I get more questions about diets than just about any other subject. It’s easy to see why. We are a nation obsessed with eating as well as with losing weight. We are bombarded with food ads showing happy, attractive, thin people chowing down on mega-meals. The result: We’re one of the fattest nations on earth.
You know that being overweight isn’t good for your health. Most of us want to take the extra pounds off, and we want to do it as fast and as painlessly as possible. There’s an entire weight loss industry happy to supply you with a variety of products and methods claiming to help you do just that. Most of these are fad diets that deprive you of calories in a big way, at least early on. In doing so, the pounds may come off quickly. However, these diets aren’t sustainable, so the pounds slowly return. Overeating followed by over-restricting becomes an endless cycle that profits those who make money by selling diet foods and weight loss plans. But it is a terrible approach to health.
It’s easy to see why failure is common. Many of us have a complicated relationship with food. From the time we were young, food wasn’t just sustenance. It was comfort. It was a reward. It was a way of showing love. Withholding food was a form of punishment. When we were bad, it was “No dessert for you.” If we didn’t finish our meals, we were told, “There are children starving in China,” and we remained at the table until the plate was clean. It’s no wonder we’re so conflicted about enjoying food without overeating and feel guilty for stopping when we are full.
Learning how to unload this baggage will allow you to make better decisions about which foods to choose. Foods shouldn’t be categorized as “good” or “bad.” There are clearly some foods that work best as “everyday” foods and some foods that are better as “sometimes” foods, but we tend to get into trouble when certain foods are labeled “never” foods. The temptation can just be too great. How do you get that balance between these types of food? This is a theme you will see running through many of the questions and answers in this chapter.
Dietary changes should not just be about losing weight, though. Choosing foods higher in fiber and lower in fat, salt, and sugar helps prevent heart disease, diabetes, and cancer. And the benefits of better eating choices can help the next generation, too. One of the most common concerns from my patients’ parents is how to get their kids to kick their junk food habit. I tell them it starts with them. Setting a good example is paramount to their children’s success.
The truth is this: You have to decide that you want to live a longer, more robust life. Maintaining a healthy weight is the first step. But it can’t be done with a quick fix. The only route to success is making long-term diet and lifestyle changes. I’m not asking you to give up anything. Healthy eating is about making simple choices and simple changes that you can live with. Follow the principles in this section and you’ll see how to do it. Remember, start small, experience success, and build from there. The little sustainable changes you make add up over time to major weight loss and improved health.
A couple of years ago I did a segment for Good Morning America in which I presented a panel of nutritionists with some of the latest, hottest celebrity diets: A raw food diet, a blood-type diet, a macrobiotic diet, and the master cleanse. Their job was to tell me which was the best, which was the worst, and which might be downright dangerous. I knew what I thought were the correct answers, but I wanted to see if they agreed. Turns out they did.
All of the diets resulted in weight loss for a simple reason: They restricted calories. Some eliminated whole categories of food; others used pseudoscience to tell you what to eat. While a macrobiotic diet can be a healthy approach to eating if done carefully, none of the diets was a healthy approach to weight loss. I view a diet as a “quick fix” when you need to lose an extra pound or two after a weekend splurge or to kick-start swimsuit season. As a long-term approach to weight loss diets just don’t work. You can’t stick to them forever, and with some diets it would be dangerous to do so.
The diet industry is huge, and Americans spend billions of dollars a year trying to lose weight. For some reason we continue to believe that the answer to losing extra pounds has got to be the newest diet book or product. When that fails, we try the next one. The result is yo-yo dieting or weight cycling: Your weight goes down due to severe, unsustainable caloric restrictions and then it comes back up, usually to a point higher than where you started.
This country is in the middle of a health crisis. More than one-third of adults are obese. Another third of adults are overweight but not yet obese. The impact on our health is deadly: Heart disease, stroke, type 2 diabetes, and certain types of cancer, all increased by obesity.
I firmly believe that the only meaningful way to lose weight is to make long-term changes to your eating habits and incorporate more activity into your days. It all starts with small steps. Even a modest weight loss will provide important health benefits. Don’t get discouraged if it takes a while to see dramatic results. Chances are you have put on your extra weight over the course of years. It could take that long to get it all off.
There are a million weight loss strategies; you can check them all out on the Internet. For me it boils down to three rules:
• Eat less.
• Eat differently.
• Move more.
There’s nothing fancy or complicated. This isn’t a short-term change where you eat something crazy for a week. It isn’t about eliminating foods you love or training to be a triathlete. It is about small, livable changes that become habits. It is as much a mental adjustment as a physical one.
Eat Less
You need food to fuel your body. Food gives you the energy to do what you need to get done. But there’s no way around it—you may be eating too much. Portion size has exploded. Everything is supersized. Remember what a bagel, a muffin, or even a fast-food hamburger looked like twenty years ago? Now they are two or even three times as large. We need to get back to healthy portions and the right balance of foods.
Cut back gradually. When you serve yourself, start by taking only three-quarters of what you would normally eat. After a month or so, do that again. Fill your plate with veggies and whole grains first, then add lean protein. Learn to eat only when you’re hungry. How many times have you gorged yourself only to think, “I didn’t even really need that”? Be conscious of when you are eating and learn your triggers for overeating—for some it’s boredom, for others stress.
Don’t be afraid to use a visual reminder. Put a big sign on your refrigerator—“Stop. Are you really hungry?” or tack up a photo of yourself at a former weight or someone at a weight you want to achieve for inspiration. Maybe you have a goal. Put a picture of someone doing an activity you hope to do, an athlete you admire, or a reward, like an outfit you want to fit into. Motivation comes in all forms.
Eating is also a social activity and no one wants to give up those get-togethers. Unfortunately, research shows that most of us eat more when we’re with others than when we are by ourselves. Find additional ways to socialize, preferably ones built around physical activity. Even going to a movie or strolling around the mall with a friend is better than always meeting for drinks and nachos.
The number of calories you need depends on your size and your amount of activity. Two helpful tools for assessing your needs are the Centers for Disease Control and Prevention’s adult BMI calculator, www.cdc.gov/healthyweight/assessing/bmi, and the U.S. Department of Agriculture’s ChooseMyPlate.gov site, which offers the new governmental food guidelines to help you make healthier choices, www.choosemyplate.gov/weight-management-calories.html.
Keep a diet diary and then go online to figure out how many calories you are consuming right now. Then look at ways to make a change. If you take in five hundred calories less each day than you burn up, you will lose around a pound per week, a realistic goal. This can be split between eating a bit less and exercising a bit more.
Eat Differently
In a 2007 New York Times article, the food writer Michael Pollan gave simple but accurate advice: “Eat food. Not too much. Mostly plants.” I couldn’t agree with him more. Eat food your great-grandmother would recognize—fruits, vegetables, and products with ingredients you don’t need a degree in chemistry to understand. Start fresh. I like to say there are no bad foods, but I make one exception: Soda. Get rid of it. Sure, you can have one occasionally, but best to get it out of the house so it’s not there to tempt you. It’s just empty calories that have absolutely no nutritional value. Cut back on other sweetened beverages. Say good-bye to the chips and all the other junk food that is going to sideline you. I’m not saying you should never eat processed food, but if you don’t keep it around, it will be easier to regulate. Save it for a treat when you are dining out. You’ll also be less tempted to indulge if it’s not in your cupboard. You might need to “retrain” your palate to enjoy less sugary and salty snacks. Replace junk food with healthier options. Instead of processed food snacks, keep dried fruit and nuts for munching. Keep a bag of baby carrots in the fridge but get rid of the ranch dressing.
These steps aren’t easy to do, so here’s my advice: Do it gradually. As a pediatrician, I often help parents wean their toddlers off juices. We start by mixing the juice with a little bit of water, then gradually increase the water and lessen the juice. After a month or so, the children are drinking water and enjoying it. You can go the same route. Gradually wean yourself from sodas, juices, and snack foods. If it’s too hard for you to eat a sandwich without chips, try the baked variety and eat half of what you normally would. I like to put a serving on my plate and put away the bag so I’m not tempted to go back for more. Fill up your plate with a side salad, carrots, or sliced apples, so you don’t feel deprived. Trade half-and-half in your coffee for milk, and go from full-fat dairy to lower-fat options.
Move More
I’m not even going to say exercise more. Just move. Take the stairs. Go for a walk—two or three times a day if you can, even for five to ten minutes: Before you start your day, at lunch, and after work. It doesn’t have to be far, but just start somewhere. Once you are walking for a while, try seeing if you can walk faster, longer, or even jog a little. Ask a friend to go with you. Join a gym. Get a trainer, anything to get you to stick to it. That’s all it takes, little steps that become bigger ones.
Changing your lifestyle to lose weight permanently is not going to be easy. You are not going to be perfect. You shouldn’t be. Just forgive yourself and get back on track if you get derailed. Food is something we should enjoy. Losing weight will never work if you equate it with punishment. Think of all the benefits of being healthier, instead of fixating on what you are giving up. It’s all about balance.
DR. B’S BOTTOM LINE:
Dieting is not the best way to lose weight. Unfortunately, there is no magic to weight loss. To lose pounds and to keep them off, you need to make a lifetime commitment to get your weight under control through healthy choices. Eat less, eat healthier foods, and move more. Your body will thank you for it.
Six meals instead of three? As my kids would say, “Sweet!” Who wouldn’t want to eat twice as often? Why stop at six? Eight is even better. Or is it?
With all the diet books and various weight loss strategies, it is so hard to convince my patients that losing weight is all about taking in fewer calories than you burn off. It doesn’t matter if you eat three meals or ten—if you consume the same total number of calories and types of food over the course of the day, your weight loss or gain will be the same.
What got everyone talking was a 2001 study in the British Medical Journal that found that people who reported eating six small meals each day had lower cholesterol than those who said they ate one or two. Suddenly experts were weighing in on why smaller meals were better. Some supposed they helped to keep your metabolism revved up. Others thought with constant grazing, overeating from hunger would be less likely than when you had a longer span between meals. But when all was said and done, there was no consensus on whether you were metabolically better off eating three or six meals.
A 2010 study finally addressed this head-on. Two groups went on a weight loss plan, consuming the same calories. One group ate three meals and the other ate six. At the end of the study, there was no statistical difference between the amounts of weight lost by the two groups.
Now, I do need to throw a bit of a wrench in the works when it comes to “a calorie is just a calorie.” There are new data that suggest the type of calorie does have some impact on how you burn it, by changing something called your metabolic rate. The higher your metabolic rate, both while exercising and at rest, the more calories you will burn up. Ever know someone who can eat as much as he wants and never gain weight? This may be due to his metabolic rate being higher. Researchers at Harvard studied people on three types of diets of equal calories: A low-fat diet, a low-carbohydrate diet, and a diet low in fat but rich in complex carbohydrates. They found that those on the traditional American Heart Association low-fat diet had the biggest drop in their metabolic rate. They just did not burn up calories as fast. Those on the low-carb diet had the smallest drop, with those on the complex carbohydrates in between. While they didn’t follow people long term, this suggests that what type of food you eat—in addition to the total number of calories—may have an impact on how easy it is to lose weight and keep it off. Stay tuned, as this is a hot area for ongoing research.
But back to six meals. I’m not saying that this style of eating is wrong or harmful. The important thing is finding what works for you. If you frequently get hungry, or are afraid of being deprived while losing weight, having smaller “meals” might work better for you. Remember, these six “meals” should each have about half the calories of traditional meals. They should also be nutritionally balanced. For others, such a small meal is just not satisfying.
DR. B’S BOTTOM LINE:
Assuming you eat the same types of food and take in the same number of calories over the course of the day, whether you eat six small meals a day or three larger traditional meals, you will gain or lose the same amount of weight.
My wife is a yoga enthusiast. At her favorite yoga studio, not a month goes by without someone sponsoring a juice fast. When she’s asked if she’ll participate, she replies, “No thanks.” She, like I, believes that eating sensibly is the best way to stay healthy and maintain a desired weight. When she questions her fellow yoginis why they are partaking or asks what they know about the actual product, she’s usually met by silence or phrases like “flushing toxins” and “cleansing systems.” No one really knows why they are shelling out hundreds of dollars not to eat, instead of spending a fraction of that amount buying healthful foods.
Fad diets, including cleanses, seem to be contagious. You hear of celebrities dropping scores of pounds for a role by drinking some horrifying lemon and cayenne pepper concoction and think, “Well I can do that, if I will look like them.” I’m not sure why many dieters are willing to go to those extremes, but when it comes to maintaining healthful eating habits, day in and day out, it seems too difficult.
The Academy of Nutrition and Dietetics (formerly the American Dietetic Association) recommends staying away from fad diets. If you lose weight too quickly, you’ll lose muscle, bone, and water and be more likely to regain the pounds quickly afterward.
The argument for juice fasts relies on two important misconceptions: That our digestive system needs a reprieve from solid foods and that nutrients in liquids can be more easily absorbed than solids. There is no scientific data to back either rationale. Unless you have a problem with your digestive system that prevents you from breaking down solid food, there is no need for a liquid diet.
When it comes to toxins, your body has quite wonderful systems for handling them. Your kidneys and liver work to remove and excrete them through bodily waste. Some toxins get deposited in your bones and other tissues and take time to be excreted. However, there is nothing to suggest that drinking liquids helps liberate these toxins from your body any faster. Similarly, colonics do not cleanse your colon any better than normal digestive function and in fact, can cause injury if incorrectly done.
A juice fast isn’t even guaranteed to make you lose weight. If the juices are low-calorie, you will lose weight, but some juices have added sweeteners, which could actually deliver the opposite effect. You will lose or gain the same amount of weight, calorie for calorie, whether you ingest it as a liquid or as a solid. By juicing your fruits and vegetables you are also losing out on the nutrients found in the skin and pulp and are more likely to feel hungry faster because you are missing the fiber. There’s just no good reason not to simply eat what you think you are drinking. That way you know exactly what you are ingesting and you’re doing it in its purest, unadulterated form. Another reason to look at the ingredients: Some cleanses contain supplements and herbal products that can be dangerous.
As always, the best medical advice for losing weight is to eat a diet based on vegetables, fruits, whole grains, and lean sources of protein. Choose water to stay hydrated.
DR. B’S BOTTOM LINE:
Juice fasts are not good for you. Effective weight loss is done through moderation, not through extreme diets focusing on short-term gains. Let your body do what it’s designed to do. It really functions quite well! You don’t need gimmicks like liquid diets to lose weight, and there is nothing to suggest that your organs need a rest. If you feel like eating lighter, concentrate on eating more fruits and vegetables. The fiber will fill you up and keep you from overeating.
When I was at the CDC and even now at ABC News, I’ve often been asked what health issues keep me up at night. I would say the one medical condition that really concerns me is diabetes. In the United States today, almost twenty-six million people live with diabetes, a chronic disease that can impact almost every organ in your body. It can cause kidney failure, vascular disease, nerve damage, heart disease, and blindness. According to the American Diabetes Association, diabetes was responsible for more than seventy-one thousand deaths in 2007. The CDC predicts that as many as one in three American adults will have diabetes by 2050 unless there is a concerted effort to curb obesity and get more active.
For many, the first thing that comes to mind at the mention of diabetes is high blood sugar. The notion that eating too much sugar directly contributes to diabetes seems logical for a number of reasons. Those living with diabetes must eat sweet treats sparingly and consistently monitor their blood sugar levels in order to keep them within a safe range.
So is eating too much sugar going to lead to diabetes? First let’s look a bit at the disease; there are actually several different types of diabetes, each having different causes and risk factors:
• Type 1 diabetes is also known as juvenile-onset diabetes because it primarily strikes children and young adults. It develops when your body’s immune system destroys the cells located in your pancreas that make insulin. It isn’t clear why this happens; it may be triggered by certain infections and it may also be inherited. Insulin is a hormone with many functions but for the purposes of this discussion it regulates how your body uses glucose. Without insulin, your body’s cells cannot use the sugar in your bloodstream for energy and it builds up. As a result, type 1 diabetics must take insulin injections.
• Type 2 diabetes is also known as non-insulin-dependent diabetes mellitus. With this disease, your pancreas still makes insulin but there is a problem in how your cells use it. They become resistant to its effects, leading to a buildup of sugar in your blood. We used to call it adult-onset diabetes because it primarily affected adults but we don’t use that term anymore as it is now being seen more and more often in children. There is a strong connection between type 2 diabetes and obesity and physical inactivity. Both are big risk factors. Left untreated it usually progresses with symptoms beginning gradually, sometimes imperceptibly for years. The good news: If you catch it early, changes in diet and exercise may be able to control it. Ninety-five percent of people with diabetes have type 2.
• Gestational diabetes is diabetes that occurs during pregnancy. Like type 2, there is a link with obesity, ethnicity, and family history. For most women, their blood sugar returns to normal soon after delivery but some develop diabetes five to ten years after childbirth, so it is important to continue to be closely monitored. Its treatment is similar to that for type 2 diabetes.
Type 1 diabetes has no link with diet and weight. With type 2 diabetes, obesity, combined with physical inactivity and genetics, is the chief determinant. But the direct relationship of sugar as a major contributor to diabetes remains largely unsupported. The American Diabetes Association puts this in the category of myth, and I think that is right. The ADA believes that it doesn’t matter whether those extra calories come from excess sugar, fat, or just overeating. It’s all the calories put together that play a role.
Some researchers aren’t so sure. A number of studies have shown an association between the amount of sugary drinks people consume and their risk of developing diabetes. However, most people who overdo it on sugar are also overdoing it on calories.
DR. B’S BOTTOM LINE:
If you are worried about developing diabetes, worry less about eating too much sugar and concentrate more on achieving a healthy weight by eating a balanced diet and getting regular exercise.
Anyone who’s been on a diet has heard the advice, “Drink eight glasses of water a day.” The theory was partially based on water filling you up to prevent you from overeating. You could always tell who was following that dictate—they were never far from the bathroom. The “8×8” maxim (eight, eight-ounce glasses) has been espoused as the solution not just for losing weight, but for everything from supermodel-worthy glowing skin to regulating the digestive system by “flushing out toxins.”
Before we go any further, let me say, I love water. Drinking water is a great thing. I wish all my patients named water, instead of soda, fruit juice, or sports drinks, as their beverage of choice. But even with my ringing endorsement, water, like everything, is best in moderation. This isn’t denying the important role that water plays in keeping our bodies functioning properly. You can live without food for far longer than you can without water. But with a normal diet, the truth is, your body does a really good job of regulating your need for liquids, primarily by letting you know when you’re thirsty!
Here’s why. One of the main functions of your kidneys is to preserve the water and salt balance in your blood. They keep the concentration of salts within a very narrow range. When you drink extra water that might dilute out these salts, your kidneys get rid of the excess water into your urine. At these times you may notice your urine is paler. When you are not drinking as much, your kidneys react by holding on to more water. Your urine gets concentrated and appears darker (and a little more pungent). Whether you are drinking eight glasses of water a day or twenty glasses, your kidneys will do their job.
The magic number eight can be traced back to 1945, when the U.S. Food and Nutrition Board, part of the Institutes of Medicine, provided guidelines for good nutrition. They calculated this figure based on the amount of water needed to break down and use your food. In the most recently published guidelines in 2004, the U.S. National Research Council increased the recommendation slightly to 2.7 liters of water for women and 3.7 liters for men. Translating liters to eight-ounce glasses, this comes out to eleven glasses for women and fifteen glasses for men. Nearly a gallon for men! How’s that possible? The guidelines note a couple of important details: Healthy people adequately meet their daily hydration needs by letting thirst be their guide. This means if you have a normal thirst mechanism and access to water, you don’t need to think about how much water you need to drink. You will drink enough. Another key point is that the water recommendations include all the water you consume. For an average diet, food provides 20 percent of your daily water needs. If you eat a lot of fruits and vegetables, you are getting even more water. Most fruits and vegetables are more than 80 percent water. Even meats have water. Cooked chicken, for example, is actually 60 percent water.
How much water you should drink really depends on your level of activity, how hot and humid it is outside, and what you eat throughout the day. As your activity level increases or you lose water through sweating and evaporation, thirst kicks in, and tells you to drink. Most of us anticipate these losses by drinking extra when we know we may have a chance of getting dehydrated.
As a doctor, there are many times I recommend that patients increase their fluid intake when they are sick. When I see someone with a cold I know that if they have a little fever and rapid breathing, they will lose extra water. However, I have to tell you, there are no studies that show increasing fluid intake will make you get better sooner. This is one of those recommendations based on experience and scientific principles rather than studies. In fact a review in the British Medical Journal suggests that increasing fluids when you have a respiratory infection may be harmful. I disagree with their conclusion, but it points out how something you have taken as the gospel may not have a lot of evidence behind it.
I do think drinking water rather than other beverages makes a lot of sense. There isn’t a lot of data to show that water itself helps you lose weight, but if you are substituting water for high-calorie drinks, it sure helps. It is the first thing I recommend to any patient who wants to cut back on calories.
DR. B’S BOTTOM LINE:
Your body actually needs more than eight glasses of water a day, but you don’t really need to think about it. Your brain and kidneys take care of that for you. Trust your body to signal when you need to drink more. That is what thirst is all about. Rather than counting glasses, look at what’s in them. If you are drinking a lot of things other than water, think about making a change. It’s one of the simplest things you can do for your health.
In my family, I’m teased for being predictable. I prefer to say I like a routine, especially when it comes to my mornings. I begin each day the same way, with the newspaper and my coffee, orange juice, and a bowl of cereal topped with fruit—bananas and raisins in the fall and winter, berries in the spring and summer. I need to eat breakfast before I can do anything else, and as it turns out that’s good for my health, too.
Many studies from around the world have shown that people who skip breakfast are more likely to be overweight. At first that might sound absurd. How can skipping a meal lead to weight gain? If weight is all about calories in and calories burned, skipping breakfast would have to decrease weight gain. However, studies show that when people skip breakfast, they are more likely to be hungry during the rest of the day and end up eating more for their other meals. Instead of saving the calories from breakfast they actually consume more total calories over the course of the day.
I find eating breakfast serves another purpose. It really improves my disposition. If I skip breakfast (or any meal, for that matter) my mood suffers. I am grumpy, can’t concentrate as well, and lose my focus. I’m not alone. This has been seen in both children and adults.
So whether you are trying to watch your weight or just get your day off to the right start, begin with breakfast. For me it also serves another purpose. It gives me a little time to wake up, catch up with what is going on in the world, and take a deep breath. All of these plus I’m doing my body a favor and keeping my weight in check to boot!
DR. B’S BOTTOM LINE:
Breakfast is often called the most important meal because it gives you energy at the start of the day and helps prevent overeating during later meals. I know it’s tempting to skip it because you’d rather sleep a little longer or aren’t hungry first thing in the morning. Even if you don’t sit down for long, grab something to get your day off to a healthful start before leaving the house or to eat on the road.
I love water. I drink it all the time: Plain water, bubbly water. It doesn’t matter. I even ask all of my patients about water: “Do you drink it? How much?”
My friend Rosemary also loves water. Whenever she comes to visit from out of state, her first stop on the way from the airport is to the gourmet supermarket to load up on her favorite bottled water. She’s half-convinced that drinking this brand, sourced from a pristine island eight thousand miles away, will cure almost anything that ails her.
Her views are not unusual. Somehow the simplicity of water has been corrupted. Pouring some from your kitchen sink just doesn’t seem good enough anymore. There’s pressure to order artisan water, and the fancier the bottle the better.
The growth of bottled water in the United States over the past decade has been absolutely meteoric. In 2009, we spent more than $10 billion drinking more than eight billion gallons of the stuff. But is it really worth it? The reality is you’re doing yourself and the environment a disservice if you’re forking out big bucks for bottled water, especially if you are doing it because you think it’s better for you. It’s not—or at least there is no way to know that it is.
Here’s the truth. Both tap water and bottled water are regulated, but the system for tap water has transparency and the one for bottled water does not. The Environmental Protection Agency is responsible for overseeing the quality of tap water through the Safe Drinking Water Act. They have given this authority to test and ensure community water standards to the states and territories. Every community water system with more than one hundred thousand customers is required to post their water quality information online. You can check on yours by reading a Consumer Confidence report at water.epa.gov. Bottled water is regulated by the Food and Drug Administration (FDA). However, there are no requirements that water bottlers share the results of their testing with the FDA or even use independent labs. While the FDA is required to inspect bottling facilities, they are considered low-risk producers and inspections are a rare event.
But doesn’t bottled water spring from a better source, as the advertisements imply? Not necessarily. Just as in Oz, where the man behind the curtain wasn’t who you thought he was, you’d be surprised to find out where most bottled water comes from. According to their websites, both Pepsi’s Aquafina brand and Coca-Cola’s Dasani water come from public water sources. That’s right, it’s just purified tap water. But tap water by law already is purified. As your grandmother might say, “Why pay for milk when you can get the cow for free?”
There is one good thing about the bottled water boom. It’s gotten people into drinking water and has moved many away from sweetened drinks. For years, the lukewarm office water fountain was ignored in favor of canned sodas. Now water is cool to consume. But we have to drink it in a more environmentally responsible way. A study by the Environmental Working Group found that every twenty-seven hours Americans consume enough bottled water to circle the equator with plastic bottles stacked end to end. Worse, most of those bottles are not recycled.
Make the better decision: If you are on the go, use reusable stainless steel or BPA-free bottles. Hopefully, carrying your own water will become the status symbol of the future. If you are sensitive to the taste of your tap water or are concerned about contaminants in your local water supply, use a filter and change the cartridge regularly.
DR. B’S BOTTOM LINE:
Bottled water is not better than tap water. As you can tell, I’m quite passionate about water being your beverage of choice. So let’s not make it more complicated than we need to. Save your money and the environment. Even in fast-food restaurants I ask for a cup of tap water—they are happy enough to oblige.
I like to joke that eggs are the Rodney Dangerfield of food. They get no respect. In the last few decades, eggs have ping-ponged between being the darlings and the demons of the diet world. In their heyday, covered with cheese and nestled next to bacon and sausages, they screamed, “Guess who’s on the Atkins Diet?” A few years passed and low-fat diets became the rage. Eggs were suddenly banished. There was a concern that eating eggs, even moderately, was responsible for high cholesterol levels, increasing the risk of heart disease. Now eggs are fighting their way back, trying to get the acceptance they deserve as one of the most nutritious and economical protein sources. In the process, they’ve left a lot of people confused about whether they should or shouldn’t eat them.
I do like eggs, but there’s more to address in this question than simply the benefits of eating or not eating them. It bothers me that eggs became the poster child for “bad” food simply because they contained cholesterol. As it turns out, for most people, cholesterol in a single food has a negligible effect on cholesterol levels in your blood. Cholesterol is naturally produced by your body. It is needed to make parts of cells and hormones, as well as to absorb certain vitamins. Your cholesterol level is the result of several factors: How much you eat, how much your body makes on its own, and how quickly your body clears it from your system. All of these play a role, as do your genetics, your weight, and your activity level.
Foods with cholesterol, if eaten in moderation, are an acceptable part of a healthy diet. Each egg contains around 185 mg of cholesterol. Most people can consume 300 mg per day and maintain normal blood cholesterol levels. If you are at high-risk for heart disease, drop that down to 200 mg per day. If you are one of the rare people who are very sensitive to dietary cholesterol, a so-called hyperresponder, you may need to carefully watch any dietary cholesterol.
Some fad diet book is always trying to convince you that it has the secret to good health, and it often involves totally cutting out a major food group. Sorry, but I just don’t buy elimination diets. Eggs are a cheap, nutrient-dense protein source. One egg is only about 70 calories, with 6 grams of protein and only 1.5 grams of saturated fat. Eggs contain essential amino acids, vitamins, and folic acid. They provide choline, an important nutrient that helps regulate the brain, nervous system, and cardiovascular system. They also have a high carotenoid content, which is good for your vision.
Eggs seem to me like a pretty healthy addition to a diet. But like all animal protein, they should be eaten in moderation.
DR. B’S BOTTOM LINE:
Don’t be swayed by fad diets that suddenly vilify foods that have been mainstays of our diets for centuries. There are many foods that we should eat more of and some we should eat less of, for many reasons. Don’t let anyone tell you that eggs can’t be part of a healthy, balanced diet.
When I first went to the CDC, I did a two-year fellowship as a disease detective investigating outbreaks of diarrheal disease. I was the envy of all my friends. After all, who wouldn’t want to study poop every single day? At work, we kept a list on the wall of the riskiest foods. After every outbreak we would add a new culprit to the list.
I remember watching my colleagues at lunch, wondering after their years implicating virtually every food, what they would eat? Was anything truly safe? I also wondered if my own dining habits would change. I love sushi and raw oysters, rare hamburgers and runny eggs—all definite food safety no-nos. One of my bosses took the truly safe approach. His lunch was boiled: Boiled chicken, boiled vegetables, boiled everything! Safe, yes, but enticing? No! I wasn’t going to go that far and you don’t have to, either.
I quickly realized there is risk in everything we eat. It was up to me to know the hazards as best as I could, to be able to make the right decisions for myself, and to give advice to others. Some advice was a no-brainer. There was the guy who called and asked me whether it was safe to eat the Thanksgiving turkey he had forgotten about in the trunk of his car. His boss had given it to him two weeks earlier. Easy decision. Pitch the bird.
I didn’t banish my favorite foods from my diet, but I definitely learned to be more discerning when it came to choosing what I ate. I became more aware of how food was being prepared and where it came from, and I learned to judge when to play it safe and when to be more daring.
I am frequently questioned about packaged produce mixes that say they are “prewashed.” After years of being told to wash fruits and vegetables, now we are being told we don’t have to. It is confusing. Like you, I’m concerned about prewashed lettuce mixes. Are they safe or should I still wash them?
Face it, who doesn’t love the convenience of these ready-to-eat salads? They are an easy way to put a meal together and get nutritious greens into your diet. According to the USDA, sales of fresh-cut lettuce and leafy greens have reached more than $3 billion annually and the demand shows no signs of slowing. But produce has inherent risks. When salad greens are cut during harvesting, the exposed surfaces become vulnerable to potential contaminants. As thousands of pounds of greens are combined, washed, and then bagged, a small amount of bacteria can spread to contaminate a large amount of the mix. The CDC reported that one-third of the major food-borne outbreaks in 2011 were associated with fresh produce. Although the FDA oversees 80 percent of food in America, performing seven thousand inspections a year, they only visit some food processors an average of once every decade. Not very reassuring.
When I first came to ABC, I went out to Salinas Valley, California, where 85 percent of all leafy greens are grown, to see how producers had responded to an outbreak of E. coli O157:H7 from contaminated spinach three years earlier. These bacteria can cause one of the nastiest food-borne diseases. It takes only a few organisms to make you sick, and an infection can knock out your kidneys. Though they never figured out how this outbreak occurred, the most likely theory was that groundwater used to irrigate the spinach had been contaminated by wastewater from nearby pigs and cattle. I visited the production facilities at Earthbound Farm and saw how they had improved their facility and added additional quality control steps by implementing additional testing for harmful bacteria. Across the industry, new voluntary standards had helped to create a buffer between cattle and salad fields. All were good steps toward safer products.
However, critics urge caution. Erik Olson of the Pew Research Group, during an interview with ABC News, raised concerns that the standards are voluntary and that no binding rules govern the industry. In 2010, Consumer Reports tested 208 containers of lettuce (both bags and clamshells). It did not find any bacteria linked to outbreaks, such as E. coli 0157:H7, listeria, or salmonella, but did find high levels of coliforms, bacteria that live in your intestines. The presence of these germs indicates some level of fecal contamination, possibly from irrigation water, runoff from livestock, poorly sanitized equipment in processing facilities, or from sick workers. There are no established limits for these organisms in produce, but they’re viewed as a rough guide to possible danger. While this sounds very alarming, the reality is that even an additional rinsing at home won’t remove all these bacteria. Some bacteria are actually inside the leaves themselves. Even more, it is likely that your kitchen, or even your hands, may harbor bacteria that could contaminate the produce during additional rinsing. How clean is your sink, really?
Just as I learned to make my own informed choices, you need to gauge your own risk tolerance. The percentage of illness caused by lettuce mixes is small, but you might feel better buying heads of lettuce and making your own mix, although this does not remove all risk, either. If you do choose to use prepared lettuce mixes (and I do!), there are some things you can do to make it safer. Bacteria take time to grow and most grow faster at room temperature, so try to buy the freshest, coldest greens you can find. The Consumer Reports study found the lowest bacteria levels in packages more than five days from their “sell by” date. So always check that date and try to use the greens within a day or two of purchase. Before buying or using the mix, check to make sure there are no slimy, damaged, or bruised pieces. These are more vulnerable to bacteria. Proper storage is also critical. Make sure the package is well refrigerated at the market and refrigerate it as soon as you get home. I like to reach into the back of the store’s refrigerator to get the package that is coldest. Keep it well sealed and away from raw meat or chicken, which could cross-contaminate it. I’ve looked into a lot of refrigerators and can’t tell you how many times I’ve seen the greens sitting right underneath the package of chicken. Not a good idea.
DR. B’S BOTTOM LINE:
Serious outbreaks of illness associated with fresh produce have a lot of people concerned and confused about boxed and bagged greens and other vegetables. If you buy from a major supplier of prewashed, prepackaged greens and handle them properly, you may actually increase your risk by doing your own washing.
When it comes to food safety practices in our own kitchens, sometimes we need to embrace actions to keep us safe that might seem counterintuitive. My friend Jodi would never think of cooking chicken, or any meat, before giving it a good rinse to “get rid of the germs.” She’s not alone. Even though this practice seems to make sense, Jodi’s actually doing more harm than good. Let me explain why.
One of my favorite segments on Good Morning America is called “Doc at the Door,” in which I come to your home and offer health advice in your living room. One of my first visits was to a neighborhood in New Jersey to check out safe cooking practices, specifically the dangers of cross-contamination from cooking poultry. What Lisa, the homeowner, didn’t know was that I had coated a chicken with Glo Germ, a fine powder that spreads like bacteria through contact but is invisible except under a black light. It spreads around the kitchen just like salmonella or campylobacter, two common chicken contaminates, would. I watched Lisa prepare the bird. Afterward we turned off the lights and checked her hands and the surrounding area to see where the Glo Germ had landed. It was incredible. The place lit up with specks and splatters of simulated bacteria.
According to the CDC, each year, one in six Americans (48 million people) gets sick by consuming contaminated foods or beverages. Three thousand die of food-borne diseases. That’s a lot of people with nasty bugs. Together, salmonella and campylobacter cause almost two million cases of food-borne illness and more than four hundred deaths annually. Many people, like Jodi, are grossed out at the thought of not rinsing their chicken before cooking, but it actually does more harm than good. When water hits the chicken, the resulting spray can spread pathogens all over your kitchen, especially the area by your sink, cutting boards, and faucet. This can result in cross-contamination if the bacteria come in contact with food that is sitting out nearby. Additionally, as you move about your kitchen touching bacteria-covered surfaces and items, you can further contribute to its spread.
Contrary to popular belief, water does nothing to kill bacteria and other pathogens. It will reduce the number of germs on the surface of the bird, but the only way to ensure that your chicken is safe to eat is to cook it until it reaches an internal temperature of 165°F. Thankfully, most people don’t like to eat rare chicken.
To further protect yourself, when preparing raw poultry, handle it as little as possible. Wash your hands with soap and water for twenty seconds after touching it, being sure to remove rings and to scrub around your nails. Wipe down the surrounding area with hot soapy water or a mixture of one gallon of hot water and one tablespoon of liquid bleach. Use paper towels to clean areas that your chicken came in contact with, or if using cloth towels, stick them in the washing machine when you are done. Use caution when cleaning your cutting board, too, making sure not to spray it too forcefully with water. To sanitize your plastic cutting board, your best bet is to run it through the dishwasher. For wood, use hot soapy water. Afterward, throw your wet sponge in your microwave for two minutes or in the dishwasher to sanitize.
DR. B’S BOTTOM LINE:
Food safety is, and should be, a major concern for cooks, but there is a lot of confusion about what to wash and what not to wash before cooking. When your concern is bacteria rather than dirt, use caution. The spray of water can actually spread germs instead of containing them.
Confession time! I used to be a real salt lover. I would put it on everything, often before tasting my food. I’m not alone, and for good reason. I’ll admit it: A little sprinkle of salt makes food taste better. The problem is, from french fries to popcorn to processed and prepared foods, you get a bunch of salt every day—way more than you need—before you even season your food. Public health officials are very concerned that this dependency on salt plays a part in promoting high blood pressure, heart disease, strokes, and kidney disease.
When we talk about table salt and health, we are really talking about sodium chloride, our main source of sodium. No one should consume more than 2,300 mg of sodium a day, about a teaspoon of table salt. The recommended daily intake of sodium for most people (children, adults over fifty, African-Americans, and anyone with a history of high blood pressure, diabetes, or kidney disease) is even less, just 1,500 mg. Yet, here’s the reality. If you are like the average American, you consume more than 3,300 mg of sodium every day, more than twice what you should. Men consume even more sodium than women, due to their increased caloric intake. In general, the amount of sodium you eat goes up in proportion to the number of calories you take in, making overweight people at even greater risk.
Many studies have shown that the more salt you ingest, the higher your blood pressure rises. The good news is there are also important studies showing that when you cut back on salt, your blood pressure comes down. Given that nearly one-third of adults have high blood pressure, addressing salt intake is an important step in improving your health.
You may be thinking, “How could I possibly eat that much salt? I don’t put a teaspoon of salt on my food.” Well here is a little secret: You could go through an entire day without reaching for a salt shaker and still get way too much sodium. Here’s why: According to the CDC, more than 75 percent of the sodium you consume is from processed foods and restaurant meals, making it more of a challenge to cut back.
The World Health Organization (WHO) and the CDC have launched campaigns to try to reduce salt intake. You may hear a bit of a debate around salt and health, much (but not all) put forward by the Salt Institute, an industry group promoting salt consumption. Some of these studies find a much smaller benefit from salt reduction in terms of blood pressure control. They feel that the jury is still out and that promoting salt reduction should wait for more definitive data. Now, I am no salt expert, but in this debate, I side with the world’s public health authorities. From my read, the weight of the evidence suggests that, at least for a considerable portion of the American population who are at risk for high blood pressure or who already have it, there is a connection and cutting back on salt makes a lot of sense.
Here are some tips to reduce your salt intake:
• Read food labels. Sodium is listed on the nutrition facts. I know it’s hard to always do, but try to keep track for a couple of days to figure out where your salt is coming from. Look at every label! Even things that don’t taste salty, like soda, contain sodium.
• When you are eating at a restaurant, ask for low-salt options. Many restaurants have them. Also, take a look at the nutrition facts the next time you are at a fast-food restaurant, if they are available. In addition to tons of calories and fat, most fast food is loaded with sodium.
• When you are in the supermarket, stick to the aisles around the edges of the store—where the produce, refrigerated, and frozen foods are. Avoid the middle of the store where the processed foods are. By “shopping the perimeter” you will increase your intake of fruits and vegetables and decrease the temptation to buy less healthy foods. Your sodium intake will go way down.
• When buying processed foods, look for the low-salt or no-salt varieties. You can always add a little back.
• Experiment using other herbs and spices to give foods a little zing. In addition to doing something really good for your health, you may find you like the new flavors.
DR. B’S BOTTOM LINE:
The bulk of the evidence supports the idea that excess sodium does, in fact, raise your blood pressure. It also suggests that cutting back on salt reduces your blood pressure. But even if you don’t believe that the connection between salt and high blood pressure exists, salty foods also tend to be less healthy foods. Skip salty, overly processed foods and you will also lower your risk of obesity and heart problems.
As a doctor, I can talk about the importance of getting enough sleep until I sound like Charlie Brown’s teacher, “wah, wah, wah.” I can ramble on about how sleep deficits result in irritability, a decrease in cognitive function, and increased risk for heart disease and diabetes, and everyone says, “Yeah, yeah, okay.” But when I say, “Not getting enough sleep can make you fat,” suddenly ears perk up. Now that I have your attention, let’s examine the importance of getting a good night’s sleep.
Adults need between seven and eight hours of sleep a night; children need even more. Since the 1960s on average, adults have gone from about eight to nine hours of sleep per night to seven hours. Almost a third of adults get less than that. During that same time period the obesity rate has increased—a lot. A big question has to be, is there a connection? Does a lack of proper sleep lead to obesity or does obesity lead to a lack of proper sleep?
It turns out that both are likely true. First let’s tackle the most intriguing part of that question, how insufficient sleep promotes weight gain. The current thinking focuses on two critical hormones in the regulation of appetite, leptin and ghrelin. On a simple level, leptin is secreted by fat cells and tells the brain that you are full: Time to stop eating. Ghrelin is secreted primarily by the stomach and stimulates appetite: Bring on the food. The interplay between these two hormones has a very important role in how much you eat and when you feel full.
Numerous studies have shown that when you are sleep-deprived, your level of leptin decreases, while your level of ghrelin—along with your appetite—increases. Not surprisingly, when sleep-deprived subjects were given open access to food they ate more. In addition, sleep deprivation can slow your metabolic rate. In other words, you are going to feel hungrier, burn fewer calories, and have more waking hours in which to eat. Put these factors together and they strongly suggest that lack of adequate sleep promotes weight gain.
Now let’s look at the other side of the question: Does obesity lead to poor sleep? This one is easy. Obesity is a risk factor for snoring and obstructive sleep apnea, a sleep disorder in which your airway gets blocked off for periods of time while you sleep. The connection to obesity may be from increased fat being deposited around the airways, which causes them to narrow. People with obstructive sleep apnea toss and turn at night as they try to open these airways.
So what are you to do? My take is that you can’t keep squeezing sleep time into whatever is left over after work and play. It needs to get the same respect and protection as these other time commitments. Clearly it’s easier said than done, but the development of good sleep habits is critical to good health. Oh, and did I mention that it may also help you lose weight?
DR. B’S BOTTOM LINE:
There are many reasons we need to get enough sleep. Your heart, brain, mood, and waistline will thank you. Pick whichever one motivates you and make an effort to develop good sleep practices. The key to good sleep is developing a routine that sets you up to succeed and sticking to it every night. Here are a few tips: Try not to exercise, eat a heavy meal, or drink alcohol close to bedtime.
Pet peeve alert! I can’t tell you how many times I have to hold my tongue when I see someone order a double cheeseburger, large fries, onion rings, and… a diet soda. While I’d rather they order the diet soda over a can of regular cola, I really wish they ordered a regular-sized burger, a side salad, and a glass of sparkling water. That’s just me.
Many public health leaders lay a lot of the blame for our current epidemic of obesity on sugary beverage consumption. I am one of them. But what about diet drinks? As obesity rates have risen, so has our appetite for artificially sweetened beverages. Is there a relationship? There have been headline-grabbing studies linking diet soda consumption to weight gain and a higher risk of obesity and associated illnesses including strokes, heart attacks, and diabetes. How could drinking a no-calorie beverage possibly be harmful?
If you normally drink two to three cans of soda a day and switch to diet soda, with everything else remaining the same, you would lose between thirty and forty pounds over the course of a year. So why are so many diet soda drinkers not losing weight? There are two main avenues of research to explain this: One focused on biology, the other on behavior.
The biologic research revolves around the soda drinker’s dependence on sweetened foods. Using artificial sweeteners, which are hundreds to thousands of times sweeter than natural sugar, can lead to a phenomenon known as “taste distortion.” Essentially, the “set point” for sweetness in the brain is altered, leading to increased consumption of sugar calories in other areas of the diet. You simply crave more sweet stuff. Other research suggests that sweetened beverages may trigger hunger and increased food intake by only partially satiating the body’s desire for high-sugar foods. Some studies suggest that these sweeteners can actually lead to a spike in blood levels of insulin, which would in turn lead to food cravings.
Then there is the behavioral research that explores why we make our dietary choices. For example, there seems to be a misguided notion among many diners that ordering a diet soft drink gives them permission to splurge a bit more since they are “saving all those calories.” They may overestimate how many calories they are cutting and instead overcompensate in other areas of their diet.
In the scientific community the connection between artificially sweetened beverages and weight gain is not universally accepted. Could diet sodas be tricking our brains into craving additional sweetness from our foods? Could they be spiking our insulin, which in turn leads us to consume additional calories? All of these things are possibilities. However, the existing research has yet to peg this down as fact. For now we have the simple fact that swapping zero-calorie drinks for sugar-laden beverages does reduce total caloric intake, as long as all else remains equal. In light of this, I will still recommend diet soda as a better alternative to sugary drinks for those who must have sweetened beverages.
DR. B’S BOTTOM LINE:
There’s a lot of research out there, but right now it’s inconclusive. While diet soda might not make you gain weight, consuming sodas, even diet sodas, adds no nutritional value to your diet. Try swapping in good, old-fashioned water for that soda. You’ll get your hydration, and it’s a completely natural beverage to boot!
The term “freshman fifteen” has become part of our lexicon. We were talking about freshman weight gain when I went to college, and my patients and their parents talk about it to me now. I took it for granted that there must be some validity to it. Think about it. Dining in college is a teenager’s dream: All-you-can-eat buffets loaded with burgers, pizza, and soft-serve ice cream. Yes, there are healthy choices as well. But let’s get serious. Few adults would choose such offerings; how could teens?
But does this lead to double-digit gains? That is a lot of weight. I decided to check it out for myself and headed back to college for Good Morning America for my “Doc at the Dorm” segment. I grabbed my backpack, threw on my sweatshirt, and headed to Boston University to see how freshmen were faring in the dining halls. What I saw wasn’t pretty. For lunch, one petite woman had pizza, two servings of pasta, chicken, broccoli, and ice cream for a total of almost two thousand calories! That’s about what she should be eating in an entire day. She wasn’t alone. I watched the whole table take multiple trips to the dining line, often four and five go-rounds.
A couple of years ago the Department of Agriculture came out with new food guidelines. They threw out the food pyramid and went with a much easier tool for remembering how to balance your diet, the Food Plate. Basically you should divide your plate into quarters. Half should be fruits and vegetables, a quarter lean protein, and a quarter whole grains. How hard could that be? The plates I saw on campus? Not even close! I wouldn’t know how to begin to classify some of these meals.
College is a big transition, with new freedoms and responsibilities. At home, kids are rarely treated to a smorgasbord at every single meal. At college, there is no parent intoning, “I think you’ve had enough.” And those extra calories don’t just come from the cafeteria. With a twelve-ounce cup of beer averaging one hundred and fifty calories, drinking adds more calories.
But freshmen are active as well, right? That’s what I thought, until I visited the gym and took a look around. Where were the freshmen? The ones I talked to in the dining hall admitted they weren’t working out. For many, the increased workload in college and all the transitions made it difficult to find the time for exercise. Everyone planned to get started working out soon, but “soon” kept getting pushed back. I began to wonder if the “freshman fifteen” was actually an understatement.
After some investigation, I found my fears unwarranted. There have been many studies that look at weight gain during freshman year. Guess what they found? In 2009, a review of twenty-four published studies found that on average, freshmen gain just under four pounds, nowhere near the fifteen pounds we expect. This is a bit more than the typical noncollege teen but not by much. The term “freshman fifteen” wasn’t even coined until it appeared in Seventeen magazine in 1989, with no data to support that number. It was taken as gospel and has spread ever since.
While the overstatement of weight gain should give high school seniors some peace of mind, they shouldn’t discount the potential weight gain that could await them. Learning to eat well in a college cafeteria is hard for many who don’t have the tools to make good choices. The best way to prevent unhealthy adults is to provide a good framework for our kids long before they go to college. Teach your kids about portion control. We shouldn’t expect our kids to skip french fries entirely, but we can let them know they shouldn’t eat them every day. If they splurge at one meal, they should learn to compensate with lighter fare the next one. It’s not just book knowledge that they should gain while living away. They need to be preparing for their lives as independent adults. Taking care of their health is a big part of that.
Another reality is that many people, especially boys, continue to grow during their college years and some weight gain is appropriate. I’m a shining example of this. I just kept on growing until I was twenty-two. When I go back to my high school reunions, I am always asked why I didn’t play on the basketball team. I remind them, I wasn’t six foot six in high school.
While we can celebrate the overstatement of the “freshman fifteen,” we shouldn’t get too excited. Many people experience a moderate but steady weight gain, typically through the five years after college. These yearly increases are when pounds really can add up. Once kids stop growing, leave school, and get jobs, their lives become more sedentary, which makes it much easier to gain weight. It’s even more critical that young adults maintain good eating habits as they make that transition to “the real world.”
DR. B’S BOTTOM LINE:
The “freshman fifteen” is a fake! However, show your kids how to eat healthfully and they’ll avoid the slow but steady weight gain that starts during college years and continues afterward. The earlier you teach your kids about the importance of a balanced diet and physical activity, the more you set them up for a healthier and longer life.
of a frozen pizza and calls it a day!)