Download fad diet - Katz Institute for Women`s Health

Fad Diets, Vitamins and Supplements Making Sense of It All
Making Sense of It All
Robert E. Graham, MD, MPH, ABIHM, FACP
Associate Program Director & Director of Resident Research
Director of Integrative Health & Therapies
Department of Medicine, Lenox Hill Hospital The Katz Institute for Women's Health Women's Conference
Celebrating Women's Health: A Better You Today, Mind Body Spirit
Tuesday, 13 May, 2014
Food faddism/fad diet
Food faddism/fad diet
• Food
Food faddism
faddism and fad diet
fad diet originally referred originally referred
to idiosyncratic diets and eating patterns that promote short‐term
promote short
term weight loss, usually with weight loss usually with
no concern for long‐term weight maintenance and enjoy temporary popularity
maintenance, and enjoy temporary popularity.
http://en.wikipedia.org/wiki/List_of_diets
The Big Ones
The Big Ones
• South Beach Diet: "bad carbs" and "bad fats" with "good carbs" and "
"good fats.”
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• Weight Watchers' ProPoints plan: Every food is worth a different number of 'points', all of which add up to your weekly limit. Moderation and meetings
Moderation and meetings.
• Zone: 30‐30‐40 breakdown to help control insulin levels and hunger, getting 30%calories from protein, 30%from fat, and 40% from carbohydrates
• 5:2 Diet: Eat normally for five days and 'fast' for two, cutting down your calorie intake to just a quarter of the usual daily amount. • Dukan Diet: “The Brits 4 phases” limit protein, add veggies, no starch or grains, re‐introduce
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• Clean and Lean Diet: The key is to stick to fresh, unprocessed foods, as close to their natural state as possible.
• Raw: restricting food that is cooked or heated above 116 to 118°
Raw restricting food that is cooked or heated above 116 to 118° F
"Eskimo diet" Smith MM, Trexler ET, Sommer AJ, Starkoff BE, Devor ST. Unrestricted
Paleolithic diet is associated with unfavorable changes to blood lipids in
healthy subjects. Int J Exerc Sci. 2014;7:128-139.
Food Magazine: Estimating Calories
Which item from McDonalds contains the most total fat? a: Large French fries (170g portion) b: Double Cheeseburger (165g portion) c: Filet‐O‐Fish
c: Filet
O Fish sandwich (143g portion) sandwich (143g portion)
d: McChicken sandwich (147g portion)
Which 15 centimetre (six inch) sub at Subway contains the most calories? a: Tuna salad (250g portion) b: Steak and Cheese (278g portion)
b: Steak and Cheese (278g portion)
c: Italian (Salami, Ham, Pepperoni and Cheese) (243g portion) d: Cold Cut Combo (249g portion)
Food Commission. Which fast food meals are healthiest? Anyone's Guess! The Food Magazine 2008; Aug:82
Standard American Diet (SAD)
Standard American Diet (SAD)
The modern (SAD) diet The
modern (SAD) diet
is the main reason why
is the main reason why people all over the l ll
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world are fatter and ld
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sicker than ever before. Everywhere modern processed foods go, chronic diseases soon follow
chronic diseases soon follow.
When people abandon their
When people abandon their traditional foods in favor of traditional foods in favor of
modern processed foods
modern processed foods high in sugar, refined flour g
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and vegetable oils, g
,
they get sick. Of course, there are many Of
course there are many
things that can contribute
things that can contribute to these health problems
to these health problems, but changes
but changes in the diet are the most
in the diet are the most important factor
important factor.
Not soon enough. Laboratory tests over the
Laboratory tests over the last few years have proven that babies who start drinking soda during that
drinking soda during that early formative period have a much higher chance of g
gaining acceptance and g
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"fitting in" during those awkward pre‐teen and teen years.
So, do yourself a favor. Do your child a favor. Start them on a strict regimen of sodas and other sugary d
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carbonated beverages right now, for a lifetime of guaranteed happiness
guaranteed happiness.
1. Drink Water, Not Calories
1. Drink Water, Not Calories
2. Eat off smaller plates
2. Eat off smaller plates
switching from a 12‐inch to a ten‐inch plate leads people to eat 22% fewer
eat 22% fewer calories.
If you downsized only your dinner plate, you'd be eliminating more than 5,000 calories a month from your diet
Eat off smaller plates
Eat off smaller plates
3. Stop eating before
you feel full
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Okinawans say: Hara hachi bu
*
*oils are very high in Omega‐6 fatty acids
often hydrogenated, which makes them high in trans fats
7% of calories in the U.S. diet in the year 1999,
mostly from processed foods
Einkorn wheat
Einkorn wheat Modern dwarf wheat
Modern dwarf wheat Modern dwarf wheat which contains 19‐28% less of important minerals
4. If you can’tt read it , don
4. If you can
read it , don’tt eat it!
eat it!
“Don't eat anything your great grandmother wouldn't recognize as food.” ‐Michael Pollan
“Don’t eat anything with more than five ingredients, or
ingredients, or ingredients you can't pronounce.” ‐Michael Pollan
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A banana is…
A banana is…
a banana
Change Philosophy
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“Pill for an Ill” to “Address the Cause”
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From: Different Time Trends of Caloric and Fat Intake Between Statin Users and Nonusers Among US
Adults: Gluttony in the Time of Statins?
JAMA Intern Med. 2014;():. doi:10.1001/jamainternmed.2014.1927
Figure Legend:
Trends of Estimates for Fat Intake Among US Adult Statin Users and Nonusers, 1999-2010Adjusted for age category, sex, race and
ethnicity educational attainment
ethnicity,
attainment, and diabetes diagnosis
diagnosis. Error bars represent 95% CIs
CIs. Larger points represent significant changes
from 1999-2000.
Date of download: 4/30/2014
From: Different Time Trends of Caloric and Fat Intake Between Statin Users and Nonusers Among US
Adults: Gluttony in the Time of Statins?
JAMA Intern Med. 2014;():. doi:10.1001/jamainternmed.2014.1927
Figure Legend:
Trends of Estimates for Caloric Intake Among US Adult Statin Users and Nonusers, 1999-2010Adjusted for age category, sex, race
and ethnicity,
ethnicity educational attainment
attainment, and diabetes diagnosis
diagnosis. Error bars represent 95% CIs
CIs. Larger points represent significant
changes from 1999-2000.
Copyright © 2014 American Medical
Association. All rights reserved.
Date of download: 4/30/2014
True or False
True or False
• A healthy diet should provide nearly all the nutrients you need. • Many people don’t eat the healthiest of diets.
Many people don’t eat the healthiest of diets
The law defines dietary supplements in part as products taken by mouth that contain a "dietary ingredient." Dietary ingredients include vitamins, minerals, amino acids, and herbs or botanicals, as well as other substances that can be used to SUPPLEMENT the diet.
Caveat #1
Caveat #1
• Don't
Don t forget that vitamin requirements and forget that vitamin requirements and
safety can depend on your personal health and certain supplements can interact with each other or with medications. • You should always check with your doctor before taking a new supplement. • Ultimately, unless you are directed to do so by a doctor, try to limit yourself to taking no more than five supplements.
“Don’t ask, don’t tell needs to “D
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be abandoned ” be abandoned.
Eisenberg, JAMA 1997
The imperfect science
The imperfect science
• Proof
Proof of safety, efficacy, quality not required of safety efficacy quality not required
before the supplement is marketed, unlike for drugs
for drugs.
• At this time, manufacturers must meet the requirements of the FDA'ss Good requirements of the FDA
Good
Manufacturing Practices (GMPs) for foods ‐
voluntary voluntary
Americans Views on Dietary Americans’
Views on Dietary
Supplements (2012)
• 38% of Americans reported having taken any dietary supplement in the past 2 years – 14% reported taking supplements regularly.
14% reported taking s pplements reg larl
• Most supplement users are NOT influenced by government opinion of efficacy. • Only 25% responded that they would cease their use of a supplement if public health authorities stated that it was ineffective.
ineffective
Blendon RJ, Benson JM, Botta MD, Weldon KJ. Users' Views of Dietary Supplements.
Arch Intern Med. 2012;1‐2. Purposes for Dietary Supplement Use Among Adults
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y pp
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Blendon RJ, Benson JM, Botta MD, Weldon KJ. Users' Views of Dietary Supplements. Arch Intern Med. 2012;():1‐2 What vitamins should you take?
Unfortunately, there's no one brand or pill that combines the recommended amount of every vitamin mineral and nutrient
recommended amount of every vitamin, mineral, and nutrient.
Multivitamin
•
A daily multivitamin is the most essential supplement to keep in your
essential supplement to keep in your arsenal. •
Here's how to find the right one:
1.
2
2.
3.
4.
Make sure it includes vitamins A, C, D, E and K, as well as potassium, zinc and iodine.
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It should contain 100% of your daily i 100% f
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value of most vitamins and minerals.
Avoid megavitamins that may contain dangerously high levels of
contain dangerously high levels of vitamins and minerals.
To maximize absorption, split your vitamin in two and take half in the morning and half in the evening
morning and half in the evening.
“A daily multivitamin is a great nutrition insurance policy.”
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Walter Willett, MD, Dr.PH
Vitamin D
Vitamin D
• Since many of us do not get a l t f
lot of sun exposure and smartly d
tl
cover up with sunscreen when we do go outside, vitamin D deficiency is common.
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• Vitamin D is important for calcium absorption and plays a critical role in protecting against osteoporosis and bone injury. t
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• It may also help prevent some cancers.
• Take 1000‐2000 IU of vitamin D Take 1000 2000 IU of vitamin D
daily.
Calcium with Magnesium
Calcium with Magnesium
• Calcium helps keep our bones and teeth strong. d t th t
• Our muscles, blood vessels and nervous systems also need calcium to function
need calcium to function correctly.
• Take 600 mg of calcium with 400 mg of magnesium daily, as magnesium may help prevent calcium's potentially constipating effects.
• Do not take calcium within 1‐2 Do not take calcium within 1 2
hours of your multivitamin, as it can interfere with absorption.
B vitamins, Folic Acid
B vitamins, Folic Acid
•
•
•
•
•
•
Found in whole unprocessed foods. Soluble in water excess B vitamins (such as
Soluble in water, excess B vitamins (such as may be ingested via supplements) are generally readily excreted, although individual absorption, use and metabolism may vary…
The elderly and athletes may need to
The elderly and athletes may need to supplement their intake of B12 and other B vitamins due to problems in absorption and increased needs for energy production.
Folic acid is a must for any woman who has Folic
acid is a must for any woman who has
even a slight chance of becoming pregnant. Even for people who won't get pregnant, folic acid is needed to make DNA and red blood cells.
If you discover you're pregnant, start a prenatal vitamin to help keep you and baby safe.
Omega‐3
Omega
3 Fatty Acids
Fatty Acids
omega‐6 (n‐6) and omega‐3 (n‐6) fats. This ratio, referred to as the n‐6 ratio, should be as close to 1 as possible.
SAD typically have ratios of omega−6 to omega−3 in excess of 10 to 1, some as high as 30 to 1.
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• Omega‐3 fatty acids can be f
found in fish oils and some d f h l
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plant and nut oils. • They help protect your h t
heart, nourish your brain, ih
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role in immunity and lubricate your joints. • There are three different There are three different
types of omega‐3 fatty acids: DHA, ALA and EPA, and not all are created
and not all are created equal. It's DHA that you want.
Take 600 mg of DHA daily.
• Take 600 mg of DHA daily.
The evidence is out there!
What Should I Eat?
What Should I Eat?
5.Eat More Plants and Fruits
5.Eat More Plants and Fruits
The bottom line?
The bottom line?
• Each
Each person has unique food and lifestyle person has unique food and lifestyle
needs. It’ss better to get your nutrients from foods, better to get your nutrients from foods,
• It
not pills. When you eat and cook whole, healthy foods,
• When you eat and cook whole, healthy foods, you don’t get individual nutrients in isolation — you get a blend of vitamins, carbohydrates, fiber, and some fat, all of which have been proven to be beneficial for health.
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^
“The doctor of the future will give no medicine, but will interest her or his patients in the care of the human
interest her or his patients in the care of the human frame, in a proper diet, and in the cause and prevention ^
of disease.”
of disease.
‐Thomas A. Edison
US inventor (1847 – 1931)