Posts Tagged With: health

Skim Milk vs. 2% Milk

While speaking to patients at Mon General Hospital this week, and giving them the nutrition education that was ordered by their doctor, I came across the same comment made by three separate patients that I had never heard before. When talking about a low-fat diet with patients, all three patients mentioned that they drink 2% or whole milk, because they heard from Dr. Oz that skim milk is bad for you. They weren’t able to say exactly why– I got “I think it has more sodium/sugar” but I told them that skim milk is actually a great choice because it has the same amount of protein as 2% or whole milk, but without all the fat! And a low-fat diet is going to be good for the heart; especially since a lot of these patients just had a CABG (coronary artery bypass grafting surgery), angioplasty & stent placement, or a NSTEMI (heart attack).  Let’s clear out the plaque and cholesterol that’s hardening your arteries and causing these blockages…switch to skim!

So when a 3rd patient mentioned today that they used to drink skim milk, but then switched to 2% because of good ol’ Dr. Oz, I knew I wanted to do some research into what he said, and then lay the facts out concerning the different nutrient profiles of different milks.  After some searching, I came across a TV clip on The Talk where Dr. Oz mentions his opinion on skim milk (the youtube video has since been removed, but his quote is below).

“Don’t drink skim milk, you don’t need to. When you take the fat out of milk, what’s left? Sugar! Skim milk is sugar milk. You want to drink 2% milk, eat 2% yogurt…people who have a little bit of fat in the yogurt lose more weight, because your body is satiated.” – Dr. Oz

Ok. First off, when you take the fat out of milk, what’s left is more than just “sugar”. Take a look:

1 cup whole milk:

  • 150 calories
  • 8g fat
  • 5g saturated fat
  • 35mg cholesterol
  • 8g protein
  • 12g carbohydrates
  • 12g sugar

1 cup 2% milk:

  • 130 calories
  • 5g fat
  • 3g saturated fat
  • 20mg cholesterol
  • 8g protein
  • 12g carbohydrates
  • 12g sugar

1 cup skim milk:

  • 80 calories
  • 0g fat
  • 0g saturated fat
  • <5g cholesterol
  • 8g protein
  • 12g carbohydrates
  • 12g sugar

So, what really happens when you take the fat out of milk? You end up with a milk that has the same amount of carbohydrates and sugars (12g), and you end up with a milk that has the same amount of protein (8g).  What also happens is that by switching to skim milk, you’ve just saved yourself 50-70 calories, 15-30mg cholesterol, 5-8g of fat, and 3-5g of saturated fats, depending on whether you switched from 2% or whole milk.

As far as the macronutrient composition of milk, 60% of the calories from skim milk comes from sugar, and 37% of the calories from 2% milk comes from sugar.  So I’m thinking that was the angle that Dr. Oz was taking when he was saying that skim milk is just “sugar milk.”  Yes skim milk does contain a higher percentage of calories from sugars than 2% or whole, but skim has the same number of grams of sugar that whole milk has.

His little blurb about fat making you satiated has some truth to it. When you eat a high-fat meal, you feel satiated, or full, because when fat reaches the duodenum (small intestine- the only place where fat is absorbed), CCK is released, which slows gastric emptying, meaning your stomach stays “fuller” longer than if you had a fat-free meal.   I think that Dr. Oz is trying to get at the idea that if someone drinks a glass of 2% milk, they’ll feel satiated. But if someone drinks a glass of skim milk, they’ll still be hungry, so they’ll start raiding their fridge and consequently gain weight that the people who drank 2% are not gaining. But that just means that people are gaining weight from the extra food they are eating, not gaining weight from drinking a glass of skim milk rather than 2%.

But I’m assuming that when people drink milk, whether it’s skim, 1%, 2%, or whole milk, they’re drinking it with a meal, or a plate of cookies. The average American is getting enough fat (make that more than enough fat) in their diet, so switching to skim milk isn’t going to make them feel starved– they’re already feeling satiated from the fat from their dinner of hamburger helper, steak, pizza, pasta, or those 3 chocolate chip cookies they just scarfed down with that glass of milk.  See what I’m saying?

So in conclusion, if you’re ordered by your doctor to be on a heart-healthy diet, a low-fat diet, or you’re just looking to decrease the amount of fat in your diet, making the switch to skim milk is a great idea. Skim milk is fat free and contains 8g of protein per cup and just 12g of carbohydrates/sugar (1 carb choice). It is not “sugar milk”– all cow’s milk contain the same amount of sugar per cup.  If you’re really concerned about your carbohydrate intake (ie: if you’re diabetic), then you might want to try soy milk, as the unsweetened variety has just 4-5g of carbohydrates instead of 12g.  So 8oz of soy milk has less carbohydrate/sugar, has 80-90 calories, 0mg cholesterol, has just 0.5g saturated fat, and contains about the same amount of protein as cow’s milk (7-9g). However, soy milk does have 4-4.5g of fat per serving, which is comparable to the fat content in 2% milk.  So again, if you’re watching your fat intake and keeping an eye on your heart health, you might want to just stick to skim rather than 1%, 2%, whole, or soy milk.

Even Batman agrees– fat free milk is best!

Categories: Clinical Nutrition, Current News, Education in the Community | Tags: , , , , , , , , , , ,

Fat, Sick, & Nearly Dead: A Dietetic Intern’s Response

Fat, Sick, and Nearly Dead” is a documentary that was released in 2010, and after hearing bits and pieces about this film for a couple of years now, I decided to watch it and see what all the fuss is about.  I took liberal notes while I was watching and thought I’d blog my synopsis and review of the film.

This documentary is about Joe Cross, a 40-year old Australian who finds himself in a tough place.   After graduating high school, he got a job at a brokerage firm on the trading floor. After 5 years Joe went into his own business and at 23 years old he was making lots of money, which meant lots of food, lots of nights out, and lots of drinking!  All this lead to significant weight gain, and at 40 years old, he found himself wearing size 44 jeans and weighing in at 309 pounds.  He also suffered from chronic urticaria, an auto-immune phenomenon which causes a red hive-like rash to break out anywhere on the body, basically at any time.

“The condition wasn’t something you wish on your worst enemy.  I would swell up and break out into hives on any part of my body that was subject to pressure, from a hand shake or sitting on a chair to lying in a bed. Anything and all pressure cause red blotches and swelling in the joints with untold pain, and even gravity was my enemy. My hands and feet suffered the most. Normal things like carrying a shopping bag, holding a baby, and walking long distances– all could have a huge  impact. So thanks to the walking time bomb I had turned my body into, I felt as if I were NEARLY DEAD. “ – Joe Cross

Joe took 15mg of prednisone daily to control his symptoms, and was fed up with taking pills.  He had tried nearly everything; 6 different doctors, pills, tests, and hospital stays.  He had tried massage therapy, herbal supplements, mud baths, and acupuncture, but nothing seemed to cure his chronic urticaria.  Finally he decided to take drastic measures, and for the next 60 days vowed to eat nothing but fresh juice made from vegetables and fruits.  Joe Cross spent 30 days in New York, drove across America, and spent the next 30 days in San Diego, all the while interviewing different Americans, sharing his story, and giving his card out to over 400 people he met along the way.

The first half of the movie focuses on Joe’s 60-day journey, which had impressive results.  On day 14 he was already down 26 pounds and was down to 10mg of prednisone a day.  On day 49, he had lost 67 pounds, and was now on 3.5mg prednisone a day.  His total cholesterol had decreased from 204 mg/dL to 135 mg/dL, and his LDL-cholesterol decreased from 132 mg/dL to 86 mg/dL. Doctors found all his electrolytes were normal and his lab results were perfect. Finally, on day 61 he had lost 82 pounds total and was down to 2.5 mg prednisone. And, two months after ending the juice fast, he no longer had to take any prednisone for his chronic urticaria, which had disappeared altogether!

The second half of the movie focuses on Phil Staples, an overweight truck driver from Iowa, who Joe ran into in Winslow, Arizona. Joe shared his juicing story with Phil, and offered him his card and said to call if Phil ever needed anything.  Amazingly, months after Joe ended his 60-day juice fast, Phil called Joe and asked for help.

Phil had found himself at 429.6 pounds at 6’1″ (a BMI of 58), due to slowly isolating himself after experiencing a 2nd divorce.  When Phil’s parents asked if they could cremate him instead of bury him (because it is too expensive to bury a heavy person), he knew he had to do something and take control of his health.  Joe Cross taught Phil about juicing and suggested Phil try the juice fast for 10 days.  Phil actually fasted for a total of 60 days and lost 90 pounds total (and has lost over 200 pounds, currently).  Mid-way through his juice fast his blood pressure had gone from 160/84 to 136/70, and his triglycerides dropped from 216 to 161.

Sounds great, right? Rapid weight loss, improved blood pressure, less medication usage, improved lab values, and improved health (no more migraines or chronic urticaria).  However, I do have several major issues with this juice fast.

1. “You do the crime, you do the time”

Joe Cross said that the first 3 days of the juice fast are terrible.  Eliminating foods from his diet caused him to feel cut off from society.  He didn’t want to be around people or food, and found himself happiest when he was laying in bed all day. He didn’t want to watch TV because of all the TV commercials about food, and he felt “very, very alone.”  Joe felt like he had this mammoth task ahead of him and wanted to just wake up 2 months later and have it all over.  But he said he knew “you do the crime, you do the time.”  This, to me, is reason enough to not start a juice fast.  The depression he experienced was serious and scary, and no one should feel like they are being “punished” when starting a healthier lifestyle.

2. Macro-nutrients vs. Micro-nutrients

Joe was under the impression that micronutrients found in fruits, vegetables, nuts, seeds, and beans are all that you need to survive. He kept saying that you should stay away from macronutrients (fat, protein, carbohydrate).  First of all, fruits and vegetables do contain macronutrients, mainly in the form of carbohydrates.  Secondly, you do need macronutrients! Our bodies function best when we are getting appropriate levels of fats, proteins, and carbohydrates, so the fact that Joe basically cut out protein and fat from his diet raises a red flag. Any diet that cuts out an entire food group (dairy, fats, protein, grains, fruits, or vegetables) should raise a red flag.  Macronutrients are not the enemy!

3. Where’s the fiber?

When you “juice” vegetables and fruit, what you’re getting is the juice, vitamins, and minerals. What you’re not getting is the fiber! All the fiber, or pulp, is being left behind. Fiber is not only important for your digestive health, but it is also important for heart health as well.  Adults should be eating 25-35g of fiber per day, and when you juice the fiber out of the fruits and vegetables, you are eliminating the major benefit that these fruits and vegetables provide.

4. Cost of a Juice Fast

According to the film, a typical cost of a juice fast is $14 per day, or $420 a month, for one person.  If you go organic, then that’s $28.50 a day, or $855 a month. Not to mention, the juicer Joe uses in the film costs around $300.  This is a major investment, and I don’t see the benefit in spending $720-$1155 for a 30-day juice fast, when you can simply spend around $150 on fresh fruits and vegetables, low-fat dairy, lean meat, and whole grains from your local grocery store each month. I don’t want people to see this film, see the costs attached, and then think “well, there’s no way I can ever lose weight, because look at that! It costs so much to juice! I can’t afford that,” which is just re-affirming the myth in people’s’ heads that eating healthy and losing weight has to be expensive.

5. Exercise?

Joe said that when he started, he thought it was all about a juice fast. “Now it’s about maintaining a balanced lifestyle.” He knows if he goes back to his old ways, he’ll be back to where he started in no time.  The part about a balanced lifestyle is true, but the film never really showed or spoke about Joe’s fitness routine during his 60 day fast. It focused entirely on his diet and not on the other half of the weight-loss component, which is exercise.  I am curious as to what his fitness routine was during this time, but unfortunately he doesn’t mention it.

Now onto the positives:

1. Getting your physician involved

Due to the nature of his diet, Joe regularly checked in with his doctor.  Before Phil started his juice fast, Joe had him check in with a doctor and Phil spoke with his doctor about the juice fast he had planned.  His 60 day juice fast was supervised by a doctor and he also had regular check-ups with his physician. Additionally, when his brother, “Bear” decided to try juicing, he made sure to follow his doctor’s orders. Bear had recently had a heart attack, and his doctor did not suggest that he go on a juice fast due to his condition.  So, Bear incorporated the vegetable and fruit juice into his current diet, rather than relying on juice 100% of the time.  I think it’s important to talk to your doctor first, before starting any new exercise program or weight loss program.

2. “Re-train your taste buds”

Joe said that one of the positives of the juice fast is that it motivates you to eat healthy after the juice fast is over.  This idea of “re-training your taste buds” I find to be true.  If someone is used to eating fast food, for example, several times a week, it can be difficult to switch over to a healthy diet, because at first you may not like any of the foods.  I don’t think a juice fast is necessary to re-train your taste buds, but I do think it is good that he included this phrase.  It’s important to keep in mind that when you start incorporating healthier foods into your diet, you may not enjoy it at first, but if you keep at it, soon enough you’ll find yourself craving oatmeal rather than a sausage and cheese breakfast burrito from McDonald’s (it’s true). You really do have to “re-train your taste buds”!

3. More fruits and vegetables!

The average American dinner plate is made up of 1/2 meat, 1/4 vegetable, and 1/4 a white, refined, carbohydrate.  A dinner plate should look more like 1/2 fruits and vegetables, 1/4 protein, and 1/4 whole grains.  Obviously there is a need for people to increase their fruit and vegetable consumption.  Joe says that by juicing, he is “supercharging” his nutrient intake because he isn’t able to eat all the fruits and vegetables he should, but it is easy to drink all of them.  But he’s still not getting the all-important fiber, remember?

Dr. Fuhrman’s Nutritarian Pyramid

Dr. Fuhrman has several cameos in this film, and his “nutritarian pyramid” is explained a bit. Basically, the idea is that low-calorie, nutrient-dense foods are at the bottom of the pyramid, and high-calorie, nutrient-poor foods are at the top of the pyramid.  I think the overall focus of increased fruit and vegetable intake is a good, broad, message to take away from the film, so I do applaud that focus.

Not convinced of the benefit of adding fruits and vegetables to your diet? Take a look at this:

So, which will fill you up better?

This image was shown in the film, and I thought it was a pretty neat visual.  If you have a calorie budget of 1800 per day, and wanted to eat a 400 calorie lunch, which would be the best choice? Obviously, eating 400 calories of vegetables is going to be a higher volume than 400 calories of oil or 400 calories of fried chicken.  Spend your daily calorie budget wisely; add more produce.

In Conclusion:

If Joe Cross, at 309 pounds decided to change his life and make a documentary about him eating a diet based off of My Plate (vegetables, fruits, lean meat, low-fat dairy, and whole grains), I highly doubt his film would have been as successful. And I’m sure he knew that too. People don’t want to hear that there is no secret to weight loss. They don’t want to hear that it’s okay to eat anything in moderation; they want to know the secret, the pill, the gimic, the next fad diet that is going to help them lose the weight.  So Joe’s fad diet of choice was juicing, and I understand from a business perspective that juicing for 60 days (rather than just eating healthy for 60 days) is what he had to do in order to sell his film and his brand.

However, I don’t think that a juice fast is the answer.  I think juicing is a great idea if someone wants to replace their morning Starbucks mocha frappuccino with some freshly juiced kale, celery, cucumber, apples, lemon, and ginger root.  It’s a great way to replace a sugary, nutrient-poor drink with a low-calorie, nutrient-dense drink.  Another reason not to do a complete juice fast is that it leaves out protein, fat, as well as several key nutrients that vegetarians and vegans need to keep an eye on, or supplement: Vitamin B-12, calcium, vitamin D, iron, zinc, and omega-3 fatty acids.

If you decide to watch this film, I hope that you do your research and think long-term.  “Permanent change only results from permanent changes in diet and lifestyle.” – Dr. Fuhrman.  The real key to losing weight, maintaining weight loss, or improving your overall health, is maintaining a healthy lifestyle.  Juicing for 60 days and then going back to the way you were eating before, is just going to bring you back to the health state you were at before.

Again, “permanent change only results from permanent changes in diet and lifestyle.”  Pick healthy changes you know you can keep for the rest of your life. Maybe that’s going on a 20-minute walk each day. Maybe that’s drinking 8 cups of water each day.  Maybe it’s switching to whole grains rather than white, refined grains. Don’t overwhelm yourself by trying out some fad diet that promises quick results.  Stick with permanent changes in diet and lifestyle, not 60-day fad-diets.

It’s a scary thought that 70% of diseases that affect us now, are affected by our life choices (diet, exercise, smoking, alcohol).  But that also means we have power to greatly reduce our risk of developing diabetes, heart disease, high blood pressure, liver disease, and certain cancers, by eating healthier and maintaining an active, healthy lifestyle. Your health is in your hands, and the choice of what to do is yours.

Categories: Current News | Tags: , , , , , , , , , , , , , | 8 Comments

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