On The Radio

This past Friday night, I was a guest on New York City-based personal trainer Jason Alexander's online radio show, All About Fitness.

Jason asked me a few general nutrition questions, and then it was on to listener phonecalls.

We discussed a plethora of topics, from fiber to protein to the Atkins Diet to fruit juice.

You can listen to -- and download -- the hour-long show by clicking here.

Enjoy!

For the record, I absolutely love doing radio and television (producers, take note!)

You Ask, I Answer: Battle of the "Diets"

Andy, are you going to blog about [the study that concluded that a low-carb diet was more successful at helping subjects achieve weight loss and healthier blood cholesterol profiles than Mediterranean or low-fat ones]?

-- Anonymous
Via the blog

I was most certainly planning on commenting on this study, mainly because of some very distracting flaws I noticed.

Let's begin with some basic information.

The study -- partially funded by the Robert and Veronica Atkins foundation (potential bias, anyone?) -- took place over 2 years, during which 85% of the 322 participants stuck with their respectively assigned diets (low-fat, Mediterranean, and low-carb.)

Now with some of my "uh, wait a minute" impressions.

Firstly, when it came to weight loss, low-carb beat out low-fat by 4 pounds (10.3 lbs vs 6.3 lbs), but edged out a Mediterranean Diet (which includes higher carbohydrate consumption) only by 0.3 lbs.

And although the low-carb diet resulted in the best blood cholesterol profiles, it's important to note that for this study, researchers "urged [the] dieters [on the low-carb diet] to choose vegetarian sources of fat and protein."

In other words, although the low-carbers had the highest saturated fat intake out of the three groups, the majority of their fats came from plant sources.

There isn't anything groundbreaking here. Anyone keeping up with nutrition research knows that mono and polyunsaturated fats are recommended for heart health.

Hence, this study calls into question the belief so many low-carb fanatics like Gary Taubes fervently hold on to -- that saturated fat is the best for blood cholesterol levels.

The study specifically mentions that the blood cholesterol levels of the low-carbers is due largely to the consumption of monounsaturated fats.

Besides, I always wondered why low-carb enthusiasts even bother bragging about improved cholesterol profiles on their diets when, two seconds later, they turn around and say that the cholesterol-heart disease link is a lie and the result of "bad science." Which is it?

The study wasn't entirely a "low carb diets RULE!" piece, either.

For instance, the Mediterranean Diet -- which was highest in fiber -- proved to be the most effective at managing blood glucose levels.

Yet again, this goes against traditional low-carb beliefs (and, once again, those Gary Taubes loves to pontificate) that the research on fiber is "inconclusive at best" and that there is no need to have it in the diet.

Before anyone jumps down my throat about whether or not I read Good Calories, Bad Calories, Gary Taubes himself said at his New York University talk in March of this year that he didn't think high-fiber grains were any healthier than refined ones.

Speaking of fiber, I noticed that the low-fat group was only asked to consume "low-fat grains."

This struck me as odd, mainly because it is hard to find grains high in fat -- they are all low-fat.

Additionally, it's hard to overlook some bias.

The study does not urge low-fat dieters to consume the healthiest grains (whole grains), yet specifically requests that low-carb dieters eat the healthiest fats.

I also found it strange that for the majority of this study the low-carb group was consuming 120 grams of carbs a day. This is definitely higher than the much lower levels recommended by most low-carb advocates.

Atkins, for instance, usually calls for no more than 100 grams of carbohydrates per day during the maintenance phase.

Finally, take a look at the numbers and you see that although the low-carb group was not calorie-restricted, their caloric intake was lower compared to their pre-study diet.

So, as always, we are talking about weight loss as a result of reduced caloric intake.

You Ask, I Answer: Gary Taubes

I would very much appreciate any thoughts you have regarding Gary Taubes.

-- Karen Carabio
Reno, NV

This question arrived in my inbox on March 3, the same day I heard that Mr. Taubes was due to speak at New York University's Department of Nutrition, Food Studies, and Public Health on March 13.

I wanted to attend that event before answering Karen's question, so as to truly familiarize myself with his theories and viewpoints.

If you are not familiar with Gary Taubes, he is a journalist and physicist who has contributed articles to Science magazine since the 80s.

He became a semi household name in August of 2002 when his article "What If It's All Been A Big Fat Lie?" made the cover of The New York Times Magazine.

Its main point? Carbohydrates -- and only carboydrates -- are to blame for rising obesity rates in the United States.

Cut out carbs from your diet, Taubes claimed, and you won't gain weight. And when he says "carbohydrates", he's even referring to whole grains.

His article paved the way for the 2002 rebirth of the Atkins diet.

And what a rebirth it was! Six hundred low-carb products were launched in 2003.

Even common products like oils, cheese, and diet sodas included large "Low Carb!" stickers on their packaging, capitalizing on consumers' growing interest in shunning carbohydrate-rich foods.

By 2005, however, the hype died down, the Atkins company filed for bankruptcy, and "low carb" was out (thank goodness!).

That certainly didn't change Taubes' mind, though.

Last year, he pubished Good Calories, Bad Calories: Challenging the Conventional Wisdom on Diet, Weight Control, and Disease.

Its main point? Dietitians are blaming the wrong guy for this country's increasing weight problems.

Obesity, Taubes claims, is not caused by overeating. Not only that -- calories have nothing to do with weight gain or loss!

So what is the cause? Taubes attributes it to insulin.

The more insulin you produce, he believes, the more weight you gain.

Therefore, it follows that carbohydrates (which raise blood glucose levels more than fat or protein, thereby signaling the body to release more insulin) cause weight gain.

At his March 13 NYU talk, Taubes presented a few more points.

He first referred to animal studies demonstrating that when animals overfeed themselves, their metabolism revs up and burns more energy than usual; when they underfeed, their metabolism slows down.

Taubes went on to explain that the same concept can be attributed to humans.

If we overeat, he explained, our bodies are smart enough to know to burn more calories. If we undereat, our metabolism slows down.

In Taubes' view, calories in and of themselves are irrelevant because our bodies can handle what comes their way.

Fair enough -- one of the main flaws behind very low calorie diets is that they end up slowing metabolism down, thereby making it easier to gain weight when regular eating patterns are resumed.

And while it is true that our metabolisms can compensate if we overeat by 50 or so calories, don't count on it to balance things out if you overeat by 300, 500, 1,000 or 1,200 calories.

Taubes claims that all overweight people are in such a state simply because of high carbohydrate consumption.

Okay, but can he point to examples of people overeating calories and NOT gaining weight?

Taubes believes that "portion control" only works because people are eating less carbohydrates.

Yes, but they are also eating less fat and protein, thereby discrediting his entire argument.

After the talk, a member of the audience asked Taubes how he explains many Asian cultures subsisting on "bad carbs" like white rice and having lower obesity rates than the United States.

His response? "Well, they've been eating rice for thousands of years, so their bodies are just used to it." Huh?

At one point in his talk, Taubes claimed that sugar and refined carbohydrates are only approximately a hundred years old or so in much of Europe and North America.

I would love to know where he got that information from, since the most basic of research on sugar points to its existence in Persia around 650 AD, and its delivery by European Crusaders to their continent in 1100 AD.

Sugar is not new. It has been consumed by civilizations around the world for centuries. Following his logic then, why aren't most humans "immune" to calories from sugar?

Overweight and obesity are clearly linked to a higher consumption of calories.

If you are skeptical, do me a favor and eat 1,000 more calories than usual (solely from pure fat or protein sources; absolutely no carbs) every day for a month.

Then, get on a scale.

Or, try the reverse and subsist on 400 calories of pure carbohydrates every single day for a month. According to Taubes, you would still gain weight.

Taubes was also asked by an audience member if he thinks it is possible for humans to live healthfully without consuming a single gram of carbohydrates.

His answer? A resounding "yes."

At one point in his presentation, he even referred to fiber as "insignificant." I thought my eyebrows were going to reach the ceiling.

I seriously wonder how he came to this conclusion; a thorough review of the evidence-based research on fiber consumption and its role in decreading cancer risks (particularly colon and prostate ones) clearly demonstrates the important role it plays in overall health.

Once again, this theory can easily be disputed by trying it out yourself.

If you think fiber is irrelevant to your health, go two weeks on a fiber-free diet -- no laxatives allowed! I'm pretty sure you'll soon realize just how crucial fiber is.

By the way, Taubes' infamous 2002 article quickly received a response from the Center for Science in the Public Interest and Washington Post health reporter Sally Squires (I am unable to find her excellent article online -- can anyone help?).

Michael Fumento of Reason magazine also added his two cents at the time.

Gary Taubes fired back a response, which in turn was replied to by Fumento.

I have provided links to all these articles to enable you to read and form your own conclusions.

I would love to hear everyone's thoughts on this.

You Ask, I Answer: Splenda

[I just read your posting on sorbitol and am wondering:] what about Splenda?

I have about a tablespoon (not full) a day with coffee.

Is it just better to have sugar and forget about it?

-- Anonymous
Via the blog

Splenda -- the brand name for sucralose -- was first launched during the peak of the Atkins revival in 2004.

Originally appearing in low-carb sweet treats like granola bars and ice cream, it was launched in supermarkets across the country for at-home beverage sweetening and baking.

So, how safe is it?

Well, on the one hand, the Food & Drug Administration has approved it as a GRAS (generally regarded as safe) food additive.

As I mentioned in a December 2007 posting about fat-replacer Olestra, though, the FDA seal of approval isn't always the most reassuring.

All we know for sure at this point is that Splenda doesn't appear to cause immediate harm.

Since it is a relatively new mass-consumed alternative sweetener, there are no long-term studies indicating what happens if it is consumed every day for 20 years.

There isn't even a study detailing the effects of regular Splenda consumption over a FIVE year period.

Interestingly enough, the Japanese Food Sanitation Council reported that some sucralose is actually absorbed by the body and hones in on the liver and kidneys. Consequently, they theorize that regular intake of Splenda could result in the enlargement of these organs.

My strategy with sucralose is to tread cautiously.

Having three cups of coffee with two packs of Splenda in each day in, day out is not the smartest of choices.

However, having two teaspoons with your morning coffee each day -- and no additional amounts in other foods -- doesn't strike me as particularly alarming.

Keep in mind that obesity rates and ridiculously high sugar intakes in the United States are not coming from people stirring a teaspoon of sugar in their latte every morning.

Rather, they are the result of the cookies, brownies, cakes, pies, flavored lattes, and monstruous ice cream sundaes that are constantly available to us.

Your overall goal should be decrease your sugar consumption to roughly 30 - 40 grams a day (one pack of sugar contains four), not to replace high sugar intake with high artificial sweetener consumption.

Weekend Fun

Cartoons often serve as scathing and witty social commentary.

Here is one I find particularly accurate, illustrating two common marketing techniques.

First, state the obvious as a "new" development (during the Atkins craze, many bottles of olive oil, which is 100% fat, boasted about their absence of carbs -- duh!).

Then, charge four times as much to make the product appear healthier or special.

Most recently, I expressed my disgust at Borba Skinwater.

Speaking With...: Lisa Sasson

Lisa Sasson has been a clinical assistant professor at New York University’s Department of Nutrition, Food Studies, and Public Health for 15 years, and has almost twenty years’ experience counseling clients in New York City with their weight management goals.

She is also co-director of NYU's Food, Nutrition and Culture summer study abroad program in Florence, Italy. It's only appropriate, then, that one of her specialties is The Mediterranean Diet.

Her knowledge of nutrition and outspoken, affable personality led to appearances on Queer Eye for the Straight Guy and A& E as well as a one-on-one nutrition counseling session with supermodel Claudia Schiffer in 2004.

Ms. Sasson is currently Nickelodeon’s nutrition consultant and has been featured in The New York Times, Reader’s Digest, Self, Time, Fitness, and was Allure Magazine’s nutrition makeover coach in 2005 and 2006.

I sat down with Ms. Sasson and picked her brain regarding the latest fad diets. The result was a candid and insightful chat.

Small Bites: How have diet fads evolved over the past few decades?

Lisa Sasson: Nutrition reminds me of fashion. If you wait long enough, a certain diet will be in vogue again.

For instance, when you look back 25 years ago, you see low-carb, high protein diets like Atkins and Scarsdale being advocated. These exact same diets resurfaced in 2003.

Then, in the 90’s, diets were advocating counting grams of fat and eliminating it from your diet. In turn, people ate lots of carbs.

Well, carbs, like all nutrients, have calories. Fat-free does not mean calorie-free.

So, people ate lots of carbs and gained a lot of weight.

SB: What themes do the most recent diet books have in common?

LS: The glycemic index is back, and so is this idea of “good” versus “bad” carbs. Whole grains are also a focus of the newest diet books.

Luckily, fat is becoming a component of most weight loss diets. Instead of calling for its elimination, the current books suggest eating healthy fats like olive oil, salmon, avocados, and nuts, which is a good push.

SB: What’s your take on “good” versus “bad” carbs?

LS: The problem I have with it is that there is no good scientific research demonstrating the importance of the glycemic index and “good” or “bad” carbs. So many factors affect the glycemic index of a food as it is. For example, the glycemic index of a potato varies depending on what you ate before, what you are eating with it, and how you prepare it.

People take it out of context. A lot of these books focus on it because it’s a catch. It makes people think, “Oh! If I eat this I am going to lose weight.” It is a great way to draw someone into believing your book is special.

SB: Which would you say is the best of the current diets?

LS: Walter Willett’s book (Eat, Drink, and Weigh Less: A Flexible and Delicious Way to Shrink Your Waist Without Going Hungry) is one of the better ones.

I liked it because he has a realistic approach. I wish he wasn’t so fixated on whole grains and the glycemic index, but he allows other carbs that may not be whole grains or “good” in the glycemic index to be incorporated.

He also recommends healthy fats, and the meals featured in the book are simple to prepare.

I liked Bob Greene’s book (The Best Life Diet) in the sense that it is done in increments and he goes into the psychological implications behind weight management.

He also stresses the importance of exercise and being more physically active.

You can’t talk about weight loss and not mention being more physically active. Not necessarily lifting weights, but just moving more. That’s the key to a healthy lifestyle.

Exercising allows you to eat more, utilize glucose better, have more muscle mass and lose weight more quickly.

SB: Are there any new diet books you aren’t too fond of?

LS: Yes, The Sonoma Diet! The woman who wrote it, Connie Guttersen, is a registered dietitian. She should be ashamed! Do you know what her first “rule” is? “Throw out anything in your house that has white flour or sugar in it”!

I mean, she takes pride in the fact that her diet mimics the Mediterranean Diet and then has the audacity to say, “Never eat pasta.”

And then she has all these phases, or “waves”, as she refers to them. The first wave is VERY restricted. There is a whole list of foods you can’t have. You can only have certain veggies, certain nuts, and certain grains.

There are also all these recipes that are so complicated. I was leafing through it and thinking, “Is someone really going to get home after a busy day and make these dishes?”

The author also makes some outrageous statements. For example, she says you can’t eat fruit during phase one because of “the carbs”.

That’s ridiculous because fruits are chock full of nutrients and fiber. Besides, they are delicious and sweet. There is absolutely no reason why people should not be allowed to eat fruit.

Should you have limits? Of course. But to restrict a natural food makes no sense. I can’t accept that anything as natural as fruit should be eliminated from a diet.

For someone to say, “I can’t eat an apple, I’m on a diet,” is just laughable.

Oh, and throughout the whole diet you can only have Barilla Plus multigrain pasta, but not regular pasta. What bothers me is that Italians aren’t eating whole grain pasta.

What matters more is what they’re putting on their pasta.

SB: What do you mean?

LS: In Italy, pasta has very little sauce on it. It’s eaten with beans and lots of vegetables, and it’s usually a side dish, not a huge meal. It is not a huge portion.

SB: What would you say to someone who critiques nutritionists as being too objective when analyzing diets? It’s easy to look at the science, but what about the personal experience?

LS: Funny you should ask that. I was looking at all these diets and thought to myself, “What does it feel like to go on these diets?” I wanted to really experience it “from the other side”, so to speak, so I decided to go on South Beach for 2 weeks. I followed it very strictly.

The good thing was that while I was on it, I had very little freedom, so I was not tempted to just pick or snack mindlessly.

So, it was easy in the sense that there wasn’t much choice. I was so hungry that whatever I ate, I enjoyed.

The bad thing is that, while dieting, I continued living my normal life. It was very difficult to exercise during these two weeks. Yoga was particularly taxing.

I was so low on carbs that I was glycogen-deprived, and glycogen is the main source of fuel. I felt light-headed, had terrible headaches, and was very moody.

It was also hard for me to look forward to the social aspect of a meal. The joy and pleasure of food was taken out.

After five days I couldn’t look at another egg because every morning I had one for breakfast. I also found it frustrating that I couldn’t just have a glass of wine with dinner.

SB: So, psychologically, it was difficult.

LS: Yeah, and what I hate about all these diet books is that none acknowledge that losing weight is not always easy.

They talk about how delicious their recipes are and all the variety they offer and how you wake up and get to eat delicious things like ricotta cheese with Sweet and Low and Cocoa powder, which, ugh, I don’t know how anyone can find that tasty. It's disgusting.

And, again, none of these books mention fatigue or boredom. They dismiss it. All they talk about is how you’re going to lose all this weight in two weeks, and how you have so much choice, and how with each phase you can eat more. Please. I wanted to search the index for “headaches” and “moodiness” to make sure I wasn’t going crazy.

SB: What about food shopping?

LS: Oh, God! I would go to the supermarket and put all these artificial food products into my cart. I had diet gellatin, diet popsicles, diet ice cream, and all these products with fifty ingredients.

Diet Jello became my best friend because I would make 2 boxes a day and make it when I was hungry. I would eat eggs, diet Jello, sugar-free pops, sugar free this, sugar free that. Meanwhile, I’m thinking, “This is expensive and I can’t have fresh fruits in my cart!”

SB: What are some common pitfalls dieters make?

LS: Setting unrealistic expectations. Rather than think of this as a change of their lifestyle, people just think of it as “I need to lose 40 pounds by my birthday.”

Healthy eating goes hand in hand with living healthfully. So, apart from eating well, people should exercise and sleep enough. All these things affect your eating habits.

Don’t look at weight loss as “I need to eat more blueberries and less salmon” or some mathematical equation.

Also, learn to listen to your body. It lets you know when you are hungry, full, or satisfied. A lot of times people can’t differentiate between hunger and boredom. You shouldn’t feel stuffed after you eat.

Also, it’s a good idea to eat BEFORE you feel famished. This will reduce your chances of overeating or choosing unhealthy foods to immediately curb hunger.

SB: How should people who want to lose weight prepare themselves psychologically?

LS: First of all, have realistic expectations. Healthy weight loss is approximately 1 pound a week. So, for twenty pounds, you are looking at four to five months.

The key is to think of this as lifestyle changes. You want to lose this weight forever, not just so you can show off your body at the beach and then not worry about it because in the winter you hide under baggy sweaters and jackets.

When you lose weight quickly and go on these ridiculous restricted diets, you slowly start breaking the rules and then ease into your normal eating habits. So, what you need to change is your eating habits, and that’s going to take time.

When you make long term commitment, you will forever have a healthier relationship with food. Weight loss will not be at the forefront, it’s going to be changing the way you eat. Eating healthfully, physical activity.

It doesn’t – and shouldn’t -- mean you can’t have desserts two times a week or pepperoni pizza a few times a month. The idea is that these foods should play less of a role. Healthy eating is not about one meal or one food, it’s about dietary patterns.

People don’t succeed on overly restrictive diets because they focus on specific nutrients instead of changing their lifestyle. People get stuck on eating less of this, more of that, and it becomes difficult to sustain socially, culturally, physically, and emotionally.

SB: Say someone is reading this and wants to start losing weight today. What would you recommend as a good starting point?

LS: The first thing I tell my clients is to get rid of liquid calories. Liquids do not satiate the way food does, so it ultimately leaves room to consume more calories.

Also, these can easily be substituted with lower calorie healthy beverages. So I would begin by replacing sodas, juices, high fat milk, beer, alcoholic beverages, cocktails, and sugary iced teas with flavored sparkling water, diluted juices, unsweetened teas, and low or non-fat milk.

Then, each day try to do more physical movement than what you currently do. It can just be an extra ten minutes of walking every day. Then, two or three weeks later, add ten more minutes. Build it up slowly.

Don’t focus on how little you are doing. Whatever you do -- even if it’s a five minute jog -- is positive.

People just see the long-term goal and lose sight of the small steps in between. They say, “I can’t get to the gym tonight. I might as well eat a whole pizza.” Well, if you can’t go to the gym, walk for 10 or 15 minutes in your neighborhood.

Also, pay attention to what you feel when you eat. Before you put something in your mouth, ask yourself, “am I hungry? Or bored?” Rate your hunger. When you feel satisfied, try to stop.

Don’t buy things that make you feel vulnerable. If potato chips are irresistible, don’t have them in your house. If you have to buy them for other family members, put them somewhere out of your way so you have some time to think before reaching for them.

Focus on fresh fruits and vegetables. Don’t get hung up on this fruit, this vegetable. If you eat close to nature, if you are eating less processed food, you are already doing a really good job. Don’t think about eliminating plums and then eating watermelon only after the third week. Fruit is healthy!

SB: How can people spot a well-rounded “diet” book versus one that is unrealistic to follow?

LS: I don’t like books that tell you, “throw out everything that has white flour or sugar! Don’t eat these foods for six weeks!” It’s so ridiculous. Telling someone to ban 30 different foods does not mean they will stick to it or lose weight.

Also, these super strict rules are unnecessary. You don’t have to subsist on whole grain pasta or brown rice to lose weight. It’s OK to eat normal pasta as long as it is cooked healthily and you aren’t having three cups of it for dinner.

If you don’t like whole grain pasta, it’s OK. It’s not the magic weight loss solution. If you’re drowing your pasta in alfredo sauce, it doesn’t matter if it’s whole grain or not.

I like books that talk about making healthy changes rather than eliminate foods.

I like books that aren’t about just seeing the top of the mountain, but rather about the steps you need to take to get there. Looking at that tall mountain can seem overwhelming and defeating. People should be encouraged to concentrate on small, continuous steps. That’s a much healthier, more realistic approach.

I also think a good plan incorporates cultural sensitivity. Not everyone drinks milk, so to tell people to get calcium from dairy, that’s very shallow. Some cultures don’t drink milk and their calcium intake is just fine.

Thanks again to Lisa Sasson for a fun and thorough interview!

Over the next few weeks, Ms. Sasson will be analyzing some of today's hottest diets. Come back to find out which ones make the honor roll and which make the hall of shame.