30-Day Nutrition Upgrade: How long do the benefits last?

“Who has noticed any long term habit change or positive changes based on the 30 Day Nutrition Upgrade?”

I found this question on my Facebook page, posted by a (perhaps skeptical?) follower.

If you’re trying to decide whether this program is worth your while, you might be interested in some of the responses posted by previous Upgraders.

“Me! I literally crave vegetables, which I did not before. I choose vegetarian options at restaurants sometimes even though I’m not a vegetarian and don’t want to be. I also opt for fish more than I used to.”

“It helped me lose weight.”

“I buy vegetables not knowing what to do with them. Then at home I look up how best to eat them. Also I prefer fish to meat whenever I can. In general i find I eat healthy with the 30DNU in mind.”

“I consistently eat more vegetables. Also, I have at least one fermented food each day.”

“I eat much less sugar and much more vegetables”

“I noticed a huge difference. I lost my sugar cravings after about 3 days and generally eat much better, even though I thought I had a pretty good diet before starting.”

(Honestly: who needs a copywriter? I’m just going to let folks who have done the program do the marketing for me!)

If these are the kinds of changes you’d like to make a permanent part of your eating habits, then I hope you will join us

Not Your Typical Nutrition Challenge

Unlike other 30-day nutrition “boot camps,” the 30 Day Nutrition Upgrade doesn’t ask you to eliminate entire food groups or follow a rigid or restrictive protocol. You don’t have to avoid restaurants, cancel social plans, or pack special food to bring with you everywhere.

You’ll just keep on living your regular life…only a little bit healthier. (I’ll show you how.)  You can even do it with your kids! (Some Upgraders report competing with their children over who can eat more vegetables during the day … and their kids love it!)

Come join us!

How to Avoid Weight Gain When You Quit Smoking

Q. I have a friend who just quit smoking. He’s started to gain the typical weight and went into his local GNC yesterday to get some supplement that’s supposed to speed up his metabolism. He already has a fairly good diet. I told him he might be better off just letting his metabolism balance itself out, rather than substituting one stimulant for another. Any ideas on how he can naturally adjust better?

A.  People who quit smoking do often gain a few pounds but changes in metabolism are the least likely culprit.   Nicotine does slightly increase one’s metabolic rate.  More significantly, however,  it acts as an appetite suppressant. Ex-smokers often eat more when they stop smoking because they have more appetite.  The mental and physical stress of nicotine withdrawal may also drive cravings for certain “comfort” foods.   Add to that the fact that ex-smokers need something to do with their hands (and mouths) to fill the time that they used to spend smoking and it’s easy to see why quitters often gain a few pounds.

But because a slower metabolism isn’t really the main issue here, a “metabolism booster” from the health food store probably isn’t going to be a very effective solution.   Here are some tips to help manage this transition. Continue reading “How to Avoid Weight Gain When You Quit Smoking” >

Are decorative pumpkins and gourds edible?

pumpkins-1708769_640

Jessica writes:

“We just threw out the pumpkins we had on our porch as decoration, and it made me wonder whether we could have eaten them. I bought them at the grocery store after all! 

Can you eat/cook any type of pumpkin? (I had a mix of regular, Cinderella, and maybe Yokohama.) If you can eat them, how long after you put them on your porch will they be edible? I’ve only used canned pumpkin to date, is the process of making your own challenging?”

Continue reading “Are decorative pumpkins and gourds edible?” >

Nutrition comparison of gluten-free flours

In this week’s episode of the Nutrition Diva podcast, I reviewed the nutritional benefits of watermelon seed flour in comparison to other gluten- and grain-free flours. You can listen to the episode here and below is a chart showing the nutritional values for several of the most common types.

1/4 cupCaloriesProtein (g)Fat (g)Sat fat (g)Carb (g)Fiber (g)Calcium (mg)Potassium (mg)
Watermelon seed flour17891535017207
Almond flour16061206472210
Coconut flour12063218106600
Cassava flour13000031220106
Gluten-free baking flour130200301459
Paleo baking flour110440.513327160
White pastry flour12030.50261658
Whole wheat pastry flour11040.502337111

Why weight loss is harder for some people

If you have excess body weight, the standard advice is to eat less and move more. Of course, we all know this is easier said than done.

For one thing, it takes a lot of work to change deeply ingrained habits and behavior patterns. It’s hard to move more when our workplaces are designed for sitting and our neighborhoods are designed for driving. It’s hard to eat less when you’re constantly surrounded by hyper-palatable food. It’s also challenging to eat less when you’ve learned to use food to cope with stress or soothe your emotions.

These are all issues that a good behavior modification program can help with. But It’s also really hard to eat less when your brain is sending you the wrong signals about whether you’ve had enough to eat.

This article is also available as a podcast. Click to listen.

If you have excess body weight, the standard advice is to eat less and move more. Of course, we all know this is easier said than done.

Hunger (the urge to eat or to seek food) and satiation (the feeling that you’re full and don’t want more food) are both regulated in the hypothalamus, the most primitive part of the brain. The hypothalamus responds to hormonal signals being sent from different organs of the body via various chemical messengers. When this system is working as it should, our hunger increases when our body needs energy and decreases when it doesn’t. The result is a stable body weight.

But sometimes, the system goes awry. Dr. Gabriel Smolarz is an endocrinologist specializing in the treatment of obesity. Here’s how he explains it:

“The hypothalamus is receiving all of these different inputs and processing the situation to then say: Should we eat? Should we not eat? Should we stop eating? We conclude that there’s dysregulation when the gas tank is full, but the hypothalamus is indicating an empty tank.”

If your brain is receiving the wrong signals about whether or not you need food, this is obviously going to make it much more difficult for you to eat less.

Are genetics to blame for obesity?

Dysregulation of appetite signals can be due to genetics—similar to the way you might inherit a dysfunction in your body’s ability to regulate your cholesterol levels or blood pressure. This may be at least part of the reason that obesity, like high cholesterol, runs in families.

Of course, our genetics haven’t changed that much in the last 100 years, while the incidence of obesity has skyrocketed. But genes aren’t always destiny. Sometimes they need an environmental trigger to unfold. What’s changed in the last 100 years is not our genetics but the environmental triggers.

What’s changed in the last 100 years is not our genetics but the environmental triggers.

We are more sedentary than previous generations. And at the same time, our food supply has gotten cheaper, more convenient, and it’s processed in ways that make it more tempting. The combination of dysregulated appetite signals with cheap and abundant high-calorie, hyper-palatable food is clearly a recipe for disaster.

This situation can be compounded by something referred to as metabolic adaptation, in which the body responds to caloric restriction by burning fewer calories and amping up the urge to eat. Here’s Dr. Smolarz again:

“If you are fortunate enough to achieve a meaningful weight loss, it’s really hard to keep that weight off. It’s basically the body saying, Oh, no, this is not good. Higher weight is better, safer, and more conducive to reproduction and survival. So after the weight loss, you’re hungrier than you were before, because of this hormonal part of metabolic adaptation.

“And then the second half of this story has to do with how much energy you burn at rest. The body says, We’re now going to conserve as many calories as we can by burning less. So if it took you a hundred calories to walk around the block, your body says, Well, we can now do this in 80 calories.

“So you’ve increased your efficiency. And if you want to continue to lose weight, you need to consume even less than you did just a few weeks ago, because now your resting energy expenditure is lower than it was before.”

One of the reasons that I advocate a slower pace of weight loss than is commonly prescribed is to minimize the unwanted metabolic adaptation. However, those with a long history of crash or yo-yo dieting may have lasting effects that make weight loss increasingly difficult.

While it’s true that if you eat less you will lose weight, it’s not an even playing field.

So while it’s true that if you eat less you will lose weight, it’s not an even playing field. One person might be able to lose a couple of pounds by cutting out a dessert here and there and taking a walk after dinner. But some people have to eat a lot less (or go around feeling hungry all the time) in order to lose a pound or maintain a lower body weight.

Is there any way to fix appetite dysregulation?

There are a variety of medications that work in the hypothalamus to regulate appetite signals. For those suffering from a dysregulation of appetite, where the hunger signals are out of sync with what their bodies actually need, these medications can make it easier to eat less and lose weight.

Several drugs have been approved by the FDA for the treatment of obesity. Some of these are similar to drugs that have been approved for the treatment of other conditions, such as Type 2 diabetes, but have been found in clinical trials to be effective in the treatment of obesity as well. (The two conditions frequently occur together.)

In the past few months, there’s been a lot of buzz about a Type 2 diabetes drug called semaglutide, which appears to be even more effective at promoting weight loss than some of the drugs approved to treat obesity.

In the most recent study, participants received intensive behavioral counseling along with a weekly injection of semaglutide or a placebo. Those receiving the behavioral counseling and a placebo succeeded in losing an average of 5% of their body weight … which is no small accomplishment. However, those who combined intensive behavior modification with the medication lost over 15% on average.

Important!
Disclosure: In addition to his work as a clinician and on the clinical teaching faculty of Rutgers Medical School, Dr. Smolarz also serves as Medical Director for Novo Nordisk, the company that developed semaglutide.

Why are these medications so under-utilized?

When you consider the prevalence of obesity and its enormous costs to individuals and society, you might think that these drugs would be more widely used.

If a person develops high blood pressure, high cholesterol, or high blood sugar, their doctor will probably suggest that they make some changes to their diet and get more exercise. And for some people, lifestyle change is sufficient to solve the problem. But for others, often those with a genetic predisposition, even the most diligent efforts with diet and lifestyle don’t fix it. At that point, the doctor will likely prescribe a medication to help modulate whatever aspect of their metabolism is out of whack.

Similarly, when a person has excess body weight, their doctor (if they mention it at all) will usually suggest that they eat less and move more. But if they are unable to get their weight down, rarely are medications discussed.

As pharmacist and obesity advocate Ted Kyle points out, 88% of people with Type 2 diabetes are prescribed medication to manage their blood sugar. And yet, anti-obesity medications are prescribed to only 3% of those with obesity. (And that’s doubled in the last ten years.)

I asked Dr. Smolarz why he thinks this is.

“I went to an allopathic medical school and a mainstream internal medicine residency program. I did a mainstream endocrinology fellowship. What I like to call essential obesity was not part of any curriculum. This dysregulation of appetite was not taught.

“Obesity is the most prevalent non-communicable disease on the planet. And we learn more about bioterrorism and how to use potassium iodide than how to use medicines in this regard.”

Not everyone who needs to lose weight needs an anti-obesity medication, of course.  Dr. Smolarz describes how he evaluates patients seeking treatment for obesity.

“You want to look for secondary causes of extra weight first, Are there other medicines that the person is taking that promote weight gain?

“There are also underlying medical conditions that could be causing this. An underactive thyroid can contribute to weight gain and be a cause of an inability to lose weight. So that’s something we would check for. Is this person perhaps an emotional eater or traumatic eater?  Maybe it’s a sleep problem.”

In addition to treating any underlying medication conditions that may be contributing to the problem, the first line of treatment is still to modify the diet, increase physical activity, and address behaviors that may be leading to overeating. But that’s not where treatment always ends.

Dr. Smolarz:

“There is no blood test that tells me you have an appetite signaling problem. I wish there was something like that. You cross things off the list, and then you say, Well, it’s not this, it’s not that. OK, I’m left with this. And so let’s approach that.

“The first part of the treatment is to ensure three key pieces: optimal nutrition, increasing physical activity, and behavior modification. I say someone is a candidate for medications when those three elements have been tried or are being currently tried, but we’re not seeing weight come off. “

However, even if appetite signals are out of whack, medication alone won’t solve the problem. Nutrition, physical activity, and behavior modification still need to be part of the program.

Dr. Smolarz:

“The medications are enabling those fundamentals to be even more successful.  The medicines allow you to tolerate a reduced caloric intake. So it’s one thing to say, You need to eat salad twice a day. You may be very hungry at 1200 or 1500 calories a day. The medicines that act as appetite suppressants make that feasible.”

Like all medications, the drugs used to treat obesity have a risk of side effects. Patients and doctors need to weigh the costs and benefits of the various medication options and select the one that is the best match for their situation. And this may be another reason that family doctors are reluctant to prescribe anti-obesity medications.

Here’s Dr. Smolarz again:

“All the drugs work a little bit differently, so it’s a bit of a challenge to master it all. Then the last piece is [the] fundamental misunderstanding of obesity as just a failure of willpower, that people just need to eat better and they should get a handle on their obesity. That’s just not the clinical reality.”

How to find help

If your health is at risk because of excess body weight and you and your doctor feel you have run out of solutions, you might consider consulting with a practitioner specifically trained in obesity medicine, which involves much more than just writing prescriptions or scheduling bariatric surgery.

The American Board of Obesity Medicine trains and certifies physicians in obesity management. Their website includes a directory where you can find Diplomates by location. The Obesity Medicine Association is another resource that can help you locate clinicians with specific training in obesity medicine.

Originally published at QuickandDirtyTips.com

What’s the latest on A2 milk?

[Transcript]

There’s a certain amount of a genetic variation in dairy cows, just the way there is with people. That’s why some of us are left-handed and some of us have red hair!  And for Dairy cattle, one of those genetic variations leads to tiny differences in the proteins in their milk.

Beta-casein is the main protein in cow’s milk. And most of the dairy cattle here in the U.S. produce milk that contains two forms of beta casein…the A1 form and the A2 forms.  But some cattle produce milk that contains only the A2 form of beta casein.

The milk looks and tastes exactly the same. It has the same nutritional profile—same amount of protein, calcium, same amount of lactose. 

About 25% of the Western population experiences some degree of digestive discomfort after consuming cow’s milk…things like gas, bloating, or loose stools. We’re not talking about a milk allergy…that’s far less common and potentially more serious.  These digestive symptoms are relatively harmless and temporary but they can be uncomfortable and inconvenient.  And they are thought to be due to an inability to breakdown lactose, which is sugar in milk.

There are a few things you can do: You can avoid dairy products. You can take a lactase supplement when you eat dairy products, that’s an enzyme that helps break down the lactose so that it doesn’t cause problems. Or you can buy dairy products that have the lactose removed or reduced. 

And there are now a handful of studies showing that for people with known lactose intolerance or who suspect they are lactose intolerant, drinking A2 milk, which  only contains the A2 form of beta casein protein, may cause fewer digestive symptoms. 

I think this is something that individuals will need to try for themselves to see whether or not it makes a difference for them. And if it doesn’t, there are other options for people who have trouble with dairy, such as the lactase supplements and lactose free milk.

It’s important to note that at this time there no other known benefits to consuming only the A2 protein and no other known risks of consuming the A1 form.

Related listening

Is protein powder too processed to be healthy?

Catherine writes:

“Virtually everyone says to cut down on processed foods.  It’s  one of the few things everyone from different camps generally agrees on.  Yet a large number of nutrition “influencers” recommend smoothies that include protein pea powder, or “beef powder”.  How the heck are those not processed food?”

You’re right: Pea protein and beef powder (yuck) would both be considered processed foods. As would soy or almond milk, yogurt, or frozen strawberries.

Virtually everything we eat is processed to some degree. Perhaps it’s helpful more to think of processing on a spectrum.  A grape still on the vine would be at one end and a grape-flavored jelly bean on the other. Somewhere in between those extremes would be raisins, grape juice, and grape jelly.

The goal is not to completely eliminate processed foods (which wouldn’t even be possible).  It’s more realistic to think about choosing foods that are closer to the less processed end of the spectrum as often as we can.

What’s the purpose of the processing?

Rather than painting all processed foods with the same brush, it’s also worth considering what the purpose of the processing is.  Is it to concentrate the sugar, increase the intensity of the flavor, or otherwise create a product that hyper-stimulates the reward centers of the brain?  Is it to increase the profit margin of a cheap ingredient?

Or does it serve to extend shelf life, increase the nutritional value of a food, improve its digestibility, or make a nutritious food safer or more convenient to prepare?

Obviously, the processing required to turn peas or whey into protein powder serves a different purpose than the processing required to turn an ear of corn into a bag of Cool Ranch Doritos.

If you enjoy smoothies, you can consider whether the benefit of the additional protein justifies the use of a somewhat processed ingredient like protein powder.  Your answer might depend on how easy it is for you to meet your protein needs from other foods in your diet.

Either way, though, even though it is somewhat processed, a smoothie would be closer to the less processed end of the spectrum than a strawberry-flavored McFrosty.

My diet is super healthy. Why isn’t my Nutrition GPA higher?

I received the following email from a frustrated user of the Nutrition GPA app.  I’m posting it here, along with my response, in case other app users might find it useful as well.

“I have been somewhat frustrated with the scores I’ve been getting on the Nutrition GPA app.  I know I definitely do not eat enough fresh fruits and vegetables some days. But I think my diet is very good otherwise–just not in ways the app measures!

“For instance, I don’t eat any meat, I eat no dairy on an average day, I rarely eat eggs, I obsess over sodium, I rarely eat baked goods–and when I do, they’re homemade, low sugar, low sodium, dairy-free, etc., and the only white flour I eat is in baguettes, Portuguese rolls, or occasional pasta. Nevertheless, I’m getting Cs and  even a D!”

How does the Nutrition GPA assess your diet?

The questions in the Nutrition GPA quiz represent the foods most strongly associated with overall diet quality, risk factors, and health outcomes.  If your grade is not as high as you think it should be, perhaps aspects of your diet that you think are “not so bad” or “occasional” are having more of an impact than you realize.
Conversely, aspects of your diet that you think of as  “very good” may not have as much impact (or be as consistent) as you think.
Let’s take a closer look at some of the details you mentioned:
  • If you don’t eat any meat, then you are always getting points on Q9.  So that’s certainly not responsible for your low grade!
  • Avoiding diary and eggs is not associated with improved diet quality or reduced health risks.  So they don’t impact your grade one way or the other.
  • If you have high blood pressure and are sensitive to the effects of sodium, then that might be an important thing for you to watch. But for the majority of the population, avoiding sodium does not improve their health or their risks. So it’s not monitored in the Nutrition GPA.
  • Baked goods that contain white flour will impact your grade–even when they are homemade, low sugar, low sodium, and dairy-free! If you’re only eating them occasionally, it shouldn’t affect your GPA too much.  But research shows that replacing white flour with whole grain flour (or avoiding it altogether) improves health and nutrition.  And that’s why you get a higher grade on days when you don’t eat things made with white flour.

There are also a few things that you DIDN’T mention. But if you are frequently having more than one alcoholic drink, more than 25 grams of added sugar, eating fried foods and/or you rarely eat fish, legumes, and nuts, this will drag down your Nutrition GPA.

All of which is to say that the whole point of the Nutrition GPA is to shine a light on those areas of our diet that could stand improving. And sometimes it reveals things that we may have over or under-estimated.  In which case, it’s working exactly as designed–and presents a great opportunity to improve your nutrition!