Imagine this. You meet someone new every minute of the day, 24 hours per day, for 196 years. That's a lot of people! In fact, it's 103 million people. And that is the number of people projected to be obese in the United States alone, in 2018, 45% of our population! A recent report by Kenneth E. Thorpe, Ph.D. outlines the troubling future we are headed towards if we don't change course in the growth of obesity. Some of the major findings from the report included some incredible points:

• Obesity is growing faster than any previous public health issue our nation has faced (that is worth reading twice). If current trends continue, 103 million American adults will be considered obese by 2018.

• The U.S. is expected to spend $344 billion on health care costs attributable to obesity in 2018 if rates continue to increase at their current levels (That is more money than the Gross National Income of all but the top 14 wealthiest nations!). Obesity-related direct expenditures are expected to account for more than 21 percent of the nation's direct health care spending in 2018.

• If obesity levels were held at their current rates, the U.S. could save an estimated $820 per adult in health care costs by 2018 - a savings of almost $200 billion dollars.

Even more startling statistics comes from the January 2010 issue of the American Journal of Clinical Nutrition:

A sampling of 324 4-year-old Chilean children showed that:

- 13% of 4 year-olds were obese

- 11% of 4 year-olds had central obesity (a larger risk factor than when body fat is stored elsewhere)

- More than 20% had lipid disorders

- 70% of the children had at least one cardiometabolic risk factor

Making a Change

The beginning of a new year marks the start of the season of new exercise programs, new diets, and new commitments. There won't likely be a change in the food options at the grocery store in the near future. People will have to shop with a stronger resolve to choose foods that promote health, reduce hunger, support blood-sugar management, and enhance energy levels. It is not easy to get started, but it's possible with the right approach. Here are a few keys to make 2010 a success:

1. Get support: Make your commitment with a friend, or get into a group program with other people facing similar challenges like eat or TEAM Weight Loss. People looking to make a lifestyle change, and are part of a social network or support community, are consistently more successful.
2. Start with a plan: At the start of the new year, many people attempt to eat less, without understanding exactly what to eat, and begin exercising more, without knowing exactly how to structure their exercise program. It is critical to get support from experts in Nutrition and Exercise. At Life Time, take advantage of a free FitPoint and Nutrition Consultation.
3. Start using Supplements: A high-quality multivitamin, omega-3 fish oil and protein powders are essential components of a solid nutrition and exercise plan.
4. Think long-term: Changing nutrition and exercise habits is not a short-term solution. The same principles that allow someone to shed the wait are the principles that allow them to keep it off, along with maintaining health status such as cardiovascular risk factors.
5. If the plan you're following isn't working, get guidance from a professional: Many people attempt the same thing they did the previous year, even though it didn't work. Every person is an individual, with a unique metabolism. If you're not seeing the changes you'd expect, talk to a Personal Trainer or Nutrition Coach for help in finding out what will work.

Changing the direction of health in our nation starts with one person at a time. Many studies have shown that as one person changes his or her lifestyle, it has a major impact on those around them. One person changing his or her life can have a significant impact on many more. This could be your year to be an inspiration for those around you.

In health,

Tom Nikkola

Resources:

Thorpe K. The Future Cost of Obesity: National and State Estimates of the Impact of Obesity on Direct Health Care Expenses. Emory Univeristy. November, 2009.

Corvalan C, Uauy R, Kain J, Martorell R. Obesity indicators and cardiometabolic status in 4-y-old children. J Clin Nutr. 2010;91:166-74

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.

Almost fifty years after recommendations were made to avoid fat to stay thin, evidence continues to grow showing the low-fat approach may not be the answer to managing body composition. Research published in the December issue of the American Journal of Clinical Nutrition again shows that the amount of fat in the diet has little to do with weight gain. The research included data from 90,000 men and women from six countries in Europe. The average fat content in the diet for the group ranged from 31.5% to 36.5%. The conclusion of the study was:

We found no significant association between the amount or type of dietary fat and subsequent weight change in this large prospective study. These findings do not support the use of low-fat diets to prevent weight gain.

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This isn't to say that if total calories are eaten in excess, it can't lead to weight gain. However, since the mid-1950's, the public has been told to stay away from fat and focus on carbohydrate as a main source of energy to manage weight. While there have been many opponents to this idea, a low-fat approach to dieting has continued to be passed on year-after-year as the most healthy way to eat. In 2002, Gary Taubes published a book called Good Calories, Bad Calories, which did a thorough review of the research (or lack of research) that led to the "low-fat diet" conclusions. The summary was that there was actually little clear evidence to justify the recommendation for low-fat dieting. In fact, in the decades since that time, we've progressively gained significant weight as a nation, loading up on our 6-11 servings of starch each day.

While the total calories consumed in a day has some impact on weight gain, our hormones also play a significant role and our diet can have a significant impact on our hormones. Carbohydrates, which are the predominant source of calories in the Standard American Diet, affect hormones much more than protein or fat. Carbohydrates affect the body's insulin levels and insulin affects the body's ability to burn fat. Consuming excess carbohydrates can lead to fluctuations in hunger and energy levels. Excess carbohydrates can lead to increased triglyceride levels in the body. It can also lead to vitamin and mineral deficiencies.

The study above does not show that you can eat as much fat as you want without worrying about weight gain. What it does show is that to avoid gaining weight, a low-fat approach is not necessary.

In health,

Tom Nikkola

Resources:

Forouhi N, et. al. Dietary fat intake and subsequent weight changes in adults: results from the European Prospective Investigation into Cancer and Nutrition cohorts. Am J Clin Nutr. 90:1632-1641, 2009

Gary Taubes. Good Calories, Bad Calories. 2007. Anchor Books, New York, New York.

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

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.

As far back as I can remember, our family always went to my Godparents house for Thanksgiving. Many of the great-tasting foods were the same from year to year and the day often unfolded much the same. We'd arrive, visit, have appetizers while watching one of the football games, eat dinner, dessert and then like magic, the adult men would fall fast asleep while the women visited in the kitchen. I can still see and hear my Godfather, Bill, snoring on the chair and my Dad sound asleep on the couch. Year after year, someone would say, "It's the turkey. That tryptophan puts you right to sleep."

Is there something special about turkey that really does knock you out, especially on Thanksgiving day? Why is it that you can have turkey on other days and there's no effect? Is there something special about a baked turkey? Or is it possible the turkey really has nothing to do with the afternoon coma many people are put in following Thanksgiving dinner?

Turkey Isn't a "Sleeping Pill"

Turkey has gotten its reputation for inducing sleep based on the fact that it contains the amino acid l-tryptophan. The body uses tryptophan to produce the neurotransmitter serotonin. Serotonin is necessary to support rest, relaxation and restful sleep. Taking the amino acid tryptophan by itself may help support sleep, which could be where turkey got is sleep-inducing reputation. However, turkey is not really deserving of this reputation.

Turkey does not contain a significant amount of tryptophan compared to other foods, especially other protein-containing foods. The chart below shows the amount of tryptophan in a 3.6 ounce (100 gram) serving. As you can see, there are many other foods that have a higher concentration of tryptophan than turkey, yet none of these foods have the reputation for inducing sleep. Tryptophan competes with other amino acids in food to be absorbed into the brain. The small amount found in food is likely not enough to cause sleep, especially in the presence of the other amino acids. So if the turkey doesn't do it, what puts people to sleep?

Adapted from the USDA nutrient database and Wikipedia

Then what causes me to fall asleep?

Considering a typical Thanksgiving Day meal, the list of foods likely includes: appetizers (typically high in carbohydrates), dinner rolls, stuffing, potatoes, gravy, turkey, green bean casserole, cranberries (usually sweetened) and of course, pumpkin pie. Although dinners vary from family to family, the majority of the foods will be fairly high in carbohydrate. The only food choice high in protein is the turkey, ham or something similar. Using my personal example from above, first come the appetizers. They're likely high in carbohydrates (yes, they're probably high in fat, too, but that won't impact blood sugar). Then comes the meal with a huge load of carbohydrates, followed by dessert, with more sugar and carbohydrates. Depending on where you get the information, Thanksgiving meals are between 3000-4500 calories.

So, once you're loaded up with carbohydrates, your blood-sugar goes up, up, up for a while and at some point it will come crashing down. That's when the lights go out. Along with falling blood-sugar, a couple of other things take place while you're sitting on the couch, more stuffed than the turkey ever could have been. Your intestines stretch out to handle the large volume of food, which can have the opposite impact of the "fight or flight" response on your nervous system. The huge feeding causes your nervous system to relax and induce sleep. Also, your digestive system needs more blood than normal to support the digestion of the meal. Since your digestive system needs it, the rest of your body gets less blood than normal, including your brain. Your body just knows that the best thing to do is make you sit still and burn as few calories as possible as it attempts to digest the massive meal.

Summary

Overfeeding is never really a healthy thing to do. The best thing to do is eat slowly, eat only one serving, and fill up more of your plate with turkey and vegetables. Eating more turkey will replace a lot of the other high-carb/high-fat foods around the table and fill you up faster. In fact, the turkey that you were told would put you to sleep may actually keep you from overdoing the food and falling fast asleep.

If you do choose to overindulge, be sure you get yourself to the gym the next day. If you average 300 calories burned per hour during exercise, you'll only need to workout for...fifteen hours to offset your meal. Fortunately, Life Time Fitness is open 24 hours a day! Happy Thanksgiving!

In health,

Tom Nikkola

Resources:

Lieberman, H. Nutrition, brain function and cognitive performance. Appetite. November 2002

Coco Blaantyne. Does Turkey Make You Sleepy? Scientific American. November 21, 2007

Joanne Holden, Nutrition Data Laboratory, Agriculture Research Service. USDA National Nutrient Database for Standard Reference, Release 20. US Dept Agriculture

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.

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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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.