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“Our study adds to growing research that counting calories is not the most effective strategy for long-term weight management. Some foods help prevent weight gain, others make it worse.” Dariush Mozaffarian, MD, Dr. PH, dean of the Friedman School of Nutrition Science & Policy, Tufts University

“The fat content of dairy products did not seem to be important for weight gain. In fact, when people consume more low-fat dairy products, they actually increased their consumption of carbs, which may promote weight gain. This suggests that people compensate, over years, for the lower calories in low-fat dairy by increasing their carb intake.” Jessica D. Smith, PhD, visiting scholar at the Friedman School and research fellow at Harvard

Food Selection Trumps Calories for Long-Term Weight Management

Two Studies and My Way

For 35 years, I’ve been saying that there is no need to count calories. If you eat the right kind of food, your body will do the counting for you. “I discovered by eating only natural, unprocessed foods, you avoid all concentrated calorie foods, and you won’t overeat,” I wrote in RIPPED, published in 1980. Star-studded researchers from Tufts and Harvard (Dariush Mozaffarian, Walter Willett, Frank B. HU, and others) came to essentially the same conclusion in two recent studies following 120,000 male and female health care workers for up to 24 years.

We’ll look at the results of the first study (New England Journal of Medicine June 23, 2011) and then go into more detail on the latest study, published online April 8, 2015, in the American Journal of Clinical Nutrition.

The 2015 study builds on the 2011 study which established that all calories are not the same. Long-term weight gain, on average one pound or less a year, was found to go up or down based on the type of food and drink consumed. Weight gain was associated with potato chips, potatoes, sugar-sweetened beverages, and red meat (processed or unprocessed), while vegetables, whole grains, fruits, nuts, and yogurt were associated with weight loss. With the right food choices, it appears that Mother Nature will bring us very near calorie equilibrium.

Jessica D. Smith, PhD, (first author in the second study) and colleagues drilled deeper by investigating the connection between different protein foods, protein foods and carbohydrate foods, and glycemic load. (Glycemic load (GL) measures how rapidly a typical serving of a food boosts blood sugar. For more details, see “New Light on the Glycemic Index” http://www.cbass.com/GlycemicIndex.htm)

This is important because current weight control guidelines are strongly calorie focused, advising individuals to consume only enough calories to meet their energy needs. They do not distinguish between different protein foods for weight management or take into account the inclination to exchange protein sources (red meat, for example) for low-quality carbohydrate sources such as white bread or sugary beverages, which encourage weight gain. Low-quality carbohydrate sources and some protein sources increase glycemic load. 

Querying the health care workers and recording weight changes at four year intervals uncovered both simple and complex interactions between food choices and long-term weight gain or loss.

Here’s what they found:

Protein foods were frequently interchanged with carbohydrate foods. Importantly, this can be good, bad, or neutral for weight management. Probably most often bad, however.

Protein foods had different relationships with long-term weight gain, with positive associations (weight gain) for meats, chicken with skin, and regular cheese; no association for milk, legumes, peanuts, and eggs; and relative weight loss for yogurt, peanut butter, walnuts, other nuts, chicken without skin, low-fat cheese, and seafood.

Increases in glycemic load (GL) were independently associated with greater weight gain. Diets with a high GL from eating refined grains, starches, and sugars were associated with more weight gain. "There is still debate about the independent value of glycemic load in weight maintenance," said senior author Dariush Mozaffarian, M.D., Dr PH., dean of the Friedman School at Tufts, "but it's clear that there is an effect. It's not all about glycemic load; fiber and whole grains are also important."

Synergistic relationships were also noted between changes in protein-rich foods and changes in GL. For example, increasing servings of foods linked to weight gain, like red meat, and at the same time increasing GL by eating more low quality carbohydrates like white bread, strengthened the foods’ association with weight gain beyond the effect of the foods individually. On the other hand, decreasing GL by eating, for example, red meat with vegetables, mitigated some of that weight gain.

Similarly, participants lost weight when servings of eggs and cheese were increased in combination with decreased GL.

“Protein foods were commonly interchanged with carbohydrate, and changes in protein foods and GL interacted to influence long-term weight gain,” the researchers concluded.

“Our study adds to growing new research that counting calories is not the most effective strategy for long-term weight management and prevention,” said Dr Mozaffarian. “Some foods help prevent weight gain, others make it worse. Most interestingly, the combination of foods seems to make a big difference. Our findings suggest we should not only emphasize specific protein-rich foods like fish, nuts, and yogurt to prevent weight gain, but also focus on avoiding refined grains, starches, and sugars in order to maximize the benefits of these healthful protein-rich foods, create new benefits for other foods like eggs and cheese, and reduce the weight gain associated with meats.”

Food selection clearly overrides calorie count. It appears that avoiding processed foods is even more beneficial than I thought. With wise food combining, it appears that 2 plus 2 can equal 5 in weight management.

Let's talk about foods choices and hunger management, a key factor not explored in the new studies.

My Way

Weight management isn’t complicated or onerous if you emphasize unprocessed, whole foods—and stay ahead of your hunger curve. Don’t miss meals. Include protein and fat in most meals and snacks. Come to every meal under control—and don’t put on the table more than you plan to eat.


 To achieve and maintain leanness it’s important to avoid hunger and feelings of deprivation.

Photo by Pat Berrett

Whole, unprocessed foods and hunger management go hand in hand. Unprocessed vegetables, fruits, and whole grains help to make meals satisfying without giving you more calories than you need. 

The apple is a good example. Each stage of processing--whole apple, apple sauce, and apple juice--causes a larger blood sugar response and less hunger satisfaction. The whole apple contains more fiber and bulk and is absorbed more slowly. It also requires more chewing and takes longer to eat.

A classic experiment at the University of Bristol in England illustrated the differences.

It took 17 minutes to eat a meal of apples, six minutes to down apple sauce, and 90 seconds to drink the juice—all containing the same amount of sugar. It should come as no surprise that subjects reported greater satisfaction after eating the apples than after drinking the juice, with the apple sauce producing an intermediate level of satiety.

Blood sugar rose to similar levels after all three meals (more slowly with the whole apples), dropped back to normal after the whole apples, but distinctly below normal after the juice, with the apple sauce again in the middle. That’s important because below-normal levels of blood sugar, called rebound hypoglycemia, cause hunger. Again, the whole apples produced a longer lasting feeling of satisfaction. Normal blood sugar response and chewing being the controlling factors.

This is, of course, what glycemic load is about. It explains why high GL leads to overeating. The three forms of apple all contain the same amount of sugar, but sugar makes up a greater proportion of the apple sauce and apple juice. The whole apple is packaged by Mother Nature for hunger satisfaction.

Adding fat and protein would’ve produced longer periods of satisfaction. Both slow absorption and level out blood sugar fluctuations. (See below)

Generally speaking, you’ll find whole, unprocessed foods along the outer walls of the supermarket—vegetables, fruits, dairy, seafood, poultry, and meat—and the refined foods packaged on the inner shelves. There are, of course, exceptions. Frozen fruits and vegetables with nothing added are a regular part of my diet. Beans canned with a little added salt are also fine; added sugar and sauce is a good place to draw the line. Canned sardines with added mustard or tomato sauce are also a regular part of my diet. (It's wise to listen to your taste buds.)

Some processing is, of course, necessary for convenience sake. Your don't have to eat food in its original state, although that's good when its convenient.

Professor Alice Lichtenstein, executive editor of Tufts University Health & Nutrition Letter, suggests focusing on whether food value is diluted. That's the difference between plain frozen broccoli and broccoli in a calorie-rich sauce. Or between frozen berries and berries in ice cream.

You don't have to sacrifice convenience to avoid empty calories. Be reasonable; use common sense. Read labels. Be wary of foods stripped of fiber, and saturated fat, sugar, and sodium added. Choose foods that fill you up and satisfy you without giving you excess calories. Avoid foods that encourage overeating—and leave you hungry sooner. The difference is clear when you understand the concept.

I mentioned the satiety value of protein and fat earlier. They generally come together, which probably explains why the Smith study said little or nothing about fat.

I try to include protein and fat in every meal and snack. My favorite protein/fat foods are sardines, salmon, whole milk, plain whole milk yogurt, hard boiled eggs, nuts (almonds, walnuts, and pecans), plain peanut butter, beans, sprouted grain bread, and cooked whole grains. Carol and I also have grilled chicken without skin or range fed beef from time to time. (Interestingly, Harvard professor Walter Willett eats red meat “maybe a few times a year…For dinner, it’s often poultry or fish.”)

We almost never eat fried foods, which encourage overeating.

These guideline also apply when eating out—especially if you eat out often. The key is to order plain foods so you can tell what you’re getting. Fried foods, sauces, mixtures, and dressings should be eaten sparingly. Carol and I usually split an entrée and dessert when we eat out (which is not often). We almost always start with a big salad, dressing on the side.

The bottom line for weight management is to emphasize vegetables, fruits, and whole grains, with protein and fat added in moderation. Avoid "processed" foods that encourage you to eat more than you need to be full and satisfied. Come to every meal under control, ready to eat, but not ravenous.

Finally—this is very important—put on the table only what you plan to eat. If you really want more, get up and get it. But stop and think first.

Eat this way and you’ll never have to count calories to stay lean. Regular exercise, of course, helps.

You’ll find many more details in our books and DVDs: http://www.cbass.com/PRODUCTS.HTM

Posted October 1, 2015

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