He Said, She Said: Weight Management

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Weight concerns are one of the main opportunities for improvement that bring people to our practice. Our approach may ring true for you or elicit skepticism.  Either way, we invite you to share your reactions and questions on our Facebook page.  Also feel free to contact us directly if you prefer to voice your questions in private.

He Said

“Weight Management.”  According to my business cards, that’s what I do.  Because weight is such a loaded term that quickly brings to mind so many thoughts, feelings, and expectations, coming up with concise language that accurately reflects my approach is a challenge that I am still trying to settle.

Indeed I do help with weight management, but not in the direct fashion that some people might expect.  We know from working with patients, collaborating with our colleagues, and reading the research that weight-centered approaches to losing weight almost always fail.  That’s the irony: The more we emphasize and focus on weight, the harder it tends to be to keep weight off.

This fact is hardly a secret.  In October, I wrote about a conference I attended where presenters showed that over 20 diets resulted in the same pattern of weight change: sharp initial weight loss followed by gradual and steady weight regain.  A few years back, I had a telephone interview with a commercial weight-loss program that was interested in hiring me.  A study they had posted on their own website showed that approximately 85% (I forget the exact number.) of their clients regained their lost weight after one year, so I asked the interviewer what strategies they had developed since that study to help prevent this rebound.  She said they realized that clients are unable to successfully transition off of the commercial meal replacements and must stay on them for life.  This is very similar to the diet drugs on the market, which also must be taken for life or else the weight will come back, as well as commercial weight-loss programs where leaders tell clients they should be prepared to be lifetime members if they want to keep the weight off.  Sounds like a great business strategy.  As you can imagine, I did not get the job, which was fine by me.  Philosophically, we were not a good fit.

It may come as a surprise to learn that the healthcare community is still uncertain to what degree weight in and of itself matters in terms of health.  The folks who officially declared obesity a disease state this past summer can cite research supporting their view.  The “Health at Every Size”® supporters, who argue that health and body weight are independent, have supportive research as well.  Personally, I have been talking about the concept of “Health at Every Size” for a decade, long before it even had that label.  As a guy whose BMI labeled me as overweight despite a very low body fat percentage, excellent labs, and solid athletic capabilities, I could see firsthand that weight was not necessarily a good indicator of health.  Lest you think that the unimportance of body weight is a fringe theory or an excuse that overweight individuals use to stay that way, my energy metabolism professor, a lean and athletic guy himself, taught us the same concept back when I was studying nutrition at a large state university.

Clearly, there is still much that we need to understand about how important weight is when it comes to our health, but how much does this question even matter?  On one hand, determining the importance of weight is of course important from a public health standpoint.  In order to best help people be healthy, we need to understand the factors at play as well as their roles.

Speaking pragmatically, however, the importance of weight is largely irrelevant.  We know from epidemiological data that overweight and obesity have become more prevalent, not more scarce, over the years.  Closer to home, even if you have not tried to lose weight and keep it off through various permutations of food restriction and/or overexercise without long-term success, you at least know several people who have.  When Joanne and I listen to our new patients share their histories, tales of weight lost and regained are par for the course.  Society as a whole has been acting under the assumption for decades that weight matters, yet this assumption has not helped us to get any thinner.  In fact, quite the opposite is true.

If we remember that weight-centered approaches almost always fail, the only alternative is lifestyle change.  Even more radical approaches, such as bariatric surgery and lifetime medications, have to be coupled with lifestyle change in order to be effective.  There is just no getting away from it.  Whether weight matters or not, or whether somebody wants to undergo a radical approach or not, the bottom line is that lifestyle change is still necessary in order to improve health.

What constitutes healthy lifestyle change is based more upon one’s baseline than it is on some idealistic vision of what one should be doing in theory.  The efforts and constructs of lifestyle change are usually limited by other factors (e.g. time, finances, personal preferences, etc.) rather than by guidelines, so in a sense guidelines do not even matter all that much when it comes to helping people in real life.  The idea is just to start wherever you are and move towards better health one small step at a time. 

More specifically, instead of gravitating towards a particular mode of exercise because it burns the most calories per unit of time, find ways of being physically active that are fun and agree with your body.  You will be happier and more likely to make the activities long-term habits.  Instead of counting grams and calories, restricting your intake, and cutting out whatever food group is being scapegoated this week, learn to eat mindfully and listen to your body’s hunger/fullness cues.

As a result of these changes, weight loss does oftentimes occur, and when it does, it tends to stay off, but it may or may not be the magnitude that you, your friends, your parents, your partner, a BMI chart, society as a whole, etc. would like.  Therefore, part of establishing a healthy lifestyle means learning to love and accept yourself the way that you are and severing any link you may have between weight and self-worth.

It is really about putting forth your best effort to be healthy while still maintaining balance in your life.  This is what I help people to do; that is what I mean by “Weight Management.”

She Said

Well, we are closing in on the end of 2013. Inevitably, after the ball has dropped and the New Year’s celebration has ended, many people start to think about their New Year’s resolutions.  What’s at the top of the list for most people?  Weight loss.  Every January we become inundated with new patients looking to us for help with their weight goals. Most of them have tried every diet and eating program in the book (losing and regaining many pounds in the process), but they are certain that this time things will be different. This time I will find the perfect diet, most people think to themselves.  This time I will have more willpower, and I will lose the weight for good!

I truly understand why so many people want to lose weight.  Every day we are bombarded by messages about our weight. Whether it is from doctors, the media, family, friends or partners, the message seems to be that it is desirable to be thin and it is bad to be fat.  Those who try to lose weight through dieting are to be admired, while those who are fed up with diets are viewed as weak-willed and lazy.  Fat is not only disliked but also feared.  According to a 2006 study by the Rudd Center for Food Policy and Obesity at Yale University, nearly 50% of the 4,000 people surveyed said they would rather give up a year of their life than be fat.  The same study found that 15-30% of the respondents would rather become unable to conceive, be depressed or become alcoholic than be obese. 5% would rather lose a limb. 4% would rather be blind.

Given most people’s dislike and, in some cases, fear of fat, it makes sense that weight loss is on the forefront of many of our patients’ minds.  But as much as I understand our patients’ feelings, focusing all of our energy on losing weight and fighting obesity by dieting restrictively and exercising excessively hasn’t helped anyone reach and maintain their goals.  I mean, if these methods really worked, would we still have a billion dollar weight-loss industry?  Of course not.

It is time to take the focus off of weight and put it on health.  As I’ve blogged about many times before, health and weight are not synonymous.  Numerous studies have shown that when talking about health, it is lifestyle behaviors that make the difference, not just weight loss.  When patients come into my office with the sole goal of losing weight, I try to help them shift their view to one that is health-focused rather than weight-focused.  By implementing healthy lifestyle changes such as eating intuitively, being more physically active, and dealing with stress appropriately, one’s weight will often settle into a “healthy weight range.”  This weight range might not be what the media or the BMI chart says is desirable, but it is one that is sustainable and will result in the best health outcomes.

To a large extent, our individual genes determine where our weight will settle.  There really is not much we can do about that.  But what we can do is work on becoming the healthiest person we can be, regardless of what we weigh.  By honoring our body’s hunger and fullness cues, being active in a way that is enjoyable to our body, and accepting and appreciating our body where it is now (not 20 pounds less than now), we will truly reach our health goals.  Now that’s a resolution worth keeping.

 

Noms: Zaftigs, Brookline

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Zaftigs

Zaftigs Delicatessen is hardly a new kid on the block when it comes to affordable, addictive Jewish- and American-style food.  Since opening up in Brookline’s Coolidge Corner in 1997, the restaurant has received numerous awards and recognition for its impressive menu of comfort food favorites.  Since Zaftigs is merely a five-minute drive from our home, we often go there for breakfast, lunch, or dinner at least once a month!

The menu at Zaftigs is large but not too overwhelming, separated into Starters, Salads, Sandwiches, Entrees, and Breakfast sections.  We often find ourselves ordering the same things over and over, but we occasionally will go out on a limb and try something new.

This past Friday evening, we were in the mood for sandwiches.  Joanne ordered her usual Nanny Fanny sandwich, which typically is made with corned beef, coleslaw, Russian dressing, and Swiss cheese on marble rye.  This time, however, she swapped out the beef and had roasted turkey instead and asked for a small salad as her side.  Jonah went for his favorite grilled cheese on challah bread (pictured above), asked them to throw some tomato slices in there, and also had a side salad.

The turkey Nanny Fanny was a really nice change from the usual corned beef version.  The turkey was tender and juicy, and the coleslaw in the sandwich added a wonderful amount of sweetness and crunch.  Zaftigs is known for its generous portions, and this overflowing sandwich was no exception. Jonah’s grilled cheese was ooey gooey and delicious, definitely a warm and comforting choice for a chilly December evening.

Given the size of Joanne’s sandwich, she was fully satisfied with eating half for dinner that night and saving the other half for lunch the next day.  And since the whole meal came out to only about $27, it was a real deal, as we basically got three meals out of it!

Zaftigs is truly a gem in Coolidge Corner (A new one opened up in Natick recently and is equally delicious.) and we will continue to go there for breakfast, lunch, dinner and everything in between!

Extreme Disappointment

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In general, I don’t watch reality weight-loss shows. I used to. Biggest Loser was one of my favorites. I was always in awe of how many pounds the contestants would lose each season, many of them shrinking to half of their starting size. But, ever since I became a dietitian, I view these shows in a much different light. Shows like My Big Fat Revenge, Biggest Loser, and Extreme Weight Loss promote dangerous messages about weight management – namely, that fat people are inherently unhealthy and that the only way to be healthy is to lose copious amounts of weight quickly by drastically restricting one’s calories and exercising like a maniac.

Despite my dislike of these shows, I do (rarely) catch an odd episode from time to time. Many of my clients watch these shows and take what the “experts” say as gospel, so it helps if I am in the know about the latest and greatest gimmicks these shows use, so I can help re-educate my clients.  

Last night, I stumbled across an episode of Extreme Weight Loss that truly disturbed me. In this episode, a 23-year-old woman named Alyssa was the individual who was chosen to undergo a year of restrictive eating and over-exercising courtesy of trainer Chris Powell.  The episode started predictably enough: initial weigh-in tears, a loss of 100+ pounds over the first 3 months (Phase 1), and the inevitable struggles to lose weight during Phase 2 (months 3-6).  

This is where things take a serious turn. After Phase 1, Alyssa found that the weight just wasn’t coming off like it had been before. No matter how much she tried to follow the meal and exercise plan, her weight was at a plateau. So, in order to reach her goal of losing another 60 pounds during Phase 2, she decided to drastically reduce her calories even more, at times eating close to nothing. This resulted in rebound binges and subsequent purging. Alyssa developed an eating disorder (ED).

At this point, the show’s producers should have stopped the program for Alyssa, insisted she get treatment for her ED, and take all of the focus off of her losing weight. Instead, Alyssa had a heartfelt talk with Chris and his wife Heidi (who herself struggled with an ED for eight years), and despite the fact that clearly Alyssa needed help dealing with her ED, they continued to encourage her to lose weight and restrict her calories. She was instructed to eat 1500 calories per day while exercising for at least three hours per day to achieve “healthy” weight loss.

At the very end of the program (and after she had completed the program, losing a total of 200 pounds), Chris offered Alyssa a two-month stay at Shades of Hope, an ED treatment center. While at first she rejected the offer, Alyssa ended up going to the program two weeks later, as it was clear that her eating issues were continuing. Why wasn’t this offer made immediately after Alyssa admitted her ED to Chris? Why did they wait until the end of the year to offer her help?

When someone is struggling with an ED, there should be no talk of trying to lose weight, whether it is in a “healthy way” or not. In a sense, the show itself taught Alyssa how to eat in a disordered (re: restrictive) way, priming her for developing an ED. By letting her continue on in her weight loss program, the show did Alyssa a real disservice and gave the message that EDs are no big deal and are just a “phase” that can be dealt with easily. Unfortunately, EDs are not only extremely damaging (and potentially fatal), but they also often turn out to be a life-long struggle, not something to be glossed over.

These shows are not only doing damage to the contestants, but also doing an enormous amount of damage to their viewers. I am hopeful that one day these shows will run out of steam and stop reinforcing the idea that losing weight and the number on the scale are the end all, be all. Maybe someday shows will promote healthy behavior change, without focusing on the numbers. But, I guess that wouldn’t make for scintillating TV.

Noms: Cook, Newton

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Last weekend, we decided to branch out and try a new restaurant.  Cook, located on Washington Street in Newtonville, opened its doors this past September.  This New American Bistro serves a wide variety of dishes, including snacks such as bacon-caramel popcorn, wood-fired flatbreads, appetizers like shrimp tacos, and a number of entrees for vegetarians and omnivores alike.

We went to Cook on the early side, as we had gleaned from the numerous Yelp reviews that the restaurant can get very busy very quickly.  When we arrived, we were surprised to see a number of television cameras and bright lights – Chronicle, Boston’s daily TV news journal, was shooting there!  We saw Anthony Everett, the host of the show, talking with the head chef, and the cameramen were taking footage of the restaurant patrons, too.  You might just see us on that episode of Chronicle, so keep an eye out!

While there were a number of items on the menu that looked delicious, Joanne ended up going the rather unadventurous route of having the roasted chicken.  It came with a parmesan polenta cake and sautéed broccoli rabe.  The chicken was juicy and tender, the polenta cake was creamy and delicious, and the broccoli rabe was cooked to perfection.  Jonah got the grilled cheese sandwich which was accompanied by a small side salad.  We decided to also share an order of French fries that came with three dipping sauces: a sriracha ketchup, a curry honey mustard, and a creamy bacon dip.  The grilled cheese was excellent, right up there with Rox Diner.  We both enjoyed the French fries with the various dips, although at the end of the meal, we felt like we could have skipped them because we had no room for dessert.

There are a number of dishes we would like to try upon our return, including some of the sumptuous- looking desserts, so we will definitely be going back to Cook sometime in the near future!

He Said, She Said: The Paleo Diet

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Even if you have not tried to “go Paleo” yourself, you at least know someone who has.  Running neck and neck with gluten-free, the Paleo Diet seems to be one of the most popular diets these days.

The idea is to eat how some of our ancestors supposedly ate: inclusion of meat and seafood, fruits, vegetables, eggs, nuts, seeds, and some oils, and exclusion of grains, legumes, dairy, potatoes, refined sugar, salt, certain oils deemed unhealthy, and anything processed.

Should you go Paleo?  Here is what we think.

He Said

Last month while I was at a wedding, I asked a child psychiatrist seated next to me if any experiences from her own childhood inspired her choice of profession.  She smiled, leaned in, and asked me, “Oh, Jonah, do you have a week?”  Both the scope and depth of the topic were much too large to cover in the few minutes before the bride was due to walk down the aisle.  Similarly, how can I possibly do justice to all of my concerns with the Paleo Diet in this small space?  I can’t, so here are just a few of them.

  • No Legumes: Legumes are a staple of the Mediterranean diet, which has been shown in research to reduce the risk of strokes, heart attacks, and cardiovascular disease deaths.  One such study published this summer in the New England Journal of Medicine found the Mediterranean diet’s benefits to be so significant that the study was stopped early because it would have been unethical to delay publishing the findings.  Legumes are a great source of cost-effective and environmentally-friendly lean protein.  Their fiber keeps us satiated, regulates our bowel function, stabilizes our blood sugar, and lowers our cholesterol.
  • No Dairy: One can live perfectly fine without dairy, and many people around the world do just that.  We can get dairy’s nutrients, including calcium and vitamin D, from other sources.  However, anytime we cut out a food group, we have to pay that much more attention to making up for the nutrients it provides, or else we face the possibility of deficiencies.  Such deficiencies are real and do happen, even in our community.  A doctor recently referred an otherwise healthy young athlete to me because it took the woman nearly a year to heal from a simple fracture.  Her body was so deficient in nutrients after going gluten-free and dairy-free that her body was unable to heal itself until the deficiency was corrected.  When we include a wide variety of food groups, such deficiencies are less likely to occur, and we do not need to pay such close attention to the minutiae of our day-to-day eating.
  • Saturated Fat: The Paleo Diet is not necessarily high in saturated fat, as one could choose fat sources that are higher in polyunsaturated and monounsaturated fats, such as fish, nuts, seeds, and certain oils.  However, the potential for excess saturated fat exists if one overconsumes red meat or coconut oil.  One point that really bothers me though is the Paleo Diet’s notion that saturated fat is not actually detrimental to our health.  As I explained in one of my blog entries, it could come to pass that saturated fat is found not to be the concern that we currently think it is, but as of now, the overall body of research does not support that conclusion.  Experts around the world (literally) agree that we should keep our saturated fat intake low in order to protect our cardiovascular health.  To expose our bodies to high levels of saturated fat while banking on the hope that doing so is not detrimental to our health is to take a heck of a risk with our cardiovascular health.
  • Environmental Impact: Even if we were best off consuming animals as our only significant protein source, the planet cannot sustain it.  The United Nations tells us that we as a global society need to move towards a more plant-based dietary pattern for environmental reasons.  Recently, one of my colleagues attended a lecture given by a pro-Paleo author, and she asked him about the environmental impact of the diet.  “Not my problem,” was reportedly his answer.  But it is his problem.  It is all of our problem.  If the earth cannot handle its inhabitants eating a certain way, we have to adjust our ways.
  • Sustainability: As with any diet, the results are only as good as the changes are sustainable.  There are thousands of life events that can bring a diet to its end: the diet worked great, but then the holidays came around, or I started a new job, or someone brought leftover Halloween candy into the office, or I got sick, or I went on vacation, or I didn’t have the willpower to keep it up, and so on.  For reasons I can only hypothesize, when a diet is working, people praise the diet, but when the diet stops working, people blame themselves or some exterior event.  For a nutritional approach to be successful, it has to work for the long term, not just at first, and it has to be flexible enough to weather the challenges that life brings our way.  Ask yourself honestly whether the Paleo Diet meets these criteria.
  • Accuracy: According to archaeologists, the Paleo Diet does not even accurately reflect how our ancestors ate.  Not only did the diets of paleolithic man vary greatly depending on geography and season, but archaeologists also have evidence that their diets did include legumes and grains, two food groups excluded from the Paleo Diet.  Furthermore, virtually all (if not literally all) of our food supply has changed with agriculture, so our blueberries, carrots, lettuce, tomatoes, and bananas, for examples, barely resemble those that our ancestors ate.

Realize that people are much more likely to be vocal about their dietary successes than their disappointments.  For example, if a given diet works for 5% (which is actually a pretty typical success rate for most diets) of the 10,000 people who try it, 9,500 disappointed people will stay relatively silent about their experiences while 500 individuals rave about it online, at the gym, in the grocery store, at the office, over Thanksgiving dinner, etc.   Therefore, the impression we get of a given diet’s success is skewed and not reflective of reality.  If you have gone Paleo yourself and you feel great, it works in your life, and you are enjoying it, great, more power to you.  For most people though, the Paleo Diet is much too strict to integrate with their lifestyles in any sort of sustainable way. 

She Said

While the Paleo Diet might seem to be a relatively new eating style to many people, it has actually been around in one form or another for almost 40 years.  In 1975, a gastroenterologist named Walter L. Voegtlin published The Stone Age Diet: Based on In-Depth Studies of Human Ecology and the Diet of Man, in which he suggested that following a diet similar to that of our caveman ancestors from the Paleolithic Era would improve one’s health.  The diet, which consists of a higher protein, fiber, and fat intake and a lower carbohydrate intake, is said to minimize one’s risk of chronic disease as well as result in weight loss.

The diet recommends a high intake of fruits and vegetables, which in addition to supplying a plethora of vitamins and minerals, also provides fiber (which helps with GI function and blood sugar levels) and antioxidants (which help fight the trouble-causing free radicals that try to wreak havoc on our cells).  Fruits and veggies are also an excellent source of potassium, which helps regulate blood pressure.

There is some evidence that a Paleolithic diet can be beneficial for those with type 2 diabetes at risk for cardiovascular disease.  A 2009 study compared the Paleo Diet and the diabetes diet to see which was more successful at managing patients’ blood sugar, weight, cholesterol levels and other health factors.  Overall, the patients that followed the Paleo Diet for 3 months had better blood sugar management levels, increased levels of “good” HDL cholesterol, lower blood pressure measurements, and greater weight loss than those who followed the diabetes diet.  After looking at the patients’ food recalls, the investigators found that the patients who followed the Paleo Diet had a higher intake of fruits, vegetables, meat and eggs compared to the patients who followed the diabetes diet.  In addition, the Paleo group took in fewer total calories, carbohydrates, and saturated fat while having a higher intake of unsaturated fat and several vitamins than the diabetes diet group.  All of these results point to the Paleo Diet being a viable option for those looking to better control their type 2 diabetes and manage cardiovascular risk factors.

I am a fan of decreasing one’s intake of processed foods in general.  These foods are often made with large amounts of sugar and sodium, and some even contain trans fats to improve the food’s taste and/or make it more shelf-stable.  According to the Academy of Nutrition and Dietetics, about three-quarters of our sodium intake comes from processed foods.  High sodium intake is linked with high blood pressure, which is associated with a higher risk for stroke and heart attack.  Aside from increasing our calorie intake and possibly leading to weight gain, high sugar intake has been linked with the development of type 2 diabetes.  Trans fats, or manmade fats, raise our “bad” or LDL cholesterol while lowering our “good” or HDL cholesterol.

In general, I am not a fan of “diets,” that is, any eating plans that lay out a set of diet rules that one should follow in order to reach his or her health goals.  But, the Paleo Diet has some interesting principles and could be advantageous for certain individuals.

Philosophy and Ethics

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The following blog entry appeared as a guest commentary in the Wellesley Townsman on November 14, 2013.

Early Saturday evening, I was driving home from the office after seeing my day’s last patient and the car immediately in front of me struck a deer.  We were in the left lane of a divided highway going east.  The deer ran across the west-bound lanes, jumped over the barrier into our lane, and got hit immediately.  There was nothing the driver could have done to avoid the collision.

While the driver was able to pull over into the breakdown lane, the front side of his vehicle completely demolished, I was stuck in the left lane.  I slammed on my brakes to avoid running over the deer and I put on my hazards in hopes that nobody would crash into me.  Everybody else just kept on driving, and as such I was not able to move over.  I had a close-up view of the deer dying right in front of my car.

The deer tried to get up, which I hoped might signify that it was miraculously okay, but then it fell over and was kicking its legs.  The flailing slowed and became almost nothing.  Eventually there was an opening in the traffic and I was able to pull around the deer.  As I did, I looked out my side window to the animal on the ground just a couple feet away.  It was bleeding profusely from its mouth, still alive, still moving its legs ever so slightly.

I pulled into the breakdown lane and called 911.  In addition to reporting what happened and the exact location, I made a point of telling them that the deer was hurt really badly and needed help.  (The driver who hit the deer, by the way, appeared to be physically fine as he stood outside his car making a phone call of his own.)

After hanging up with 911, I had no idea what to do.  Getting out of my car and going to check on the deer crossed my mind, but the chances that I would get hit by a car myself were high and who knows how an injured wild animal would react to a human approaching it.  Besides, I am not a vet, and even if I was I had no medical supplies of any sort and no way to transport the animal.  In other words, the best I could have done anyway would have been to keep it company.

Feeling completely helpless, I left.  As I drove away, I saw a single police cruiser approaching the scene.  Traffic continued on, squeezing through the bottleneck caused by the dying deer in the road.  (I did later follow up with the police, who termed the deer’s injuries “catastrophic” and confirmed that it did not survive.)  Angry at what I perceived to be an underwhelming response, I thought to myself, “If a human ran out into the road and got hit like that, an ambulance and fire truck would have been here immediately, not just a lone police cruiser, and other drivers wouldn’t be passing by the body like it was nothing more than a nuisance.”  One of my friends who is a veterinarian later explained to me why there was nothing that could have been done to save the animal even if the entire staff of Angell instantaneously arrived on the scene.

When Joanne and I met up at home, she could tell that I had been crying.  We love animals.  Any of you who have seen our waiting room pictures know how important our pet bunny is to us.  Our honeymoon largely revolved around animals: snorkeling with marine life in Fiji, spotting mountain goats, dolphins, seals, and penguins in New Zealand, and getting close up with kangaroos, wallabies, emus, parrots, casuaries, and koalas in Australia.  We like deer too.  Helplessly watching one die in front of me in obvious pain was very, very difficult.

Although I am still am omnivore, my eating pattern has been trending towards vegetarianism in the last few years for reasons that have nothing to do with health benefits or supposed virtue.  At first, I started eating less animal products just because they tend to be more expensive and require more care in food preparation than vegetarian alternatives.

Then ethical questions came into play.  We nearly went to an Italian restaurant once before discovering that they serve rabbit, a decision that is certainly within their rights, but one that we felt we could not support by giving them our business.  From that evolved several questions: Why was I okay eating other animals, but not rabbits?  If I owned a pet fish, would I still eat seafood?  If chickens were cuter, would I still eat poultry?  If I like feeding the pigs at the local farm, what am I doing eating pulled pork sandwiches?  How can I find cows funny, stop to take their picture when I drive by them, and then eat a hamburger as if the patty grew on a tree somewhere?  Given that I criticize steak houses and BBQ joints that decorate with pictures of cows and pigs, respectively, because I do not want to be reminded of what I am really eating, aren’t I just turning a blind eye to reality by seeking out restaurants without such decor?  Where do we each draw the line between the animals we value and protect and those that we are okay sacrificing to feed ourselves in the face of perfectly fine plant-based alternatives?  No answer is right or wrong; these are questions of personal philosophy.

After Saturday’s accident, we went out to dinner as planned to a nearby Greek restaurant that we like.  I ordered a bunch of side dishes: tatziki and pita, butternut squash, and rice pilaf.  Someday, fad-diet aficionados will no doubt focus their fear on protein, just as they once did on fat and now do on “carbs,” but until then I don’t think anybody will deem my meal anything close to balanced.  Still, the idea of ordering my usual Mediterranean salad with a skewer of chicken on it after what I just witnessed felt disgusting.

I tell my patients all the time that they are not lab animals or homework assignments from some nutrition textbook.  Real life is complicated, messy, and far from perfect.  I know all about the advantages of eating meat (complete proteins and essential amino acids, heme iron, zinc, B12, and the like) but being a dietitian and having that knowledge does not make me exempt from the complexities that influence the way we eat.  Our food choices are about way more than just nutrients and calories.

Meal Enjoyment and Nutrient Absorption

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In nutrition school, I was taught that there were certain nutritional facts that always held true. A calorie is a calorie. If you eat 500 calories less per day for a week, you will lose one pound of body weight. Just because a “healthy” food might not be enjoyable to you or taste good, it is still important to eat it for good health.

Well, there is some interesting evidence that when it comes to nutrition, how much we enjoy our meals may be just as important as what our meals are made of.  In October of 2000, Tufts University Health and Nutrition Letter discussed a study that measured how one’s enjoyment of a meal affected one’s nutrient absorption. In the study, researchers from Thailand and Sweden teamed up to see if cultural preferences for a food would affect the absorption of iron from a meal.

In the first phase of the study, two groups of women, one from Thailand and the other from Sweden, were fed a typical Thai meal. Needless to say the Thai women preferred the taste of the meal more than the Swedish women did. Interestingly, even though all of the meals contained the exact same amount of iron, the Thai women absorbed twice as much iron from the meal than the Swedish women did. In the second phase of the study, the two groups were served a typical Swedish meal with the exact same iron content. In this case, the Swedish women absorbed significantly more iron from the meal than the Thai women did. 

In the second phase of the study, the Thai group and Swedish group were split up into two subgroups. The two Thai subgroups were given an identical Thai meal, but one of the subgroup’s meals was pureed into a mush. Even though both of the meals had the exact same iron content, the women who ate the mushy meal absorbed 70% less iron than the other group. The study was repeated in the Swedish group and the results were similar.

So what does this tell us? Taste and enjoyment matters to nutrient absorption! If you are one of those “nutrition martyrs” who eat foods that you really don’t enjoy just because they are “good for you,” it’s likely that you aren’t absorbing much of the nutrients from those foods. Conversely, even if you are eating a food deemed “unhealthy” by the food authorities, if you are truly enjoying and savoring it, you will be absorbing more nutrients from it.

Now, this isn’t license to only eat “junk.” But, instead of forcing yourself to eat healthy, but not tasty food, how about finding healthier foods that you enjoy? Instead of eating fat-free cheese, which, ahem, tastes like plastic, how about savoring some real sharp cheddar from a Vermont dairy? Instead of munching on low-quality chocolate, how about enjoying a piece of dark chocolate that is full of antioxidants? I am willing to bet that if you start to incorporate more pleasure into your meals, you’ll be happier and healthier.

He Said, She Said: Vegetarian vs. Omnivore

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Due in part to the rise and fall of the Atkins diet as well as the current popularity of the paleo diet fad, we frequently receive questions about which is healthier, eating meat or being a vegetarian.

He Said

Eating healthy and eating animals are not mutually-exclusive behaviors.  However, a vegetarian lifestyle offers several advantages compared to living life as an omnivore.

  1. Vegetarian protein sources tend to be lower in saturated fat, the type of fat that experts across the world agree raises the risk of cardiovascular disease.  For example, a three-ounce grilled steak contains approximately five grams of saturated fat while an equivalent serving of tofu has less than half that amount.
  2. Vegetarian sources are much higher in fiber.  One cup of black beans contains 15 grams of fiber, whereas one cup of chicken breast contains none.  Among fiber’s benefits are bowel regularity, cholesterol management, and reduced cardiovascular disease risk.
  3. Vegetarian options are typically cheaper in comparison to meats.  For example, most meat-based burritos with guacamole at Chipotle cost $8.45, while a vegetarian burrito with guacamole is only $6.25.
  4. A vegetarian lifestyle reduces the environmental impact that comes with raising animals for their meat.  According to a 2011 report from the United Nations Environment Programme, “Impacts from agriculture are expected to increase substantially due to population growth increasing consumption of animal products.  Unlike fossil fuels, it is difficult to look for alternatives; people have to eat.  A substantial reduction of impacts would only be possible with a substantial worldwide diet change, away from animal products.”
  5. A vegetarian diet spares the lives of countless animals that would otherwise be slaughtered for their meat.  According to statistics that the USDA released in September, 2,820,000 cattle, 64,500 calves, 9,560,000 pigs, and 208,100 lambs were slaughtered in the month of August alone.

Nothing says one has to declare himself or herself a vegetarian in order to reap these benefits.  Consider incorporating more meatless meals and snacks into your routine in order to improve your health, the environment, and the welfare of animals.

She Said

While vegetarianism definitely can be a very healthy lifestyle, life without meat can come with consequences.

  1. Meat, fish, and poultry are packed with a number of nutrients that are important for the body.  All of them are excellent sources of protein, which is essential for numerous body functions, including building tissues and fortifying the immune system.  While one can get proteins from plant sources, they tend to be less concentrated; that is, you would need a lot more of the plant to get the same amount as found in meat.
  2. Meat also is an important source of iron, which is essential for the formation of red blood cells.  And again, while one can get iron from non-meat sources, it is not as readily absorbed by the body as iron from meat sources.
  3. Finally, vitamin B12, found only in meat, fish and poultry, is essential for a myriad of functions, including cell differentiation and fetal spinal cord formation during pregnancy.  Vegetarians need to be extra careful about getting enough B12, as it can result in a type of anemia.  Most doctors would suggest that those who do not eat any meat, fish or poultry should receive monthly B12 shots administered by a health practitioner.

Bottom line: If you lead a vegetarian lifestyle, you will need to be especially careful about getting enough protein, iron, and B12 in order to be healthy.

Fitspiration or Fat-Shaming?

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In fat-shaming news, Maria Kang, a 32-year-old fitness fanatic and mother of 3, posted a photo of herself and her three sons (then aged 3 years, 2 years, and 8 months) on Facebook with the caption “What’s Your Excuse?”  In the photo, Kang is wearing only a sports bra and tiny workout shorts, showing off her toned and sleek body.  Clearly, the photo and caption are meant to be “fitspirational” to all of the new moms out there who haven’t yet made losing weight their top priority and to show them that even with 3 kids under the age of 3, you too can have the body of a fit model.  Needless to say, the internet has been ablaze with both positive and negative feedback on the image.

I actually saw this woman on the Today Show this morning, and she was rather unapologetic about the message her photo is sending.  She reiterated the fact over and over that the photo was meant to be inspirational, not a knock against fat people.  That may have been her intention, but honestly, the caption clearly implies judgment against those who “haven’t lost their baby weight yet.”  That perhaps if these overweight women just tried a little harder, they too could bounce a quarter off their abs.

Kang, who is a former personal trainer and beauty queen, clearly has always been in good shape.  Given this fact, it’s not surprising that she was able to “bounce back” to her original shape after her pregnancies.  But the fact is that she is in the minority.  The average woman in the U.S. does not look like Kang and even if she were to put in all of the extraordinary time and effort to achieve Kang’s physique, it is very unlikely that she would be able to maintain it.

So, yes, I do believe that this image is fat-shaming. Instead of sending the message that if you just try hard enough, you can have a hard body after baby, how about telling new moms that they are beautiful and that they should appreciate what their bodies can do for them (e.g. give birth!).  Now that would be inspirational.

Individualized Nutrition Counseling

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I spent the last four days at the Cardiometabolic Health Congress, where international experts in cardiovascular and metabolic health gathered to discuss the latest developments in our field.  One of the talks that I think will be of most interest to you, our readers, addressed the question: Which diet is the best for losing weight?

The presenter discussed a study that compared the weight loss of subjects put on over 20 different popular diets.  As it turned out, there was no significant difference in weight loss between any of the diets.  The pattern was the same for each: sharp initial weight loss, followed by steady weight regain.

In other words, the study supports what other research has shown too, namely that dieting does not work in the long run.  Furthermore, it does not matter which diet one chooses, as each diet is just as good at ultimately failing as any of the others.

The presenter shared another study that looked not at weight, but at actual markers of health (i.e. cholesterol, blood pressure, blood sugar, etc.) and found that the dietary approach that a person takes absolutely matters in regards to these markers.

So, what is that dietary approach that makes such a difference for health?  An individualized approach.  There is no one eating pattern that will work for everybody; it has to be tailored to the person in question.  The presenter stressed the importance of taking into account the specific person’s preferences, risk factors, current habits, and goals.

In other words, to really make a difference in terms of somebody’s health, he or she does not need another diet, but rather individualized nutrition counseling.  We at Soolman Nutrition and Wellness LLC already knew that, which is why you see the term “Individualized Nutrition Counseling” on our website, business cards, brochures, and advertisements.  I will say though that it was nice to receive confirmation that the approach we take with our patients is supported by the most current research.

If somebody you know is sick of diets failing and he or she is ready to get healthy, send him or her our way and we will be happy to help.