An essential health resource for current and former smokers - An essential health resource for current and former smokers

Junk Food: The New Smoking

As much as cigarettes have become more and more socially unacceptable over the past few decades, a new dangerous trend is replacing them – excessive junk food consumption.

Now, before you cringe and compare me to New York City’s ex-mayor Bloomberg with his bans on trans fats and oversized sodas, hear me out.

Overconsumption of junk food

It would be unacceptable to give children cigarettes as rewards for doing well in school – yet it’s completely ok to shower them with candies, slurpees, sodas, etc. At most business lunches, there are probably more unhealthy choices than healthy. Heck – I’ve attended lectures on diabetes and obesity where an abundance of pastries, cookies, and donuts were served. TV is full of ads for junk food, sodas, etc. And let’s be honest – in this day and age, someone is much more likely to go up to a person smoking a cigarette and chide them than to someone drinking a large soda while munching on a hot dog and fries.

I know what you’re thinking – smoking is much more dangerous then eating junk food; furthermore it’s addictive. While those arguments are certainly true, what I don’t understand is why junk food consumption for the most part is completely acceptable. As a result, we’re seeing the amount of obesity in both children and adults reach an all time high. The obesity-related illnesses such as diabetes, heart disease, stroke, liver disease, and certain cancers are threatening to reverse some of the gains that we’ve made in life expectancy.

The solutions isn’t to ban junk food…

I am not here to suggest banning junk food completely – such an idea is unrealistic and unnecessary. What I do propose is for us to take a long hard look at what we’re eating and what we’re feeding our children, and make small changes. Perhaps we can demand more healthy choices at school and at the workplace. Certainly, whatever is in our control currently should be optimized. Don’t add a third junky item to your child’s lunch bag – provide an apple or carrot sticks. Encourage your children to drink more water instead of sugar laden beverages – and do the same yourself.

I have a feeling that years from now we will look back with dismay at how an entire generation of people was being poisoned with horrible food much in the same way that we look back at how cool and acceptable smoking was for so many years.

- Tamir


Fruits and Vegetables Decrease Mortality

With the overabundance of different health gurus and diets out there, often spewing conflicting advice, it can seem hard to decide how to go about establishing a healthy diet. Low fat. Low carb. High protein. Vegetarian. The truth is that many diets have something to offer. However, many are too extreme, and for no good reason.

That is why we emphasize the basics in our book and blog. Stick to a minimally processed, natural diet. Eat more fruits and vegetables. Cut down on sugar, fried foods, processed carbohydrates, and unnatural fats. Eat things close to how they’re found in nature.

Based on a recent study published in the Journal of Epidemiology and Community Health, we can add another simple, straight forward piece of nutritional advice: Aim for 7 or more servings of fruits and vegetables daily.

The study followed survey data over an average of about 8 years in over 65,000 people over the age of 35. They found that those who consumed seven or more portions a day of fruits and vegetables decreased their risk of dying by 42%. This included a 25% reduced chance of dying from cancer and a 31% chance of dying from heart disease. Vegetables seemed to be slightly more protective than fruit. Of note, canned fruit actually increased the risk of dying by 17% (presumably because it has fewer vitamins and is often loaded with sugar).

There you have it. A simple goal most people can strive for. Although it may seem daunting, 7 servings is not as much as you think. Include some fruit for breakfast and snacks, add a salad and cooked vegetables to lunch and/or dinner, munch on some carrot sticks or other veggies as a snack, and before you know it you’ve reached your goal. Furthermore, don’t forget that it isn’t all or nothing. The above study showed that eating 5-7 servings reduced mortality by 36%, 3-5 servings by 29%, and as little as 1-3 servings a day by 14%. If you can’t get to 7 servings, aim for whatever is feasible. Often times, if you start with 2-3 servings, you can over time slowly increase the amount until you hit seven. Doing things gradually is often more effective than effecting drastic changes.

- Tamir


The Link Between Saturated Fat and Heart Disease May Not Be What You Think


What is the link between saturated fat and heart disease?

In our book, we mention that saturated fat probably isn’t a big deal when consumed in moderation. For a while now, despite many experts in the field of nutrition crucifying saturated fats as nutritional pariahs causing heart attacks, the evidence behind those claims has been quite sketchy. This has led to scientists revisiting the original claims.

A very large, well-done study from the Annals of Internal Medicine provides solid evidence that saturated fats probably aren’t so bad. The study looked at data from over 600,000 people involved in different types of studies all looking to find an association between intake of different types of fat (mostly from diet, but also supplements) and risk of heart disease. With the exception of trans fats (a harmful type of processed fat found in margarine, shortening, and many processed foods), no other type of fat seemed to have much of an impact (although some studies did suggest a slight possible benefit with intake of omega 3 fats found in fish).

What could explain the research results?

How can this be, you ask? First of all, saturated fats are a heterogenous group of fats. Stearic acid from meat is different from palmitic acid from dairy; both are different from shorter chained fatty acids found in coconuts. To lump them into one group is an oversimplification. Second, although some types of saturated fats do indeed raise LDL (the “bad cholesterol”), they tend to increase the amount of “large fluffy” LDL particles which do not contribute much to clogging arteries (versus the “small dense” types that do). Third, saturated fat can raise HDL or “good cholesterol,” which protects the heart.

Finally, a lot of diet studies are very poorly designed. For example, there’s a very common type of study which is done comparing a “Western-type” diet consisting of foods high in sugar, white flour, fried foods, and red meat, to a healthy type diet rich in fresh fruits and vegetables, fish, nuts, beans, etc. Guess which group does better? Of course, the healthy type diet. However, how do we know that the saturated fat or meat was what made the “western” diet worse? Perhaps it was the high intake of sugar, fried foods, white flour, trans fats, or other processed foods.

It seems more and more that the proper diet to follow is what we discuss in our book – one that is close to how things are found in nature. The more processed a food is, the less healthy it is. Thus, an apple is healthier than apple juice. Whole grains are better than bleached white flour. Berries or watermelon are healthier than sugar. Free range beef is healthier than cured hot dogs.

This doesn’t mean that you should go deep fry everything in butter. However, if you focus on eating a natural diet high in fruits and vegetables, and you regularly exercise and don’t smoke, then don’t stress so much – that piece of cheese or pat of butter isn’t going to do you in.

- Tamir


Quick weight loss tips

I recently came across the following article, which has over a dozen quick tips to help us to lose weight. You can click on the link for the full article. Below I highlight some of the quick weight loss tips that I found most interesting.

  1. Eat with your non-dominant hand – a study in moviegoers showed that those who ate with their non-dominant hand (in most people their left hand) consumed half as much popcorn as those eating with their dominant hands.
  2. Get enough sleep – those with the least amount of sleep had increased levels of a hormone that causes hunger and decreased levels of a hormone that causes satiety
  3. Use olive oil instead of butter with bread – researchers found that those using olive oil ended up consuming less bread and calories overall. Furthermore, olive oil, especially extra virgin, is probably healthier than butter.
  4. Chew each mouthful – a Japanese study found that fast eaters on average weighed 15 ½ pounds more than people who eat slowly. When study participants were asked to chew each mouthful 15-20 times, they ended up consuming significantly fewer calories.
  5. Clench your fists for 30 seconds – this has been shown to reduce food cravings and prevent temptation to indulge.
  6. Eat in a quiet restaurant – eating in loud, noisy places causes our heart rate and blood pressure to increase which leads to us eating more and drinking more alcohol.
  7. Don’t shop hungry – people who shop hungry tend to buy too much high calorie, high sugar, high fat food.
  8. Compounds in chili peppers, cayenne pepper, jalapeno peppers, olive oil, and apple peels may help boost weight loss.



Consuming too little salt: How recent research disputes current guidelines

Too little salt also isn't good

Many of the current health guidelines stress limiting the intake of salt (referred to as sodium on nutrition labels) as a means of reducing adverse health outcomes, particularly strokes and heart attacks. The current guidelines in the US recommend limiting salt intake to less than 2,300 mg of sodium a day and less than 1,500 mg in high-risk individuals.

However, recent research, including a large study published in the American Journal of Hypertension, disputes these findings.

The study authors looked at data from over two dozen studies investigating salt intake and mortality, especially from heart disease. Data included over 250,000 people, both healthy and with underlying diseases. What they found was that people who consumed the least amount of sodium (less than 2,645 mg daily) as well as the most (over 4,945 mg), had higher rates of mortality and cardiovascular disease by roughly 10-15%.

What does this mean for us? It so happens that for the most part, the saltiest foods are ones that are processed and unhealthy anyway. These include canned foods and soups, instant meals, chips, many breads, cured meats, etc. One way you can tell is by looking at the nutrition labels. Any food that has more than 150-200 mg of sodium per serving is on the high side (note that some canned soups can have up to 1,000mg!). By cutting down on processed foods, which are anyway unhealthy, you automatically reduce excess salt in your diet. After that, if you like to add a pinch of salt here and there, it’s unlikely to be a big deal.

The only caveat I have is for people with certain medical problems such as heart failure or kidney disease. They should follow the advice of their doctors and nutritionists.

- Tamir


How Can Smelling Fresh Fruit Help You Eat a Healthier Diet?

Fruit display

Sticking to a healthy diet can be difficult, so it’s good to have some aces up your sleeve.

Two new studies published in the journal Appetite show some neat little tricks you can use to help you choose healthy fare.

The first study split 115 people ages 18 to 50 into two groups. All test subjects were given some made-up purpose for being in the study. One group was told to wait in a room that was sprayed to smell like fresh fruit while the other group was told to wait in a similar room but without the fruity odor.

Afterwards, all participants were taken to another room and told to pick an appetizer, main course, and dessert from a set menu. Each course had a healthy choice and an unhealthy choice. The group that had waited in the room that smelled of fresh fruit were much more likely to choose the healthy dessert than the group from the unscented room (50% vs. 75%).

The second study looked at how food is presented. Diners at a restaurant on two different nights were offered an identical healthy meal; the only difference being how it was presented on the plate. More diners judged the meal as being tasty when the presentation was neat and appealing.

The take home message from both studies is that incorporating small changes/ideas can help you continue making healthy choices. It’s well-known that olfactory and visual stimuli affect what we eat and crave. Who hasn’t walked by a bakery, smelled the wonderful aromas, looked at the delicious baked goods in the display case, and not had a craving to run inside and buy something? By trying similar things with healthy foods (smell a fresh apple or orange before going out to eat, make your meals look vibrant and appetizing), you increase the odds of maintaining good eating habits.

- Tamir


8 kinds of “healthy” foods that are high in calories

There are few things more frustrating than going on a strict diet, trying your very best to lose weight or to improve your cholesterol or sugar levels, only to fail miserably – and all because of common misinformation. There are many foods out there that people think are healthy (or at least acceptable), but in reality are loaded with many calories, unhealthy fats, and sugar. Below, in no particular order, are 8 “healthy” foods that are high in calories.

1) Granola

High calorie granola

What can be healthier than rolled oats or puffed rice?

If you look at the nutritional labeling on most granola products, you’ll see that they’re high in calories, sugar, and fat. Often, the serving size will be quite small to deceive the consumer (make note of the serving size, figure out the actual portion size someone would typically eat, and add up the calories). Many brands also contain unhealthy high fructose corn syrup and cheap vegetable oils.

2) Sweetened yogurt

High calorie sweetened yogurt

Yogurt is usually thought of as healthy. Add the image of a fresh-looking strawberry or blueberry to the packaging, and what better food can you snack on?

Unfortunately, many fruit-flavored yogurts (or those with other flavors such as chocolate or vanilla) contain as much sugar as soda. A better choice would be plain yogurt with cut up pieces of fresh fruit.

3) Juice


I’ve had several patients, including people who are diabetic, tell me that they drink juice a lot, or that they substitute orange or apple juice for soda or iced tea. After all, juice can be “all-natural” with “no sugar added.”

Unfortunately, even 100% juice is jam-packed with sugar. Although there’s no sugar added to it, one cup of fruit juice contains the sugar content of a few pieces of fruit (which is often as much sugar as soda), without any of the fiber that the whole fruit has which helps slow down the absorption of the sugar. Stick to water or seltzer with a squeeze of lemon or lime for flavor.

4) Energy bars

Energy bar on a plate

Energy bars also give off the image of health; you picture some muscular athlete at the gym chomping on his power bar after bench pressing 500 pounds.

Energy bars may have their place with professional athletes who are training for hours every day. However, for the vast majority of people, one energy bar can contain more calories than what you just burned off at the gym.

5) Sports drinks

Sports drinks equal sugar for the most part

Another scam. They’re basically water, sugar, and a bit of salt for “electrolyte” replacement. Some will contain a few vitamins for “energy.” Again, these may have some merit if you’re running the New York City marathon; but for most of us, energy drinks basically equal sugar. Keeping a bottle of water, and eating a healthy snack after your workout will accomplish the same with fewer calories and more nutrients.

6) Healthy-sounding restaurant meals

Healthy-sounding restaurant meals

Every year, there are countless stories published online about healthy-sounding restaurant entrees such as salads that contain an enormous amount of calories. While it’s true that lettuce and other vegetables are quite low in calories, when you factor in the dressing, croutons, cheese, or any of the other high-cal toppings, some salads contain more calories than a large burger. The best thing to do is get dressing on the side and to stick to vegetables only.

7) Low fat foods

Low-fat foods

These include baked goods, prepackaged meals, ice cream/frozen yogurts, and other processed foods. Although they have less fat, they tend to contain more sugar. Furthermore, since fat provides some satiety, many people tend to overindulge out of hunger and/or the mistaken notion that something with less fat is the equivalent of celery or cucumbers in terms of its effect on the body.

8) Pasta

Pasta is calorically dense

In the age of low-carb diets, many people do avoid pasta when dieting. Pastas aren’t worse than any other grain-based product. The problem is that they’re extremely calorically dense. The serving size on most packages says ½ cup of uncooked pasta. Most of the time, people eating pasta consume much more than this amount. Factor in cheese, creamy sauces, or sugary tomato sauce, and you can easily pack away over 1,000 calories in a few minutes.

- Tamir

(Images link back to their sources.)


Hungry between meals? Snack on fruits and vegetables

When going on a diet, one of the hardest things to manage is hunger. Sure, it’s easy in theory to “cut back” on breakfast, lunch, and dinner, eating smaller portions. Forgo snacks, and voila, you’re well on our way to weight loss.

But as we all know, between our tiny meals, we feel hungry. Mmm – those donuts next to the coffee machine look good. That candy bar in the vending machine will hit the spot. And look at that, chips are only 75 cents!

Planning for when you’re hungry

If you don’t plan ahead, it’s very hard to stick to a healthy diet in the long run. One simple strategy is to simply incorporate more fruits and vegetables into your diet.

Snack on fruits and vegetables like these

To start off, include fruits or vegetables with all of your meals, and try to start off the meal with a fruit or vegetable. For example, start off breakfast with half a grapefruit. Start off lunch with a large vegetable salad. This will fill you up somewhat, leaving less room for unhealthier fare.

Throughout the rest of the day, every time you feel hungry, eat a fruit or a vegetable. Apples, pears, oranges, peaches, plums, apricots, berries, bananas, carrots, cucumbers, peppers, cherry tomatoes, and celery sticks are all examples of readily available snacks you can munch on instead of chips, cookies, and candy.

Furthermore, if you currently smoke and want to quit, you can try using fruits and vegetables as a smoking cessation aid. Every time you crave a cigarette, reach for a fruit or vegetable. Eat slowly, chewing your food at a relaxed pace, savoring the flavors. Hopefully, the symbolism inherent in consuming a healthy snack and the experience of it will cause you to second guess your desire for a cigarette while at the same time satisfying your oral fixation. Adopting healthy snacking habits may also help to mitigate the weight gain that often occurs when quitting smoking.

- Tamir

(Image links to source, shared under this license.)


Truth to the ‘apple a day’ adage

We all know the old adage, “An apple a day keeps the doctor away.”

An apple

There’s more truth to this than many realize. In an interesting study published in the British Medical Journal, researchers used a mathematical model to compare the reduction in cardiovascular disease (heart attacks, strokes, etc.) achieved by eating an apple a day to taking a “statin” cholesterol medicine in people over the age 50. They assumed a 70% compliance rate, and assumed that the caloric intake would remain the same in the apple group (presumably through the hypothetical person eating fewer calories from other food).

The results showed a similar reduction in cardiovascular risk between the 2 groups! Since statins can have side effects such as muscle aches, it seems that achieving the risk reduction through adding an apple to one’s diet makes more sense. (However, if you’re already on cholesterol medication or have other health problems such as diabetes or heart disease, then do NOT stop them on your own – there may be a good reason that you are on them.)

Small improvements can make a difference

The take home point is that in otherwise healthy people, a very small lifestyle change, eating one apple, makes as much of a difference in improving health as taking most potent blockbuster medications. This should be encouraging to those of you who find it hard to completely overhaul your unhealthy lifestyles. For example, if your current diet is fast food, donuts, and soda, if you smoke, if you don’t get much exercise, then you might be thinking, “What’s the point of making small improvements? I have so much to fix!” Instead, make small changes. Add some fresh fruits and vegetables. Cut out a serving of soda. Eat half a donut rather than 2. Add a 15 minute walk to your day. Reduce the number of cigarettes that you smoke.

After all, if eating one apple can improve a person’s health by a significant amount, then making several small changes, even if you don’t ultimately end up with a perfect lifestyle, seems well worth it.

- Tamir

(Image links back to source, and is shared under this license)


Portion control is essential for a healthy diet

In the world of fad diets and weight loss supplements, a common claim is “Eat as much as you want and still lose weight!” In some cases, people will lose weight. For example, if all I eat is cabbage or celery, then yes, I’ll lose weight. In other cases, this just isn’t true, and the duped consumer quickly finds out that the “amazing” weight loss supplement that they had shipped from abroad for the low price of $69.99 plus shipping and handling is a hoax.

But even when the claim is true, the problem is that once a person is sick of eating only celery or soup or whatever the fad of the day is, they revert to their old eating habits with the “eat as much as you want mindset” still very much in place – with disastrous consequences. I’ve seen many patients over the years who lost a lot of weight through extreme fad diets, only to regain it all, often with extra weight.

Portion control--not!

The few successful diets I’ve witnessed are ones that emphasize portion control. These include Weight Watchers and Overeaters Anonymous. Unfortunately, in the U.S., portion sizes have grown tremendously. Restaurants, aiming to please customers, offer gigantic sandwiches, mounds of fries, and sodas in cups large enough to fit most of your arm. Then there’s the ever present all-you-can-eat buffet. We don’t stand a chance if we don’t change our mindset.

Start by changing portion sizes

One of the most important things you can do when adopting a healthy diet is to work on limiting portion sizes. Even healthy foods will make you gain weight if eaten in large amounts. I would even go so far as to say that if you’re an impulsive eater, then before even changing the actual foods you eat, work on limiting the portion size. Have one donut for breakfast instead of two (or three). Have a small order of fries instead of supersizing. Take just one cookie from the cookie jar. Once you’re able to control how much you eat, it will be easier to start changing what you eat.

In addition, if you’re eating out of stress or depression, then seek treatment. Don’t drown your worries or sorrows in a pint of ice cream. If you eat out of boredom, then find a hobby to occupy your time with. Cut back on watching TV, an activity which is largely a waste of time and is associated with constant snacking.

Once you start successfully controlling portion sizes, you’ll find it easier to stick to a healthy diet in the long term. If you know you can control yourself when indulging in an occasional treat, you know you won’t have to give up junk food 100% – something that drives most of us to eventually drop a healthy diet. You know you’ll have more control over how much you eat.

Finally, self control may help you if you smoke, especially if you chain smoke. Of course it’s best to quit, but if that isn’t possible (or desirable) at the moment, then control the “portion” of cigarettes that you smoke daily. Instead of lighting the next cigarette with the previous one, limit yourself to a few “must have” cigarettes a day.

- Tamir

(Photo links to source, which is under this license)