Health Benefits Cutting 297 Calories A Day

Bob Crowther (68) highlights a July 11, 2019 article in THE LANCET - a two year study examining the effects of calorie restriction on cardiometabolic risk factors in healthy adults.   

Adho Mukha Svanasana

Downdog (2015)

 BACKGROUND

US Centers for Disease Control and Prevention
About 610,000 people die of heart disease in the United States every year - or, 1 in every 4 deaths

METABOLIC SYNDROME
A Cluster Of Metabolic Disorders 
[American Heart Association]

Medical diagnosis can be met when three or more of the following biomarker measurements are observed in an individual - increasing cardiovascular risk:

1 - Abdominal Obesity: waist circumference greater than 40 inches for men, greater than 35 inches for women

2 - Triglyceride: blood serum fat level of 150 milligrams per deciliter of blood or higher

3 - HDL Cholesterol: high density lipoprotein cholesterol values of less than 40 mg/dL in men, 50 mg/dL in women

4 - Blood  Pressure: systolic pressure (top number) of 130 millimeters  of mercury or greater; diastolic pressure (bottom number) of 85 mm Hg or greater

5 - Fasting Glucose: blood sugar levels at, in excess of 100 milligrams per deciliter

[Underlying causes of metabolic syndrome include overweight and obesity, physical inactivity, genetic factors, getting older]

2015 - 2020 US Dietary Guidelines

Recommended 

Daily Calorie Consumption Estimates

[Varies On Age, Height, Weight, Physical Activity]

Adult Women: 1600 - 2400

Adult Men: 2000 - 3000

YET
Pew Research Center Analysis
(Bob Curley)

. The average daily caloric intake for Americans rose 23% from 1970 to 2010

. In 2010, the average American consumed 2,481 calories

Evaluating Health Benefits

From
 CALORIE REDUCTION 

Anahad O'Conner of the New York Times reported on the Kraus investigation, its significant and noteworthy findings:

. it "was the first major clinical trial to examine the effects of caloric restriction in a group of middle-aged or younger adults who were either normal weight or just slightly overweight but not obese.

. The goal of the trial was to look at whether caloric restriction could influence healthy aging and disease."

[Kraus findings build on hypothesis that it's not just weight loss that leads to these improvements, but some more complex metabolic change triggered by eating fewer calories than what's expended. (Samiha Khanna)]

Authors

Prof William E. Kraus, MD (Duke University)
[There were 11 Co-Authors]

Article Title

2 years of calorie restriction and cardiometabolic risk (CALERIE): exploratory outcomes of a multicentre, phase 2, randomised controlled trial

[This study by Kraus, colleagues used data from CALERIE = Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy]

Journal 

THE LANCET Diabetes & Endocrinology

 (July 11, 2019)

Funding
(55 Million)

National Institute on Aging and National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

Duration Of Study

May 8, 2007 to February 26, 2010

Involving

3 Clinical Centers in the USA

Participant
 Details

Healthy, Lean to Overweight 
Average Age Men & Women (38), Range: 21- 50 

Body Mass Index (BMI)
Average Baseline (25.1), BMI Range: 22.0 to 27.9 

BMI Defined

[= person weight in kilograms (kg) divided by height in meters squared]

Obese Individual Has A BMI of 30, Higer

Participant Pool

218 Individuals Selected, Randomly Assigned 
[238 Were Assessed, Some Eliminated Based On Concerns About Physical Or Mental Health] 

Participant Ethnic Backgrounds
 76% White, 15% African American
 9% Asian, Native American or Pacific Islander



Study Design

Experimental and Control Groups Composition

Experimental Group - 143 individuals were assigned to a 25% caloric restriction diet, 117 participated for 2 years:

• Initially 44 Men, 99 Women 
• Ate 3 Meals/Day Prepared At 3 Clinical Centers For First Month To Understand What A 25% Reduction In Calories Looked Like 
• Choice Of Six Meal Plans Made Available (Cultural Preferences)
• Received Individual, Group Behavioral Counseling For First Six Months On Basics Of Calorie Restriction, Learned To Cook Low Calorie Meals

Control Group - 75 individuals began, 71 completed full 2 years:

• Initially 22 Men, 53 Women
• 'Ad Libitum': Continued Usual Diet  
• Received No Behavioral Counseling
• Met With Researchers Every Six Months 

 Cardiometabolic Risk Factors Evaluated

Baseline data of known biomarkers impacting health span (for cardiovascular and metabolic risk factors including diabetes) were obtained for both groups:

1. Blood (Systolic, Diastolic) and Renal Pressure Values
2. Cholesterol (LDL Cholesterol, Total Cholesterol to HDL Cholesterol Ratio) ... LDL often referred to as 'bad' cholesterol
3. Metabolic Syndrome Score (based on data about abdominal circumference, blood pressure, cholesterol, triglycerides, glucose)
4. Glucose Homeostasis (Measures of Fasting Insulin, Glucose, Insulin Resistance, 2h-Glucose)
5. Inflammation: High Sensitivity C-reactive Protein (hs-CRP) linked to heart disease, cancer and cognitive decline

FINDINGS

Major Cardiovascular & Metabolic Health Benefits 

[Experimental Group]

"Calorie restriction caused a persistent and significant reduction from baseline to 2 years of all measured conventional cardiometabolic risk factors"

• Cut 297 Calories A Day: Average Calorie Reduction (from 2,467 to 2,170) After 2 Years [Over First Six Months, Cut Calories by 20%]
• This Was A 11.9% Reduction, Not The 25% Goal Sought
• Lost About 10% Weight [On Average, 7.5 kg (= 16.5+ pounds)]
• Decrease in Fat Mass Loss (71%), Did Not Change Protein Intake, Ate Slightly Fewer Carbohydrates

AND

• Lower Total Cholesterol, LDL Cholesterol Values - decreased significantly after one year; change was maintained at two years

• 24% Less Blood Serum Triglycerides (Fats)

• Improved Blood Pressure (Systolic, Diastolic) - lowering evident as early as six months, reached statistical significance by one year and persisted for the duration of the study

With Significant Improvement In:

• hs-CRP values (Less Inflamation)
• Insulin Sensitivity Index (Reduced Risk Of Type 2 Diabetes)
• Metabolic Syndrome Score (Lower Risk Of Heart Disease, Diabetes, Stroke)

Also Noted:

• Increase In Micronutrients (Vitamins A, K and Magnesium) 
• Better Sleep, Increased Energy, Improved Mood
• No Significant Increases In Hunger Or Food Cravings

[Control Group]

Mean Reduction Calorie Intake: 0.8% 
Increased Weight: 0.1 Kg (= 0.22 pounds)

Dr. Kraus noted the Control Group participants did not see any of these health benefits of the Experimental Group during the same 2 Year span

Towards Eliminating 297 Calories A Day

Kraus: "It's not hard to achieve that amount of calorie restriction." "That's essentially an after-dinner snack." ... Identify a non-essential component of your diet you can easily skip. (Anahad O'Conner, A. Pawlowski)

What 297 CALORIES Looks Like

(Anahad O'Conner, Susie Neilson, Bob Curley)

. A large bagel, a few chocolate cookies, a small Starbucks Mocha Frappuccino

. About six standard-size Oreos (cookies)

. A ham and cheese croissant at Starbucks (320)
. A regular cheeseburger at McDonald's (300)
. A grab-size bag of potato chips (274)
. A small order of french fries at McDonald's (230)
. A Snickers candy bar (280)

Nutrition experts point out that it's more important to focus on what kind of foods you're eating as opposed to overall calories. (Bob Curley)

Madelyn Fernstrom

(NBC News, Health and Nutrition Editor)

"The calorie-restriction diet can take a lot of mental focus and discipline to maintain, but it can be achieved by eating a variety of low-calorie fruits and vegetables, fiber-rich starch, lean plant and animal proteins, and heart-healthy fats." (A. Pawlowski)

 INTERPRETATION OF DATA

"2 years of moderate calorie restriction significantly reduced multiple cardiometabolic risk factors in young non-obese adults." 

" These findings suggest the potential for a substantial advantage for cardiovascular health of practicing moderate calorie restriction in young and middle-aged healthy individuals, and they offer promise for pronounced long-term population health benefits."

"The extent to which their metabolic health got better was greater than would have been expected from weight loss alone" 

The authors recognized calorie restriction could reduce the "ravages" of cardiovascular disease, diabetes and obesity, possibly boosting  longevity. (A. Pawlowski)

QUOTES, PERSPECTIVES
 On Various Topics

 Kraus On Calorie Reduction:

• "We expected there to be [some] improvement on cardiometabolic factors because of weight loss.' ... "But ... we didn't expect the degree of improvement we saw." (Susie Neilson)

• " ... the magnitude was rather astounding. In a disease population, there aren't five drugs in combination that would cause this aggregate of improvement (Anahad O'Connor)

• "Caloric restriction in this study improved [the biomarkers for metabolic syndrome] dramatically early, and maintained improvements in all five of these parameters rather remarkably."  & Modestly cutting calories "improved even normal biomarkers to be supernormal. Clearly caloric restriction is going to reduce risk of obesity and diabetes among those at greater risk, but it also may actually impact individuals who have minimal risk, so it has broad application over a wide population potentially." (Bob Curley)

Also

• On Why Calorie Restriction Would be So Beneficial: "That's the million dollar question. Its something we really don't know."

• "It's not just due to weight [change]. There is something else about restricting calories that seem to have benefits on cardiometabolic factors that we don't really understand." (A. Pawlowski) 

• Kraus speculates: "We could be resetting the baseline in normal people so it will be longer until they get certain diseases" adding an evaluation of study participants in 10 years was a way to see if there was a legacy effect (see Becky Upham section on Calorie Restriction: The New Fountain Of Youth? and comments on the Diabetes Prevention Program informing Kraus thinking)

Kraus On Study Design 
Using Younger, Mostly Normal-Weight Population

"We designed this study on the basis of the results we've seen in animal trials where calories have been restricted." 
In most cases, the earlier you start the calorie restriction, the greater its effects on the life span and health span.
Health span is the period between the start of the intervention and the start of the disease 
Kraus and his team also wanted to see what benefits, if any, calorie restriction could have for people who weren't overweight (Becky Upham)

&

Susan B. Roberts, Sr. Scientist (Co-Author)
U. S. Department of Agriculture Human Nutrition Research Center on Aging
 Tufts University (Boston)

About Experimental Group

They tended to eat less fat than the control group ... "At the same time they had big increases in vitamin K and magnesium intakes" (markers of a generally healthy diet) (Becky Upham)

"They were eating more healthy foods ... Things like nuts, whole grains, green vegetables and legumes." (Anahad O'Conner)

Editorial Commentary On Study

Frank Hu, MD, PhD Director Of Nutrition
 (Harvard T.H. Chan School of Public Health)

Combining calorie restriction with other strategies like intermittent fasting, a low carb diet or the Mediterranean diet could help people stick with a healthy lifestyle that ensures a lean body over the long term - "the optimal way to promote longevity" (A. Pawlowski)

"Calorie restriction may be a useful tool for better health and weight loss, but it's unclear whether the changes in the new study will ultimately translate into longevity and reductions in chronic disease." ... Hu questioned whether caloric restriction would be practical for most people given that "we are living in an obesogenic environment with an abundance of energy-dense, nutrient-poor foods that are cheap, accessible and heavily marketed." (Anahad O'Conner)

Whether these findings could have real-world application is unclear. Although participants in the study were highly motivated and the intervention was intensive, many people couldn't comply with the goals of the study." (Becky Upham)

1

"Because individual food choices are shaped by the food environment the long-term sustainability of calorie restriction and its benefits on bodyweight can be easily undermined."

2

"Therefore, improving the food environment by making healthy food choices more accessible, affordable, and the norm while reducing the accessibility of ultra-processed and highly palatable foods is essential to supporting healthy food choices."

3

"To this end, policy solutions including sugar taxes, financial incentives producing and purchasing healthy foods, food labelling, and better regulation of food marketing are needed to improve the global food environment." (1,2,3 Jacqueline Howard)

Another Viewpoint

Dr. Subbarao Myla, Director Cardiac Cath Labs
Hoag Memorial Hospital Presbyterian
(Newport Beach, California)

He noted the study was "well designed" ... adding: "it would be interesting to see what happens to the contestants in this study two years after the study ended, if they sustained these habits or not"

Myla was interested in expanding the small trial sample size 'to determine whether similar results would emerge among a larger and more diverse group of people over a longer period of time'

He added: "The study did not address measures of activity which is very hard to control for. Weight loss is best supplemented and sustained by increasing activity." (Jacqueline Howard)

Speculation
An Unresolved Question Of Interest

Dr. Krause asks: could decreasing calorie intake extend life of humans as done with other animals?  
[Calorie restriction has been shown to increase the life span of various organisms and reduce their rate of cancer and other age-related ailments. (Anahad O'Conner)]

" The question is does caloric reduction extend life span or health span - the period between birth and when people develop diseases. ... In all organisms, caloric restriction seems to effect both, while exercise affects health span but not life span." (Bob Curley) 

Future Analysis

Kraus:
"We have collected blood, muscle, and other samples from these participants and will continue to explore what this metabolic signal or magic molecule might be." (Samiha Khanna)

Other next steps for research would be to combine caloric restriction used in this study with other lifestyle interventions, such as modest physical activity (Becky Upham)

Another
 Perspective 
David Sinclair, Professor Of Genetics
(Harvard Medical School)

On Caloric Restriction And Aging
(Susie Neilson)

... the study demonstrates a significant problem with using caloric restriction to improve human health: It's really hard to maintain, even for motivated people. Of the 143 participants who originally began the restricted diet, 26 dropped out before the two years were up. (Small sample size was a limitation of the study.)

"You can't expect the elderly or frail to do this severe dietary regimen. We need alternatives, be they intermittent fasting or medicines that mimic calorie restriction."

 Sinclair is working to understand how caloric restriction works on a molecular level so that he and others can come up with medications that confer the same benefits without the pain and difficulty.

The goal of any caloric restriction research is the reduction - any maybe elimination - of aging-related diseases.

"Aging isn't considered a medical condition - it's just too common. Hopefully, in the near future, we won't accept it."

"That's what calorie restriction offers: It compresses the period of sickness. People one day will hopefully live into their 90s in a healthy way and pass away more quickly and [less] painfully than we do now."

Sources (Reporters, Organization)

 Anahad O' Conner (NYT), Bob Curley (Healthline), Jacqueline Howard (CNN health), Samiha Khanna (DukeHealth), Susie Neilson (npr), A. Pawlowski (TODAY DIET & FITNESS), Becky Upham (Everyday Health)

 STUDY REFLECTS MY EXPERIENCES

I too achieved significant improvements, reducing cardiometabolic risk factors, over several years: positive health outcomes similar to those participants in the Experimental Group described by Kraus and colleagues in their two year trial.

 [During one year I lost 13.2 pounds (10.3% body weight) and, while intentionally eating more, successfully maintained my weight in the 120's at the end of the following 12 months] 

Complementing this lifestyle focus on making better and more informed nutrition choices, I continued my daily yoga sessions - whole body physical asanas contributing to maintaining and enhancing my mobility.

Walking and hiking at times have further contributed to my current health status.

Trader Joe's and Whole Foods continue to be sources of many nutrient-rich and diverse food selections including frozen fruits and vegetables.

I have enjoyed adding whole black figs to the various small home prepared meals.

Whole Black Fig

(Trader Joe's)

Knowledge of some family medical history, potential genetic risk factors have continued to inform my decisions and behaviors over many years.

[My dad was diagnosed with late onset diabetes and later experienced metastasis of colon cancer; my mom was diagnosed with congestive heart failure, had a stoke leading to partial paralysis.] 

Eating better, moving daily, reducing sources of stress and ones genetics all undoubtedly have contributed to many welcomed health status updates enjoyed as a senior - including my recent (June) colon evaluation I remained awake to witness.  

It's encouraging knowing lifestyle choices can, do have significant positive consequences.

I look forward to reading future observations from studies by Dr. Kraus and his colleagues.

Your reaction(s) my comments are welcomed.

#BobCrowther #Nutrition #Yoga

Positive Health Update, Physician Nutrition Education

Bob Crowther (68) highlights further lowered health risk factors during the past twelve months along with quotations from a recent opinion article about nutrition in The Journal of the American Medical Association (JAMA).

Encouraging Health Status From Lifestyle Choices

Senior Yoga Mobility
In
Hanumanasana

2013 
Making Progress 
In
Upright Forward Split

Demonstrating
Whole Body Range Of Motions, Limitations
Of
Muscles, Joints, Connective Tissues

 Seeking 
to
Improve
 Extending Legs Forward & Backwards
Raising Torso Towards Full Upright Position
 Shoulder Mobility, Having Arms Up Straight 


During 2018 -2019

• This Asana Is Included During Each Evening Yoga Session
• Yoga Blocks Are Used Often To Facilitate My Movements
• Have Been Experiencing Decreasing Lower Back Mobility Limitations 
• Enhancing Pelvic Girdle, Spinal & Shoulder Girdle Muscle Flexibility

Remaining focused on my daily yoga activities during this past year have contributed to the positive health outcomes I share below.

Fourth Annual Meeting With Dr. Jarrod Faucher
(Geriatric Specialist, St Vincent's Hospital)

[127.7 POUNDS]

Since March (2016), after reviewing my first blood and urine assay data in approximately 9 years, I significantly modified daily nutrition habits and made better and more informed food selection decisions.

As a consequence, both 2017 and 2018 lab assay data reflected improved health outcomes from the daily lifestyle choices I made.

My 2019 April 26th conversation with Dr. Faucher provided an opportunity to inquire about various evaluation numbers including data from four assays of blood samples after fasting 15+ hours (a urine sample analysis was not deemed necessary). 

MY FOCUS

This past year I remained relatively healthy, free of any illness, and only began experiencing nasal congestion during the two weeks before our meeting.

I was able to further enhance various health indicator values realized during the past two years without taking any prescribed medications, vitamins or supplements from: 

[1] two a day (morning, evening) yoga sessions in my condo

[2] adding hiking to my yoga, walking as physical activities of choice

[3] preparing most meals at home from nutrient-rich, high quality food sources to obtain proteins, carbohydrates and fats

 CONSEQUENCES OF ADDRESSING
 POSSIBLE
 HEALTH RISK FACTORS:

• Maintained Weight in 120's  
• Lowered Heart Rate, Maintained High Blood Oxygen Level
• Decreased Systolic Blood Pressure (Best In 4 Years)
• Reduced Triglycerides Value 
• Lowered LDL Cholesterol, Increased HDL Cholesterol
• Improved Cholesterol/HDL Ratio (Lowest To Date)
• Good Glucose, Electrolyte (sodium, potassium, chloride) Values
• Likely Enhanced Immune Protection  
• Limited Dupuytren's Contracture Mobility Impairment

By:

• Eating real food, restricting consumption of processed sugars in various forms and moving my body (yoga, hiking)
• Consuming mostly plants (vegetables, fruits, grains, seeds, legumes, spices, herbs), some seafood, occasional dairy and meat
• Limiting daily salt intake, drinking water at each meal & throughout the day
• Daily preparing own food, consuming small portions at each meal
• Monitoring weight daily, keeping (incomplete) food logs
• Receiving flu, pneumonia, recombinant shingle vaccines
• Having regular dental cleanings, good daily dental hygiene practices
• Stretching palms each day multiple times

I intentionally ate more during the past twelve months yet maintained a desired weight range to enable more challenging yoga whole body mobility. 

For several years I have commented on various nutrition topics - sharing information from various sources (personal, articles and books) - most recently in January, February and March. 

These posts may have influenced my friend Arno Tilles, MD to share a link to a published report on medical nutrition education in the April 9, 2019 issue of JAMA.
[My conversations with Arno on yoga fitness, nutrition, overall health and wellness topics over many years have been appreciated, valued.]

I have cited some of the author's words for your consideration.

TITLE
Nutrition Education In Medical School, Residency Training, and Practice
by
Stephen Devries, MD 
Walter Willett, MD
 Robert O. Bonow, MD

FIRST PARAGRAPH

"Nutrition education in medical school is rudimentary, at best, and limited for the duration of graduate medical education for many specialties. Requirements for meaningful nutrition education in all phases of medical training are long overdue."

FOUR REASONS

 Why Nutrition Education Deserves Special Attention:

[1]

"A 2018 report by the US Burden of Disease Collaborators identified poor-quality diet as the leading cause of death in the United States. The prevalence and cost of diet related diseases are predicted to climb if left unchecked."

[2]

"There is a renewed interest in a shift in health care from disease management to health promotion and prevention, areas that physicians will find difficult to adequately advance without a solid foundation in clinical nutrition.

[3]

"Patients are barraged by information on diet and health from the media, and physicians need to be knowledgeable in this area to help patients interpret and act on the confusing, and often contradictory, nutrition messages in the public domain." 

[4]

"There is increasing attention on the wellness and self-care of residents and fellows. Lessons learned by physicians-in-training about clinical nutrition might not only serve to improve patient health, but also have the potential to enhance physician self-care through greater awareness and knowledge of the dietary influences on well-being. This knowledge in turn can help make physicians more effective counselors."

SOME OBSERVATIONS

'Beginning with medical school, the time devoted to nutrition is limited, with an average of 19 total hours over 4 years, and is focused largely on biochemistry and vitamin deficiency states. ... Following medical school, nutrition education during the 3 or more years of graduate medical education is minimal or, more typically, absent."

" ... both residency and fellowship training ... lack a requirement for physician-in-training to learn about nutrition or diet. Similarly, requirements for nutrition education are lacking in speciality training programs

AND

The authors make a case that " ... guiding patients to make dietary changes is a team effort and can include appropriately trained dietitians, nutritionists, nurses, health coaches, and chefs. ... currently, most physicians do not have enough education in nutrition to contribute meaningfully to that team."

"Problems related to poor-quality diet and obesity are the result of many complex personal and societal factors that extend far beyond the the influence of physicians and hospitals. But physician visits are ideal opportunities to reinforce the message that attention to nutrition and lifestyle are critically necessary for optimal health and that medications alone, however important, will rarely be sufficient. Importantly, adequately trained physicians also may be stronger and better-prepared advocates for public policy that addresses the underlying causes of poor nutrition and food insecurity."

SUGGESTIONS
[1]

"The most useful approach to including meaningful nutrition education into all phases of medical training is not to consider nutrition a new unit in curriculum but, rather, to integrate concepts related to nutrition within the existing content. In this way nutrition can be more appropriately understood as a vital, practical determinant of health rather than an isolated discipline." 

[2]

"Physicians and health care organizations can collectively begin to emphasize their seriousness about nutrition in health care by practicing what they (theoretically) preach ... At minimum, a consensus to align food served in medical training programs and conferences with the Dietary Guidelines for Americans would be a welcomed approach."

LAST PARAGRAPH

"An emphasis on nutrition is not only good medicine, but is also becoming sound economics. As new value-based models for payment of medical services take hold, financial incentives in medicine will increasingly align with prevention-oriented services, and among them should be a greater focus on nutrition."

FUTURE WELLNESS ROADMAP

Daily lifestyle choices made these past years as a senior will continue during 2019 into 2020 and undoubtedly contribute to the relatively good health, mobility I now enjoy.

Share your reactions to my comments. 

#BobCrowther #Nutrition #Yoga

Yoga, Nutrition: Evaluating Fast Foods

Bob Crowther (68) cites multiple sources about a recent study led by Megan A. McCordy focusing on fast food variety, portion size, dietary energy and micronutrients including sodium of entrees, desserts and sides over 30 years.

MAINTAINING A LEAN BODY EATING REAL FOOD

Enhancing Spinal Mobility

Full Lotus Variation
The Yoga Loft
 (2017)
PHOTO BY PATTY TREMBLAY

Demonstrating

Joint Mobility

&

Supple Lower Body Muscles 
With
Limited Spinal, Back Range Of Motions 

My ongoing lifestyle focus emphasizing both yoga mobility and nutrition have led to positive health outcomes as I continue to age - celebrating today my 68th birthday.

Maintaining a lean body as a senior has been facilitated by making better, more informed daily food choices than during past decades (in my 20's, 30's and 40's.)

Weight loss in preparation for reconstructive thoracic surgery enhancing my breathing at 50 in 2001 was maintained afterwards - in part by changing poor eating habits. 

Decreasing consumption of fast foods including drinks with high concentrations of sugar was one significant behavioral change I made. 

I recall lowering various health risk factors by changing my nutrition in the years following my surgery and before my introduction to Ray Hoyt and the hatha yoga classes he taught in Webster & Dudley, MA.

History Of Fast Foods

Fast Food Nation

Eric Schlosser

The public was introduced to the negative health impact, consequences of the fast food industry in Eric Schlosser's book (Fast Food Nation) first published in 2001, again with Afterword in 2012. 

Two years later Micheal Moss published Salt Sugar Fat - providing details behind the CEO decisions, science and branding of processed foods by the Big Food Industries.

2014 Publication

Despite these publications and disclosures, fast food companies have thrived as the rise in obesity and diabetes throughout the US has continued. 

An
 UPDATE ON FAST FOODS 
[LESS HEALTHY TODAY]

In my February, 2019 post I shared some highlights of THE TRUTH ABOUT FOOD by David Katz - including his perceptions of an ideal nutrition, his warnings about the ongoing lies perpetuated by Big Food including their Fast Food selections.

Given this history, I was not surprised reading the New York Times article by Tiffany Hsu with the title: Bigger, Saltier, Heavier: Fast Food Since 1986 in 3 Simple Charts - one of many brief publications citing data from a February, 2019 study published in Journal of the Academy of Nutrition and Dietetics.

Hsu and other reporters named below* share some details of the study led by Megan A. McCrory and health science colleagues (Allen G. Harbaugh, Sarah Appeadu and Susan B. Roberts) affiliated with Boston University and Tufts University.

ARTICLE TITLE

Fast-Food Offerings in the United States in 1986, 1991, and 2016 Show Large Increases In Food Variety, Portion Size, Dietary Energy, and Selected Micronutrients

BACKGROUND 

The average amount of total daily calories from fast food increased from 4% (1977-1978) to 11% (2007-2010)

10 FAST FOOD Chain Menus Examined

• Arby's, Burger King, Carl's Jr.
• Dairy Queen, Hardee's
• Jack in the Box, KFC
• Long John Silver's, MacDonald's, Wendy's

SOURCE OF DATA OVER 30 YEARS

[1] Data were obtained from the Fast Food Guide in 1986 and 1991 and from online sources in 2016.

[2] Authors examined 1,787 entrees, side dishes and desserts from the 10 chains.

[3] During this time, there was a 226% increase in the variety of items in these three categories - approximately 23 new items per year. 

ENTREES ... increase in:

• portion size: 13 grams/decade (39 grams)
• energy (kcalories): 30/decade (90)
• sodium: 4.6 percent daily value/decade (approximately 14%), up from 27.8% to 41.6%
• calcium: 1.2% DV/decade

DESSERTS ... increase in:

• portion size: 24 grams/decade (71 grams) 
• energy (kcalories): 62/decade (186)
• sodium: 3.6% DV/decade
• calcium: 3.9% DV/decade
• iron: 1.4% DV/decade

       [4 of the ten restaurants had increased calcium and iron]

SIDES (like chips, soups, French fries)

• relatively stable portion size
• energy (kcalories): ~14/decade increase (42)
• sodium: increase from 11.6% to 23.6% of recommended DV

STUDY CONCLUSIONS FROM ABSTRACT

"These results demonstrate broadly detrimental changes in fast-food restaurant offerings over a 30-year span including increasing variety, portion size, energy and sodium content."

"Research is needed to identify effective strategies that may help consumers reduce energy intake from fast-food restaurants as part of measures to improve dietary-related health issues in the United States." 

Additional Information

FAST FOOD Consumers:

• On any given day, approximately 37% American adults under the age of 20 and 45% young adults (20-39) (Josh White)

• Consumption of an average entree and side was near 40% of a 2,000 calorie daily diet (average of 767 calories). (Jeff Gelski)
• Adding a caloric beverage increased this percentage to 45-50%.

• Most of the new menu items over the years have tended to be less healthy than the regular items (David Disalvo)

AND

. About 40% of American adults (50 - 74) through 2015 to 2016 are obese - up from 13% in 1960 to 1962 and 23% in 1988 to 1994. (Gary Stern) 

. The "frequency of eating away from home is positively associated with increased risk from chronic health conditions like hypertension, obesity and insulin resistance." (Gary Stern)

. Obesity is now the second leading risk factor for disability in the United States (Susan Perry)

Selected McCrory Responses
 to
 Questions From Gary Stern
[I have edited wording of some questions] 

[1] Why are fast-food items getting larger? -" ... It's a bargain, and you get a lot of food for a relatively small amount of money. ... Perhaps the healthy food demand hasn't gotten big enough for the fast food restaurant to respond to."

[2] Why listing of food calories isn't having more impact? - "It is having a small impact. There was one study ... that compared changes in calories from 2008 to 2015 ... there was a decrease if about 9 calories ... The problem is that nine calories is not enough."

[3] Why is menu labelling having minimal impact? - "There are many possible reasons: 1)People look at the numbers and don't know what that means, 2)People may ignore numbers, 3)They are having some impact since most of these restaurants offer salads."

[4] What's the effect of increasing sodium and calcium levels of fast food items? - "It varies by individual, but for a lot of people, high sodium contributes to high blood pressure, which puts people at risk of strokes and dying. Stroke is one of the top 10 causes of death in the U.S. and high blood pressure contributes to stroke and heart disease."

[5] Target audience who dines out at fast food chains? - "I'd say for the most past, the audience consists of many college students, lower-income people, and people who are on the run and just like the food"

[6] What recommendations for people who dine at fast food chains? - " ... try ordering the next size down ... if they go with a friend, try splitting an order of french fries ..."

[7] Why aren't salad, vegetarian dishes or plant-based burgers more popular? - "I think in general people don't go to fast food for healthy stuff. One main reason they choose to eat what they eat is it tastes good ..."

[8] Have fast-food eateries offered right to order half or one-third portions at one half the price? - "Usually when they offer smaller portions, its more expensive. When they offer smaller portions, it must be the same bargain for the customers." 

[9] Is there anything the study didn't cover? - to paraphrase: the study did not examine combo meals, it focused on individual menu items

McCrory QUOTES

"Given the popularity of fast food, our study highlights one of the changes in our food environment that is likely part of the reason for the increase in obesity and related chronic conditions over the past several decades, which are now among the main causes of death in the U.S."  (David DiSilvo, Tara Law, John White)

"Despite the vast number of choices offered at fast-food restaurants, some of which are healthier than others, the calories, portion sizes, and sodium content overall have worsened (increased) over time and remain high." (David DiSilvo)

"We need to find better ways to help people consume fewer calories and sodium at fast food restaurants." (Susan Perry)

"We would like to see more changes, such as restaurants offering smaller portion at proportional prices." (Susan Perry)

The investigators "hope their study will bring greater awareness about the health risks associated with frequent consumption of fast foods." 

MY TAKEAWAY

This report by McCrory and colleagues further reinforces my daily decisions these past years to prepare meals at home: eating real food, mostly plants, without the excess levels of salt, sugar and fat found in the heavily processed fast food selections.

*Sources & Affiliation: Jeff Gelski (Food Business News), David DiSalvo (Forbes), Susan Perry (MinnPost), Chase Purdy (Qurtz), Tauren Dyon (UPI), John White (Kotatv, Gray News), Dennis Thompson (HealthDay), Tiffany Hsu (NYT), Gary Stern (Food & Drink), Tara Law (Time)

Do share your thoughts with me.

FUTURE FOCUS

I anticipate providing an update on my health status after meeting in late April with my Geriatric Specialist.

#Bob Crowther #Nutrition #Yoga