How yogurts and ‘milks’ mess with your head.

The big news in Olympic history before the games even started was the yogurt embargo. Yogurt, specifically US shipments of Chobani Greek (style) yogurt, was banned from Russia because of paperwork issues. If Americans were outraged about the politics of this ban on yogurt-eating liberty, fair enough. But trust me, the impact on athletes’ nutritional status and performance was non-existent. Did Gold miss medaling for figure skating due to it? Hardly. Did Ligety capture two golds in spite of his yogurt free diet? Absolutely.

Yogurt's impact on you.

Did you know? That individual yogurt you’ve been buying isn’t what you thought it was. Yes, you too have had limitations placed on your yogurt.  Same price, with even greater costs, as you’ll see, so keep reading.

I was rushing down the aisles of Stop and Shop last week, hitting the perimeter for the essentials. Produce, bread, eggs and yogurt, to name a few— were on the list. Not a regular ‘Stop and Shop shopper’, I was struck by the relatively low prices on the yogurt, the Greek yogurt, the Chobani Greek yogurt, specifically. So I grabbed some arms’ full and dropped them into my cart. But before moving on, I took a double take. The packaging was subtly different, though not strikingly so. Same shape, ever so slightly different label design. They were slightly cuter, even.

And then I realized. The container was once again downsized, this time from 6 ounces to 5.3. And the calories were similarly reduced. Yes, yogurt has slimmed down once again. The tag line should read “now with less calcium (only 15%!), fewer calories, and other nutrients you were expecting—all for the same price!”

What yogurts used to be.

When I was an elementary school kid, I remember buying individual containers of yogurt—Dannon at that time. They were 8 ounces, and they certainly weren’t lite—these were the olden days, where the only diet product with artificial sweeteners was an awful tasting cola called Tab. It’s possible they were low fat, but not fat free—that also didn’t exist back then, to my knowledge. And they were in the mid to upper 200 calorie range. At that time, it wasn’t odd to have a yogurt—along with a fruit or a muffin, let’s say, for a quick lunch or breakfast. And that might have been just fine.

That was then. But now?

While I hate to talk calories, I think it’s important here: prepackaged yogurts these days are the caloric equivalent of an 8 old glass of skim or low fat milk. That’s right. We're talking a standard paper cup size,  the equivalent of 2/3 of a 12 oz soda can portion. Would you expect a small glass of low fat milk, by itself, to be an adequate meal? How about for someone you really care about? Do you have a double standard here—okay for you, not for them? I consistently see patients consuming it with the expectation that it ought to be enough.

You and the Olympians.

The consequence on the yogurt-deprived American athletes may have been on their psyche—they may be accustomed to doing things the same way perceiving that if they change, they won’t get the same results. But truly, unless they are vegetarians dependent on the high protein content of Greek-style yogurts, protein malnutrition would not threaten a medal.

This one's 8 oz still!

But the impact of the manufactures’ sneakily shrinking serving size is much greater for you. You eat one and expect it to satisfy like it used to. Or if you, like me, grew up in the era of fuller fat yogurts, you may still be in the mode of considering a yogurt a meal or a significant part of one. No, we simply can’t rely on portion sizes to dictate our needs! (Read more on this topic: http://dropitandeat.blogspot.com/2010/08/size-matters-but-not-how-you-think.html and http://dropitandeat.blogspot.com/2014/01/role-modeling-with-lean-cuisine-diet.html)

Milking it

While we’re on the subject of dairy, let’s talk about milk, or rather, beverages mistakenly referred to as milk. Think rice, coconut, hemp, and almond beverages. Beverages, because referring to them as milk misleads us. There is nothing milk like about them, except, perhaps, the shade of grey/off white. Sure, they may be fortified with calcium or vitamin D (although not all are, in fact), but when you pour a glass of milk-beverage you expect that it’s going to satisfy like a glass of milk. Yet many of these beverages are little more than fortified water or fail to match milk nutritionally.

You’ve already heard my rant about almond beverage.

Some almond milks have as few as 30 calories--I'm not recommended these, and all have only about 1 gram of protein—that’s 7 grams less than a glass of cow’s milk. Soy milk is consistently better matched with cow’s milk for protein (usually at 6 or 7 grams) but may be much lower calorie as well. Coconut water is neither high in protein nor calcium or D, but at least they call if ‘water!’. Hemp milk (yes, really) comes in at 2-3 grams of protein and calorically is a match for 2% or whole milk. Rice milk also matches calorically, but has only 1 gram of protein.

Who cares?

Why address this topic? Because I want you to not be fooled into thinking that these yogurts and milk beverages are adequate. When you get hungry after a pseudo milk drink, I don’t want you to blame yourself. When you are feeling less than satisfied with what you thought was your usual yogurt, think again.

Maybe there's a reason you're scavenging for food!

Start looking around, because these aren’t the only items shrinking. Did you think you plowed through the whole 1/2 gallon of ice cream? Well for the record, most brands (at least here in the US) have shrunk, too. Breyer’s, one of my favorites, now has 6 not 8 cups per container. In fact, it has fewer calories per cup, too—but interestingly, they’ve not advertised that! They have substituted guar or tara gum as a filler, displacing some of the cream and whole milk.

I realize that we all don’t need more saturated fat from cream, and some might benefit from an adjustment in portions. But if you’re noticing you’re hungrier these days with your same products, take a second look. You just may not be getting what you thought. Maybe your body is just trying to tell you something. Perhaps it’s time to start trusting your signals—and taking a second look at the package sizes.

Have you had this experience? Wondering why you’ve been hungrier? Seen other products that have shrunk without telling us? Please share!

Thanks for reading and passing this on!

Diet Solution to Weight Gain Epidemic Revealed!

An RD’s lessons from the Harvard Study

Thanks to Right Angle Tutors for use of this photo

Harvard researchers just discovered the cure to the so-called obesity epidemic. Or so you may think from their press release June 22, 2011 and from the media blitz that followed Effect of Lifestyle On Weight Gain, published in the NEJM. Powerful statements linking specific foods and food categories with resulting weight change emerged. And any progress we had made as a society toward a balanced approach to eating, to a move away from rigid food rules, crazy diets, and food paranoia was destroyed. They concluded the following:

• There are ‘good’ foods and there are ‘bad’ foods 
• Focusing on specific foods to avoid versus counting total calories is the way to consume less 
• Changing carbohydrate type is the answer for weight control, by eating less sugars and other sweets
• Fruits, vegetables, whole grains, nuts and yogurt prevent long term weight gain



Do the fruit and nuts get to count as a fruit serving in my chocolate?

• Potato chips, French fries, boiled, baked, mashed potato, sweetened soda, and meats are associated with the obesity epidemic

The study results and conclusions were further echoed throughout the media. Even Jane Brody, from the NY Times, wrote an article entitled “Still Counting Calories? Your Weight-Loss Plan May be Outdated”, where she states that it is no surprise that French fries led the list of foods that contributed to the greatest weight gain. Yet the Harvard study authors go out of their way to emphasize that the results do not suggest it’s about how many calories per French fry (its “caloric density” or calories per serving)—so why draw the conclusion that of course (high calorie) French fries would be high on the list for causing weight gain?

The authors do acknowledge that, “weight stability requires a balance between calories consumed and calories expended…” (although the media fails to highlight this little detail). Yes, they still agree that weight management comes down to calories. But what they hope to define are the foods which are associated with our over consuming calories, along with possible explanations.

What’s it all about?

Harvard School of Public Health evaluated three separate studies to see how changes in our eating and in lifestyle factors impact our weight gain over time. Researchers evaluated self-reported changes in lifestyle factors (cigarette smoking, exercise, alcohol consumption) in addition to changes in individual foods consumed. They looked at three large groups of participants over a 12-20 year period, reassessing every 4 years. They then drew some conclusions and released them in a Press Release and a professional journal article.

Because weight gain creeps up on us (or at least in this study population of non-obese individuals), the authors suggest it is more difficult to know what’s contributing to weight gain, which averaged 16.8 pounds over a 20-year study period. And so they undertook this colossal venture to find us the answers. Well, at least they tried to.

Before I share my reaction to the studies’ results, conclusions and media frenzy, let me state that I have no financial interest in the National Potato Growers Association (is there one, even?).  Or, I might add, with Coca Cola and PepsiCo. But I do have a vested interest in not propagating diet myths. And it is this fear of public misinformation that drives me to invest the time reading the full research article (all 13 pages), which I suspect many of the popular press’ journalists failed to do.

My conclusions on the Harvard study

Servings

Can you guess how much ice cream I ate? And how much I had
from the container before acknowledging I was eating?

Twenty-five years counseling patients and I can assure you that most people are not very adept at accurately assessing their portions. Sure, we can accurately report how many fruits we consumed, but how many chips? Or how much mashed potato? And I’d bet my serving of French fries differs from yours! Ask a dozen different people and you’ll undoubtedly find there’s a tendency to underestimate portions.

That is, unless you are underweight or anorexic; these populations tend to overestimate portions. And beverages are most notoriously challenging for us to estimate (unless of course they are in a marked can). When I have people measure their drinking glasses at home to determine just how much soda they drink, they are shocked. What they assume to be 8 ounces is typically double that amount.

Prepackaged food items and individual units will naturally be more accurately evaluated—individual yogurt cartons and fruits, for instance. Even grains that we tend to measure may be easier to assess, such as oatmeal, rice and cooked whole grains. These very foods that we are more likely to accurately assess our portions of, tend to be lower in calories. Without a doubt, this could distort the study's findings.

Sometimes a potato isn’t just a potato

How do you make mashed potatoes? I’ve heard of recipes that include a whole stick of butter, and some with only half a stick; there are those that add heavy cream and those that add a splash of milk. What’s my point? Did the researchers have information about the contents of these mashed, boiled, and baked potatoes, before concluding that it was the “refined carbohydrate” that was the culprit here leading to weight gain? The study emphasizes that it’s not about calories per serving. But here’s the problem: the serving size is not measured in the study, and we simply can’t make any conclusions about caloric density, if we don‘t even know the content, never mind the quantity, of what’s really in each portion!

Food selection may be a marker for more conscientious eaters

A colleague once said “if she’s eating rice cakes for breakfast than she’s not too serious about gaining weight”. Point well taken. Those who take the time to cook whole grains, such as brown rice, quinoa and buckwheat, are not likely to be the frequent diners at McDonald’s. Perhaps we could say the same for yogurt and low fat dairy eaters. Does anyone start drinking skim milk because of the taste? Eating these foods may simply identify those people who care about their health and the direction of their weight. Weight change may have nothing to do with the individual food itself.

Lifestyle changes they should have assessed

In their next study perhaps they should look at variables that truly impact our weight. Here are a few questions for their next questionnaire:

• Do you eat your potato chips right out of the bag, or do you measure them? 
• Do you have a second and third portion immediately or do you wait to see if you are still hungry? And if you wait, how long do you wait for? 
• Do you reach for food when you are hungry, when your body needs fuel? Or do you find yourself reacting to a triggering conversation with a loved one with some sweets or chips? 
• Do you eat the chips mindfully at the table, without distraction, or are they consumed while driving, watching TV or at the computer screen?

Trust me--these cause weight gain. That is, when you eat them
right from the bag without attention to portion!

These behaviors have everything to do with our weight change. We are less accurate assessing our food intake when distracted. And our mindfulness about hunger and satiety likely gets lost as well. Not eating with all our senses can make us feel like we haven’t yet had our needs met, and so we keep seeking, looking for more food to eat.

Secrets hidden in the Study that nobody advertised

Meat

For all of you Zone Diet and Atkins followers believing that more protein is good and carbs are bad, think again. This study showed that over time, meats, both processed and unprocessed types, were associated with weight gain. So if you are still stuck in the need for more protein for weight management, heed the warning. But remember, this is based on self-reported portions, a potential flaw in this study!

Dairy

So it’s notable to me that yogurt and low fat dairy products as a category (adjusted by age) significantly link with decreasing weight over time. Why notable? Because Walter Willett, one of the study authors, has never been fond of supporting milk consumption. In previous presentations promoting his Mediterranean Oldways Diet Pyramid, he spoke strongly against inclusion of milk and milk products. 


Never shy to ask my questions at conferences, I pressed him on this subject some time ago. His response fell short. He emphasized that some have intolerances to milk, and generalized about milk’s high fat content. And what about low and non-fat diary? And what about Lactaid milk for the intolerant? The majority of the population does not have a milk allergy, so why such an omission of dairy for the general healthy population? Let’s acknowledge that low fat dairy and yogurt are valuable, based on this study’s data.

Diet Soda

There was no meaningful association between diet soda intake and weight change over time. Drinking it isn’t likely to cause weight loss. And contrary to previous media hype, diet soda won’t result in increasing weight either. But it certainly doesn’t add anything nutritionally to your intake. And, consuming it may displace some milk, which definitely does have its merits.

Exercise

Exercise itself didn’t link with weight change, but a change in exercise level did. One more time?

If you’ve been doing the same amount and intensity level of physical activity over years, what happens? Well, think back to when you first started to exercise. It was quite a workout. But after doing it consistently for a while, it got easier. And with greater ease, you weren’t working as hard. And when you weren’t working as hard, you were burning fewer calories. And if you were using up fewer calories, over time, even if your eating remained the same, you would gradually gain weight. For the under eaters and over exercisers among you, let me remind you that you are not at any advantage if you continue to restrict you calories, relative to your need, while exercising. You, too, will suffer, ultimately breaking down the very muscle you aim to increase, and slowing your metabolic rate.

Still reading? Here's the take home message!

So what have the Harvard researchers really taught us? To be critical readers of the media, and of research, for starters. To recognize that studies like these are merely looking at associations, between weight change and changes in foods, and in lifestyle factors. We still don’t know why the link between potato products and weight gain. Maybe if we controlled for serving sizes and preparations we’d see a link with caloric density and weight gain. But maybe not.

Is it me, or do you see a smiley face in my husband's sushi?

I support inclusion of whole grains, fruits and vegetables and yogurt in our diets. But I also know that there’s a place for white, refined carbohydrate sources such as pasta, rice and low fiber French toast. And do I need to emphasize there’s a place for chocolate?

It may be, with more information, we will find some valuable links about foods and their impact on our fullness, affecting our weight over time. But I’d be a lot more cautious, and the media ought to be too, about labeling foods as bad versus good, perpetuating the myth information that causes us to stress eat. 

Time to Clear My Plate. Before You Get Triggered by My Plate, Read This.

Oh, Michelle, I so appreciate your honest and passionate concern for improving the health of our nation, particularly our kids. Really I do! But quite frankly, the subtle messages conveyed through the new USDA My Plate set us way back in our progress.

That’s not to say that I find nothing favorable about it. I do like the bright colors (they make me feel like a kid again), and the concept of half the plate as fruits and vegetables is truly a helpful, and reasonable teaching visual. And, a message I can support. But here’s where we part.

Where are the fats?

Ok, I realize that in the written food group description fats get mentioned, but not encouraged. And let’s face it—it’s the visual image that makes the biggest impact. And in that regard, fats are absent. Yes, in spite of the latest Dietary Guidelines for Americans summarizing the enormous body of research and declaring that increasing (unsaturated) fats should be a goal, comprising up to 30% of all our calories, this message is lost in My Plate.

In fact, in the description accompanying the image, it even sheds a negative light, saying “oils are not a food group”. And by oils they really mean fats, because avocado, for instance is not oil. Funny, in past pyramids, such as 2005, fats were a distinct part of the pyramid and were scattered around as a component of the other food groups. And if fats are not a food group, why is protein? If I remember my basic nutrition way back the three macronutritent groups making up all foods are protein, fats and carbohydrate. Yet My Plate places the nutrient protein on the plate, a component of foods, as if it’s a food, yet states that fats have no place? I don’t get it.

Where’s my favorite food group?

But perhaps the biggest problem I have is the omission of those “empty calorie” villains, the “sweets”. Past health messages from the American Dietetics Association and the recent aforementioned Dietary Guidelines for Americans 2010 instructs us to “find balance between food and physical activity.” At no point do they suggest we should eliminate sweets to prevent obesity.

And speaking of those additional calories, why make such an overreaching statement like “Enjoy your food, but eat less”? Should I suggest this to my normal weight sons? To the healthy growing kids I see? To the many I work with struggling with trusting their hunger, many of whom are working hard to increase their calories by appropriately eating more? Should I be eating less as I’m training for a biking event this month? Such an unnecessary and detrimental generalization! Would it take an eating disordered child for Michelle to be more sensitive to such absurd health recommendations?

This dietitian endorses a health-promoting message to include junk food!

Here’s the scoop. Black and white messages about good foods to eat and bad foods to avoid are damaging. They contribute to society being misinformed about weight management, and about eating in a healthy, balanced and pleasurable way. In life kids and adults are going to eat cupcakes and chocolate and ice cream in all flavors. The problem won’t be that we’re eating these foods. It’s that we view them as bad, feel guilty, and end up overeating them, because we have been convinced that we have done wrong by consuming them—in any amount. Rigid rules and clear omissions teach us nothing. They reinforce the wrong messages. It’s time to get with the times.

Why the beef about dairy?

And to the critics of inclusion of a dairy serving, like Walter Willet at Harvard (who says there’s no evidence to support including a dairy requirement), I’d like to ask you this—are you thinking we’re going to meet our requirement for calcium and Vitamin D from sardines, canned salmon, almonds and broccoli? I don’t think so. Perhaps the USDA could have done better by broadening that category to say “milk and fortified soy milk”; no other non-dairy alternative provides as much protein as well as calcium and Vit D. Yes, there is evidence that we need an adequate intake of these two nutrients, and practical, economical, acceptable sources are few and far between outside of dairy products.

As for the interactive resources, I would love to share my thoughts. But after signing in, the program failed to work when I tried to explore the physical activity section.

Time to go eat. 

My plate will include some homemade waffles this morning, fruit, yogurt, and real Vermont, full sugar maple syrup. And I just might decide to include a piece of pastry for my afternoon snack. And in spite of what My Plate urges, I have no intentions of reducing my portions from their usual level!

Thanks for reading! Enjoy your sweets today.