Gary Taubes has done it again. He published another op-ed article on obesity and diet and insulin response. The problem is that Gary Taubes knows enough to be dangerous. He is a amazing journalist – an award winning journalist, in fact – so is able to write very persuasive manuscripts that sound like they are based solely on science when in fact they are primarily a product of his own conjecture. He is NOT a scientist and he continues to misinterpret data, inappropriately extrapolate his own conclusions from legitimate studies, and interject his own speculative opinions. In some respects he’s on the right track, but has developed his own “anti-sugar”/”anti processed foods” agenda that skews his perspective and narrows his focus. I am not a fan of excessive sugar in the diet. As a diabetes educator and a nutrition expert I am well aware of the effects of a diet that is high in sugar and/or processed foods, and I don’t advocate it. I tell my patients and clients “the closer to the tree the better” when it comes to the foods we eat. It’s not just that people in the US are eating too much sugar these days; it’s also about what they are NOT eating. There are tremendous benefits to be gained from eating a variety of fresh fruits and vegetables. The refined sugars and grains are usurping these healthy foods, especially the vegetables. People don’t eat nearly enough vegetables with all of their valuable vitamins, minerals, fiber and phytonutrients. And the portions of most foods are absolutely excessive. (The number one comment about American food made to me by peopel from other countries is about the shockingly large portions served and consumed in the US.)  Don’t get me wrong, I don’t think Mr. Taubes is intentionally trying to throw people off track. In fact I suspect he honestly believes what he is sharing, and that his intentions are good. But that doesn’t change the fact that many of his statements and conclusions are wrong, or speculative at best.

In his recent article for News Week magazine, Why the Campaign to Stop America’s Obesity Crisis Keeps Failing, he does his usual trick of weaving scientific facts with conjecture and opinion. It all sounds logical. It get’s people riled up and speaking out against “the anti-obesity establishment” (whoever that is… he doesn’t actually bother to fully define this. But then, isn’t that one of the oldest tricks in the book to get people to align themselves with you… form an alliance against a common enemy?) Mr. Taubes states that the old adage of energy in vs. energy out is not valid, and obesity is a much more complicated equation that includes the influence of hormones. I agree. But then again, those of us who are truly on the front lines of the nation’s obesity epidemic – those of us dealing with real people and science, not those who are removed from the human faces of obesity – we know very well (and have for a long time) that weight management isn’t simply a matter of counting calories. Or, as I often tell my patients who are engineers (the ones who get frustrated that the numbers don’t add up) the equation does work, but we don’t know all of the variables. Also, the human body is a biological system; and biological systems adapt – which means the variables are always changing.  As an endocrine geek, I agree that hormones have a lot to do with the body’s response to food and lifestyle, but he has over-simplified the interactions of food and exercise (I’ll address that more thoroughly in a future article)… and he has completely ignored the fact that STRESS has a big influence on hormone balance. Many medical anthropologists believe the effects of stress explain why there is fatness in populations even during economically difficult times. It’s not unique to the USA… the same happened in Cuba during the Cuban Missile crisis when the population was starving due to restricted trade to Cuba. This wasn’t associated with too much refined food. Stress has significant affects on hormones and energy balance that go far beyond the emotional eating that some individuals do when stressed.  Taubes also failed to consider the fact that we are largely a sleep-deprived nation – which also significantly influences hormonal balance. Research has shown that inadequate sleep directly effects weight gain.

Contrary to Gary Taube’s accusations, many nutrition and exercise experts really do know what needs to be done to defeat obesity, but insurance won’t pay for it so people aren’t coming to see the experts. Or they will come for the 3 visits per year that insurance pays for…which even the experts know is not nearly enough time to really help people establish healthy habits. Also, most exercise experts agree hands down with Mr. Taubes that the oft recommended 150 min of exercise/week is too low to promote fitness and overall health. This was stated by several experts who presented at the SCAN sports nutrition symposium I attended last month. Exercise IS beneficial in treating and preventing obesity.. it just has to be ENOUGH exercise, the right kind of exercise, and at a high enough intensity to make a difference. There is also new research that it’s not just the exercise people are NOT doing that contributes to health problems, but also all the sitting they ARE doing. The average American now spends more hours in a day sitting than sleeping. Research suggest that if part of that time was spent standing (not even walking), health would improve.  The endocrine (hormone) system is a spider web of feedback loops for these chemical messengers of the body. There are countless points at which energy balance can be disrupted along hormonal pathways. Hormones from the brain, thyroid, gut, and adrenals (by the kidneys) all influence each other and affect how energy is used, produced and stored in the liver, muscles and other organs. There are numerous factors that can, and do influence all of these hormones. So, to zero in on a few dietary factors and blame them for being the sole factors that influence hormones to cause the body to store fat is just wrong. A poorly balanced diet with too many refined sugars and grains may be a piece of the puzzle, but the scope of our nation’s obesity problem is so much bigger than the narrow focus which Gary Taubes repeatedly blames. Obesity in the US is a multifaceted problem and is going to take an open mind and broad perspective to adequately address the many contributing factors.

I’ll get back to you as to why Mr. Taubes understanding of insulin and fat storage is “half a bubble off.” Hint: it doesn’t work the same under all conditions or across all populations.

**For more insights about sugar in our diets see my previous article Sugar Over Kill, uncovering the truth about sugar in our diets.  

Lest anyone accuse me of having ties to sugar or processed food industries, it is probably worth stating that my graduate research (in the early 1990’s) was sponsored in part by the Sugar Institute, but did not produce outcomes favorable to their marketing efforts. In fact, my research, which involved the effect of diet on insulin secretion, suggested that a high sugar diet is an unhealthy choice… and I published my results stating just that. I’m interested in facts – not marketing or hype – just facts interpreted correctly. So let’s get started looking at some of the current claims about sugar which are circulating in the popular press and on social networks. What is true and what is questionable?

A recent article published in the Huffington Post on April 10, 2012 has this sensationalized title “Sugar In Food: 8 Eats With More Than A Twinkie.” This article is a great example of how information is taken out of context and extrapolated to fit the author’s agenda. It contains a few accurate facts and a lot of what I like to call half-truths or statements that are “half a bubble off.” One of the central statements of this article is this:

In 2009, the American Heart Association recommended that women eat or drink no more than 20 grams of sugar a day, and men no more than 36 grams. That means one Snickers bar, at 30 grams of sugar, would be about all the sugar the average man should eat in an entire day. For women, that equivalent to about one Twinkie, which will set you back 18 grams.

In truth, what the statement on the website for the American Heart Association actually said:

“The American Heart Association (AHA) recommends limiting the amount of added sugars you consume to no more than half of your daily discretionary calories allowance. For most American women, that’s no more than 100 calories per day, or about 6 teaspoons of sugar. For men, it’s 150 calories per day, or about 9 teaspoons. The AHA recommendations focus on all added sugars, without singling out any particular types such as high-fructose corn syrup. For more detailed information and guidance on sugar intake limits, see the scientific statement in the August 2009 issue of Circulation, Journal of the American Heart Association.”

To take this statement in context we must first define what discretionary calories are. The USDA defines these as “the difference between total energy requirements and the energy consumed to meet recommended nutrient intakes.” Their statement then goes on to explain

“Because of sedentary lifestyles and food choices that frequently are relatively high in added sugars and solid fats, most Americans have used up discretionary calories even before meeting recommendations for nutrient intakes. The maximum amount of discretionary calories is based on the difference between their total daily calorie requirement and the number of calories used to meet nutrient recommendations.

Discretionary calories can be available only when the amount of calories used to meet recommended nutrient intakes is less than the total daily calorie expenditure. The magnitude of this difference, and whether it is positive or negative, depends on two factors: (1) the nutrient content of the foods consumed, and (2) the total energy requirement, which, in turn, is greatly dependent on the level of physical activity.”

So what exactly does that mean? In a sense it is suggesting that sedentary Americans are often under-nourished but over-fed. Discretionary calories are essentially the “extra” calories that we can spend however we want once our nutritional needs have been met by the rest of the food that we eat each day. It’s kind of like having a little spending money left after all the bills have been paid. Right away there are a few things to point out. First, not everyone in America is sedentary. Those who are physically active often have more “discretionary calories” to spend each day because their total daily energy (calorie) need is higher than it is for sedentary individuals. Second, people who eat a lot of nutrient dense food (fruits, vegetables, whole grains, lean protein) can get their nutrient requirements met without spending a lot of calories, so will have more “discretionary calories” that they can afford to spend on other things without usurping necessary nutrients. Third, perhaps the focus is too much on what NOT to include (i.e. empty calories such as sugar) and not enough on what TO include (nutrient-rich whole foods). I find that when I am able to successfully guide people to include more nutrient-dense whole foods in their diets, the less nutritious food tends to fall out on it’s own.  In other words, I believe it does more good to cheer for fruits and veggies than it does to boo sugar and fat.

Another important distinction made by the AHA that the Huffington Post article does not acknowledge is that the AHA is referring to ADDED SUGARS. This is relevant because these are the discretionary (extra) calories referred to above. Sugars that occur naturally in foods are generally part of nutrient-dense foods so are part of a healthy package that nature has assembled and which our bodies can include as part of a healthy diet. For instance, dairy products and fruits all have some naturally occurring sugars that come as part of a package that includes vitamins, minerals and (in fruits and veggies) fiber. A 6 oz. serving of plain yogurt contains about 12 gm of naturally occurring lactose (milk sugar). So if a container of sweetened yogurt contains 25 gm of sugar, only 13 of those are ADDED SUGAR. Likewise 1 cup of tomato sauce with no added sugar contain 8 gm of naturally occurring sugar from the tomatoes. I am still going to advocate that you purchase a variety without added sugar (or make your own), but I want to emphasize that simply looking at “sugar” content on food labels doesn’t tell the whole story. Below is a chart sumarizing the foods mentioned in the Huffington Post article as being surprisingly high in sugar. Take a look at what taking a closer look at the facts reveals about the accuracy of the accusations. I’ve included facts about total sugar, added sugar, and serving sizes; and my own commentaries about each food item. Also keep in mind that the more exercise you do, the more you can afford to include a bit of added sugar to your diet – especially if you eat a lot of whole , nutrient-rich foods as the main part of your diet. Too much sugar is not good – neither is too much hype. Be sensible and be wise and keep your eye on the big picture.

1. Quality Time and Attention are Preferred Over Food Rewards. When I regularly spend time with my dog on routine walks he doesn’t ask for treats nearly as much. It could be that his appetite is somewhat suppressed from the exercise; but I suspect the bigger issue is that he is getting to spend quality time with me on a regular basis. Begging for treats used to be a way of begging for my attention; and I in turn gave them to him out of guilt (and love?). When I’m home in the evenings I’m usually busy in the kitchen or on my computer, and admittedly often shoo my beloved dog out of the way. Unable to get quality time with me, he then settles for second best and does the cutest tricks to beg for treats. Giving him a good regular dose of positive attention has decreased his need for the poor substitute food is for attention. How often do parents do something similar with their kids – giving them “special” meals or snacks out of guilt for not having time to spend with them? I know it happens with my clients much more than people want to admit.
2.  Having an Exercise Partner is Rewarding. I’ll have to admit, I get a kick out of just saying the word “walk” around my dog (a yellow lab mix). He completely spazzes out when hears the word – gets so excited he can barely contain himself. His energy and excitement to hit the pavement is contagious. And once outside on his leash – oh halleluiah! He exudes joy! He wants to run…at least until he finds an interesting bush! Our walks end up being more like bush to bush interval training. It’s all good. He’s a lot of fun to trot around with and pushes (or pulls) me more than I might push myself some days.
3. Having Someone Counting On You is Motivating. On those days when I have so much to do I want to forego the walk and get on with my agenda for the day, or am tempted to take a lazy Sunday and lounge around… my fabulous dog goes into this silent but persistent dance looking at me, looking at the door, looking at his leash, looking at me… all the while trotting between these three objects of his focus. “Ok! OK! I’ll go already!” Somehow I FIND time to squeeze in at least a short walk to appease the persistent pooch – and I’m never sorry for having taken time to do so. Even on days when the weather involves horizontal rain, he manages to do his happy dance and get us out for a walk at the first break in the weather and before the next storm starts (yes, somehow he knows…).
4. Changing out my Exercise Routine to Include a Family member is Not so Difficult. I will still go for long bike rides or hikes on the weekend without my favorite pooch, but switching out my weekday routines several days a week to include my furry companion is not that difficult. And as I’ve reported, the rewards are many. My former habits involved pursuing my own fitness while ignoring my dog’s (whom I consider to be part of my family). Not cool. Unfortunately it reminds me of patterns I often seen in adults with pets as well as with kids. They trot off to the gym, go for a run, ride, swim, or a quick pick up game of something – and leave the kids at home or in the childcare at the gym. While I think there is a place for these things, how easy would it be to include the kids in some of their exercise time during the week? Family walks, even a few days a week build healthy habits and healthy kids (and pets). Your kids too little to engage in a game or sport? Try playing catch with them in the back yard… trust me, you’ll get plenty of running in chasing wildly thrown balls. Involve kids and pets in your exercise; be a role model they can see not just hear about. It can make all the difference in healthy habits and attitudes.

Most CSAs offer various sizes of orders to accommodate the needs of large or small families (or singles).  What a CSA box or bag contains may differ between CSAs. The most common is for a CSA bag/box to be sort of a “surprise package” that contains whatever happens to be in season – often a mix of fruits and vegetables. Some agreements allow for customers to choose between a “mixed bag”, “just fruits” or “just vegetables.” Some allow for customers to be informed ahead of time what is going into the CSA box/bag and to “opt out” of receiving certain items if they prefer. Each contract and CSA does things a little differently, but the end result is a supply of fresh, locally grown produce for consumers, and community support for local farmers that helps ensure they stay in business (and able to continue supplying us with that great produce!).

For many people, receiving a weekly CSA box or bag presents both a blessing and a challenge. The positives include a reliable source of fresh produce that they are committed to receiving, and therefore are likely to eat. This is a great way to help increase your daily servings of fruits and veggies! Simply put, we are more likely to eat fruits and veggies if they are already in our homes; and it helps not to have to give much thought about what or when to shop for them.  The challenge comes in eating it all before it goes to waste, and in figuring out what to do with some of the more obscure items in the CSA delivery. (What DOES one do with a kohlrabi, for example?)

The solution is two-fold, and really just sort of forces us to establish healthy habits that I encourage most of my clients to form any way. One of the things that most helps anybody be successful at healthy eating is planning ahead. I suggest taking one day a week to plan out your meals for the week (even if it’s a tentative plan). This can mean planning 7 dinners for the week, or it can mean planning 4 meals and 3 nights of leftovers…whatever works best for you and/or your family. In the U.S. meals are generally planned around meat/protein, and vegetables are often more of an after-thought.  I often encourage my clients to plan their meals around the veggies and figure out what kind of protein will go with them. It’s generally a much healthier way to plan a meal. When you have CSA produce that needs to be used up…it becomes a catalyst for this type of meal planning. I love it!  I also like that being introduced to produce we might not normally purchase helps to stretch our repertoire of fresh, healthy choices. I enjoy figuring out how to prepare new or unusual foods, and am happy to help others to do the same. To me, CSA boxes provide opportunities rather than challenges.

Community Supported Agriculture connects local farmers with local consumers in a unique way. CSA’s allow community members to honor and embrace local growers and producers; and provide a means of improving the health of local consumers. If you haven’t yet tried a CSA, I encourage you to do so. CSAs are a win-win opportunity for local farms and for our health.

Follow this link to find a local CSA near you.

Last week, before the news of the new MyPlate icon broke, I was contemplating the proportions served at restaurants. Admittedly, I don’t eat out very often (maybe a couple times a month, if that), but last week I had two meals out –one at a nice restaurant and one with a friend in the dining room of an assisted living home. I was struck that in both places most of the plate was taken up by the protein portion of the meal. At the nice restaurant I ordered a NY steak with grilled asparagus and  potatoes au gratin with goat cheese. The meal was plated rather fancily with a small serving of potatoes au gratin (less than 1/2 cup) carefully stacked like poker chips in the middle of the plate, about 4 pieces of grilled asparagus neatly layered next, and then 2 thinly sliced pieces of steak artfully laid across it all – hiding the vegetables. In this case, the only thing I saw when my plate was presented was the steak (about 8 oz.).At the assisted living facility I had my choice of ordering steak or fish (cod, I think), and had a choice of baked potato, rice, green beans and/or asparagus for “sides”. I was planning on doing a long bike ride the next day so was looking for extra carbs. I ordered the fish, a vegetable and a double portion of rice. Once again, the protein portion trumped all. The fish took up over 1/2 my plate and the “double portion of rice” took up about 1/4 of the plate, as did the veggies. Presentation was not as important at this dining hall, but there is an assumption that the nutritional needs of the residents should be. I pondered how Americans have come to see meat as the central part of the meal, and consider everything else to be “sides”. In so many other parts of the world, grains and vegetables make up the majority of a meal meat is what is considered more of a garnish (if present at all). My how we have evolved in our Western “civilization”!

It makes me question what “normal” looks like on the plates of most Americans. I have the image of the 1/2 vegetable, 1/4 starch, 1/4 meat plate in my head and roughly follow that pattern at home. However, I know that many of my patients and clients eat out several times a week, and I can’t help wonder if their perception of a “normal” dinner plate is one which is predominately meat.  Are restaurants influencing the perception of the customers or just catering to a pre-existing perception? Who knows? I do think it would be interesting, however to  request a MyPlate proportioned meal at restaurants. I wonder what would happen? I’m guessing I’d be met by a blank stare. The explanation would be easy enough: “Just give me a serving of meat/fish about the size of the palm of my hand, a serving of starch (rice, potato, pasta, etc.) about the size of my fist, and fill the rest of the plate with vegetables.” Given the size of many restaurant plates, that could be a LOT of veggies! Ok by me…I’d be in vegetable heaven (as long as I had them hold the butter and sauces). As most restaurant portions currently stand, even ordering a double order of veggies is not likely to trump the meat portion.  So I challenge you to have a little fun next time you eat out and request a MyPlate proportioned meal.  At the very least, it could be somewhat amusing… and at best, you could be improving your health, helping to educate the restaurant employees, and re-shaping the way America thinks about balanced eating. Bon Apatite!

As a nutrition expert, I do my best to stay on top of the latest research, trends and opinions – not an easy task, as new information seems to emerge daily. I study the metabolic pathways and various physiological systems of our bodies, and the effects of various nutrients, eating trends, diseases, and exercise habits on them. I look at the biochemistry of phytochemicals, the claims and research about how they may or may not benefit our health, longevity and sport performance. I listen to my clients, colleagues and adversaries and do my best to hear with an open mind what all are saying – what the latest beliefs, experiences and trends are. Then I weigh this against the available research and my sage wisdom and experience, and come to the best educated conclusions I can.  I then try to translate it all into practical recommendations for my patients and clients. What goes through my brain is biochemistry, endocrinology and exercise physiology mumbo jumbo….what comes out of my mouth is “eat a variety of fruits and vegetables.” Grin.

Let me give you a few reasons why I’m such an advocate for eating fruits & veggies:

1. They are high in potassium,which plays a key role in regulating blood pressure. When the balance of sodium and potassium is “out of whack” blood pressure can go too high or too low.  The popular trend is to pick on sodium, but the truth is that if people ate more plant-based foods (good sources of potassium), they wouldn’t need to restrict sodium as much. Additionally, athletes need potassium to replace that which is lost in sweat – this helps keep electrolytes balanced, the heart beating, and muscles from cramping. Any fruit or vegetable is a good source of potassium – did you know a potato has more potassium than a banana?
2. They are high in fiber. Fiber keeps us regular – keeps things moving through our intestines.  This not only keeps us more comfortable, but gives less opportunity for our bodies to be exposed to carcinogens or other toxins that are on their way out of the body. A fiber-rich diet also helps control cholesterol and blood sugar, and increases satiety so that we get full faster and are less likely to over-eat. (see list of fiber content of foods)
3. They are packed with vitamins.Most fruits and vegetables are very nutrient dense – they have a lot of nutrition per calorie.  They are great sources of vitamins A, E, K, thiamin (B₁), riboflavin (B₂), Niacin (B₃), pyroxidine (B₆), folate (B₉),  B₁₂, Pantothenic acid (B₅), biotin (B₇), and vitamin C. Not all contain the same vitamins, but by eating a variety of different colored fruits & veggies, you are likely to get a good variety of vitamins.
4. They contain phytochemicals.These are chemical compounds that are naturally occurring in plants which are believed to have a variety of health benefits. New research is emerging every month espousing the positive health effects of phytochemicals. Some phytochemicals are believed to ward off cancer, others are potent anti-oxidants believed to ward off aging. Some have anti-inflammatory properties which may help athletes heal and reduce delayed onset muscle soreness that comes with training. Still others may help decrease symptoms of asthma or help prevent degenerative eye diseases. We are only beginning to discover the potential of these health-boosting chemicals. Interestingly, many of these phytochemicals don’t have much effect by themselves (when isolated from the plant) but appear to work together (synergistically) with other phytochemicals. Which brings me back to my original admonition… eat a variety of whole fruits and vegetables.

The advice is simple, the rationale more complex. But the good news is that it is not difficult to include a variety of plant-based foods in our diets. Try these easy tips to get started:

• Start by adding fruit (fresh, frozen or dried) to every breakfast, to lunch and as a snack each day.
• Make sure you have veggies in both lunch and dinner – and work towards having more than one variety at each of these meals.
• Mix veggies into scrambled eggs, and add fresh or dried fruit to oatmeal or dry cereals.
• Put sliced vegetables on sandwiches and/or pack a salad full of colorful veggies and legumes for lunch.
• Have at least 2 types of veggies for dinner (example: sweet potato & broccoli, salad and grilled veggies, green beans, tomatoes & onions)
• Try to include legumes as a regular part of your meals as well (lentils, black beans, split peas, garbanzo beans, etc.).

It takes a little fore-thought when getting started but once the habits are formed, having a diet filled with whole fruits & vegetables is a fairly easy task. Oh, and by the way, contrary to popular belief, it’s not necessarily more expensive. Including seasonal produce and decreasing processed foods may actually save you money on your groceries. And will likely save you money on medical expenses in the long run.

** See if you can include at least 7 servings of fruits and/or vegetables each day. And remember, the greater the variety, the greater the benefit. Eat your colorful (plant) foods!

How much is in a “serving” of fruits or vegetables?

• ½ cup of fresh fruit or fruit juice
• ¼ cup dried fruit

• ½ cup of cooked vegetables
• 1 cup of raw vegetables
• 2 cups salad greens
• ½ cup vegetable juice

Click here for a more complete list.