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Archive for December, 2008

Speaking With…: Ian Smith

Most of you know him simply as “Doctor Ian,” nutrition expert on Vh1′s Celebrity Fit Club, creator of the 50 Million Pound Challenge, host of the nationally syndicated radio show HealthWatch on American Urban Radio Networks, and author of #1 New York Times Bestsellers like The Fat Smash Diet.

Yesterday, Dr. Smith — a graduate of the University of Chicago Pritzker School of Medicine — launched his latest work, The 4 Day Diet, which is composed of a variety of 4-day modules.

My e-mail interview with him, transcribed below, covers the new book (I received an advance copy last month in preparation for our correspondence) as well as other current issues of interest in the fields of nutrition and public health.

The concept of motivation plays a significant role in this book. What motivated you to pen The 4 Day Diet?

So many people who I’ve worked with over the years have always talked about a lack of motivation or the inability to stay motivated. They wanted to know how to figure out a solution to this deficit.

I looked at all of the best diet books and none of them really gave the topic of motivation any real coverage. I know as a fact that the mental part of dieting is the most critical, because if your mind isn’t in the right place, then regardless of how good the plan might be, you’re not going to succeed.

The 4 Day Diet is my rendition of a COMPLETE program. There’s the mental plan, diet plan, and exercise plan. The people who I worked with while creating this program not only lost a lot of weight, they lost it consistently and they constantly told me how “doable” the program was compared to others they had followed.

I also wrote the 4 Day Diet so that if parents want to put the entire family on a program, this could be that program. Most diet plans are not kid-friendly, but the 4 Day Diet is one that everyone can enjoy and see results.

The psychological and emotional factors behind weight loss are thoroughly explored in The 4 Day Diet. Do you recommend that, if financially possible, people simultaneously seek psychological counseling before/while trying to achieve significant weight loss?

In the best of worlds, people who need to lose a serious amount of weight or who have some psychological component to their cause(s) for being overweight would seek some type of psychological consultation. It’s not because they’re crazy or not smart. It’s because sometimes we have anxiety or stress-related problems and don’t even know it, and a professional might help tease these problems out.

I know that everyone can’t afford to go to a psychiatrist/psychologist or doesn’t want to go, so that’s why I’ve included this material in the 4 Day Diet.

A lot of people will learn more about the cause of their problems and the strategies they can employ to solve them as they go on and lose the weight while regaining their health.

On a similar note, do you think periods of high stress are not a good time to begin implementing dietary changes?

One of the worst times to start a diet program is during a period of high stress. I tell people all the time, if you have some type of major life disruption such as relationship problems, job problems, financial crisis, loss of a loved one, medical crisis–these are not the times to undertake a diet program.

Unfortunately, too many people start a program simply because they believe it’s the right time on the calendar to do so and they don’t make sure it’s the right time in their life. Success is more attainable if one begins this journey at the most appropriate time.

That being said, one must also guard against coming up with every excuse in the book as to why they shouldn’t lose weight. Major stress-inducing situations are the only things that should stand in the way, not the small stuff.

Are you at all concerned the “Be Thinner by Friday!” label on the cover of the book can set up unrealistic expectations in readers or make this look like a gimmick?

There is that risk and to be honest I wrestled with the idea of putting it on the cover. I had those exact concerns, but the publishing team felt as though given my history of creating medically sound programs and being honest with people, that they would not interpret it as a gimmick.

The truth of the matter is that with the 4 day detox that’s at the beginning of the program, people will lose weight right away. Will they lose all of their weight? NO WAY! That’s not what I’m saying. They will lose weight and they will think differently.

One of the chapters talks about “thinking thin.” That is as important as the physical part of looking thin. So, people will be thinner by Friday not just physically but mentally, and they will be on the road to significant changes if they stick to the plan.

Is there a particular reason why the modules [in the diet plan] only allow one teaspoon of milk (even skim or low fat) in coffee?

Great question. The honest answer is that people tend to go overboard. If the limit is 1 teaspoon, then most people are going to have 2. If I said 2 teaspoons were allowed, then they would rationalize having 3. Sometimes you can’t win.

The major point with this is that you must try to cut calories wherever possible, even a small amount. If you get into the behavior of cutting calories with drinking coffee, then you’re also likely to do the same when there are bigger calories at stake such as eating an entree or dessert.

It’s all about learning how to make lifestyle changes that will lead to permanent good health.

What is your approach to people who “excuse themselves” from ever attempting to lose weight by saying “it’s just how they are built” because they come from “large families”?

This is one of the most frustrating excuses I hear when people talk about reasons they don’t try or can’t lose weight. The truth of the matter is that unless one has a genetic medical condition that has been inherited from their family, there really is no such thing as “coming from a large family, therefore it’s inevitable that they are large.”

Can you come from a tall family? Yes. But that’s genetic. Weight is rarely genetic. Families tend to be large because the choices they make from a dietary and exercise perspective make them large. There are no genetic plans that say everyone in a family is going to be 50 pounds overweight.

But if there’s a medical condition that’s inherited, then that’s a different story. The truth is that you have a better chance of winning the lottery than truly being large “because your family is large.”

Only 40 percent of medical schools in the United States offer a nutrition course. Of that 40 percent, very few actually require it as part of their curriculum. What are your thoughts on the apparent dismissal of nutrition that appears to be prevalent in the medical field (i.e.: “to lower blood pressure, take this pill, rather than be mindful of sodium and potassium intake.”)

I think the lack of nutritional education is medical schools is a tremendous oversight and we are now seeing the manifestation of it with the obesity crisis we’re now facing. More doctors and nurses need to know a lot more about nutrition and supplements and non-medicinal ways to control weight.

Obesity is a medical epidemic just like the plague was an epidemic. The front line fighters against this epidemic should be the doctors and nurses and other healthcare professionals. But there’s not enough nutritional and related training, thus they are not effective at fighting on the front lines.

Are doctors entirely to blame for the obesity crisis? Absolutely not. Do doctors share some of the blame? Absolutely. I hope in the coming years that medical schools will see the need to take nutrition as serious as they take pharmacology and physiology and help train a new generation of obesity fighters.

Mandatory calorie labeling has proven to be a successful policy in New York City. What are some other public health nutrition policies you would like to see implemented in the coming years to help people achieve their health goals?

I think NYC has gotten off to a good start and I hope it proves successful and others will follow this lead. There are lots of health nutrition policies that should be implemented over the coming years to help cut into our obesity problem.

I think that schools across the country are getting an F grade when it comes to providing healthy food for our children. This is an embarrassment for the US, a country so rich and so full of resources and intellectual capital. Our children need to be served healthier food and mandated to participate in regular physical activity. At a time when we need children to be more active, we’re dramatically cutting funding to programs and classes that would help our children get moving and lose some of this weight that will only harm them in their adult years.

I also believe that the government needs to be more instrumental in helping lower-income areas attract healthier grocery stores. Too many neighborhoods have nowhere to shop but stores that sell unhealthy, calorie-rich, sweet, processed foods and not enough natural, fresh food.

Yes, the communities must first want and then work to get these stores in their communities, but the government at some level should step in and play some role in incentivizing businesses to set up shop in these very needy communities. Remember, the healthier our fellow citizens, the healthier we all are!

Many thanks to Dr. Smith for taking time to participate in Small Bites’ “Speaking With” section!

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In The News: Just Say No

Today’s Chicago Tribune business section features a simple and to-the-point article on the — pardon the pun — massive weight loss aid industry.

While it does not break new ground, it effectively communicates a message that, in my opinion, should be displayed on huge billboards in every city: DIET PILLS ARE A WASTE OF MONEY.

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Numbers Game: Answer

According to figures from the National Health and Nutrition Examination Survey (NHANES), per capita sodium intake in the United States increased 56 percent between 1970 and 2000.

Not at all surprising, considering the rampant increase in meals eaten at restaurants and consumption of frozen foods.

Dietary guidelines recommend no more than 2,400 milligrams of sodium a day, but the average adult in the United States consumes, on average, anywhere from 3,300 to 3,800 milligrams.

Remember — the more processed a food item, the higher its sodium levels (i.e.: three ounces of grilled chicken contain approximately 10 times less sodium than three ounces of chicken nuggets.)

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Ugh

The title of this post says it all.

Dr. Maximo Ravenna, who I blogged about earlier this year, continues his brainwashing of the Argentine population in regards to nutrition.

I have encountered a fairly high number of otherwise intelligent people who have bought into this man’s claims that flour is addictive (this includes whole grain flours) and that the only guaranteed way to lose weight– and keep it off — is by going on a 600 calorie a day diet… for the rest of your life.

Suffice to say that someone I know down here who has been on this diet since 2004 eats three slices of cheddar cheese and one hard boiled egg for lunch most days.

Whereas most Registered Dietitians are weary of VLCD’s (very low calorie diets), Dr. Ravenna condones them.

In a recent article for Argentina’s Gente magazine, he writes, “Very low calorie diets have been used in clinical medicine for forty years, proving their efficacy and safety.”

What he fails to mention is that VLCD’s are used in very limiting situations and under strict medical supervision in hospital settings — NOT by any Tom, Dick, or Jane in their day to day life.

Many people who start with Dr. Ravenna are recommended to go as low as 400 calories a day for as long as 16 weeks!

His quick detox plan, advertised as a “healthy way to lose up to 5 pounds in one week,” suggests the following meals:

  • Breakfast consisting of a cup of black coffee accompanied by one grapefruit
  • Lunch made up of a one-egg omelette and mixed green salad
  • Dinner consisting of 1 cup of roasted vegetables
  • Snack consisting of whipped egg whites with Splenda and a quarter cup of strawberries

Since many of his patients lose quite a bit of weight (who WOULDN’T on a 400 calorie a day diet?) his popularity continues to soar and thousands of Argentine men and women consider him a bastion of hope.

All I see in his diet plan is medically-backed anorexia.
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Numbers Game: Soaring Sodium

According to figures from the National Health and Nutrition Examination Survey (NHANES), per capita sodium intake in the United States increased ______ percent between 1970 and 2000.

a) 19
b) 31
c) 47
d) 56

Leave your guess in the “comments” section and come back on Monday for the answer!
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You Ask, I Answer: Calcium & Weight Loss

What are your thoughts on the belief that high calcium intakes help with weight loss?

– Flor (last name withheld)
Buenos Aires, Argentina

Since the public loves the idea of magic bullets and fat-burning foods, the notion that a little extra calcium in the diet results in more effective weight loss really struck a nerve.

A few years ago, the dairy industry began advertising the claim that three glasses of skim or low-fat milk a day were more than just a good source of calcium — they also helped with weight management.

Truth is — there is no concrete science to support those statements.

The vast majority of clinical trials looking at calcium and weight loss fail to demonstrate a link between high intakes of the mineral and higher rates of weight loss.

Notice that even the “calcium helps you lose weight” campaign ultimately came down to calories. After all, consumers were encouraged to drink low-fat or skim milk, not whole.

If calcium in and of itself were a miraculous fat burner, it technically wouldn’t matter if the product containing it were fat-free or not.

I encourage everyone to always be suspicious of specific foods or nutrients marketed as “fat burning,” and instead keep in mind that weight management is more about general dietary patterns.

Drinking six cups of green tea a day isn’t going to do much in terms of weight loss if your total caloric intake is 1,000 calories higher than it should be.

Similarly, chugging down a glass of skim milk along with a 450 calorie muffin isn’t going to produce any amazing results.

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You Ask, I Answer: Lectins

I was wondering if you had any views on the health impact of lectins in food, assuming the food has been properly prepared.

I’ve had difficulty finding anything reliable or well referenced.

– Anonymous
Jersey, Channel Islands

Lectins are certain proteins — and natural insectides! — found in a variety of foods, including legumes, grains, dairy products, and some vegetables.

When consumed in certain quantities, they can cause severe gastrointestinal distress. It is also theorized that long-term lectin consumption can raise the risk for certain types of cancers.

However, cooking renders lectins inactive, so you are only vulnerable if you tend to eat certain foods (such as legumes or rice) in raw or undercooked forms.

Peter D’Adamo, author of The Blood Type Diet, blames lectins for a myriad of health problems.

According to Dr. D’Adamo, lectins can cause red blood cells to stick together and form clots if they are eaten by someone with a certain blood type.

While lectins have been implicated in the clogging of arteries in some animal species, we do not know if that effect is replicated in humans.  If it were, though, it would not be limited to humans of one particular blood type.

Again, unless your diet is very high in raw legumes, grains, and dairy, I don’t think you have a reason to be too concerned.

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You Ask, I Answer: Fiber

I have a question I was hoping to get your take on.

Recent news advocate a higher consumption of fiber. In response, there seems to be an overwhelming array of new products supplemented with additional fiber.

I have noticed that 25 – 35 grams per day is deemed ideal, but with these new products, it is very easy to go over that figure.

I have estimated my total intake to be as high as 60 grams a day sometimes.

Is it dangerous to consume too much fiber? Should I be worried about vitamin absorption?

– Susan (last name unknown)
Via the blog

Fiber recommendations have been around for decades. The 25 – 35 grams per day guideline is not as new as many people think.

What has emerged over the past few years are new studies highlighting the importance of fiber in the diet.

Some people erroneously believe that if “x” amount of fiber is beneficial to health, then twice or three times as much is even better!

Not quite.

Although 25 – 35 grams are the standard recommendation, the majority of adults can take in as many as 50 grams without any negative health consequences.

Your body is sure to let you know when you’ve had too much of a good thing.

In the case of excessive fiber intake, the symptoms to look for includes abdominal pain, very loose stools, bloating, and persistent gassiness.

Mind you, those symptoms can also show up if you are suddenly increasing your fiber intake (say, from 10 grams a day to 25 grams a day) or if your diet is high in fiber but very low in liquids.

I am not a big fan of extremely high fiber cereals like All Bran.

Although they can provide as much as 80% of daily fiber needs in one sitting, I would much rather people spread out their fiber throughout the day and get it from foods that naturally contain it (as opposed to added on in copious amount during processing.)

Excessive fiber intakes don’t tend to inhibit vitamin absorption; iron and calcium absorption is most heavily impacted.

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Numbers Game: Answer

A prospective study on holiday weight gain published in the New England Journal of Medicine in the year 2000 found that, on average, people gain 1 pound(s) during the holidays (from mid-November to early January).

I know, I know. Just one?

It may not sound like a lot, but consider that these holiday pounds are usually not lost once the New Year begins — or ever, for that matter.

You can see, then, how someone can gain ten pounds in the course of a decade simply by being careless over a five-week period — even if they are on top of their game the other 47 weeks!

Some studies have also found that people who are already overweight tend to put on an additional pound during the holidays.

I would be interested in seeing this same study done in countries where the holidays take place during the Summer months (i.e.: anywhere south of the Equator,) where rich, high-calorie foods aren’t as weather appropriate.

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Supersize Skies

I arrived in my home country of Argentina earlier today.

There are certain things I can always count on during my annual December trip: ninety degree weather, daylight past 9 PM, and looks of confusion when I mention things like “tofu,” “seitan,” “hummus,” and “vegan desserts.”

Prior to arriving to Buenos Aires, I flew from New York City to Miami.

I found the on-board snack choices quite interesting.

We coach-class passengers could purchase a jumbo 450-calorie cookie for $3, an entire container of Lay’s Stax for that same amount, or a cheese/nut/raisin platter for $4.

The platter aside (which, nutritionally speaking, I was very satisfied with), we are looking at jumbo portions being the ONLY options.

As Brian Wansink and others have found, when food is in front of us, we are highly susceptible to eating it in its entirety, regardless of our hunger level.

It boggles my mind that instead of offering, say, a 200 calorie bag of potato chips, the only option provided to passengers is a tube containining eight 150 calorie servings!

Since some of these flights last 3 or more hours, it is completely feasible that what starts out as a desire for a small nibble could easily turn into intermittent snacking on three or four 150-calorie servings of potato chips.

This is why I always recommending bringing your own healthy snacks on board. You’ll save money — and unnecessary calories!

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Dear Governor…

Several readers have e-mailed me over the past week asking what they can do — and who they should contact — to get mandatory calorie labeling in their state’s fast food chains.

The folks at the Center for Science in the Public Interest kindly provide a form letter you can submit electronically to your Governor.

If advocacy writing is your forte, you can always use that letter as inspiration for your own missive.

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If You’re Still Looking For That Perfect Gift…

… for a nutrition-phile, I highly recommend What The World Eats (which I was actually gifted yesterday!).

An adaptation of last September’s Hungry Planet by award-winning photo journalist Peter Menzel and author Faith D’Aluisio, this made-to-be-displayed-on-the-coffeetable book captured what a week’s worth of groceries looks like for 25 families in 21 countries.

Weekly food expenditures are broken down by category (i.e.: dairy, fruits/vegetables/nuts, snacks, etc.) and meticulously itemized.

The beautiful photographs are accompanied by illuminating narratives of each family’s experience with food.

The Aboubakar family, for instance, is originally from Sudan, but resides in a refugee camp in neighboring Chad.

Their food is rationed and minimally diverse (their only two sources of grains consists of sourghum and a patented corn-soy blend).

The Dong family of Beijing, meanwhile, spends $155.06 US dollars on food each week; $27.95 are spent solely on beverages like Coca-Cola, instant coffee, grapefruit juice, and beer.

Peppered throughout the book are incredible statistics (annual consumption of soft drinks per person in France adds up to 23.8 quarts; in the United States, that figure clocks in at 54.8 GALLONS!) and a variety of informative charts and graphs.

This work of food for thought should satisfy many curious minds’ hunger.

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You Ask, I Answer: PolyCystic Ovary Syndrome, Milk

I have a condition known as PolyCystic Ovary Syndrome, which results in my hormones being all out of whack.

I’m befuddled as to which would further alter my hormone levels more (and which hormones that would be): cow’s milk or soy milk?

I have read that bodybuilders [try to avoid] soy-based protein powders because they increase estrogen [levels], but I have also read reports that the hormones in cow’s milk can cause girls to [begin] puberty at a younger age.

Would drinking organic milk be the solution?

– Rachael (last name unknown)
(city unknown), NJ

Let’s first begin by touching upon some nutrition-related specifics regarding PolyCystic Ovary Syndrome (POS).

The hormones found at high levels in affected individuals are a group of male hormones known as androgens.

One interesting theory that has emerged about risk factors for POS (other than being overweight or obese) surrounds the body’s inability to use up insulin efficiently.

Since high levels of free-floating insulin building up in the blood can increase the amount of androgens produced, it is believed this could be a factor behind the development of this syndrome.

This is also why POS in itself is a risk factor for Type-2 diabetes.

From a nutritional standpoint, the best recommendation is to lose excess weight, as this often results in more efficient use of insulin by the body and, consequently, lower production of androgens.

The catch-22 is that, for many individuals, it is precisely this hormonal imbalance that can add a degree of difficulty to achieving weight loss.

Consequently, I highly recommend that you speak to a Registered Dietitian (as opposed to picking out a diet plan from a book or magazine, even if it is from a highly reputable source.)

With POS, you need a customized plan based on your individual situation.

It really doesn’t make a difference to your condition whether you include dairy or soy milk in your diet, as neither of these have a particular effect on androgen levels.

As for the link between hormones in milk and early puberty — I don’t buy it.

After all, milk consumption has been on a steady decline over the past two decades. It’s children’s intake of soda — not milk — that has skyrocketed since the 1980s!

A much more realistic explanation for the recent trend of earlier puberty initiation? Increasing obesity rates among children.

Highly respected endocrinology journals have published a handful of studies over the past few years — such as this one — making interesting physiological connections between high BMI levels and earlier sexual maturation in girls.

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You Ask, I Answer: "No Salt Added"

I bought some soup [labeled] “No Salt Added.”

[The nutrition label on the back] says each serving (there are two in each can) has 25 milligrams of sodium.

Shouldn’t it be zero milligrams since there’s no salt added?

– Rebecca Alpert
(city withheld), GA

Welcome to the confusing world of food labeling.

For starters, many people mistakenly interchange the terms “salt” and “sodium,” even though they mean different things.

Sodium is a mineral. Salt is the combination of sodium and chloride (approximately 40% sodium and 60% chloride).

If you’re talking numbers, this means that one gram (1,000 milligrams) of salt contains 400 milligrams of sodium and 600 milligrams of chloride.

A lot of people get confused when they read some literature calling for no more than 5 grams of salt a day, while other materials make reference to 2,400 milligrams of sodium.

Five grams of salt amount to roughly 2,000 milligrams of sodium (40 percent of 5,000), NOT 5,000 milligrams.

As for “no salt added” items containing sodium — they are technically telling the truth.

“No salt added” simply means that sodium chloride is not tacked on. Ingredients naturally containing sodium can be included in these products.

Remember, many foods naturally contain tiny amounts of sodium. A cup of raw broccoli, for instance, provides 30 milligrams.

From a legal standpoint, products with a “no salt added” claim are required to also print “not a sodium-free food” in the front of their packaging (although this is usually done in tiny print.)

Considering that most soups pack in as much as 700 milligrams of sodium per serving, 25 milligrams is certainly very low!

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In The News: The City of Brotherly Love Gets Tough

Add another city to the “calories on menu boards” list!

On Thursday afternoon, Philadelphia mayor Michael Nutter “signed a bill that orders chain restaurants [— including coffee shops, ice cream parlors and convenience stores — with a total of 15 or more stores, whether in the city or elsewhere,] to display calorie, saturated fat, trans fat, carbohydrate, and sodium information [for all menu items by January 1, 2010.]

The cherry on top? “Nutter signed the bill at the Center for Obesity Research Education at Temple University,” the Associated Press reports.

I am personally looking forward to the day trans fat labeling becomes irrelevant following a national ban on restaurants’ use of partially hydrogenated oils (that is no starry-eyed dream — Denmark paved the way in 2003, and Switzerland followed suit in April of this year.)

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