Amy Stephens

MS, RDN, CSSD, CDCES

Licensed dietiTian

specializing in sports nutrition and diabetes

Always Hungry? Here’s Why

Article from NY Times

Sunday Review/Opinion

 

By DAVID S. LUDWIG and MARK I. FRIEDMAN  MAY 16, 2014

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.

Photo

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.

 

Study shows twice as likely to lose weight by meeting with Dietitian-Nutritionist

Two year study published in Managed Care, January 2013 with 1,400 participants with either receiving nutritional counseling or dieting on their own.  Participants who met with dietitians were two times as likely to lose weight and increase exercise than no nutritional counseling.

 

Bottom line:  Make biggest impact with your weight loss efforts by working with a Registered Dietitian/Nutritionist.  Skip the misinformation and inappropriate dieting techniques and obtain guidance by an educated professional.

 

Managed Care Article, 2013

Mercury in Fish

Fish is great source of omega-3 fatty acid which has been shown to promote brain development.  This article published in the New York Times entitled, “Sorting Out the Risks of Fish” discusses overall health benefits of fish outweigh the risk of low-moderate mercury containing fish.  Check out the link on comprehensive mercury list, has a chart that shows which fish are highest to least mercury content.   Choose fish from the low-moderate columns to get best source of omega-3’s with least amount of mercury.

 

NY Times Article on Mercury in Fish

 

Comprehensive list of mercury content of fish

 

Chia Seed Apple Pie Pudding Recipe

It’s hard to find another nutrient-packed food with fiber, omega-3’s, and is low in calories.  Chia Seeds, yes as in, 80’s Chia Pet.  These tiny seeds are packed with nutritious fiber and can be used to create a variety of pudding-like foods.  Can be mixed with Almond milk (as in recipe below) to make a raw, great tasting, and vegan/gluten-free pudding that non-vegans  will also love.  Low in carbohydrates, 1 Tbsp has 7 grams carb (mostly complex),  5 grams fiber, 70 calories, and 4 grams fiber (mostly omega-3).

 

Modification for diabetes or blood sugar issues –  use 1 date as a natural sweetener (recipe calls for 4-5).  Each date has 66 calories, 16 grams carbohydrate, 1.6 grams fiber and 167 mg of potassium.

 

 

Recipe from Jennifer Vagios

Serves: 1 (make more, trust me)

Time: 10 minutes (if pre-soaked chia pudding) otherwise 40 mins-overnight.

Equipment:

Food Processor

Ingredients:

For the chia pudding:

  • 2 tablespoons chia seeds (black variety is nutritionally superior)
  • 3/4 cup almond milk

For the Apple Pie Bit:

  • 1 green apple (I think I’ll use 1.5 apples next time)
  • 1/2 cup walnuts (or other nut)
  • 4-5 dried medjool dates (pit removed)
  • 1 teaspoon apple pie spice (make your own: 4 teaspoons ground cinnamon, 2 teaspoons ground nutmeg + 1 teaspoon ground cardamom-yields 2 tablespoons).

Assembly:

1. Make the pudding by combining the chia seeds and almond milk. Place in a mason jar or other cute container you can seal. Refrigerate while you make the pie mix.

2. Place all other ingredients in the food processor and pulse. Be careful not to over mix. It will become paste like..and that’s okay, but I prefer a little chunkiness.

3. Pause for a moment and appreciate the fact that your kitchen will now smell like apple pie. It’s pleasant to notice the little things now isn’t it? (there’s the yoga teacher in me telling you to PAUSE & BREATHE).

4. Combine 1/2 a cup of the apple pie filling with the chia pudding, stir well and place back in the refrigerator. Let the flavors merge and get cozy with one another for 20 minutes up to an hour or even overnight.

You’ll want to make a double batch. Trust me.

 

Make it more Awesome: (Yes, you can).

 

  • The leftover Apple Pie filling can be used as a dip, added to your oats, or smeared on some toast. Endless possibilities here. Make a smoothie!
  • Use other nuts, I think I’ll pre-toast some almonds next time.
  • Use other liquids like coconut milk, cashew or even hemp milk.
  • Breakfast in a pinch! Make this at night and have it ready to grab in the morning.

 

Heidi’s Kale

We know kale is a superfood and we need to eat more but are not sure how to make it taste good, too.  Kale is loaded with potassium, vitamin C, and vitamin A.  One cup raw kale has just 33 calories and 7 grams of carbohydrate which is similar to 1/2 apple.

I call this raw kale salad, Heidi’s kale, because I had it at my friend Heidi’s house and loved it.  Since then, my dinner guests are always impressed at how good kale can taste.  You can make this recipe healthier by using pumpkin seeds, chickpeas and apples or more decadent by adding goat cheese and cranberries.  Since there is no cooking, the nutrients stay more intact.

1 or 2 bunches of kale. Massage with olive oil for 2-3 minutes. Set aside for a few hours.

Add:

  • cranberries
  • Pumpkin seeds
  • Apples
  • Goat cheese

Dressing:

  • Lemon, 1/2 squeezed
  • olive oil, 3 Tbsp
  • honey, optional 1 Tbsp
  • Salt and pepper to taste

You can also add lots of veggies like cucumber, olives, chick peas, beets, avocado, carrots; basically whatever I have lying around. It always tastes good if the kale is softened.

 

 

 

Marcia’s Chili con Carne

This is a great recipe, easy to make and can be made ahead of time.  Recipe can easily be adjusted to accommodate vegetarian or vegan diets.

 

 

1 onion, peeled and chopped

1 lb. ground beef/turkey or 10 oz tofu

1 – 15 oz can chopped tomatoes

2 Tbsp. chili powder

2 cloves garlic

1 cup chopped carrots

1/4 – 1/2 tsp. salt

1 tsp. sugar

1 can red kidney beans

1 can Cannellini beans

1 can corn (no juice)

 

Directions

1.  Cook onions in oil until tender/golden.  Add carrots cook additional 5 min.

2.  Add ground beef/turkey or tofu and cook until brown.

3.  Add minced garlic

4.  Add can of tomatoes with 1/2 can boiling water

5.  In a little cup, mix chili powder, salt and sugar with cold water to create a paste.  Add to meat.

6.  Cover and simmer for 1 hour.  Check regularly that it is not losing too much liquid.  Can easily burn on bottom.

7.  Uncover and add beans and corn.

8.  Cook for 1/2 hour longer.

 

Notes:

Best when left over night.

Serve with sour cream and grated cheddar cheese.

Cedar Planked Salmon

Ingredients

  • 3 (12 inch) untreated cedar planks
  • 1/3 cup vegetable oil
  • 1 1/2 tablespoons rice vinegar
  • 1 teaspoon sesame oil
  • 1/3 cup soy sauce
  • 1/4 cup chopped green onions
  • 1 tablespoon grated fresh ginger root
  • 1 teaspoon minced garlic
  • 2 (2 pound) salmon fillets, skin removed

Directions

  1. Soak the cedar planks for at least 1 hour in warm water. Soak longer if you have time.
  2. In a shallow dish, stir together the vegetable oil, rice vinegar, sesame oil, soy sauce, green onions, ginger, and garlic. Place the salmon fillets in the marinade and turn to coat. Cover and marinate for at least 15 minutes, or up to one hour.
  3. Preheat an outdoor grill for medium heat. Place the planks on the grate. The boards are ready when they start to smoke and crackle just a little.  This recipe can be done in an oven by placing cedar planks on cookie sheet and bake at 350 degrees fahrenheit for 20 minutes.
  4. Place the salmon fillets onto the planks and discard the marinade. Cover, and grill for about 20 minutes. Fish is done when you can flake it with a fork. It will continue to cook after you remove it from the grill.

 

4 Bean Soup Recipes

Here are some great high-fiber, low calorie soup recipes that are easy to prepare. Each recipe contains mostly vegetables, beans, and herbs with little oil or parmesan cheese for flavor. They are filling and are a great substitute for green salads in the winter. You can make a large amount and keep separated into portions to grab and heat up for a quick healthy meal.

Three Bean Minestrone

4 tablespoons extra-virgin olive oil
1 large white onion, peeled and diced
2 medium carrots, peeled and diced
2 celery stalks, diced
1 cup cooked (or canned, drained and rinsed) pinto beans
1 cup cooked (or canned, drained and rinsed) white kidney beans, cannelloni or Great Northern beans
1 cup cooked (or canned, drained and rinsed) light or dark red kidney beans
8 cups water or broth
rind from a small piece of Parmigiano-Reggiano (optional)
2 zucchini, diced
2 medium red tomatoes, diced
4 cups baby spinach
1 teaspoon black pepper
6 teaspoons extra-virgin olive oil for drizzling
optional – 6 tablespoons Parmigiano-Reggiano freshly grated

In a large stock pot over low heat, combine the olive oil and onions. Sweat the onions until wilted and soft, about 10 minutes. Add carrots and cook 3 minutes. Add celery, beans, water and Parmigiano-Reggioano rind and cook for about 20 minutes.

Add diced zucchini and cook for another 20 minutes. Add tomatoes and their juices, cover and cook at a low simmer for at least 30 more minutes.

Add spinach, season with kosher salt and black pepper, and cook 2 to 3 minutes longer.

Serve with a drizzle of extra-virgin olive oil and grated Parmigiano-Reggiano cheese. Serves 6.

Nutritional Info for 1 1/2 cups serving size
Calories: 280, Total fat: 16 g, Carb: 28gm, Fiber 10g, Protein 12 gm

Afternoon Bean and Turkey Soup
I found this recipe at www.BeanInstitute.com/recipes

1 or 2 turkey carcasses
½ cup dry light red kidney beans
½ cup small red beans
2 small or l large onion, chopped
1 – 2 cups peeled and sliced carrots
¼ green or sweet red pepper
4 stalks of celery and heart, including any leaves that are fresh and green
1 – ½ teaspoons dry thyme
1 teaspoon ground turmeric
1 teaspoon season salt
2 teaspoons salt
1 tablespoon dry parsley or ½ cup fresh
½ cup brown rice or whole grain
PREPARATION:
1 p.m. — Put 1 or 2 turkey carcasses in a large stockpot.
Cover with water. Simmer for 1 – 2 hours.
3 p.m. — Sort and rinse beans. Add beans to the pot. Simmer.
4 p.m. — Remove turkey from the pot to a platter. Cool. Add vegetables, herbs and spices. Simmer. Pull bones apart and remove meat and skin. Cut meat into small pieces. Stir the mixture to check for bones and gristle. Remove and discard all bones and gristle. Return meat to pot.
5 p.m. — Rinse brown rice in a sieve and add to the soup. Simmer.
6 p.m. — Serve with crackers or whole wheat bread, glass of milk and fruit dessert.
Refrigerate or freeze and label any leftovers for future use.
If you need to start later, combine steps. Two hours is the minimum cooking time to make a good broth, cook the meat off the bones and tenderize the beans. Brown rice needs 45 minutes to cook. Add or substitute the vegetables and seasoning your family prefers or you have available.
4 p.m. — Put everything but the rice in the pot. Use high heat, stir and tend the pot until it simmers. It will take 20 to 30 minutes. Adjust the heat to maintain a simmer.
5 p.m. — Add the brown rice.
5:45 p.m. remove the carcass. Return the meat to the soup and serve.

Nutrient information for 1 1/2 cups serving size: 144 calories, 7 g protein, 28 g carbohydrates,
7 g fiber

Kale and White Bean Soup
kale-white-bean-soup-46
Created by Chef Ann Cooper. Featured at the 2013 Beans For A Better Life seminar in Dallas, Texas.

Ingredients:
1½ cups onion, diced
1½ tbsp extra virgin olive oil
½ tsp garlic, minced
½ lb. (dry weight) cannellini beans, cooked (roughly 2½ cups cooked)
4 cups vegetable stock (plus a bit more to adjust liquid to your personal taste)
1 bay leaf
½ tsp fresh rosemary, roughly chopped
1 tsp kosher salt
1/8 tsp freshly ground black pepper
2 cups carrots, medium dice
7 cups kale, chopped
3/4 cup parmesan cheese, grated

Makes 8 servings.

Preparation:
kale-white-bean-soup-1
Sauté onions in oil for 5 minutes or until soft. Add garlic and cook for an additional minute.
Add cooked beans, stock, salt, pepper, bay leaf, and rosemary and simmer for 10 minutes.
Add carrots and cook another 5 minutes.
Add kale and cook about 12 minutes or until kale is tender. Add more vegetable stock if your soup needs more liquid, and warm through.
Check seasoning, adjust as needed, and serve sprinkled with grated parmesan cheese.

Nutritional Info for 1 1/2 cups serving size
Calories 171, Total fat 5.1g, Carb 20gm, Fiber 5.5g, Protein 10gm

– See more at: http://beaninstitute.com/kale-and-white-bean-soup/#sthash.HyBPQ7S6.dpuf

Lentil Soup

**Can use less oil to lower calorie content.**

1 onion, chopped
1/4 cup olive oil
2 carrots, diced
2 stalks celery, chopped
2 cloves garlic, minced
1 teaspoon dried oregano
1 bay leaf
1 teaspoon dried basil
1 (14.5 ounce) can crushed tomatoes
2 cups dry French lentils
8 cups water
1/2 cup spinach, rinsed and thinly sliced
2 tablespoons vinegar
salt to taste
ground black pepper to taste

Makes 6 servings

Directions

In a large soup pot, heat oil over medium heat. Add onions, carrots, and celery; cook and stir until onion is tender. Stir in garlic, bay leaf, oregano, and basil; cook for 2 minutes.

Stir in lentils, and add water and tomatoes. Bring to a boil. Reduce heat, and simmer for at least 1 hour. When ready to serve stir in spinach, and cook until it wilts. Stir in vinegar, and season to taste with salt and pepper, and more vinegar if desired.

Nutritional Info for 1 1/2 cups serving size
Calories 340, Total fat 10g, Carb 44gm, Fiber 21g, Protein 17gm

How can a Registered Dietitian help you

I’ve heard many times, “Which foods are the best to eat?” or “I became a vegetarian to lose weight”. Often times, patients end up in my office having difficulty adhering to strict elimination meal plans or are so confused by the rules of a specific diet. The posting below, by, Staci Lyons, is a great explanation about how a registered dietitian professional can help create an individual nutrient dense meal plan that is based on sound nutrition information.

Posted on www.maplevalleyreporter.com
By Staci Lyons
Pinnacle Medical Wellness

The food that we eat and the events that take place during digestion is a complex science.

Few understand these complexities beyond the limited scope of what might be remembered from an eighth grade health class. What’s worse is the constant presentation of poor and sometimes even false information about this process and the way in which it affects our bodies.

When surveyed, most Americans admit to taking much of their dietary cues from friends and family or the media. Unfortunately, friends and family are often just as misinformed. The media, particularly those groups involved in the marketing of products that we consume, can often provide misleading information in an effort to sell more of their products. Are sports drinks really a good source of hydration? Is the Paleo diet that the neighbor raves about really the answer to shedding unwanted pounds? Is the barbecue chicken wrap a healthy alternative when ordering at the burger restaurant named after a red bird? Warning: The answer to that one may be shocking!

The end result of this confusion is that many individuals live day to day in a constant state of dysfunction — their bodies protesting with the warning signs of fatigue, inflammation, undesired weight gain, and illness. Poor nutrition and dietary habits are problems that carry serious consequences. According to the Centers for Disease Control and Prevention, nearly 10 percent of Americans are now diabetic with an additional 30 percent classified as pre-diabetic. Poor diet is identified as the primary cause of Type 2 diabetes. A recent study points to a very strong link between obesity and breast cancer. The list goes on and on.

Of course, most individuals do not purposely aim to maintain unhealthy eating habits. A registered dietitian can help make sense of this scientific puzzle.

As a qualified medical professional, an RD is able to provide an individualized plan and the education needed to optimize body function and help cut through some of the misinformation. A registered dietician is licensed through the state and earned a four-year degree from an accredited university which is an important point to contrast against the qualifications and education of others that may offer nutrition counseling at the local gym or the late night infomercial.

Dietary counseling is a growing discipline. Where once difficult to find, registered dietitians can now be found practicing in our community.

Ask your physician or physical therapist about recommending a registered dietitian. It might be a good investment of time and money as a way of avoiding the financial and personal consequences of poor health.