Carrying excess weight may have a greater impact on the risk for diabetes than it does on the risk for heart disease or early death, a new study has found.
To look at the effect of obesity independent of genetics, Swedish researchers followed 4,046 pairs of identical twins whose average age was 58. One of the twins was overweight, and the other was not. Since identical twins have the same genes, their weight difference could not be attributed to genetics. The study is in JAMA Internal Medicine.
After accounting for physical activity, smoking and educational level, the researchers found that having a higher body mass index, or B.M.I. — even among those in the obese range of 30 or higher — was not associated with an increased risk for heart attack or death. But a high B.M.I. was associated with an increased risk for diabetes.
“Based on these results, the association between obesity and cardiovascular disease is explained by genetic, not environmental, factors,” said the lead author, Peter Nordstrom, a professor of geriatric medicine at Umea University. “Unfortunately, this also means that environmental factors that reduce obesity do not reduce the risk of cardiovascular disease or death. But they most certainly decrease the risk for diabetes.”
Obese children who cut sugar from their diets saw improvements in markers of heart disease after just nine days, a study in Atherosclerosis found.
For the study, researchers evaluated 37 children ages 9 to 18 who were obese and at high risk for heart disease and Type 2 diabetes. The children were given food and drinks totaling the same number of calories, fat, protein and carbohydrates as their typical diets.
The only change was their sugar intake: The researchers swapped foods high in added sugars, like pastries and sweetened yogurts, for options like bagels and pizza. This lowered dietary sugar from 28 percent to 10 percent, and fructose from 12 percent to 4 percent of total calories.
After nine days, the researchers found a 33 percent drop in triglycerides, a type of fat tied to heart disease; a 49 percent reduction in a protein called apoC-III that is tied to high triglyceride levels; and dramatic reductions in small, dense LDL cholesterol, a risk factor for heart disease.
“Sugar calories are not like other carbohydrate calories,” said Dr. Robert Lustig, a co-author of the study and professor of pediatrics at Benioff Children’s Hospital at the University of California, San Francisco. “Without changing total carbohydrate, or fat, or protein, we were able to accomplish this enormous improvement in their cardiovascular risk factors,” unrelated to weight loss, he said.
Preschool children who are in bed by 8 p.m. are far less likely to be obese during adolescence than children who stay up late, a study has found. Their risk of teenage obesity is half the risk faced by preschoolers who stay up past 9 p.m.
The research analyzed data gathered on nearly 1,000 children born in 1991 whose bedtimes were recorded when they were 4½ years old, and whose height and weight were recorded at age 15. The children were part of the Study of Early Child Care and Youth Development, done under the auspices of the National Institute of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Among the children who were in bed by 8 p.m., 10 percent were obese as teens, compared to 16 percent of those who went to bed between 8 and 9 and 23 percent of those who went to bed after 9, according to the study, published in The Journal of Pediatrics.
The researchers adjusted for such factors as socioeconomic status, maternal obesity and parenting style and still found that the children who went to bed by 8 p.m. were at less than half the risk of teenage obesity as those who were up past 9, said Sarah E. Anderson, the paper’s lead author and an associate professor of epidemiology at the Ohio State University College of Public Health in Columbus.
Although the study does not prove that early bedtimes protect against obesity, Dr. Anderson said, “there is a great deal of evidence linking poor sleep, and particularly short sleep duration, to obesity, and it’s possible the timing of sleep may be important, above and beyond the duration of sleep.”
“This provides more evidence that having an early regular bedtime and bedtime routine for young children is helpful,” she said.
To stem the current epidemic of obesity, there’s no arguing with the adage that an ounce of prevention is worth a pound of cure. As every overweight adult knows too well, shedding excess pounds and keeping them off is far harder than putting them on in the first place.
But assuring a leaner, healthier younger generation may often require starting even before a baby is born.
The overwhelming majority of babies are lean at birth, but by the time they reach kindergarten, many have acquired excess body fat that sets the stage for a lifelong weight problem.
Recent studies indicate that the reason so many American children become overweight is far more complicated than consuming more calories than they burn, although this is certainly an important factor. Rather, preventing children from acquiring excess body fat may have to start even before their mothers become pregnant.
Researchers are tracing the origins of being overweight and obese as far back as the pre-pregnancy weight of a child’s mother and father, and their explanations go beyond simple genetic inheritance. Twenty-three genes are known to increase the risk of becoming obese. These genes can act very early in development to accelerate weight gain in infancy and during middle childhood.
In the usual weight trajectory, children are born lean, get chubby during infancy, then become lean again as toddlers when they grow taller and become more active. Then, at or before age 10 or so, body fat increases in preparation for puberty – a phenomenon called adiposity rebound.
In children with obesity genes, “adiposity rebound occurs earlier and higher,” said Dr. Daniel W. Belsky, an epidemiologist at Duke University School of Medicine. “They stop getting leaner sooner and start putting on fat earlier and put on more of it.”
Still, twin and family studies have shown that many children with these genes remain lean. Furthermore, these same genes were undoubtedly around in the 1960s and 1970s when the obesity rate in children was a fraction of what it is today.
So what is different about the 2000s? Children today are surrounded by a surfeit of unwholesome, easy-to-consume calorie-dense foods and snacks accompanied by a deficit of opportunities to expend those extra calories through regular physical activity. And countering a calorie-rich, sedentary environment is now harder than it should be, with the current heavy emphasis on academics, parental reluctance to let children play outside unattended, and intense competition from electronics. All these circumstances may give obesity genes a greater chance to express themselves.
“There is no going back to a world in which calories are scarce and obtaining them is physically demanding,” Dr. Belsky wrote in an editorial in JAMA Pediatrics. “And governments and their publics have shown little enthusiasm for regulations restricting access to palatable, calorie-dense foods.”
Curbing consumption of sugar-sweetened beverages and keeping calorie-dense junk food out of the house and other settings where young children spend time is crucial. This is especially important for infants and children with large appetites that are not easily satisfied.
It’s also essential that parents model good eating habits, experts agree. “If you do it, they’ll do it,” David S. Ludwig, an obesity specialist at Children’s Hospital Boston, said. “Young children are like ducklings, they want to do what their mothers do.”
Equally important, Dr. Belsky said, is “allowing children in institutional settings – in day care, preschool and elementary school – to be as active as they choose to be rather than forcing them to sit quietly in chairs most of the day. Being physically active encourages a healthy metabolism. Active children are not constantly hungry.”
He added, “In the face of the obesity epidemic, eliminating the handful of opportunities for kids to be active during the day is a shame. Sedentary behavior becomes a life pattern.”
Another critical issue is the vicious cycle of overweight that starts with future mothers and fathers who are overweight or obese. “If we want healthy kids, we need healthy moms before pregnancy and during pregnancy,” Dr. Belsky said. “There are multiple pathways by which unhealthy levels of weight before and during pregnancy can influence a child’s weight going forward.”
As Dr. Ludwig explained, “Although genes are not modifiable, the weight of the mother before and during pregnancy is. Excessive weight gain during pregnancy predicts not just the baby’s birth weight but also the likelihood of obesity in middle childhood.”
The father’s weight is also turning out to be important, Dr. Ludwig said. “Acquired factors influence gene expression,” he said. “Being heavy alters DNA in the father’s sperm that changes gene expression and can be passed down to the next generation.”
Most, though not all, studies have linked a longer duration of breast-feeding to a reduced risk of overweight in children. Although Dr. Ludwig said that the effect “is not dramatic,” a more important benefit of breast-feeding may be “exposing the baby to a wider range of tastes based on what a mother is eating. If a breast-feeding mom eats a large variety of nutritious foods, the child is more likely to like them.”
Antibiotics given early in life, however, may counter any potential benefits of breast-feeding for weight gain, a new study found. Researchers at the University of Helsinki in Finland reported that when breast-fed infants are treated with antibiotics, the antibiotics kill off health-promoting bacteria that live in the gut. “The protective effects of breast-feeding against infections and overweight were weakened or completely eliminated by early-life antibiotic use,” the team wrote in JAMA Pediatrics last month.
Even if children have already started on a path of poor eating habits and excess weight gain, Dr. Ludwig said it is not too late to make healthful changes. As founder of the Optimal Weight for Life program and author of “Ending the Food Fight: Guide Your Child to a Healthy Weight in a Fast Food/Fake Food World,” he advocates an authoritative, but not an authoritarian, parenting style that eliminates stress and conflict over what and when a child eats.
“Never force food on a child,” he insists. “Stand your ground in a gentle but firm way and be prepared to do a little negotiating. When a child refuses to eat the dinner that’s served, put it away in the fridge to be eaten later. If the child says ‘I’m not going to eat it,’ the response should be, ‘Fine, just go to bed,’ not ‘O.K., I’ll make you mac and cheese.’
“Children should be allowed to control their bodies, but parents have to provide the guidance and control the environment,” Dr. Ludwig said.
Life-threatening ailments like heart disease, cancer, stroke and Type 2 diabetes most often afflict adults. But they are often consequences of childhood obesity.
Two new studies, conducted among more than half a million children in Denmark who were followed for many years, linked a high body mass index in children to an increased risk of developing colon cancer and suffering an early stroke as adults. The studies, presented at the European Obesity Summit in Gothenburg, Sweden, this spring, underscore the importance of preventing and reversing undue weight gain in young children and teenagers.
One study, of more than 257,623 people, by Dr. Britt Wang Jensen and colleagues at the Institute of Preventive Medicine, in Bispebjerg, Denmark, and Frederiksberg Hospital in Copenhagen, grouped children according to standard deviations from a mean B.M.I., adjusted for a child’s age and sex.
They found that each unit of increase in being overweight at age 13, generally corresponding to a two- to three-point increase in B.M.I., increased the risk of developing colon cancer by 9 percent and rectal cancer by 11 percent.
The second study, involving 307,677 Danish people born from 1930 to 1987, used a similar grouping of B.M.I. The risk of developing a clot-related stroke in early adult life increased by 26 percent in women and 21 percent in men for each unit of increase in being overweight at all stages of childhood, but especially at age 13.
According to the American Academy of Child and Adolescent Psychiatry, obesity most often develops from ages 5 to 6 or during the teen years, and “studies have shown that a child who is obese between the ages of 10 and 13 has an 80 percent chance of becoming an obese adult.”
In a study published in 2014 in The New England Journal of Medicine, Solveig A. Cunningham and colleagues at Emory University found that “overweight 5-year-olds were four times as likely as normal-weight children to become obese by age 14.” The study, which involved a representative sample of 7,738 kindergartners, found that the risk of becoming obese did not differ by socioeconomic status, race or ethnic group, or birth weight. Rather, it showed that excess weight gain early in life is a risk factor for obesity later in childhood across the entire population.
Children are generally considered obese when their B.M.I. is at or above the 95th percentile for others of the same age and sex. Currently, about one-third of American children are overweight or obese. By 2012, the Centers for Disease Control and Prevention reports, 18 percent of children and 21 percent of adolescents were obese.
The adverse effects of excess weight in childhood and adolescence don’t necessarily wait to show up later in life. In a review of complications resulting from youthful obesity, Dr. Stephen R. Daniels, a pediatrician at the University of Colorado School of Medicine and the Children’s Hospital in Denver, found that problems in many organ systems were often apparent long before adulthood. They include high blood pressure; insulin resistance and Type 2 diabetes; high blood levels of heart-damaging triglycerides and low levels of protective high-density lipoprotein (HDL) cholesterol; nonalcoholic fatty liver disease; obstructive sleep apnea; asthma; and excess stress on the musculoskeletal system resulting in abnormal bone development, knee and hip pain, and difficulty walking.
Problems of youthful obesity go beyond physical ones. Obese adolescents have higher rates of depression, which in itself may foster poor eating and exercise patterns that add to their weight problem and result in a poor quality of life that persists into adulthood.
In a study conducted in Singapore, researchers reported that “individuals who were obese in childhood are more likely to have poor body image and low self-esteem and confidence, even more so than those with adult onset obesity.”
Another study by Dr. Jeffrey B. Schwimmer of the University of California, San Diego, and colleagues found that obese children and adolescents reported a diminished quality of life that was comparable to that of children with cancer.
Taken together, the data speak to the critical importance of preventing undue weight gain in young children, a task that depends largely on parents, who are responsible for what and how much children eat and how much physical activity they engage in. As researchers from the University Medical Center Groningen in the Netherlands put it, “Early recognition of overweight or obesity in children by their parents is of utmost importance, allowing interventions to start at a young age.” Yet, they found in a study of the parents of 2,203 5-year-olds, “parents underestimated their overweight child in 85 percent of the cases.”
Though it seems logical that parents who think their children are overweight would make a special effort to assure they would “grow into” their weight as they get older, research has shown the opposite. Such children tend to get even fatter, according to findings from the Longitudinal Study of Australian Children reported in April in the journal Pediatrics by Eric Robinson of the University of Liverpool and Angelina R. Sutin of Florida State University College of Medicine.
Even being labeled overweight can itself be damaging and make it harder for children to avoid bad habits, the authors suggested. A 2014 study of girls aged 10 to 19 found that “regardless of actual weight, adolescents who reported having been labeled ‘too fat’ by a family member or peer were more likely to become obese nearly a decade later.”
“I encourage parents to change the environment at home,” Dr. Daniels of the University of Colorado said in an interview. “Without being authoritarian, they should limit high-calorie-dense foods, keep sugar-sweetened beverages out of the house and assure that kids eat the right amount of fruits and vegetables and fewer calorie-dense snacks. Parents also need to be tuned into opportunities for physical activity and set hard-and-fast rules about television and time spent on electronics.”
Following the “5210” daily program endorsed by the American Academy of Pediatrics can help: Aim for five fruits and vegetables a day; keep recreational screen time to two hours or less; include at least one hour of active play: and skip sugar-sweetened beverages and drink water.
Linda Guinee, 60, a survivor of breast cancer, particpated in an earlier trial to see if weight-loss could improve her outcome. She lost 15 pounds and increase her physical activity.Credit Shiho Fukada for The New York Times
Should weight loss be prescribed as a treatment for breast cancer?
Scientists are recruiting thousands of women for a large clinical trial to find out. The plan is to put heavy women age 18 and older who were recently given diagnoses of breast cancer on diets to see if losing weight will keep their cancer from coming back.
“If it shows that losing weight by increasing physical activity and reducing calories improves survival, weight loss and physical activity could become a standard part of treatment for millions of breast cancer patients around the world,” Dr. Ligibel said.
In a sense, the clinical trial is long overdue. Once a woman is given a breast cancer diagnosis, obesity is associated with a higher risk for recurrence and lower likelihood of survival in women of all ages, Dr. Ligibel said.
Studies showing that obese and overweight women are more likely to die of their breast cancer date back decades. Just two years ago, a meta-analysis crunched the numbers from more than 80 studies involving more than 200,000 women with breast cancer, and reported that women who were obese when diagnosed had a 41 percent greater risk of death, while women who were overweight but whose body mass index was under 30 had a 7 percent greater risk.
But while those studies showed an association between weight and breast cancer mortality, they weren’t designed to find out if weight loss after diagnosis improves survival or reduces the chance of a recurrence.
“Nobody understands biologically why that is,” Dr. Ligibel said, adding that researchers will be collecting blood samples throughout the trial to track metabolic changes that occur with weight loss. Exercise is also part of the program, and participants will work with health coaches. Fitbit is donating all the products that will be used to track their activity and weight.
The researchers will look at markers of inflammation and metabolism, including levels of insulin, insulinlike growth factor and hormones that regulate fat storage.
“There’s a physiology of obesity that happens in everybody, but many of the changes we see in obesity actually are factors that influence the growth of cancer,” said Dr. Pamela Goodwin, one of the study’s investigators and a professor of medicine at Mount Sinai Hospital in Toronto.
These changes include higher insulin and glucose levels, inflammation and an increase in certain proteins, all of which appear to fuel cancer growth, Dr. Goodwin said.
Obesity “makes a great environment for cancer to get a foothold and progress,” said Barbara Gower, a professor of nutrition at the University of Alabama at Birmingham, who is running a small short-term trial to see what happens when women with ovarian cancer remove all sugar and starches from their diet. “The hormonal messages getting through to cancer cells are that it’s a good time to grow, and the nutrition they need is there, too.”
While a drug may target one of the factors, Dr. Ligibel said, weight loss and exercise may be a more powerful intervention because they lead to a combination of changes. “You have something that can potentially change all of them to a metabolically healthy low inflammatory state,” Dr. Ligibel said.
The trial, which will get underway this summer, will cost an estimated $15 million to $20 million. It’s sponsored by the National Cancer Institute and the Alliance for Clinical Trials in Oncology.
Researchers are recruiting 3,200 women from across the United States and Canada who have a recent diagnosis of Stage 2 or Stage 3 breast cancer. Participants must be overweight, with a body mass index of at least 27, and have hormone receptor positive or triple negative tumors. (Women with another type of breast cancer, known as HER2-positive, will not be included because their prognosis does not appear to be associated with weight, researchers said.)
Participants must be 18 but there is no upper age limit, though they must be able to walk “a couple of city blocks and have a life expectancy of at least five years for other causes,” Dr. Ligibel said.
Volunteers will be randomly assigned to either a telephone-based weight loss program or to a control group for comparison. The goal for those in the intervention is to lose 10 percent of their body weight over two years. Participants will continue to be followed for 10 years to see whether their cancer progresses or not.
Weight loss is challenging, and some cancer treatments cause weight gain. But an earlier trial that tested a similar telephone-based weight loss intervention on a smaller scale found that women with breast cancer lost 4 to 5 percent of their body weight, Dr. Goodwin said.
“Breast cancer is a teachable moment,” she added.
The new trial might help doctors identify which patients will benefit most from losing weight, and whether even moderate weight loss is helpful, said Dr. Clifford Hudis, the new chief executive officer of the American Society of Clinical Oncology and former chief of Memorial Sloan Kettering Cancer Center’s breast medicine service, who was involved in the design of the Breast Cancer Weight Loss trial.
“If I tell patients they need to lose 20 pounds, they just roll their eyes and say it’s impossible,” Dr. Hudis said. “But if we could say they only need to lose 3 percent of their body weight, that wouldn’t be so scary. That’s more manageable.”
Should parents talk to an overweight child about weight? Or should they just keep their mouths shut?
Parents in this situation are understandably torn. Say something, and they risk shaming a child or worse, triggering an eating disorder. Say nothing, and they worry they’re missing an opportunity to help their child with what could become a serious long-term health problem.
Now a new study offers some guidance: Don’t make comments about a child’s weight.
The study, published in the journal Eating & Weight Disorders, is one of many finding that parents’ careless — though usually well-meaning — comments about a child’s weight are often predictors of unhealthy dieting behaviors, binge eating and other eating disorders, and may inadvertently reinforce negative stereotypes about weight that children internalize. A parent’s comments on a daughter’s weight can have repercussions for years afterward, contributing to a young woman’s chronic dissatisfaction with her body – even if she is not overweight.
“Parents who have a child who’s identified as having obesity may be worried, but the way those concerns are discussed and communicated can be really damaging,” said Rebecca Puhl, deputy director of the Rudd Center for Food Policy and Obesity at the University of Connecticut. “The longitudinal research shows it can have a lasting impact.”
The impact on girls may be especially destructive, she said, because “girls are exposed to so many messages about thinness and body weight, and oftentimes women’s value is closely linked to their appearance. If parents don’t challenge those messages, they can be internalized.”
The new study included over 500 women in their 20s and early 30s who were asked questions about their body image and also asked to recall how often their parents commented about their weight. Whether the young women were overweight or not, those who recalled parents’ comments were much more likely to think they needed to lose 10 or 20 pounds, even when they weren’t overweight.
The study’s lead author, Dr. Brian Wansink, a professor and the director of Cornell University’s Food and Brand Lab, characterized the parents’ critical comments as having a “scarring influence.”
“We asked the women to recall how frequently parents commented, but the telling thing was that if they recalled it happening at all, it had as bad an influence as if it happened all the time,” said Dr. Wansink, author of the book “Slim by Design.” “A few comments were the same as commenting all the time. It seems to make a profound impression.”
Some studies have actually linked parents’ critical comments to an increased risk of obesity. One large government-funded study that followed thousands of 10-year-old girls found that, at the start of the study, nearly 60 percent of the girls said someone — a parent, sibling, teacher or peer – had told them they were “too fat.” By age 19, those who had been labeled “too fat” were more likely to be obese, regardless of whether they were heavy at age 10 or not.
Several studies have found that when parents encourage overweight teenagers to diet, the teenagers are at higher risk of lower self-esteem and depression and of being overweight five years later.
Research by Dianne Neumark-Sztainer, a professor at the University of Minnesota, found that when parents talked to their teens about losing weight, teenagers were more likely to diet, use unhealthy weight-control behaviors and binge eat. Those behaviors are less likely to develop when conversations with parents focused on healthy eating behaviors, rather than weight per se.
Harsh comments about weight can send the message that parents are “tying weight to some kind of perception about how the child is valued,” Dr. Puhl said, and that can trigger negative feelings. “The children are internalizing that, and thinking they’re not O.K. as a person. And that is what’s leading to other outcomes, like disordered eating.”
So what’s a parent to do? Do they just stand by while their child gains weight?
Dr. Neumark-Sztainer was besieged by parents asking her this question, and wondering, “How do I prevent them from getting overweight and still feel good about themselves?”
In her book, called “I’m, Like, SO Fat: Helping Your Teen Make Health Choices About Eating and Exercise in a Weight-Obsessed World,” she notes that parents can influence a child’s eating habits without talking about them. “I try to promote the idea of talking less and doing more — doing more to make your home a place where it’s easy to make healthy eating and physical activity choices, and talking less about weight.”
For parents, that means keeping healthy food in the house and not buying soda. It means sitting down to enjoy family dinners together, and also setting an example by being physically active and rallying the family to go for walks or bike rides together. Modeling also means not carping about your own weight. “Those actions speak louder than words,” Dr. Puhl said.
While your children are young, “there doesn’t need to be a conversation at all – it really is just about what’s being done at home,” Dr. Neumark-Sztainer said.
If an older child is overweight, “wait for your child to bring it up, and be there to support them when they do,” she said. “Say, ‘Look, I love you no matter what size you are, but if you would like, I will support you. I suggest we focus not so much on your weight but on your eating patterns and behaviors. What would be helpful for you?’”
The federal government’s decision to update food labels last month marked a sea change for consumers: For the first time, beginning in 2018, nutrition labels will be required to list a breakdown of both the total sugars and the added sugars in packaged foods. But is sugar really that bad for you? And is the sugar added to foods really more harmful than the sugars found naturally in foods?
We spoke with some top scientists who study sugar and its effects on metabolic health to help answer some common questions about sugar. Here’s what they had to say.
Why are food labels being revised?
The shift came after years of urging by many nutrition experts, who say that excess sugar is a primary cause of obesity and heart disease, the leading killer of Americans. Many in the food industry opposed the emphasis on added sugars, arguing that the focus should be on calories rather than sugar. They say that highlighting added sugar on labels is unscientific, and that the sugar that occurs naturally in foods like fruits and vegetables is essentially no different than the sugar commonly added to packaged foods. But scientists say it is not that simple.
So, is added sugar different from the naturally occurring sugar in food?
It depends. Most sugars are essentially combinations of two molecules, glucose and fructose, in different ratios. The sugar in a fresh apple, for instance, is generally the same as the table sugar that might be added to homemade apple pie. Both are known technically as sucrose, and they are broken down in the intestine into glucose and fructose. Glucose can be metabolized by any cell in the body. But fructose is handled almost exclusively by the liver.
“Once you get to that point, the liver doesn’t know whether it came from fruit or not,” said Kimber Stanhope, a researcher at the University of California, Davis, who studies the effects of sugar on health.
The type of sugar that is often added to processed foods is high-fructose corn syrup, which is the food industry’s favored sweetener for everything from soft drinks to breads, sauces, snacks and salad dressings. Made commercially from cornstarch, high-fructose corn syrup is generally much cheaper than regular sugar. It contains the same components as table sugar – glucose and fructose – but in slightly different proportions.
What about “natural” sweeteners?
Food companies like to market agave nectar, beet sugar, evaporated cane juice and many other “natural” sweeteners as healthier alternatives to high-fructose corn syrup. But whatever their source, they are all very similar. To suggest one is healthier than another is a stretch, experts say. In fact, last month, the F.D.A. urged food companies to stop using the term evaporated cane juice because it is “false or misleading” and “does not reveal that the ingredient’s basic nature and characterizing properties are those of a sugar.”
Is high-fructose corn syrup worse than regular sugar? How is it different?
High-fructose corn syrup and regular sugar are so similar that most experts say their effects on the body are essentially the same.
The main difference is that the variety of high-fructose corn syrup used in soft drinks tends to have more fructose. In one 2014 study, researchers analyzed more than a dozen popular soft drinks and found that many sweetened with high-fructose corn syrup – including Pepsi, Sprite, Mountain Dew, Coca-Cola and Arizona Iced Tea – contained roughly 40 percent glucose and 60 percent fructose. Regular sugar contains equal parts glucose and fructose.
Why doesn’t the F.D.A. require that added sugars be listed in teaspoons rather than grams?
When the new food labels go into effect, the daily recommended limit for added sugars will be 50 grams, or roughly 12 teaspoons, daily. (One teaspoon of sugar is 4.2 grams.) But the new food labels will list the amount of added sugars solely in grams.
Many nutrition advocates have urged the F.D.A. to require that food labels list added sugars in both teaspoons and grams on food labels, arguing that Americans often underestimate the actual amount of sugar in a product when it’s expressed in grams alone.
But the F.D.A. ultimately sided with the food industry, which opposed the teaspoon proposal.
“It would be difficult, if not impossible, for a manufacturer to determine the volume contribution that each ingredient provides toward the added sugars declaration,” the agency said. “For example, a cookie made with white chocolate chips and dried fruit would have added sugars in the form of sugar in the batter as well as in the white chocolate chips and the dried fruit.” The F.D.A. also said that requiring both grams and teaspoons would “cause clutter and make the labels more difficult to read.”
But Michael Jacobson, the president of the Center for Science in the Public Interest, an advocacy group that had petitioned the F.D.A. to require the teaspoon measurement, said the agency was under enormous pressure from the food industry, “which knows that consumers would be far more concerned about a product labeled 10 teaspoons than 42 grams.”
So what’s the issue with added sugars?
It mainly comes down to the way they’re packaged.
Naturally occurring sugar is almost always found in foods that contain fiber, which slows the rate at which the sugar is digested and absorbed. (One exception to that rule is honey, which has no fiber.) Fiber also limits the amount of sugar you can consume in one sitting.
A medium apple contains about 19 grams of sugarand four grams of fiber, or roughly 20 percent of a day’s worth of fiber. Not many people would eat three apples at one time. But plenty of children and adults can drink a 16-ounce bottle of Pepsi, which has 55 grams of added sugar – roughly the amount in three medium apples – and no fiber. Fiber not only limits how much you can eat, but how quickly sugar leaves the intestine and reaches the liver, Dr. Stanhope said.
“You can’t easily eat that much sugar from fruit,” she said. “But nobody has any problem consuming a very high level of sugar from a beverage or from brownies and cookies.”
Why is it a problem to have too much sugar?
Many nutrition experts say that sugar in moderation is fine for most people. But in excess it can lead to metabolic problems beyond its effects on weight gain. The reason, studies suggest, is fructose. Any fructose you eat is sent straight to your liver, which specializes in turning it into droplets of fat called triglycerides.
“When you ingest fructose, almost all of it is metabolized by the liver, and the liver is very good at taking that fructose and converting it to fat,” said Dr. Mark Herman, an assistant professor of medicine at Harvard. Studies show a predictable response when people are asked to drink a sugary beverage: A rapid spike in the amount of triglycerides circulating in their bloodstreams. This also leads to a reduction in HDL cholesterol, the so-called good kind.
Over time, this combination – higher triglycerides and lower HDL – is one major reason sugar promotes heart disease, said Dr. Aseem Malhotra, a cardiologist and adviser to the United Kingdom’s national obesity forum. This sequence of events may even overshadow the effects of LDL cholesterol, the so-called bad kind.
“What many people don’t realize is that it’s triglycerides and HDL that are more predictive of cardiovascular disease than LDL cholesterol,” Dr. Malhotra said. “I’m not saying LDL isn’t important. But if there is a hierarchy, triglycerides and HDL are more important than LDL.”
Dr. Malhotra said that when people reduce their sugar intake, “their overall cholesterol profile improves.”
“I see this in so many of my patients,” he added. “The effects are rapid.”
How much sugar is too much?
One of the largest studies of added sugar consumption, which was led by the Centers for Disease Control and Prevention, found that adults who got more than 15 percent of their daily calories from added sugar had a higher risk of cardiovascular disease. For the average adult, that translates to about 300 calories, or 18 teaspoons of added sugar, daily. That may not sound like a lot. But considering that a single 12-ounce can of Coca-Cola has almost 10 teaspoons of sugar, it can add up quickly
The study found that most adults got more than 10 percent of their daily calories from added sugar, and that for 10 percent of people, more than 25 percent of their calories came from added sugar. The biggest sources for adults were soft drinks, fruit juices, desserts and candy.
While those might seem like obvious junk foods, Dr. Malhotra said, about half of the sugar Americans consume is “hidden” in less obvious places like salad dressings, bread, low-fat yogurt and ketchup. In fact, of the 600,000 food items for sale in America, about 80 percent contain added sugar.
Everyone’s tolerance for sugar is different. Studies show, for example, that people who are already obese may be more susceptible to metabolic harm from sugar than others. But Dr. Malhotra said that he generally advises people to follow the World Health Organization’s guidelines, which recommend that adults and children consume no more than about six teaspoons daily of added sugar.
“Could I tell you the exact limit where sugar starts to definitely impact cardiovascular health?” he said. “That’s difficult. But I think if people stick within the W.H.O. limits, then their risk is reduced.”
Anyone who still needs motivation to move more may find it in a new study showing that, in addition to its other health benefits, exercise appears to substantially reduce the risk of developing 13 different varieties of cancer. That is far more types than scientists previously thought might be impacted by exercise. The comprehensive study also suggests that the potential cancer-fighting benefits of exercise seem to hold true even if someone is overweight.
The idea that exercise might change someone’s susceptibility to cancer is, of course, not new. Many studies have found that people who are physically active, either through exercise or while on the job, tend to be less likely to develop certain types of cancer than people who are sedentary.
But those studies primarily looked at associations between exercise and a few common malignancies, such as breast cancer in women, and colon and lung cancers in both women and men.
Whether physical activity, and more precisely, regular exercise, would also lower our risk for other cancers has remained an open question.
So for the new study, which was published this week in JAMA Internal Medicine, scientists with the division of cancer epidemiology and genetics at the National Cancer Institute, as well as Harvard Medical School, and a number of other institutions around the world turned to a large trove of epidemiological health studies conducted in the United States or Europe.
In these earlier studies, researchers directly measured volunteers’ body mass and other health markers and also asked about their diets and exercise habits. The researchers then tracked the participants for a decade or more, noting disease diagnoses or, in some instances, deaths.
Such studies help to establish links between lifestyles and disease risk. But the number of people involved must be hefty if the associations are to be persuasive.
To gain sufficient numbers now, the Cancer Institute researchers gathered data from 12 large-scale studies that, pooled together, involved 1.44 million men and women.
The researchers focused on specific information for each of those 1.44 million people about whether they exercised, and how vigorously and how often. They also zeroed in on whether and when, after each study’s start, the participant had been diagnosed with any type of cancer.
Then, using elaborate statistical methods, they computed the role that exercise, and in particular, moderate or vigorous exercise such as brisk walking or jogging, seemed to be playing in people’s risks for cancer.
It turned out to be considerable. For most cancers, people who reported exercising moderately, even if the time that they spent exercising was slight, had significantly less risk of developing 13 different types of cancer than people who were sedentary.
The researchers found a reduced risk of breast, lung and colon cancers, which had been reported in earlier research. But they also found a lower risk of tumors in the liver, esophagus, kidney, stomach, endometrium, blood, bone marrow, head and neck, rectum and bladder.
And the reductions in risk for any of these 13 cancers rose steeply as people exercised more. When the researchers compared the top 10 percent of exercisers, meaning those who spent the most time each week engaging in moderate or vigorous workouts, to the 10 percent who were the least active, the exercisers were as much as 20 percent less likely to develop most of the cancers in the study.
On the other hand, they found an increased risk of two types of malignancies — melanoma and slow-growing prostate tumors — among people who exercised the most. Those findings can most likely be explained, in large part, by certain characteristics of active people, said Steven Moore, an investigator at the National Cancer Institute who led the study.
“People who exercise generally go in for more checkups” than sedentary people, he said, resulting in more screenings for conditions such as so-called indolent prostate cancers. (There was no discernible association, positive or negative, between exercise and aggressive prostate tumors.) “They also often exercise outside,” he continued, “and are more prone to sunburns” than people who rarely work out, potentially contributing to a greater risk for melanoma.
Encouragingly, the associations between exercise and reduced cancer risks held true even when the researchers factored in body mass. People who were overweight or obese but exercised had a much lower risk of developing most cancers than overweight people who did not move much.
Just how physical activity may be undercutting the risk for so many disparate types of cancers is not yet fully understood, Dr. Moore said, although he and his colleagues suspect that changes in exercisers’ hormone levels, degree of inflammation, digestion and overall energy balance most likely contribute.
Bear in mind, though, that this was an observational study, so it cannot directly prove that exercise reduces cancer risks, only that there is an association between more exercise and less disease. It also relied on participants’ memories of exercise, which can be unreliable.
But even with those limitations, the findings sturdily suggest that exercise may help to reduce the risk of many types of cancer, “and it has few side effects and doesn’t cost much,” said Dr. Moore, who runs almost every day.
Readers posted almost 400 comments to the article and flooded the Internet and my inbox with questions and sentiments about extremely short workouts. Given the extent of the response and the astuteness of the questions, I thought I would address some of the issues that arose over and over.
Q. Are high-intensity interval workouts actually better for you than longer, endurance-style workouts — or just shorter?
A. Better is such a subjective word. At the moment, the two types of workouts appear to be largely equivalent to each other in terms of a wide variety of health and fitness benefits.
In the study that I wrote about, “1 Minute of All-Out Exercise May Equal 45 Minutes of Moderate Exertion,” for instance, three months of high-intensity interval training practiced three times per week led to approximately the same improvements in aerobic endurance, insulin resistance and muscular health as far longer sessions of moderate pedaling on a stationary bicycle.
One type of workout was not more beneficial than the other, in other words, but one required much, much less time.
Other studies have generally produced similar results, although, to be honest, the science related to interval training for health purposes and not simply for athletic performance remains scant. An interesting new review of past research to be published in June did conclude that, for overweight and obese children, short sessions of intense intervals may lead to greater improvements in endurance and blood pressure than longer bouts of moderate exercise, although the authors did not discuss how best to get children to complete frequent interval sessions.
The upshot of the available science is that if you currently have the time and inclination to complete long-ish, moderate workouts — if you enjoy running, cycling, swimming, walking or rowing for 30 minutes or more, for instance — by all means, continue.
If, on the other hand, you frequently skip workouts because you feel that you do not have enough time to exercise, then very brief, high-intensity intervals may be ideal for you. They can robustly improve health and fitness without overcrowding schedules.
What about combining brief high-intensity workouts with longer, endurance workouts?
Alternating high-intensity workouts with endurance-style workouts may yield the greatest health and fitness gains of all.
In a 2014 study, a group of sedentary adults began either a standard endurance-training program, in which they pedaled a bicycle moderately for 30 minutes five times a week, or swapped one of those bike rides for an interval session. All of the participants wound up significantly more aerobically fit after 12 weeks.
But the men and women who had completed one interval session per week had developed slightly more overall endurance than the other volunteers. As a result, they had lowered their risk for premature death by about an additional 18 percent, the study’s authors conclude.
Do I have to use a stationary bicycle for interval training?
Most recent studies of high-intensity intervals have involved computerized stationary bicycles because scientists can easily monitor the riders’ pace and intensity. But there is nothing magical about the equipment. The key to high-intensity interval training is the intensity, which most of us can gauge either with a heart rate monitor or our own honest judgment.
For moderate exercise, your heart rate typically should be between 70 and 85 percent of your maximum. (I recently wrote about how to determine your individual maximum heart rate.) This intensity would feel like about an 8 on an arduousness scale of 1 to 10.
During an intense interval, however, your heart rate should rise to 90 percent of your maximum heart rate, or above. Think of this as feeling like about a 9.5 on the 10-point scale. You maintain that intensity for only 10 or 20 seconds at a time, however, followed by several minutes of very easy exercise before repeating the intense work.
Almost any type of exercise can be used for interval training, including running up the stairs in your office’s stairwell during your lunch hour, said Martin Gibala, a professor of kinesiology at McMaster University in Hamilton, Ontario, and an expert on intervals. (His book about the science and practical implications of high-intensity interval training will be published in early 2017.)
Will high-intensity intervals help me to lose weight?
Few studies have yet looked at the long-term effects on body weight of exercising exclusively with high-intensity intervals, although some experiments do hint that high-intensity interval training can reduce body fat, at least in the short term.
In a 2015 study, for example, overweight, out-of-shape men who began either to jog or otherwise exercise moderately for an hour five days per week for six weeks or to complete intensive interval training for a few minutes per week all dropped body fat and about the same percentages of fat, despite very different amounts of exercise. Likewise, a group of women recovering from breast cancer who were assigned either to moderate exercise or brief interval training for three weeks lost comparable amounts of body fat during the study.
But these were small-scale, brief experiments. Whether interval training helps or hinders long-term weight control is still unknown.
Young rats prone to obesity are much less likely to fulfill that unhappy destiny if they run during adolescence than if they do not, according to a provocative new animal study of exercise and weight. They also were metabolically healthier, and had different gut microbes, than rats that keep the weight off by cutting back on food, the study found. The experiment was done in rodents, not people, but it does raise interesting questions about just what role exercise may play in keeping obesity at bay.
For some time, many scientists, dieting gurus and I have been pointing out that exercise by itself tends to be ineffective for weight loss. Study after study has found that if overweight people start working out but do not also reduce their caloric intake, they shed little if any poundage and may gain weight.
The problem, most scientists agree, is that exercise increases appetite, especially in people who are overweight, and also can cause compensatory inactivity, meaning that people move less over all on days when they exercise. Consequently, they wind up burning fewer daily calories, while also eating more. You do the math.
But those discouraging studies involved weight loss. There has been much less examination of whether exercise might help to prevent weight gain in the first place and, if it does, how it compares to calorie restriction for that purpose.
These rats were young enough, though, that they were not yet overweight.
After weighing them, the researchers divided the animals into three groups.
One group was allowed to eat as much kibble as they wished and to remain sedentary in their cages. These were the controls.
Another group, the exercise group, also was able to eat at will, but these animals were provided with running wheels in their cages. Rats like to run, and the animals willingly hopped on the wheels, exercising every day.
The final group, the dieting group, was put on a calorie-restricted meal plan. Their daily kibble helpings were about 20 percent smaller than the amount that the runners ate, a portion size designed to keep them at about the same weight as the runners, so that extreme differences in body size would not affect the final results.
After 11 weeks, all of the animals were moved to specialized cages that could measure their metabolisms and how much they moved around. They then returned to their assigned cages for several more weeks, by which time they were effectively middle-aged.
At that point, the control animals were obese, their physiques larded with fat.
The runners and the lower-calorie groups, however, although they also had gained ounces, had put on far less weight than the controls. None were obese.
Both exercise and portion control, in other words, had effectively protected the animals against their fated fatness.
But beneath the skin, the runners and the dieters looked very unalike. By almost all measures, the runners were metabolically healthier, with better insulin sensitivity and lower levels of bad cholesterol than the dieters. They also burned more fat each day for fuel, according to their metabolic readings, and had more cellular markers related to metabolic activity within their brown fat than the dieting group. Brown fat, unlike the white variety, can be quite metabolically active, helping the body to burn additional calories.
Interestingly, the runners also had developed different gut microbes than the dieters, even though they ate the same food. The runners had greater percentages of some bacteria and smaller populations of others than the dieters or the control group; these particular proportions of gut bugs have been associated in a few previous studies with long-term leanness in both animals and people.
Perhaps most striking, “the runners showed no signs of compensatory eating or compensatory inactivity,” said Victoria Vieira-Potter, an assistant professor of nutrition and exercise physiology at the University of Missouri who oversaw the study. They didn’t scarf down more food than the control group, despite running several miles every day and, according to the specialized cages, actually moved around more when not exercising than either of the other groups of rats.
In essence, the runners, while weighing the same as the dieters at the end of the study, seemed better set up to avoid weight gain in the future.
Of course, these were rats, which do not share our human biology or our tangled psychological relationships with food and body fat.
This study also involved young, normal-weight rodents and cannot tell us whether exercise or dieting alone or in combination would aid or hinder weight loss in people (or animals) who already are overweight, Dr. Vieira-Potter said. Metabolisms change once a body contains large amounts of fat, and it becomes increasingly difficult to permanently drop those extra pounds.
So better to avoid weight gain in the first place, if possible. And in that context, she said, “restricting calories can be effective,” but exercise is likely to be more potent in the long term and, of course, as common sense would tell us, doing both—watching what you eat and exercising—is best of all.
After a trip to Fitness Ridge, Jennifer Morton ended up staying there.Credit Victoria Tarter
There was no reason for Jennifer Morton to move to Utah, except one: It was the place she lost 40 pounds.
In 2009, Ms. Morton was working 90-hour weeks as the director of learning at a large company outside Louisville, Ky. She traveled 80 percent of the time, and her weight shot up. Panicked and exhausted, she quit her job and checked into Fitness Ridge (now called Movara Fitness Resort), a weight-loss and fitness retreat in southern Utah.
She ended up staying a month.
“All of a sudden I was in a place where everybody was like me,” said Ms. Morton, 40. “It felt like home.”
Five weeks later, it really was: She packed up her belongings and settled into a house less than a mile from the resort in the town of St. George. Not long after, she began teaching classes at Movara on emotional eating and food addiction, guiding clients through their own body battles.
“It just made sense to do this,” Ms. Morton said. The low cost of living was appealing, as was the natural beauty. But most importantly, she could continue the healthy lifestyle she had embraced.
“At the resort, the way you feel about who you are is so important to protect that you’re willing to stay in that environment to make sure it sticks,” said Ms. Morton, who began doing triathlons after her stay. “If you find your best self somewhere, you definitely don’t want to leave it.”
People like Ms. Morton are adopting a model familiar to those fighting substance abuse, who are often encouraged to change their environments and relationships post-rehab in order to “stay clean.” (Minnesota, for example, is half-jokingly referred to as “Minnesober” because of the large number of rehab centers there and the many people in various stages of recovery, who often remain in the state after treatment.)
“Addiction is a lifelong problem that people have to deal with, and it’s the same with weight,” said Dr. William Yancy, director of the Duke Diet and Fitness Center in Durham, N.C. “Even if they reach their goal, it’s something they need help and support with.”
“It speaks to the power of the proverbial ‘toxic food environment,’” said David Sarwer, director of the Center for Obesity Research and Education at Temple University’s College of Public Health. “When we’re in our normal day-to-day routines, and those routines have become second nature to us, there are countless negative influences on our eating habits and sedentary behavior that contributes to weight gain.”
Relocating, he said, offers an opportunity to create new habits. “In these cases, people have the opportunity to make a significant commitment to health and well-being to live in a geographical location that promotes health,” he said.
From 2007 to 2012, Marjorie S. Fine went twice a year to the Duke diet and fitness program. She would lose about 30 pounds during her two-month stay, and regain half when she returned home to Miami. “I would chip away at the weight, but never really be anywhere near 99 percent successful,” said Ms. Fine, 69.
Late in 2015, she and her husband moved full-time to Durham (once called the “diet capital of the world” because of the number of weight-loss facilities there). She exercises and eats lunch at Structure House, a residential program in town, six days a week, and attends individual therapy and weekly Overeaters Anonymous meetings there.
“As with any other addiction, you have to work on it on a daily basis,” said Ms. Fine, who has now lost 65 pounds and hopes to lose another 40.
“It’s very important to have that shared experience and problem solve together,” said Catherine J. Metzgar of the University of Illinois at Urbana-Champaign, the lead author of a study that found social support and being accountable to others helped some women lose and maintain weight loss. “Having your family and others in your social circle buy into what you are doing is also important.”
Cindy MacKenzie, 62, a former teacher and self-described yo-yo dieter, retired with her husband in 2015 to southern Utah. The couple purchased a home about a five-minute drive down the road from Movara, where Ms. MacKenzie used to go for annual weight-loss visits.
“We have definitely bought into the program,” said Ms. MacKenzie, who still regularly attends the resort. Back in Silicon Valley, where they used to live, “we would go out to eat all the time, we would drink. Here, there are no threats, no temptations.”
“If you’re living in a community where every single one of your friends and family members is devoted to overeating and an unhealthy lifestyle or to misusing various drugs and alcohol, it’s really hard to change in that environment,” said Maia Szalavitz, a former heroin and cocaine addict and author of the book “Unbroken Brain: A Revolutionary New Way of Understanding Addiction.”
On the other hand, surrounding yourself with too many people with similar issues can be risky. “A lot of people get into a very closed world that’s kind of limited,” she said. “Sometimes you make each other better, and sometimes worse.”
Of course, most of us cannot afford to uproot our families, lives and jobs in the name of healthy living. (Structure House’s base price for new participants, for example, is $10,500 for a four-week stay.) And even if we could, we bring our struggles with us. (In bumper sticker terms: “Wherever you go, there you are.” )
Jean Anspaugh, 62, lost 100 pounds at the Rice House program in Durham, where she stayed for seven years, renting an apartment nearby and taking odd jobs to pay the costs. She figured she would “stay thin forever.” But she didn’t. Work, bills and relationships took their toll, and she got “mainstreamed back into the dominant culture, which eats all the time.”
“Nobody realizes how hard it is to lose weight and keep it off,” said Ms. Anspaugh, a folklorist in Fairfax, Va., and author of “Fat Like Us.” “It’s a full-time job.” She has regained some of the weight but still feels that Durham, “the place where the magic happened,” is home. “I miss the mind-set,” she said. “I miss my tribe.”
Ms. Morton, too, acknowledged that moving to Utah wasn’t a panacea. “You still have to do the same things: build your community, get involved, find the people you like,” she said. And she now is wrestling with “emotional management — meaning, working through the parts of myself that will keep me successful over the long run.”
Still, she has no plans to leave.
“Weight and fitness is definitely on the forefront of my mind, so I think it keeps me accountable because I have to face it every day,” she said. “Also, it helped me realize — we’re all the exact same. We are all dealing with the same set of four or five problems; they just manifest differently in each one of us. It has helped me on my weight management program, and also on my journey to be a good human.”
Mark Mattson, a neuroscientist at the National Institute on Aging in Maryland, has not had breakfast in 35 years. Most days he practices a form of fasting — skipping lunch, taking a midafternoon run, and then eating all of his daily calories (about 2,000) in a six-hour window starting in the afternoon.
“Once you get used to it, it’s not a big deal,” said Dr. Mattson, chief of the institute’s laboratory of neurosciences. “I’m not hungry at all in the morning, and this is other people’s experience as well. It’s just a matter of getting adapted to it.”
In a culture in which it’s customary to eat three large meals a day while snacking from morning to midnight, the idea of regularly skipping meals may sound extreme. But in recent years intermittent fasting has been gaining popular attention and scientific endorsement.
It has been promoted in best-selling books and endorsed by celebrities like the actors Hugh Jackman and Benedict Cumberbatch. The late-night talk show host Jimmy Kimmel claims that for the past two years he has followed an intermittent fasting program known as the 5:2 diet, which entails normal eating for five days and fasting for two — a practice Mr. Kimmel credits for his significant weight loss.
Credit Gary Taxali
Fasting to improve health dates back thousands of years, with Hippocrates and Plato among its earliest proponents. Dr. Mattson argues that humans are well suited for it: For much of human history, sporadic access to food was likely the norm, especially for hunter-gatherers. As a result, we’ve evolved with livers and muscles that store quickly accessible carbohydrates in the form of glycogen, and our fat tissue holds long-lasting energy reserves that can sustain the body for weeks when food is not available.
“From an evolutionary perspective, it’s pretty clear that our ancestors did not eat three meals a day plus snacks,” Dr. Mattson said.
Across the world, millions of people fast periodically for religious and spiritual reasons. But some are now looking at the practice as a source of health and longevity.
Valter Longo, the director of the Longevity Institute at the University of Southern California, initially studied fasting in mice that showed that two to five days of fasting each month reduced biomarkers for diabetes, cancer and heart disease. The research has since been expanded to people, and scientists saw a similar reduction in disease risk factors.
Dr. Longo said the health benefits of fasting might result from the fact that fasting lowers insulin and another hormone called insulinlike growth factor, or IGF-1, which is linked to cancer and diabetes. Lowering these hormones may slow cell growth and development, which in turn helps slow the aging process and reduces risk factors for disease.
“When you have low insulin and low IGF-1, the body goes into a state of maintenance, a state of standby,” Dr. Longo said. “There is not a lot of push for cells to grow, and in general the cells enter a protected mode.”
Critics say that health benefits or not, various forms of intermittent fasting are too impractical for most people.
The 5:2 diet, for example, advocates eating without restrictions for five days and then consuming just 500 calories — roughly the equivalent of a light meal — on each of the other two days of the week. Another regimen, called alternate-day fasting, involves eating no more than 500 calories every other day.
A third regimen, which Dr. Mattson follows, is known as time-restricted feeding. The idea is to consume all of the day’s calories in a narrow window, typically six to eight hours, and fasting for the remaining 16 to 18 hours in a day. Studies of time-restricted feeding practices in both animals and humans have suggested that the practice may lower cancer risk and help people maintain their weight.
The scientific community remains divided about the value of intermittent fasting. Critics say that the science is not yet strong enough to justify widespread recommendations for fasting as a way to lose weight or boost health, and that most of the evidence supporting it comes from animal research. Advocates say the body of research on intermittent fasting is growing rapidly and indicates that the health benefits are striking.
The 5:2 diet, in particular, is backed by “promising” studies that show that it lowers weight and improves blood sugar, inflammation and other aspects of metabolic health, said Joy Dubost, a registered dietitian and a spokeswoman for the Academy of Nutrition and Dietetics, the country’s largest organization of dietitians. She noted that fasting isn’t appropriate for pregnant women, people with diabetes and people on medications.
“Most people who do this understand that it’s not about binge eating,” Dr. Dubost said. “But they like that it gives them the freedom not to worry about calories, carbs and other restrictions on days when they’re not fasting.”
Krista Varady, an associate professor of nutrition at the University of Illinois at Chicago, has studied the effects of alternate-day fasting on hundreds of obese adults. In trials lasting eight to 10 weeks, she has found that people lose on average about 13 pounds and experience marked reductions in LDL cholesterol, blood pressure, triglycerides and insulin, the fat-storage hormone.
Dr. Varady found in her research that intermittent fasting was easiest when people ate a moderately high-fat diet and were allowed to consume up to 500 calories on their fasting days. In her studies, 10 percent to 20 percent of people usually find the diet too difficult and quickly stop. Those who stick with it typically adjust after a rocky first few weeks.
“We’ve run close to 700 people through various trials,” Dr. Varady said. “We thought people would overeat on their feast days to compensate. But people for some reason, regardless of their body weight, can only eat about 10 or 15 percent more than usual. They don’t really overeat, and I think that’s why this works.”
In 2011, Dr. Mattson and his colleagues reported a studyof the 5:2 program that followed 107 overweight and obese women. Half of the subjects were assigned to eat no more than 500 calories each on two consecutive days each week. A control group was assigned to follow a low-calorie diet.
After six months, both groups had lost weight. But the intermittent fasting group lost slightly more — about 14 pounds on average — and had greater reductions in belly fat. They also retained more muscle and had greater improvements in blood sugar regulation.
Dr. Mattson’s interest in intermittent fasting grew out of work on animals that showed that alternate-day fasting protected mice from strokes, Alzheimer’s and Parkinson’s disease, and consistently extended their life spans by 30 percent. Dr. Mattson and his colleagues found that alternate-day fasting increased the production of proteins that protect brain cells, enhancing their ability to repair damaged DNA. Fasting, he said, acts as a mild stress that makes cells throughout the body stronger, shoring up their ability to adapt to later insults.
In this way, intermittent fasting is like exercise, which causes immediate stress and inflammation, but protects against chronic disease in the long run. Eating fruits and vegetables may have a similar effect. While very large doses of antioxidants can cause cancer in humans, moderate amounts of exposure can make cells more resilient, Dr. Mattson said.
“There is overlap between the way cells respond to exercise, to fasting, and even to exposure to some of the chemicals in fruits and vegetables,” he added.
Dr. Mattson is now starting a rigorous clinical trial of people 55 to 70 years old who are prediabetic and at high risk for developing Alzheimer’s disease. He plans to study whether intermittent fasting may slow cognitive decline.
Dr. David Ludwig, a professor of nutrition at the Harvard T. H. Chan School of Public Health, said one benefit of fasting is that it forces the body to shift from using glucose for fuel to using fat. During this process, the fat is converted to compounds known as ketones, a “clean” energy source that burns more efficiently than glucose, like high-octane gasoline, Dr. Ludwig said.
The same process, known as ketosis, occurs when people go on extremely low-carb, high-fat diets. Dr. Ludwig said ketones seem to have unique effects on the brain. High-fat diets, for example, have been used for years to treat people who suffer from epileptic seizures.
“There are extensive reports of children who had debilitating seizures who were cured on ketogenic diets,” Dr. Ludwig said. “If it benefits the brain to prevent seizures, then maybe it benefits the brain in other ways.”
Dr. Ludwig noted that the long-term effectiveness of fasting had not been well studied. He cautioned that for many people, fasting is simply too difficult and may slow metabolism. A potentially more practical approach is to limit sugar and other processed carbohydrates, replacing them with natural fats, protein and unrefined carbohydrates, he said.
“It takes a very disciplined person to skip a couple meals every day,” he added.
But Dr. Mattson, who has been skipping meals for decades, said the adjustment to skipping breakfast and lunch was a lot like the change that occurs when a couch potato starts exercising.
“If you’ve been sedentary for years and then you go out and try to run five miles, you’re not going to feel very good until you get in shape,” he said. “ It’s not going to be a smooth transition right away. It takes two weeks to a month to adapt.”
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For years Dr. Mark Hyman was a vegetarian who kept his intake of dietary fat to a minimum. Whole-wheat bread, grains, beans, pasta and fruits and vegetables made up the bulk of his diet, just as the federal government’s dietary guidelines had long recommended. But as he got older, Dr. Hyman noticed something that bothered him: Despite plenty of exercise and a seemingly healthy diet, he was gaining weight and getting flabby.
At first he wrote it off as a normal part of aging. But then he made a shift in his diet, deciding to eat more fat, not less – and the changes he saw surprised him.
He lost weight, his love handles disappeared, and he had more energy. He encouraged his patients to consume more fat as well, and many of them lost weight and improved their cholesterol. Some even reversed their Type 2 diabetes.
Today, as the director of the Cleveland Clinic’s Center for Functional Medicine, Dr. Hyman has become an outspoken advocate about the health benefits of eating fat. He promotes it on talk shows, educates other doctors, and has even managed to wean his close friend Bill Clinton off of his previously prescribed low-fat vegan diet.
Now in a new book called “Eat Fat, Get Thin,” Dr. Hyman takes a deep dive into the science behind dietary fat, making sense of decades of confusing health recommendations and building a case for why even saturated fats, which have long been vilified, belong in a healthy diet. Dr. Hyman argues that Americans have been misled about the benefits of fat because of a disconnect between nutrition science and food policy. In the book he challenges the nutrition orthodoxy while also exploring the food industry’s outsize influence on official health recommendations.
Recently, we sat down with Dr. Hyman to discuss his thoughts on the gap between nutrition science and health recommendations, the reason you should always plan your meals, and why he never leaves home without a stash of “emergency foods” in his backpack. Here are edited excerpts from our conversation:
Why did you write “Eat Fat, Get Thin”?
I wrote it because we’ve been suffering from 40 years of bad advice about fat that’s led to the biggest obesity and diabetes epidemic in history. The myth that fat makes you fat and causes heart disease has led to a total breakdown in our nutritional framework. I felt it was important to tell the story of how fat makes you thin and how it prevents heart disease and can reverse diabetes. I think people are still very confused about fat.
In the book you argue that nutrition recommendations are often contradictory. How so?
This year, for example, the U.S. Dietary Guidelines for the first time removed their longstanding restrictions on dietary fat. But they still have recommendations to eat low-fat foods. They say total fat is not an issue, but you should drink low-fat milk and eat low-fat dairy and other low-fat foods. It’s a schizophrenic recommendation from the government, and it’s the same with other professional organizations such as the American College of Cardiology and the American Heart Association. There’s a mismatch between the science and the government and professional recommendations.
What’s driving this disconnect?
I think the government based its recommendations on some very flawed science, which took hold. It became policy that was turned into the dietary guidelines and the food pyramid that told us to eat six to 11 servings of bread, rice, cereal and pasta a day and to eat fats and oils sparingly. It’s very hard to overturn dogma like that. It’s embedded in our culture now. It’s embedded in food products. The food industry jumped on the low-fat bandwagon, and the professional associations kept driving the message. Unfortunately the science takes decades to catch up into policy and into practice. And I’m trying to close that gap by bringing awareness to the latest science on how fats and carbs work in your body.
You reviewed hundreds of studies while writing this book. What is your conclusion on saturated fat?
It’s a huge area of controversy. But large reviews of randomized trials, observational research and blood-level data have all found no link between saturated fat or total fat and heart disease. Yet there are still recommendations to limit saturated fat because it raises total cholesterol and LDL cholesterol. But it also raises HDL, and it increases cholesterol particle size, so you actually get a net benefit.
What do you say to scientists who argue that saturated fat does in fact cause heart disease?
I think the challenge with the research is that a lot of the data combines saturated fat in the context of a high-carbohydrate diet. The real danger is sweet fat. If you eat fat with sweets – so sugar and fat, or refined carbohydrates and fat – then insulin will rise and it’ll make you fat. But if you eliminate the refined carbs and sugar, that doesn’t happen. I think saturated fats can be bad in the context of a high-carbohydrate diet. But in the absence of that, they’re not.
What foods do you eat and recommend to your patients?
What I eat is a cross between paleo and vegan diets. It combines elements of the two, so I call it a “pegan” diet. It’s low in sugars and refined carbs, and it’s very high in plant foods. About 70 to 80 percent of your diet should be plant foods. It should also include good-quality fats like nuts and seeds, olive oil, avocado, coconut oil and fatty fish. It should basically include whole, fresh food that’s unprocessed and high in fiber and phytonutrients. I always say that vegetables should make up 50 to 75 percent of your plate.
In a world where fast food is everywhere, wouldn’t that be fairly difficult for most people?
It’s actually very easy to eat well if you just know what to do. The reason most people don’t succeed is they don’t plan their food. They plan their vacations, they plan their kitchen redesign, but they don’t plan out what they’re eating, and that’s a recipe for failure. I always think through how and where I’m going to get my food every day of every week. I also carry with me a set of emergency food so that I’m never in a food emergency.
What are the “emergency foods” that you carry?
I have to protect myself from myself because I’ll eat whatever if I’m hungry in an airport. So I always carry packets of almond butter, cashew butter, an Evolution bar, a Bulletproof bar, a Tanka bar and a KIND bar. I basically have fat and protein as my snacks, and I have enough food in my bag to last an entire day so I don’t make bad choices.
We talked a lot about fat. But what is one overarching message you would most like people to understand?
I think we have to get rid of the prevailing dogma that all calories are the same, and that we just need to exercise more and eat less, which is what the food industry and the government promote. The truth is that you can’t exercise your way out of a bad diet. Metabolism is not a math problem. It’s a hormonal problem. Food is not just energy. It’s information. It’s instructions that turn on or off different switches in your body that regulate hunger and metabolism. Obesity is not about how much you eat. It’s about what you eat. If you just focus on quality, not calories, then the quantity takes care of itself.
Obese individuals who lose as little as 5 percent of their body weight can improve their metabolic function and reduce the risk of developing Type 2 diabetes and heart disease, a new study has found.
Many current treatment guidelines urge patients to lose between 5 percent and 10 percent of their body weight in order to experience health benefits, but the recommendations were based on earlier studies that didn’t distinguish between participants who lost only 5 percent of their weight and those who lost more.
The study, a clinical trial, randomized 40 obese individuals with signs of insulin resistance to either maintain their body weight or go on a low-calorie diet and lose 5 percent, 10 percent or 15 percent of their body weight.
It found that insulin sensitivity improved significantly after participants lost just 5 percent of their body weight, as did triglyceride concentrations, blood pressure and heart rate. There were no improvements in markers of inflammation at that level of weight loss, however.
“Losing 5 percent is much easier than losing 10 percent, so it was important to understand what the differences might be,” said Dr. Samuel Klein, a professor at Washington University School of Medicine and senior author of the study, published in the journal Cell Metabolism. “You get a big bang for your buck with 5 percent.”
On a recent trip to Tanzania with four grandsons, my most important task (beside protecting them from the jaws of a lion or leopard) was to keep them, and myself, in good health. It would not have been much fun to be stuck in a tent next to the commode or flattened on a cot while the rest of the gang viewed a dazzling array of wild animals from the safety of a Land Rover.
Although I came prepared for the worst, I did everything I could to make our trip the best. And I’m happy to report, no one got sick and we all had a great time.
When I described the steps I took to friends and physicians, they urged me to write about them. So here goes, along with a host of other helpful travel hints from well-informed professional sources.
No. 1: I reminded my grandsons daily, any water you drink or use to brush your teeth must come from a sealed bottle that you open. Ice wasn’t an issue in the bush, but that too should be prepared from bottled water. When you take a shower or swim in a pool, keep your mouth shut. (This warning was particularly pertinent for one grandson who always sings in the shower.)
No. 2: Before every meal, we each chewed one pink tablet of bismuth subsalicylate (sold as Pepto-Bismol and various store brands).
I have used this preventive since first reading about it in 1980 in The Journal of the American Medical Association in a study led by Dr. Herbert L. DuPont, an infectious disease and travel medicine specialist at the University of Texas, Houston. The study described how using these tablets greatly reduced the risk of traveler’s diarrhea among American students traveling to Mexico. In a subsequent study published in 1987, Dr. DuPont and colleagues reported that two tablets chewed four times a day reduced the risk of developing diarrhea by 65 percent. (Each tablet contained the standard dose, 262 milligrams of bismuth subsalicylate.)
I have relied on these tablets, albeit in a lesser dose because I’m a lot smaller than average, during trips to Vietnam, Thailand, Peru, Indonesia, India and Nepal, and never got sick despite eating salads and peeled fruit, which one is warned to avoid. In fact, in India and Nepal, my traveling companion, who also took the tablets, and I were the only ones who stayed healthy even though the others in our group assiduously avoided those no-no foods and we did not.
So for the five of us going to Tanzania, I packed 15 tablets for each day of our trip — and no one experienced the slightest gastrointestinal upset. That wasn’t the case, though, for most of the others on our itinerary. However, if you choose to try this preventive, I suggest you check first with your doctor and perhaps consider using Dr. DuPont’s larger dosage.
Without a preventive, which is no guarantee against food-borne illness, stick to “safe food” that is cooked and served hot, and fruits and vegetables you have washed in bottled water and peeled yourself. Never eat undercooked foods — eggs, meat, fish or poultry — or any food sold by street vendors.
Reduce your exposure to germs by washing your hands often, and always before eating. A hand sanitizer with at least 60 percent alcohol can be used if soap and water are unavailable.
I took no chances, especially since I was responsible for four children. I had an emergency supply of Lomotil (for digestive problems) and azithromycin (Zithromax Z-pak, for infections) just in case.
No. 3 (really No. 1 chronologically): I made sure we were all up-to-date on routine vaccines — measles-mumps-rubella, varicella (chickenpox), diphtheria-tetanus-pertussis, polio and an annual flu shot — and added two (for hepatitis A and typhoid) that the Centers for Disease Control and Prevention recommends for travelers to Tanzania. You can review recommendations for other destinations on the C.D.C. website at cdc.gov/travel. We also each filled prescriptions for generic Malarone (atovaquone proguanil) to prevent malaria, and I checked daily to be sure the boys remembered to take it.
I also packed an ample supply of sunscreen, insect repellent with 20 percent or more of DEET, and a first-aid kit of hydrocortisone cream, antibiotic ointment and a variety of bandages, though happily the latter two were never needed. For one grandson prone to motion sickness, I took some meclizine as well.
As the oldest traveler in the group (and the shortest now that my youngest grandson, at age 11, has passed me), I am acutely aware of the risk of blood clots when flying long distances. I always book an aisle seat so I can get up every hour or so and walk around for a minute. It also helps to move your legs and flex your ankles frequently. You might also wear graduated compression stockings on very long trips. Similar precautions apply to long car or train trips.
Although the risk of clots is generally very small, they can be life-threatening. At greatest risk are people over 40, those who are obese or pregnant or have limited mobility (for example, because of a leg cast) or who have a personal or family history of clots. Estrogen-containing medications also raise the risk; I usually take one of those, raloxifene, prescribed to protect my bones. But it can increase the risk of a clot, so I stop taking three days before a plane trip of four or more hours. For more information, check the C.D.C. advisory on blood clots and travel, and talk to your doctor.
Even when traveling alone, I always purchase travel health and medical evacuation insurance because, well, you never know. People on my various trips have broken bones or become seriously ill and had to return home mid-trip. Two men died while snorkeling on separate trips of mine.
Consider carrying a card that lists your blood type, any chronic illnesses or serious allergies and the generic names of prescription medicines you take. Bring some extra doses in case of travel delays.
Other worthy precautions: To avoid nasty parasitic diseases like schistosomiasis, do not swim or wade in fresh water in developing countries or wherever the sanitation is poor. Pools should be chlorinated. However adorable an animal (domestic or wild) may be, keep your distance. Do not touch or feed any animal you don’t know. Some carry rabies. Should you get bitten or scratched by an animal, wash the wound immediately with soap and clean water and, if at all possible, get to a doctor quickly.
If you expect to be at a high altitude (8,000 feet or higher), consult your doctor about medicine to prevent altitude sickness, which can take more than the starch out of a person. I was glad I did when traveling to Cusco, Peru (11,154 feet) and climbing in the Sacred Valley of the Incas (9,000 feet). The recommended preventive is acetazolamide (generic version of Diamox).
Maya, a cat owned by Larissa and Doug Peluso, of Eatontown, N.J., was overweight. The Pelusos feared she wouldn’t like her new diet.Credit
Maya has had a tough time slimming down. After 16 months of dieting, she’s dropped 10 pounds and 6 ounces.
True, that’s more than 40 percent of her body weight.
At her heaviest, the domestic shorthair cat tipped the scale at 24.9 pounds. She looked like a furry Pilates ball.
The decision to lose weight was not Maya’s; it was her owners’, Larissa and Doug Peluso, of Eatontown, N.J. Maya’s mobility was decreasing: She could no longer jump on their bed, and they knew she might be suffering from joint pain and facing diabetes. Their vet said they had to help her regain her feline figure.
Still, they hesitated.
If they reduced portions, Mrs. Peluso worried, “Would Maya get aggressive and depressed?” With no treats to curry Maya’s good graces, “Maybe she would hate us.”
But a new study in The Journal of Veterinary Behavior suggests that owners need not fear rejection if they restrict their cats’ calories. After an eight-week diet, the cats actually demonstrated more affection after they were fed, their owners reported.
“Maybe owners will now be more likely to do what’s healthy for their cats,” said Dr. Bonnie Beaver, executive director of the American College of Veterinary Behaviorists. ”
In recent years, the epidemic of overweight and obese cats has alarmed veterinarians. “My friends in general practice now say they are surprised when a cat comes in with an ideal body weight,” said Dr. Martha G. Cline, a veterinary nutritionist at Red Bank Veterinary Hospital in Tinton Falls, N.J., who monitors Maya’s weight.
Many factors contribute to weight gain in house cats. Among them is the complexity of the human-animal bond, namely how humans demonstrate love with food, and how cats learn “affectionate behavior” in order to get fed.
“We say, ‘dogs have owners, cats have staff,’” said Dr. Richard E. Goldstein, chief medical officer at the Animal Medical Center in New York. “A cat learns to manipulate us very well: when she’s hungry, she’s the most affectionate cat in the world. And people will do anything to keep their cats happy.”
Many owners “free-feed” cats, letting them graze at will. But bored indoor cats, like bored indoor humans, may eat beyond satiety. “Cats don’t self-regulate well,” said Dr. Goldstein.
Concerned with the human role in feline obesity, Cornell researchers asked: If a cat’s food were reduced, would its behavior change? If so, how would owners translate those changes? For the study, 48 cats, each at least 25 percent over ideal weight, were put on one of three restricted diets, equal in calories. Owners answered extensive questionnaires about their cats:
Before the diet, when your cat was hungry, did it beg? Meow? Pace? After feeding, did it jump in your lap? Since the diet, does your cat bat at you? Hide? Hiss? Steal food?
Good news, cat owners! More than three-quarters of the cats lost weight. And though the frequency of pre-feeding behavior increased — begging, meowing, pacing — it did not begin earlier. (Translation: The cats may have intensified owners’ guilt about giving them less food, but did not protract their misery.)
Better yet, owners felt that despite the restricted feeding, the cats did not turn vindictive. Instead, owners believed the cats showed more affection. After feeding, the cats would more often purr and sit in the owner’s lap.
“We don’t know why,” said Dr. Beaver. “But cats don’t hold a grudge if you limit their food.”
Dr. Emily D. Levine, the study’s lead author, now a veterinary behaviorist in Fairfield, N.J., said that one reason cats gain too much weight is that owners “misread” their pet’s behavior, unwittingly reinforcing it with treats. .
When cats rub up against their owners throughout the day, owners like that behavior, she said, so they feel guilty and think, “ ‘Oh, they must want more food.’ So people feel good feeding their cats and don’t know other ways to give them affection.”
And sometimes, if cats are expecting to be fed and the owner isn’t obeying, the cat may swat. “So you feed them to stop the behavior. There’s a learned component. It works.
“A lot of cats are bored and that’s the bigger picture,” she said. “If the only thing they have to do all day is eat, they will ask for more and more.” Rather than overfeed cats to please them, she said, owners could engage their natural curiosity with interactive play, even training them — really — to go to their place and wait for food.
Over the years, Mrs. Peluso didn’t notice as Maya, now 11, gained weight, a phenomenon similar to that of parents who do not see their children becoming obese.
Maya had new-found energy after slimming down.Credit
Putting Maya on a diet was hard. “The begging! The meowing! I felt like I was torturing her!” she said.
With just a few more pounds to reach her goal, Maya is a different cat. “The light is turned on inside her,” said Mrs. Peluso. Maya chases toys and plays hide-and-seek with their other cat. “She can jump on our bed and sleep with us,” she said. “We unknowingly got her into that situation, but we’ve been able to bring her back.”
Some behavior modification obstacles remain, particularly when the couple goes on vacation. Mrs. Peluso’s mother cat-sits.
“My mother says, ‘Where are the treats? The cats need to know I love them!’” And so, Mrs. Peluso said, “I have to hide cat treats from my mother.”
Dawn Lerman and her dad at her bubbe’s house in 1970.Credit
“Eat your soup. It’s good food,” my paternal grandmother, Bubbe Mary, would say.
“Eat your soup. It’s good food,” my dad would playfully tell me, as he reminisced over the wonderful Jewish dinners his mom used to cook for him when he was a boy.
Split pea soup, poppy seed challah with six strands, braised brisket and potato kugel were a frequent occurrence.
“Your Bubbe loved to fatten me up even when the doctors would shame her for how obese I was,” he said. “But Bubbe was proud that her job as a fluffer in the garment district could provide me with such extravagance. Every dairy meal had butter, milk and cheese, and Bubbe made sure there was plenty for seconds and thirds.”
I giggled remembering some of the holiday meals at Bubbe’s, and how I hardly had a chance to swallow one thing before my plate was filled again.
“Just a little more,” she always encouraged. “Food is meant to be eaten, not wasted,” she’d say, squeezing my cheeks until they were bright red and stung with pain. “Think of all the hungry children in the world.”
With each bite I took, Bubbe would profess her love. “Shayna maideleh! Beautiful girl! Who loves you the most in the world?” she would say, as she checked that I polished off every last crumb on my plate.
But other than holidays, we did not visit Bubbe much. My dad was a rising star in the ad industry — he was an international creative director at the ad agency McCann Erickson, but Bubbe was confused about what he did for a living and was disappointed that he did not have a regular job like his brother Melvin, who was an accountant. Even before I knew what an accountant was, I knew my dad’s job was super-fun as he got to work with Tony the Tiger and the Pillsbury Doughboy. But Bubbe was never impressed: “A Jewish boy should be a doctor or a lawyer!”
My dad felt that if they were not talking about food, the room was silent, so he made jokes — most of which Bubbe did not understand — to break the silence. Even when my dad was a child, he did things that she did not understand, like creating satirical comic books, or questioning why they had two different sets of dishes, or turning the lights on and off on Shabbat when she strictly forbid it.
As my dad showed me how to slice the mushrooms for the soup, he talked about his new account: Campbell’s. The current campaign, “M’m! M’m! Good!” was no longer generating enough sales, and it was my dad’s job to help create a slogan that would sell more soup.
While we stirred in the barley and shredded the meat for the broth, my dad shared the story of how when he was in the sixth grade, he got beaten up by a bunch of bullies who jumped him from behind, hitting him with lead pipes until he was unconscious.
“Fat mama’s boy! Fat mama’s boy!” they taunted. The beating was so bad that he spent a week in a coma, and the doctors didn’t know if he would live or die.
Helpless, my bubbe cooked all day and all night, praying for his recovery. She hoped the smells of her famous mushroom barley soup, which she schlepped to the hospital, would revive him. When my dad awoke, Bubbe was standing there with a big pot, a bowl and a ladle — fully believing in the healing powers of her thick broth, made with beef bones, beef chuck and tomato paste.
My bubbe cooked all through the night when my dad was in the hospital, showering him with cinnamon raisin rugelach, sponge cake with an orange glaze, and mandel bread with big chocolate chips — feeding him obsessively, but never telling him she loved him.
My dad wanted to feel comforted by all the amazing food she had worked so hard to prepare, but he felt angry. He wanted to be thin. He wanted to be popular. He wanted to have self-confidence. The very food, which brought him such extreme pleasure, caused him to be bigger than the other kids, leading to ridicule and worse, landing him in the hospital.
When my dad dieted, he felt as if he was betraying my grandmother and dissolving the one bond they shared. Of course, as a child I didn’t know any of this; I didn’t understand the relationship between my father, my grandmother and food. I just knew that Bubbe Mary was a wonderful baker, and my dad missed her even though he would never say it.
As my dad served us each a warm bowl of mushroom barley soup with sweet parsnips and bay leaves, we looked at each other. “Eat your soup. It’s good food,” we said in unison — imitating Bubbe’s Yiddish accent.
The next day when my dad came home, he smiled, announcing the new tag line and jingle for Campbell’s soup, “Soup Is Good Food,” inspired by my bubbe’s soup.
The soup that revived my dad when he was in a coma. The soup he taught me to cook. The soup that said “I love you” the way Bubbe showed her affections best — spoonful by spoonful.