The Great Debate: Carbs vs. Fat

 

Submitted by Amy Sercel MS RD CD

Edited by Marcia Bristow MS RDN CSSD CD

A few weeks ago, the media yet again caught onto a new nutrition study.  You might have heard about it in an article titled something like “Large diet study suggests it’s carbs, not fats, that are bad for your health,”¹ “New study favors fats over carbs,”² or even, “Large-scale dietary study: fats good, carbs bad.”³ Many of these articles dramatically over-simplify the original research.

The study analyzed the diets of 135,335 people living in 18 different countries, then followed these people for an average of 7 years to track their health outcomes.  After seven years, the researchers compared participants’ original dietary patterns to their risks of dying from any cause, developing cardiovascular disease, and dying from cardiovascular disease during the time of the study. 

Researchers found that the risk of dying from any cause increased as people ate more carbohydrates.  Specifically, when carbohydrates made up about 77% of a person’s total calorie intake, they were 12-22% more likely to die during the study than when carbohydrates made up about 46% of total calorie intake.⁴ Right now, it’s recommended that 45-65% of your calories come from carbohydrates

On the other hand, people who consumed an average of 35% of their calories from fat had a 5-10% lower risk of death, heart disease, stroke, or heart attack than people who only consumed about 10% of their calories from fat.  Furthermore, people with higher intakes of saturated fat were not any more likely to develop heart disease, have a heart attack, or die from a heart attack.⁴ The highest intake of saturated fat was around 12% of total calories.  The current recommendations suggest that 20-35% of calories come from all types of fat, and no more than 10% of calories come saturated fat.

It’s interesting to compare the original research to the articles published in the media.  These articles seem to promote the idea that all carbohydrates are “bad.”  This may lead you to believe you should stop eating carbohydrates altogether and eat more of all types of fat.  In reality, the original research article does not recommend doing so.  The researchers did not find any health benefit when carbohydrate intake was less than 50% of calories.⁴

Furthermore, carbohydrates come from a wide variety of foods.  While it’s true that foods like candy, soda, and refined flour are all sources of carbohydrates, you also get carbohydrates from fruits, vegetables, dairy products, beans, nuts, and whole grains.  These foods provide important vitamins and minerals, as well as fiber and antioxidants that have been shown to protect against certain diseases.

There are several limitations to this study that make it difficult to draw conclusions that apply to the average person’s diet.  Most significantly, the researchers did not differentiate between the sources of participants’ carbohydrates, and the authors admit that the countries with the highest carbohydrate intakes tend to eat large quantities of white rice and white bread.⁴ It’s already known that eating a diet high in refined carbohydrates and sugar elevates your blood sugar and may lead to insulin resistance, which in turn can cause your liver to secrete more triglycerides into your blood because your cells aren’t getting the energy they need from carbohydrates.  As a result, you may be more likely to develop cardiovascular disease if your sugar intake is high.⁵

At the same time, peoples’ needs for carbohydrates, protein, and fat vary significantly based on their lifestyle and activity levels.  For example, endurance athletes may need up to 70% of their calories to come from carbohydrates to make sure that their muscles have enough fuel to keep them going during an athletic event.  This is important for athletes, but would not necessarily be healthy for someone who is less active.  More follow-up studies are needed to confirm this study’s findings before any of the current nutritional recommendations can be modified.   

Rather than changing your diet based on one research study, meet with a Registered Dietitian who can provide you with individualized, evidence-based recommendations based on your unique lifestyle and needs.  Reduce your intake of refined carbohydrates like white flour and foods high in sugar, and make an effort to choose whole grains, fruits, vegetables, beans, lean protein, and unsaturated fats whenever possible.  These general recommendations have stood the test of time and are not going to change based on one research study.

References:

1.         Large diet study suggests it’s carbs, not fats, that are bad for your health - CBS News. https://www.cbsnews.com/news/large-study-suggests-carbs-not-fats-bad-for-you/. Accessed September 12, 2017.

2.         Bakalar N. New Study Favors Fat Over Carbs. The New York Times. https://www.nytimes.com/2017/09/08/well/new-study-favors-fat-over-carbs.html. Published September 8, 2017. Accessed September 12, 2017.

3.         Large-Scale Dietary Study: Fats Good, Carbs Bad - Slashdot. https://science.slashdot.org/story/17/08/30/0444248/large-scale-dietary-study-fats-good-carbs-bad. Accessed September 12, 2017.

4.         Dehghan M, Mente A, Zhang X, et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. The Lancet. August 2017. doi:10.1016/S0140-6736(17)32252-3.

5.         Insulin Resistance and Lipid Disorders. Medscape. http://www.medscape.com/viewarticle/584885. Accessed September 12, 2017.

Should You Try the Whole30?

Submitted by Amy Sercel MS RD CD

Edited by Marcia Bristow MS RDN CSSD CD

“Do you really want to eat another hard boiled egg?”  That’s what one woman asked herself every time she felt hungry for a snack during the Whole30 Diet.  This restrictive, month-long program seems to be the latest nutrition fad.  The diet’s website claims it will help fix a wide range of health issues, including low energy, food cravings, difficulty with weight loss, aches and pains, skin rashes, and seasonal allergies.¹ To get these results, participants must avoid the following foods for thirty days:

• Any added sweeteners, including sugar, honey, maple syrup, and artificial sweeteners
• Alcohol
• Any type of grains, including wheat, rice, and quinoa
• All legumes, including black beans, chickpeas, soy beans, and peanuts
• All dairy products
• Carrageenan
• MSG
• Sulfites

The program claims these foods promote inflammation and damage the intestinal lining, leading to health problems.  The Whole30 rules also state that you can’t weigh yourself or take body measurements throughout the thirty days, must re-start if you break the rules at any time, and can’t re-create “junk” foods, even if you use ingredients that fit with the program’s requirements.  This means that muffins or pancakes are still out, even if they’re made with coconut flour, eggs, and raisins, and pizza or baked goods made with almond flour and no added sweeteners are not allowed either.  In addition, the program recommends eating no more than two servings of fruit per day, limiting your snack consumption as much as possible, and avoiding carbohydrates before a workout.² Participants are instead expected to eat three meals per day, each centered on a 3-6 ounce serving of meat, fill the remainder of their plate with vegetables, and include small servings of approved fats like tree nuts, coconut flakes, or vegetable oils.

Problems With the Whole30

The Whole30 is a highly restrictive program that forbids several food groups without providing any evidence-based explanation as to why these foods are harmful.  It’s likely that you’re supposed to purchase their book to learn the rationale; however, food groups like dairy, legumes, and grains have been part of the human diet for thousands of years and are known to provide important health benefits.  For example, one study found that people who eat 2.5 ounces whole grains each day are around 20% less likely to develop and die from heart disease than people who do not eat grains.  Whole grains also provide fiber that is known to improve gut health and reduce your risk for developing Type 2 Diabetes.³

Along the same lines, legumes and dairy are known to be nutritious food groups that provide protein, carbohydrates, and a variety of vitamins and minerals.  Legumes are a good source of fiber, which supplies food for the good bacteria in your intestines and promotes digestive health.  Legumes also contain several anti-inflammatory compounds that have been shown to protect against colorectal cancer.⁴

Dairy consumption has also been associated with decreased inflammation and risk for Type 2 Diabetes.  One study looked at people with metabolic syndrome (an inflammatory disease) who were overweight or obese and regularly consumed less than one serving of dairy per day.  Just one week after increasing their dairy intake to three servings per day, participants experienced a decrease in inflammatory stress, improved insulin sensitivity, and lower blood pressure.⁵ Dairy products also make up a significant source of calcium in the American diet.  Avoiding dairy can result in a low calcium intake, which can lead to osteoporosis and contribute to high blood pressure.  While you can get calcium from vegetables, your body does not absorb this calcium as easily as it absorbs calcium from dairy.  Furthermore, eating a high-protein diet, such as the one recommended by the Whole30, can cause you to excrete more calcium in your urine, which would make it even more challenging to consume enough calcium from food while following this program.⁶

Finally, eliminating food groups and restricting what you eat might help you lose weight in the short term, but it is very unlikely that you will maintain any weight loss you experience during the Whole30.  The diet is only intended to last for thirty days, so it is likely that you will eventually go back to your old eating patterns.  A review of 31 studies followed people on diets for between two and five years and found that between 30 and 60% of participants had re-gained all or more of the weight they initially lost in the first six months of the diet.  In fact, people who went on a diet were more likely to gain weight within four years than people who did not go on a diet.^7,8 While it may seem like you could just re-do the Whole30 to lose any weight you re-gain, this is not the healthiest option.  The cycle of losing and re-gaining weight is associated with heart disease, stroke, and diabetes, meaning that the Whole30 could set you up for future health problems if you use it as a quick weight loss tool.

Positive Aspects of the Whole30

Despite these problems, thousands of people claim that the Whole30 Diet has changed their lives for the better.  It’s likely that people feel better and lose weight during the course of the diet because they are now eating significantly more vegetables while avoiding processed and fried foods, added sugar, and alcohol.  Vegetables provide a variety of important vitamins and minerals, and if you suddenly start eating more of them you may correct nutrient deficiencies you didn’t know you had, making you feel more energized and healthy.  At the same time, avoiding foods high in added sugar and refined carbohydrates will help keep your blood sugar even and therefore cause you feel more energetic and experience fewer cravings throughout the day.

Furthermore, in order to comply with the Whole30’s rules, people who complete it need to become familiar with reading food labels to make sure they aren’t accidentally eating a forbidden ingredient.  Paying attention to the nutrition facts label will help you get an understanding of the number of calories and grams of fat, carbohydrates, and protein in processed foods and learn to make the most nutrient-dense food choice in the grocery store.  Once you develop this habit on the Whole30, you may continue it and become more mindful of the nutrient content of foods you choose even after going off the diet.

Lastly, the Whole30 provides an online forum where participants can ask questions and seek support from each other.  Identifying as part of group in this way might help keep people accountable and provide motivation to continue working towards their goals, making this a positive aspect of the Whole30 program. 

A Better Solution

Rather than overhauling your diet and avoiding important food groups for a month, you would be better off incorporating some of the Whole30’s recommendations into your typical meal pattern.  Limit the amount of added sugar, refined grains, alcohol, and processed foods you consume, but recognize that it is perfectly acceptable to consume these foods every so often.  Eat a wide variety of vegetables and lean protein at each meal, and remember the value of eating whole grains, legumes, and dairy.  Meet with a Registered Dietitian who can help you modify your current meal pattern and find ways to enjoy a variety of nutrient-dense foods within your calorie needs.  Make changes that fit in with your food preferences so you will be able to continue them for the long term.  After all, healthy habits should last a lifetime, not just thirty days. 

References:

1.         The Whole30® Program. https://whole30.com/whole30-program-rules/. Accessed August 23, 2017.

2.         Whole30 101: Rules vs Recommendations | The Whole30® Program. https://whole30.com/2015/01/rules-recommendations/. Accessed August 24, 2017.

3.         Harvard T.H Chan School of Public Health. Whole Grains. The Nutrition Source. https://www.hsph.harvard.edu/nutritionsource/whole-grains/. Published January 24, 2014. Accessed August 24, 2017.

4.         Clemente A, Olias R. Beneficial effects of legumes in gut health. Curr Opin Food Sci. 2017;14:32-36. doi:10.1016/j.cofs.2017.01.005.

5.         Stancliffe RA, Thorpe T, Zemel MB. Dairy attentuates oxidative and inflammatory stress in metabolic syndrome. Am J Clin Nutr. August 2011:ajcn.013342. doi:10.3945/ajcn.111.013342.

6.         Weaver CM, Proulx WR, Heaney R. Choices for achieving adequate dietary calcium with a vegetarian diet. Am J Clin Nutr. 1999;70(3):543s-548s.

7.         Wolpert S. Dieting does not work, UCLA researchers report. UCLA Newsroom. http://newsroom.ucla.edu/releases/Dieting-Does-Not-Work-UCLA-Researchers-7832. Accessed August 24, 2017.

8.         Mann T, Tomiyama AJ, Westling E, Lew A-M, Samuels B, Chatman J. Medicare’s search for effective obesity treatments: diets are not the answer. Am Psychol. 2007;62(3):220-233. doi:10.1037/0003-066X.62.3.220.

9.         Karfopoulou E, Anastasiou CA, Avgeraki E, Kosmidis MH, Yannakoulia M. The role of social support in weight loss maintenance: results from the MedWeight study. J Behav Med. 2016;39(3):511-518. doi:10.1007/s10865-016-9717-y.

Nutrition for Athletes Part 4: Eating on the Road

 

Submitted by Amy Sercel MS RD CD

Edited by Marcia Bristow MS RDN CSSD CD

Whether you’re traveling for a competition or simply having a night out with friends or family, there will undoubtedly be times that you find yourself eating away from home.  In times like these, it may be challenging to find foods that fit with your nutritional goals.  Even when you’re away from home, you still need to think about getting a balance of carbohydrates, protein, and fat in each meal and snack.  Carbohydrates, found in foods like whole grains, fruits, vegetables, and dairy products, will provide the fuel you need before exercise and replenish your muscle glycogen stores after a workout.  Lean protein, found in foods like chicken, beef, fish, eggs, and dairy products, provide the building blocks your muscles need to grow and repair themselves.  Healthy fats found in olive and canola oils, avocadoes, and nuts, help you meet your calorie needs and absorb the fat-soluble vitamins A, D, E, and K.¹

The best way to make sure you’ll eat well-rounded meals and snacks is to plan ahead.  If you’re traveling, pack a few snacks so you won’t get too hungry between meals.  Some easily transportable foods include:

• Trail mix with nuts and dried fruit
• Whole-wheat bagels spread with nut butter
• Fresh vegetables with hummus
• Low-fat yogurt with granola
• String cheese and a piece of fruit

If you’ll need to stop at a restaurant for a meal, look for restaurants along the route you’ll be driving before you leave your home.  Check to see if the restaurant’s menu is online so you can get a good idea of the different options you could order, and consider whether the restaurant will let you make a substitution if the original meal won’t meet your nutrition goals.  Some healthy ideas could be:¹

• A burrito with grilled vegetables and lean protein, such as chicken, steak, or fish
• A sandwich, hamburger, or veggie burger with lettuce and tomato 
•  A grilled chicken salad with low-fat dressing
• Vegetable soup with a turkey sandwich

You should also feel free to ask the chef to prepare your food differently than written on the menu.  Most restaurants will make an effort to prepare foods exactly how you want them and are used to customers asking for their meals to be individualized in some way.  For example, ask for a side of vegetables instead of French fries when getting lunch, or order whole grain toast instead of a biscuit at a breakfast restaurant.  If something comes fried, ask if you can get it grilled, broiled, or baked instead.  If a salad comes with dressing on it, ask that the dressing be left on the side so you can choose the amount you’ll use. 

Eating away from home doesn’t mean you’ll have to sacrifice your nutrition goals!  Planning ahead and making substituting healthier options will allow you to make sure you get the nutrients you need to prepare you for your workout or competition.

References:

1.         Sports, Cardiovascular, and Wellness Nutrition. Eating on the Road. 2012.

Nutrition for Athletes Part 3: During Exercise

 

Submitted by Amy Sercel MS RD CD

Edited by Marcia Bristow MS RDN CSSD CD

Eating balanced meals on a day-to-day basis and fueling properly before exercise has a huge impact on the way you feel and perform.  It’s just as important, however, make sure you continue to fuel and hydrate during exercise.  During exercise, the goals of refueling include replenishing your carbohydrate stores, fluids, and electrolytes.

Carbohydrates

As you exercise, your muscles get energy from the glycogen your body has stored in your muscles and liver.  During exercise that lasts for less than 45 minutes, you won’t experience any negative effects of this.  In longer activities these stores get used up you might feel tired and less able to concentrate.  Eating carbohydrates can help prevent you from using up these stores and keep you performing at your peak.  Re-fueling regularly is especially important if you’ll be exercising for two hours or more, when higher carbohydrate intake has been linked to improved athletic performance.¹ As with eating just before activity, it’s best to choose sources of carbohydrates that are digested easily, so they don’t weigh in your stomach and slow you down.  You’ll also want to avoid foods that are high in fiber and fat.

It’s recommended that you get about 0.5 grams of carbohydrates per pound of your body weight per hour of exercise, either through a sports drink or through more easily digested carbohydrate foods.² For example, a 150-pound person would need about 75 grams of carbohydrates per hour.  You could get this by eating four medjool dates or a large banana with a 20-ounce sports drink.  The amount of time you’ll have to eat during exercise will vary based on your sport.  If you don’t have time to eat a full meal, sports drinks or supplements like GU can give you the carbohydrates you need to stay fueled.  Practice re-fueling with carbohydrates during exercise so you’ll know which foods work best for you and won’t run into any surprises on the day of your competition.

Fluids

If you get dehydrated during exercise, you’ll probably feel lower endurance levels and have trouble concentrating.  More severe dehydration can even lead to decreased blood flow to your muscles and significantly lowered exercise endurance.¹ To prevent this, aim to drink between ½ and 1 cup of a sports drink that contains carbohydrates and electrolytes per hour of activity.  Look for sports drinks that list glucose, maltose, dextrose, or maltodextrin as the first ingredient, as you’ll be able to digest and absorb these sugars more easily than fructose or sucrose.

You can get an idea of the amount of fluids you need to perform your best by experimenting with hydration in your training sessions to learn your sweat rate.  Weigh yourself before and after activity; a loss of 1 pound represents a loss of about two cups of fluid, and you’ll need to drink that much fluid to ensure that you stay properly hydrated.¹ Losing more than 2% of your starting body weight is considered excessive fluid loss, and will lead to fatigue and impaired exercise performance.  For a 150-pound person, this would mean losing 3 pounds during activity.

Electrolytes

When you exercise for more than two hours in a row, you will also need to replenish the electrolytes lost in your sweat: sodium and potassium.  Taking in too much water without replenishing these electrolytes can lead to “water intoxication,” or overhydration.  This can lead to nausea, vomiting, confusion, seizures, and even loss of consciousness and death.¹ Sports drinks are fortified with electrolytes, and foods like fresh or dried fruits, pretzels, or crackers will also provide sodium and potassium as you exercise.

Keeping your carbohydrate stores high, replenishing your electrolytes, and staying hydrated during exercise will help you make sure you perform your best.  For individualized recommendations, talk to a Registered Dietitian who can make you a plan that will work for your food preferences and athletic goals.

References:

1.         Thomas DT, Erdman KA, Burke LM. Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and Athletic Performance. J Acad Nutr Diet. 2016;116(3):501-528.

2.         Sports, Cardiovascular, and Wellness Nutrition. Fueling for Performance: How proper timing of meals affects both sport and academic performance. NCAA.org - The Official Site of the NCAA. http://www.ncaa.org/health-and-safety/nutrition-and-performance/fueling-performance-how-proper-timing-meals-affects-both. Published December 18, 2013. Accessed March 29, 2017.