Weight Loss: The Failure of Moderation

Great article about moderation and overeating.  As someone who's battled a lifelong weight problem and won - I've been in my target range for over six years now - I highly recommend putting some of your trigger foods on your "not in my house" list and then sticking to it.  If you were good at controlling how much of those foods you ate, you wouldn't be struggling. Keep those foods out of your life, and you'll be amazed how your palate resets itself to healthier flavors!

One of the biggest problems I have with nutrition education is the “everything in moderation” approach... We were taught that unless you told people that no foods were “off limits” and that all foods are healthy “in moderation”, you could be doing people a disservice.

The problem is, people don’t want to hear the truth…

I think this mentality largely comes from the fact that many dietitians are themselves recovering from disordered eating. My instructor, while drinking her diet coke in-between powerpoint slides, would tell us how limiting food groups could lead to “orthorexia” and this led to an eating disorder. I remember raising my had and saying, “Don’t you think a certain level of orthorexia might be important in our modern food landscape with hyper-palatable foods everywhere we turn?”. The entire class gasped and stared at me. I hear whispers among the students. This challenge to what we were being taught was blasphemy. I would clearly induce anorexia by suggesting someone avoid processed sugars. My professor stood behind her statement.

Someone recently told me she had bariatric surgery a few years ago. Clearly the moderation thing is working for her.

People going on crash diets often gain the weight back. Frustrated with this, many are gravitating to the “everything in moderation” theory, and simply trying to maintain their weight. This is supported by dietitians, our government’s advice and by the food industry (of course)!

Chick-fil-A’s to-go paper bag states suggests that you “Stay Balanced” so if you splurge during the day, balance it with more exercise. Oh, and eat their 8-count chicken nuggets every three to four hours.

A new study, published in the journal Appetite illustrates how “moderation” means different things to different people. The researchers hypothesized that people’s own food preferences would have a huge influence on what they consider “moderation”.

When considering their own food intake, people like to “favor themselves” and are notoriously poor judges of how much they’ve just consumed, both in volume and in calories. They can’t seem to remember what  they just ate, but often feel that they’re doing well with their food choices, regardless of their weight.

Proving their hypothesis, the researchers found that the more people consumed of a particular item, the larger their sense of “a moderate amount” was. Furthermore, people tended to view their own consumption as “better than moderate”. Meaning, what they ate was less than what they consider a “moderate intake”. This was regardless of their BMI, so both healthy and obese participants answered the questions in a similar manner.

The University of Georgia’s Michelle vanDellen, an assistant professor in the department of psychology, led a study that found that the more people like a certain food, the more forgiving their definitions of moderation. 

“These results suggest people evaluate their own consumption as moderate. If anything, people seem to define moderation as greater than their current consumption, indicating that they do not actually think of it as limited consumption of an item. Moreover, definitions of moderate consumption are related to levels of personal consumption: the more people consume of a food or beverage item, the more of that item they consider to be moderate consumption. In contrast, people’s perceptions that they consume an item moderately were unrelated to the amount of each item they actually consumed and the amount of that item they consider moderate… That is, people may implicitly endorse their reported consumption as appropriate because the typical amount they eat is less than what they define as moderate.” The researchers concluded. 

Additionally, in “Better Than Before“, author Gretchen Rubin describes how moderation usually fails most dieters, but also mentions that most nutritionists are moderators. Her book is a fascinating look into what motivates people, and what works in order to change habits. If you haven’t already read it, I recommend it highly.

A few months ago, I was allowed to sit in on an Overeaters Anonymous meeting, to learn what they were like. It was really eye opening. People were describing how they would go to the store and buy cake mix, bake themselves a cake, and then EAT THE WHOLE THING. Others would talk about how they would have to take the junk food in the house and toss it in the garbage, then cover it with water so they wouldn’t go back into the garbage, dig it out, and binge on it. One woman reported that her car was her “vehicle” and that she could never make it home from the store without devouring and entire package of cookies. You know what worked for all of them? Abstinence. Nearly all said they were only successful when they cut out wheat and sugar, which were “trigger foods” for them.

The more I work with people, the more I realized that people are looking for clear answers. Most people really like to hear, “eat this, don’t eat that”. This is why paleo works as a weight loss tool. The reason why people sometimes gain wait following their 30-day challenge is because 80/20 is very hard to self-regulate. I’ve noticed it quickly becomes 60/40, then 30/70. I personally am blessed to have Celiac disease, because I am automatically abstaining from a large group of foods that most people have no “off switch” for. Sugar doesn’t really do it for me – but salt does! I know that I can’t go near potato chips and even gluten free pizza can be an issue for me.

It’s also completely NOT YOUR FAULT that certain foods can trigger overeating. Our brains are designed to seek out calorically dense foods. During our hunter-gatherer times, berries were hard to come by, so our receptors are highly stimulated by sweet and or salty foods. That’s what kept us alive. Today, however, our brains have not caught up to our modern 24/7 access to junk food. This food bypasses our normal satiety signals and we can’t help but overeat it. The only solution is to develop a mild form of orthorexia and eliminate certain foods from your lunchbox, pantry, diner plate, and dessert tray. If you know that you can’t have just one bite of ice cream, then it’s probably not a great idea to keep it in your house.

A note on paleo treats like cookies, brownies, cakes and everything in that category: I don’t have an issue if people eat them, but please don’t consider them in your first 30 days if you’ve had issues with overconsumption of hyper-palatable foods. A paleo brownie is still a brownie. If you’re trying to reset your palate, then do yourself a favor and abstain as you’re getting used to eating “normal” foods like meat and veggies. I don’t keep baked goods in my house, I don’t “bond” with my kids over making cookies, and I advise my nutrition clients to do the same.

Now, if you’re in the 1-4% of Americans that happens to have an actual eating disorder that requires you to view “everything in moderation”, I’m not speaking to you in this post.

Maybe you’re one of the few healthy, successful moderators. If so, great. But if you’re in the position of giving out nutrition advice, then it’s time to reconsider the “everything in moderation” stance, as it’s likely going to fail the majority of your clients. I know for many of my nutrition clients, if I tell them “a little bite won’t hurt”, they would eat the whole damn pie.

original article:
http://robbwolf.com/2016/06/07/a-little-bite-wont-hurt-the-failure-of-moderation/

study on moderation:
http://www.sciencedirect.com/science/article/pii/S019566631630099X

Better than Before, by Gretchen Rubin
http://www.amazon.com/Better-Than-Before-Habits-Procrastinate/dp/0385348630?ie=UTF8&keywords=better%20than%20before&qid=1465415295&ref_=sr_1_1&sr=8-1

Diet and Exercise Best way to Fight Cancer

Newly diagnosed cancer patients should be told to diet and exercise, amid mounting evidence that shedding the pounds is the best way to fight the disease, global experts have advised.

A daily brisk walk of just 25 minutes was found to almost halve mortality among breast cancer sufferers, while a waistline larger than 35 inches increased death rates by one third.

Results from a slew of trials showed “powerful” and “groundbreaking” evidence of the benefits of a slim waistline, with weightloss and exercise helping even those with advanced cancer.

Even those who took little exercise before diagnosis saw major benefits, experts told the world’s largest cancer conference, in Chicago.

"This is absolutely ground-breaking. These were women with late stage ovarian cancer. They were able to exercise and willing to and having very favourable results."

Melissa Irwin

Health watchdogs the National Institute for Health and Care Excellence last night said they would consider the evidence, which could result in fresh advice to millions of Britons, with two in three adults overweight or obese.

Experts said losing 5 per cent of body weight – which could mean as little as ten pounds – could lead to a 20 per cent increase in breast cancer survival. 

Leading oncologists said a cancer diagnosis offered a “window of opportunity” to convince patients to make lifestyle changes which could prolong their lives. 

They said those receiving a diagnosis should be warned to lose weight and take more exercise, even if such conversations were “sensitive”. 

One expert at the American Society of Clinical Oncology’s annual conference, launching the first trial into high intensity exercise for prostate cancer patients, said the NHS should prescribe personal trainers for those diagnosed with cancer.

Obesity is linked to more than 10 types of the disease, including breast, bowel and ovarian cancer.

But until now, much of the emphasis has been on preventing weight gain to reduce the chances of developing the disease, rather than raising the issue in patients with cancer. 

Prof Melinda Irwin, Associate Director of Cancer Prevention for Yale Cancer Center, said diagnosis was a time for patients to make lifestyle changes. 

She said: “After treatment, weight loss is the most powerful thing you can do. It’s the next best pill to treatment and it’s free and has no side effects.”

Prof Irwin said doctors needed to be “sensitive” in raising the issue with newly diagnosed patients, but should not duck the issue. 

“Every woman diagnosed with breast cancer should be being counselled about weight loss and weight management, and about the role of exercise,” she said. 

“Diagnosis offers a window of opportunity, and diet and exercise can have a profound and powerful effect.”

Yale research led by Dr Irwin tracking almost 5,000 breast cancer sufferers found that three hours brisk walking a week was linked to a 46 per cent fall in mortality.  Even when women took up such regimes after decades of sedentary living, death rates fell by as much as 33 per cent. 

The observational study could not prove that the exercise caused the gains. 

But a raft of studies by Yale released in Chicago this week will reveal direct evidence about the mechanisms activated via weight loss and exercise. 

Dr Irwin said she was particularly excited about results from the first ever randomised controlled trial looking at the impact of exercise on ovarian cancer.

More than half the women in the six month trial had advanced disease.  

But those enrolled in a walking programme, doing at least 20 minutes a day of exercise saw “profound changes” in key biomarkers which reflect cancer progression.

“This is absolutely ground-breaking. These were women with late stage ovarian cancer. They were able to exercise and willing to and having very favourable results,” she said. The study of 144 women, found the half who were prescribed exercise saw a 27 per cent drop in levels of leptin, a hormone associated with cancer, and a 15 per cent decrease in IGF-1, a natural human growth hormone which fuels cancer spread. 

Article in the Telegraph dated 6/6/16

Sweden Becomes First Western Nation to Reject Low-fat Diet Dogma in Favor of Low-carb High-fat Nutrition

Sweden has become the first Western nation to develop national dietary guidelines that reject the popular low-fat diet dogma in favor of  low-carb high-fat nutrition advice.

The switch in dietary advice followed the publication of a two-year study by the independent Swedish Council on Health Technology Assessment. The committee reviewed 16,000 studies published through May 31, 2013.

Swedish doctor, Andreas Eenfeldt, who runs the most popular health blog in Scandinavia (DietDoctor.com) published some of the highlights of this study in English:

Health markers will improve on a low-carbohydrate diet:

…a greater increase in HDL cholesterol (“the good cholesterol”) without having any adverse affects on LDL cholesterol (“the bad cholesterol”). This applies to both the moderate low-carbohydrate intake of less than 40 percent of the total energy intake, as well as to the stricter low-carbohydrate diet, where carbohydrate intake is less than 20 percent of the total energy intake. In addition, the stricter low-carbohydrate diet will lead to improved glucose levels for individuals with obesity and diabetes, and to marginally decreased levels of triglycerides.” (Source.)

Dr. Eenfeldt also translated an article from a local Swedish newspaper covering the committee’s findings:

Butter, olive oil, heavy cream, and bacon are not harmful foods. Quite the opposite. Fat is the best thing for those who want to lose weight. And there are no connections between a high fat intake and cardiovascular disease.

On Monday, SBU, the Swedish Council on Health Technology Assessment, dropped a bombshell. After a two-year long inquiry, reviewing 16,000 studies, the report “Dietary Treatment for Obesity” upends the conventional dietary guidelines for obese or diabetic people.

For a long time, the health care system has given the public advice to avoid fat, saturated fat in particular, and calories. A low-carb diet (LCHF – Low Carb High Fat, is actually a Swedish “invention”) has been dismissed as harmful, a humbug and as being a fad diet lacking any scientific basis.

Instead, the health care system has urged diabetics to eat a lot of fruit (=sugar) and low-fat products with considerable amounts of sugar or artificial sweeteners, the latter a dangerous trigger for the sugar-addicted person.

This report turns the current concepts upside down and advocates a low-carbohydrate, high-fat diet, as the most effective weapon against obesity.

The expert committee consisted of ten physicians, and several of them were skeptics to low-carbohydrate diets at the beginning of the investigation. (Source.)

One of the committee members was Prof. Fredrik Nyström, from Linköping, Sweden – a long-time critic of the low-fat diet and a proponent of the benefits of saturated fat, from sources such as butter, full fat cream, and bacon. Some quotes from Prof. Nyström translated into English from Dr. Eenfeldt:

“I’ve been working with this for so long. It feels great to have this scientific report, and that the skepticism towards low-carb diets among my colleagues has disappeared during the course of the work. When all recent scientific studies are lined up the result is indisputable: our deep-seated fear of fat is completely unfounded. You don’t get fat from fatty foods, just as you don’t get atherosclerosis from calcium or turn green from green vegetables.”

Nyström has long advocated a greatly reduced intake of carbohydrate-rich foods high in sugar and starch, in order to achieve healthy levels of insulin, blood lipids and the good cholesterol. This means doing away with sugar, potatoes, pasta, rice, wheat flour, bread, and embracing olive oil, nuts, butter, full fat cream, oily fish and fattier meat cuts. “If you eat potatoes you might as well eat candy. Potatoes contain glucose units in a chain, which is converted to sugar in the GI tract. Such a diet causes blood sugar, and then the hormone insulin, to skyrocket.”

There are many mantras we have been taught to accept as truths:

“Calories are calories, no matter where they come from.”

“It’s all about the balance between calories in and calories out.”

“People are fat because they don’t move enough.”

“Breakfast is the most important meal of the day.”

"Of course these are not true. This kind of nonsense has people with weight problems feeling bad about themselves. As if it were all about their inferior character. For many people a greater intake of fat means that you’ll feel satiated, stay so longer, and have less of a need to eat every five minutes. On the other hand, you won’t feel satiated after drinking a Coke, or after eating almost fat free, low-fat fruit yogurt loaded with sugar. Sure, exercise is great in many ways, but what really affects weight is diet.” (Source.)

Will the USDA Now Revise Their Guidelines?

The scientific literature implicating the dangers of refined carbohydrates and the benefits of healthy fats has been around for decades now. One probable reason why this study was done in Sweden is that a lot of people were obvious already following such a diet. Currently in Sweden, it is estimated that only 14 percent of the population are obese compared with one-third in the USA.

So will the U.S. follow suit and explore revising USDA dietary guidelines? Not likely.

As the recently published article YOU the Taxpayer are Funding the Agri Business Takeover of our Food Supply points out, the USDA nutritional guidelines favor the heavily subsidized crops of wheat, soy, and corn. The political forces are just too strong in the U.S. right now to allow any dietary advice that would cut into corporate profits and their production of cheap food to dominate world food supplies.

This dietary advice of a low-carb high-fat diet has been around since the 1920s, when the ketogenic diet was developed at John Hopkins Hospital to cure epilepsy in children who did not respond to drugs. With the advent of the USDA diet guidelines, starting with the McGovern Report in the 1970s, fat was condemned and the low-fat diet advice was promoted through the healthcare system. You can see original TV coverage of this report from 1977 in this YouTube clip from The Fat Head movie:

In 2002, science journalist Gary Taubes began writing on the dangers of the high-carbohydrate diet and benefits of a high-fat diet, and his work was published in both the N.Y. Times and Time Magazine. His article title was “What If It Were All a Big Fat Lie!”

With mainstream media now covering the truth about the fallacies of the low-fat diet in the early 2000s, Dr. Atkins and his low-carb high-fat diet, which had been around for many years, gained a huge following. Various forms of the low-carb high-fat diet exist today in the U.S., but they are still considered “fringe” and “extreme.” The low-carb high-fat diet is routinely attacked by the government and medical system, even as pharmaceutical companies rush to make patented drugs that mimic the ketone effects of the diet, particularly in cancer treatment, the largest market share for pharmaceutical companies.

So, while Sweden has taken a huge step forward in following a commission who looked at over 16,000 studies and confirmed science that has been around for many years, don’t expect the U.S. government to do anything similar anytime soon. It is up to you to do your own research to understand the REAL facts about a healthy diet.

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Lustig on Sugar and Chronic Metabolic Disease

Another very important video from Dr. Robert Lustig from the kids obesity unit at UCSF.

I really admire Robert Lustig's clarity, his scientific background and his stand for people's health and continuing to speak out about the obesity crisis, despite mass apathy and media-driven confusion.  

Here are some highlights from this excellent video:

(On whether obesity is just due to behavior)

"How do you explain obesity in six-month-olds?  They don’t diet and exercise.

Obesity is occurring in countries that still have malnutrition.  This looks much more like an exposure, than it actually does, like changing behavior.

There’s really no such thing as behavior.  There’s really just biochemistry.   Biochemicals change in the brain, driving behavior.

In obesity, what is driving that behavior?  I can sum that up in one word:  Insulin.  Insulin does two things:  Drives energy into fat cells, thereby increasing the amount of energy stored, therefore the obesity.  But, the other thing that Insulin does is it blocks the signal in the brain that would normally convey satiety and signalling energy adequacy.  That signal is called Leptin, and Leptin is a hormone that’s made from your fat cells, goes to your brain and tells you you’ve had enough.  But insulin blocks that signal.  So by doing peripheral changes which drive energy deposition and inducing central changes that drive starvation at the level of the brain you can see how that would turn into a vicious cycle of consumption and also disease.  So what we have learned is that Insulin is the bad guy in this story.

Q: So what can families and individuals to do change their biochemistry, or is this not something they shouldn’t be worried about at all?

The question is, what caused the Insulin rise?  If you look at studies from the 1970’s  in terms of how high your insulin went in response to a glucose challenge, maybe 50 microunits per ml.  Now we’re up to 100, 150, sometimes even 250 microunits per ml (for the same test), in kids.  So the question is how come kids are releasing twice or 3 times the insulin they were before.  And that is the crux of the obesity question. 

So, what’s changed during that time?  Certainly our genes have not changed.  But our diet has clearly changed.  And, what makes insulin go up?  Sugar.  But what kind of sugar.?  Well, there are three molecules that constitute the standard sugars.  There’s glucose, which is absolutely essential for life.  It’s so important that if you don’t get any, your body makes  it in order to keep your blood glucose level up.   There’s galactose, which is in milk sugar, which is immediately converted to glucose in the liver… 

And then there’s the last one - Fructose.  Fructose is the sweet part of table sugar.  It’s in sucrose.  It’s in hfcs, it’s in maple syrup, it’s in agave nectar and it’s the thing we seek, virtually every caloric sweetner,  it’s the thing we like.  The problem is that fructose is not glucose, never was, never will be.  Glucose is a 6 membered ring, fructose is a 5 membered ring.  Glucose is regulated by insulin.  Fructose is not regulated by insulin.  Glucose goes to glycogen or liver starch in the liver for storage and that is a non toxic storage form of energy in the liver, which is good, and it’s what you want to make, so you have ready energy for exercise, so if you’re glycogen depleted from either starvation or from severe exercise, you can rebuild glycogen with fructose.  

But, what happens if you’re not.  What happens if you’re at rest… and you take in a large sugar load, say a soft drink or a sports drink, or one of these energy drinks, which has an enormous bolus of sugar.  What happens is that the fructose is not converted to glycogen.  It has no choice to go down to the energy mitochondria, the little energy burning factories in the cells.  They overwhelmed, these mitochondria, and they have no choice but to take the extra energy that’s been provided by the fructose and turn it into liver fat.  Liver fat drives all the other chronic metabolic diseases, by inducing insulin resistance in the liver, liver fat drives cardiovascular disease, lipid problems in the blood, hypertension, diabetes.  And possibly cancer and dementia as well.  So that’s where the problem is.  The overload of Fructose to liver mitochondria, driving chronic metabolic disease. 

....

Q: What do you recommend that the patient who is concerned about the health risks of obesity do?

I can sum it up in three words: eat real food.  Real food has fiber and real food is primarily low in sugar.  … The problem is, when we purify [food] the stuff, that concentrates the dose and ultimately leads to an over-the-threshhold effect, and once you achieved the threshold in the liver for fructose, you start getting disease.  The question is where is that threshold.  And it’s probably different for different people.  It seems to be lower for latinos.  Anything you can do to increase your threshold would be good.   One of those things is fiber and the other one is exercise.  And that’s what we say.  Eat properly.  Eat real food.  Exercise.  And you’re good to go.   And that’s what I espouse as well.  But I do it based on the science.

A couple of points I got from this video that hadn't occurred to me before: 

1. Adding fiber to foods doesn't really work.  Fiber, as it occurs naturally in food, is a combination of soluble and insoluble, and they are together that way for a reason.  Watch video for more details, but basically, foods with fiber added and taking supplemental fiber is not the same as eating food with fiber intact.

2. Making a smoothie out of a fruit destroys the fiber in it.  Eat the fruit, don't drink it, even as a smoothie (goes for juicing too).

  

Gut Bacteria May be Key to Weight Loss

CBS News 3/29/13
Normally we shudder when we think of bacteria, but a new study reveals that some of these microorganisms may be able to help us lose weight.

The study, published in the March 27 issue of Science Translational Medicine, showed that bacteria in the guts of mice changed after they had gastric bypass surgery, a procedure in which surgeons divide a person's stomach and connect the small intestine directly to the smaller walnut-sized portion. When these different microbes were transplanted in sterile mice who did not have the surgery, those animals lost weight quickly. 

 "Simply by colonizing mice with the altered microbial community, the mice were able to maintain a lower body fat, and lose weight - about 20 percent as much as they would if they underwent surgery," senior author Peter Turnbaugh, a Bauer Fellow at Harvard's Faculty of Arts and Sciences (FAS) Center for Systems Biology, said in a press release.

For the experiment, the researchers performed the gastric bypass surgery on a group of obese mice and recorded their weight loss, metabolic performance and gut microbe levels. They then compared their progress to other obese mice who had placebo surgeries and stayed overweight or had placebo surgeries and then were placed on a lower-calorie food diet.

The mice who had the gastric bypass surgery lost about 30 percent of their body weight in three weeks and had different bacteria in their stools than the other two groups. The mice who had the placebo surgery and didn't go on a weight loss diet regained the weight they initially lost by the end of three weeks. That suggests the surgery, not the weight loss, changed the microbes in the mice.

To further confirm the results, lean, germ-free mice received gut microbes from one of 
the three groups. Those that got the bacteria from the gastric bypass mice lost weight and fat, while the others did not.  Turnbaugh said that though the numbers seem high, weight loss could have been even greater.

Because the mice who received the bacteria weren't on a special diet to increase their weight, there could be an even more drastic weight loss if the mice were eating high-fat or high-calorie food, he said.The study shows that gastric bypass may be successful for weight loss for more reasons than just simply making the stomach smaller and shortening the area where the body absorbs calories. But, scientists don't exactly know why or how the bacteria changes just yet.

"We know the effects of bariatric surgery are not just mechanical and we don't know the full reasons why it works so well, especially in the resolution of diabetes," Dr. David Haslam, associate professor of pediatrics and molecular microbiology at Washington University in St. Lewis, told the BBC. "There is more to it than meets the eye."

It's still a long way before this process is replicated in humans, but the researchers hope that one day they will be able to use this method to help dangerously obese people lose weight without surgery. One of the problems with the study is that the bacteria was able to be transplanted in germ-free mice, but it will be hard to do that for humans, Jeffrey Cirillo, a professor with the department of microbial and molecular pathogenesis at Texas A & M Health Science Center, explained to HealthDay.

However, for people who just need to lose a few pounds here or there, Turnbaugh still thinks hitting the gym is their best option.

"It may not be that we will have a magic pill that will work for everyone who's slightly overweight," he said. "But if we can, at a minimum, provide some alternative to gastric bypass surgery that produces similar effects, it would be a major advance."

"We need to learn a good deal more about the mechanisms by which a microbial population changed by gastric bypass exert its effects, and then we need to learn if we can produce these effects - either the microbial changes or the associated metabolic changes -- without surgery," senior author Lee Kaplan, an associate professor of Medicine at Harvard Medical School, added in a press release. "The ability to achieve even some of these effects without surgery would give us an entirely new way to treat the critical problem of obesity, one that could help patients unable or unwilling to have surgery." 

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