Even though people are dining out today less often than in the past, according to a recent Zagat survey, the average person still eats out 3.2 times per week (previous statistics were 3.3 times per week). While it can be easier to cook a healthy meal at home, knowing what all of the ingredients are, it's still quite possible to eat well at a restaurant as long as you do some investigating before going out. Most restaurant websites have the nutrition information for their menus. Waiting until you get there is a recipe for disaster, as you can easily choose with your stomach instead of your brain. We'll look at a common situation many of us face each week.

As we were getting our morning started, my wife got an email from a friend inviting her to lunch at Red Robin, a burger restaurant here in the Twin Cities. Actually, they're all over the country. To make sure she didn't sabotage her nutrition plan, she got on their website and did a little homework prior to going out for lunch.

A Typical Scenario

When invited to go out, many people won't consider what they're going to eat until they get to the restaurant. The smell of the food, the pictures on the menu, the descriptions of the menu options can all lead to diet sabotage. Since my wife was planning to go to Red Robin, we'll use that menu as an example.

Let's say you wait to get to the restaurant to decide what to order. If you wait, it's much more likely you'll go with what your stomach is telling you. Here are some of the menu options, and their associated nutrition information.

• Royal Red Robin Burger with Fries (no soda): The "It's the weekend. I'll eat whatever I want" meal: 1625 calories, 101 g fat, 108 g carb, 66 g protein
• California Chicken Burger: The "It's got chicken on it so it must be good for you" meal: 946 calories, 57 g fat, 49 g carb, 55 g protein
• Caesar's Chicken Wrap: The "Wraps are healthy" meal: 852 calories, 43 g fat, 69 g carbs, 40 g protein
• Fajita Fiesta Pollo Salad: The "I need to eat more salads" meal: 1000 calories, 62 g fat, 59 g carb, 51 g protein
• Onion Rings: The "I barely ever order them so I'll treat myself" side dish: 724 calories, 54 g fat, 62 g carb, 7 g protein

The menu is pretty extensive, and contains a LOT of great tasting items, too many to include in these examples. The point is, it's pretty easy to eat half or more of a day's worth of calories in a single meal. Doing that 3.2 times per week, even with an otherwise healthy diet can quickly halt or even reverse the results of a sound nutrition plan. Now, let's look at this with a little bit of planning. Fortunately, at Red Robin, like many other restaurants, you can customize your menu item of choice. Their website shows you what it does to the nutrition information to exchange or replace ingredients in any of the menu items.

My wife was looking for a salad, which is pretty typical for a lunch meal for her. The Cobb Salad sounded good. The Cobb Salad with Ranch dressing looks like this:

1156 calories, 82 grams of fat, 44 grams of carbs, 8 grams of fiber, 56 grams of protein

Can you eat a salad without dressing? Absolutely! This one has blue cheese and avocado on it too, so there's plenty of extra flavor without the need for dressing. When you drop the dressing, the meal looks like this:

736 calories, 38 grams of fat 42 grams of carbs, 8 grams of fiber, 54 grams of protein (A reduction of 420 calories!)

That's a lot better! What else could be done? Well, she was not going to be super-active today, so the focaccia bread really wasn't necessary. She also doesn't care for black olives or tomatoes, although they could certainly could have been left on if she did. Without the focaccia bread, tomatoes or olives, the salad still had grilled chicken breast, one ounce  of blue cheese crumbles, avocado (healthy fat), hard-boiled egg, crumbled bacon and salad mix. The nutrition information now looks like this:

495 calories, 27 grams of fat, 14 grams of carbs, 4 grams of fiber, 49 grams of protein (Another reduction of 241 calories!)

Not bad at all! Plenty of healthy protein, a reasonable number of calories, healthy fat from the avocado and not a ton of excess carbohydrates that would leave her drained of energy later in the afternoon.

Summary

Dining out can be an enjoyable experience and does not need to be one of the reasons for not managing weight. With a little bit of planning, you can enjoy a great meal at your favorite restaurant. A couple of additional reminders for the next time you eat out are:

- Skip the soda. Drink water, unsweetened tea, milk, even a glass of wine, which can all be a lot less calories that soda.

- Ask for extra steamed vegetables or a salad instead of the fries, coleslaw, onion rings, etc.

- Go for grilled chicken or fish, but check on how it is prepared. If you're going for steak, get the filet, as it is much leaner.

- Skip dessert. You REALLY don't need it, and, half an hour after you leave the restaurant, you'll be glad you skipped it. The ten minutes of satisfaction while you eat it won't be worth the extra hour or more you'll need to spend doing intense cardio to burn it off.

The most important part of all of this is to ask your server to prepare it the way you want it. If you wait until the meal comes and you plan to remove the ingredients you don't think you should eat, or plan to leave the focaccia bread on your plate, you'll be battling the will of your stomach. Before the meal is finished, you may find the dressing and bread are no longer on your plate, and it won't be because someone else ate them for you. Plan ahead and enjoy your meal.

In health,

Tom Nikkola

This article is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations in this and other articles is at the choice and risk of the reader.

Dr. Atkins may have brought a heightened awareness of the use of low-carbohydrate diets, but their use in weight-loss is hardly new. They have been used in clinical practice since the 1800s. However, if you ask the average person about whether they are safe or healthy, you'll receive quite a mix of responses. More than likely, most people will say they are unsafe, bad for your heart, increase cholesterol, lead to malnutrition and a so on.

A Research Review of Diets from A to Z

Vegetarian, Dr. Christopher Gardner and his team, developed a unique research study which compared the results of four different diets: Atkins, LEARN, Ornish and Zone Diets. The four diets covered the spectrum from low-fat to low-carb. It was a unique research study in that it actually used specific diets rather than only putting research subject on various nutrient intake plans. A total of 311 overweight and obese women took part in the study and were divided amount the four different diet groups. Each group received classroom education and support in their specified diet plan. They were instructed to follow the diet as explained in the book. During the study, carbohydrate, fat and protein intake was as follows:

Looking at the comparison of the diets from month two to month twelve, there are a few interesting points that stand out.

- Based on the books, there is a clear difference in fat and carbohydrate intake between the Atkins and the Ornish plans, with the Zone and LEARN diets being in the middle of the other two.

- For both the Atkins and Ornish diets, you can see the eventual movement away from the very low carb or very low fat diet. With today's variety of foods, it's more difficult to stay at the extreme of either diet plan.

- Even though the Atkins group did eventually increase their carbohydrate intake and lower their fat intake, it still did not come close to the standard way of eating, which was more like the LEARN group.

Study Findings

Even though it rarely makes news headlines, many research studies have shown that low-carb diets are as good and sometimes better, for weight loss than low-fat diets. The results of this study reiterate those findings. They were as follows:

- Women on the lowest carb diet had more weight loss and body fat percentage loss

- LDL cholesterol fell the most for the Ornish group and rose slightly with the Atkins group. Although the slight rise in LDL cholesterol was seen as a negative in the past, there is mounting evidence to show that a rise in LDL cholesterol from higher fat intake comes from large-particle LDL cholesterol, which does not have a negative effect on health.

- HDL cholesterol (healthy cholesterol) rose the most with the Atkins group an did not rise at all with the Ornish group

- Triglycerides fell the most with the Atkins group

- Blood pressure decreased the most with the Atkins group and the least with the low-fat group

- Fasting insulin decreased the most with the Atkins and LEARN groups and fasting glucose decreased the most with the Atkins group

Summary

There have not been many long-term studies done to compare low-carb and low-fat diets. This study resulted in several important teaching points. First, it showed that sticking to the extreme of a very low carbohydrate or a very low fat diet is very difficult unless someone cooks each meal for an individual. That said, the Atkins group, although their carbohydrate intake increased and their fat intake decreased over the twelve months, did consume significantly less carbohydrate and more fat than the other groups. The low-carb group had better weight and body fat loss, and improved heart health risk factors more than the other groups. An October research review of low-carb diets in Current Diabetes Reports concluded:

"Although science continues to advance in this field, current research suggests that low-carbohydrate diets can be a viable option for achieving weight loss and may have beneficial effects on glycemic control, triglyceride levels, and high-density lipoprotein cholesterol levels in some patients."

Although reduced-carbohydrate diets may not be necessary for everyone to lose weight, evidence suggests that they can be beneficial for many people. The Atkins group was not able to maintain the low-carbohydrate levels they started with, but they still took in far less than the other groups and had better results in the end.

For a full review of the study in an entertaining lecture by Dr. Gardner, click on the video below.

In health,

Tom Nikkola

References:

Gardner C, Kiazan A, Alhassan S, Kim S, Stafford R, Balise R, Kraemer H, King A. Comparison of the Atkins, Zone, Ornish, and LEARN Diets for Change in Weight and Related Risk Factors Among Overweight Premenopausal Women. JAMA 2007;297(9):969-977

Wylie-Rosett J, Davis NJ. Low-carbohydrate diets: an update on current research. Curr Diab Rep. 2009 Oct(5)396-404

Thisarticleis not intended for the treatment or prevention of disease, noras a substitute for medical treatment, nor as an alternativetomedicaladvice. Use of recommendations in this and other articles isatthechoice and risk of the reader.

Take a walk through the diet book section at any bookstore and prepare to be amazed. There are countless books on what is considered the optimal diet for health and weight loss. It is no wonder we are confused on what to eat. Many books have an "acceptable" food list along with rigid rules to follow in order to get the results promised. Depending on the plan, the food lists vary on what is considered healthy. To make things even more confusing, we are now seeing healthy recommendations in the grocery store as well. As a side-note, the FDA has helped put a halt on the promotion of the most current labeling program, called Smart Choices, which was a food industry-driven labeling plan.

Today, I want to just quickly touch on some common "healthy eating" misconceptions. To keep the article reasonable in length, I've added a comment or two to explain why these "nutrition recommendations" may not be that nutritious after all. However, I encourage you to explore these misconceptions further. The comments section at the end of the article would be a great place to discuss each one of these further.

Eat egg whites, but not the yolk

With eggs being a nutrition staple since almost the beginning of time, it's odd that in the past 20-40 years, we suddenly need to stop eating the yolk. Egg yolks, especially from pastured chickens, are loaded with nutrients. Eggs are considered by many nutritious experts as nature's perfect food. They are also one of the best sources of protein available. Egg yolks are one of the best sources of choline. Choline is essential for brain function.

Drink and eat non-fat dairy

Milk straight from the cow has fat. In order to "de-fat" milk it has to be processed in a way that damages the health giving compounds found in milk. The best choice is non-pasteurized, non-homogenized full fat milk. If you are concerned about the calories drink a half-cup instead of a full cup. You will be more satisfied as the milk has healthy fats like CLA that keep you satiated. If you're not ready for full-fat, try the 2%.

If you can't get your fruit in, drink juice or eat dried fruit

Whole fruit is far more filling and less calorie-dense than fruit juices or dried fruit. Fruit juice is loaded with sugar, even if it's unsweetened. People have a tendency to drink more of it compared to whole fruit as well. Because the water is gone from dried fruit, people can easily eat far more dried fruit for a snack than they can whole fruit.

Salmon is a great source of healthy fats

Wild Alaskan salmon is certainly filled with heart-healthy omega-3 fatty acids. However, farm-raised salmon, which is usually fed grain (can you believe that) does not have the same fatty acids because they are not fed their natural diet. Eat salmon often, just make sure it is Wild Alaskan.

Foods that say they are high in omega-3s are healthier

It's true, most people need more omega-3 fatty acids in their diet. However, foods with "added omega-3s" do not contain enough to enhance your health. Food manufacturers are adding omega-3's in the form of plants. Plant-based omega-3, such as flax, does not provide the same benefits as omega-3 fish oil. which is very high in the omega-3s DHA and EPA. Plant-based omega-3 is high in ALA, which must be converted by our bodies into DHA and EPA. We are not very good at converting it, so you're much better off getting the majority of your omega-3s through fish oil.

Avoid saturated fat

Saturated fat helps increase HDL (good) cholesterol and when it increases LDL cholesterol, it's thought to increase large-particle LDL. Large-particle LDL cholesterol is not thought to affect heart disease risk. Foods that contain saturated fat, such as eggs, coconut oil, and animal proteins raised on their natural diet can be part of a healthy nutrition program.

Nuts are a great source of protein

Nuts can certainly be part of a healthy diet. It's better to view them as a source of healthy fat as opposed to a protein source. They have about 8 grams of protein and 16 grams of fat in a serving. To get enough protein from nuts for a meal or snack requires a lot of total calories. Get your protein from other sources, and use nuts to increase your intake of healthy fats.

Soy protein is a perfect health food

With soy's low-fat and no-cholesterol content, it's easy to understand how soy is promoted as a health food. While soy has been eaten in Asian cultures for hundreds of years, it has been eaten in a different form than is usually sold in stores today. Edamame, tempeh and miso can be included as part of a healthy diet, but other forms of soy, like soy milk, contain anti-nutrients and phytoestrogens that have the potential to lead to health issues.

The book The 150 Healthiest Foods on Earth, written by Dr. Johnny Bowden, contains the Top 10 Health Foods of 15 different nutrition experts, including the author himself. Interestingly, none of the experts picked soy in their Top 10 list.

Summary

These are just a few of the many misconceptions common in the diet industry. Each time a new concept for healthy eating comes out, a new niche of products is found. The idea of low-fat led to hundreds of low-fat foods, many of which were not natural foods. The popularity of omega-3 fatty acids is seen in many foods now with "added omega-3s." If we strive to eat real food that has been raised or grown the way nature intended, they possess the healthy nutrients our bodies need to live a long and healthy life. As always, there is only so much that can be discussed in a single article. If articles like this lead you to additional questions, feel free to use the comments section below to continue the discussion.

In health,

Tom Nikkola

This article is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations in this and other articles is at the choice and risk of the reader.

"I know what I need to do, I just don't do it." Does that sound familiar? I hear that from close to nine out of ten people I talk to about leading a more Healthy Way of Life. I often give people the benefit of the doubt in assuming they do know someinformation about nutrition and exercise, although it is often a mixed amount of accurate and innaccurate information from news, friends and conflicting books or magazines. Some people really do know some good information about nutrition and exercise, but don't follow through with what they know. So, for some, it's knowing what to do. For others, it's just doing it. Over the next several months, we'll take a look at some of the basic habits of a Healthy Way of Life. To help those that want to know more about what do do, we'll discuss some topics for the purpose of education. For those that need to just do it, each week can be a challenge to start changing habits.

Willingness to Change

If you were to ask people within your social circle how willing they are to change their exercise & nutrition habits, you'd likely get a variety of reasons. Some of the reasons may include: I don't have time, it's not realistic, it's too restrictive, I can't eat what I want to eat, etc. The reasons often include assumptions about what proper nutrition is. Too many people equate good nutrition with being on a diet, which means needing to give up foods they like, OR it means they must change their daily habits to make a new way of eating fit in with their lifestyle.  To live a more healthy way of life, we have to be willing to change. When the fear of continuing down the path we are on is greater than the comfort of staying in our normal routine, we are ready to do something different. Some of the triggers that help people take on a more healthy lifestyle include:

- seeing the impact poor choices are having on their children

- a friend or family member facing the destructive results of poor nutritional habits

- the scale hitting an all-time high

- needing to find a new store to shop for clothes

- a picture of themselves that opens their eyes

Many people reach the point of willingness to change and some make a very valiant effort to do it, but they just cannot stick with it.

Ability to Change

A very small percentage of people can dramatically change their lifestyle overnight. Many will attempt to do so, but if they try to change too much at once, they may hit a point of saying "this is just too inconvenient." Also, if they dramatically change their nutrition and exercise habits and don't see a dramatic change in their health and fitness, they may end up claiming "this doesn't work for me" or "I just can't lose weight." The truth is, changing the effects of a lifelong way of eating can take time. Every time you eat, you are affecting your entire body's biochemistry. Undoing years of poor choices can take time. To make the changes stick, I cannot stress enough the importance of making one to two small changes into habits and then focusing on the next small habit. When done the right way, it is amazing how different your lifestyle can be over the course of a year.

You may have heard the story of a frog in boiling water, but I want to put a different spin on this story. If you haven't heard it before, it goes something like this:

If you put a frog in boiling water, it will immediately jump out. If you put a frog in cold water and slowly turn up the heat, it will stay in the water until it boils to death.

This story is often told to explain how we can become more and more deconditioned or sick over time without knowing how far we are from health. Put another way, if someone attempts to change too much, too fast, even though he or she is making healthy choices, it can be such a drastic change that they throw up their hands an say "I can't do this." The point is, if you start from where you are today, and work on very small changes, you can drastically change who you are over time, without feeling like it's too much to take from week to week.

Getting Started

You don't have to wait for a New Year's Resolution to make a commitment. Start now. There is a reason this weekly article will be written on a Sunday. The week is just beginning. As the weeks go on and we get into food choices, you may be able to run to the store to prep for the week. Before taking on the challenge of change, you have to commit yourself to it. Willingness to change usually has to include a reason to do so. So, for this week, there are two challenges.

First, consider how much better your life will be if you commit to a lifestyle change. What would be different a year from now? How would you feel? How would it impact your life and the life of those around you?

Second, be willing to share with others. There are millions of people who feel just like you, have gone through similar experiences, and want to know they have someone like themselves to relate to.One of the most underutilized features of the new website is the ability to communicate through discussions and through comments in blog posts. My hope is that this weekly series will result in comments following the post, that lead to discussions with those who are actively trying to change their lifestyle. No one has arrived at an ideal lifestyle. We're all just at different points long the path. So, for this week (don't leave me hanging ) please post a comment that describes how your life will be different by committing to making one new change ever week over the upcoming year. If you're reading this and are already along that path, please share your experience so far. I'm hoping you will continue to share your thoughts, successes and struggles as we look at one new habit each week.

In health,

Tom Nikkola

This article is not intended for the treatment or prevention of disease, noras a substitute for medical treatment, nor as an alternative to medicaladvice. Use of recommendations in this and other articles is at thechoice and risk of the reader.

The use of sugar and sugar alternatives is one of the most debated areas of nutrition today. It is also an area of significant confusion. More of the population today understands the negative impact of consuming excess sugar, whether it is in the form of high-fructose corn syrup, sucrose, or other "natural" sugars. One alternative is nonnutritive sweeteners (NNS). In considering the use of nonnutritive sweeteners, people are confronted with very opposing viewpoints. To make this even more complicated, there are several different NNS to choose from. In the first post on this subject, we looked at whether NNS use has been shown to increase appetite. In the second one, we looked at the evidence behind whether NNS support weight loss. Today, we'll take a look at the four most common nonnutritive sweeteners - aspartame, saccharin, acesulfame-K and sucralose. There are many others, such as stevia and various sugar alcohols. Those may be topics for another day.

How much can we use?

The FDA has established acceptable daily intake amounts for NNS. The current ADI equivalents for NNS are as follows:

- Aspartame: 18-19 cans of diet cola

- Saccharin: 9-12 packets of sweetener

- Acesulfame-K: 30-32 cans of diet lemon-lime soda

- Sucralose: 6 cans of diet soda

Does this mean that consuming more than these amounts in a single day will cause problems? No. It means the above is the average daily amount that can be consumed, according to current research and not result in complications for the average population. On an individual level, some people may not handle one of the above NNS at all. In this case, they should completely avoid that NNS. It would be the same recommendation if someone had a severe peanut allergy. They should stay away from any peanut consumption. But that does not mean the rest of the population needs to refrain from eating peanuts. As we look at some of the concerns around the various NNS below, this is an important point to consider. Every person has a unique metabolism and may be sensitive to any number of ingredients in our food supply, natural or processed/man-made. If someone finds they respond poorly to a NNS, they should avoid it, but it does not mean their friends need to.

Diet soda is not the only place NNS are found, but non-calorie/low-calorie beverages are where the most NNS are consumed by the population. In diet drinks, it is common to find only one of the NNS used. The most commonly used NNS in diet drinks is aspartame. As we'll see below, aspartame also has more question marks surrounding it than the other NNS, which is why diet drinks are so often called into question.

In foods and pre-made mixes, more than one NNS is often used. A combination such as Sucralose and Ace-K provides a more natural-tasting sweetness to a product, and significantly reduces the amount of either one used in a product because of the synergistic effect of the two sweeteners.

Pros and Cons of NNS

Many of the health concerns related to NNS have come from anecdotal reports, which have not yet been proven through research. Some of the perceptions of NNS have been shaped by the food industry as well. As an example, when sucralose (Splenda) came onto the market, the sugar industry was quick to cast doubt on the product, as it had an interest in avoiding the decreased use of sugar. To complicate research conclusions, much of the research on NNS has favored the party funding the research. When research has been done by a NNS company, the research has provided positive results. When research has been done by other parties more interested in showing negative effects of NNS use, the results have more often been negative. Much of the disagreement about NNS stems from the fact that the NNS requires a man-made process to create the product. If NNS were produced by nature, it is not likely there would be such strong opposition.

The most common reported occurrence with the use of some NNS is headaches. Because each NNS is different, if the use of one NNS causes headaches, it should not be concluded that all NNS use causes headaches for an individual. According to anecdotal reports, aspartame seems to have more negative observations associated with it than other NNS. In looking at the messages to the public about the use of NNS, some of the points of view are quite extreme. If more research in the future paints a different, conclusive picture on any of the NNS below, we'll be sure to share that. Below is a brief summary of the four main nonnutritive sweeteners.

Aspartame

Aspartame is commonly sold under the brand name "Nutrasweet." Headaches are the most commonly discussed concern with the use of aspartame. Allergic reactions have also been allegedly observed with the use of aspartame, such as swelling  of the lips, tongue and throat. When studies have been done to review these observations, researchers have had trouble replicating the occurrences with random sampling of the population. When swelling or hives have occurred in research, it occurred in placebo groups like it did in the aspartame groups, so no conclusions could be drawn. Because beverages often contain other ingredients, such as caffeine, it is possible the perceived side-effects could come from something other than aspartame. However, for those who do not respond well to aspartame or a different sweetener, it would be wise to use an alternative, or avoid NNS use.

The largest concern for aspartame use is in those with phenylketonuria, which is a rare inborn error of metabolism where they cannot metabolize phenylalanine. Significant ingestion of aspartame by those with phenylketonuria is thought to be a risk for neurological disorders. Though studies have shown that those with phenylketonuria can tolerate the aspartame amounts found in diet cola, use should be moderated. The phenylalanine content of a 12 oz diet Coke is 90 mg. Phenylalanine is found naturally in foods as well. In fact, milk contains 404 mg in an 8 ounce glass. That is not to say milk should be avoided. It is just to point out that phenylalanine is also found in nature. Those with a history of depression may be more sensitive to aspartame use as well.

Another negative for aspartame is that it is not stable in non-acidic fluids or when heated. One of the breakdown products is methanol, or "wood alcohol" which is toxic to the body. A healthy adult can metabolize up to 2000 mg of methanol per day. A 12-ounce diet Coke provides 18 mg of methanol. Again, this is found in nature. In fact, tomato juice provides 71 mg of methanol in 8 ounces. Of course, tomato juice provides a host of other nutrients as well, so you cannot compare the two. Of all of the NNS, aspartame seems to carry the most concerns with it. An occasional diet cola is not likely to cause problems. For many people, diet cola is used to help them get through the day and is used as a major source of caffeine. Using it on more than an occasional basis is probably not a good idea.

Saccharin

In 1977, saccharin, commonly known as "Sweet n' Low" was tied to bladder cancer in studies on rats. The studies used megadoses of saccharin, equivalent to 800 to 1000 cans of diet soda for an average adult. Since that time, it has had the reputation for increasing the risk of cancer. However, studies since that time have not supported the idea that it poses a serious health risk. In the research done on this NNS, it has been shown to be safe in the diet. It is not as popular a NNS because of the bitter aftertaste if leaves in the mouth. It is also not commonly used in cooking or baking.

Acesulfame-K

Ace-K has been approved for use since 1988. It is 200 times sweeter than sucrose, and is usually used in combination with another sweetener. In megadoses, the methylene cholride in Ace-K could cause problems, but it is rarely used by itself, and because it is so sweet, the amounts used are extremely low. It is mainly used to enhance the taste profile of another sweetener, so minimal amounts are used. It has not received much attention as it is used in such small amounts, and has not been associated with health complications. It can be found in some alcoholic beverages, but is generally used as a NNS in foods, sauces and confections.

Sucralose

Marketed under the brand name Splenda, this is one of the newer major sweeteners on the market (the newest is Truvia, which we won't cover today). Sucralose is created by changing the structure of a sugar molecule. Sucralose has the benefit of working well with heat and in baking. When it came to market, its close resemblance and taste to sugar caught the attention of the sugar industry. The sugar industry was quick to point out the fact that sucralose contained chlorine, which created a reputation for sucralose that it could lead to problems from people ingesting chlorine. This was a somewhat misleading way to cast doubt on sucralose, as the chlorine does not break apart from the sucralose. Instead, it passes through the body undigested, which is very different than ingesting pure chlorine. Normal table salt also contains half of its structure as chlorine. In some people, sucralose can cause bloating or gas, but again this could be dose-dependant. Overall, the evidence behind sucralose has been positive.

Summary

Overall, for  the majority of the population, the use of NNS in moderation seems to be okay. Having said that, there is no doubt that someone reading this article has personally experienced a negative effect of one or more of the NNS. Some people do not tolerate one or more of the NNS well. These are also the stories that are most commonly discussed in media and books. The stories of the millions of people who do handle NNS well do not make for as exciting a story. Of all of the NNS available, it seems that aspartame would best be moderated. In people consuming large volumes of diet soft drinks, replacing most of those soft drinks with water is an important step toward optimal health.

The biggest challenge in reviewing this group of nonnutritive sweeteners in a single article was to cover as many high-points as possible without taking up so much space that the full article would not be read. If you choose to do your own research on using NNS, choose your sources wisely. The opinions on NNS can be quite extreme and may exaggerate some of the truths. It makes for a great story, and may make someone sound like more of an expert. In reality, as a population, we consume far too much sugar and total calories. The moderate use of NNS can be appropriate, so long as the products used do not displace the use more nutritious choices. Small amounts of diet cola are likely a better choice than regular cola. Water or unsweetened iced tea is a better choice than diet cola.

In health,

Tom Nikkola

Go to: Non-Calorie Sweeteners: Do they increase appetite?

Go to: Non-Calorie Sweeteners: Do they support weight loss?

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Geha R, Buckley CE, Greenberger P, Patterson R, Polmar S, Saxon A, Rohr A, Yang W, Drouin M. Aspartame is no more likely than placebo to cause urticaria/angioedema: results of a multicenter, randomized, double-blind, placebo-controlled, crossover study. J Allergy Clin Immunol. 1993 Oct;92(4):513-20.

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Food & Nutrition Australia. Review of Non-nutritive Sweeteners. Food & Nutrition Australia. June, 2008

Magnuson B. Straight Facts on Aspartame & Health. Article prepared by Magnuson for The Beverage Institute for Health & Wellness

Mattes RD, Popkin BM. Nonnutritive sweetener consumption in humans: effects on appetite and food intake and their putative mechanisms. Am J Clin Nutr 2009;89:1-14

Aragon A. Artificial sweetener use: current controversies. Alan Aragon Research Review. April 2009

Lutsey P, Steffen L, Stevens J. Dietary Intake and the Development of the Metabolic Syndrome: The Atherosclerosis Risk in Communitites Study. Circulation 2008;117:754-761

Vartanian L, Schwartz M, Brownell K. Effects of Soft Drink Consumption on Nutrition and Health: A Systematic Review and Meta-Analysis. Am J Public Health. 2007;97:667-675

Nettleton J, Lutsey P, Wang Y, Lima J, Michos E, Jacobs D. Diet Soda Intake and Risk of Incident Metabolic Syndrome and Type 2 Diabetes in the Mult-Ethnic Study of Atherosclerosis. Diabetes Care. 32:688-694, 2009

This article is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations in this and other articles is at the choice and risk of the reader.

Six-pack abs. Defined shoulders. Loose-fitting clothes. These aren't images that are usually pictured with the promotion of dietary fiber. However, increasing your fiber might be another key to supporting your fitness program. Look at this impressive list of health and fitness benefits associated with increasing fiber intake:

+ Improves satiety - stay full longer so you don't eat as much

+ Improves mineral absorption - help your body recover and repair itself by absorbing more micronutrients

+ Slows carbohydrate absorption and reduces the body's insulin response - keep your body burning more fat because your insulin levels won't be as high

+ Enhances digestion - avoid the poor digestion associated with today's lower-quality diet

The daily recommended intake of fiber is a minimum of 25-35 grams. The average American consumes less than 15 grams per day! Unfortunately, with today's highly-processed diet and food made in a hurry, dietary fiber intake is quite low. The most-often recommended sources of fiber are whole-grains, fruits and vegetables. You've no-doubt heard the consistent recommendation to increase whole-grains in the diet. However, not everyone's biochemical individuality allows them to tolerates gluten. While others, are more conservative with their carbohydrate intake, which may make it more challenging to achieve a higher-fiber diet. As a reference, fiber content in common foods looks like this:

- 1/2 cup vegetables, 1-3 grams (lettuce has only .7 grams per cup)

- 1 serving of fruit: 1-5 grams (skin included for most fruits)

- 1 oz nuts & seeds: 1-4 grams

- 1/2 cup orange juice: 0.5 gram (other juices are usually less)

- 1/2 cup legumes: 3-8 grams

- 1 slice bread: 0.5-3 grams

- 1 serving most cereals: 0.2-4 grams (All Bran and Fiber One are much higher)

It's best to strive to meet the daily fiber recommendations through whole-foods, but very few people achieve that on a daily basis. To help support your daily fiber needs, we've added a unique fiber source, called Sunfiber, to our new meal replacement powder FastFuel Complete. FastFuel Complete will be coming out in October. Sunfiber is clinically proven to reduce the glycemic index of foods, increase mineral absorption and increase satiety, so you stay full longer. You'll get five grams of this unique fiber in each serving of Fast Fuel Complete. If you're regularly consuming a whole-foods diet and add FastFuel Complete to your plan, you may find it easier to exceed the daily minimum amounts of fiber suggested for your diet.

Thinking about the fiber in your nutrition plan may not sound as exciting as looking at the latest supplement, or timing your meals with your workout. However, meeting your daily fiber intake is an important piece of the puzzle for maintaining your health and fitness. It's possible to consume too much fiber, but based on the average American's diet, most people do not need to worry about that. However, they do need to worry about consuming too little. Feed yourself some fiber and it might help you flatten that stomach.

In health,

Tom Nikkola

References:

Jim LaValle. Cracking the Metabolic Code. Basic Health Publications, Laguna Beach, CA 2004

USDA, Agriculture Research Service. Fiber Content of Foods. USDA National Nutrient Database for Standard Reference, 2004

Mayo Clinic Staff. Dietary fiber: An essential part of a healthy diet. Mayo Clinic. http://www.mayoclinic.com/health/fiber/NU00011

de Cassia Freitas K, Amancio OM, Ferreira Novo N, Fagundes-Neto U, de Morais MB. Partially hydrolyzed guar gum increases intestinal absorption of iron in growing rats with iron deficiency anemia. Clin Nutr. 2006 Oct;25(5):851-8.

Kondo S, Xiao JZ, Takahashi N, Mivaji K Iwatsuki K, Kokubo S. Suppressive effects of dietary fiber in yogurt on the postprandial serum lipid levels in healthy adult male volunteers. Biosci Biotechnol Biochem. 2004 May;68(5):1135-8

Heini AF, Lara-Castro C, Schneider H, Kirk KA, Considine RV, Weinsier. Effect of hydrolyzed guar fiber on fasting and postprandial satiety and satiety hormones: A double-blind, placebo-controlled trial during controlled weight loss. Int Jour Obesity. 1998; 22:906-909

Slavin JL, Greenberg NA. Partially hydrolyzed guar gum: clinical nutrition uses. Nutrition. 2003 Jun;19(6):549-52.

This article is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations in this and other articles is at the choice and risk of the reader.

Last week's article discussed sugar consumption and its impact on health. The next day, Monday (August 24), the American Heart Association released a report recommending a reduction in sugar consumption for the US population. The idea of cutting back on sugar sounds easy for those who consume small amounts of sugar. However, for those who have been consuming larger amounts, it may be easier said than done. One way to transition from the use of large amounts of added sugars may be the use of similar foods or beverages which contain non-caloric sweeteners, also called nonnutritive sweeteners (NNS). Because of the controversy and confusion surrounding them, we'll take a look at some of the more recent studies that have been done and discuss what they have and have not shown us. We'll look at their effect on weight management, potential side effects and other details research has shown us.

In January, Richard D Mattes and Barry M Popkin did an extensive report on NNS which was published in the American Journal of Clinical Nutrition. This report and other papers listed will provide a reference source for the topics discussed. I hope to cover the whole topic over the course of four articles as follows:

1. Impact on Hunger
2. Use in Weight Management
3. Potential Concerns
4. Summary

Types of Nonnutritive Sweeteners

The list of sugar substitutes includes saccharin, aspartame, acesulfame-potassium (ace-K), sucralose, neotame, and stevia. Other than stevia, which is quite new, a significant number of safety studies have been done on these sweeteners. A few observational reports have called their recommended use into question. To keep things simple, we'll consider them as a group for now, and look at them individually at another time.

Nonnutritive sweeteners are most commonly thought of in diet soft drinks. This is also the use that has caused the most controversy. However, NNS are also used in food and mixes to improve the palatability and/or manage the caloric content of the food. The use of NNS can be beneficial when attempting to manage caloric content in the diet and still enjoy foods with a sweet taste.

NNS and Effect on Appetite

The first question we'll look at with NNS is "Do they increase appetite?" If their use made people more hungry, it would be hard to justify using them for the purpose of reducing calories in the diet. The effect of NNS on appetite has been studied on several occasions. The majority of studies on appetite are based on the use of NNS in beverage form, without the addition of calorie-containing food. This is an important point because some people will use the results of these studies to apply to all NNS use. In reality, NNS in calorie-containing food have no effect on appetite. Also, diet drinks consumed with food have no effect on hunger.

When NNS are used in non-calorie, flavored drinks, apart from food, some results have shown an increase in appetite and others have not. It seems possible that consuming a pleasant tasting beverage would activate the digestive process and could lead to hunger. Interestingly, a study on non-calorie soup also increased appetite. Since the soup did not contain NNS, it provided some clues that any short-term stimulation of appetite without the presence of calories is a result of the palatability of what is consumed, rather than the result of the chemical structure of NNS.

Additional studies have been done on the consumption of NNS through capsules or nasogastric tubes, which both deliver the NNS to the digestive system without the individual tasting them. These studies resulted in no effect on appetite, which further shows that the NNS effect on appetite is not likely due to the chemical structure, but due to its positive effect on taste.

Nonnutritive sweeteners are also used in foods and dietary supplements to provide enhanced taste without adding additional sugar-based calories. In this case, NNS consumed in calorie-containing foods has shown no effect on appetite. Their use may be beneficial in order to satisfy taste requirements without adding additional calories or increasing dietary sugar consumption.

Summary

Nonnutritive sweeteners may affect appetite in some people, but if they do, it seems to only occur when no calories are consumed at the same time. The most common way to consume NNS without any other calories include diet soft drinks and other sugar-free drinks. NNS consumed in beverages with food, or as an ingredient in calorie-containing foods, do not seem to affect appetite. From personal experience, moderate consumption of diet soft drinks has helped people deal with cravings and hunger associated with a reduced-calorie diet, as long as they are not the main source of hydration. Also, protein shakes, which often contain NNS for flavor, can actually help people deal with the hunger while also providing proper balanced of nutrients to support fitness and body composition goals.

In health,

Tom Nikkola

Go to: Non-Calorie Sweeteners: Do they support weight loss?

Go to: Non Calorie Sweeteners: Pros and Cons

References:

Mattes RD, Popkin BM. Nonnutritive sweetener consumption in humans: effects on appetite and food intake and their putative mechanisms. Am J Clin Nutr 2009;89:1-14

Aragon A. Artificial sweetener use: current controversies. Alan Aragon Research Review. April 2009

Lutsey P, Steffen L, Stevens J. Dietary Intake and the Development of the Metabolic Syndrome: The Atherosclerosis Risk in Communitites Study. Circulation 2008;117:754-761

This article is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations in this and other articles is at the choice and risk of the reader.

During my time as a Personal Trainer, I met many members in FitPoints who were eagerly beginning a new fitness program. We often discussed their health and exercise history, as well as details on their eating habits. It seemed like more than half of the time, as we began discussing nutrition, they were excited to tell me that as part of their commitment to their new fitness program, they had given up coffee. While the commitment to make a change to eating habits was a noble one, the focus on dropping coffee may have been somewhat misdirected. Over the years, there has been a perception that drinking coffee has a negative impact on health. Many studies, however, have shown the contrary. Coffee drinking may be one of the habits many of us have that can actually support our health. While it's not appropriate for every individual, most healthy people can get a lot of benefit from drinking coffee during the day.

Defining a "Cup of Coffee"

The meaning of a "Cup of Coffee" has changed dramatically over the past ten years. To many people, it no longer means the drinking plain coffee, black, or with cream or sugar. In fact, if you go to Starbucks, there are actually 87,000 different combinations of "coffee" you could drink. In reviewing the health benefits of coffee, we'll explore only real coffee. Except in the case of just adding milk to your coffee, adding anything else to it is likely to significantly increase the calories, and possibly limit any health benefits you may have gotten from the coffee itself.

Health Benefits

As more research has been done, the evidence is indicating that there seems to be many more positives than negatives with coffee consumption. Many of the studies are epidemiological studies, so they cannot prove coffee causes the benefits described in the studies. They only show an association, which will lead to further research on the subjects. Recent studies have shown coffee consumption may reduce diabetes and heart disease risk. Studies suggest some non-caffeine components of coffee increase insulin sensitivity and thereby reduce the risk of diabetes. The reduction in heart disease risk is thought to come mostly from the caffeine in coffee because there is no significant protective effect from decaffeinated coffee. It is still possible, though, the flavonoids found in coffee, and also in tea, cocoa, and chocolate, could provide some cardiovascular protection.

In a recent study, drinking three cups of coffee for three weeks was shown to increase a group of bacteria called Bifidobacterium. The bacteria are associated with some health benefits, but more research will be required before conclusions can be drawn. An additional benefit of coffee is it contains many antioxidants. In fact, coffee is the number one source of antioxidants in the American diet, more than any other food or beverage. This also requires more study to understand whether the antioxidants are absorbed once they are ingested.

Weight Management Benefits

In considering the current state of the US population, the most important benefit of coffee may be its effect on fat metabolism and energy expenditure. Since diabetes risk and many other health complications are associated with overweight and obesity, it is possible coffee's effect on lipid metabolism also helps to reduce diabetes and heart disease risk. Caffeine is likely the only contributor in coffee to the thermogenic effect. Six cups of coffee, or about 600 mg of caffeine, can increase energy expenditure by 100 calories per day. All else being equal, that is about ten pounds of body fat over the course of a year. Even as a tolerance to caffeine is perceived over time, the thermogenic effect is not reduced. Not only does caffeine increase the number of calories burned in a day, but it also shifts the body's metabolism toward using more fat versus carbohydrate, and it may increase the desire to move around more, which would also burn additional calories. If the body is burning a higher percentage of fat, and it moves around more, it will use up more fat stores. Of course, these fat-burning benefits will not make up for the result of drinking a sugar and fat-loaded "coffee" drink. If an individual does get the benefit of burning an extra 100 calories per day, but she is also drinking a 400 calorie coffee drink, there will be little benefit from the thermogenic effect.

Peformance Benefits

High-performance athletes have long known the advantages of caffeine consumption. Many of today's sports performance products have caffeine in them. Coffee is still the most common way of taking in additional caffeine to enhance performance. Caffeine has been shown to increase focus and alertness, improve coordination, decrease perceived exertion, increase time to exhaustion, and increase utilization of fat for energy. Each of these advantages can be beneficial for various sports. Since individual responses to caffeine can vary, some will derive much benefit from its use, and others may notice no difference at all.

Risks

Common concerns about caffeine use include a negative effect on calcium levels in the body, which could reduce bone density, possible increases in blood pressure and heart rate, reduced insulin sensitivity, and possible dehydration. In regards to bone density, the most significant issues seem to occur when women consume less than the recommended amount of calcium each day. Data is not conclusive, but if sufficient calcium is taken in each day, it may offset any losses caused by the caffeine in coffee. Acute increases in blood pressure are common. For many people, the effect on blood pressure seems to subside with long-term use. As low-carb dieting became popular, the concern over caffeine affecting insulin sensitivity became more well-known. The effect is acute and is more pronounced when caffeine is consumed with carbohydrate. If it was a long-term concern, it would conflict with the research showing that coffee consumption may reduce the risk of Type II diabetes. As for the concern of dehydration, caffeine consumed through coffee contains more than enough water to offset any dehydrating effect it may have. Caffeine is more of a concern when it is consumed by itself in a pill form. Heavy caffeine consumption is not recommended during pregnancy, as animal research has shown a negative effect of caffeine during pregnancy.

Summary

To summarize, the current evidence seems to say moderate coffee consumption provides more possible health benefits than risks. Individuals metabolize caffeine differently, so it's probably best to avoid heavy use without knowing your level of tolerance. In the quest for improved health and fitness, there are many other things that would be better to eliminate from the diet before focusing on your morning coffee, unless you're ordering something more extravagant than black coffee or espresso. The more fancy it sounds, the more calories it likely contains. Skip the Grande Vanilla Frappuccino with whip (470 calories, 14 g fat, 75 g carbs, 62 g sugar, 12 g pro) or the Green Tea Frappuccino with whip (490 calories, 14 g fat, 82 g carbs, 69 g sugar, 12 g pro). Try getting back to the old-fashioned way - black, in a to-go cup or in a mug.

I tried to fit a lot of information into what was supposed to be a small amount of space. There are likely other questions that could be addressed, or comments that could be made. I would encourage members and team members to ask additional questions and share comments on this or any of the other Nutrition blogs.

In health,

Tom Nikkola

Resources

Antonio, Jose et. al. Essentials of Sports Nutrition and Supplementation.Totowa, NJ: Humana Press, 2008

WebMD. "Coffee: The new health food?" WebMD. 2009 http://men.webmd.com/features/coffee-new-health-food

Keizers GB, De Galan BE, Tack, CJ, Smits P. Caffeine can decrease insulin sensitivity in humans. Diabetes Care. 2002 Feb;25(2):364-9

Salazar-Martinez E, Willett W, Ascherio A, Manson J, Leitzmann M, Stampfer M, Hu F. Coffee Consumption and Risk for Type 2 Diabetes Mellitus. Ann of Intern Med. 2004;140:1-8

Greenberg J, Boozer C, Geliebter A. Coffee, diabetes, and weight control. Clin Nutr 2006;84:682-93

McDonald, Lyle. Coffee, Diabetes and Weigth Control - Research Review. BodyRecomposition. February 9, 2009.

Jaquet M, Rochat I, Moulin J, Cavin C, Bibiloni R. Impact of coffee consumption on the gut microbiota: A human volunteer study. Int Jour of Food Microb. March 2009;130,2:117-21

Greenberg J, Dunbar C, Schnoll R, Kokolis R, Kokolis S, Kassotis J. Caffeinated beverage intake and the risk of heart disease mortality in the elderly: a prospective analysis. Clin Nutr. 2007;85:392-8