Calorie Density: A Simple Yet Powerful Concept

Anthony Lim, MD, JD

2018 International PBNHC

September 15th, 2018

San Diego, CA

Life LessonWe stand on the shoulders of the giants who come before us.

“Calorie density is the simplest approach to healthful eating and lifelong weight management.”

Jeff Novick

Time

Weight

Healthy Weight

The Weight Loss Plateau

Objectives

1. Understand the concept of “Calorie Density” and the benefits of eating a low calorie density diet

2. Identify common “pitfalls” that patients fall into when it comes to Calorie Density.

3. Learn principles for how to apply Calorie Density in daily life.

WHAT IS CALORIE DENSITY?

Amount of Energy (calories)

Unit weight of food(pounds or grams)

.

Calorie Density of Various Food Groups

0

500

1000

1500

2000

2500

3000

3500

4000

100300

500600

8001500 1500

23002800

4000Calories/lb

Calories/lb

What average caloric density should I aim for?

• WCRF/AICR recs (2007) in “Food, Nutrition, Physical Activity & The Prevention of Cancer: A Global Perspective”

– #1 recommendation: maintain healthy body weight

• Plant-based diet

• Meat – condiment

• Public Health goal: Average energy density of diets be lowered to 1.25 cal/gm (567 cal/lb)

~ 600 calories/lb

Calorie Density of Various Food Groups

0

500

1000

1500

2000

2500

3000

3500

4000

100300

500600

8001500 1500

23002800

4000Calories/lb

Calories/lb

WCRF/AICR Recommendation

500 calories

OR

5 oz bag of gummi bears 7 lb watermelon

800 Calories

OR

1 cup cashews (~ 3-4 oz)

5 med-sized baked potatoes

Dr. Terry Shintani

Variable Begin End Change % Change

Calories (kcal/day)

2594 1569 -1025 -40%

Weight (lbs) 264 247 -17 -6%

BMI 40 37 -3 -8%

Cholesterol (mg/dL)

222 191 -31 -14%

LDL (mg/dL) 147 130 -17 -12%

TG (mg/dL) 236 138 -98 -42%

FBS (mg/dL) 162 123 -39 -24%

SBP (mm Hg) 134 122 -12 -9%

DBP (mm Hg) 84 75 -9 -11%

Shintani TT et al. Obesity and cardiovascular risk intervention through the “ad libitum” feeding of traditional Hawaiian diet. Am J Clin Nutr. 1991;53:1647S-51S.

Obese Native Hawaiians fed their traditional “pre-western-contact” diet ad-libitum improved all their health measures.

* Anecdotal improvement of symptoms from arthritis, asthma, gastritis, fatigue, acne, headaches, impotence, and other medical conditions.

Aug 2018181 lbs

BMI 25.2BP 110/72

TC 171

Oct 2016226 lbs

BMI 31.5BP 136/85

TC 214

COMMONPITFALLS

Pitfall: Meat-Like Substitutes

Pitfall: “Healthy” plant-based snacks

1500 calories per pound

Calorie Density of Various Food Groups

0

500

1000

1500

2000

2500

3000

3500

4000

100300

500600

8001500 1500

23002800

4000Calories/lb

Calories/lb

2050 cal/lb 2150 cal/lb

250 cal/lb

Calorie Density of Various Food Groups

0

500

1000

1500

2000

2500

3000

3500

4000

100300

500600

8001500 1500

23002800

4000Calories/lb

Calories/lb

Pitfall: Dried fruit and nuts/seeds

Calorie Density of Various Food Groups

0

500

1000

1500

2000

2500

3000

3500

4000

100300

500600

8001500 1500

23002800

4000Calories/lb

Calories/lb

Aug 2018181 lbs

BMI 25.2BP 110/72

TC 171

Oct 2016226 lbs

BMI 31.5BP 136/85

TC 214

SETTING

SUBWAY • Spinach, lettuce, tomato, green pepper, onions (100)

• No sauces, spreads, cheese• Water

• Wheat bread (1250)

CHIPOTLE • Fresh veggies (100)• No cheese, dairy, or guac• Spices

• Brown rice (850)• Side tortilla (1300)• Lots of salt

CHICK-FILL-A

• No sauce, cheese, or fries • Veggie wrap tortilla (1250)• Ketchup (450)

IN-AND-OUT

• Onion, lettuce, tomato (100) • Hamburger bun (1250)• Pink sauce (1650)

HOME • Frozen mixed veggies (100)• Canned beans (300 – 650)• Success brown rice (550)• Potatoes (400)

• Ezekiel bread (1100)• Apple sauce (200)• Mixed nuts (2600)• Candy (2300-2400)• Corn chips (2600)• Potato chips (2250)

Pitfall: Flour, sugar, snacking, & eating out…

Chipotle vs Success Brown Rice

850 cal/lb

550 cal/lb

My Recommendations for Patrick

1. Stop eating out.

2. Stop snacking on nuts and CRAP (Calorie Rich and Processed) food.

3. Cut back/eliminate flour products.

4. Consider overnight oats in place of grape nuts cereal.

5. Increase exercise frequency.

Calorie Density of Various Food Groups

0

500

1000

1500

2000

2500

3000

3500

4000

100300

500600

8001500 1500

23002800

4000Calories/lb

Calories/lb

Patrick has lost a total of 8 pounds so far in the two weeks since incorporating additional calorie density principles.

PRACTICALAPPLICATION

6 Simple Calorie Density Principles for Lifelong Health

1. Eat freely: vegetables, fruits, starchy vegetables, intact whole grains, legumes

2. Exercise caution with these foods: breads, bagels, dry cereals, crackers, tortillas, added sugar, dried fruit, nuts, seeds, avocado, “hidden” salt & oil when eating out, and liquid calories

3. Eliminate one or more category(ies) of food from your diet if self-restraint is too difficult or you are not getting results

4. Sequence your meals

5. Aim for a 50/50 plate

6 Simple Calorie Density Principles for Lifelong Health

1. Eat freely: vegetables, fruits, starchy vegetables, intact whole grains, legumes

2. Exercise caution with these foods: breads, bagels, cereals, crackers, tortillas, added sugar, dried fruit, nuts, seeds, avocado, “hidden” salt & oil when eating out, and liquid calories

3. Eliminate one or more category(ies) of food from your diet if self-restraint is too difficult or you are not getting results

4. Sequence your meals

5. Aim for a 50/50 plate

6. “Dilution is the solution through substitution”

Acknowledgements

• Dr. Scott Stoll and Susan Benigas

• My family

• My mentors

• My patients

• God

THANK YOU!

2714

2352

2087

Dietary Fat Avg Daily Calories

% surplus or deficit

Avg Food Intake (lb)

Avg CD(Cal/lb)

Total WtLoss/Gain (lbs)

Palatability

15-20% 2087 - 11.3% 3.3 632 - 0.9 2.63

30-35% 2352 - 3.2 735 0 2.58

45-50% 2714 + 15.4% 3.1 875 + 0.7 2.48

Fat and oil increase average daily caloric intake.

Lissner L et al. Dietary fat and the regulation of energy intake in human subjects. Am J Clin Nutr 1987;46:886-92.

2014

Weight 298

BP 140s/90s

Meds Zetia, Norvasc,

Pristiq, Albuterol

Activity Level Sedentary

2016

173

110s/70s

None

> 5 miles per day

“10-point checklist” for maximal weight loss

1. No animal products

2. No added oil

3. No added sugar

4. No juice, sweetened beverages, or alcohol

5. No/minimal added salt

6. No flour products

7. No dried fruit

8. No/minimal high caloric density plant-based foods (nuts, seeds, avocado, coconut, olives)

9. Sequence your meals

10. 50/50 plate method at each meal (serving of fruit for dessert)