Empty calories+empty glass= full sized

Nutritionists: Soda making Americans drink themselves fat

By Caleb Hellerman
CNN

(CNN) -- If you're searching for a villain in America's obesity epidemic, most nutritionists tell you to put one picture on the wanted poster: a cold, bubbly glass of soda pop.

"Liquid candy" to detractors, sweetened soft drinks are so ubiquitous that they contribute about 10 percent of the calories in the American diet, according to government data.

In fact, said Dr. David Ludwig, a Harvard endocrinologist whose 2001 paper in the Lancet is widely cited by obesity researchers, sweetened drinks are the only specific food that clinical research has directly linked to weight gain.

"Highly concentrated starches and sugars promote overeating, and the granddaddy of them all is sugar-sweetened beverages," said Ludwig, who runs the Optimal Weight for Life Program at Children's Hospital in Boston.

The rise in soft drink consumption mirrors the national march toward obesity. At the midpoint of the 20th century, Americans drank four times as much milk as soda pop. Today, the ratio is almost completely reversed, according to the U.S. Department of Agriculture. Meanwhile, in the past 30 years the national obesity rate has more than doubled, and among teenagers, more than tripled, reports the Centers for Disease Control and Prevention.

"Soda pop is a quintessential junk food," said Michael Jacobson, who heads the Center for Science in the Public Interest, which lobbies for government restrictions on foods it considers unhealthy. "It's just pure calories, and no nutrients. It's like a bomb in our diet."

Jacobson said the CSPI is pushing to require obesity warning labels on the sides of soda cans, like the surgeon general's warning on cigarettes.

While nutritionists are united in their dislike for nondiet soda, the "why" is controversial.

Some point a finger at high-fructose corn syrup, or HFCS, the sweetener used in most nondiet drinks. Last month, researchers at Rutgers University said they'd identified compounds in HFCS which may start a chemical chain reaction, leading to diabetes.

Most scientists, though, say there's little difference between HFCS and simple sugar, either in chemistry or the way they're handled by the body.

A bigger problem, doctors say, is simply the sheer number of calories. You'll find about 400 calories in a 32-ounce "extra-large" Coke, a fast-food staple. That's nearly a quarter of what the average adult woman needs in a whole day.

Scientists also say the body doesn't respond to liquid calories in the same way it would if those calories came in the form of French fries or chocolate cake. Appetite is controlled by a complex mix of hormones. Some signal the brain that your stomach is getting full. Others, including a hormone known as ghrelin, signal it's time to eat again.

If you eat a big burger, the level of ghrelin drops for a few hours. That drop doesn't happen if you drink a Big Gulp soda, even if it has more calories than the burger, according to Wayne Campbell, a professor in the Department of Foods and Nutrition at Purdue University.

"We're finding your hunger does not go down as far when you consume a beverage, as when you consume a solid," Campbell said. The result: Even with 400 liquid calories in your stomach, you polish off the burger too.

Campbell cautioned that the ghrelin theory isn't proven and that other factors -- such as a food's smell, or the sensation of chewing -- may affect appetite just as much, or even more. Our expectations also play a role.

"Soup is the anomaly to the liquid calorie research," he said. "People perceive soup as a meal, unlike drinking a Coke. So when we've done these types of studies, but used soup as the liquid, we don't see the same differences in [appetite] response."

The sugar in soda pop not only provides a massive dose of calories, but triggers a vicious appetite cycle, said Ludwig, who wrote "Ending the Food Fight," about healthy eating for children.

"It's rapidly absorbed, which raises blood sugar and in effect causes the body to panic." The body releases insulin to break down the sugar, "but the body overcompensates, and blood sugar drops below the fasting level," lower than it was in the first place.

Recognizing low blood sugar, the body releases ghrelin and other hormones, inducing hunger, inducing us to eat even more, Ludwig said.

The public is catching on, he said.

"In our obesity clinic, we used to routinely see patients coming in who were drinking four or five soft drinks a day. Now it's rare. That seems to be the first factor that comes to mind, when people are trying to lose weight."

Soft drink companies, under fire, are taking steps including a pledge last year to phase out nondiet soft drinks from America's schools.

A progress report issued Monday by the American Beverage Association said that shipments to schools of sweetened soda are down 45 percent since 2004, while shipments of bottled water are up 23 percent.

"There's no question the changes that are happening in schools are a mirror of what's happening in the larger marketplace," said Susan Neely, the ABA's president & CEO. "Adults, like kids, are reaching for lower-calorie beverages. ... As a consumer product company, we want to give consumers what they want."

While fighting obesity is complicated, Ludwig said, the first step is clear. "Giving up sugary soda for diet drinks, or water, will cause you to lose weight."

Skip the Soda

Study Links Diet Soft Drinks With Cardiac Risk

By Ed Edelson
HealthDay Reporter,

HealthDay

Posted: 2007-07-23 16:11:02

MONDAY, July 23 (HealthDay News) -- Drinking more than one soda a day -- even if it's the sugar-free diet kind -- is associated with an increased incidence of metabolic syndrome, a cluster of risk factors linked to the development of diabetes and cardiovascular disease, a study finds.

The link to diet soda found in the study was "striking" but not entirely a surprise, said Dr. Ramachandran Vasan, study senior author and professor of medicine at Boston University School of Medicine. There had been some hints of it in earlier studies, he said.

"But this is the first study to show the association in a prospective fashion and in a large population," Vasan said.

That population consisted of more than 6,000 participants in the Framingham Heart Study, which has been following residents of a Massachusetts town since 1948. When the soda portion of the study began, all participants were free of metabolic syndrome, a collection of risk factors including high blood pressure, elevated levels of the blood fats called triglycerides, low levels of the artery-protecting HDL cholesterol, high fasting blood sugar levels and excessive waist circumference. Metabolic syndrome is the presence of three or more of these risk factors.

Over the four years of the study, people who consumed more than one soft drink of any kind a day were 44 percent more likely to develop metabolic syndrome than those who didn't drink a soda a day.

The findings are published in the July 24 issue of the journal Circulation.

A variety of explanations, none proven, have been proposed for the link between diet soft drink consumption and metabolic syndrome, Vasan said. That association was evident even when the researchers accounted for other factors, such as levels of saturated fat and fiber in the diet, total calorie intake, smoking and physical activity.

One theory is that the high sweetness of all soft drinks makes a person more prone to eat sugary, fattening foods. Another is that the caramel content of soft drinks promotes metabolic changes that lead to insulin resistance. "These are hotly debated by nutritional experts," Vasan said.

Vasan, who noted that he is not a nutritional expert, said he leans toward the theory that "this is a marker of dietary behavior" -- that people who like to drink sweet soda also like to eat the kind of foods that cardiac nutritionists warn against.

"But we cannot infer causality," Vasan said, meaning there is no proof that soda itself is the villain. "We have an association. Maybe it is a causal one or maybe it is a marker of something else."

Carefully controlled animal studies might resolve the cause-and-effect issue, he said.

Dr. Elizabeth G. Nabel, director of the U.S. National Heart, Lung, and Blood Institute, which funds the Framingham Heart Study, said in a prepared statement: "Other studies have shown that the extra calories and sugar in soft drinks contribute to weight gain, and therefore heart disease risk. This study echoes those findings by extending the link to all soft drinks and the metabolic syndrome."

Dr. Suzanne R. Steinbaum, director of Women and Heart Disease at Lenox Hill Hospital in New York City, said, "There is no safe way of eating junk food, just as we learned the lesson from trans fats and partially hydrogenated oils often found in fat-free or low-fat cookies. Diet soda does not protect us from the development of what we are trying to avoid by consuming it."

More information

Learn more about metabolic syndrome at the American Heart Association.

SOURCES: Ramachandran Vasan, M.D., professor of medicine, Boston University; Suzanne R. Steinbaum, M.D., director, Women and Heart Disease, Lenox Hill Hospital, New York City; July 24, 2007, Circulation

How Does Your Waistline Matter? Let Us Count the Ways.

NYTimes Explores Obesity



AT age 39, with diabetes and high blood pressure in her family, Linda M. was starting to worry about her weight and its health consequences. She was 5 feet 6 inches tall and weighed 170 pounds, which placed her in the overweight category, according to the standard definition. Although she was not officially obese, she said, “I realized I was not at my ideal weight.”

But Linda was in for a surprise during an appointment last fall with Dr. Judith Korner, an obesity specialist at Columbia University. Instead of weighing her, Dr. Korner whipped out a tape measure and measured her waist.

It was 35 inches, putting her in a danger zone, Dr. Korner explained. An overweight woman with a waist 35 inches or larger, or an overweight man with at least a 40-inch waist, is at increased risk for diabetes and heart disease.
“That was an education,” said Linda M., who did not want her last name revealed because of her weight. “I did not realize that my waist determined my future risk.”

Obesity specialists differ on what measurements are best.

Linda’s body mass index, or B.M.I., for example, was 27.4, far from the obesity category, which starts at 30. She would have to weigh 185 pounds to have a B.M.I. that high. (For comparison, a man who is six feet tall and weighs 221 pounds is considered obese.)

If a doctor were to use B.M.I. exclusively to evaluate Linda, the conclusion would be that her weight was not a serious health risk. She had only one risk factor for heart disease — a high level of triglycerides — and the guidelines for B.M.I. say that overweight people need two factors, like high triglycerides and a high cholesterol or blood pressure levels, to be considered at serious risk.

B.M.I. has limitations. Muscular men might have high B.M.I.’s, which make them seem fatter than they are. Old people often have deceptively low B.M.I.’s because they have lost so much muscle in the aging process.

In Linda M.’s case, adding her waist measurement to her B.M.I. indicates a high health risk, according to guidelines published by the National Heart, Lung and Blood Institute. For Dr. Korner, the test is useful in assessing if people like Linda M. — overweight but in a gray zone — face a true health risk? If her waist had been less than 35 inches, Dr. Korner would have been less concerned.

Dr. Ned Calonge, chairman of the United States Preventive Services Task Force, said the panel preferred B.M.I. measurements to determine whether people are fat enough to place their health at risk. For most adults, he explained, B.M.I. “is more feasible or has better validity than other measures.”

But, Dr. Calonge added, it is not enough to simply diagnose someone as obese. The goal should be better health.

And the problem with testing for obesity, using B.M.I. or anything else, is that the sort of counseling most patients get from their doctors has not been shown to improve health, Dr. Calonge said.

“You now have a, quote, diagnosis,” Dr. Calonge said. And there is at least fair evidence from research that intense and expensive counseling about diet and exercise can help people lose weight and improve conditions that place them at risk for heart disease. But, he added, “it is uncertain whether less intense interventions have any impact at all.”

For Madelyn Fernstrom, the director of the Health System Weight Management Center at the University of Pittsburgh Medical Center, the goal of a medical exam is not to document how fat someone is but to rule out rare metabolic conditions that might be causing the weight problem. An exam also helps to determine whether there are associated medical conditions that should be treated, like diabetes or high cholesterol or blood pressure.

As for Linda M., waist measurement made the difference.

“After that, I got myself in gear,” she said. “I tried to eat less sugar and healthier snacks; I was more conscious of what I was selecting.”

She lost 20 pounds and a couple of inches from her waist. Her triglycerides are lower, yet still a bit high. But, she says, as she sees it, with a smaller waist, “I’m out of the danger zone.”
Talk To Your Doctor:

• What is my body mass index?
• What does it tell me about my health risk?
• Does my waist size put me at higher risk for medical problems?
• Are there metabolic conditions that might be causing me to gain weight?
• Where can I go for practical advice on how to improve my diet and an exercise regimen to lose weight?

Hot Topic

Research shows that a little spice can go a long way...

Prevent diabetes: Australian researchers found that women who ate chili sauce daily had lower spikes in their blood sugar (glucose) levels after meals than those with blander diets. More stable glucose levels reduce diabetes risk.

Stave off Alzheimer's: Curry contains tumeric, which is high in curcumin. According to a study published in Journal of Alzheimer's Disease, this antioxidant helps sweep away amino acids that can build up in your brain's blood vessels. Over time, these blockages can lead to dementia.

Protect against obesity: Early research from Taiwan found that chili peppers' capaicin may reduce the number of fat cells your body produces.

My Philosophy: Not a New Year's Resolution, a New Life Resolution/Revolution

Part 1
Because I am slim and fit, a lot of my clients and friends ask me if I diet. I don't believe the word "diet" should be a verb (as in, "Are you dieting?"). I'm a strong believer that one's diet should be a way of life. I don't believe in good foods or bad foods (chocolate cake=bad, rice cake= good). It should be noted that I do not consider highly processed foods, most fast foods, and foods containing certain artificial ingredients (hydrogenated oils, artificial sweeteners, &c.) real food that is fit for consumption. Few things in life are black and white, so why should we expect what we eat to be so simple and binary?

My philosophy is that we should listen to what our bodies are telling us. If we are gaining weight, are becoming hypertensive, if our cholesterol levels are high, if we're always hungry/stuffed, we should take a good, unbiased look at what we eat, when we eat, why we eat, and how we eat, and we should modify those things until we are healthy. What we consume should not negatively affect us, and if it does and we do not change our eating habits, we only have ourselves to blame. We don't have to diet (ie. deprive) we need to adjust our diet (how, how much, and what we eat).

Losing Weight

To effectively lose weight, one needs to adjust their diet as well as their activity level. Doing one without the other probably won't have much of a lasting effect. Think of it as a lifestyle change that will give you a changed body, a healthier body. Our bodies are amazing things. They will do only what we ask of them. If you want the strong, lean body of an active, healthy person, you are going to have to embark on the process of becoming a strong, active, healthy person. You won't get a strong, lean body by watching 20 hours of tv a week and substituting rice cakes for potato chips. If you're willing to accept that your lifestyle as it is now is not giving you the physique you want and committed to altering your lifestyle and adopting a healthier diet and more physical activity, your body will listen. It may grumble, it may ache and complain, but it will listen.

A good friend of mine is always saying, you are the master of your own destiny. You are the master of your body as well.

Change Your Diet, Change Perspective

It's common for many people to improve the quality of their food, make healthier choices, and still find they are not losing weight. Portion size is very important. It is crucial. American meals, especially the ones served at restaurants, have lost all sense of proportion. Our dinner plates are huge. Our spoons are huge. We need to relearn what a real portion size is and accept that. As long as we believe that a steak should be 24 ounces (as opposed to 4-6 ounces), we are not going to get the bodies we want.
At home, use smaller plates and fill them mostly with brightly colored vegetables. Keep your protein portion about the size of a deck of cards and your starch about 1/2 cup (think of a baseball cut in half). Still hungry? Have some more steamed string beans, some more beets, another helping of broccoli.
When you are actively trying to change your diet, to nurture your palate to accept and enjoy healthier real flavors, and to lose weight, you may want to step away from the desserts for a while. You should probably cut out alcohol, which is high in calories. This does not mean that you will forever forgo these items, but just know that for the time being, you are taking a break and resetting your palate and your body. If you must, savor just a bite of some high quality sweet instead of having a whole dessert or candy bar.
When you achieve your goal weight, remember that you can have anything you want occasionally and in moderation.

Exercise

The healthiest way to lose weight is to adopt a healthy diet and exercise. We should all be getting 45 minutes a day of exercise. At least. Our bodies are designed to be active. Unfortunately, our jobs often require we sit still for long periods of time. This starts a vicious circle of fatigue and inflexibility. This vicious circle continues even when we first start working out. It can last a few weeks, but slowly, surely, your body will wake up and rise to the occasion. It will do what you ask of it; it will get stronger, more flexible, healthier. You will feel stronger, healthier. You'll have more energy. As you come into your body, you'll be amazed at how good it feels to be more active, to be stronger. Your body is meant to be strong and healthy and your hard work and exercise will be rewarded. Your body is a part of you. Don't neglect it.

Math

While I don't believe we should be wed to the scale, there are some important numbers to consider. 3500 is the number of calories in a pound. If over the span of a month, you consume 7000 extra calories, you will gain two pounds of fat. Likewise, if over the span of a week, if you decrease your calorie consumption by 200 calories a day (that's about equal to a slice of cheese and a can of soda) while increasing your energy expenditure (exercise) by about 300 calories every day, you can expect to lose a pound.
What about all those diets you read about that tell you to cut out carbs and you'll lose 10 pounds in a week.... well, most of that is water. It is safe and reasonable for most people to lose between 1-2 lbs a week. Unless you have an excessive amount of weight to lose, dropping more than 1-2 lbs a week usually indicates you are dehydrated (a side effect of ketosis, the state your body goes into when it's deprived of carbohydrates).
Going back to what I wrote earlier about being wed to the scale... you should use how you look, how you feel, how your clothes fit, as better indicators of your progress. Muscle weighs more than fat. How much more? A pound of fat is about the size of a large grapefruit. A pound of muscle is about the size of a small orange or tangerine. So if you are losing fat and gaining muscle, the numbers on the scale might not be moving very much. If the jeans you banished to the back of your closet or some other "thin clothes" are telling you you lost weight but your scale is telling you otherwise, rest assured that you may not have lost "weight" but you certainly lost fat.

Avoiding Gestational Diabetes

Women who exercise regularly before conceiving are less likely to develop diabetes during pregnancy, according to a Harvard study. Brisk walking before pregnancy reduced the risk of gestational diabetes by 24% compared to walking at an easy pace. In contrast, women who watched at least20 hours of TV each week and did not exercise before pregnancy were 2 times as likely as exercisers to develop gestational diabetes. While lifelong physical activity clearly matters, previous studies show that women can also reduce the risk of diabetes by exercising during pregnancy. -Archives of Internal Medicine

Magic Number: 2.2

2.2 lbs, or 1 kg

If you're overweight, 2.2 is the number of pounds you need to lose to reduce your risk of diabetes by 16 percent says a new study published in Diabetes Care. You can easily lose that amount in a month if every day you burn an extra 100 calories by exercising and trim 150 calories from your diet (about equal to one regular soda). Even better, the effect of the weight loss is cumulative. Drop 4.4 pounds to cut your risk by 32 percent; shed 6.8 to lower your odds by 48 percent.