UPDATED INFORMATION ON DIETS: NO NEED FOR FADS

Researchers analyzed nutrition studies in a new review published in the Journal of the American College of Cardiology, which intends to cut through the confusion about the best dietary patterns to reduce cardiovascular disease, our greatest killer. The review concludes that current evidence strongly supports eating plenty of fruits, vegetables, whole grains, legumes, and nuts in moderation. Although more controversial, some heart–healthy diets may also include very limited quantities of lean meat, fish, low–fat and nonfat dairy products, and liquid vegetable oils.

The review examined several of these dietary patterns as well as “hypes and controversies” surrounding nutrition to provide the population with information about dietary habits.

Their advice: “There is a growing consensus that a predominantly plant–based diet that emphasizes green, leafy vegetables, whole grains, legumes and fruit is where the best improvements are seen in heart health.”

Other nutrition topics covered in the review include:

  • Eggs and cholesterol. Although a government report issued in 2015 dropped specific recommendations about upper limits for cholesterol consumption, the review concludes, “it remains prudent to significantly limit intake of dietary cholesterol in the form of eggs or any high cholesterol foods.”
  • Vegetable oils. Coconut oil and palm oil should be discouraged due to limited data supporting routine use. The most heart–healthy oil is olive oil, though perhaps in moderation as it is still higher calorie, research suggests.
  • Berries and antioxidant supplementation. Fruits and vegetables are the healthiest and most beneficial source of antioxidants to reduce heart disease risk. There is no evidence to support adding high–dose antioxidant dietary supplements benefits cardiovascular health.
  • Nuts. Nuts can be part of a heart–healthy diet. But beware of consuming too many, because nuts are high in calories.
  • Juicing. While the fruits and vegetables contained in juices are heart–healthy, the process of juicing concentrates calories, which makes it is much easier to ingest too many. Eating whole fruits and vegetables is preferred, with juicing primarily reserved for situations when daily intake of vegetables and fruits is inadequate. If you do juice, minimize calories by avoiding adding extra sugar or honey.
  • Gluten. People who have celiac disease or other gluten sensitivity (about 1% of the population) must avoid gluten—wheat, barley and rye. For patients who don’t have any gluten sensitivities, many of the claims for health benefits of a gluten–free diet are unsubstantiated and are best ignored .
  • The authors also addressed why there can be confusion surrounding nutrition studies. Unfortunately, many of these studies are funded and/or influenced by the food industry and likely have some bias, or are totally inaccurate.

Confounding the issue further, it’s very hard to separate the effects of specific nutrients in a food. For example, an apple contains many components including proteins, vitamins and fiber..

Many people who eat a healthy diet also have other healthy lifestyle behaviors, such as regular physical activity, getting enough sleep, and not smoking, and it can be hard to pinpoint the diet’s effect separate from these other behaviors. Moreover, some nutrition studies tend to be based on surveys that rely on people’s memories of what they ate, which isn’t always reliable.

The founder of modern medicine, Hippocrates, said, “Let food be thy medicine.” If we can get the population to understand the value of nutrition, they could enjoy a greater reduction of cardiovascular and other diseases, and that is certainly more cost–effective than treating diseases before they are causing symptoms or signs.

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DIETING: DON’T FORGET HUNGER

hunger

Throughout the evolution of all species, including humans, food intake has been governed primarily by the sensation of hunger. This may explain why obesity is seldom encountered in animals. Although records are obviously limited prior to the dawn of civilization, human obesity is likely also to have been rare. Thus it is likely that, when guided by the primordial sense of hunger, all bodies will likely respond with the attainment of a normal food intake and weight. Also, when combined with a large requirement of physical work through antiquity, humans were destined to keep food intake and caloric consumption in a delicate and proper balance.

For at least the past century, our dietary intake has been largely decoupled from hunger for a variety of reasons. We often adhere to regular “eating hours” such as noon for lunch, meals are often centered on social functions rather than hunger, snack foods are easily available when sitting to watch TV, with the addition of a “yummy” dessert, we often exceed eating requirements beyond the point of satiation, and the list goes on and on. Compounding this problem further, requirements for physical effort have been greatly reduced for obvious reasons.

So what am I trying to say? If our food intake were governed solely by hunger and limited by satiation, a large component of weight control would be in place, and any diet strategy would be more apt to succeed if this principle were observed.

This hypothesis has been recently tested by experimental data appearing in a 2016 study in the American Society for Nutrition entitled “Intuitive Eating Dimensions Were Differently Associated with Food Intake in the General Population.” The study compared the so-called “intuitive eating, i.e., eating in response to physiological hunger and satiety cues rather than emotional cues, termed “unconditional permission to eat”. Prior evidence had supported the idea that such intuitive eating was associated with lower body weights, but little was known about its association with food intake per se.

The study noted above included a total of 9581 men and 31,955 women aged ≥18 years. Eating patterns were assessed by using a validated version of a detailed intuitive eating scale derived from dietary records over a six year period. The associations were compared between intuitive eating and unconditional permission to eat, and food intakes were assessed by statistical analysis.

Results from this study were quite illuminating: In women, higher physical reasons scores were associated with lower caloric intakes. Also, a higher physical reasons score was associated with lower sweet- and fatty-food intake in both women and men, as well as lower intakes of dairy products, meat, fish, and eggs, and a higher whole-grain intake in women. In contrast, higher intuitive eating scores were generally associated with a higher caloric intake that contained lower fruit, vegetable, and whole-grain intakes.

The conclusion of the study: Physical hunger is associated with healthier dietary patterns with better weight control, whereas the so-called “unconditional permission to eat”, was associated with unhealthier diets. From a public health perspective, these findings suggest that we all should be eating primarily in response to hunger and satiety signals rather than the myriad of emotional/social signals. What remains to be proved, however, is, whether those individuals already controlled by emotional factors can be converted to a dominant pattern of food consumption in response to hunger

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RAPIDITY OF WEIGHT LOSS AND LONG TERM SUCCESS: ANOTHER MYTH DESTROYED?

Conventional wisdom dictates that gradual weight reduction for the treatment of obesity is more apt to be sustained in the long run when compared with rapid weight loss through “crash diets” of any type.  I had always subscribed to this former notion until it was subjected to objective research—invariably a good idea that often debunks so-called “common sense.”

The following study to which I refer should form the basis of future research for confirmation; that’s how science works.

The study was entitled “The effect of rate of weight loss on long-term weight management: a randomised controlled trial,” which appeared in the journal Lancet Diabetes & Endocrinology, 2014.

The study was a two-phase randomized trial in a Melbourne (Australia) metropolitan hospital.  It included 204 volunteers (51 men and 153 women) aged 18—70 years, who were quite obese (body mass index between 30 and 45 kg/m2). During phase 1, they randomly assigned the subjects to enter a 12-week rapid weight loss program, or a 36-week gradual program, both aimed at a 15% weight loss. Those participants who lost 12·5% or more of their body weight during phase 1 went on a weight maintenance diet for 144 weeks (phase 2). The primary outcome was the residual weights of both groups at the end of the study (week 144).

Of the 200 participants, half were randomly assigned to the gradual weight loss group and the remaining half, the rapid weight loss group, After phase 1, 50% of the participants in the gradual weight loss group, and 81% in the rapid weight loss group achieved 12·5% or more weight loss in their allocated times, and these latter participants who had lost this weight then entered into phase 2.  At the end of this latter phase, although both gradual weight loss and rapid weight loss participants had regained most of their lost weight, there was no significant difference between the two groups (gradual weight loss regained 71·2% of their lost weight, versus rapid weight loss, 70·5%).

From these data the authors concluded “The rate of weight loss does not affect the proportion of weight regained within 144 weeks. These findings are not consistent with present dietary guidelines which recommend gradual over rapid weight loss, based on the belief that rapid weight loss is more quickly regained.”

But their conclusion, while correct, requires some qualification. First, a greater proportion of individuals in the rapid weight loss program achieved an initial significant weight reduction (-12.5%), as opposed to those in the gradual category. Second, most of the initial weight reduction was regained at the later—longer—interval in both groups. This finding is consistent with our long-held belief that those who are obese have great difficultly maintaining a satisfactory weight in the long run—no matter how they initially reduce. This, unfortunately, is the sad truth!

My conclusion is that, even though the odds for long-term success are stacked against those who are obese, they should initially try to get the weight off as promptly as possible through any possible safe program. Then work like a demon to keep it off  afterwards through whatever means one can conjure up, but—let’s face it—basic and permanent lifestyle changes will also be necessary. Personally, I have yet to find the “holy grail” for sustaining an ideal low weight in the long-term. Judging from the vast numbers of recommendations out there in the media, ads, the cyber world, etc, I don’t believe anyone else has come up with the answer either to this troubling enigma—notwithstanding all those blatant claims out there!

 

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