Eat your breakfast

You’ve probably heard it a billion times. “Don’t skip breakfast!” But most Americans, adults and children, are not heeding this advice. There are a bunch of reasons why you should eat breakfast within one hour of waking. And it’s even better if the meal is Zone balanced – the correct amount of lean protein, low-glycemic carbohydrates and a dash of monounsaturated fat.

After sleeping a full night, your blood sugar level is low, and you are in a catabolic state. This means that body has been using up stored energy in the liver as well as beginning to cannibalize your muscle for energy. If you skip breakfast, your blood sugar stays low and cannibalization of your muscle will continue. This is a stress situation, and the body releases more cortisol as a response. This creates insulin resistance that increases insulin levels further, driving down blood sugar even more. No wonder by mid-morning you are incredibly hungry.

The whole basis of the anti inflammatory diet is to keep your insulin in a zone, not too high and not too low. This will stabilize blood sugar and prevent continuing muscle degradation for energy. Eating a Zone breakfast can help keep your insulin stabilized, provide the necessary protein to start rebuilding muscle mass and increase the levels of glycogen in the liver. This is called anabolism. It is this continued balance of catabolism and anabolism that we call metabolism. As long as the two phases of metabolism are balanced, so are your weight and your mood. This is why breakfast is so critically important for your alertness, productivity, increased cognition and memory, satiety, and weight control because it starts your day out on a high note as opposed to digging a deeper hormonal hole that you try to crawl out during the rest of the day. A balanced Zone breakfast is also the easiest way to keep your sugar cravings under control during the day. In other words, you will not need the constant trips to the vending machine or your secret stash of candy to artificially maintain blood sugar levels.

Still not convinced? Then give your kids breakfast. Research shows a link between regular breakfast consumption and improvement in academic performance and psychosocial functioning as well as cognition among children. Eating a breakfast every day will be the best way to protect any child against becoming overweight. Make that a Zone breakfast balanced in protein, low glycemic-load carbohyrates, and monounsaturated fat, and you have the ideal pediatric weight-loss program as obese children are less hungry at their next meal as demonstrated at Harvard Medical School more than a decade ago.2 This finding at Harvard was also confirmed by a research study in the Journal of the American Dietetic Association on breakfast consumption among children that found the prevalence of obesity to be higher in those who regularly skipped breakfast.3 Evidence also suggests that breakfast consumption may improve cognitive function related to memory, test grades, and school attendance.4 Want the smartest and leanness kid in the school? It’s easy — feed them a Zone breakfast every day. While you are at it, make each of their meals a Zone meal and give them plenty of EPA and DHA at the same time.

[1] Affenito S. “Breakfast: A Missed Opportunity.” Journal of the American Dietetic Association 107:565-69 (2007)

2 Ludwig DS et al, “High glycemic index foods, overeating, and obesity.” Pediatrics 103: e26 (1999)

3 Deshmukh-Taskar P et al. “The relationship of breakfast skipping and type of breakfast consumption with nutrient intake and weight status in children and adolescents: The National Health and Nutrition Examination Survey 1999-2006.” Journal of American Dietetic Association 110:869-78 (2010)

4 Rampersaud G et al. “Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents.” Journal of American Dietetic Association 105: 843-60 (2005)

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.

More bad news on Toxic Fat with a glimmer of hope

Last month, I discussed disturbing new data on the impact of omega-6 fatty acids on genetic expression (Cardiovascular Psychiatry and Neurology (2009;2009:867041). At the recent International Fatty Acid Conference in the Netherlands I had the opportunity to talk with Joe Hibbeln, the lead author, of that study at length.

During the conference, his group presented more data on how excess omega-6 fatty acids double the production of endocannabinoids (the hormones that make you hungry). Furthermore, increasing the intake of omega-6 fatty acids from 1 percent of total calories (what it was in 1960 and apparently all the way back to 1900) to 8 percent of total calories (the current level in the American diet) causes massive genetic changes that result in greater obesity.

It should be noted that the American Heart Association recommends 5-10 percent of total calories should be omega-6 fats. Let’s put this into perspective. 1 percent of total calories represents about 20 calories or about 2 grams of omega-6 fatty acids. That’s the amount to fill about one-half teaspoon. Eight percent of the total calories (assuming a 2,000-calorie-per-day intake) represent 16 grams of omega-6 fatty acids. That’s the amount that would fill a tablespoon.

There it is. The difference between being lean and fat may be determined by a very small amount of the same fats being pushed by agribusiness and the American Heart Association. These fats are ubiquitous as they also represent the cheapest form of calories and are the foundation of American agribusiness.

The only good news from the conference is that if you take 2 grams of EPA and DHA per day, you can reverse the inflammatory damage done by the increase in omega-6 fatty acid consumption. So maybe our obesity epidemic started the day that mothers stopped giving their children a daily tablespoon of cod liver oil that would have contained 2.5 grams of EPA and DHA. Fortunately, you can get the same amount of EPA and DHA today with only four capsules or one teaspoon of OmegaRx and without the excessive toxins contained in today’s cod liver oil or other fish oil available in grocery or health-food stores.

But without the added EPA and DHA in the American diet, we are probably doomed to become fatter, sicker and dumber with each succeeding generation.

United States’ major export: Obesity

By Dr. Barry Sears

Back in 2005, in my book “The Anti-Inflammation Zone” I wrote that many trends start in the United States and then cover the globe. We’ve exported Big Macs, Coca-Cola and the USDA Food Pyramid.

Now, five years later a report from the research organization, Datamonitor, indicates we have also exported childhood obesity – now more than one-third of European children are obese.

The organization attributes this weight gain to increased affluence and blames the usual suspects. “This is caused by a combination of eating too many calories and not doing enough physical activity,” according to the report.

That’s the same mantra that is used over and over in the United States. But obesity will not be curbed by eating less and exercising more unless we find shelter from the perfect nutritional storm that began in the United States and now has been exported across the globe.

New research indicates the primary factor has been the increasing consumption of omega-6 fatty acids found in vegetable oils, made in the USA.

The United States is also the king as far as processed foods are concerned, and we’ve been happy to share our junk food with children around the world.

And in Europe, as well as here at home, the amount of omega-3s consumed has dramatically declined.

The solution is to follow an anti inflammatory diet, increase intake of omega-3 fatty acids and dramatically reduce the intake of omega-6 fatty acids. Unfortunately this is easier said than done because of the ubiquitous presence of omega-6 fatty acids in virtually every processed food. Fortunately, increased intake of EPA and DHA (about 2.5 grams of EPA and DHA per day) can dilute out the inflammatory impact of these excess omega-6 fatty acids on our genes.

The bottom line, no pun intended, is that if there is no dietary change, children will continue to get fatter no matter how much they exercise because the genes that make children fat and keep them fat are being constantly turned on by diet they consume.

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.

Bringing back the lost art of cooking

If someone were to look at your eating habits throughout the week, what would they find? Are you the one who religiously stops at Dunkin’ Donuts or Starbucks in the morning for your caffeine fix? Do you pack your lunch or eat out each day? Is eating out still considered a treat for you or is eating in a rarity?

For many Americans the hectic pace of life has led them to eat the majority of their meals away from home. Despite the numerous television shows that captivate our attention from Top Chef and Iron Chef to The Food Network, many individuals have no clue how to cook and have to rely on convenience foods for their meals. This can wreak havoc on our waistlines. A recent editorial in the Journal of the American Medical Association proposed how to address this on the pediatric level with the reemergence of Home Economics. Most kids probably have no idea what “Home Ec” is, but the thinking is that having a revamped course that equips students with the know-how on cooking basics, calorie requirements, budgeting principles, food safety and nutrition, will lead to the development of life skills that will help to reverse obesity and the diet-related diseases that are becoming more prominent in this population (1).

Let us know your thoughts. Do you think bringing back Home Economics would make a difference with the eating habits of the current youth?

1) Lichtenstein AH, DS Ludwig. Bring Back Home Economics Education. JAMA. 2010;303(18):1857-1858.

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.

A calorie’s a calorie … not quite

Anyone who has tried to lose weight before I’m sure is familiar with the magic number of 3,500. That is the number of calories believed to be equivalent to one pound of body weight. Simply lower your caloric intake by 500 calories per day, and you’ll lose one pound per week. If only it were this easy. For people who like dealing with numbers, equations like this make sense, but for those of us who have tried to make this equation a reality, it can lead to frustration when the scale doesn’t change at the end of the week or as quickly as we’d like despite our hard efforts.

Unfortunately, our bodies aren’t machines and don’t always react to changes in intake or expenditure as we’d like them to. A recent commentary in the Journal of the American Medical Association by Katan and Ludwig brings this equation to light with regards to public health initiatives to influence the obesity epidemic (1).

Traditional thinking suggests that when energy intake exceeds energy expenditure, weight gain results; and when energy intake is less than energy expenditure, it leads to weight loss. In the short term this may be true, but it may not be as simple as a 500-calorie deficit per day. Katan and Ludwig point out that if someone were to consume a 60-calorie cookie every day for the rest of their lives, in theory it should produce a one-half-pound weight gain in a month, six pounds in one year and 27 pounds in a decade; but this doesn’t happen. Overfeeding studies suggest that this additional 60 calories will result in about a six-pound weight gain, which will level off after a few years. These additional calories will go into repairing, replacing, and carrying the extra body tissue (1). The same thing happens with weight loss. The initial decrease in intake and expenditure will result in weight loss, but our bodies become very efficient and go into a conservation mode where these deficits will eventually stabilize. It will take an even greater reduction in calorie intake and expenditure to accomplish a new low. Although little changes can make a difference, when dealing with the obesity epidemic, it would take drastic reductions that would be unrealistic on a personal level, so public health initiatives will need to focus on the food supply, manufacturing policies and environment to encourage change (1).

1) Katan MB, Ludwig DS. Extra calories cause weight gain–but how much? JAMA. 2010 Jan 6;303(1):65-6.

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.

Getting kids to eat more fruits and vegetables

It is well known that portions sizes in the United States have increased tremendously throughout the years, but what about increasing portion sizes as a way to promote increased fruit and vegetable intake among children? It may just a work.

A recent study published in the March edition of Obesity examined just that (1). The study took 43 boys and girls ages 5 and 6 and fed them dinner once a week for two weeks. Each dinner consisted of a pasta dish with tomato sauce, milk and varying portion sizes of carrots, broccoli, and unsweetened applesauce. At each meal the size of the pasta dish remained the same, but the portion size of the vegetables and fruit served were doubled between visits. At the meal in which the portion size of the fruit and vegetables was increased, the children consumed 43 percent more of the fruit dish and less of the main entrée. This may be one way to get your kids to eat more fruits and vegetables and decrease their intake of more energy-dense foods.

Kids tend to be picky eaters so when preparing vegetables you need to get creative. In addition, it’s important to continue to expose them to various fruits and vegetables numerous times. The best time to introduce new fruits and vegetables is during meals they enjoy rather than having all new foods that are foreign to them. Consider having colorful salads with a dash their favorite salad dressing or melt some low-fat cheese on top of their broccoli. Incorporate vegetables into the meal itself instead of serving them separately or in the morning give them a yogurt parfait with fresh strawberries.

Starting a garden or getting kids involved with the preparation of their favorite fruits and vegetables also works to boost consumption of these foods. This doesn’t mean you have to smother vegetables in high-fat sauces and dressings or put sugar on fruit, but the more creative and tasty you make it, the more they’ll eat.

1) Kral TV, Kabay AC, Roe LS, Rolls BJ. Effects of doubling the portion size of fruit and vegetable side dishes on children’s intake at a meal. Obesity (Silver Spring). 2010 Mar;18(3):521-7.

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.

Water and Weight Loss: Is there a connection?

Throughout my career, a common question that arises is whether water consumption before or during a meal really helps with weight loss. A common responses to this question is that people often confuse hunger for hydration, but a recent study may provide an answer to this question that is based on science. A randomized clinical trial published in the February edition of Obesity examined how water intake might affect weight loss in overweight and obese individuals age 55-75 (1). One group received a low-calorie diet with an emphasis on increased water consumption (water group: 16 fluid ounces of water prior to each of the three daily meals), and the other received a low-calorie diet alone (non-water group).

Neither group was aware of the true intention of the study prior to participating. There were no differences between the two groups at the start of the trial with regards to age, anthropometrics, blood chemistry or physical activity. Measurements were taken at baseline and at the end of 12 weeks. At the end of the trial both groups had lost a significant amount of weight, but those who had been instructed to consume 16 fluid ounces of water prior to each meal had a 44 percent greater weight loss than the non-water group. This equated to an approximate four-pound difference between the two groups. The mechanism through which water may be impacting weight is not fully understood, but it may be in part that it reduces energy intake at each meal and increases feelings of fullness.

1) Dennis EA, Dengo AL, Comber DL, Flack KD, Savla J, Davy KP, Davy BM. Water consumption increases weight loss during a hypocaloric diet intervention in middle-aged and older adults. Obesity (Silver Spring). 2010 Feb;18(2):300-7.

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.

Give your second brain a chance

Most people think of the brain as the primary organ that does all of the information processing for the body. Actually, you have a second brain that is just as important. This second brain is your gastrointestinal (GI) tract that constantly senses dietary input and sends the resulting information to the brain to tell it when it can switch from seeking food to other activities, such as building cathedrals. This is why biological urges always overwhelm cognitive urges. Controlling these biological urges is not a matter of willpower but an integrated hormonal balancing mechanism. Try holding your breath for 25 minutes. It simply can’t be done not due to a lack of willpower, but because after about two minutes, the body’s need for a continual supply of oxygen overwhelms any other desire or course of action. The same is true of eating. It’s not a matter of willpower that controls appetite, but continual hormonal communication from the second brain as to whether or not there are adequate calories in the pipeline that can be ultimately converted to chemical energy to keep the body going.

There are hundreds of hormones released from your second brain to relay information on the body’s current food status. Two of the most important are PYY and GLP-1. These hormones are released from L-cells deep in the lower part of the GI tract. PYY is released in response to protein (1,2), and GLP-1 is released in response to carbohydrate (3). Both hormones are important because they also regulate satiety.

Both of these hormones are significantly increased after gastric bypass surgery (4,5), and this may account for the dramatic long-term benefits of the surgery on both weight loss and diabetes (6-8). The secret of the success of gastric bypass surgery may lie in the re-routing of the GI tract, which now brings a lot more protein and carbohydrate to their receptors found in L-cells that are located in the most distant parts of the GI tract. Apparently in obese individuals, much of the ingested protein and carbohydrate is broken down and absorbed much higher up in the GI tract. As a result, a relatively small amount of these macronutrients are sensed by the L-cells resulting in limited amounts of PYY and GLP-1 released from the GI tract to suppress hunger. As a consequence, obese individuals are constantly hungry.

This also begins to explain many of the seemingly contradictory reports on the benefit of low glycemic-load diets, like the Zone Diet, for weight loss (9, 10). The end result is to state that all diets are equally effective in weight loss since a “calorie is a calorie”, and if you restrict calories, the weight loss is identical. Of course, this simple thinking neglects genetic diversity. One study done by Harvard Medical School indicated that in genetically identical rats, weight gain is strongly correlated to the glycemic load of the diet (11). Based on this study, Harvard later conducted a clinical experiment putting overweight individuals on iso-caloric diets with differing glycemic loads for 18 months (12). If you just looked at the changes in weight, both diets were equally effective, indicating again that a “calorie is a calorie”. However, if the two groups are broken into high-initial-insulin responders versus low-initial-insulin responders, you find a very different picture emerging. For the high-insulin responders, their weight loss and long-term weight maintenance was considerably better on the low glycemic-load diet, just as it was with genetically identical rats. So this means that for those with a high initial insulin response to carbohydrates, a low glycemic-load diet, like the Zone Diet, would be their most appropriate choice, indicating a “calorie is not a calorie,” especially when you take into account genetics.

So how does this all science tie together in the real world? My hypothesis is that the fast insulin responders are simply digesting the protein and carbohydrate in a meal and absorbing it at a faster rate. This means carbohydrates enter into the bloodstream at a faster rate (i.e. high glycemic index) and fewer macronutrients (both protein and carbohydrate) are able to reach the lower part of the GI tract where the L-cells are located. This means that less PYY and GLP-1 will be secreted. As a result, there is less satiety, and they are likely to consume more calories. A low glycemic-load diet delays the absorption of carbohydrates, so that more GLP-1 is released from the L-cells. But you also have to slow down the absorption of protein so more PYY can be released. The type of protein that is broken down at the slowest rate is casein coming from milk. Other proteins, such a whey and soy, are rapidly broken down and absorbed in the upper regions of the GI track ensuring very little protein will ultimately reach the L-cells, causing an increase in PYY secretion.

So the ideal diet for those overweight individuals with a high initial insulin response may not only be a low glycemic-load diet (i.e. Zone Diet), but also a diet rich in casein. That’s why I am excited by the new generation of Zone Foods. They have a low glycemic load (similar to fruits) and are also rich in casein. The combination of the two factors may result in increased satiety because the delayed digestion and absorption means more of the initial carbohydrate and protein in the meal is reaching the L-cells, thus potentially releasing more GLP-1 and PYY.

If you aren’t hungry, then cutting back on calories is much easier, especially if you have a high initial insulin response to meals. This is the science behind the new Zone Foods. The science is complex, but the actual execution of that science is not, as long as you like to eat Zone bread, Zone pasta, and Zone pizza.

References

1. Batterham RL; Heffron H; Kapoor S; Chivers JE; Chandarana K; Herzog H; Le Roux CW; Thomas EL; Bell JD; Withers DJ Critical role for peptide YY in protein-mediated satiation and body-weight regulation. Cell Metab 4: 223-233 (2006)

2. Karra E; Chandarana K; Batterham RL. “The role of peptide YY in appetite regulation and obesity.” J Physiol 587: 19-25 (2009)

3. Jang HJ, Kokrashvili Z, Theodorakis MJ, Carlson OD, Kim BJ, Zhou J, Kim HH, Xu X, Chan SL, Juhaszova M, Bernier M, Mosinger B, Margolskee RF, and Egan JM. “Gut-expressed gustducin and taste receptors regulate secretion of glucagon-like peptide-1.” Proc Natl Acad Sci U S A 104: 15069-15074 (2007)

4. Holdstock C; Zethelius B, Sundbom M, Karlsson FA, and Eden Engstrom B. “Postprandial changes in gut regulatory peptides in gastric bypass patients.” Int J Obes (Lond) 32: 1640-1646 (2008)

5. Morinigo R, Moize V, Musri M, Lacy AM, Navarro S, Marin JL, Delgado S, Casamitjana R, and Vidal J. “Glucagon-like peptide-1, peptide YY, hunger, and satiety after gastric bypass surgery in morbidly obese subjects.” J Clin Endocrinol Metab 91: 1735-1740 (2006)

6. Laferrere B, Teixeira J, McGinty J, Tran H, Egger JR, Colarusso A, Kovack B, Bawa B, Koshy N, Lee H, and Yapp K. “Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes.” J Clin Endocrinol Metab 93: 2479-2485 (2008)

7. le Roux CW, Welbourn R, Werling M, Osborne A, Kokkinos A, Laurenius A, Lonroth H, Fandriks L, Ghatei MA; Bloom SR. “Gut hormones as mediators of appetite and weight loss after Roux-en-Y gastric bypass. Ann Surg 246: 780-785 (2007)

8. White S, Brooks E, Jurikova L, and Stubbs RS. “Long-term outcomes after gastric bypass.” Obes Surg 15: 155-163 (2005)

9. Dansinger ML, Gleason JA, Griffith JL, Selker HP, and Schaefer EJ “Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial.” JAMA 293: 43-53 (2005)

10. Gardner CD, Kiazand A, Alhassan S, Kim S, Stafford RS, Balise RR, Kraemer HC, and King AC. “Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial.” JAMA 297: 969-977 (2007)

11. Pawlak DB, Kushner JA, and Ludwig DS. “Effects of dietary glycaemic index on adiposity, glucose homoeostasis, and plasma lipids in animals.” Lancet 364: 778-785 (2004)

12. Ebbeling CB, Leidig MM, Feldman HA, Lovesky MM, and Ludwig DS. “Effects of a low-glycemic load vs low-fat diet in obese young adults: a randomized trial.” JAMA 297: 2092-2102 (2007)

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.

Examining sloth and gluttony at the genetic level

The common refrain for treating obesity is simply “eat less and exercise more”. With obesity rates increasing, how is it possible that so many Americans seem to be unable to follow such simple instructions? The answer may lie in our genes.

Nothing contained in this blog is intend to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.