Amy Stephens


Licensed dietiTian

specializing in sports nutrition and diabetes

What Do Your Thoughts Have to Do with Eating and Weight Loss?

Our thoughts are very connected to the foods we choose.  I like how this article describes successful tips and strategies for coping with behavior change.  It’s written by a knowledgable cognitive behavior therapist and provides useful tips.

Pregnancy weight gain tilts scales for child becoming obese

Date:  March 9, 2015
Source:  Columbia University’s Mailman School of Public Health
For the first time, researchers studied the effects of gestational weight gain on childhood obesity risk among a multi-ethnic urban population. The researchers determined that excessive pregnancy weight gain was associated with greater overall and abdominal body fat in children and obesity at age seven. Excessive pre-pregnancy weight gain was associated with an increased risk of childhood obesity of approximately 300 percent.


See full article in Science Daily:

Mediterranean diet is associated with lower weight in children but has become less common, says study

Published online at


Mediterranean diet is associated with lower weight in children but has become less common, says study

By Nathan Gray+, 31-Jul-2014

A diet that is very similar to the traditional Mediterranean diet is associated with lower body weight and fat percentage in children; however such diets are not common among children in Mediterranean countries, say researchers.


Try These Safely Flavored or Sweetened Waters

Add flavor without excess calories and sugar or potentially dangerous additives

• May 30, 2014
Posted in Sugar in Food.


Looking for flavor in your water? If a fresh squeeze of lemon or lime isn’t handy, some brands offer natural flavors and/or safe sweeteners like stevia or erythritol, or just a little sugar.


Act now to download your FREE copy of Sugar in Food: How Much Sugar Should You Eat? without cost or obligation.


Carbonated. Stores are stocked with unsweetened, naturally flavored carbonated waters like Dasani Sparkling and LaCroix. For diet-soda-like sweetness, R.W. Knudsen Spritzer Zero Calorie uses erythritol and rebiana (stevia), while Something Natural Sparkling Water (30 calories in an 11 oz. bottle) contains stevia and about 1 ½ teaspoons of sugar.

Non-carbonated. Looking for flavor but no sweetness? Take a Hint—Hint water, that is. If you like exotic flavors like Ginger Lemon Peel or Lemongrass Mint Vanilla, try Ayala’s Herbal Water. (Hint and Ayala also make carbonated waters.)

Drops. Like MiO, most brands use artificial food dyes and the questionable artificial sweeteners acesulfame potassium and/or sucralose. Two that don’t: SweetLeaf Sweet Drops Water Enhancer (stevia) and Skinnygirl Water Enhancer (stevia plus 5 calories’ worth of sugar in a half-teaspoon squeeze). Both add a subtle sweetness to the water.

Powders. True Citrus’s line of citrus-flavored sweetened and unsweetened powders delivers no more than 10 calories per packet. We liked the refreshingly tart True Lemon Original Lemonade (stevia and about half a teaspoon of sugar). Crystal Light’s Pure line of flavored powders (30 calories per packet) also uses rebiana and about 1 ½ teaspoons of sugar.


Always Hungry? Here’s Why

Article from NY Times

Sunday Review/Opinion



CreditSarah Illenberger


FOR most of the last century, our understanding of the cause of obesity has been based on immutable physical law. Specifically, it’s the first law of thermodynamics, which dictates that energy can neither be created nor destroyed. When it comes to body weight, this means that calorie intake minus calorie expenditure equals calories stored. Surrounded by tempting foods, we overeat, consuming more calories than we can burn off, and the excess is deposited as fat. The simple solution is to exert willpower and eat less.

The problem is that this advice doesn’t work, at least not for most people over the long term. In other words, your New Year’s resolution to lose weight probably won’t last through the spring, let alone affect how you look in a swimsuit in July. More of us than ever are obese, despite an incessant focus on calorie balance by the government, nutrition organizations and the food industry.

But what if we’ve confused cause and effect? What if it’s not overeating that causes us to get fat, but the process of getting fatter that causes us to overeat?

The more calories we lock away in fat tissue, the fewer there are circulating in the bloodstream to satisfy the body’s requirements. If we look at it this way, it’s a distribution problem: We have an abundance of calories, but they’re in the wrong place. As a result, the body needs to increase its intake. We get hungrier because we’re getting fatter.

It’s like edema, a common medical condition in which fluid leaks from blood vessels into surrounding tissues. No matter how much water they drink, people with edema may experience unquenchable thirst because the fluid doesn’t stay in the blood, where it’s needed. Similarly, when fat cells suck up too much fuel, calories from food promote the growth of fat tissue instead of serving the energy needs of the body, provoking overeating in all but the most disciplined individuals.

We discuss this hypothesis in an article just published in JAMA, The Journal of the American Medical Association. According to this alternative view, factors in the environment have triggered fat cells in our bodies to take in and store excessive amounts of glucose and other calorie-rich compounds. Since fewer calories are available to fuel metabolism, the brain tells the body to increase calorie intake (we feel hungry) and save energy (our metabolism slows down). Eating more solves this problem temporarily but also accelerates weight gain. Cutting calories reverses the weight gain for a short while, making us think we have control over our body weight, but predictably increases hunger and slows metabolism even more.

Consider fever as another analogy. A cold bath will lower body temperature temporarily, but also set off biological responses — like shivering and constriction of blood vessels — that work to heat the body up again. In a sense, the conventional view of obesity as a problem of calorie balance is like conceptualizing fever as a problem of heat balance; technically not wrong, but not very helpful, because it ignores the apparent underlying biological driver of weight gain.

This is why diets that rely on consciously reducing calories don’t usually work. Only one in six overweight and obese adults in a nationwide survey reports ever having maintained a 10 percent weight loss for at least a year. (Even this relatively modest accomplishment may be exaggerated, because people tend to overestimate their successes in self-reported surveys.) In studies by Dr. Rudolph L. Leibel of Columbia and colleagues, when lean and obese research subjects were underfed in order to make them lose 10 to 20 percent of their weight, their hunger increased and metabolism plummeted. Conversely, overfeeding sped up metabolism.

For both over- and under-eating, these responses tend to push weight back to where it started — prompting some obesity researchers to think in terms of a body weight “set point” that seems to be predetermined by our genes.

But if basic biological responses push back against changes in body weight, and our set points are predetermined, then why have obesity rates — which, for adults, are almost three times what they were in the 1960s — increased so much? Most important, what can we do about it?

As it turns out, many biological factors affect the storage of calories in fat cells, including genetics, levels of physical activity, sleep and stress. But one has an indisputably dominant role: the hormone insulin. We know that excess insulin treatment for diabetes causes weight gain, and insulin deficiency causes weight loss. And of everything we eat, highly refined and rapidly digestible carbohydrates produce the most insulin.

By this way of thinking, the increasing amount and processing of carbohydrates in the American diet has increased insulin levels, put fat cells into storage overdrive and elicited obesity-promoting biological responses in a large number of people. Like an infection that raises the body temperature set point, high consumption of refined carbohydrates — chips, crackers, cakes, soft drinks, sugary breakfast cereals and even white rice and bread — has increased body weights throughout the population.

One reason we consume so many refined carbohydrates today is because they have been added to processed foods in place of fats — which have been the main target of calorie reduction efforts since the 1970s. Fat has about twice the calories of carbohydrates, but low-fat diets are the least effective of comparable interventions, according to several analyses, including one presented at a meeting of the American Heart Association this year.


CreditSarah Illenberger

A recent study by one of us, Dr. Ludwig, and his colleagues published in JAMA examined 21 overweight and obese young adults after they had lost 10 to 15 percent of their body weight, on diets ranging from low fat to low carbohydrate. Despite consuming the same number of calories on each diet, subjects burned about 325 more calories per day on the low carbohydrate than on the low fat diet — amounting to the energy expended in an hour of moderately intense physical activity.

Another study published by Dr. Ludwig and colleagues in The Lancet in 2004 suggested that a poor-quality diet could result in obesity even when it was low in calories. Rats fed a diet with rapidly digesting (called high “glycemic index”) carbohydrate gained 71 percent more fat than their counterparts, who ate more calories over all, though in the form of slowly digesting carbohydrate.

These ideas aren’t entirely new. The notion that we overeat because we’re getting fat has been around for at least a century, as described by Gary Taubes in his book “Good Calories, Bad Calories.” In 1908, for example, a German internist named Gustav von Bergmann dismissed the energy-balance view of obesity, and hypothesized that it was instead caused by a metabolic disorder that he called “lipophilia,” or “love of fat.”

But such theories have been generally ignored, perhaps because they challenge entrenched cultural attitudes. The popular emphasis on calorie balance reinforces the belief that we have conscious control over our weight, and that obesity represents a personal failure because of ignorance or inadequate willpower.

In addition, the food industry — which makes enormous profits from highly processed products derived from corn, wheat and rice — invokes calorie balance as its first line of defense. If all calories are the same, then there are no bad foods, and sugary beverages, junk foods and the like are fine in moderation. It’s simply a question of portion control. The fact that this rarely works is taken as evidence that obese people lack willpower, not that the idea itself might be wrong.

UNFORTUNATELY, existing research cannot provide a definitive test of our hypothesis. Several prominent clinical trials reported no difference in weight loss when comparing diets purportedly differing in protein, carbohydrate and fat. However, these trials had major limitations; at the end, subjects reported that they had not met the targets for complying with the prescribed diets. We wouldn’t discard a potentially lifesaving cancer treatment based on negative findings, if the research subjects didn’t take the drug as intended.

There are better ways to do this research. Studies should provide participants with at least some of their food, to make it easier for them to stick to the diets. Two studies that did this — one by the Direct Group in 2008 and the other by the Diogenes Project in 2010 — reported substantial benefits associated with the reduction of rapidly digestible carbohydrate compared with conventional diets. We need to invest much more in this research. With the annual economic burden of diabetes — just one obesity-related complication — predicted to approach half a trillion dollars by 2020, a few billion dollars for state-of-the-art nutrition research would make a good investment.

If this hypothesis turns out to be correct, it will have immediate implications for public health. It would mean that the decades-long focus on calorie restriction was destined to fail for most people. Information about calorie content would remain relevant, not as a strategy for weight loss, but rather to help people avoid eating too much highly processed food loaded with rapidly digesting carbohydrates. But obesity treatment would more appropriately focus on diet quality rather than calorie quantity.

People in the modern food environment seem to have greater control over what they eat than how much. With reduced consumption of refined grains, concentrated sugar and potato products and a few other sensible lifestyle choices, our internal body weight control system should be able to do the rest. Eventually, we could bring the body weight set point back to pre-epidemic levels. Addressing the underlying biological drive to overeat may make for a far more practical and effective solution to obesity than counting calories.

David S. Ludwig directs the New Balance Foundation Obesity Prevention Center at Boston Children’s Hospital and is a professor of pediatrics at Harvard Medical School. Mark I. Friedman is vice president of research at the Nutrition Science Initiative.


Is organic better for your health? A look at milk, meat, eggs, produce and fish.

Washington Post Article

By Tamar Haspel, Published: April 7


Organic or conventional? It’s a choice many grocery shoppers are faced with, over and over. The price difference is easy to see; it’s right there on the product. The quality difference is much harder. Is the organic milk better for your kids? Is the conventional lettuce more likely to carry pathogens?

Leave aside for the moment whether organic agriculture is better for the planet and whether organic livestock have better lives, although there’s a strong case for both of those arguments. Leave aside flavor, too, because it’s subjective and variable. What motivates many organic buyers, particularly the parents of small children, is health benefits, and there are two questions: Do organics do us more good (in the form of better nutrition), and do they do us less harm (in the form of fewer contaminants and pathogens)?

Because the risks and the benefits vary by product — meat is different from produce — it’s important to look at each category separately. While every category has the potential to harbor pathogens (such as E. coli in produce and salmonella in chicken), there are some product-specific concerns, including pesticide residue in produce and hormones in milk.

Here’s a rundown of the evidence on nutrition and contamination levels for organic and conventional products in five categories — milk, produce, meat, eggs and fish — to help you decide whether to buy organic or stick with conventional.



Nutrition: Compared with conventional milk, organic milk has higher levels of omega-3 fats, which protect against heart disease and may decrease the risk of depression, stroke, cancer and other diseases, but the quantities are too small to be very meaningful. (It takes 11 quarts of organic milk to equal the omega-3s in four ounces of salmon.) Milk’s omega-3 content is a function of the cow’s diet, and higher levels reflect more grass. (A few other nutritional differences between organic and conventional milk have been studied, but there isn’t enough research to draw conclusions.)

Contamination: Neither organic nor conventional milk contains antibiotics. By law, every truckload of milk, organic and conventional, is tested for veterinary drugs, including antibiotics, by trained dairy workers. Any load that tests positive is pulled out of the food supply. In 2012, that was one in 6,000 loads. Organic cows aren’t given antibiotics, and conventional ones are given them only for illness, and their milk isn’t used until after a withdrawal period.

The U.S. Department of Agriculture tests for pesticide levels and has found them to be “very low.” The main culprit is DDE, a remnant of the agricultural pesticide DDT.

DDT was banned years ago, but the USDA said it “is very persisten[t] and remains in many cropland soils. It is also in the body fat of all Americans and most farm animals and wildlife. Conventional and organic farmers can do little to avoid the DDE residues in milk. Over the next thirty to fifty years these residues will gradually decline below limits of detection.”

Pasteurization fails some of the time, allowing milk contaminated with bacteria to get into the food supply, but there are no reports comparing illnesses caused by organic vs. conventional milk.

Hormones: The issue with milk is that many conventionally raised dairy cows, unlike organic ones, are injected with bovine growth hormone (BGH, the synthetic version of which is called either recombinant bovine growth hormone, rBGH, or recombinant bovine somatotropin, rBST) to increase their milk production. The problem isn’t the hormone itself — it’s unlikely to survive pasteurization or human digestion and, even if it did, its mechanism doesn’t work in humans — but rather a compound called insulin-like growth factor (IGF-I).

Both organic and conventional cows have IGF-I in their milk, but cows that get hormone treatment may have more of it. Humans also produce IGF-I, and a recent review of many studies concluded that milk drinkers generally have higher IGF-I levels. But it may not be because of IGF-I in milk. Eating animal and soy protein can also increase IGF-I levels in our bodies. It’s not the IGF-I in foods, but how the body responds to other compounds, that increases human levels.

Some research has linked IGF-I to cancer. The American Cancer Society found that “some early studies found a relationship between blood levels of IGF-I and the development of prostate, breast, colorectal and other cancers, but later studies have failed to confirm these reports or have found weaker relationships.” The organization concluded in 2011 that “the evidence for potential harm to humans is inconclusive.” A 2009 FDA report says that IGF-I levels in rBGH milk are safe

The use of rBGH has fueled concerns among some parents about giving milk to children, but the FDA report concluded that “consumption by infants and children of milk and edible products from rBGH-treated cows is safe.”

Bottom line: Organic milk has higher omega-3 fat levels, but probably not enough to make a difference. Exposure to pesticides, contaminants or hormones is not a significant risk in either organic or conventional milk.



Nutrition: Many studies have compared the vitamins, minerals, macronutrients and other compounds in organic and conventional produce, and a 2012 review concluded that the results were all over the map. The one exception was that the phosphorus content of organic produce is higher, although the review, done by Stanford University scientists, calls that finding “not clinically significant.” Along with calcium, phosphorus helps build strong bones and teeth.

Contamination: There are two issues for foods that grow in the ground: pesticides and pathogens. There is widespread agreement that organic produce, while not pesticide-free, has lower residue levels and fewer pesticides. A study using USDA data found that 73 percent of conventional produce sampled had residue from at least one pesticide, compared with 23 percent of organic, though that study is more than 10 years old. There also isn’t agreement about whether that’s meaningful for human consumption.

Carl Winter, a toxicologist at the University of California at Davis, says that the Environmental Protection Agency, working from animal research and factoring in the special sensitivities of human subgroups such as babies and children, has found that lifetime risk of adverse health effects due to low-level exposure to pesticide residue through consumption of produce is “far below even minimal health concerns, even over a lifetime.”

Dana Barr, a research professor at Emory University’s Rollins School of Public Health, has less faith in the EPA standards. She points to one particular pesticide class, organophosphates, and notes evidence — including a 2013 review she co-authored — correlating exposure to possible neurological problems such as ADHD and lower IQ in children, which she says the EPA standards don’t adequately consider.

But another review last year by a different group of scientists found “the epidemiologic studies did not strongly implicate any particular pesticide as being causally related to adverse neurodevelopmental outcomes in infants and children.” As of December 2013, the position of the Centers for Disease Control and Prevention was that high levels of organophosphate exposure were associated with some neurobehavioral problems in farm communities with exposure higher than that in the general population.

An American Academy of Pediatrics 2012 report noted the correlation between organophosphate exposure and neurological issues that had been found in some studies but concluded that it was still “unclear” that reducing exposure by eating organic would be “clinically relevant.”

The EPA expects to have a new assessment of organophosphates in 2016. In the meantime, the agency has determined that certain foods —snap beans, watermelon, tomatoes and potatoes — are likely to have higher residues of the pesticide than other produce. If you’re pregnant or feeding small children, you may want to consider organic versions of those foods.

As for pathogens, the 2012 Stanford review found that E. coli contamination is slightly more likely in organic than conventional produce.

The best strategy to reduce risk from produce isn’t to buy either organic or conventional. Rather, it’s to cook your food. A CDC review notes that leafy vegetables, led by lettuce and spinach, are the No. 1 cause of food-borne illnesses, responsible for 22 percent of food-borne illnesses.

Bottom line: While there may be no significant nutritional difference between organic and conventional produce, organic does have lower levels of pesticide residue. However, there isn’t universal agreement on the risk those residues pose.



Nutrition: As with milk, the main issue here is omega-3 fats. Some organic meat and poultry have more of them than conventional products do. The reason is diet: Animals that eat more grass have lower fat levels overall and higher omega-3 levels than animals fed more grain.

Although measurements of omega-3 fats in beef vary, the numbers are low and substantially below what can be found in a serving of salmon.

Contaminants: The USDA randomly tests carcasses for residues of pesticides, contaminants and veterinary drugs including antibiotics. In 2011, it screened for 128 chemicals, and 99 percent of the tested carcasses were free of all of them.

It found a few with residue violations and a similar small number with residue within legal limits (mostly of arsenic and antibiotics). Although the USDA doesn’t report organic and conventional separately, contaminant risk overall is extremely low.

The bigger concern is pathogens. Studies of bacterial contamination levels of organic and conventional meat show widely varying results. These findings suggest that organic meat may be slightly more likely to be contaminated, possibly because no antibiotics are used. But conventional meat is more likely to be contaminated with antibiotic-resistant bacteria. The 2012 Stanford review found that slightly more organic chicken samples were contaminated with Campylobacter than conventional samples and that organic pork was more likely than conventional to harbor E. coli. But the risk in meat overall was essentially the same. And whether meat is conventional or organic, the solution is adequate cooking.


Bottom line: There doesn’t seem to be much difference, health-wise, between organic or conventional meats. Grass-fed beef has a slight edge over grain-fed because of higher omega-3 levels, but the amounts are probably too small to affect human health.



Nutrition: As with milk and meat, the omega-3 levels of eggs are affected by the hens’ diet and can be increased by pasturing or diet supplementation for either organic or conventional hens. Eggs high in omega-3s are generally labeled.

Contaminants: There’s very little research on contaminants in eggs. The USDA’s 2011 National Residue Program tested 497 egg samples and found no residues of pesticides, contaminants or veterinary drugs, including antibiotics. This isn’t surprising because, according to Pat Curtis, a poultry scientist at Auburn University, laying hens aren’t routinely given antibiotics, and there is a mandated withdrawal period after they do get the drugs (to treat illness) before their eggs can be sold. The 2012 Stanford review concluded that there is “no difference” in contamination risk between conventional and organic eggs.


Bottom line: There are no significant differences affecting health between organic and conventional eggs.



The USDA has not issued any organic standards for farmed fish or shellfish, but several overseas organizations have. (Because there’s no way to control the diet of wild fish, “organic” doesn’t apply.) Canadian standards prohibit antibiotics and hormones, restrict pesticides and set criteria for acceptable feed. There’s not enough research comparing organic and conventional fish to draw any conclusions about their health benefits.







Chia-Seed Pudding for Breakfast: Tart, Sweet and Good for You

Posted in NY Times, April 2014.


APRIL 14, 2014


Chia seed breakfast pudding. Credit Evan Sung for The New York Times

Chia seeds may be having their moment as the darling of the natural food set, but that’s not what made me want to sample the unusual chia-seed pudding at El Rey, a coffee bar on the Lower East Side that offers a small menu of dishes and pastries.

For me, the lure is in the seeds’ tapioca-like texture (and, I won’t lie, the fact that they are related to chia pets, which I loved as a kid).

When chia seeds are soaked in some kind of sweet, milky liquid (milk, coconut milk, almond milk), the whole thing turns custardy, and the seeds take on a pleasingly slippery texture while remaining very slightly al dente at the core. The pudding has the appeal of tapioca, but is easier to make (you don’t need to cook it), nutritionally dense and slightly more exciting to crunch.

The simplest chia-seed pudding doesn’t even require a recipe. Just cover the raw seeds with some kind of liquid, sweeten it to taste and let it sit at room temperature. After as little as 15 minutes, the seeds soften and swell, and the liquid all but disappears. Instant pudding, but good for you, too.

At El Rey, the chef Gerardo Gonzalez offers a breakfast version that’s a more sophisticated take. He mixes the seeds with both coconut milk and almond milk seasoned with sugar and sea salt, then garnishes it with apricots simmered in passion-fruit nectar, toasted almonds and coconut flakes.

It’s a complex jumble of tart, sweet and milky flavors, with a multitude of interesting textures. It makes an excellent breakfast, an unusual and not-too-sweet dessert and, if you mention the pets, an amusing conversation starter too.


Chia seeds are nutritionally dense seeds that will thicken any liquid you add them to. Mix them up with coconut and almond milks and you’ve got an almost instant pudding with a tapioca-like texture and gently sweet flavor. This recipe is meant for breakfast, but if you add a little honey to the seeds as they swell, it will be sweet enough for dessert. You can use either black or white chia seeds here, or a mix. The pudding will continue to thicken as it sits, so feel free to thin it out to taste with a little more almond or coconut milk before serving.

1 hour
  • 130 grams whole dried apricots (about 20), more as needed
  • 1/3 cup passion-fruit juice or nectar (passion fruit-pear is fine)
  • 50 grams sugar (3 tablespoons)
  • 1 1/2 teaspoons lemon juice
  • Fine sea salt, as needed
  • 2 cups unsweetened almond milk
  • 1/2 cup coconut milk
  • 85 grams chia seeds (1/2 cup)
  • 45 grams toasted kasha (1/4 cup), optional (see note)
  • Roasted whole almonds, coarsely chopped, as needed
  • Toasted unsweetened coconut flakes, as needed
  • Sliced banana, as needed, optional


Coarsely chop half of the dried apricots. Place chopped apricots in a small pot with passion-fruit juice, 25 grams sugar (1 1/2 tablespoons), lemon juice and a pinch of salt. Simmer very gently over low heat until apricots are soft and liquid has turned syrupy, about 30 minutes.
While chopped apricots cook, put remaining whole apricots in a bowl and cover with boiling water. Let soak until plump, 10 to 20 minutes. Drain and reserve plumped apricots and the apricot sauce for garnish.
Meanwhile, in a quart container with a lid (or use a cocktail shaker), combine almond and coconut milks, remaining 25 grams sugar (1 1/2 tablespoons) and a pinch of salt. Stir in chia seeds and kasha, if desired; shake thoroughly so that seeds are evenly hydrated. Let rest at least 20 minutes or until pudding has a rich, creamy texture. Seeds should be fully hydrated. (Pudding will keep for up to 3 days but may require rehydrating with more almond or coconut milk as the seeds continue to absorb liquid.)
To serve, spoon pudding into bowls. Top with apricot sauce, plumped apricots, almonds, coconut flakes and sliced banana, if desired.
4 servings
  • NOTE

    Toasted kasha, also known as buckwheat groats, can be hard to find. But you can easily toast raw kasha in a dry skillet for 2 to 3 minutes, stirring often. Or leave it out.