.”

All the above foods (excluding the Cosmo) are delicious and healthful.  They’re also “out of fashion” (including the Cosmo).  If this sounds a little ridiculous, read on.

Food Fashions Fade, Food Value Doesn’t

People may be “done” with kale, but is it less healthful than it was when it was “in”?  Of course not. It’s a superfood.  A baked potato is one of the best sources of potassium, even better than a banana, and has as much vitamin C as a tomato!  It always has!  Even so, all the buzz is that white potatoes are bad and sweet potatoes are a little better, but still a “starchy vegetable” to be eaten in minimal amounts. (Thanks, Harvard.)  

Fashion eating aside, the nutritional qualities of these foods have ALWAYS been there.  Whether it’s kale or cauliflower, or They’re as nutritious today as when they were first “discovered” by food fashionistas. 

Consider the following:

A healthful Russet Burbank white potato grown in Idaho!
  • Kale is every bit as good for you now as it was when you first tasted it.  It may even taste better now, since all that attention motivated chefs to develop inventive ways of eating kale.  Bravo.
  • White potatoes. Before you were told of their “horrors”, they were a staple food for millions of people from Paris to Poughkeepsie to Peru.  The nutrition they had is the nutrition they still have.  (Check out for a ridiculous number of facts and recipes. 
  • Bread?  It takes a hit for having “carbs” and gluten, which celebrities tell us are both bad (proof you should never get nutrition advice from celebrities).  Yet, it’s been a staple, indeed, the “staff of life” in many cultures throughout history.  Made with whole grains, it’s also loaded with fiber, vitamins and minerals.  It’s versatile, oh, and people like it. 
  • Cottage cheese?  PLEASE!  If you think it’s only for elderly ladies who lunch, experts disagree. registered dietitian nutritionist and exercise physiologist Jim White is one guy trying to set the facts straight about the value of cottage cheese. “If your goal is to increase lean muscle, mass try cottage cheese with a serving of your favorite fruit after a hard earned workout,” he says. He educates clients that a typical cup of low-fat cottage cheese boasts a walloping 27 grams of protein for those muscles, plus 200 mg of calcium to support bone health.

Sometimes fashionable eating can have benefits.  I love anything that gets people eating more veggies, yogurt, and whole grains of any kind.   But I get concerned that people strop eating these foods when the trend fades and the benefits also go missing from their diets, especially if they replace them with something less healthful.  (Example: plant-based “milks” are more hype than benefit.)

Cut-To-The-Chase Advice

Work it.  Let food fashions motivate you to try a new food.  If you like it, keep eating it!    If it’s nutritious and out of fashion, it’s still just as good for you as it was when everyone else was eating it to be “in.”  Never be intimidated about eating healthy food you like.

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!

CDC Report On Physical Activity: Some Good News (& Some Bad)

The good news?  We’re actually moving more!  This recent report from the CDC found that 23% of Americans are meeting physical activity recommendations established back in 2008. That’s even better than the goal set by Healthy People 2020 to have at least 1 in 5 Americans be “physically active”. We’ve exceeded the goal of 20% two years early, and since the CDC report is based on 2010-2015 data, probably even more Americans are active now.

The Bad News

If 23% are active, that means more than 3 in 4 Americans are sedentary. Even in Colorado, the most active state, only 1 in 3 adults met the activity guidelines, so 2 in 3 did not. A few other notables from the report:

• Women were less active than men in almost every state. Fewer than one in five (18.7%) women met the activity guidelines, but more than one in four men (27.2%) did.

• Working matters. If you’re unemployed, you’re less likely to be active. Nearly 29% of working men met the activity guidelines, for instance, but only 21% of non-working men did. Among working women, almost 21% met the guidelines, but only 14.6% of non-working women did. (Physical impairment to activity was not assessed.)

The Real Goal: We ALL need to be active

It’s easier than you think. Let’s be clear: you don’t have to join a gym, play a team sport, or be a competitive athlete. Please, I grew up totally incompetent at every sport that involved a ball. It’s about being more fit and staying fit, regardless of your age and weight, and there are many ways to get there.

Yes, your physical health will benefit, but the mood improvements may be even more motivating. Exercise gives you a mental lift, owing to the endorphins produced with moderate exercise. You don’t have to be a runner to get a “runner’s high”.

What constitutes being “physically active”?

The fed’s 2008 guidelines defined being “physically active” as follows:

• 150 minutes per week of moderate-intensity aerobic activity AND

• Doing muscle-strengthening activities at least twice weekly.

What’s “moderate intensity” activity?

• Brisk walking is a perfect example of moderate intensity. Brisk walking of moderate intensity was found in this review to be about 100 steps per minute. Easy enough for anyone to measure. (Tip: kids love using the stopwatch on their phones for tracking stuff like this!)

• Try the “talk-sing” test. If you can talk during the activity, it’s probably moderate intensity. If you can sing, it’s pretty light. That’s your sign to pick up the pace.

The Cut-To-The-Chase-Nutrition Philosophy: 


That 150 minutes a week (30-minutes a day for five days) may sound daunting, so break it up into 10-minute parcels. The best time to be active? When you WILL be active. No obsessions needed her, just move as often as you can, whenever you’re able.

Do it during your lunch hour for 10 minutes, then have lunch. Work up to a 30-minute walk on your lunch hour, then enjoy a healthy meal. Walking is the easiest and simplest, but it’s also effective.

Check with your doctor to make sure your body is ready to match your motivation. Safety first: don’t be a “weekend warrior” and do the whole 150 minutes in one day.

I always advocate being more active because I think I’m lucky to have the ability to do so. I’ve worked with people with physical disabilities for decades. They’d give anything to be active. I’m not wasting my physical abilities – and I still can’t catch a ball. Start SOMEWHERE, but start now, 10 minutes at a time.

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,  Caprese salad: Jessica Rossi,

You Can’t Get “Energy” From an “Energy Drink”

Kids and teens seem to want more “energy,” especially in this world where multi-tasking is expected and their desire for non-stop involvement with social media and all things “screen-based”.  Indeed, constant engagement is the new normal, to the point that kids (and let’s face it, adults, too) can fear disconnecting from it, even if that means cutting into sleep time. Indeed, Sleep can start to seem like a waste of time.

Enter: “Energy drinks”

Different from “sports drinks,” energy drinks are marketed for their ability to help with focus, concentration (although real evidence is sketchy at best), and overall vigor. The reality: anything called an “energy drink” is really just a liquid stimulant – something to give you a buzz. That buzz usually comes from the added caffeine, but these drinks often have potentially harmful herbs or other compounds as well, including:

• St. John’s wort,
• Yerba mate,
• Methylxanthines,
• Taurine, and more

These ingredients supposedly help improve “focus and concentration” (real evidence for this is sketchy at best) but can also interact negatively with medications kids might be taking.

Sure, coffee and tea have caffeine as well, but their caffeine content is proportional to their volume and even then, kids don’t need the caffeine in them either. If they like the taste of coffee (I do), there are certainly caffeine-free versions they can drink (count me in there as well). On the other hand, a 2-oz. “shot” of an energy drink can have the equivalent of 3 large cups of coffee – and anyone can slam that back in a gulp or two. The makers often throw in some vitamins and minerals to foster the illusion that it’s almost nutritious, but that’s window dressing and don’t be fooled for a minute.

Energy ≠ Vitality

What concerns me about these drinks is their potential for misuse by teens. One “energy shot” in the evening and they’ll be up until all hours, only to crash the next day when they should be – and need to be – rested and alert.

Some kids use the stimulants as a study aid or because they think the extra focus will help them on a test. Caffeine may or may not, but it’s certainly no substitute for studying and it inevitably has diminishing returns. Once started however, it can be a hard habit to break.

If you need more convincing that “energy drinks” are bad news, the American Academy of Family Physicians opposes even the sale of these drinks to persons under the age of 18 years.

The Bigger Issue: More “Energy” Isn’t the Problem

If kids — or adults — feel they need more energy, they don’t need a drink, they need more sleep. According to the National Sleep Foundation, 7 hours of sleep per night is the bare minimum acceptable amount for school-aged children and teens. Most need between 8 and 10 hours, and aren’t getting it.

Sleep is a big deal. It’s like oxygen – it has no substitute. When you’re well-rested, thinking is clearer, decision-making is more rational, less impulsive. Some hazards of not getting enough sleep:

• Eating impulsively – it’s the body’s futile attempt to get more energy
• Weight gain – see this recent study pointing to a lack of sleep as a risk factor for obesity in kids.
• Poor concentration, cloudy thinking
• Lethargy – you don’t want to be active when you’re already exhausted

What to do for more sleep

If you suspect your kids are using energy drinks, it’s crucial that they stop. Instead of being critical with them, just factual.  Make getting sleep a family priority. Here are some tips for creating a home environment that supports a great night’s sleep:

Shut it down. That means all technology — at least an hour before bedtime, preferably 2 hours. The world will spin, I promise. Cuts down on mindless snacking, too.
Remove screens from bedrooms.
Close the kitchen 2 hours before bedtime. GI tracts need time to wind down.
Bath time. A hot bath or shower relaxes everyone.
Warm milk. Don’t laugh. Warm drinks are relaxing, but the tryptophan in milk may even help produce some serotonin – the brain’s own sleep aid.  Plus, most kids — and adults — aren’t getting the calcium they need.  This helps close the gap — and maybe their eyes — a little more.


That’s what a just-published study suggests, and whether it’s actually true or not, it bears a closer look.

“Social jet lag”?

This is just the difference in our sleep schedules between workdays (for kids that means school days) and non-workdays. Usually it means we sleep later on weekends.

How could social jet lag make people fat?

This latest study, involved 3412 children ages 8-10 years, and found that those having a different sleep schedule on weekends (or non-work/school days) also are more likely to be obese and have metabolic differences associated with obesity, like a higher waist-to-hip ratio and higher body fat percentage.

Interestingly, the kids didn’t get any less sleep on weekends, they just went to bed later — about an hour later – and awakened that much later as well. Average delayed bedtime was about 43 minutes later than during the week, but most of the kids still slept their usual 9 hours (for adults, this is like a fantasy!).

This study can’t determine just WHY these results occurred because it wasn’t longitudinal, just cross-sectional. It’s possible that the higher weight of the late-sleepers is a lifestyle marker: kids who stay up later on weekends might also do more nighttime snacking.

It’s not just kids though. In this study of social jet lag in adults, the authors concluded, “misalignment of sleep timing is associated with metabolic risk factors that predispose to diabetes and atherosclerotic cardiovascular disease.” Even if we still manage to slog through the next day, but in the long run this practice may be doing more harm to our bodies and our weight than what we put into our mouths.

Re-setting our circadian clocks is totally doable

You or your kids may not be “morning people” but so much of their – and our – days, at least during the week, requires us to be awake and at our best in the morning.  Give yourself and the family some time to get this all done, but the steps are totally worth it, for better sleep, better functioning during the day, and maybe even better weight and health.

Here’s how to start:

Shut it down early. Even if you and your kids swear you’re not tired, cut the noise from TV, videos, and screens at least an hour before bedtime. Music is fine, but not stuff that makes you want to get up and dance.
• Lose the “blues” – blue light, from devices like cell phone and computer screens, but also from the TV and even the power lights from the routers and such, really interfere with sleep because they prevent you from winding down.
• No power napping in the afternoon. If your kids often need naps after school, they need more sleep at night, period.
Decaffeinate after noontime. The kids, too.  That means skipping colas, iced tea, and any of those sweet (and too caloric) coffee drinks that many teens (and adults) like.
Move more, sleep better. Daily, regular physical activity really helps re-set your sleep cycle. You’re more likely to want to wind down if you’ve been active during the day. It’s just healthy lifestyle practice anyway, and better sleep is another benefit.
CLOSE THE KITCHEN! Your digestive system has to wind down, too, and it needs to do so a good two hours before bedtime. You’ll get deeper, more satisfying sleep.