Eat Plenty of Vegetables Rich in Alpha-Carotene!

Most, if not all, of us have been told as children to "eat your vegetables so you can grow up strong and healthy" and research continues to show us that eating our vegetables has many benefits.  Vegetables are typically rich in nutrients, low in calories, and contain many health-supporting antioxidants.  One such anti-oxidant is alpha-carotene.

A nutrition research study published a few days ago in the Archives of Internal Medicine examined the possible link between alpha-carotene and the risk of death in over 15,000 adults who took part in the Third National Health and Nutrition Examination Survey Follow-up Study.  At the beginning of the study blood samples were collected from study volunteers, who were then followed for about 14 years.  The study researchers measured blood levels of alpha-carotene and analyzed the link between alpha-carotene levels and risk of dying.  The study investigators reported that higher levels of alpha-carotene were linked with a lower risk of dying from all causes.  Specifically, compared to individuals with low levels of alpha-carotene (0 - 1 micrograms/dL), individuals with alpha-carotene blood levels of:

• 2 - 3 micrograms/dL showed a 23% reduction in the risk of death from any cause
• 4 - 5 micrograms/dL had a 27% reduced risk of death
• 6 - 8 micrograms/dL were at a 34% reduced risk of dying from any cause
• 9 micrograms/dL or more had a 39% reduced risk of death

This new study clearly shows a potential link between higher blood levels of alpha-carotene and a lower risk of death during the study's 14-year follow-up, suggesting that higher alpha-carotene levels might be important for living a longer, healthier life.  This is also supported by the lower risk for death specifically due to poor heart health observed in this study.  As you might expect, higher alpha-carotene blood levels can be obtained by eating more foods rich in alpha-carotene.  These include orange and dark green-colored vegetables like carrots, sweet potatoes, winter squash, broccoli, green beans, spinach, collard greens, kale, and romaine lettuce.

According to current recommendations, adult men and women should eat anywhere between 2.5 to 3.5 cups of vegetables daily depending upon specific needs.  Despite this many of us rarely consume enough vegetables each day.  This new study continues to impress upon us the importance of eating plenty of vegetables each day.

Are you eating all your vegetables?

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Choose Foods That Are Eaten Slowly

Enhancing satiety, or our feeling of fullness, is a major target many weight loss strategies.  One aspect of this concept is that eating foods that make us feel full after consuming only relatively small amounts will cause us to eat less throughout the day.  Another approach is to eat more slowly, which has been reported to allow our brains to send fullness signals to our stomach and result in us consuming less calories.  One study has even reported that the earlier feelings of fullness associated with eating slowly are due to the release of aromas from the food during chewing.

Because some foods can be eaten more rapidly than other foods, a new nutrition study has examined the possible link between the eating rates of foods (how fast a food item can be eaten) and the amount of food we eat and the impact on the nutritional quality of our diets.  For this study, nutrition researchers asked 37 study volunteers to consume 50 grams of 7 different foods.  A total of 45 different foods were tested.  The researchers measured how long it took to consume each food item, subsequent food intake, and nutritional quality of the overall diets.  The results of this study showed:

• The length of time it took to consume the food items ranged from 4.2 grams per minute (slow) to 631 grams per minute (fast).
• Consumption of foods that could be rapidly eaten was linked to an increase in overall food consumption and calorie intake.
• Intake of carbohydrates, protein, and fiber were reduced by consumption of rapidly eaten foods.
• Fat consumption was not reduced by consumption of rapidly eaten foods.

This is a unique and interesting study that shows a link between how quickly a food can be eaten and diet quality.  Overall, this study suggests that consuming rapidly eaten foods can lead to an unrealized over-consumption of food, which can lead to an increased risk for becoming overweight or obese.  Additionally, choosing foods that can be eaten quickly puts us at risk of consuming a nutritionally-poor diet.  The results of this study emphasize the importance of our food choices and eating habits.  Choosing foods that naturally lend themselves to being consumed slowly and then consciously forcing ourselves to consume our food at a more leisurely pace can be important and easy steps to developing healthier eating habits.  

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Childhood Obesity Linked to Adult Health

As we have discussed in several previous blogs, childhood obesity is a major concern both in the U.S. and worldwide.  According to the most recent data, over 30% of U.S. children 2-19 years of age are overweight, while 17% of U.S. children are obese.  Research has clearly shown that childhood obesity has a number of negative health effects on children; however, the impact of childhood obesity on later adult health has been a subject of some debate.

A new systematic review paper published online in the International Journal of Obesity summarized the long-term impact of childhood obesity on adult health and mortality.  The study authors searched the scientific literature published between 2002 and 2010.  Analysis of these papers revealed:

• 4 of the 5 studies that examined lifespan found that childhood overweight or obesity was linked to a substantially higher risk of early death in adulthood.
• All of the studies that reported on heart health showed that childhood overweight and obesity was linked to poorer heart health in adulthood.
• Nine studies reported that childhood obesity was linked to a variety of chronic health conditions and disability in adulthood.

Around the same time that this first paper was published, a second review paper on the same topic was also published.  Unlike the first paper, this second review paper is free to download.  The authors of this second review do a wonderful job of both describing the immediate health impact of childhood obesity and detailing the effect of childhood obesity on future adult health and lifespan.  This review paper clearly shows that many research efforts to date have reported that childhood obesity can have a major impact on adult health.  The study authors even indicated that if some of the science on childhood obesity is correct, then there is likely to be a dramatic increase in healthcare costs and possibly a decline in life expectancy in the U.S.

Together, these two review papers paint a rather bleak picture of our future health as a nation.  While most of understand the huge negative health impact obesity can have on our children, many of us probably do not realize the impact childhood obesity will have on a child's future health and quality of life as an adult.  Many of us like to believe that while a child might be overweight, he or she will grow into their weight as they become older.  Research suggests that this is probably not the case.  These two studies clearly point out the need for focusing on maintaining a healthy body weight throughout life, starting at early childhood.

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Honest Body Size Perceptions Are Important

One of the largest obstacles to losing weight that many of us have is developing a realistic perception of our true body size.  In a previous blog, I discussed a Harris Interactive poll of 2,400 survey respondents that reported 30% of overweight individuals believe they are within a normal body size and that 70% of obese individuals believe they are simply overweight.  This study clearly shows that as a population we need to develop a truer perception of our body size.

A new, larger obesity research study examined our perceptions of body size, what we choose to do about it, and the potential role of health care professionals in improving our perceptions. For this study, obesity researchers analyzed data from nearly 17,000 adults who took part in the National Health and Nutrition Examination Survey from 2003 - 2008.  The study investigators reported that:

• 73% of women and 55% of men reported a desire to lose weight; however, only 57% of women and 40% of mean actually reported trying to control their weight. 
• 48% of overweight men and 23% of overweight women perceived themselves as being at their correct body weight.
• The vast majority of overweight individuals (74%) and nearly one-third (29%) of obese individuals have never been diagnosed as overweight or obese by their health care provider.
• Most overweight or obese survey respondents (74% of women and 60% of men) reported trying at least one weight loss strategy.
• Only about one-third of overweight or obese individuals reported using both diet AND exercise to lose weight.
• Obese or overweight individuals diagnosed as such by their health care provider were more likely to diet, exercise, or do both compared to individuals not diagnosed as overweight by their health care provider.

This study is a fascinating look into our perceptions of body size, what we chose to do about it, and the important role health care providers can play.  It is clear from this large population-based study that nearly two-thirds of us profess a desire to lose weight; unfortunately, only about a third of us actually take steps to lose the weight we desire to lose.  Part of this is apparently because many overweight individuals, men in particular, perceive themselves to be at a normal, healthy body weight.  Developing a more realistic and accurate perception of our body size is clearly an important step towards losing weight.  Developing a more realistic perception of our true body size can be aided by our health care providers.  Considering that the data from this study suggests that a proper body weight diagnosis by a health care professional can motivate many of us to lose weight, it is very disturbing to read that nearly 75% of overweight individuals are never diagnosed as such by their health care providers.  This clearly shows that health care providers can play an important part in our weight loss efforts.  The results of this study indicate the importance of an honest, straight-forward discussion of body size and weight control strategies with our health care providers as a first step to obtaining and maintaining a healthy body weight throughout life.

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Be Careful When Interpreting Size 'Labels'!

Because many of us find it difficult to estimate correct portion sizes and many food providers throughout the world use slightly different portion sizes, we have found it easy to rely on size labels like 'small', 'medium', 'large', or 'extra large' when purchasing and consuming food.  Unfortunately, recent research from the University of Michigan indicates that we as consumers easily misinterpret these size labels.

In a series of 5 studies, nutrition researchers tested consumer's ability to differentiate sizes based on how they were labeled and to determine if the size labeling had an impact on consumption habits.  Some of the observations recorded by these researchers included:

• Labeling a large size as 'small' or 'medium' caused study subjects to perceive them as 'small' or 'medium' rather then recognizing the true size.
• Subjects consumed more food when they perceived large portion sizes to be small or medium based on the size label used.
• Subjects found it difficult to believe that an item labeled 'medium' or 'large' was in fact the size labeled if the item appeared visually small.
• Switching 'small' and 'large' labels caused some subjects to perceive a small item as larger than a large item.
• Individuals less likely to be deceived by the size labels placed on the food were those who were very nutrition conscious.

Overall, the researchers noted that consumers typically underestimate how much they eat and the underestimation becomes larger when the meal size increases.  This can clearly lead to over consumption of food on a daily basis.  Unfortunately, this happens without us realizing it.  Since we generally believe the size label, we tend to believe that we have not consumed too much and feel less guilty about what we are eating.

This is interesting information in the wake of the fast food marketing report, which indicated that some fast food restaurants are simply re-naming their portion sizes to give a smaller appearance rather than actually serving smaller sizes.  For those of us that noticed 'smaller' portion sizes at our favorite fast food restaurant, we might not actually be eating less like we thought because of our tendency to believe the size label.  Becoming more nutritionally aware, particularly about portion sizes, is an important step in our ability to choose foods wisely and fight obesity.

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High Cortisol Levels Increase Calorie Intake

Cortisol is an important hormone produced by our adrenal glands.  Under normal circumstances, cortisol plays an important role in blood sugar health, maintenance of healthy immune function, and much more. However, stress can cause a chronic elevation of cortisol, which then can have a variety of negative health effects.  Chronic stress has also been implicated in the risk for obesity. 

A recent nutrition study explored the relationship between cortisol levels and dietary habits in overweight and normal weight women.  In this study, 127 overweight women and 21 normal weight women had their cortisol excretion rate measured over a 24-hour period.  The relationship between the cortisol levels and information collected on dietary intakes were then analyzed.  The researchers reported that:

• Obese women excreted substantially higher levels of cortisol than women maintaining a normal body weight.
• Regardless of the volunteers' body mass index, higher levels of cortisol were linked to larger waist sizes. 
• Higher consumption of carbohydrates, fats, and overall calories was linked to higher cortisol levels in obese women.

These research results continue to suggest a possible link between chronic stress and obesity.  Because the study summary did not discuss stress, it is unclear whether stress might have been involved in the poor dietary choices of the overweight women.  Since long-term elevations in cortisol can be a sign of stress, it is possible stress might be one of the factors related to the study observations.  Nonetheless, this study indicates that elevated cortisol levels, whether from stress or some other reason, might have a major impact on our dietary habits such that we tend to eat more foods high in calories, high in fats, and high in carbs.  These foods, particularly those high in fats and calories, can have a major negative impact on our efforts to maintain a healthy body weight.  Keeping cortisol levels within a normal range, perhaps be reducing stress, might be one way to help maintain a healthy body weight. 

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The Right Way To Eat Nuts

Nuts are a delicious snack for those of us who are not allergic to them.  They come in a wide variety with different tastes and textures and have a variety of nutritional benefits.  Nuts are one of the best plant sources of protein, are generally rich in fiber, contain a number of antioxidant phytonutrients, and most of the fat in nuts is of the unsaturated kind.  However, nuts are typically pretty high in calories and it is easy to eat way more than we should at a single sitting without ever realizing it.

So what is the best way to eat nuts and still enjoy their nutritional benefits?  According to new research presented at the American Dietetic Association's recent Food & Nutrition Conference & Expo, you should buy them with the shell still on.  According to a recent news story from Food Product Design, researchers presented data at this conference a few days ago showing that eating in-shell pistachios helps us become more aware of our snacking behaviors.

In one study, volunteers chose their own amount of pistachios as they entered a classroom.  The weight of the portion selected, the portion remaining at the end of the class, and their feelings of fullness and satisfaction were assessed.  Student volunteers offered in-shell pistachios consumed 86 fewer calories than students offered shelled pistachios (125 calories vs. 211 calories).  According to the researchers, in-shell pistachios slowed consumption allowing fullness cues to become active resulting in students eating in-shell pistachios to consume 41% fewer calories while feeling just as full and satisfied as students offered shelled pistachios.

In the second study, subjects were offered pistachios under specific dietary habit conditions.  Individuals were given a bowl containing 4 ounces of in-shell pistachios and an empty bowl into which they placed the shells.  Every two hours during an 8-hour period, 2 more ounces of pistachios were added as needed.  Under one condition, the bowl of pistachio shells was not emptied until the end of the day, while in the second instance, the bowl of shells was emptied every two hours.  Emptying the bowl of shells every two hours caused the study volunteers to eat 48 more calories than leaving the bowl of shells in place all day.  Despite eating 23% fewer calories by leaving the empty shells in the bowl, study subjects reported feeling just as full and satisfied.

This is a truly interesting study that shows us how simple conveniences like eating nuts already shelled can increase the number of calories from snacks we consume.  Many nuts are sold in cans without shells and while they make a delicious snack, many of us find it easy to eat way to many once that can is opened.  Buying nuts still in their shells can help us to slow our snacking down and allow us to feel full more quickly, resulting in us snacking less.  If this is true for pistachios, which can be de-shelled by hand, eating nuts with shells that require the use of a nutcracker might slow us down even more!  The next time you decide to choose nuts for your evening snack, consider buying ones with the shells still on and enjoy!

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Fast Food Nutrition Still Needs Improvement!

In the national effort to reduce childhood obesity, there has been a large push by a variety of advocates to improve fast food nutrition and marketing.  While this movement has resulted in some commendable improvements in fast food, such as a reduction in the amount of trans fat in fried foods and an increase in more fruit and vegetable options, a new report from Yale University's Rudd Center for Food Policy & Obesity clearly indicates that more still needs to be done.

This new report studied the marketing efforts of 12 of America's largest fast food chains and assessed the nutritional quality of over 3,000 children's meal combinations.  A summary of this new study paints a rather disturbing picture:

Unhealthy foods still the norm:

• Of the more than 3,000 meal combinations analyzed, only 12 met the Yale researchers nutrition criteria for preschool children and only 15 met the nutrition criteria for older children.  That's less than 0.5% of the meals tested!
• Meals purchased by teens averaged 800-1,100 calories, which is about one-half of their daily recommendation.  This suggests that eating at a fast food restaurant puts teens at risk for consuming many more calories than needed.
• At least 30% of the calories from fast food meals came from sugar and saturated fat and a single meal often provided one-half of a child's sodium recommendation.

Healthier options are not emphasized:

• Healthier side dishes are rarely the default or 'regular' side provided with a meal.  The standard, automatically-provided side dishes remain French fries and a soda.
• Fast food restaurants are frequently renaming their portion sizes to give the appearance of being smaller rather than actually providing smaller portions.

Fast food marketing continues to increase:

• The number of fast food advertisements seen by preschoolers and children ages 6-11 in 2009 have increased by about 25-30% on average compared to the year 2007.
• 15% of preschoolers ask their parents every day to take them to a fast food restaurant, while 40% of children 2-11 years of age ask to go at least once per week.
• Over 85% of parents report taking their children to a fast food restaurants at least once per week.

This is important information for everyone, but particularly so for those who choose to dine at fast food restaurants.  It is important to remember that we can choose healthier options when dining at fast food restaurants (or any restaurant for that matter).  For example, one kid's meal that includes 4 chicken tenders + fries + a soft drink provides 645 calories, 906 mg sodium, 63 calories from fat, and 120 calories from sugar. In contrast, by replacing the fries with apple slices and the soft drink with fat-free milk, we cut calories (350 calories) and sodium (515 mg) nearly in half while reducing the amount of calories that come from fat and sugar.  Yale University's Rudd Center for Food Policy & Obesity has established a web site, Fast Food FACTS, where you can learn more about fast food nutrition and your child's exposure to fast food marketing.

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Coffee Extracts for Weight Loss?

Some research studies have suggested that drinking coffee might help with weight loss, reduce weight gain, and possibly help support normal blood sugar health.  These possible benefits of coffee consumption have been reported to be due to coffee's content of caffeine, antioxidants, and other components.  However, the research to date is sparse and shows inconsistent results, alluding to the need for continued research into the possible weight loss benefits of coffee.  Two such studies were recently published.

In the first study (free to download), weight loss researchers conducted a review and analysis of previously published human clinical trials on weight loss and green coffee extracts.  Green coffee extracts are typically rich in a number of antioxidant polyphenols including chlorogenic acid.  Animal  studies with green coffee extracts have suggested that they might support normal blood sugar health and normal blood lipid health through several different mechanisms.  The study investigators examined the results of 3 randomized, human clinical research studies on the effectiveness of green coffee extracts on weight loss.  They reported that regular consumption of green coffee extracts was significantly linked to a reduced body weight (about 5 pounds versus control subjects); however, the results were highly variable.  The results of this analytical study suggest that green coffee extracts might have a place in one's weight loss program, but so far the benefits appear modest and vary widely.

In a second weight loss study, researchers asked 54 adult, overweight men and women to consume a beverage that either contained coffee mannooligosaccharides (4 grams/day) or did not contain them as part of a weight maintenance program.  The study volunteers consumed their beverage 2 times each day for 12 weeks.  For this study, the weight loss researchers measured body composition at the start and end of the study as well as body weight and measures of appetite and feelings of fullness each week during the study.  The weight loss researchers reported that men consuming coffee mannooligosaccharides daily for 12 weeks had a reduced body volume, lower body fat, and less belly fat than men consuming the placebo beverage.  These benefits were not observed in the women volunteers.

These two new weight loss papers suggest that coffee extracts might support healthy weight loss and body composition changes; however, these results varied greatly and benefits were not observed in all groups.  Further research is clearly needed to determine the effectiveness of these coffee components for healthy weight loss and body composition.

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Calcium and Vitamin D in Childhood Obesity

In a previous blog, we discussed the beneficial impact of higher calcium intakes and higher vitamin D blood levels on successful weight loss in adults.  New research studies also suggest that vitamin D and calcium might reduce the risk of obesity for some children.

In one childhood obesity research study, investigators examined the relationship between calcium intake and body composition in African-American children (free to download).  In this study, 186 African-American children at risk for being overweight were asked with the help of their elders to record food intake for 3 days.  Body composition and body weight measures were taken and analyzed in respect to nutrient intake.  The investigators reported:

• Less than half of the children met the dietary recommended intake of any of the vitamins and minerals measured with only about 1% meeting calcium recommendations and about 4% meeting vitamin D recommendations.
• When the study volunteers were examined as a whole group, no links were evident between calcium intake and body composition or body mass index.
• However, when looking at differences between boys and girls, it was clear that girls who consumed less than 314 milligrams of calcium per day had a higher percent of fat mass than girls who consumed more than 634 milligrams of calcium per day.

In the second childhood obesity research study, investigators assessed the link between vitamin D blood levels and changes in body mass index and waist size in more than 450 5-12 year old children.  For this study, blood levels of vitamin D were measured at baseline and classified as deficient (less than 50 nmol/L), insufficient (more than 50 nmol/L, but less than 75 nmol/L) or sufficient (more than 75 nmol/L).  Body changes were assessed yearly for approximately 3 years.  In this study, children deficient in vitamin D were shown to have greater increases in body mass index, skin-fold thickness, and waist size over the 3-year follow-up period than children with sufficient blood levels of vitamin D.  Additionally, a lack of vitamin D was linked to slower growth rates in girls.

These two studies both show that deficiencies in calcium and vitamin D might be linked to some children having an increased risk for becoming overweight or obese.  The reason for the difference between African-American boys and girls in regards to calcium's impact on body fat is uncertain; however, the study researchers point out that their analysis was negatively effected by the very low percent of children consuming adequate levels of calcium (1%).  In truth, the insufficient intake of most vitamins and minerals in this group of children is one of the most disturbing results of this first study.  In this study, less than 10% of the children consumed adequate amounts of calcium, magnesium, phosphorus, potassium, folate, vitamin D, vitamin A, and vitamin K based on food intake records!  Ensuring that children get adequate nutrition is an important step to both maintaining overall health as well as possibly reducing their risk for both childhood and adult obesity.

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Fitness Is Declining In College Students

Most of the time when we think about diet, lifestyle, exercise, and obesity, we think about body weight and weight loss.  While these factors are an important component of being physically fit, we often don't give as much thought to how physically fit we are as a population.

A new obesity and wellness research study (free to download) was conducted to determine if the physical fitness of college students changed over time and, if so, how those changes effected measures of obesity like body mass index (BMI) and body fat.  Nutrition researchers analyzed the results of MicroFit tests from over 5,000 students attending a private Seventh-Day Adventist college where each student enrolled in a physical activity class was required to take the MicroFit test.  Information collected on body weight, body fat, muscle strength, aerobic fitness and more from 1996 to 2008 was analyzed.  Fitness was measured by estimating VO2max, which is a measure of the maximum oxygen uptake during a graded exercise and is considered to be one of the most accurate measures of physical fitness.

The results of this data analysis showed that:

• While there was some yearly fluctuation, physical fitness, as measured by VO2max, declined overall during the 13 years examined.
• Physical fitness declined at a faster rate for male college students (0.812 mL/kg/min) than female college students (0.414 mL/kg/min).
• During the 13 year study period, percent body fat increased in both males (0.513% per year) and females (0.654% per year).
• The proportion of male college students classified as having poor physical fitness increased dramatically, while the number of male students classified as excellent, fit, or fair declined steadily.  Similar, but less dramatic, changes were observed in college females.

Overall, this study showed that both male and female college students are apparently becoming less physically fit and gaining more body fat over time.  One of the most interesting aspects of this study is the study population.  Seventh-Day Adventists are a religious group that stresses a very healthy lifestyle that includes eating a healthy vegetarian diet and getting plenty of exercise.  It has been reported that their lifestyle choices have resulted in a lifespan that is typically about 10 years longer than the average American.  This is reflected in this new study by the fact that the average body mass index of the students was about 24, which falls within the accepted healthy range, while average body fat was only about 12% in male college students and 22% in female college students.

While it is not completely unexpected to see a decrease in physical fitness during the college years due to the college lifestyle of little sleep, skipping meals, too much snacking and too much fast foods, one has to wonder how rapidly physical fitness is declining in the general population where healthy diet and lifestyle habits are not as frequently stressed.  Finding ways to increase physical activity, improve eating habits, and improve overall physical fitness during the college years should be an important part of our fight to reduce obesity.

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