Lifestyle Nutrition

Eat Well & Thrive

Continuing Education

The link between obesity and eating out

Posted on September 7, 2018 at 1:05 PM Comments comments (0)

The more you eat out, the more likely you are to be overweight, say obesity experts who have studied the link between eating out and obesity, which are both on the rise.

A third of the calories Americans eat come from restaurants, including fast-food franchises, deli and take out, which is almost double what it was 30 years ago, according to the U.S. Department of Agriculture. For the average consumer, eating one meal away from home each week translates to roughly two extra pounds a year. More than half of adults eat out two or more times a week, and 12 percent eat out more than seven times a week. As a result, the pounds are adding up.

Why do Americans choose to eat out? They cite that they have less time for cooking, longer commutes, more households where both adults work, poorer cooking skills and many more options for meals out. How many more calories a person consumes out depends on the meal. A consumer's weight also plays into how many calories they consume while eating out. For the overweight/ obese individuals, an away-from-home meal added on average 1200 calories a day versus similar food group meals portioned and prepared with health in mind.

Wrong kind of calories

Eating out tends to pack on the pounds more than dining at home. Portion sizes are larger, and restaurant foods tend to be higher in sodium, fats and calories and those calories tend to be the kind that promotes obesity. Foods can be fat promoting or fat fighting and the nutrition scientists all agreed that eating any meal out is more likely to be a fat storage promoter.

"The calories we eat out, for a variety of hormonal and metabolic reasons actually cause more weight gain," said the director of research and education for Florida Hospital Celebration Health's metabolic medicine and surgery institute. Obesity-promoting foods include fat and sodium laden meats, sugar, high-fructose corn syrup, processed grains and trans fats; all cheap ways that restaurants add flavor. These foods lead to changes in blood sugar that cause cells to store food energy rather than burn it. On average, a commercially prepared breakfast provides fewer fiber rich choices, while most dinners away from home include vegetables that are prepared with extra fats and more starch options; according to the USDA economic researchers. The study also noted that restaurant diners eat less well. One meal out typically lowers overall diet quality enough to shift the average adult's diet from fair to poor on the Healthy Eating Index. The index is the tool the USDA uses to measure diet quality. When people eat out they tend to make poorer nutritional choices partly because people often associate eating out as a special occasion, or a time to splurge even if eating out has become a routine.

Paying with their health

As Americans have looked to restaurants to deliver them from cooking, commercially prepared choices have gotten savvier in luring customers. One way is by super-sizing portions, which appeals to America's appetite. For example, a bagel 20 years ago averaged three inches in diameter and had 140 calories. Today's bagels average six inches and contain 250 to 550 calories. Studies repeatedly have shown that consumers eat more when portions are larger. Of course, eating at home most of the time is the most likely solution while eating at home doesn't always equal eating healthy, it increases the odds. When you cook for yourself, you have more control.

Take Responsibility: When all is said and done you must take responsibility for your own health and wellness. Restaurants provide a great service, but in the end, you need to make decisions based on the importance you assign to your health and weight management goals. Bottom Line: Limit eating out to an occasional treat, not as a consistent lifestyle choice. “It is not what we do every once in a while that defines us, but rather what we do consistently.”

These are the resources that provided this information and shaped my opinion: Florida Hospital Celebration Health's metabolic medicine and surgery institute, USDA, Overeating in America: association between restaurant food consumption and body fatness in healthy adult men and women ages 19 to 80. Obes Res 1999;7:564–71.2010 Am J Epidemiol. 2003 Jul 1; 158(1):85-92.

Energy Drinks; are they a safe pick me up?

Posted on September 7, 2018 at 1:00 PM Comments comments (0)

A study published in the Journal of the American Medical Association confirms that energy drinks can raise your cardio-vascular health risks. Increased heart rate and blood pressure appears to be the foundational adverse effects. Dehydration can directly exacerbate this risk and energy drinks do not hydrate, in fact, they tend to be dehydrating.

So while an energy drink seems to help with your energy slumps, they really just temporarily mask the symptoms of fatigue and actually foster ongoing fatigue by fostering your system to cycle exalts and crashes. This cycling has been shown to decrease the immune system, which in turn makes us more susceptible to mental exhaustion and illness. Mental and physical exhaustion elicits certain hormones, some of which signal the evolutionary signal of hunger, seeking to replenish energy producing dietary tools to keep us afoot and therefore not easy prey for a saber tooth tiger’s snack.

What are those evolutionary hunger hormones? Well, let me introduce you to your hunger hormones, leptin and ghrelin. Leptin is a hormone, made by fat cells, that decreases your appetite. Ghrelin is a hormone that increases appetite, and also plays a role in body weight. Ghrelin, the appetite increaser, is released primarily in the stomach and is thought to signal hunger to the brain. Researchers have suggested that ghrelin levels play a big role in determining how quickly hunger comes back after we eat. But Leptin is supposed to be lower when you're thin (so your hunger is less suppressed) and higher when you're overweight (so your appetite is decreased by signaling satiety) that’s the normal evolutionary survival way it is programed to work. Too thin: suppress the hormone that signals you are full and if you are too heavy, increase the hormone that tells signals you are full. Perfect right? Not so; there is good evidence to support what I have been saying for years; Evolution has not caught up with modern man; i.e. that we have grocery stores and restaurants on every corner and enough money to fill our bellies without hitting a rabbit in the head or gathering berries. A recent study from University of California at San Francisco concluded that when someone practices dietary/lifestyle habits that produce chronic “sugar roller coaster rides” their body’s build up a resistance to the appetite suppressing hormone, Leptin, over time.

So while the energy drink question is always - “Is it OK to drink these to avoid the daily dip in energy?” The real question should be “What is the underlying cause(s) of your energy slumps?”

Kick your energy level up a notch with these tips. You won't feel wired when it’s time to wind down, either

Start Your Day with a good Fiber source

This is the meal that sets the stage for the entire day. Studies show that breakfast helps keep you alert starts your metabolism for the day and keeps you satisfied until your morning snack time.

The type of breakfast you choose can mean the difference between feeling sluggish or full steam ahead. Think of food as your fuel. Remember what your learned about dietary bio-chemistry. You need to make your daily carbohydrate macronutrient choices around 50-55% since your body only lives on carbohydrates; but both fiber and protein keep your sugar load steady. Make sure each meal/snack provides both. This is a strategy that keeps your tummy feeling fuller longer and your blood sugar steady. By contrast, when you eat high sugar choices; ex: pasta- your sugar spikes, then drops a short time later, leading to an energy crash. For a power-packed morning meal, a good example could be: Egg and high fiber toast or pita pocket with a side of low sugar yogurt and berries or other fruit. For variety, alternate with a high fiber cereal, such as Fiber One Original, 1 oz of raw nuts and berries or other fruit.

Take Lots of Short Breaks

This can make you more productive by helping you avoid burnout. You have imprinted the feelings of hunger and fatigue in your body so be patient and its okay to take a few minutes to refresh. There was some good research published by the Louisiana State University that found taking several short breaks throughout the day was better than naps or rests over 20 minutes long.

Snack Right

Is your stomach growling? Stop – think are you really hungry or is this phantom hunger? Phantom hunger can be from, dehydration, stress, inactivity, boredom or dramatic swings in blood sugar levels. Your body is signaling destress; adding in more food just feeds the downward cycle related to obesity. Don’t just dash to your refrigerator or nearby restaurant. Most phantom hunger choices will raise your blood sugar for a short-lived boost, and then leave you feeling drowsy and still hungry for the rest of the day. Take a quick walk to move oxygen into your cells. Drink a glass of water or your fresh juice recipe to replenish hydration. If you are traveling when the arms of Morpheus embraces you and that hunger monster will not be denied- eat an Extend bar slowing with water or better yet- plan ahead and pack a snack from home. These can be very simple like apple slices with peanut butter, fiber one trail mix or low fat crackers with a portable cheese like string cheese

Get Moving

There’s a good reason to “get up and go” when you are feeling tired. Take a few minutes to walk around. A 10-minute walk provides more energy than eating a candy bar, a study from the Journal of Personality and Social Psychology found. Get up and walk every hour or two. This kind of mindfulness can help you address phantom hunger in addition to assisting in any needed weight loss. Being overweight is a prominent culprit in experiences lower energy levels.

Stress; overt or internal

Everybody has some pressure in their lives and chasing life to the point of consistently be overbooked can cause anxiety, sleep loss, overeating, and/or exhaustion. Exercise, sleep and reducing stress are important in fighting fatigue. But nutrition is the dominant area of lifestyle that can affect energy levels throughout the day.


Being hydrated is an easy and inexpensive way to increase energy levels. You don't need vitamin water or sports drinks; they only add extra unneeded calories. Keep a fresh water source with you at all times and drink throughout the day. Add lemons, limes or oranges for taste variety.


Posted on April 15, 2018 at 1:55 PM Comments comments (5)

This information is solely provided to assist you in a conversation with your physician. Consult your physician regarding the applicability of any information provided to your symptoms or medical condition. Only your physician is qualified to determine what is right for you and your specific health concerns

Let’s begin with “What is cholesterol?”

Cholesterol itself is a waxy, fat-like substance that is primarily made by the liver, although some comes from the diet. It is an essential component of cell membranes and is used by the body to produce hormones and vitamin D. Cholesterol is carried through the bloodstream attached to two different categories of lipoproteins: low-density lipoproteins (LDL) and high-density lipoproteins (HDL). LDL is commonly known as the “bad or Lousy cholesterol” because it transports cholesterol from the liver throughout the body, and potentially allows it to hang out in your artery walls. HDL, known as the “good cholesterol or Healthy” picks up cholesterol from the blood and delivers it to cells that use it, or takes it back to the liver to be recycled or eliminated from the body – now the latter is what a well-behaved body is supposed to do!

How much cholesterol do we need?

Most of the 1,000 milligrams of cholesterol that your body needs to function each day, according to the American Heart Association, is manufactured in the liver of a well-functioning body- About 75%. Only around 25 percent comes from the cholesterol you eat. If you eat a well composed diet, your liver manufactures just as much cholesterol to supply your cells with what they need. But if your liver makes too much cholesterol, which can be an inherited problem and/ or if you take in too many calories, especially in the form of certain fats and sugar, your cholesterol levels rise as your liver converts extra sugar to fat. This new research syncs with decades of data on how sugar causes insulin resistance, high triglycerides, lower HDL (good) cholesterol and dangerous small LDL (bad) cholesterol. It also triggers the inflammation we now know is at the root of heart disease.

Conflicting information- What’s the truth?

We still have some differing views, so controversy over whether high cholesterol is in itself a cause of heart disease (the lipid hypothesis), or a symptom of an inflammatory condition that is the true cause of heart disease (the inflammation hypothesis) continues to be debated. According to the latter theory, chronically high levels of inflammation creates small lesions (like a scrape) on arterial walls; the body sends LDL to heal those lesions (like a bandage) but it ultimately accumulates and oxidizes, causing blockages. From this perspective, the best lifestyle approach to lower cardiovascular disease risk is to lower inflammation in the body rather than simply LDL levels.

Recent evidence indicates that your sugar load is probably a greater contributor to heart disease than is consumption of saturated fat. While high fat/high sodium may contribute to inflammation; poorly managed sugar loads appear to be the alpha culprit. This suggests that the inflammatory hypothesis may in fact have more validity than the conventional lipid hypothesis. Researchers have identified cholesterol's partner in crime as inflammation; which is simply the flood of white blood cells and chemicals that our immune system unleashes to ward off damage or infection. Cholesterol wouldn't be nearly as dangerous without this process, which is thought to play an essential role in atherosclerosis, the hardening that occurs when low-density lipoprotein (LDL) layers on “too many bandages” in the arteries. When high levels of cholesterol occur in the bloodstream, excess LDL begins to seep into the inner wall of the artery. This triggers an inflammatory response, which actually speeds up the accumulation of cholesterol in the artery wall. This in turn produces more inflammation and now that’s where those flagged labs come from. Eventually the deposited cholesterol hardens into a plaque, which can rupture and lead to the blood clots that cause heart attacks and strokes. Some experts now believe that inflammation is the link between the many diseases and conditions that affect the heart and brain. Just focusing on “sweets” is a flawed mindset. Some food choices may have a high sugar conversion but aren’t thought of as a sugary choice. Here’s how sugar works: Most carbohydrates must break down into glucose before you can absorb them. If you convert more sugar than your body needs, the excess amount is stored in your liver in the form of triglycerides, a type of fat that can cling to artery walls as it travels through the bloodstream. High triglyceride levels contribute to atherosclerosis, the formation of plaque in blood vessels. It also appears to contribute to lowering your high-density lipoprotein, the "good" cholesterol, according to an Emory University study published in the April 2010 issue of "JAMA." People in the study who ate the highest sugar producing foods had the lowest HDL and the highest blood triglyceride levels. People who ate the lowest had the highest HDL and the lowest triglyceride levels. If LDL cholesterol and/or triglycerides are an area of concern, ask about your HDL cholesterol since low HDL cholesterol is also a major risk factor for heart disease;

I was interested in who is practicing from the inflammation point of view

And I found that many “super doctor” endocrinologists were on board. The American College of Endocrinology and The Metabolic Institute of America are fertile ground for comprehensive and unique multiple interventional approaches to the cardio-metabolic high risk patient, preventing and managing obesity, diabetes and cardiovascular disease with a focus on inflammation factors. “Inflammation is the common denominator in nearly all of the diseases we deal with "Heart disease, diabetes, dementia all seem to have links to inappropriate, low-grade, chronic inflammation." Inflammation appears to be aggravated by poor and/or unbalanced diets. Research shows that high-calorie, high-fat meals cause a sudden spike in inflammatory markers because they flood the body with blood glucose and triglycerides. “While we have been told to swap eggs for Cheerios, my research says this is dead wrong. Learn more about “Super Doctors” • http/www.superdoctors

Warrior or Victim?

So yes it may be true that as we age we are more likely to see higher LDL cholesterol scores and yes some families seem to have more incidents of certain diseases. But before we give up, let’s explore if it is possible to reduce bad cholesterol levels and improve the good one? Past research has shown a strong association between obesity and high blood pressure and poor lipid profiles. So if you are overweight, start by losing a little fat. If you are not overweight don’t assume that your pro-active options are inconsequential. It was once assumed that obesity was automatically tied to high LDL cholesterol and triglycerides. However, in a recent subgroup analysis, researchers studied subjects with higher GI impact models that had a BMI in an acceptable range and still have concerns with high triglycerides and LDL cholesterol. So while many patients with these maladies may be overweight or obese; this should not be the overlying suspect for high LDL/low HDL cholesterol and/or high triglycerides. Whether you are overweight or not; consider these natural helpmates as well: Being in charge of what you consume at least        80-90% of the time is a smart strategy. Give due diligence to the nutrition fact of the foods you consume and remember that sugar isn’t just from “sweets”. And while we are focusing on pro-active things: don’t forget that high fats and sodium can also impact inflammation which may impact your cholesterol and triglyceride scores. Think integrative and toss in some consistent exercise/activity to ensure you are doing everything you can to support your health goals.

These are the resources that provided the information that I used in this article and shaped my opinion: Emory University study published in the April 2010 issue of "JAMA •Dr. Yehuda Handelsman •American College of Endocrinology’s• Metabolic Institute of America