‘Pie hole’, colloquial for one’s mouth, is believed to have evolved in the USA in the 1980s from the British expression ‘cake hole’ (coined in the mid 20th century). Pie hole refers to a mouth, as in: shut your pie hole or, in this case: put less in your pie hole.

Wednesday, September 10, 2014

Diets: Low Carb, Low Fat or Something Else?

"Which diet is best?" Such a depressing question, but one that is still being studied because people are still asking. It's big business too, with so many boutique and 'brand' name diets available.

A new study set out to strip down the evidence and see what was left underneath. This meta analysis analysed 48 randomised control trials (kind of the gold standard when we talk about study design) that included over 7,200 people. The median age was 45, median BMI was 33 (obese).

They divided the diets thus:
  • Moderate macronutrient (55-60% of calories from carbohydrates, 15% from protein)
  • Low carb (<40% of calories from carbs, 30% from protein)
  • Low fat (60% of calories from carbs, 10-15% from protein)
One note is that most government guidelines recommend ~45-65% of daily calories come from carbs (the US recommends >50% of that come from whole grains).

Just like my labrador, who swears by her monotonous duck and legume diet, people swear black and blue about their diverse, and often dubious diets.

The analysis found that low fat and low carb dieters had the greatest weight loss success at 6 months, about 8kgs. However, at 12 months, 1-2kgs of this effect was lost (aka, people gained it back).

If you're thinking lower carb, think glycemic index (GI). Good quality, whole grain carbs are a better choice than refined foods that are high GI. For example, oats are high in fiber and harder to digest than white bread... Make your intestines work for a living. Low GI foods aid weight loss and improve blood glucose/insulin regulation.

The study also found that exercise and education on behavioural changes enhanced weight loss. Kind of like how taking swimming lessons and staying in the shallow end of the pool decrease your chances of drowning.

Even though only minor differences were found between brand name diets (eg: Jenny Craig vs Atkins vs Southbeach vs Weight Watches vs Ornish vs Nutrisystem), we can take solace in that any diet/modification resulted in weight loss compared with no changes at all.

Many such 'organised diet programs' are expensive, have high attrition rates, and a high probability of regaining 50% or more of lost weight in 1 to 2 years. You're better off spending your money on fresh food rather than fancy, fad diets fraught with fleeting and frustrating results. After all, in my class, 50% is an F... Just saying.

Take home:
  • Behaviour changes form habits, rather than short term change
  • Making changes you can actually stick to in the long term will improve weight loss

An article from earlier this year about how different brand diets stack up.

Wednesday, August 27, 2014

Overload, Overeat, Overweight

We all think we are excellent at judging. Whether it's the next door neighbour's lawn, Angelina Jolie's dress, our spouse's taste in clothes, or the fact that our best friend watches Glee. The fact of the matter is, we may be great at judging those things, but we're pretty pathetic at judging how much food we need.

There's all this hubbub about how grown-ups eat almost everything on their. There are many theories as to why this may be. And yes, there's a slew of research that says larger portions means eating more calories, which leads to weight gain, yada yada yada (1, 23)

But, this isn't always a bad thing. Packing your plate with large portions of nutrient dense, calorie sparse foods like salads and vegetables will actually improve health. Veggies are full of fiber, vitamins and minerals. Two recent publications add to much evidence already showing high vegetable intakes reduce weight gain, increase longevity and reduce chronic diseases (1, 2).
Not a balanced meal either

Packing your plate with plentiful provisions of peppers, peas and pumpkins will prevent piling on the pounds while positively protecting your health (P-word for health?)

Another study shows eating large volumes/satisfying portions of lower calorie food is an excellent way to feel satiated and prevent weight gain.

However, I'd say you're lying if you said you saw people stashing carrot sticks rather than fried chicken. 

It's large portions of 'discretionary' or 'sometimes' foods that are problematic. More on your plate means more in your belly. In the short term, this often means intestinal discomfort, reflux or heartburn. Long term, this means weight gain, disease and, ultimately, as always, death.
Maybe after a Michael Phelps workout
What about those pint-sized pie holes, aka the kiddies? According to this new study, children on average ate 59% of food on their plate. Parents often see this as 'bad' and coerce their children into finishing their meal. This is most definitely a problem, a big one.

I'm going to preface this next paragraph with an important proclamation: No healthy child self-starves.

Children are excellent at regulating their food intake based on internal cues of hunger and satiety, much better than adults. If a child is not hungry, they're not hungry. Forcing them to eat teaches them to ignore their internal cues which gives rise to problems like overeating, weight gain and mindless eating. Not to mention, if someone is yelling at you to finish eating, eating might not be a particularly pleasant experience...

What to write home about:
  • Adults are inherently poor at judging how much food they need
  • Adults who overload their plates ultimately over-stuff their pie holes
  • Children are good at self regulation where food is concerned  
  • Fill your plate with extra veggies or salad -> this allows you to eat more and feel satisfied without consuming copious calories
  • Provide your kids with healthy choices and appropriate portions -> then listen to them, if they're full, they're full...

Thursday, August 14, 2014

Food Adventures of Costa Rica

"Globesity": the term used to describe the predominance of obesity throughout the world. No longer only a #FirstWorldProblem, but something far reaching to all corners of the globe. Here are my experiences from a recent adventure through Costa Rica as both a foodie and dietitian.

Selfie in San Jose, Costa Rica
But first, let me take a selfie... And give some background stats: In Costa Rica, 60% of women aged 24-45 are overweight or obese, compared to only 2% in 1982. Women 45-64 have an incidence of obesity 128 times greater than in 1982. Overall, 62% of women and 60% of men are overweight or obese.

In the USA as of 2011-12, 69% of adults were overweight or obese. Australia is in hot pursuit with around 63% of adults overweight or obese in 2011-12. The life expectancy in Costa Rica is almost 78 years, which is about the same as the US. Australians are living an average of 82 years.
Sodas and fruit markets in San Jose, Costa Rica
But back to Costa Rica: The traditional 'soda' (small market-style eatery) was typically empty. Instead, urban Ticos were swarming American fast food stores like Mc Donald's, Pizza Hut, Quizznos, Wendy's, Subway and KFC. The interesting aspect of this is many menu items adapt to embrace local food culture, for example a KFC plate often comes with beans, rice and plantains (see below).

How the menus change.
In all our previous travels, we live by a couple of simple rules:
  1. Eat street food where there's a line
  2. Eat where the locals eat
Fast Food in Costa Rica
If we had done this in CR, we would have found ourselves dining on Mc Donald's ice creams, KFC, burgers, hot dogs and pizza. Needless to say, we're not the type who travel abroad to eat low-quality American food.
Daily rain in Costa Rica

CR produces and grows so many beautiful fruits and vegetables- it's hard not to given it rains daily. Yet, the majority of meals comprise mostly of (oily) starches and meat with a small side of shredded cabbage salad or stir fried veg.

We definitely got the feeling that urban Ticos love desserts. Pretty much every block in downtown San Jose and Herradura was home to numerous Panaderias (bakeries) and lots of advertising for desserts like ice cream, cakes and pastries.

Because I love sweets and admiring beautiful cakes and desserts, I stopped at many of them to look (and sample) some of the sweet, flaky offerings (which were quite delicious). The dietitian part of my brain immediately noticed the absence of whole wheat or whole grain bread- something worth mentioning.
Cakes, dulce de leche/crema pastries, meat pastries, bread
Fruit on the other hand, was everywhere. Fruit venders were all over the San Jose streets, at bus stations (even the rural ones) and most meals we ate included fruit. This was rambutan season (a Malaysian fruit related to the lychee). We pretty much bought a bag of them everywhere we traveled.
In terms of traditional Costa Rican fair, here's the best of our food porn pictures:
A collection of fish, fried yucca/plantains, vegetables, meat and rice.
To me, the picture below best captures the cycle of obesity we saw in CR and is also the unfortunate truth for most of the world: The unhealthy habits of parents, often from outside influences like persistent advertising of convenient food, transferring through the generations.
Costa Rica is a wonderful, lush, beautiful country. This article only focuses on our food experiences, not all the other tremendous encounters we were fortunate enough to experience.
Beautiful countryside in Costa Rica
And finally, it wouldn't be a proper trip without a couple of circus pictures: