Yoga and Nutrition
Monday
Oct082012

The best apple muffins. Full-stop.

Another fall recipe to brighten a chilly day. It's rare that I say "this is the best" recipe for something. But when it's true, it's true...

 

Fresh Apple-Oat-Chia Muffins  

(Delicious, naturally rich in fiber, and contain healthy monounsaturated fat)

 

Ingredients

2 eggs

 

¾ cup canola oil

¼ cup butter, melted and allowed to cool + 1 Tbs for coating muffin tins

1 tsp vanilla extract

¾ cup sugar

1 ½ cups unbleached all-purpose flour (can substitute whole wheat pastry flour for all or some)

1 tsp baking powder

½ tsp baking soda

½ tsp salt

½ tsp cinnamon

¼ cup golden raisins

½ cup chopped walnuts

1 ¼ cups oats

1 cup shredded and peeled fresh apples (about 3 medium apples)

¼ cup chia seeds

 

Preparation

1. Preheat oven to 350*F.  Lightly grease muffin tins with 1 Tbs butter. Gently press shredded apple slices between paper towels or dish towels to remove excess moisture.

2. In large mixing bowel, combine eggs, canola oil, butter, vanilla, and sugar until smooth and well-blended.

3. Add flour, baking powder, baking soda, salt, cinnamon, and stir until just combined.

4. Stir in raisins, walnuts, oats, apples until just combined.

5. Distribute batter evenly into muffin tins.

6. Sprinkle tops with chia seeds.

7. Bake ~ 30 minutes or until tops brown. Allow to cool slightly before removing to wire rack.

These muffins can be enjoyed immediately, but also keep well for several days if wrapped. Put extras in the freezer and take out individually to thaw and eat any time.

Tuesday
Oct022012

Bring out the butternuts! 

It's that time of year again. In September, I fight tooth and nail against the approaching fall.  But by October, I'm making peace with the cooler weather, the lack of favas, the shortening days, and... Oh, who am I kidding? There are only two things that allow me to accept the season: 1- I know it's impermanent. Summer will be back, and 2- Butternut squash.

So, a tasty fall recipe for you. I had fun with this. I hope you will, too.

 

Roasted Fall Squash Salad

(Full of vitamins A, C, K, E, fiber, and wonderful fall flavors)

 

Ingredients:

1 butternut or other fall squash, peeled and roughly cut into 1-2”pieces

1 head garlic, peeled and separated into cloves

1 red onion, chopped roughly into flat rounds

1 Tbs + ¼ cup olive oil

1 can chick peas (garbanzo beans), rinsed and drained

2 medium oranges, peeled and cut into wedges

½ cup currants

¾ cup chopped parsley

¼ tsp pine nuts

Salt, black pepper, cayenne pepper, nutmeg, and cloves, to taste

1 bunch raw kale, rinsed, dried, and chopped (optional)

------------------------------------------------------------------------------------------------------------------------------
 

Preparation: 

1. Preheat oven to 450*F.  Lightly coat baking sheet with 1 Tbs olive oil.

2. In a large bowl, toss squash, garlic, and onions in remainder of olive oil to coat, and spread pieces on sheet. Roast in oven ~30 minutes or until starting to brown. Allow to cool slightly, then remove from oven and place in serving bowl.

3. Add chick peas, oranges, currants, parsley, pine nuts, and spices to roasted vegetables.

4. Serve over bed of kale, if desired. This dish also goes beautifully with any raw or steamed dark greens, as well as over brown rice or quinoa.

 

Serves about 4.

Friday
Sep072012

Loosening the grip on calories

In plenty of settings, it’s appropriate to focus on exact numbers. If you receive chemotherapy, you want the dosage calculated perfectly. When you redo your apartment, you need to know the precise wall surface area so you don’t run out of paint -- or buy an extra hundred dollars' worth. And so on.

But evidence is starting to confirm something I’ve long believed: for the purposes of weight management, longevity, and quality of life, we've likely overestimated the importance of calculating calories.

What IS important, then? Focusing on behaviors and big-picture.

Two recently published studies support a less calorie-defined approach to wellness. In the first, published in the Journal of the Academy of Nutrition and Dietetics, weight reduction strategies were examined in overweight and obese women.1 Focusing on changing behaviors -- such as decreasing desserts, meats, and sugar-sweetened beverages, and increasing vegetables and fruits -- was associated with weight reduction after two years. As we know, weight loss itself isn't so much the challenge as keeping weight off over time. Two years is a great start, and longer than most previous studies have looked at.

People get tired of counting calories. Recording the calorie content of every food you eat is time consuming and -- to be blunt -- annoying. It's also likely to be full of error. Determining the exact calorie content of a given meal is a hard task even for a nutritionist, let alone someone who is untrained and guess-timating. However, writing down the types of foods you eat, and aiming to choose more of some and less of others, seems pretty do-able, straightforward, and realistic over time. Personally, I'd rather work on decreasing fried foods overall (again, decreasing doesn't mean "never eating" -- it means choosing less) than figuring out if a given serving of French fries contained 423 calories or 512 calories.

The second study, conducted over 23 years by the National Institute of Aging and published last week in the journal Nature, looked at severe caloric restriction in rhesus monkeys.2 (I won't get into the ethical ramifications of this here, but I have a very definite opinion on the matter.) In contrast to previous assumptions based on rodent studies and another monkey study, calorie deprivation didn't increase simian life spans. It may have decreased certain disease risks,* but at what cost, and to what ultimate benefit? I can't quite imagine subsisting on 30% fewer calories a day and maintaining anything resembling my current active lifestyle.

None of this is to suggest caloric intake is irrelevant. But I do propose loosening our grip on calorie-counting, and embracing long-term behaviors, quality of foods, and balance. Would you rather think in terms of fewer donuts, more fruit? Fewer burgers, more whole grains? Less sitting, more moving? Or spend your evenings with a calculator and a bunch of numbers that may or may not add up to... anything?

 

* Interestingly, the quality and kind of food monkeys ate in this study versus the other with conflicting results was very different. In the former, monkeys ate a lower-sugar, mostly whole foods diet, and the difference in calories between experiments and controls didn't make a difference in mortality. BUT, in the latter, where the unrestricted monkeys ate the equivelant of a highly refined, sugar-laden diet, reducing calories did increase years of life. Again, this points to the benefits of a diet containing certain types of food (more natural, less refined, less homogeneous) than simply a lower-calorie regimen.

 

1. Barone Gibbs B, Kinzel LS, Pettee Gabriel K, Chang YF, Kuller LH. Short- and long term eating habit modification predicts weight change in overweight, postmenopausal women: Results from the WOMAN Study. J Acad Nutr Diet 2012;112(9):1347-1355.e2.

2. Mattison JA, Roth GS, Beasley TM, Tilmont EM, et al. Impact of caloric restriction on health and survival in rhesus monkeys from the NIA study. Nature 2012 Aug 29. doi: 10.1038/nature11432.

Monday
Jul162012

Fava Love

I was introduced to fava beans, aka broad beans, the summer I turned 15. My friend's Italian grandfather grew them in his backyard garden on Long Island. My friend would bring bagfuls to our house. I already had a huge crush on said friend, and this seductive veggie offering got him in good with my mom, too. She’d get all happy about the favas (it's the little things, right?) and make up them up for dinner. I didn’t share her enthusiasm at the time, but somehow when I grew up, my tastes changed, and I grilled my mom on the best preparation techniques for the fresh beans.

Here in NYC, I buy them at the market during those precious couple of months when they are in season. 

Preparing favas is a labor of love, but sweetly satisfying. Once you’ve got them cooked and peeled, you can do anything with them, really. I like them to shine as the stars of a given dish.  They’re beautiful with olive oil, garlic, and a bit of raw watercress and baby tomatoes, over gemelli or fusilli. I also love them on their own with generously shaved Pecorino and a sprinkle of black pepper (that was my dinner last night, with a dessert of cold watermelon and dark chocolate…).

What's more, favas are nutritional dynamos. A fantastic source of protein and fiber, they also contain abundant micronutrients such as iron, folate, and magnesium. 

Here’s my suggested method for cooking up a batch -- a la mom. Keep in mind that you need about a pound of fresh uncooked whole fava pods to yield about ½ cup of ready-to-eat beans.

1.  Pour yourself a glass of Pinot Grigio to keep you company.

2. Remove beans from their pods. (While you don’t want terribly spotted or shriveled pods, don’t expect them to be unmarred. The beauty is on the inside when it comes to favas.) Discard or compost the pods.

3. Steam the beans with their outer protective outer shells still on. You can do this with a steamer basket in a saucepan filled with an inch of water, just as you’d steam any vegetable. Or you can do it the lazy-girl way:  Place the beans in a big microwave-safe bowl, fill with 1/2-inch water, and cover with a dinner plate. Microwave for about 3-5 minutes, or until the outside of the beans look sweaty and a little wrinkled, but not mushy.

4. Rinse the beans under cold water, so you don’t burn your fingers in the next step, then drain.

5. Using your thumbnail or a paring knife, make a tiny slit into the outer sheath of the bean, and give it a gentle squeeze or wiggle until the inner bean slides out from the shell. Now, my mom is a wizard at removing each bean completely whole and intact. I tend to break them in half a lot. Be patient. You’ll get the hang of it.

6. You can use them immediately, or store in the refrigerator or freezer in plastic bag.

 

[A sad but true safety note: Fava beans are a source of the amino acid tyramine (like aged cheese, fermented soy, and some other wonderful foods), so should be avoided by persons who take certain drugs, including MAOIs, due to potential serious interactions.]

 

Sunday
Jul012012

Losing it, keeping it off, and keeping it real

A new patient called me. She had started one of many commercial semi-fad diets and asked my opinion of the “foods” it included. I explained it wasn’t the acute diet that worried me, but what she’d do after the diet was over. Her BMI was now 32. She reasoned, “I’m obese, I just need to take the weight off quickly.” I reasoned back, “Taking the weight off is easy; keeping it off is the concern.”

Since post-diet weight regain was first addressed in the literature in 1959, research has not inspired optimism. [1] Data from the National Weight Control Registry (NWCR) and the National Health and Nutrition Examination Survey (NHANES) suggest that less than 1/4 of people who intentionally lose weight through caloric restriction are able to maintain even a 10% loss of their initial body weight after a year. [2,3] Five years out, and the data look even less promising.

Regain happens. And we’re not necessarily talking about personal failure or lack of willpower. Very real biologic, endocrine, (epi)genetic, and environmental factors contribute to the intractability of overweight and obesity. This isn’t to say self-discipline doesn’t matter. But it is harder for a 130# woman who used to weigh #230 to maintain her weight, compared with a woman who has always been #130. Evidence shows that metabolic adaptations to weight loss, such as changes in appetite-related hormones and gut peptides, persist as long as one year after goal weight loss is achieved. [4] There are also disproportionate changes in resting energy expenditure (REE) during and after weight loss. [5] The upshot: a metabolic milieu that favors regain.

Can these physical conditions be attenuated by the types of foods one eats during or after caloric restriction for weight loss? Are some calories “better” than others?  

A study reported in JAMA last week addressed these questions, and it’s being tweeted and talked about all over [6]. Researchers recruited 21 overweight or obese young adults in Boston to participate in a 7-month adventure in controlled weight loss. After stabilization, participants followed 12-week active weight-loss phase. Caloric restriction was measured for a goal of 12.5% weight loss (this diet was 45% carbohydrate, 30% fat, and 25% protein).  For the next 12 weeks, they followed 3 different but isocaloric diets in a 3-way crossover design. Here's a breakdown:

Diet 1, "Low-fat" = 60% carbohydrate, 20% fat, 20% protein. Personally, I'd have to take down my avocados a notch. Not fun.

Diet 2, "Low glycemic index" = 40% carbohydrate, 40% fat, 20% protein.  Definitely doable, and not rocket science: "healthful fat... vegetables, legumes, fruits."

Diet 3, "Very low carbohydrate" = 10% carbohydrate, 60% fat, 30% protein. Zero wiggle room for some whole wheat couscous or chickpeas (let alone a cookie). In fact, while participants were on this phase of study, they were required to take Metamucil with each meal in order to get a modicum of fiber.

Now, I'd like to quote the study authors on what might be THE most important sentence of this article: "In view of the mechanistic nature of this study, relying on a feeding protocol, we did not design the diets for long-term practicality."

We'll get back to that. First, the study results.

The primary outcome measured was REE. Compared with baseline values, participants' REE dropped the most during the low-fat diet, and the least during the very low carbohydrate diet, suggesting a metabolic benefit toward weight maintenance with the Atkins-like diet. But when we look at the actual number of calories burned, REE was only 67 kcal/d higher with the very low carbohydrate diet compared with the low-fat diet. That's the difference of a small apple. However, total energy expenditure (TEE) differed by 300 kcal/d -- say, a pb&j sandwich. The authors report, "The physiologic basis for the differences in REE and TEE remains subject to speculation."

Other metabolic indicators were measured, such as leptin (a hunger-signalling gut hormone), urinary cortisol (a marker of stress), C-reactive protein (a marker of inflammation), and serum cholesterol. While these did vary based on the 3 diets, "no consistent favorable pattern emerged" with any one diet. In fact, cortisol and C-reactive protein were highest during the very-low carbohydrate diet. Although leptin levels increased the most during the low-fat diet, participants' subjective measures of hunger didn't vary significantly during the different diets.

If we had to choose a favorite among these 3 diets based on the study results, the low glycemic index diet would likely win.

However, none of these results point to a significant change in the metabolic milieu favoring weight regain after an initial loss.

And why would we expect them to, really? Reductionist thinking in nutrition and health -- whether counting calories, dictating macronutrient percentages, or isolating micronutrients -- hasn't gotten us very far.

Even if significant, relevant changes had been observed, could these results be translated for application to the general population? The small group of participants were carefully selected, highly motivated, and well-paid to follow diets that were admittedly not designed for "long-term practicality."

Lest all this sound terribly depressing to anyone who is trying to lose weight, sustain loss, or counsel patients in doing so, I'll conclude with 5 common characteristics of people who DO lose weight and keep it off for at least a year. [3,7]

1. They don't "accidentally" skip meals. 78% eat breakfast. It's possible that a morning meal containing both carbohydrate and protein may help counteract compensatory hormonal hunger and satiety mechanisms.

2. They are physically active. Seriously. 90% exercise an average of 1 hour per day.

3. They actively self-monitor. 75% weigh themselves at least once a week. Many keep food diaries. They stay accountable.

4. 62% watch fewer than 10 hours of TV weekly. Not only is TV-watching an utterly sedentary behavior, but advertisements and TV programs trick our brains into wanting to eat more, mostly thanks to clever food industry marketing. Reduce environmental cues that signal you to want to eat, and you're a step ahead.

5. They individualize their own diets (no cookie-cutter formulas or calculating exact percentages), recognize that weight-loss is a long-term venture, acknowledge that behavioral changes must last a lifetime, and seek and perceive greater social support.

None of these behaviors are crazy, expensive, or "new" -- and they certainly don't feed America's multibillion dollar weight-loss industry.

Bottom line(s): Eat vegetables. Exercise. Don't be afraid to have a little chocolate now and then. Turn off the TV. Call your friends. Exercise some more.

 

 

References

1. Stunkard A, McLaren-Hume M. The results of treatment for obesity: a review of the literature and report of a series. Arch Intern Med. 1959;103:79-85.

2. Wing RR, Hill JO. Successful weight loss maintenance Annu Rev Nutr 2001;21:323-41.

3. Kraschnewski J, Boan J, Esposito J, et al. Long term weight loss maintenance in the United States. Int J Obes 2010;34:1644-54.

4. Sumithran P, Prendergast LA, Delbridge E, et al. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med 2011;365:1597-1604.

5. MacLean PS, Bergouignan A, Cornier MA, Jackman MR. Biology’s response to dieting: the impetus for weight regain. Am J Physiol Regul Int Comp Physiol 2011;301:R581-600.

6. Ebberling CB, Swain JF, Feldman HA, et al. Effects of dietary composition on energy expenditure during weight-loss maintenance. JAMA 2012;307:2627-34.

7. Hindle L, Carpenter C. An exploration of the experiences and perceptions of people who have maintained weight loss. J Hum Nutr Diet 2011;24:342-50.