How fat got a bum rap.

With all this talk about fake news and alternative facts, you might be lead to believe that this is a new phenomenon. While, admittedly, the recent assertions of alternative facts in place of actual dialog is disconcerting, the fact of the matter is that the art of developing and disseminating false narratives has been around a long, long time.

Take the Sugar Research Foundation (SRF), a trade association for the sugar industry in the United States, for example. Fearing market share losses in the wake of a handful of papers linking sucrose to serum cholesterol levels (and ultimately chronic heart disease) back in the 1960s, the organization funded a research program specifically designed to discredit these links and instead point the finger directly at dietary fat consumption. Given that both theories existed at the time, a credible argument could have been made, at least to some capacity. However the way by which the SRF demonized particular dietary fats—which ultimately impacted both federal policy and public opinion– is suspect at best.

The SRF hired credible nutritionists, expressed desired conclusions, provided the articles deemed relevant for analysis and had access to early drafts to a report that would eventually be titled, “Dietary Fats, Carbohydrates and Atherosclerotic Disease.” The report attacked possible biases and inconsistencies in individual reports that correlated sugar consumption with chronic heart disease (CHD) while not addressing the greater trends that emerged across these studies, and concluded that the only step required to reduce the risk of CHD was the elimination of saturated fats from one’s diet. Additionally, when the report was released in The New England Journal of Medicine in 1967, the SRF’s participation and funding was omitted.

All this comes from a recent report by JAMA Internal Medicine that had access to SRF internal documents. It’s a pretty interesting read that sheds light on how an industry is capable of influencing federal policy decisions.

The Future Is Now!

Is it just me or does it appear that folks are walking around in groups, just staring at their phones and not talking to each other? You know, more than usual…

Of course I’m talking about Pokémon GO, the augmented reality game that seems to have tapped into the greater social subconscious. Given it’s current popularity, it’s likely one of the more visible examples of the merging of technology with physical exercise.

The premise of the game is simple enough: Pokémon are little creatures you want to collect. The app lets you know when any are in your general vicinity…but there’s a catch. You have to actually get off the couch and walk to the specified location to attempt to add the creature to your collection. Additionally, the app has a speed threshold of 10mph to discourage people from biking or driving to the various locations. In other words, if you’re moving too fast when in route, you won’t be able to capture the Pokémon.

Entertaining, sure, but the game is pretty basic from the physical activity side of things. If you like general idea, however, there are plenty of apps that offer more robust exercise metrics within the construct of a game. Zombies, Run!, for example, not only has you running from the undead in a variety of customizable missions, but it enables you to track such stats as time, calories burnt, distance and pace. And, as discussed in a previous blog, there are a variety of smart watches available for folks who want to break down and analyze their workouts.

But where’s this all going? Does the utility of such apps and devices end with the individual consumers…or might the ever-increasing stockpile of exercise-related data be put to some other use at some point in time?

According to the World Bank, the average life expectancy of an American in 2014 was 79 years, up from 70 years in 1960.   This improvement is generally accredited to advancements in the health care industry and the implementation of preventative medicine.

And yet, according to the CDC, chronic diseases are still the leading forms of death and disability, place a disproportionate burden on our heath care system, and can significantly impact the quality of one’s life. While there are certain risk factors that are beyond our control (age, gender, race, heredity), modifiable factors (such as a sedentary life style, poor diet, and the use of tobacco products) are proven contributors to the development and acceleration of preventable chronic diseases. As our population is both growing and living longer, it is highly likely preventative medicine will begin to place greater priority on these modifiable factors.

Education will only go so far, though. What would it take to get the greater population to actively embrace better lifestyle choices?

Good question.

My pet theory is that it might all eventually boil down to health insurance premiums. High health insurance premiums, to be specific. In this hypothetical scenario modifiable lifestyle choices would be broken down into a variety of easily verifiable metrics; each of which would have a minimum recommended metric. Regularly meeting a minimum recommended metric would result in a slight break in the premium. Regularly meeting most of the minimum recommended metrics, however, would result in a much more sizable break.

In terms of physical activity, perhaps a metric would be meeting the American Heart Association’s baseline exercise regiment for cardiovascular health: 30 minutes of moderate exercise 5 days a week or 25 minutes of vigorous exercise 3 days a week. Perhaps exceeding this baseline would result in a larger discount. Regardless, the strategy would be to reward those who make healthy lifestyle choices instead of penalizing those who do not.

Far-fetched? Perhaps.

Admittedly, people wearing devices capable of monitoring exercise, vital stats, nutritional consumption, and alcohol and tobacco use sounds like something out of a Terry Gilliam flick. Yet just the other day I stumbled upon this advertisement which, one could argue, is a baby step in this direction:

Screen Shot 2016-07-19 at 11.08.20 AM

According to their website Health IQ claims to have negotiated lower heath insurance rates for their members “by measuring data from over 1MM health conscious [sic] people”.   The company’s belief, under Our Mission, is “…the best way to improve the health of the world is to celebrate the health conscious [sic] rather than harass and cajole those who are not.”

Minor grammatical error aside, I’m intrigued.

Ask Dr. Dadcore*

*Dr. Dadcore is not a doctor

 

A long-time reader writes:

“Dear Dr. Dadcore,

A number of gluten-free diets have popped up over the last couple of years. What’s the deal with gluten?

Sincerely,

Your wife

PS – We’re almost out of cat food, could you pick some up on the way home today.”

 

Thanks for the question, Rachael. Given that gluten is found in the endosperm of grass-related grains, one might falsely conclude that it was a carbohydrate of some kind. In fact, gluten is a protein compound and is primarily responsible for the elasticity of dough and the chewiness of bread.

At the root of the gluten-free diet phenomenon is celiac disease, an autoimmune disease affecting approximately 1 out of every 133 Americans. The disease damages the lining of the small intestine, which ultimately impedes the absorption of nutrients.

The consumption of gliadin–one of the proteins that comprise gluten—by a person with celiac disease triggers an inflammatory response which eats away at the hair-like villi that line the small intestine and are responsible for the absorption of nutrients. The prolonged unchecked consumption of gliadin results in the diminished absorption of certain vitamins, minerals, protein and overall energy.

 

If diagnosed with celiac disease, as there is no current cure, the best way to ensure that your body absorbs all the required nutrients it needs is through the implementation of a gluten-free diet. Sounds easy enough at face value, but given the extant that wheat-like grains are processed, and the fact that gluten is often employed as a binding agent in foods you’d be surprised where gluten can end up.  (Processed cheeses and meats, soy sauce, root beer, and canned baked beans being just a few examples.)  Log story short, you’ll want to make sure that any processed foods purchased are labeled “gluten-free”.

 

The purveyors of the gluten-free diet are also appealing to those who identify themselves as gluten-sensitive or –intolerant; those who experience milder versions of the symptoms exhibited with celiac disease though without the autoimmune component. In other words, the absorption of nutrients is not an issue. And while the ranks of the gluten-sensitive significantly outnumber those with celiac disease, the process of diagnosing is significantly more subjective and as of yet there is no conclusive data indicating that a gluten-free diet is warranted.   That said, if you think you feel better by reducing your gluten intake…then stick with it, by all means.

 

After all, gluten is found in all wheat-based products, the lion-share of which are made with refined flour. In contrast to whole grains, refined flour is low in nutrients & fiber, and induces large fluctuations in blood glucose and insulin levels upon consumption.

 

Ultimately the gluten-free phenomenon is really just an aspect of a larger dietary fad which preys upon our lack of understanding of chronic inflammation in the body….but I’ll save that for a later date.   In the meanwhile, if you’ve got a burning question pertaining to nutrition or fitness you’re welcome to leave me a message on my contact page. I may not have an answer, but I’ll happily research the matter and discuss what I’ve learned.

“…and knowing is half the battle.” – G.I. Joe

Yeah, yeah…it’s been while since I posted last, I know. Long story short, both the kids and I are back in school and it’s taken a while to recalibrate.

Well, truth be told, I’m still recalibrating…but I wanted to pass along a few things I learned about nutrition labels in—wait for it—my nutrition class.

Standardized food labeling, as we know it, is a product of the Nutrition Labeling & Education Act, established in 1990 by the U.S. Food and Drug Administration, and contains 5 components:

  • Name of product
  • The net contents
  • An ingredient list
  • Contact information of food manufacturer, packer or distributer
  • Nutrition data

Meat and poultry are exempt from this particular format as they are under the jurisdiction of the U.S. Department of Agriculture (USDA).   The USDA developed its own standardized labeling in 2012, though as the label is usually located on the bottom of the packaging, it doesn’t have the visual impact of the FDA’s. Heck, if you weren’t looking for it, you might not even be aware of its existence. Additionally, while the labels require the inclusion of saturated fat content, disclosure of the product’s trans fat content is voluntary.   In defense of the USDA, the trans fat levels in meat are traditionally low and they are of the naturally occurring variety, which shouldn’t be confused with the industrially produced trans fats found in margarine and processed foods.

Coffee and most spices are also exempt from labeling given that they contain insignificant amounts of the nutrients covered by the FDA’s labeling guidelines.

The ingredients list, usually located at the bottom of the Nutrition Facts graphic, is a list of all the ingredients in their common names in descending order according to weight.   Is this an earth-shattering revelation? Hardly, though it was news to me.

There are three kinds of claims that can be found on packaged food labels: nutrient claims, health claims, and structure-functioning claims—the first two requiring FDA approval.

Nutrient Claims like “High in fiber” or “low fat” correlate with the data on the Nutrition Facts graphic, which is based on a daily diet of 2000 Calories. According to Nutrition: An Applied Approach, which distilled data from the FDA’s Food Labeling Guide, nutrient claims must adhere to the following guidelines:

Energy:

  • Calorie Free – Less than 5 kcal per serving
  • Low Calorie – 40 kcal or less per serving
  • Reduced Calorie – At least 25% fewer kcal than reference (or regular) food

Fat and Cholesterol:

  • Fat Free – Less than 0.5 g of fat per serving
  • Low Fat -3 g or less fat per serving
  • Reduced Fat -At least 25% less fat per serving than reference food
  • Saturated fat free-Less than 0.5 g of saturated fat AND less than 0.5 g of trans fat per serving.
  • Low Saturated Fat- 1 g or less saturated fat and less than 0.5 g trans fat per serving AND 15% or less of total kcal from saturated fat
  • Reduced Saturated Fat – At least 25% less saturated fat AND reduced by more than 1 g saturated fat per serving as compared to reference food
  • Cholesterol free -Less than 2 mg of cholesterol per serving AND 2 g or less saturated fat and trans fat combined per serving
  • Low Cholesterol – 20 mg or less cholesterol AND 2 g or less saturated fat per serving
  • Reduced Cholesterol – At least 25% less cholesterol than reference food AND 2 g or less saturated fat per serving

Fiber and Sugar

  • High Fiber – 5 g or more fiber per serving*
  • Good source of fiber – 2.5 g to 4.9 g fiber per serving
  • More or added fiber – At least 2.5 g more fiber per serving than reference food
  • Sugar Free – Less than 0.5 g sugars per serving
  • Low Sugar – Not defined; no basis for recommended intake
  • Reduced/less sugar – At least 25% less sugars per serving than reference food
  • No added sugars or without added sugars – No sugar or sugar-containing ingredient added during processing

Sodium:

  • Sodium Free – Less than 5 mg sodium per serving
  • Very low sodium – 35 mg or less sodium per serving
  • Low Sodium – 140 mg or less sodium per serving
  • Reduced Sodium – At least 25% less sodium per serving than reference food

Relative Terms:

  • Free, without, no zero – No or a trivial amount of given nutrient
  • Light (or lite) – This term can have three different meanings: (1) A serving provides 1/3 fewer kcal than or half the fat of the reference food; (2) a serving of a low-fat, low-Calorie food provides half the sodium normally present; or (3) lighter in color and texture, with the label making this clear (for example, light molasses)
  • Reduced, less, fewer – Contains at least 25% less of a nutrient or kcal than reference food
  • More, added, extra, or plus – At least 10% of the Daily Value of a nutrient as compared to reference food (may occur naturally or be added); may be used only for vitamins, minerals, protein, dietary fiber, and potassium
  • Good source of, contains, or provides – 10% to 19% of Daily value per serving (may not be used for carbohydrate)
  • High in, rich in, or excellent source of – 20% or more of Daily value per serving for protein, vitamins, minerals, dietary fiber, or potassium (may not be used for carbohydrates)

*High fiber claims must also meet the definition of low fat; if not, then the level of total fat must appear next to the high fiber claim

Health Claims frame aspects of a product’s nutritional data in the context of heath concerns. For example, the box of a whole-grain cereal might indicate, “Low fat diets high in whole-grain fiber may reduce the risks of certain cancers.”   Given the qualitative nature of such claims, the FDA grades all health claims on a scale of A through D–all but “A” requiring the addition of some form of disclaimer:

Table 1. Standardized Qualifying Language for Qualified Health Claims.

Scientific Ranking* FDA Category Appropriate Qualifying Language**
Second Level B “…although there is scientific evidence supporting the claim, the evidence is not conclusive.”
Third Level C “Some scientific evidence suggests … however, FDA has determined that this evidence is limited and not conclusive.”
Fourth Level D “Very limited and preliminary scientific research suggests… FDA concludes that there is little scientific evidence supporting this claim.”
*From Guidance for Industry and FDA: Interim Evidence-based Ranking System for Scientific Data.

**The language reflects wording used in qualified health claims as to which the agency has previously exercised enforcement discretion for certain dietary supplements. During this interim period, the precise language as to which the agency considers exercising enforcement discretion may vary depending on the specific circumstances of each case.

Structure-Function Claims describe how specific nutrients within a product theoretically apply to functions and structure within the body. For example, a milk carton may contain the claim “Builds Stronger Bones.” It is important to remember that such claims do not require FDA approval. At worst, they can be factually inaccurate or misleading. At best, they’re claims made in a vacuum, devoid of context. For example, while it’s true that milk contains calcium and calcium is an integral nutrient in the maintenance of healthy bones, if you are unable to properly absorb calcium due, for example, to an undiagnosed Vitamin D deficiency, then the claim is technically inaccurate.

Long story short: caveat emptor.  The more you know, the better decisions you can make.

Want to know even more?  Click here.

Every Good Mechanic Has A Large Bag Of Tricks

So, you recently decided to make your health a priority. Not only have you been running regularly for the past few weeks, but you’ve lost a few pounds in the process. Not bad! One problem, though…you hate running. In fact, you are reminded just how much you don’t enjoy running every time your foot makes contact with the ground.

Well…before frustration sets in, let’s analyze things.  What is it you don’t like about running? A lot of folk claim it’s hard on the joints. If that is the case, perhaps try an elliptical machine if you have access to one. For the greater part they replicate the motions involved in running without the impact-related stress on the knees and ankles.

I ran outdoors for a couple of years in college. While I loved the way I felt after I ran, I found the act, itself, to be boring. Mind-numbingly boring. SOUL. CRUSHINGLY. BORING.

It wasn’t until I signed up for my first Tough Mudder—a good twenty years later—that I begrudgingly came to the conclusion that I needed to integrate running into my workout regiment. Due to circumstance, however, I did so on a treadmill…and was pleasantly surprised.   Seemingly, the combination of consistent foot strikes onto a surface with the slightest of give, the ability to “set and forget” a pace, and the lack of having to be visually “on guard” enabled me to bust out of the immediacy of it all and zone out.

That’s right…I’m one of those weirdos who actually prefers running on a treadmill. I am at ease with this.

Ultimately what I’m getting at here is that the more positive things you are able to associate with exercising, the easier it will be to successfully integrate exercise into your life in the long-term. Possible drivers include:

Social Interaction

Play a team sport in high school? Enjoy a good sweat as long as it isn’t achieved purely in the name of exercising? Don’t reinvent the wheel…join a rec league. Grab a buddy, dust off your racket and head to the tennis courts. Check out Craigslist, where there’s usually something fun and free.

Like the camaraderie of team sports, but looking for something a little more intense? Enroll in a boot camp.   There’s a slew of cross training classes out there that offer a good workout while fostering team spirit.

Goal Setting

One of those deadline-driven procrastinators? No harm in that. Embrace it and set a deadline. If you’re just beginning to exercise, don’t go overboard.  Sign up for a 5k six months out.   Want a little added pressure? Get a few friends to sign up with you.

Technology

There’s all kinds of devices out there for the data-driven individual. If you just want a glorified pedometer, there’s good odds that you’ve got one on your smart phone or iPod. If you’re looking for something a little more advanced, there are a variety of watches capable of monitoring and recording your heart rate.

I’m a fan of such devices for a couple of reasons. Firstly, if I know that I’m tracking my activity over the course of the day, I start getting competitive with myself. (“I walked five miles yesterday…let’s see if I can walk six today.”) Before I know it, I find myself walking to places I’d normal drive or taking the stairs instead of the elevator.

Most of these devices also offer an online component, allowing you to enter additional information, such as food intake.   Honestly enter your diet and activity over the course of a week and you’ll quickly have an understanding of what you need to do to get to where you want to be.

These are just a few things I thought of off the top of my head and is by no means a definitive list. Everyone is different. Figure out what works for you…even if it’s just having the ability to read a book or watch television while on a stationary bike.

You’ve already made the psychological commitment, now you just need your bag of tricks. Happy hunting.

“Eighty percent of success is showing up.” – Woody Allen

Ahh, the marvels of the modern age. Sure, we’re still working on jet cars, but we’ve got access to the world’s information in our pockets, an abundance of cheap produce regardless of season, and machines that go “ping”. One of the downsides to all the technological wonders of our world, however, is that we’ve grown particularly sedentary. Over the past 50 years obesity rates in adults and children—not to mention the related onset of type two diabetes—has increased dramatically. And while what and how we are eating is certainly part of the problem, there’s no denying that, as a nation, we are not getting enough exercise.

According to the American Heart Association, the baseline exercise regiment for overall cardiovascular health is 30 minutes of moderate-intensity at least 5 days a week, 25 minutes of vigorous-intensity at least 3 days a week, or some hybrid of the two.   “So what’s the difference between moderate- and vigorous-intensity?” you ask. Good question.

The intensity of a workout is measured by one’s heart rate. The target heart rate for moderate-intensity workouts, such as brisk walking, water aerobics or even gardening is 50-69% of one’s maximum heart rate. The target heart rate for vigorous-intensity workouts , such as cycling over 10 miles an hour, jogging or swimming, is 70-85% of one’s maximum heart rate.

Heart rates are measured in beats per minute (bpm). While there are all kinds of fancy ways to pinpoint one’s maximum heart rate, to quickly estimate simply subtract your age from 220. For example, I’m 45, so my estimated maximum would be 175 bpm. That established, I can extrapolate that my estimated target range for a moderate workout is 88 – 121 bpm; 122 – 149 bpm for a vigorous workout.

I’ll further discuss heart monitoring devices in next week’s blog, but in the meanwhile here’s a quick tip to roughly gauge your heart rate: conversation will begin to become labored when one achieves the target heart rate for a vigorous workout.

Now that we hopefully have a better understanding of the AHA’s baseline exercise recommendations, by a show of hands how many of you meet or surpass these recommendations? In 2013, the Center for Disease Control and Prevention estimated that only 50% of American adults meet this guideline. Incorporate some basic muscle training—which federal government standards include—and this number drops to 20%.

Every year millions of people resolve on New Year’s Eve to “lose weight” or “go to the gym”. And every year it becomes challenging to find an open treadmill or weight machine…at least until mid-February. So, why is that?

In their book, “NASM Essentials of Personal Fitness Training”, The National Academy of Sports Medicine (NASM) attempts to understand these “resolutioners” within the framework of the transtheoretical model of behavior change.   Stages of this model, as adapted by the NASM, include:

  • Precontemplation
    • Not yet intending to exercise
  • Contemplation
    • Considering beginning to exercise in the next 6 months
  • Preparation –
    • Occasionally exercising
    • Planning to exercise in the next month
    • Believes in the health benefits of exercise though may have unrealistic expectation
  • Action
    • Exercising regularly for under 6 months
  • Maintenance
    • Exercising regularly for over 6 months
    • While the new habit (exercise) has become routine, one still may be susceptible to the allure of old habits

The NASM concludes that the lion share of resolutioners never make it past the preparation stage due to unrealistic expectations. Therefore, the role of the personal trainer is to set realistic goals and assist in the building of a social support network for their clients so that they can transcend to the Action and Maintenance phases of behavioral change.

Given that the book is a more-or-less a personal trainer manual, this conclusion is not terribly surprising, if perhaps oversimplified. I am going to suggest that those who manage to successfully alter their behavior, i.e. incorporate exercise into a weekly schedule, do so not merely because they had realistic expectations, but because somewhere in the Contemplation or Preparation phase there was a reassessment and reordering of priorities.

The simple fact of knowing you need to be more physically active doesn’t cut it. You’ll have all the best intentions, but there will always be a seemingly viable excuse waiting in the wings. Realize that your health is a priority, however, and you’ll see these excuses for what they really are.

After I decided to make my health a priority, I made a pact with myself:  over the course of the next year I had to exercise to some capacity 5 days a week.  This didn’t mean that I was going to give 110% every workout, but I had to show up.  By the end of the year, I could probably count on one hand how many times I failed to meet that goal.

Now don’t get me wrong, this really is just half the battle…or four-fifths the battle, as Woody Allen would have us believe. Without this psychological foundation, however, the path to long-term success is significantly more challenging, if not impossible.

So before you give voice to this year’s NYE Resolution—whatever it may be—mull it over a bit before-hand and make sure you’re ready to show up.

Greetings And Salutations

My name is Geoff Clarke. I’m a 45-year-old stay-at-home dad transitioning to a career centered around nutritional science and personal training.

“So, what’s that all about?” you ask. Well….

All of my life I was one of those guys who ate whatever he wanted with little to no consequence…”was” being the operative word. Somewhere in my early-thirties something changed: my metabolism, to be specific. Not quite ready to address the issue at hand, however, I did the next most practical thing: I bought a larger set of pants.

This little dance went on for a number of years. I experienced “sympathetic weight gain” when my wife was pregnant with our first child.   Though while she shed her pounds quickly after birth, mine remained. Undaunted, I stuck to my guns and kept buying larger pants. That is, until the birth of our second child.

At that point I was at my heaviest—235 lbs. (While that may not seem overly excessive, bear in mind that I’m 5’10” and weighed a whoppin’ 125 lbs. when I graduated high school.) Additionally, I had also just been informed by my doctor that I was “pre-diabetic”—a nice way of saying that type 2 diabetes was in my future if I didn’t change things.

So I decided to change things.

Not for me, mind you, I decided to change things for my kids. Certainly, I wanted to ensure that I was in good heath so that I could be there for them as long as I could…but it was more than that. I wanted them to know that one simply doesn’t have to accept adversity at face value…that even if not readily armed for the task, one can start chipping away at a problem…that, if determined, a once-daunting obstacle can be reduced to a harmless mound of chips over time.

The funny thing is, in the back of my mind I always knew there would be some motivator that would literally get me off my butt—I just didn’t know when it would manifest. And while I make no claim of being the perfect parent, this desire to teach through example is likely my favorite aspect of parenthood.

Anyway, my youngest is now 8 years old. Over this time I have transitioned from an inactive guy in his late-30s who ate poorly and drank too much, to a guy in his mid-40s who attempts to feed his family with as few processed foods as possible and participates in 12-mile mud runs for fun. Not only do I feel great, I have the confidence that only comes through knowing I could whup my 25-year-old self. Take that, youth!

As I embark upon my new career path, I’ll be using this blog to process thoughts and information. I would love to say that it was my idea, but really, my wife suggested it.

Thanks for reading. I hope you continue to do so.