A Snack Cake a Day Keeps the Doctor Away?

As an educator and scientist, it is my goal for students to think critically. For the courses I teach, those issues pertain to energy intake and energy expenditure. Thus, to have them thinking outside the box, I decided to initiate a “diet” concept that originated during discussions with my graduate students a few years ago. The premise of the project is to better understand dietary energy and its effect on health outcomes. The question being, does it matter where our energy is derived if we meet the recommended daily allowance of essential nutrients? To that end, it is often recommended to avoid foods containing refined grain, added sugar, and solid fats (e.g., grain-based desserts like cookies and cakes) as some have labeled them as obesigenic. Thus, those foods were the centerpiece of my daily “menu.”

In an attempt to meet other nutrient needs (protein, vitamins, and minerals), I included a few low-calorie vegetables, whole milk, and a multi-vitamin/mineral supplement (one to two per day). Energy intake was set at 1,800 kcals/day. The limit was selected as an amount I thought I could maintain with minimal effort, yet would still allow for relatively rapid weight loss (1–2 kg/wk). It was designed so that on most days meals or snacks would consist of 400–450 kcals of energy consumed four times throughout the day. Exercise was a part of my lifestyle, but at a level below what is recommended as I only exercised 60–90 min/wk (cycling, walking, and resistance training).

The initial duration of four weeks was selected based on issues pertaining to the structure of the class. That duration was long enough to elicit change, but short enough to be able to discuss the outcomes early in the semester. Also, data indicate that foods containing SoFAS (solid fats and added sugar) lead to detrimental outcomes relative to markers of cardiovascular disease especially lipid-lipoproteins. The duration was extended once the public interest increased. To highlight other aspects of energy balance and obesity issues, it was decided to continue that eating behavior until my body mass index (BMI) was in the “healthy” range of 18.5–25 kg/m2.

Results to Date: My BMI is 25.8 kg/m2 and my body weight has decreased by 10 kg (22 lbs). After four weeks (mid-September), body fat decreased by 5.4 kg (12 lbs). The markers of heart disease risk all improved as total cholesterol, LDL cholesterol, triacylglycerol, total:HDL ratio, triacylglycerol:HDL ratio all decreased 20–30% and HDL-cholesterol increased 5%. These variables will be reassessed once my BMI is < 25 kg/m2 and again after additional 4 weeks of weight maintenance (mid-November).

Implications: Assuming that decreasing weight in order to no longer be overweight is healthy, does it matter how we get there? Do biomarkers play a role in that answer? In other words, if I had posted my results (body composition and CVD biomarker changes) without posting how those results were achieved would most consider my health to improve? I would speculate that most would consider my health was improved, or at least my risk for cardiovascular disease was decreased.

With the global effort to reduce obesity, the overwhelming message is to decrease weight—not body fat, yet that is presumed to be the meaning. Given the public intensity to reverse increasing BMI values, it might be presumed that any means to do so should be supported. If all means are not acceptable, then the public health message must change to reflect that the means are as important, if not more so, than the ends.

If the method is important, how are we to know what methods are acceptable or recommended? That is, it seems to be that health and healthcare costs are key outcome variables. If a method leads to improved valid outcome variables, should that method be considered healthy even if it contradicts current recommendations?

Mark Haub, Ph.D.
Associate Professor
Dept. of Human Nutrition
Kansas State University
haub@ksu.edu

19 Responses

  1. Hi Mark,
    One of the issues is that of ‘overweight’ vs. level of fitness. It is very possible to be above a 25 BMI yet have a high level of fitness (eg many pro athletes) as well as to be in a ‘healthy’ BMI range and at a less than satisfactory level of fitness (eg couch potato who watches their calorie intake closely). Perhaps the focus on BMI should be replaced by % body fat, resting heart rate, and blood pressure, for example. BMI being a square function, while most people grow in three dimensions (and weight is a function of volume) has inaccuracies if the person in question is not of average height. Regarding your diet in the study, I would be concerned about the (presumably) low level of fiber and what negative health effects that could have.

    Mark

  2. Mark — Totally agree and these issues (fitness and other assessments) are discussed at length in our class. However, while the concepts are “accepted”, for some reason they are lost in many, if not most, public messages. In my professional opinion, the message should be to improve health regardless of weight or fat (% or otherwise). Your point of using other markers needs more public discussion, which I hope is an outcome of the “publicness” of this exercise. I hope that the gaps/issues that were purposefully incorporated, as you recognized, gain public traction to elicit change. — Mark

  3. Instead of eating a twinkee, you can eat two medium apples which 1) keeps you full for a longer time therefore makes your dieting more bearable, 2) are full of antioxidants that helps keep cancer and other chronic diseases away, 3) are loaded with fiber that is a must for gastrointestinal health.
    If you continue your diet for long term, I am sure you will face some health problems.

  4. Leyla – Great statements and that scenario (eating fruit with fiber) certainly is a possibility, but I am unaware of data indicating that fruit elicits greater satiety than dessert/snacks when matched for calories. Moreover, the effort to reduce obesity, the top public health issue according to many, advocates for reduced weight or BMI. Thus, this exercise was focused on addressing that issue using foods many prefer to eat, yet health professionals recommend avoiding.

    As I understand the science, I do not think there are data to support the notion that eating fruit/fiber elicits greater satiety than dessert when matched for available energy. Moreover, the cost of the apples are nearly 10 times the cost of a twinkie. I have been following this lifestyle for 9 weeks, and I personally have not found it unbearable.

    The effect on gastrointestinal health also needs more investigation as there are minimal clinical trials completed. One recent study (Stewart et al, Ann Nutr Metab, 2010) reported four different dietary fibers elicited “mild to moderate GI symptoms” with no effect on markers of chronic disease — the weight loss diet I have followed did elicit change in markers of chronic disease. Their study was only two weeks, but my blood values did change in that same limited period of time. Maybe the diet I am following is more heart healthy, while higher fiber diets are more GI healthy? We cannot overlook genetic issues when making health assumptions nor the fact that my case report (n=1 and designed for class discourse not peer-reviewed publication), like an associative study, cannot indicate cause-effect.

    In summary, your comments/suggestions definitely hold merit, but critical as saturated fat was once assumed unhealthy, but recent clinical data indicate that increasing saturated fat intake (and without increasing fiber) can actually lead to improved health outcomes. Thus, more clinical data are needed to clarify many diet-health questions.

    This exercise was not to determine an “optimal” diet, but was designed to highlight flaws in focusing only on weight or fat loss. Lastly, the discourse this exercise has elicited in class and publicly has been fantastic. Thank you for your comments and suggestions — Mark

  5. Wonderful personal intervention study, Mark. I certainly would fall into the camp of believers that in the absence of any other outcomes measured, that your “health” had improved.
    Whether or not the means to the end are relevant requires clear agreement of the “end” desired. Your outcomes reflect, as your wrote, a mitigation of atherosclerotic CVD risks.
    Regarding other measures of “health” there are no data. In fact you reference BMI and body fat, but did not report any body fat data.
    The question you raised – how are we to know what methods are acceptable or recommended – requires rigorous controlled study (as you know) likely including measurement of a variety of outcomes. In the absence of such, it is probable and prudent that public “health” recommendations will continue to be made based on epidemiological correllations – correllations aimed at targeted but limited measures of “health”.

  6. Mark, Great n=1 experiment. Personally I believe sugar has been demonized. Let’s face it it is a great inexpensive source of calories. The problem is too much sugar. I used to have with breakfast a couple of spoonfuls of fruit jam. I changed that to having fresh berries or black grapes with a spoonfool of brown sugar with my morning cereal. This way I get the calories and the fresh fruit vitamins, phytochemicals and fiber. The whole subject is fascinating but I agree that a lot more research needs to be done. Obesity does not result from fats and sugars but from TOO MUCH fats and sugars!

  7. Pat and Pedro — I agree with both. Since this was an ‘exercise’, I chose basic outcome variables. However, relative to your point Pat, some studies have used limited variables and still claimed, or inferred, improved health and were published in peer-reviewed journals. Pedro, I think your last point gets lost in the effort to reduce sweeteners and fat. Nutritionists and dietitians tend to focus on individual foods versus total intake.

    It’s been interesting that such a basic case study has illustrated several gaps in our (as a whole, not individually) understanding of the diet – health relationship. Thank you both for noticing and voicing important issues — Mark

  8. Mark

    Fascinating study. I agree with you that I really don’t think it matters where the nutrients are derived from and that losing weight and controlling the obesity epidemic is essential. For this, satiating food products can be developed with enhanced nutritional properties. I also believe that all foods in moderation is key. Recognizing the importance for healthier snacks/dessert alternatives, I developed a line of instant puddings and gelatins that are high in fiber and heart healthy and are very satiating. The puddings are also fortified with protein and I find that when the puddings along with milk required to make them and when topped with fresh fruits provides the best of both worlds. I would be happy to send you some samples.

  9. Malathy — That (‘regular’ food with enhanced nutrition) is my goal as well. Behavior change is a novel pursuit, but years away. Thus, my professional efforts are to find ways to make foods that people already eat a little healthier — just a you described (increased fiber + protein). It still baffles me why some were bent out of shape when Froot Loops added fiber to their recipe. Makes me wonder if those in opposition were reacting to the ‘brand’ and not what was in the box. I am not saying Froot Loops are the healthiest cereal option, but the added fiber enhanced it. It is frustrating to me (and a reason for the diet exercise) that people will target foods based on a single ingredient — typically ‘sugar’ or saturated fat — and overlook the other nutrients that are included.

    Keep up the good work and I look forward to seeing your products on shelves across the globe. Best wishes — Mark

  10. Mark,

    I think your study suggests there are more factors at work in obesity. You wrote that the study “duration was long enough to elicit change.” You pre-suposed that a change would occur. I believe your mindset was a factor in reducing your BMI. This is a Mind, Body, and Spirit issue. Someday there will be an MMI (mind mass index) and SMI (spirit mass index) to combine into a unified obesity theory.

    Jeff

  11. Interesting study. Although it defies what I’m personally all about I do like those thinking outside the box and breaking conventional wisdom apart. I’d be interested in seeing the long term effects of this that can’t be seen in a short study (a few weeks is extremely short when studying a diet). Similar issues as astronauts losing bone density. The amount of protein and fat you’re getting from the milk and other sources is an important part of that equation, and how much sugar from junk food. The exact types of exercise and intensity levels will also be a huge variable since the diet could be pretty good for some types of athletes but not others. It’d be interesting to see the study taken further with higher exercise amounts and varying levels of junk sugar (keeping other factors constant). Will a few years of getting calories from consuming sugar in place of other sources modify your metabolism in such a negative way that it could be devastating later and not even be noticeable now? Could diabetes be a concern with doing this? It can be entirely genetics and your body’s initial metabolic rate may prevent that, but could affect someone else who is much more susceptible. Good study, thanks.

  12. So, you can enjoy what you’re eating and be healthy? Something is wrong here: it beats the shit out of the politically correct nutritional dogma. They still get to cling to “yes, but the long term…” They may have a point: I personally guarantee that if you continue this diet for the next 60 years you will eventually die.

    Thanks for posting.

  13. Ursus – Spot on, that’s what was said about low carbohydrate for years, yet there were limited clinical studies illustrating the longterm effects of low fat until Dr. Jeff Volek, at UConn, came onto the scene to compare the diets.

    I hope all of the preservatives keep me around past your 60 year guarantee :-).

    Jeff — As a student of psychology many moons ago, I agree that the mindset can be an important factor regarding physical health.

    Cheers – Mark

  14. Jason — Your points are similar to those raised in my classes. The problem is that the public health message is focused on weight, BMI, and fat. The other important factors are rarely raised in the typical 1-2 minutes soundbites provided by media. Rest assured, as I have only begun this ‘public’ project, there are many weeks and months ahead to address more issues. As stated previously, the same concerns were raised about saturated fat, and now there is ample data indicating that nutrient, by itself, does not increase heart disease even though that concept is still taught by some.

    Best wishes — Mark

  15. What was the actual intent of publicizing this project? I trust that your students already knew the basics that constitute the entirety of your results:

    Weight loss happens when fewer calories are eaten than are burned.

    Sudden changes in dietary stimulus will require weeks for the body’s adaptive reaction to catch up and cause stasis.

    Brief periods of junk-food consumption will have no necessarily permanent effect one way or the other on health markers and body composition.

    I consider the final roll-out this year of the corn industry’s campaign to favorably reposition high-fructose corn syrup, and I wonder if there is a pending wave of projects such as yours. After all, one hardly needs an n=1 partial-junk diet to confirm that eating a Twinkie every day is no big deal. (Obviously, it is the consumption of ONLY cheap, calorically-dense, and nutrient-poor food that is causing increasing obesity and health risks in some segments of the US population.)

    But food companies would financially support giving a professorial patina to social-media-driven publicity that leads to, as you wrote, “typical 1-2 minute soundbites” extolling the ‘not-so-badness’ of junk food. In your opinion, should we be expecting more of this?

  16. Markus — My personal intent of publicizing this was to appease my department head, who requested the story. The public interest took over after that initial university release.

    One of the remaining issues that is interesting is that some feel the process I chose was unhealthy yet the biomarkers paint a different picture — which picture is health? I think a key aspect of this was that someone “from within” went against the grain. Another issue that has not received much attention is the use of supplements for whole-foods to meet nutrient needs. This is interesting given many stated I would experience nutrient deficiencies if the diet continued.

    I totally agree that the concepts are basic. However, given the magnitude of interest, there still appears to be confusion among professionals and consumers alike.

    Also, your concept/comment about the negligible effects of eating energy dense foods occasionally is not necessarily agreed upon by some dietitians or health professionals.

    Regarding sound bites, that is an issue that needs resolved. However, another issue that needs addressed is that some health professionals misreported information (Dr. Oz made a public mistake by incorrectly calculating the energy balance/deficit of my project).

    On a positive, we will be examining ways to make some of these foods ‘healthier’ in the coming months via clinical trial(s) to test some outcomes of altering the ingredients with items deemed by many to be healthy — whether they are is a different story.

    Great comments and hope these discussions move nutrition and food science forward.

    Thanks — Mark

  17. Your department head asked you to post weekly results on Facebook?

    This is the “social-media-driven publicity” to which I referred, and which leads to the shallow type of “1-2 minute soundbites” that you decry—while simultaneously relying on them for raising your own visibility.

    Your acknowledgement of the utterly “basic” nature of your project underscores this motivation aspect related to my original question. The initial KSU press release to which you refer stated that you were “…attempting to prove some common beliefs about nutrition are untrue.” KSU’s online College News publication was headlined, “Haub uses snack diet to debunk nutrition myths.” (Curiously, this headline was used when you had just started your ‘experiment’. Was this a case of study bias?)

    But what “myths” were those? The ‘myth’ that eating fewer calories than are burned can cause fat loss? The ‘myth’ that losing bodyfat can lead to improved health markers? Setting up an easy straw-man ‘myth’ and then knocking it down hardly counts as “debunking”, nor does it “prove” any known nutrition facts to be untrue.

    It does, however, make for great soundbite material. You have written in another blog that the “media has their agenda, which tends to be different than mine—they want to highlight the ‘junk’, while my intent is to highlight gaps in our understanding of diet, health, and weight.”

    But isn’t this extremely disingenuous on your part? As I pointed out, you have offered no research to further a discussion of “our understanding of diet, health, and weight.” (Unless you believed that a common dietary assumption is that eating snack food for a couple of months causes permanent health damage.)

    Rather, you have used the junk-food aspect as an attention-getter for you and your department, incorporating the very “someone from within” angle that you admit. To now claim that the media has a “different” agenda than yours strikes me as silly. You both shared the exact same purpose: competing for viewers.

    Unfortunately, of course, the residual impact for many ill-informed and overweight people—after the media have moved on to the next superficial health tidbit—will be that a nutrition professor said it was OK to live on junk food. And I doubt that you are naive enough to have believed that this aspect would be obscured by a simplistic ‘calories matter’ observation. This is probably the one area of nutrition that cannot be said to be an American knowledge “gap”. If anything, the “confusion among professionals and consumers” that you mention in your reply has been increased, not clarified, because of this publicity stunt.

    I’m not criticizing your results or even your intent. Coming from a family of professors, I understand the need to ‘publish or perish’. But one would have hoped that, in your case, this effort led to more than an n=1 reconfirmation that weight loss is a matter of calories in versus calories out. This has been known for a century or so.

    But to return to the apparent main issue, how are your book-publication discussions going?

  18. Markus — Sorry, for the late reply. Great points and all valid.

    I think an issue that gets lost (and I have lost it, too, on occassion) is that this was a project/experiement, not a scientific study – since the ‘PI’ would be the “case”, creates a validity problem. The experiment (testing a concept/theory) is similar to a case report where I, the case, reported what I ate and how that food, in the amounts eaten, affected health outcomes. It is no more, or less, than that.

    Regarding my bias, I my hypothesis (the food would lead to weight/fat loss) did not include bias regarding CVD and diabetes markers – I was thinking the ‘null’ hypothesis would be evident given the public and professional views regarding the health related aspects of ‘junk’ food. That is, I was anticipating illustrating to the students that someone might lose weight, but biomarkers might contradict that “healthy” observation. However, that did not happen to my surprise. Even Dr. Stork (MD) made the distinction that most people don’t eat it the way I did — indicating it may not be the food but how it is incorporated into one’s lifestyle.

    If this simple project led to greater public and professional confusion, I take that to mean this concept is more complex than “energy in energy out” or “move more, eat less”. If it were that simple, it is my belief that this experiment would not have reached global interest. Why this was a global story should be examined by someone as most professionals agree that it’s a simple concept, yet the concept was not understood by even some in the medical community — evidenced by the piece run by Dr. Oz, where they talked about me without notifying me or incorporating any of my comments. He made mistakes with little evidence (no published studies I am aware of) to support his comments pertaining to cravings, fuel, and “energy”.

    I will say my biggest mistake was the Good Morning America effort, that was a big “fail” on my part as I was naive to think that my views would be shared, which they were not.

    Going back to the intent, I was interested in seeing whether the foods or their ingredients (sugar and HFCS have been a hot topic lately) affect health as suggested. From a biased perspective, some scientists and educators state those foods I ate would lead to increased CVD risk and obesity. My hypothesis was the energy, not the food, would control those risk markers and body weight/composition.

    This effort did lead to more than energy in/out knowledge. Additional issues covered: whole food vs processed food/supplements; weight loss may not always healthy; can health ‘improve’ when following a lifestyle that is not recommended; the understanding and application of glycemic index & load (cake + icing has been measured as Low GI, yet assumed to elicit a glucose “spikes”); and, the current biomarkers may not accurately affect health (out of context). Bear in mind, there were a number issues discussed in class (and a few times publicly when time allowed – a few 20-30 minute radio discussions). Also, the students hear messages publicly and in other classes that paint the picture that what I did “can’t” happen – I thought showing them might be more convincing than talking about it would be more convincing and interesting. Thus, as a class experiement, it was successful. It seems I failed in the public arena, which is fine and this is a skill I am working to improve.

    Regarding competing for viewers, I am unsure how to respond as I never called anyone in the media to ask them to air the story. In every case, I was contacted. It might be cutting hairs, but I view ‘competing’ as actively seeking attention.

    While I have been enticed by pursuing a book (especially individuals like Alan Colmes state it would sell millions), I have not pursued that endeavor. I have struggled with the decision as it would be a way to financially care for my family. However, as stated at the beginning of this article, I am an educator and scientist. Should I decide to give up one of those, then I might pursue author.

    Thanks again and the capacity to have discourse is a positive, even if the project itself was a public failure. I do think it was one of the most effective classroom exercises I have used to date.

    Best wishes — Mark

  19. You write that your “experiment…reached global interest,” yet that reflects precisely the type of publicity-seeking mentality to which I referred. There was no real “global interest”; there was your 15 minutes of mostly national fame as the professor who said it was OK to eat Twinkies. Now that those 15 minutes are over, there is no lasting effect from the incident, except among those nutritionally uneducated people who loved hearing that their junk-food diets are not so bad after all.

    For your stunt to have constituted an “experiment”, you would have had to do a lot more testing than to merely include some junk food in your supplemented diet, and you would have had to do this for a much longer timespan. It was already well known that eating such empty calories does not cause much (if any) change in biomarkers, when consumed for a brief period of time. Therefore, your attempt here to contend that you were trying to enlighten people about this issue sounds hollow: Scientists certainly didn’t learn anything from it, and the unenlightened folks merely heard confirmation that junk food is OK.

    If your students truly needed more information on the basic facts of lipolysis and nutritional effects, perhaps you should have directed them to read the copious existing research on these matters, rather than your Facebook posts. I still don’t see what you purportedly “proved” that wasn’t common knowledge to people who use more extensive and credible sources of learning. While your students may indeed “hear messages publicly and in other classes” that are shallow and incorrect, especially on Facebook, I certainly hope that you do not use that as your standard for instructional comparison.

    Again, I’m not trying to condemn you for choosing a superficial way of documenting your brief junk-food intake, nor am I faulting you for taking advantage of the superficial and temporary media attention. That’s the way that the media covers most health matters, which is why you received cursory and incomplete coverage by GMA and Dr Oz (who has lost most of his credibility as a health practitioner, anyway). But what did you expect? You didn’t conduct any real research, and you chose to publicize only the most attention-getting sort of summary—one which appears to have been predetermined, judging by your university’s press-release headlines that you somehow knew that you would “debunk” nutritional myths before you had even started your diet. That doesn’t sound like any serious research that I have conducted or encountered.

    I do not know your original motivation, of course, so I do not attack your intent (although I do question it), and I commend anyone who wants to add something substantive to the nutritional discussion. But the salient points in my posts are those that still pertain to this episode. In terms of furthering nutritional knowledge, it was, as you pointed out, a “failure”. But in terms of angling for a small publishing deal or some industry funding, your approach would be appropriate.

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