Dietary Lapses

What is the frequency and predictors of dietary lapses?  A paper from several years ago looks into this, abstract:

BACKGROUND:

Adherence to dietary prescriptions is critical for successful weight loss and weight loss maintenance. However, research on specific instances of inadherence (lapses) is limited, and findings regarding the frequency, nature, and causes of lapses are mixed. Additionally, no studies have examined lapses over the course of a weight loss program.

PURPOSE:

In the context of a reduced calorie diet prescribed as part of a behavioral treatment, we aimed to characterize lapse occurrence, examine lapse frequency across treatment, examine predictors of lapses, and assess the relationship between lapses and weight loss.

METHODS:

Adults (n = 189) enrolled in a 12-month behavioral weight loss program completed ecological momentary assessment (EMA) at baseline, mid-treatment, and end of treatment. At each EMA survey, participants indicated whether a lapse had occurred, and responded to questions assessing situational, environmental, and affective states.

RESULTS:

Lapse frequency showed a curvilinear relationship over time, such that frequency first decreased and then increased. Lapse frequency at baseline was negatively associated with early and overall weight loss. Lapses most often occurred at home, in the evenings, on the weekends, and entailed eating a forbidden food. Greater overall levels of assessed affective and environmental triggers predicted lapses, and greater momentary hunger and deprivation, and the presence of palatable food, also prospectively predicted lapses.

CONCLUSIONS:

In addition to characterizing lapse frequency, the current study identified prospective predictors of lapses across treatment. These findings support the importance of lapses to weight control and provide insight for potential targets of intervention to prevent lapse occurrence.

One point I would raise in response to: "Lapses most often occurred at home, in the evenings, on the weekends, and entailed eating a forbidden food. Greater overall levels of assessed affective and environmental triggers predicted lapses, and greater momentary hunger and deprivation, and the presence of palatable food, also prospectively predicted lapses" is to suggest that a pre-planned cheat meal (for those more overweight) or cheat day (or those who cab be more flexible, who have less weight to lose) may alleviate some of these problems.  The key is discipline, not to "cheat" all week.  "Cheating" may help reset metabolism and leptin levels and avoid the slowing of metabolism that accompanies dieting (although this requires more evidence).  The psychological benefits are obvious.

Physiotherapists And Knee Osteoarthritis

How consistent are physiotherapists in the advice they give to knee osteoarthritis patients?  It could be better, it seems.  The important message from the linked paper's abstract: 

Quality indicator compliance less than 50% was found for: education on the importance of weight loss, providing self-management strategies, spreading treatment session over longer periods and regular evaluations of the exercise therapy.

Less than 50% give advice for weight loss!  Shouldn't that be one of the first things one would say, given how many people in Belgium, where this study was conducted, are overweight?

Short Chain Fatty Acids And Weight Loss

Can short chain fatty acids contribute to weight loss?  A paper looks at this, abstract:

Elucidating the mechanisms by which short chain fatty acids (SCFA) reduce body weight may assist in the development of an effective weight control strategy. Dietary supplementation of acetate, propionate, butyrate or their admixture was shown to significantly inhibit the body weight gain induced by high-fat diet feeding. Supplementation of SCFAs caused significant changes in the expressions of G-protein coupled receptor 43 (GPR43) and GPR41 characterized by increases in the adipose tissue and reductions in the colon. Additionally, they influenced the bacterial community structure in feces, with a reduction in the proportion of Firmicutes and an increase in the proportion of Bacteroidetes. The effects of dietary SCFAs on the GPR expression and gut microbiota composition may further result in body weight reduction by enhancing triglyceride hydrolysis and FFA oxidation in the adipose tissue, promoting beige adipogenesis and mitochondrial biogenesis, and inhibiting chronic inflammation.

Keep in mind that short chain fatty acids can be produced in the colon by the fermentation of dietary fiber by the gut microbiota, with beneficial effects for colonic health.  However, the effects described in this paper required direct supplementation of these agents into the diet of the test mice.  Nevertheless, the findings suggest a role for short chain fatty acids in weight control.

Carbon Dioxide Secretion And Weight Loss

Here is a hypothesis paper that suggests that carbon dioxide excretion maybe linked to problems with weight loss.  Abstract:

Weight regulation depends on the difference between weights of absorbed and metabolised carbon and excretion of the end products of metabolism, calories and carbon dioxide, which can be independently and variably excreted. Calories can be variably excreted as heat by vasoconstriction or vasodilation and carbon dioxide can be excreted variably as exhaled carbon dioxide (the major route of carbon excretion). Unless there are changes in ventilatory carbon excretion, 'metabolism,' 'genetic factors,' 'hormones' or 'exercise' do not provide complete explanatory mechanisms for weight changes, obesity and failure of diets. Low sensitivity of respiratory centres to carbon dioxide may cause overweight and dietary failures after initial weight loss.

Individuals less sensitive to carbon dioxide, and thus with impaired respiratory activity, may have more trouble with obesity and weight loss, opening up new avenues of prevention and treatment.

Food Quality Over Quantity

Following up on this post, read this about the same study.

Paying attention to the quality of the food is more effective for weight loss than religiously counting calories, according to a new study.

Researchers at Stanford University found there is no significant difference in weight change between a healthy low-fat diet versus a healthy low-carbohydrate diet.

The 12-month weight loss study of 609 individuals found the tactic of choosing whole, unprocessed foods and not worrying about calories resulted in similar weight loss for people following both diets.

The study also found there is no specific insulin levels associated with the dietary effects of weight loss and no specific gene pattern that affected which diet made an individual lose weight.

Again, the take home points about weight loss: food quality is more important than counting calories, genetic excuses are not justified, and fad diets are not required.

Back To Basics: Exercise And Diet In The Management Of Chronic Disease

It is important that physicians understand and relay to their patients the importance of physical activity/exercise and diet/weight control in the management of many common chronic diseases. Instead of just pushing pills, physicians need to stress lifestyle changes for their patients.

Read this; abstract:

INTRODUCTION:The increase in obesity rates in the U.S. and other less developed industrial countries have led to a worldwide epidemic of chronic disease states. Increased obesity rates are implicated in the treatment failures for illnesses such as coronary artery disease, diabetes, heart failure, hypertension and cancer. Effective prevention of obesity through diet and exercise contributes to the successful medical management of multiple chronic disease states.OBJECTIVE:Review the last 10 years of literature (2006-2016) on the effects of diet and exercise as they relate to the prevention of chronic disease.METHOD/DATA REVIEWED:Cochran Database of Systematic Reviews and other original articles using the National Center for Biotechnical Information database.CONCLUSION:The success in management of chronic disease lies in a physician's ability to educate patients and effective utilization of the resources available to that provider. Patient accountability for their individual chronic disease states is a problem related to patient education, patient participation, access to care, and payment resources. Financial, racial, and socioeconomic barriers must be addressed in the creation of an effective plan. Teaching on the importance of diet and exercise needs to occur early in life and be continually reinforced for successful outcomes. In the last 10 years, there has not been a significant study suggesting a single successful model of diet and exercise that can control chronic diseases. Cardiac, diabetic, and cancer patients have reduced hospital admissions, improved diabetic control, and improved quality of life scores related to coordinated diet and exercise programs, however. Patients may be unwilling or unable to be accountable for health care coordination. The development of exercise and obesity prevention policies and the adjustment in financial rewards to health care organizations will have a major impact in implementing these programs over the next 10 years.

Four Approaches To Weight Loss

By FatM1ke - Central_Obesity_011.jpgCentral_Obesity_008.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=4412552

Here is a review paper on weight loss that focuses on four methods: (1) juicing/detoxification, (2) intermittent fasting, (3) paleo, and (4) high intensity training.  The first three methods all led to weight loss due to caloric restriction; however, the extreme “fad diets” of juicing or detoxification lead to weight gain when the normal diet is resumed. Paleo, if followed continuously, would seem to enable the weight to be kept off; the basic lesson is that a diet needs to be a sustainable, long-term commitment, not a short-term extreme such as, for example, juicing. Intermittent fasting also can work if followed on a regular basis.  I myself cut back on saturated fat, “junk” food and excess sugar, while increasing fruit, whole grains, and vegetables (with one “cheat day” in which I really don’t eat that unhealthy either).  Caloric restriction is what all have in common.  Interestingly, “high intensity training” worked as well, despite the recent paradigm that says that weight loss is overwhelmingly about diet and not exercise (the latter of which has a host of other benefits). Perhaps the type of exercise is important, and one wonders if all variables are taken into account; perhaps those who do “high intensity training” have healthier diets.  Abstract:

PURPOSE OF REVIEW:

The purpose of this paper is to review the epidemiology of obesity and the most recent literature on popular fad diets and exercise regimens that are used for weight loss. The weight loss plans that will be discussed in this article include juicing or detoxification diets, intermittent fasting, the paleo diet, and high intensity training.

RECENT FINDINGS:

Despite the growing popularity of fad diets and exercise plans for weight loss, there are limited studies that actually suggest these particular regimens are beneficial and lead to long-term weight loss. Juicing or detoxification diets tend to work because they lead to extremely low caloric intake for short periods of time, however tend to lead to weight gain once a normal diet is resumed. Both intermittent fasting and the paleo diet lead to weight loss because of overall decreased caloric intake as well. Lastly, studies on short bursts of high intensity training have shown remarkable weight loss and improvements in cardiovascular health. Review of the literature does suggest that some fad diets and exercise plans do lead to weight loss; however, the studies are quite limited and are all based on the concept of caloric restriction.

Nut Intake Equals Reduced Weight Gain

By Sage Ross - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=30392736

Nut intake is associated with “reduced weight gain and a lower risk of becoming overweight or obese.”  So, in moderation, eating a healthy “energy-dense food” like nuts can be beneficial for weight control.  Don’t over-indulge of course, but it would seem like a handful of nuts is better than a handful of doughnuts.  Abstract:

PURPOSE:There is inconsistent evidence regarding the relationship between higher intake of nuts, being an energy-dense food, and weight gain. We investigated the relationship between nut intake and changes in weight over 5 years.METHODS:This study includes 373,293 men and women, 25-70 years old, recruited between 1992 and 2000 from 10 European countries in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Habitual intake of nuts including peanuts, together defined as nut intake, was estimated from country-specific validated dietary questionnaires. Body weight was measured at recruitment and self-reported 5 years later. The association between nut intake and body weight change was estimated using multilevel mixed linear regression models with center/country as random effect and nut intake and relevant confounders as fixed effects. The relative risk (RR) of becoming overweight or obese after 5 years was investigated using multivariate Poisson regressions stratified according to baseline body mass index (BMI).RESULTS:On average, study participants gained 2.1 kg (SD 5.0 kg) over 5 years. Compared to non-consumers, subjects in the highest quartile of nut intake had less weight gain over 5 years (-0.07 kg; 95% CI -0.12 to -0.02) (P trend = 0.025) and had 5% lower risk of becoming overweight (RR 0.95; 95% CI 0.92-0.98) or obese (RR 0.95; 95% CI 0.90-0.99) (both P trend <0.008).CONCLUSIONS:Higher intake of nuts is associated with reduced weight gain and a lower risk of becoming overweight or obese.

Daily Self-Weighing And Weight Control

At left, a different kind of weighing.  By National Geographic, Ancient Egyptians - Book of the Dead, Public Domain, https://commons.wikimedia.org/w/index.php?curid=6851635

Daily self-weighing has been shown to be effective in weight loss control and maintenance - and prevention. The abstract summarizes the findings, including the all-important take-home message: "Daily self-weighing was associated with significant declines in BMI and body fat percent over time."  Abstract:

Daily self-weighing has been suggested as an important factor for weight loss maintenance among samples with obesity. This study is a secondary analysis that examined daily self-weighing in association with weight and body composition outcomes over 2 years among young women with vulnerability for weight gain. Women (N = 294) of varying weight status completed self-weighing frequency questionnaires and weight was measured in the clinic at baseline, 6 months, 1, and 2 years; DXA scans were completed at baseline, 6 months and 2 years. Multilevel models examined the relationship between daily self-weighing (at any point in the study) and trajectories of BMI and body fat percentage. Daily self-weighing was associated with significant declines in BMI and body fat percent over time. Future research is needed to examine causal relations between daily self-weighing and weight gain prevention. Nonetheless, these data extend the possibility that daily self-weighing may be important for prevention of unwanted weight gain.

Physical Activity Can Affect Genetic Susceptibility To Weight Gain

By Javierlayus - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15900701

One often hears the excuse that genes makes someone overweight (note of course that humans have not undergone some sort of rapid genetic change precipitating the obesity epidemic).  It is therefore useful to know that a study has shown that to the extent that genetic differences between people can influence weight gain, that the weight gain can be "diminished by increasing physical activity."  Of course, controlling diet is usually the greatest factor in weight control, even taking genetic differences into account.  Again, genetic differences influencing weight gain have always existed; the skyrocketing expansion of waistlines and BMIs cannot be attributed to genetics as the major factor. Excerpted from the abstract:

Whether change in physical activity over time modifies the genetic susceptibility to long-term weight gain is unknown…In the combined cohorts, 4-year BMI change per 10-risk allele increment was -0.02 kg/m2 among participants with greatest increase in physical activity and 0.24 kg/m2 among those with greatest decrease in physical activity (P[interaction]<0.001), corresponding to 0.01 kg versus 0.63 kg weight changes every 4 years (P[interaction]=0.001). Similar but marginal interactions were observed for the BMI-GRS (P[interaction]=0.045). Our data indicate that the genetic susceptibility to weight gain may be diminished by increasing physical activity.

The magic of soup

We all know that hot drinks and liquids, such as tea and soup, are great for cold and flu. Even researchers have tried to uncover the mechanisms behind the healing properties of hot drinks:

This study investigated the effects of a hot fruit drink on objective and subjective measures of nasal airflow, and on subjective scores for common cold/flu symptoms in 30 subjects suffering from common cold/flu. The results demonstrate that the hot drink … did cause a significant improvement in subjective measures of nasal airflow. The hot drink provided immediate and sustained relief from symptoms of runny nose, cough, sneezing, sore throat, chilliness and tiredness, whereas the same drink at room temperature only provided relief from symptoms of runny nose, cough and sneezing. … In conclusion, the results support the folklore that a hot tasty drink is a beneficial treatment for relief of most symptoms of common cold and flu.

Soups might be the best means to health when colds and seasonal fatigue descend on us. However, soups have healing and preventive powers beyond the times of sickness:

1. Soups help us maintain our healthy weight. How? Soups are filling due to the bulk created by the water. This low energy density generates the sense of satiety faster and we stop eating sooner. By the way, as explained in one of the episodes of the British documentary Food Unwrapped, Diet Special, one cannot substitute soup by adding a cup of water to your regular (dry) meals.

2. Soups are easier to digest. The liquid and the small bites of soft vegetables are easy on our digestive system, and the nutrients can be utilized more readily.

3. Soups are full of vegetables and fruit; therefore, eating soups increase our fiber intake.

4. Soups are made with healing herbs. In fact, soup recipes incorporate the same herbs that make the most healing teas: winter savory, oregano, thyme, sage, rosemary, peppermint, parsley, dill, cayenne pepper, ginger, turmeric, and more. The soup veggies and fruit are also powerful boosters of health and immunity: garlic, onion, peppers, lemons, tomatoes, cabbage, sweet potatoes, tomatoes, butternut squash, beans, zucchini, etc.
 

Chicken soup
Take some time this holiday season, and cook a chicken soup that can feed an army. You will need a whole chicken, one large onion, 4-5 medium size potatoes, 20 baby carrots, 3-4 stalks of celery, 1/2 cup rice, parsley, peppermint, winter savory, salt, and crushed red pepper.

Wash one whole chicken, remove everything from the body cavity and wash the inside. Place the chicken in a large pot and add cold water sufficient to cover the chicken. (I use my biggest pot for this recipe, the pot should have a volume of four times the chicken volume.) Bring to boil. Watch the surface carefully, because once the water starts boiling, you should remove the foam with a spoon. Once the foam is removed, add one big chopped onion, 5-10 big carrots in chinks or 20-30 whole baby carrots, and 3-4 chopped celery stalks. To cover all veggies, you will need to add more water at this time. Bring to boil. Once the soup is boiling again, add 4-5 medium size chopped potatoes and simmer the soup for 40-50 minutes, or until the chicken is ready to be de-boned. Take out the chicken from the pot (this step could be tricky, you will need a good grip of the chicken with large spoons or spatulas). I leave the chicken in a dish to cool for 5 minutes. While deboning, add half-a-cup of rice to the soup. I throw the skin and the bones, chop the meat and scoop it back into the pot. Continue boiling until the rice is ready (10-15 minutes). Before turning off the heat, add chopped parsley, 1-2 tablespoons of dried winter savory, 1-2 tablespoons of dried peppermint, red hot flakes, and salt to taste. This recipe yields approximately 20 portions, so plan to freeze and have ready-to-eat dinners on winter workdays.

Cabbage soup
I recently tried a new cabbage soup recipe, which I modified a bit. I heated two tablespoons of olive oil, softened ½ large onion, diced. To the onion, I added ½ large cabbage cut into small cubes. After 3 minutes, I added 4 cups of water (the volume depends on how thick you like your soups), ½ tsp ginger powder, a pinch of turmeric, ¼ tsp black pepper, and 1 tsp salt. After bringing back to boil, I simmered for 5 minutes. the soup tasted great with a few drops of lemon juice.

Tomato soup/tea
Finally, here is a recipe for tomato tea (or soup) that I have not tried yet. It seems that is a great remedy for cold, flu and sore throat. When I prepare this remedy myself, instead of oregano oil, I would add a bit of crushed dry oregano, thyme, winter savory, and peppermint.

Bulgur and apple dessert

Ingredients
You will need 1 cup of bulgur (I use quick cooking 100% whole grain Bob’s Red Mill), ¼ cup of old fashioned Quaker oats (this can be increased or skipped, according to your taste), 3-4 medium size apples, a dash of cinnamon, and 2 Tbsp of sugar (or mashed banana).
 
Directions
Cook one cup of bulgur wheat in two cups of water by simmering for 12 minutes. At the end, add the oats and turn the heat off. Slice thinly the apples and microwave them to soft (I microwave them for 2-3 minutes). Mix the wheat, apples, cinnamon and sugar (or banana), cover, and let it cool to room temperature. Store in a glass jar in the refrigerator. Serve as a dessert or breakfast.
 
Play
For more health benefits, add flax seeds, walnuts, lemon peel/juice, and raisins. Instead of sugar, sweeten the dessert with mashed bananas. Finally, add a spoon of peanut butter or coconut oil. 


 For more on bulgur, watch the video below:

Four guidelines to keep children’s weight under control

Below are the slightly modified recommendations by Dr. Robert Lustig, MD, UCSF School of Medicine:

1. Get rid of every sugared liquid in the house. Children should drink only water and milk.
 

2. Provide at least five servings of vegetables and/or fruit a day (this equals about five handfuls).

3. Serve individual portions. Serve a second portion only if the child still claims to be hungry after waiting for 20 minutes.

4. Children should have at least 60 minutes of physical activity every day.

If you would like to know more about some of these recommendations, watch “Sugar, the bitter truth”, a great presentation by Dr. Lustig available on YouTube.