Thanksgiving statistic

Happy Thanksgiving!

It may or may not shock you to learn that the average American consumes 4,500 cals and 229 g of fat on Thanksgiving.

I'm not concerned with the caloric intake nearly as much as I am the fat intake. With all the healthy tweaks one can make without sacrificing taste, I don't understand it at all. But at least it's limited to once a year.

Make it a day to cherish your family and friends and have the holiday center around that.

By the way, I apologize for my lack of posts. I have so many articles I want to share with you - some really neat information and studies - and hope to soon.

Competitive female bodybuilders and disordered eating and other compensatory behaviors

While research examining disordered eating weight obsession, abnormal behaviors to control weight and full-blown eating disorders comparing female athletes to non-athletes is somewhat equivocal, research seems to support that “the incidence of eating disorders and subclinical levels of eating disturbances appears to be much higher among people who participate in sports, physical activities, or occupations which emphasize thinners or low body fat for enhanced performance” in order to be lean and to also show self-control and discipline.

This study, published in Eating Disorders, included 20 competitive female bodybuilders (CFBBs) and a control group of 20 recreational female lifters (RFWTs) to study the above as well as build on and compare previous results on body dissatisfaction, disordered eating, perfectionism and steroid use in their male counterparts.

To be a CFBB, a woman had to either be actively training for a competition or had done one within the last year. To me, those would be two separate subgroups, as the goals and mentality would be different. RFWTs lifted at least twice a week for 7+ months wh0o had never competed nor had any goal to within the next year.

Because we don’t know what stage the CFBBs were in (cutting, bulking, recomping, how far out from competition they were, etc), I think another control group should have been added: cardio. Some CFBBs rely on diet alone, but when cutting, especially as the competition nears, many engage in high intensity interval training (HIIT). It would also be potentially useful in determine if CFBBs were overdoing the cardio. I also think knowing what stage the CFBBs were in could be relevant to findings and potential implications and/or interventions. It seems like just like those are training for an upcoming competition versus those who recently competed should have been separate subgroups, so too would cutters versus bulkers. And all should be looked at as an aggregate and separately.

Measures included in Beck Depression Inventory, the Eating Disorder Inventory, a paper and pencil version of the Eating Disorder portion of the computerized Diagnostic Schedule, a Bodybuilding questionnaire, The Anabolic Steroid Questionnaire, Drive for Bulk and Drive for Tone.

Note that some of these measures are well-known and commonly used, whereas a couple were developed, and there was no mention of how the questions were formed or by whom, test-retest, reliability and validity, sample questions, etc.

I also think it would have been useful to know how long both groups were working out for. Were they overexercising, either in general or in a non-purging bulimia type of way?

CFBBs reported more binge eating behaviors, were more overly concerned with body weight and shape, had more strict dieting habits, were more dissatisfied with their bodies, exercised more vigorously and had a higher rate of anabolic steroid use than did RFWTs, although they too have a higher prevalence of some of these things than the general population.

For example, bulimia was an issue for 15% of the competitive bodybuilders and 12% of the control group, both of which are much higher percentages than are seen in the general population. Because the rate was so high among recreational lifters too, clearly body dissatisfaction, weight control via unhealthy eating can’t be 100% attributed to or connected with bodybuilding.

While eating behaviors among CFBBs  mimic those with eating disorders, the psychological profiles do not match.

40% of CFBBs used steroids, which kind of shocked me. But maybe this means many competitors were in the bulking stage, especially since they had a greater drive for bulk and muscle tone. This number really seems so high to me. Wow.

However, they also used extreme cardio and strict dieting to control their weight, which would suggest more of them were cutting, in my opinion.

Binge eating was also common in the competitive bodybuilders, which to me also resonates with cutting (prior to competition or soon after), “as “strict dieting, either by avoiding forbidden foods or caloric restriction both of which are common in competitive bodybuilding to reduce body fat, may predispose bodybuilders to binge eating by increasing deprivation of desired foods or decreasing sensitivity to internal cues such as hunger or satiety.”

Ultimately, there is a chicken/egg scenario: Do women recovering from eating disorders disproportionately gravitate toward competitive bodybuilding and/or do the characteristics of bodybuilding foster a subgroup that becomes prone to developing eating disorder-esque behaviors, body dissatisfaction and steroid use?

randi morse, randi.morse@gmail.com, newton, ma

Quote #5

"Overeating is overeating, whether it comes from nutritious food or junk food"  - Keith Ayoob, associate professor of pediatrics at Albert Einstein College of Medicine.

randi morse, randi.morse@gmail.com, newton, ma

A physiological change one year after weight loss among obese individuals

Sumithran et al recently published an article in NEJM wherein they studied 34 adults (originally 50 subjects, but 34 in the end) with an average baseline BMI of 34.7 to assess regulators of appetite (leptin, ghrelin, peptide yy, gastric inhibitory polypeptide, glucagon-like peptide l, amylin, pancreatic polypeptide, cholecystokinin and insulin) and subjective ratings of hunger throughout a 10 week weight-loss program and throughout a year following.

It had previously been shown that some of the peripheral hormonal signals as well as energy expenditure changed significantly in periods of caloric restriction, promoting weight regain, so the purpose of this study was to determine if this would be the case with prolonged maintenance of weight reduction.

This is important because many who attempt to lose weight and have an initial loss due to calorie restriction are unable to maintain their decreased weight and regain the weight lost. There is a “high rate of weight regain after diet-induced weight loss.” Many attribute this to lack of self-control, but if regulators of appetite remain changed, this would attest to a physiological reaction.

For 8 weeks subjects were put on 500-550 calories per day (optifast and some non-starchy veggies), which they call a “very-low-energy” diet.

I’d say it’s more like starvation and completely unnecessary. I think weight loss and potential hormonal changes from such an extreme deficit could confound findings and affect the results. I know there are other longer-term programs, like the HCG diet, that have a similar caloric intake, but most obese people do not go on such extreme diets, so I question the generalizability of findings in these obese individuals to the obese population as a whole.

For weeks 9 and 10, subjects who lost 10+% of their baseline body fat were gradually put on regular foods to stabilize their weight and discontinue further weight loss.

At the end of week 10, subjects no longer consumed the optifast shakes, and a dietician counseled individuals on what their caloric should be based on their energy expenditure and recommended low GI carbs, a reduced intake of fat and 30 minutes of exercise most days of the week.

Besides my issues with the calorie intake, I hate that body composition was measured via a Tanita scale. Scales are so inaccurate, and worse, inconsistent, as body fat measure. I am not sure why DEXA scans or something known to be more accurate was not used. Therefore, in my opinion, these numbers are crude estimates as opposed to hard data. At least the subjects did fast overnight before and consistently did so before each of the three tests (baseline, 10 weeks, 62 weeks), but I still find this method completely insufficient.

Many of the hormones, peptides and nutrients involved in one’s body weight regulation changed and lasted for 12 months after weight less, even after some weight was regain, showing that it’s not all about behaviors or willpower, but there were physiological changes.

A decreased energy expenditure lasted the full year.

At the end of week 10, the average weight loss was 13.5 (14% of their baseline weight) and body fat lost was 9.8%, and 7.9 kg and 5.3%, respectively, at the end of week 62, so subjects had gained some weight and body fat back, but were still 8.2% their initial weights and at a lower body fat. Everything was higher at week 10, which is when subjects first went off the supplement.

I want to note that no behavioral measures were involved, so we don’t know if subjects went back to old habits at all or if all results were based on the physiological changes, which, of course, were real. We don’t know how many calories subjects consumed, if they worked out, etc.

All subjective appetite-related factors – hunger, desire and urge to eat, prospective consumption - had increased at a statistically significant level from baseline to weeks 10 and 62, with preoccupation with thoughts of food increasing at week 10, but increasing substantially and at a statistically significant level at week 62. Interestingly, fullness didn’t change from baseline to the other two test points, but significantly decreased at week 62 than at week 10.

The authors suggest that medications might be necessary to manage long-term weight loss in obese individuals. People who continue to be obese after weight loss suggests that “there is an elevated body-weight set point in obese persons that efforts to reduce weight below this point are vigorously resisted,” a point which I agree with (in general, not just with obese people).

My concerns with the study have been noted above, but I do still think this is a useful study and has potential implications.

randi morse, randi.morse@gmail.com, newton, ma

Nutritarianism: Not another fad diet

“[Y]our body has an amazing healing potential waiting to be unleashed by the gift of superior nutrition.”

Simply put, the premise behind nutritarianism, developed by Dr. Joel Fuhrman, is to eat foods – focusing on a diet centered around greens, other vegetables, fruit, beans, nuts and seeds – that are micronutrient-dense and phytochemical-rich in order to strengthen our immune systems and protect us against and reverse illness and disease. An added bonus is weight loss or control (I will have a future post on an article about that).

Part of our problem is that we conform to fad diets that focus on low this and high that, paying complete attention to macronutrients, but the “health-enhancing qualities of a diet are not accurately determined by the level of either for or carbohydrate [or protein]. They are determined by the amount and the diversity of micronutrients.” You can be on a weight loss diet but still be really unhealthy.

The main idea behind nutritarianiam, though, is that food does not just supply us with basic nutritive functions but also has a level of nutrition that protects against and fights disease and benefits the immune system and promotes longetivity. Further, we can prevent most common modern day diseases, such as cancer, heart disease, heart attacks, strokes and dementia, by eating foods rich in vitamins, minerals, and especially phytochemicals.

Greens, cruciferous veggies, mushrooms, onions, and berries play a major role in our health, building our immune system, and protecting against cancer, especially when we eat a combination of them. As well, seeds are high in protein and nutrients.

Nutritional status and health are one factor determining whether or not you get sick and to what degree. When people are well-nourished and healthy, a virus can remain harmless. Optimal nutrition can indirectly and directly protect against infectious disease. Maintaining nutritional adequacy all throughout the year is the best way to protect against illness.

Those are strong claims, and ones he backs up with research and studies (to see more specifics on that as well as specific diseases and vitamins, check out his books, especially Super Immunity), and is a very powerful idea. It really does give credence to the idea that our health is in our hands and that “we are made from the food we eat.”

Dr. Fuhrman thinks 90% of our diet should come from plant-based foods, contrary to what the current practice in the US is, with less than 5% of our calories coming from fruits, veggies, seeds, and nuts. In fact, he thinks the standard American diet is so devoid of nutrients that most of our phytonutrient intake comes from a latte. How sad is that?

He recommends having less than 10% of non-micronutrient-dense foods, no more than one or two a day, and if this includes meat or fish for you, “choos[e] eggs, grass-fed meats, clean wild fish, and naturally raised,

In his pyramid, 30-60% of cals come from vegetables (1/2 raw and ½ cooked), 10-40% from beans/legumes, 10-40% from fruits, 10-40% from seeds, nuts, and avocado, 20% or less from whole grains and potatoes, rarely from eggs, oil, fish and fat free dairy, and rarely from beef, sweets, cheese and processed foods.  We should aim for six fresh fruits and eight servings of veggies a day, including 2 servings of cruciferous veggies (at least 1 of which is raw).

It is easy to find out the foods highest in nutrients by looking at the Aggregate Nutrient Density Index (ANDI), which compares different vitamins, minerals and antioxidxants, with scores ranging from 1000-0. A complete list can be found online, but kale is at the top, and soda is at the bottom. In general, green vegetables are the most nutrient-dense foods that exist.

Dr. Fuhrman has an equation, Health = Nutrients/Calories, suggesting that there is a direct relationship between health and longevity and the more nutrients consumed  per calorie. In other words, ““your health will improve as you eat more foods with a high nutrient-per-calorie density and fewer foods with a low nutrient-per-calorie density.”

There are a few things that Dr. Fuhrman is against (but I want to emphasize that nothing is completely off-limits) that others deem healthy and might surprise people.

First, fish. He acknowledges the benefits of omega 3’s (which he suggests getting instead from flaxseeds and walnuts), DHA and EPA, and thinks that fish is better than other animal products, but still suggests limiting it because it is polluted , containing mercury and PCBs. If you are going to eat fish, try to eat ones containing less mercury, such as shrimp, tilapia, haddock, scallops, squid, trout, hake and ocean perch.

Animal products. I don’t think this will surprise people, based on what I’ve already said about nutritarianism, but according to Dr. Fuhrman, animal products do not do a body good. It can be cancer-producing, and “even egg whites and lean white mean…[are] not longevity-favorable.” He even likes chicken to a cookie in terms of lacking phytochemicals, and immunity-protecting qualities. Reducing animal products is also an automatic consequence of having a diet that is high in micronutrients per calorie.

Milk and dairy. Dairy has sort of always been controversial, and claims on both ends are too extreme and are major exaggerations. But Dr. Fuhrman’s view is you can get the benefits of milk through plant foods, which are high in micronutrients and phytochemicals, and low in saturated fat (if you have whole milk, although he doesn’t like fat free either), which milk is not.

Oil. Finally, someone who agrees with me about oil. Yes, I have read all the research about its health benefits, and dieticians would always try to get me to include olive or coconut oil in my diet (I occasionally added the latter), but I wouldn’t, partly because I am a volume eater, but also partly because of Dr. Fuhrman’s beliefs, which do overlap with my volume eating behavior. Oil is high in calories, low in nutrients, contains no fiber, and is processed. Including more oil lowers the nutrient-per-calorie density of a diet. I will say, though, that for those who are trying to gain weight or just have a hard time getting enough cals in because they get full really quickly, oil is an easy solution. I would recommend nut butter instead, but do think that is a bit more filling and might be a harder choice for some.

I know the Mediterranean diet has proven to have so many health benefits, with heaps if research to back it up, but Dr. Fuhrman suggests this is because of its focus on vegetables and nuts and not because of its emphasis on fish or oil. But I do think the fact that the Mediterranean diet has so much research to back it up shows that you can eat those foods, even though nutritarianism recommends seriously restricting them.

Some people might think this diet is too restrictive to really be healthy, but I argue it’s not. Just like with vegetarianism, veganism, and raw foodism, which nutritarisnism is often compared to but is different than (in part because vegetarians and vegan can still eat a diet full of processed foods), supplementation with vitamin B12,  vitamin D and fish oil is advantageous and probably necessary, but otherwise, you can get everything you need. Avoiding meat and dairy as much as possible might make you think you can’t get enough calcium or protein (a future post will be on the issue of protein), but that is false. Calorie for calorie, bok choy, for example, has more calcium than milk, and broccoli more protein than beef. But those are two of a cornucopia of examples.

He can be a wee bit extreme, though, saying things like, “[t]he white the bread, the sooner you’re dead.” I do however, understand his point, and think the statement is more for shock value and might make people shy away from such a lifestyle, thinking there is no room at all for moderation, when there is, although I don’t think it’s encouraged (and I agree with that. I am not a “anything in moderation” person, although believe it’s  fine for others to be that way).

Basically, nutritarianism is about “the combination of more fruits and veggies in conjunction with a reduction in animal products that offers us the greatest opportunity for longevity.”

I am not a nutritarian. For example, I have two servings of dairy a day. But I still really believe in its tenets and it resonates and intrigues me more than any other lifestyle diet.

randi morse, randi.morse@gmail.com, newton, ma

Sports nutrition knowledge (or lack thereof) among college athletes

This study, “Evaluation of Iranian College Athletes’ Sports Nutrition Knowledge,” aimed to assess university athletes’ knowledge of nutrition as well as the factors that determine their knowledge, namely, their sources of information.

66 basketball players and 141 football players, almost evenly split among males and females, from 4 medical and 8 nonmedical schools (mean age 21.8) filled out a two-part questionnaire. The first part was demographic information and whether or not the subjects had any nutrition training, whereas the second part of the questionnaire examined the meat of the issue: sports nutrition knowledge.

I found Jesseri et al’s description of the questionnaire completely unsatisfactory, so I looked up the reference they used for the measure’s reliability and validity, and found a little more information.

The sports nutrition knowledge questionnaire was developed by six sports dieticians whose questions on concepts relating to sports nutrition were based on  their knowledge and expertise of “practices and misconceptions” encountered by athletes and coaches as well as on  literature.

The questionnaire is 84  questions  (according to the creators. The Jesseri article says 88) divided into five subcategories: 1) The ‘general nutrition concepts’ subsection, which comprised about half the questions, and dealt with identifying the main macro- and micronutrient in specific foods; 2) the recovery subsection (7 questions), which included theoretical and practical sports nutrition aspects; 3) the fluid subsection (5 questions), which asked about adequate fluid intake pre-, during, and post-workout; 4) the weight subsection (15 questions), which asked about weight gain (largely based on myths regarding protein) and weight loss; and, 5) the supplement subsection (11 questions), which addressed athletic supplements, especially creatine.

I wish I had sample questions, had more idea of what the questionnaire was about, and had more information on how the instrument was formed and had more substance, and I only went into the detail I did because I think it is important to know exactly what “sports nutrition knowledge” means in regards to this study and its findings and implications.

The results section too did not go into depth nearly as much as I would have liked. I am very interested in this topic, so I was disappointed. That said, the overall knowledge score was 33.2%, and women, athletes at med schools, those who had completed a university nutrition class, and those who got their information from a nutritionist or dietician scored better than their peers, and these were independent predictors.

For sources of information, 89.4% got theirs from their coach, which is important because, as the authors state, most have little nutrition-specific education (much like how I always say to never trust a personal trainer about nutrition unless they have a separate and specific degree or certificate in nutrition), followed by the media (e.g., cooking shows on which chefs impart their own nutrition beliefs, and, sadly, only two reported a dietician or nutritionist being in the top three sources. Further, only 3 subjects got their info from physicians, and 11 from college classes.

I really wish the subcategories section were richer and provided more in depth information, and there is some more information than I am providing here (barely), but for the subcategories, athletes scored highest on the nutrient subcategory (although none scored higher than 45.3%), and lowest in the supplement category.

The authors find the fact that the total mean percentage of wrong answers overrode the unsure responses (the questionnaire allowed for “yes,” “no,” and “unsure” answers) noteworthy because if they had answered “unsure,” maybe subjects would be more likely to look up the information or at least realize their gaps in knowledge, whereas wrong answers are more likely to indicate that subjects truly believe their responses are correct and are more likely to follow (and maybe pass along to others) faulty information. The authors didn’t say all of that, but that is what I understand and do agree with.

One finding that I think totally also pertains to bodybuilders and personal trainers, as well as the general public, is that two-thirds of athletes thought protein powder can increase size and muscle mass and 47% of men and 43% of women thought protein powder was necessary. I know people think this when it comes to cutting as well, and not just bulking.

Another comparison to bodybuilders is that a study found that96.8% did not know the important role minerals play and 88.2% did not know the importance of water. The latter really surprised me.

I do not think the fact that this study was an Iranian one matters at all. I think the fact is that people know little about nutrition and often obtain their knowledge from less-than-reputable sources, and athletes are hardly immune to that. Ones who are getting their knowledge from coaches and trainers probably think they are in good hands, but they these people are really doing them a disservice.

It might be important to note that Iranian schoolchildren do not receive any nutrition education in their curriculum. Changing this might be one change that would make a difference in both future athletes and coach’s knowledge of nutrition and provide a solid basis for nutrition as a whole. Moreover, requiring classes in college would do even more benefit as would having dieticians or nutritionists involved, especially as there is currently no defined position for them on sports-science teams in Iran. Providing college athletes with proper sources of information, which did make a statistically significant difference in this study, could also help dispel myths and increase athletes’ knowledge-base. Of course teaching coaches about sports nutrition could be key since the majority of athletes, and not surprisingly, I might add, get their info from them.

randi morse, randi.morse@gmail.com, newton, ma

Quote #4

"Exercise is not a thing we do to fix a problem - it is a thing we must do anyway, a thing without which there will always be problems." - Mark Rippetoe

randi morse, randi.morse@gmail.com, newton, ma