calorie density: a simple yet powerful concept
TRANSCRIPT
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Calorie Density: A Simple Yet Powerful Concept
Anthony Lim, MD, JD
2018 International PBNHC
September 15th, 2018
San Diego, CA
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Life LessonWe stand on the shoulders of the giants who come before us.
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“Calorie density is the simplest approach to healthful eating and lifelong weight management.”
Jeff Novick
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Time
Weight
Healthy Weight
The Weight Loss Plateau
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Objectives
1. Understand the concept of “Calorie Density” and the benefits of eating a low calorie density diet
2. Identify common “pitfalls” that patients fall into when it comes to Calorie Density.
3. Learn principles for how to apply Calorie Density in daily life.
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WHAT IS CALORIE DENSITY?
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Amount of Energy (calories)
Unit weight of food(pounds or grams)
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.
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Calorie Density of Various Food Groups
0
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100300
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8001500 1500
23002800
4000Calories/lb
Calories/lb
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What average caloric density should I aim for?
• WCRF/AICR recs (2007) in “Food, Nutrition, Physical Activity & The Prevention of Cancer: A Global Perspective”
– #1 recommendation: maintain healthy body weight
• Plant-based diet
• Meat – condiment
• Public Health goal: Average energy density of diets be lowered to 1.25 cal/gm (567 cal/lb)
~ 600 calories/lb
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Calorie Density of Various Food Groups
0
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8001500 1500
23002800
4000Calories/lb
Calories/lb
WCRF/AICR Recommendation
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500 calories
OR
5 oz bag of gummi bears 7 lb watermelon
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800 Calories
OR
1 cup cashews (~ 3-4 oz)
5 med-sized baked potatoes
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Dr. Terry Shintani
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Variable Begin End Change % Change
Calories (kcal/day)
2594 1569 -1025 -40%
Weight (lbs) 264 247 -17 -6%
BMI 40 37 -3 -8%
Cholesterol (mg/dL)
222 191 -31 -14%
LDL (mg/dL) 147 130 -17 -12%
TG (mg/dL) 236 138 -98 -42%
FBS (mg/dL) 162 123 -39 -24%
SBP (mm Hg) 134 122 -12 -9%
DBP (mm Hg) 84 75 -9 -11%
Shintani TT et al. Obesity and cardiovascular risk intervention through the “ad libitum” feeding of traditional Hawaiian diet. Am J Clin Nutr. 1991;53:1647S-51S.
Obese Native Hawaiians fed their traditional “pre-western-contact” diet ad-libitum improved all their health measures.
* Anecdotal improvement of symptoms from arthritis, asthma, gastritis, fatigue, acne, headaches, impotence, and other medical conditions.
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Aug 2018181 lbs
BMI 25.2BP 110/72
TC 171
Oct 2016226 lbs
BMI 31.5BP 136/85
TC 214
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COMMONPITFALLS
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Pitfall: Meat-Like Substitutes
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Pitfall: “Healthy” plant-based snacks
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1500 calories per pound
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Calorie Density of Various Food Groups
0
500
1000
1500
2000
2500
3000
3500
4000
100300
500600
8001500 1500
23002800
4000Calories/lb
Calories/lb
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2050 cal/lb 2150 cal/lb
250 cal/lb
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Calorie Density of Various Food Groups
0
500
1000
1500
2000
2500
3000
3500
4000
100300
500600
8001500 1500
23002800
4000Calories/lb
Calories/lb
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Pitfall: Dried fruit and nuts/seeds
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Calorie Density of Various Food Groups
0
500
1000
1500
2000
2500
3000
3500
4000
100300
500600
8001500 1500
23002800
4000Calories/lb
Calories/lb
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Aug 2018181 lbs
BMI 25.2BP 110/72
TC 171
Oct 2016226 lbs
BMI 31.5BP 136/85
TC 214
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SETTING
SUBWAY • Spinach, lettuce, tomato, green pepper, onions (100)
• No sauces, spreads, cheese• Water
• Wheat bread (1250)
CHIPOTLE • Fresh veggies (100)• No cheese, dairy, or guac• Spices
• Brown rice (850)• Side tortilla (1300)• Lots of salt
CHICK-FILL-A
• No sauce, cheese, or fries • Veggie wrap tortilla (1250)• Ketchup (450)
IN-AND-OUT
• Onion, lettuce, tomato (100) • Hamburger bun (1250)• Pink sauce (1650)
HOME • Frozen mixed veggies (100)• Canned beans (300 – 650)• Success brown rice (550)• Potatoes (400)
• Ezekiel bread (1100)• Apple sauce (200)• Mixed nuts (2600)• Candy (2300-2400)• Corn chips (2600)• Potato chips (2250)
Pitfall: Flour, sugar, snacking, & eating out…
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Chipotle vs Success Brown Rice
850 cal/lb
550 cal/lb
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My Recommendations for Patrick
1. Stop eating out.
2. Stop snacking on nuts and CRAP (Calorie Rich and Processed) food.
3. Cut back/eliminate flour products.
4. Consider overnight oats in place of grape nuts cereal.
5. Increase exercise frequency.
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Calorie Density of Various Food Groups
0
500
1000
1500
2000
2500
3000
3500
4000
100300
500600
8001500 1500
23002800
4000Calories/lb
Calories/lb
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Patrick has lost a total of 8 pounds so far in the two weeks since incorporating additional calorie density principles.
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PRACTICALAPPLICATION
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6 Simple Calorie Density Principles for Lifelong Health
1. Eat freely: vegetables, fruits, starchy vegetables, intact whole grains, legumes
2. Exercise caution with these foods: breads, bagels, dry cereals, crackers, tortillas, added sugar, dried fruit, nuts, seeds, avocado, “hidden” salt & oil when eating out, and liquid calories
3. Eliminate one or more category(ies) of food from your diet if self-restraint is too difficult or you are not getting results
4. Sequence your meals
5. Aim for a 50/50 plate
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6 Simple Calorie Density Principles for Lifelong Health
1. Eat freely: vegetables, fruits, starchy vegetables, intact whole grains, legumes
2. Exercise caution with these foods: breads, bagels, cereals, crackers, tortillas, added sugar, dried fruit, nuts, seeds, avocado, “hidden” salt & oil when eating out, and liquid calories
3. Eliminate one or more category(ies) of food from your diet if self-restraint is too difficult or you are not getting results
4. Sequence your meals
5. Aim for a 50/50 plate
6. “Dilution is the solution through substitution”
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Acknowledgements
• Dr. Scott Stoll and Susan Benigas
• My family
• My mentors
• My patients
• God
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THANK YOU!
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2714
2352
2087
Dietary Fat Avg Daily Calories
% surplus or deficit
Avg Food Intake (lb)
Avg CD(Cal/lb)
Total WtLoss/Gain (lbs)
Palatability
15-20% 2087 - 11.3% 3.3 632 - 0.9 2.63
30-35% 2352 - 3.2 735 0 2.58
45-50% 2714 + 15.4% 3.1 875 + 0.7 2.48
Fat and oil increase average daily caloric intake.
Lissner L et al. Dietary fat and the regulation of energy intake in human subjects. Am J Clin Nutr 1987;46:886-92.
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2014
Weight 298
BP 140s/90s
Meds Zetia, Norvasc,
Pristiq, Albuterol
Activity Level Sedentary
2016
173
110s/70s
None
> 5 miles per day
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“10-point checklist” for maximal weight loss
1. No animal products
2. No added oil
3. No added sugar
4. No juice, sweetened beverages, or alcohol
5. No/minimal added salt
6. No flour products
7. No dried fruit
8. No/minimal high caloric density plant-based foods (nuts, seeds, avocado, coconut, olives)
9. Sequence your meals
10. 50/50 plate method at each meal (serving of fruit for dessert)