Personalized nutrition?

Recent scientific findings are beginning to lend support to a new approach to diet, one personalized to the individual.

Despite the hype, though, personalized nutrition may not be ready for practical application in the clinic.

This debate is not new–and is far from settled.

Ludwig, Astrup, and Willett (2015) suggest a path forward: “To avoid polarization in the scientific dialogue and public confusion, feeding studies, clinical trials, and observational studies warrant cautious interpretation, regardless of whether the outcomes support or challenge conventional nutritional understanding. Ultimately, the most reliable evidence on the health effects of diet, especially as it pertains to chronic disease, will derive from a combination of multiple lines of investigation, including mechanistic investigations, epidemiologic observations, feeding studies with surrogate outcomes, and longer term behavioral trials.”

The above quote makes me feel warm and tingly inside. 

Ludwig, D. S., Astrup, A., & Willett, W. C. (2015). The glycemic index: Reports of its demise have been exaggerated. Obesity, 23(7), 1327-1328.

3 Simple Tactics for Improving Your Health and Fitness, Starting Now

1. Train your midsection in no more than three to five sets of three to five reps of your preferred abdominal exercise.

To strengthen your midsection, follow just two rules: the rule stated above and 2) focus on contraction, not on reps and fatigue.

Pavel Tsatsouline, on episode 55 (at 27:35) of The Tim Ferriss Show (i.e., a podcast), describes applying this method using the plank:

Illustration of the basic plank exercise.

The basic plank. Make sure your hands form fists.

Rather than struggle to hold a plank for 60-90 seconds, perform a basic plank for 10 seconds. Contract absolutely every muscle below your neck—as if someone plans to “walk by and kick you in your ribs.” Rest. Perform a plank for 10 seconds. Rest. Perform a plank for 10 seconds. Done.

Repeat this sequence three times a week for several months. Three to five sets of holding a plank for 10 seconds, three to five times. Simple and doable.

2. Your personal narrative may be deterring you from pursuing your health goals. Write and edit your own story to challenge how you perceive yourself.

“Some researchers believe that by writing and then editing our own stories, we can change our perceptions of ourselves and identify obstacles that stand in the way of better health. It may sound like self-help nonsense, but research suggests the effects are real.”

3. Identify where you stand on the continuum between whole, real foods and fads.

The closer on the continuum you are to eating whole, real foods, the better off you are. Remember, though, that it’s a continuum, so don’t agonize over staying on the very far end. Simply inch away from the fads. Find a spot on the continuum that’s sustainable for you.

In case you’re wondering, here’s what a match-up of real, whole foods vs. fads looks like.

###

Health lifestyle cluster membership—how do you self-identify?

“Physical Fantastics”: the most health-oriented group. They neither smoke nor drink beyond moderation. They also exercise routinely, eat a healthful diet, and watch their weight. (estimated to be approx. 24% of the U.S. population)

“Active Attractives”: this group also is relatively health-oriented, although more for reasons of appearing attractive than for purely health reasons. They are unlikely to smoke, but they drink frequently. Although they intend to exercise, eat healthfully, and watch their weight, their actions fall short of their intentions. (estimated to be approx. 13% of the U.S. population)

“Tense but Trying”: those in this group drink only in moderation and are average or above average in terms of exercise, nutrition, and weight control. They smoke cigarettes but would like to quit. (estimated to be approx. 10% of the U.S. population)

“Decent Dolittles”: neither smoke nor drink, but neither do they exercise or eat healthfully, and they are markedly overweight. (estimated to be 24% of the U.S. population)

“Passively Healthy”: persons tend to not smoke nor drink alcohol beyond moderation and get a considerable amount of exercise. They are unconcerned with what they eat and, as a result, consume a high-fat diet. (estimated to be 15% of the U.S. population)

“Hard-living Hedonists”: smoke and drink heavily, eat poorly, and get an average amount of exercise (estimated to be 6% of the U.S. population)

“Noninterested Nihilists”: smoke heavily, eat poorly, and do not exercise, although they are unlikely to drink beyond moderation. (estimated to be 7% of the U.S. population)

Bear in mind the original research behind the development of the above “healthstyles” was published in 1996, i.e., the proportions likely have changed since then. Monday through Thursday, I’d classify myself as a “physical fantastic,” who then more often than not becomes a non-smoking passively-healthy type over the weekend. Nothing’s wrong with washing down a cheeseburger with a glass of pinot noir every now and then, right?

How would you classify yourself?

Original research: Maibach, E. W., Maxfield, A., Ladin, K., & Slater, M. (1996). Translating health psychology into effective health communication: The American healthstyles audience segmentation project. Journal of health psychology, 1(3), 261-277.

My source for this post: Glanz, K., Basil, M., Maibach, E., Goldberg, J., & Snyder, D. A. N. (1998). Why Americans eat what they do: Taste, nutrition, cost, convenience, and weight control concerns as influences on food consumption. Journal of the American Dietetic Association, 98(10), 1118-1126.

ACA open enrollment begins November 15

“If even a health economist will confess to needing better access to price and quality information when choosing a health plan, it’s a sure bet that many other Americans need it as well.”
Austin Frakt 

If you obtain health coverage through the Affordable Care Act and haven’t already chosen a plan for the next coverage year, maybe it’s time to start doing your homework. The Kaiser Family Foundation has a great consumer resources page.

Fast food entrepreneur ditches fried food for quinoa

24-hour-health-food-restaurant-atlanta

A 24-hour health-food restaurant in the South—breaking news or just a slow news day?

At first glance, I guessed the sub-headline for this article must be the comedic genius of the folks over at The Onion: “Richard Thomas opened a health-food restaurant after a nutritional consultant told him that fried food was bad for his customers.”

Not so—credit belongs to the headline writers at The New York Times. The restaurant featured in the article—The R. Thomas Deluxe Grill—has definitely made it on to my list of Atlanta restaurants to try. It’s practically in my backyard and I’m embarrassed to admit that this is the first I’ve heard of it.

Based on the photo above, a 24-hour health-food restaurant in the South truly must be an anomaly. Or, could this highlight a growing trend? I’m hopeful it’s the latter.

Graffiti, rabbit holes, and hidden gems: Discover something new (to you)

rabbit_graffiti

“Blogging is not writing. It’s just graffiti with punctuation.”
— Dr. Ian Sussman to Alan, in the movie Contagion

I started writing this blog with few expectations other than with a broad objective to provide useful content for anyone interested in understanding:

  1. how to take steps—whether large or small—toward living a healthier lifestyle, and 
  2. how the scientific, research, and public policymaking processes both facilitate and impede our attempts to do just that. 

Most readers of this blog will learn that for practical purposes, lifestyle changes occur via a series of small decisions made day after day. It’s an unsexy framework, to say the least, but that’s where I fall. Clearly, my background is not in marketing. However, if anything I write inspires a 180-degree transformation for the better in any reader, I’m all for it. 

I first published to this blog on January 24th of this year. About eight months and 17 posts later, there is one pitfall I want be especially vigilant of: creating just another wall of graffiti.

In my view, one strategy for avoiding skirting on the edge of Internet vandalism involves giving credit where credit is due. Continue reading

Vertical vs. horizontal programming: Which approach should you leverage to achieve your health improvement goals?

When in doubt, a vertical approach may be your best bet.

When in doubt, a vertical approach may be your best bet.

Vertical vs. horizontal programming: The individual perspective

Exactly how many measurable changes do you need to implement to improve your health? One, two, two dozen?  Only a few, really—fix your diet, get up and move, and quit the tobacco. You’ve heard all of this before. I’m not here to preach. 

I will, though, throw out a suggestion: consider whether taking your next step in the right direction will be part of a vertical or a horizontal approach. As an individual, the approach that nudges you toward making changes today, rather than tomorrow or next week, is the right approach for you.

Vertical programming emphasizes making changes in one area exclusively—such as using a pedometer and aiming for 10,000 steps each day—while modifying nothing else about your routine. In contrast, horizontal programming emphasizes a more comprehensive approach that requires altering multiple aspects of your routine simultaneously—maybe all three of the biggies listed above.

For many (if not most) of us, horizontal programming may be doomed to failure. In other words, is implementing multiple changes at one time simply too overwhelming? It’s likely. Horizontal programming is an ideal to work toward. How do you get there? Start with vertical programming, which provides a realistic starting point. Change one thing, stick with it for a while. Continue sticking with it. A little bit more. Still sticking with it. Okay. Make another change. Continue sticking with the first change. Stick with the second change. And so on. Continue reading

The obesity problem: A permanent fixture in the headlines we read?

The Lancet last week published some pretty grim statistics. Worldwide, between 1980 and 2013:

  • The proportion of adult men with a body mass index (BMI) of at least 25 kg/m2 increased from 28.8% to 36.9%
  • The proportion of adult women with a BMI of at least 25 kg/m2 increased from 29.8% to 38.0%

The authors of the study conclude:

Because of the established health risks and substantial increases in prevalence, obesity has become a major global health challenge. Not only is obesity increasing, but no national success stories have been reported in the past 33 years. Urgent global action and leadership is needed to help countries to more effectively intervene.

The media had a field day:

Without a doubt, this is nothing short of a global problem in need of global solutions.

In the meantime, success on the individual level not only is possible, but is occurring as I write this.

###

Increasing adiposity: Consequence or cause of overeating?

In a recent “Viewpoint” (i.e., opinion) article for JAMA, David Ludwig and Mark Friedman compare and contrast prevailing and alternative models of obesity.

The prevailing model:

Voluntary changes in calorie intake predictably produce short-term weight change, suggesting the possibility of conscious control of body weight over the long term.

Evidence exists, though, that contradicts the prevailing model:

However, feeding studies demonstrate that changes in energy balance produce biological adaptations that antagonize ongoing weight loss or gain. For instance, in a study in which 41 lean or obese research participants were underfed or overfed to achieve 10% to 20% weight change, energy expenditure decreased or increased, respectively.

That is, the body tends to defend its baseline body weight. Continue reading

Health freakonomics: A short list of Freakonomics podcasts for health freaks

I listen to a ton of podcasts—in the car, at home while doing chores, and while working out. A favorite of mine is the popular Freakonomics podcast by Stephen Dubner and Steven Levitt, based on the pair’s best-selling non-fiction books.

The core principles of economics have been applied to health issues, per se, for quite some time and offer unique insights into what ails modern societies.

Here’s my short list:

 Is America’s Obesity Epidemic for Real? (21:05)

You Eat What You Are, Part 1 (30:08)

— 100 Ways to Fight Obesity (37:21)

 ###

The three-word headline that caused an uproar

Is butter really back?

Is butter really back?

A recent headline in the The New York Times garnered a flurry of attention, both good and bad. The headline: “Butter is Back.”

In the article, Mark Bittman describes how results from a recent meta-analysis vindicate saturated fat—and therefore, butter—as a villain in our diets.

The attention, no doubt, stems from a combination of the prominence of the author—Mark Bittman, the Times’ acclaimed food writer—and one of the article’s many messages that happened to receive the most air time:

You can go back to eating butter, if you haven’t already.

What about the other messages from the article that help shape the context and our understanding around why such a statement is not nearly as blasphemous as many of the harsh reactions would have us believe?  Continue reading

Focusing on the global burden of risk factors, not diseases

In Vietnam, the switch from bicycles to motorbikes as the primary means of transportation has reduced physical activity and, in turn, contributed to rising rates of chronic diseases.

In Vietnam, the switch from bicycles to motorbikes as the primary means of transportation has reduced physical activity and, in turn, contributed to rising rates of chronic diseases.

During his TED talk in 2006, Hans Rosling describes how he informally tested his class of Swedish undergraduate students at the start of the term.

He asked his students: “Which country has the highest child mortality of these five pairs?”

— Sri Lanka or Turkey
— Poland or South Korea
— Malaysia or Russia
— Pakistan or Vietnam
— Thailand or South Africa

Rosling chose each pair so that one country had twice the child mortality rate of the other country in the pair.

He discovered that his students, for the most part, were unable to select which country—out of the five pairs—had the highest child mortality rate.  Continue reading

Confused? This probably has something to do with it.

An eye-opening (to say the least) infographic on the accelerating pace of scientific publishing and the rise of open access.

— A list of papers published in 1880 would fill about 100 pages.

— Today, we’re looking at a page published every 45 minutes.

How many of these papers discuss “new” or “breakthrough” findings in health, nutrition, causes of morbidity and mortality, and so on? My guess: more than we could read in multiple lifetimes.

Yes, no wonder so many of us are confused.

###