First the fat, then it was the salt and now it’s our sugar.

Cut back on your sugar and carbohydrates? Increase the fat in your diet? Ten years ago fat was the killer in our diet and carbohydrates the answer to preventing heart disease, the bane of our fast food society.

Dr. Atkins (of Atkins Diet fame) was one of the first to suggest that sugar, not fat was the reason for our epidemic of obesity. A recent review of 23 studies in 2017 supported this claim with the observation that study participants on a low carbohydrate diet often lost 2-3 times as much weight as the low fat groups. 

And even more interesting, many of the low carbohydrate group lost weight without any calorie restriction. 

The appetite suppressing effects of dietary fat were associated with an unexpected reduction in participants’ total daily calories. This “fat effect” is why we often take a trip to the refrigerator within a few hours of a chinese meal (generally low fat) and can find ourselves skipping that early lunch after a breakfast of bacon and eggs (high fat).

Then there were the studies showing that excess sugar increased the risk for heart attacks and strokes. In 2014 the Journal of the American Medical Association published a study showing that that North Americans who ate 25 percent of their calories as sugar had a fatal heart attack rate 2.75 times that of those who ate less than ten percent as sugar calories.

A meal high in sugar--or a sugared drink--leads to a rapid rise in blood sugar. Unless that extra sugar is used by exercising muscles (one of the reasons a good walk after dinner is a healthy habit), it is converted almost immediately to a type of fat called triglycerides.

These in turn cause fatty deposits in the lining of blood vessels and are the reason for the increased risk for a stroke or heart attack.

Even cancer has been linked to a high sugar diet. Rapidly growing cancer cells get almost all of their energy from sugar in a process that is oxygen-independent, while normal cells get their energy from fats, protein, and sugar in a process that is dependent on oxygen.

This observation led to speculation that the occasional cancerous cell (resulting from a spontaneous mutation) would have a better chance of survival in the presence of a high blood sugar. The theory is supported by a recent study showing an increased risk of colon cancer recurrence in patients with higher total daily carbohydrate diets.

Why has it taken so long for this to be sorted out? That is a story in itself and a great example of why industry funded research should always be suspect.

In the 1940s there was an ongoing argument in the medical literature on the role of fats versus sugar as the major risk factor for heart disease. To quote from an online blog by Dr. Mirkin, “... in 1965, John Hickson of the Sugar Research Foundation (now the Sugar Association) wrote to Harvard researchers asking them to write an article showing that sugar was safe and healthful. He paid them $6,500 and asked them to review only the research papers favorable to the sugar industry.”

This was the first step in a cascade of events that demonized fat and promoted sugar as heart healthy. And it has taken 50 years for the real facts to come to light.

But the wheel turns and we are now coming back around to our grandmother’s advice to eat a balanced diet. The healthiest approach is not an artificially low fat versus low sugar diet, but instead about eating a balanced diet—a bit of meat, occasional fish, a side of pasta, and several portions of fruit and vegetables. And getting rid of that sugar bowl in the kitchen and on the table.

It won’t be easy. Evidence from PET scans shows the same brain activity changes with the over consumption of sugar that we see in drug or tobacco addiction. And when you talk to someone who has tried to limit the sugar in their diet, their story reminds you of the withdrawal symptoms described by smokers and alcoholics. That is several weeks of withdrawal symptoms with a long term residual urge to have that piece of candy or sugared cereal. 

But in their next breath the successful will just as quickly tell you how much better they feel. So to keep you and your family healthy, it is time to think about taking that sugar bowl off the table….and then out of the kitchen.

References

https://www.ncbi.nlm.nih.gov/pubmed/23136358   
Dietary glycemic load and cancer recurrence and survival in patients
with stage III colon cancer: findings from CALGB 89803.

http://www.drmirkin.com/nutrition/honey-is-not-better-than-hfcs.html

http://www.drmirkin.com/nutrition/big-sugar-paid-harvard-to-say-that-sugar-is-healthful.html

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32252-3/abstract

http://www.drmirkin.com/nutrition/sugar-added-to-foods-linked-to-heart-attack-risk.html

https:// www.healthline.com/nutrition/23-studies-on-low-carb-and-low-fat-diets

https://www.healthline.com/nutrition/6-graphs-the-war-on-fat-was-a-mistake#section6

https://nutritionfacts.org/video/are-sugary-foods-addictive/

http://www.drmirkin.com/heart/added-sugars-linked-to-high-blood-pressure.html

Diabetes and dementia - its the pp blodd sugar. https://www.drmirkin.com/health/diabetes/how-pre-diabetes-increases-risk-for-dementia.html

Three tips to jump start that weight loss resolution.

The last few cold days of Winter are here. That can only mean that the longer days of Spring are just around the corner. This is ideal time to see how you’re doing with your New Year’s resolutions, especially that plan to lose a few pounds after the holiday food blitz. If you have been having trouble moving your numbers the right way, these three tips may help you re-energize your program.

Quality over quantity

The traditional approach to weight control (dieting) is based on rigorous portion control and counting calories. Eat fewer calories than you expend each day and watch the dial on the scale plummet. But a recent study suggests that it is the quality of your diet, not quantity is more important.

One study was done to see if there were any advantages of recommending a low fat versus a low carbohydrate diet. Both groups were instructed on cooking and eating nutrient-dense, minimally processed whole foods whenever possible. One group was instructed on low carbohydrate foods and the other on low fat alternatives. Both were asked to try to cut down on portion size, but neither was asked to count calories. At the end of a year both groups lost an equal amount of weight. And participants were most surprised that they did not have to restrict or even think about calories to do so.

The conclusion? Losing weight is not as much about limiting fats or carbohydrates as it is about changing your eating habits to focus on whole foods (those you prepare at home and are not pre-processed and packaged ready to eat).  

This may require changes to your lifestyle - more cooking at home, no more quick lunches in the car after a drive-thru lunches at McDonalds - but using whole foods (more vegetables, less added sugar, fewer refined grains) will be healthier as it helps you control your weight.

And after you have shed those unwanted pounds, the same whole food approach, once you have changed your eating habits, is easy to maintain.

No white at night

When you eat the balance of your daily calories is as important to any diet plan as your total daily calories

Calories, especially carbohydrate calories (the “white” foods - bread, pasta, rice) eaten early in the day are metabolized preferentially by active muscles over the following three or four hours. And any carbohydrates not used for immediate energy needs are processed into into fat and stored for future use.

Thus, it makes sense to eat the bulk of your calories early in the day (before 2 PM) when it is most likely you will be up and about at work or doing chores and errands. If you make dinner the big meal of the day, a larger percentage of the meals calories will go directly to fat. If you want to minimize that happening, take a walk (it doesn’t have to be a long one) right after dinner.

A good goal might be a 25-50-25 caloric split for breakfast-lunch-dinner.

Consider fasting

There is solid science behind fasting. An English study compared a traditional calorie restricted diet with one that kept total weekly calories the same but added fasting two days a week (they did allow 700 calories on those two days). Over the three-month study, the average weight loss of the fasting group was twice that of the traditional diet group.  And sixty-five percent of those who fasted intermittently lost weight, compared to only 40 percent of those on calorie-restricted diets.

One fasting approach is to adopt a weekly meal plan that includes five days of a normal diet and two “fasting” days.

A second idea would be to modify your daily routine to extended the fasting period to 16 hours (you already have seven or eight while you are sleeping) and then plan your meals for the remaining eight hours. This has been called a 16:8 plan. This is not an absolute and a few bloggers with work shift challenges have suggested that 14:10 works as well.

For an extended daily fasting period, the meal to skip is the late evening meal. When a morning fast was compared to an equivalent evening fast, equal weight was lost, but blood markers of inflammation increased in the morning fast group.

With the daily fast scenario, dieters that move towards two meals a day with just a snack or salad for dinner. One small study compared two groups of women on similar low-calorie diets. One group ate 700 calories for breakfast, 500 for lunch and 200 for dinner, while the other group reversed that with 200 - 500 - 700. Over three months, the large breakfast group lost twice as much weight as the large dinner group.

The message seems clear, eating fewer calories in the evening appears to prove the adage: Eat breakfast like a king, lunch like a prince and dinner like a pauper.