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Bonnie Modugno, MS, RD

Nutrition Consultant, Author, Speaker
Bridging the Gap Between Knowledge and Behavior

530 Wilshire Blvd Suite 310
Santa Monica, CA 90401
(ph) 310-395-4822 (fax) 310-917-2274
(email) bonnie@muchmorethanfood.com
You are here: Home / Archives for weight loss

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

A Critique of Gary Taubes on Dr. Oz

October 18, 2011 by

Dr. Oz, of You on a Diet fame, faced off with Gary Taubes, author of Why We Get Fat on his show March 7, 2011. Dr. Oz attempted a dramatic upstaging with signs proclaiming that Gary Taubes promotes eliminating all carbohydrates. Trailers introduced Gary as “The Man Who Thinks Everything Dr. Oz Says Is Wrong”. Great television, lousy science.

I spent a few hours surveying the aftermath of Gary Taubes’ guest appearance. Mr. Taubes’ fans and detractors duke it out on his blog in a condensed version of a controversy that has festered over the last fifty years.

A SHORT HISTORY OF CARBOHYDRATE vs. PROTEIN

In the 1960’s the very low carbohydrate Atkins and Stillman diets were popular weight loss plans. In the 70’s Weight Watchers took center stage, in line with the high carbohydrate, low fat recommendations of the 1977 Dietary Goals for the United States.

By the 1980’s both Dr. Ornish and Pritikin promoted a 10% fat diet, making Weight Watchers look moderate. High carbohydrate diets became the norm. Corporate America flooded the marketplace with low fat everything.

Very low calorie, low fat prepared meals and meal replacements soon took center stage. Women were offered high carbohydrate semi starvation at 900 calories a day, while men wasted away on 1500 calories a day.

At the same time medically supervised fasts gained traction. Oprah Winfrey’s infamous moment pulling a wagon of fat on television underscored the opportunity for significant weight loss.

By the 1990’s Barry Sears published The Zone. Soon, Atkins resurfaced and extremely low carbohydrate diets were the rage once more. Weight Watchers and other high carbohydrate programs have endured, but many high carbohydrate plans now allow more protein.

Today we have Dr. Oz championing carbohydrate while Gary Taubes explains the perils of elevated insulin, a condition linked with eating excessive carbohydrate.

GARY TAUBES ON “WHY WE GET FAT”

In Good Calories, Bad Calories (c2006), and more recently in Why We Get Fat (c2010) Gary Taubes explores how the body regulates the calories we eat. Mr. Taubes directs attention to regulators of energy metabolism, specifically the role of insulin. Research tells us that carbohydrate intake drives insulin secretion. Elevated insulin levels drive fat storage. At the same time elevated insulin blocks fat utilization.

Some people are very sensitive to insulin. They secrete little insulin in relationship to their carbohydrate intake, and remain lean. Others are more insulin resistant. They secrete more insulin with a given intake of carbohydrate. The increased insulin makes it easier to store fat, and very difficult to lose what is already stored.

DR OZ CHAMPIONS CARBOHYDRATES

Dr. Oz champions the low fat, low cholesterol mantra of most cardiologists. He celebrates healthy carbs, promotes lean protein, and endorses healthy fats. He is careful to encourage fruits, vegetables and whole grains with plenty of fish, nuts and seeds while demonizing refined sugars and starches, saturated fats and trans fats.

I took the liberty of assessing Dr. Oz’s diet, or at least the food he claims he would usually eat, as shown during the March 7 episode.1 A cursory analysis estimates that his preferred diet contributes a strong 22% of calories from protein, a meager 36% of calories from carbohydrate, and close to 42% of calories from fat. This is not a high carbohydrate diet.

Gary Taubes has been trying to debunk the health halo of a high carbohydrate diet ever since his 2002 article, “What if It’s All Been a Big Fat Lie.” Dr. Oz’s lower carbohydrate diet ironically supports this position.

A PLANT BASED DIET IS NOT NECESSARILY A HIGH CARBOHYDRATE DIET

Dr. Oz’s staged controversy with Gary Taubes is misguided theatrics at best. At worst, it is dishonest.
Dr. Oz appears to prefer a diet with carefully chosen and limited carbohydrates. Despite the abundant plant based foods, it is not a high carbohydrate diet. The distinction is important.

There are people who seem to eat plenty of carbohydrate without negative consequences. They don’t readily store excess fat or develop diabetes, cardiovascular disease or other problems. It doesn’t seem fair, but metabolism is not about fairness.

Most of us live with a metabolism that has evolved to survive scarcity. Many people are insulin resistant—for whatever reason—and will feel better, manage weight more effectively and decrease risk of disease if they eat fewer carbohydrates. Most people do not have to eliminate carbohydrate to accomplish these goals.

IS THERE A RIGHT WAY TO EAT?

There is no single “right way” to eat. A more meaningful discussion could help people figure out what balance of carbohydrate, protein and fat works best for them. In the meantime, it is important to note a few basic guidelines that allow each of us to eat well, no matter what that balance looks like.

1. Eat whole foods. Minimize intake of highly processed, adulterated foods.

2. Eat through your day, and avoid getting over hungry. Feeling over hungry often leads to over eating.

3. Eat foods together for maximum satisfaction.
• Include enough protein for satiety (feeling content)
• Add enough healthy fat. Fats help you feel satisfied longer.
• Preferably choose whole fruits and vegetables, beans, legumes, and whole grains when you include carbohydrates, Limit highly refined sugars and starches.

4. Stop eating before you are full. The goal is to quiet hunger, not store for hibernation.

5. Season for full flavor, not just sweet or salty.

6. Allow enough time to purchase, prepare, and eat your food.

7. As you can, take the opportunity to celebrate food in its rightful place.

Food quantity estimates were based on pictures of preferred meals shown on the March 7 video. While not actual measures, the quantities reflect proportions of food on each of the plates.

Sizing Up Dr. Oz’s “Preferred” Diet

This food is low carbohydrate even if the amounts are only estimated

Breakfast
1 c. low fat plain yogurt
1 c. blueberries

Snack
2 oz. walnuts
1 med sliced orange

Lunch
4 c. wild green salad with 4 oz. seitan
½ c. quinoa
2 T. salad dressing

Snack
1 oz. roasted almonds
1 oz. dark chocolate

Dinner
6 oz. salmon
1 c. spinach
1 c. brown Rice
3 c. field greens w/ ½ c. grape tomatoes
2 T. salad dressing

Filed Under: Blog Tagged With: Atkins, carbohydrate, diet, Dietary Guidelines, Dr. Oz, fat, Gary Taubes, Ornish, Pritikin, protein, The Zone, weight loss, Weight Watchers

Top Rated Diets–What’s Missing?

October 18, 2011 by

A recent report from US News Health captured my attention. Twenty two experts ranked 20 popular diets. The experts also identified the best diet for weight loss, diabetes, and heart health. This is supposed to be good news.

The report identifies the best diets byname and category. The reviewed diets include:

Atkins
DASH Diet
Eco-Atkins
Glycemic Index Diet
Jenny Craig
Mayo Clinic Diet
Medifast
Mediterranean Diet
Nutrisystem
Ornish Diet
Paleo Diet
Raw Food Diet
Slim-Fast
South Beach Diet
TLC Diet
Vegan Diet
Vegetarian Diet
Volumetrics
Weight Watchers
Zone Diet

The hair on the back of my neck is standing out, so there must be more than a few things that bother me about this article. Let me try to address my biggest concerns.

1. Neither the study nor the experts talk about finding an approach to food that works for the person, as opposed to the goal or condition. The focus is on weight loss, diabetes, and heart health, not the individual. Why do health professionals keep doing that? Intellectually I know they know better.

2. The scientists place great emphasis on research, but research in weight management is horribly lacking.

Research is preoccupied with key questions: Did the patients lose weight? How much? How fast? Did they keep it off?

How much did cholesterol drop? What is their HgbA1C? Is it statistically significant? The focus is primarily on the goal. The process is mostly ignored.

3. The researchers seem preoccupied with their preconceived ideas of balance and what our diets should look like. The words sensible and safe are used repeatedly in the top rated diets.

The higher carbohydrate bias championed by the health and medical community for the last 40 years is obvious in the critiques of each diet. Even moderate carbohydrate restrictions recommended in the South Beach Diet and The Zone Diet plans are criticized. The Paleo diet received the lowest rating of all.

4. The energy-balance equation is given far too much emphasis. Too few diets help people learn how to work with their bodies. Most diets limit calories one way or another. Certain diets manipulate energy from protein, carbohydrate, and fat, but still limit calories.

Too often a successful dieter enjoys the down regulation of energy hormones and other regulators while they are dieting but doesn’t understand why. No wonder after they slip, blow it, or successfully complete the diet, dieters can completely lose their footing.

5. Little attention is paid to the aftermath of a diet. The researchers talk about whether someone can be consistent or continue following the diet as a lifestyle. Why do we expect someone to follow a specific or rigid diet for their entire life?

In my experience, I find clients succeed best when they know how to eat well enough. They can eat “cleanly” for discreet periods of time, especially for specific goals. But it is also important for them to learn how to relax a bit and still get results.

In the process clients learn what is enough to keep them in a steady state–another word for maintenance. They learn what is more than they can handle–and how to get back on track.

I want my clients to learn how to manage the range of what works for them. I want them to cultivate skills to maneuver through the range. I hope they can learn an approach to food that is flexible and adaptable; an approach that truly works for them.

6. What happens when someone needs to lose weight and is also diagnosed with diabetes and heart disease? The diets were ranked for each condition. The ranking shifted significantly for each of the specific conditions.

The DASH diet ranks as the number one overall choice because of it’s “ability to prevent or control diabetes, and role in supporting heart health.” How does an average of scores by professionals who don’t have any information about a patient determine the best diet choice?

ENERGY METABOLISM IS A CORE COMPONENT OF EACH CONDITION

I am concerned that there is no discussion about the common metabolic pathways and factors that influence each of the conditions: obesity, diabetes and heart disease. Wouldn’t it help to explain how these conditions are linked to each other?

When my clients figure out an approach to food that works for them, blood sugar drops, lipids levels improve, and body fat takes care of itself.
A diet need to be an approach to food that works for someone and with someone, not the condition they are diagnosed with.

Filed Under: Blog Tagged With: Atkins, Atkins Eco, DASH, diabetes, diets, Glycemic, heart health, hypertension, Jenny Craig, Mayo Clinic, Medifast, Mediterranean, Nutrasystem, Ornish, Paleo, Raw Food, Slim Fast, South Beach, The Zone, TLC, US News, Vegan, Vegetarian, Volumetrics, weight loss, Weight Watchers

Why I celebrate McDonald’s New Happy Meal

October 18, 2011 by

McDonald’s announced it’s newest Happy Meal version yesterday. Media swarmed at the news and Michelle Obama added her words of encouragement.

The newest Happy Meal version includes 1/4 cup of apples and a smaller 100 calorie (1.1 oz) portion of French fries along with a choice of entree and beverage. McDonald’s estimates calorie savings up to 20% for any one Happy Meal. Most weight loss experts celebrate that kind of change. But not everyone has nice things to say.

A CRESCENDO OF CRITICS

There is a rising crescendo of voices that want to denigrate every food option that doesn’t meet their idea of acceptible or healthy. Andy Bellitti complains that there aren’t adequate nutrients in the Happy Meal. Mark Bittman tweets, “It is McD’s ‘job’ to make money, mostly by selling junk.” Yoni Freedhoff retweets Andy Bellitti’s assumptions and tells everyone, “we need to cook.” Marion Nestle says “I’m not impressed.”

The collective angst directed at McDonald’s no matter what they do is curious to me. I am a dietitian, seeing private patients for 25 years in Santa Monica. I taught at Santa Monica College for 15 years, 12 at UCLA Extension. I am no slouch when it comes to addressing nutrition science or working with real patients as they navigate food in their real world.

At the same time, I have consulted with McDonald’s Operators of Southern California (MOASC) for almost 20 years.(1) I see the food that they buy. I observe their crew cooking the same. This food is purchased from the same vendors supplying our neighborhood supermarkets.

I am left to wonder about all the angst and condemnation directed to fast food in general, and McDonald’s specifically.

DATA DISTORTION

Public health authorities tagged fast food as the culprit in the escalating incidence of obesity–especially for children– decades ago. We keep getting fatter despite it all. Has all their noise been ineffective? Could it be that the considerable amount of time and energy denigrating fast food is misdirected?

Part of the problem may be rooted in data distortion. Recently I was scouring the Report of the Dietary Advisory Committee on the Dietary Guidelines for Americans. I came across this statement:

“There is not enough evidence at this time to similarly evaluate eating out at other types of restaurants and risk of weight gain, overweight, and obesity.”

Does this mean that fast food has been the primary focus just because there was no other data to address eating at sit down restaurants?

I wonder what we will find out. Most sit down restaurants offer hamburgers topping 1000, 1200, 1500 calories and more. French fries are often served in only one size–a lot. For years one restaurant offered French fries in only one serving size, a one pound basket. Now they offer “endless fries”.

The largest hamburger at McDonald’s yields 770 calories, the smallest at 210 calories. McDonald’s offers small, medium and large fries–ranging from 2.5 oz. (230 cal) to 5.4 ounces (500 cal) per serving.

OBESITY IS A FOOD PROBLEM, NOT A FAST FOOD PROBLEM

In all the criticism about fast food, it is easy to miss the bigger picture. Our entire food supply is incredibly abundant and adulterated. The increasing incidence of obesity and disease is overwhelming to anyone who understands the trends.

Is the answer to continue to denigrate every effort by McDonald’s as not good enough? I don’t think so.

WHAT CAN WE DO TO MAKE A DIFFERENCE?

The 2010 Dietary Guidelines Scientific Advisory Committee, many researchers and clinicians agree. The obesity problem is too big for any of us to solve on our own. I hear the call for all sectors of society to step up:

individuals, families, physicians and allied health professionals, public health advocates, policy makers, scientists and small and large businesses, including farmers, agricultural producers, food scientists , food manufacturers and food retailers of all kinds.

EVERY FOOD VENUE NEEDS TO STEP UP, BUT SO DOES GOVERNMENT

We need to address the issues of abundance and adulteration of the food supply at every point of purchase: supermarkets, convenience stores, food marts at gas stations and snacks offered in pharmacies and drug stores. We need to look at every sector of catering and restaurant industry, from quick service restaurants to fine dining. Every entertainment venue, food cart, food truck and vending machine deserves the same scrutiny.

But mostly we need the government to step up, specifically the USDA, the FDA, and the EPA. As long as problematic ingredients, additives, animal feed and husbandry practices, and farming practices are deemed safe and/or legal, the rest of the sectors are left to go it alone.

As for everyone wanting to believe that eliminating fast food is the answer, I would remind you that research colleagues in science labs tell us even the lab rats are getting bigger. What are they feeding the mice?

(1) The opinions expressed here are my own. This blog is not supported nor sponsored by any commercial interest.

Filed Under: Blog Tagged With: Andy Bellatti, animal feed, animal husbandry, calories, children, EPA, farming, fast food, FDA, food, food additives, food science, French fries, Happy Meal, Marion Nestle, Mark Bittman, McDonalds, Michelle Obama, obesity, restaurants, USDA, weight loss, Yoni Freedhoff

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