Does the Vitamin and Mineral Content of Food Influence Our Food Intake and Body Fatness?

The Claim: We Overeat Because Our Diet is Low in Vitamins and Minerals

We know that animals, including humans, seek certain properties of food.  Humans are naturally attracted to food that's high in fat, sugar, starch, and protein, and tend to be less enthusiastic about low-calorie foods that don't have these properties, like vegetables (1).  Think cookies vs. plain carrots.

In certain cases, the human body is able to detect a nutritional need and take steps to correct it.  For example, people who are placed on a calorie-restricted diet become hungry and are motivated to make up for the calorie shortfall (2, 3).  People who are placed on a low-protein diet crave protein and eat more of it after the restriction is lifted (4).  Humans and many other animals also crave and seek salt, which supplies the essential minerals sodium and chlorine, although today most of us eat much more of it than we need to.  At certain times, we may crave something sweet or acidic, and pregnant women are well known to have specific food cravings and aversions, although explanations for this remain speculative.  Research suggests that certain animals have the ability to correct mineral deficiencies by selecting foods rich in the missing mineral (5).

These observations have led to a long-standing idea that the human body is able to detect vitamin and mineral (micronutrient) status and take steps to correct a deficit.  This has led to the secondary idea that nutrient-poor food leads to overeating, as the body attempts to make up for low nutrient density by eating more food.  In other words, we overeat because our food doesn't supply the micronutrients our bodies need, and eating a micronutrient-rich diet corrects this and allows us to eat less and lose body fat.  These ideas are very intuitive, but intuition doesn't always get you very far in biology.  Let's see how they hold up to scrutiny.

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10 Resolutions for a Healthy New Year

Hi friends! How were your holidays?  Very good here.  I did a recap of our Christmas day celebration on Honey We're Home if you want to take a peek.  Healthwise, I'm proud to say that I stuck to a good workout routine that definitely helped me not feel too bad about enjoying all the extra food I ate in the last couple of weeks.  I am ready to kick off the new year strong and was thinking about things we can do daily to change our health for the better today.

I'm not talking about general goals like, "lose weight", I'm talking specific actions that you can incorporate into your daily routine that hopefully become a habit and add up to some pretty big changes at the end of 2014.  

1. Control Portion Sizes  Sometimes we eat too much just because the sizes served to us in restaurants are so big that we forget what a realistic portion size looks like.   Drink sizes are huge, refrigerators are huge.  Have you looked at a fridge from the 50s and laughed at how tiny it compares to today's varieties?  Instead of eating straight from a bag or box (because it's hard to tell how much you're consuming), portion out your snacks into baggies or small tupperware.  Use smaller plates and understand that most portion sizes are about the size of your fist. 

2.  Don't Go Hungry  If you wait until you're starving to eat, chances are your food choices will be poor and you will overeat.  By balancing your meals and snacks evenly throughout the day, you are more likely to eat better and stay fuller longer.  Bring healthy snacks to work or keep them in your purse.  Things like nuts and apples don't need to be refrigerated, but if you have access to a fridge, you can bring cold snacks like cheese or Greek yogurt.

3.  Quit Smoking  Period.  We all know by now it's terrible for our health.  I've never smoked so I cannot say I understand the addiction or how hard it is to quit.  I do know that your family members probably wish you would quit because they want you alive and healthy for a long time.  I tell this to my parents all the time.  I have several friends who quit using acupuncture and/or hypnosis.  

4.  Get More Sleep  Stress and lack of sleep are so hard on a body physically.  Do what you can to wind down at night, so you can get the rest you need.  Getting off the computer, cell phone and turning down the lights can help get you ready for bed.  Sometimes I'll just get in bed before I'm ready to go to sleep, intending to read, then quickly fall asleep not realizing how tired I actually am.  

5.  Eat Breakfast My quick go-to breakfasts are oatmeal, toast with peanut butter, or Greek yogurt with granola.  My friend makes a protein smoothie for breakfast.  Whatever it is, it's good to get your metabolism going and start your day with calories and energy. 

6.  Eat More Veggies  Incorporating vegetables into our diet is important because they contain essential vitamins and minerals that offer protection against many diseases like cancer, heart disease, stroke and diabetes.  Try switching out one meal a week for a salad loaded with veggies or add a vegetable to one of your daily meals.  I like to snack on a handful of mini carrots or celery and peanut butter.  Baked Kale chips are awesome.  Edamame is delicious.  A veggie omelet is a good way to incorporate more vegetables and you can always toss some spinach into a smoothie. 

via Catapult Fitness

7.  Slash Sodium The recommended limit of sodium is a teaspoon (or 6 grams) daily. Besides contributing to water retention (i.e. bloating), sodium can raise blood pressure. Processed foods contain the most, so make sure to read labels. Lower sodium diets are linked to decreased risk of heart disease, but are also associated with lower hypertension and weight management.  via Reader's Digest

8.  Cut Out Soft Drinks  Soda, soft drinks, pop (whatever you call it) has no nutritional value and can pack on the pounds.  Giving up these drinks (without doing anything else) can reap great rewards in terms of weight loss.  I read at FitDay that estimates show that two cans of soda per day adds approximately 24 to 35 pounds of fat per year, depending on body size, age, habits, etc.. Some people (weighing in at 140 pounds) have reported that by giving up two cans of soda per day, without exercise, they lost 20 pounds in six months.  

9.  Drink More Water We talked about drinking water recently and how much is enough.    Ladies Home Journal found the benefits are: 1) younger looking skin and better complexion by staying hydrated; 2) helps lose weight by keeping you feeling satiated; and 3) boosts mood and brain power.  

10.  Get Active Even 10 to 30 physical activity has positive benefits like weight loss, improved mood and energy,  and better sleep.  The easiest way I've found to to incorporate exercise is by walking more.  It costs nothing and you can do it anywhere.  I park far away from the door at stores and take the stairs when possible.  If your weather permits right now, just open the door and walk around the block a few times.  Once you start this habit, it will feel so good that you'll crave more.  Even if it's difficult at first, the payoff is worth it and it gets easier!  

Here's to a HEALTHY and FIT 2014!

You can eat a lot during the Holiday Season and gain no body fat, as long as you also eat little

This post has been revised and re-published. The original comments are preserved below. Typically this is done with posts that attract many visits at the time they are published, and whose topics become particularly relevant or need to be re-addressed at a later date.

Food Reward Friday

This week's lucky "winner"... peanut M + M's!!!

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The Friedewald and Iranian equations: Fasting triglycerides can seriously distort calculated LDL

This post is a revised version of a previous post. The original post has been or will be deleted, with the comments preserved. Typically this is done with posts that attract many visits at the time they are published, and whose topics become particularly relevant or need to be re-addressed at a later date.

***

Standard lipid profiles provide LDL cholesterol measures based on equations that usually have the following as their inputs (or independent variables): total cholesterol, HDL cholesterol, and triglycerides.

Yes, LDL cholesterol is not measured directly in standard lipid profile tests! This is indeed surprising, since cholesterol-lowering drugs with negative side effects are usually prescribed based on estimated (or "fictitious") LDL cholesterol levels.

The most common of these equations is the Friedewald equation. Through the Friedewald equation, LDL cholesterol is calculated as follows (where TC = total cholesterol, and TG = triglycerides). The inputs and result are in mg/dl.

    LDL = TC – HDL – TG / 5

Here is one of the problems with the Friedewald equation. Let us assume that an individual has the following lipid profile numbers: TC = 200, HDL = 50, and trigs. = 150. The calculated LDL will be 120. Let us assume that this same individual reduces triglycerides to 50, from the previous 150, keeping all of the other measures constant with except of HDL, which goes up a bit to compensate for the small loss in total cholesterol associated with the decrease in triglycerides (there is always some loss, because the main carrier of triglycerides, VLDL, also carries some cholesterol). This would normally be seen as an improvement. However, the calculated LDL will now be 140, and a doctor will tell this person to consider taking statins!

There is evidence that, for individuals with low fasting triglycerides, a more precise equation is one that has come to be known as the “Iranian equation”. The equation has been proposed by Iranian researchers in an article published in the Archives of Iranian Medicine (Ahmadi et al., 2008), hence its nickname. Through the Iranian equation, LDL is calculated as follows. Again, the inputs and result are in mg/dl.

    LDL = TC / 1.19 + TG / 1.9 – HDL / 1.1 – 38

The Iranian equation is based on linear regression modeling, which is a good sign, although I would have liked it even better if it was based on nonlinear regression modeling. The reason is that relationships between variables describing health-related phenomena are often nonlinear, leading to biased linear estimations. With a good nonlinear analysis algorithm, a linear relationship will also be captured; that is, the “curve” that describes the relationship will default to a line if the relationship is truly linear (see: warppls.com).

Anyway, an online calculator that implements both equations (Friedewald and Iranian) is linked here; it was the top Google hit on a search for “Iranian equation LDL” at the time of this post’s writing.

As you will see if you try it, the online calculator linked above is useful in showing the difference in calculated LDL cholesterol, using both equations, when fasting triglycerides are very low (e.g., below 50).

The Iranian equation yields high values of LDL cholesterol when triglycerides are high; much higher than those generated by the Friedewald equation. If those are not overestimations (and there is some evidence that, if they are, it is not by much), they describe an alarming metabolic pattern, because high triglycerides are associated with small-dense LDL particles. These particles are the most potentially atherogenic of the LDL particles, in the presence of other factors such as chronic inflammation.

In other words, the Iranian equation gives a clearer idea than the Friedewald equation about the negative health effects of high triglycerides. You need a large number of small-dense LDL particles to carry a high amount of LDL cholesterol.

An even more precise measure of LDL particle configuration is the VAP test; this post has a discussion of a sample VAP test report.

Reference:

Ahmadi SA, Boroumand MA, Gohari-Moghaddam K, Tajik P, Dibaj SM. (2008). The impact of low serum triglyceride on LDL-cholesterol estimation. Archives of Iranian Medicine, 11(3), 318-21.

Does "Metabolically Healthy Obesity" Exist?

Obesity is strongly associated with metabolic alterations and negative health outcomes including diabetes, cardiovascular disease, and some types of cancer (1, 2, 3, 4).  Excess body fat is one of the primary causes of preventable health problems and mortality in the United States and many other affluent nations, ranking in importance with cigarette smoking and physical inactivity.  Obesity is thought to contribute to disease via the metabolic disturbances it causes, including excess glucose and lipids in the circulation, dysregulated hormone activity including insulin and leptin, and inflammatory effects.  This immediately raises two questions:

1. Does metabolically healthy obesity exist?
2. If so, are metabolically healthy obese people at an elevated risk of disease and death?

Does metabolically healthy obesity exist?

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Are You Drinking Enough Water?

One thing I noticed after the Thanksgiving break was that I was drinking less water because I wasn't working out and I got out of the habit of keeping my water cup full at home.  I felt like my skin was looking dull and icky, so this week, I got back on my normal water routine.  

It helps so much to have a large bottle or cup that you like to drink from near you so you remember to drink water throughout the day.  I like the insulated cups the best so they don't sweat and create a puddle on your furniture.  The one pictured on my desk is from Wal-Mart and holds 20 oz. of water.  I drink about 3 of these a day, so about 60 oz. of water.  

It used to be recommended that people drink 8, 8 ounce glasses of water a day = total 64 ounces.  But now, the Institute of Medicine sets general guidelines for total water intake and recommends that women consume a total of 91 ounces (that’s about 2.7 liters) per day – from all food and beverages combined. But, depending on your diet, about 25% of the water you consume comes from your food.  

I've read that most healthy people get enough water in the food and liquid they take in on a regular basis, but you can gague whether you're getting enough water by if you feel thirsty or your urine is dark.  

I feel better when I'm drinking water throughout the day and definitely notice a difference in my skin.  

I really like these 24-Ounce Insulated Cups.  They come in a variety of colors too for a great price.  I always prefer a lid (just in case of spills) and straw.

How much water do you drink per day?  Do you use a special cup too?  

Healthy Beef Burritos

I've often talked about one of my go-to healthy meals, Tex Mex to go, and sometimes I mix it up and make it into a healthy beef burrito.  It's super easy and delicious!

I like to make a big batch, so I start with 2 packages of Laura's lean ground round or sirloin (4% fat).  Lean beef still has plenty of flavor, try it if you typically go with something fattier.  I'd be surprised if your family even notices the difference.

Then, I add two packages of low sodium taco seasoning and mix with 1.5 cups of water and bring it to a simmer until the meat has absorbed all the seasoning.  Meanwhile, I heat up a large can of low-fat refried beans.  

For me, the key to a delicious burrito is fresh pico de gallo (salsa), which is very easy to assemble.  I make it the same way I make guacamole, just without the avocados.   Just dice up tomato, white onion, jalapeno (deseeded for milder flavor) and cilantro and toss it all together with a squeeze of lime.

When the beans are heated through and the meat is ready, I assemble my burrito on a whole wheat tortilla (that I warmed up on the stove or in the microwave) and add low-fat cheese and sour cream- just a touch. 

Let me know if you try it and how you like it. 

Healthy Hair

About a year and a half ago, I accidentally (and stupidly) fried my hair in an effort to save money and do an at-home Keratin treatment.  The Keratin treatment was supposed to turn my naturally-a-little-frizzy hair into smooth, shiny locks.  The box clearly stated NOT to use it on bleached hair (which I have), but I thought it would be okay.  Wrong!  After you put the treatment on your hair, you are supposed to comb it through very straight.  As I started combing my hair, it starting coming out in big chunks.  I quickly washed the product out of my hair, but the damage was done.  It continued to break for months after that, I had to chop it, and I've been working on growing it back out, healthy, ever since.

Of course, it looked nice chopped when it was just styled from my awesome hairdresser.  But, I have a major cowlick and could never get it to stay side swept like that.  I really don't mind the shorter length, I  just want it to be healthy!

Now, I try to wash it every other day (I can't go more than that with workouts) and only dry it with a hairdryer or use a curling iron on the first day, trying to let it air-dry as much as possible.  Then I might put it up in a top knot the next day.   

I use Kerastase oil (just on the "pony tail" so it doesn't get weighed down) and I think it's been working miracles.  It's the green one for damaged hair.  I was surprised to see that Amazon sells it- I used to have to wait until I had a hair appointment at the salon.   

I only use it a couple times a week and a tiny bit goes a long way. It makes your hair really sleek and shiny, taking out the frizz too.  It also smells divine.  I love the Kerastase shampoo and conditioner too, but it's expensive so I don't always buy it. 

I wanted to ask y'all about Biotin supplements.  I read that Biotin is often recommended for strengthening hair and nails, though scientific data supporting this outcome are weak. Nevertheless, biotin is found in many cosmetics and health products for the hair and skin.  I found this brand on Amazon and it had a lot of great reviews, but I was wondering what you think or if you've tried it.  

Let me know!

Protein IQ

How was your Thanksgiving?  I was home the whole week with my son and we also had house guests, so I didn't get in any exercise.  My body is craving a good workout, so this week it's back at it!  I can hardly believe we're in December already and it's just 3 weeks until Christmas!  Let's make these 3 weeks count so we can finish the year strong.  And so we don't add on additional weight that we have to work to lose in the new year.  You with me? 

If you can't make it to the gym and/or just don't have time to workout, you can still accomplish so much by watching what you eat.  I love this visual example of how much protein, veggies, and starches should be on our plates.

Via Lauren Conrad

And this list of proteins is pretty helpful too.  I aim for about 90 grams of lean protein a day when I'm trying to gain muscle and get lean.  I used to count and measure all my food but now I'm pretty good at estimating it.  If you want an easy way to track your calories, protein, carbs, and fat, try MyFitnessPal.com.  It's a free site and is very easy to use.

Via Women's Health

So, what are you doing to finish 2013 healthy and strong?  

Food Reward Friday

This week's lucky "winner"... Oreo cookies!!!

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Dried mussels: A little plate with 160 g of protein (plus some comments on high-protein low-carbohydrate dieting)

Many hunter-gatherer groups employed various methods of drying to preserve meats. Drying also increases significantly the protein content of meats; this is the case with dried mussels. I discussed this effect of drying before here with respect to small fish (). The photo below is of a plate with about 240 g of dried mussels that I prepared using the simple recipe below.



To prepare your mussels as in the photo above, you will have to steam and then dry them. You can season the mussels after you steam them, but I rarely season mine. Almost none of the food I eat requires much seasoning anyway, because I use nature’s super-spice, which makes everything that has a high nutrient content taste delicious: hunger ().

- Steam the mussels for about 10 minutes, or until all are open.
- Remove the mussels from the shells; carefully, to avoid small shell pieces from coming off into the mussels (they are not kind to your teeth).
- Preheat the oven to about 200 degrees Fahrenheit, and place the mussels in it (on a tray) for about 1 hour.
- Leave the mussels in the oven until they are cold, this will dry them further.

About 240 g of mussels, after drying, will yield a meal with a bit more than 160 g of protein – i.e., the proportion of protein will go from about 20 percent up to about 67 percent. In this case, most of the calories in the meal will come from the protein, if you had nothing else with it, adding up to less than 800 calories.

This comes in handy if you need to have lunch out, as the dried mussels can be carried in a plastic bag or container and eaten cold or after a light re-heating in a microwave. To me, they taste very good either way; but then again anything that is nutritious tends to taste very good when you are hungry, and I rarely have breakfast. I often eat them with pre-cooked sweet potato, which I eat with the skin (it tastes like candy).

You may want to think of dried mussels prepared in this way as a protein supplement, but a very nutritious one. You will be getting a large dose of omega-3 fats (3.11 g) with less omega-6 fats than you usually get through fish oil softgels (where n-6s are added for stability), about 1,224 percent of the recommended daily value (RDV) of magnesium, 461 percent of the RDV of selenium, 1,440 of the RDV of vitamin B12, a large dose of zinc, and (interestingly) almost 100 percent of the RDV of vitamin C.

Since mussels are very low in the food chain, accumulation of compounds that can be toxic to humans is not amplified by biomagnification (). But, still, mussels can be significantly affected by contaminants (e.g., petroleum hydrocarbons), so sourcing is important. The supermarket chain I use here in Texas, HEB, claims to do very careful sourcing. Telltale signs of contamination are developmental problems such as thin shells that shatter easily and stunted growth ().

For those readers who are on a low-carbohydrate diet, please pay attention to this: there is NO WAY your body will turn protein into fat if you are on a low-carbohydrate diet, unless you have a serious metabolic disorder (see this post: , and this podcast: ). And I mean SERIOUS; probably way beyond prediabetes. Do not believe the nonsense that has been circulating in some areas of the blogosphere lately.

A high-protein low-carbohydrate diet is one of the most effective diets at reducing body fat, particularly if you do resistance exercise (and you do not have to do it like a bodybuilder). That is not to say that a high-fat low-protein diet (like the "optimal diet") is a bad idea; in fact, the optimal diet is a good option if you do not do resistance exercise, but that is a topic for a different post.

Beans, Lentils, and the Paleo Diet

As we continue to explore the foods our ancestors relied on during our evolutionary history, and what foods work best for us today, we come to legumes such as beans and lentils.  These are controversial foods within the Paleolithic diet community, while the broader nutrition community tends to view legumes as healthy.

Beans and lentils have a lot going for them.  They're one of the few foods that are simultaneously rich in protein and fiber, making them highly satiating and potentially good for the critters in our colon.  They're also relatively nutritious, delivering a hefty dose of vitamins and minerals.  The minerals are partially bound by the anti-nutrient phytic acid, but simply soaking and cooking beans and lentils typically degrades 30-70 percent of it, making the minerals more available for absorption (Food Phytates. Reddy and Sathe. 2002).  Omitting the soaking step greatly reduces the degradation of phytic acid (Food Phytates. Reddy and Sathe. 2002).

The only tangible downside to beans I can think of, from a nutritional standpoint, is that some people have a hard time with the large quantity of fermentable fiber they provide, particularly people who are sensitive to FODMAPs.  Thorough soaking prior to cooking can increase the digestibility of the "musical fruit" by activating the sprouting program and leaching out tannins and indigestible saccharides.  I soak all beans and lentils for 12-24 hours.

The canonical Paleolithic diet approach excludes legumes because they were supposedly not part of our ancestral dietary pattern.  I'm going to argue here that there is good evidence of widespread legume consumption by hunter-gatherers and archaic humans, and that beans and lentils are therefore an "ancestral" food that falls within the Paleo diet rubric.  Many species of edible legumes are common around the globe, including in Africa, and the high calorie and protein content of legume seeds would have made them prime targets for exploitation by ancestral humans after the development of cooking.  Below, I've compiled a few examples of legume consumption by hunter-gatherers and extinct archaic humans.  I didn't have to look very hard to find these, and there are probably many other examples available.  If you know of any, please share them in the comments.

To be clear, I would eat beans and lentils even if they weren't part of ancestral hunter-gatherer diets, because they're inexpensive, nutritious, I like the taste, and they were safely consumed by many traditional agricultural populations probably including my own ancestors.

Extensive "bean" consumption by the !Kung San of the Kalahari desert

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Checking In & Melissa Bender Fitness

I was so pumped with the "finish the year healthy and strong" and have loved reading your comments about your plans to do the same.  Week one getting back to the gym was really tough, I was sore, sore, sore.  But, that's the pain that comes from being sedentary too long and it's a good sore- if you know what I mean.  Sitting in the steam room at my gym after a hard workout is on my thankful tree list this year. 

Week two, I started to feel like I was getting my groove back.  Don't get me wrong, it's still difficult getting into those workouts, but about 15-20 minutes in and the music is pumping on my iPod and something just clicks and the workouts start feeling GOOD!  Do you know what I mean?  That is the best.  And in just two weeks, I can see small changes to my body that are really inspiring.  

And now, week 3, I'm backing off because I'm not feeling too good- got run down, feeling sick, and have to listen to my body and take a little break for about a week.  I am just like you and I can't do everything all the time, and obviously I don't kill myself to post on both of my blogs daily, but just when I have something I want to share with you and can make the time to share.  I only want to write things here that you will find useful, beneficial, inspiring, or informational.  

So, today, I'm just saying, I'm not giving up, I'm not giving in.  I just needed a little break.  Back at it real soon.  Can't keep me down.  :)

How's it going for you?  

And I wanted to share a fitness blog I found that I was really impressed with- Melissa Bender Fitness.  This woman trained for a fitness competition without ever training in a gym- she did all her workouts at home. No excuses, right?!  I know getting to a gym is a struggle for a lot of people, so I thought you might want to check her site out.  She shares in great detail all her contest prep including food and workouts.  Let me know what you think and tell her I said hi!  

_________________________

Recent and Upcoming Appearances

Smarter Science of Slim

Jonathan Bailor recently released an interview we did a few months ago on the neurobiology of body fat regulation, and the implications for fat loss.  It's a good overview of the regulation of food intake and body fatness by the brain.  You can listen to it here.

Super Human Radio

Carl Lanore interviewed me about my lab's work on hypothalamic inflammation and obesity.  I'm currently wrapping up a postdoctoral fellowship with Dr. Michael Schwartz at the University of Washington, and the interview touches on our recent review paper "Hypothalamic Inflammation: Marker or Mechanism of Obesity Pathogenesis?"  Dan Pardi and I are frequent guests on Carl's show and I'm always impressed by how well Carl prepares prior to the interview.  You can listen to the interview here.

The Reality Check podcast

Pat Roach of the Reality Check podcast interviewed me about the scientific validity of the "carbohydrate-insulin hypothesis" of obesity.  The Reality Check podcast "explores a wide range of controversies and curiosities using science and critical thinking", and a dash of humor.  This one should be very informative for people who aren't sure what to believe and want a deeper perspective on the science of insulin and body weight regulation.  You can listen to it here.

Obesity Society conference

Next Thursday 11/9, I'll be speaking at the 2013 Obesity Society conference in Atlanta.  My talk is titled "The Glial Response to Obesity is Reversible", and it will be about my work on the reversibility of obesity-associated hypothalamic neuropathology in mice.  My talk will be part of the session "Neuronal Control of Satiety" between 3:00 and 4:30, specific time pending.  See you there!

Latitude and cancer rates in US states: Aaron Blaisdell’s intuition confirmed

In the comments section of my previous post on cancer rates in the US states () my friend Aaron Blaisdell noted that: …comparing states that are roughly comparable in terms of number of seniors per 1000 individuals, latitude appears to have the largest effect on rates of cancer.

Good point, so I collected data on the latitudes of US states, built a more complex model (with several multivariate controls), and analyzed it with WarpPLS 4.0 ().

The coefficient of association for the effect of latitude on cancer rates (path coefficient) turned out to be 0.35. Its P value was lower than 0.001, meaning that the probability that this is a false positive is less than a tenth of a percent, or that we can be 99.9 percent confident that this is not a false positive.

This was calculated controlling for the: (a) proportion of seniors in the population (population age); (b) proportion of obese individuals in the population (obesity rates); and (c) the possible moderating effect of latitude on the effect of population age on cancer rates. The graph below shows this multivariate-adjusted association.



What is cool about a multivariate analysis is that you can control for certain effects. For example, since we are controlling for proportion of seniors in the population (population age), the fact that we have a state with a very low proportion of seniors (Alaska) does not tilt the effect toward that outlier as much as it would if we had not controlled for the proportion of seniors. This is a mathematical property that is difficult to grasp, but that makes multivariate adjustment such a powerful technique.

I should note that the 99.9 percent confidence mentioned above refers to the coefficient of association. That is, we are quite confident that the coefficient of association is not zero; that is it. The P value does not support the hypothesized direction of causality (latitude -> cancer) or exclude the possibility of a major confounder causing the effect.

Nonetheless, among the newest features of WarpPLS 4.0 (still a beta version) are several causality assessment coefficients: path-correlation signs, R-squared contributions, path-correlation ratios, path-correlation differences, Warp2 bivariate causal direction ratios, Warp2 bivariate causal direction differences, Warp3 bivariate causal direction ratios, and Warp3 bivariate causal direction differences. Without going into a lot of technical detail, which you can get from the User Manual () without even having to install the software, I can tell you that all of these causality assessment coefficients support the hypothesized direction of causality.

Also, while we cannot exclude the possibility of a major confounder causing the effect, we included two possible confounders in the analysis and controlled for their effects. They were the proportion of seniors in the population (population age) and the proportion of obese individuals in the population (obesity rates).

Having said all of the above, I should also say that the effect is similar in magnitude to the effect of population age on cancer rates, which I discussed in the previous post linked above. That is, it is not the type of effect that would be clearly noticeable in a person’s normal life.

Sunlight exposure? Maybe.

We do know that our body naturally produces as much as 10,000 IU of vitamin D based on a few minutes of sun exposure when the sun is high (). Getting that much vitamin D from dietary sources is very difficult, even after “fortification”.

Finishing the Year Strong Update & Tex Mex Casserole with Egg Noodles

We last talked about our goal of finishing 2013 healthy and strong and I so appreciate your feedback in the comments.  Your courage to share where you are in your journey helps me be transparent in mine too and I feel like we're in this together.  I got in 4 really great workouts last week, and I feel that that's a good fit for my current schedule through the end of the year.  It takes some planning and preparation to make sure to get to the gym, but if I workout hard for at least 50 minutes, I'm good with 4 days. 

Getting started back into a weight-lifting/workout routine is especially hard because you are so SORE for the first few days.  I had to take Advil a few times, but I'm already fine.  And isn't it funny how after just a few workouts you feel 5 pounds lighter?!  My scale says I'm down half a pound.  It's a start!

via

On Halloween, I ate 2 chocolate chip cookies that a mom from my son's school made and a mini Reese's Peanut Butter cup.  To be honest, the cookies were delicious, but I should have just had one, and the Reese's didn't taste that good- probably because I'm a PB cup snob now, having fallen in love with the homemade variety.  The point is, if I'm going to "cheat" I want it to be worth it!  And I know that finishing the year strong requires some sacrifice and diligence with my food especially during the week.  So, I'm being more conscious of what foods I'm choosing and having something really good to look forward to on the weekend.  On Saturday night, we went out to a great restaurant and I ate oxtails and potatoes- so good, but really rich, so I only ate about 1/3 of what was on my plate.  I had 2 glasses of wine and for dessert, had a big ole ice cream cone that I really enjoyed.  Back on the wagon for Monday.   

My other tip for this week is to SHARE MEALS when you go out to eat, if possible.  I'm usually full after half my meal, but feel like I need to finish, so I'll end up eating too much.  Leftovers from restaurants usually end up in the trash and it's a shame to waste the food and money.  Sharing with someone eliminates that and you don't leave the table feeling so heavy from overeating.  

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I made a healthy meal last week that I think you might like too.  I warn you that it's not the prettiest dish, but very tasty and full of protein.  It's kind of a Tex-Mex casserole with egg noodles.  I really believe that "abs are made in the kitchen", which is why the eating portion is so crucial to seeing results.  My meals last week pretty much consisted of:

7am- oatmeal and coffee

10am- protein shake 

12pm- this casserole

3pm- tuna sandwich and Sun chips 

6pm- this casserole

8pm- Greek yogurt or hot cocoa

I also stopped in Starbucks a few times (which is a step back from my previous daily addiction).  

Ingredients

1 Jennie O- Extra Lean Ground Turkey

1 Laura's Lean Beef (94% Lean) - or go leaner

1 bag No Yolk Egg Noodles

1/2 container of Philadelphia Cream Cheese (1/3 less fat) - or use fat free

1 cup Shredded Mexican cheese (2%) - or use fat free

1 package Taco Seasoning (low sodium)

*Update 2/16/14:  add some minced parsley, chopped onion and garlic for added flavor

Directions

Preheat oven to 350 degrees.

Boil the egg noodles for about 8 minutes, then drain.

Meanwhile, (*Update 2/16/14, brown the onion and garlic) and then add the two meats until cooked though, add the seasoning mix with about a cup of water and let it boil until the water and seasoning is absorbed.  Then, I add the parsley.

Off the heat, add the cream cheese and the shredded cheese to the meat mixture and stir until all melted and mixed in.  Add in the noodles and stir until combined. 

Pour the entire thing into a 9x13 baking dish, top with remaining 1/2 cup of shredded cheese.  Bake for about 20 minutes.  *Update 2/16/14:  I'm not baking this dish anymore because I felt like that dried it out.  

I based this dish on a pin from Pinterest, but lightened it up.  To make it even lighter, use leaner beef and fat free cream cheese and fat free shredded cheese.  Some people may also like to add salsa to this for more flavor. 

If you portion this dish into 10 servings, below is the nutrition information.  I use myfitnesspal.com to calculate the nutrition- it's free and really user-friendly. 

So, how's it going for you?  If you've fallen off the wagon, just get back on!

via Nike

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Buckwheat Crepes Revisited

One of my most popular posts of all time was a recipe I published in 2010 for sourdough buckwheat crepes (1).  I developed this recipe to provide an easy, nutritious, and gluten-free alternative to flour-based crepes.  It requires no equipment besides a blender.  It's totally different from the traditional buckwheat crepes that are eaten in Brittany, in part because it's not really a crepe (I don't know what else to call it, maybe a savory pancake?).  I find these very satisfying, and they're incredibly easy to make.  They're especially delicious with fresh goat cheese, or scrambled eggs with vegetables, but they go with almost anything.  Chris Kresser also developed his own version of the recipe, which is fluffier than mine, and more like a traditional pancake (2).

Buckwheat is an exceptionally nutritious pseudograin that's rich in complete protein and minerals.  In contrast to most whole grains, which have low mineral availability due to phytic acid, buckwheat contains a high level of the phytic acid-degrading enzyme phytase.  This makes buckwheat an excellent source of easily absorbed minerals, as long as you prepare it correctly!  Phytase enzyme works best in an acidic environment, which may be part of the reason why so many cultures use sour fermentation to prepare grain foods.  My original recipe included a sour fermentation step.

But there's a problem here.  Buckwheat doesn't ferment very well.  Whether it's because it doesn't contain the right carbohydrates, or the right bacteria, I don't know, but it spoils rapidly if you ferment it more than a little bit (using a strong sourdough starter helps though).  Others have told me the same.  So here's my confession: I stopped fermenting my buckwheat batter about a year ago.  And it tastes better.

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New Post on Eat Move Sleep Blog

Yesterday, the Dan's Plan blog Eat Move Sleep published a blog post I wrote about sleep, artificial light, your brain, and a free computer program called f.lux that can help us live healthier lives.  Head over to Eat Move Sleep to read it.

Finishing the Year Healthy & Strong

*First let me apologize for having to truncate my posts (causing readers to have to click "read more" to read the post in its entirety) because my blog content has been stolen by some thief with a domain registered in India.  Thank you Leanne for letting me know- I had no idea.  Back in August 2012, several well-known bloggers started truncating their posts because "scraper sites" had been stealing their blog content.  I never worried about it and, as a reader, I find truncated posts kinda annoying, so I never did that.  But I have to now.  My entire blog- every word and photo has been scraped and is now appearing as original content on another blog.  So annoying! And the worst part is, I haven't yet figured out what I can do about it.  So, I just wanted to explain why I'm now truncating my posts- apparently this makes it much harder for the thieves.  I hope you'll keep reading!

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I think I need to get your attention and my own regarding the reality that the holidays are just around the corner!  I get giddy with excitement this time of year.  Halloween is in a couple days, which really just marks the beginning of the real holiday season for me.  I love everything that is related to this time of year, including the coziness of colder weather, wearing red and feeling festive, getting together more with family for longer, relaxed gatherings, celebrating family traditions, shopping for gifts for family and friends, decorating the house, and yes, of course, all the yummy FOOD and DRINKS!

But seriously, do we have to just check out in the health department this time of year?  I've already gained a few pounds in last couple of months as I've slacked off my workouts and discovered this ridculously delicious gelato that I've been induldging in too often.  It happens.  But, we need to be reasonalbe and balanced.  I know I'm less happy and more uncomfortable when I'm heavier.  Just a few extra pounds on my very short frame (5'1) makes my jeans too tight.  And even a couple extra pounds are hard to lose.

I want to look and feel GREAT this holiday season!  

via Nike

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Aging and cancer: The importance of taking a hard look at the numbers

The table below is from a study by Hayat and colleagues (). It illustrates one common trend regarding cancer – it increases dramatically in incidence among those who are older. With some exceptions, such as Hodgkin's lymphoma, there is a significant increase in risk particularly after 50 years of age.



So I decided to get state data from the US Census web site (), on the percentage of seniors (age 65 or older) by state and cancer diagnoses per 1,000 people. I was able to get some recent data, for 2011.

I analyzed the data with WarpPLS (version 4.0 has been just released: ), generating the types of coefficients that would normally be reported by researchers who wanted to make an effect appear very strong.

In this case, the effect would be essentially of population aging on cancer incidence (assessed indirectly), summarized in the graph below. The graph was generated by WarpPLS. The scales are standardized, and so are the coefficients of association in the two segments shown. As you can see, the coefficients of association increase as we move along the horizontal scale, because this is a nonlinear relationship. The overall coefficient of association, which is a weighted average of the two betas shown, is 0.84. The probability that this is a false positive is less than 1 percent.



A beta coefficient of 0.84 essentially means that a 1 standard deviation variation in the percentage of seniors in a state is associated with an overall 84 percent increase in cancer diagnoses, taking the standardized unit of the number of cancer diagnoses as the baseline. This sounds very strong and would usually be presented as an enormous effect. Since the standard deviation for the percentage of seniors in various states is 1.67, one could say that for each 1.67 increment in the percentage of seniors in a state the number of cancer diagnoses goes up by 84 percent.

Effects expressed in percentages can sometimes give a very misleading picture. For example, let us consider an increase in mortality due to a disease from 1 to 2 cases for each 1 million people. This essentially is a 100 percent increase! Moreover, the closer the baseline is from zero, the more impressive the effect becomes, since the percentage increase is calculated by dividing the increment by the baseline number. As the baseline number approaches zero, the percentage increase from the baseline approaches infinity.

Now let us take a look at the graph below, also generated by WarpPLS. Here the scales are unstandardized, which means that they refer to the original measures in their respective original scales. (Standardization makes the variables dimensionless, which is sometimes useful when the original measurement scales are not comparable – e.g., dollars vs. meters.) As you can see here, the number of cancer diagnoses per 1,000 people goes from a low of 3.74 in Utah to a high of 6.64 in Maine.



One may be tempted to explain the increase in cancer diagnoses that we see on this graph based on various factors (e.g., lifestyle), but the percentage of seniors in a state seems like a very good and reasonable predictor. You may say: This is very depressing. You may be even more depressed if I tell you that controlling for state obesity rates does not change this picture at all.

But look at what these numbers really mean. What we see here is an increase in cancer diagnoses per 1,000 people of less than 3. In other words, there is a minute increase of less than 3 diagnoses for each group of 1,000 people considered. It certainly feels terrible if you are one of the 3 diagnosed, but it is still a minute increase.

Also note that one of the scales, for diagnoses, refers to increments of 1 in 1,000; while the other, for seniors, refers to increments of 1 in 100. This leads to an interesting effect. If you move from Alaska to Florida you will see a significant increase in the number of seniors around, as the difference in the percentage of seniors between these two states is about 10. However, the difference in the number of cancer diagnoses will not be even close to the difference in the presence of seniors.

The situation above is very common in medical research. An effect that is fundamentally tiny is stated in such a way that the general public has the impression that the effect is enormous. Often the reason is not to promote a drug, but to attract media attention to a research group or organization.

When you look at the actual numbers, the magnitude of the effect is such that it would go unnoticed in real life. By real life I mean: John, since we moved from Alaska to Maine I have been seeing a lot more people of my age being diagnosed with cancer. An effect of the order of 3 in 1,000 would not normally be noticed in real life by someone whose immediate circle of regular acquaintances included fewer than 333 people (about 1,000 divided by 3).

But thanks to Facebook, things are changing … to be fair, the traditional news media (particularly television) tends to increase perceived effects a lot more than social media, often in a very stressful way.

Faith

just fyi . . . 

via Candy to My Soul

Healthy Yogurt Station

After seeing the breakfast bar in my kitchen (which now includes a quick morning oatmeal), Leanne (Away We Go) emailed me to share something similar she does in her home with yogurt.  She created an adorable, functional way to have a healthy yogurt snack with a variety of toppings.  It's great to have all these yummy ingredients on hand and easily accessible.  Here's Leanne to tell you how she did it.

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Yogurt cups have always been a popular snack in our house and over the past few months we have pretty much made the switch to Greek. The health benefits are plentiful and these days the options for flavours are endless! I absolutely love the individual containers that include a portion of toppings to add in.  I find the combination of nuts, granola or even dark chocolate to be a very satisfying late afternoon snack!  However, as much as I love these little treats, I do find their cost adds up. In order to save a bit of money, but keep this healthy option in our kitchen I decided to put together a little Yogurt Station. 

To get started, I gathered a variety of nuts, seeds and dried fruit from the bulk section of our grocery store and placed them in some glass jars that I already had on hand. 

I placed a washi tape label on each jar to identify it's contents. I think that washi tape is great for this job because it can easily be switched out as the contents of the jar change.  

The jars fit nicely in this small basket, which is a perfect fit for our pantry shelf.  

Here is a list of what I currently have in our "Yogurt Station"

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roasted almonds

 candied pecans

homemade granola

dried cranberries

shaved dark chocolate

 pumpkin seeds

honey

cinnamon

Now I am able to buy large tubs of Greek yogurt, which saves money and waste (the individual servings are often too large for my kids). When we need a little snack we grab the basket from the pantry and top our yogurt to fit our mood! I love granola and honey in the morning, and pecans with dark chocolate before bed!

Thanks so much for sharing Leanne!  I adore the jars and washi tape labels too! - Megan

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If you have a healthy food recipe with bright, gorgeous photos and would like to be featured on Honey We're Healthy, email me at: honeywerehealthyblog@gmail.com

Vitamix Blender- Worth It?

Last year I was considering purchasing a Vitamix blender and then was shocked to see how expensive they were when I visited the website.  I was so naive about the price!  I wrote about it on Honey We're Home, asking people if they thought the Vitamix was worth it and got a lot of responses, mostly people encouraging me to make the splurge and others saying blenders that sell for much less will do the job fine.  I was still on the fence when I was at Costco one day and they had a Vitamix 5200s on sale (but now I can't recall the exact price) so I went ahead and bought it.  Amazon sells a Vitamix5200s for $449.99 ($100 less than the Vitamix website).

I have to say I love it!  I mix protein smoothies in it almost daily and they contain ice and frozen fruit, which blend up perfectly.  Perhaps a less expensive blender would also work, but I'm confident this one will last a very long time- it comes with a 7-year warranty.  

I will say, the downside of my Vitamix blender is it's height- it won't fit on the counters under our cabinets because it's too tall.  We tend to keep ours out near the kitchen sink because we use it so often, and store it in a lower cabinet where it fits fine.  I just rinse it with hot soap and water right after each use, and lay it upside down to dry.  

One feature I really like is that it's not that loud compared to other blenders I've heard.  Now, I want to venture outside of just making smoothies.  I know you can make soups, dips, salsa, and have even heard of chicken salad and dough.  

Do you have a Vitamix?  I'd love to hear what you are making in your blender besides smoothies.  

I'm considering pureeing up some veggies to sneak into my son's food (maybe into his blueberry muffins or something like that).  Any recommendations? He's the pickiest eater I've seen!

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On Honey We're Home: Easy Homemade Kids Halloween Treats