Sunday, February 28, 2016

A Calorie is a Calorie - or is it?

A Calorie Is A Calorieor Is It?

Last week I attended the Cardiovascular Disease Prevention Symposium.  Oddly enough I found myself enjoying the Endocrinologist’s talk the most.  Don’t get me wrong, I enjoyed the whole conference, but definitely was intrigued by Dr. Lustig’s talk the most.  I read Dr. Lustig’s book, “FAT Chance Beating the Odds Against Sugar, Processed Food, Obesity, and Disease”, sometime last year.  In his book he addresses this question and others to begin to understand the obesity problem.  So what’s the answer you ask?  Depending on who you ask will depend on the answer you get.  Dr. Lustig’s recently published a study linking sugar, specifically fructose, to metabolic disease.  More on that study after I try and dissect the question, A calorie is a calorie – or is it?  As a dietitian I’m not here to give you the easy answer (or the answer you want to hear).  I’m here to help others to be healthy.  So read on to find out why it’s so confusing and I’ll try to help explain it.
There are three problems with “a calorie is a calorie.”

First let’s be honest.  There is absolutely NO way anyone could actually burn off the calories if you’re eating like the average American is eating.  A chocolate chip cookie has the equivalent calories of twenty minutes of jogging, and if you were to eat a Big Mac that would require four hours of biking.  Do people really do that?   I’ve never been of the mindset to eat something and go work it off through exercise (and again with the way we’re eating it’s next to impossible unless you’re Michael Phelps).   Case in point.  I made a chocolate mug cake the other night that called for coconut sugar, coconut oil, and deemed itself, “naturally sweetened & healthy”.  I’ll try anything once.  I have a program where I can analyze the calories in a recipe– 851 calories to be exact in that so called healthier dessert.  Now maybe I wasn’t supposed to eat the whole thing, but the recipe was being advertised “for the single lady on Valentine’s Day”.  Sheesh.  The following day I happened to be running my long run, 8 miles.  I decided to check and see how many calories I had expended.  Per my Fitbit, 697 calories.  Not even an 8 mile run was enough for the “healthy, naturally sweetened dessert” (and btw I used half the amount of coconut sugar the recipe called for!)  
I’ve counseled a lot of clients and I try to explain this concept of calories in = calories out (energy expenditure).  Because the concept is true:  if you take in more calories than you’ll use for that day you will gain weight (and vice versa, if you take in less calories than you need for the day it’s possible you’ll lose weight).  But what I also try to explain is that our energy expenditure is dependent on the quality and the quantity of the calories that you ingest.  You can eat a medium-sized apple for ~95 calories or you can have 2 Hershey nuggets for ~90 calories.  The calories are almost equivalent; however, the apple provides far more nutrients than the chocolate.  (I’m not saying that you can’t ever have chocolate but understand that on a day to day basis we should be taking in high QUALITY calories, not the empty ones.)  Therefore “a calorie is NOT a calorie.” 

Second, if a calorie is a calorie, then all carbohydrates should be the same, since they release 4.1 calories per gram of energy when burned.  But they’re not.  There are complex carbohydrates and there are simple carbohydrates – completely different in how they break down in your body and what they provide to you (vitamins, minerals, and fiber).   A doughnut for breakfast is not the same as a couple of slices of whole wheat toast.  The same goes for fat.  If they were all the same they’d release 9.0 calories per gram of energy when burned.  They are NOT all the same.  There are healthy fats (ones that have positive benefits-anti-inflammatory, help clear out the plaque) and there are unhealthy fats (those that can cause heart disease and a fatty liver).  The same concept goes for protein – there is high-quality protein and there is low-quality protein.  That’s why eggs were never “bad” in my book – they are truly a high-quality protein.  All those years, bacon and sausage were making eggs look bad.  So therefore, proteins are NOT all the same.  Proving once again, “a calorie is NOT a calorie.”
The third problem with “a calorie is a calorie” comes from this concept that we are eating more than we did in years past (the U.S. secretary of health and human services stated this and when you ask what our problem is as a nation people believe this to be true).  Are we eating more of everything or are we eating more of certain things?  The U.S. Department of Agriculture actually keeps track of the nutrient disappearance.  Our total consumption of protein and fat have remained constant (as our obesity pandemic has accelerated).  So if our total calories have increased but our total consumption of fat AND protein was unchanged, that means something else had to go up.  That leads us to look at the carbohydrates.  Our carbohydrates increased from 40 percent to 55 percent.  When you look a little bit closer, yes the complex carbohydrate intake increased a little, but the bigger increase was in the simple carbohydrates, specifically fructose.  If we are to have an answer to this global problem of obesity then we need to understand the causes and effects of this change in our diet – we’re eating more sugar. 

All these contradictions lead us to now understand that a calorie is NOT a calorie.  Maybe a better way to say this is a calorie burned is a calorie burned.  I’m always trying to help my clients understand the keys to weight loss.  I reflect after a nutrition counseling session if I did my best to relay this message.  I know there are some that leave from my office thinking they can eat anything they want (wrong)and just go do some exercise to balance it out (wrong).  And then there are others that really understand that they need to make changes in what they’re eating.  People need to understand that the quality (along with portion control) of the food matters.  This will be a key part in understanding this obesity problem we have on our hands. 
Dr. Robert Lustig recently published his study proving that fructose is making us fat.  In the study he (and others) recruited 43 children between the ages of 9 and 18 who were considered at particularly high risk for diabetes and related disorders.  All the subjects were black or Hispanic and obese, and had at least one or more symptoms of metabolic syndrome, a cluster or risk factors that includes hypertension, high blood sugar, abnormal cholesterol and excess body fat around the waist. 

On average, the subjects were taking in about 27% of their daily calories from sugar.  By comparison, the average American takes in about 15 percent, although children typically do consume much more because they consume the highest intake of sugar-sweetened beverages.
The participants were paired with dietitians.  They replaced the sugary foods in their diets with other foods purchased at the local grocery store.  The goal was not to eliminate carbohydrates, but rather to reduce SUGARY foods and replace them with starchy foods without lowering body weight or calorie intake.  Again, all that was changed – remove the food with ADDED SUGAR and replace them with a NO-ADDED-SUGAR version.  Example:  instead of a sugar-laden yogurt, the children would eat a bagel.  Instead of pastries, they’d eat potato chips.  It wasn’t as if they were trying to feed them only healthy foods.  The remaining sugar came from fresh fruit (along with the benefit of fiber).
The study only lasted nine days due to money constraints with their study through the NIH (National Institutes of Health).  It didn’t matter.  In that short time span they saw marked changes.

On average, the subjects’ LDL cholesterol, the kind implicated in heart disease, fell 10 points.  Their diastolic blood pressure fell 5 points.  Their triglycerides, the fat that travels in the blood and also contributes to heart disease, dropped 33 points.  And their fasting blood sugar and insulin levels, indicators of their diabetes risk, also markedly improved.
Dr. Lustig was trying to set out and prove that added sugar, fructose specifically, can be linked to metabolic disease.  As he said at the conference, “someone should be held liable now that there’s proof.”  He’s been saying this for years and has finally been able to prove it, isolating the effect of sugar on metabolic syndrome and insulin resistance.  While many might find it controversial – he didn’t reduce their caloric intake, but rather simply reduced their consumption of added sugars.  This study proves Lustig’s original statement – A calorie is not a calorie – The source of the calories determines where in the body they go.  Sugar calories are the worst, because they turn to fat in the liver, driving insulin resistance, and driving the risk for diabetes, heart, and liver disease.  This has enormous implications for the food industry, chronic disease, and health care costs. 

What does this mean in layman’s terms?  We need to cut back on added sugar in the food we are eating.  Start paying attention to the food you buy at the grocery store.  Cereal and yogurt are two foods off the top of my head that are LOADED with extra sugar.  Instead buy plain yogurt and add your own fruit (cinnamon and vanilla are also great flavor enhancers).  And cereal, just stop buying it altogether – it might be one of the worst foods ever.  The recommendations for women are 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.  For now, if you’re buying a packaged product it’s hard to know exactly how much you’re consuming.  However, in the coming year the nutrition label will begin to distinguish between naturally occurring sugars and added sugars.  Or better yet, follow these simple rules by Michael Pollan when in doubt:
1.  Eat Food.
2.  Not too much.
3.  Mostly plants.


Sunday, February 14, 2016


Valentine’s Day.  A day for love.  Love is defined as, “an intense feeling of deep affection.”  Love comes in many forms:  partnership, friendship, hugs, kisses, food, and even solidarity.   Many times on Valentine’s Day we put the focus on others in our lives.  But I challenge you this Valentine’s Day to love yourself.  The saying goes, you can’t love someone else until you truly love yourself.   YOU are special, YOU deserve love, and YOU should practice self-love.  Here are a few suggestions to show yourself some love:

Self-Acceptance – Accepting yourself for who you are is one of THE most important steps to self-love.  In this world of social media there are posts/pictures all the time that can lead one to begin to compare themselves with others.  Social media tends to promote “perfect pictures” and that’s not always truth.  Stop comparing yourself and begin to accept yourself.  We each have beautiful qualities about ourselves, whether they be physical or emotional, that attract people to us.  We definitely don’t need to look like or act like anyone else but ourselves.  We are unique and different.  That’s what makes the world so beautiful.
Minimize What’s minimalism?  Minimalism is a tool to rid yourself of life’s excess in favor of focusing on what’s important – so you can find happiness, fulfillment, and freedom.  We often times begin to accumulate “stuff” and we often equate this “stuff” to love.  When in fact, sometimes this “stuff” is literally weighing us down.  It doesn’t mean you’re not able to own material possessions, but the problem today is the meaning we assign to our stuff.  We at times give too much meaning to our things.  A minimalist will search for happiness not through things, but rather through life itself.  Today is Valentine’s Day.  Rather than buy yourself something that will only last for a small moment in time, i.e chocolate, flowers, etc, treat yourself to an experience – something that you will be able to look back and remember – really living in the moment.  Which leads us to the next way to practice self-love:
Pamper Yourself – Respect your body for the amazing vessel that it is!  Take care of your body.  Simple self-care techniques:  exfoliate your skin, take a soothing bath, get a mani/pedi, indulge in a massage, prioritize your sleep routine – all of these are ways to show respect to your body by showing it the love it NEEDS and deserves! 

Nourish Your BodyI talk about this one all the time as a dietitian.  The old saying, “you are what you eat”.  There is some truth to this.  Our bodies naturally detoxify themselves (that amazing liver and kidney just doing their thing!)  But if we continuously put junk in, we will feel like garbage.  Replenish your body with real, whole food.  Food can provide the nutrients our bodies need and help sustain us by providing us with the nourishment that we need.  This is just one other way to show yourself some love – choosing healthy food  WILL help you to thrive!
Write yourself a note – We all have our days.  Some days are busier and more stressful than others and that can get the best of us sometimes.   Try writing yourself a positive note or have an inspirational quote you like written somewhere so that you can see it first thing in the morning or during the day (when you need to get over the mid-day slump).  We all can use a pep talk sometimes and having the reminders nearby is helpful (so the negative thoughts don’t take over). 
Be the ENERGY you WANT to attract – “Your friends should motivate and inspire you.  Your circle should be well rounded and supportive.  Keep it tight.  Quality over quantity, always.”  As we get older, the number of friends we have does tend to shrink – it’s the shift from having a large volume of friends to having those close to us that we can truly depend on.  Your vibe attracts your tribe – be the energy that you want to have surrounding you: uplifting, supportive people.
Be Grateful– Finding things to be grateful for on a daily basis can help change your inner dialogue.  Last year I made the commitment to start my day and end my day with one thing that I was grateful for.  It truly helped change my perspective on things that I used to think would be “earth shattering” or I would let ruin my day. 

We so many times tend to have negative internal conversations with ourselves.  Practicing gratitude can help change this internal chatter.  Are you grateful for a healthy body – that moves and allows you to be able to do exercise?  Are you grateful for your sense of smell – for that freshly baking bread in the oven –currently the situation in my house.  Are you thankful for being able to learn from your mistakes?  Are you grateful for this present moment?  Gratitude is an attitude of practice.
Let It Go– This is definitely easier said than done.  But the truth is you never really are able to move forward unless you do leave the past in the past – “You can’t reach for anything new if your hands are still full of yesterday’s junk.” ~Louise Smith  Each day is new and fresh and I do believe that’s helpful in committing to letting things go.  Again, easier said than done, but a step in the right direction if you’re truly wanting to move forward.

“Me” Time– Everybody needs ME time.  Taking time out of the day, even if it’s just 10 minutes is so important for us.  We often times give so much of ourselves – whether it’s at work with our patients or whether it’s at home with our family – the key is to give back to yourself so you have more to give to others.  If you run yourself into the ground, what good will you be to anyone else?  Don’t feel guilty or think you’re being selfish, think of it as giving back to yourself.  This giving back will help you recharge, reset, and reenergize!  Not only is this important for you but it’s important for those around you as well.
Disconnect To Connect– In this day and age, we are TOO connected – from our cell phones that receive emails from work to our smart watches that receive text messages (thanks Fitbit Surge, but no thanks).  Truly take time at the end of the day to disconnect from all of your devices.  Evidence shows that our devices are creating havoc when it comes to our sleep patterns – even MORE reason to disconnect.  Take time to reconnect with how you’re feeling, what you’re thinking and even what might be going on in your body – I use it as a wind down time before bed.  I reflect on the day and write down in my gratitude journal a few things that occurred during the day.  A calm mind helps for sound sleep.
Positive Affirmations– With time, positive affirmations can help transform our mind.  Truly focusing on the positive moments in our day will help in removing that negative chatter I mentioned before.  Start with something positive about yourself.  It can be something as simple as your hair looks good this morning or something from the previous day that you’re proud that you accomplished – possibly handling a stressful situation at work in a positive manner.  Stay consistent with your positive affirmations, over time it will help change your outlook and again remove the negative self-talk it’s so easy to get into the trap of.

Learn Forgiveness– with yourself!  No one is perfect and I’ve always said that practice is what makes perfect.  There are going to be some hits and misses – the true failure lies in not even trying!  So be a little easy going on yourself and be proud of yourself for even trying.  Today I tried making homemade rolls once again – epic fail.  Instead of getting upset with myself I already told myself I WILL be trying again (I’m already reflecting on what went wrong).  And while bread making is not something to get uber upset about, remember this practicing forgiveness goes to the deeper stuff – not beating yourself up at the latest “mistake” you made but rather focusing on what you learned from that situation.  Each struggle or mistake helps you to learn new things.  This in turn helps us to be strong, amazing people – sure that have some imperfections but that make us each unique beings.
Practice Saying “No”– This one is important.  Learning to say no helps you to set boundaries for yourself and helps protect you (from those that WILL take advantage of you).  Believe me when I say it IS uncomfortable to say no but it IS important.  There’s no way for you to please everyone and sometimes you already have enough on your plate – saying yes will only add to that stress and create aggravation.  Remember the goal is to practice self-love – respect yourself by standing up for yourself – and practice saying no (so when the time comes you’ll be able to put yourself first and say no!)
Have FUN!  Do not get me wrong – there is definitely a time and place for being serious.  But on the flip side, make sure you leave some time for FUN!  When was the last time you danced?  You sang karaoke? Or went paddle boarding?  I’m reading the book, Big Magic, by Elizabeth Gilbert and this is the essence of her novel – she wants you to embrace your curiosity, find what fuels your happiness, and face your fears – so you can uncover the “strange jewels” that are hidden within each of us.  Be creative and find what stokes your spirit – giving back to yourself with some fun!
So this Valentine’s day, as you may be off showing all the special someone’s in your life how much you care for them, don’t forget about YOURSELF! 
“You can search throughout the entire universe for someone who is more deserving of your love and affection than you are yourself, and that person is not to be found anywhere.  You yourself, as much as anybody in the entire universe deserve your love and affection.” – The Buddha