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

Increase weight loss by working out less?

Really? -
Judging from the ever rising overweight/obesity rates in the United States, I think it's safe to assume that a majority of Americans subscribe to the work out less plan. I find it a bit alarming when scientific data is released and the news takes a portion of a study's findings out of context and reports on it. Typically we can end up misguided and confused. That's why it's so important to understand the bigger picture surrounding "sound bites" like this post's title. This reminds me of a radio ad that would, ironically, air while I was training at the gym.  The advertisement was pushing a diet pill which promised weight loss without the "unhealthy stress and strain of exercise"! I'll spare you a rant, but I will say that the ad was eventually changed so that it did not include the word unhealthy.  Calling exercise unhealthy is blatantly inaccurate. Yet, unfortunately this isn't obvious to everyone. But I digress...

What's going on? -
Saying that we can increase weight loss by working out less is ambiguous because this statement tells only part of the story. So, before you scratch that workout off your to-do list, please read on. According to a study published in the American College of Sports Medicine's (ACSM) Journal of Medical Science and Sports Exercise, it's possible to burn more calories and spend less time working out. However, the key to this result lies in how intensely you workout. Before I go on, it might be helpful to recall the caloric balance equation and its role in weight maintenance, and you can read more about this in a past post found here.

Image from CDC website

Consider a typical day of food consumption and energy expenditure. Simply put, if calories eaten exceed calories burned, we end up with a calorie surplus for that day and over time this leads to weight gain. On the other hand, if we burned more calories than we ate, than over time this leads to weight loss. If  calories in are equal to calories out, the scale is in balance and weight is maintained. Another thing to keep in mind is that we are always expending energy, even while we're resting.


Back to the study - The researchers wanted to see what the energy expenditure at rest of males, aged 22 to 33, would be on a day when they performed a vigorous indoor cycling exercise bout vs. on "a controlled resting day" when they performed no exercise at all.  I underlined and bold faced the word vigorous because this is very important to note. In this case vigorous exercise is defined as performing a physical activity at a level that causes you to be too out of breath to talk. Working out at this intensity level "resulted in a significant [emphasis added] elevation in post exercise energy expenditure, that persisted for 14 hours" after the exercise bout ended (ACSM).


Wow! This sheds some much needed light on that rather ambiguous statement that implies we can increase weight loss by working out less. Now we understand that it's possible to decrease the amount of time we spend working out, but this must be accompanied by an increase in the intensity of our workout to a vigorous level. This is because the research suggests that we can burn additional calories above and beyond what we burned during the workout, even while we're at rest! This is sometimes referred to as caloric after burn.

Here's the data: During the vigorous cycling bout these guys expended 520 calories (kcal).  This isn't surprising because we all know exercise expends calories. We also know that vigorous exercise burns more calories than low and moderate intensity exercise. However, what is really exciting is that after the men finished exercising, and with their post exercise activity level restricted and monitored, they continued to  burn an additional 190 calories (kcal)  during the 14 hours after their workout, as compared with control days when the men were inactive. "The 190 calories burned after exercise above resting levels represented an additional 37% to the net energy expended during the 45-min cycling bout." 

Bottom Line - 
The study's test subjects were young men, so the results may not be the same for women, or for an older population.  Also, we might not be able to workout at a vigorous level for 45 minutes. Given this and other studies on vigorous intensity exercise which show the added benefit of caloric after burn, it seems beneficial to try to incorporate little bouts of vigorous intensity exercise in our workouts. But if you've never exercised, or haven't worked out in years - BEGIN SLOWLY and always consult your physician before beginning any exercise program. Obviously any exercise is better than none, but I like the idea of putting in a little more effort, giving it a little less time and reaping bigger rewards from my workout.  It seems like a win/win to me and that's no sound bite.

In the next post there will be some suggestions for vigorous intensity bout exercise programs and also a discussion relating to another study that shows bouts of vigorous intensity exercise have been shown to be beneficial in reducing inflammation in overweight and obese men. Chronic inflammation is linked to all kinds of health problems.

In the meantime, keep moving! 

Sources
CDC - http://www.cdc.gov/obesity/data/trends.html
ACSM - American College of Sports Medicine - http://journals.lww.com/acsm-msse/Abstract/2011/09000/A_45_Minute_Vigorous_Exercise_Bout_Increases.6.aspx
CDC - http://www.cdc.gov/healthyweight/calories/index.html
chronic inflammation -  http://www.drweil.com/drw/u/ART02012/anti-inflammatory-diet

Try a new f-word while exercising - FUN!

How's that New Year's resolution you made to exercise coming along? Maybe you've doubled down on your efforts, but are wondering if it's really worth it. Why does something that we know is good for us and that seemed so exciting just a few weeks ago, turn into a lackluster chore we begin to avoid? Rather than dreading it, slugging it out half-heartedly or abandoning your goal altogether, how about considering a different strategy? Try putting a little fun in your exercise program!

Yes, you read that right. FUN! Okay, so, maybe for you another F-word comes to mind when thinking about exercising, but, before you discount the idea as absurd, think about it for a minute... Can exercise really be fun and if so, what could make it fun? I think our response to this question might be influenced by our past experiences with physical activities.  Reflect back to when you were a kid. Did you ride a bike, a skateboard, or a scooter? Did you play tag, hide and seek, jump rope, and run races? What about shooting hoops, roller-blading or hula-hooping? You get the idea. These are all physical activities that for most of us are associated with fun. Now, what comes to mind when you think about your next workout on the treadmill, elliptical trainer or recumbent bike? If you said fun, good for you, but you're definitely in the minority.

The bottom line is for many of us is that physical activity has lost this element of fun. So, if your wondering why you're struggling with waning motivation, or you've moved past that stage to just giving up altogether, take a look at your workout and ask yourself - is this fitness routine boring and uninspiring? Case in point, faced with taking the stairs or the escalator, which would you choose? Well, not surprisingly, an experiment conducted by Volkswagen found that the majority of people would use the escalator - that is until they made the stairs fun.  Check it out:

 

The Fun Theory

 If you're wondering, how do I make my workouts fun?  Here are a few suggestions:

1. Revisit some of the childhood activities you once liked to do, although you may have to scale them back to accommodate your current fitness level
2. Know what you like and reward yourself for doing it. If you find being outside exhilarating, than choosing a form of indoor exercise isn't going to work for you.  Consider hiking through a local park, planting a garden or walking the dog.  Commit to it and reward yourself when you reach a predetermined goal. See SMART goals post here on how to set specific, measured, attainable, realistic and time-targeted goals, another key to being successful.
3. Progress g r a d u a l l y. This prevents pain and injuries. Remember, we had to learn to crawl before we walked. This applies to everyone. Even if you were a super athlete in college. If you've not exercised in a few years - you need to take it slowly. A few words about exercise and pain. Now, don't get me wrong, there will be a measure of discomfort, but this isn't pain and it will decrease over time. Exercise shouldn't be torture.  The old "No pain no gain" thinking has been replaced with the much wiser - "Train, don't strain."
4. Mix up your activities.  Variety is the spice of life, so they say and in this case it helps to prevent overuse injuries, as well as boredom and monotony.
5. Enlist the help of a buddy. Exercise is more fun if you have the support of a like minded friend. Mutual encouragement is a wonderful motivator.
6. Make exercise less like a "routine" and more like a game - a mental game that is.  Set a little "contest" for yourself for each physical activity you undertake.  For example, today when I perform the plank I'm going to hold this position for 10 extra seconds.  Make this  mini-challenge attainable, but not too easy, and then make sure you congratulate yourself when you win. 

Of course, always check with your physician before beginning any exercise program.

So, are you ready to stop cursing those dreaded workouts and put some fun back into fitness? Just give these ideas a try and perhaps you'll find a new attitude about your exercise resolution. You've got nothing to lose, right? Well, except maybe the few pounds you've resolved to lose already.   I look forward to hearing all your success stories. Happy new year!

References
Association for Applied Sports Psychology - Exercise Adherence - http://www.appliedsportpsych.org/Resource-Center/health-and-fitness/articles/exercise-adherence
The Fun Theory - http://thefuntheory.com/

Eating for healing: the restorative power of food

It's been a year since a doctor gave me the life altering news that I had a disease. If, at this point you're thinking well I'm not sick, so this post doesn't pertain to me.  Please, consider reading on. Eating for healing isn't just for those dealing with illness. This lifestyle is for everyone who wants to support their body as it copes with disease, or attempts to deal with the daily assaults of living.  This may sound a bit dramatic, but our bodies really are in a state of constant warfare against environmental toxins, aging and disease. Doesn't it seem prudent to give the body a hand with some nutritional weaponry?

                                    Photo by Anna Pelzer on Unsplash

Eating for healing may not be a magic bullet, but research is showing that food and medicine are not distinctly separate domains (1).  This wisdom has been known by some cultures for centuries. In Western society, the trend away from botanical medicines began when two chemists took an herbal analgesic called salicylic acid and synthesized the synthetic drug Aspirin from it (2).  The pharmaceutical industry was born from this progress and has resulted in the ability to entirely or partly replicate many medicinal botanicals.

What are medicinal botanicals?
The University of Minnesota Life Science Foundation defines them as "plants (or substances that come from plants) that are used to treat or prevent disease" (3). To underscore the importance of botanicals in the treatment of disease,  the Biotechnology Center for Agriculture and Environment at Rutgers University states that "natural products continue to make the most dramatic impact in the area of cancer" (2).  This is because "a primary advantage of botanicals is their complex composition consisting of collections of related compounds having multiple activities that interact for a greater total activity" (2). In other words, synthetic compounds just aren't able to replicate what nature provides.


Plant foods as medicine
The European Botanical Forum has a compiled a very comprehensive and informative Compendium of Botanicals that have been reported to contain substances that may be of health concern when used in food or food supplements found here. Also of note, is their discussion of the role of plant food nutrients, as well as the plants' secondary metabolites and their effects on our health.  The following is a quote from their discussion of understanding the benefits to our health of botanicals:

"In seeking to achieve optimum nutrition, for many years attention has been focused on nutrients because their lack in the diet leads to deficiencies with characteristic clinical symptoms. However, the role of other food components in achieving optimal health is now better understood. Most of these food components are from plants which are rich in bioactive secondary metabolites. These are substances produced by the plant in adaptation to local environmental conditions, which, for example in the Mediterranean area, are often pro-oxidative. This requires an adaptive response from the botanical, producing protective bioactive compounds such as polyphenolic molecules. This is particularly relevant for human health because the intake of these plants results in the transfer of those protective compounds to the human organism."

Simply put, research is now beginning to understand that the interactions that occur between plants and their environment result in substances that can have a profound impact on the health of those of us who eat these plants. The researchers from Rutgers articulate this concept in another way:  "Plants must maintain and protect themselves through diverse arrays of complex natural products that they make from the inorganic components of air, soil and water because they lack the flight response. ...Plants can live hundreds of years without succumbing to diseases or predation.  It should come to no surprise that some of the compounds that have enabled plants to survive may also be used to maintain the health and well-being of humans" (2). Wow! This could give an additional meaning to Kermit the Frog's lament of "It's not that easy being green."

Seriously though, my purpose in sharing the above was to underscore the dire importance of including plant foods in your diet.  Having said that, eating for healing is not just about consuming a few more servings of fruits and vegetables a day, although this is definitely a good thing to do for your health. Let's take a closer look at a few of the nutritional strategies that were recommended to me. 


Options for nutritional paths to healing -
First, I'd like to share that when I began considering disease treatment plans, I sought the expertise of many qualified resources. What I'm sharing is the advice of these experts, and it has proven invaluable to me in determining the best course of action for me. Having a team of physicians that will consider and support your desire to choose the best treatment for you is priceless.  If you are dealing with an illness and struggling to navigate through the standard practice of care maze, I encourage you to pursue finding these experts.  They do exist!

My journey led me to an outstanding oncologist and functional medicine doctor who recommended the Comprehensive Elimination Diet, which is discussed in more detail here. In addition, this physician felt it was important to incorporate detoxification measures into my lifestyle (more about this in the post here). Another physician suggested I try the Anti-Inflammatory Diet.  Dr. Andrew Weil also has some excellent info on this program here. I have discovered that many components of these diet strategies overlap and compliment each other. Ultimately, what I found most productive for me was to pick certain components of these diets and combine them into an amalgamation that has become my lifestyle.

I'm ecstatic to say that the results speak for themselves. My annual follow up with the radiologist was so positive it prompted him to ask me about my treatment plan! I've also shared in previous posts that since my husband joined me on my eating for healing journey he has lost over 40 pounds, is healthier and feels better than he has in years. Clearly for us, making the decision to eat for healing has been positively life transforming! So, on to the bottom line. 

 
Key components of eating for healing
Here are the strategies that I feel are critical, along with their supporting elements. It's important to note that the components share many common elements. 

1. Eliminate or limit foods that can cause chronic inflammation
2. Aid the body in detoxification and support liver function
3. Increase foods that have healing properties
• Eat a colorful variety of plant foods - Serving recommendations can be found at the Centers for Disease Control (CDC) Fruits and Veggies Matter website here and you can also read more in my blog post about this found here and here.  
• When possible eat organic foods because pesticides and herbicides actually thwart the production of phenolics. As mentioned above, phenolics are chemicals that act as a plant's natural defense and they also happen to be good for our health. Read more here.
• Limit or avoid foods made with refined grains, like white bread and pasta and eat more whole grains. For now, I have made the choice to restrict wheat because I wanted to make more room in my diet for the nutritional benefits of other grains that I wasn't eating because of my love of wheat.  Ancient grains like farro, quinoa and amaranth, for example, are a few that I'm eating now. The important take away here, is that you want to avoid refined white flour and foods containing this flour because the refining removes much of the grains nutritional benefits, as well as negatively effecting insulin.  More about whole grains here and on insulin below.
• Avoid prepackaged, processed and refined foods. Always choose whole foods.
• Eat low glycemic index foods. This prevents a rapid rise in insulin which can contribute to infllammation in the body.  Check out this website for more info on the glycemic index (GI) of foods. A good rule of thumb: Foods with more fiber usually have a lower GI.
• Liberally use spices that have anti-inflammatory properties. Examples: ginger, turmeric and curry.
• I avoid dairy to reduce risk of inflammation, especially from non-organic sources (lactose intolerance runs in my family), but I do eat some organically produced goat dairy products. 
• Drink plenty of filtered water. 
• Get more Omega 3 in your diet. Western diets are much higher in Omega 6 fats. Research suggests that a 1:1 ratio of Omega 3 to Omega 6 is healthier (5).  Supplement with a quality fish oil and eat more food sources of Omega 3 fats. For example walnuts, ground flax seeds or flax seed oil. Read more about fats here and here.  
• Eliminate partially hydrogenated oils. Check food labels for trans fats and avoid fried foods.
• Reduce saturated fats by cutting back on red meat and full-fat dairy foods.

The University of Michigan's Healing Foods Pyramid is a great visual representation of many of the elements just discussed. You can view the full sized, printable version here.

University of Michigan's Healing Foods Pyramid

The journey back to health and a "new normal" has been a long, winding and rather bumpy road, but as it is with many of life's passages, it has led to greater wisdom and strength. It's important to stress that what I discerned to be the best course of treatment for me does not suggest it is the only path to take. My choice is not better or more correct than any other treatment options.  Only you, along with the assistance of your health care provider, can decide what is best for you. Healthy or otherwise, our bodies can always use the nutritional support that eating for healing provides.

The next post will outline a weekly menu with meal suggestions to get you started.  In the meantime, I encourage you to begin by implementing one of the dietary strategies mentioned above each week, or perhaps you're ready to dive right in and try the Elimination Diet, the Anti-Inflammatory Diet, or the Healing Foods Plan. Go for it! You have nothing to lose, except maybe a few unwanted pounds, and you might even find you have gained renewed health. 

Sources
(1) Pieroni, A., Price, L., Eating and Healing: Traditional Food as Medicine, Haworth Press, 2006.
(2) Barbara Schmidt, David M. Ribnicky, Alexander Poulev, Sithes Logendra, William T. Cefalu, Ilya Raskin, A natural history of botanical therapeutics. Science Direct. - http://mss3.libraries.rutgers.edu/dlr/TMP/rutgers-lib_24171-PDF-1.pdf 
(3) University of Minnesota Center of Spirituality and Healing - http://www.takingcharge.csh.umn.edu/explore-healing-practices/botanical-medicine-0
(4) European Botanical Forum - Benefits of Botanical Foods -http://www.botanicalforum.eu/uploads/Fact%20File%203.pdf 
(5) http://www.ncbi.nlm.nih.gov/pubmed/12442909
Wikipedia - secondary metabolites - http://en.wikipedia.org/wiki/Secondary_metabolite
Wikipedia - bioactive-  http://en.wikipedia.org/wiki/Bioactive
Wikipedia - polyphenol antioxidant - http://en.wikipedia.org/wiki/Polyphenol_antioxidant
Functional Medicine - http://www.functionalmedicine.org/content_management/files/ifm_Comp_Elim_Diet_091503.pdf
Dr. Weil - http://www.drweil.com/drw/u/PAG00361/anti-inflammatory-food-pyramid.html

Am I burning fat? Aerobic exercise & energy use

Now that we have a general understanding of the energy balance equation which was discussed in last week's post found here, let's focus on how this all relates to something commonly referred to as the fat burning zone. You may have seen this zone, along with the cardio zone, illustrated on the treadmills, elipticals or aerobic exercise heart rate charts at your fitness center or gym. These zones are based on aerobic training principles and in theory are true, but in application can be somewhat misleading.

Basic Principles of Fitness Training-

If one of your fitness goals is to lose weight, you might be thinking that the fat burning cardio workout listed on your treadmill is the way to go. However, before we look at the fat burning zone specifically, I want to highlight a few basic principles of fitness training first. In order to put together an effective exercise program we need to address:

1. Overload - Overload is the amount of stress or demand that we put on our body during exercise. In order to improve our level of fitness we need to challenge our bodies during our workouts by increasing our level of effort. The amount of overload effects the level of intensity of our workouts and this in turn influences the improvements in our fitness level. If we work out too easily we are likely to see little change in our fitness level, whereas too much overload can lead to injury or burn out.(3)
2. Progression - The human body has the amazing capacity to adapt to the demands of exercise by improving its functioning. Because of this ability it is essential to make changes to your workout after you notice that the current level you're working at is becoming too easy. This isn't always a simple assessment, nor is it something many people want to do.  We get comfortable with a routine, so it is easy to become complacent.  This is why many people plateau, or find themselves at a point where they see little to no change in their fitness level (3).

Now that we understand two core principles of fitness training, we need to know how to apply them. When putting together a workout we now know that we must consider the amount of overload needed to maintain or improve our particular level of fitness and for a specific fitness component.  In this post, for example, we're looking at improving our cardiovascular fitness level and body composition by doing aerobic exercise. In order to address the progressive overload principles we must consider 4 areas that are represented by the acronym FITT, which stands for:

• Frequency (how often we perform the activity)
• Intensity (how hard we are challenged by the activity)
• Type (mode of activity)
• Time (how long/duration of the activity) (4)

I prefer the acronym FITTER - which adds Enjoyment and Rest into consideration as well. Adherence to an activity is more likely if it is enjoyed. Arguably more important is the balance between exercise and rest. Too much of a good thing is possible with exercise.  Having said that, over training is something I rarely see.  In fact, the opposite is more often the case.

So, at this point you might be wondering what all this has to do with the fat burning zone. Well, what the fat burning zone is referring to is the level of intensity, along with the amount of time an aerobic activity is performed at, and the macronutrient (fats, carbs, proteins) energy sources used by the body to accomplish the task. By the way, if you're curious to know what exactly constitutes an aerobic workout you can read more here, and if you'd like to catch up on our discussion of energy sources from last week you can find that here.  Now, this bring us to the three energy systems utilized by the body during physical activity. 

Physical Activity and the Three Energy Systems-

As discussed last week, in order to function our bodies need energy in the form of food. We get this fuel from the carbs, fats and proteins found in what we eat and drink. However, the amounts of  these macronutrients the body uses for energy vary depending on the type of activity we're performing.

1. For immediate, explosive energy needs the body uses the immediate energy system. This system fuels activities that last for about 10 seconds or less.
2. For high intensity acitivities lasting for about 10 seconds to 2 minutes the body uses the nonoxidative (anaerobic) energy system. 
3. For any activities lasting longer than 2 minutes the oxidative (aerobic) energy system kicks in. (3)
   

It's important to note that the body typically uses all three energy systems when we exercise, or in activities of daily living (3).  "The intensity and duration of the activity determines which system predominates" (3). For example, if you're running late and walking quickly to catch the bus you're using the oxidative energy system. But if the bus pulls up and you need to sprint to catch it, the other systems become important because the oxidative energy system isn't able to supply energy fast enough to sustain this high-intensity effort.

Modified Borg Rate of Perceived Exertion Scale
Image from ACE

Fat Burning Zone and Exercise Intensity-

So, back to the fat burning zone... The wisdom behind this zone is that if you're exercising in a target heart rate range (read more about this here) of between 50-60% of your maximum heart rate (MHR) (4), or a level 3-4 on the on the modified Borg Rate of Perceived Exertion (RPE) Scale shown at left, (more about that here) you will be utilizing more of the oxidative system, which draws more energy from the body's fat stores.  While this is true, it's just part of the picture.

 Let's look at an example taken from research done at the University of Wisconsin at LaCrosse.  "A 160 pound male walks at a pace of 3.5 miles per hour. At this pace 40% of his energy is supplied from fat sources and 60% from carbohydrate sources.  On another day the same subject runs for 30 minutes at a pace of 6.5 miles per hour.  At this faster pace (higher intensity exercise), 25% of his energy is supplied from fat sources and 75% from carbohydrate sources" (7). Clearly, this would seem to validate the theory that lower intensity exercise utilizes a greater percentage of fat for energy.

However... Please hang in there for a little math, because this will distinctly illustrate the key point I'm attempting to make. "At the 3.5 miles per hour pace the subject burned a total of 240 calories during his 30 minute walk. He therefore burned 96 total fat calories (40% of 240 calories = 96 calories). At the 6.5 miles per hour pace, the same subject burned a total of 450 calories during his 30 minute run. Therefore, he burned 112 total fat calories (25% of 450 calories = 112 calories), which exceeds the number of fat calories burned during the lower intensity exercise session" (7). Not only did this study subject ultimately burn more fat calories, but he was able to burn more total calories overall working out at the higher intensity level for the same amount of time.

The bottom line-

Remember the energy balance equation? Calories in = calories out. When it comes to changes in body composition and weight loss, clearly higher intensity exercise is a better zone to shoot for because it burns more calories than the lower intensity so-called "fat burning zone". That being said, it is important to keep in mind your level of fitness. Obviously, if you're just beginning an exercise program you want to start at a lower intensity and build up gradually. This is where the progression and overload we talked about earlier comes into practice.  With all this talk about burning calories, let's not forget the impact that a healthy nutrition plan has on the "calories in" part of the energy balance equation. Armed with these fitness tools and knowledge, you're closer to achieving your weight loss goals and better health. 


Sources
(1) Whitney, E., Rolfes, S., Understanding Nutrition 11th ed., Thomson Wadsworth
(2) http://en.wikipedia.org/wiki/Metabolism
(3) Fahey, T., Insel, P., Roth, W., Fit & Well: Core Concepts in Physical Fitness and Wellness, 6th ed.
(4) IDEA Fit - http://www.ideafit.com/fitness-library/comparing-intensity-monitoring-methods-0
(5) American Council on Exercise (ACE) -http://www.acefitness.org/
(6) American Heart Association on body composition -http://www.americanheart.org/presenter.jhtml?identifier=4489
(7) Wescott, W.,  What is Fat Burning Zone?
(8) Hoeger, W. K., Hoeger, S. A., Lifetime Physical Fitness and Wellness: A Personalized Program 

Understanding energy use and the fat burning zone

Fahey, Insel and Roth, Fit and Well

Have you resolved to lose weight this year and get rid of some excess body fat?  Maybe you made the same resolution last year, but are determined that this year's outcome will be different. Perhaps you're a workout veteran who is now finding it difficult to shed those last few stubborn pounds. Whatever the case, I think it's safe to say that we are all familiar with how diet and exercise directly impact our body composition.  This is the ratio of body fat to lean body weight (including water).The illustration on the left shows the body composition of a fit 20-24 year old male and female.

Knowing our body composition is a useful measure of fitness. It can be determined in a number of ways. The most common method being bio-electrical impedance. You can read more about the different measuring methods and tools here.  In order to improve the odds of achieving weight loss this year, it's important to understand how our weight and body composition are influenced by our energy expenditure.  So let's take a closer look.

Energy equation - Generally speaking, too much or too little body fat results from an energy imbalance (1). You may be familiar with the energy equation:

energy in = energy out 

Image from The Science of Sport, Tucker PhD & Dugas PhD

The way the body regulates weight is actually quite complex, but the simple picture is that when a person's food intake (energy in) is in balance with their calorie expenditure (energy out) their body weight usually remains stable. If food intake is less than the calories expended, weight loss usually occurs. Conversely, if more calories are taken in than are used up, the body stores these excess calories as fat, and a person typically gains weight.

A few interesting fat facts: Body fat isn't all fat. It's composed of a mixture of fat (87%), some protein and water. A pound of body fat = 3500 calories. A healthy adult can have an ample reserve of fat stores at anywhere from 50,000 to 200,000 calories (1). Fat is stored by the body as fuel for energy. Our bodies need essential fat. The health benefits of eating the right types of dietary fats were discussed in previous posts, The Skinny on Fat, More Skinny on Fat and Understanding the Omegas. It's only when there is an excess of fat that health problems can result. This brings us to how our body composition is influenced by the body's energy needs. 

Energy In 
Food and beverages provide the energy in. The amount of energy provided depends on the type and amount of things a person eats and drinks. The 3 major macronutrients found in food that provide energy are: carbohydrates, fats and proteins. Heat is given off when the body breaks down or metabolizes food. This is measured in kcalories, or what we more commonly refer to as calories. Scientists have determined that:

• 1 gram of carbohydrate = 4 kcalories 
• 1 gram of fat = 9 kcalories 
• 1 gram of protein = 4 kcalories 
• 1 gram of alchohol = 7 kcalories

Knowing the calorie content of the macronutirents is helpful  in determining the energy value of foods. For example, "a food containing 12 grams of carbohydrates, 5 grams of fat and 8 grams of protein will provide 48 carbohydrate calories, 45 fat calories and 32 protein calories for a total of 125 calories (1)".  Keep in mind that the efficiency of our digestion system also influences the amount of energy yielded by the macronutrients and absorbed by the body. This is why a high fiber meal has less energy absorbed than a meal containing less fiber. Fiber causes food to be moved through the intestines more quickly resulting in less absorption. You can read more about the value of eating nutrient dense vs. energy dense foods here. For now, suffice to say that in order for weight loss to be successful, it is important to consider not only how much food we are consuming, but the types of food we are eating as well.

Energy Out affected by 3 factors:

Basal Metabolic Rate- The "energy out" part of the energy balance equation occurs whenever the body uses calories for energy. The good news is we expend energy constantly just staying alive. This is called our basal metabolism. "About two-thirds of the energy the average person expends in a day" is used to maintain life. Everyone has their own unique basal metabolic rate (BMR) and the BMR can fluctuate in an individual depending on their physical condition or circumstances (1). The chart below lists the factors that influence BMR.

Whitney and Rolfes, Understanding Nutrition, 11th ed.

 Thermic effect of food - As mentioned earlier, when the body digests and metabolizes food, energy is required and heat is generated. This is what is called the thermic effect of food (TEF) and can be estimated at "10% of energy intake" (1). According to Whitney and Rolfes, however, "for most purposes the TEF can be ignored when estimating energy expenditure..." (1). 

Physical Activity - Energy output is also affected by our level of physical activity, and this is one area where we can affect a change in the composition of our bodies. By increasing physical activity we accelerate the amount of energy needed to support the work of the muscles and other body systems. Different kinds of physical activities, as well as the frequency, intensity and duration of the activity will influence energy demands.  In addition, body mass and body weight play a role in the amount of energy needed.  The chart below lists a few activities and their corresponding number of calories burned per minute while we are engaging in them.

ACE Fitness

Let's consider walking, for example.  This chart from the American Council on Exercise (ACE) doesn't specifically mention at what level of intensity the walking is being performed, but let's assume a normal pace. Walking at a normal pace, a person who weighs 120 lbs. will use approximately 6.5 calories per minute. Walking for 20 minutes uses a total of 130 calories. Now, let's put this into perspective, and the point I'm trying to make isn't to belittle the positive effect of burning 130 calories. However, what if after their walk this person rewards themselves with a Starbucks 16 ounce strawberry smoothie made with 2% milk that has 280 calories? (4) This person would now have to walk an additional 23 minutes to burn off this beverage and keep the energy equation in balance. These kinds of energy use imbalances are common and occur daily. Over time they can begin to add up to those extra pounds we struggle to get rid of each year.

So what's all this have to do with the fat burning zone?  We'll delve into this in more detail when I post about the exciting world of physical activity, the energy systems and what this means to us in terms of burning calories no matter what zone we are in. In the meantime, keep up the good work with those resolutions and keep making fitness a priority in your lives!


Sources
(1) Whitney, E., Rolfes, S., Understanding Nutrition 11th ed., Thomson Wadsworth
(2) http://en.wikipedia.org/wiki/Metabolism
(3) Fahey, T., Insel, P., Roth, W., Fit & Well: Core Concepts in Physical Fitness and Wellness, 6th ed.
(4) Starbucks nutrition info http://www.starbucks.com/menu/drinks/vivanno-smoothies/strawberry-vivanno-smoothie 

Aerobic exercise: How hard should I work out?

"How hard should I be working out?" This is one of the most common questions people ask me during fitness training. This is a good question and the answer is different for everyone. This is because an individual's exercise intensity level, or how hard they need to be working, is directly related to things like their fitness level, age and health. Everyone should ask themselves this important question before beginning an exercise program and when reassessing a current workout. Knowing your exercise intensity level is important in determining how best to bring about improvements in your health.

You may have heard the expression "in the zone" with regard to exercise intensity. This can be used to describe target heart rate (THR) training levels which are benchmarks that are measured during aerobic exercise. You may have seen this range visually depicted in a chart on your gym's treadmill control panel. Some use the misleading phrase "fat burning zone", more on this later, where others just say training zone. In any case, the theory of training in a target heart rate zone can seem a little perplexing.

Adding to the confusion, especially for women, is the emerging scientific data about a gender specific formula for maximum heart rate, which directly impacts how a woman knows if she's in "the zone." Additional information is available here, but before we get into that let's take a look at several factors that are helpful in determining whether or not you're working hard enough during your aerobic workout.

What is an aerobic workout? When we perform aerobic exercise, or aerobics as coined by Dr. Kenneth Cooper way back in 1968, we are increasing our need for oxygen by performing an activity that engages the larger muscles of the body.  This sustained activity, in turn, causes the heart and lungs to work harder than when the body is at rest in order to provide more oxygenated blood to fuel the working muscles (1). There are many health benefits to aerobic exercise (3), and the Mayo Clinic lists ten of them here.  One reason we are focusing on in this post is heart health. 

Heart rate or pulse is the rate at which blood is squeezed out of the heart per minute (BPM). We can use our heart rate to measure how hard our heart is working at rest or during aerobic exercise. This can be done by taking a pulse or heart rate and determining our BPM number. Pulse points are places where an artery passes close to the skin and makes it easier to feel blood pulsing through it. There are several pulse point locations on the body, but 2 of the more commonly used sites are found on the wrist (radial pulse), or on the neck (carotid pulse).

Once you've found your pulse, count the number of times you feel the blood pulsing under your fingers for 10 seconds. Then multiply that number by 6 and you will have your heart rate for one minute. For a more precise measure, you can also use a blood pressure monitor that counts your pulse for you. To learn more about manually taking your pulse, just follow the link here to the Cleveland Clinic's website.

Resting heart rate (RHR) is another useful indicator of heart health. This is the number of times our heart beats per minute while we aren't engaging in any activity and is best taken in the morning before we get out of bed (3). I suggest measuring it for 3 mornings and then taking the average. According to the National Institutes of Health, a normal RHR range is:
Newborn infants - 100-160 BPM
Children 1 to 10 yrs. - 70-120 BPM
Children over 10 and adults (including seniors): 60-100 BPM
Well-trained athletes - 40-60 BPM (5)

Maximum heart rate (MHR) - Knowing your MHR will help you in calculating your target or training heart rate (THR).  The gold standard for determining your MHR is to take a doctor supervised treadmill test. However, for many of us this may not be practical, so exercise physiologists have developed several formulas to help estimate MHR.  One of these is called the estimated maximum heart rate formula:

MHR = 220 BPM - age

At the beginning of this decade, research conducted on the estimated MHR formula found that it "underestimated MHR in older adults" (7). These scientists proposed a new MHR formula:

MHR = 208 - 0.7 x age

This year, more recent research has found that this formula overestimates the MHR for age in women, especially those over the age of 35. See footnote (8). As a result of this finding a new gender specific MHR formula is being proposed, however it is not yet being used in a clinical setting because the research is considered preliminary. The gender specific formula is:

MHR = 206 - .88(age)

After we have determined our MHR we can calculate our training heart rate.


Training heart rate (THR) and finding the right intensity for you - THR is the desired heart rate range which will provide us with the most benefit from our aerobic workouts. Calculating a THR zone helps us determine the level of sustained exercise intensity that best challenges our heart and lungs safely. When calculating THR, I prefer to use the Karvonen or Heart Rate Reserve Formula.  This formula is more personalized because it factors in the resting heart rate (RHR) to determine heart rate reserve (HRR). The formula for calculating HRR is:

HRR = MHR - RHR

Now we move to the next step in determining THR. We multiply HRR by the desired training intensity range at which we want to workout. The American College of Sports Medicine recommends healthy adults exercise at a range beginning at 55% and up to no higher than 90% of MHR.

Let's put all this information into practice. A 30 year old healthy female who has a RHR of 70 and is of average fitness level wants to determine her THR zone.  Here is how she would calculate her THR range:
Begin by calculating MHR. Using the new gender specific MHR formula -
MHR = 206 - .88(age)
179.6 = 206 - 26.4
MHR = 180
Next we determine HRR using the formula HRR = MHR - RHR
HRR = 180 - 70
HRR = 110
Now we plug the HRR number into the rest of the Karvonen equation to determine the THR range.  We begin with the lower end of her training range (light to moderate) or 65%.
THR = 110 x .65 + RHR
THR = 71.5 + 70
THR  lower range = 141
Now we find the THR for our sample female of average fitness level at the top end of her training range (moderate to vigorous) or 85%.
THR = 110 x .85 + 70
THR  higher range = 164

So, this individual would monitor and strive to maintain for the duration of her aerobic activity a target heart rate zone between 141-164 BPM.  These numbers would be adjusted as her fitness level changed.


How much aerobic exercise is enough?   According to the American College of Sports Medicine healthy adults under the age of  65 should shoot for at least 30 minutes of aerobic activity, 5 days a week.  The Center for Disease Control (CDC) suggests healthy adults get at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity aerobic activity per week. This activity should be sustained for bouts of at least 10 minutes. For even greater health benefits the CDC urges us to shoot for 300 minutes of moderate intensity or 150 minutes of vigorous intensity aerobic activity per week, or an equivalent mix of both, again in bouts of at least 10 minutes.

What's light, moderate or vigorous intensity activity?  According to the CDC, "moderate intensity means "you're working hard enough to raise your heart rate and break a sweat." Examples would be:

• walking fast
• doing water aerobics
• riding a bike on level ground or with few hills
• playing doubles tennis
• pushing a lawn mower (CDC)

Vigorous intensity aerobic activity means "you're breathing hard and fast, and your heart rate has gone up quite a bit" (CDC). Examples include:

• jogging or running
• swimming laps
• riding a bike fast or on hills
• playing singles tennis
• playing basketball

So, having plowed through the formulas and worked through the calculations, we now know how to determine our THR zones.  As important and useful as this information is, it should be noted that it is all an estimation.  One research study found that when monitoring aerobic exercise in a group setting, perceived rate of exertion, or how the person exercising is feeling, was as good an indicator of training intensity as THR calculations.  Plus, the exercisers didn't have to stop to take their pulse. Whatever method you choose to monitor your exercise intensity,it is always best to work within your comfort level and not to exceed 90% of your MHR because of increased risk for injury.

The short video below from the American College of Sports Medicine's Exercise is Medicine Library talks more about using Rate of Perceived Exertion as a way to monitor THR. The take away from all of this is to just get moving because exercise really is good medicine.

Don't forget: It is important to check with your physician before beginning any exercise program. Next post will take a look at the misleading concept of the fat burning training zone, and will be much shorter I promise!

Sources
(1) http://en.wikipedia.org/wiki/Aerobics
http://www.google.com/dictionary?aq=f&langpair=en|en&q=aerobic&hl=en
(3) http://www.mayoclinic.com/health/aerobic-exercise/EP00002/NSECTIONGROUP=2
(4) http://www.americanheart.org/presenter.jhtml?identifier=4701
(5) http://www.nlm.nih.gov/medlineplus/ency/article/003399.htm
(6) Physical activity & health: an interactive approach, Thomas, D.Q., Kotecki, J.E.
(7) Tanaka et al., Age predicted maximal heart rate revisited http://content.onlinejacc.org/cgi/content/full/37/1/153
(8) St. James women take heart study http://circ.ahajournals.org/cgi/content/full/108/13/1554 
American College of Sports Medicine
Centers for Disease Control