Weight loss success: nutrient dense foods cut calories and control hunger

When it comes to maintaining or reducing body weight, the key to long term success is to choose foods with a low energy density. What is energy density in foods? The Center for Disease Control defines it as “the amount of energy or calories in a particular weight of food.” This is generally represented as the number of calories in a gram (kcal/g). This brings me to the law of thermodynamics, or energy balance equation, which I’ve discussed in a past post here.

Energy balance - Understanding this concept is important to successful weight loss, gain or maintenance.  So, here’s a brief review: if you consume more calories than you burn, you will gain weight. If you burn more calories than you consume, you will lose weight. However, a big caveat: while a calorie is a calorie, the nutrients you consume affects metabolic and hormonal secretions which may cause you to store fat instead of utilize the fat for energy, and vice versa. The types and varieties of food and beverages you ingest effect weight management, but more importantly, they are essential to your total wellness.

Understanding caloric need - Exercise is a variable that increases caloric expenditure and metabolism. In order to determine an estimation of the calories you need to consume to gain, maintain or lose weight, it's helpful to calculate your total daily energy expenditure (TDEE). You can use the calculator found here, which calculates basal metabolic rate (BMR) using the Mifflin-St Jeor equation, and then applies an activity multiplier. It's best to underestimate your acitivity level when using the calculator if you're looking to lose weight because this puts you on the conservative side of daily caloric needs. Then, if you want to calculate how many calories you should eat daily to achieve weight loss at a steady, healthy pace, you subtract 15-20% from your TDEE number. Conversely, if you're looking to gain weight, add 15-20% to the TDEE. It's not recommended that you subtract more than 25% from your TDEE calculation. You don’t want your calorie intake to drop to an unhealthy and unsustainable level.

The amount of calories you eat is important, but not the whole picture in a healthy diet. Good nutrition includes a balance in the macronutrients listed below and the way you accomplish this is in the way you combine the foods you eat in a meal. For example, rice and beans.  These two foods are considered a complete protein when eaten together. If you're a vegan. In general, try to get your total daily caloric intake from a variety of whole foods as follows: 

• Protein: 1 gram per pound of body weight
• Fat: .45 grams per pound of body weight
• Carbs: The remaining number of calories left will be filled with carbs

Nature counts the calories – Back to our discussion of low energy dense foods and how they help with weight loss.  It seems Mother Nature really does know best because “foods with a lower energy density actually provide fewer calories per gram than foods with a higher energy density (CDC).”  Also, low energy dense foods are typically more nutrient dense. Nutrient density is a measure of the nutrients provided per calorie of food, or the “ratio of the amount of a nutrient in foods to the energy provided by these same foods (Nestle).”

So, it’s a win/win situation when you choose low energy/high nutrient dense foods because not only do they contribute fewer calories to the energy balance equation, they also provide greater nutritional value per calorie, which is especially beneficial for our health. These foods are the best of both worlds so to speak. 

Let’s look at a simple example of a higher nutrient/lower energy density food and a lower nutrient/higher energy dense food containing the same amount of calories per serving:   

	Nutrient Dense	Energy Dense
171 calories/serving	2 wedges of watermelon (approximately 1/8 of a whole watermelon)	14 ounces of Dr. Pepper
Nutritional Facts per serving	Calories 171 Calories from Fat 7 Total Fat 0.743g Saturated Fat 0.371g Polyunsaturated Fat 0.371g Monounsaturated Fat 0.371g Cholesterol 0mg Sodium 7mg Potassium 636mg Carbohydrates 43.086g Dietary Fiber 2.229g Sugars 35.286g Protein 3.343g Vitamins & Minerals: Vitamin A 67% · Vitamin C 78% Calcium 4% · Iron 7%	Calories 175 Calories from Fat 0 Total Fat 0g Saturated Fat 0g Polyunsaturated Fat 0g Monounsaturated Fat 0g Cholesterol 0mg Sodium 70mg Potassium 0mg Carbohydrates 46.2g Dietary Fiber 0g Sugars 44.8g Protein 0g

Arguably, it might not seem equitable to compare a beverage with a food, but watermelon is 91% water by weight, so it's not too biased of a comparison. Remember, we are comparing identical calories per serving here. The numbers speak for themselves. If I’m trying to consume fewer calories in an effort to lose weight, watermelon is the better food choice by far. Where’s the Vitamin A and C in the soda? The numbers indicate a lot of sugar, no fiber or protein. The soda simply contains what are referred to as "empty calories" which provide energy, but no nutrition.  So after I drink my soda my body gets an injection of simple sugars and a blast of salt. Ironically, the salt can make me thirsty and this leads me to drink another soda later, but that's for another post!

On the other hand, the 2 wedges of watermelon provide 67% of the daily requirement of Vitamin A and 78% of Vitamin C.  That’s some good stuff! Plus, the 2.3 grams of fiber in the watermelon will help me feel fuller for a longer period of time than the soda, which has 0 grams of fiber. I might even feel full after eating 1 wedge of watermelon. Therefore, I can eat less of this food and decrease my calorie intake while keeping my hunger satisfied for longer than I could with a soft drink. This brings me to my next point, which can be pivotal to weight loss success.

Eat more to lose weight? – Really?! Usually losing weight is equated with starving oneself and eating minuscule portion sizes, right? However, foods with a low energy/high nutrient density typically contain fewer calories per serving than the same amount of a high energy/low nutrient density food and they provide more vitamins, minerals and also phytochemicals. You can read more about phytochemicals and their amazing health benefits here. 

Now, let’s look at another example comparing the nutritional information for servings of an nutrient dense food with a calorie dense food, but of differing calorie content:

	Nutrient Dense Food	Energy Dense Food
Food choice	Kale	French Fries
Calories per serving	1 cup chopped 33 calories	1 medium serving (117 g) 365 calories
Nutritional facts per serving	Total Fat 0.6 g    Saturated fat 0.1 g           Polyunsaturated fat .2 g               Monounsaturated fat 0 g              Cholesterol 0 mg              Sodium 25 mg    Potassium 329 mg            Total Carbohydrate 6 g   Protein 2.9 g Vitamin A 133% Vitamin C 134% Calcium 10%      Iron 5% Vitamin D 0%      Vitamin B-6 10% Vitamin B-12 0%               Magnesium 7%	Total Fat 17 g     Saturated fat 2.7 g           Polyunsaturated fat 6 g   Monounsaturated fat 7 g              Trans fat 0.1 g    Cholesterol 0 mg              Sodium 246 mg  Potassium 677 mg            Total Carbohydrate 48 g Dietary fiber 4.4 g            Sugar 0.4 g          Protein 4 g          Vitamin A 0% Vitamin C 9% Calcium 2%         Iron 5% Vitamin D 0%      Vitamin B-6 20% Vitamin B-12 0%               Magnesium 10%

Once again, the data doesn’t lie. As the above comparison shows, I would have to eat a whopping 11 cups of chopped kale to equal the amount of calories I would consume in a medium serving of fries! If I’m trying to lose weight, the good news is that I can eat more kale while consuming far fewer calories than I would if I were to eat the French fries. This means I will feel fuller for a longer period of time. I’m also fueling my body with less unhealthy fats and far more nutritional value. Like I said before, it’s a win/win.

Move over vegetarian, I'm a nutritarian -  So are you ready to transition to a nutritarian diet which is eating more low-energy/nutrient dense foods? If you said yes, congratulations! You're making a good choice for your health. Are you unsure how to decide which foods to choose? A good starting point to help you in your search to find the most nutrient dense foods is to check out the ANDI guide. ANDI stands for aggregate nutrient density index and was developed by Dr. Joel Furhman.

This is from Dr. Furhman's site: "Adequate consumption of micronutrients – vitamins, minerals, and many other phytochemicals – without overeating on calories, is the key to achieving excellent health. Micronutrients fuel proper functioning of the immune system and enable the detoxification and cellular repair mechanisms that protect us from chronic diseases. A nutritarian is someone whose food choices reflect a high ratio of micronutrients per calorie and a high level of micronutrient variety."

With this in mind, the ANDI guide categorizes whole foods and then scores them on a scale from 1 to 1000 based on an extensive range of micronutrients, including vitamins, minerals, phytochemicals and antioxidant capacities. In addition, Dr. Furhman's original ANDI guide has been updated to reflect a more accurate picture of each food's nutritional qualitywhich now considers certain beneficial phytochemicals, such as angiogenesis inhibitors (i.e. cancer prevention, read more here), organosulfides (found in onion, garlic and cruciferous veggies), isothiocyanates (organosulfur compounds found in cruciferous veggies and are among the most effective cancer-prevention agents known), and aromatase inhibitors (suppress the synthesis of estrogen and thought to aid in the prevention of breast cancer).

The ANDI guide can be a useful tool in your determining healthy food choices, but it isn't the holy grail. I like what Dr. Furham says and I believe his suggestion is the best advice when it comes to choosing foods.  He says: “…nutrient density scoring is not the only factor that determines health benefits… if we ate only foods with a high nutrient density score, our diets would be too low in fat. For that reason we have to pick some foods with lower nutrient density scores.” Also, he notes that if thin individuals or those who are very active ate only foods with the highest nutrient density, they would become so full from fiber that it's likely they would be unable to meet their caloric needs. Remember my kale example above? One can only eat so much fiber. Balance and variety are key to consuming the greatest number and variety of micronutrients.

You may already know that kale is a better food choice than French fries, so if you operate on the simple premise that your diet should emphasize fruits, vegetables, and whole grains and not prepackaged, processed or fast food, you probably don’t need the ANDI guide to tell you where to get the most nutritional bang for your buck. However, if you’re uncertain as to whether or not you’re making the best food choices for your health, the ANDI rankings are a good starting point. 

I really like Dr. Weil's anti-inflammatory "diet" approach and I have incorporated some of his wisdom into my lifestyle as well. I've blogged about the health benefits of reducing the risk for chronic inflammation in an earlier post. Look for more on that in a future post.  In the meantime, I'll leave you with this food for thought:

Sources:

• CDC Low energy dense foods and weight management - http://www.cdc.gov/nccdphp/dnpa/nutrition/pdf/r2p_energy_density.pdf
• Nutrient Density, Clemson Cooperative Extension - http://www.clemson.edu/extension/hgic/food/nutrition/nutrition/dietary_guide/hgic4062.html
• Food and Nutrition, Nutrient Density - http://www.nestle.com/asset-library/Documents/Library/Documents/Nutrition_Health_Wellness/Food-and-Nutrition-Issue09-Nutrient-Density-Jan2008.pdf
• Sports Science Exchange, Energy Balance and Weight Reduction - http://www.uni.edu/dolgener/UG_Sport_Nutrition/Articles/Energy_Balance.pdf
• Simple Science Fitness, Energy balance and law of thermodynamics -http://simplesciencefitness.com/ 
• Whole Foods Market uses ANDI guide - http://www.wholefoodsmarket.com/healthy-eating/andi-guide
• Nutrient Rich, ANDI Guide - http://www.nutrientrich.com/1/aggregate-nutrient-density-index-andi-score.html

Eating for healing: Functional foods that support health

If you're considering eating for healing you might be wondering exactly what to eat. Obviously, there is an overwhelming variety of foods from which one can choose.  Taking into account the fact that we should consume a certain amount of calories daily, it makes sense to select foods that provide the biggest nutritional benefit per calorie.  Functional foods are an excellent choice because they provide health benefits that extend beyond basic nutrition (1).

Functional foods -
Be aware, however, that all functional foods aren't equally beneficial. This category of foods can also include processed foods which have been fortified or enriched with vitamins and minerals that are lost during manufacturing or storing (2).  Processed wheat flour is an example of a fortified food because some B vitamins and iron are added back in to it after the refining process. Another instance of fortification is when micronutrients which aren't normally present in a food are added. Calcium enriched orange juice would be an example of this type of mineral enrichment (3). At first glance fortification and enrichment of foods seems like a good thing.  However, I think it just makes sense to consume unprocessed foods that retain their naturally occurring, unaltered nutrients whenever possible.

So, let's take a look at one functional food that deserves more publicity - black rice. This unprocessed rice has been a staple for a large part of the world's population, but it's only recently gaining popularity here in the US.  I'm not sure why it's taken so long to catch on because I love the delicious nutty taste, firm texture and exotic touch that black rice adds to any dish. Not only does this rice look and taste good, but it's health benefits are outstanding.

Health benefits -
Research has shown that consuming black rice reduces the build up of plaque in the arteries and it also helps to reduce inflammation (4). These health benefits are thought to be the result of the intact outer bran layer that black rice retains.  White rice, on the other hand, loses this outer bran layer during processing.  In addition, research published in the Journal of Agriculture and Food Chemistry reported on the effects of black rice bran on skin inflammation in lab mice.  This study found that the black rice reduced inflammation by 32%, compared to controls and these benefits weren't seen in tests performed with brown rice extracts (5). These results show the potential anti-inflammatory and anti-allergenic benefits that black rice bran possesses. For those looking to reduce chronic inflammation, I think this food is definitely worth adding to your diet.

Here's a quick, easy and tasty recipe suggestion:
Asian Black Rice Stir Fry
Black Rice - cook per package directions (I found the Forbidden Rice brand at Market Street)
julienne carrots
Fresh pea pods
sliced red and yellow peppers
sliced green onion
sliced bok choy
julienne squash
ginger
handful of sesame seeds
cashews

After you've prepped the vegetables, heat grapeseed oil in a wok and add the vegetables in the order listed and cook until tender but crisp. Add organic sesame oil and tamari to taste, stir and top with cashews and enjoy.

Emerging science is giving us a better understanding of how the nutrients in the foods we eat can effect our health, and black rice is just one example of an excellent functional food. So, when faced with the decision of what to eat for our next meal it's important to consider our bodies' unique and specific needs, and then choose foods that will support these needs.  The next post will discuss functional foods in more detail. Until then, when planning your menus over the next few weeks, I encourage you to keep in mind this quote from Hippocrates:  "Let food be thy medicine..." 

Sources
(1) University of Michigan - http://www.med.umich.edu/mfit/nutrition/knowhow/pdfs/FuncFoodsExamples.pdf
(2) http://en.wikipedia.org/wiki/Functional_food 
(3) http://www.eufic.org/page/en/page/FAQ/faqid/fortified-enriched-food-products/ 
(3) http://www.foodinsight.org/Resources/Detail.aspx?topic=Background_on_Functional_Foods
(4) http://jn.nutrition.org/content/131/5/1421.short
(5) http://pubs.acs.org/doi/abs/10.1021/jf102224b

The TLC way to health and weight loss

What comes to mind when you hear the acronym TLC?  If you were thinking of the expression: tender, loving care, you're right.  I would also like to suggest the following additional meaning for the TLC acronym: True Lifestyle Change. I think both of the meanings of TLC are appropriate in this case because when it comes to our health we should treat ourselves with tender, loving care. When it comes to weight loss the only way to long term success is through true lifestyle change.

I wish I could say that true lifestyle change happens quickly and easily, but I can't. What I can share is what has worked for my husband and me. We've made lifestyle changes that resulted in our losing weight and reducing our percentage of body fat significantly. More importantly, we feel better! The surprise for us was that weight loss wasn't our intended goal when we began changing our eating habits. Yet, that has been one of the results of our TLC. So, if this has you a little intrigued, please read on.

It's import to note that the first part of this plan actually is a relatively well-known diet.  However, I  can't stress enough the importance of viewing this initial diet phase as the beginning of a larger commitment to establishing healthy exercise and eating habits for the long term. Perhaps, the very words habit, commitment and long term may feel a little intimidating at first.  After all, a diet implies doing something finite, maybe for several weeks. However, a lifestyle commitment is a permanent change, and this can seem overwhelming even to the most determined and well-intentioned of us. That being said, the only way to keep weight off permanently is to make permanent changes.



My oncologist and functional medicine physician, Carolyn Matthews, recommended that I do the Comprehensive Elimination Diet. Perhaps you've heard it called the Detox Diet, or the Anti-inflammation Diet. They are all similar. She explained that current research suggests that bolstering the immune system could be beneficial in fighting cancer.  According to the National Cancer Institute, "patrolling cells of the immune system provide continuous bodywide surveillance, catching and eliminating cells that undergo malignant transformation. Tumors develop when this immune surveillance breaks down or is overwhelmed."

So, what does the immune system have to do with the Elimination Diet? Experts are recognizing that sensitivities in some people can cause them to react poorly when they consume or are exposed to certain foods and chemicals. This is different from an allergy or an intolerance. The top 6 food sensitivities are: gluten, dairy, yeast, eggs, corn and soy.

A food or chemical sensitivity can cause the body's immune system to kick in. When the immune system is overstimulated, or is in a state of chronic response, a variety of adverse health conditions can occur (Linus Pauling Institute).  One or several of these conditions might be familiar to you: constipation, GERD, asthma, sinus problems, irritable bowel, psoriasis and eczema, just to name a few (Tom Malterre, MS, CN).  The Elimination Diet helps detect what foods might be irritating the body and causing an immune response, through a process of removing specific foods and food categories from the diet.

According to the information Dr. Matthews provided me:

"The main rationale behind the diet is that these modifications allow your body's detoxification machinery, which may be overburdened or compromised, to recover and begin to function efficiently again. The dietary changes help the body eliminate or 'clear' various toxins that may have accumulated due to environmental exposure, foods, beverages, drugs, alcohol, or cigarette smoking ...this process is generally well tolerated and extremely beneficial." 

I'm not going to sugar coat it.  The first 21 days are challenging. That's why I suggest that you might want to consider discussing this with your family, or enlist the help of someone who can be your buddy. It will definitely improve your chances of success. I couldn't have done it without my buddy. It's also recommended that the timing of when to start the diet be carefully considered, because dining out or traveling during the first 21 days can increase the difficulty.  

Another important point to mention is calorie consumption. Remember: for weight maintenance the formula is calories in = calories out. We haven't intentionally restricted our calories.  Still, my husband has lost 28 lbs and counting!  This is occurring because we are now eating more nutrient dense foods and feel fuller, so sometimes we consume less calories than we need for weight maintenance. Just the elimination of empty liquid calories will allow you to consume calories from more nutritious and filling foods. You can calculate your caloric intake needs at the Mayo Clinic's site here. Last, but not least, everyone is different so your response to this program will be unique to you. Remember, before beginning any new diet or exercise program you need to check with your physician.

I hope I haven't discouraged you by discussing the above details. I can assure you that if you stick with the first 21 days you will feel better. I know I do. After the three weeks of elimination are complete, you will be well on your way to a True Lifestyle Change that will lead you to permanent weight loss and improved health.  So, are you ready to begin? The link to the Comprehensive Elimination Diet my doctor gave me is here.  The University of Wisconsin School of Medicine and Public Health also has a 6 page handout here, with very user-friendly tables of information.


Final thought: Don't you deserve a little TLC? I look forward to hearing your success stories!

Update to this post 9/12/10 - Once you've completed the initial elimination phase you will begin the process of adding foods back into your diet. This is where the TLC really kicks into gear.  If you're in need of further direction, check out the Eat More, Weigh Less post here that discusses a nutrition plan recommended by the Centers for Disease Control.  This plan is basically a continuation of what you have already begun in the Elimination Diet with the exception that you will begin adding grains, dairy etc. back in if you had eliminated them from the start.  It outlines the steps and strategies that will help guide you through the process of choosing foods that are less energy (calorie) dense, but more nutrient rich.This type of nutrition plan is a win/win.  Here's to improving our health through good nutrition! 

Sources
National Cancer Institute, Immunity and Cancer - http://www.cancer.gov/cancertopics/understandingcancer/immunesystem/Slide32
Zar, S., Food Hypersensitivity - http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2036.2001.00951.x/full
http://www.sciencemag.org/cgi/content/short/307/5717/1920 \
Linus Pauling Institute - http://lpi.oregonstate.edu/ss07/inflammation.html
Malterre, Tom, MS, CN, The Whole Life Nutrition Cookbook
Mayo Clinic calorie calculator - http://www.mayoclinic.com/health/calorie-calculator/NU00598
http://www.holisticmd.org/downloads/CompleteEliminationDiet.pdf