More Than Food

I actually made a reservation for dinner last night. Our Anniversary. It has been months, many months since I made the effort. I don’t know when I will do it again. The meal at Fraiche in Santa Monica was a big disappointment. I should have paid more attention to that posting on Chow Hound.

Yesterday afternoon I scanned Chow Hound at the last minute for inspiration. I was frustrated that most of the recommendations were in West Hollywood, downtown or environs that weren’t going to work. My husband wanted to drive home from downtown and go together. I knew I was not going to get him in the car again for any significant distance. I opted for a restaurant we had been to a couple of years ago.

WHEN ONE FRAICHE IS NOT THE SAME AS THE OTHER FRAICHE

Fraiche was then a very hot ticket in Culver City, and friends from Pasadena called us at the last minute to join them. Their plans had fallen through with another couple. We were delighted to throw on our fancy clothes to meet them, a bonus without the hassle of crossing town.

The meal was all it was chalked up to be. I can’t even remember what we ordered. I still remember the quiet stillness after tasting each appetizer or entree. That moment when I breathed in the full experience and sighed. Everything was delicious, and the service and execution was notable.

Last night was not. Not delicious, not notable. The service was more disruptive than anything else. I was left wondering why the well meaning staff insisted on refilling my water after every two sips.

I tried the Poached Peach Salad and kept trying to understand it. The ingredients did not work together, at least they didn’t last night. There was no sense of compliment, the flavors and textures were fighting each other. I kept trying to taste something delicious. Most of the salad went back to the kitchen.

My braised short ribs were decent, but I didn’t come to the restaurant for decent. They were succulent but over seasoned. The sauce completely overwhelmed the chard that was completely hidden by the meat. I just saw a pool of brown on my plate. The nice compliment of polenta took the edge off of the intensity of the short ribs, but i came home to enjoy a fresh peach and latte.

FEEDING ME DOESN”T NEED TO BE A COMPETITION

I am kind of done with chefs and restaurants that over reach and seem to be in an incessant scramble to create the next amazing taste. I don’t want to have to pay for that competition especially when it is not working. Amazing food doesn’t need to be so busy, so pretentious. It is almost as if I can taste when the restaurant loses focus.

I suppose that is why when we do go out to eat, it’s pretty casual and mostly ethnic. It’s food that celebrates fresh herbs, fruits and vegetables. We enjoy many within walking distance of our home: Lebanese, Vietnamese, Japanese, Thai and authentic Mexican (not the Americanized versions with sour cream and guacamole on everything). They are all within a few blocks. They work, especially on that day when there is not enough time, energy or inspiration to be in my own kitchen.

When I do want to go out for a special occasion, I don’t mind paying for the experience. But it is painful to pay handsomely for mediocre food. That happens too often in this city. In the meantime, I am looking forward to being back in my kitchen tonight.

I read the LA Times headline, “A Short Period of Gluttony Can Have a Lasting Effect” and sighed. I have come to suspect that over eating, and binge eating in particular, impacts metabolism more than just eating more calories. Something far more significant occurs when we overeat.

Now research from Sweden underscores an impact on body fat even two years after a 4 week “binge”. During the study 18 subjects consumed an average of 70% more calories than usual. (The experimental subjects were instructed to double their food intake, but were only able to increase it by 70%.) The researchers note that the calories came from two meals a day bought at fast food establishments, or from other sources of “high protein and saturated fat foods.”

WAS IT REALLY THE PROTEIN AND SATURATED FAT?

I find it remarkable that the researchers emphasized the protein and saturated fat content of the meals (typically from meat and cheese at fast food establishments). I suspect added sugars and refined starches from fast food are much more problematic. It is important to note that those refined sugars and starches are equally if not even more available at all sources of food: supermarkets, convenience stores, sit down restaurants and vending machines alike.

Simple sugars and refined starches drive insulin secretion and insulin drives preferential fat storage. The data from this study doesn’t tell us enough to know exactly what was eaten nor if it was actually the protein and saturated fat that did the damage or something else. The researcher’s bias is showing.

IS THIS THE INFLUENCE OF NUTRIENT PARTITIONING?

Just how much of the weight gain is the calories consumed versus the type of calories consumed? We can’t tell from this study.

I know that sugars–especially high fructose corn syrup– and partially hydrogenated fats (trans fats) have been suspected of driving excessive fat storage because they are known to increase visceral and liver fat stores. The increase of these kinds of fat stores is linked to insulin resistance.

Insulin resistance is metabolic condition where the body more readily diverts food (energy) into fat stores instead of being burned as fuel. The theory is that this specific nutrient partitioning is a key factor in the increasing obesity of all people, not just Americans.

We need more specific information about the types of fast food consumed and their ingredients to speculate further. It would also be interesting to find out if the same kind of weight gain occurs when the 70% extra calories come from healthy sources of protein, fats and produce as opposed to whatever was consumed at the local fast food outlets. I don’t know if we’ll ever get to know. Who is going to willingly sign up for that research?

WHO WERE THE SUBJECTS?

I am also wondering who the research subjects were in the first place. The LA Times story reports, “Swedish researchers recruited 18 healthy, young adults who had normal body weights for the study. The participants were instructed to limit their physical activity to 5,000 steps a day or less, which is considered a sedentary lifestyle.” There was also a matched control group for the study.

But the researchers also report that there was wide variation in the results. The researchers report that the average body weight increase was 6.4 kg–that is over 14 pounds in 4 weeks. They also report that there was a 2.8 kg range–over six pound difference between the low gainers and the high gainers.

Think about it. Maybe some people gained only 11 pounds while others gained almost 18. We don’t know exactly how that range lined up, but there are significant differences between the subjects. I wonder why?

Were the high gainers those who ate more calories? Did they eat different calories? Or do some people gain more weight despite calorie intake being similar–or even less? I would like to know more, but that data is not included in the PDF manuscript currently available online.

SIX AND TWELVE MONTHS AFTER THE STUDY AND THEY ARE STILL FATTER

Six months after the four week experiment, the subjects had lost most of the weight gain, – over 10 pounds on average, with a range of almost 7 pounds. That means it is possible some people lost less than 7 pounds and others could have lost as much as over 13 pounds. Again, different subjects had a different outcome and we don’t know why.

Twelve months after the four week experiment, the study participants maintained an average of 1.5 kg (over 3 pounds) higher weight than at the start of the study, with a five pound range among all subjects. (A five pounds range means some people probably lost weight compared to their starting weight and some people maintained more than a 3 pound weight gain) All of the weight still left was determined to be fat weight. Any water weight or other lean body mass gained during the experiment had already been lost.

What about the control group? After 2.5 years, there was no material change in the control group–the average weight change was measured at 0.1 kg-with a range of 2.5 kg (5 pounds). You can see from this data how “no change” doesn’t really mean no change for everyone. Someone had to gain while others lost weight for the average change to be so small.

THE TAKE-AWAY MESSAGES

And the lesson here? First, overeating is problematic for most people. This study suggests that short term binges of overeating impacts the body more than just an increase in stored energy. If the energy balance equation worked perfectly, people should be able to lose the fat weight as readily as it was gained. They didn’t–and they didn’t for over 12 months.

The second takeaway is that it is not likely each participant responded the same to increases in calorie intake. We don’t have the data to explicitly document this observation, but there were wide enough ranges in the data that I would suggest researchers look at this phenomena more closely.

Work by Chris Gardiner has already suggested that not everyone loses fat weight in the same way, despite calorie intake. My guess is that weight gain is not the same for everyone, either.

WEIGHT MANAGEMENT IS NOT A ZERO SUM GAME

The findings of this study have strong implications. Eating exactly what your friends are eating isn’t a good idea–especially if you know your body can’t handle it. A diet may work for a friend or colleague but not for you. Anecdotal evidence of a diet’s success is weak. Despite that fact, every commercial diet plan sold heavily depends on anecdotal evidence to market the product.

There is no one right way to eat for every person, so it is important to figure out an approach to food that works for you. But if you overeat for short durations of time, there is a metabolic price to be paid. It is more than just having to burn off those calories.

Maybe we should turn our attention to addressing why people over eat rather than coming up with the next new diet. Calorie restriction pretends that this is a zero sum game. It’s not.

Weight management is complex and beyond calories in and calories out. The sooner the general public (along with the medical, nutrition and science world) catches up with that truth, the better.

August 25, 2010

I did a double take passing by my local Whole Foods Market today. It is a convenient one block walk from my office and I am thrilled to have such fabulous food so conveniently located. Granted, I passed right by today, carting $80 worth of farm fresh produce from the Santa Monica Farmer’s Market. I like it all.

I silently smiled as I walked by the sign strategically placed at the corner of 5th and Wilshire Boulevard in Santa Monica. I can’t wait to hear people respond to this new offering. Aren’t pizza and hamburgers traditionally relegated to the realm of junk food? Aren’t these the kinds of foods public health officials rail against in their condemnation of fast food?

The truth is that there is nothing inherently unhealthy about either the hamburger or a piece of pizza. It is sloppy and ridiculous thinking that any one food is healthy or unhealthy. The real issue is one’s overall diet. Diet in this context refers to the mix of food that is included in your meals, snacks and beverages through the day, over time.

So why do people rail against pizza and hamburgers? Take a closer look. What is in a hamburger? Bread, meat, often some vegetables like lettuce and tomato. Does anyone call a steak with a garnish of vegetable and a piece of bread junk food? It is not much different nutritionally speaking.

WHEN HAMBURGER ISN’T A JUNK FOOD

The picture becomes clearer when you look at the side dishes. Consider what happens if you add a side salad and a glass of milk instead of fries and a soda. Is the hamburger meal still junk food? See? It is the overall meal that counts. Not just one of the items.

The same goes for Pizza. Bread, tomato sauce, and cheese. It could be pasta with sauce and Parmesan cheese. Anyone calling a plate of pasta marinara junk food? Does it matter if it is served with garlic bread and a soda or sauteed vegetables and a salad? Again, it is the whole meal that makes the difference.

So, before people get hysterical at the idea of pizza and hamburgers at Whole Foods, consider what that meal could be. There is fresh fruit, hearty soups and a whole salad bar that can be paired with either entree. That makes for a meal that is delicious, balanced and convenient. Just what many health conscious consumers need.

A HEALTHIER BALANCE AVAILABLE AT MANY DIFFERENT KINDS OF RESTAURANTS

Ironically, you don’t have to go to Whole Foods to get that healthy balance. Some of the most maligned fast food restaurants offer fresh fruits and vegetables to pair with a hamburger. I propose a moratorium on simple minded and simplistic labeling of what is junk and what is healthy. It is not the individual foods or their individual ingredients. Either your overall diet is working for you or it isn’t.

Granted, I am a huge proponent of most foods being raised sustainably and “close to the earth.” I prefer to buy organic foods, even as articles clamor to tear down claims of nutritional superiority. (It’s more about antioxidants and the environment) I preferentially purchase meats that are grass fed, wild caught fish, pastured chickens and eggs. (Its about the health of the animals, minimizing abusive use of fertilizers and pesticides for the feed, caring for the environment and improving my omega 3 intake while decreasing intake of omega 6 fatty acids) I want to eat close to the earth and enjoy purchasing foods from local farmers. (Its about community and enjoying foods at their peak of flavor)

At the same time, until the general public gets over its love affair with cheap food, there is little opportunity for many restaurants to do anything other than source food as cheaply as possible. Until most farmers and agribusiness are convinced that it is worth their while to farm and ranch more sustainably, the current sustainably grown food supply isn’t adequate to meet overall demand for food.

So, in the meantime, I celebrate the opportunity to eat a healthy balance of food at many different kinds of restaurants, even fast food establishments. And I continue to celebrate the amazing food supply available to me most days of the week at local Farmer’s markets. It is time to eat for health, not for some ideological notion of what is healthy.

An email from my husband first hinted at the problem. Millions of eggs recalled, and his business is food distribution. Another very difficult day at the office.

He has lived in parallel universes for awhile now. Most of the food he sells is conventional, directed to the restaurant, hotel and institutional market. Price point is the paramount concern. Quality is a close second, but often price trumps quality. How food is raised and how the crops, animals and the workers are treated isn’t even on the table (pun intended).

Then he comes home. I buy pastured eggs and chickens from Healthy Family Farms. Organic raw milk from Organic Pastures. I buy grass fed lamb and beef from a variety of sources, including my husband’s food supply company. Fish is mostly purchased wild caught or from species that are sustainably and responsibly farmed. Sometimes I can find it fresh, but Trader Joe’s does a nice job with flash frozen product that is reasonably priced. I don’t always want to pay $20 and more a pound for wild caught salmon.

Ninety percent of our produce comes from local Farmer’s Markets. I am blessed, living in Southern California with a 52 week growing season. Years ago I would run in for flowers and rush off to work. Today, I visit one of five different markets depending on the day and in which direction I am headed. All of them are within walking distance or a short 10-15 minute bike ride from my home or office. I fill both bike panniers and peddle home with $60-80 dollars worth of fruits and vegetables that won’t last the week at my house.

A year ago an experiment with grass fed, pastured and organic foods bloomed into my way of life. (See my earliest blog entries for a day to day accounting of the experience.) I know I prefer eating “closer to the earth”, but I am not rigid. I still buy jicama and pineapple this is not exactly locally grown and often not organic. I enjoy a meal away from home less than I used to, but still a few times a week. Even in Southern California it is not easy to order food prepared with the ingredients I use myself without spending an amount I would allocate for a special occasion. These ingredients cost all of us more.

TRAVELING IS ESPECIALLY CHALLENGING

I find traveling to be especially challenging. I get a wake up call almost every time I venture out of my community. A two week excursion to the wilderness of the Pacific Northwest earlier this month left me with few options. The wild caught salmon was easy. But organic produce was non-existent in the liquor store-hardware store-bait and tackle shop-markets that dotted our route through the Olympic Peninsula. Grass fed meat and milk products were not to be found.

To be fair, I am sure there were sources along the way that I didn’t take advantage of. But, I didn’t realize that once I left Aberdeen it would be another four days and 95 miles until I stepped into another supermarket with more than three varieties of fruit. At the end of the trip, I did source raw milk at one dairy in Sequim, Washington, but didn’t stop. By that time we were just hours away from Seattle and pressed to make the next ferry. We had plans in the city.

HOW MUCH MORE FOR EATING “CLOSE TO THE EARTH”?

Over the year, my husband has often balked at the cost of our new food supply. He has a unique perspective. He knows exactly what he pays wholesale for conventional product at his company. He experiences shock every time he manages to pick up a few items even at a conventional local market. It makes him shake his head to hear I am paying 2-3 times and sometimes more for our own food at the array of places I now shop.

But I feel better and I am leaner, my HDL (good) cholesterol is up 20 points, my CRP level measuring inflammation is less than 0.5 and I have less than a 1% chance of cardiovascular disease in the next 10 years. For someone whose dad died at 44 of heart failure that means a lot.

It doesn’t help that too many of my cousins currently take medications for hypertension, dyslipidemia, diabetes and the like. All of our parents struggled with these diseases at very young ages and most were diagnosed, some even had their heart attacks or died in their 30’s. The higher risk is in our genes, but the costs are borne by us all.

Sure, we pay more for health insurance–there is always a hrummph when the consultant sees cause and age of my dad’s demise. I am followed more closely by my physician and have even visited the ER to check out a few incidences of indigestion–just to be sure. But everyone pays more for health insurance and all kinds of costs with so many sick people in our population taking so many drugs for what could be significantly improved with better attention to food choices, food production, and basic decisions about how we raise crops and animals.

CHEAP ENOUGH FOOD

In this context just how expensive is my food? Cheap enough.

Ironically, as the price of my food purchases has increased, there is not really much increase in overall food costs. I realize I have become more thoughtful when planning meals. I purchase what we need, and cook smaller portions. There is far less waste when I pay a premium. I am surprised since I never thought of myself as wasteful.

The benefits have been accumulating over time and are also immediate. We have become accustomed to the most delicious fruits and vegetables, the sweet creamy freshness of raw, grass fed milk, and the leaner and tastier grass fed meats. I find myself anticipating the peak season for corn and tomatoes in summer, the upcoming favorite Fuji apples in October and I will mourn when the best of stone fruit leaves the market next month.

The season’s impact on the food supply has added dimension and variety to my own plate. Paradoxically I enjoy my food more when it is not available year round. I enjoy what is in season, at the peak of flavor and freshness. I am truly eating closer to the earth and happily paying more—and paying less.

August 17

I’m vacationing in Carpinteria this week, a second home for most of my life. My family started visiting Carpinteria when I was a baby and by my 16th birthday we were lucky enough to visit often, staying at one of the units my dad built just two blocks from the beach.

Over the past 20 years, the extended Modugno family has enjoyed a family reunion at the Carpinteria State Beach every August. I blathered my family history to Bill Coleman one Wednesday at the Santa Monica Farmer’s Market in June, and he invited me to come visit the farm. I did, just this last Monday.

Bill’s wife, Delia, busily prepared lunch in the kitchen of a wide open framed home while I sat with Bill and his son, Romeo, on the covered porch. It was lovely, even as I squirmed feeling a bit out of place. I’m usually in the kitchen.

We covered a lot of territory, comparing family food traditions and my work as a dietitian in Santa Monica. I have come a long way from the conventional training of my college days. I appreciate all the science, but realized a few years back that I really didn’t connect with food anymore–at least not the growing part. I spent the last few years reading extensively, especially taken by Joel Salatin’s story in The Omnivore’s Dilemma by Michael Pollan. I was intrigued enough to read his own story in “Everything I Want To Do Is Illegal.” I have been fascinated ever since.

EATING CLOSE TO THE EARTH

I have always been drawn to food–even as an anorectic. I was classic, cooking for everyone else but not eating myself. Thank goodness that is over. Food has evolved far beyond the uneasy truce I negotiated as I healed from the eating disorder. Today my relationship to food could best be described as joyful.

I would have never guessed I could become so respectful of the growing part. I am not quite enamored, as I don’t trust that I have a green cell in my thumb. I tend to kill most everything I put in the ground, but Bill tells me it is probably a lack of time. Farming takes plenty of it. As a matter of fact, I do remember that part.

My father was a part time farmer–basically growing every thing he could in 3/4 acre of land that surrounded our house in Sylmar, California. My dad was one of ten kids, the first generation offspring of Italian immigrants from a poor agricultural region in Puglia. He actively gardened from early spring through the middle of fall with seemingly little effort. It seemed like anything he pushed into the ground grew and produced. By the end of summer, my sisters and I would proudly pull our wagon through the neighborhood offering tomatoes, chard, peppers and zucchini to all takers.

But it wasn’t all fun. I often sense my stunted relationship with food started as a child. My dad demanded a bucket of weeds for permission to go anywhere or do anything. He was relentless. He would reel in anyone who wanted to join me for any excursion or privilege. There was always a price to pay no matter who wanted to do something with me, whether it be one of my five sisters, my cousins or some hapless and unsuspecting friend. I even witnessed my older sister’s boyfriends get hoodwinked into picking a few buckets every time they came over to the house. It’s a wonder they ever came back.

BACK TO LUNCH ON THE COLEMAN FARM

After a pleasant hour of sharing stories, we moved inside to the farm table as it was filled with the day’s meal. The next hours passed seemlessly, with the convoluted conversation of three generations sitting at the table with a most willing guest. I hadn’t passed so many dishes since I was living at home, eating at our own family table.

Delia prepared traditional Filipino foods that embraced the harvest of the day. I tasted bitter melon for the first time, definitely preferring it when eaten with the chicken curry than the stronger taste all by itself. My favorite new food was the freshly picked and cut bamboo shoot salad. This tasted nothing like the dead and lifeless canned variety, my only previous experience. I didn’t hesitate to take thirds.

Later as Bill guided me around the farm, he showed me the precious young shoots in the stand of bamboo just off the house porch. We walked past the bathtub used to wash produce before it is taken to market, and paced alongside rows of herbs and greens, as he named each variety. I noted the drip irrigation, a direct benefit of Romeo’s degree in agriculture, and the carefully measured rows of new growth, timed to meet demand over the growing season. I loved being this close to the source.

EATING “WEEDS”

As we passed the purslane, I started laughing. I had told Bill about the evening I was sent to my room for refusing to eat the “weeds” my dad picked that day. It’s been over thirty years, but I wondered if it could be just the stuff I passed on years ago. Bill deftly pulled out his knife and cut me a bunch. I took in the simple cooking instructions and wondered if I would really eat them. How could I not?

Today the purslane was cleaned and added to a salad for lunch. Crisp, a bit sweet and sour. The young leaves blended beautifully in my salad accompanying a grilled pork chop and baked beans. Tonight for dinner, I cleaned the rest, sauteing the ends first in a bit of oil and garlic and adding the tops later. They were amazingly tender, bright in flavor. Delicious.

The subtle sweet and tangy flavors of the cooked purslane were delightful, especially given that the store bought romaine lettuce I used in a salad was a bit wilted and bitter, belying an age much older than I would have thought. I just went shopping two days ago. I am definitely going to miss Wednesday’s farmer’s market in Santa Monica this week. But you will see me at the Thursday market here in Carpinteria.

Last Thursday evening I listened to three farmers and an executive chef share their views and experiences working close to the earth. KCRW’s Good Food host, Evan Kleiman, moderated the Santa Monica Farmers Market quarterly panel about meat and sustainability. Panelists featured farmers Marcie Jimenez (Jimenez Farm), Greg Nauta (Rocky Canyon Farm) and Mark McAffee (Organic Pastures Dairy) and Rustic Canyon’s executive chef, Evan Funke.

I am encouraged and reinforced. It is good to commune with those of like mind. There is much to gain from eating close to the earth, including meat and animal products raised by people who are committed to working with animals in the most humane and responsible way. We all benefit.

Key barriers continue to limit the supply of these fabulous meat products. The most critical being the lack of independent abbatoirs to service the smaller number of animals at these independent local farms. A slaughterhouse or abattoir is an industrial facility where animals are processed for consumption as food products.

Greg Nauta of Rocky Canyon Farms claims he has to reserve space six months in advance at the only facility available to him. That leaves no opportunity assess his animals and their readiness on an ongoing basis. He gets to guess.

Three counties in the state have written law to prevent an abbatoir from being established within county boundaries. This leaves local, humane farmers without a place to slaughter their cattle, and many people without the dense nutrient foods from animal products that keeps many of us healthy and fit. Not everyone thrives on a vegetarian diet.

VEGETARIAN DIETS NOT FOR EVERYONE

I applaud the encouraging words from these panelists and the forward thinking exhibited by Santa Monica’s farmer’s market director. For decades the vegetarian mantra has dominated the headlines when it comes to “healthy eating.” As much as I love my fruits and vegetables, I need animal protein to feel my best. There is a wide range of food patterns that compliment the adage to eat close to the earth.

Whole foods, including healthy fats from grass fed animals and their dairy products, are effective ways to improve the risk factors that point to increased risk of disease. By eating healthy fats and decreasing highly refined sugars and starch, my patients decrease triglycerides, improve “the good” HDL-cholesterol, decrease inflammation scores, and even lose fat weight.

Ironically just this week, Medicare has cleared Ornish and Pritikin intensive diet and health programs so they can be covered by Medicare payments. These programs have been around for decades, extolling the virtues of an extremely low fat diet–mostly less than 10% of total calories.

The proposed 2010 Dietary Guidelines also support a low fat intake. With current research showing dietary fat is not the problem, and saturated fats important for increasing the “good” cholesterol (HDL), I often feel like I am living in two different worlds. It is as if the government can’t quite keep up with the literature, at best the review process is so arduous that by the time the recommendations come out, they are already a bit outdated.

THE CRITICAL ISSUE IS ACCESS

I was lucky enough to be one of the few who crammed into Santa Monica Library last week. I love the concept of the conscientious carnivore. It brings to mind the best practices of any culture, treating the source of their food supply with gratitude and respect.

There is room for everyone to figure out an approach to their diet that works for them. The challenge will be access. Access for the farmers and ranchers to bring their animals to slaughter, access for consumers to purchase these products at convenient locations (not everyone can get to the Wednesday market in Santa Monica between 8:30 am and 1 pm).

And the greatest challenge may be the one voiced by someone in the audience last Thursday night. How do we expand access for people of limited economic means? These foods are more expensive. I don’t have the answer here.

AFFORDING CLOSE TO THE EARTH
Last spring I talked to a group of young Latina mothers. They lived in a poor community seemingly far removed from the city but only a few miles south of Colton in San Bernardino County. They asked me about grass fed meat and organic produce. Their socioeconomic status did nothing to keep them from addressing some of the most current nutrition topics of the day.

These women know that their diet when they visit their homeland is healthier. These women travel with their families to Mexico each year for weeks at a time. They eat closer to the earth in their home country, with little access to the adulterated abundance sold in our supermarkets. They lose weight and feel better while they visit family at “home”. How ironic that the poor of third world counties eat grass fed meat and organic produce from their yards because they can’t afford otherwise.

As more of us look to buy grass fed, organic food grown close to the earth, I wonder how our food supply will change. I am looking forward to November and the next quarterly event sponsored by the Santa Monica Library. What a fabulous use of community resources.

Finally some sanity in the research linking weight and body mass index (BMI) to increased risk of morbidity and mortality (research speak for disease and death). A recent study in the Archives of Internal Medicine has identified waist circumference as far more predictive of health risk, including death. For decades the public and professional masses have been bombarded with a distorted perception of risk from the scale. Too many experts insist that weight alone or BMI is the best predictor of risk for both disease and death. Hogwash.

I have said for years that the scale is a very crude tool, and BMI is a simple ratio of weight and height. Many studies confirm that fitness trumps weight. Studies of active people and fit athletes bear this out. The heavier body mass from hypertrophied muscles increases both weight and one’s BMI, but doesn’t necessarily increase risk of disease or death. Most often a healthier active lifestyle actually decreases risk of morbidity and mortality because fitness is a huge factor decreasing health risks.

Of course, it helps if the athlete is also eating a healthy diet, not smoking or engaging in other risky behaviors. But you wouldn’t know it by reports from the obesity police. You know, those researchers, clinicians and writers who want to believe too many ills and illnesses are traced to body weight. The use of “obesity” as a risk factor often lies in universal but unwarranted trust of BMI as an accurate measure of risk. It was never designed to assess risk in an individual person. Even in population studies the use of height/weight and BMI has skewed all kinds of findings.

WEIGHT IS NOT A GOOD PREDICTOR OF RISK
The truth is that weight is not a good predictor of health risk. The scale measures weight without any ability to discriminate between lean body mass and body fat, as well as how that body fat is distributed. It is time to put the scale in it’s place. It provides us with a number that has meaning only when it is taken into context with body composition, body fat distribution and the entire person. It may be useful as a indicator that all is not well metabolically, but there is risk is thinking only the overweight and obese are at risk. There are plenty of thin, “normal” weight folks with evidence of metabolic disorders, including diabetes, dyslipidemia, and hypertension.

Rather than rely on the unreliable but very visible marker of body size, maybe we should mostly focus on more significant metabolic markers that indicate risk. Often the same metabolic challenges are present whether someone is carrying significant excess body fat or just a little heaviness in the belly. Conventional blood tests often indicate the metabolic story

METABOLIC MARKERS ARE MORE EFFECTIVE THAN ASSESSING BODY MASS

Increasing glucose levels over time–even before the established threshold for diabetes (126 mg/dl) or pre-diabetes (110 mg/dl)–is a strong indicator for me. Insulin resistance is probably distorting fat metabolism for decades before a test shows blood glucose levels that are diagnosable. The real story here is insulin, something we don’t measure regularly.

Escalating glucose levels indicate the body is not responding to insulin effectively. Excessive insulin secretion in response to insulin resistance is known to increase inflammation, enhance fat storage, and interfere with signals of hunger and satiety. The fundamental metabolic challenges are already doing damage. The obvious question is, “Why are we waiting for evidence of diabetes to do something?”

High triglyceride levels often indicate more carbohydrate in the diet than one can handle. Or maybe it’s just the wrong kind of carbohydrate. Excessive intake of refined starches and simple sugars– especially high fructose corn syrup– are linked to elevated triglyceride levels.

Depressed HDL-cholesterol levels often indicate someone is not mobilizing fat effectively, possibly due to excessive insulin secretion. Too much carbohydrate in the diet? Overeating? Excessive stress? Not enough exercise? Problematic medications? This is when I turn detective.

I review blood tests very differently than most physicians. While doctors are looking for clues to diagnose disease, I am looking for clues to assess metabolism. I want to see if blood test results provide some insight in to how the body is using fuel, both glucose and fat. I want to see if there are indicators that the body is preferentially storing fat instead of using that fat for fuel, something called nutrient partitioning. I want to connect the dots for my clients, guiding them to a lifestyle that allows them to use both glucose and fat effectively for fuel.

IT IS TIME TO EAT FOR HEALTH, NOT WEIGHT

The bottom line in this study is that a good look in the mirror or measures like girth circumferences (get out the tape measure) give us a far more useful picture of risk than measures of weight or BMI. More sophisticated tools are often available to assess body fat for research studies, including MRI (magnetic resonant imaging) and CT (computerized tomography) scans. Being very expensive tests, I doubt the health industry will tolerate using these tools to assess body composition and body fat distribution.

It is probably too soon to expect the hysteria about weight to settle down, but maybe we can hope. In the future, maybe health organizations will stop flagging people for high risk based only on their weight and begin to really look at, talk to, and assess the individual. Maybe school nurses will not report BMI on report cards or notify parents that their child is obese without assessing the true risk for these kids. Maybe doctors will stop being preoccupied by the number on the chart and assess the patient’s entire lifestyle, assessing risk for disease from a more comprehensive perspective. And finally, maybe we can put away the scale and BMI as a number that determines who is OK and who is not. Too many people are ruled and manipulated by these numbers. It is time to eat for health, not weight.

Randy Dotinga of Business Week glosses over the details and fails to ask the more penetrating questions. In an article published on August 2, 2010, “Low-Carb, Low-Fat Diets Tied For Long-Term Weight Loss” there is so little “news” that I wonder why it was published.

That is, except for the fact that many people–and scientists– want the issue of weight loss to be all about calories. We will be “treated” to these poorly investigated findings as long as there are scientists who insist that weight is primarily determined by the balance of calories in versus calories out.

WEAK AND LACKING ANALYSIS
Actually, I find much to be lacking in the analysis of the results. I continue to find that different people lose fat weight easily depending on their genetic predisposition and environmental factors. For these reasons, a calorie is not a calorie when it comes to weight loss. I will argue forever that it is not just about the calories. The real issue is what happens to the calories we eat. Are they used as fuel or preferentially stored as fat? This phenomena is something nutritionists call nutrient partitioning.

A few other points…

First, we have no idea how the candidates were recruited and whether they were screened for any evidence of insulin resistance. The more insulin resistance, the more likely calories in end up being calories stored.

The study also didn’t address the range of result, just the average—pretty limited data that can obscure all kinds of insight. While the aggregate average may look the same, I wonder what was the most and least amount of weight lost in each group. And where did those individuals plot across the range?

Lastly, while the researchers are quick to point out that either diet works, no one asked the participants how they felt eating the different diets. It is not lost on me that the research identified a moderate fat restriction for the low fat diet, but an extreme carbohydrate restriction for the low carbohydrate diet. That seems strange.

Lastly, scientists interpreting the research don’t bother to recognize that there are many ranges of C/P/F between these two extremes. The question is not whether you should restrict fat or carbohydrates. The questions is, “What balance of carbohydrate, protein and fat works for you?”

Someone needs to teach journalists how to ask the critical questions so the resulting article is meaningful. Much of the interpretation of the research claims more than what the data actually presents. At the same time, I believe many scientists want to mold the results to say just what the article says. Calories count, but they aren’t the entire story. Effective weight management is beyond calories.

New research underwritten by The Calorie Control Council asserts that using artificial sweeteners helps decrease intake of calories without overeating or hunger. The recent study states that study participants consumed a “pre-meal” dose containing sucrose (table sugar), stevia or aspartame and successfully consumed fewer calories without greater hunger or over eating at other times. From the details revealed in the report, I still have questions. But, I think the study design has a lot to do with reported outcomes.

When artificially sweetened products are consumed and what they are consumed with makes a difference. This study looks at sweetened products consumed before a meal. The emphasis of the study’s findings is to underscore fewer calories consumed. But the majority of criticism I read focuses on what happens to those calories, something scientists call nutrient partitioning.

It is my thinking that the body responds to artificial sweeteners consumed with food differently than when these same artificially sweetened products are consumed alone. When the taste of sweet registers on the tongue, the body is already secreting digestive enzymes and hormones getting ready for calories. One of those hormones is insulin. The role of insulin is to help glucose move out of the bloodstream into the cells of our body to be used for energy or stored as fat.

THE EFFECT OF INSULIN AND ENERGY PARTITIONING
When low calorie and calorie free products are consumed, the calories never come. I postulate that a resulting drop in blood sugar after consuming artificial sweeteners can trigger a sense of hunger, and drive a person to eat more–especially if you were using that diet soda to avoid snacking or to skip a meal in the first place.

I observe many clients mitigate this outcome by limiting artificial sweetener consumption to mealtime. By consuming artificial sweeteners during a meal, I suspect blood sugar is readily stabilized, especially when the meal contains enough protein.

I find the Calorie Control Council’s position to be somewhat disingenuous here. My guess is that the researchers fully understand the implication of their products on hunger and satiety. The authors state that this research was designed to quiet some of the concern about the role of artificial sweeteners distorting the body’s regulation of hunger and satiety. There is a glaring omission. The study fails to address the probable difference between artificial sweetening agents consumed with out calories from use of artificial sweetening agents consumed during a meal.

ARE ARTIFICIAL SWEETENERS “OK”?

I am often asked if artificial sweeteners are “OK”. I have very mixed feelings. Overall I think artificial sweeteners are problematic as they drive a desire for sweet. Along with ever present caloric sweeteners, the taste of sweet seems to drive the desire for more and more sweet.

If someone is able to quiet that craving with an artificially sweetened product during a meal, there is probably less fall out and the practice may be helpful in the long run. Of course, which sweetener makes a difference, despite whether it offers calories or not.

For the “non-nutritive” sweeteners–those that don’t offer significant calories, I suggest using sweeteners that have less impact on the body. That means avoiding aspartame (nutrasweet), as i don’t trust the use of a product that contributes to amino acids that can cross the blood/brain barrier and impact the balance of neurotransmitters in the brain. I sense less impact from Splenda (sucralose) and Truvia (a blend of rebiana derived from stevia and erythritol) , although they have not been as widely used, nor studied for as long of a period of time. Time will tell.

Consuming caloric sweeteners isn’t necessarily less complicated. See Susan Dopart’s discussion regarding sweeteners on the Huffington Post for more information.

Maybe it is time to get used to less sweet, or at least rely on whole foods most of the time.