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March 2018
Volume 3, Issue 3

David Katz

No matter where we look, it seems we’re constantly faced with information deluges of every kind. There are articles shared on social media, surfaced in internet searches, emailed to us by our well-meaning friends and family — and while some of them are true, some of them are clearly not. And then there’s the worst of them all — the news that sure seems like it’s true, but something seems not-quite-right. And then on top of sussing out the fact from the fiction, there’s the even bigger issue of too much media: When is it doing us more harm than good to have headlines constantly blared in our faces, coming at us from every possible kind of screen? In this edition of Health Between the Headlines, we not only unpack some recent health headlines, but we also provide some tips for being healthy media consumers — because what we consume and its impact on our bodies and minds isn’t just limited to food. 
 
For last month's issue, click here.

What should really be the takeaways from the most buzzed-about health studies? We unpack it for you here.

Which is better
for weight loss:
a low-fat or
a low-carb diet?

The Study

A new study in JAMA examined how a low-carb or a low-fat diet affected weight loss among overweight adults, and also sought to find out if genotype or insulin secretion would factor into the diets’ weight loss effects. For the “Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS)” randomized clinical trial, conducted by THI member Christopher Gardner, PhD, professor of medicine at Stanford University’s School of Medicine, about 600 adults ages 18 to 50, who did not have diabetes and who were considered overweight or obese by their body mass index (they had a BMI between 28 and 40), were randomly assigned to consume either a healthy low-fat diet, or a healthy low-carb for 12 months.
 
Over the 12-month period, health educators held 22 small group sessions with the study participants, which “focused on ways to achieve the lowest fat or carbohydrate intake that could be maintained long-term and emphasized diet quality,” according to the study abstract. Specifically, for the first eight weeks of the study, the participants were advised to either limit the amount of fat they consumed to 20 grams (about a handful of nuts) or the amount of carbohydrates they consumed to 20 grams (about one-and-a-half slices of whole wheat bread). Then after that time period, the participants were advised to gradually increase the carbs or fats they consumed in their diets; ultimately, by the end of the study period, the people assigned to the low-carb group were consuming 132 grams of carbs a day (before the study, the group was consuming an average of 247 grams a day). Meanwhile, the people assigned to the low-fat group were consuming 57 grams of fat a day (before the study, this group was consuming an average of 87 grams of fat a day). In addition to these specific guidances, the study participants were also generally advised on what “healthy” choices entailed — for instance, an avocado is a healthier example of a food with fat, compared with something with lard. It’s healthier to go for the whole foods and vegetables, versus the processed foods — and in general, consume less sugar and refined flour.
 
At the end of the study period, about 80 percent of the participants remained in the study. There were no significant differences in weight changes between the study participants who consumed the healthy low-carb diet and the healthy low-fat diet. Plus, “neither genotype pattern nor baseline insulin secretion was associated with the dietary effects on weight loss,” according to the abstract. Specifically, the researchers found that both groups lost an average of 13 pounds by the end of the study period, though that was just an average — some people lost 60 pounds, while others actually gained weight.
 
“The study adds to the evidence that the best diet for weight loss is a healthy one – where the focus is on increasing intake of vegetables, legumes, fruits, whole grains, lean meats, lower fat milk and limiting intake of refined grains, added sugar, and highly processed energy-dense foods,” says THI council member Lorrene Ritchie, PhD, RD, Director of the Nutrition Policy Institute (NPI) at the University of California’s Division of Agriculture and Natural Resources. “You may end up eating a relatively lower total fat or lower total carb diet – either is fine as long as focus is on healthy foods.” 

 

A Look at the Media Coverage

Media coverage included headlines such as “The Key to Weight Loss Is Diet Quality, Not Quantity, a New Study Finds” (NY Times), “Your DNA won't determine the best diet to help you lose weight” (LA Times), “Counting Calories May Not Be the Key to Weight Loss After All” (Fortune), “Genes might not predict success of low-fat or low-carb diet” (Reuters), and “Why You Probably Shouldn't Waste Your Money on DNA-Based Diets” (Livescience). 
 
To Ritchie, the media coverage for the most part fairly represented the study findings; they “provided information about a few things that were not emphasized in the scientific article, such as the behavioral modification component of the intervention.” Some of the headlines, however, could have used improvement: “For example, the NY Times title implied that you can eat all you want and still lose weight. It is true that it is harder to overeat if, for example, your diet is higher in fiber and it is easier to overeat if your diet is rich in highly processed foods that tend to be energy dense and highly palatable,” she says. “But calories still count and you will gain calories if you eat more than you need and lose calories if you eat less. Likewise, the title of the LA times article implies that DNA doesn’t matter. What is true is that we just don’t yet know enough about which genes are important. But research is ongoing to try to figure out how better to personalize nutrition.”

THI member Tom Rifai, MD, FACP, founder of the health coaching, consulting and education company Reality Meets Science, said that the NY Times coverage specifically was “essentially accurate, although [it] missed the simple and high likelihood that both groups on average decreased their collective diet’s calorie density (aka calorie concentration or more practically, ‘calories per bite of food’) with the encouragement of basing both approaches on low starch vegetables — the lowest calorie density and highest nutrient density foods. Such a shift down in calories per bite of food allows people to feel full on fewer calories. Simple, elegant, and one can fill in the rest of their eating pattern and call it whatever one likes: ‘Mediterranean,’ ‘DASH,’ ‘healthy Vegan,’ [or] ‘proper Paleo.’ By having a base of low starch veggies, minimal added refined carbohydrates and no/low beverage calories, it makes all of them far more similar to each other than any are to the CRAP-SAD (calorie rich and processed standard American diet).” 

It is the overall quality and calorie density of one’s eating pattern that matters.”
– Tom RIfao, MD, FACP

How YOU Should Apply the Findings to Your Life

Ritchie can sum up the takeaways of the study for the general public in five points. Firstly, “calories count, but instead of counting calories, focus on eating healthy foods – plenty of vegetables, whole grains, fruit, lean proteins, healthy fats,” she advises. Secondly, “avoid deprivation. Not many people can endure misery for long. The study encouraged people to eat healthy but not be overly restrictive about it and find a diet that they could sustain for life.” Thirdly, “‘going on a diet’ implies you will someday ‘go off it’ and that’s indeed what most folks do – so while you may lose some weight, over time, most people return to old habits and right back the weight comes. Eating healthy is for life – so the key is finding the healthiest diet that works for you.”
 
Fourth, Ritchie advises people to be mindful of what, and when, they eat. “Have you ever driven somewhere and not been paying attention and realized you are not sure where you are exactly? Same thing happens when eating. You can turn on the TV and all the sudden realize you ate way more than you needed. Once you get in the habit of eating healthy it requires less attention. But mindless eating is never a good ideal,” she says. Finally, “personalized nutrition is where we may be heading. But the science is not there yet. The good news is that you can personalize yourself – find the healthy foods you like and that work for your lifestyle – and then make them habitual!”
 
For Rifai, overall, the study shows that “it is not whether one is eating ‘low fat’ or ‘low-carb’ – it is the overall quality (nutrient density, with high fiber being a great marker of such) and calorie density of one’s eating pattern (not to mention care over beverage calories) that matters.” Rifai considers himself a “plant predominant flexitarian,” which means that he eats “predominately minimally and unprocessed processed plants, along with [a] modest amount of animal-based nutrition consistent with Blue Zones and longevity, along with ‘just enough crap to not want to go nuts’ nor feel restricted.”
For the general public, Rifai can also sum up the takeaway of the study in several points. No. 1? “Change your home (and even car as well as work) food environment(s) so you have easy access to fresh vegetables, whole fruits” — and that’s coupled with point No. 2, which is “change your home (and even car as well as work) food environment(s) so you have little access to CRAP (calorie rich and processed) so-called ‘food’ and sugar, fat or alcohol-based beverage calories.”
Rifai also recommends seeking out professional help for factors he calls “mind matters” that can obstruct your healthy eating and exercise success. Issues with sleep quality and stress management, not to mention grief, loss, trauma, depression, and anxiety, can “obstruct success and need to be managed proactively,” Rifai says. “The strong seek, don’t avoid, getting professional help.”

Finally, Rifai says, “understand that while calories count, you don’t have to count calories to lose weight! Just eat lots of vegetables, whole fruits (best and healthiest dessert!) to get you full for less calories, and make them easily (mindlessly) accessible while conversely keeping access to CRAP foods ‘down to a dull roar’ (as my childhood homeroom teacher used like to say in the mornings!). By modifying our environments so that we are not constantly exposed to CRAP in environments we can control, we will be far more easily able to achieve healthy eating and be able to apply the DIETFITS lessons for life, rather than for a ‘quick fix.’ We really need to keep in mind that, goodness knows, there are certainly going to be plenty of opportunities to eat CRAP food and drinks everywhere we step outside of our homes, work or car. So do what you can when you can.” 

Check out THI Founder David Katz's take here.


When does media consumption become unhealthy?

We asked three THI council members their best advice for consuming media in a healthy way — and how to know when your news habit is becoming detrimental to your health.

We’re inundated by media, whether it’s news being sent right to our email or pushed as alerts on our phone, streaming TV shows, email and text alerts, or updates from friends and family, or silly memes and ads, on social media. And that’s just technological media — not including the more tangible arts of books, theater, and art. What different effect does each kind of media have on us? 

“Cellphone in pocket, computer at work, television at home, and everyone always watching what's going on around,” says THI member Fabio Dos Santos, MD, founding President of the Brazilian Association of Lifestyle Medicine — our lives are constantly connected, but too much information can be detrimental to our brains, through effects on memory and decision-making.
 
THI member James Gordon, MD, a psychiatrist, author, and founder and director of The Center for Mind-Body Medicine, notes that the effects of media on us are variable, as people use media in so many ways. Whether it’s email, social media, or reading the news, Gordon also notes that people have also started to use media as a substitute for interacting with people. “I think when people are feeling uncomfortable, it’s a reflex,” he says. “It’s kind of a combination of greater connectivity, but also greater isolation.”  

Would you call any kind of media “better” or “worse” than others? When does media consumption start to veer into the territory of having negative effects on health?


“Spending too much looking, reading, watching, and hearing all media in total is likely to have a detrimental effect on one’s health,” says THI member Michael F. Jacobson, PhD, co-founder and senior scientist at the Center for Science in the Public Interest. “And besides the time spent, the information purveyed by so many authors, websites, and gurus is simply not reliable.”
 
Adds Dos Santos: “There is no doubt that acquiring information in any way that comes has its benefits. But the burden of information, especially digital, has increased exponentially and the brain is not giving more. Our memory is no longer so reliable and we are forced to decide at every moment.”
 
Our brains seem to have a decision-making limit, especially with regard to determining priorities, to where “even seemingly simple activities, such as resolving bank transactions and buying airline tickets over the internet, can lead to exhaustion,” says Dos Santos. “The mental space has a limit.”
 
And then there’s the social side of media consumption — and its potential negative effects. Gordon mentions a popular episode of “Black Mirror,” in which members of society are constantly being “rated,” and if you don’t have a high enough rating, you can’t do certain things.  The commentary on society of this episode is “chilling,” Gordon says — “there’s that sense of always being rated and always comparing oneself to others.” He also mentions cyber bullying, particularly among young people, some of which can involve “the spreading of information that ostensibly was either private or was shared only intimately, that becomes public knowledge.” 
 

What can we as consumers do to mitigate those negative effects? 


Jacobson advises that “best is to rely on responsible sources of information: American Heart Association, THI, Center for Science in the Public Interest, Harvard School of Public Health’s Nutrition Source, the government’s Dietary Guidelines for Americans, etc.”
 
And more broadly, Dos Santos says that “our great challenge is to know what to select. Information has to be metabolized to become knowledge. There has to be a filter. Our memory system files according to importance.”
 
“Every attitude implies an analysis and the appropriate conduct of the data,” he adds. “If the brain finds difficulty in this process, the person becomes paralyzed. What makes us decide is the relevance of the information. That's why real, physical contact is so important.”
 
Even if a certain kind of media consumption is considered “normal,” you can choose the level of participation you want to have in it, Gordon says. “It’s a question of how do we balance it. Each person’s going to be different.” 

“Don't spend your life
looking at screens!”

– Michael Jacobson, PhD

Do you have any advice for “healthy’ media consumption? Would you advise a certain ratio of consumption of a certain kind of media over another? 

“Don’t spend your life looking at screens!” Jacobson says. “In general, I think that mainstream newspapers, TV stations, [or] National Public Radio are far more reliable than most information on the Internet.”
 
For Dos Santos, “to avoid exhaustion, when a person becomes excessively stressed and can generate even physical symptoms, I recommend a shutdown of the routine. I think we have to create some situations where you pull away. I call it ‘brain reset.’” 
 

How do you practice healthy media consumption in your own life? 

“I avoid unreliable authors, websites, hosts, etc., and look at all media reports with a somewhat jaundiced eye,” Jacobson says. “I also don’t give any credence to anecdotes by individuals on Facebook, in magazines, etc.”
 
Adds Dos Santos: “I like the idea of ​​dedicating a period of my day to myself, doing nothing. Even for a few minutes. Be present in this concept without specific technical obligations just feeling the importance of being there. But BE THERE!”
 
For Gordon, he tries to be intentional about the times of the day he consumes media. “I don’t keep a phone in the bedroom … so once I go to bed, I don’t look at any electronics,” he says. “I don’t have a television in my bedroom, I don’t have a computer or phone in my bedroom. That’s a place that is kind of an electronics-free zone.” As for when he does read the news, Gordon says he generally “looks at news at the beginning of the day and the end of the day.”
 
“I think it’s a question of finding a [media consumption] balance that works for each of us,” he says. 

Check out THI Founder David Katz's take here.

The True Health Coalition is home to thousands of members unified in support of the initiative's core principles. The Council of Directors now includes over 320 leading experts and influencers from over 30 countries, committed to cutting through the noise and educating on only the evidence-based, proven principles of lifestyle as medicine. Council members include physicians, research scientists, chefs, authors, journalists, and other opinion leaders.

Elissa Epel, PhD

Elissa Epel, Ph.D, is a Professor in the Department of Psychiatry, at University of California, San Francisco. She is the Director of the Aging, Metabolism, and Emotions Center and the Center for Obesity Assessment, Study, & Treatment, (COAST), Associate Director of the Center for Health and Community, and Associate Director of the NIH-funded UCSF Nutrition and Obesity Research Center (NORC).She studies psychological, social, and behavioral processes related to chronic psychological stress that accelerate biological aging, with a focus on the telomere/telomerase maintenance system. She also studies the interconnections between emotional processes, eating, and metabolism. With her collaborators, she is conducting clinical trials to examine the effect of mindfulness training programs on cellular aging, weight (including during pregnancy), and parenting stress for parents of children with developmental disorders. She leads or co-leads studies funded by NIA and NHLBI, including a Stress Measurement Network, and a multicampus center on obesity funded by UC Office of the President. She has been involved in National Institute of Aging initiatives on role of ‘stress’ in aging, and on reversibility of early life adversity, and now on Science of Behavior Change. She is a member of the National Academy of Medicine, and a fellow of the Association of Psychological Science, and Academy of Behavioral Medicine Research. She is on the scientific advisory boards for the Mind and Life Institute, and on the European Society of Preventive Medicine Board.  Epel has co-written a book for the public with Elizabeth Blackburn, Nobel laureate, which covers the biological, social, psychological, environmental and nutritional factors shaping telomere length and rate of aging. The NYT-bestselling book is called “The Telomere Effect: The new science 

Jay Kenney, PhD, RD, FACN

Newly retired, Dr. Kenney was for 33 years the Chief Nutrition Research Specialist at the Pritikin Longevity Center in Miami. Since 1975, Pritikin’s multidisciplinary faculty has been educating people worldwide in how to prevent and treat hypertension, obesity, type 2 diabetes, dyslipidemia, and coronary artery disease with diet and lifestyle changes. For two decades, Dr. Kenney has also written numerous continuing education courses for registered dietitians on a wide variety of topics, such as “Diet To Prevent and Reverse Insulin Resistance and Type 2 Diabetes,” “Salt Toxicity: Is It a Major Threat To Public Health?” and “Diet and Osteoporosis.”
 
Dr. Kenney received his PhD in Nutrition from Rutgers University and is board certified in Human Nutrition Sciences from the American Board of Nutrition. He is also a Fellow at the American College of Nutrition. He has traveled throughout the U.S. speaking at conferences for doctors, dietitians, and other health professionals on the relationship between diet and disease. He has published articles for scientific journals, including the Journal of Nutrition and the Journal of the American Dietetic Association.
 
Looking back on his 33 years with Pritikin, Dr. Kenney’s colleagues are grateful for his work not only as a first-rate nutrition research specialist but also as an educator. Like Nathan Pritikin, the founder of the Pritikin Longevity Center, Dr. Kenney was gifted at steering people away from “quick fix” fad diets and other nutrition myths. Like Nathan Pritikin, he was also gifted at convincing people that we really could wipe out killers like coronary artery disease, type 2 diabetes, and hypertension by wiping out the chief source of these killers – a lousy diet.
 
Simple and strong (and always laced with humor) was Dr. Kenney’s approach to teaching. “He was a visionary.” says Tom Rifai, MD, FACP, founder of Reality Meets Science, LLC, and a member of the Council of Advisors to True Health Initiative. “He had excellent foresight and elegant nutrition genius. Years before others had realized the value of low-calorie-dense, high-nutrient-dense eating, Dr. Kenney was writing about it, and teaching it.”
 
 
 

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