Blog | Bonnie Modugno, MS, RD

COPING WITH BOREDOM: How much do you eat when you’re not hungry?

January 19, 2012 by

In a recent study, twenty five percent of British office workers claimed to be bored and used chocolate or coffee to cope. They also tended to use alcohol at the end of the day.

Boredom is uncomfortable. It is much more fun to be engaged in a preferred activity or spending time in good company. Food and drink provide immediate gratification. Both are relatively cheap, available 24/7, can be consumed alone or with others, and are not illegal.

SELF SOOTHING WITH FOOD AND DRINK

Businesses including entertainment, technology and law firms commonly stock roomfuls of snacks and treats, effectively coercing workers to work longer hours and right through lunch. Other workers pay for their gustatory entertainment at cafeterias, vending machines or upscale convenience stores found in high rise office buildings. Food and drink would be ideal coping mechanisms if it weren’t for those pesky side effects when you consume more than your body needs or can handle.

Ideally we eat delicious and satisfying food when we are hungry and stop when we are satisfied. This is food’s rightful place. Without hunger, entertaining ourselves with food opens Pandora’s Box.

OVER EATING, OVER DRINKING, INFLAMMATION

Eating more than we need triggers a cascade of metabolic consequences that increase inflammation. To add insult to injury, most popular snack foods contain one or more problematic ingredients known to increase makes things worse all by themselves: excessive fat–especially trans fats; refined starch, sugar and high fructose corn syrup; sodium and alcohol.

Inflammation is linked with everything from heart disease, diabetes and cancer to autoimmune disease states and Alzheimer’s. This is true whether weight is normal or excessive. People who don’t gain excessive fat weight eating poorly do not “get away with it” in the long run.

How can people step away from using refined starch, sugar, caffeine or alcohol to cope with boredom? What are your favorite ways to self soothe without using food?

Filed Under: Blog Tagged With: Boredom, coffee, diabetes, drinking, eating, inflammation, office, office workers, weight

San Francisco Supervisors Vote to Pass Kid’s Meal Toy Ban

October 18, 2011 by

Nov 3, 2010
Just yesterday the San Francisco Board of Supervisors voted to pass a toy ban for meals that they deem unhealthy. This law presumptuously determines that no toy may be given if a meal contains more than:

• 600 Calories

• 35% Calories from fat, 10% saturated fat (except if fat is in nuts, nuts butters, seeds, eggs and reduced fat cheese)

• 0.5 gm trans fat

• 640 mg sodium per meal or 480 mg sodium for a single item

• 10% of sugar based Calories and 35% of fat based Calories in beverages

Meals must also contain:

• 1/2 cup fruit or 3/4 cup vegetable

There is no parameter for the source of the foods, level of processing, or adequate protein. There is no discussion of total calories from refined sugars and/or starches in the food.

When compared to nutrition data that the government collects, very few kids eat like this. Over 5500 children’s meals were analyzed from 2002-3 NHANES data by Univ of Washington’s School of Public Health. The analysis included the original requirement that each meal contain 1/2 cup of fruit and 3/4 cup of vegetable. Less than 1/10 of one percent of meals met these specific guidelines.

There is a big problem with such seemingly sound recommendations. No science is available to show that this particular meal composition will decrease child obesity. There is no science, but lots of good intention. Good intention is not good enough.

NO INSIGHT INTO METABOLISM, HUNGER OR SATIETY

What is horribly missing in the discussion regarding child obesity is the incredibly complex and not yet fully understood mechanism of satiety (a sense of feeling satisfied after a meal) and energy partitioning. The key question is why does the body compel us to keep eating even after we have enough, and where do are those calories go?

The short answer is that eating more has historically been advantageous and linked with survival. The human body has exquisitely evolved to adapt to survive scarcity. Chilean miners are a case in point.

Without rapid metabolic adaptation in response to the minimal food intake available to the miners after the cave in, they would have been dead before they were found. Within days of near starvation, the body shifts to preferentially burning fat for fuel. You won’t feel great, but you will be alive.

TOO MUCH REFINED SUGAR AND STARCH IS THE PROBLEM

Research has begun to suggest that excessive intake of refined sugars and starches is probably more of the problem in child obesity than either total fat or saturated fat intake. We are at a nutritional crossroads and it is time for some clarity in the health and nutrition debate.

1. There is no one right way to eat. It is simplistic and over-reaching to think that the nutrition parameters outlined in the toy ban are appropriate for all children. It is important to hold parents and caregivers accountable and responsible for what children get to eat. They know their children better than any politician.

2. We do not have the research that tells us what is healthy for all children. Did the supervisors ever consider that the nutrition information they are working with is not all there is to know?

3. Thin kids drink the same amount of soda as heavier kids. They also eat about the same amount of calories, carbohydrate, protein and fat. So is the issue that heavy kids eat and drink too much, or is it that some kids just get away with it? Maybe it’s time to stop using body size as the litmus test for what kids get to eat.

4. There is no refuge in the neighborhood supermarket. People can make poor food choices anywhere.

5. Knowledge is not behavior. It is easy to talk about what you should eat. The real test is what you do eat. Too many people—including health professionals– don’t walk the walk.

6. It’s not where you eat; it’s what you eat when you get there. At many sit down restaurants the fries come in one pound servings and the beverage refills keep coming at no extra cost. The portions are not small, medium and large—just mostly very large.

7. Fast food restaurants were the first restaurants to offer “choose your side” menu options for kids so that they could also enjoy fruits and vegetables on their plate. In 2004 McDonalds adopted the Happy Meal option nationally, allowing families to choose 1% low fat milk and apple dippers instead of soda and fries at no extra cost.

In 2005 I surveyed 14 sit down restaurants with a kid’s meal menu located in Los Angeles, California. Less than 7% of offerings on these menus offered a fruit or vegetable in the meal. By 2007 the landscape had changed dramatically. 70% of the same restaurants were now offering a fruit or vegetable option on the kid’s menu. By 2009 the National Restaurant Association made healthier kids meals a priority.

SOME CHANGE CAN BE GOOD

When I suggested the Happy Meal option to McDonald’s Owner Operators of Southern California (MOASC) in December of 2002, I was encouraged by the reception and willingness of these business owners to be part of the solution

Today McDonald’s is one of the largest sellers of apples and salads. McDonald’s adopted standards for animal welfare and feeds championed by animal scientist, Temple Grandin, PhD. McDonald’s is already answering Michelle Obama’s call for every player in the food and nutrition community to address factors that contribute to child obesity.

McDonald’s creates impact with even small changes. I wonder why public health proponents, journalists and the public at large cannot see the opportunities to work with McDonald’s, instead of pretending that if fast food went away there would be no child obesity.

STUMPED BY A FIXED MIND SET

Anne Dweck, PhD, a professor of psychology at Stanford University talks of a fixed mind set versus a growth mind set. I’d like to think health professionals embrace a growth mind set, learning new things and incorporating that new knowledge into their current thinking.

Too many public health pundits, public and clinical health care workers, teachers and other “influencers” continue to denigrate the food at McDonald’s no matter what it is and how it has changed. This is a sign of a fixed mind set. The fixed mind set is marked by refusing to consider new information.

These same influencers continue to believe that all fast food is bad as if all other choices are good. Not only is this not true, but this simplistic thinking leads people to believe they are eating well as long as they are not eating fast food. This is a sign of a fixed mind set.

These influencers continue to extol the virtues of full service supermarkets without considering how people shop and what they really eat at home. This is a sign of a fixed mind set.

CULTIVATING A GROWTH MIND SET IS A MORE CHALLENGING JOURNEY

It is challenging to shift from a fixed mind set into the murkier territory of a growth mind set. The certainty and absolute nature of a fixed mind set is seductive and compelling. And it is often wrong.

Public health advocates have been blaming fast food for increasing child obesity for decades. Today the San Francisco Board of Supervisors voted to ban toys from kid’s meals that don’t meet their specific definition of “healthy.”

There is no science that has determined that their prescribed meal will improve the situation, but the public health pundits would like us to believe that the changes they propose will mean all children eat more healthfully.

The average McDonald’s Happy Meal customer eats two meals a month at McDonald’s. I don’t know that banning toys from meals that don’t meet these nutritional guidelines is going to dramatically change the health status of these kids. I certainly don’t want to be the mom who decides today her kids get to eat fries—but they don’t get a toy.

Please note: I consult for the Owners and Operators of McDonald’s in California. This blog is an independent enterprise and my personal and professional opinion. It is not the position of McDonald’s Corporation or any individual owner.

Filed Under: Blog Tagged With: child obesity, Happy Meal, San Francisco, toy ban

Sodium: Its about flavor, not salty

October 18, 2011 by

The sodium war heats up with USDA dietary guidelines threatening to lower sodium recommendations to 1500 mg a day. The logic escapes me when current intake ranges around 3600 mg a day and the current guideline of 2300 mg a day hasn’t enjoyed any success.

An editorial in the Nov, 2010 edition of American Journal of Clinical Nutrition argues the point. The conclusion? “Sodium intake in the US adult population appears to be well above current guidelines and does not appear to have decreased with time.”

Despite almost forty years of admonishing the American public to reduce sodium, little has changed. Americans experience more heart disease and more hypertension. Is it really the sodium?

In the same journal there is an accompanying editorial, written by three scientists (two who have consulted for the Salt Institute). The editorial challenges USDA recommendations to reduce sodium intake for everyone. I am inclined to agree with the naysayers.

I think the scientists pushing for greater universal sodium restriction are missing the boat on at least two accounts. First, sodium intake influences fluid balance in the body. But it does not act independently. Insulin drives sodium re-absorption in the kidneys.

INSULIN DRIVES SODIUM RE-ABSORPTION AND FLUID RETENTION

Overeating, especially eating more carbohydrate, increases insulin secretion. The more insulin, the greater re-uptake of sodium and water. People feel bloated, fuller, thicker. They can gain 3-5 pounds of weight overnight. It may not be fat weight, but they still can’t get their pants zipped the next morning.

This is probably the reason Walter Willet, PhD, a co-author of the original research, states that overeating is more of the problem than actual sodium intake.

LEARNING HOW TO USE SALT: ITS ABOUT FULL FLAVOR

Second, the discussion to reduce sodium is often accompanied by feeble recommendations to make food taste better with herbs and different cooking methods. How we cook our food is not the biggest problem.

70% of sodium intake comes from highly processed and adulterated packaged foods. Eating more whole foods, cooked from scratch, is a far more effective strategy to reduce sodium. In addition, public health educators and dietitians need to teach people how to use salt to make foods taste delicious, not just salty.

Salt is an amazing cooking ingredient. If used correctly salt enhances the complex mix of flavors in food, elevating taste to a whole new level. I think people could learn to appreciate delicious food seasoned with the right amount of salt. It would be far more appetizing to use salt effectively than to try to cut salt out altogether.

TRIGGERING RESISTANCE

On a behavioral level, the scientists get this all wrong. There is nothing like telling someone they shouldn’t do something to trigger resistant behavior. The oppositional two year old lives on inside most of us.

My goal is to encourage people to experience delicious food that is well seasoned. Add just enough salt to enhance all the flavors. Combine this effort with recommendations to eat more whole foods and less highly processed adulterated food. Encourage people to honor how much is enough.

True education always takes more time, more money and more effort than simply telling people to stop using salt. Teaching the public how to use salt may be more successful than the past ineffective efforts to cut salt out. Forty years is a long time to be recommending the same thing, expecting different results.

Filed Under: Blog, Middle Tagged With: hypertension, salt, sodium, USDA

The Tyranny of Choice

October 18, 2011 by

November 15, 2010

I tend to celebrate the range of food choices in my community and forget that having choices is not always a blessing. Making choices requires that you have enough information, time and energy to make decisions. It is easy to forget that sometimes all that effort can feel overwhelming.

I recently was speaking to a group of young teenage mothers. I was ready to initiate a discussion on making better choices when one of the young women raised her hand. She sighed and then spoke. Her message was clear. She was tapped out between school, raising a child, homework, working on the weekends and all the trappings of managing a household in the adult world.

At the end of her story, she stated her truth. She doesn’t want so many choices. It is easier just to eat what is put in front of her.

TOO MANY CHOICES

It is tempting to dismiss this young mother’s diatribe as pitching an adolescent fit, but many adults are equally overwhelmed in the marketplace. I work with clients who refuse to enter a big box store or even the local supermarket chain stores. In 2009 the average number of items in a supermarket totaled 48, 500. That’s a lot of choices.

These clients find themselves far less overwhelmed at local neighborhood markets and specialty stores. Smaller chains like Trader Joe’s and Fresh and Easy Neighborhood Markets are popular options.

LIMITED CHOICES

Smaller stores offer a limited mix of items. There aren’t dozens of choices of each item, but that seems to be ok. The customers seem pretty satisfied with the choices they do have.

Stores can limit the kinds of products they offer. On Trader Joe’s website they proudly claim that they only sell quality products with natural ingredients:

• NO artificial flavors, colors or preservatives
• NO genetically modified ingredients
• NO MSG
• NO added Trans Fats

Fresh and Easy boasts neighborhood markets that focus on the consumer. A video on their website summarizes the Fresh and Easy mission: shopping that is simpler, fresher, and allows one’s budget to go further.

Fresh and Easy markets also tout an emphasis on quality. Each food department identifies limited food ingredients or food preparation practices. Efforts include bakery items without added trans fat, artificial colors or flavors; milk products from cows who have not been given rBST hormones, and responsibly sourced fish as well as pork grown without hormones.

WHAT ABOUT LIMITED QUANTITIES?

Americans like value, and often value means getting as much as possible for the lowest price. While McDonald’s discontinued “Super-sizing” years ago, the legacy of super sizing lives on. “Too many choices” refers to the quantity of items as well as the number of items.

Big box stores are huge perpetrators of more is better. Why buy 6 ice cream cones at $4.99 when you can buy 36 and save a few bucks?

My answer is simple. It’s probably better for most people to buy less. Too many people buy 36 and think eating six is not so bad. Looking at 30 still in the box triggers no more than a shrug. Having so many left over feels different than eating six and polishing off the entire box.

In the world of bigger is better we have created a distortion of how much is enough. No wonder Americans are shocked at 8 oz. glasses of soda and other beverages when they travel abroad. At too many stores and fast food establishments a medium serving is 32 ounces. At sit down restaurants the servings may be only 16-24 ounces, but possibly more of a problem with limitless refills.

WHY DO THEY SERVE EXTRA LARGE IN THE FIRST PLACE?

My son often struggles with quantity. He likes big. He eats with his eyes, and more always seems to taste more delicious. He has historically struggled with, “How much is enough?”

As he navigates these early teen years, the struggle has intensified. Other kids eat more snack foods and empty calories in a day than Noah can manage in a month, and he is the one with an elevated BMI. Just last week he cried out, “Why do they serve extra large in the first place?”

There are probably many reasons, none of them considering the current health and nutrition challenges of the day. At one of Noah’s favorite take out places, he used to sneak away and treat himself with an extra large shake for $7. At 38 calories an ounce, the 32 ounce serving provides about 1200 calories.

The company proudly advertises only 1 gram of fat per ounce (about 288 calories). My guess is that there is a very modest amount of protein. Sugar– both the natural sugar found in milk and a significant amount of added sugar– makes up the rest of the calories.

MORE IS NOT BETTER
Why do restaurants serve 1200 calorie shakes? Why are there 1400 calorie burgers? Why do restaurants offer 3000 calorie entrees?

Ironically, many of the highest calorie items are served at sit down restaurants, not just the fast food eateries that get most of the grief from public health authorities. Why do restaurants do this when health authorities consider escalating obesity and diabetes rates an epidemic?

Maybe more of us need to start asking hard questions. Maybe it’s time to grow up and realize that more is not better. Sometimes less is more.

Filed Under: Blog, Middle Tagged With: BMI, calories, choices, diabetes, fast food, Fresh and Easy, obesity, restaurants, supersizing, Trader Joe’s, value

Questioning 5 Nutrition Myths on Huffington Post

October 18, 2011 by

Nutrition misinformation is ubiquitous. Sometimes the misinformation is lack of deeper thinking. A recent Huffington Post entry by Kristin Kirkpatrick, MS, RD, LD, caught my eye for just that reason.

Ms. Kirkpatrick addresses 5 dissonant myths probably tied together since it’s Thanksgiving week. She addresses myths about carbohydrates, eating late at night, weight gain during the holidays, the nutrient value of fresh vs. frozen food and the five second rule about eating food after it has been dropped on the floor. Each of the discussions left me wanting. Here’s my take on each of them.

1. THE CARBOHYDRATE MYTH

In 2002, researchers analyzed the diets of over 10,000 Americans by categorizing them by their carbohydrate intake. They found that those who had the highest intake of carbohydrates had the lowest overall intake of calories and were more likely to be at a normal weight.

My first thought is, “How nice it is to be insulin sensitive.” People who enjoy insulin sensitivity can eat a higher carbohydrate diet, they don’t get sugar and carbohydrate cravings, and they don’t gain water or fat weight readily. Of course they are leaner and eat less.

One third of Americans are born relatively insulin resistant. Lifestyle factors can make this worse. There are many studies that show many people thrive on a lower carbohydrate intake, some showing remarkable differences in weight management depending on genetic predisposition. (See work by Chris Gardner)

Continuing to insist that carbohydrates aren’t bad is missing the point. The question for each of us is how much and what kind of carbohydrates work best to give us the energy and sense of well being we seek.

2. THE MYTH ABOUT EATING LATE AT NIGHT

A calorie is still a calorie whether it is 6:00 p.m. or 10:00 p.m. The main importance is how many calories you consume throughout the day.

A calorie is a calorie. But not all calories are treated the same in our body. Nutrient partitioning is a phenomena that determines if your food will be used for energy or stored as fat. People who are insulin resistant secrete more insulin in response to their food intake. Excessive insulin drives energy into fat stores. This often causes a rebound hypoglycemia, increasing hunger and cravings for carbohydrate.

In addition, sleep and food intake influence hormonal responses that impact your appetite. As explained by Susan Dopart, MS, RD, a higher carbohydrate diet without adequate protein tends to increase ghrelin levels and “grows the appetite.”

Calories count, but hormones are potent factors determining what happens after you eat those calories. Weight management is not merely a math problem. If it was, we would have solved it by now.

3. THE WEIGHT GAIN DURING THE HOLIDAYS MYTH

They found that the average weight gain from Thanksgiving to New Year’s was less than 1 pound (0.8lb)

One of the biggest mistakes science makes is reporting findings that lead people to believe that the average experience is everyone’s experience. This data would be much more useful if the researchers or the author discussed the range of weight gain.

On the same diet people have very different experiences. Dr. Gardner’s research shows just that. My guess is that the insulin sensitive people experience far less weight gain, if any, as they enjoy the treats of the season.

Insulin resistant folks enjoy a few sweets, start to gain, experience even more carbohydrate cravings, and are soon slipping and sliding through the rest of the holidays. These are the folks who bring up the average. They can readily gain 5, 10 pounds and more between Halloween and the New Year.

It works in reverse as well. Weight loss is almost always easier for insulin sensitive folks.

My husband and friend once rode over 500 miles in a fund raising bike ride. Both riders ate the same food for the entire week. Both ate mountains of pasta, bowls of rice and handfuls of cookies to fuel themselves over the miles. The insulin sensitive guy lost 2.5% body fat over the 7 days. My husband lost 0.5%.

In private practice for over 25 years, I continue to observe people with a ride range of metabolic responses to food. Each person is their own puzzle and deserves to develop an approach to food that works for them. The person who gains 5-10 pounds over the holidays needs different support and guidance than the person who gains little or nothing.

4. THE FRESH VS. FROZEN FOOD MYTH

In the winter, however, eating fresh means not only paying more, but perhaps getting fewer nutrients. That’s because during the winter months, many fresh produce options have to travel hundreds and sometimes even thousands of miles to reach the grocery store.

I mostly don’t have a problem with this content, except I live in Southern California and the Huffington Post is a national, if not global publication. It is curious to me that the writer would limit her comments to her experience in the Northeast.

I appreciate the challenge of fresh fruit and vegetables in the Northeast. I remember a favorite aunt who lived in the Hudson River Valley. She would often chatter excitedly about the opening of farmer’s markets in early June. It would give me pause. In Southern California, my farmer’s markets are open all year long.

The disconnect for me is the assumption that produce traveling thousands of miles has fewer nutrients. I don’t think the issues is miles as much as time since harvesting. I’ve spoken to supermarket produce workers in Los Angeles. Too many people don’t know that produce in supermarkets is often sold 7-10 days post harvest–even with the San Jouquin Valley just a few hundred miles away.

The nutrition issue is freshness, not distance. It is important to not confuse the issue of nutrients with other significant discussions like sustainability. In the end, I agree that frozen produce may be the best nutritional bet during winter months for many people.

5. THE MYTH OF THE FIVE SECOND RULE

They found that when a piece of bologna was picked up off the tile floor that over 99 percent of the bacterial cells from the floor were transferred to the bologna.

People hear the word bacteria and get scared. We are a bacteria phobic people. For decades science and medical thinking has hinged on the premise that bacteria is bad. I’m not so sure.

We need healthy bacteria to keep us protected from opportunistic pathological strains. There is much discussion in the health care community that what we are lacking is enough healthy bacteria in our soils, in our food, in our guts. Lack of healthy bacteria has been linked to increasing incidence of gastro-intestinal diseases, asthma and allergies, as well as poor immune systems.

Today pro-biotic and pre-biotic supplements are sold everywhere. We pay extra for these bacteria to be added to our food. Why not let ourselves eat food that is a little less sterile? The real issue isn’t whether there is or is not more bacteria on our food. We need to ask better questions. Is it harmful? Is it helpful?

We need to be honest about what bacteria to be concerned about. Most of the pathogenic bacteria linked to our food supply is associated with animal and human feces, open wounds, and spoiled food. I don’t know if the bacteria found on the floor matches this risk.

My guess is that the researches know and probably reported this data in their findings. I would find the discussion more significant if Ms. Kirkpatrick could have addressed what kind of bacteria they found and it’s relative risk profile.

Filed Under: Blog Tagged With: bacteria, calories, holiday eating, late night eating, myths, nutrients, nutrition, Susan Dopart, weight, weight gain

Eating More Protein, less refined starch is best to lose weight

October 18, 2011 by

Higher protein, lower refined carbohydrate diets best help patients maintain weight loss. A six month diet study recently published in the New England Journal of Medicine shows that after intense weight loss, a higher protein diet coupled with low glycemic carbohydrate resulted in less weight regained. Arne Arstrup, one of my favorite researchers, recently completed the Diogenes study with colleagues at the Faculty of Life Sciences, University of Copenhagen.

A total of 772 European families participated in the study, which was comprised of five different diet types:

A low protein diet (13% of calories–a typical American diet) coupled with high glycemic carbohydrates
A low protein, low glycemic carbohydrate diet
A high protein (25% calories), high glycemic carbohydrate diet
A high protein, low glycemic carbohydrate diet
A control group which followed current dietary guidelines (high carbohydrate diet, but using lower glycemic foods)

All the adult subjects were restricted to 800 calories a day for eight weeks prior to the study. The average weight loss was 11 kg–twenty four pounds. After the initial eight week, the subjects were divided into one of the five groups for a six month diet intervention. Key findings are summarized below:

1. People eating a low protein, high glycemic diet re-gained about 3 1/2 pounds during the study.

2. People eating the higher protein, lower glycemic diet re-gained a bit over 1.5 pounds during the study.

Both results are rather impressive, considering the duration of the study. What is most interesting is the experience of the participants, a key element not often assessed in weight loss research.

MORE SATISFIED ON HIGHER PROTEIN, LOWER GLYCEMIC FOODS

Despite the challenges of working with the glycemic index (see below), the study results are noteworthy. Participants eating more protein and less refined carbohydrate felt more satisfied. The researchers reported that the participants could eat until they were “full” without counting calories or gaining excessive weight.

More participants eating a higher protein diet completed the study. Only 25% of the participants eating the higher protein diet dropped out compared to those eating the low protein higher glycemic foods. 37% of those participants dropped out. Overall 71% of the participants completed the six month study.

The lower drop out rate for families eating a higher protein intake is a very telling measure. People have a difficult time following a plan when they don’t feel satisfied. It is exhausting to restrict yourself day after day when you don’t feel content and every thought is about food.

LESS CHILD OBESITY

Even more impressive, the prevalence of overweight children in the study decreased significantly. Since families were enrolled in the study, the children ate what the parents were eating. The prevalence of overweight children in families eating the higher protein, low glycemic carbohydrate diet dropped from 46 to 39% over the six month course of the study.

I often what would happen to child obesity if we were able to raise our children in a world that did not offer highly refined sugars and starches at every meal, every snack, and every special occasion. These highly refined foods are the most accessible, least expensive, and most immediately gratifying. Most snack foods, desserts and sodas have a high glycemic value and a kind of “sin factor” appeal.

RETHINKING DIETARY GUIDELINES

Drs. Astrup and colleagues are quick to point out that a higher protein, lower glycemic dietary protocol doesn’t match up with European dietary guidelines. “The official dietary recommendations are not sufficient for preventing obesity.”

That goes for current US Dietary Guidelines as well. The proposed 2010 USDA guidelines continue to focus on reducing fat and saturated fat with only modest attention to sugar and refined starch. USDA farm policy continues to subsidize corn, soy and wheat–making all those highly refined foods, snacks and treats very inexpensive.

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A NOTE ABOUT HIGH AND LOW GLYCEMIC FOODS

Foods with carbohydrate content impact blood glucose levels. A food that increases blood glucose level dramatically is thought to have a high glycemic index. A food with a glycemic index over 70 is considered “high”, 55-70 is considered “medium”, and under 55 is considered “low”.

Many factors influence the glycemic value of foods: the degree of processing, extent of cooking, even the temperature the food is eaten. In order to reduce the glycemic index of foods the participants were given specific instructions regarding food choices. They were told to eat pasta al dente and preferably cold, to eat brown or parboiled rice over white rice, and to cook potatoes as little as possible.

The glycemic index is not a perfect tool, which is why the index is somewhat controversial. Many people assume foods with sugar have a high index. That is true when sugar is consumed alone. As soon as fat and protein are combined with the sugar, the food typically exhibits a lower index. Both the fat and protein buffer the glycemic response. In this way ice cream (60) and sweetened yogurts (36) boast a lower glycemic values than white bread (70) or a soda (65).

GLYCEMIC LOAD versus GLYCEMIC INDEX

Another complexity with the glycemic index is that each food was evaluated using 50 gram of carbohydrate in the food. This is different than simply measuring 50 gram (about 1.5 ounces) of the food. Carrots boast a higher index (72) than typical sweets. This has lead many people to consider carrots taboo–too high in sugar.

To consume fifty grams of carbohydrate from jelly beans you get to eat about 19 large jelly beans. To consume fifty grams of carbohydrate in carrots you need to eat 21.6 ounces–about 1 1/3 pounds– of raw carrots. Since most people would cry out with a stomach ache before they finished over a pound of carrots, some researchers prefer to talk about “glycemic load”.

The glycemic load is a concept that takes into consideration the amount of a typical portion in addition to the glycemic value of the individual food. I wonder what the glycemic index is for a handful of carrots versus a handful of jelly beans. That would be a fair comparison using the more practical concept of glycemic load.

Filed Under: Blog Tagged With: child obesity, diet, glycemic index, maintenance, protein, weight

The Elephant in the Room: Fast Food (Doesn’t) Make You Fat

October 18, 2011 by

Probably the most stated and universally accepted nutrition sound bite is this one: Fast Food makes you fat. People believe all the public health hype. If you frequent a fast food establishment, you are inherently eating bad food, food that will have your cholesterol soaring and your waistline expanding. Hog wash.

What makes perfectly intelligent and often well educated people accept and believe such a ridiculous sound bite? How does one sector of the food environment get so much grief about its food when obesity and health issues linked to food are so enormous (pun intended)? The incidence of obesity in America– and child obesity in particular– is a bigger and more complex problem than any one food source.

GOVERNMENT GOVERNING BADLY

I have sat in a few city council as well as Planning and Land Use Meetings (PLUM) in Los Angeles the last few years. I was invited to speak at a high school event in San Francisco with Supervisors Eric Mar and Bevan Duffy. I may be naïve, but I am appalled at the lack of transparency and the hidden agendas.

The government types seem to universally accept that fast food is the culprit. Fast food is making everyone obese. This argument wouldn’t be so specious except lots of thin people eat fast food. Many obese people don’t eat fast food. Even the “average” customer at McDonald’s frequents the restaurant just over 2 times a month. Are those two meals a month really making so many people obese?

My cynical self sees the elephant in the room. Government types have jumped on the fast food bashing bandwagon to further their agendas. They see a universally misunderstood, emotionally charged issue that can be manipulated for their own benefit. They are running fast and loose with the facts. Overwhelmed, underfunded and outgunned by the food industry, desperate public health entities lunge at any opportunity they can to gain a foothold.

PEOPLE WANT TO BELIEVE THE MYTH: SIT DOWN RESTAURANT FOOD IS HEALTHIER

Earnest public health advocates as well as dedicated clinicians continue to pound the point home: Fast food makes you fat. Avoid fast food. Avoid fried food. Avoid sugar. Cut down on salt. Too bad fast food establishments aren’t the only places you can buy “fast food”, food high in sodium, sugar, and fat.

In 2005 I looked at what the so called “healthier” sit down restaurants were feeding the kids. After reviewing 14 kid’s menus from local neighborhood cafes and chain restaurants the evidence was clear. These sit down restaurant served children the same food as their quick service counterparts.

Overwhelmingly the menus offered hamburgers and fries, some form of fried chicken strips and fries, pizza, and the like. Less than 7% of the restaurants offered a fruit or vegetable on the menu. Often milk wasn’t an option for the lower cost meal. Resorts and hotel restaurants fared even worse. Less than 5% of their kid’s menu options offered a fruit or vegetable.

Sit down restaurants often offer all you can drink sodas and free dessert. I did not assess serving size, but at a glance I know that most restaurants do not following USDA guidelines regarding calorie intake suitable for a child. When he was young, my child ordered his share of kid’s meals. My guess is that very few of these establishments put any thought into the amount of energy they serve the kids.

NUTRITION ON THE MENU: WILL IT CHANGE BEHAVIOR?

In January of 2011 we are supposed to see nutrition information available on every menu of every restaurant with at least 20 sites in California. Early evidence shows that this information could be a game changer.

Many popular chain restaurants serve meals or entrees that hover between 1000-2000 calories each. Early in the game, one popular national chain known for generous portions jumped the gun and listed their four digit entrees, noting the calories directly on their menu and website. Entrees offered anywhere from 1000, 2000, even 3000 calories each!

Rumor has it that sales dropped dramatically. Within months new menus without the calorie amounts were printed. Most calorie information was removed from the website. Now a separate reference book is available with the information for those who ask.

Some establishments have devised ingenious and disingenuous ways to deceive the public. I have seen menus list all the items separately—even when they are usually served together. It is common that the 900 calorie sandwich is listed in one location. The 700 calorie French fries are listed someplace else. The beverage calories are listed but ultimately unknown. There is no telling how many free refills you will accept.

Typical portions today are enormous. We have a distorted sense of value. We want to believe more is better. It is not unusual to be served food on a platter. The platter for my meal at one local bistro looks suspiciously similar to the platters my mom would use to serve a family of eight.

One restaurant chain had the nerve to try to identify their 1000+ calorie meals as “2 servings”.

EATING OUT MAY NOT BE THE ONLY PROBLEM

The National Restaurant Association reports that 50% of every food dollar is spent away from home. Research says people eat more calories at restaurants than at home, but I wonder.

Does the research consider just the meals eaten at home? What about the snacks? We are no longer a country that eats at a table. Snacking accounts for 40% of food intake for children and many adults. I suspect that most people probably eat a modest meal at home. I think most people don’t cook much. They are probably assembling a quick or simple meal because they don’t have the time, energy or desire to put together a full dining experience.

Breakfast is a bowl of cereal, a yogurt, a muffin or a piece of toast. Lunch may be a sandwich or a salad, possibly with a piece of fruit. At their first session most of my clients report that eat very little food before “the witching hour”, about 3 or 4 o’clock in the afternoon.

When you eat very little throughout the day, the body provides additional energy from stored carbohydrate (glycogen) in the liver. Every time you feel hungry during the day and put off eating your body ends up tapping into this reserve. By the witching hour, the calorie cheaters have tapped out the stored energy and hunger hits and sticks with a vengeance.

Sometimes the feeding frenzy begins before anyone even thinks of dinner. Snacks come out of hiding in a desk drawer or purse. The office kitchen is scanned for leftover bagels or donuts. Somebody’s desk has a jar of candy available for the taking. There is an organized run for “coffee”, a euphemism for the highly caloric beverages that are served at coffee houses everywhere.

I know many clients who come home from work and start eating the minute they enter the doorway. There are snacks before dinner. Anyone who cooks and assembles food can be found munching on the ingredients while they prepare their plate. All too often dinner extends into the living room after dinner with a serial intake of snacks in front of the television. I wonder if the researchers are counting all the calories consumed at home or just those consumed at the dinner table. For these folks “dinner” lasts from 5 until 10 PM.

ABUNDANT, HIGHLY ADULTERATED FOOD IS EVERYWHERE

Every supermarket, convenience store, liquor store, pharmacy, hospital cafeteria, entertainment venue, and vending machine sells food that is highly refined and adulterated.

Increasing rates of obesity, diabetes, heart disease and cancers are true public health crises. Children born today will likely not live as long or with the same health as their parents. We cannot afford children with type II diabetes. We cannot afford young adults on dialysis. Medical care is not cheap. We cannot afford the excessive amount of cheap, tasty food that we are offered everywhere, all the time.

FOOD IS (relatively) CHEAP

Our food supply has radically changed during the last half century. In 1947 the average household spent 27% of their after tax dollars on food. Today families spend between 9-12% of their net income on food. Food is relatively cheap. But not all food is cheap in the same way.

Fresh fruits and vegetables cost more. Between 1985 and 2000, USDA data tells us that the cost of fresh fruits and vegetables increased 118%. During that same time period the cost of sodas increased 20%.

USDA farm policy continues to subsidize wheat, corn and soy. The exact ingredients used to make highly refined and adulterated foods. It is government policy that makes bread, cookies, candy and soda so cheap. How ironic that these refined carbohydrates are now considered to be the problem, driving the obesity epidemic even more than fat intake.

Even beef and milk are relatively cheap to buy. Subsidized corn and soy are used as animal feed in order to maximize profits at the feed lot. These animals are not allowed their natural diet in order to allow us a cheaper, fattier, less healthy product at the market. For years I have had a hard time trying to rationalize a national farm policy that flies in the face of national health policy.

BUYING FOOD AT THE SUPERMARKET DOESN’T MAKE IT HEALTHY

Supermarkets are no refuge. Average supermarkets offer 48,000 items. One study assessed the nutritional quality of supermarket food. Foods earned one star for good food choices, two stars for better choices and three stars for the best choices. The two nutritionists who designed the program did not assess candy, gum or alcohol. Still, less than 25% of the products offered earned even one star.

Supermarkets cater to our fast paced, busy lives. Convenient and pre-prepared food is the fastest growing sector in the marketplace. Over ten years ago I started asking my clients if they cook or “assemble”.

Less floor space is dedicated to basic whole foods. Raw produce, dairy and meats fill up a miniscule percentage of a market’s footprint. Even markets that cultivate a healthier image make most of their profit on the value added items, not to mention all the supplements and so call “health foods” that are highly refined and processed themselves.

CONFUSING THE ISSUES

The truth is that the obesity and health challenges we face as a nation are daunting. It is seductive to latch onto absolute sound bites declaring “fast food is fat food” like a tenacious bull dog. But there is trouble ahead. In the face of mounting evidence that dispels the myths, public health and government bull dogs are not letting go.

When undue resources are directed towards demonizing fast food, little attention is paid to the dismal state of our food supply everywhere. I have clients wanting to lose weight, diagnosed with any number of metabolic diseases, who don’t understand why they are struggling. Sometimes they boast, sometimes they lament: “But I don’t eat fast food.”

Fast food doesn’t inherently make anyone fat. Fast food is not inherently more caloric, higher in fat or more refined sugar than food served anywhere else. It is not even served in the largest portions.

When fast food restaurants serve vegetable and fruit salads, grilled chicken sandwiches, one percent milk and other “healthy” fare, how can people continue to believe that fast food inherently serves food that is less healthy than every other food venue?

EMBRACING EDUCATION, CELEBRATING CHOICE

People with influence continue to misinform the public at their own peril. They will soon be exposed as the opportunistic and short sited “man behind the curtain that they are. We can only hope the shrill pundits attacking fast food are as gracious in their exposure as The Wizard of Oz.

Current research is already questioning the high carbohydrate, low fat mantra. Renown nutrition epidemiologist Walter Willet has stated that the research shows refined sugars and starches are likely much more of the problem. There is even rumbling that saturated fats are not as problematic as once thought, especially the saturated fats derived from animals that consume their natural diet. These fats are rich sources of omega 3 fatty acids, conjugated linoleic acids and other healthful nutrients.

FOOD QUALITY STARTS ON THE FARM, FINISHES IN THE KITCHEN

We are learning that the quality of food, how animals are fed and how crops are grown impact the nutrient density of that food. When soil is nurtured will the full spectrum of nutrients from composted foods and waste products, the entire soil ecology improves. The activity of worms and other insects enhances the viability of the soil. Grass grows better, animals feed better, crops grow better, and we feed better.

I appreciate that eating food in its most natural state reduces intake of problematic ingredients like high fructose corn syrup and partially hydrogenated oils (trans fats). I have learned that telling people to avoid salt during cooking is futile. Salting foods appropriately when cooking is not the problem.

Seventy percent of all sodium consumed comes from highly processed and refined items. Some the most significant sources of sodium don’t even taste salty. Bread, pastries and cereal contribute surprising amounts of sodium in the diet because people eat these foods frequently.

In sum, every fast food establishment has the opportunity to prepare and serve excellent food. There is nothing inherently unhealthy about fast. While the slow food movement has its merits, my guess is that most proponents of eating “close to the earth” have been stuck eating on the run. There is no reason to shun fast food done well.

THE NUTRITION MESSAGE NEEDS TO CHANGE

Convenience and taste are the two top factors driving people’s food choices. Quick service restaurants are here to stay. The message needs to change. We need to encourage fast food patrons to make judicious food choices at fast food restaurants. We need to encourage everyone to make judicious food choices everywhere. We need to help people avoid a polarized relationship with food.

It serves no one to make people feel guilty about eating anything other than “healthy” food. Guilty people end up pretending. They become opportunistic eaters, taking advantage of every treat and extra serving offered. They become closet eaters, even their best friends don’t know. They lie to their doctors, they lie to their dietitians, they lie to their families, and to themselves.

It’s time to be far more honest about food. It’s not where you eat. It’s what you eat when you get there.

Filed Under: Blog Tagged With: cholesterol, farm bill, fast food, fat, government, kids meals, National Restaurant Association, obesity, public health, restaurants, saturated fat, sugar, supermarkets

SPIN: The Misinformation of Sound Bite Nutrition

October 18, 2011 by

Stone Hearth Newsletters leads with a story titled, “We have no idea what, or how much, we are eating: new study” Click on the link and you are sent to a story in MedPage Today titled “Recipe for Healthy Eating Not Easy to Stick To” I would have never guessed they are reporting on the same story.

While Stone Heart’s title is basically sensationalistic and misleading, I find fault with both leads. Med Page today pretends that it’s author’s version of healthy eating is the only one. In addition, Med Page quotes a senior Consumer Reports Health editor who is obviously confused. Since when is dieting the same thing as healthy eating?

Nancy Metcalf, senior editor at Consumer Reports Health (CRH) said, “We were surprised to find that very few Americans weigh themselves and count calories, two strategies that can help dieters stay on track.” I wonder why editors at CRH think that people need to weight themselves or count calories to be healthy eaters.

COUNTING CALORIES, WEIGHING SELF NOT NECESSARILY HEALTHY BEHAVIORS

In over 25 years of private practice I have learned that restrained eaters and chronic dieters often count calories and weigh themselves every day. Most of my clients with eating disorders count calories and weigh themselves at least once a day. Neither behavior is necessarily a marker of health.

The researchers also asked people about other food behaviors. How many servings of fruit and vegetables was probably on of the more reliable indicators. About 58% report getting five or more servings of fruit and vegetables a day. That’s actually impressive. Years ago the average intake was 1.2 servings a day.

WHAT FOOD BEHAVIORS ARE HEALTHY?

The rest of the report summary takes an interesting spin. The report states that about half of the population isn’t careful about limiting unhealthy foods. The language of article is negative, disparaging that more people don’t follow a fairly narrow definition of healthy eating.

The MedPage article states “Just 54% of people surveyed said they watch how many sweets they eat every day or on most days, while 51% said they limit fats (my italics). Is that really so bad?

HOW MUCH SWEET IS TOO MUCH?

Sweets are not necessarily taboo. Eating a square of chocolate or cookie after a meal doesn’t negate the healthfulness of the meal. Without some sense of quantity and frequency, comments like this lead people to believe the goal is to eat no sweets. This kind of thinking is a sure fire set up for “what the hell effect.” Someone trying to be healthy may feel like they “blow it” by eating one cookie, only to give up in frustration and eat the entire box.

This is the difficult thing about trying to ascertain the nature of a healthy diet. Some people eat well while they continue to consume a variety of foods with added sugar each day. Others can’t get away with even a small sweet once a day. It is virtually impossible to set a “reasonable” limit that works for everyone without being unnecessarily restrictive for some and overly generous for others.

WHAT ABOUT DIETARY FAT?

Both the amount and types of dietary fat recommended to consumers are debated these days. Scientists, researchers, and clinicians alike are questioning the 40 year old mantra to reduce fat intake. Both Walter Willet, PhD of Harvard and Andrew Weil, MD currently question the decades old advice. In fact, both have stated that fats are not the problem here. They believe real issue is excessive sugar and refined starches.

In December, 2010, Gary Taubes published “Why We Get Fat”. It also refutes the low fat mantra, explaining how a high carbohydrate, low fat diet can increase the risk of obesity as well as incidence of diabetes, cardiovascular disease and other inflammatory states.

There is plenty of evidence that there is not one right or healthy way to eat. The sooner public health advocates, consumer groups, researchers and clinicians come to recognize the need for more sophisticated nutrition advice, the better. In the meantime, the world of soundbite nutrition continues to polarize and confuse consumers.

Someone moved the cheese. We can no longer be preoccupied with yesterday’s problem, trying to determine the specific nutrient parameters of a healthy diet. We need to move on to the challenges we face today. How can we help individual consumers figure out an approach to food that is right (healthy) for themselves? That is a much different, and a much more challenging, puzzle to solve.

Filed Under: Blog Tagged With: Andrew Wiel, calories, Consumer Reports, fat, Gary Taubes, Med Page, Stone Hearth Newsletter, sugar, Walter Willett, weight

Another Distorted Reason to Avoid Fast Food

October 18, 2011 by

Today you can read Another Reason to Avoid Fast Food by Dr. Joseph Mercola. The subject is about toxic chemicals–specifically fluorocarbons– in our food, our water and measured in our body. His answer is to avoid fast food. What a distortion of the truth.

Fast food bashing is quite popular and an intensely emotional exercise today. Some people love to hate and revile fast food despite growing sales. I find the hysteria both misguided and disingenuous.

CONSULTING FOR A FAST FOOD LEADER

First, a disclaimer. I have consulted for the McDonald’s Owners and Operators of Southern California (MOASC) for over 18 years. Some people jump on that fact as proof of biased alliances. Rather than striking down my credibility, I think the close up view I get of the food at McDonald’s is a unique vantage point. It serves to amplify the distortion of those bent on framing fast food as the culprit of all that is wrong in our food supply. The elitism and lack of critical thinking from fast food critics is appalling.

I have learned much in my work with the McDonald’s entrepreneurs and the employees of their small businesses. Mostly I have learned that the food they serve is much the same as the food most people buy in their local supermarket. For those of us who choose to buy organic, grass fed, sustainably grown, or more locally produced food, those brands don’t quite fit the bill. But those brands feed America.

There is not enough organic, grass fed, unprocessed food to feed the masses today. It is important to keep a personal effort to eat “close to the earth” in perspective. We are cultivating a slow moving revolution. It takes time. Reviling every other food source in the meantime creates harm and distrust. What is everyone else supposed to eat?

FAST FOOD BASHING JUST NOT HONEST

I find the incessant harping about fast food just not honest. Dr. Mercola’s article is a case in point. A quick review leads the reader to believe fast food wrapping is the source of the fluorocarbons PFOS and PFOA while conveniently letting the reader assume that other food packaging is somehow not a problem. Not true.

REGULATION OF FLUOROCARBONS

The Environmental Protection Agency (EPA) is belatedly tracking and regulating fluorocarbons and other chemical substances. Granted, maybe theses substances should have never been allowed to be manufactured in the first place, but that could be said about most plastics. Imagine everyone trying to turn back the clock to live in that world.

We are way past being able to recreate the past. In the meantime, more accurate data in EPA reports shows overall body burden of these fluorocarbons (the amount of the chemical that accumulates in our body and can be measured in our blood) is decreasing. The voluntary industry efforts to reduce usage are working. So what else can be done? Is cutting out fast food the answer?

WHERE ARE THE FLUOROCARBONS?

I have many questions. On top of the list is, “Which industries use the most fluorocarbons?” and “How do we get the most exposure?”

The Center for Disease Control tells us:

Perfluorochemicals (PFCs) are a group of chemicals used to make fluoropolymer coatings and products that resist heat, oil, stains, grease, and water. Fluoropolymer coatings can be used in such varied products as clothing, furniture, adhesives, food packaging, heat-resistant non-stick cooking surfaces, and the insulation of electrical wire.

Consumer products like Teflon coated pans and breathable synthetic outdoor wear are easy to identify, but fluorocarbons are found everywhere. Data from EPA tells us that PFOA fluorocarbons are employed in hundreds of products in almost all industry segments, including the aerospace, automotive, building/construction, chemical processing, electrical and electronics, semiconductor, and textile industries. They are used in surfactants and as surface treatment chemicals in many products, including fire fighting foams; personal care and cleaning products; and oil, stain, grease, and water repellent coatings on carpet, textiles, leather, and paper. Hmmm.

Nothing in these documents implies that fast food wrappings are a primary source nor is there indication that cutting out fast food would demonstrably make a difference in the total body burden of fluorocarbons.

FLUOROCARBON TOXICITY IS MORE THAN A FAST FOOD ISSUE

So why the disproportionate attention to fast food wrappings? What about all food wrapping materials? What about wrappings for take out food from sit down restaurants? Packaging for doggie bags? The majority of wrapped food products in grocery stores? If there is a problem, it would seem to be with with every source of food contact, not just one that is convenient to demonize.

Food wrapping and fluorocarbons are not a fast food issue. The presence of fluorocarbons in our environment is a food issue and much more than a food issue. It is important to appreciate the difference.

NOTE: This writing reflects the personal and professional position of Bonnie Modugno, MS, RD. All comments and opinions expressed in the blog are my own.

Filed Under: Blog Tagged With: body burdon, fast food, fluorocarbons, food, Huffington Post, Mercola, toxic

Chaos in the Nutrition World

October 18, 2011 by

Whole-fat dairy products may lower diabetes risk, so says a Harvard study in Annals of Internal Medicine. The following day Stone Hearth Newsletter noted a study in the American Dietetic Association Journal that states high-fat dairy product eaters have a 40% higher risk of mortality.

Let the food fight begin.

Actually, this food fight has been brewing for about 100 years. In Good Calories, Bad Calories (2007), Gary Taubes painstakingly chronicles the historic struggle to establish the nature of a healthy diet. Of note is a particularly one sided battle over the last forty years.

The proponents of a high carbohydrate, low fat diet won out with a little help from McGovern’s Senate Select Committee on Nutrition that established a form of the US Dietary Goals in 1972. One researcher, Mark Hegsted, was the primary nutrition resource and the proposed goals reflected his position. Many researchers suggested that the high carbohydrate, low fat recommendations were premature, but were paid no heed. USDA adopted the effort as their own and continues to adhere to a one diet fits all orientation.

2010 DIETARY GOALS NOT UNIFORMLY SUPPORTED

The 2010 USDA Dietary Goals were made available for public comment earlier this year. They don’t differ enough from the earlier versions. The scientists on the committee continue to support a higher carbohydrate, low fat diet. There is more attention to how food is grown. There is more emphasis on whole foods. But that doesn’t go far enough for most of us who recognize there is not one right way to eat.

From Walter Willett of Harvard, a reknown nutrition epidemiologist, to Andrew Weil, MD, a media savvy and published practitioner in Arizona, there has been tempest brewing in the teapot. Both of these scientists have blunted stated that fat is not the problem. The nutrition factor most significantly aligned with obesity and other lifestyle disease states is refined sugar and starches. The diseases include cardiovascular disease, diabetes, and cancer as well as a slew of other inflammation based maladies.

LOW FAT OR LOW CARB?

So what is the problem, sugar or fat? The question underscores a bigger problem. The heart of the dilemma is not which diet is better. The real issue is what mix of carbohydrate, protein and fat works best for any one person. This question strikes a fatal blow to the concept that there is one right way to eat. There isn’t.

People are complex organisms, with a host of genetic traits that are influenced by a plethora of environmental factors. It is pure hubris to think there is one right way to eat. The sooner the scientific community comes to acknowledge this truth, the sooner the chaos clears up.

There is no chaos when health professionals recognize that each individual needs to find a range of food intake that helps them metabolize energy effectively. There is no confusion when a person discovers what balance of carbohydrate, protein and fat works best. There is a public health nightmare in the making.

INSIGHTFUL, SKILLED PROFESSIONALS NEEDED

If people are so different, health professionals will need to dramatically improve their game. There is no place in this new world for simplistic diet sheets telling people what food to avoid and what food to include. There is no place for pontificating on the virtues on any one diet. Anyone offering nutrition advice can no longer hinge recommendations on what works for them. That goes for all the lay people anxious to tell others what to eat, too.

There is fabulous opportunity for thoughtful, skilled professionals to assist people in determining an approach to food that works. With more sophisticated insight, dietitians can actually use their science based training to help clients understand their experience with food. Physicians and all other health care providers will either need to step up themselves or refer appropriately.

KNOWLEDGE IS NOT BEHAVIOR

There will be no universal diet plans or diet prescriptions. Dietitians will need to work with the patient to figure out the answers. This will take time, more than the usual 15-30 minute nutrition consult with little follow up. We will finally reach a turning point in nutrition counseling. Effective counseling will replace nutrition sessions that focus on delivering education and assessing knowledge. Knowledge is not behavior.

Now the real dilemma. Who is going to pay for this?

Filed Under: Blog

Whole-fat dairy products may lower diabetes risk, so says a Harvard study in Annals of Internal Medicine. The following day Stone Hearth Newsletter noted a study in the American Dietetic Association Journal that states high-fat dairy product eaters have a 40% higher risk of mortality.

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