Eating Healthy Doesn't Happen Overnight: It's a Lifelong Process, Here's My Story

Eating healthy doesn’t happen overnight, it’s a life-long process of trial and error.  For anyone who tells you otherwise, they're wrong.  You’re not going to fix your diet in one fell swoop.  It takes time.  It takes energy.  It takes effort.  But you know what, it’s totally worth it.  Once you’ve got your dietary system in place, eating healthy becomes so much easier.  I wouldn’t go so far as to say that it is effortless but it is much easier.  I like to tell people that if they put in the work now and establish a good foundation that later on they won’t have to focus so much time and energy on eating healthy.  This allows them to focus on the more important things in life: friends, family, experiences, and good times.

The long and winding road of healthy eating.

To illustrate what I’m talking about I’d like to share my healthy eating journey with you.  I still don’t eat as well as I should, but I’ve come a long, long ways.  I’ve built my foundation and now I don’t have to spend as much time, energy, and effort in eating healthy.  

Despite becoming a registered dietitian my dietary habits didn’t really change from high school through my Master’s degree at Iowa State.  My diet consisted primarily of peanut butter and jelly or lunch meat sandwiches, cereal, black bean salsa, and frozen pizzas along with “healthy” snacks such as string cheese, yogurt, carrots, and nuts.  My diet during this time wasn’t necessarily unhealthy, it was just extremely limited.

From high school to the beginning of my time at East Carolina University (ECU) I was extremely physically active, which helped me get away with poor dietary practices.  The first semester at ECU I stopped riding my road bike (as a result of a chronic back injury), ate the same diet I was accustomed to eating as an athlete, studied all day, drank too much alcohol, and gained 20 pounds….my freshman 15 came during the “freshman” year of my PhD.

After my first semester at ECU I transformed myself back into the weight lifter I was during my undergraduate days.  I hadn’t seriously lifted weights since college but with my back not cooperating and no longer having hours and hours to ride my road bike anyways, the transition to weight training was a necessity.  During this time, I also had to “unlearn” all the poor dietary habits that I had previously undertaken as a road cyclist to maintain my body weight.  The high sugar yogurt, eating bagels instead of bread, and other high calorie dietary habits that I had previously adopted to maintain my weight needed to be changed.

One of the advantages I had at ECU was that we were connected to a medical school with a hospital cafeteria.  This provided me with an entrée and two vegetables every day for lunch.  It was during this time that I also finally started making tacos and a few other meals at home on my own.  During my last year at ECU my girlfriend (now wife), Kathleen and I moved in together.  She cooked far more than I did and I picked up a few of her recipes.  I probably only really knew how to cook around 10 meals at the time but it was a start.

In January of 2013 I moved to Denver, CO with Kathleen.  In Denver, Kathleen and I slowly started cooking more and more meals.  To be honest, part of this was for health reasons but the major reason we started cooking more was to save money.  Between my unsteady job prospects and my wife’s post-doctoral fellowship salary, we didn’t have a lot of money to eat out.  We slowly and progressively added more and more meals to our repertoire.  I don’t have exact numbers on how many meals we added each year we’ve lived in Denver but today we have 103 recipes in our recipe manager (Paprika).  To be fair, I recently went through our recipe manager and deleted out 50 or so recipes that we either a) downloaded from the internet and never made b) made the recipe but didn’t like it or c) decided it was far too much work to make again.

During our time in Denver we’ve also branched out and learned how to make several vegetarian based dishes such as quinoa, couscous, quiche, and a variety of bean-based dishes that are now staples of our diets.  We have ditched regular yogurt for Greek yogurt, tried to eat more nuts, and eat quite a few hard-boiled eggs.

Our newest meal-planning endeavor is to plan our meals for an entire month at a time.  This will prevent us from needing to plan meals out each week prior to grocery shopping.  Neither one of us enjoy this task, so only having to complete it once per month or once every 2 months is a welcome change.  To help with our monthly planning we have also developed the following weekly system to guide our recipe selection and grocery shopping:

1) Breakfast:

• Individualized options, Kathleen and I tend to have different preferences for weekday breakfast (i.e., bagel with cream cheese/peanut butter, oatmeal or smoothie)
• One weekend morning brunch meal (e.g., eggs, potatoes, breakfast burritos)

2) Lunch: vegetarian based recipe

• Usually a single main dish supplemented with snacks (e.g., fruit, yogurt, string cheese, nuts, cut up veggies, and granola bars)
• Vegetarian emphasis: 8 out of 10 of our current lunch specific meal recipes are vegetarian

3) Dinner:

• Pre-plan 4 meals/week
• At least 2-3 of these meals have to make enough to have leftovers, which supplement the other 3 dinner meals of the week
• We have ~40 consistent recipe options that we choose from with the goal of trying at least 2 new recipes per month
• Of the 4 dinner meals we are making a concerted effort to eat at least one vegetarian meal, one fish-based meal and the other two can be meat based
• We use our crockpot at least once, if not twice, per week
• We usually cook at least 1 of our 4 pre-planned meals on Saturday/Sunday to allow for recipes that are more complex or have longer cooking times can’t be done during the week

We’ve come a long, long way since my college days of peanut butter and jelly sandwiches but these changes didn’t just happen overnight, they took over 5 years and are still a work in progress.  In the process of making all of these dietary changes we have:

• tried ~50 recipes that just didn’t stick
• still don’t have great fish recipes
• need to find more good vegetarian dishes
• have tried Blue Apron and didn’t really like it (If you want to know why it didn’t work for us, let me know and I’d be happy to share my thoughts. Our dislike wasn’t with Blue Apron specifically, it’s just the brand we happened to try)
• struggled with finding time to grocery shop and prepare meals
• ignored planning weekend lunches (we need to tackle this next!)

But you know what?  We’re pretty happy with where our diets are today and someday soon we’re going to (finally) get to a place where we have our routine down.  We like the foods we eat and the rest of our lives have become so much easier (or unburdened) by being able to eat healthy, remain healthy and active, lean, and when we do go out or want to have some cookies or ice cream, we can easily fit them into our diets without feeling one bit of guilt.  We have never sacrificed taste for health. 

Instead of trying to make several grandiose changes that you and I both know aren’t going to stick, make a commitment to sustainable, lifelong changes.  Start to change the small things in your diet that can make you healthier today.  Realize that to be successful, you will need to commit to it for the long term.  In the end, you’ll be so much happier that you did.

Not everyone has to follow our template, the way we do things is only a suggestion and is still evolving.  However, we have developed a system that works for us.  In 2018, I hope that you take a little time, energy, and effort to develop or refine a system that works for you.  In 2019 and beyond, you’ll be glad you did!

 Todd M. Weber PhD, RD

The Blessed Trinity of Weight Loss Needs a New Member

In Christianity, the Father, the Son, and the Holy Spirit make up the Blessed Trinity.  They are all God, yet they are all distinct “beings” holding equal power and responsibility.

Figure 1. The Blessed Trinity (courtesy Alchetron)

In the world of weight loss, the Blessed Trinity can be likened to:

1) Nutrition

2) Physical Activity

3) Behavior Change/Modification

Although many people rank these elements differently in terms of importance, research (and experience) has shown that we require all three to be successful.  Yet, this Blessed Trinity is still somehow incomplete.  There is another leg that’s missing. 

If you think about the blessed trinity of weight loss, dietitians are in charge of nutrition, personal trainers are in charge of physical activity, and behavioral psychologists or another health professional are in charge of behavior change/modification.  All three professionals’ roles and responsibilities overlap with one another to some degree; however, no one professional is solely responsible for helping to control the client’s environment.

In biblical terms, the 21st century food environment is currently akin to the Blessed Trinity’s arch nemesis, Satan.  There are an infinite number of food temptations around every corner, everywhere you look, everywhere you are, everywhere you plan to be.  Whether you’re at work, home, commuting, on social media or watching television, it is impossible to escape the temptation of food.

Figure 2. Food Environment Flooded with Food.

We need someone to either fight Satan, or convert him to our side.  Unlike the true Blessed Trinity of the Father, the Son, and the Holy Spirit, which can “manage” Satan, dietitians, personal trainers, and behavioral psychologists are no match for our current food environment. 

There is no amount of nutrition education, calories burned at the gym, or behavior modification/willpower/cognitive training that is going to overcome our food environments.  Despite our best efforts, our current food environment is an unstoppable force.  Merely being in its presence will cause you to overeat.  However, there is a solution:

Fix the food environment = fix the problem.

With our biological drive to eat tasty, salty, fatty, sugary foods, coupled with an excessive amount and opportunity to eat, overeating is the inevitable result.  Our biological drive to eat isn’t going to change (much); however, we can change our (personal) food environments to decrease both the amount we eat and the opportunities we have to eat.

The food environment is too important to continue to rely on dietitians, personal trainers, and psychologists to manage in addition to the other roles they play.  I’m not trying to understate the importance of these professionals.  They all do great and important work.  But the problem is, their work and where you, the client, live, work, and play (your environment) are in completely different galaxies.  This is why we need someone to monitor your food environment and to see the world as you see it in your day-to-day life.    

We need to add a fourth member to the Blessed Trinity, someone whose sole purpose is to help you monitor/manage your food environment.  I’m not exactly sure what to call this person or if this occupation even exists; however, the name that comes to my mind is a Food Environment Manager (FEM).  If you fix the food environment, there isn’t as much of a need for extensive nutrition education, knowing the number of calories consumed versus calories expended, and you don’t have to rely on willpower to guard against overeating.  You take care of your food environment and your food environment takes care of you.

Continuing to address weight management in our current three-pronged approach is only going to result in more long term failure.  Knowing what to do is far different from knowing how to do it and eating healthy is no exception.  If we can control your food environment, eating healthy becomes much more routine, sustainable, and automatic.

Todd M. Weber PhD, MS, RD

Who Says Fitbit is Dead?

During the past couple of years there has been a lot of talk about how Fitbit, once one of the hottest wellness items on the market, is “dead”.  It’s true that many Fitbit (and other wearable device) users stop using their devices after a few months.  In fact, in 2016 less than half of registered users were still using their Fitbit devices.

Table 1: Fitbit User Figures (adopted from the Motley Fool).

It has also been well documented that purchasing a Fitbit doesn’t lead to meaningful weight loss.  This is frustrating but isn’t surprising as this has been a common theme in the home gym industry for years.  How many treadmills or ellipticals are collecting dust and/or serving as a clothes rack in your basement? 

I believe that the problem isn’t necessarily with Fitbit, it’s with us.  Consumers treat Fitbit like many of the other health & wellness solutions out there, like a quick fix, when in reality, a Fitbit is really just another tool…and a good one at that.

Fitbit solves the painful problem of trying to track your total daily physical activity (exercise and movement of any kind).  Our jobs and our lives are so incredibly sedentary (oftentimes not by our choice) and movement quantity, of any kind, is what many of us need to focus on first, before setting more advanced goals (i.e. getting “fit”).

The problem is that moving more requires us to carve time out of our already crazy schedules.  Recently, a solution to this time crunch has become more and more popular: high-intensity interval training (HIIT).  HIIT is becoming more and more popular, however, HIIT is also not a stand-alone health solution but another tool/part of the equation. 

Contrary to popular belief, you cannot perform one HIIT session and call it day.  One HIIT session will help an individual get closer to their goal of more movement, but one HIIT session will not cancel out an entire day’s worth of sitting.  Nowhere in the history of humans have we been as inactive as we are today.  In hunter-gatherer times, you could not drive your car to the hunt site, perform 45 minutes of high-intensity prey stalking/killing, and drive your car back home to sit on the couch or work in your office the remainder of the day.  The more likely scenario involved walking several miles, stalking prey, waiting, stalking more, followed by a burst of activity, killing the animal (if you are lucky as there were likely many unsuccessful hunts), and carrying your kill back home (weight lifting).

Put another way in more modern terms, HIIT is akin to taking your kids to a sporting event, concert or buying them a lot of presents on Christmas.  These individual actions will make your kids very happy in the short term, but to have a truly great relationship with your kids you really just need to be there for them.  You need to spend time with them.  I am not a parent so I might not know what I’m talking about, but I can speak from the side of the child.  My parents never showered me with gifts or took me to concerts but they were always there for me and I have a great relationship with them. 

But, this article isn’t about HIIT or parenting, it’s about tracking physical activity/movement.  These days it is easy to log your distinct exercise sessions.  Whether that is manually via a notebook or an electronic log, using an exercise watch (e.g., Garmin, more advanced Fitbits) or an app on your phone (e.g., Strava, Nike+), there are many tools available.  But, how do you measure your overall total daily physical activity (exercise and other movement)?  Fitbit offers a simple way to track your physical activity in an easy to understand, metric: total steps.  I believe the basic function of a Fitbit should be to ensure that you spend enough time with physical activity to form a great relationship with your health and your body.

Now, to be fair and in full disclosure, I’ve used a Fitbit religiously since I purchased my first Fitbit Zip in November of 2014.  Since then I have kept track of my steps, as shown in the graphics below:

Figure 1: Todd Weber's Steps per Day from 2015 to 2017

An example of what my step count looks like on a monthly basis is also shown below.  As you can see I don't get a crazy amount of steps/month but I am very consistent.

Figure 2: Todd Weber's Steps per Month (2017) as seen on the Fitbit Website.  Consistency is King!

So, by defending Fitbit I’m really defending my own way of life.  I lift weights, commute by bike and hike (mostly in the summer).  Outside of those activities, I do very little to no other endurance exercise (a.k.a., cardio).  The only information I record in my exercise log are details about my weight lifting. This means that I have no official record of the bike rides, hikes or even short walk breaks that I take during the day to clear my mind.  Thus, without my Fitbit, I REALLY HAVE NO IDEA about my activity level on any given day. Having this knowledge at my fingertips doesn’t make me perfect in my physical activity habits.  I still have plenty of days with less than the ideal number of steps (< 10,000), but it’s safe to say that I’d be lost, and likely a lot more inactive, without my Fitbit. 

With life pulling us in so many different directions, what harm does passively tracking your physical activity do?  Maybe you don’t want to know how physically inactive you are, maybe it makes you ashamed, maybe you’re not ready to make a change or don’t think you have the time to change.  All I can say is that you can’t afford not to.  You all know this and so do I.  Let 2018 be the year where you keep track of your health.  You don’t have to wear a Fitbit to keep track of your health but it makes it so much easier. 

To good health,

Todd Weber PhD, RD

8 Books to Better Your Body and Your Life in the New Year

Let’s face it, most diet/health & wellness books just plain suck.  They tend to be incomplete, biased, myopic, hyper-focused, conspiracy laden, ill-informed, fad driven, flavor of the month texts that likely won’t help you accomplish much of anything other than passing time.  Reading them may make you (temporarily) feel better in knowing that you are trying to do something to better yourself; unfortunately, the vast majority of these books are NOT the answer to the questions you should be asking: how do I eat better, live better, and feel better?

Example of Diet/Health & Wellness Books not Worth Reading.

But don’t despair, there are a few select books out there that are well-written, absolutely extraordinary and are SOOOOOO worth reading.  These texts can help you build a framework with which you can approach health & wellness in the coming year and if you are serious about improving your health and well-being I would suggest reading one or several of them.  I’ve read 5 of the eight books and will introduce them to you in the order that I read them.

Diet/Health & Wellness Books Worth Reading: Some of My Favorites.

1) The Power of Habit.  Brushing your teeth, backing your car out of the driveway, driving to work.  These are all automatic behaviors.  We do them without even thinking.  This text was the first to introduce me to how so many of the things we do throughout the day are pre-programmed. It also gave me the idea that this is how we need to approach health & wellness, take behavior out of the equation and make your (healthy) actions automatic.

2) The Compass of Pleasure: How Our Brains make FATTY FOODS, Orgasm, EXERCISE, Marijuana, GENEROSITY, VODKA, Learning, and GAMBLING FEEL SO GOOD.  Truly a remarkable read.  Neuroscientist David Linden demonstrates how the brain is a pleasure-seeking machine.  Whatever brings us pleasure is what the brain seeks out; even volunteering may not be all “that” altruistic as it makes us feel good.  The Compass of Pleasure begins to explain why we seek/crave food and makes numerous relevant comparisons to the world of addiction.

3) WHOLE: Rethinking the Science of Nutrition.  T. Colin Campbell had a long and outstanding academic career publishing nearly 400 research papers.  Here he outlines how the “reductionist” approaches of the scientific method are insufficient for studying what makes a food healthy and how nutrition proponents of today cherry pick research to support their products, claims, and causes.  Truly eye opening.  A sometimes dense read but well worth it.

4) Mindless Eating: Why We Eat More than We Think.  The environments in which we live and work have an enormous impact on the quality and quantity of the food we eat.  By changing food labels, food presentation, portion size, lighting, food convenience, and a variety of other variables, author Brian Wansink shows us how making simple changes to your food environment causes drastic changes in your food consumption (and most likely your health).  Amazing work.

5) The Hungry Brain: Outsmarting the Instincts that Make Us Overeat.  Take books 1-4 in this list and combine them into one.  Probably my favorite book to date as it covers neuroscience, behavior change, and the environmental impact on your food decisions all at once AND science based suggestions on how to overcome them.  The text is neuroscience heavy at times and is written for a more professional audience, but is a fantastic read nonetheless.  I will be reading this again!  I can’t say enough about this text.

6) Lift Like a Girl: Be More Not Less.  A girl after my own heart.  A no nonsense, I am going to call out your bullshit, I am going to destroy your pathetic, bourgeois, health & wellness norms and tell you exactly what you need to do to be healthy, kind of girl.  If you need motivation and a new direction, author Nia Shanks is a must read.  She also has a ton of free content on her website, check it out.  One of my all-time favorites!

7) The Diet Fix: Why Diets Fail and How to Make Yours Work.  Although I have not yet read Dr. Yoni Freedhoff’s book, his premise is absolutely, 100% correct.  Written through the lens of an obesity doctor with years of experience, Yoni not only knows the academic literature but also knows how to apply it.  Based upon his social media feed and blog I am confident this is a great book for anyone wanting a step-by-step how to guide to fixing your diet.

8) Science and Development of Muscle Hypertrophy.  Again, I haven’t read this book yet either; however, Dr. Brad Schoenfeld is one of the world’s premier experts in muscle development.  I don’t know anyone who has contributed more practical knowledge to muscle hypertrophy than Dr. Schoenfeld.  I have learned a tremendous amount from him over the past couple of years by following him on social media.  Unlike bodybuilders, Muscle & Fitness, and your run of the mill, meathead, Dr. Schoenfeld is able to blend real world experience with cutting edge science.  Interested at all in building muscle?  This is your read.

Well, there you have it.  These are my favorite diet/health & wellness texts.  All of them, in my opinion, are worth reading.  If you think there are some that I am missing, please let me know.  I’d like to read them.

Todd M. Weber PhD, RD

Three Easy Steps You Can Take to Drastically Improve Your Nutrition Knowledge

Let’s face it, when it comes to nutrition, everyone thinks they know nutrition, when in reality, their knowledge is probably quite limited.  Now to be fair, this isn’t their fault.  I mean, when you think about it, where did you learn about nutrition?  When and where did you develop your views?  Nutrition is nowhere to be found in the k-12 education system and doesn’t have to be taken in college.  So where do we receive our nutrition education? 

Food marketing/advertising, the news media, and word of mouth……it’s no wonder we don’t know what the hell we’re talking about when it comes to nutrition.  Here are 3 simple rules for better understanding nutrition.

1) Don’t Believe Anything Food Marketing Tells You. 

All Natural, Clean, Organic, High-Fiber, Cholesterol Free, Sugar Free, Reduced Sodium, a Good Source of, Light, Diet, Simple Truth, Fresh, Inflammation Fighting, Plant-Based, Collagen and Gelatin, Superfoods, Juicing, Cleansing, Detoxing, Antioxidants, Multi-Grain, Gluten-Free, GMO-free, Artisanal, BPA-Free, Antibiotic-Free, Hormone-Free, Probiotic, Omega-3, Grass Fed, Cage Free or Free-Range, Made with Real Fruit/Sugar, No Artificial Flavors or Preservatives, High-Protein, High Fructose Corn Syrup, Local, Real, Freshly Caught, Wild, More Protein than Sugar

Meaningless nutrition buzzwords + a grain of scientific evidence = food marketing strategy

Now, I know that this equation is an oversimplification.  Some of these buzzwords are relevant to human health in a specific context and some people reading this are going to be irked that I am glossing over or ignoring their importance.  However, do you really think that people are going to take the time to figure out which words are important and in what context?  I don’t think so. 

Food marketers constantly utilize non-contextual “facts” to help create ambiguity about the healthiness of their food product and/or to create a “health halo” whereby a food is now thought to be good for you when in fact it has very little nutritional value (example: regular yogurt contains an excessive amount of sugar, yet that can be overlooked because of the “health halo” created by the probiotics yogurt contains).

Arbys: We Have the Meats

I actually prefer the straight forward advertising of Arby’s “We have the meats” and Hardee's/Carl Jr.’s advertisements that are completely tasteless (supermodel sexily eating burger).  At least their approaches are straightforward: our food tastes good and is bad for you but you the consumer are not concerned about your health, so go ahead and eat a ton of this cheap, crappy food.  At least this type of advertising is to the point rather than food companies often trying to “educate” us into thinking their products are “healthy” by throwing a catchy jingle, nutrition buzzword, and soft female voice together in a commercial explaining how healthy their food is (A hem…. Panera!).  I challenge you to compare and contrast the calorie counts of Arby's and Panera Bread.

Panera Bread: Clean Eating

2) Don’t Believe/Trust Media Sources.

I bet you’ve never heard this one before, “According to a recent study…”  This is classic FM radio, television news, and Today Show banter and what I refer to as factoids and tidbits.  I don’t even know what the point of these supposed public service announcements are other than to confuse us and plant seeds of doubt in our minds.  People have short attention spans.  I get it.  So, you want to compress the information into a short period of time before losing them.  But tell me, when was the last time you learned something from one of these stories and applied it to your life?  My guess is never.

If you really want to learn more about something, you have to work at it.  Firing off 30 second, non-contextual factoids isn’t doing anyone any good.  I think we’d be far better off not covering these “news” stories at all or taking the time to do a featured story on the topic at hand.

3) Find Health Mentors/Trusted Sources of Information.

I have been fortunate enough to be able to obtain a MS in Exercise Physiology and a PhD in Bioenergetics and Exercise Science.  Along the way, I was mentored by several exceptional scientists who taught me so many things including how to think critically, form and test hypotheses, and how to decipher bullshit from real science.  I devoted much of my life from 2000 to 2013 to learn about nutrition, exercise science, and health and wellness.

But you can say, Todd, that’s all fine and dandy, but I don’t have 13 years to devote to learning about nutrition, nor do I have access to academic mentors.  How do I find reliable sources?  Well, I’m happy to say that I have done some of the dirty work for you. 

I have a shortlist of people I think you should follow if you want to learn more about nutrition/health & wellness.  After graduating with my PhD in Bioenergetics and Exercise Science in July of 2013 I have been constantly searching for people that I could continue to learn from within the health & wellness field.  Here are the best of the best (in my opinion via Twitter):

Nia Shanks

Stephen Guyenet, PhD

James Wong

Brad Schoenfeld, PhD

Dylan Mackay, PhD

Brenda Davy PhD, RD

YLMSportsScience

Kevin C. Klatt

Kevin Hall, PhD

Kevin Folta

Dr. Michael Joyner

Ted Kyle

The reason why these individuals are such great follows are that

1) they post often

2) their posts contain relevant, reliable, scientifically sound information

3) don’t have (an obvious) agenda/ax to grind

4) are curious and in search of the truth

5) are not going to steer you in the wrong direction.

If you follow these three simple steps

1) Don’t Believe Anything Food Marketing Tells You. 

2) Don’t Believe/Trust Media Sources.

3) Find Health Mentors/Trusted Sources of Information.

You will be well on your way to better understanding nutrition and health & wellness in general.

Sincerely,

Todd M. Weber PhD, MS, RD

Personal Activity Intelligence (PAI), the Next Big Thing in Wearable Technology: a Review

When I say, PIE, what comes to mind?  Apple, cherry, strawberry, banana cream or pumpkin of course.

Figure 1. Google Image Search of Pie.

But that’s not what I’m referring to here.  What I’m talking about has the potential to be the next big thing in wearable fitness technology, Personal Activity Intelligence or PAI (pie).  Sounds cool and catchy, right?  We have smart phones, smart cars, smart thermostats, finally, we have “smart” exercise. 

PAI is the product of a collaboration between a company called MIO GLOBAL and a Norwegian Sports Scientist, Ulrik Wisløff.  I first encountered PAI and Dr. Wisløff at the American College of Sports Medicine National conference in Denver, Colorado in June of 2017.  To say that I was excited about PAI after this conference was an understatement.

Figure 2. MIO GLOBAL SLICE.

The reason why PAI is such a breakthrough is that it solves the following problem: not all steps (movement) are created equal.  Walking, running, taking the stairs, strolling through the park, window shopping, and climbing a mountain are performed at far different intensities and have drastically different effects on energy cost, fitness levels, and health, yet the majority of wearable devices treat all steps as being the same (see their video below).

Although many of today’s fitness trackers can measure heart rate, most people have no idea how to use this information (other than bragging about resting heart rate).  This is where PAI comes in.  PAI awards you “PAI points” for moderate to vigorous activity as indicated by your heart rate data.  The more vigorously you exercise, the more PAI points you accumulate.  PAI then tallies your points over a 7-day rolling average.  If you have 100 or more points over a week, you’re good to go, less than 100, you better get some more exercise.

Figure 3. Seven Day Rolling PAI Average.

Figure 4. One Day of PAI; Hour by Hour.

Not only is PAI easy to understand, it also simplifies exercise prescription.  When you think about it, how is exercise prescribed and tracked?  Our current recommendations are diverse and are prescribed under the following variations:

1. Thirty minutes of moderate to vigorous aerobic activity on all or most (5+) days of the week and
2. Resistance exercise 2-3x/week or
3. Obtain 10,000 steps/day or
4. Track your distance in miles

Here are the problems with each of these measures that PAI solves.

1) I’ve never spoken with anyone who diligently tracks exercise time.  You might say, let’s go for a walk but do you actually track the total time you walk and add it up over the course of a week?

2) Accelerometers (i.e. Fitbit) do a terrible job of tracking resistance exercise.  I’ve known (and personally experienced) a great number of people lifting very heavy weights (think CrossFit) and yet after a workout that nearly kills them, they obtained a measly 800 steps.  Are you kidding me!  I almost died during that workout.  Squatting down to sit on the toilet hurts and yet, you’re only giving me 800 steps?  [Insert your expletive of choice here]!

3) People can obtain 10,000 steps per day without an elevated heart rate.  For example, as part of their jobs (i.e. a department store worker) many people will be active for a large majority of his/her workday (6+ hours) but will be operating at an extremely low intensity because they are not a) continuously moving fast enough or b) repetitively lifting something heavy.  Although they have spent a great deal of time being active, they were not moderately to vigorously active to the point where they will become more aerobically fit.

4) One can also track distance covered (in miles) but this seems to be more common in runners and cyclists rather than the general public.

PAI solves each of these problems by being able to distill down time, exercise intensity, steps/day, and heart rate into one meaningful, understandable metric, PAI!

In my mind, PAI could be the new exercise currency.  Not time, not reps, not steps, not distance, PAI.  Instead of 10,000 steps/day or 150+ minutes of exercise per week, get 100 PAI each week.  If you can get 100 PAI over a 7-day rolling average, you’re right on track!  And there is sound scientific evidence to back PAI up.  PAI also puts into action what we've known for some time, that when it comes to health and longevity, fitness is more important than physical activity (Figure 5).

Figure 5. Effects of Physical Activity versus Physical Fitness and Relative Risk of Mortality (Williams, PT 2001 MSSE).  Fitness (PAI) is a much better health predictor than physical activity (total steps).

My Review of PAI:

Now with all the potential that PAI has, I must say that I have been extremely disappointed and frustrated with this device (MIO GLOBAL SLICE) for the following reasons:

1) PAI seems to be WAY too dependent on vigorous exercise.  For example, I rode my bicycle 18 miles (to and from a brewery) and yet I received “0” PAI!  An 18-mile bike ride should warrant some PAI.  I understand the connection between moderate to vigorous exercise and fitness (Figures 5 & 6) but anyone who knows me, knows that I don’t “lolly gag” on a bike!  I’m in decent shape but not the kind of shape where I can ride 18 miles without elevating my heart rate.  

2) De-valuing movement.  Tying into point #1, low intensity and moderate intensity exercise gets treated like (insert derogatory metaphor here) by PAI.  Exercise physiologists and public health professionals might as well have a giant Metabolic Equivalency Table (MET) bonfire.  Gardening, yard work, washing dishes, doing laundry, vacuuming, and walking for your health…apparently, none of this “low” intensity physical activity matters anymore.  Figure 4 shows that I was "low intensity" active for 1 hour and 29 minutes on July 24th and yet received no PAI. 

According to this system we should just do 14 minutes of high intensity exercise/day and call it quits (I might actually try this).  In a society where public health professionals are fighting our “sedentary” epidemic, I don’t think it is a good idea to encourage people to adopt an “all or nothing” approach to getting physical activity.  Presumably I could bike 100 miles at a low intensity but wouldn’t get any PAI.  This doesn’t make sense.

Figure 6. PAI Zones for a 35 Year Old

3) Mystery PAI.  I have accumulated 40 PAI overnight when not even wearing my device.  This is just plain stupid.  I don’t know how else to address this flaw.

4) Low battery life.  MIO GLOBAL claims that you can go 5 days without a charge.  That doesn’t seem possible as more often than not, wearing the MIO GLOBAL for one day results in a battery at less than 50%, so I charge it overnight to ensure that I can use it the next day.  That’s fine.  I charge my I-Phone every night but when you’re used to a Fitbit Zip that requires a battery change once every 3 months, this is a big ask.

5) I don’t trust the heart rate feedback.  Maybe I should have listed this deficiency first or maybe I am saving one of the best for last.  But there have been numerous times where I am working exceptionally hard (uphill, near maximal effort on bike) and my heart rate is 126?  Give me a break.  In addition to the heart rate being inaccurate/untimely, oftentimes I will perform a workout at a given time, let’s say 3pm and my PAI points in the application will show up at 6pm.  It would be useful if PAI was better synced with the time I am performing my exercises so that I am more aware of the types of exercise that award me more points.

6) Your PAI data is deleted after 7 days. While writing this post I decided to look back at my PAI data and compare it to my Fitbit Zip.  Much to my chagrin, PAI data is erased from its application after 7 days.  Grrr.

7) Other observations.  The MIO GLOBAL SLICE is priced comparably to other wrist worn activity trackers.  I haven’t worn a Fitbit or Garmin activity tracker but they can’t be as uncomfortable as the SLICE.  Please take a note out of Timex’s book: they make an ultra- comfortable wrist watch for $30.  I know these devices are completely different but please make it happen.  I know, I know that means millions of (re)design hours and distribution complexities that I don’t even begin to understand, but…..please. 

Final Conclusions:

1) Don’t buy a MIO GLOBAL SLICE (PAI) in its current version!  It’s not worth it!

2) PAI is a super cool concept that could be the future of the accelerometer world.  For the fitness world, PAI could become as commonplace in our vernacular as the previous non-existent terms/things such as the I-POD, I-PHONE, Facebook, Twitter, etc.  It has the potential to be a game changer.  It’s just not there yet.

3) It is important to note that PAI is a fitness tracker, not an activity tracker.  If your goal is simply to move more, a Fitbit Zip will do the trick.  Although I didn't show you the data, the SLICE was horrendous at counting steps, not even close to the Fitbit Zip I was simultaneously wearing. 

4) Wearing the MIO GLOBAL SLICE has been interesting.  I want this to work more than anything.  I was so excited about this.  I even had a client of mine buy one of these.  For his sake and mine I regret buying this.  It just isn’t ready yet.  The theory is great.  The execution is terrible.  Maybe I should have listened to the online reviews.

Figure 7. PAI Reviews on Google Play.  Maybe I should have listened.

Todd M. Weber PhD, MS, RD

Evolutionary Perspectives on the Paleo Diet: Advantages and Flaws of Ancestral Nutrition

In recent years, the word “paleo” has transcended the realm of scientific jargon and become commonplace in the American vocabulary. Sadly, this not due to the fact that Americans have suddenly become interested in paleontology and anthropology (sigh), but because of the explosion in popularity of the Paleo diet. This diet, which is modeled after the feeding behaviors of our human ancestors, has created a paradigm shift in how some nutrition experts and enthusiasts interpret “optimal” nutrition, though it is not met without significant controversy. Unfortunately, most nutrition professionals have little to no understanding of even the most basic concepts in the field of evolutionary biology, or even realize how fundamentally important it should be to approach nutritional science from an evolutionary perspective. As Theodosius Dobzhansky, a prominent evolutionary biologist once famously said, “Nothing in biology makes sense, except under the light of evolution.”

Seeing that nutrition is inherently a biological science, it should not be exempt from this evolutionary light, and furthermore the Paleo diet should be praised for illuminating that light. However, as with any good scientific hypothesis, it should not be met without critical examination and/or rigorous testing based on the best evidence available. 

Caveman: (courtesy FOODmanufacture.co.uk)

So, what is the Paleo Diet?

The Paleo Diet encompasses a short list of foods that either come from animals or directly from the earth. This includes grass fed meats and seafood, fresh fruits and vegetables, eggs, nuts, seeds, and plant oils from sources such as olives, walnuts, avocados, and coconuts. This diet strictly prohibits grains, legumes such as peanuts and beans, refined sugar, and virtually any food that has been processed. 

Advantages

At the most basic level, the Paleo diet offers many improvements to the typical Western diet that are comparable to those of the highly touted Mediterranean diet. One of the most significant improvements is the replacement of processed, chemical, and sugar laden foods with whole foods like fruits, vegetables, and meat. This simple replacement will not only improve the nutrient density of one’s diet, but there is mounting scientific evidence that it can improve a plethora of health issues including diabetes and metabolic syndrome and anecdotal evidence suggesting improvements in depression and digestive disorders.

Aside from a few controversial foods such as butter, coconut oil, and red meat, the majority of the foods on the Paleo diet promote health in many ways. This diet has been shown to be particularly effective at reducing inflammation and may be capable of restoring the body’s microbiome, which mounting evidence links to a host of modern day chronic diseases. This is largely due to the fact that the Paleo diet is rich in nutrients that are rare in the Western diet, particularly omega 3 fatty acids, phytonutrients, and prebiotic fiber.

In addition, “empty calories,” especially those in the form of simple sugar, bread, cookies, candy, etc. are virtually non-existent on the Paleo diet. Carbohydrates are in relatively low supply compared to what most Americans consume or are recommended to intake, and when carbohydrates are consumed, they typically come in the form of fruits, starchy vegetables, plant fiber, and small amounts of honey. 

Flaws

The Paleo diet cuts out a tremendous amount of the foods that comprise the American diet (which in some cases can be a good thing); however, it also eliminates beans, dairy, and whole grains, which are considered to be healthful by the vast majority of dietitians. Non-paleo plant based foods such as chickpeas, beans, whole grain cereals, and peanuts are high in protein and other essential nutrients, and many “healthy” people eat these foods in large quantities. While Paleo supporters argue that there is evidence that properties in these foods are inflammatory and/or toxic, others argue that the evidence for the existence of these negative properties is weak and that we should probably just ignore this line of reasoning all together.

The Paleo diet also tends to come with a dogmatic, all-or-nothing culture surrounding it, which is almost never beneficial for nutritional quality. Certain foods, such as arrowroot, spark endless internet debates about whether they qualify as worthy of being considered Paleo, even though your ancestors probably never ate them. The Paleo diet also allows breads and pastries to be recreated with nut flours such as almond and coconut flour, which your ancestor probably never ate.

In addition, the use of cooking oil in the Paleo diet is interesting as the development and use of cooking oil occurred after the Paleolithic era ended (for example: the earliest accounts for the use of olive oil occurred within the past 6,000 years, well past the end of the Paleolithic era of 10,000 years ago).  Finally, the Paleo diet relies upon the use of butter and ghee, which are both dairy products and thus should technically not be part of the Paleo portfolio.

In other words, the “paleo-ness” of many foods is debatable and often subjective.

The Paleo diet is very rigid in its nutrition guidelines, which are over-simplified compared to what the data suggests “cavemen” were likely eating. There is no single ancestral diet, rather, human populations all over the planet ate different foods in different amounts depending on the environment in which they lived. Paleolithic humans were opportunistic eaters, which means that they ate whatever was available to them in order to survive. To assume that all early humans ate the exact same foods is scientifically inaccurate. Ironically, humans were probably able to successfully radiate across the globe partly because they are physiologically flexible enough to survive off of such a variety of foods. This trait is actually favored by natural selection, and is not unique to humans. 

Take Home Message

Survival is the essence of what drives evolution. A species that cannot pass its genes down to the next generation will go extinct unless it can adapt to a changing environment and reproduce even when conditions are less than optimal. A common misconception in evolutionary science is that evolution produces species that are perfectly adapted to their environment. The success of a species depends on whether or not it produces offspring, not on how well suited it is to its environment. The Paleo Diet assumes that Paleolithic humans were perfectly adapted to the food they consumed, but there is no evidence to suggest that this is true. Like all other species, early humans probably cared little about consuming an optimal or specific diet and more about surviving on what was “good enough.”

The premise of the Paleo diet is founded on several evolutionary misconceptions, which should be taken into account by anyone who is strictly following it. From an evolutionary perspective, it seems reasonable to hypothesize that the foods listed on the Paleo diet should be optimally suited for the human diet. The rate at which foods such as grain and dairy were introduced into the human diet was at the evolutionary speed of light (i.e. within the last 10,000 years), however, the human genome did not stop evolving after the Agricultural Revolution. Nor was it ever ideally adapted to the Paleolithic food supply in the first place. While there are many positive aspects of the Paleo diet, particularly its emphasis on whole, unprocessed foods, it is certainly not the “perfect” diet. It is a model which, like all other evolutionary hypotheses, should questioned and rigorously tested. As of now, there has been little research on how the Paleo diet impacts human health, especially when compared to other diets. Until more experimental data is available, it is hard to draw meaningful conclusions that support the diet’s health claims. 

Meredith Fontana, MS

Paleontologist and future dietitian

Is Coconut Oil Good for You, Bad for You, or None of the Above?

Beginning in 1961, the American Heart Association (AHA) began recommending Americans reduce saturated fat intake.  By 1973 the AHA went a step further in recommending Americans limit saturated fat intake to <10% of total daily calories.  This advice was based upon the recognition that saturated fat consumption and its ability to increase blood cholesterol was strongly correlated to the incidence of heart disease.  As such, it was (and still is) recommended that saturated fats, especially from animal sources such as red meat, eggs, and cheese be limited.

Figure 1. Fats: the Good, the Bad, and the Ugly.

In recent years, the scientific community has challenged the saturated fat/heart disease hypothesis and reignited the debate regarding the relationship linking saturated fat to the development of heart disease.  At the same time the popularity of the Paleolithic (Paleo) diet has exploded within the fitness community.  The Paleo diet is based upon the foods that were consumed during the Paleolithic era, which spanned the vast majority of human history, starting ~2.4 million years ago and ending ~10,000 years ago.  It was around this same time that  many of the mobile hunter/gatherer societies were slowly transitioning into stationary farmers.

The hunter-gatherer philosophy of the modern day Paleo diet includes many of the foods that were available to the Paleolithic man including fish, eggs, meat, nuts, seeds, vegetables, and fruit and excluding those that were not, such as highly processed foods, dairy, grains, and legumes. 

In comparison to modern day dietary guidelines, the Paleo diet does an excellent job of emphasizing fish, nuts, seeds, fruits, and vegetables while also excluding highly processed, high carbohydrate foods.  However, the Paleo diet’s emphasis on high protein consumption, which in today’s modern societies likely comes from meat consumption (and not just fish and chicken) is in direct conflict with the Dietary Guidelines for Americans and the AHA recommendations due to the diet’s concomitant high intake of saturated fat. 

Now to be fair, there is some recent evidence in modern humans, anthropological evidence in our Paleolithic ancestors, and more recently in the Inuit population of Greenland that a diet high in saturated fat and animal protein caused little to no heart disease; however, in recent years the absence of heart disease in populations eating a diet high in saturated fat has also largely been debunked.

Figure 2. Type of Dietary Fat and Risk of Coronary Heart Disease. E = % isocaloric change in energy intake in place of carbohydrate. 1%E = 1% of daily energy replacement of carbohydrate with fat, 2%E = 2% replacement of carbohydrate with fat, etc. Trans = trans fat; Sat = saturated fat; Mono = monounsaturated fat; Poly = polyunsaturated fat.

The best available evidence we have on the relationship between dietary fat and heart disease suggests that trans fat (partially hydrogenated fats that are solid at room temperature and found in cookies, cakes, and pastries as well as other highly processed goods) are by far the worst types of fats, followed by saturated fats, monounsaturated fats, and polyunsaturated fats.

Figure 3. Fats, Carbohydrates, and Heart Disease: isocalorically substituting fat for carbohydrates on the risk of coronary artery disease. Substituting saturated fat (SFAs) with refined carbohydrates does not change your risk.  Substituting SFAs with MUFAs (monounsaturated), PUFAS (polyunsaturated) or whole grains decreases your risk of coronary artery disease.  Trans fat always increases your risk.

The vast majority of modern day Paleo diets rely heavily on coconut, butter, ghee, avocados, and olive oil.  In and of itself, the use of cooking oil in the Paleo diet is interesting as the development and use of cooking oil occurred after the Paleolithic era ended (for example: the earliest accounts for the use of olive oil occurred within the past 6,000 years, well past the end of the Paleolithic era of 10,000 years ago).  Furthermore, the Paleo diet relies upon the use of butter and ghee, which are both dairy products and thus should technically not be part of the Paleo portfolio.

This article is not meant to be an indictment against the Paleo diet but the Paleo diet does help to put the use of coconut oil into a context many of us are familiar with.  For many Paleo enthusiasts, coconut oil represents the exclusive cooking oil.  Butter is linked to the development of heart disease but butter is an animal-based, saturated fat product.  On the other hand, coconut oil is a saturated fat but is a plant-based product.  So, are people who ingest lots of saturated fats through coconut oil home free from worrying about heart disease?

Butter is an animal product and coconut oil is plant based.  With that in mind, is coconut oil bad for us, good for us, or none of the above?

Figure 4. Fatty Acid Percentages of Commonly Used Oils.  Greater than 90% of coconut oil’s calories come from saturated fat.  By comparison, olive oil is approximately 14%, and butter is 63% saturated fat (not pictured above), a lightweight compared to coconut oil.

The proponents of coconut oil will argue that the difference between butter and coconut oil lies in the fact that coconut oil, although largely composed of saturated fat, contains a different subtype of saturated fat.  Coconut oil’s type of saturated fat is a medium chain triglyceride, whereas the saturated fat in butter is a long chain triglyceride.  Without getting too technical, medium chain triglycerides are metabolized by the liver directly into energy and do not participate in the synthesis of cholesterol, whereas butter does. 

However, with all that being said, when we recently spoke with a leading expert (whose name wished to not be disclosed) on the relationship between heart disease and diet in the field of medicine regarding the potential health implications of the use of coconut oil in every day cooking.  She told us that

“... as you know it's only within the last 5-7 years that it's (coconut oil) become a popular oil in (certain groups) of the US population, although it's certainly been a common oil in Asian, African, and some South American populations for decades, if not millennia.

A PubMed search for "coconut oil" predominantly results in animal studies, reviews, and a few small trials - predominantly in Asian populations - thus very few (well, I haven't seen any) long-term large-scale human observational studies or trials specific to CVD precursors, and none of "hard" CVD endpoints.  The few short-term trials in humans occasionally show differences, and occasionally show no differences in cholesterol and/or lipoprotein levels compared with a variety of other fats/oils, depending on the study race/ethnicity, underlying medical conditions, duration of feeding, sample size, comparison oil(s), etc.

So, there are a few human studies on inflammatory and lipid markers, a few on unrelated outcomes (skin conditions/diseases, predominantly), but in my opinion, nothing definitive one way or another with respect to CVD.  In other words, if you compare the coconut oil literature to the evidence base that exists for olive oil in CVD, it's like comparing an ant hill to the Alps.  And, importantly, it took that mountain of evidence on olive oil before it could start being consistently recommended by major organization/government guidelines as cardioprotective. In other words, there's still a long way to go before we can declare coconut oil as benign, helpful, or harmful for CVD or other cardiometabolic conditions.” 

In summary: It’s still too early to tell if coconut oil is “bad for you, good for you, or none of the above”.  So before you start exclusively using coconut oil as your primary cooking oil source, let other people be the epidemiological guinea pigs and use olive oil or another mono- or polyunsaturated fat as your primary cooking oil source.  The worst type of fat you can eat is clearly trans fat (avoid by looking for partially hydrogenated on nutrition labels) so stay away from that.  The jury is still out on coconut oil.

So Why Even Use Coconut Oil? Coconut oil is tremendously delicious when used in the kitchen, as its full, rich fatty flavor is enhanced when virgin un-refined oil is used, providing a deep coconut flavor.  It is perfect for adding moisture, and a rich-mouth feel to baked goods of all varieties, without adding an overpowering flavor of only coconut.  It is also perfect for stir-fry, roasting vegetables or mixing it into a morning oatmeal.  There are many great recipes that provide a variety of ways to cook with coconut oil.

Coconut oil is solid at room temperature, as other saturated fats are, but its melting qualities are superior for various cooking purposes.  If you wish to use coconut oil to cook with, do so sparingly, mixing your oil choice with other options such as olive oil, canola oil, and peanut oil to incorporate other fat sources.  Be sure to mix it up: remember, a healthy diet consists of BALANCE, so mixing up your oil choices is a large component and helpful hint in practicing this.

Best,

MacKenzie Spears

Todd M. Weber PhD, MS, RD