Tags Posts tagged with "Weight Loss"

Weight Loss

The path to improved health: Your body needs vitamins and minerals, known as micronutrients, to nourish and keep it healthy and to reduce risk for chronic diseases. Getting them through food ensures that your body can absorb them properly.
Increasing food quality makes a difference

By David Dunaief, M.D.

Dr. David Dunaief

Hunger is only one reason we eat. There are many psychological and physiological factors that influence our eating behavior, including addictions, lack of sleep, stress, environment, hormones and others. This can make weight management or weight loss for the majority who are overweight or obese — approximately 75 percent of the U.S. adult population — very difficult to achieve (1).

Since calorie counts have been required on some municipalities’ menus, we would expect that consumers would be making better choices. Unfortunately, studies of the results have been mostly abysmal. Nutrition labeling either doesn’t alter behavior or encourages higher calorie purchases, according to most studies (2, 3).

Does this mean we are doomed to acquiesce to temptation? Actually, no: It is not solely about will power. Changing diet composition is more important.

What can be done to improve the situation? In my clinical experience, increasing the quality of food has a tremendous impact. Foods that are the most micronutrient dense, such as plant-based foods, rather than those that are solely focused on macronutrient density, such as protein, carbohydrates and fats, tend to be the most satisfying. In a week to a few months, one of the first things patients notice is a significant reduction in their cravings. But don’t take my word for it. Let’s look at the evidence.

Effect of refined carbohydrates

By this point, many of us know that refined carbohydrates are not beneficial. Well, there is a randomized controlled trial (RCT), the gold standard of studies, with results that show refined carbohydrates may cause food addiction (4). There are certain sections of the brain involved in cravings and reward that are affected by high-glycemic (sugar) foods, as shown by MRI scans of participants.

The participants consumed a 500-calorie shake with either a high-glycemic index or with a low-glycemic index. The participants were blinded (unaware) as to which type they were drinking. The ones who drank the high-glycemic shake had higher levels of glucose in their blood initially, followed by a significant decline in glucose levels and increased hunger four hours later. In fact, the region of the brain that is related to addiction, the nucleus accumbens, showed a spike in activity with the high-glycemic intake.

According to the authors, this effect may occur regardless of the number or quantity of calories consumed. Granted, this was a very small study, but it was well designed. High-glycemic foods include carbohydrates, such as white flour, sugar and white potatoes. The conclusion: Everyone, but especially those trying to lose weight, should avoid refined carbohydrates. The composition of calories matters.

Comparing macronutrients

We tend to focus on macronutrients when looking at diets. These include protein, carbohydrates and fats, but are these the elements that have the most impact on weight loss? In a RCT, when comparing different macronutrient combinations, there was very little difference among groups, nor was there much success in helping obese patients reduce their weight (5, 6). In fact, only 15 percent of patients achieved a 10 percent reduction in weight after two years.

The four different macronutrient diet combinations involved an overall calorie restriction. In addition, each combination had either high protein, high fat; average protein, high fat; high protein, low fat; or low protein, low fat. Carbohydrates ranged from low to moderate (35 percent) in the first group to high (65 percent) in the last group. This was another relatively well-designed study, involving 811 participants with an average BMI of 33 kg/m², which is defined as obesity (at least 30 kg/m²). Again, focusing primarily on macronutrient levels and calorie counts did very little to improve results.

Impact of obesity

In an epidemiological study looking at National Health and Nutrition Examination Survey data, results demonstrate that those who are overweight and obese tend to be lacking in micronutrients (7). The authors surmise that it may have to do with the change in metabolic activity associated with more fat tissue. These micronutrients include carotenoids, such as lutein, zeaxanthin, beta-carotene, alpha-carotene and beta-cryptoxanthin, as well as vitamin B12, folate and vitamins C, E and D.

However, it does not mean this population should take supplements to make up for the lack of micronutrients. Quite the contrary, micronutrients from supplements are not the same as those from foods. Overweight and obese patients may need some supplements, but first find out if your levels are low, and then see if changing your diet might raise these levels. With a few exceptions, such as vitamin D and potentially B12, most micronutrient levels can be raised without supplementation. Please ask your doctor.

Steroid levels

It may seem like there are numerous factors influencing weight loss, but the good news is that once people lose weight, they may be able to continue to keep the weight off. In a prospective (forward-looking) study, results show that once obese patients lose the weight, the levels of cortisol metabolite excretion decreases significantly (8).

Why is this important? Cortisol is a glucocorticoid, which means it raises the level of glucose and is involved in mediating visceral or belly fat. This type of fat has been thought to coat internal organs, such as the liver, and result in nonalcoholic fatty liver disease. Decreasing the level of cortisol metabolite may also result in a lower propensity toward insulin resistance and may decrease the risk of cardiovascular mortality. This is an encouraging preliminary, yet small, study involving women.

Therefore, controlling or losing weight is not solely about willpower. Don’t use the calories on a menu as your sole criteria to determine what to eat; even if you choose lower calories, it may not get you to your goal. While calories may have an impact, the nutrient density of the food may be more important. Thus, those foods high in micronutrients may also play a significant role in reducing cravings, ultimately helping to manage weight.

References: (1) www.cdc.gov. (2) Am J Pub Health 2013 Sep 1;103(9):1604-1609. (3) Am J Prev Med.2011 Oct;41(4):434–438. (4) Am J Clin Nutr Online 2013;Jun 26. (5) N Engl J Med 2009 Feb 26;360:859. (6) N Engl J Med 2009 Feb 26;360:923. (7) Medscape General Medicine. 2006;8(4):59. (8) Clin Endocrinol.2013;78(5):700-705.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

‘Why’ is as important as ‘how’

By David Dunaief, M.D.

Dr. David Dunaief

Weight loss should be a rather simple concept. It should be solely dependent on energy balance: the energy (kilocalories) we take in minus the energy (kilocalories) we burn should result in weight loss, if we burn more calories than we consume. However, it is much more complicated. Frankly, there are numerous factors that contribute to whether people who want or need to lose weight can.

The factors that contribute to weight loss may depend on stress levels. High stress levels can contribute to metabolic risk factors such as central obesity with the release of cortisol, the stress hormone (1). Therefore, hormones contribute to weight gain.

Another factor in losing weight may have to do with our motivators. We will investigate this further. And we need successful weight management, especially when approximately 70 percent of the American population is overweight or obese and more than one-third is obese (2).

Focus on improving your health by making lifestyle modifications like walking your dog.

Obesity, in and of itself, was proclaimed a disease by the American Medical Association. Even if you don’t agree with this statement, excess weight has consequences, including chronic diseases such as cardiovascular disease, diabetes, osteoarthritis, autoimmune diseases and a host of others. Weight has an impact on all-cause mortality and longevity.

It is hotly debated as to which approach is best for weight loss. Is it lifestyle change with diet and exercise, medical management with weight loss drugs, surgical procedures or even supplements? The data show that, while medication and surgery may have their places, they are not replacements for lifestyle modifications; these modifications are needed no matter what route is followed.

But the debate continues as to which diet is best. We would hope patients would not only achieve weight loss but also overall health. Let’s look at the evidence.

Low-carbohydrate vs. low-fat diets

Is a low-carbohydrate, high-fat diet a fad? It may depend on diet composition. In the publication of a randomized controlled trial (RCT), the gold standard of studies, results showed that a low-carbohydrate diet was significantly better at reducing weight than low-fat diet, by a mean difference of 3.5 kg lost (7.7 lb), even though calories were similar and exercise did not change (3).

The authors also note that the low-carbohydrate diet reduced cardiovascular disease risk factors in the lipid (cholesterol) profile, such as decreasing triglycerides (mean difference 14.1 mg/dl) and increasing HDL (good cholesterol). Patients lost 1.5 percent more body fat on the low-carbohydrate diet, and there was a significant reduction in an inflammation biomarker, C-reactive protein (CRP). There was also a reduction in the 10-year Framingham risk score. However, there was no change in LDL (bad cholesterol) levels or in truncal obesity in either group.

This study was 12 months in duration with 148 participants, predominantly women with a mean age of 47, none of whom had cardiovascular disease or diabetes, but all of whom were obese or morbidly obese (BMI 30-45 kg/m²). Although there were changes in biomarkers, there was a dearth of cardiovascular disease clinical end points. This begs the question: Does a low-carbohydrate diet really reduce the risk of developing cardiovascular disease (CVD) or its subsequent complications? The authors indicated this was a weakness since it was not investigated.

Digging deeper into the diets used, it’s interesting to note that the low-fat diet was remarkably similar to the standard American diet; it allowed 30 percent fat, only 5 percent less than the 35 percent baseline for the same group. In addition, it replaced the fat with mostly refined carbohydrates, including only 15 to 16 g/day of fiber.

The low-carbohydrate diet participants took in an average of 100 fewer calories per day than participants on the low-fat diet, so it’s no surprise that they lost a few more pounds over a year’s time. Patients in both groups were encouraged to eat mostly unsaturated fats, such as fish, nuts, avocado and olive oil.

As David Katz, M.D., founding director of Yale University’s Prevention Research Center, noted, this study was more of a comparison of low-carbohydrate diet to a high-carbohydrate diet than a comparison of a low-carbohydrate diet to a low-fat diet (4).

Another study actually showed that a Mediterranean diet, higher in fats with nuts or olive oil, when compared to a low-fat diet, showed a significant reduction in cardiovascular events — clinical end points not just biomarkers (5). However, both of these studies suffer from the same deficiency: comparing a low-carbohydrate diet to a low-fat diet that’s not really low fat.

Diet comparisons

Interestingly, in a meta-analysis (a group of 48 RCTs), the results showed that whether a low-carbohydrate diet (including the Atkins diet) or a low-fat diet (including the Ornish plant-based diet) was followed, there was a similar amount of weight loss compared to no intervention at all (6). Both diet types resulted in about 8 kg (17.6 lb) of weight loss at six months versus no change in diet. However, this meta-analysis did not make it clear whether results included body composition changes or weight loss alone.

In an accompanying editorial discussing the above meta-analysis, the author points out that it is unclear whether a low-carbohydrate/high-animal protein diet might result in adverse effects on the kidneys, loss of calcium from the bones, or other potential deleterious health risks. The author goes on to say that, for overall health and longevity and not just weight loss, micronutrients may be the most important factor, which are in nutrient-dense foods.

A Seventh-Day Adventist trial would attest to this emphasis on a micronutrient-rich, plant-based diet with limited animal protein. It resulted in significantly greater longevity compared to a macronutrient-rich animal protein diet (7).

Psyche

Finally, the type of motivator is important, whatever our endeavors. Weight loss goals are no exception. Let me elaborate.

A published study followed West Point cadets from school to many years after graduation and noted who reached their goals (8). The researchers found that internal motivators and instrumental (external) motivators were very important.

The soldiers who had an internal motivator, such as wanting to be a good soldier, were more successful than those who focused on instrumental motivators, such as wanting to become a general. Those who had both internal and instrumental motivators were not as successful as those with internal motivators alone. In other words, having internal motivators led to an instrumental consequence of advancing their careers.

When it comes to health, an instrumental motivator, such weight loss, may be far less effective than focusing on an internal motivator, such as increasing energy or decreasing pain, which ultimately could lead to an instrumental consequence of weight loss.

There is no question that dietary changes are most important to achieving sustained weight loss. However, we need to get our psyches in line for change. Hopefully, when we choose to improve our health, we don’t just focus on weight as a measure of success. Weight loss goals by themselves tend to lead us astray and to disappoint, for they are external motivators. Focus on improving your health by making lifestyle modifications. This tends to result in a successful instrumental consequence.

References: (1) Psychoneuroendocrinol. online 2014 April 12. (2) JAMA 2012;307:491-497. (3) Ann Intern Med. 2014;161(5):309-318. (4) Huffington Post. Sept 2, 2014. (5) N Engl J Med. 2014 Feb 27;370(9):886. (6) JAMA. 2014;312(9):923-933. (7) JAMA Intern Med. 2013;173:1230-1238. (8) Proc Natl Acad Sci U S A. 2014;111(30):10990-10995.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.

The types, quantity and quality of dietary fat all matter. Stock photo

Dietary fat is one of the most controversial and complicated topics in medicine. Experts have debated this topic for years, ever since we were told that a low-fat diet was important. There are enumerable questions, such as: Is a high-fat diet good for you? What about low-fat diets? If this is not enough, what type of fats should we be consuming?

There are multiple types of fats and multiple fat sources. For instance, there are saturated fats and unsaturated fats, which include monounsaturated and polyunsaturated. There are also trans fats, which are man-made. However, there are several things that we can agree on, like we need fat since the brain is made of at least 60 percent fat (1), and trans fats are downright dangerous. Trans fats are the Frankenstein of fats; anything created in a lab when it comes to fats is not a good thing.

How have we evolved in the fat wars? Originally we were told that a low-fat diet was beneficial for heart disease and weight loss (2). This started in the 1940s but gained traction in the 1960s. By the 1980s, everyone from physicians to the government to food manufacturers was exclaiming about a low-fat diet’s benefits for overall health. But did they go too far trying to make one size fit all? The answer is a resounding YES!!

There are only three macronutrients: fats, carbohydrates and protein. Declaring that one of the three needed to be reduced for everyone did not have the results we wanted or expected. Americans were getting fatter, not thinner, heart disease was not becoming rare, and we were not becoming healthier.

Some fats more equal than others

The biggest debate recently has been over the amount of fats and saturated fats. The most recent 2015-2020 Dietary Guidelines for Americans do not limit the amount of fat, but do limit the amount of saturated fat to less than 10 percent of our diet (3). Does this apply to everyone? Not necessarily. Remember, it is very difficult to apply broad rules to the whole population.

However, the most recent research suggests that foods containing pure saturated fats are not useful, may be detrimental, and at best are neutral. Meanwhile, poly- and monounsaturated fats are potentially beneficial. You will want to read about the most recent study below.

Sources of fat

Pure saturated fats generally are found in animal products, specifically dairy and all meats. The exception is fish, which contains high levels of polyunsaturated fats. Interestingly, most foods that contain predominantly unsaturated fats have saturated fat as well, though the reverse is not typically true. There are also saturated plant oils, like coconut and palm. Processed foods also have saturated fats. Potentially beneficial polyunsaturated fats include fatty fish and some nuts, seeds and soybeans, while potentially beneficial monounsaturated fats are olive oil, avocados, peanut butter, some nuts and seeds (4). Let’s look at the research.

Saturated fat

takes a dive In the ongoing battle over saturated fats, the latest research suggests that it is harmful. In recent well-respected combined observational study (The Nurses’ Health Study and Health Professional Follow-up Study), results show that replacing just 5 percent of saturated fat with poly- or monounsaturated fats results in significant reductions in all-cause mortality, 27 and 13 percent, respectively (5). There were also significant reductions in neurodegenerative diseases, which include macular degeneration, Parkinson’s, Alzheimer’s and multiple sclerosis.

However, when reduced saturated fats were replaced with refined grains, there was no difference in mortality. There were over 126,000 participants with an approximate 30-year duration. Also, the highest quintile of poly- and monounsaturated fat intake compared to lowest showed reductions in mortality that were significant, 19 and 11 percent, respectively. Not surprisingly, trans fat increased the risk of mortality by 13 percent.

The polyunsaturated fats in this study included food such as fatty fish and walnuts, while the monounsaturated fats included foods such as avocado and olive oil. Eating fish had the modest reductions in mortality, 4 percent. The authors suggest replacing saturated fats with healthy poly- and monounsaturated fats that are mostly plant-based, but not with refined grains or trans fat.

Previous study showed neutrality

This was a meta-analysis (a group of 72 heterogeneous trials, some observational and others randomized controlled trials), with results showing that saturated fats were neither harmful nor beneficial, but rather neutral (6).

However, there were significant study weaknesses. The researchers may have used foods that include both saturated fats and unsaturated fats. This is not a pure saturated fat comparison. What did those who had less saturated fat eat instead — refined grains, maybe? Also, the results in the study’s abstract partially contradicted the results in the body of the study. Thus, I would pay a lot more attention to the above study than to this one. Again, though, even the best outcomes for saturated fats in this study did not provide a beneficial effect.

What about butter?

In a meta-analysis (group of nine observational studies), results showed that butter was neither beneficial nor harmful, but rather neutral in effect (7). Then is it okay to eat butter? Not so fast! Remember, the above study showed that saturated fat was potentially harmful, and butter is pure saturated animal fat. Also, there are study weaknesses. It is not clear what participants were eating in place of butter, possibly refined grains, which would obfuscate the potential harms. It was also unclear whether there were poly- and monounsaturated fats in the diet and what effect this might have on making butter look neutral.

Unearthing a saturated fat study

In a randomized controlled trial (Minnesota Coronary Experiment), this one from 1968 to 1973 and not fully analyzed until recently, results showed that polyunsaturated fat from corn oil, compared to a diet with higher saturated fat, reduced cholesterol level while increasing the risk of mortality (8).

The researchers expected the opposite result. Is this a paradox? Fortunately, no! Corn oil is used in processed foods and has a high amount of inflammatory omega-6 fatty acids that may negate the positive results of reducing cholesterol. Plus, the patients were only consuming the corn oil for a short 15-month period, which is unlikely to be long enough to show beneficial effects on mortality.

The bottom line is this: It’s not about low-fat diets! Saturated fats have not shown any benefits, and could be potentially harmful, but at best, they are neutral. However, foods that contain high amounts of poly- or monounsaturated fats that are mostly plant-based have shown significant benefit in reducing the risk of death and neurodegenerative diseases.

However, there are several caveats. Not all unsaturated fats are beneficial. For instance, some like corn oil may contain too many omega-6 fatty acids, which could contribute to inflammation. Also, replacing saturated fats with carbohydrates, especially refined grains, does not improve health. I told you fats are not easy to understand. It can be helpful to change our perception of fats: They are not “good and bad.” Instead, think of them as “useful and useless.” For our health, we should be focused on the “useful.”

References: (1) Acta Neurol Taiwan. 2009;18(4):231-241. (2) J Hist Med Allied Sci 2008;63(2):139-177. (3) health.gov/dietaryguidelines/2015. (4) http://www.heart.org. (5) JAMA Intern Med. 2016;176(8):1134-1145. (6) Ann Intern Med. 2014;160(6):398-406. (7) PLoS ONE 11(6):e0158118. (8) BMJ 2016;353:i1246.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

Stock photo

A military report has concluded that one in three Americans are currently too overweight to enlist in the armed services.

According to Still Too Fat to Fight, a military study, at least nine million Americans between the ages of 17 and 24 are too overweight to serve in the military. The Army Recruiting Station of Smithtown has witnessed this problem in some of their applicants.

Still Too Fat to Fight and its predecessor Too Fat to Fight, both released by Mission: Readiness, are studies that discuss the problems with overweight citizens and the military force.

“Being overweight or obese is the number one medical reason why young adults cannot enlist,” according to the study. “The United States Department of Defense spends approximately one billion dollars per year for medical care associated with weight-related health problems.”

Mission: Readiness is a national security organization, and their mission calls for smart investments in America’s children. It operates under the umbrella of the nonprofit Council for a Strong America.

“I’ve seen, in my experience, it’s been consistent that a certain amount of applicants have been too overweight to enlist,” Sgt. 1st Class Daniel Carmack said.

Retired Army Gen. Johnnie E. Wilson said, in Too Fat to Fight, that the threat could become much bigger.

“Childhood obesity has become so serious in this country that military leaders are viewing this epidemic as a potential threat to our national security,” he said. “We need America’s service members to be in excellent physical condition because they have such an important job to do.”

While Carmack said he does not foresee the issue becoming too threatening, he said it does “put us in a situation where we need to be more selective.”

Carmack, a senior ranking official at the Smithtown recruiting station, has been working in recruitment for the past four years, and has been on Long Island, at the Smithtown office, for the past two. He said he has found success with the Future Soldier Physical Fitness program.

The Future Soldier program is a training program that is “designed to get future soldiers ready for basic training,” Carmack said. The program includes information about basic training, general military orders, military time, and physical exercise.

The program is meant to make future soldiers more prepared, and also help motivate and train citizens who are interested in joining the military but are unable to due to issues like their weight.

“Most of the time, young ladies and men want to join the program, and they typically stay with us until they can enlist,” Carmack said. “I have worked with quite a few men and women to help them achieve their goal and get to that acceptable weight limit for Army standards.”

Future Soldier Anthony Troise, of Smithtown, has benefitted from this program.

When Troise was in high school, he discovered his interest in the military, and learned he would need to improve himself in order to enlist. He started training on his own, and once he was 17, met the standards and began attending the Future Soldiers program.

“I’ve lost a few pounds, and am benefiting physically and in my health overall from this program,” Troise said. “It’s a lot of physical fitness and a lot of cardio and core. Every time they want to improve different aspects.”

According to Still Too Fat to Fight, during the Iraq war, Congress expanded the number of military recruiters. The Army also experimented with accepting physically fit recruits who had more excess body fat than those previously allowed.

The Army discovered that overweight recruits were 47 percent more likely to experience a musculoskeletal injury, such as a sprain or stress fracture. Since then, the Army has stopped accepting overweight recruits.

Carmack said that the Future Soldier program is making positive success against this issue.

“A structured program is the best way to combat it.”

Mission: Readiness, an organization of retired senior military leaders, focuses on 17 to 24 year-olds in the Unites States that can’t serve in the military due to a variety of reasons including poor education, being overweight, and having a criminal history.

Get healthier before the season ends

By Lisa Steuer

Summer is in full swing. Ideally, you would have started working toward your summer body a few weeks or even months ago. But if you still have some progress to make, here are some last minute steps to get in better shape before summer ends.

Increase water intake. Leave a full 24 to 32-oz water bottle by your bed every night, and when you wake up in the morning, immediately drink that as you get ready. During the night your body hasn’t taken in much liquid, so it’s thirsty in the morning. Drinking water immediately in the morning gets your systems running and can aid in fat loss. You’ll also find that it’s very energizing. In addition, increase your water intake throughout the day, aiming for a gallon. Stay away from soda and other sugar-laden beverages.

Drinking water immediately in the morning gets your systems running and can aid in fat loss.

Eat a healthy breakfast. This can set you up for eating healthy the rest of the day. Try Greek yogurt with fruit, an omelet with veggies, or throw some fruit, natural peanut butter and almond milk in the blender for a delicious smoothie you can take on the go.

Prepare your lunches for the week every Sunday. Being prepared is one of the most important keys to success when it comes to health and weight loss. An example of a meal you can easily make in bulk: 4 oz. of lean ground turkey or chicken, one-fourth cup of quinoa, and one cup of veggies like broccoli. Bake the broccoli in the oven while making the quinoa and meat on the stove, and before you know it you’ve got a week’s worth of healthy lunches.

Replace your morning coffee with green tea with lemon at least a few times a week. While black coffee is healthy, the cream and sugar that often accompanies coffee is full of calories. Green tea has zero calories, contains antioxidants and has been shown to aid in fat loss.

Order smart at restaurants. It’s not as difficult as one may think, especially because many restaurants now have healthier menu sections. As a basic rule, look for words on the menu like grilled, baked or broiled and stay away from anything fried or breaded.  If possible, view the menu online before you go so that you’re prepared.

Increase cardio activity. Try to do something at least five days a week. Schedule a run every morning or a walk every evening. Go for a bike ride or swim laps. Sign up for a new and different fitness class each week. Just get out and get moving!

Have fun experimenting with new recipes. Eating healthy doesn’t have to be boring. Experimenting with new recipes can help keep you motivated. Try out healthy swaps— for instance, more often than not, you won’t even notice the difference when you swap out sour cream for Greek yogurt. Check out fitnessrxwomen.com for some great ideas.

Green tea has zero calories, contains antioxidants and has been shown to aid in fat loss.

Be active during downtime. While at home watching TV, do some crunches, planks, sit-ups, jumping jacks, etc. Do some squats while you’re heating something up in the microwave. Get creative!

Cut down on sugar, alcohol and sodium. It’s OK to have a treat once a week or so, but you may find that when you cut out sugar and alcohol, you’ll feel much better anyway. When a sweet craving strikes, try a small piece of dark chocolate or a chocolate protein shake. And while we do need some sodium in our diet, too much will lead to bloating.

Track your food intake with a food log or app like My Fitness Pal. You may be surprised at how much you’re actually consuming without realizing it.

Sign up for a 5K that occurs in the fall. It will keep you on track this summer and help motivate you to stay active. Even if you’ve never done a 5K before, it’s a great way to challenge yourself. You’ll feel amazing when you cross that finish line after all your hard work!

Lisa Steuer is the managing editor of FitnessRx for Women and FitnessRx for Men magazines. For more fitness tips, training videos, healthy recipes and print-and-go workouts that you can take with you to the gym, visit www.fitnessrxformen.com and www.fitnessrxwomen.com.

The Metabolic Reboot Smoothie, pictured above. Photo by Lisa Steuer

By Lisa Steuer

Contrary to what some may believe, there are many tasty ways to eat healthy. Whether your goal is to lose weight or improve your well being, smoothies are a great and easy option.

Making a smoothie — when you blend ingredients together — is different from juicing. When juicing, the juice is extracted from fruits and vegetables, leaving behind a pulp that is often thrown away. In addition, this strips the fruit of its fiber but leaves the sugar.

While juicing is still considered healthy in moderation, having a fiber source with your healthy drink is important, said Shoshana Pritzker, RD, CDN, who owns Nutrition by Shoshana in East Islip. Fiber keeps you feeling fuller for longer, is good for digestion and helps control blood sugar.

Still, many people turn to juicing-only type diets in order to “cleanse.” However, this is not really necessary, Pritzker said.

“You have a liver and a kidney that do a phenomenal job at making sure your system is clean and healthy, so there really is no way to detox better than what your body does already on its own,” said Pritzker. A better option, instead, is to focus on filling your diet with plenty of fiber-rich fruits and vegetables to keep you healthy and your system running smoothly.

The kind of smoothie you make can be dependent on your goals. For instance, add green tea to a smoothie to help boost your metabolism if you want to lose weight. Or make a health blend with antioxidant-rich ingredients like blueberries. “Overall, you should just be looking for a healthy blend of ingredients you like. Because if you don’t like it, you’re not going to drink it,” said Pritzker.

Making the Perfect Smoothie
Like any healthy meal, the ideal smoothie should contain all three macronutrients: protein, complex carbs and healthy fats. For protein, you could use a scoop of protein powder, non-fat dairy milk or non-fat yogurt (either Greek or regular, depending on your personal preference); the healthy fat could be fish oil, flaxseed, peanut butter, nuts, coconut oil or even an avocado (“You can’t even taste it. It makes it really thick and creamy,” said Pritzker). And your complex carb could be a high-fiber cereal or granola. A smoothie that contains all three macronutrients could even work as a meal replacement.

In addition, if you’re concerned about your fruit going bad before you get a chance to use it, give frozen fruit a try, as it’s just as healthy as fresh fruit (just check the label to make sure it contains no added sugar). “The only thing you want to stay away from is canned fruit,” said Pritzker. “Canned fruit is usually kept in syrup.”

Here are three smoothie recipes Pritzker shared. For more recipes, visit her website at nutritionbyshoshana.com, where you can also download a free smoothie recipe e-book.

Metabolic Reboot Smoothie: Makes 1 serving
Ingredients:
1 scoop vanilla whey protein powder
1/2 frozen banana
1/4 fresh avocado
1 cup chopped kale
1 cup fresh or frozen blueberries
1/2 – 1 cup brewed green tea, cooled
Ice
Directions:
Add ingredients to blender and blend until smooth. Enjoy!

Antioxidant Power Smoothie: Makes 1 serving
Ingredients:
1 cup fresh or frozen mixed berries (blueberries, raspberries, strawberries, blackberries, etc.)
1 cup frozen chopped spinach
1 apple, cored and cubed
1/2 frozen banana
1 tablespoon flaxseeds or ground flaxseeds
1/2 – 1 cup water or milk of choice
Ice (optional)
Directions:
Add ingredients to blender and blend until smooth. Enjoy!

PB & J Breakfast Smoothie: Makes 1 serving
Ingredients:
6 ounces plain, nonfat, Greek-style yogurt
2 tablespoons natural peanut butter
1/2 cup fresh or frozen purple grapes
or strawberries
1/2 cup dry oats
1/2 to 1 cup milk of choice
Ice (optional)
Directions:
Add ingredients to blender and blend until smooth. Enjoy!

Lisa Steuer is the managing editor of FitnessRx for Women and FitnessRx for Men magazines. For fitness tips, training videos and healthy recipes, visit www.fitnessrxformen.com and www.fitnessrxwomen.com.

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Weight loss should be a rather simple concept.  It should be solely dependent on energy balance: the energy (kilocalories) we take in minus the energy (kilocalories) we burn should result in weight loss if we burn more calories than we consume. However, it is much more complicated. Frankly, there are numerous factors that contribute to whether people who want to or need to lose weight can.

The factors that contribute to weight loss may depend on stress levels, as I noted in my previous article, “Ways to counter chronic stress.” High stress levels can contribute to metabolic risk factors such as central obesity with the release of cortisol, the stress hormone. (1)  Therefore, hormones contribute.

Another factor in losing weight may have to do with our motivators.  We will investigate this further. And we need successful weight management, especially when approximately 70 percent of the American population is overweight or obese and more than one-third is obese. (2)

Recently, obesity in and of itself was proclaimed a disease by the American Medical Association. Even if you don’t agree with this statement, excess weight has consequences, including chronic diseases such as cardiovascular disease, diabetes, osteoarthritis and a host of others, including autoimmune diseases.  Weight has an impact on all-cause mortality and longevity.

It is hotly debated as to which approach is best for weight loss.  Is it lifestyle change with diet and exercise, medical management with weight loss drugs, surgical procedures, or even supplements? The data show that, while medication and surgery may have their places, they are not replacements for lifestyle modifications; these modifications are needed no matter what route is followed.

But, the debate continues as to which diet is best. We would hope patients would not only achieve weight loss, but also overall health.

Let’s look at the evidence.

LOW-CARBOHYDRATE DIETS VS. LOW-FAT DIETS
Is a low-carbohydrate, high-fat diet a fad?  It may depend on diet composition.  In a newly published study of a randomized controlled trial (RCT), the gold standard of studies, results showed that a low-carbohydrate diet was significantly better at reducing weight than low-fat diet, by a mean difference of 3.5 kg lost (7.7 lbs.), even though calories were similar and exercise did not change. (3)
The authors also note that the low-carbohydrate diet reduced cardiovascular disease risk factors in the lipid (cholesterol) profile, such as decreasing triglycerides (mean difference 14.1 mg/dl) and increasing HDL (good cholesterol). Patients lost 1.5 percent more body fat on the low-carbohydrate diet, and there was a significant reduction in inflammation biomarker, C-reactive protein (CRP). There was also a reduction in the 10-year Framingham risk score. However, there was no change in LDL (bad cholesterol) levels or in truncal obesity in either group. This study was 12 months in duration with 148 participants, predominantly women, with a mean age of 47, none of whom had cardiovascular disease or diabetes, but all of whom were obese or morbidly obese (BMI 30-45 kg/m2).
Although there were changes in biomarkers, there was a dearth of cardiovascular disease clinical endpoints.  This begs the question; does a low-carbohydrate diet really reduce the risk of developing cardiovascular disease (CVD) or its subsequent complications?  The authors indicated this was a weakness since it was not investigated.
Digging deeper into the diets used, it’s interesting to note that the low-fat diet was remarkably similar to the standard American diet; it allowed 30 percent fat, only 5 percent less than the 35 percent baseline for the same group.  In addition, it replaced the fat with mostly refined carbohydrates, including only 15 to 16 g/day of fiber.
The low-carbohydrate diet participants took in an average of 100 fewer calories per day than participants on the low-fat diet, so it’s no surprise that they lost a few more pounds over a year’s time.
Patients in both groups were encouraged to eat mostly unsaturated fats, such as fish, nuts, avocado and olive oil.
As David Katz, M.D., founding director of Yale University’s Prevention Research Center noted, this study was more of a comparison of low-carbohydrate diet to a high-carbohydrate diet than a comparison of a low-carbohydrate diet to a low-fat diet. (4)
Another study actually showed that a Mediterranean diet, higher in fats with nuts or olive oil, compared to a low-fat diet showed a significant reduction in cardiovascular events- clinical endpoints not just biomarkers. (5)  However, both of these studies suffer from the same deficiency: comparing a low-carbohydrate diet to a low-fat diet that’s not really low-fat.

DIET COMPARISONS
Interestingly, in a meta-analysis (a group of 48 RCTs), the results showed that whether a low-carbohydrate diet (including the Atkins diet) or a low-fat diet (including the Ornish plant-based diet), the results showed similar amount of weight loss compared to no intervention at all. (6)  Both diet types resulted in about 8 kgs. (17.6 lbs.) of weight loss at six months versus no change in diet.  However, this meta-analysis did not make it clear whether results included body composition changes or weight loss alone.
In an accompanying editorial discussing the above meta-analysis, the author points out that it is unclear whether a low-carbohydrate/high animal protein diet might result in adverse effects on the kidneys, loss of calcium from the bones, or other potential deleterious health risks.  The author goes on to say that for overall health and longevity and not just weight loss, micronutrients may be the most important factor, which are in nutrient-dense foods.
A recent Seventh-day Adventist trial would attest to this emphasis on a micronutrient-rich, plant-based diet with limited animal protein.  It resulted in significantly greater longevity compared to a macronutrient-rich animal protein diet. (7)

PSYCHE
Finally, the type of motivator is important in whatever our endeavors.  Weight loss goals are no exception.  Let me elaborate.  A recently published study followed West Point cadets from school to many years after graduation and noted who reached their goals. (8)  The researchers found that internal motivators and instrumental (external) motivators were very important.  The soldiers who had an internal motivator, such as wanting to be a good soldier, were more successful than those who focused on instrumental motivators, such as wanting to become a general.   Those who had both internal and instrumental motivators were not as successful as those with internal motivators alone.  In other words, having internal motivators led to an instrumental consequence of advancing their careers.
When it comes to health, an instrumental motivator, such weight loss, may be far less effective than focusing on an internal motivator, such as increasing energy or decreasing pain, which ultimately could lead to an instrumental consequence of weight loss.
There is no question that dietary changes are most important to achieving sustained weight loss. However, we need to get our psyches in line for change. Hopefully, when we choose to improve our health, we don’t just focus on weight as a measure of success.  Weight loss goals by themselves tend to lead us astray and to disappoint, for they are external motivators.  Focus on improving your health by making lifestyle modifications.  This tends to result in a successful instrumental consequence.

REFERENCES
(1) Psychoneuroendocrinol. online 2014 April 12.  (2) JAMA 2012;307:491–497.  (3) Ann Intern Med. 2014;161(5):309-318.  (4) Huffington Post. Sept 2, 2014.  (5) N Engl J Med. 2014 Feb 27;370(9):886.  (6) JAMA. 2014;312(9):923-933.  (7) JAMA Intern Med. 2013;173:1230-1238.  (8) Proc Natl Acad Sci U S A. 2014;111(30):10990-5.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, go to the website www.medicalcompassmd.com and/or consult your personal physician.