20/20 InSights

Moderation Monday

jkrieger — Mon, 25 Aug 2008 21:30:00 GMT

Apparently some people in the supplement industry are up in arms about a B-vitamin study showing that supplemental B vitamins did not reduce risk of cardiovascular events or death.

Of course, this response isn't surprising coming from industry, but some of their criticisms are amusing. Dr. Daniel Fabricant criticized the study's exclusion criteria, saying that many of the study's subjects were taking beta blockers (drugs that help control blood pressure) or statins (drugs that help control cholesterol) at the same time.

Dr. Fabricant, this shouldn't matter. This is what randomization is all about. If you randomly assign your subjects to the treatment or placebo (which was done in this study), the two groups will balance themselves out. In fact, in a summary report of the study here, it states, "the groups did not differ significantly regarding age, gender, clinical, laboratory or angiographic findings, cardiovascular risk factors or concomitant medication".

Supplemental B-vitamins have been pushed in the past because they are known to lower homocysteine. Homocysteine is a protein in the blood that has been found to be correlated with heart disease; the higher your homocysteine level, the higher your risk of disease. However, this doesn't necessarily mean that homocysteine causes heart disease. In fact, this study, along with many others, have failed to show any benefit from lowering homocysteine levels with B vitamin supplementation.

As I mentioned in another blog, we tend to get a little bit crazy in our society when it comes to vitamin/mineral supplementation. We automatically think more is better (although more could actually be worse). We expect that taking a multivitamin/mineral is going to stop us from getting cancer or heart disease or some other terrible condition. But that's not the purpose of a multivitamin/mineral. Really, the reason to take a multivitamin/mineral is more as a safeguard against potential deficiencies. This means the doses don't need to be very high. Doses near the RDA should be more than adequate in a multivitamin (with some exceptions, like vitamin D).

Remember, everything in moderation....

Hungry Decisions

jkrieger — Thu, 21 Aug 2008 16:44:00 GMT

There's a good article over on FoodNavigator on how hunger causes us to make bad decisions in regards to eating. You can read the article here.

Here's a good excerpt:

“When individuals extend the interval between meals or consume more of their food away from home, they are significantly more likely to consume more calories and more calories from solid fats, alcohol, and added sugars (discretionary calories) at each eating occasion.

“For example, going five hours between meals instead of four adds about 52 calories for someone on a diet of 2,000 calories per day; extending that interval from four to six hours would add about 91 calories to the meal. Going longer stretches between meals is also estimated to lower diet quality at each meal.”

This adds to the body of evidence that frequent, small meals (5-6 per day) is important in hunger control and weight management. The longer you go without eating, the more calories you'll end up eating at a meal, and the less likely you'll make good choices at that meal. I know, for myself, if I go to the grocery store hungry, I'm much more likely to buy foods that I normally would never buy. Or, if I go too long without eating, I'll make less healthy choices at my subsequent meal. You can reach this "I'm so hungry I don't care what I eat" state.

Anyone want to share their experiences related to this subject? What are your strategies for avoiding this? With our busy lifestyles, it can be easy to fall into these traps.

Insurance...for treatment or prevention?

jkrieger — Mon, 18 Aug 2008 22:50:00 GMT

Back in 1999, I had a brief 3-month stint in cardiac rehab, working a lot with coronary artery bypass graft (CABG) patients.

We had a Phase II and Phase III to our treatment. Phase II was for clients soon after their discharge from the hospital, and typically lasted for 12 weeks. It involved closely monitored aerobic exercise, along with some weight training and flexibility training.

Phase III was a maintenance program for patients that had graduated from Phase II, and again involved closely monitored exercise, although at a lower frequency.

Phase II was often covered by insurance, but Phase III wasn't. I remember discussing with my colleagues about this how the insurance companies would save themselves money in the long run if they covered Phase III. The importance of exercise in the prevention of future cardiovascular events (like heart attacks) is well documented in scientific studies. But the insurance companies would only pay for the post-surgery rehab, which only gets patients "back on their feet" so to speak. Often, the patients who did not continue to exercise after Phase II ended back up in the hospital at some point down the road, which obviously cost the insurance companies more money...probably more than they would've payed for an on-going prevention program.

The reason I bring this up is because a colleague recently emailed me an article in the New York Times about weight loss camps for kids, and how they usually weren't covered by insurance. Unfortunately, when they weren't covered by insurance, the families couldn't afford the programs.

It's been well-established that childhood obesity leads to a host of health problems, and that more and more children are experiencing type 2 diabetes, a disease that only middle-to-older aged adults used to get. The burden that these problems will place on our health-care system and on employers is tremendous. For example, it's been estimated that a type 2 adult diabetic's health-care costs are 2.3 times greater than a person without diabetes. In the long-run, insurance companies probably would save more money by paying for preventive programs rather than paying for the problems after they've already occurred.

I'm interested in hearing your thoughts. What do you think? Do you think insurance companies should cover preventive programs? If not, why not? If so, what types of coverage would be fair?

Artificial/Natural Wars Episode III: Return of the Sweeteners

jkrieger — Fri, 15 Aug 2008 19:00:00 GMT

A long time ago, in some blogs far, far away, I talked about how the line between artificial and natural is more like a fog rather than a line.

I also talked about how natural ingredients aren't inherently any safer or better for us than artificial ingredients.

I also mentioned how natural ingredients can be used to disguise what's really in a product.

A recent experience I had shows this perfectly. I had a meeting with the CEO of a beverage company planning to come out with a new drink. The drink was sweetened with agave syrup, a sweetener that comes from the agave plant.

He made a big deal out of this, because agave syrup is a natural sweetener. This drink was going to be marketed towards health & fitness-conscious people as a post-workout recovery drink.

Agave syrup is big as a sweetener in health foods because of its "natural" label. Health-conscious people like this as an alternative to sweeteners such as high-fructose corn syrup, which they don't consider natural. Also, agave syrup is extremely sweet, much moreso than normal table sugar, meaning you don't need as much to get the same sweetness.

However, what makes agave syrup so sweet is exactly what makes it unhealthy for you, despite its "natural" label.

Agave syrup is almost 90% fructose. Sweetening something with agavey syrup is like using pure crystalline fructose as a sweetener. Fructose is almost 200% more sweet than regular table sugar. It's the fructose content of agave syrup that makes it so sweet.

But it's this high fructose content that makes agave syrup unhealthy. Too much fructose in the diet is associated with a lot of health problems, including insulin resistance, metabolic syndrome, disruption of appetite regulation, fat formation in the liver, and high blood cholesterol and triglycerides. It's estimated that the American diet is much, much too high in fructose.

By comparison, high fructose corn syrup is only 55% fructose, and isn't much different from normal table sugar. Thus, high fructose corn syrup is actually a healthier choice of sweetener than agave syrup, despite the fact that agave syrup is "natural".

So, don't be fooled by "natural" labels. Agave syrup is probably one of the worst sweeteners out there, even though it's "natural."

Monday Mix

jkrieger — Tue, 12 Aug 2008 00:02:00 GMT

MORE D, LESS DEATH

If you aren't already sick of me talking about vitamin D, well, I'm going to talk about it again.

In a study in the Archives of Internal Medicine, researchers found that people who had the lowest blood levels of vitamin D had a 26% greater risk of death from any cause as compared to people with the highest levels. This was a well-designed epidemiological study of over 13,000 people.

The evidence is becoming overwhelming how important vitamin D is to your health. Thus, it's extremely important that you consider getting your vitamin D levels tested by your doctor. If your levels are low, then adequate sun exposure and vitamin D supplementation will probably be necessary. Even if your levels are fine, getting some sun exposure and supplemental vitamin D is a good preventative measure. Consider supplementing with a minimum of 1000 IU, and try to get 15-20 minutes of sun exposure to your hands, arms, and face about three times per week.

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RUN LONG, LIVE LONG

Vitamin D isn't the only thing that may help you live longer. Another study in the Archives of Internal Medicine found that people who ran regularly had a 39% decreased risk of dying during old age than people who did not run. The researchers looked at runners who ran about 4 hours per week in their 50's, and continued to run about 76-80 minutes per week into their 70's and 80's. They compared the runners to controls who did not run.

Another interesting aspect of this study was that the researchers found that the runners had less disability with old age. Many people associate running with an increased risk of joint problems with age, but the researchers did not find this. In fact, running delayed the onset of disability by about 16 years.

The bottom line is that exercise truly is a miracle drug. Nothing works better for slowing the effects of aging than exercise.

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SALT SENSITIVE?

I used to be of the opinion that high salt intakes only increased blood pressure in people who were "salt sensitive." However, a recent study indicates that I may have been wrong.

In a study published in the American Journal of Clinical Nutrition, researchers looked at salt intake and people's genes. The researchers looked at a special gene for angioitensinogen, a chemical in your body that is related to blood pressure control. In this study of over 11,000 people, the researchers found that the effects of salt on blood pressure were not affected by a person's genotype. People that had higher salt intakes and higher salt excretion in their urine had higher blood pressures, regardless of their genetics.

While not salting your food can help reduce your salt intake, the best way is to simply avoid processed foods. In fact, only 10% of your daily salt intake comes from salting your food. Processed foods, like canned goods, soups, frozen meals, and deli meats are the real culprits. These foods often have high sodium contents because of the flavor and because of the increase in shelf life. Check the sodium content of the food labels, and talk to your dietitian if you have concerns that your sodium intake may be too high.

Out-D-oor Exercise

jkrieger — Mon, 11 Aug 2008 23:57:00 GMT

Summer months bring the sun. Well, usually. Yeah, we got off to a bad start to our summer here in the Northwest, but things have improved.

Of course, even if we had a completely lame summer, summer months bring something else....travel. Road trips and vacations are popular summer activities. So you're bound to get some sun somewhere.

In a past blog, I talked about vitamin D, and how sunlight is your most important source. So whether you're on vacation or sticking around here in the summer, if you just get 15 minutes of sun exposure (without sunscreen) 2-3 times per week, you're getting a nice dose of D.

This is particularly important if you're overweight, as people who are overweight are more deficient in vitamin D than people of normal weight.

Since exercise is an important component of any weight loss program, you might want to consider doing your exercise outside during the summer months. A recent study showed that overweight people who exercised outside were 47% less likely to be vitamin D deficient than people who didn't exercise outside.

So, take advantage of your vacation or any sunny days you may get, and get some outdoor exercise in, especially if you're overweight.

A good way to see if you're getting enough vitamin D is to have your doctor test you for your blood levels. If your levels are deficient, you know you need to get more sun or may need to supplement.

Those are my thoughts for this first week in August. Forecast looks good, so I think I'm going to go grab myself some vitamin D :)

Monday Hodge-Podge

jkrieger — Mon, 28 Jul 2008 23:06:00 GMT

Good afternoon, everyone! Here's a bunch of interesting stuff I've been reading about lately....

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INTERVAL TRAINING FOR METABOLIC SYNDROME

A study was recently published in the journal Circulation indicating that interval training may work better than steady cardio for improving metabolic syndrome. In this study, two groups exercised 3 days per week. One group did steady aerobic exercise for 47 minutes at 70% of maximum heart rate. The other group did a 10 minute warmup at 70% maximum heart rate, and followed that with four 4-minute intervals at 90% maximum heart rate, with a 3-minute recovery between each interval at 70% maximum heart rate. They then did a 5 minute cooldown.

The researchers found that interval training resulted in superior improvements in metabolic syndrome risk factors, fitness, insulin signaling (the ability of insulin to tell cells to take sugar out of the blood), blood sugar reduction, and endothelial cell function (the function of the cells that line your blood vessels). The interval training also reduced the body's ability to form fat more than the steady cardio did.

So, if you've got no conditions that might stop you from throwing in some intense interval training into your workout regimen, then give interval training a shot. It will make your workout more interesting, and you'll get better results.

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DON'T MONKEY AROUND WITH TRANS-FATS

I'm sure you know that trans-fats aren't good for you. They increase your risk of heart disease and diabetes. Well, it looks like they can also make you fat. In a study on monkeys, researchers found that trans fats increased body weight without an increase in calories. This means that trans fats are stored much more efficiently in your body as fat than normal fats are. Also, the researchers found that trans fats increase abdominal obesity and insulin resistance.

So, if you didn't have enough reasons to avoid trans fats in your diet, now you have another one.

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EASY ON THE SELENIUM

I mentioned in a past blog how we're a bit too antioxidant-crazy in our society. Antioxidants in moderation are good for us, but too much can be harmful.

Selenium is a mineral that our bodies need in low amounts. It is used to make important antioxidants called selenoproteins. However, be careful of getting too much. One study found that people who got 200 micrograms of selenium each day had a 55% greater risk of developing diabetes over the next 7-8 years. These were people who weren't getting much selenium in their diet, either.

The RDA for selenium is 55 micrograms. If you stick with doses of 55 - 70 micrograms that are found in most multivitamins, you'll be getting plenty of selenium. I'd stay away from antioxidant supplements that contain doses higher than 100 micrograms.

Another fish oil plug

jkrieger — Mon, 21 Jul 2008 22:52:00 GMT

I hope everyone had a great weekend!

In some past blogs, I mentioned how fish oil is good for your brain and also that it may help with weight loss.

Well, let's add appetite control to that list.

In a study out of Spain, researchers reported fish oil to decrease appetite.

They assigned overweight subjects to one of 4 diets:

No seafood + 6 placebo capsules
150 grams of lean fish, 3 days per week (provided less than 260 milligrams of omega-3 fatty acids)
150 grams of salmon, 3 days per week (provided more than 1.3 grams of omega-3 fatty acids)
6 fish oil capsules per day (provided more than 1.3 grams of omega-3 fatty acids)

They then had the subjects rate their satiety after a test meal. The subjects receiving either the salmon or the fish oil reported being more full and less hungry than the subjects on the other diets.

Scientists aren't quite sure how the omega-3 fats help to control appetite. It may have something to do with the fact they are involved in the transport of appetite-regulating chemicals in the brain.

I've said it before and I'll say it again. There are three supplements that I think everyone should take....a basic multivitamin, extra vitamin D, and fish oil. The benefits of fish oil are just too overwhelming to not take it.

Probiotic Passion

jkrieger — Tue, 15 Jul 2008 18:48:00 GMT

Happy mid-July, everyone! Finally summer seems to have arrived in the Northwest (knock on wood).

If being overly-crazy about antioxidants wasn't enough, it seems this year the rage is with probiotics.

Probiotics are basically live bacteria that are supposed to give you health benefits. That's right, people, you're eating live bacteria. No, E. Coli is not a menu item on the drive-thru at Jack in the Box (although it used to be.)

Not to say that you don't eat bacteria everyday...there's always bacteria on many of the foods we eat, but they never make it alive through the nasty acidic environment of your digestive system. There is some bad bacteria that can make it through your digestive system and make you sick (salmonella, anyone?), but proper cooking and food storage/handling usually gets rid of most of those.

In fact, there are live bacteria sitting in your large intestine right now, eating away at any undigested food that makes it down there. You might be freaked out to know that you have E. Coli sitting in your intestine right now. Don't worry...most forms of E. Coli are harmless...it's not the strain you might find in undercooked meat. The E. Coli you have in your intestine is helpful to you...it helps form vitamin K, and also prevents bad bacteria from taking over.

But let's get back to probiotics. The idea is, by eating these bacteria, you will get all sorts of benefits from a healthier immune system to less allergies to cheaper gas prices.

OK, I'm being facetious, but you get my point. Food manufacturers are taking advantage of the hype by adding probiotics to all sorts of foods. You can even get probiotics as a pill-type supplement.

Is there any substance behind this hype?

Yes and no.

First, you need to realize that not all probiotics are created equal. You can have bacteria strains that have the same Latin name but have different effects. For example, there are beneficial strains of Lactobacillus acidophilus, and then there are strains that just make yogurt. So, just because you're eating yogurt that has "live active cultures" doesn't mean the bacteria is going to give you any benefit. In fact, some bacterial strains don't even make it through your stomach intact!

Some food manufacturers don't even list the exact strain on the ingredient label. The label may say Lactobacillus acidophilus, but there are thousands of strains of this bacteria. If the label doesn't tell you the exact strain, you have no idea if what you're getting will benefit you.

The amount of bacteria is also something you need to look at. You usually need millions or billions of colony-forming units (CFU's). If the amount of bacteria isn't listed on the label, then avoid the product. Also, vague statements like "proprietary formula" are a red flag.

You also need to consider why you're taking the probiotic. In fact, probiotics have no benefit to already healthy people. There's not a shred of good scientific evidence that taking a probiotic will help you if you already have a healthy digestive tract.

Probiotics can help people with certain conditions, however:

Bifidobacterium infantis 35624, found in the OTC product Align, is the only probiotic that's been found in good studies to help with Irritable Bowel Syndrome (IBS).
Lactobacillus Rhamnosus GG (LGG), found in Culterelle and Dannon's Danimals Drinkable Yogurt, has been found to decrease the risk of antibiotic-associated diarrhea. It also may decrease the risk of traveler's diarrhea and acute viral (not bacterial) infectious diarrhea.
Lactobacillus casei immunitas, found in DanActive, has been found to reduce the risk of antibiotic-associated diarrhea.
Bifidiobacterium animalis lactis (Bifidus regularis), found in Activia, may help with irregularity
Saccharomyces boulardii, found in Florastor powder, can decrease the risk of antibiotic-associated diarrhea and traveler's diarrhea.

The bottom line is, if you're on antibiotics, if you're traveling, if you're irregular, or if you have IBS, probiotics may benefit you, as long as you stick with the particular strain that's been shown to help with your condition. But if you're already healthy, eating probiotics will only eat into your wallet.

Measure your burn

jkrieger — Mon, 07 Jul 2008 18:31:00 GMT

Hi, everyone! I hope everyone enjoyed their holiday.

A long time ago, in a blog far, far away, I mentioned the importance of total daily energy expenditure to your success in losing weight and keeping it off. I also mentioned a device called the Sensewear Armband, which estimates the amount calories you expend each day.

Well, we're now offering this as a service to you, our current 20/20 clients and 20/20 alumni.

It's a pretty nifty device. It only measures about 2 inches by 2 inches, and you wear it on the back of your left arm. It measures skin temperature, galvanic skin response (electrical resistance of the skin), heat flux, and motion via a 3-axis accelerometer (side-to-side, up-and-down, and forward/backward). It then takes this data, and combines it with information about you (like your age and weight), and gets an estimate of your energy expenditure.

The most accurate method to measure your energy expenditure is through a technique called doubly labeled water. However, this fancy-schmancy technique is only available to scientists and is insanely expensive (over $1000 per person!). Research shows that the armband does pretty good when compared to doubly labeled water. In fact, in most people, the armband will be accurate to within +/-300 calories. That's pretty good for such a small device.

I know from personal experience that the device works pretty well. The armband measured my energy expenditure at around 3,300 calories per day. Given the error rate in the armband, that means my true energy expenditure is between 3,000 and 3,600 calories per day. I know, from meal-tracking, that I need to eat around 3,000 to maintain my body weight. So, at least for me, the device is nearly right on.

If you've hit a plateau in your weight loss, and you can't seem to figure out why, this can help you narrow down the causes of why you're not improving. For example, maybe your physical activity levels are too low. Or, maybe you're off on your meal-tracking and you're eating more than you think you are. Regardless of the reasons, this is a very handy tool. It can also be fun for those of you who are simply curious what your daily energy expenditure is.

If you're interested in finding out how many calories you burn, then you can sign up for a "Measure Your Burn Profile" for $60. With this package, you get to wear the armband for 3 full days, and you get an analysis of your results.

If you're a 20/20 alumni and you would like to discuss the results with a dietitian, then there is an alumni package that includes the 3-day rental, analysis of your results, and a 30-minute dietitian appointment.

If you want more information, you can call 425-869-4764.

GET OUT FOR SOME ADVENTURE!

jkrieger — Tue, 01 Jul 2008 00:05:00 GMT

With summer finally being here in the Northwest, I say it's time that you get out of your gym routine and get outside.

Now, when I say get outside, I don't mean just go out for a jog or something.

I mean get out and do something new or unusual. I'm talking trying an activity you haven't done before.

For example, my passion is kiteboarding. If you don't know what that is, imagine riding a wakeboard, but instead of being pulled by a boat, you have a giant kite pulling you.

Yes, that's me, kiteboarding at Jetty Island in Everett. Imagine being able to catch 20-30 feet of air when you jump, but then land softly in the water. Yes, you can do that with kiteboarding. And let me tell you, you'll never get a better ab workout than this sport.

The cool thing about this sport is you can take your gear anywhere in the world with you. For example, I took my gear to Maui and went kiting there. You can't do that with most other sports!!!! Not only that, but you can also do it on the snow with a snowboard (called snowkiting), or on the land with a landboard.

That pic is not me (I have yet to snowkite), but you get the idea. There are plenty of places you can learn kiteboarding right here in the Seattle area.

Of course, I'm being biased here, as there's many other things you can do. For example, one of my fellow coworkers and friends here, Dave Joyce, is into adventure racing. Think of a triathlon, but instead of running, biking, and swimming, you are mountain biking, trail running, kayaking, or whatever else is called for on the race. Often, you can compete as a team. In fact, I know Dave has gotten some of his clients to participate in adventure racing with him as a team.

Speaking of adventure racing, there are plenty of trails around here where you can go mountain biking. Or, if you prefer the road, the east-side is loaded with bike lanes.

Now, if you're not the adrenaline/extreme sports type, there are plenty of places around here where you can go on a hike. From Snow Lake near Snoqualmie Pass (which I've hiked before)....

...to Tiger Mountain just north of the Issaquah Highlands...

...to Mount Si near North Bend. For Mount Si, you can either hike Little Si (which is a shorter hike, but still good exercise) or Big Si (steep and long hike if you're looking for a big challenge).

This is just a fraction of the adventures you can have around here in the summer, and these are just off the top of my head as I write this. So, take advantage of this beautiful weather we've had. You'll have plenty of time to hit the gym in the winter.

Breakfast like a King...

jkrieger — Mon, 23 Jun 2008 17:14:00 GMT

Ever heard the phrase "Eat breakfast like a king, lunch like a prince, and dinner like a pauper"?

Apparently there may be some science to back up this old quote.

At the recent annual meeting of the Endocrine Society in San Francisco, researchers from Virginia Commonwealth University looked at the effects of a high protein, high carb breakfast on weight loss and appetite.

They took 94 obese women, and put them on one of two of the following diets:

Low carb

1085 calories

17 grams of carbs
51 grams of protein
78 grams of fat

Meal breakdown:

Breakfast

290 calories
7 grams carbs
12 grams protein
24 grams fat

Lunch

425 calories
5 grams carbs
21 grams protein
28 grams fat

Dinner

370 calories
5 grams carbs
18 grams protein
26 grams fat

Low-carb diet with high carb/high protein breakfast:

1240 calories

97 grams carbs
93 grams protein
46 grams fat

Meal breakdown:

Breakfast

610 calories
58 grams carbs
47 grams protein
22 grams fat

Lunch

395 calories
34 grams carbs
28 grams protein
13 grams fat

Dinner

235 calories
5 grams carbs
18 grams protein
11 grams fat

For 16 weeks, the women aimed for weight loss. For another 16 weeks, the women aimed for weight maintenance.

After the 1st 16 weeks, both groups lost weight. The women on the low carb diet lost 28 pounds, and the women on the low carb/big breakfast diet lost 23 pounds (this difference was not statistically significant).

What's interesting, though, is what happened during the 16 week maintenance phase. The women on the low carb diet gained about 18 pounds back, while the women on the low carb/big breakfast diet lost an additional 17 pounds. The women eating the big breakfast also reported less hunger and carbohydrate cravings, and more satiety and fullness prior to lunch.

One of the people I work with pointed me to this study, and had some interesting comments of her own. She said:

The main reason it caught my eye was that it’s what I did yesterday – big breakfast/brunch with friends mid-morning, then no snacking or any “bad” stuff until dinner. I probably went too long without food, but it was weird not to get hungry at all. I had a two-egg omelet and 2 pancakes with syrup, so much higher carb content than usual, and higher fat with a little butter and the eggs…. It was interesting.

So does this mean that we should all be eating a huge breakfast with a lot of protein and carbs? Before you make that conclusion, there are some limitations to this study to consider. First, the big-breakfast group ate a lot more protein throughout the day....42 more grams! Since protein increases satiety, we don't know whether it was the big breakfast that was helping, or simply more protein. Second, the big-breakfast group ate almost 200 calories more per day. Maybe they were less hungry simply because they were eating a bit more. These two flaws in the study make it difficult to make any solid conclusions. The researchers should've matched the energy intake and protein/carb/fat breakdown between the groups. One group would've ate a large portion of their calories in the morning, and the other group would've spread it out evenly through the day. Only then would we know if a big breakfast really helps. So, if you're on a low-carb, low protein diet (which doesn't even fit Atkins), a high carb/high protein breakfast is going to help you. But to you, the 20/20 client, this study doesn't tell you much.

Stressing the weight off

jkrieger — Tue, 17 Jun 2008 18:35:00 GMT

A lot of people gain weight in response to stress. However, there's also those people who lose weight in response to stress. Yes, people like me....those people you love to hate.

Why the dramatic difference? Why can one person lose 10 pounds when he/she breaks up with a significant other, but another person gains 10 pounds in the same situations?

A recent study published in the American Journal of Clinical Nutrition shed some light on this issue.

The researchers took 99 college-age men and put them through a mental stress test, as well as a cold pressor test (where you stick your arm in ice-cold water and get the body's stress response). They measured the subjects' adrenaline response to the tests. They then followed up with the subjects 18 years later to see how their weight changed.

They found that the subjects that had higher adrenaline responses to stress had lower changes in weight. Adrenaline (or epinephrine) is a hormone involved in your fight or flight response. This is what happens when you skydive, a bear is chasing you, the Mariners just gave up a home run in the 9th inning to lose the game, your S.O. finds out you just spent the family savings on a plasma TV, etc, etc, etc.

One of the effects of this adrenaline response is an inhibition of your digestive system....including a decrease in appetite. The higher your adrenaline response, the less you will tend to eat. Thus, some skinny people have a biological advantage when it comes to stress and body weight.

So now we at least have a little insight into why some people lose their appetite in response to stress, while others don't. Unfortunately, there's not much you can do to change your adrenaline response to stress. If you're one of the unlucky ones who wants to eat in response to stress, it still comes down to stress control and behavioral management.

D is For Darn Good, Part Deaux

jkrieger — Mon, 09 Jun 2008 16:39:00 GMT

More and more evidence is coming out in favor of higher doses of vitamin D than current recommendations.

In a recent blog, I talked about how vitamin D reduces your risk of cancer. I also talked about how numerous people are vitamin D-deficient, particularly people at northern latitudes like our Seattle area.

Another thing I mentioned in the blog was how the current RDA (400 International Units, or IU) may be well below what many people need to maintain optimal blood levels of vitamin D. I also said how higher doses, like 800 or 1000 IU, may not be enough.

Well, a study was just published in the American Journal of Clinical Nutrition suggesting we may need A LOT more vitamin D than any of us think.

In this study, the researchers took 138 subjects and gave them vitamin D for 6 months. Every 2 months, they adjusted the dose, trying to find the right dose to keep blood levels at an optimal level.

The researchers found that people needed 3800 - 5000 IU per day, to maintain optimal concentrations! This is 10 times the RDA!

It's obvious that people need to be getting a lot more vitamin D then what they're getting. It's also obvious that the current RDA is waaaaayyyy too low. Unfortunately, the current "official" upper limit for vitamin D intake is 2000 IU, which was established back in 1997. But, as I mentioned in my previous vitamin D blog, a lot of scientists are thinking now that this upper limit is waaaayyyyy too conservative, and should be put at 10,000 IU.

Unfortunately, science is often slow to change. The Food & Nutrition Board (FNB) sets all of these values, and they usually meet every 10 years to set new ones. That would mean they should have begun their meetings in 2007, but I don't know if they did or not.

In the mean time, I know I'm going to be upping my personal vitamin D dose from my current dose of 1,000 IU to 2,000 IU or higher. Yes, that's above the "official" UL, but I trust the newer data that indicates the official UL is too conservative. With the way our winter, err, I mean our summer has been around here lately, it's obvious I won't be getting any D from the sun any time soon :)

Stadium Nutrition

jkrieger — Thu, 29 May 2008 00:14:00 GMT

"Stadium Nutrition" is an oxymoron if I've ever heard one.

Ever wondered about the calorie and fat content of some of the foods you can get at your local neighborhood professional sports stadium?

Stadium nachos with cheese has around 1040 calories, 55 grams of fat, and 2460 milligrams of sodium!

A slice of pizza has 465 calories, 24 grams of fat, and 1200 milligrams of sodium!

A stadium dog has 370 calories, 20 grams of fat, and 1360 milligrams of sodium.

Two cups of popcorn has 170 calories, 12 grams of fat, and 250 milligrams of sodium. Stadiums give you a lot more than just two cups!

A plain burger and bun will give you 382 calories and 21 grams of fat (and that's plain...without anything else!).

A 12 ounce beer has 157 calories.

A single soft pretzel has 180 calories and 1 gram of fat.

Other than the nachos, peanuts are one of the biggest whoppers of them all. One cup of stadium peanuts will give you 854 calories and 72 grams of fat!

My personal favorite has always been the garlic fries, but I couldn't find any nutritional info on them.

So there you have it....a sampling of the calories you can get when you hit the ballgame. And most people eat more than just one item! That's not to mention the increased costs of eating at the ballpark. All the more reason to take your food with you when hitting the ballpark....you'll save both cash and calories.

Obesity contributes to global warming?????

jkrieger — Tue, 27 May 2008 17:01:00 GMT

Just the other day, one of my colleagues sent me a link to a Reuters article stating that obesity may contribute to global warming.

This Reuters piece is a perfect example of how the media can completely misrepresent scientific research.

The headline of the Reuters piece reads, "Obesity adds to global warming, study finds." The headline alone is way off-base.

The Reuters article is referring to a recent publication in the journal The Lancet. However, this publication was NOT a study as the headline insinuates. It was simply a letter to the journal. You can read the letter here (free registration required).

Also, this "study" did NOT find that obesity "adds to global warming." The authors did a few simple calculations, and estimated that obese people consume about 18% more food energy than normal-weight people. They then suggested that this increased food intake would contribute to higher food demand and thus more need to transport food (which would increase greenhouse gas emissions). They also suggested that overweight people would drive around more rather than walk; this would increase greenhouse gas emissions both through increased driving and through the increased energy needed to move larger bodies.

This speculation is a long way from finding that "obesity adds to global warming." To support this headline, you would need a study (not a letter!) that clearly showed that the eating & driving activities of overweight people made a significantly higher contribution to greenhouse gases than normal weight people, and that this contribution was large enough to be of concern.

Whether you believe in global warming or not, it's clear that this media report took speculation and turned it into something more. This is why you always want to be very careful when reading media reports on research.

Sweetening Size

jkrieger — Thu, 22 May 2008 00:24:00 GMT

Those of you who have been reading my blog for a while know that I've occasionally talked about artificial sweeteners, and how all the scientific evidence indicates they are perfectly safe for most people.

Now, when I say safe, I mean safe from a toxicity point of view. These substances aren't going to harm you. They don't cause cancer...they don't cause Parkinson's....they don't cause multiple sclerosis....they don't cause Gulf War syndrome....yada, yada, yada.

However, when it comes to weight gain, that's where things get a bit more tricky. A recent article came out in the Journal of the American Medical Association, discussing evidence that artificial sweeteners may be linked to weight gain. Some of this hoopla was generated over a study done in February. In this study, 8 rats consuming saccharin-sweetened yogurt ate more food overall and put on more weight during a two week period compared to 9 rats consuming sugar-sweetened yogurt. Why? The scientists felt that the artificial sweeteners caused a disconnect between sweet taste and calories. In other words, when the rats ate something sweetened with sugar, the sweetness told their brains they were taking in more calories, which caused the rats to compensate by eating less later. However, when the rats got the artificially-sweetened yogurt, they weren't getting the calories their brains were expecting based on the taste. So, the "sweet feedback" decreased, and the animals didn't regulate their food intake as well.

In a study on humans, researchers found that, although artificial sweeteners and sugar stimulated the same taste buds, they affected the brain differently. Only sugar stimulated the part of the brain that responds to food rewards. This brings about the possibility that artificial sweeteners may not be as satiating as normal sugar.

Does this mean artificial sweeteners will make you fat? Not quite. First, keep in mind that the rat study was a very small study (17 rats isn't very much for an animal study). Also, humans are much more complicated than rats when it comes to regulating food intake.

There are also studies that show the opposite. In one study, rats actually lost weight when they consumed aspartame (Nutrasweet). In a study on humans, people ate less calories when they consumed aspartame-sweetened soda as compared to sugar-sweetened soda (although this was an older study that only lasted 3 weeks). In another 10-week study, people that ate sugar-sweetened foods gained weight, while people who ate artificially sweetened foods did not.

This all probably seems very confusing to you. However, let me make some sense of it. The reason you see all this conflicting information is that people's responses to artificial sweeteners vary. In people who are "sweet sensitive" (i.e., their taste buds are very sensitive to sweetness and they experience sweet taste with more intensity than other people), artificial sweeteners can stimulate appetite. In people who are not sweet-sensitive, artificial sweeteners won't have any effect.

As with many things, moderation is key. Artificial sweeteners in low amounts aren't going to represent a problem for most people who are trying to lose or maintain weight. In fact, they're often necessary to sweeten protein shakes (protein helps suppress appetite, and who wants a bland protein shake?). Just don't go overboard on them. If you start consuming artificially sweetened products all of the time, you might interfere with your brain's "sweet feedback" mechanisms and make it more difficult for your body to regulate appetite.

D is for Darn Good

jkrieger — Mon, 12 May 2008 21:18:00 GMT

More and more evidence is coming out showing how important vitamin D is to your health.

FoodNavigator just mentioned a study where people with high vitamin D levels had a 55% lower chance of getting fatal cancer.

The German scientists measured blood levels of vitamin D in 3,299 patients over a period of 7.75 years. People with the highest level of vitamin D in their blood were 55% less likely to die of cancer than people with the lowest level of vitamin D.

There are two ways you can get vitamin D. One is through food. However, we tend not to get a lot of vitamin D in our foods. The best sources are dairy and fish. For example, one cup of fortified milk has about 100 International Units (IU) of vitamin D. One 3.5 ounce serving of oily fish has 200 - 300 IU.

Most of our vitamin D comes from sunlight. If you expose your face, arms, back, or hands for 10-15 minutes to the sun, twice per week in the summer or warm climates, and without sunscreen, you'd get a dose of about 3000 IU of vitamin D. Of course, here in cloudy Seattle, and many other areas at high latitudes, don't get a lot of sun. This puts people at a risk of being vitamin D deficient. For example, up to 97% of Canadians are vitamin D deficient at some time during the winter and spring.

Even incidental sun exposure may not be enough. One study showed that 25% of people in southern Arizona had deficient levels of vitamin D in their blood.

The RDA for vitamin D is 400 IU. However, studies are showing that may not be enough for people to maintain adequate levels. Even 800 IU may not be enough. Also, certain populations may be at a greater risk of deficiency. For example, obese people tend to have lower levels of vitamin D. Aged and dark-skinned people are also at a greater risk, since their skin doesn't make vitamin D as well from the sun as lighter skinned people.

The National Academy of Sciences has said that the safe upper limit for vitamin D intake is 2000 IU per day. However, many researchers now are saying this is overly conservative, and that 10,000 IU should be the new upper limit.

All of this new evidence has caused us to look into reformulating our 20/20 multivitamin. We currently have 400 IU of vitamin D in there, but we are now considering upping that level to 1600 IU.

In a previous blog, I mentioned how, if there were only two supplements that people should take, it should be a multivitamin and fish oil. Well, with all of this vitamin D research coming out, I have to add vitamin D to that list. I've added a 1000 IU vitamin D supplement to the fish oil and multivitamin that I already take. So vitamin D is something you may want to consider adding as a supplement, particularly if you are overweight or have dark skin. Even if you aren't in these categories, it still might be a good idea because of the northern latitude we live in, and all the gray skies we get here in the Northwest.

More obesity drugs?

jkrieger — Thu, 08 May 2008 20:43:00 GMT

Reuters is reporting on a study where scientist blocked a certain brain enzyme in mice, and it helped them stay slim.

The scientists focused on an enzyme in the brain called CaMKK2. It plays a role in appetite stimulation. It takes orders from a hormone called ghrelin, which is produced by your stomach and signals hunger.

The scientists bred mice that couldn't produce CaMKK2. They stayed thin whether they were on a low-fat or high-fat diet. Then they took normal mice and injected their brains with a drug that would block CaMKK2. By doing this, the mice were protected against insulin resistance and pre-diabetes, two harmful effects of a high-fat diet.

The scientists said that the next challenge is to find an oral version of the drug that can cross the blood-brain barrier, as many chemicals are unable to do this. You can't stick a needle through a person's skull!

That's not the only problem. As I mentioned in a previous blog, every obesity drug that has been introduced so far hasn't done so well. Why? Human appetite regulation is very complicated. If you knock one system out, there will be dozens of others that will take its place. This makes the quest for an obesity drug somewhat futile.

You can still never beat lifestyle change for losing weight. It's really the only way to lose it and keep it off long term.

Antioxidant Insanity

jkrieger — Tue, 29 Apr 2008 20:58:00 GMT

I'd say that we are a bit antioxidant crazy in our society.

Antioxidants are pushed for everything from stopping the aging process to preventing cancer to enhancing the immune system. You'll find them added to everything from juices to skin creams.

If you don't know what an antioxidant is, it's a substance that helps stop free radicals. Free radicals are missing an electron, so they like to go around and take electrons from other sources, like your cells. This can cause damage to the cells; this process is called oxidation. This damage is believed to be involved in numerous diseases, including heart disease and cancer, as well as aging. Antioxidants are supposed to prevent this damage; they stop the free radicals in their tracks by "appeasing" them with an electron.

In our society, we're all about more is better. More money, more cars, more things...and more antioxidants. We'll take megadoses, hoping that we'll slow the aging process and prevent cancer. We'll rub it all over our skin to prevent wrinkles. We'll put them in our hair to help stop it from turning gray. I'm surprised we aren't using them to prevent the latest subprime mortgage crisis.

However, just like with anything else, you can have too much of a good thing.

The first sign that too many antioxidants could be a problem was seen in a study published in 1994, where researchers found that smokers who took high doses of beta-carotene (an antioxidant) got more lung cancer than smokers who didn't. A few years later, another study performed at The Hutch showed the same thing. Further research has confirmed these results.

More research has come out indicating too many antioxidants can be a problem. In a previous blog, I mentioned how megadoses of vitamin C might cause skin cancer. A recent meta-analysis (a "study of studies") also indicated that high doses of single antioxidants might increase mortality. While this meta-analysis has some flaws, it raises the possibility that you can have too much of a good thing.

Why would too many antioxidants cause a problem? Well, too many antioxidants can have a pro-oxidant effect. This means, rather than stopping oxidation, they contribute to it! Another thought is that, if you take too many antioxidants, you suppress your body's natural antioxidant defense mechanisms.

The old cliche' of "everything in moderation" applies here. Antioxidants in moderation have health benefits, but in excess, they have health detriments. You should get most of your antioxidants from eating a variety of fruits and vegetables, and then take a basic multivitamin (like our 20/20 multivitamin) as a safeguard against any potential deficiencies. But leave the antioxidant supplements on the store counter.