Blog | Bonnie Modugno, MS, RD

Do “Americans Eat Too Damn Much”?

May 17, 2012 by Bonnie

David Lazarus recently wrote a diatribe scolding gluttonous Americans in the Los Angeles Times. The notion that Americans just “eat too damn much” is a popular screed. Experts weight in and determine that it is advertising and marketing to kids that is the problem. Others claim there is not enough exercise. Well yes, and no. The issue is far more complex than these solutions suggest. Here are a few thoughts I shared with Mr. Lazarus.

Dear David,

I am glad I read your column on a regular basis. You have written insightful pieces, made poignant arguments, and exposed many wrong doings. I trust you are an intelligent and thoughtful man, but your screed regarding obesity is absolutely off the rails. You faltered the minute you embraced weight as the problem and assumed that the calorie balance equation is all there is to understand about energy metabolism. You assume that if people are obese it is merely because they are too gluttonous for their own good. You couldn’t be more mistaken.

Ironically, those of us in the trenches as well as many researchers are beginning to recognize the many ways and reasons people gain fat weight preferentially. Calories are only one of many factors. There are fewer and fewer people invested in the simplistic belief that “eat less, exercise more” is the answer to the growing obesity epidemic. In fact, the people who are still believers tend to be those people who have little personal or hands on experience with weight management (and please take that literally—researchers who mostly crunch numbers and publish the articles don’t count. Talk to those of us who work with patients and clients on a one-to-one basis)

Most of my clients struggle mightily. Of course calories count, they just are not the only thing that counts. Far more impressive people than I have argued that the issue is multifaceted and very complex . These authors identify 10 putative factors that have at least the same potential to impact the obesity epidemic as the currently popular and repeated arguments re: marketing to kids and not enough exercise. Studies show that thinner children can eat more calories, sugar, refined starch, and fat than their heavier counterparts. Clearly, obesity is not merely a math problem.

In my own work, I notice significant lifestyle factors that influence energy metabolism and create an environment that makes it more difficult to utilize fat and glucose effectively for fuel.

Poor food composition and distribution
Poor food quality (often an economic issue—see Adam Drewnowski’s work for more details) that is subsidized by government farm policy. Highly refined starch, sugar and fat is far cheaper to purchase per 100 calories than fresh fruit, vegetables, and lean protein sources
A preoccupation with “safe” that destroys all bacteria, including healthy bacteria that can improve gut microbiota and immune function
A gut microbiome that is linked to greater fat synthesis secondary to poor food quality
Gut peptide secretion secondary to food intake and gut bacteria that seems to alter appetite regulation
Sleep deprivation and poor sleep hygiene that increases sugar cravings and alters appetite
Chronic pain and may other sources of stress that exacerbate insulin resistance secondary to excessive cortisol secretion (consider a society that keeps raising the bar, increasing expectations, evaporating a safety net, etc)
Long hours at work and extensive commute time that erode time and energy for physical activity; anxiety on the part of workers that if they don’t sacrifice their personal life, they will soon be out of a job
Preoccupation with (financial) success, both in school and work, that pushes aside quality of life factors
Little or no appreciation or time to adequately shop, prepare and eat whole foods. We pretend we can do it even with 10-12 hour days away from home
Poor nutrition status for women of childbearing age. We know that pre-pregnancy nutrition status and the intrauterine environment influences the offspring’s metabolic health. Babies born to mothers with gestational diabetes and other states of insulin resistance (including obesity) are much more likely to become diabetic and/or struggle with metabolism and suffer high rates of birth defects. About 50% of births are unplanned for both married women and unwed teens. This does not bode well.
Exposure to endocrine disruptors and other obesogens that influence glucose tolerance, thyroid function, and insulin sensitivity via the environment—especially secondary to plastics, pesticides, and other contaminants (95% of which reach us via our food supply)

In addition, there are fundamental societal and system issues that complicate people’s access to adequate nutrition care and support.

Little money, time or willingness to teach life skills (including cooking, shopping, menu planning, budgeting, etc) to students. Somehow the overworked parents are supposed to do it all.
Negligible resources for adequate nutrition education in K-12. It is not easier to eat well today. It was easier when all we had to worry about was getting enough. Most schools don’t teach nutrition, and if they do it is taught by someone who isn’t really educated about nutrition. The information ends up being dogmatic and rigid—not very effective. Maybe the instructor’s degree is in PE or health, biology or the like….not good enough.
Pretending primary care doctors and nurses can deliver effective nutrition counseling. Doctors don’t get much nutrition training and often demonstrate even less skill in counseling. Nurse’s get about one semester’s worth. Have you ever asked how many patients get referred to dietitians or qualified nutrition counselors even with legitimate diagnoses?
Medical nutrition therapy (MNT) is rarely covered except for diabetics and folks with renal disease. Even then, time and access to an RD is laughable. Diabetics are supposed to be effectively “managed” at one local institution with four 15 minute appointments a year. And we wonder why people are “non compliant” and “lost to follow-up”
Everyone with dyslipidemia (cholesterol problems), hypertension, inflammatory states like gout, asthma, and allergies, and even cancer is likely to have to pay for MNT out of pocket unless dietitians accept a fraction of usual billing costs (but this is nothing new—it’s just that I can’t see 8-10 people in an hour and do any good—that’s not counseling, it’s pretending that knowledge is the same as behavior and there is only one right way to eat)
Individuals struggling with obesity, disordered eating and outright eating disorders are likewise not typically covered unless they are seen within a medical setting with an MD on board. The medical model doesn’t work so well when it comes to nutrition counseling. Our process is much like the therapeutic model used by mental health practitioners.
The government’s latest position with new funding for covering obesity basically establishes the primary care MD as the gatekeeper and employer for all nutrition services. How ironic that as someone with 25 years of experience working with clients in my own practice I am now expected to have an MD set the protocol and standards for my practice. Currently I teach MD’s, nurse practitioners, physician assistants and other health providers how to effectively help patients regain metabolic health.

Despite all of this, obesity isn’t the real issue. Weight has never been an effective bio-marker for disease or surrogate for health. It is sloppy and lazy science/journalism/public policy that continues to perpetuate the myth. The real issue is metabolic health.

Filed Under: Blog Tagged With: appetite, calories, exercise, farm bill, food costs, gluttony, gut peptides, metabolism, obesity, weight

Losing Weight Is Not a Math Problem

May 7, 2012 by Bonnie

How many times have you read “a calorie is a calorie?” Countless weight loss studies test different diets and everyone loses weight. Calories are drastically limited in most of the diets. At a deficit of 500-1000 fewer calories a day, the diets typically allow people 50-75% of recommended intake.

Of course everyone loses weight. The researchers conclude that it doesn’t matter what diet you use, all of them will work equally well. So the mantra lives on, “Eat Less, Exercise More.” But losing weight is not merely a math problem.

In more sophisticated studies, some diets works better for specific individuals. In 2007 research by Chris Gardner (a nutrition researcher at Stanford University) found that a higher carbohydrate diet helped insulin sensitive people to lose fat weight more effectively. The higher protein diet worked better for people who were insulin resistant.

Researchers with David Ludwig at Harvard University studied a group of overweight adolescents. The teens eating lower glycemic carbohydrates (more whole grains, fruits and vegetables, beans and legumes) lost more fat weight than those eating a calorie restricted low fat diet with all the usual fare.

The test subjects ate whole grains, not refined. They ate oatmeal, not sugared refined cereals. They ate more fruits and vegetables. Not chips, pretzels and other refined snacks foods. They drank water, not sodas.

The teens eating more whole foods also sustained a lower BMI even six months after the research ended. The calorie restricted subjects regained the weight lost—and more. That’s a familiar scenario for too many people.

DIETING AND DISORDERED EATING

The endless struggle to lose weight has cultivated a population of yo-yo dieters, chronic dieters, and many people with disordered eating and diagnosable eating disorders. What’s missing is an approach to food that works with the body, mind and soul of the person who is trying to lose weight. Each person needs an approach to food that works for them.

Ironically weight is not a good measure of success. Many in the medical and public health community want to believe weight is a useful way to measure health. It isn’t. Thin people develop heart disease, hypertension, diabetes, digestive disorders, and cancer. The idea that body fat drives the disease state is one of the great distortions of modern medicine.

WHAT’S DRIVING WEIGHT GAIN? WHAT’S DRIVING DISEASE?

What we eat influences our body in ways not anticipated by people who think obesity is a math problem. For most of my clients, poor metabolic health precedes the diagnosis of disease regardless of their weight.

When people eat poorly, the body adapts—and not in a good way. A diet rich in refined starches and sugar can increase insulin resistance—an underlying condition linked to diabetes, heart disease, cancer, and more.

In addition, eating refined sugar and starch promotes a different bacteria flora to reside in our digestive tract. Eating excessive refined sugar and starch promotes the secretion of gut peptides that influence appetite. Certain gut peptides, like ghrelin, signal the brain and compel us to eat more. It is even thought that the gut microbes linked with refined sugars and starches can promote fat gain.

THERE IS NO ONE RIGHT WAY TO EAT

Ideally your food plan allows your body to metabolize both fat and glucose effectively for fuel. It allows you to feel satisfied after eating. It provides you with energy needed to complete the tasks of your day—both work and play.

A successful approach includes foods you enjoy, foods that are readily available, and foods that you can afford. The actual mix of food that works for you may be very different than the mix of food that works for someone else.

WHICH DIET?

Too many people ask me what kind of diet I support. Is it Paleo? Raw Foods? Vegan? Do I promote Weight Watchers? The Zone? Pritikin?

This question reveals a distorted understanding of the process. Decades of dieting has cultivated a belief that there is one right way to eat. You just have to find it. People spend too much of their lives trying one diet after another Sometimes they get stuck trying the same one over and over and hoping for a different result.

Ironically the medical world also needs to abandon the idea that there is a single dietary approach to treat any one disease. It is critical that we start treating the patient, not the diagnosis.

There should be is no such thing as a diabetic diet, as if every diabetic will benefit by the same exact food plan. The same goes for diets promoted for any single disease, as well as weight loss itself.

AN APPROACH TO FOOD THAT WORKS

Magical thinking distracts people from the real task at hand: cultivating an approach to food that works. Too many people try and eat like a thin friend, a thin sister or the biggest loser. That food intake may actually make everything worse. It may be so unsustainable that you soon abandon the effort.

We can do better. Anyone who struggles with their weight or their health deserves to figure out an approach to food that works for them.

Filed Under: Blog Tagged With: appetite, bacteria, cancer, diabetes, diet, exercise, fat, ghrelin, glycemic index, gut peptides, heart disease, obesity, Paleo, Pritikin, resistant starch, sugar, Vegan, weight loss

Resistant Starch–How much is in your diet?

April 30, 2012 by Bonnie

Resistant starch is known to impact digestion, metabolism and appetite regulation. I have been intrigued for years and signed up to hear a presentation at the California Dietetic Association meeting last week. National Starch Food Innovation sponsored the talk. They are selling a product (which I am currently testing in my own kitchen), so I knew to be aware of the slant. Yet, the science was compelling and mirrors much of what I observe in my own practice–and my own kitchen.

SOURCES OF RESISTANT STARCH IN THE FOOD SUPPLY

Resistant starch in found in whole plants foods, especially beans and legumes and whole grains. But whole grain really means the whole grain. As soon as you grind a grain into flour much of the resistant quality is lost. A 2008 article by Mary Murphy, MS, RD, in the Journal of the American Dietetic Association provides a good review of food sources of resistant starch.

Cooking can significantly alter the resistant quality of starch. A cup of whole oats contain s 17.6 grams of resistant starch. A cup of cooked oats contains only 0.5 grams. Intact whole wheat berries contain 13.6% resistant starch. Whole grain flours contain only 1.7%.

Studies estimate that Americans consume about 5 grams of resistant starch a day. Recommendations range from 15-20 grams a day. Click on the link below to identify common foods that are rich sources of resistant starch.

Resistant starch chart

WHAT WE THINK WE UNDERSTAND ABOUT RESISTANT STARCH AND METABOLISM

Resistant starch seems to impact our health in key and fundamental ways. Our diet determines the kind of microbes that live in our gut. There are about 10x more bacteria than human cells and anywhere from 500-2000 different species.

The type of microbes that reside in our gut changes in response to our diet. Scientists now believe that these microbes have a lot to do with energy metabolism and how the body signals hunger and satiety.

When we eat mostly refined sugars and starches, we cultivate gut microbes that promote fat storage. Studies show that a different microbial flora probably helps people more effectively manage their weight. The changes in metabolism stimulate a different signaling to the brain. The body is satisfied longer and less hungry–even the next day.

TRANSLATING KNOWLEDGE INTO BEHAVIOR

As you look at the list, keep in mind that even though some foods may be a relatively rich source of resistant starch,there are other factors that influence how the body metabolizes energy. Weave together an approach to food that works by including the factors that work for you.

1. Pay attention to hunger cues and how much is enough. No amount of resistant starch will protect you from over eating or eating for entertainment.

2. The relative amount of carbohydrate, protein and fat still matters for those of us who are insulin resistant. (HINT: Despite 2.8 grams of resistant starch found in pizza, I doubt anyone in my family would enjoy greater metabolic health living on it!) Continue to enjoy mostly protein and produce and then test to see how much starch you can manage. Some people handle large servings of starch, others not so much. The starch we eat is modest–about 20-30 percent of the plate and sometimes none at all.

3. Keep moving. Physical movement improves how the body uses fat for fuel. Physical activity increases insulin sensitivity up to 60%. The bulk occurs in the first 20 minutes of movement and you can enhance your metabolic health even when activity is broken up throughout the day.

4. Start planning what resistant starchy foods fit into your diet. My son is using mashed pinto beans and cheese for a quick breakfast in the morning. I am throwing more beans and legumes into soups and salads. My husband is using homemade granola in the morning and experimenting with resistant starch in our homemade bread recipe. What are you willing to try?

Filed Under: Blog Tagged With: bacteria, cancer, diabetes, digestion, fat, glucose tolerance, heart disease, Hi-Maize, incretins, insulin sensitivity, metabolism, microbiota, resistant starch, weight loss

Health Counseling: Who thinks the same message works for everyone?

April 11, 2012 by Bonnie

Blood tests–specifically serum cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides–remain the backbone of screening for cardiovascular disease. My father died at 44 from congestive heart failure. I have my levels tested regularly. I finally cleared time to get a fasting blood test.

BLOOD TEST RESULTS

Fasting tests are the biggest challenge. Mornings are a rush, getting my son off to school and both my husband and I off to work. I don’t want to fast until mid morning by the time I could get to the lab. I don’t feel good and am not nice when I get over hungry. I waited until my son’s spring break last week.

The results look better. Total cholesterol, LDL cholesterol and triglycerides dropped. HDL cholesterol stayed steady. But obviously not good enough for Kaiser. I received my annual counseling letter in the mail yesterday. They want me to sign up for a cholesterol class and I may need medication.

I already argued this issue with my physician last year. There is no good data suggesting medication for women without previous evidence of disease (not just a risk factor) is beneficial.

Out of curiosity my husband attended the cholesterol class last year. It was taught by a nurse who couldn’t answer his food questions. (Where are the dietitians?) He came back with a 113 page manual that was published in 2003. I reviewed the material and found it dated and inaccurate.

FOLLOW THE ENCLOSED DIET

I focus on the rest of the letter. The next line reads, “Please follow the enclosed cholesterol diet.” (I repeat, where are the dietitians?)

I almost choke on the words. I am admonished to eat more fruits and vegetables. Eat less red meat. Replace butter and margarine with oils. Limit foods high in cholesterol. Be physically active and lose weight.

The same message is sent out every year. Are the administrators and health professionals at Kaiser merely happy to check off the box or do they truly believe this is the path towards behavior change?

ONE SIZE DOES NOT FIT ALL

David Katz, MD is the founding director of Yale University’s Prevention Research Center. His 2011 Lenna Frances Cooper Memorial Lecture was published in the February, 2012 edition of the Journal of the Academy of Nutrition and Dietetics. He makes many valuable points, but this one sticks. “Messages that most effectively motivate behavior change are tailored messages; customized messages; individualized messages.” Five references follow this statement.

I already know what I am doing and why I am doing it. I don’t plan to change. But I cringe for other Kaiser members who would benefit from attentive and individualized nutrition consultation. Why do Kaiser patients get an anonymous and formulaic counseling letter from Kaiser each year?

Filed Under: Blog Tagged With: Academy of Nutrition and Dietetics, behavior, cholesterol, counseling, David Katz, health, heart dieseae, Kaiser Permanente, medication, nutrition, triglyceride, Yale

A Sweet Battle: Is high fructose corn syrup nutritionally the same as sugar?

March 24, 2012 by Bonnie

Nobody is claiming white table sugar is good for you, but HFCS stands accused of being much worse. Three days ago the LA Times reported that sugar producers filed suit against the Corn Refiners Association for false advertising. The Corn Refiners Association is known for ads that claim “high fructose corn syrup (HFCS) is nutritionally the same as table sugar” and that “your body can’t tell the difference”. This controversy has roiled scientific conferences for years. It is hotly debated in corporate boardrooms, and now the courts get to weigh in.

THE DIFFERENCE BETWEEN SUGAR AND HFCS

Much of the confusion lies in that both products–white table sugar and HFCS–are made from two basic simple sugars known as monosaccharides: glucose and fructose. In white table sugar one molecule of each is bound together to make a disaccharide called sucrose. The glucose and fructose molecules exist in a one-to-one ratio. Commercial sources of sucrose include sugar beets and sugar cane. This is the conceptual essence of “natural”–the plants make the sucrose.

To make HFCS, corn syrup is manipulated in a factory to create different ratios of glucose to fructose. The most common formula in food manufacturing is 55% fructose and 45% glucose, but there are formulas for up to 90% fructose. This is most certainly not “natural”.

YOUR BODY KNOWS THE DIFFERENCE

HFCS is not the same nutritionally as sucrose, and your body certainly knows the difference. Fructose is metabolized very differently than glucose. All cells can use glucose for fuel. Fructose must first be metabolized in the liver and converted to glucose. When high levels of fructose are consumed, the excess energy is laid down as fat in the liver. This process can progress to fatty liver disease, non-alcoholic steatohepatitis (NASH), and eventually to cirrhosis.

It is possible to over consume fructose without HFCS. This maybe difficult with actual fruit, but people do it all the time with excessive intake of juice. Juice is just not the same as the fruit itself.

Juicing means most of the fiber is left behind. While someone would rarely eat more than one orange, a small 10 oz glass of juice contains the calories and fructose of 2 1/2 oranges. I have witnessed restaurants serve 20-24 ounces of juice as a single serving and ask if someone wants a refill.

HFCS has become the primary sweetening of all sodas, fruit drinks, sweetened teas, energy drinks and the like. It is cheaper than table sugar. The number of these products has swelled enormously over the years. Just take a look at your local grocery-convenience-liquor-drug store. Many producers have the nerve to promote these products as “health foods” and have designed labels to convey a fresh and wholesome image.

HFCS is also used as a filler, thickener and taste enhancer in all sorts of processed foods, from salad dressings and peanut butter to frozen dinners and condiments. It is everywhere.

ALCOHOL WITHOUT THE BUZZ

Endocrinologist, David Lustig, MD, of UC San Francisco has taken to calling HFCS as “alcohol without the buzz”. He writes and speaks vehemently about the consequences of our relatively recent experiment with this cheap and ubiquitous source of sweetening in our food supply. HFCS didn’t start entering our food supply until the 1970′s. It is no coincidence that statisticians citing increasing rate of childhood obesity use 1970 data as a starting point.

Currently HFCS holds “generally regarded as safe” (GRAS) status according to the FDA. A National Institute of Health website discussing NASH states the cause is unknown and there is no known cure. Just how long before some of this changes?

Filed Under: Blog, Uncategorized Tagged With: childhood obesity, corn refiners association, corn sugar, David Lustig, diabetes, fatty liver, fructose, glucose, high fructose corn syrup, NASH, natural, NIH, nonalcoholic steatohepatitis, obesity, sugar

Is All Red Meat Risky?

March 14, 2012 by Bonnie

All red meat is risky” glared the headlines of Tuesday’s LA Times. That got my attention. We eat red meat probably 6-8 times a week between lunches and dinners.

This story deserves more scrutiny.

LIMITS OF EPIDEMIOLOGICAL STUDIES

First off, this is an epidemiological study. That means a group of people were asked about their eating and lifestyle habits 20 years ago and that data was compared to mortality records. There are a few reasons to question the findings.

First, association is not the same as cause and effect. No one, not the researchers nor the journalist makes this point clear. The thinking is that if you study lots of people (110,000 in this case) over a long period of time (20 years), the data has stronger statistical significance. It does. But the study design limits interpretation. An epidemiological study won’t ever be able to prove beef causes the outcomes described.

WHAT’S A FOOD FREQUENCY QUESTIONNAIRE ?

Second, people being surveyed were asked about their food habits using a food frequency questionnaire, a very limited tool. Here is what some scientists have to say:

“The substantial limitations of FFQs have been known for some time (1) and published studies based on FFQ-derived data have long included in their discussion sections a litany of weaknesses due to suboptimal dietary assessment. However, few of us expected the astonishingly poor measurement characteristics of FFQs when compared with doubly labeled water (a gold standard for energy intake)”

I find the lead author’s assertion that “there is no amount of red meat that is good for you” rather arrogant given the limitations of the study.

A VEGETARIAN DIET ISN’T NECESSARILY HEALTHY

Lastly, this study is presented as if it can stand alone, without any context of other findings. A note to the journalists: It is not enough to have Dr. Ornish offer his opinion. That is not science; it is pandering to his particular bias regarding a vegetarian diet. When people eat a plant based diet, they don’t just eat vegetables. They often eat lots of refined starch and sugar.

The thinking that people will eat more healthfully and have less chronic disease without red meat is an interesting assumption. I know many of my own clients who are healthier, leaner, with less evidence of disease from actual bio-markers like blood pressure, serum glucose levels, lipid values (cholesterol, triglycerides, etc) and body composition when they eat enough protein—including red meat— in their diet.

IS IT THE CATTLE OR WHAT WE DO TO THEM?

I do have a few reservations. There are a couple of reasons eating beef could be associated with greater risk of disease. Cattle are raised over a longer period of time than poultry. They accumulate more fat.

1. When they are fed a diet of corn, soy and stale bakery products (allowed by the USDA up to 2.5 kg. per day) their fat is higher in pro-inflammatory omega 6 fatty acids and after six months of a feedlot diet, the omega three contents drops in direct relationship to time away from the pasture. It is clear that the animal scientists who champion this feed were far more concerned with yield and quality of the product (ie: profit potential) than any nutritional ramifications.

2. Persistent organic pollutants accumulate in fat tissue. These substances are endocrine disruptors and have a very strong link to disease. Cattle have a greater body burden than other animals because of their longer lifespan and greater fat accumulation before slaughter.

So is it the beef or the way we conventionally feed cattle? Is it red meat or the fact that we spew polluting chemicals into our environment and can’t find the political will to contain the contamination?

We don’t have those answers. In the meantime, I will continue to enjoy my grass fed beef, knowing I am doing what I can to minimize what I see as the real risks to my health.

Filed Under: Blog Tagged With: animal feed, beef, disease, endocrine disruptors, environment, epidemiological study, fat, food frequency questionnaire, grass fed, Harvard, mortality, Ornish, persistent organic pollutants, USDA

Nutritionism: Is Eating for Nutrients the Answer?

March 8, 2012 by Bonnie

Eat cereal and milk for a rich source of 10 nutrients. Enjoy diced dried plums for fiber, berries for antioxidants, citrus for vitamin C, bananas for potassium. Include eggs and fish for the best source of protein, olive oil for monounsaturated fatty acids, flax seed and fish oil for omega three fatty acids. Add cinnamon, tumeric, or capsicum to foods for a metabolic boost.

Does anyone else wonder if sound bite nutrition is helping or hurting?

Everyone eats. And the experts are falling over themselves to give advice. How often have you been confronted with someone sharing their five favorite flat belly foods, their seven secrets to the best YOU, as well as the ten foods you should never eat again. The constant dull roar of sound bite nutrition is mind numbing. Nutritionism–the act of eating food for specific nutrient content–is alive and well. In our expert driven culture, fixing the American diet with helpful hints threatens to overwhelm, and not necessarily help all that much.

MORE THAN THE SUM OF ALL NUTRIENTS

Our health and nutritional status is more than the sum of all nutrients consumed. Good nutrition is not a game to see who gets the most. It is not a contest to eat only the best sources of any one nutrient. What matters most is that you eat well enough and enjoy food in it’s rightful place. A close second goal is getting the balance of energy you need in a way that allows you to burn fat and glucose effectively for fuel. When these two goals are achieved, the other nutrients usually fall into place.

Sure, vitamins and minerals are important. So are nutrients that are yet to be identified as “essential” like antioxidants and omega three fatty acids. But consuming these nutrients in isolation doesn’t insure you are eating a diet that works for you. Sometimes sound bite nutrition is merely distracting, sometimes it harms.

WHEN SOUND BITE NUTRITION BITES YOU BACK

Despite our abundant food supply, nutrition myths and misinformation are commonplace. The complexity gets reduced to the polarized thinking of good and bad foods. Even the nutrition experts who know better get stuck in polarized thinking. How many dietitians are still handing out lists of “Foods to Include” and “Foods to Avoid”?

I witness the harm of sound bite nutrition in my office every day.

The diabetic who can’t get a handle on his blood sugar, until (when pressed) he finally remembers he drinks three glasses of acai juice a day “for the antioxidants”.

The frustrated dieter who starts every day with a huge bowl of “high protein cereal”, that is still mostly carbohydrate.

The client with hypertension who is very proud that he doesn’t add salt to his food. But he drinks a sports drink with electrolytes (including sodium) every day because it’s “better than water”.

The frantic and out of work patient who can’t afford better food brings in a bag of supplements for me to check out, lamenting, “They cost me hundreds of dollars every month.”

SOUND ADVICE, NOT SOUND BITES

You hear soundbite nutrition everywhere. People share their latest diets, the most popular food crazes, and topical research reported just today–too often with little context.

Most critically all the nutrition tidbits are spouted off as if everyone has the same needs and will respond the same way. This is the most egregious error of all–and is entirely driven by the scientific community.

As long as research focuses on statistical significance, we are doomed to “treat to the mean.” It is not true that everyone has the same nutrient needs nor do we all respond well to the same diet. I challenge every health care professional–including dietitians who are typically the most educated about food and nutrition–to step away from the abstract and impersonal sound bite. I urge every eater to resist the seduction of nutritionism without context.

Have you been tripped up by sound bite nutrition? I’d like to hear your story.

Filed Under: Blog Tagged With: diet, dietitians, energy, monounsaturated fats, nutritionism, omega 3, omega three fatty acids, protein, sound bites, vitamins

GREEK YOGURT OFFERS 2-3 TIMES MORE PROTEIN, LESS SUGAR

February 26, 2012 by Bonnie

February 26, 2012

“Greek yogurt sales stirring up the food industry” says Tiffany Hsu of the LA Times. The popularity and rise in sales of Greek yogurt are truly remarkable. Too bad the reporter only side-swiped the issue by reporting Greek yogurt is “perceived to be filling.” It is more filling and it’s the protein.

Protein has a profound capacity to enhance satiety–the feeling of being satisfied after eating. Conventional breakfasts of cereal, bagels, muffins or pastries (mostly carbohydrate and fat) leaves too many eaters wanting–and feeling hungrier all day long.

It is no coincidence that the incidence of obesity and diabetes swelled during the reign of high carbohydrate low fat diets. People ended up eating more when they didn’t feel satisfied.

GREEK YOGURTS OFFER MORE PROTEIN, LESS SUGAR

Enter Greek Yogurt with 16-20 grams of protein and more per serving, often with a fraction of added sweetening. The better balance of protein and carbohydrate –with or without the fat–means feeling satisfied longer. I have one client who recently told me that learning about Greek yogurt was worth the time and money spent on nutrition counseling all by itself!

A cup of plain yogurt contains 8-12 grams of lactose, the natural sugar found in milk. Plain yogurts only contain the lactose. Flavored Greek yogurts boast a mere 15-20 gram of total sugar. That means a mere 1-2 teaspoons of added sugar compared to the 1-2 tablespoons of added sugar found in conventional flavored yogurt. And most conventional yogurts contribute only 6-7 grams of protein.

Greek Yogurt is popular because of the protein. Despite the added cost, Greek yogurt is a quick and convenient breakfast, snack and source of protein at any other meal.

The LA Times article mentions Ben and Jerry’s foray into Greek yogurt frozen desserts. This should be interesting. Will the added protein offset the added sugars? I’m not so sure. If you try it will you let me know?

Filed Under: Blog Tagged With: Ben and Jerry's, breakfast, carbohydrate, dessert, diabetes, fat, greek yogurt, obesity, protein, satiety, snack, sugar, yogurt

Less trans fat, number of obese stabilize. Is there a link?

February 15, 2012 by Bonnie

Last week The Center for Disease Control reported than the presence of trans fat has decreased in our blood by 58% between 2000 and 2009. The FDA mandates nutrition labels to include trans fats in packaged foods as of January, 2006.

Food manufacturers were given significant advance notice of the initiative, enough time to reformulate their products. The process of partially hydrogenating vegetables oils was invented by a German Scientist at the turn of the century. Crisco was on the shelf with recipe books in 1911. The FDA determined partially hydrogenated fats were “generally regarded as safe” (GRAS status) in 1958.

CELEBRATING THE PROBLEM

Americans were admonished to switch to margarine in the 1970′s in a misguided effort to reduce risk of heart disease. An appalling lack of science and an overabundance of hubris spurred a revolution in processed foods. I remember reading full page ads in the LA Times, exhorting companies to abandon the saturated fats of the day. Soon “healthier” vegetable oils were replacing palm and coconut oil as well as butter, lard and other saturated fats. What a mess.

Partially hydrogenated fats were found in suspected places and unsuspected places. Ironically the biggest source of trans fat came from bread, crackers and bakery items–about 40% of all trans fat in the food supply. The partial hydrogenation of vegetable oil allowed these products to last longer on the shelf.

SOURCES OF TRANS FATS

Ironically, french fries and other fried foods contributed far less trans fat than bakery items. Unfortunately, the public health bias regarding fast food meant undue attention was placed on that sector.

My husband works in the food industry, when I called Cargill and Archer Daniel Midland and asked them how much liquid shortening was sold with partially hydrogenated vegetable oil, the answer was blunt and direct: 99%. Practically every restaurant, cafeteria and food service institution in America was using liquid fry oil with partially hydrogenated fat, regardless of whether you were talking about the local diner, the restaurant of a five star hotel or your community schools and hospital.

THE TROUBLE WITH TRANS FATS

Over time researchers started to question the GRAS status of trans fats. While FDA scientists didn’t start addressing the issue until after 2000, industry scientists were already aware that there was an problem in the early 1990′s.

One veterinarian from Wake Forest University ran a study on monkeys, giving both the experimental and control groups the same number of calories, the same amount of fat and the same amount of activity. The only difference was the type of fat used in their chow. The experimental monkeys were fed 7% of their calories from trans fats. Olive oil made up the rest of the fat and 100% of the fat in the control group.

After 8 years, the control monkeys gained 1.2% of their body weight. The experimental monkeys gained 6.8%. If we try to translate that data into human terms, this would be equivalent to a 130 pound human female gaining 10# of fat just because the she ate food containing manufactured trans fat. And most of it would be in her belly.

LABELING TRANS FATS

Labeling trans fats in foods set up a firestorm. Mostly it has been a good thing. The one unfortunate truth is that the FDA allows manufacturers to state “O” trans fats when in fact a product has less than 0.5 gm of trans fat per serving. The American Heart Association recommends no more than 2.5 grams of trans fat per day.

Trans fats on food labels

It is quite easy to eat more than “one serving” of anything. How many people eat just one ounce of a muffin? Most commercial muffins, cookies, and other bakery items are eaten in 2, 4, and 6 ounce portions.

It is important to note that not all trans fat is the same. Ruminant animals (cows and the like) also produce naturally occurring trans fats. These trans fats are actually thought to be health promoting. It is the artificially manufactured trans fats from partially hydrogenated vegetable oils that scientists believe to be the problem.

LESS TRANS FAT TODAY AND OBESITY TRENDS HAVE FLAT LINED

Since 2006, sales of foods adulterated with trans fats have plummeted. The CDC report that we carry less trans fat is our blood underscores the consumer response to labeling trans fats. Just last week Shari Roan of the LA Times reported that obesity rates are leveling off. The usual experts touted how all our public health efforts are starting to work. I’m not so sure.

For the most part, public health efforts are wishful thinking guided by some science and driven by the need to do something. Telling people to eat less fat didn’t work out so well. Telling people to avoid saturated fat didn’t work out so well. Neither has the tired and overused, “eat less, exercise more.”

But I bet reducing trans fat in the food supply maybe one effort that has really paid off. I suspect eating less trans fat has a whole lot to do with obesity rates leveling off. How do you reduce partially hydrogenated (trans) fats in your diet?

Filed Under: Blog Tagged With: Archer Daniel Midland, cafeteria, Cargill, CDC, fast food, fat, FDA, fried food, GRAS, hospital, LA Times, obesity, partially hydrogernated fats, public health, restaurants, schools, trans fat, weight

Cannellini Bean and Calamari Salad–another way to avoid Bisphenol A

February 2, 2012 by Bonnie

This week I cooked cannellini beans from Coleman Family Farms for a favorite recipe from Joyce Goldstein’s Mediterranean Fresh (cannellini beans with sun dried tomato vinaigrette, pg 193). I may have a hard time buying canned beans again. The taste, the texture, everything was amazingly more delicious.

Yes, it takes time to cook beans from scratch, but the effort is worth every delicious bite. Mostly the issue is thinking ahead. You will always want to soak the beans. In addition to amazing flavor, cooking beans from scratch is one way to hedge against additional doses of Bisphenol A (BPA) found in the linings of most canned foods.

THE CONVENIENCE OF CANNED

Canned beans are a convenient and easy source of low glycemic carbohydrate. I love them, but not the BPA found in the can’s lining. BPA is linked with nasty metabolic consequences including diabetes, cardiovascular disease and infertility in exposed workers. We don’t study the impact of agents that potentially interfere with normal metabolic processes nearly enough. I am working to limit our exposure.

My husband operates a food distribution company and I have long enjoyed the cost savings when he brings home staples like canned beans by the case. Yes, the heat treatment in canning can significantly reduce the vitamin content of these foods, especially heat sensitive vitamins like thiamin. At the same time, our diet is mostly whole foods; I know we get enough of most vitamins and minerals.

THE DANGER OF ENDOCRINE DISRUPTORS

Endocrine disruptors like BPA are found in virtually everyone who is screened. 95% of these agents enter our body via the food supply. They bioaccumulate–the more you consume the more you store.

Avoiding plastics is one way to limit exposure. Avoiding canned lining with BPA is another. There are a few brands that package in bisphenol A free cans, including Eden foods and some, but not all, canned products at Trader Joe’s.

Just yesterday I called my husband to replenish our stock of Pomi tomatoes (the tetrapak does not contain bisphenol A). This summer I am seriously considering canning my own.

As for more cannellini beans, Bill told me yesterday that they are done for the season. Next year I will definitely be buying more cannellini beans from Coleman Family Farms.

Filed Under: Blog Tagged With: Beans, bisphenol A, BPA, canned foods, cardiovascular disease, coleman family farm, diabetes, Eden foods, endocrine disruptors, infertility, Joyce Goldstein, plastic, pomi tomatoes, tetrapak, trader joes

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