Human Biology.

The prevalence of obesity (a body mass index over 30) among U.S. adults is 42 percent and rising. Although lifestyle choices (like what we eat and how much we move) are important, our natural biology plays a key role in the current obesity epidemic. “Human biology is designed to encourage us to eat when food is there,” says Susan B. Roberts, PhD, a professor at the Friedman School and senior scientist on the Energy Metabolism Team at the Human Nutrtion Research Center on Aging. “This normal biology combines with an unhealthy food environment and food culture to cause weight gain. So-called ‘low willpower’ is normal human behavior, not some defect.”

What to do: Take control of your food environment. Stocking the house with healthy (whole and minimally processed) foods, watching portion sizes, preparing more food at home, and choosing wisely when eating out or ordering in can all help curb the natural tendency to overeat.

Metabolic Adaptation.

In addition to storing energy (calories) for future use, fat (adipose tissue) acts as a powerful endocrine organ, secreting hormones and other molecules into the blood. “Many of the hormones released by adipose tissue are involved in regulating appetite, energy expenditure, and fat storage,” says Leon I. Igel, MD, a Tufts alum who is an endocrinologist and chief medical officer for Intellihealth. For example, adipose tissue releases the hormone leptin to signal we’ve had enough to eat. Individuals with obesity can develop a lack of sensitivity to leptin, or leptin resistance. With this condition, one doesn’t get the normal feelings of fullness and satiety and the body starts to burn less calories at rest. Leptin resistance thus contributes to a vicious cycle of obesity.

Many other hormones are released by fat cells, including those involved in glucose tolerance, insulin sensitivity, cell growth, inflammation, and the formation of blood clots in veins and arteries. “As levels of adipose tissue increase,” Igel explains, “multiple metabolic pathways stop working as they should. This leads to the development of a number of medical conditions associated with obesity.” Metabolic changes are also responsible for making it difficult to maintain weight loss.

What to do: Science suggests specific foods have different effects on weight gain. “Eat more minimally processed fruits, vegetables, nuts, beans, whole grains, fish, and yogurt,” says Dariush Mozaffarian, MD, DrPH, dean of policy for the Friedman School and editor-inchief of this newsletter. “Foods with live probiotics and fermented foods may also help protect against weigh gain. Eat less refined grains, starches, sugars, and red and processed meat. Avoid soda and other highly sweetened drinks. Alcohol is also associated with weight gain—if you drink, do so moderately. Other animal foods, like milk, cheese, poultry, and eggs, appear, in observational studies, to be relatively neutral for long-term weight gain.”

Getting adequate sleep, increasing physical activity, and finding ways to reduce or deal with stress can also help address some of the physiological reasons we gain weight.

Even metabolic adaptations that slow metabolism and make weight loss maintenance difficult may be responsive to dietary intake. “Recent controlled trials show metabolic adaptation is influenced by diet quality and composition,” says Mozaffarian. “This research found that after weight loss resting metabolic rate was best maintained on a high fat, low carb diet (60 percent energy from fat, 20 percent from carbs) compared to a low fat, high carb diet (20 percent energy from fat, 60 percent from carbs), leading to about 300 more calories of energy expenditure a day.” Effects were in between on a moderate fat, moderate carb diet (40 percent energy from each). All the carbohydrates in these diets emphasized fruits, non-starchy vegetables, beans, and whole and minimally processed grains, rather than refined grains and added sugars.

Health Impacts.

Obesity is the root cause for many medical diseases, including heart disease, stroke, type 2 diabetes, and certain types of cancer. It is also a risk factor for poor self-esteem, depression, obstructive sleep apnea, osteoarthritis, gout, female infertility, gallstones, pancreatitis, and non-alcoholic fatty liver disease. “This makes obesity its own complex medical disease,” says Igel. “We treat each of these other weight-associated conditions individually, but if we are able to treat obesity itself, we reduce all of these other medical issues at the same time.”

What to do: As with the treatment of other conditions—like high blood pressure, high cholesterol, and diabetes— medication may be necessary if lifestyle modifications are not enough. New medications, in combination with lifestyle changes, can help overcome the body’s metabolic adaptations and assist with weight loss. However, these tend to be expensive and are not yet widely covered by health insurance programs. It is important to recognize that people with obesity who struggle to lose weight are fighting a real battle with their own bodies. It’s equally important to understand that we are not entirely helpless in the face of our genes, hormones, and metabolism. Lifestyle modification, including diet and physical activity, is still the cornerstone of obesity treatment. Accepting that obesity is a disease will help reduce stigma and discrimination, increase research dollars and insurance coverage, and move us all toward a healthier future.

The post Obesity is a Disease: Why, and Why it Matters appeared first on University Health News.

Nicola McKeown, PhD, an associate professor at the Friedman School and whole grain expert, answers: “Nutrition publications (including this one) often recommend oatmeal—and steel-cut oats in particular— as a healthy, whole-grain, breakfast option.

“After the inedible husk is removed from an oat grain, the resulting groat (inner kernel) can be cut into smaller pieces or steamed and flattened with a roller. The rolling breaks the grain’s structure down, so the resulting product cooks more quickly and has a softer, more consistent texture. Quick or instant oats generally undergo further processing, such as precooking and then drying.

“All oats are nutritious, fiber-rich whole grains and, as long as other ingredients are not added, the nutrient content of all of these products is essentially the same. Among other health-promoting nutrients, oats are rich in beta-glucan, a soluble fiber associated with reducing blood cholesterol levels and colon cancer risk. Cut oats retain more of their intact structure than rolled. They therefore take longer to digest and raise blood sugar levels even more slowly. This may help you feel full longer. What is important to consider is that both rolled and steel-cut oats are a better choice than instant varieties, which boost blood sugar more and are more likely to come with undesirable added ingredients (like sugars).

“Steel-cut oats tend to have a firmer and chewier consistency than rolled. You may find you like them better as the base for a salad, grain bowl, or pilaf. Experiment with the wide variety of other whole grains (like barley, quinoa, bulgur, buckwheat, wheat berries, amaranth, and more), too. You can even eat them warmed with cow’s milk or soymilk and topped with fruit and nuts for a wonderful—if less traditional—breakfast.

“The enjoyment of food is essential not only to perpetuating healthy eating habits, but also to the enjoyment of life. Don’t feel obligated to eat something you don’t enjoy just because it’s ‘good for you!’”

What are “net carbs” and why are they only included on the labels of certain foods?

Judith C. Thalheimer, RD, LDN, managing editor if Tufts Health & Nutrition Letter, answers: “Some carbohydrates—specifically fiber but also, to some extent, sugar alcohols—are not fully broken down by the body, and therefore provide few (if any) calories and cause little or no rise in blood sugar levels. The term net carbs refers to the amount of fully digestible carbohydrate in a food—how much carbohydrate will actually be absorbed into your body. It is calculated by subtracting grams of dietary fiber and half the grams of any sugar alcohols from grams of total carbohydrate.

“The term was invented by food manufacturers to appeal to followers of the low carb diet trend (although it may also be somewhat helpful for people with diabetes who require insulin and count carbs to calculate dosages). Legally, food manufacturers are only required to list total carbohydrates, dietary fiber, sugars, and added sugars on the Nutrition Facts label. That is why you won’t find net carbs included on all products.

“More fiber generally equates to lower net carbs. Consuming plenty of naturally high fiber foods (like fruits, vegetables, legumes, and whole grains) in place of low-fiber refined options is associated with health benefits, but that does not mean all foods that claim they are low in net carbs are good choices (particularly processed foods that tend to have nutrition facts labels). Many of these products are highly processed (see the September 2021 Special Supplement for information on the health dangers of ultraprocessed foods). Additionally, many of these foods contain added fibers, rather than natural fibers. Check this space in next month’s issue for a discussion of the difference between natural and added fibers.”

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Two small randomized clinical trials were not able to demonstrate a benefit of high dose zinc, vitamin C, or vitamin D3 for patients with COVID-19.

The first study, conducted in the U.S., examined whether high-dose zinc and/or highdose ascorbic acid (vitamin C) reduced the severity or duration of symptoms compared to usual care among 214 adults diagnosed with COVID-19. The participants (who were not hospitalized) received 50 milligrams (mg) zinc gluconate, 8,000 mg ascorbic acid, both, or standard care for 10 days. There was no significant difference in outcomes between participants receiving standard care (no supplements) and those in the supplement groups.

The second randomized controlled trial gave 240 patients hospitalized in Brazil with moderate to severe COVID-19 a single dose of 200,000 IU of vitamin D3 or a placebo. While serum levels of 25-hydroxyvitamin D went up in the supplement group, the hospital length of stay was no different than the control group. Admission to intensive care units, need for mechanical ventilation, and death rate was also not significantly different between the two groups. [Editor-in-chief’s note: These results are not definitive. Small studies can miss moderate benefits.]

While experts around the world continue to search for ways to treat COVID-19 infection, doing our best to prevent exposure through social distancing, mask wearing, and hand washing is still essential as the vaccine rolls out.

(Minimally Processed) Low Fat vs. Ketogenic Diet: No Clear Winner

A controlled feeding trial conducted by the National Institutes of Health (NIH) found no evidence that a healthy ketogenic diet was better than a healthy low fat, high carbohydrate diet for hunger or fat accumulation over two weeks. Participants lived in a lab at the NIH for four weeks. For two weeks, participants were provided a plant-based, extremely low fat diet (around 10 percent fat, 75 percent carbs). For another two weeks, they were offered an animalbased, extremely low carb (ketogenic) diet (around 75 percent fat, 10 percent carbs). They were allowed to eat as much as they wanted.

Participants consumed 550 to 700 fewer calories per day on the low carb diet. They lost weight on both diets, although only the low fat diet led to a significant loss of body fat. Challenging common thinking, the high carb diet did not lead people to overeat, and the high fat, animal-based diet did not result in weight gain.

Importantly, both diets were not typical American foods, but meals made with healthy, minimally processed foods and ingredients. A 2019 study by the same lab showed that a diet high in ultraprocessed food led to overeating and weight gain compared to a minimally processed diet. So, results could be different with a more typical, processed American diet.

If you are trying to lose weight, or just trying to support your health and well-being, follow a dietary pattern that suits your needs and preferences and avoid highly processed foods.

Ultraprocessed Food Intake Associated with Cardiovascular Health

The more ultraprocessed foods (UPFs) we consume, the worse our cardiovascular health is likely to be, a new study suggests. UPFs are mixtures of industrially refined starches, sugars, fats, isolated proteins, and other additives with little, if any, whole food ingredients (for example, most breakfast cereals, energy bars, instant soups, pre-packaged cookies and cakes, some chicken nuggets, and many packaged salty snacks). Previous research has found high intake of UPFs to be associated with overweight, obesity, high triglyceride and LDL cholesterol levels, high blood pressure, type 2 diabetes, cardiovascular disease, and death. The current study compared participants’ level of UPF intake with a score of how they measured up to the American Heart Association’s seven metrics of cardiovascular health: body mass index, smoking, physical activity, dietary quality, total serum cholesterol, blood pressure, and fasting blood sugar.

More than half the total calorie intake in this representative sample of U.S. adults came from UPFs. Higher intake of UPFs was associated with lower cardiovascular health scores. People who consumed the most ultraprocessed foods were more likely to have diabetes compared to people who consumed the least. They were also more likely to be overweight or obese, smoke, and be less active.

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Focus more on your overall eating pattern than individual foods. A number of dietary patterns are well supported by research as being beneficial for your cardiovascular health, while, for others, the evidence is lacking or suggests potential shortfalls. No single dietary pattern is perfect for everyone, but the dietary patterns outlined in the following pages provide you with plenty of options to help you customize an eating plan for your individual needs and preferences. Remember, your eating plan is not a short-term quick fix; you are going to be in this for the long haul.

You’ll notice a common theme among the healthy eating patterns: They are higher in vegetables, fruits, whole grains, low- or nonfat dairy, seafood, legumes, and nuts, moderate in alcohol (among adults), lower in red and processed meats, and low in sugar-sweetened foods and drinks and refined grains.

It’s never too late to change the way you eat to benefit your heart health. If need be, take small steps and build your heart-healthy eating pattern incrementally. Use the information in this chapter as a blueprint to guide you in this process. As you modify your diet, do it in a way that includes types of foods you enjoy and want to share with other people.

The Tufts MyPlate for Older Adults

In your younger years, you probably didn’t think much about how many meals you ate or how much food you consumed to satisfy your appetite. Now that you’re older, you might be surprised that you shouldn’t be eating like you once did. The needs of your body change with age, and your dietary pattern should be adjusted to meet those needs. If you’re like many people, your calorie requirements decline with aging, due to changes in your metabolism and physical activity level, but you still need the right nutrients to fuel your body’s engine (see “Nutrients of Concern Among Older Adults”).

So, experts at the Tufts Human Nutrition Research Center on Aging developed MyPlate for Older Adults, geared toward the dietary issues relevant to older adults. The MyPlate for Older Adults is a visual guide that offers examples of foods that can help you shift your diet to a healthier eating pattern that you can sustain, and it corresponds with the DGA (see “MyPlate for Older Adults”). For more information, visit https://hnrca.tufts.edu/myplate.

A Healthy Way to Eat in the U.S.A.

You don’t have to eat foods that are unfamiliar to you (or most Americans) to follow a heart-healthy eating pattern. In fact, the DGA’s “Healthy U.S.-Style” eating pattern is derived from foods that Americans typically consume.

The key elements of the Healthy U.S.-Style dietary pattern include:

• 5 cups per day of vegetables (including dark-green, red, orange, and starchy vegetables and legumes) and fruit
• 6 daily servings of grains, of which at least half are whole grains
• 3 daily servings of dairy
• 5.5 ounces of protein each day, including seafood, lean meats and poultry, and eggs, as well as nuts, seeds, and soy products
• About 5 teaspoons of unsaturated vegetable oils each day

For examples of serving sizes of fruits, vegetables, grains, and proteins, see Chapter 3. Visit the DGA website to learn about food recommendations for other daily calorie totals and get more details: https://health.gov/dietaryguidelines/2015/guidelines/appendix-3.

A Mediterranean-Style Diet

There’s a reason why many medical experts recommend that you “eat like a Greek.” In general, the incidence of heart disease has been lower in Greece, Italy, Israel, and other countries bordering the Mediterranean Sea, due, in part, to how they eat (although other factors, such as physical activity, probably play a role, too). That doesn’t mean you can load up on pizza, spaghetti and meatballs, and “Americanized” versions of Mediterranean foods that contain more meat, sugar, and calories, though. Instead, follow the traditional eating patterns enjoyed in countries around the Mediterranean decades ago, when rates of chronic diseases there were among the lowest worldwide.

There’s no single Mediterranean diet because the foods consumed across the region are as diverse as the cultures residing there. However, their dietary patterns do share a number of common traits (such as a higher intake of unsaturated fats than a typical Western eating pattern). According to the American Heart Association (AHA), these are characteristics common to a Mediterranean dietary pattern:

• High consumption of fruit, vegetables, nuts, and seeds
• A high intake of beans and potatoes, as well as bread and other cereals
• Consumption of unsaturated fats; more than half the fat calories come from monounsaturated fats, especially from olive oil
• Low to moderate intake of fish, poultry, and dairy products
• Little red meat consumption
• Low intake of eggs (zero to four times a week)
• Low to moderate consumption of wine.

Research suggests that following a Mediterranean-style eating pattern is associated with a lower risk of heart attack, stroke, and death from cardiovascular events, as well as lower LDL cholesterol levels and potential benefits for brain health.

How to ‘Go Greek’

You don’t have to eat exotic, hard-to-find foods when following a Mediterranean-style diet, but the majority of your foods will be whole, minimally processed items, rather than prepared foods that come in boxes, bags, or cans or from fast-food joints. The DGA provides an example of this dietary approach on their website at https://health.gov/dietaryguidelines/2015/guidelines/appendix-4/. For further guidance, visit the website for Oldways, a nonprofit organization in partnership with the World Health Organization and Harvard School of Public Health: oldwayspt.org/traditional-diets/mediterranean-diet.

DASH to a Healthier Diet

The National Institutes of Health sponsored the Dietary Approaches to Stop Hypertension (DASH) trials to help determine the best dietary pattern for cardiovascular health and, more specifically, lowering blood pressure and preventing hypertension. The initial DASH study found that, compared with a control diet resembling a typical Western eating pattern, a diet rich in fruits and vegetables, as well as a combination diet high in fruits, vegetables, and low-fat dairy products and low in saturated and total fat, were associated with significant reductions in systolic and diastolic blood pressure. The second trial, the DASH-Sodium study, found that reducing sodium consumption from about 3,300 milligrams (mg) a day to about 2,300 mg a day was associated with blood pressure reductions among the participants who followed the combination diet high in fruits, vegetables, and low-fat dairy products, as well as those who ate the original DASH study control diet. Reducing sodium even more, from 2,300 mg to 1,500 mg a day, resulted in further blood pressure reductions and was particularly beneficial for people who already had high blood pressure. In the studies, the DASH diet also was associated with reductions in LDL cholesterol. Other research supports the overall cardiovascular benefits of the DASH eating plan.

The DASH dietary pattern is low in sodium and saturated fat, while being rich in unsaturated fat, potassium, calcium, magnesium, fiber, and protein. A major advantage of the DASH approach to eating is that it doesn’t require special foods or complicated menus. Instead, the DASH plan spells out the kinds of foods to eat and how much you should consume each day based on different calorie requirements (see “Delve Deeper into the DASH Diet”).

The DASH studies included people with hypertension or at increased risk for it, but you don’t have to have high blood pressure to benefit from the DASH way of eating. Because the diet and other heart-healthy eating plans share many basic tenets—namely, increased consumption of fruits, vegetables, whole grains, and low-fat and nonfat dairy products, along with fewer foods high in saturated fat, sodium, and added sugars—the DASH diet is also in line with dietary recommendations to improve other aspects of heart health and reduce key cardiovascular risk factors besides blood pressure, such as hyperlipidemia, type 2 diabetes, and obesity. Simply put, the DASH dietary pattern “exemplifies healthy eating,” as the DGA notes.

The MIND Diet for Your Brain and Heart

The DASH and Mediterranean diets have been well studied for their beneficial effects on the heart and blood vessels. Some research suggests that these diets also may benefit your brain. These findings prompted researchers to develop the appropriately named Mediterranean-Dash Intervention for Neurocognitive Delay (MIND) eating pattern as a dietary strategy against Alzheimer’s disease (AD). MIND is a hybrid diet that takes elements from the DASH and Mediterranean eating patterns and emphasizes consumption of foods linked to better brain health while limiting or avoiding those that are bad for your brain. The MIND diet recommends consuming green leafy vegetables, berries, nuts, beans, whole grains, fish, poultry, and olive oil, and limiting red meat, cheese, butter, pastries and sweets, and fried or fast foods.

In a study involving 923 men and women, ages 58 to 98, followed an average of 4½ years, researchers assigned scores based on how well the participants adhered to the MIND diet, a DASH diet, or Mediterranean-style eating pattern. Those with the highest MIND diet scores (reflecting the closest adherence to the diet) were 53 percent less likely to develop Alzheimer’s disease than the participants with the lowest scores. Even moderate adherence to the MIND diet (the second-highest third of MIND scores) was associated with a 35 percent lower AD risk, whereas only the top third of DASH or Mediterranean diet scores were associated with lower AD risk.

A Look at Plant-Based Diets

As the findings from the DASH study and many other investigations suggest, following a dietary pattern that is based primarily on plant foods and contains fewer animal-sourced foods is associated with a lower risk of cardiovascular disease, obesity, hypertension, type 2 diabetes, and other conditions. In general, vegetarian and vegan diets are lower in saturated fat and sodium and higher in unsaturated fat and beneficial fiber than the typical “Western” style of eating. The DGA outlines a vegetarian diet that includes dairy foods and eggs as an example of a healthy dietary pattern https://health.gov/dietaryguidelines/2015/guidelines/appendix-5/.

If you follow a vegetarian style of eating, eat a bounty of whole fruits, vegetables, whole grains, and legumes, while limiting processed foods high in added sugars, saturated fat, sodium, and refined grains. Include plenty of plant protein sources in your diet, such as legumes, nuts, seeds, quinoa, and soy products. If you’re a lacto-ovo-vegetarian, meaning that you consume milk, milk products, and eggs along with plant foods, you also can get protein from these sources.

Animal foods also are the main dietary providers of vitamins B12 and D, calcium, iron, zinc, and omega-3 fatty acids, so be sure you’re getting enough of these essential nutrients from other sources (see “Sources of Key Nutrients for Vegans”). Instead of abandoning animal products altogether, you might try following a pescatarian diet, which includes fish in addition to plant foods. Fish can provide you with protein, vitamins B₁₂, and D, some calcium, and (especially cold-water, fatty fish) omega-3 fatty acids. Another option is a lacto-ovo-vegetarian eating plan, which includes milk, eggs, and milk products and can provide you with calcium, vitamin D (in fortified products), and protein without any consumption of animal flesh. Some evidence suggests that eating a lacto-ovo-vegetarian diet is associated with a reduction in heart disease and stroke risk factors (see “Vegetarian, Mediterranean Diets May Improve Cardiovascular Risk Factors”).

Choose the Right Foods

Just because you cut out or limit animal-sourced foods from your diet doesn’t guarantee you’ll be eating healthfully. You still need to be smart with your food selections. Technically speaking, French fries, potato chips, and doughnuts are vegan, but they’re hardly heart-healthy food choices.

So, if you follow a plant-based dietary pattern, make sure you do more than refrain from eating meat. Fill your vegetarian plate with good choices that will benefit, not detract from, your heart health.

Diets in Question

The healthful dietary plans endorsed by the DGA and most other health experts are supported by a significant body of scientific research. The recommendations take into account, among other things, data on what most Americans are eating, the relationships that different foods have with good health, and how these foods fit into a pattern that maximizes optimal health outcomes.

Finding a dietary pattern that’s best for you can be difficult, especially when you’re faced with a barrage of marketing campaigns promoting diets that promise everything from rapid weight loss to better memory. Oftentimes, these eating plans require you to limit or cut out certain beneficial foods that normally are part of a well-balanced diet. And, questions remain about what their full impact is on your heart and other aspects of your health over the long term, as well as whether people can stick with them in the long run.

Low-Fat Eating

Low-fat diets were once considered the norm for heart-healthy eating. After all, it would be expected that trimming fat from your diet would help you cut calories and manage your weight. With nine calories per gram, fats are more energy dense than protein and carbohydrates, which contain four calories per gram.

However, a low-fat diet is not among the healthy dietary patterns included in the DGA. Similarly, the AHA notes that fats are an important part of a heart-healthy diet. You just have to choose your fats carefully (see Chapter 2 for more about healthful and unhealthful fats). By following a dietary pattern emphasizing fruits, vegetables, and whole grains, as well as low-fat/fat-free dairy products, legumes, fish, skinless poultry, and liquid vegetable oils for food preparation and salad dressing, your overall diet naturally will be rich in beneficial unsaturated fats and lower in saturated fat.

Low-Carb Diets

The general idea behind a low-carb diet is that when you eat very little carbohydrate, you force your body to use its fat stores as a source of energy instead of the glucose that’s produced following carbohydrate consumption.

Diets low in carbs and higher in protein may provide some weight-loss benefits in the short term. And, evidence suggests that eating plenty of foods high in refined carbs, such as white bread, white rice, white pasta, and products containing added sugars, can contribute to weight gain and increase the risk of type 2 diabetes. The downside of a low-carb diet is that you have to restrict beneficial carb-containing foods, such as whole grains, fruits, and vegetables, that are key elements of well-established heart-healthy dietary patterns. And, for the majority of individuals, it is hard to stick with a low-carb diet in the long term; although low-carb diets often produce short-term weight loss, the success rate in keeping the weight off is poor. The bottom line is that it’s more important to focus on the quality of your carbohydrate sources than to drastically cut your carb intake. If you want to cut back on carbs, start by limiting or avoiding refined carbohydrates.

The Keto Diet

The keto (ketogenic) diet severely restricts carbohydrates and forces your body to use fat instead of blood glucose as its main source of energy. Your body converts fat into fatty acids and ketone bodies, which serve as fuel in the absence of glucose.

Like other low-carb eating patterns, a ketogenic diet necessitates cutting out healthful foods rich in complex carbs (for example, many fruits, whole grains, and beans) along with poor carb choices, like refined grains. Typically, vitamin supplements are recommended to make up for nutrients that are not derived from food when these carb sources are eliminated from the diet. Furthermore, some versions of the keto diet encourage foods high in saturated fat, including fatty cuts of meat and processed meats.

Some studies suggest that a keto diet can provide some benefits in terms of weight loss and diabetes management. However, questions remain about how long people can maintain a ketogenic diet and whether its benefits are sustainable. And, for the most part, health experts agree that there is no evidence for the long-term benefits and safety of a ketogenic eating pattern. Note that women who want to become or are pregnant should avoid a ketogenic diet.

The Paleo Diet

This dietary pattern is intended to mimic the eating habits of humans living in the Paleolithic period, better known as the Stone Age. The notion behind the Paleo diet is that, since modern ways of eating (like diets rich in saturated fat, refined carbohydrates, and added salt and sugar) can contribute to chronic medical conditions, eating like our early ancestors did may help us avoid some of these problems. Fact is, research has shown that humans in the Paleo period rarely lived beyond their 30s, so they probably died of an infectious disease or accident before they could develop heart disease, cancer, and other chronic diseases. Plus, several of the foods recommended by followers of today’s Paleo diet weren’t available to our Stone Age ancestors.

The Paleo diet does have its upsides. It recommends consuming beneficial foods like fresh fruits and vegetables, nuts and seeds, fish, and other seafood, while avoiding refined grains, added sugar, and salt. Some research suggests that following a Paleo diet may help with short-term weight loss and blood glucose control, but long-term data are lacking.

However, some aspects of the Paleo eating pattern are concerning. For one, the diet calls for eliminating several foods recommended by nutrition experts, such as legumes, whole grains, and dairy products. Also, followers of the Paleo eating pattern are advised to choose grass-fed meats, which are purported to be healthier than other types of meat (whether this is the case remains under debate). As a result, you might think grass-fed beef is better for you than it really is, so you might run the risk of consuming too much of it, resulting in a high intake of saturated fat.

Overall, the Paleo diet has not been researched as intensively as other common dietary patterns, and its long-term effects aren’t known. And, the DGA and large, reputable health organizations, including the American Heart Association and American Diabetes Association, have not endorsed the Paleo diet.

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Myth #1: All Grains are Bad News

Sensationalist diets may attempt to pin everything from heart disease to brain fog on grains, but research shows this food group definitely should not be blamed for all of society’s ills. Case in point: A 2016 study in The Journal of Nutrition showed that people who ate a whole-grain heavy diet for two months experienced improvements in blood pressure numbers. Scientists in Denmark found that among more than 55,000 people studied those who ate the most servings of whole grains had a lower risk of developing type 2 diabetes. One recent study even found that people who consumed a low carbohydrate diet, which often means being skimpy in grains, were at greater risk of premature death from maladies like heart disease. Just like other food groups, grains should play a role in an overall healthy diet. The key is to double down on unrefined whole grains such as quinoa and oats because these will give you more nutritional bang for your buck compared to refined grains and sugar.

Myth #2: High Carb Diets are Fattening

In fact, the opposite can be true. Many people will maintain a healthy weight while eating plenty of carbs—and not just ultra-endurance athletes. A 2018 study published in Nutrients showed that people who followed a plant-based high-carb diet (about 70% of daily calories) for four months experienced benefits in their body composition including a drop in body fat levels. A separate investigation showed that higher intakes of carbs, specifically those containing more fiber, when consumed as part of a calorie controlled diet played a big role in weight loss success among people at risk for diabetes. “This just shows that no one food will make you fat, just like no one food will make you thinner,” says Alissa Rumsey MS, RD, founder of Alissa Rumsey Nutrition and Wellness in New York City. What matters most she says, whether you’re following a high-carb or low-carb diet, is that your overall diet contains mostly high-quality foods in appropriate portions. But, yes, polishing off a half loaf of bread will make most people gain weight.

Myth #3: Fret Not About Natural Sugars

Maple syrup, honey, high fructose corn syrup or table sugar—they’re all very similar from a health perspective. A 2015 study in The Journal of Nutrition found that when people ate the same amount (about two tablespoons) of honey, sucrose (i.e. white sugar) or much-maligned high fructose corn syrup every day for two weeks, they experienced the same concerning metabolic changes including a rise in blood triglycerides and markers of inflammation, both risk factors for heart problems. Though “natural” sweeteners like coconut sugar and maple syrup may contain higher amounts of certain nutrients and antioxidants, it’s hardly enough to outweigh the concerns of eating too much of them. “The key is to make the choice to eat foods with added sugars as long as you are eating an overall balanced, nutritious diet,” notes Rumsey.

Myth #4: Whole Grains Should be Your Go-To Fiber Source

The Academy of Nutrition and Dietetics recommends women aim for 25 grams of fiber per day and 38 grams per day for men.Yes, whole grains can help you nail this quota but you’re likely going to need more help to get there. For instance, a half-cup serving of brown rice has about three grams of fiber while certain brands of whole-wheat bread may only deliver a single gram per slice. “The key to getting the fiber you need daily is to vary your sources including fruits, vegetables, pulses and whole grains,” Rumsey says.

Myth #5: Today’s Wheat Has More Gluten

Despite the internet gossip, Rumsey says there is no proof that the gluten content of wheat has increased with modern agriculture. But regardless of wheat’s gluten potency, research continues to show that the vast majority of people experience no health benefits from avoiding gluten (a protein, ironically, not a carb). In fact, a study published in the BMJ found that people who follow a gluten-free diet but don’t have celiac disease can be at a greater risk for heart disease, largely because they aren’t consuming enough whole grains and the nutritional benefits that come with those.

Myth #6: Avoid Fruit Because it Has Sugar

Criticism of sugar is so widespread that the naturally occurring sugar in foods such as fruit and milk has also come under fire. But comparing the sugar in an apple to the sugar in candy just doesn’t work. “The sugar in fruit is also bundled with fiber, vitamins and antioxidants which you don’t get when consuming sugar from highly processed foods,” says Rumsey. Besides, you get much less sugar from a piece of fruit compared to what you get from sweetened items, like soda and boxed cereal. For example, a medium orange has about 13 grams of sugar, while a can of soda delivers three times as much. No wonder you’d be hard pressed to find a study linking fruit intake with weight gain and health woes.

—Matthew Kadey, MS, RD

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Let’s break things down a bit. The average slice of cheese pizza, according to the U.S. Department of Agriculture, contains 266 calories, 9 grams of fat, 11 grams of protein, and 2 grams of fiber.

Pizza’s basic ingredients include mozzarella cheese, which is a good source of protein and calcium; tomato sauce, which is a good source of vitamins A and C as well as lycopene; and white flour, which besides being easy to digest, doesn’t have many benefits at all.

With the cheese being high in saturated fat and the white flour crust having very little fiber and nutrients, what’s a pizza lover to do?

Is Pizza Healthy If I Make It At Home?

The answer to the “Is pizza healthy?” question depends on numerous factors. Is your pizza topped with whole milk cheese and/or fatty meats? Was your pizza baked in a deep-dish pan ladled with grease or does it have a very thick crust?

Here are six tips to turn your pizza into a healthier meal for you and your family:

1. Make your own healthy pizza at home. Being able to control what goes into your pizza will help you cut down on unnecessary salt, fat and sugar, and you can avoid any chemicals and preservatives that are normally present in commercially prepared pizzas.
2. Load up on veggies. Pizza is the perfect vehicle for your favorite vegetables as well as some ones you haven’t tried before, because they’re both delicious and nutritious. Peppers, onions, mushrooms, and olives are all healthy pizza topping ideas, but don’t be afraid to experiment. Give squash, broccoli, artichokes, kale, peas, and asparagus a try. Roasting them first in little olive oil, salt, and pepper will add even more flavor.
3. Go easy on the cheese—or skip it altogether. There are almost no rules these days when it comes to pizza, so who says you can’t skip the cheese? It reduces the amount of fat and calories, and makes it vegan-friendly. But if you can’t bear to part with the cheese, try the low-fat version of your favorite cheese or cut in half the amount of full-fat cheese you usually use to make a low-fat pizza.
4. Try using a whole-wheat crust. Swapping out the white flour dough for whole wheat will provide more fiber to aid in digestion, help your body absorb nutrients, and help you stay fuller longer.  And if you need to grease your pizza pan before baking, try using just a light touch of olive oil or a canola oil cooking spray. If you’re on a low-carb diet, you can even try skipping the bread and building your pizza on zucchini “boats” or a cauliflower crust.
5. Choose a thinner crust. Less dough means fewer carbs and calories, as well as a crispier crust.
6. Pump up the protein, but dial down the fat. Adding meat to your pizza is a good way to increase its protein content, but swap out traditional processed toppings, like pepperoni and sausage, for leaner proteins such as grilled chicken, ground turkey or a small amount of lean steak.

Is Pizza Healthy If It Comes from My Freezer?

If you’re looking for a quick and convenient meal, frozen pizza can be a good choice, but it also can be laden with salt, fat, and preservatives that can sabotage your diet. Luckily, there are some brands that are better for you.

Trader Joe’s Pizza Parlanno is the top pick of frozen pizzas with meat, according to the October 2016 issue of Environmental Nutrition. One serving has 330 calories, 16 grams of fat, and 33 grams of carbs. In the meatless category, EN had 12 top picks—one of which was Amy’s 4 Cheese, which has 290 calories, 14 grams of fat, and 31 grams of carbs. Check out the chart below for the rest of EN’s frozen pizza picks and for additional nutritional information.

If you choose a frozen pizza for your meal, consider adding a side salad to boost your fiber and vitamin intake. Also, be sure to stick to the suggested serving size so that you don’t mistakenly double the number of calories and amounts of fat and salt.

Originally published in 2016 and regularly updated.

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People who eat the most organic foods have the lowest risk of cancer, suggests a study published Oct. 22, 2018, in JAMA Internal Medicine. Organics have no pesticides, which have been linked to cancer. Organic food consumption was studied among nearly 69,000 people (78 percent women) against 16 products, from which an organic food score was created. Then, the participants recorded their diets twice more, seven years apart. Data showed that participants with the highest organic food scores had the lowest reports of cancers. People who registered high on the organic index ate diets high in fruit, vegetables, legumes, nuts, and fiber, and low in meat, poultry, milk, and processed foods.

Eating Nuts Could Help with Weight Loss

Researchers found that eating an ounce of nuts or a tablespoon of nut butter in place of one portion of red meat, processed meat, French fries, desserts, or potato chips daily lowered risk of weight gain and obesity. Food frequency questionnaires from more than 100,000 women in two study groups at four-year intervals showed that nut-eating participants had less weight gain than those who did not make the substitution, according to findings presented at the American Heart Association annual conference in November 2018. Participants were generally white and worked in the health profession. However, researchers felt the results would be applicable to all ethnicities and career types.

Curcumin May Help with Body Weight, BMI

Eleven clinical trials, with 876 participants (53 percent women), were evaluated together to see if people who took curcumin supplements (an ingredient in the spice turmeric) had a lower body weight, waist circumference, or body mass index (BMI) than those who didn’t use it. Results, published in Critical Reviews in Food Science and Nutrition, Oct. 29, 2018, found a definite connection between curcumin—which is known to fight inflammation—and body weight and BMI, but not with waist circumference, except where people who were overweight took more than 1,000 milligrams (mg) for at least eight weeks. One teaspoon of fresh or ground turmeric, a spice used most commonly in curry dishes, has 200 mg of curcumin.

Reducing Carbs Is Best for Weight Loss, Metabolism

Eating fewer carbs is more effective in weight loss than reducing your overall calories, according to a study published in The BMJ, Nov. 14, 2018. During the first phase of a two-phase study, 164 participants—between the ages of 18 and 65 with a body mass index of 25 or more—followed a diet designed to generate 12 percent weight loss. In the second phase, those who achieved the weight loss goal were randomly assigned a test diet with either high, moderate, or low carbohydrates. Results showed that the lower-carb diets increased participants’ metabolism, and those eating fewer carbs burned more calories. In addition, people who eat a lot of carbohydrates create more insulin than people who don’t, which plays a role in weight gain. The study found that those participants who had been producing the most insulin saw the best results with the low-carb diet.

Eating Late May Increase Hypertension, Diabetes Risk

Here’s a good reason to follow the adage, “Eat like a king in the morning, a prince at lunch, and a pauper at night,” even though many people do the opposite. Research presented by Columbia University at the American Heart Association conference in November 2018 showed that when people ate one-third of their daily calories after 6 p.m. it increased their risk of hypertension by 23 percent, and their odds of prediabetes by 19 percent. This study was conducted with 12,708 people ages 18 to 76 in the Hispanic community. More than half of participants admitted eating one-third of their meals after 6 p.m. Late eaters, after consuming just 1 percent of their daily calories after 6 p.m., had higher fasting glucose levels (a test taken after fasting for eight hours), higher insulin levels, and higher blood pressure readings. The results of this study show that “when” you eat makes a difference in how your body breaks down and uses food as energy.

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Low-carb breads are a great way to help adults and even kids stay on a low-carb diet, by packing alternative-bread sandwiches for school and camp lunches! There’s no reason why kids can’t enjoy the benefits of eating nutrient-dense low-carb foods too. In fact, research suggests it’s a great way to manage the health of young people.

Fortunately, low-carb alternatives are growing in popularity and availability. Combine this fact with a little at-home baking and it’s entirely possible to avoid traditional breads altogether. Many high-carb foods are refined, processed and contain added sugar, additives and preservatives that aren’t good for anyone.

Here’s a quick list of some popular and nutritious low-carb bread alternatives that you can purchase or, even better, bake yourself!

Low-Carb Bread Option #1: Cloud Bread

Simply put, cloud bread’s taste and texture is fantastic. You may never want to go back to traditional bread after trying it—you’ve been warned. Sure it has a fun name, but what IS this stuff really? Cloud bread is a high-protein alternative to bread, made of: eggs, cream cheese, cream of tartar and very little to no natural sweetener. A low-carb, high protein alternative to bread? Sign us up! With the added perk of being freezable, toastable and delectable, this low-carb gift from heaven is a no-brainer for your diet! It’s not widely available in stores, but it’s super simple to make at home. There’s a ton of recipes out there, so track one down on your favorite food blog, bust out that bread pan, and get cracking!

Low-Carb Bread Option #2: Almond Flour Bread

Almond flour is having a moment in the spotlight right now. People are realizing that this versatile ingredient is perfect for cutting the carbs out of your favorite dishes. Most recipes that call for traditional flour can be replaced with almond flour, along with a little tweaking. This applies to bread as well. While low-carb flours like almond flour have a reputation for making things a bit more dry and dense, this can be corrected for by adding more moisture into your recipes. I’ve even been able to make an almond flour version of my grandmother’s classic banana bread with a little experimentation. With a low-carb lifestyle, you don’t have to give up all of the dishes you’ve grown to love over the years.

Low-Carb Bread Option #3: Cauliflower Pizza Crust and Tortilla Wraps

You may have heard about using cauliflower as a pizza crust before, as the trend is incredibly popular right now. But, another trick for this miraculous, nutrient-rich little plant is to turn it into tortilla style wraps. This alternative is a fun and creative way to impress kids and family by transforming an ingredient they think they know everything about! Now you can enjoy your favorite wrap while maintaining a low-carb lifestyle, it’s a win-win! Pro-tip: frying the cauliflower into the shape you desire is the best way to make sure it holds its shape.

Low-Carb Bread Option #4: Focaccia-Style Flax Bread

This is a personal favorite of mine. Not only is this bread one of the most delicious low-carb bread alternatives, a lot of recipes are also a good source of protein and fiber. Flax bread is quite popular for those who are allergic to nuts or follow a vegan diet. If you exercise frequently and try to maintain a low-carb lifestyle, using focaccia-style flax bread as an alternative can help you hit those protein needs more easily than traditional breads.

For related reading, visit these posts:

• Healthy Bread: Is There Such a Thing?
• What Is Sprouted Grain Bread, and How Healthy Is It?
• Sourdough Bread Health Benefits Make it the Best Bread Choice
• Refined Carbs: Are They Our Worst Enemy?
• Low-Carb Diet Advice: Don’t Ignore Key Nutrients

This article was originally published in 2018. It is regularly updated.

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Pros of Paleo. This specialized diet has its merits and drawbacks. Encouraging people to focus their eating efforts on nutrient-dense whole foods like wild salmon and sweet potatoes at the expense of processed foods rich in refined grains and sugary calories is something to be celebrated. For some individuals, this is enough to spur weight loss (eliminating food groups often leads to an initial drop in calorie intake) and there is evidence that it can improve blood sugar control, especially in those with type 2 diabetes. The diet also advocates careful food label reading which can make people more cognizant of what ingredients they are buying. The food industry has certainly taken notice, releasing a constant stream of new packaged products ranging from meat bars to pancake mixes to grain-free granola that meet paleo standards. The diet also trumpets consuming less industrialized types of protein such as free-range eggs, grass-fed beef, and wild fish, which may bring more nutrition to the table.

Pitfalls of Paleo. Of concern, whole grains, beans, lentils, dairy—all eliminated by most paleo followers—are great sources of vitamins, minerals, and antioxidants that can contribute to overall dietary needs. Indeed, by eliminating entire food groups, paleo devotees are at heightened risk for certain dietary deficiencies such as fiber, magnesium, and vitamin D unless they choose their “allowed” foods wisely to make sure they get what they need. It should be noted that the vast majority of research shows that diets rich in whole grains and legumes helps in the battle against many chronic diseases. And without grains, very active individuals may have a hard time eating enough carbohydrates to power their workouts (although paleo is not technically a low-carb diet). For some people, being hyper focused on eating “clean” paleo foods can set the stage for an unhealthy relationship with food and eating disorders.

The Bottom Line. All in all, the paleo diet may work for some people, while others will find it unsustainable. An ever-growing body of evidence suggests there’s no such thing as a single “best” diet—and you need to determine what works best for you, whether or not you choose to eat like a caveman.

—Matthew Kadey, MS, RD

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As described by Laura Hartung, MA, RD, LDN, CPT, intuitive eating “is an attunement of mind, body and food. [It’s] an approach that teaches you how to create a healthy relationship with your food—where you ultimately become the expert of your own body.”

What Does “Intuitive Eating” Mean?

According to a study published in the Journal of Counseling Psychology, there are three main characteristics to intuitive eating:

1. Eating for physical, not emotional reasons. Eating for physical reasons means a person eats only to relieve hunger instead of using food as a coping mechanism to deal with feelings such as anxiety, loneliness, sadness, or, yes, boredom. “The higher women’s tendency to eat for physical rather than emotional reasons, the lower their binge eating and food preoccupation,” say the researchers.

2. Relying on internal hunger and satiety cues to guide eating habits. When you recognize the feelings of hunger and fullness, you’ll be less likely to overindulge. As explained by the researchers, those who aren’t able to trust or follow their bodies’ cues “lose their innate ability to regulate their food intake and are more likely to experience dietary restraint, weight gain, and emotional eating.”

3. Giving yourself unconditional permission to eat. No foods are forbidden when you practice intuitive eating. Instead, you can eat what you want whenever you feel hungry. The result, believe it or not, may be a healthier diet and lower calorie intake. “People who allow themselves to eat unconditionally are less likely to overindulge in food, engage in binge eating, and experience guilt when eating,” according to the researchers.

Another important facet of intuitive eating, they say, is the art of practicing “gentle nutrition”—in other words, the ability to make food choices that promote better health while also tasting good. For example, people may choose foods to help promote energy, fight off inflammation, increase stamina, and improve cognitive function.

“Individuals who practice gentle nutrition may ask themselves, ‘How does this food make my body feel? Do I like this feeling?’ and ’Does this food give me lasting energy? How do I feel after I eat it?’—and may use this information to guide their future food choices, but not in a rigid way,” the researchers explained.

How to Practice Intuitive Eating

According to Rochelle Sirota, a New York-based certified dietitian-nutritionist, intuitive eating uses a hunger satiety scale that measures from 1 to 10. Number 1 is associated with extreme hunger while 10 represents a feeling of extreme and uncomfortable fullness. “Trying to stay closer to the middle numbers of the hunger scale is usually recommended by those who are proponents of the Intuitive Eating approach,” she says.

You don’t want to feel too hungry, nor do you want to feel too full. What you need to do is trust your body to tell you what it wants, when it wants it, and how much you should eat.

What’s a Healthier Way to Lose Weight: Intuitive Eating or Dieting?

According to Sirota, the healthiest way to shed pounds and keep them off is by practicing intuitive eating. The reason: Intuitive eating doesn’t cause as much anxiety as calorie restriction.

Instead of focusing on cutting calories and reducing portion sizes, you’re forced to reevaluate the way you eat and improve your relationship with food, Sirota says. Hartung has the same philosophy: “[Intuitive eating is] healthier because, as we know, diets are temporary and don’t work in the long term. Diets are a temporary fix, not a long-term solution. Intuitive eating is helping to create a healthy relationship with food.”

Is Intuitive Eating Good for Your Health?

The short answer to this question is yes, says Sirota. In addition to helping you maintain a healthy weight and choose healthier foods, intuitive eating also helps you to avoid the uncomfortable feelings associated with being hungry or stuffed. “Tuning in to one’s levels of hunger and satiety can hopefully become a skill that helps in avoidance of states of extreme hunger as well as avoiding overeating to the point of discomfort,” Sirota says.

Another bonus: Intuitive eating helps you foster a better relationship with food, encouraging you to eat not when you’re emotional, but when you’re hungry. With intuitive eating, Hartung says, “you balance your emotions to balance your eating.

Plus, you give yourself unconditional permission to eat anything you choose. There’s no guilt about having a donut or slice of pizza. You become one with your decisions and accept them.

Intuitive eating also helps you to achieve what Hartung describes as “body-food-choice congruence.” In other words, you learn to choose foods that make you feel good and energetic when you eat them.

“We learn to opt for the meal with the most positive associated feelings, using these sensations as information to help us make energy-giving decisions,” Hartung explains. Yes, the donut tastes good, but if it makes you feel bloated every time you indulge, you’ll stop craving it.”

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