Health Implications of Chronic Sugar Consumption Among Endurance Athletes

In endurance sports, sugar-based nutrition products reign supreme. Take a look at the ingredients of any sports drink, gel, or energy bar on the market. The chance it contains sugar as a primary ingredient is pretty high. 

It's because of demand, right?

Possibly. 

Conventional approaches to sports nutrition do revolve around high consumption of carbohydrate, and simple sugars, especially immediately before, during and after hard training sessions and racing. Just the other day, for example, I had breakfast with a fellow triathlete and coach, whose plate was filled with pancakes slathered in maple syrup. He took down the entire thing.

From a purely performance standpoint, there is some evidence supporting a predominantly carbohydrate diet/fueling strategy, particularly at higher intensities. But, more and more research on lipolysis and "fat adaptation" among endurance athletes is showing simple sugars and carbohydrates shouldn't be the primary fuel source, it should be fat. 

Research continues to also pour in showing the long term health implications of chronic sugar consumption. The basic point is this: consuming lots of sugar accelerates the aging process, possibly just as much as smoking. (For example, read this article.)

But, back to endurance athletes. There isn't a ton of research available specifically on this population, but a few studies have emerged. One from earlier this year, I think, is indicative of the caution we, in the endurance sports community, should be taking with an over reliance on sugar-based nutrition.  

The study compared 35 triathletes with 35 non-exercising control individuals. It found an increased risk of dental erosion among triathletes, and a significant correlation between dental caries and cumulative weekly training volume. Basically, a higher prevalence of dental caries was seen among triathletes with higher training loads, presumably due to the larger amounts of mostly sugar-based exogenous fuel sources.

In trying to limit simple sugar consumption during training and racing I take three basic approaches:

1. Don't carry fuel for 90-95% of my workouts. Because I've adapted my metabolism over time to better tap into fat stores, I can easily go for a 2 hour run or a 3 hour bike ride with just water and be perfectly fine. Daily nutrition influences performance.

2.  If I'm in need of a clean fuel source, like during a marathon, I use UCAN Superstarch. It's been my go-to for almost two years, and I don't plan on changing that any time soon.

3. When possible, though, I'm a fan of using whole food sources of nutrition. This is what I did earlier this year during a 16-hour, 300k bike ride through northern New Jersey. I carried plastic bags filled with coconut flakes, coconut oil, almonds, cashews and flax seed crackers. More resources, like the Feed Zone Portables Cookbook, are available to make this approach easier too. I'm looking forward to experimenting more with this in the coming year.

New Paleo, Low-Carb & Health Blogs

I always love finding new resources. Thanks to Jimmy Moore for his great work compiling new blogs in health, low-carb and Paleo.

Here's his list of "46 New Paleo, Low-Carb & Health Blogs for November 2013" -- stoked to be included as #6 on this list!

So, as you take a few days off from work, kick your feet up on the couch and eat Thanksgiving left-overs, take a look at some of these resources.

What's wrong with the conventional wisdom on cholesterol and how it could actually be harming us

I just finished reading health blogger and podcaster, Jimmy Moore's, new book called Cholesterol Clarity: What the HDL is Wrong with My Numbers. For those interested in diving deeper into one of nutrition's most misconstrued and contentious issues, or simply want the "straight dope on cholesterol" (borrowing from the name of Peter Attia's unparalleled blog series on the issue, which I HIGHLY recommend), this is a must read book. Not only does it provide some of the latest research and thinking on the topic through a series of interviews with 28 leading experts in the field, but Moore packages the information in an accessible way for the widest possible audience, whether you're a lipid researcher or someone who just wants to stay healthy.

So, let's dive into some the main issues in the book and some of my key takeaways. 


Cholesterol is actually a good thing that plays an irreplaceable role in the body. Bottom line: if you don't have cholesterol, you die. Morbid, but true. Here are a few essential things it does or supports in the body:

• Hormone production, including estrogen, progesterone, testosterone, pregnenolone, adrenaline, cortisol, and DHEA
• The health and efficiency of cell membranes
• Nervous tissue, including the white matter in your brain
• Optimal adrenal gland function, which modulate a number of different vital hormones like adrenaline as well as kidney function
• Water and electrolyte balance
• Formation of Vitamin D
• Immune function

By far, one of the most important things influenced by cholesterol is something called coenzyme Q10, or CoQ10. Some, like Nora Gedgaudas, the author of Primal Body, Primal Mind, have called CoQ10 the "single most important nutrient for the functioning of the heart."

When cholesterol is too low, bad things can happen. Based on the important functions listed above, you can probably guess some of the negative things that can happen in the body when cholesterol is too low. For example, cholesterol actually plays a very important role in tissue repair, specifically with stem cell production. As a result, blood vessels can become stiffer - not a good combination with small, dense LDL particles. Research has also shown a close link between low cholesterol and a higher risk of infection, cancer, and a variety of mental side effects, such as depression and a higher likelihood of suicidal behavior.

In fact, research has documented that people with the lowest cholesterol levels actually had the highest rate of death from coronary heart disease and demonstrate a greater risk for some cancers. In addition, this study actually found that almost half of patients hospitalized for heart disease (80% experiencing acute symptoms), had LDL cholesterol levels less than 100 mg/dL, which is the current recommended level by the American Heart Association. As Moore argues, LDL cholesterol (and total cholesterol) are bad predictors of heart disease risk.

Dietary cholesterol doesn't really impact your numbers. The amount of cholesterol from food makes up only about 15-30 percent of your body's total cholesterol. In fact, the overwhelming majority of cholesterol our bodies use - up to 2 grams every day - is actually produced within the body itself, mostly in the liver. Cholesterol is tightly regulated by the body and as Dr. Chris Masterjohn explains in Cholesterol Clarity, "if we eat a lot of cholesterol, our bodies make less of it; if we eat less cholesterol, our bodies make more of it. In most people, the majority of cholesterol that is circulating in the blood is made by their own bodies."

All LDL isn't "bad cholesterol." There are actually two kinds, or patterns, of LDL cholesterol. Pattern A is large and fluffy, regarded by experts as generally harmless. Pattern B, on the other hand, are potentially more dangerous since they are small and dense. Many will say that this measure of particle size and number, or LDL-P, is a much better way of determining risk, than the traditional LDL-C measure that shows up on a standard lipid panel (which is actually a calculated number, not one that's directly measured - more in the next section on this).

Thankfully, there are more and more options available to test for this. One such test is called the NMR LipoProfile test made by the relatively new diagnostic testing company in North Carolina, LipoScience. The test uses NMR technology (which stands for nuclear magnetic resonance and is regarded as one of the best technologies on the market) to actually measure the number of LDL particles in a blood sample.

Of course, certain dietary choices can influence the ratio of Pattern A and Pattern B LDL in the blood, which Moore also flags as quite concerning. He particularly focuses in on the relatively recent trends towards promoting polyunsaturated fats, mostly in the form of vegetable oils (things like canola oil, soybean oil, etc). It is true that there is a fair bit of research showing the effectiveness of polyunsaturated fats (PUFAs) at lowering LDL in the blood. The problem is that PUFAs help achieve this reduction in LDL primarily through decreasing the number of good Pattern A LDL particles, leaving mostly Pattern B. You can see how this can be extremely concerning for heart disease and atherosclerosis risk. One of the best ways to increase the number of good Pattern A particles and decrease the number of Pattern B particles is by eating quality saturated fats from things like coconut, and grass-fed beef and butter.

LDL is actually a calculated number on your standard lipid panel. If there is one number from the standard lipid panel that doctors focus on, along with total cholesterol, it's LDL. The entire statin-prescribing system, argues Moore, has been built upon artificially defining a certain threshold for LDL and total cholesterol (which isn't really rooted in any solid evidence as mentioned above) and teaching physicians (very well) to automatically prescribe the drug once your numbers exceed these thresholds. Usually any conversation about diet is secondary or nonexistent. This is essentially how Lipitor and other statin drugs have become some of the most commonly prescribed medication on Earth.

Among some alternatives, like testing for LDL particle size and number, there is also pretty strong consensus that your ratio of HDL cholesterol to triglycerides is a better gauge of current heart health. Both numbers are on the standard lipid panel, which makes them a bit more accessible. The easiest prescription to maximize HDL while minimizing triglycerides is by avoiding carbohydrates and eating more fats.

Keeping total cholesterol low, as guidelines recommend, is 100% counter-intuitive. The prevailing guidelines by a variety of public health authorities focus exclusively on total cholesterol and LDL, and specifically keeping these two numbers low. In the case of total cholesterol, guidelines suggest this number should be kept under 200. But the irony of all of this is that if you're trying to keep total cholesterol low, you're assuming all components that make up the total should be kept to a minimum.

Most people know this is hardly the case. As I mentioned, having a lot of large, fluffy Pattern A LDL particles is not nearly as harmful as having a lot of Pattern B. Also, when it comes to HDL cholesterol, or the so-called "good" kind, every leading health authority suggests we need to keep this number as high as possible. This seems like a big contradiction to say keep some cholesterol particles, like HDL, high, while applying an arbitrary cap to total cholesterol.

Statins do a lot more harm than good. Though statins do lower LDL cholesterol (which I hope I've already convinced you is not necessarily a good thing), here are a few examples of the documented negative consequences of taking statins:

• This 2013 article found a 21% increased risk of death among women with breast cancer who took statins compared to those who didn't. Other studies have documented the link between statin use and musculoskeletal diseases and joint pain.
• Compared to people who did not use statins, statin users had had a 50% increased risk for any musculoskeletal pain, a 59% increased risk for lower back pain, and a 50% increased risk for lower extremity pain.
• This review article documents the ample evidence showing increased risk of cardiovascular disease in women among statin users, including a three-fold increase in risk of coronary artery and aortic artery calcification.
• Statin use has been shown to hinder the positive effects of exercise among overweight and obese individuals. 

It's all about inflammation. If there is one thing to worry about instead of cholesterol, Moore argues, we should be much more concerned about inflammation in the body and the things that cause it. This is the true cause of atherosclerosis. In his words, "without inflammation, cholesterol can't harm you." It's really all about cholesterol oxidation, which is nearly a two-fold better predictor of heart disease risk than simply looking at cholesterol alone. So, we should be focusing more on things that cause chronic inflammation in the body, which results from poor diet, smoking, lack of sleep, infrequent exercise, elevated stress, and a compromised gut, just to name a few that Moore references. One of the best blood markers for determining the amount of chronic inflammation in the body is something called high-sensitivity C-reactive protein, or hs-CRP. Many experts have argued that hs-CRP is a much better biomarker to track because it's a much better predictor of heart disease and health complications than total cholesterol or LDL.  

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This book is definitely for everyone. I thoroughly enjoyed the balance struck between offering practical guidance while underpinning it all with sound science. If you're trying to cut through all the noise out there on cholesterol or you're interested in tracking your own health and wellness, this is definitely worth the read. My only critique - but this is coming from a researcher who loves evidence - is the lack of citations in the book. Moore does provide some suggested references for additional reading, but I personally could've really benefited from the book to a greater degree with citations, particularly for many of the chapters discussing the science.

Nonetheless, I highly recommend taking a look at this book. It'll definitely challenge (and maybe even change) the way you think about cholesterol.

Note: I was not compensated in anyway for writing this posting. Views are my own.

How to cycle carb intake to improve performance

Over the past couple years I've slowly adapted my body to become more efficient at burning fat as a primary fuel source. This has meant that carbohydrates have become a smaller and smaller part of my overall diet. But, that's not to say there isn't a time and place for strategic carb intake, especially to improve performance. So instead of relying on carbohydrates as my body's primary fuel source on a daily basis, I cycle carbohydrate intake around certain times of the day and certain times of the week depending on when I really need them.

Here are the three basic rules I follow:

Limit overall carbohydrate intake on easy days.
Monday is generally a recovery day for me with some foam rolling in the AM, some more in the PM, and usually a 30 minute yoga session in the evening. Because this is my least active day of the week, carbohydrate intake is also at its lowest. As a general rule of thumb, the more aerobic the workouts, the greater proportion of my daily calories come from fat and protein.

Plan carbohydrate intake around hard workouts, especially fasted workouts.
Hard sessions, particularly hard and longer sessions, when I'm really tapping into glycogen as a fuel source, recovery is key. This is especially the case if I'm planning another session that day or even the next day. There's been a bit of research looking at the optimal timing and ratio of macro-nutrient intake post-exercise, and many researchers and trainers will say a carbohydrate to protein ratio of about 3:1 consumed anywhere between 20 minutes to 60 minutes post-workout. I don't measure anything out, count calories, or really track much, but after a long-hard session I'll make I'm eating a good balance of fat, carbs, and protein from all quality whole food sources. Post-exercise nutrition is a lot more important for fasted workouts since almost all of the research to date has been on subjects in a fasted state.

Gradually increase carbohydrate over the course of the week leading up to a race.
The week of a race is when I most often step up the carbohydrate intake -- gradually. As mentioned in the first point, I'll start the week relatively low-carb. Then, as the week progresses, I'll slightly increase carbohydrate intake, usually starting around Wednesday. These usually aren't huge changes: adding a banana to my lunch, a small sweet potato to dinner, or a handful of oats for breakfast. The biggest benefit to this approach is if you're anticipating tapping into a fair bit of glycogen as a fuel source during the race (for example with a shorter olympic distance triathlon, which is at a much higher intensity). In training your body was so used to running on a small amount of carbohydrates that when there's a larger than "normal" influx, there's almost a sensation of increased energy at higher intensities (similar to something like an athlete training at altitude and coming back to sea-level but certainly a lot less pronounced).

Now, what kinds of carbohydrates do I tend to use? Here's a list of a few of my favorites:

1. Sweet potatoes - packed with anti-inflammatory properties and antioxidants, these have quickly become my go-to for pre-race carbohydrates. Add some grass-fed butter and quality sea salt and you're good to go!

2. Quinoa - actually a seed rather than a grain, quinoa is really growing in popularity in health and nutrition circles. Why? In addition to it being a fairly slow release carbohydrate, it contains 14-15 gram of protein per 100 grams and has all nine essential amino acids. (The 20 amino acids are the building blocks of protein and essential amino acids are those that cannot be made naturally by your body.) The major issue before eating, however, is to make sure they are soaked and sprouted to remove the harmful saponins.

3. Nuts - these are one of my daily staples and I will usually have a handful with lunch, especially walnuts, almonds, cashews, or Brazil nuts. Though a great carbohydrate, protein, and fat source, a word of caution to not consume too many, since nuts do also contain decent amounts of pro-inflammatory omega-6 fatty acids along with the beneficial omega-3 fatty acids.

4. Squash - this is an absolute go-to during the fall and winter when squash is in-season. For those who stay away from gluten, like myself, spaghetti squash is a fantastic substitute.

5. Bananas - an endurance athlete's best friend. A single banana can really go a long way for pre- and post-workout fueling. It's simple and easily digested. For longer workouts on the weekend, I might have half before and half afterwards. You really don't need much.

So, give these strategies a try and let me know what you think.

Now Available on Google: Searchable Nutritional Data

Want to know how much sugar is in an apple; or how much potassium is in a banana; or the amount of saturated fat in coconut?

Well, Google has made the answers to those questions much more accessible.

A couple weeks ago Google announced it would make all kinds of nutritional information searchable. Typing in the search command "how much fat is in coconut milk" brings up your standard nutrition facts panel, much like the nutrition fact labels on products you see in the grocery store. Specific data includes calories, fat (saturated, polyunsaturated, and monounsaturated), cholesterol, sodium potassium, total carbohydrates (fiber and sugar), protein, and vitamins and minerals.

The function primarily pulls data from a database maintained by the U.S. Department of Agriculture and looks like this:

 

While this function is certainly helpful in providing a quick glimpse of basic nutrition data for general foods, it does lack a bit of detail. You are able to distinguish between whole milk and skim, but you can't look at the labels for specific brands. Or if you search for nutritional facts on "crackers," there isn't the capacity to look at data for all the various kinds, such as those that primarily use seeds instead of flour.

Though nutrition facts tell part of the story about food, it doesn't tell the whole thing (and in my opinion, not even the most important part). The most important part of the nutrition facts on a product isn't how many calories or grams of sugar, but the INGREDIENTS. The ingredients list can generally tell you everything you need to know and alert you to any red flags for things that can impact your health (for example, things like hydrogenated oils).

Regardless of its limitations, the function is a great example of the power of big/open data to help inform consumers. The extent to which consumers are actually able to understand and use this data is another story, but kudos to Google for making it available. I'm looking forward to seeing how the function evolves and if additional information is added in the future.

"Food: Transforming the American Table"

Last weekend I was at the National Museum of American History where I toured the new exhibition  "FOOD: Transforming the American Table 1950-2000," which attempts to depict some of the major changes in food production, preparation, and consumption in the United States over the past half century.

The exhibit's website explains that "the public will be invited to take a seat at a large, communal table in the center of the exhibition to share their own thoughts and experiences about food and change in America." The irony, of course, is that the exhibit portrays all the reasons why a communal table isn't necessarily the best symbol for American meals anymore.

But as I strolled through the exhibit, two things really struck me. First, I was curious as to why the focus was only on 1950-2000. This was certainly a period of rapid change within the American food system and particularly with consumer preferences, but I couldn't help but get the sense that the exhibit was trying to convey this transformation as inevitable. Basically that "as a growing, industrialized country, the natural progression (i.e. transformation as the exhibit title says) is towards a system of abundance, convenience, and processed food."

The framing reminded me of a 2011 TED talk by Mehmood Khan, the chief executive officer of PepsiCo's Global Nutrition Group and it's chief scientific officer. His basic argument is that to feed a growing global population, we need food processing. I found it quite a coincidence that when I left the exhibit and took a look at the sign recognizing its primary sponsors, the Land o'Lakes Foundation was listed right there at the top.

I was recently in a media workshop where the facilitator made the important point to distinguish between the facts and the truth. I won't argue with the facts that were presented in the exhibit, but it's important to remember how they are presented.

Which leads me to my second point (and related to twisting the facts). The exhibit was full of fascinating food marketing and advertising.

Consider these two LIFE magazine covers from 1955 and 1962. What I find most interesting is the second of these two covers that prominently features fresh fruit and vegetables with the title "Bounty of Food." The irony of this, of course, is that though we'd certainly characterize the American food system as plentiful, there isn't necessarily a bounty of nutritious foods, like fruits and vegetables. Instead, and in part due to subsidies that incentive production of crops like corn, wheat, and soy, we see a bounty of processed food very different than what's depicted on the cover.

And here's an example of an advertisement for diet soda. It's fascinating to see how current advertising around diet and low calorie soda hasn't really changed all that much. Sure it may only have a few calories, but many diet sodas contain ingredients that really fly under the radar with consumers, including the artificial sweetener aspartame. Aspartame has been shown to cause migraines and a variety of other effects on health. This, of course, often goes unnoticed with a sole focus on calories.

This final picture I found fascinating and mostly because I'm currently in the middle of Waterlogged by Tim Noakes, which really debunks many of the common beliefs and assumptions of hydration. One of his main conclusions (which I won't talk about too much - the subject of a future blog post) is that dehydration isn't actually a bad thing if you're talking about endurance performance. Specifically, there have been countless studies showing a close relationship between change in body weight (i.e. level of dehydration through water loss) and performance. Those who had the highest percent change in body weight were those who performed best. Unfortunately, we've seen companies that produce sports drinks do a very good job of convincing us otherwise.

Overall, I was glad to see the museum take on the issue of food in the United States. Our food system has changed quite dramatically and over a relatively short period of time, and I thoroughly enjoyed how some of these changes were presented. There are some interesting pieces related to local food movements, in particular, that were certainly worth taking a look at. Oh, and if you're a fan of Julia Child, her kitchen that is on display is a big hit.

So, if you're around the National Mall anytime soon, I certainly recommend making a stop in to tour the exhibit.

Is that really tuna you're eating? The unfortunate reality of seafood fraud

The importance of consuming fish has become a fairly common part of nutritional advice. There are certainly a variety of well-known health benefits to eating fish, particularly cold-water fish that contain a strong omega-3 fatty acid profile. In my February Reading Roundup I linked to a major study just published in the prestigious New England Journal of Medicine that showed the benefits of eating a Mediterranean diet, which according to the study protocol, included a recommended three or more servings of fish (preferably fatty) a week.

But, before you go and buy just any piece of fish, make sure it's really what the label says it is.

A few weeks ago there was a new study released that generated quite a bit of buzz in the media; the focus - fraud in the seafood market. The study, conducted by a company called Oceana, used DNA analysis to answer the basic question: is the seafood we buy at the grocery store or sushi restaurant really the type of fish that's being marketed?

Over three years (2010 to 2012) Oceana staff and volunteers involved in the study purchased some 1,200 seafood samples from 675 retail outlets in major cities in 21 states in the United States. The specific retail outlets they looked at were restaurants, sushi venues, grocery stores and seafood markets, and used the well-known websites Zagat and Yelp to identify retail outlets. Those involved with the study focused particularly on a select group of fish species that had been found to be mislabeled in other studies or had some regional significance.

The genetic identify was found in 97 percent of all samples tested, which consisted of 46 different types of fish, with more than 80 percent consisting of various types of salmon, snapper, cod, tuna, sole, halibut and grouper.

Here's what they found.

Snapper was the most commonly mislabeled type of fish, followed by tuna and cod. Salmon, which was the most sampled type of fish, was also found to be correctly labeled the most. Also, seabass was never found to be correctly labeled, and yellowtail was only found correctly labeled three times (compared to mislabeled 24 times).

My wife and I love sushi, but this next graph certainly gave me reason to pause. Almost three-quarters of all fish sampled at sushi restaurants was found to be mislabeled! On a more positive note, the majority of fish samples were taken from fish in grocery stores, but they were also found to have the lowest percentage of mislabeled fish.

More than half of all fish sampled in Pennsylvania and southern California were found to be mislabeled. That's pretty staggering. Even more so, there were nine additional cities where 25% of fish samples were found to be mislabeled (even including my hometown of Washington, DC).

Salmon is a huge part of my diet (along with a lot of other people being one of the most commonly consumed fish in the U.S.), so I was particularly interested in this next graph looking specifically at mislabeled salmon. One specifies in particular to note is wild salmon, which was found to be mislabeled a number of times as Atlantic salmon. A similar mislabeling was found for king salmon.

What is the bottom line here? Is it that we should stay away from sushi restaurants or not eat as much fish? Don't count on me being one of those people. I think the real value of this study is to reinforce a point I continue to try and make through this blog: pay attention to where your food comes from and the quality of the food we eat really matters. I'll still continue to have the occasional sushi meal, but I certainly make sure I'm going to a reputable restaurant that I know sells a quality product. Ditto with the grocery store. 

So, I'll leave you with this...continue to ask questions and investigate where your food comes from. It matters. Because in the end, that piece of tuna you're eating, may not be tuna.

"Pink" 5-hour ENERGY Drink: Inherent contradiction to public health?

 Some facts on energy drinks...

• Energy drinks are consumed by an estimated 30% to 50% of adolescents and young adults, but some experts suggest this number is even higher.
• A recent review of the health effects of energy drinks on children, adolescents, and young adults concludes, "for most children, adolescents, and young adults, safe levels of consumption have not been established."
• Energy drinks are not regulated by the U.S. Food and Drug Administration because they are marketed as nutritional or dietary supplements (see the bottom left of any 5-hour Energy bottle).
• According to a recent New York Times investigation, 13 deaths over the last four years have cited the possible involvement of 5-Hour Energy.

 

Behind non-melanoma skin cancer, breast cancer is the leading cause of death among women in the U.S. Breast cancer is also the most common cancer among women worldwide. In this regard, I am all for raising awareness about breast cancer. I also recognize the very specific role caffeine can play in exercise performance (this is of course within limits). 

With this all in mind, is this a fundamental contradiction to public health?

Challenging Nutrition Dogma: Is it really all about calories?

Along with cholesterol, there may not be a more misunderstood nutrition concept than fat. Is it bad? Is it good? What kinds are good? What's the difference between triglycerides and fatty acids? Why do I hear so much about omega-3s? Why do people say saturated fat is bad?

I recently finished reading Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health, by science writer Gary Taubes. More so than many other nutrition books out there, Good Calories, Bad Calories puts into perspective current nutritional guidance with what the evidence shows - and I mean all the evidence. The book is several years old (published in 2007), and Taubes has since written another book on similar issues called Why We Get Fat (which is much more accessible for the less technical audience), but for anyone truly interested in nutrition, food policy, and health, this is a must-read.

Coming from a science writer, I expected a fairly thorough presentation of the research. At the same time, though, journalists and the media don't necessarily have the best record when it comes to accurately and objectively writing about health and medical studies (but that's an issue for another article). But, taking one look at the 44 pages of notes and the book's 66-page bibliography, there's an immediate appreciation for the full picture Taubes attempts to paint.
 
The essential thesis of the book is that "obesity is caused by a defect in the regulation of fat metabolism." In other words, "obesity is a disorder of fat accumulation NOT a disorder of overeating."

To better understand what this exactly means, lets consider several important points.

First, Taubes argues that energy expenditure and energy intake are independent variables. This essentially turns the classic "calories in/calories out" paradigm on its head, which assumes energy intake and expenditure are dependent. In the classic "caloric balance" model, the assumption is that energy change (or fat accumulation), and therefore obesity, is the result of (or dependent upon) overeating (energy intake) or physical inactivity (energy expenditure). 

Taking a little detour back to physics, energy is neither created nor destroyed. So, the change in energy (or change in fat mass) is the difference in energy consumed and energy expended. But, this equation says nothing of causality. Is fat accumulation caused by increased food intake, or does increased fat accumulation cause increased food intake?

This is a good time to introduce a major piece to this entire puzzle -- hormones. In the book, Taubes gives a very illustrative example about why hormones play such an important role in fat metabolism. Think about growing children. The energy balance is obviously positive, which is why children grow. But, children aren't growing more because they eat more. Instead, the causality is reversed, and children eat more because they are growing. "They require the excess calories to satisfy the requirements of growth; the result is positive energy balance. The growth is induced by hormones and, in particular, growth hormone."

One could think of a similar example with pregnant women. Weight gain during pregnancy is the result of hormonal changes. "This hormonal drive induces hunger and lethargy as a result. In the context of evolution, these expanded fat stores would assure the availability of the necessary calories to nurse the infants after birth and assure the viability of the offspring." In essence, fat metabolism, including the distribution of fat, is a hormonal issue. And its these hormonal changes that influence energy consumption.

In terms of fat metabolism, there may not be a more important hormone than insulin. Insulin is produced in the pancreas, and is said to be the "principal regulator of fat metabolism," which has been known since the 1960's. How does it work? Essentially, if fatty acids are to be mobilized from inside fat cells (and burned as fuel), insulin levels must be low (Quick distinction on terminology: fat is stored as triglycerides - the reason being triglycerides are three fatty acid molecules held together with a glycerol making it too big to cross the cell membrane. Fatty acids are burned as fuel. Fat enters/exits the cell as fatty acids, a smaller molecule). Conversely, when insulin levels are high, fatty acids are shuttled into fat cells and stored rather than burned as fuel. This happens when glucose (when burned as the primary source of fuel) produces something called glycerol phosphate, which assembles fatty acids into triglycerides in fat cells. (A good overview can be seen in this series of video clips.)

Basically, the accumulation of fat in fat cells is regulated by the availability of glycerol phosphate, and the production of glycerol phosphate is directly related to the amount of glucose available. Conversely, "when blood sugar levels decrease, fatty-acid levels rise," and therefore become the predominantly energy source. As Taubes puts it, "the one fundamental requirement to increase the flow of fatty acids out of adipose tissue...and so decrease the amount of fat in our fat tissue, is to lower the concentration of insulin the bloodstream."

Taubes recounts early experiments on insulin from the 1920's (just after insulin was discovered) that demonstrated the role of insulin as a "fattening hormone." These studies showed that "when insulin was injected into diabetic dogs in the laboratory, or diabetic human patients in the clinic, they put on weight and body fat. As early as 1923, clinicians were reporting that they had successfully used insulin to fatten chronically underweight children...and to increase their appetite in the process."

Now what causes high levels of insulin? In short, carbohydrates (insulin is also released when eating protein, but a much smaller amount), and most commonly refined carbohydrates and sugar (fructose has a particularly unique effect, which Dr. Robert Lustig discusses in great detail in this now popular lecture 'Sugar: The Bitter Truth'). "The more carbohydrate flooding the circulation after a meal, the more will be converted to triglycerides and stored as fat for future use."

Taubes goes into a bunch of other related issues, such as issues of hunger, satiety, diabetes, and the like (all of which are extremely interesting and thoroughly researched), but here are two basic take-aways:

All calories are NOT created equal. One hundred calories of bread has a distinct physiological and hormonal response compared to 100 calories of salmon. And it's this hormonal response - principally the high levels of insulin - that drives fat metabolism, not necessarily the number of calories.

Fat isn't a bad thing. Two quick examples: Fat is fundamental to the many cells that make up our body. Without fat, there would be no cell membrane to maintain the cell's integrity. Second, without fat, nerve cells would not have something called myelin, which is essential for cell signalling (or how our nervous system communicates, or 'tells' our body to do certain things). This article on fat consumption in children and depression reinforces the close link between fat and cognitive functioning. 

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Nutrition science isn't clear-cut. It's littered with studies that claim "associations" and "links," but few point to causality. More so than anything, Taubes reminds us of this in his book. Just because obesity may be associated with something, doesn't mean that it is caused by it. It is this short-coming by which much of current nutrition and dietary guidelines are based. And if for no other reason, this book is worth the read because it firmly puts into context current dogma, and underscores the need for rigorous science to better inform nutrition policy, guidelines, and the general public's understanding of the issue.

How I ran less to run better: 5 things I did to qualify for Boston

This post is the final part of a series of posts on endurance sports and heart health.

Training is both a science and an art form. There are, of course, scientifically supported ways to optimize performance - training structure, duration, intensity, biomechanics, etc. But, as much as I've learned from books, podcasts, and other coaches, I've learned even more from simple experimentation. That's where the science starts to blend with the art form.

To me, training has always been about testing myself and finding new ways to achieve even greater performance. By developing an intimate understanding about my physiology - how my body responds best; when it's tired; when to up the intensity; and what type of fuel is best - I've been able to make huge improvements and go beyond what I originally thought were my physical limits.

In my previous post I talked about how nervous I was leading into the 2012 Philadelphia Marathon. It wasn't the distance, but my preparation. My training was dramatically different than what I was doing just a few years ago. I basically had two fundamental goals with my 2012 training: 1) maximize performance (particularly speed); but at the same time 2) optimize overall health and well-being. The first part is fairly obvious, but the second is a much greater recognition and appreciation for many of the negative health effects resulting from chronic endurance exercise. I wrote about this in greater depth here and here.

5 things I changed to improve my training and qualify for Boston:

1. Biomechanics

Running is all about efficiency and economy. One of the greatest causes of stride inefficiency is over-striding, or when your foot lands in front of your center of gravity. Think physics - force is always equal and opposite. When you over-stride, the force generated comes back up into your heel, your knees, and your hips, slowing you down, but also increasing the risk of injury. The biggest warning sign is a significant heal foot strike. (I'll admit, I followed the classic "heal-toe" advise for several years and even wound up with a slight hamstring injury from overstriding.) So, the goal was to make sure my foot always struck under my hips.

To get there I changed three things: 1) I started actively picking up my feet (as opposed to pushing off the ground); 2) I increased my cadence; and 3) I ditched my old clunky shoes with tons of cushion for a more minimalist shoe, which forced me to address some of my faulty biomechanics I was getting away with, and assumed a more natural stride and foot strike.

2. Training volume

Less became more and quality replaced quantity. There's a growing body of research that points to the benefits of high intensity interval training, particularly when comparing metabolic and biochemical adaption with traditional endurance training. In addition, interval-based training is one way to get around some of the longer-term negative health effects, particularly with the heart (which I reference above), from chronic endurance training. I made intervals the foundation for my training approach.

My weeks usually included three days of solid run sessions, with a fourth optional recovery day. One week always included a shorter interval-based workout (never more than 40 minutes), a shorter tempo or fartlek run, and a longer interval-based session. The focus was always on intensity during the workout, and recovery afterwards. Long workouts were never more than 2 hours or longer than 16-17 miles total, and total weekly mileage was never more than 30ish miles. This is in stark contrast to the 40+ miles a week of old.

Training philosophy was the hardest thing to change, mostly because it was totally counter to everything I previously thought. But, I trusted it, and it worked. 

3. Training style

Becoming a better runner isn't necessarily always about running more. I think my many of my improvements over the past 18 months have a lot to do with the non-running parts of my training. Triathlon training has been key. First, cycling forced me to improve the strength, power, and endurance in my legs, particularly my quads and glutes, offering a great carry-over effect with my running. Also, incorporating sessions that improved my cycling cadence had a similar effect that "taught" my legs to turn-over faster, which was essential for the tweeks I made in my biomechanics.

Second, swimming had less of a carry-over effect, but my interval-based training in the pool improved my cardio-pulmonary capacity in ways that complemented my running. Not to mention, including kicking drills on a regular basis were great for both strength and recovery.

Lastly, I religiously incorporated at least one (and often two) days of strength training and/or plymometric work to increase power and develop functional strength. This has been vital for injury prevention, longevity, and speed.

4. Overall Nutrition

Goodbye processed food, wheat and many carbohydrates. Hello real, whole foods.

I was never overweight, but my diet wasn't necessarily "clean." In other words, because I was playing sports and exercised (and probably from a genetically faster metabolism), I found I was able to get away with not always paying close attention to what I ate. Things like pasta, bread, chips, pancakes, cookies, etc, were pretty routine. I even thought I had to eat this way because my body was burning so many calories and carbohydrates.

Now, vegetables, fat, and protein form the foundation of my diet, with carbohydrates, such as oats, lentils and quinoa cycled into my training based on when my hardest workouts are. By keeping carbohydrates in check, and being strategic with intake, my body adapted to burn more fat as the primary fuel source. Not to mention, I'm able to maintain a much more constant blood glucose level, rather than the peaks and valleys that go along with massive insulin spikes. One of the simplest (though hardest at first) things I found was to eliminate wheat, which is one of the biggest culprits with blood glucose fluctuations. Not only are there a variety of ways wheat contributes to chronic disease (a must read on the subject is "Wheat Belly" by Dr. William Davis), I also found eliminating wheat (and all refined carbohydrates and sugars) helps me 1) maintain more constant energy levels; 2) allows for better recovery post workouts (particularly long/intense workouts), and 3) because stored carbohydrates carry more than double their mass in water, drop about 15-20 pounds of what I call "junk weight."

One of the huge advantages of dropping this "junk weight" - where I went from weighing about 20lbs less during the 2012 Philly Marathon compared to 2007 - was it's effect on running economy. In what is probably one of the most comprehensive book on running, Dr. Tim Noakes writes in "The Lore of Running" that research has shown that "the addition up to 4kg to the torso increased the oxygen cost of running by...2.5%." Further, that "the addition of 0.5kg to each thigh or to each foot increased the oxygen cost of running by 3.5% and 7.2% respectively." In short, a lighter runner can more easily be a more efficient runner.

5. Race-Day Nutrition

I said goodbye to sports drinks and gels, both in training and on race day. Instead, I used UCAN Superstarch for workouts over 90 minutes and on race day. UCAN Superstarch is a slow-releasing, high molecular-weight carbohydrate that results in a much smaller insulin spike compared to simple sugar-based products like sports drinks and gels.

Why is this important?

Two points. First, the body has a limited supply of glycogen, or storage sugar, which, if used exclusively, is exhausted over the course of a couple hours (faster at higher intensities). This is the basic reason behind consuming sugar in the form of sports drinks or gels during a marathon or triathlon. However, this leads me to the second point. When suger is ingested, huge insulin spikes follow, resulting in the body preferentially burning glucose and essentially shutting down its ability to burn fat. When blood glucose levels are maintained in a more moderate range, the body is better able to tap into its massive fat stores. And for those more fat adapted through their everyday diet, like myself, this has huge performance and endurance benefits.

There ya have it. Five big changes I made to improve my running performance. These weren't all done overnight, and many were things that took a lot of patience. But in the end, it was about trusting the approach, and trusting myself.

Let me know your thoughts.

Food marketing to children: How big a problem is it?

Food marketing is a more than one billion dollar a year industry. The comparison often made is that the marketing budget of food companies alone far and away exceeds the entire budgets of organizations like the World Health Organization to address the negative health ramifications associated with chronically consuming the types of foods most often marketed on TV, on the radio, or (and increasingly) on the Internet.

One of the biggest public health battles currently being waged is the marketing of unhealthy food products to children and adolescents. The argument is such advertising is coercive, as children this young are not cognitively able to understand or deconstruct the advertisements they see. Many of the world's largest and most powerful food and beverage companies, like Coca-Cola, General Mills, Kraft and others, have recently made voluntary pledges to market their products more responsibly to children under the age of 12. And they report some progress, but the fact is, marketing of unhealthy foods, loaded with sugar, refined carbohydates, and unhealthy fats, is still a major issue and is playing a huge role in the exploding obesity and diabetes epidemics, particularly among children and adolescents.

Recently the Rudd Center for Food Policy & Obesity at Yale University published a report of findings from a recent survey of almost 2,500 parents about food marketing practices to children and adolescents. Parents of children ages 2-17 who were living at home in June-July of 2009, 2010, and 2011 were asked questions about where their children see food and beverage advertising, what types of products they see most often, and how often they see them.

Though the findings reveal some fascinating insights into the concerns of parents, one word of caution when interpreting the results below. The study used a non-probability based panel, which means the findings can't be generalized to the entire U.S. population. In addition, the results were not weighted to adjust for any possible oversampling of key demographic groups, such as females, or Hispanics, or Caucasians.

Here are some of the study's main findings...

 

1. TV is by far the most common food and beverage marketing vehicle, but the Internet, radio and in-store advertising where the next three most common. From 2009 to 2011, Internet overtook Radio as the top place where children see/hear food marketing after TV, according to respondents. With the constant changing role of the Internet, the growing use of social media, and the increasing hours adolescents spend 'connected,' the Internet will undoubtedly be a major marketing channel in the years to come. More on this below.

 

2. Fast food, cereal, and soda/pop are the top three food and beverage categories children see advertised most often (at least once per day). A worrying trends seen in all categories is the slightly higher percentage for non-white respondents - essentially providing support that minorities (as well as low-income and less-educated) are often the targets of food and beverage marketing. The percent of African American parents whose children saw ads at least once a day was significantly higher than both Hispanics and Caucasian parents for ALL food categories.

 3. The cost of healthy foods was perceived as the biggest obstacle to ensuring healthy eating habits in children - fast food restaurants, prevalence of junk food, and too much TV/computer were the second, third, and fourth biggest obstacles. Though cost is undoubtedly a major consideration, particularly for low-income families, the argument that health food "costs too much" is often made by only thinking of food in terms of calories, rather than nutrient content. I wrote more about the limitations of this approach in this posting.

4. Parents of all races view the media as the most negative influence on healthy eating for their children, followed closely by the food industry and government. Media and the food industry are obvious villains here, but to see more than half of parents view the government as a negative influence is quite interesting, particularly as the government holds the regulatory and legislative power to control food marketing. More interesting is the significant difference between white and minority (both African American and Hispanic) parents and their negative views of government (white parents rated government roughly 10 percent more negative than minority parents).

5. Schools held the least negative views among parents, and were seen as the best place to intervene to promote healthy eating habits among their children, particularly through nutrition standards for school lunches and other available foods (like vending machines).

6. Regulation of a wide range of communication channels is strongly supported, with the most support for stricter controls on TV commercials. The largest support by parents (and the largest increase between 2010 and 2011) is for regulations to limit TV commercials marketing unhealthy foods to children under 12. Interesting, more than 50% of all parents in the survey supported regulation to limit unhealthy food marketing through all communication channels list in the survey. The overwhelming support of parents for government regulatory intervention is, I think, a strong indicator of just how big an issue this has become.

 

Some Final Thoughts

Food marketing to children and adolescents is a huge issue. There is a lot at stake - like many other products, brand loyalty is important. A 10 year old who develops a taste for Pepsi, might just stick with having a 20 oz bottle with lunch everyday for the next 60 years -- that's $27,375 over the course of a lifetime. Not a bad profit...and that's just one person. Now imagine what this picture looks like not just across the US, but increasingly in countries like India and China, where there are huge cohorts of youth, an attraction to "Western" brands, often a favorable business environment, and the potential for huge profits. 

My second thought is on the Internet. Children born in the 21st Century are growing up, quite literally, attached to technology. It's no longer just watching TV, but kids are spending more time on computers, tablets and smartphones. And these are children under 5 years old! Technology hold tremendous potential, and enormous power. However, we haven't even scratched the surface on the range of developmental effects that technology have on children. One major variable in this is not just the technology itself, but the information children consume by using the technology, such as advertisements about cereals, or soda, or fast food. This is going to be one of the next major battlegrounds, and parents are already very concerned.

Lastly, it seems regulation will need to play a key role in all this, and there is almost unanimous consensus on it (even from industry). But at the same time, food and beverage companies are spending more and more on marketing, and spending for health and nutrition education keeps declining. There has even been considerable research, including this recent study, showing medical schools fall short on teaching students about obesity and nutrition. I wonder how effective food advertisements would be if understanding about basic food and nutrition concepts was just a little higher. 

It's an over-used saying, but knowledge in this case really is power. The knowledge scale about nutrition is grossly in favor of food and beverage companies. What can we do to tip the scales back?

Let me know your thoughts. 

Food for Thought on Food Day

Yesterday was Food Day, a "nationwide celebration and a movement toward more healthy, affordable, and sustainable food." Started by the Center for Science in the Public Interest, the initiative has an impressive and fairly diverse listing of partner organizations, which include public health organizations like the American Public Health Association, activist groups such as Jamie Oliver's Food Revolution, and trade associations, including the Organic Trade Association.

Thousands of events were held across the country under the initiative, all devoted to highlighting five priorities in healthy diets, sustainable agriculture, reducing hunger, and protecting the environment and workers' rights.

Regardless of political leanings or views about the individual organizations associated with Food Day, the multidimensional emphasis is a useful way to think about the challenges of today's food system (and the one we envision for the future). Not only are there individual decision-making forces at play, there are even greater societal and systemic forces that effect everything thing from food production and availability, to the policies and guidelines set by governments and promoted to consumers.

 

Five Thoughts on Today's Food Challenges

• Data - The nutrition field includes a lot of murky data that relies often on associations and correlations rather than causality. This challenge dates back to some of the early research on diet and nutrition from the 1950's, but nonetheless is now the foundation for much of the current dietary guidelines and recommendations. If you're interested in diving deeper, Dr. Peter Attia, founder of the new Nutrition Science Initiative, provides an interesting overview of some of the history, and his organization has an incredible review of the literature to date (both a summary and citations). On a broader level and as obesity, heart disease, and other chronic diseases become increasing prevalent globally, many countries, particularly low-income countries, data systems "remain weak" according to the World Health Organization, and there is a "vital need" to improve them. If we're going to make evidence-based policies, we need to understand the science and epidemiology of nutrition, obesity, and chronic disease - and this means data.

On one of the main streets in Guhlshan, Dhaka, Bangladesh.

• Demographics - More than half the world's population reside in cities. By 2035, all regions will have reached the 50% urbanization threshold. How will food systems change? How must they adapt? A popular trend in the U.S. has been farmer's markets, which increased from 1,755 in 1994 to 7,864 in 2012, according to USDA data. Such markets provide urban dwellers the opportunity to purchase fresh produce and meats. However access is often inequitable, and scalability is a major constraint. Accessing nutritious food is of particular concern as cities continue to grow globally, and more people are concentrated in informal settlements, or slums. Research shows a high prevalence of chronic disease risk factors among the poor, such as this study from Soweto, South Africa, where 60% had more than one heart disease risk factor, 44% were obese, and 56% had hypertension. Research from a Brazil slum show similar trends, particularly with women. Among women 20-60 years old, 29% were overweight and 17% were obese.

• Diet - I like to think of diet not as an intermittent activity, but rather a lifestyle. And diet composition is just as important as overall energy (i.e. calories). Not all food is created equal. For example, not all beef is equal (e.g., grass-fed versus beef raised on a grain diet), which impacts, among other things, the ratio of omega 3/omega 6 fatty acid ratio in the beef. The latter of which the average person consumes way too much of, and prompts the body to do things like store fat rather than burn it. A similar story can be told for eggs, and many other products. In addition, some types of food today are quite different in genetic make-up than their ancestors of a 50-100 years ago - wheat being a big one - which is associated with a variety of health issues, and the nutrient quality found in many fruits and vegetables has declined over the last century as well.

• Dollars - healthy eating does not have to come at the expense of your wallet. A recent study by the USDA highlighted this precise point. It found that "for all metrics except the price of food energy, the authors find that healthy foods cost less than less healthy foods." In other words, if you evaluate based on edible weight (rather than cost per calorie) vegetables, fruit, and dairy foods were found to be less expensive than most "protein foods, and foods high in saturated fat, added sugars, and/or sodium." What's most promising is that there are emerging some practical solutions, like the tech start-up Zipongo, which is trying to make healthier choices the easier choice through a web-based health community and iPhone app, which "essentially combines the best of Mint.com and Groupon to create a service that gives users their own personalized wellness plans (and the ability to manage them), while offering discounts at the grocery stores they shop at the most."

• Difference - as in, make a difference. If nothing else, Food Day is a testament to the power of civil society and organizing. Food is one of, if not, the most important way to invest in your own health. Understanding the importance of food, what's in it, where it comes from, and how to prepare it can be an extremely empowering way for individuals to control their own health. Challenge yourself by filling your cart with real, whole foods next time you're at the grocery store (things like vegetables, seafood, meats (like grass-fed beef and free-range poultry), nuts, and fruit. Support efforts to teach children about food preparation and nutrition, such as home economics classes in schools, which are being cut. And lastly, learn, investigate, and challenge the "conventional wisdom." The newspaper headline or short soundbite on the radio may not be the entire story.

What are your thoughts on today's most pressing food issues. Leave a comment.

Flawed from the start? NIH study of diabetics cut short after failing to show effect on heart disease risk

The objective of the 11-year, $220 million NIH funded study made sense – entitled the Look AHEAD trial - to see if an “intensive lifestyle intervention program” focused on improved diet and increased physical activity would lower heart risks, such as fatal and non-fatal stroke and heart attack, among more than 5,000 diabetics. There were of course high expectations, and researchers offered several reasons for the study’s perceived failings, which was recently halted. The National Institutes of Health released this statement on Friday, October 19, 2012.

But, was the study destined to fail from the start?

There is broad recognition about the close association between being overweight or obese, and risk for developing diabetes and heart disease. So, the study’s design went after this association, but did so by focusing exclusively on calories for the diet portion of the intervention and strictly followed dietary composition guidance by groups like the American Diabetes Association and the National Cholesterol Education, which advises a diet of 65% carbohydrate, 15% protein, and 30% fat (with a maximum of 10% of total calories from saturated fat). 

Yes, caloric intake is important to manage weight – the study called for “1200-1800 kcal/day depending on the individual’s baseline weight.” However, the study’s protocol also called for  “commercially available liquid meal replacements that will replace two meals and snacks each day” and a “frozen entrée” for an evening meal. This begs the question, is it surprising there was no effect observed on heart disease risk (even though weight loss was achieved, albeit a much greater percentage in the first year than over the entire timeframe of the study) when people were encouraged to each pre-packed frozen dinners and liquid meal drinks like Ensure.

If you’re curious, take a look at the nutrition labels and ingredients in products like Ensure:

In one bottle:

• ·      250 calories

• ·      40g of carbohydrate, with 22g from sugar (64% of total calories)

• ·      9g of protein (14.4% of total calories)

• ·      6g of total fat, with 1g of saturated fat (21.6% of total calories)

Ingredients: Water, Salt, Corn Syrup, Corn Maltodextrin, Milk Protein Concentrate, Soy Oil, Soy Protein Concentrate, Cocoa Powder (Processed with Alkali), Canola Oil. Less than 0.5% of the Following: Corn Oil, Potassium Citrate, Magnesium Phosphate, Magnesium Chloride, Calcium Phosphate, Soy Lecithin, Sodium Citrate, Sugar, Carrageenan, Choline Chloride, Ascorbic Acid, Natural & Artificial Flavor, Potassium Chloride, dl-Alpha-Tocopheryl Acetate, Ferric Phosphate, Zinc Sulfate, Niacinamide, Manganese Sulfate, Calcium Pantothenate, Cupric Sulfate, Vitamin A Palmitate, Thiamine Chloride Hydrochloride, Pyridoxine Hydrochloride, Riboflavin, Folic Acid, Chromium Chloride, Biotin, Sodium Molybdate, Sodium Selenate, Potassium Iodide, Cyanocobalamin, Phylloquinone, and Vitamin D3.

But a quick glance at the first five ingredients – of which there are 40 total – you will see corn syrup and corn maltodextrin as the third and fourth respectively. Basically, a bottle of lots of sugar with some added vitamins and minerals.

A similar glance at some of the popular frozen meal brands, like Lean Cuisine, shows a similar story of consuming many of the ingredients that undermine health rather than protect against heart disease, like sugar, carbohydrates, and vegetable oils. Here is an example of the beloved Chicken Parmesan dish:

• ·      300 calories

• ·      39g of carbohydrate, with 10g from sugar (52% of total calories)

• ·      18g of protein (24% of total calories)

• ·      8g of total fat (24% of total calories)

Ingredients: TOMATOES, BLANCHED SPAGHETTI (WATER, SEMOLINA), COOKED BREADED WHITE CHICKEN MEAT, GROUND AND FORMED (WHITE CHICKEN MEAT, WATER, SEASONING (MODIFIED FOOD STARCH, SUGAR, POTASSIUM CHLORIDE, YEAST EXTRACT, DEXTROSE, SPICE, ONION POWDER, GARLIC POWDER, PAPRIKA), ISOLATED SOY PROTEIN, SODIUM PHOSPHATE, SALT. BREADED WITH: ENRICHED BLEACHED WHEAT FLOUR (NIACIN, REDUCED IRON, THIAMINE MONONITRATE, RIBOFLAVIN, FOLIC ACID), DEXTROSE, SALT, MALTODEXTRIN, PARMESAN CHEESE (PARTIALLY SKIM MILK, CULTURES, SALT, ENZYMES), WHEY, ENZYME MODIFIED PARMESAN CHEESE (PARMESAN CHEESE {MILK, STARTER CULTURE, SALT, ENZYMES}, CREAM, NATURAL FLAVOR), SPICE, ONION POWDER, GARLIC POWDER, PARSLEY, CARAMEL COLOR, SOYBEAN OIL, EXTRACTIVES OF PAPRIKA. BREADING SET IN VEGETABLE OIL), TOMATO PUREE (WATER, TOMATO PASTE), PART SKIM MOZZARELLA CHEESE (CULTURED MILK, SALT, ENZYMES), ONIONS, 2% OR LESS OF WATER, SUGAR, SOYBEAN OIL, BASIL, MODIFIED CORNSTARCH, GARLIC PUREE, SALT, POTASSIUM CHLORIDE, SPICES, SKIM MILK, XANTHAN GUM, FLAVORS. 

Take Away 

So, was this study flawed? How can you make any impact on preventing heart disease – even in the presence of weight loss – when meals are loaded with sugar and carbohydrate? Diets high in both have been linked to worse predictors of heart disease risk and certainly aren’t doing much to help manage diabetes. Chronic and high levels of sugar and carbohydrate consumption require a matched insulin release, the hormone you’re precisely trying to control to prevent and/or manage diabetes.

Diet composition and quality of food matters. This study seems to be another example of how an exclusive focus on caloric consumption has its limitations with respect to overall and long-term health goals. I wonder if different results would have been achieved had all of the intervention group ate fewer calories, a lower composition of carbohydrates/sugars, and foods were all from real, quality sources, like fresh vegetables, meat, fish, fruit, and nuts?

Let me know what you think. Please post a comment.