Cheater

A millions years ago I asked for questions and am just now getting around to answering them. I am nothing if not consistent in my procrastination.


Rose asked:   How bad are occasional (less than once a week) cheat meals for health?

My short answer is: I don't know. Helpful! I mean, I don't know if there is a way to quantifiably measure that, and I'm sure it varies from person to person. It also depends on what is defined as "health". Is it weight loss, healthy cholesterol/TGs, etc. There is evidence that even one meal high in saturated fat can affect the anti-inflammatory properties of HDL cholesterol and hinder blood vessels expansion-which would create higher blood pressure as quickly as 3 hours later.

Your cholesterol and triglyceride levels fluctuate with each meal-this is why you have to fast before having a lipid profile done. Saturated and trans fats (found primarily in whole-milk dairy products, fatty meats, poultry, partially hydrogenated vegetable oils) are the are the main dietary contributers to increasing LDL cholesterol (LDL=Less Healthy) and decreasing HDL. (HDL=Healthy) The American Heart Association recommends no more than 7% of your daily calories come from sat/trans fats. So from a cardiovascular standpoint, yes, cheats can negatively affect your health. If your eating is otherwise good, this can net out a bit. The problem comes from too many cheats and not enough good days. If you want to cheat, try to cheat with foods that are low in saturated fats. When you are good, try to have a diet high in poly- and monounstaturated fats (Poly: safflower, sesame, soy, corn and sunflower-seed oils, nuts and seeds. Mono: olive, canola and peanut oils, avocados) as these foods increase the good cholesterol and help negate some of the damage from the cheat days.

In terms of weight loss: I advocate occasional cheating. Long term, maintainable changes to diet and exercise are what pretty much every health professional recommends. Diets high in fruits and vegetables, whole grains, lean dairy, etc.  But honestly, I don't want to live a life where I don't have cake at a birthday party. Or a margarita on the beach. Or cheeseburgers. Something I try to do is identify when it is really worth it. If it is a unique food that I love, but don't have it regularly. My aunt's key lime pie on vacation (which is smack your momma good and I could eat every day!) is a "better" cheat to me than say pizza. I can have pizza anytime. I just remind myself-this is not the last time you will ever see pizza. You can have it again. Just not much tonight (guess who is going to a picnic with pizza tonight.) No one can maintain a super strict, all healthy diet every single moment of the day. Except my father in law, but he isn't a lot of fun. A planned or structured cheating plan can help some people better commit to the healthy diet the rest of the time. Just the psychological feeling of "I can have this thing I'm dying for on Friday. I can make it til then!" can be hugely beneficial to your mental health.

For me, when I'm trying to lose weight, I have to have a long run of eating well. Like a month of calorie deficits before my body gets the idea of what's happening and starts dropping weight. Even if I have a 1 lb decrease in calories in a week, having a big meal or big cheat seems to cancel it completely out. Mathematically, I know this should not be the case but I promise this is just how my body works. Weight loss is both an art and a science. Science says expend more calories than you take in and you will lose weight. But, it isn't always that easy. Stupid biochemistry.

Once I kind of get over that block and start losing weight, I can be a little more liberal with cheats. Many people find that a cheat can break them out of a weight loss plateau-it kind of confuses the body . And sometimes when you have been at that plateau for a long time, you just need a mental break and then recommitment.

In my opinion it really comes down to what are you doing 80-90% of the time. Is the majority of your intake healthy, or is every meal a cheat meal? What do you do after the cheat? I can definitely get caught up in the "oh, well today is totally screwed already so I might as well eat everything. For the next 8 days. " Better to brush it off, really really enjoy that cheat and make sure to spend it on something you truly love, and then get back to it even stronger.

I hope that answered your question, Rose, in a very long winded way!

What do you guys think? Cheat days: good or bad? How often do you splurge on food? Is it difficult for you to reign yourself back in? Have any other questions? Come talk to me so I don't feel like I'm talking to myself!

Also, check out Jen in Training's great giveaway. But don't enter it b/c I want to win.  

http://jenintraining.blogspot.com/

It is almost Dietitian Day

March 9th is National Dietitian Day!

From ADA: Registered Dietitian Day was created by the American Dietetic Association to increase the awareness of registered dietitians as the indispensable providers of food and nutrition services and to recognize RDs for their commitment to helping people enjoy healthy lives. Registered Dietitian Day and National Nutrition Month® promote ADA and RDs to the public and the media as the most valuable and credible source of timely, scientifically-based food and nutrition information.

So I thought we could do an Ask an RD Day here. Ask me anything and I will try to answer. Nutrition recommendations, research, questions about your intake, etc. Anything you want! If I don't know, I'll research it. You can leave me a comment or email me at confessionsofadietitian@gmail.com. I'll post answers this week! 

Diet Soda and Heart Attack/Stroke Risk

So, one of my initial plans when starting this blog was to talk about nutrition topics in the news and various research that has come out. Instead, it has been mostly random rambling b/c that is who I am. In an effort to be more educational and helpful, today we are going to talk research. Specifically this new study that has come out linking diet soda and stroke risk.

Let me preface this with I LOVE DIET COKE. A lot. I don't even pretend. I know it isn't good for me. I don't care. I need it to live.

I've seen several articles and posts mentioning this study. I feel the media tends to take research and make sweeping statements as to why we're all going to die immediately. They like to jump on "study results" and go nuts. There is much, much less information about the study methods, results, and actual statistics. When I went to grad school I thought I would be learning *more* about nutrition, since that is my field. Nope! It is all research. How to analyze, perform, and interpret whatever research is happening in your area. Y'all, I hate hate doing research. I don't mind doing a nice lit review or meta-analysis, but I would rather be punched in the throat than have to design and actually do my own study. The moral of this story is: grad school wants to teach you how to be a good consumer and interpreter of data. It is your job as the expert in whatever field to look at the actual study/stats/methods and turn it into easily understandable, meaningful information for your target audience.

The number one rule of interpreting results is Correlation does not imply causation. It is very, very difficult to prove that one variable causes anything. 

So let's talk about this study, shall we? To be fair, I can't access the full actual paper yet since it is from a meeting and hasn't been published yet. Interestingly, there is exactly 1 result when "diet soda stroke" is searched for in PubMed (and it has to do with epilepsy.) So there obviously aren't tons of studies out there on that subject. Researchers at the University of Miami Miller School of Medicine found that in a group of 2500 participants, daily diet soda drinkers had a 61% greater risk for stroke/heart disease than drinkers of regular soda.

First the good stuff: 
-It is longitudinal. It took place over 9 years which yields much more information.
-It has a large-ish sample size-2500 participants.
-It identifies soda vs diet soda drinkers, not soda vs non-soda drinkers. (Also, it is very hard for my extremely southern self to call it soda. Everyone knows Coke=any soda.)
-Sample was diverse. 
-Researchers did control for age, history of stroke/heart disease. 

Now, here are some criticisms

-Yes, the study had 2500 participants. Of those, 900 participants claimed to drink no diet soda. Only 160 (8%) said they had diet soda everyday. Results found in 160 participants aren't necessarily applicable to the general population.

 -They gave a food intake questionnaire (and I've spent literally months in epi discussing the efficacy of each possible intake tool. not sure which one they used or it's validity.) at the beginning of the study and then never followed up. They just assumed intake remained the same over a decade.

-The study used self-report to identify intake. Self report is just a bad idea in nutrition research. People vastly overestimate the good and underestimate the bad stuff. Or they lie, b/c they think it is what you want to hear or they are embarrassed. 

--It is hard to tease out and quantify, but there is a segment of the population that eats terribly and drinks diet coke. Diet coke is associated (meaning it doesn't cause) obesity, in some part due to the fact that those who are overweight can be trying to cut calories by drinking diet. There is discussion on how insulin responds to artificial sweeteners and whether or not that can be linked to insulin resistance/ diabetes.


-They didn't look at sodium intake which is a known risk factor for vascular problems.  

-They did not look at weight/obesity over time. Which again, is a known risk factor for heart disease/CVA.

--But here is the key: THEY DID NOT CONTROL FOR OR ANALYZE THE DIETS OF THE PARTICIPANTS. So the participants might be drinking 1 Diet Coke with the 3 Big Macs, supersized fries, and apple pie daily. We don't know. -



Studies like this make headlines because the results are sensationalized. The media makes it sound like "If you are totally healthy, run 5 miles per day, are vegan, and a healthy weight...but drink 1 diet coke/day you are 60% more likely to have vascular complications." Which is just not possible to say based on these results. Again, this is the first study to link diet soda and vascular disease. If there is a link, it will be be able to be duplicated in studies that come after.

The biggest problem with nutrition research is that it is so difficult to isolate effects. Disease risk is multi-faceted, and sometimes we just don't understand it. Scientists are able to agree that it is better to get your nutrients from foods vs supplements, but they have been unable to determine exactly why. There are so many individual components of food: vitamins, minerals, phytochemicals, macronutrients, etc and they all work together in a unique way that isn't found artificially. Good health is a combination of so many genetic, environmental, and behavioral components that it is very hard to isolate the effect of each little piece.


I'm obviously not making a case that Diet Coke is good for you. It isn't. Go drink some water or green tea instead. What I'm trying to do is help people be informed consumers of research. Look at the methods, use common sense, and above all trust an RD ; ) Anyone who looks at the methods can see they didn't analyze or control for diet and realize that makes the results pretty weak. Just not everyone goes that next step. I would encourage everyone to really try to examine the study, not just the 'results' the media grabs on to. You might look at the methods and find them convincing. That is great! Just make sure it is an informed decision. Or just ask me and I will tell you what to do.

What do you think? Is this study significant enough to cause a change in your Diet Coke consumption? Am I completely wrong and blinded by my love for coke? Have any questions?