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Vitamin D: Now I’m a believer

by Monica Reinagel, MS, LDN

One of the most electrifying sessions I attended at Andrew Weil’s Nutrition and Health Conference in April was one given by Dr. Michael Holick on Vitamin D.  Dr Holick is a well-known, even notorious, name in nutrition research circles. He’s been insisting for years that vitamin D deficiency is far more wide-spread and dangerous than anyone realizes and he has a reputation (which he himself promotes!) of being a bit of a kook.

A few years ago, he was famously booted from the Boston University dermatology faculty for making heretical statements about the benefits of moderate UV exposure (which stimulates the production of vitamin D in the skin) and has been chided and derided by the dermatology establishment ever since.

I thought I had a pretty good idea of what to expect from Holick’s presentation; it would be all about the miraculous powers of vitamin D and the dire consequences of deficiency.  I tend to take these sort of Wonder Nutrient presentations with a grain of salt.  When you spend your whole life researching a single compound–like many of these researchers do, I think you can start to lose your sense of perspective. As the old saying goes: When you’re holding a hammer, everything starts to look like a nail.

The evidence is always reasonably compelling. And by the end of every Wonder Nutrient presentation, you find yourself thinking, I really should start taking that, and I should probably start recommending it to my patients, too. The problem is that after a few dozen of these presentations, you (and your patients) have a list of 40 nutrients that you “need” to be taking.

It’s probably a backlash against too many Wonder Nutrients but, as many of you know, I’m not all that big on dietary supplements. Whenever possible, I think it’s better to meet your nutritional needs with actual foods. I myself take very few supplements.  And I have become immune to the persuasive power of Wonder Nutrient lectures.

And yet, after hearing Dr. Holick’s presentation, I literally stopped on my way back to the hotel to buy a bottle of vitamin D (1000IU).

First, I’ve gotta say, if you ever have a chance to see this guy speak, don’t miss it. All 1,200 of us in the audience were blown away (300 slides in 50 minutes). But it wasn’t just his over-the-top presentation that made me break my ban on Wonder Nutrients.  It was the cumulative impact of the data.

To me, the most compelling reason why vitamin D is really in a category of its own, and why most people need far more vitamin D than they can ever get through their diet, is this: Our bodies were not designed to meet our vitamin D requirements through dietary sources–we evolved to produce vitamin D in our skin, when the sun hits it.

That’s why people who originally lived further from the equator have lighter skin–it allows more UV rays to penetrate, which compensates for the weaker rays at those latitudes. The traditional diet of the northern and southern latitudes is also more likely to include oily fish, the richest dietary source of vitamin D.

But now, most of us spend most the daylight hours indoors. Any skin that is showing is slathered in sunscreen to prevent skin cancer and wrinkles. We don’t eat much cod liver.  We get most of our vitamin D from fortified dairy products and vitamin supplements, but it’s not nearly enough to meet our requirements.

Holick claims that the majority of Americans are chronically and dramatically D-deficient.  Among those at particular risk are those with dark-skin, the elderly, the obese (because vitamin D tends to become trapped in fat cells) and anyone living about the 35th parallel (which runs through Arizona and Georgia).  That is the latitude above which it is impossible to manufacture vitamin D in the winter months, even (as Holick to colorfully pointed out) you were to stand on the roof stark naked from noon to 3pm every day.

So what?

Every cell in the body has a receptor for vitamin D. Low blood levels of vitamin D are strongly linked to increased rates of cancer, osteoporosis, chronic pain syndromes, multiple sclerosis, rheumatoid arthritis, Type I diabetes, and  hypertension.

In fact, if you chart deaths from colon cancer, prostate cancer, or multiple sclerosis geographically, you can pick out the 35th parallel by eye because the difference in mortality rates is so much higher above that line. (Deaths from multiple sclerosis are 100% higher above 37 N. than below it! )

There’s much more to Dr. Holick’s argument (about 280 slides worth) but suffice it to say, I’m a believer.  Vitamin D is now one of only three nutrients I take as supplements (along with fish oil and calcium).

Dr. Holick and others are compaigning to have the government recommendations for vitamin D increased from the current recommendation of 200 – 600IU (depending on your age) to 1,000IU of vitamin D3 (cholecalciferol) for everyone. Based on his data, I support that recommendation.

Note: Vitamin supplements containing vitamin D2 (calciferol) are only about half as potent as D3 (cholecalciferol). Also, be cautious with sources that contain both vitamin D and vitamin A (such as supplements or cod liver  oil) and be sure that the amount of vitamin A (retinol) that you’re getting from all sources does not exceed 10,000IU.

For more information on vitamin D and health, visit Dr. Holick’s site at http://vitamindhealth.org/

Greetings from the 5th Annual Nutrition and Health Conference

by Monica Reinagel, MS, LDN

[Archival: Originally published on my (discontinued) NutritionData.com Blog]

Monicadrweil I’m writing to you from sunny Phoenix, where I’m attending the 5th Annual Nutrition and Health Conference, hosted by Dr. Andrew Weil and the Program in Integrative Medicine at the University of Arizona.

The sessions I’ve attended so far have been full of great, practical insights into how we can make our diets healthier. I can’t wait to to share this information with you in more detail! I only have a few minutes before the next session begins but wanted to dash off a quick post with some of the highlights so far.

In the opening session this morning, Dr. Weil set the stage for the rest of the conference with some general observations about diet and the role it plays in our long-term health.  A few nuggets:

On fat: Low-fat diets (less than 20%) are not only unsatisfying and difficult to stick to, but they don’t appear to be necessary for good health.  Dr. Weil argues (and I agree) that diet containing 30 to 40 percent of calories from fats is perfectly healthy. Of course, what kind of fats is important. Most of the fat in your diet should come from monounsaturated sources, such as extra virgin olive oil or canola oil.

At the same time, Dr. Weil points out that there’s no reason to be paranoid about saturated fat:

“You need to limit your intake of saturated fats but you don’t need to be afraid of them. Set a budget for your saturated fat consumption [I recommend 10% of calories–MR] and then decide how you want to spend it. If you love butter or ice cream, spend your saturated fat budget on those foods. Personally, I love cheese, so that’s what I choose to spend my saturated fat calories on.”

On protein: We’ve been trained to think in terms of “good” and “bad” carbs and fats but we tend to think of proteins as all “good” calories.  The problem with protein foods, says Dr. Weil, is what often comes along with them.  Conventionally-raised livestock may contain antibiotics, hormones, pesticide residues; fish may contain mercury, PCBs, and other contaminants.

Most of us could get along on a lot less protein than we are currently eating. Dr. Weil recommends  getting 10 to 20% of your calories from protein– and much of it from vegetarian sources.  Those with diminished kidney function may want to eat an even lower-protein diet to save wear and tear on the kideys:

“One thing I see in traditional medicine is that we wait too long before we tell people with kidney disease to start restricting protein. We wait until they are in kidney failure.  If we started them on a low-protein diet ten years earlier, at the first signs of declining kidney function, we could probably avoid or at least delay the onset of kidney failure.”

On essential fatty acids and balance:  With all the emphasis on getting more omega-3 fatty acids, we’ve started to think of omega-6 fatty acids as “bad” nutrients. Dr. Weil reminds us that omega-6 fatty acids are essential for good health!  The problem is one of balance.

“The body is designed to function in a state of dynamic tension–between forces that push and forces that pull. We need to support both forces in equal measure to remain healthy.”

And consider this: The amount of omega-3 you need to consume to keep your body in balance is directly related to the amount of omega-6 in your diet, Weil points out.

“It takes very little fish oil to balance the blood chemistry of someone eating a diet that is very low in omega-6 fatty acids. But for most Westerners, who consume a huge amount of omega-6 in their diets, it takes an enormous amount of fish oil to accomplish the same goal.”

There was so much more to report, but I’m out of time for the moment. I’ll post updates throughout the conference and will also post in greater detail on some of the more interesting research after I get home. Wish you were here!

Is Fasting a Good Way to Lose Weight?

by Monica Reinagel, MS, LDN

People fast for many reasons: as a religious observance or spiritual ritual, as a political protest, in preparation for medical procedures, or as an occasional health practice.   And studies have confirmed that short-term fasting can have a number of health benefits. Yet fasting for the purposes of losing weight is not generally seen as a good idea.

Fasting Doesn’t Teach You How to Eat Better

One argument is that you need to learn healthy eating habits in order to achieve long-term weight control. Fasting is by necessity a short-term strategy. Sooner or later, you have to begin eating again. And skills such as exercising portion control, choosing more nutritious foods and fewer empty calories, eating more vegetables and whole grains are not developed by fasting.

And we’ve all heard the argument that people who skip meals (whether one or a whole day’s worth) tend to eat more calories later to compensate. (More on that in a moment.) But a series of new studies, summarized in the U.S. News and World Report, suggest that there may be a legitimate role for modified fasting as a weight loss tool.

Fasting as a Dieting Strategy

A group of researchers in Louisiana conducted a small study in which overweight subjects ate just 20% of their normal caloric intake every other day. On the days in between, they ate as much as they wanted. On average, they lost about 8% of their body weight over the next two months.

Inspired by these results, Kenneth Webb decided to try his own version of the program. Webb calculated his daily calorie requirements (you can calculate yours with this Daily Needs Calculator) and ate just 30% that many calories every other day. On the alternate days, he ate 130%.  Over the course of about seven months, he lost 30 pounds. Not surprising, because he reduced his overall calorie intake by about 20%. But Webb says his one-day-on, one-day-off routine has a psychological advantage: He claims that it’s easy to be disciplined for a single day, knowing that the next day he’ll be eating as much as he wants–with no guilt.

Health and Anti-Aging Benefits of Fasting

There appear to be health benefits to fasting as well. Short-term fasting has been shown to reduce the risk of heart disease, improve insulin sensitivity, and slow the cellular aging process.   Some research suggests that fasting every other day may be almost as effective (and far less difficult) than the practice of calorie restriction.

Still, fasting isn’t for everyone.  For some, going an entire day on just a few hundred calories is simply too uncomfortable. For others–especially anyone who has struggled with eating disorders–the alternating sequence of fasting and feasting may lead to out-of-control binging.  You’ll have to be the judge of whether this strategy is a good fit for your lifestyle, disposition, and relationship to food.

And if you do decide to try it, remember that when calories are limited, the quality of them matters even more.  On your fasting days, be sure to concentrate on nutritious foods like fruits, vegetables, and lean protein.

A final thought: We’ve all been led to believe that skipping meals is an ineffective way to lose weight. But research from Cornell University suggests that restricting calories for one meal per day may be an effective weight loss strategy.

In a small, 2-week study, one group was given a 200 calorie (kcal) lunch (such as a cup of yogurt or bowl of soup) and another was given a 600 calorie (kcal) buffet lunch.  Both groups were allowed to eat as much as they wanted the rest of the day.  Surprisingly, those who ate only 200 calories for lunch didn’t seem to compensate by eating more the rest of the day. In fact, their daily calorie intake was, on average, precisely 400 calories less than those who ate the larger lunch, leading to weight loss.

Time for you to weigh in (so to speak!) on this interesting topic:

Have you ever tried modified fasting as a weight control strategy? How did it work for you?

Do you think every other day fasting would be a workable lifestyle? Easier than dieting every day?  Or do you think its just a gimmick?

Would the possible health benefits of fasting, aside from weight control, motivate you to try this approach?

I look forward to your comments and discussion!

Modified Fasting: a good weight control strategy?

by Monica Reinagel, MS, LDN

Mpj042253000001 People fast for many reasons: as a religious observance or spiritual ritual, as a political protest, in preparation for medical procedures, or as an occasional health practice.   And studies have confirmed that short-term fasting can have a number of health benefits.

Yet fasting for the purposes of losing weight is not generally seen as a good idea.

One argument is that you need to learn healthy eating habits in order to achieve long-term weight control. Fasting is by necessity a short-term strategy. Sooner or later, you have to begin eating again. And skills such as exercising portion control, choosing more nutritious foods and fewer empty calories, eating more vegetables and whole grains are not developed by fasting.

And we’ve all heard the argument that people who skip meals (whether one or a whole day’s worth) tend to eat more calories later to compensate. (More on that in a moment)

But a series of new studies, summarized in the U.S. News and World Report, suggest that there may be a legitimate role for modified fasting as a weight loss tool. Continue reading “Modified Fasting: a good weight control strategy?” >

On lard, pie crusts, and whether all saturated fats are the same

by Monica Reinagel, MS, LDN

Two related questions posted on the blog recently:cherry pie

Q. I’ve been reading that lard is now considered a good fat, as long as it’s not hydrogenated. I realize that lard is still saturated fat, so it’s not ‘good’ like olive oil. And like all fats, it must be eaten in moderation.  But I’m wondering what you think about going back to Gramma’s pie crust recipe. Crisco/butter just never did make the same good crust …

Crust-y Curious

Q. Like Crusty Curious, I’ve also been wondering about lard and pie crusts, as well as other saturated fats. If we limit our intake of saturated fats to recommended amounts, does it matter what TYPE of saturated fat we use? Are palm oil, coconut oil, butter, lard, and beef drippings (for homemade gravy) all equivalent, nutritionally? Or is there some good reason to avoid certain of these? 

Judy

A. Pie crusts are a matter near and dear to my heart and I’ve been collecting pie crust recipes for years. My current favorite uses a mixture of butter (for flavor) and lard (for flakiness).  But you will find equally ardent advocates for all-butter crusts and even some die-hard shortening devotees.

Epicurious.com’s Food Editor Sarah Kagen has long been a fan of this recipe, which uses part butter and part shortening. “But lately,” she says, “I’ve had several crusts made with part butter and part lard, and I have to say, I think I’ve been converted. The lard creates flakiness like shortening, but it adds a wonderful golden toastiness.”

Epicurious.com’s Associate Editor Lauren Salkeld (who is a graduate of the French Culinary Institute’s Classic Pastry Arts Program) says, “We made all butter dough in school, so that’s what I’m used to. I find it flaky and I prefer the flavor.”

Aside from the culinary debate, is there any difference nutritionally between butter, lard, and the naturally saturated fats found in palm kernel and coconut oil (used to make trans-fat free shortening)?

Here are a few facts that might surprise you :

1. Butter contains about 20% less fat and calories per ounce than lard or saturated vegetable fat, because it contains some water. (When substituting butter for other fats, adjust quantities accordingly.)

2. All of these products contain a mixure of saturated, monounsaturated, and polyunsaturated fats. Lard actually contains the least amount of saturated fat (11g per ounce) while coconut oil contains the most (24g per ounce).

3. Animal fats (lard and butter) contain more monounsaturated fat than palm kernel and coconut oil. In fact, lard contains more monounsaturated fats (13mg per ounce) than saturated fats (11g per ounce).

4. Butter contains twice as much cholesterol (60mg per ounce) as lard (27mg per ounce). Vegetable shortenings contain no cholesterol.

5. Lard contains 280mg of omega-3 fatty acids per ounce; butter has 88mg per ounce. (Palm kernel and coconut oil contain little or no omega-3s).

6. Butter contains a fair amount of vitamin A (700mg per ounce) whereas palm kernel oil contains a good helping of vitamin K (7mcg per ounce).

7. Both palm kernel and coconut oils contain natural phytosterols, which can help to reduce cholesterol levels by blocking the cellular uptake of cholesterol.

Regardless of what form of fat you’re trying to build a case for, you can find some support for it here. And of course there’s the argument that saturated fat isn’t really bad for you, anyway; it’s the carbs you eat with it that do the damage. (More comforting for bacon eaters than pie lovers.)

The only fat I can advise you to avoid completely are shortenings made with partially hydrogenated vegetable oil (old-style Crisco) or a mixture of fully hydrogenated and unhydrogenated vegetable oils (new-style Crisco). The former is full of trans fats and the latter, although it claims to be nearly trans fat free, is full of “interesterified fats,” which appear to be no better for you. (Also take care to select lard that has not been hydrogenated.)

No matter what form of fat you use, of course, pie crust is not a low-fat item.  One slice of a double-crust pie will use up about a quarter of your daily allowance of fat and around 80% of your allowance for saturated fat (not counting the filling).

So, in answer to the questions above, as long as your overal intake of fat, calories, and saturated fat is not excessive, and you are avoiding all hydrogenated products, use whatever you like to make your pie crust. (And send me your recipe!)

Living Well to 100

by Monica Reinagel, MS, LDN

What would it take to live to 100—in good health? An international consortium of researchers recently gathered at Tufts University in Boston to debate the answer. This meeting brought together heavy-hitters from every corner of medical research—cardiovascular medicine, endocrinology, nutrition, obesity management, experimental genetics, sleep research, and more.

After two days of research presentations on every aspect of the aging process, the panelists were asked to consider:

What are the top five things we should do if we want to live well to 100?

You might be surprised at the answers. It’s not about expensive medical interventions, drugs, or futuristic technology. According to the best available research, it all comes down to a few simple habits—things we all can do.

Continue reading “Living Well to 100” >

Calorie Restriction: Life extension or eating disorder?

by Monica Reinagel, MS, LDN

Cutting calories isn’t just for dieters anymore.  A growing number of people are embracing extreme, calorie-restricted diets in the hopes that it will drastically extend their lifespan…to 120 or beyond. (See also “Extreme Calorie Restriction for Long Life”  on MSNBC.com).

Proponents of Calorie Restriction (or CR) typically eat 30-40% fewer calories than it would take to maintain what is generally considered to be a “healthy” weight.  They generally lose quite a bit of weight before stabilizing at a much lower body weight.  The motivation for such extreme deprivation? Animal studies in everything from fruit flies to primates indicate that CR can extend the maximum lifespan of the animal in question as much as 20 or 25%.  There are no human studies verifying that CR will have the same effect on humans, but short-term studies show that CR does reduce biomarkers for aging along with lowering the risk of chronic diseases like heart disease and diabetes.  For many, that’s evidence enough. Continue reading “Calorie Restriction: Life extension or eating disorder?” >

Calorie Restriction: Life Extension or Self-Starvation?

by Monica Reinagel, MS, LDN

Cutting calories isn’t just for dieters anymore.  A growing number of people are embracing extreme, calorie-restricted diets in the hopes that it will drastically extend their lifespan…to 120 or beyond. (See also “Extreme Calorie Restriction for Long Life”  on MSNBC.com).

What is Calorie Restriction?

Proponents of Calorie Restriction (or CR) typically eat 30-40% fewer calories than it would take to maintain what is generally considered to be a “healthy” weight.  They generally lose quite a bit of weight before stabilizing at a much lower body weight.  The motivation for such extreme deprivation? Animal studies in everything from fruit flies to primates indicate that CR can extend the maximum lifespan of the animal in question as much as 20 or 25%.  There are no human studies verifying that CR will have the same effect on humans, but short-term studies show that CR does reduce biomarkers for aging along with lowering the risk of chronic diseases like heart disease and diabetes.  For many, that’s evidence enough. Continue reading “Calorie Restriction: Life Extension or Self-Starvation?” >