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Last week the video below titled “Is Sugar Toxic?” spread around the internet.  To date the video has been shared on Facebook over 4000 times and on Twitter almost 1000 times.

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If you don’t feel like watching entire 15 minute segment I’ll sum it up for you by saying that the video suggests that sugar (with an emphasis on high fructose corn syrup) is responsible for all things evil including obesity, heart disease, strokes, Cancer, and the creation of the Twilight saga.

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In light of the fact that I probably consumed my body weight in Easter chocolate last weekend, the real question that results from watching this clip is whether or not sugar is, in fact, truly toxic.

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So Is Sugar Toxic?

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A key element of toxicology is that the risks of any such substance are dependent on the dose.  Even water (yes, water) can even be toxic if consumed in excess.  With psychiatric disorders like psychogenic polydipsia patients can consume so much water that they dilute the sodium levels in their blood so much they can actually die.

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Toxic substances are generally assigned something called an LD50 (median lethal dose) which is the amount required to kill half the members of a tested population after a specified test duration.  Fortunately for me (after my weekend festivities), the LD50 for sugar is about 30 grams per kilogram of body mass.  For a 200 pound man that would require the consumption of just over 6 pounds of sugar for them to be at risk of acute sugar toxicity.  That probably isn’t very likely.

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Of course, I’m just messing around here and showing off my relatively poor understanding of toxicology.  The risks presented in the video above are mostly discussing the chronic risks of sugar consumption.  However, I still believe that this largely still related to dose more than the fact that sugar is inherently some kind of special substance to be demonized.

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And putting the blame on high fructose corn syrup really isn’t fair either since a recent meta-analysis has demonstrated that “fructose does not seem to cause weight gain when it is substituted for other carbohydrates in diets providing similar calories”.  Another meta-analysis also found that “fructose intake in isocaloric exchange for other carbohydrates significantly decreased diastolic  and mean arterial pressure. There was no significant effect of fructose on systolic blood pressure. The hypercaloric fructose feeding trials found no significant overall mean arterial blood pressure effect of fructose in comparison with other carbohydrates.”

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In short, high fructose corn syrup doesn’t seem to be any worse than other forms of carbohydrates for obesity or blood pressure.  That doesn’t mean it is good for you either and there is still some concern/debate about other issues, but I really think it comes down to how much people are really consuming.

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Further to all these points above though, is the very real fact that telling people sugar is toxic (which I’m not totally in agreement with if the amount consumed is reasonable) probably isn’t going to change anyone’s behavior anyway.  As I’ve stated before, education is only a small part of the solution to most weight/health problems anyway.  Most people eating too much sugar are generally aware of the fact that it isn’t considered a health food.  Blasting them with this information is probably a waste of time when we need to focus on ways of actually getting people to take action on what they already know instead.  Therein lies the solution (and also the problem).

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In Conclusion

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Having a little bit of sugar isn’t going to make your pancreas explode and turn you into an instant diabetic.  A healthy diet combined with exercise can do with a little room for some indulgences once in a while.  If you eat junk all day every day like Snoop Dogg smokes pot then you’ll be in trouble.  But otherwise you don’t need to worry about a few Easter treats.  Don’t let some silly internet video tell you otherwise.

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If you’re a personal trainer you’ve undoubtedly heard (or probably said) the following sentence:

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“Man…if I could only get clients that followed everything I told them to do they would all get incredible results.  Why can’t they just listen to me?!?  Why don’t they just do what I tell them?”

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After all, they are paying you good money to tell them what to do, right?  Your job is to seek out the best training and nutrition information and convey it to them and their job is simply to follow it!

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Of course, regular readers of this blog know that I don’t agree with this position and that I believe most times it isn’t knowledge that limits the success of our clients, but the application knowledge.  And while can debate the relative importance 6 meals per day versus 2 meals per day (probably nothing in my opinion), the reality is that this doesn’t make a lick of difference to our clients because they’re just struggling to put anything we say into action.

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I’ve said before that I think psychology trumps physiology for fat loss and muscle gain in most of our clients.  I have also discussed the concept of creating behavior change being one of the biggest missing elements in the skill sets of most trainers.  Well…recently my colleague Dr. John Berardi, owner of one of the world’s largest body transformation companies, put out 4 incredible (and free) videos that illustrate the importance of this area and provide insight on how it should be done.

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If you are a personal trainer, strength coach, or even someone who is seeking to create change in their own life, these videos are an absolute MUST.  If I had to hire and train a trainer to work for me right now, these would honestly be some of the first videos I would have them watch (they are THAT good).

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Of course, embedding has been disabled for these videos so I can’t add them right here in this post, but I’d highly recommend you check out each of the links below to see the videos.

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The Compliance Solution – Part 1

The Compliance Solution – Part 2

The Compliance Solution – Part 3

The Compliance Solution – Part 4

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In the interest of transparency, these videos are a lead in to the sign up for of Precision Nutrition’s Personal Training Certification, but this is only mentioned briefly in the 4th video.  You do not have to enter your email to view the videos and I make no money if you do decide to sign up.  I honestly just think these are some of the best videos I’ve seen in regards to personal training that I’ve seen in years.

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For those who are personal trainers (and are considering launching an information product in the future), this video series is a shining example of how to launch a product while not selling your soul and making audacious claims about total nonsense.  JB is a class act and the information he provides here is top notch.

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Enjoy!

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Yesterday I posted the following picture on Facebook.  I stated that the meal contained meat, potatoes, rice, cabbage, asparagus, and strawberries.  After posting I asked the question “How many calories are on this plate?”  Before you scroll down for the answer, take a look at the photo and take a stab at it yourself.

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The answers ranged from 400 calories to 1200 calories, all the way up to “GET THAT IN MA BELLEH” (with my wife also being a smartass and suggesting that it was 4500 calories – Love you baby).  After taking guesses a dietitian colleague of mine and I independently totalled up the plate using online calorie software.  And interestingly enough, we got totally different answers!

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Her total was 1500 calories whereas mine was closer to 1000.  But when we looked at the reason for the differences they were largely attributable to differences in the estimated sizes of the portions on the plate (we both agreed that the meat was probably pork).  However, the big point here is that whichever estimate you agree with the fact remains that the food on that plate represents far more calories than most people should be consuming in a single meal.  It also means that even trained professionals have a hard time agreeing on quantities when looking at a plate like this.

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With the Christmas season upon us and the number of parties, dinners, and potluck events that will inevitably be a part of it, I think that this plate would actually even be a conservative estimate of intake for a lot of people.  There are almost always pre-dinner treats like veggie trays, hummus, and chocolates kicking around.  An even then a single plate of food might be less than most people eat (you know…try a little of everything and then go back for a second helping of the stuff you really like).  Combine that with the calories from wine, beer, and desserts (you know you HAVE to try at least one slice of each kind of pie right?) and you’ll be consuming a boatload energy that will ultimately be stored as fat.

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Doing this task made me think back to previous holiday seasons where I hadn’t paid much attention at events like these.  This year I think I’ll be a little more attentive to what I’m eating.  If nothing else, when you’re making up your plate this holiday season I hope this task inspires you to be a little more cautious with your consumption to0.  After all, the best way to lose weight in January is not to have gained it in the first place.

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Have a great weekend!

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PS: Today is the last day to save $100 on the Peak Diet and Training Summit and (due to popular demand) there is now a 2 pay option for those who prefer to pay in installments.  This package is a true beast with 15 DVDs, 2 info packed manuals, 2.0 NSCA continuing education credits, and a bunch of other bonuses available only this week.  There is no risk as the product is fully refundable so go and pick it up before the deal disappears.  Order your copy HERE.

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Over the past few weeks I’ve put together an extensive (and I hope valuable) series on training clients with obesity.  In Part I of the series I described the categorization and classification of obesity.  In Part II I shared some resources and very important concepts about obesity management.  In Part III I discussed how I would go about training those with a BMI greater than 35.  In Part IV I talked about the training I would use for those with a BMI below 35, but still above 30.  And in Part V I presented a summary of the various types of bariatric surgery that are most often sought by those with obesity.  Today I want to finally bring the series to a close with a final piece about nutrition for those with obesity.

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What We Know About Diets

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I think some of the largest trials comparing diets in the real world (such as the famous A to Z Study) have demonstrated that while low carb diets generally get the lead for early weight loss, after a year they aren’t really that much better than moderate or higher carb diets.   Granted, there was a statistically significant difference in the A to Z Study, but is it really significant in terms of what it means to you or your clients?  Here are the results from the paper.

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Mean 12-month weight loss was as follows: Atkins, −4.7 kg (95% confidence interval [CI], −6.3 to −3.1 kg), Zone, −1.6 kg (95% CI, −2.8 to −0.4 kg), LEARN, −2.6 kg (−3.8 to −1.3 kg), and Ornish, −2.2 kg (−3.6 to −0.8 kg). Weight loss was not statistically different among the Zone, LEARN, and Ornish groups.

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So basically, the Atkins group lost an average of 10.3 pounds, the Zone group lost 3.5 pounds, the LEARN group lost 5.7 pounds, and the Ornish group lost 4.8 pounds after one year!!!  In this case the “best” diet yielded an average weight loss of approximately 0.2 pounds per week.

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What I feel this study really tells us isn’t that one type of diet is superior to another for weight loss, but that our biggest issue with diets is compliance.  In fact, what I think you’ll find if you talk to any client with obesity is that many of them have tried numerous diets for weight loss in the past and some of them may actually have done VERY well (losing even 100 pounds or more) only to put it back on.  The key here is not to find some magical diet that will elicit the most rapid fat loss possible, but to find a nutrition plan that the client will be able to maintain for life.

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Wait a Minute…

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Isn’t that what I usually say for non-obese clients too?  Gee willikers.  Could we be on to something here?  Does this mean there is no magic diet that will instantly result in ripped abz for only $39.99?  Could it also be that if we simply identified and address the barriers that prevent us from being able to adhere to ANY diet we’ve selected that we’d get better results?  Nah…couldn’t be.  That would make too much freakin’ sense.

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Anyway, the biggest nutritional factor that is required to result in weight loss success is a moderate calorie deficit.  As simple as it sounds, the key is to make sure the calories consumed by the client are less than those that are burned.  I should reiterate again that this should be a MODERATE deficit and your client need not lose weight rapidly and you must resolve to teach them the proper way to lose weight despite their insistence that they’d like it to go faster.  The more severe the plan, the less likely the client is to stick to it for life which (as we discussed above) the single MOST important element of any nutrition plan.

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I should note that in some medical obesity management programs very low calorie diets (VLCD) consisting exclusively of nutritional protein shakes totalling 800-900 calories per day are sometimes used for rapid weight loss.  You should NOT follow this practice with your clients.  Programs like these MUST be medically supervised as there are risks associated with gall stones from rapid weight loss (possibly leading to pancreatitis), low sodium levels, and life threatening blood sugar crashes if the person is on insulin (as many with obesity who have Diabetes are).

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Aside from that, the diet should contain enough protein for muscle maintenance, fiber, and plenty of fruits and vegetables.  But I need to state again that creating a moderate calorie deficit and finding a nutritional lifestyle program that will stick (along with identifying and addressing barriers to compliance) are the two biggest concerns.  Without these, you can pretty much forget about everything else.  And, of course, since these clients often struggle with sudden change and making it stick in the long term (as do most clients actually), it is important to implement progressive behavior change to get the client onto the plan rather than an instant jump to super strictness.  Doing this will empower the client and make them more willing to take further steps as their confidence grows.

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In short, there is no magic but consistant and slow behavior change and a reasonable diet.  Anything else is just setting your client up for failure.  And if you doubt it, I’ll leave you with this.  Below is an image of the weekly weight values of a client I’ve worked with for the last nine years.  The first year averaged a 2-3 pound per week weight loss and beyond that it was much slower.  But the point to be really taken is that weight loss is easy.  Long term maintenance which is where the truly gifted trainer aims to shine.

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As usual, if you have any questions, comments, or random insults you can leave them below and I’ll make sure to address them.

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Also, if this article has been useful to you please don’t hesitate to share, “like”, tweet, +1, or whatever funky social media thing you can do to spread the word.

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Recently I started writing a series on training obese clients that has evolved into much more than I had expected.  In Part I of this series I described the categorization and classification of obesity, in Part II I shared some resources and very important concepts about obesity management, in Part III I discussed how I could go about training those with a BMI greater than 35.  In Part IV I talked about the training I would use for those with a BMI below 35, but still above 30.

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Today I want to begin talking about nutrition for those suffering with obesity.  However, discussions about nutrition and the obese client would be lacking without at least a brief mention of gastric bypass surgery.  So today I will cover that, and then I should have only one more post on nutrition related stuff that should wrap things up.

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Now before you tune out because you think gastric bypass has nothing to do with you or your clients, trust me when I say you need to hear this.  Even if you are not a believer in this type of surgery, chances are that if you train obese clients long enough you’ll run across one that is considering or has had some form of bariatric surgery.  If or when that happens, you should be informed with the best possible information so that you can provide appropriate guidance and support.

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And even if you never happen to personally train someone who has had this surgery or wants to have this surgery, it will help to inform you that this surgery is by no means “the easy way out” that some may perceive it to be.  I feel that fitness professionals should make an effort to at least understand the basics bariatric surgery as this is part of weight management for many (even if you don’t agree with it).  So…let’s get at it!

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Laproscopic Banding

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The first and least invasive type of bariatric surgery is simply called laproscopic adjustable banding (popularly known as the Lap-Band).  With this surgery, a small adjustable band is inserted through very small incisions and placed laproscopically around the top of the stomach.  This limits the amount of food that can enter the stomach and thereby causes people to lose weight.  This is called a restrictive surgery because of this limitation.  People that have had this surgery also have a port below the skin in the abdomen that allows them to have saline added or removed to make the band tighter or looser depending on their needs.  Of all of the bariatric surgeries available, this is the least invasive and it has the smallest surgical risk.  It is also removable so if some decides it isn’t right for them, the band can be removed.

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From the data I’ve seen at conferences and from hearing surgeons talk about this procedure, it seems as though the weight losses seldom meet the expectations of the patient, weight is almost fully regained in many cases, and the band is frequently removed.  As a result, it seems that gastic banding is losing favor in some circles.  One of the things that strikes me as most interesting about banding is that we’re basically providing a removable (temporary) treatment for what I’ve suggested is a chronic condition.  If removing treatment results in the return of the condition, it might be wise to question the use of temporary solutions.  Of course, I’m not saying that there isn’t a place for banding (they often use them when they feel such a surgery is warranted in children – don’t even get me going here), but the data I have seen on them is generally not promising.  I won’t ignore that some have great success with these, but I think this is the exception rather than the rule.

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Sleeve Gastrectomy

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The sleeve gastrectomy is also a laproscopic procedure in which part of the stomach is actually cut off and removed.  The remaining section of the stomach is actually quite small which limits the amount of food a person can consume and allows them to lose weight.  This too qualifies as a restrictive procedure and it is only slightly more risky than the laproscopic band, but it is permanent.  This surgery generally has greater weight losses than laproscopic banding and (from what I’ve seen) is better in terms of preventing weight regain.  However, the results aren’t as great as with the “gold standard” gastric bypass surgery we’ll talk about next.

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Roux En Y Gastric Bypass

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While there have been many versions of this surgery over the years, the roux en y gastric bypass is now the gold standard against which all bariatric surgical procedures are compared.  In this surgery, like the sleeve gastrectomy, part of the stomach is removed to limit the amount of food that can be consumed except that with the sleeve the stomach can hold 150ml of food while this procedure typically limits food to about 30ml (two tablespoons).  Then, the small intestine is cut part of the way along and attached to the new stomach pouch.  This prevents much of the food that is ingested from being absorbed by the body resulting in even greater weight loss.  For this reason, this procedure is classified as a restrictive and malabsorptive procedure.  It is obviously not reversable.

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The highlights of this procedure is that the weight loss is typically greater than the two previously mentioned.  It also does have some greater weight loss maintenance than the other two as well.  What is more important though (and probably why this procedure gets so much appreciation from physicians and patients) is that it can be an almost instant cure for Type 2 Diabetes.  In other words, you could be a Type 2 Diabetic today, get the surgery, and then you’re pretty much off your meds.  There is even some talk about doing this procedure on non-obese Diabetics whose disease is really difficult to control, but I’m not sure whether this will pan out.

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I want to be clear here with my own perspective in that I don’t think the data on this is 100% reliable as the follow up isn’t the best in many of these studies and some are not randomized controlled trials.  The big issue with follow up is that the people that are probably most likely to make themselves available for this are those that are doing well.  Those who aren’t probably don’t want to be followed up.  For this reason, I think that perhaps this surgery may be good for some Diabetics, but I’m cautiously optimistic.

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I also want to be clear about some of the downsides.  First, the surgical risk is higher with this than the other surgeries I’ve mentioned.  I don’t think it is terrible, but worth noting.  And because the surgery is malabsorptive, there are some major nutrient deficiencies that occur with many patients.  Of course, they are typically told to take certain vitamin and mineral supplements for the rest of their lives following surgery, but some are non-compliant with this and they end up with serious issues.  There are also other issues like increased rates of suicide, divorce, addiction, and other issues following this surgery that make it important to weigh the risks and rewards of this procedure.

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Biliopancreatic Diversion with Duodenal Switch

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This procedure is the most intensive procedure of them all and it is only usually considered for the very obese patient.  Generally it begins with the restrictive component where the stomach is reduced very much like the sleeve gastrectomy.  From there, it becomes difficult for me to describe so I’ll just use a video to illustrate for those who are interested.

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This procedure can be done in two parts with more severely obese patients.  In the first procedure, the restrictive part is done to reduce the size of the stomach.  Then, after the patient has lost some weight and is less of a surgical risk, the surgeon can go back in and add the malabsorptive element to continue the weight loss.  While the roux en y is the gold standard, the duodenal switch can also be used for those who have regained weight after this procedure as it is pretty much the only thing left in the surgical arsenal.

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As you might guess, the risks for this surgery are higher than those associated with any of the previous, but the results are also usually pretty darn good too.  Ultimately, the more risky the surgery, the greater the potential weight loss.  However, with all surgical procedures you really have to look at the pros and potential cons of this operation.  Similar to gastric bypass, there are many possible issues that can present.

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I honestly can’t tell you what to do in the case of a client that has had any of the above surgeries because they’ll all present differently.  My primary goal with this post was to bring a basic understanding of surgical weight management to the fitness world in the hopes that it will begin to build a bridge between fitness and physicians as we attempt to understand each other’s methods.

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I can tell you that without lifestyle modification any of the above surgeries can result in weight regain and the reappearance of obesity related issues like Diabetes, hypertension, and so on (remember what I said about obesity being a chronic condition?).  So even if we don’t agree with the methods, it is important that we be prepared to partner with people that have had them (and their physicians) because many family doctors are at a loss for what to do with these patients.  By having at least some understanding, you will be in a position to help.

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If you want more information on this topic I would highly recommend you take the time out to read Dr. Sharma’s series called Why I Support Bariatric Surgery.

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There are 5 parts and they are all fantastic.  They can be found here. 1, 2, 3, 4, 5.

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But before you think I’m totally going to allow only the positives to be highlighted here, Dr. Sharma wrote a 5 part follow up series called Why Bariatric Surgery Can Fail which I think is also solid and provides more information than I can possibly cover here in this single post.

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You can read this series here. 1, 2, 3, 4, 5.

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In the end, I guess I didn’t teach you much about how to handle these clients, but being aware of them, what they’ve had done, and the potential issues can only point you in the right direction.  If nothing else, you probably just learned something you never thought you’d learn in this industry. 

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If this article helped you in any way or you think it may help others you know, please share it on Facebook, Twitter, Google+, or whatever social media outlet is your addiction.  Or if you’re lazy like me just hit the “like” button or +1 button.  Thanks.

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PS: I know I possibly covered a lot of unfamiliar ground here so if you’ve got questions, drop ‘em below.

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PPS: Check out Part VI of this series HERE.

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