What if we call it "calorie cycling" instead?

A study I commented on earlier this week (and another I talked about last year) look at the merits of something they're calling Alternate Day Modified Fasting (ADMF) as a way to lose weight.  But the word "fasting" appears to have a lot of baggage--to many, it implies extreme, dangerous, or even disordered eating.

ADMF is not really fasting at all.  A more accurate term, Calorie Cycling, is now gaining traction and this rebranding may allow people to get  beyond their assumptions and preconceived notions for long enough to evaluate this approach on its merits.

There seems to be a deeply entrenched--but completely arbitrary--notion that we should eat the same number of calories every day. Fans of the evolutionary nutrition movement would point out that primitive man certainly did not have the luxury of constant, consistent access to food. We now suffer from an epidemic of over-nourishment. Maybe it's time to think outside the box a little?

The Logic Behind Calorie Cycling

If you were to cut your normal daily caloric intake by a third, you would lose weight--and fairly quickly. But there are problems with this approach to weight loss:

1. You will probably experience hunger.

2. Staying on the regimen requires constant vigilance, monitoring, and self-control.

3. After about 72 hours of sustained caloric restriction, your body will adjust by slowing its metabolism (slightly).

So, let's say we take the same reduced number of calories. But instead of spreading them evenly throughout the week, we alternate very low calorie days and normal or slightly above normal days. 

Instead of this:

you have this:

 
Over the course of the week, you'd consume the same number of calories on either regimen and experience comparable weight loss.  And, for the sake of argument, let's assume that in both scenarios, you are eating a well-balanced array of nutritious foods.

Does calorie cycling offer any advantages?

Well, for one thing, because there is no sustained calorie restriction, your body does not adjust its metabolism or start catabolizing lean muscle tissue as it would on a sustained low-calorie diet.  Additionally, some people report that calorie cycling requires less will-power than constant restriction. Although you may feel hunger on your low-intake day, you can eat to satisfaction on your high-intake day. Contrary to assumptions, research shows that most people will eat only slightly more calories than normal following a skipped meal or fast.

As a bonus, some studies suggest that calorie-cycling may have benefits unrelated to weight loss, such as reducing oxidative damage, improving insulin resistance, and slowing mitochondrial aging.

Calorie cycling clearly isn't for everyone, and I'd strongly encourage anyone considering it to check in with their doctor or nutrition professional first. Those suffering from hypoglycemia, pregnant, or with a history or risk of eating disorders are not good candidates, for example. Aside from health issues, some people may simply prefer or be more successful on a more traditional approach.

But for some, it may be a helpful alternative strategy. At the very least, I think it's worthy of further investigation and study.

Diets don't work for you? How about fasting?

I was interested to see this new study in the American Journal of Clinical Nutrition which found that an alternate day fasting technique helped people lose weight and improve their cholesterol profiles.

I've talked about the pros and cons of modified fasting for weight loss before and in the last year I've been experimenting with this technique for some of my nutrition counseling clients. This study confirms my own observation: For some people, eating very little some of the time is easier than eating a little less all of the time.

In this particular study, the participants ate whatever they wanted every other day. On the days in between, they ate a single mid-day meal which provided about 25% of their normal calorie needs. At the end of eight weeks, the participants had lost about ten pounds a piece, lowered their body fat by about 6%, and also lowered their total and bad cholesterol.

Is fasting easier than dieting?

Here's what's especially interesting to me: The subjects were able to stick to the diet just as well when they were on their own as they were when their fast-day meals were provided as part of the study.  

What do you think? Would it be easier for you to cut way back on calories every second day if you knew you could basically eat what you wanted the next day?  It seems to be an effective way for overweight people to drop a significant amount of weight.

Modified fasting could also be adapted as a long-term maintenance strategy as well. You might find, for example, that you can avoid regaining the weight by fasting one day a week and eating ad libitum the rest of the days.

Your thoughts?

Is resistant starch better than whole grain flour?

Q. How does resistant starch compare with whole wheat flour nutritionally?  I have been using a half and half  mixture of all-purpose/white whole wheat flour for all my baking.  Would it be "better" to use 100% resistant starch instead?  We are not diabetic, just interested in the best possible generally healthy eating.

A. First, for those who might not be familiar with it, resistant starch is a non-digestible carbohydrate that acts a lot like fiber. Adding resistant starch to the diet can improve bowel function, act as an appetite suppressant, and reduce the calories and glycemic impact of  carbohydrate foods. (You can learn more about resistant starch in this episode of my weekly nutrition podcast.)

Foods containing resistant starch

Resistant starch is found naturally in dried beans, unripe bananas, and starchy foods like potatoes, rice, and pasta that have been cooked and then cooled. Interestingly, sourdough bread contains more resistant starch than regular bread. But as you can see, baking with whole grain flour makes a much bigger difference than using sourdough (and using both is best of all):

White bread = 1.5% resistant starch

White sourdough = 1.8% resistant starch

Whole grain bread = 3% resistant starch

Whole grain sourdough = 4% resistant starch

Resistant starch as a flour replacement

There is also a product called Hi-Maize which is a resistant starch that can be used as a flour replacement in baked goods.  Using resistant starch in place of flour will increase the fiber and decrease the calories and glycemic impact of the finished product.  But I wouldn't recommend replacing ALL of the flour with it. 

For one thing, it's expensive. I found it on Amazon for about $20 for a five pound bag. For another, while fiber is good for you, it is non-nutritive. It contains none of the vitamins or minerals found in whole grain flour. Finally, I don't think you'd be happy with the result.  Breads made with 100% resistant starch would probably turn out more like paper mache than anything you'd want to eat.  The recommendation is to substitute resistant starch for up to 25% of the flour in a recipe.

I haven't yet tried baking with resistant starch. Has anyone else? I'd be curious to hear about your results.

Planning your Thanksgiving menu? Here are some healthy ideas

Few of us exercise strict dietary control on Thanksgiving Day. Most of us cut ourselves a little slack to enjoy the traditional pleasures of turkey, potatoes, stuffing, gravy, pumpkin pie--more or less guilt-free. 

While certain dishes may be non-negotiable at your house, there's usually a bit of flexibility with the side dishes. Here are some truly delicious recipes that will up the nutritional ante of the meal. (If you've been invited to dinner, offer to bring a dish. Take one of these and you're guaranteed to have at least one healthy option.)

Each of these recipes from our sister site Epicurious.com has been analyzed using Nutrition Data's recipe analysis feature, so you can see the full nutritional breakdown of each one and save it to your My Recipes for future reference.

Edamame Dip with Crudite 
A lot of the damage on Thanksgiving Day happens before you even sit down to dinner. After filling on nuts, chips and dip, and crackers and cheese all afternoon, you're likely to arrive at the dinner table already stuffed! Instead, enjoy crisp crudite with a creamy but low-fat dip.
Click here for the recipe
Click here to view nutritional analysis.

Lemon-Roasted Green Beans with Marcona Almonds
Skip the heavy mushroom soup and fried onion treatment and try this light and elegant green bean dish. You can roast the green beans in the oven along with the turkey. If you can't find Marcona almonds, blanched regular almonds work just as well.
Click here for the recipe
Click here to view nutritional analysis.

Carrots and Brussels Sprouts
This just may be the perfect Thanksgiving side dish: seasonal, colorful, delicious, and super-nutritious as well.  The sweetness of the carrots is the perfect complement to the slight astringency of the Brussels sprouts. You can prep the vegetables ahead of time to make things less hectic in the kitchen.
Click here for the recipe
Click here to view nutritional analysis.

5 Minute Slaw
Just what the over-worked cook ordered: a side dish that practically makes itself.  In addition to being low in fat and calories and high in valuable nutrients, a crisp shredded salad is a welcome contrast to the heavier dishes on the menu.
Click here for the recipe
Click here to view nutritional analysis.

From our family to yours, a healthy happy holiday!

How much fructose can you safely eat?

Q. I'm confused by conflicting things I've read about fructose.

[In this article], I read that:

When large amounts of fructose are ingested, they do "provide a relatively unregulated source of carbon precursors for hepatic lipogenesis." In other words, if you eat too much fructose, the liver can make the excess into fat. 

But later in the same article, another scientist is quoted as saying:

There is no evidence that reasonable consumption of fructose in a typical diet has any adverse effect on the liver or that it produces more body fat than sucrose or glucose.

I'm confused. Should we be concerned about fructose actually being stored as fat?  And how much fructose would a typical person have to eat for fat conversion to begin?

A. Notice that whenever the negative effects or dangers of fructose are discussed, it's always in regard to  "large amounts of fructose" or "too much fructose" or "when fructose is consumed in excess."

If you eat too much of ANY nutrient, the excess will be stored as fat. Fructose may be converted to fat more efficiently than glucose but these fat stores are readily mobilized when energy is needed. Over the long term, body fat accumulates because we take in more energy than we spend.

Here's an analogy I used in a recent episode of my weekly podcast: 

Your body stores energy (or calories) in a variety of formats and places in your body. You store a little bit in your blood, a little bit in your muscles, some in your liver, and the rest you store as body fat. It’s a little like storing your money in a number of places. You probably have some in your wallet, possibly some more in your dresser drawer, some in a checking account, and maybe the rest is in a money market account. 

Your body alternately makes and burns body fat all day long, transferring fuel in and out of its various accounts.  When you eat, energy is stockpiled in your body's accounts. As you go through your daily activities, you draw down these reserves. Which account you withdraw energy from will probably depend on how much you need and how fast you need it.

But just like with your money, regardless of which account you withdraw from, you’re still spending the same amount. If you spend less than you deposit, your net worth goes up. And when you burn fewer calories than you take in, you’re going to gain body fat.

Is fructose really the problem?

While it's true that our consumption of fructose has gone up dramatically, it has simply paralleled the increase in our intake of sugar (and calories). Even with the increased use of high fructose corn syrup, the proportion of sugar consumed as fructose has not changed significantly.  So, regardless of what happens when you feed huge quantities of pure fructose to lab rats, I think it's a little silly to say that  the negative effects of too eating much sugar are because of fructose.

How much fructose can you safely eat?

In my opinion, if your intake of added sugar is not excessive and your total calorie intake is appropriate to your needs, you probably don't need to worry about consuming too much fructose.

What's excessive? The World Health Organization recommends limiting added sugars to 10% of calories (something in the neighborhood of 50g/day).  More recently, the American Heart Association has recommended limiting added sugars to 5% of calories. Both are well below the threshold where fructose consumption would be a concern.

What's an added sugar? The WHO defines added sugar as concentrated sugars (white sugar, brown sugar, honey, maple syrup, etc.) that are used in processed foods and beverages, recipes, or at the table.  The naturally occurring sugars in fruits and dairy are not considered added sugars.

Can you eat too much fruit?  You can eat too much of anything. But no-one is claiming that excessive fruit intake is behind the rise in obesity or diabetes (although fruit juice might be another story). Reasonable intake in the context of a typical diet is two to four servings of whole fruit a day.

P.S. The entire article is well-worth reading.

Can better nutrition help small kids grow faster?

Q.  I have a 10 year old daughter who is small for her age and wants to grow and gain some weight. She eats well when she likes what is on the table, however she is kind of picky. She does not care for meat and doesn't eat many vegetables. She loves fruit and would live on pizza if we let her. She takes a multi-vitamin every day. I don't know what to do that would be healthy for her and help her grow. Should I give her a nutrition drink supplement?

A.  First, don't worry too much about your daughter's picky eating habits. It's very common for kids to shun vegetables in favor of pizza and still grow up strong and healthy.  Keep on doing what you can to encourage healthy eating habits without turning the family dinner table into a battle zone.

The truth is that your daughter's height is probably not a nutritional issue. Severe malnutrition can result in poor growth, but I'm fairly certain that this is not the case with your daughter.  Short of growth hormone injections (highly controversial) there's not too much you can do to affect her height, which is genetically programmed.

If, on the other hand, your daughter is underweight, getting more calories into her will help her gain weight.  Foods that are calorie-dense as well as nutrient dense can help. Whole milk, full fat yogurt and cottage cheese, cheese, peanut butter, dried fruit, and nuts are all nutritious, calorie-dense foods that she might enjoy.

I'm not a big fan of nutritional supplement drinks. They're usually very high in sugar (high-fructose corn syrup) and the vitamins and minerals they provide are all found in a multi-vitamin, which she's already taking. I think she'd be better off getting her calories from real food!  You could experiment to see if you can come up with a healthy "milkshake" to supplement her calorie intake. Try some whole milk, frozen bananas, cocoa powder, peanut butter, and a little honey.

Here are some more resources for you to explore.

Growth calculators. Here are a series of calculators that show you how your child's height, weight, and body mass compare to the norms. And here is a calculator that shows you a healthy weight for a child of a certain age and height.

Nutrition for Kids. Here are some previous posts on getting kids to eat healthy, getting kids to eat more vegetables, a recent episode of my weekly podcast focusing on kid's nutrition, and a n interview I did on the Ben Greenfield Fitness Podcast on the subject of kids, nutrition, and obesity

Calorie-dense foods. When you look up foods on ND, you'll see our Nutritional Target Map, which shows you how nutrient dense and how calorie-dense every food is.  Foods for healthy weight gain are those that are both, and they'll map in the lower right hand corner of the map.

People looking to lose weight usually want to select foods that fall in the upper right hand corner of the Nutritional Target Map. These are foods that are nutrient dense but not calorie dense.

For more on how to use the Nutritional Target Map, see our help page. Here is our Nutritional Map Search Tool.

Lactose intolerance less common than we thought?

The National Dairy Council was eager to spread the word about a new study which found that the incidence of lactose intolerance may be much lower than previously estimated: Their press release was dutifully picked up by the health "newswires."

Lactose intolerance is thought to be extremely common, particularly among those of non-European descent. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD) estimates that up to 90% of Asian Americans, 70% of African and Native Americans and 50% of Mexican Americans lack the enzyme that allows them to digest milk sugars.

This latest study, however, focused not on how many people might have a deficiency of the lactose-digesting enzyme, but on how many people thought they were lactose intolerant. Two completely different things.  According to their survey, only 10% of Hispanic Americans and 20% of African Americans say they are lactose intolerant.

News or Propaganda?

The rest of the press release goes on to talk about the nutritional  benefits of dairy products and how health care practitioners should "encourage people with lactose intolerance to try lower-lactose dairy food options to ensure they get the essential nutrients found in dairy," citing "several practical solutions that can allow for consumption of milk and milk products."  And finally, this somewhat ominous warning:

"The report cautions that lactose intolerance should not require avoidance of dairy foods."  Cautions? Really? What exactly are the dangers of avoiding dairy foods again?

No matter how you feel about the nutritional value of dairy products, this kind of propaganda has no place in medical reporting--especially when the press is so prone to simply pick up these sorts of press releases and run with them as news.

Back to the actual study results

Propaganda aside, what does this study really tell us? If the NIDDKD numbers are correct, then this study suggests that the vast majority of lactose intolerance is undiagnosed. Does that matter?

If you are technically lactose intolerant (you lack the lactose-digesting enzyme) but eating dairy causes you no symptoms, is there any reason to avoid it?  The NIDDKD seems to consider lactose intolerance more of a lifestyle issue than anything else. It's fairly harmless--unless symptoms are severe. Severe, sustained diarrhea, for example, could cause dehydration, electrolyte imbalances, and upset the balance of intestinal flora.

But maybe there are simply a lot of people who could feel a lot better than they do--folks with mild to moderate symptoms that they don't associate with dairy products.  If anything, perhaps this study simply is a red flag to health care practitioners to consider undiagnosed lactose intolerance in patients who report chronic symptoms.  Avoiding dairy (or using lactaid or lactase-treated products) on a trial basis is simple enough and could potentially improve quality of life.

What do you think?

Vitamin D deficiency doesn't "explain" kidney disease

The winner of this week's Most Misleading Medical Headline Award is:

Low Vitamin D Level Explains Most End-Stage Renal Disease Risk in African Americans

I beg to differ. 

African Americans are more likely to have low vitamin D levels. They are also more likely to suffer from kidney disease. The correlation between these two facts appears strong. However, this "explains" nothing.  There's no evidence to show that vitamin D deficiency causes kidney disease--nor any proposed mechanism to explain how it might do this. And, as the investigators themselves point out, no evidence that raising vitamin D levels will reduce this risk.

Maybe I need to create a new category for these posts: Good research, badly reported.

Where do I find the potassium content of foods?

Q. My husband needs to reduce potassium/sodium levels in what he eats. I find the sodium levels but potassium is rarely listed. How do I find this?

A. Information about sodium is required on the nutrition facts label but information about potassium is optional--and many manufacturers don't include it.  The ingredient list won't contain many clues, either.  Products that are marketed as "heart-healthy" are more likely to list potassium content, by the way. Usually, these are foods that are relatively high in potassium and low in sodium.

You can look up the potassium content of foods here on ND, of course. Simply scroll down to the Nutrient Information box on any food detail page to see the amount of potassium that food contains. (Remember to select the appropriate serving size at the top of the page.) You can also use our nutrient search tool to research which foods are highest and lowest in potassium and sodium. 

In general, fruits and vegetables are the richest sources of dietary potassium. The average person eats about 3,000 mg of potassium a day. People with the highest intake of fruits and vegetables take in 4 or 5 times as much.

Fruits and vegetables that are particularly high in potassium include beet greens and spinach, potatoes, lima beans, green soybeans (edamame), bananas, prunes and prune juice, acorn squash, tomato juice, and raisins.  

Fruits and veggies for a low potassium diet

Of course, fruits and vegetables are among the healthiest foods that you can eat--which creates a bit of a dilemma for those who need to restrict potassium.  Fruits and vegetables that are relatively low in potassium include turnips and turnip greens, Napa cabbage, bean sprouts, leeks, pears, blueberries, cranberries, and apples. Cooking (and draining) vegetables and fruits can also remove up to 70% of the potassium--although other nutrients are lost as well. 

Hope that helps!

Diabetes Month: Three ways to reduce your risk

November is American Diabetes Month, an annual observation that "shines a spotlight on a serious disease that leads to potentially life-threatening complications such as heart disease, stroke, kidney disease, blindness, and amputation."

I'm  not sure a spotlight is enough: We need a fire extinguisher.  The number of adults (and children!) with Type 2 diabetes is growing at a sickening pace--and with that, the amount of money being spent to treat the disease and its complications, to say nothing of the human costs.

Diabetes: more than just an expensive nuisance

Too many people tend to think of diabetes as a relatively minor thing--an inconvenience, a hassle, an expense. It's much more than that. Diabetes kills almost 6,000 Americans every week. Thousands more lose limbs...or their eyesight.  And if current trends continue, this is the future faced by one out of every three American children.

Diabetes is highly preventable

Here's the most frustrating thing about this: The vast majority of Type 2 diabetes could be prevented. There is a genetic component, but Type 2 diabetes is by-and-large what we call a "lifestyle" disease. In other words, it's a disease that most people could avoid by making healthier choices.

Regardless of your family history, you can vastly reduce your risk of diabetes by doing three simple things.

1. Lose weight if you need to.   Being overweight is a primary risk factor for developing diabetes and one that you can control.  Losing even 10% of your current body weight dramatically reduces your risk of developing diabetes. 

2. Get moving.  Regular exercise improves insulin function, helps you maintain a healthy weight, and reduces your risk of diabetes. It can be as simple as taking a brisk 30-minute walk every day.

3. Eat a low-glycemic diet.  A diet high in sugary foods, beverages, and refined carbohydrates increases your risk of developing Type 2 diabetes by over-working your insulin receptors and pancreas.  Trade the sweets and starches for whole fruits and vegetables, protein foods, legumes, whole grains, and healthy fats and your risk plummets.

It's never too late to prevent Type 2 diabetes

If you already have Type 2 diabetes, the same things that help prevent Type 2 diabetes can help you treat and even reverse the disease.

Learn more:

Diabetes Risk Calculator

What's a Low-Glycemic Diet?

Four Weeks to a Fitter You

Nutrition Data Type 2 Diabetes Resource Center

Nutrition Data Dieting & Weight Loss Resource Center