Liquid Calories

Listen to Katherine discussing juicing on National Public Radio’s Kojo Nnamdi Show on WAMU 88.5 FM.

Juicing is all the rage these days, with juice cleanses, celebrity juicers, and Starbucks opening its first Juice Bar. On National Public Radio’s Kojo Nnamdi Show, I discussed juicing and juices. Find the link below…

I’ve been drinking orange juice every morning of my life. You’d think I’d be sick of it by now. But every morning, I look forward to my “sunshine in a glass,” and it never disappoints. Especially on those occasions when it’s fresh-squeezed. I could live on the stuff. Just thinking of it makes me salivate!

But I save my juice for 4 ounces in the morning because, while it packs a nutritional punch, it also puts on pounds, and fast! Here’s how…

My client, Caroline, who was successfully losing weight, was disappointed one recent week that she didn’t lose weight as usual. It didn’t make sense to either of us. Her food intake was stellar. She was even a little more physically active than usual. It wasn’t until we reviewed her food diary thoroughly that we discovered the culprit was liquid calories, and they added up in a way that surprised her. In her case – as is the case with many of us  – that extra glass of wine or mixer, juice as a snack here and there, can add up in ways we don’t expect.

Liquid calories in just about any form, whether alcohol, juices, or sodas, are stealth calories. They come in undetected under the radar screen but have an impact that can be enormous. Scientific evidence is confirming that though these liquids count as calories, our bodies don’t detect them the same way they would if we were eating solid food. When we eat calories in the form of solid food, we naturally compensate by reducing the rest of our meal’s or day’s food intake. But when people ingest liquid calories, studies show, they don’t compensate for them by eating fewer calories.

“Fluid calories do not hold strong satiety properties, don’t suppress hunger and don’t elicit compensatory dietary responses,” says Richard D. Mattes, MPH, PhD, RD, Professor of Foods and Nutrition at Purdue University. “When drinking fluid calories, people often end up eating more calories overall.”

This may help explain the results of the Harvard Nurses Health Study of more than 50,000 women over eight years. The researchers found those who increased their intake of sugar-sweetened beverages, such as sodas or fruit punch, from one per week to one or more per day, increased their calories by 358 daily and gained significant weight. Women who reduced their intake cut their calories by 319 calories and gained less weight. Earlier studies demonstrated that consumption of sugar-sweetened soft drinks increased the likelihood of obesity in children, but this is the first finding from a long term observational study in adults.

The mechanisms controlling hunger and thirst are completely different, and liquids, even if they contain calories, don’t seem to satisfy hunger even if they quench your thirst. Physiologically, your thirst is quenched once your blood and cell volume is increased by water. This signals your brain that you are no longer thirsty.

Hunger is regulated in your stomach and intestines. While you’re eating, nerves in the stomach wall detect that it is stretching and send satiation signals to the brain. The intestines also release nerve regulators and hormones. At the same time, the hunger hormone, ghrelin, released by the stomach when it is empty, goes down. All of which help you feel satiated.

 There are several theories explaining why liquid calories cause lower satiety and increased overall calorie intakes, but it’s still not fully understood. First, cognitively, people have a harder time realizing that liquids count. Also, the mouth-feel of a liquid versus a solid may generate different signals, less time and involvement with food, and reduced psychological satisfaction. Finally, liquids, because they travel more quickly through the intestinal tract, alter the rate of nutrient absorption, which can affect satiety hormones and signaling. It’s likely that all of these reasons are relevant.

Emerging research is finding the hunger hormone ghrelin may play a physiological role.

 “When the number and type of calories are the same, the calories in liquid form won’t suppress ghrelin as effectively as if the same calories were in solid form,” says David E. Cummings, associate professor of medicine at the University of Washington and the Veterans Affairs Puget Sound Health Care System.

While Cummings hasn’t tested many types of fluids and their varying effects on ghrelin, other researchers have found drinking fluids may produce varying degrees of satiety, depending on what they contain.

It’s fairly well-established that alcoholic beverages and sugary liquids, especially sodas and fruit drinks aren’t completely registered or compensated for and simply add extra calories.

 “Some beverages cross over the line into being a food,” says Barbara J. Rolls, professor of nutritional sciences at Pennsylvania State University. She conducted studies which found people felt more satiated and consumed fewer calories when they had milk-based drinks at the beginning of a meal. The high protein levels in addition to cognitive beliefs about milk being a food may make it more satiating.  Also, fluids with food in them, such as soups, are very satiating.

 But most caloric fluids Americans consume are not satiating. When you consider that an appropriately sized meal is anywhere from 400 to 700 calories, and one Big Gulp is 640 calories, you understand the scope of the problem! A Starbuck’s Frappuccino can total anywhere from 300 to 600 calories. One glass of wine contains at least 100 calories. And one mixed drink can set you back 300 calories or more. Double or triple these numbers at any given party, tack on the calories in your meals, and you can understand how weight gain is the inevitable result.

My clients who have become aware of liquid calories have achieved impressive results. Take Bob Levey, former Washington Post columnist. Bob wrote about the importance of cutting out his daily lemonade in his successful weight loss effort. My other client, Julie, easily switched her daily Frappuccino to a skim coffee latte and saved 250 calories. My friend, Linda, slowly phased out her daily soda by adding more and more ice to it each week until she was only drinking water. She lost 30 pounds over a year.

 Most people find reducing liquid calories is an easy change. Since liquid calories don’t contribute to feelings of satiety, cutting them doesn’t lead to feelings of deprivation or hunger. And there are so many great substitutes. The one liquid that’s important to keep drinking is water. In the winter time, I love sipping water as herbal teas through the day. In the summer, it’s selzer with a twist of lemon or lime, and the occasional diet soda.

Of course, if we are mindful of our calorie intake, a moderate daily dose of wine or other caloric beverage can easily be integrated into our routines. The key is mindfulness and moderation.

Listen to Katherine discussing juicing on National Public Radio’s Kojo Nnamdi Show on WAMU 88.5 FM.

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The Numbers

The Numbers

Original content, The Washington Post

Here are some common foods and their saturated fat content (calories/grams saturated fat):

Butter, 1 tablespoon 102/7

Corn oil, 1 tablespoon 120/2

Olive oil, 1 tablespoon 119/2

Canola oil, 1 tablespoon 124/1

Prime rib, 1 ounce 110/11

Lean roast beef, 1 ounce 47/2

Skinless chicken breast1 ounce 48/0.3

Cheese, 1 ounce 100/6

Reduced fat cheese, 1 ounce 70/3

Whole milk, 1 cup 150/5

1 percent milk, 1 cup 102/1.5

Skim milk, 1 cup 86/0

— Katherine Tallmadge

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So Saturated

Original Content, The Washington Post

Saturated fats are the “evildoers” of the nutrition world, and they come in the guise of some of the most delicious foods: butter, cream, cheese, chocolate, coconut, prime rib.

How could something so good be so bad? Well, first of all, let me assure you that not all saturated fats are created equal. In fact, some of the foods high in saturated fats have redeeming qualities that may mitigate their damage. Second, if there’s one thing I’ve learned in the field of nutrition, there’s never just one magic — or deadly — bullet.

I discovered the power of saturated fats while working with patients. I found when saturated fats are cut to extremely low levels, cholesterol levels drop precipitously. I was stunned at what a simple dietary change could achieve.

The National Academy of Sciences says Americans should minimize their intake of saturated fats, which play a role in raising bad cholesterol (LDL) and increasing the risk of cardiovascular disease, which kills half of all Americans.

Foods contain a mixture of fats, some of which are essential for health. Certain polyunsaturated fats (the omega-3 fatty acids in seafood, flax and walnuts, and omega-6 fatty acids in soybean and corn oil) are essential. You need them in your diet because your body can’t synthesize them, and you’ll develop deficiency symptoms without them.

Saturated fats are nonessential fats, which means that the body can make them on its own, so they’re not needed in the diet. Chocolate and animal fats found in dairy, meat, lard and tallow are high in a saturated fat called stearic acid. While other saturated fats raise LDL levels, stearic acid has been found to have a neutral effect on LDL. In fact, some folks in the chocolate, dairy and meat industries have pointed to this neutral effect as a reason to go ahead and enjoy these foods without worrying about the risk of heart disease.

But a new study appears to challenge this claim. Scientists have found that while it’s true that stearic acid doesn’t raise LDL levels, it still may increase the risk of cardiovascular disease because it increases fibrinogen and C-reactive protein levels in the blood. Fibrinogen and C-reactive protein are both indicators of inflammation, an emerging risk factor in cardiovascular disease development as well as cancer and many other diseases.

“This news is going to change the thinking about stearic acid being neutral,” said David Baer, lead investigator of the study, conducted at the Department of Agriculture’s Diet and Human Performance Laboratory in Beltsville.

In addition to stearic acid, there are three other common saturated fats — palmitic acid (found in palm oil, chocolate and meat), lauric acid (found in coconut) and myristic acid (the most potent LDL-raiser, found in dairy and coconut). These three fats raise not only LDL but also HDL, thus keeping constant that important ratio between the “bad” and the “good” cholesterol. Scientists are not sure how much protection this provides, despite the fact that HDL levels are high. These saturated fats may also cause inflammation, but the research isn’t definitive yet.

But some foods that are rich in saturated fat contain protective, healthy nutrients as well. Chocolate, for instance, contains antioxidants and anti-platelet factors. Coconut also contains antioxidants. There is some evidence that these benefits may help outweigh the risks from the saturated fat. But most experts believe it is still not good to eat large amounts of these foods.

Saturated fats, which are solid at room temperature, have other negative effects. When they’re high in the diet, they replace in the body’s cells the more positive unsaturated fats, which are liquid at room temperature. The saturated fats become incorporated into cell membranes and make the membranes more rigid, causing malfunctions leading to, among other things, insulin resistance.

“Saturated fats can reduce insulin’s ability to control blood glucose and in the long run may cause type 2 diabetes,” says Frank Hu, associate professor of nutrition and epidemiology at Harvard University’s School of Public Health.

Adding to the diabetes connection, a recent Johns Hopkins University study found that dietary saturated fat correlated with higher levels of belly fat, a known risk factor in heart disease, hypertension and diabetes. High-saturated-fat diets may even play a role in dementia and Alzheimer’s disease.

Unsaturated oils do just the opposite. If they’re prevalent in the diet and can compete successfully with saturated fat, they incorporate into the cell membranes instead and increase cell fluidity and flexibility, which is one of many reasons scientists believe they’re so beneficial to overall health.

In fact, there is also a theory that the ratio of polyunsaturated fat to saturated fat in the diet may be more influential in heart disease risk than the absolute numbers — yet another example of the importance of balance in the world of nutrition.

Several large studies have verified that when people replace saturated fat with unsaturated oils, a 40 percent to 65 percent reduction in heart disease deaths can be achieved, especially when a little omega-3 fatty acid is added. Interestingly, these studies showed only a modest reduction in LDL, which illustrates the importance of paying attention to other risk factors such as inflammation.

Comparatively, treatment with statin drugs that lower LDL cholesterol (arguably one of the most prescribed medications today) reduces heart disease deaths by only about 30 percent because it doesn’t remove all the risks. So even when taking statins, dietary change is essential.

“Diet and lifestyle change can work better than statins,” says Ernst Schaefer, director of the Lipid and Heart Disease Prevention Program at the New England Medical Center. “But the problem is compliance.”

Many people find it challenging to reduce the amount of saturated fat in their diets. Life without chocolate or butter seems draconian and a goal that is impossible to meet. But a heart-healthy diet need not be so austere if you keep balance and variety in mind.

The trouble comes with extremes, when you’re eating burgers, fries and a shake — all in one meal. Try this instead: Choose a leaner burger with a green salad and vinaigrette on the side and a bowl of berries and nuts for dessert. The antioxidants from the salad and berries, and the healthy fats from the nuts and vinaigrette just might counterbalance the saturated fat in the burger.

Another solution would be to try to always have surf with your turf. The anti-inflammatory compounds in the omega-3 fatty acids in fish may help counteract the inflammatory compounds in the beef.

“And if you burned what you ate through activity, this all wouldn’t be as much of a problem!” says Baer, research physiologist at USDA.

Know your saturated fats:

Health authorities say that if your LDL is lower than 130, you shouldn’t exceed 10% saturated fat calories. If your LDL is higher than 100, you should keep your saturated fat to no more than 7% of your total calories. I’ve found you can even take it lower, say 3 – 4% of calories- for more dramatic results.  But you’ll never get to zero, as a little saturated fat is in just about everything, even some healthy foods!

 

10%                 7%                   3-4%

For the typical 2,000 calorie diet, that’s  22 grams,        15 grams,         7 – 9 grams

 

Here are some common foods and their saturated fat content

cal/g sat fat

Butter, 1 Tbsp                                    102/7

Corn Oil, 1 Tbsp                    120/2

Olive Oil, 1 Tbsp                    119/2

Canola Oil, 1 Tbsp                 124/1

English Walnuts                      185/2

Prime Rib, 1 oz                                   110/11

Lean Roast Beef, 1 oz             47/2

Skinless Chicken Breast, 1 oz 48/0.3

Wild Coho Salmon                  39/0.3

Flounder                                  33/0.1

Cheese, 1 oz                            100/6

Reduced Fat Cheese, 1 oz       70/3

Whole Milk, 1 cup                  150/5

1% Milk, 1 cup                       102/1.5

Skim Milk, 1 cup                    86/0

Chocolate, 1 oz                       135/5

Cocoa, 1 oz                             75/2.5 (“Droste” Cocoa)

Coconut Milk, 1 cup              452/51

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Every Day, in Many Ways

photo by ADA

Original Content: The Washington Post

What are some ways we can eat berries every day?

“A no-brainer,” says Janie Hibler, author of “The Berry Bible” (William Morrow, 2004), “is a berry smoothie for breakfast.” For lunch, she says, throw a handful into your salad. For snacks, carry dried berries and nuts. At dinner, berries go beautifully with meats, grains and main courses. You can also make berry popcicles, syrups for pancakes and spritzers.

Hibler recommends always having berry purees or coulis on hand. “A sauce rivaled by none,” she says. But berries also are great added to drinks, smoothies, yogurts, cereal — you name it.

To make a coulis, rinse and drain the berries, puree them in a food processor and add a little sugar or even liqueur, if desired. It will keep in your refrigerator for three to four days or can be frozen for a month.

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Lead Us Not Into Temptation

Original Content, The Washington Post

Don’t count on willpower! Instead, make things easy on yourself and your family by controlling your environment. To increase the likelihood of eating healthfully, make your food tasty, accessible and convenient:

• Clean, chop and store fruits and vegetables in plastic containers next to healthful dips. For the kids, keep them at eye level in the fridge so they’re easy to grab. (Or, if you’re pressed for time, buy fruits and vegetables already cleaned and chopped at the salad bar.)

• Make several-serving batches of delicious entrees, soups and salads, store them in plastic serving-sized containers in your fridge or freezer to prevent that stop for fast food on the way home.

• Weigh and measure foods before cooking or portioning at the dinner table. You can’t overeat it if you haven’t cooked it. Avoid serving “family style.”

• Eat, then shop! Don’t go grocery shopping hungry and always go with a list to prevent impulse purchasing.

• Minesweep for calorie bombs! If you can’t have just one cookie or one chip, keep them out of the house to avoid temptations.

• Quality, not quantity. Splurge on smaller amounts of your favorite expensive healthy delicacies such as raspberries, hearts of palm, wild salmon or crab meat instead of buying supersized but lower quality foods; those extra calories get stored as excess body fat.

• Buy the gadgets you’ll need: nonstick pans, a heavy-duty stock pot, food scale, measuring cups and spoons, plastic baggies of all sizes and plastic containers that go from freezer to microwave.

• Each healthful and delicious meal deserves your entire attention: Overeating is inevitable if you’re distracted by reading, working or watching TV. Sit at your dining or kitchen table without distractions and make eye contact and conversation with your family members while you eat. — Katherine Tallmadge

© 2004 The Washington Post Company

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Grains of Truth

Original Content, The Washington Post

In the world of nutrition there seems to be no shortage of complexity and confusion. But I’ve found that simple and straightforward solutions are often strikingly successful. In no area is this more true than the remarkable power of whole grains.

Over the years, countless clients of mine have struggled with various gastrointestinal complaints such as constipation or irritable bowel syndrome. Many have come to me after trying costly medications, usually with little relief.

In most cases, symptoms disappeared once they began increasing their fiber intake by eating adequate amounts of whole-grain foods. Some of my clients even teasingly call these foods their wonder drug.

But while it’s true that whole grains are valuable for their fiber content, their benefits are much more vast. Whole grains play a profound role in health. A growing body of research shows whole grains — wheat, oats, rice, rye and corn, for example, may help keep body weight down and prevent diabetes, heart disease and some cancers.

The importance of whole grains in health came to light in the 19th century, when refining grains became popular — and its negative consequences were learned. In Asia, chickens were cured of symptoms of a human illness called beriberi, characterized by muscle wasting and nerve degeneration, when they were fed the discarded part of polished white rice. It was later found that the parts discarded during the refining process contain the essential nutrient, thiamin (a B vitamin) necessary to prevent beriberi.

In 1975, researchers Dennis Burkitt and Hugh Trowell published a book of scientific observations comparing the diet of Africans eating their native whole grains versus North Americans and British eating their diet of highly refined carbohydrates. The researchers described for the first time the role that whole, unrefined foods play in reducing coronary heart disease, diabetes and cancer. Since then, numerous other research studies have chronicled the effects of whole grains on human health.

A whole grain has three parts: bran, germ and endosperm. The bran and germ contain fiber, Vitamin E, B vitamins (thiamin, niacin, riboflavin and pantothenic acid) minerals (calcium, magnesium, potassium, phosphorous, sodium, selenium and iron), protein, essential oils, antioxidants and phytochemicals (plant substances that may protect health). The endosperm contains mostly starch with a little protein and very few nutrients. When a grain is refined, turning whole wheat flour into white flour or brown rice into white rice, only the nutrient-poor endosperm is left. The riches found in the bran and germ are lost.

Food manufacturers attempt to make up for the loss in nutrients by enriching refined grains (those found in breads, pasta, rice and cereals, for instance) with some essential nutrients, such as B vitamins and iron.

But overwhelming scientific evidence has found major health differences in people who eat more whole grains compared with people who eat refined grains, proving enrichment doesn’t make up for the difference:

• Whole grains are our major source of fiber. The grain’s outer layer (the bran) keeps us regular and helps prevent hemorrhoids, diverticulitis, and reduces risk for ulcerative colitis (Crohn’s disease).

• Whole-grain intake is strongly correlated with reduced cardiovascular disease. This is partly explained by the soluble fiber in grains (oats, rye and barley have the highest levels), which is associated with cholesterol lowering. But other substances in grains, such as antioxidants like Vitamin E, also play a role.

• People who eat more whole grains also have lower body weights, according to epidemiological research. This is attributed to the fiber, which promotes feelings of fullness in foods that are generally low in calories.

• Many studies have shown a strong link between whole-grain intake and reduced incidence of type II diabetes. This may be partly because the fiber in whole grains slows down stomach emptying, causing a lower rise in blood glucose and insulin. Also, whole grains contain nutrients such as Vitamin E and magnesium, which may help improve insulin sensitivity.

• This research is less consistent, but whole grains may also help prevent cancers, especially of the intestinal tract and maybe even breast cancer. Several theories have been put forth explaining the mechanisms. For one, the fiber speeds intestinal transit, which reduces exposure to potential carcinogens. Also, antioxidants enter the circulation through colon cells, providing long-term antioxidant protection through the entire digestive tract, according to Joanne Slavin, a professor in the department of food science and nutrition at the University of Minnesota in St. Paul. Ninety percent of a grain’s antioxidants aren’t released until they get to the colon, the last stage of digestion, where they may provide maximum protection against cancer.

Interestingly, grains are still a mystery to researchers. They are so complex and full of a multitude of different compounds, scientists are largely unsure of what components of the grain are responsible for the benefits.

“We’re not sure if the benefits are from the fiber or the phytochemicals,” says Simin Liu, assistant professor of medicine and epidemiology at Harvard. “In my opinion, it’s the thousands of phytochemicals in whole grains which produce most of the benefits.”

To prove his point, Liu points to a four-year National Cancer Institute-funded study of high-fiber cereals in which wheat bran was added in the processing as opposed to naturally occurring in a whole grain. Researchers were surprised to find the high-bran diet did not prevent colon polyps, often a precursor to cancer.

“The data doesn’t support the claim that added bran fiber or fiber supplements make a positive difference in colon cancer, which is why I like to use the term ‘whole grain foods’ instead of fiber. The data only point to whole foods,” says Liu.

But while whole grains provide this wide array of health benefits, most Americans don’t take advantage of them.

“American adults eat six to seven servings of refined grains but only one serving of whole grains a day, with children eating less than one serving — well below U.S. Dietary Guideline recommendations of at least three servings,” says Slavin.

While science continues its search for the answers, I recommend you switch from refined-grain products to whole-grain products. Instead of white bread or crackers, choose whole wheat, whole rye or whole grain breads and crackers. Instead of white pasta or white rice, choose whole wheat pasta or brown rice or cereals made with whole oats or whole corn. Try unusual grains such as bulgur (cracked whole wheat), whole wheat couscous or exotic grain-like substances such as quinoa and amaranth.

But looking for whole-grain foods in your supermarket can be challenging. Many “whole wheat” or “multi-grain” breads, for instance, are made predominantly of white flour, even though the label may say “wheat flour.” Be sure the first ingredient on the nutrition label of your pasta, cereal, crackers or bread is a “whole” grain such as whole wheat, whole oats or whole rye. Also look for a whole-grain product containing three or four grams of fiber per one ounce (28 grams) or per 80- to 100-calorie serving. That signifies that the grain is likely in its most natural state.

Katherine Tallmadge is a Washington nutritionist and author of “Diet Simple” (Lifeline Press, 2004). Send e-mails to her at food@washpost.com.

Grain Guide

The grain family includes barley, bulgur, corn, millet, oats, rice, rye and wheat. Amaranth, buckwheat, and quinoa belong to a different botanical family. But they all contain protein, B vitamins, minerals and fiber, as well as antioxidants. Though corn, oats, rice, rye and wheat are relatively easy to find and cook, other of these healthful ingredients may require a search and some guidance before cooking:

AMARANTH This tiny seed, often found in health food stores, can be used to make flour or pasta. Add the seeds to your bowl of cereal, rice or stir-fry.

BARLEY This versatile grain makes a great pilaf or risotto; use the cooked leftovers in a salad, stir-fry or tuna salad.

BUCKWHEAT The seeds of the plant are used to make buckwheat flour, the basis of blini. Buckwheat groats are the hulled and crushed kernels of the seed and are usually cooked in a manner similar to rice. When the groats are toasted, they are called kasha. Add buckwheat to soups, stew, meatloafs or hamburgers. Cook buckwheat groats for a hot breakfast cereal.

BULGUR (also BULGHUR) Made from whole-wheat berries that are steamed, partially de-branned, dried and crushed or cracked, bulgur wheat is available in coarse, medium and fine grinds. A staple of the Middle Eastern diet, it is seen in salads such as tabbouleh or stews. It can also be cooked like a rice pilaf.

MILLET Cracked millet can be cooked like couscous; another variation, pearl millet, can be cooked like rice or a hot breakfast cereal. Millet flour is used in roti, an Indian flatbread.

QUINOA Pronounced “KEEN-wah,” this grainlike product is often found in health food stores. The grain, which must be simmered, has a delicious roasted flavor and can be added to vegetable dishes or rice. Quinoa flakes, a hot cereal similar to oatmeal, make a hearty breakfast.

— Katherine Tallmadge

© 2004 The Washington Post Company

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After Atkins

photo by ADA

Original Content, The Washington Post

A new client shared a familiar story with me: This man, who has struggled with his weight for years, went on the Atkins low-carbohydrate diet, and the pounds seemed to melt away. But after a few months, they started to creep back on. Another woman on Atkins lost only part of her desired weight and then hit a plateau. Still others find that after success with Atkins, their cholesterol levels soar, a potential danger to their health. They all came to me fearful that going off the Atkins diet would mean gaining their weight back. But they knew they had to figure out a different way to achieve their goals permanently.

Their fears are well-founded and point to a central dilemma in weight loss: While losing weight is exhilarating and energizing, it also can be fleeting.

“Unless people transition, they’re going to fail, because the Atkins diet produces weight loss but not weight maintenance,” says James Hill, director of the Center for Human Nutrition at the University of Colorado in Denver. “If people lose weight with the Atkins diet, they need to consider their weight loss as Phase 1 and be prepared to keep it off differently, which would be Phase 2.” Hill was co-author of the Atkins diet study published in the New England Journal of Medicine last year. It found that those in the Atkins diet group had a greater weight loss after three and after six months compared with those on a low-calorie, low-fat diet. After one year, though, there was no difference between the two diet groups.

But weight regain is not a problem unique to the Atkins diet. The struggle has been going on for as long as people have been looking for quick-fix, formulaic diets. In the 1970s, people lost weight by cutting carbohydrates with Atkins or Scarsdale. The ’80s brought us high-protein, modified fasts (remember Oprah and Optifast?). In the ’90s, low-fat diets were the rage. Now we’ve come full circle with low-carb diets. All these diets work because they dramatically lower your calorie intake. But the challenge is the same no matter what diet you follow: At some point, you must transition from the diet to a healthy, everyday eating plan that will maintain your weight and enhance your health.

In 1994, Hill and others founded the National Weight Control Registry to study the characteristics of people who successfully maintain their weight losses (known as “maintainers”). People in the registry have lost an average of about 70 pounds and have kept it off for an average of seven years.

The registry and other studies have found many factors that separate successful weight-loss maintainers from unsuccessful regainers:

• Diet: The registry found maintainers eat a low-fat diet with 24 percent of their calories coming from fat, 19 percent from protein and 56 percent from carbohydrates (much of it low-calorie, complex carbohydrates). Only 1 percent eat a low-carbohydrate diet (with less than 24 percent of their calories from carbohydrates).

The registry and other studies have found that maintainers eat more vegetables and fewer calorie-dense foods, such as fried food, fats, fatty meats and sweets, and they often substitute low-fat for high-fat foods.

Maintainers reduce portion sizes, reduce frequency of snacking, and they eat foods such as cheese, butter, high-fat snacks, fried foods and desserts less than once a week. They become satisfied with smaller portions and are less attracted to sweet or fatty foods.

Regainers increase their fat intake while maintainers keep it consistently low. But maintainers don’t completely deny themselves. They changed their basic food patterns, but they allowed themselves fewer but more meaningful indulgences. Regainers, on the other hand, went on very restrictive diets not permitting themselves any room for favorite foods. They felt deprived and easily fell back into old patterns.

• Eating style: The registry found successful maintainers prepare and eat the majority of their food at home, dining out about once a week, which is less often than the general population. The registry and another study found maintainers are more likely to eat five times a day, while regainers are more likely to skip meals, snacking on candies and chocolates more often. The registry found that a strikingly high number of maintainers eat breakfast.

• Self-monitoring: The registry reported that 75 percent of maintainers weigh themselves at least weekly or daily. This helps them nip any minor weight gains in the bud. On the other hand, regainers either accept larger weight gains or don’t notice their weight creeping up until they gain a large amount. One study found that successful maintainers develop a “healthy narcissism” about their appearance and physical condition. The registry and numerous studies have found that maintainers monitor their eating by occasionally keeping food diaries to increase awareness.

• Physical activity: Nine out of ten of the registry participants engage in regular physical activity. “During weight loss, diet is the driver. But during weight maintenance, physical activity becomes the key,” says Hill, whose new book, “The Step Diet” (Workman, 2004), incorporates elements from registry findings.

• Coping skills: Most people have comparable levels of stress and unpredictability in their lives, but some are able to handle it more effectively than others. Maintainers are more likely to face their problems, while regainers react emotionally or avoid problems by sleeping, drinking or eating. Maintainers are also more likely to seek support from friends, family and professionals.

• Lifestyle: Many maintain weight loss only upon making major lifestyle adjustments. One study found when home-bound women became more involved in activities outside of their homes, they were more likely to maintain weight loss. They became more confident and took responsibility for their lives and their size. The activities you choose to engage in and the people you spend time with influence weight-maintenance success. Often this means making new, healthier friends and including spouses in your lifestyle changes. Spousal support is necessary for long-term success, even if it may not be necessary short term.

• Goals and expectations: Maintainers are more likely to be patient, setting small, reachable goals. They accept dietary change as part of their lives rather than as part of a temporary diet. They realize they need to be continually conscious of their food and activity levels and work at staying in shape.

The evidence is clear: The battle of the bulge is won at the margins. Sweeping dietary overhauls are impractical and don’t work over time. Shrewd, small, concrete changes that can be easily incorporated into your daily routine lead to success.

Katherine Tallmadge is a Washington nutritionist and author of “Diet Simple” (Lifeline Press, 2004). Send e-mails to her at food@washpost.com.

© 2004 The Washington Post Company

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Accept No Substitutes: Dangerous Supplements?


Original Content, The Washington Post

Taking multivitamins, Vitamin B-6, Folic Acid, Magnesium, Zinc, Copper, and particularly Iron, may increase death rates, according to a recent study published in the Annals of Internal Medicine. Only Calcium and Vitamin D were correlated with positive benefits.

Let me explain…

Many of us want to include nutrients, the right vitamins and minerals in our diet. But we often don’t want to eat all the foods and calories required to get this balance. What we’re looking for is a magic supplement that will give us more energy, improve the quality and length of life and prevent the chronic diseases of today such as heart disease, cancer and diabetes.

While we know that certain foods have been shown to provide these benefits, can the right supplement do the same?

Leading researchers are increasingly convinced that while supplements can serve many positive purposes, they cannot take the place of a well-balanced diet, and may even be dangerous.

The Importance of Food

“The thousands of vitamins, minerals and phytochemicals [beneficial plant compounds] in whole foods act synergistically together to create a more powerful effect than the sum of their parts, producing a result which cannot be recreated by supplements,” says Jeff Prince, vice president for education at the American Institute for Cancer Research.

Over the past century, nutrition experts gained a fuller appreciation of the need for a plant-based diet. Research began to show in the 1970s that certain patterns of eating, beyond vitamin and mineral intake, were influencing illnesses.

By the 1980s, they found that populations that ate more fruits, vegetables and high-fiber foods experienced lower rates of cancer, heart disease and diabetes. Also, by that time, discoveries had been made that newly discovered phytochemicals and certain vitamins and minerals acted as antioxidants and might prevent chronic diseases such as cancer and heart disease. After all, it had been found that people with high blood levels of two antioxidant vitamins (a form of vitamin A called beta carotene and vitamin E) had reduced lung cancer rates. It had also been observed that people who ate more dark-green leafy vegetables (high in beta carotene) experienced less lung cancer, even if they smoked.

Sensing a major breakthrough, the National Institutes of Health funded one of the biggest studies ever conducted. Known as the ATBC (Alpha-Tocopherol, Beta Carotene) Cancer Prevention Study, published in the New England Journal of Medicine in 1994, it tested the theory that the antioxidant vitamins beta carotene and alpha-tocopherol (vitamin E) would prevent lung cancer in smokers, the highest-risk population. After following 29,000 male smokers for six years, the stunned researchers found “a higher incidence of lung cancer among the men who received beta carotene supplements than among those who did not. In fact, this trial raises the possibility that these supplements may actually have harmful as well as beneficial effects.”

Needless to say, these revelations sent shock waves through the scientific community. “This study was a turning point in the nutrition field, especially when multiple studies kept confirming that supplements didn’t work at preventing cancers and heart disease,” says David Klurfeld, national program leader for human nutrition at the USDA’s Agricultural Research Service. “People think that we can pull out the fiber, pull out the antioxidants. But research does not back that up. Study after study says you gain the most benefit from whole foods.”

That is not to say that supplements are of no use. They can be of great benefit, when taken based on individualized needs. This study, and others like it, stress the importance of personalizing your supplement needs by reviewing your medical, family and personal history, your food intake, THEN and only THEN, decide what you might be lacking and make an educated decision, preferably with the help of a registered dietitian and your doctor. Supplements simply can’t compete with better food choices. Consider these findings:

• When the ATBC Cancer Prevention study data was re-analyzed years later for consumption of fruits and vegetables, researchers found that while supplements did not prevent lung cancer, eating fruits and vegetables high in beta carotene (e.g., carrots, sweet potatoes), lycopene (e.g., tomatoes) and lutein/zeaxanthin (deep-green leafy vegetables such as spinach and kale) reduced lung cancer risk.

• A diet high in cereal and vegetable fiber (35 grams versus 15 grams) reduces the risk of colon cancer by 40 percent, according to recent findings in the EPIC (European Prospective Investigation into Cancer and Nutrition) study. But studies of fiber supplements have failed to find any benefits and some have found an adverse effect.

• A diet high in fruit reduces lung cancer risk by 40 percent, also according to new EPIC study findings. Another study found subjects with a high fruit intake had a 44 percent lower risk of lung cancer compared with subjects eating the least amount of fruit. But when subjects added beta-carotene supplements, there was no benefit from the fruit.

• Men who ate 10 servings of tomato products weekly reduced their risk of prostate cancer by 35 percent compared with men who ate fewer than 1.5 servings, according to a Harvard Health Professional study. While the benefit is largely attributed to the phytochemical lycopene, trials of lycopene so far have found it is less potent than the tomato.

• A diet high in fruits and vegetables reduced stroke risk by 28 percent, and fruit alone reduced the risk by 40 percent, according to a study published in the American Journal of Clinical Nutrition in 2003. No dietary supplements have been found that significantly reduce stroke risk.

• People who ate collard greens or spinach two to four times per week had a 46 percent decrease in risk for age-related macular degeneration (the leading cause of blindness) compared with those who ate these vegetables less than once per month, according to a study published in the Journal of the American Medical Association this year. No studies have found supplements prevent or improve macular degeneration.

• People who eat more soy have a decreased risk for coronary heart disease, breast cancer and prostate cancer. But when various components of soy foods have been isolated and studied, these finding have not been replicated, and some have found adverse effects.

• A diet high in antioxidant-rich foods helps prevent cardiovascular disease, but the studies of individual antioxidant supplements have been so inconclusive that the American Heart Association recently issued an advisory against taking them to reduce cardiovascular disease

“Researchers are working as fast as we can to find the most effective components in foods,” says Janet Novotny, research physiologist at USDA’s Human Nutrition Research Center in Beltsville. “But so far, studies have shown that while fruits and vegetables are associated with decreased risk of chronic disease, studies of the isolated compounds in fruits and vegetables haven’t shown an effect.”

Food and dietary patterns are complicated and expensive to study, and can defy the brightest minds and best intentions. In the meantime, the best advice is to eat a plant-based diet with at least five to nine servings of fruits and vegetables (you’ll get the most benefit with the higher amount), at least three to four servings of whole grains and regularly eat legumes as a side dish or occasionally as your protein source.

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Have Your Fill

Original Content, The Washington Post

It’s not rocket science: Eat fewer calories than you burn and you’ll lose weight.

But somehow it seems almost impossible to do. How could something so simple be so hard? The dilemma we all face is how to eat less without feeling hungry and deprived. The solution, while not as important for short-term weight loss, is essential to weight maintenance. Any diet that keeps us hungry is doomed to fail over the long haul.

For decades, scientists have been digging for clues about what influences the decisions to start and stop eating. They have found that our bodies have a complex physiological signaling system that tells us when we’re hungry and when we’ve had enough. When you’re eating, nerves in the stomach wall detect your stomach is stretching. They send satiation messages to the brain and you start to feel full. When food is sensed in the intestines, several substances are activated there as well, including nerve regulators and hormones such as cholecystokinin (CCK).

The physiological sensation of hunger has been more difficult for researchers to pin down. Emerging research points to ghrelin (pronounced GRELL-in), a hormone sent into your bloodstream by the stomach when it is empty.

The level of ghrelin “goes up before meals — making you hungry — while the other satiating hormones go up after eating [with ghrelin going down], causing you to stop,” says David E. Cummings, associate professor of medicine at the University of Washington and the Veterans Affairs Puget Sound Health Care System. “With these two systems, you have physiological control over pre-meal hunger and post-meal satiety.”

Of course, we’re not automatons governed strictly by physiology. The decision to eat is also governed by things we can control.

“In humans, ghrelin may not be the only driver. Initiation of meals is a complex process that deals with social cues, smells, sights and more,” says Phil Smith, co-director of the Office of Obesity Research at the National Institute of Diabetes & Digestive & Kidney Diseases.

Evidence suggests that many factors are related to your satisfaction with a meal and ultimately, your ability to lose and maintain weight:

Portion size In a series of widely known experiments over the past five years, researchers found that the amount of food you are served will affect how full you feel and how much you eat. In the studies, people were given varying amounts of macaroni and cheese, submarine sandwiches and bags of popcorn or chips. In each case, when they were served smaller portions, they ate those portions and felt satisfied. But when they were given larger portions, without realizing it, the subjects (including children, in other similar studies) ate significantly more — sometimes 50 percent more.

This effect persisted. Over two days, when portions were 50 percent larger at each meal, subjects ate 16 percent more (328 extra calories in women and 522 extra calories in men per day). When the portions were 100 percent larger, subjects ate 26 percent more (531 extra calories in women and 806 extra calories in men).

Those extra calories, added daily over the course of a year, would pack 50 pounds more on women and 80 pounds more on men.

“This is a case where physiological satiety cues are overridden by environmental cues such as large portions and the easy availability of food,” says Barbara Rolls, co-author of the studies and a professor of nutritional sciences at Pennsylvania State University in University Park. “When served larger portions, people adjust their level of satiety to accommodate greater calorie intakes.”

Fortunately, studies also have found that the reverse is true. When good-tasting, lower-calorie foods or portion-controlled meals are available, people will eat those and feel just as satisfied. In fact, studies of successful weight loss maintainers find they easily adjust to smaller, more appropriate portions of higher-calorie foods.

An interesting study showed that preschool-age girls who regularly overeat can be taught how to change their behavior by learning to pay attention to their natural hunger and satiety signals.

Water and air content Rolls and colleagues found that as long as the volume of the food is high, people can feel full with fewer calories. In a study published in 2000, participants who drank milkshakes blended with more air (compared with the same shakes containing less air) ate 12 percent less at the next meal without realizing it.

In the most recent experiment, which will be published in the Journal of the American Dietetic Association in October, the researchers served salads of various sizes and calorie levels before a main course to determine the effect on the calorie intake of the whole meal. Participants consumed the fewest overall calories — 100 calories fewer — when they were served the largest, lowest-calorie salad before a meal.

Researchers surmise that a large food volume caused by water or air, even without added calories, influences satiety in a variety of ways. It causes stomach stretching and slows stomach emptying, stimulating the nerves and hormones that tell you when it’s time to put down the fork. Also, seeing a large volume of food can increase your ability to feel satisfied by it.

Finally, the larger a meal is and the longer a meal goes on, studies show, your satisfaction declines and you lose interest in completing it.

“Water is the component in food which has the largest influence on how much you eat,” says Rolls, who co-authored “The Volumetrics Weight-Control Plan” (HarperTorch, 2003). “These studies show eating a high-water-content, low-calorie first course enhances satiety and reduces calorie intake at the next course.”

Type of diet New research on ghrelin reveals it can work against weight loss. Apparently, losing weight under most conditions — low-calorie diets, anorexia, binge-purging and high levels of exercise — can increase ghrelin that’s circulating in the bloodstream and cause hunger. This is the body’s evolutionary way of holding on to body fat and surviving during the famines that threatened our ancestors, according to Cummings. But his research found one diet in which weight loss did not increase ghrelin levels: a low-fat one. After three months, people on a 15-percent-fat diet lost significant weight. But their ghrelin levels stayed the same.

Cummings cautioned that levels of fat higher than 15 percent — say, 20 or 25 percent — as well as other diet methods, may also prevent rises in ghrelin; not every situation has been tested.

But these results help explain studies of successful weight loss maintainers, most of whom eat a low-fat (less than 24 percent of calories) diet.

There’s a lot more to learn about why we eat. Researchers are studying types of foods, diets, meal timing, meal patterns, habits learned from childhood, genetics and sensory factors. But in the meantime, there is plenty that we do know to help us eat the right number of calories but still feel full and satisfied.

Katherine Tallmadge is a Washington nutritionist and author of “Diet Simple” (Lifeline Press, 2004). Send e-mails to her at food@washpost.com.

Pump It Up

Get back to basics and listen to your body signals. Start by rating your hunger on a five-point scale:

0 = ravenous

1 = hungry

2 = could eat, could wait

3 = satisfied, no longer

hungry

4 = uncomfortably full

5 = stuffed

Give yourself a rating before you start eating and another rating when you finish. You should eat when you’re hungry (1) and stop when you’re no longer hungry (3)*.

To feel full with fewer calories, try these tips from Barbara Rolls, co-author of “The Volumetrics Weight-Control Plan” (HarperTorch, 2003), whose research shows that people have greater success with weight loss when they eat larger servings of foods that have a high water content, such as cooked grains, vegetables, fruits, soups and stews:

• To lower the calories and increase the portion size of a favorite recipe, pump up the volume by adding vegetables as often as you can. This way, you can eat your usual portion for fewer calories.

• Choose fresh fruits over dried fruits or juices. For 100 calories, you could eat 1/4 cup of raisins or two cups of grapes. (You’re more likely to fill up on the grapes.)

• Whip air into your yogurt and fruit snack by putting it into a blender and turning it into a smoothie.

• Try air-popped popcorn (3 cups is only 90 calories) or flaky or puffed cereals.

• Start lunch or dinner with a bowl of broth-based vegetable soup or a big vegetable salad with low-calorie dressing.

• Turn main courses into soups or salads by adding water or vegetables.

— Katherine Tallmadge

*Adapted from “Eating Awareness Training” by Molly Groger (Summit Books, 1983)

© 2004 The Washington Post Company

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In the Night Kitchen

Original Content: Washington Post

Does this sound familiar? You get home from work, stressed and ravenous. You head straight for the kitchen, grab a bowl of nuts or a plate of cheese and crackers. You nibble as you’re preparing dinner.

After dinner, you settle on the couch, most likely in front of the television, and zone out with some favorite snacks, such as popcorn, chips, nuts, ice cream, peanut butter or sweets — whatever that’s tasty and easy to grab.

Welcome to the typical American evening! For many people, it’s an endless graze that doesn’t stop until they go to bed.

Evening overeating is an issue that contributes to many peoples’ weight problems. I’ve been surprised at just how many people struggle with this. I used to myself. Even disciplined people who carefully watch their intake during the day break down at night. I can’t count how many times I’ve heard these refrains: “I’m fine during the day, my problem’s at night,” or “If I could control my eating at night, my weight problem would probably disappear. . . . ” It’s become clear to me that evening overeating is not just an isolated problem but the convergence of a host of lifestyle issues — stress, exhaustion, loneliness, disorganized eating and hunger.

In today’s fast-paced world, many people are constantly hopping from meeting to meeting or from chore to chore during the day and don’t have time to sit down and eat a decent meal. So we become ravenous.

In the evening, there’s more time for eating, so we eat not only larger meals, but continuous ones. Those who are tired or stressed find that food is an easy way to reward themselves at the end of the day. Food can provide a little companionship for the lonely or depressed. Researchers who have identified “night eating syndrome,” the most severe form of evening overeating that affects about 5 percent of people who seek obesity treatment, say it is stress-related.

“We believe the night eating syndrome is a stress disorder. One of the characteristics of the syndrome is that sufferers eat at least one-third of their calories after the evening meal,” says obesity researcher Albert J. Stunkard, who has studied nighttime overeaters since the 1950s. He recently co-authored “Overcoming Night Eating Syndrome: A Step-by-Step Guide to Breaking the Cycle” (New Harbinger Publications, 2004).

Evening overeating is an important problem to solve because Americans who eat most of their daily intake of food at night eat more overall calories, according to a study reported in the Journal of Nutrition in June. And that makes them more susceptible to weight problems.

“The late-night period was when the highest-density foods were eaten. Eating a high proportion of daily intake in the late evening, compared to earlier in the day, was associated with higher overall intake,” researcher John M. de Castro concluded in the study, which analyzed food diaries of about 900 men and women.

De Castro, professor and chair of the department of psychology at the University of Texas at El Paso, also found that evening eating was less satisfying for people, which may help explain why they eat more.

In the evening, you get lower satiety. People tend to eat very large meals but then eat again shortly afterward, de Castro said.

For those who succumb to nighttime overeating, I recommend you attack this problem by assessing why this may be happening to you, and then devise personalized strategies for eating lighter at night. Some points to consider:

Breakfast: De Castro’s study found that a “high proportional intake in the morning is associated with low overall daily intake.” This finding confirms my experience of 20 years: Eating a bigger breakfast is the single most effective way of curbing evening overeating. Other studies have confirmed the importance of breakfast for maintaining weight loss.

I advise my clients to eat one-third of their daily calories in the morning. For most people, that’s at least 600 calories, much more than they’re used to consuming.

While solving other issues such as end-of-day stress and exhaustion is important, too, I’ve found that nothing works unless morning eating is beefed up first. Eating more in the morning is a scary proposition for many people who fear that they’ll continue their evening overeating on top of the bigger breakfast. But my clients who bite the bullet and give it a try are amazed to find that it reduces cravings and gives them a sense of control, so that it is easier to eat more moderately later in the day.

Interestingly, de Castro found that people are more sated with the food they eat in the morning. “If they eat a large breakfast, they’ll wait a long time before eating again. They get a lot of bang for the buck,” says de Castro.

Organized eating: Researchers have found that most people with the more severe “night-eating syndrome” don’t have regular meal and snack times. I have also found this is true for evening overeaters. Most overeating is due simply to undereating throughout the day and poor planning. I hear so many people say “I have no will power,” or “I hate myself because I have no discipline.” But they somehow regain their discipline and will power by simply planning and eating regular daytime meals and snacks.

That’s why I advocate cooking in large batches and regular grocery shopping so that you have healthy and delicious foods at your fingertips when you get home from work in the evenings.

Trigger foods: Many people who overeat in the evenings have “trigger” foods, specific foods they crave and are more likely to overeat, such as chips, chocolate or peanut butter. The experts find the avoidance of trigger foods can reduce evening overeating.

Assessing hunger: Your body lets you know what it needs. One key to lasting weight management is being in touch with your body and its signals. In the evening, before you eat, get rid of distractions. Take a few deep breaths and stop to think if you’re physically hungry. If you’re hungry, eat. If you’re not, or if you’re not sure, you shouldn’t eat.

Stress management: Many people overeat in the evenings as a way to cope with the stress and exhaustion they may feel or to reward themselves at the end of a hard day. But this is a self-defeating response either way. When you come home, never head straight for the kitchen. Instead, hop in the shower or tub to decompress, take a walk or stretch. Once relaxed, then decide what you’d like for dinner.

Of course, these actions are only possible if you’ve fed yourself properly during the day and you’re not ravenous.

Reducing behavioral associations: Like Russian scientist Ivan Pavlov’s famous dogs, we can train ourselves to salivate and crave food in connection with just about any activity. Playing cards, eat. Watching a movie, eat. Going to the mall, eat. Talking on the phone, eat. Reading in bed, eat. Watching TV, eat.

The experts recommend that you eat only when you are seated at the dining or kitchen table, without distractions, so that you don’t develop an association between eating and any activity, place or person. The only stimulus for eating should be hunger. Distractions tend to reduce inhibitions to overeating.

When to eat: There is no hard-and-fast rule governing the timing of your last meal in the evening. I recommend that evening calories don’t exceed lunch or breakfast calories and that you eat at least two-thirds of your day’s calories before dinner. It’s important to go to bed feeling light, not full. This way, you awake hungry for a big breakfast.

Katherine Tallmadge is a Washington nutritionist and author of “Diet Simple” (Lifeline Press, 2004). Send e-mails to her at food@washpost.com.

© 2004 The Washington Post Company

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