Are Low Carbohydrate Diets Best for Weight Loss?

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If you haven’t been bombarded with advertising for low carbohydrate foods, diets, plans and crazed anti-carbohydrate friends and coworkers in the past few years, you must be living on a remote island somewhere (taking any visitors?). The anti-carbohydrate, pro-fat crowd (including keto, Paleo, and Whole 30 – aka Paleo reinvented) devotees might be onto something. But that “something” isn’t a miraculous cure for obesity. Should you trade your low fat, higher carbohydrate diet for full fat foods and “bread” made from cauliflower and mozzarella cheese? It’s time to look past the media headlines to the latest research on low fat vs. low carbohydrate diets.

In this article I’ll cover:

  • the latest research on lower carbohydrate diets;
  • what this research means for you; and
  • a sidenote on the insulin hypothesis.

Should you switch to low carbohydrate vs. high carbohydrate foods?

The Latest Research on Low Carbohydrate Diets

In an attempt to determine which diet is best for weight loss, one of the latest studies collected and analyzed studies on low fat and low carbohydrate diets. A systematic review and meta-analysis, which combines the results of several studies, compared intervention studies > 1 year in length where participants were placed on low fat diets, low carbohydrate diets, other high fat dietary interventions or they continued eating whatever they wanted (their typical diet). Low fat diets ranged from  < 10% of calories from fat to < 30% of calories from fat. The diet interventions used ranged from providing instructions at the start of the study and expecting participants to follow the diet plan to regular counseling sessions with dietitians, food diaries and cooking lessons to actual feeding studies where participants were given most of their overall food intake (with the last approach the most well-controlled). Some studies coached participants to cut calories while others, including those put on low-carbohydrate Atkins-style diets, were told to eat until they were full without worrying about calories.

They analyzed results from 13 trials that examined weight maintenance as well as studies that didn’t include weight loss as a primary goal. In these studies low-fat and high-fat diets lead to a similar amount of weight loss. Low-fat diets were superior only when compared to the subjects’ normal diet – in other words actually going on a diet led to greater weight loss than not dieting (no surprise there). The tiebreaker came from an analysis of 35 weight loss trials, 29 of which were conducted using adults who were overweight, obese, or had type II diabetes. Overall, there was no difference between low-fat and high-fat diet interventions. Low-fat diets led to greater weight loss compared to groups who didn’t diet. However, higher fat diets were the clear winner (according to the headlines), leading to significantly greater weight loss after a year than low fat diets. Before tossing out your steel cut oatmeal, whole-grain bread and fresh Summer fruit, let’s take a closer look at this data. It was pulled from a comparison between low-fat diets and high-fat diets that varied by more than 5% of calories. So did low carbohydrate, higher fat diets really win or was it because subjects cut calories? Is it easier to cut calories on low carbohydrate, high fat diets? Participants on low carbohydrate diets lost about 2.2 pounds more weight after one year versus those on a low-fat diet. A 2.2-pound difference in weight loss after one year on a diet isn’t very impressive, especially considering many of the subjects were overweight or obese to begin with.

The End of Higher Carbohydrate, Low-Fat Diets?

Based on these results the authors suggest low-fat diets shouldn’t be the go-to recommendation for weight loss. However, the results of this study are mainly applicable to overweight, obese and type II diabetics – the primary populations examined in these studies. We can’t take the authors conclusion that low carbohydrate, higher fat diets are better if you are looking to lose a few pounds for a beach ready body. What works for an obese adult or type II diabetic will not necessarily work for an active adult who wants to get a 6-pack. Secondly, previous research shows low carbohydrate diets tend to produce greater weight loss, initially, than low fat diets (some of this is water weight since carbohydrates store 3-4 times their weight in water in the form of glycogen in muscles and the liver and your glycogen stores will start dropping when you drastically lower your carbohydrate intake) yet after a year, weight loss is equivalent between both diets. Other research shows weight loss over the first six months on a diet is the main predictor of both weight loss success and sticking to a diet over the long-term. Greater weight loss initially = better adherence = better success over time.

Long-term Success

What’s more disappointing than the paltry 2.2-pound difference between the low-fat and high-fat diets after one year is the total average weight loss in the studies designed for weight loss – a mere 8.25 lbs. after 1 year. Instead of declaring low carbohydrate, higher fat diets a clear winner over low fat, higher carbohydrate diets (especially considering the 2.2 pound difference), we should be asking why it’s tough to stay on a diet, any diet? Why aren’t study participants losing more weight? I don’t have the answer to these questions and leading weight loss researchers don’t seem to have a complete picture right now either.

If you want to lose weight, choose a lower calorie diet primarily based on high quality foods or create your own plan that fits into your lifestyle and is one you can stick with it. There are many diets that could, potentially, work for you. If you want to try a low carbohydrate diet for a while, by all means go for it (especially if you need to see that number on the scale move pretty quickly)! If cutting carbs sounds like being in detention, then skip that approach! I’m giving you permission to alter your plan as often as you need to based on changes in your lifestyle (some research papers actually suggest doing this and I am a huge fan of this approach), motivation, and results.

Conceptually, low carbohydrate diets are very easy. You don’t have to worry about portion sizes, log calories, count points or determine if you have to eat less at dinner to make up for a lunchtime splurge. Decision-making is boiled down to: it contains carbs and therefore off my diet or it is low in carbs and the carbs it does contain are high in fiber so I can eat it. Just don’t buy into the hype that low fat, higher carbohydrate diets are the only way to lose weight or that these diets are better, over the long term, than other dietary approaches that also cut calories.

References

Tobias DK, Chen M, Manson JE, Ludwig DS, Willett W, Hu FB. Effect of low-fat diet interventions versus other diet interventions on long-term weight change in adults: a systematic review and meta-analysis. Lancet Epub before print. 29 October 2015.

Greenberg I, Stampfer MJ, Schwarzfuchs D, Shai I; DIRECT Group. Adherence and success in long-term weight loss diets: the dietary intervention randomized controlled trial (DIRECT). J Am Coll Nutr 2009;28(2):159-68.

Franz MJ, VanWormer JJ, Crain AL, Boucher JL, Histon T, Caplan W, Bowman JD, Pronk NP. Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Diet Assoc 2007;107(10):1755-67.

Hall KD. Predicting metabolic adaptation, body weight change, and energy intake in humans. Am J Physiol Endocrinol Metab 2010;298(3):E449-66.

Hall KD, Sacks G, Chandramohan D, Chow CC, Wang YC, Gortmaker SL, Swinburn BA. Quantification of the effect of energy imbalance on bodyweight. Lancet 2011; 378(9793).

Rosqvist F, Iggman D, Kullberg J, Cedernaes J, Johansson HE, Larsson A, Johansson L6, Ahlström H, Arner P, Dahlman I, Risérus U. Overfeeding polyunsaturated and saturated fat causes distinct effects on liver and visceral fat accumulation in humans. Diabetes 2014;63(7):2356-68.

 

 

 

How Much Protein Can Your Body Use from One Meal?

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Steak is a high protein meal

How much protein can your body digest and use at a time? If you you eat the right amount of protein at every meal you’ll supposedly hit the sweet spot – maximum muscle growth and satiety (fullness) without wasting food or money. General guidelines based on short term trials and one cross-sectional study suggest adults need regular meals including 25 – 45 grams of protein per meal to maintain or build muscle mass and maximum strength (1, 2, 3). However, it is possible that more protein per meal may be beneficial in some instances while the per meal amount might not matter very much in others. Your body can and will digest all of the protein you eat in a sitting (it might take a while) and it doesn’t just discard any excess that isn’t used to build structures in the body.

In this article I’ll cover:

  1. Why should we focus on a “per meal” dose of protein?
  2. What happens to “leftover” protein;
  3. What influences protein requirements;
  4. How you can estimate your protein needs.

Does the Amount of Protein Per Meal Matter?

In a really cool study conducted by well-known protein scientists, the minimum amount of protein per meal found to maximally spike muscle growth was 0.11 grams per lb. of body weight in younger adults and 0.18 grams per lb. of body weight in older adults (over 71 years of age) (2). Older adults need more protein due to a decline in muscle response to protein intake that occurs with age. In addition to a minimum, there is an upper limit of protein intake; anything beyond this threshold dose will not be used to build muscle. For example, one study examined 4 ounces of beef containing 30 grams of protein compared to 12 ounces of beef containing 90 grams of protein. The larger serving did not lead to a greater increase in acute muscle protein synthesis compared to the 4 ounce serving (4). So now we know we need some protein, but not 90 grams in one sitting. However, we still don’t know what the minimum upper limit is, beyond which higher intakes do not lead to increases in muscle mass or muscle functioning over time (5).

More evidence for a per meal dose came from a short-term study that found an even pattern of high quality protein at each meal (30 grams per meal; 1.2 g/kg for the day) as opposed to a skewed pattern (10 grams at breakfast, 15 g lunch and 65 g at dinner; 1.2 g/kg for the day) may be best for maximally stimulating muscle building in young adults (1).

Despite the evidence in favor of an even distribution of protein intake throughout the day, a short-term study in older, resistance trained adults given 2x the RDA – 0.68 grams of protein per lb. bodyweight (1.5 grams per kg) per day in an uneven or even pattern (see chart at the end of this article) or the RDA of 0.36 grams of protein per lb. bodyweight (0.8 grams per kg) per day again in an uneven or even pattern found the pattern of intake didn’t matter. Consuming 2x the RDA, regardless of whether it was consumed in an uneven or even pattern, led to a significantly greater increase in muscle protein synthesis compared to consuming 1x the RDA. The pattern of protein intake didn’t matter, possibly due to age-related decline in muscle response to protein intake,  greater total daily protein intake or some other factor (6).

What Happens to Excess Protein Intake?

There is no long-term storage site for amino acids, the building blocks of protein. After eating a thick juicy steak, creamy bowl of split pea soup or sizzling soy fajitas, your body digests the protein and absorbs the amino acids, using them to build new structures, including muscle. When excess protein is consumed, more than the body needs at that point in time, the rest is used for energy or  converted to body fat. The nitrogen (from amino acids) is combined with other compounds to form urea, a harmless waste product, which is processed by the kidneys and excreted in the urine.

What Influences Protein Requirements?

Though 90 grams in one sitting may be more than necessary for muscle, science has yet to figure out the exact threshold beyond which there is no benefit for muscle. This is a complicated question as there are many factors that influence a person’s daily protein needs as well as how much protein a person may need at each meal. These include but are not limited to: age, training status, total daily calorie intake (if dieting total protein needs are higher), overall amount of protein consumed each day; the type (anti-nutrients?), quality and leucine (or EAA) content of the protein consumed at each meal, other nutrients consumed at meal time, training program, lean body mass, health status and goals.

How Much Protein Do You Need at Each Meal?

Given the research to date, does a per meal does matter?

If you are dieting, yes.

If you don’t get at least 0.55 grams protein per lb. body weight (1.2 grams per kg), yes.

If you eat plenty of protein every day and a decent amount at regular meals throughout the day, it might not matter that much, or at all.

For now, stick to the general guideline of at least 25 grams per meal (the amount of an average female’s palm worth of chicken, turkey, red meat, fish). You may need more, per meal, to maximize muscle growth and repair  if:

  • You are older (relative term since we don’t know exactly what age qualifies as “older). Aim for 1.0 – 1.5 grams of protein per day (7) and regular meals with a good amount of protein per meal. If you have chronic kidney disease, follow the advice of your RD and MD.
  • You eat primarily vegetarian proteins.

Many factors influence a person’s nutrition needs. If you want to maintain or gain muscle mass and strength, concentrate on your total daily protein intake (at least 0.55 grams of protein per lb. of bodyweight; 1.2 grams per kg) followed by how much you consume at each meal. There is no one-size-fits-all ideal protein intake per meal and the body doesn’t just “waste” protein that isn’t used for muscle building. For now, research suggests 25 to 45 grams per meal is a good general guideline. More may be better for muscle. Less may be necessary if you have chronic kidney disease.

Table: Quantity of dietary protein intake, but not pattern of intake, affects net protein balance primarily through differences in protein synthesis in older adults (select data and average leucine intake calculated)

Amount Pattern Meal Protein (grams) Protein as a % of total calories Average leucine intake per meal (calculated)
1x RDA Uneven Breakfast 11.1 8 0.89
Lunch 14.9 8 0.89
Dinner 47.8 12 3.56
Total 73.7 10 4.45
Even Breakfast 22.3 15 1.63
Lunch 21.5 9 1.63
Dinner 22.0 9 0.81
Total 65.8 11 4.07
2x RDA Uneven Breakfast 18.1 15 0.80
Lunch 24.3 12 1.60
Dinner 78.4 22 4.79
Total 120.8 19 7.99
Even Breakfast 38.0 25 2.98
Lunch 36.5 17 2.98
Dinner 37.9 18 2.23
Total 112.4 19 8.2

References

1 Mamerow MM, Mettler JA, English KL, Casperson SL, Arentson-Lantz E, Sheffield-Moore M, Layman DK, Paddon-Jones D. Dietary protein distribution positively influences 24-h muscle protein synthesis in healthy adults. J Nutr. 2014 Jun;144(6):876-80.

2 Moore DR, Churchward-Venne TA, Witard O, Breen L, Burd NA, Tipton KD, Phillips SM. Protein ingestion to stimulate myofibrillar protein synthesis requires greater relative protein intakes in healthy older versus younger men. J Gerontol A Biol Sci Med Sci 2015;70(1):57-62.

3 Loenneke JP, Loprinzi PD, Murphy CH, Phillips SM et al. Per meal dose and frequency of protein consumption is associated with lean mass and muscle performance. Clin Nutr 2016 Apr 7.

4 Symons TB, Sheffield-Moore M, Wolfe RR, Paddon-Jones D. A moderate serving of high-quality protein maximally stimulates skeletal muscle protein synthesis in young and elderly subjects.J Am Diet Assoc 2009;109(9):1582-6.

5 Deutz NE, Wolfe RR. Is there a maximal anabolic response to protein intake with a meal? Clin Nutr 2013;32(2):309-313.

6 Kim IY, Schutzler S, Schrader A, et al. Quantity of dietary protein intake, but not pattern of intake, affects net protein balance primarily through differences in protein synthesis in older adults. Am J Physiol Endocrinol Metab 2015;308(1):E21-8.

7 Paddon-Jones D, Campbell WW, Jacques PF, Kritchevsky SB1, Moore LL, Rodriguez NR, van Loon LJ. Protein and healthy aging. Am J Clin Nutr 2015 Apr 29.

 

 

Is Coffee Good for You?

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CoffeeDrinking coffee will leave you dehydrated and geeked out on caffeine. For several decades we’ve been warned about America’s favorite beverage. Yet these dire warnings were largely based on assumptions rather than actual science. A growing body of evidence suggests your morning Cup O’ Joe may be good for you! Here’s a look at the latest research.

What’s in a Coffee Bean?

Coffee beans are actually seeds from coffee cherries. They are picked, dried, and roasted turning them from green to those familiar aromatic brown beans we know and love. It’s ironic that a beverage made from seeds has gotten such a bad rap. Green coffee beans are naturally rich in antioxidants including chlorogenic acids, compounds that are readily absorbed in the human body, have antibacterial and anti-inflammatory actions and are associated with many health benefits including a reduction in cardiovascular disease, type II diabetes and Alzheimer’s disease. Antioxidants protect plants from disease and pests. Some antioxidants also protect human cells from harm. Roasted coffee beans are loaded with antioxidants (contrary to popular belief, they are not destroyed during roasting) and scientists are slowly uncovering the metabolic fate of each type antioxidant as well as the potential health benefits associated with regular coffee intake.

Potential Health Benefits

A National Institutes of Health study published in 2012 found older adults who drank caffeinated or decaffeinated coffee were less likely to die from heart disease, respiratory disease, stroke, injuries and accidents, diabetes, and infections. Those who drank over 3 cups per day had a 10% lower risk of death compared to those who did not drink coffee. Though this study only showed an association between coffee consumption and a decreased risk of death, it provided some reassurance to people who couldn’t seem to give up their favorite beverage. Studies published over the past three years lend strength to the relationship between regular coffee intake and a decreased risk of certain diseases.

Heart Health
A study published in the British Medical Journal’s publication Heart, examined diet and artery health in over 25,000 Korean men and women. Those who drank 3 to 5 cups of coffee per day were 19% less likely to have the first signs of atherosclerosis,  plaque buildup on artery walls, compared to those who were not coffee drinkers. Lower intakes were not associated with a reduction in plaque buildup. Drawbacks to this study: diet was examined at one point in time and study subjects were asked to recall their coffee intake over the previous year (people generally don’t recall their food / drink intake with great accuracy). Also, keep in mind this study showed an association between coffee intake and artery health, it doesn’t prove that coffee reduces plaque buildup on artery walls or that it can prevent cardiovascular disease. More research is needed to understand how coffee intake could potentially support heart health.

Cancer
A recently published study found individuals previously treated for stage III colon cancer who were regular coffee drinkers, consuming at least 4 cups of caffeinated coffee per day, had a 42% lower risk of recurrence of colon cancer and 33% lower risk of dying from the disease. This study found an association between coffee intake and decreased risk of colon cancer recurrence.

Research on coffee intake and risk of various cancers is mixed with some showing it is protective and others suggesting it may increase risk. Keep in mind there are many potential factors that impact cancer risk and risk of cancer recurrence with a sedentary lifestyle, high body fat and alcohol intake strongly associated with increased risk of certain types of cancer. Fruit and vegetable intake is associated with a decreased risk of some types of cancers. As for your Cup O’ Joe, time and more research, will tell us how America’s favorite beverage fits in the picture.

Should You Increase Your Coffee Intake?

All of these studies on regular coffee consumption include higher intakes. No benefits are noted for lower intakes – one to two cups per day. Keep in mind that some people should avoid or be cautious with caffeine intake including kids, teens, people with anxiety disorders, glaucoma, heartburn or cardiovascular disease. Also, pregnant women should avoid higher intakes of caffeine – more than 3 cups of coffee per day (regular sizes cups). Now about the caffeine – regular intake of moderate amounts of caffeine will not dehydrate you.

If you drink coffee in moderation, enjoy it! Don’t increase your intake based on these studies or start drinking if you aren’t a regular coffee consumer. Future research will tell us more about the many naturally occurring compounds in coffee, their actions in the body and the potential link between coffee and disease risk.

References
Heart 10.1136/heartjnl-2014-306663
New Eng J Med 2012;366:1891-1904.
J Nutr 2008;138(12):2309-15.
Mol Nutr Food Res 2005;49:274–84.
J Agric Food Chem. 2006;54:8738–43.
Am J Epidemiol 2002;156:445–53.
Biol Pharm Bull 2006;29:2236–4
Pest Manag Sci 2003 Apr;59(4):459-64.
J Clin Oncol 2015 Aug 17. [Epub ahead of print]

 

 

Meal Delivery Services & Menu Planning

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Tilapia

Menu Planning

If spending time on Pinterest boards trying to figure out what you should make for dinner this week isn’t exactly your thing, save time and energy by letting a pro do the work for you.  My colleagues at My Menu Pal sell individual meal plans for incredible prices (just $1.49 for 4 entrees, 1 – 2 side dishes with each entree, Nutrition Facts, helpful hints and a shopping list). Check out their current special and E-book by clicking here. If you want to do even less work, consider a meal delivery service.

Meal Delivery Services

There are two different types of meal delivery services – one involves popping the meals in the oven and setting the timer (I call these Heat and Eat). The second kind sends you a box of ingredients and a recipe and its your job to put the meal together (Recipe Creations). Though they cost more than buying the ingredients and cooking for yourself, they save time (and time is money, especially if you work for yourself) and may actually cost less in the the long run if you frequently eat out or food goes bad before you get a chance to eat it.

Heat and Eat

This option is for someone who travels often, is too busy to shop and cook or doesn’t want to cook. Your meals will be delivered to your doorstep and your only job is to heat them up. Most of these services have a limited number of selections that you will get tired of eating over and over again for months at a time. However, they also serve as good fill-in meals if you want a few per week to save some time on food preparation and you can cook the rest of the time.

All of the following are nationwide unless cities are specified:

Freshly (most of the U.S.)
For: athletes, general healthy eating, weight loss
* Many athletes will need 4 meals per day or more depending on calorie needs

Good variety of meals though, like all meal services, the total number of options are limited. They add at least one new meal to their menu each week. The entire menu is gluten and peanut free. They also accommodate specific dietary preferences and food allergies.

Meals are delivered fresh and never frozen. Choose from 4, 6, 9 or 12 meals per week. The more meals you get the lower the price per meal. So for instance, 4 meals per week will cost $12.50 per meal while 12 per week will cost $8.99 per meal. Free shipping. You can put your meals on pause or skip a week if you notify them ahead of time.

Fuel Food:
For: athletes, general healthy eating, weight loss
Meals are weighed and portioned. Each meal is $7.50 (if you order 300 meals!) or more. Shipping is $5 per meal in FL and more in other states.

Hello Fresh:
For: general healthy eating
Nationwide. No calorie or macronutrient information listed. Starts at $8.75 per meal for 2 or more adults. Vegetarian options available.

Bistro MD:
For: weight loss, general healthy eating (you may need to add more calories)
5 and 7 day programs for weight loss. Women’s programs average 1,200 calories per day. Men’s – it doesn’t say. At 1,200 calories per day I would be concerned about muscle loss esp. if protein intake is low. Use code RD25Off for 25% off and free shipping.

Healthy Chef Creations:
For: general healthy eating
This service includes breakfast, lunch, and dinner options. Dinners start at 15.99 for a “regular size” meal and cost about $21.99 for a “large size” meal (free shipping). Nutrition information isn’t listed though you can customize the meals to suit your dietary needs. They include a few quacky things like detox drinks and they don’t have a nutrition expert overseeing their meals.

My Fit Foods (AZ, CA, TX, OK)
For: weight loss, general healthy eating, athletes
I love how easy their website is to navigate. They have breakfast, lunch and dinner options with many meals between $5 – $8 (caveat – their meals are low in calories so most people, even those who are dieting will need 3 meals + snacks or 4 or more meals daily). For many athletes – the portion sizes will need to be 3-4x larger so that puts the meals at around $15 – $28 per meal if you are eating over 3,000 calories per day. They also have options grouped by dairy free, gluten-free, low-carb, low sodium, spicy and vegetarian.

Fresh N Fit (Atlanta, GA)
For: weight loss, general healthy eating
Flexible (no subscription required) and they have several options including Paleo, gluten-free, vegetarian, low-carb (< 15% net carbs, which means total carbohydrates – fiber), customized (you can specify no beef, no seafood, no pork etc.). Total daily calories include a 1,200 calorie option and 1,800 calorie option. At 1,200 calories per day I would be concerned about muscle loss esp. if protein intake is low. Active adults will likely need to supplement or order additional meals to get enough calories each day. Try promo code BCH10 or Mark40 to get $10 off your first order or $40 off a week plan.

Christophers To Go (Atlanta, GA)
For: general meal delivery, delivered fresh.

Nutrition information provided.

Options: Paleo, gluten free, dairy free, vegan, vegetarian.

Prices: $4.59 – $21.99 per meal
› Every meal is labeled with ingredients and nutrition information.

› The menu always has vegetarian, paleo, gluten free, and dairy free options.

Sunfare (LA and Phoenix):

They have a few different meal options including Artisan (organic, gluten-free, non-GMO, Vegetarian, and Paleo.

New Orleans: there are many local options. Check them out by clicking here.

 

Recipe Creations

This style of meal delivery is for people who don’t want to shop or measure ingredients but do want to cook. All of the ingredients are measured and delivered to your door along with the recipe. Choose this service if you enjoy cooking but you want the convenience of somebody shopping for you. You will spend time on on meal preparation – sometimes more than 30 minutes. Advantages: no food waste, saves shopping time.
Disadvantages:  if you are short on time this option is not for you because you will spend time cooking. Meal delivery services aren’t for very choosy eaters or those who have several food allergies or  sensitivities.

Plated – this nationwide subscription service allows you to choose anywhere from 1 – 7 meals per week. They offer 9 total choices per week including vegetarian, meat and seafood options.

  • Cost: starts at $12 per serving (for one person).
  • Nutrition Facts: they estimate their meals are 600-800 calories each. Click on each entrée to find out the nutrition information.

Blue Apron – this nationwide subscription service is flexible and has a wide array of recipes (there are no repeats within the same calendar).  Try before you buy – they list all recipes for each dish on their website (click on one and scroll down).  They also offer free recipes emailed to you each week (scroll down to the bottom of this page).

  • Cost: starts at about $9 per serving.
  • Nutrition Facts:  these are provided under each recipe with the caveat that different sizes of produce and amount of oil used will alter the nutrition facts.

Hello Fresh – this nationwide delivery service has three different choices and will, omnivores (meat eaters), vegetarians and a family box.

  • Cost: starts at $8.75 per person.
  • Nutrition Facts: none that I could find. They estimate each meal contains 500-800 calories per serving.

Peach Dish –  Southern cooking delivered nationwide.

  • Cost: though this service is $12.50 per meal, there’s additional shipping fee in several states including AZ, CA, CO, IA, ID, KS, MN, MT, ND, NE, NM, NV, OK, OR, SD, UT, WA, WY.
  • Nutrition Facts: listed as a separate tab on each recipe.

Check out this review of the best meal delivery services by reviews.com.

If you’ve tried any of these meal delivery services, please leave comments!

Meal Planning Made Easy

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salmon with veggies

If you don’t have the luxury of eating in a cafeteria with a variety of options each day, it makes sense to plan your meals ahead of time. Doing so will save you time and money. If saving money doesn’t entice you, consider this: eating at home can help you lose weight. A study published in the Journal of the Academy of Nutrition and Dietetics found the average meal at 360 restaurant dinner meals examined contained 1,200 calories. If you choose to dine at an American, Italian or Chinese restaurant, that meal may cost you a whopping 1,495 calories. Don’t worry, I have no intention of having you replicate the instagram photos from fitness buffs who eat perfectly portioned bland-looking chicken, broccoli and brown rice twice a day, every day. Instead, I am an advocate for taste, variety, and better nutrition. Here are the 4 steps you should take to start planning better-for-you meals ahead of time:

1 – Take Inventory

Go through your cabinets, refrigerator and freezer at least once per month and throw out anything that is past it’s expiration date, freezer burned, molded, and stale or smells bad (smell your cooking oil too and if it doesn’t smell normal, toss it). Half-eaten anything that is more than a day old? Trash. This is also a great time to take inventory of what you have on hand.

2 – Stock Your Kitchen

After taking inventory, decide what you need (sticking to your grocery list will save you from impulse buys you don’t need after looking at your grocery store circular). Essential foods include shelf stable, refrigerator and frozen foods. I like the option of preparing a meal in 5 minutes or less. Frozen and canned items allow me to do this.

Shelf Stable:

  • Beans, lentils and legumes (tip: some lentils can be soaked for just 40 minutes and added to a wide variety of dishes from salads to spouse, stews and grain-based dishes)
  • Bread
  • Canned vegetables, beans, fish and chicken
  • Condiments including chicken, beef or vegetable broth, mustard, hot sauce and any other commonly used condiments
  • Cooking oil – get good quality cooking oil. Pay more for a brand you trust. Olive oil is the most adulterated food on the market so you do get what you pay for.
  • Nutrition bars
  • Nuts, nut butters and seeds (all can be refrigerated; opened nut butters should be refrigerated)
  • Popcorn, whole grain snacks
  • Protein powder
  • Rice, pasta, whole grains, cereals and other similar foods. Grab a few options that you can make in a just a few minutes including couscous. Also, vary your rice, pasta and whole grains – look for black, red or purple rice, bean pastas and more.
  • Soups (boxed, bagged or in cans)
  • Spices & seasonings (including salt and pepper). If you don’t use these regularly get dried spices or refrigerated spices in squeezable tubes.
  • Ziploc bags – these will come in very handy if you travel (always pack food and supplements to go)!

Fresh:

  • Dairy (milk, yogurt, cheese)
  • Eggs (consider egg substitutes for their shelf life)
  • Fresh vegetables and fruits
  • Fish, poultry, meat

Frozen:

  • Fish, poultry, meat
  • Fruit
  • Vegetables

3 – Menu Planning

There are a number of ways you can approach menu planning but one of the easiest ways is to center your meals around the protein rich foods you plan on eating. So for instance, if you choose chicken, lean ground beef and fish, you can center 7 meals on those three proteins. Or, if your week is hectic and you are very busy, you can plan meals around protein-rich foods that take just minutes to prepare such as canned tuna, eggs and rotisserie chicken.

After you pick your protein rich foods, decide on recipes or quick prep meals. You might want to do this by determining what perishable foods you have on hand and need to use. So, let’s say you have mushrooms in the refrigerator and chicken defrosting. If you don’t feel like eating chicken Marsala but you aren’t sure what else you can make with a little flavor, type these words in Google to get other meal ideas “chicken, mushrooms, recipe, quick, easy.” (Also check out Cookinglight.com’s “5 Ingredient Cookbook, Fresh Food Fast”)

After determining which meals you are eating each day of the week, write a shopping list by figuring out any extras you may need to buy and what staple foods you are out of. Be flexible with your list depending on the season and sale prices. Shopping in season often means you will not only get the best looking produce but you will save money too. So for instance, if your recipe calls for sweet potatoes but butternut squash is a steal – go for the squash.  When you make your shopping list, you can do it on an app, in the notes section on your phone, or the old fashioned way with pen and paper. I make mine in the order of the grocery store I am shopping in so I can cross items off one by one without having to scan the entire list to make sure I’m not forgetting something before I move onto the next section of the store.

If the weekly circular tempts you with sugary cereals, cookies and candies on sale, don’t pick it up. You won’t miss out on a bargain because you’ll figure out which healthy foods are on sale when you look for the items on your list – all stores flag these items for you.

Quick sample meal ideas:

  • Rotisserie chicken, 10 minute brown rice (or thawed and microwave brown rice from your freezer), frozen veggies
  • Rotisserie chicken wraps with hummus (spread the hummus on first) and any crunch veggies you desire (shopped carrots, cucumbers etc.)
  • Whole-wheat pasta, spaghetti sauce and frozen turkey meatballs with added veggies such as cooked (or steamed) mushrooms, squash, zucchini
  • Whole wheat pasta, canned tuna, light cream of mushroom soup (either made into a casserole and baked along with frozen peas, ½ cup milk and chopped onions at 400ºF for 20 minutes or you can heat up the soup and mix the ingredients together and eat it.
  • Canned tuna, light mayo, chopped celery and onions for a tuna sandwich.
  • Grilled salmon drizzled with lemon, asparagus and a sweet potato.

4 – Storing and Packing

You can freeze almost any food and reheat it easily. Even brown rice – just cook it, let it cool completely and portion it into zip-loc bags (make sure no air is in the bag) for later. Two important things to remember when freezing foods – freeze them in airtight containers and label them so you know what you made and when it was frozen. The longer you leave food in the freezer the greater the likelihood of texture and taste changes over time (sometimes resulting in freezer burn). Foods that freeze well include:

  • Breads
  • Canned foods (once out of the can of course)
  • Casseroles (keep in mind that mayonnaise and other cream sauces do not freeze well)
  • Egg whites (raw)
  • Grains, cooked
  • Granola (homemade or store bought)
  • Herbs, fresh
  • Nuts, seeds (these should not be kept opened on shelves for long periods of time as they can go rancid)
  • Cheese – some types freeze better than others
  • Fish, poultry, meat (raw meat and poultry freezes better than cooked meat and poultry because of moisture lost during cooking).
  • Fruit, though this must be completely dry and frozen in portions (unless you want it stuck together in big clumps). The texture may change so fresh fruit that is frozen may be best used when blended in shakes.
  • Sauces
  • Soups, stews, stock
  • Yogurt – if you want to eat it frozen. If it defrosts the consistency isn’t so great.

Thaw food in the refrigerator, a microwave or immersed in cold water only (in a leak proof plastic bag submerged in the water that should be changed every 30 minutes), not out on countertops or in kitchen sinks.

Recommended Freezer Storage Time (for quality only, frozen food is safe indefinitely if left frozen).

Food Months
Bacon and Sausage 1 – 2
Casseroles 2 – 3
Egg whites or egg substitutes 12
Frozen dinners 3 – 4
Ham, hotdogs, lunchmeats 1 – 2
Meat, uncooked roasts 4 – 12
Meat, uncooked steaks or chops 4 – 12
Meat, uncooked ground 3 – 4
Meat, cooked 2 – 3
Poultry, uncooked whole 12
Poultry, uncooked parts 9
Poultry, cooked 4
Soups and stews 2 – 3
Wild game, uncooked 8 – 12

See, that wasn’t so tough! Get started planning, preparing and cooking right away. If there are a limited number of dishes you feel comfortable cooking, check out quick and easy cookbooks or resources on line. Each time you try a new recipe you’ll expand your horizons and taste buds and also be able to prepare a wider variety of meals on the fly in the future.

References
USDA. Freezing and Food Safety. http://www.fsis.usda.gov/factsheets/focus_on_freezing/

 

The Truth about Detox Diets

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Detox Diets and Cleanses

Detox diets promise to clean up the mess left behind from daily life so you feel better, more energetic and lose excess body fat. Consider them the Merry Maids for your body. They come with an army of equipment and compounds to attack years of buildup from environmental toxins, pesticides, allergens, waste, and inflammatory substances. This “sewage sludge” is stuck to your gut, interfering with digestion, leaving you bloated, tired, fat and with joints and muscles that feel like they are on fire.

In theory this sounds great. But there’s one glaring issue. The human body doesn’t need to “detox” because it comes equipped with organs designed to remove waste products. Plus, many detox diets are simply very low calorie plans with added laxatives and diuretics (because instant, yet temporary, weight loss might fool you into believing the outrageous claims on detox and cleansing products). Instead of wasting your money, take the top 3 good points about many of these diets and incorporate them into your overall nutrition plan:

Drink More Water

There are a few studies showing that individuals who are obese can lose weight by drinking 2 glasses of water before each meal. Plus, many people don’t get enough water or total fluids each day anyway and dehydration can make you feel sluggish and grouchy. So, grab it from the tap or if it’s more convenient, fill up your stainless steal water bottles and carry them with you at all times.

Eat More Fruits and Vegetables

The average American is falling short on fruit and vegetable intake. According to the National Cancer Institute, people with diets rich in plant foods, such as fruits and vegetables, have a lower risk of getting some types of cancer as well as diabetes, heart disease and high blood pressure. Produce generally has fewer calories than many other foods making it a great addition to a weight loss diet.

Get Friendly with Bacteria

Many detox plans include unfiltered apple cider vinegar – the kind that has a cloudy appearance – is full of probiotics. Probiotics are friendly (beneficial) bacteria – the kind that live in your gut and have a number of important functions in your body. Improving your gut bacteria may support immune functioning, improve the health of your intestinal tract, increase your body’s absorption of certain nutrients and alleviate constipation. Apple cider vinegar is acidic so I don’t recommend drinking it straight. Instead, dilute it in a big glass of water or another beverage. Other great sources of probiotics include kefir, yogurt (check the container for “live and active cultures”), miso soup, tempeh, sauerkraut, kimchi.

Add 2 glasses of water before each meal, load up on vegetables and fruits and make an effort to consume probiotic-rich food daily and you will reap the rewards of better nutrition without wasting money on detox diets and cleanses.

References:
Parvez J et al. J Appl Microbio 2006;100(6):1171-1185.
Parretti HM et al. Obesity 2015, 23(8):1785-1791.
Dennis EA et al. Obesity 2010;18(2):300-307.

 

Protein Before Bed for Greater Muscle Gains?

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protein before bedA recently published study found a protein rich snack before bedtime led to greater gains in muscle mass, strength, and type II muscle fiber size in young men participating in a resistance training program. Yet a closer look at the details of this study suggest the timing (before bed) might not matter at all.

In this study 44 young men were given a supplement containing 27.5 grams of casein and 15 grams of carbohydrate or a placebo that contained no protein, carbs or calories before they went to sleep each night for 12 weeks. They also lifted weights 3 times a week under the direction of a supervised and periodized program. The young men were instructed not to change their diet (other than the supplement). Food logs were taken to access dietary intake. Both groups consumed about 1.3 grams of protein per kg bodyweight before the study started. However, the group given the supplement consumed a total of 1.9 grams per kg bodyweight during the study while the placebo group continued eating the same amount of protein as they did before the study started – 1.3 grams per kg bodyweight. So, was it the timing of protein before bed, the total difference in protein intake or both that led to the results? We don’t know. However, the total protein intake of the placebo group was on the lower end of the recommended range (1.2 – 2.0 though higher values may be beneficial for some, especially those who are cutting calories) anyone should consume if they want to get stronger and bigger.

So what’s the bottom line?

We don’t know if consuming protein right before bed will help young, healthy and active adults make greater gains from their strength training program compared to consuming the same total amount of protein each day without a protein-rich bedtime snack.

My protein recommendation for now:

Meet your daily protein needs based on your goals first and if a pre-bedtime protein-rich snack helps you do this and sleep well at the same time, then great. If eating or drinking before bed interferes with your sleep (running to the bathroom counts as interfering) then this strategy may do more harm than good.

References:
Snijders T, Res PT,Smeets JSJ, van Vliet S, van Kranenburg J, Maase K, Kies AK, Verdijk LB, van Loon LJC. Protein Ingestion before Sleep Increases Muscle Mass and Strength Gains during Prolonged Resistance-Type Exercise Training in Healthy Young Men. J Nutr 2015.

Res PT, Groen B, Pennings B, Beelen M, Wallis GA, Gijsen, AP, Senden JM, Van Loon LJ. Protein ingestion before sleep improves postexercise overnight recovery. Med Sci Sports Exerc 2012;44:1560–1569.

Which Fat is Best for Heart Health?

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Butter

If you are more confused than ever about dietary fats, you’re not alone. Can a high fat diet help you lose body fat? Which fat is best for heart health – butter, coconut oil or vegetable oil?

What is Cholesterol & Why is it Essential?
Cholesterol is an essential component of all cell membranes and a precursor to hormones, vitamin D and bile acids (needed for the digestion of fat). It is so important that your body regulates cholesterol balance to ensure your cells receive a continuous supply of cholesterol.

How does High LDL Contribute to Cardiovascular Disease?

Though cholesterol is critical for life, low density lipoprotein cholesterol, LDL cholesterol, is considered a risk factor for heart disease because excess LDL can lead to an increase in plaque buildup in your arteries. Think of this process like a garden hose with gunk stuck in it. The gunk interferes with water flowing through the hose. If too much debris gets in there, no water will flow through.  Likewise, plaque in your arteries will decrease the amount of blood that moves through your arteries at one time and a complete blockage could lead to a heart attack or stroke.  Now, this is a simplistic view, especially considering LDL isn’t just one particle but instead, several that contain different amounts of cholesterol. Some research suggests that smaller, more dense LDL particles are more artery clogging. However, in addition to particle size, total number of LDL particles and oxidation of LDL contribute to the disease process.

As LDL particles travel through the bloodstream, excess LDL particles can stick to artery walls (particularly walls that are damaged due to smoking, high blood pressure and other insults). Trapped LDL becomes oxidized and sets off an inflammatory cascade resulting in the development of plaque (gunk) stuck to arteries – atherosclerosis.

Coronary Artery Disease

How Can I Lower my LDL Cholesterol?

Cholesterol in food has little effect on your blood cholesterol.

Years ago we were told to stay away from shrimp, eggs and other high cholesterol foods. Yet this advice wasn’t based on sound science – cholesterol in food has little effect on your blood cholesterol levels. So there is no need to take these nutrient-rich foods out of your diet. Shrimp is loaded with protein, and is a good source of iron plus it contains just 80 calories per serving. Eggs are also packed with nutrition – the whites are an excellent source of protein and the yellow color you see in the yolk is from antioxidants – plant compounds that protect plants from disease and protect your body from the damaging effects of free radicals, compounds that are essential but can cause damage as well.

Coconut Oil, Butter and Other Solid Fats are Not the Best Options

Man-made trans fats (partially hydrogenated oils) are the worst kind of fat you can eat. However, they should, finally, be making their way out of our food supply over the next few years. High levels of *saturated fat, the kind that is solid at room temperature like butter, increases HDL (the “good” cholesterol but not a target of therapy – doctors don’t focus on HDL levels because increasing HDL does not lower heart disease risk) and LDL cholesterol in the blood. In controlled diet experiments where saturated fat is replaced with polyunsaturated fat rich vegetable oils, risk of heart disease is reduced. Replacing saturated fat with monounsaturated fat, the kind found in olive oil, also lowers LDL but not to the extent that polyunsaturated fat does.

Coconut oil is popular and calorie for calorie it might be better for weight management than other fats. However, coconut oil raises our total, good and bad cholesterol levels. And therefore, it is not the best option for heart health.

Excess Carbohydrate Intake can Increase LDL

Overconsumption of carbohydrate-rich foods can also increase VLDL cholesterol (very low density lipoprotein). Foods with added sugars, in particular, are potent stimulators of VLDL production when the energy (calories) aren’t needed right away for energy or increasing glycogen stores (stored carbohydrate in your liver and muscle).

Best Fats for Your Heart

Nuts, seeds, avocados, olives and liquid oils are your bets for heart health. Oils with more polyunsaturated fat have a greater impact on LDL cholesterol than those rich in monounsaturated fat. Make sure you are choosing the right oil for the right cooking application. Many oils can’t stand high heat and they break down, damaging the structure (and function) of the oil.

Fatty Acids in Oils

Conclusion

Many factors contribute to high blood cholesterol levels, including genetics, overweight/obesity, inactivity, smoking, diabetes and age, making cholesterol management a multifactorial issue. Saturated fat increases LDL cholesterol but, as I’ll say over and over, we are all different and, people vary in their response to dietary saturated fat due to intrinsic differences in fat metabolism as well as other factors including obesity, insulin resistance and high triglycerides.

Replace fats that raise cholesterol with liquid oils, nuts, seeds, avocados, and olives. Consider your overall diet as well. Eat a plant-based diet including vegetables (non-starchy veggies as well as beans, lentils and peas), fruits, nuts, seeds and whole grains (oats, barley etc.). Consume fatty fish ( salmon, mackerel, herring, halibut, sardines etc.) at least two times per week. Limit your intake of foods with added sugars and refined starches as well as your alcohol consumption. 

* There are differences in specific saturated fatty acids and their effects on blood cholesterol. Therefore, some foods high in saturated fat do not raise LDL cholesterol. Also, oils have a different array of vitamins (primarily vitamin E) and plant-based compounds that may be beneficial for heart health.

Fatty acids composition of oils taken from the USDA Nutrient Database.

In Search of the Perfect Diet

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Nutrition pathway to changes

I am running into more and more nutrition purists. People who think their approach to eating is absolutely perfect, free from all harmful substances, and better than any other approach to nutrition. The purist sits across from me, preaching about GMOs, pesticides, carbohydrates, gluten, processed foods and salt, talking at warp speed only to take a breather so they can sip on their organic greens drink (mixed into pH balanced water of course). Meanwhile, deep from within their soul I feel their longing for acceptance, as if they are in a confessional, looking for me to forgive their past nutrition sins – a life full of bread, dairy and fast food grilled chicken – and commend them on becoming a disciple of nutrition purity. Their eyes search, looking away as they ramble and catching mine again as they look for an expression from me. Anything. Even a simple head nod would provide the validation they are looking for.

I’m always happy when people move from less than healthy diets to more healthy diets. The problem with nutrition purists is they believe there is ONE diet for everyone. ONE pattern of eating and everything else is wrong. They aren’t looking for advice or information from me but instead want me to acknowledge they are doing everything right. Forget science because this person is drinking the Kool-Aid (err, powered dehydrated veggies) from internet blogs written by some self-proclaimed nutrition expert who relies on sensationalism and scare tactics. Their mind is closed to learning anything that doesn’t fit within the doctrine of this self-proclaimed nutrition expert (quack). So I sit there with a blank look on my face though in the back of my mind I am wondering things like “if only this 20-something year old fit male knew the research on this subject was conducted in obese postmenopausal women.”

Saying there is one diet that fits all is akin to giving everyone the same workout program. If you’re a strength coach or personal trainer, would you put everyone on the exact same program? Would you give an 82 year-old grandma who has never worked out the same program as a 43 year-old marathoner? No. So why on earth would you give everyone the exact same nutrition guidelines and supplements? Please, throw away those silly one-pagers with nutrition “rules” you aimlessly hand out to everyone that walks through your door.

My job is to move a person from where they are to better so they meet their goals. Everyone has a different starting place, set of beliefs, goals, health history, medications they are on, food likes and dislikes, cooking skills, budget, training program and more. Nutrition is like a road map – there are many routes you can take, some are quicker that others, some have roadblocks, traffic or require a vehicle that can jump a few curbs or possibly even a bike to make it through narrow spaces. Going to a seasoned nutrition profession is like hitting Google Maps and figuring out the best route for you. The alternative is aimlessly driving in a foreign city without street signs (ciao Pescia Italy! I have fond memories of driving in circles, next time I’ll bring a GPS and my Italian will be much better too, I promise).

So, before you drop your jaw and blast me after hearing I told a client he could eat fast food once a week, stop to consider this person’s starting place: fast food everyday. And some clients aren’t willing to give up certain foods or drinks so make substitutions, so I meet them where they are. If I try and switch a junk food eater who binges on alcohol to an all-organic diet without cheeseburgers and fries, chances are they will fail and give up.

Nutrition is a complex science. There isn’t ONE approach that works for everyone or one that every single person is willing to follow. So, if you are that person who is bound to a single nutrition doctrine, please open your ears a little and be willing to consider there are many factors that should be considered before a person goes on a diet or makes drastic dietary changes. And please, read a few research studies or textbooks prior to preaching to others because chances are 90% of what you reading isn’t backed by science or common (biochemistry) sense.

Should You Go on a Detox from Sugar?

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Should You Go on a Detox from Sugar?

Oh my gosh, the TODAY show just launched a new initiative called the 10-day sugar detox (#NoSugarTODAY). I’m so sick of detoxes! Though most people should reduce their intake of added sugars, let’s call a spade a spade: sugar is hardly “toxic”. Before giving a nutrient so much power, let’s get the facts right:

              –  No one single nutrient is responsible for poor health, weight gain, etc.

                –  Diet is a confluence of factors: food, lifestyle (exercise, activities of daily living,  sleep and more), etc.

                  –  Rather than focus on the single nutrient, think *really* hard about what you want to accomplish.

Why Should We Give Up Sugar?

It’s tough to tease out single ingredients like sugar and their potential health effects. However, we are eating too much added sugar – the kind that is mixed in during cooking or food processing. Men are averaging 335 calories from added sugars (20 teaspoons) whereas women are taking in an average of 239 calories (15 teaspoons) from added sugar each day. Kids are consuming a whooping 16% of their calories from added sugars.[1] The majority of added sugar in our diet comes from our food (as opposed to beverages). And while some of the sources are things you might expect: sodas, desserts, nutrition bars, etc., some of the added sugar culprits are seemingly healthy foods such as salad dressings and sauces. Added sugar enhances taste and provides calories but has no real nutrition value, in other words, no vitamins, minerals or plant based compounds that are important for good health. Naturally occurring sugars are found in foods packed with good nutrition including fruits, vegetables and dairy products. Though added sugars have nothing to offer you, giving up the sweet stuff for 10 days may be a short-term solution yet ineffective for the long term.

Here’s why the TODAY Show is missing the mark with this 10-day detox:

– 10 days isn’t long enough to change a habit. It’s more like taking a vacation.

– The cold turkey approach rarely works. You’re better off gradually reducing.

– Foods with naturally occurring sugars such as 100% fruit juice and dried fruits are wrongly maligned. In fact, the majority of research shows moderate amounts of 100% fruit juice are not linked to overweight or obesity in adults or children).

– You’re allowed to go right back to your old eating habits after 10 days. So what’s the point?

Why Limit Yourself to 10 Days? Set Yourself Up for a Lifetime of Success

–  Figure out why you are tempted to do a sugar detox and then plan to specifically address that issue.

–  Log your food intake for at least 3 days via MyFitnessPal. See how much sugar   you’re really eating. Can you tell which foods are sugar-added vs. naturally sweet?

–  Find small changes to reduce added sugars. For instance, you may need to cut down on sodas, or swap ice cream for a 100% fruit juice pop, or make your own vinaigrettes (really easy – especially if you take flavored vinegars and combine them with extra virgin olive oil; or try one of these simple, unique recipes)

–  Don’t deprive yourself of foods with naturally-occurring sugars. When I crave something sweet I reach for dried figs (or other fruit), plain yogurt, or sparkling water mixed with 100% fruit juice. All of these give me vitamins, minerals, and healthy plant-based compounds called polyphenols.

–  Reassess your food intake after 1 month and see if you can make any additional improvements).

–  Bottom line: progress is in the small steps, not giant leaps (or in this case, detoxes).

Many Americans should cut down on added sugars and make room for more nutrient-dense foods. But, don’t thrown the baby out with the bathwater and then go on an all-out sugar binge because you feel deprived. Forget the “detox,” figure out your “why” (why would you do a detox? What do you hope to gain?) and then carve out a reasonable plan for change that doesn’t focus on one single dietary variable. After all, there is no one food or ingredient that leads to obesity, chronic disease, feeling like your energy is zapped, or any other health issue.

[1] Ervin RB, Ogden CL. Consumption of added sugars among U.S. adults, 2005– 2010. NCHS data brief, no 122. Hyattsville, MD: National Center for Health Statistics. 2013. http://www.cdc.gov/nchs/data/databriefs/db122.pdf

[2] O’Connor TM, et al. Beverage intake among preschool children and its effect on weight status. Pediatrics. 2006. 118:e1010-e1018.

[3] Field AE, et al. Association between fruit and vegetable intake and change in body mass index among a large sample of children and adolescents in the United States. Int J Obes Relat Metab Disord. 2003. 27:821-826.

[4] O’Neil CE, et al. A review of the relationship between 100% fruit juice consumption and weight in children and adolescents. Am J Lifestyle Med. 2008. 2:315-354.

[5] Johnson L, et al. Is sugar-sweetened beverage consumption associated with increased fatness in children? Nutrition. 2007. 23:557-563.