Three squares vs. a day of smaller meals: Which is better for healthy weight loss?

By Jill U. Adams, Published: August 26 E-mail the writer

Three square meals a day: For years we’ve been told they are essential to health. But popular dieting advice suggests that eating more meals — albeit smaller ones — may be a better approach, especially for those looking to shed extra pounds. Some new diets advocate going the other way: consuming only one small meal a couple of days a week followed by days of unrestricted eating.

These diets claim to help people manage the tricky business of taking in fewer calories. What does science say about their effectiveness?

Let’s start with the idea that lots of little meals is better than three squares. While numerous studies have indicated a link between a snacking diet (four to six small meals or adding healthful snacks to the three squares) and maintaining a healthy weight, the research remains inconclusive.

A classic study published in the New England Journal of Medicine in 1989 compared “nibbling” — 17 snacks a day — to a traditional three meals that were equivalent in calories. Seven men ate each way for two weeks, and researchers found lower cholesterol and insulin levels with the nibbling diet — factors that lower risk for heart disease and metabolic diseases such as diabetes. And in large surveys of how people eat, researchers have found lower body weights in people who report eating more often than three times a day.

While this might suggest that nibbling (within reason) is good, surveys can find only associations, not cause and effect. In addition, though a recent review of clinical studies found that frequent meals make people feel less hungry, this eating pattern does not necessarily correlate with weight loss. That may seem confusing, but it’s the current thinking, according to Heather Leidy, an assistant professor of nutrition and exercise physiology at the University of Missouri in Columbia who co-authored the review.

At the Johns Hopkins Weight Management Center in Baltimore, overweight people seeking to shed pounds are generally advised to spread out small meals over the course of a day while keeping an eye on calories. The act of eating and digesting increases the resting metabolic rate — the calories your body burns to keep up physiologic functions without any physical exercise — so eating more frequently should favor weight loss, according to the center’s director, Lawrence Cheskin. Also, he says, “it keeps people satisfied — they’re less likely to do a big overeat.”

Unless — and this is a big unless — eating more frequently leads people to consume more calories. You can guess what happens then.

How about skipping breakfast? We’ve long been told to eat breakfast for health and attentiveness. For dieters, breakfast is thought to keep hunger at bay and prevent overeating the rest of the day.

A small study published last month pokes holes in this conventional wisdom. Researchers at Cornell University either fed breakfast to or withheld breakfast from 18 student volunteers. Those who skipped breakfast reported being hungrier than those who ate breakfast; they also ate more at lunch. Still, they did not eat enough to fully compensate for the missed meal. In fact, those who had skipped breakfast took in 408 fewer calories over the course of the day than those who ate breakfast.

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How Exercise Can Help Us Sleep Better

By GRETCHEN REYNOLDS

As a clinical psychologist and sleep researcher at the Feinberg School of Medicine at Northwestern University, Kelly Glazer Baron frequently heard complaints from aggrieved patients about exercise. They would work out, they told her, sometimes to the point of exhaustion, but they would not sleep better that night.

Dr. Baron was surprised and perplexed. A fan of exercise for treating sleep problems, but also a scientist, she decided to examine more closely the day-to-day relationship between sweat and sleep.

What she and her colleagues found, according to a study published last week in The Journal of Clinical Sleep Medicine, is that the influence of daily exercise on sleep habits is more convoluted than many of us might expect and that, in the short term, sleep might have more of an impact on exercise than exercise has on sleep.

To reach that conclusion, Dr. Baron and her colleagues turned to data from a study of exercise and sleep originally published in 2010. For that experiment, researchers had gathered a small group of women (and one man) who had received diagnoses of insomnia. The volunteers were mostly in their 60s, and all were sedentary.

Then the researchers randomly assigned their volunteers either to remain inactive or to begin a moderate endurance exercise program, consisting of three or four 30-minute exercise sessions a week, generally on a stationary bicycle or treadmill, that were performed in the afternoon. This exercise program continued for 16 weeks.

At the end of that time, the volunteers in the exercise group were sleeping much more soundly than they had been at the start of the study. They slept, on average, about 45 minutes to an hour longer on most nights, waking up less often and reporting more vigor and less sleepiness.

But Dr. Baron wondered if the novice exercisers had experienced immediate improvements in their sleep patterns. And on a day-to-day basis, had working out on any given day produced better sleep that night?

Boring deep into the data contained in the exercising group’s sleep diaries and other information for the new study, Dr. Baron discovered that the answer to both questions was a fairly resounding no. After the first two months of their exercise program, the exercising volunteers (all of them women) were sleeping no better than at the start of the study. Only after four months of the program had their insomnia improved.

They also rarely reported sleeping better on those nights when they had had an exercise session. And perhaps most telling, they almost always exercised for a shorter amount of time on the days after a poor night’s sleep.

In other words, sleeping badly tended to shorten the next day’s workout, while a full-length exercise session did not, in most cases, produce more and better sleep that night.

At first glance, these results might seem “a bit discouraging,” Dr. Baron said. They also would seem to be at odds with the earlier conclusion that four months of exercise improved insomniacs’ sleep patterns, as well as a wealth of other recent science that has typically found that regular exercise lengthens and deepens sleep.

But, Dr. Baron pointed out, most of these other studies employed volunteers without existing sleep problems. For them, exercise and sleep seem to have a relatively uncomplicated relationship. You work out, fatigue your body and mind, and sleep more soundly that night.

But people with insomnia and other sleep disturbances tend to be “neurologically different,” Dr. Baron said. “They have what we characterize as a hyper-arousal of the stress system,” she said. A single bout of exercise on any given day “is probably not enough to overcome that arousal,” she explained. It could potentially even exacerbate it, since exercise is itself a physical stressor.

Eventually, however, if the exercise program is maintained, Dr. Baron said, the workouts seem to start muting a person’s stress response. Her or his underlying physiological arousal is dialed down enough for sleep to arrive more readily, as it did in the 2010 experiment.

Of course, both of these studies were small, involving fewer than a dozen exercising volunteers, all of them middle-aged or older women. “We think the findings would apply equally to men,” Dr. Baron said. But that idea has yet to be proved.

Likewise, it is impossible to yet know the sleep-related impacts of workouts of different types (like weight training), intensities or timing, including morning or late-evening sessions.

Still, the preliminary message of these findings is heartening. If you habitually experience insomnia and don’t currently exercise, Dr. Baron said, start. Don’t, however, expect that you will enjoy or even complete workouts the day after a broken night’s sleep, or that you will sleep better hours after you’ve exercised.

The process is more gradual and less immediately gratifying than the sleep-deprived might wish. But the benefits do develop. “It took four months” in the original study, Dr. Baron said, but at that point the exercising volunteers “were sleeping at least 45 minutes more a night.” “That’s huge, as good as or better” than most current treatment options for sleep disturbances, including drugs, she said.

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Nutrients are better on a plate than in a bottle

By Hope Warshaw, Published: August 13

Q: I think I eat pretty healthful, balanced meals. Do I still need a multivitamin and mineral supplement?

A: Here’s the bottom line. Most people who are healthy and eat healthfully don’t need a daily multivitamin and mineral supplement. They don’t need individual vitamin or mineral supplements, either. According to the Dietary Guidelines for Americans, most children older than 9 and adults who eat sufficient amounts of nutrient-dense foods (that’s mainly fruits, vegetables, whole grains, legumes/beans, low-fat dairy foods) and consume at least 1,600 calories can meet their nutrition needs from foods.

Yes, this sounds like heresy or, at best, counterintuitive to consumers faced with the marketing prowess of the dietary supplement industry. The mantra “If a small amount is good for you, then more must be better” hasn’t, according to research, been wise advice.

Over the past couple of decades, one study after another has set out to research the health effects of large doses of vitamins or minerals, particularly antioxidants. And they’ve found no significant benefits. Worse yet, some have uncovered health concerns, such as increased risk of heart disease or cancer.

An explanation? “Oxidation, the process by which the body uses oxygen to convert food to energy, creates free radicals, often billed as evildoers in our bodies,” says Paul Offit, chief of the division of infectious diseases at Children’s Hospital of Philadelphia and author of “Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine.” Those free radicals can damage cells and the lining of arteries, one reason they’ve been linked with aging, certain cancers and heart disease. But, Offit says, we’ve discovered we need free radicals to kill bacteria and cancer cells. When people take large doses of antioxidants (such as selenium, beta-carotene, and vitamins A, C and E), “they can tip the balance towards an unnatural state in which the immune system is less able to kill harmful invaders.”

Yet Americans continue to swallow boatloads of supplements.

A study this year in the Journal of American Medical Association Internal Medicineanalyzed the use of supplements among a large sample of American adults. “We found half of U.S. adults use dietary supplements, most commonly a multivitamin and mineral supplement,” says the lead author, Regan Bailey, a dietitian and nutritional epidemiologist in the Office of Dietary Supplements at the National Institutes of Health. Bailey adds, “Our study reveals that adults use supplements primarily for their assumed health benefits, yet there remains a lack of sufficient research on this.” Interestingly and somewhat predictably, Bailey’s research showed that the adults studied tended to report eating more healthfully, practicing moderation with alcohol, exercising and abstaining from smoking.

Another important concern raised by Bailey’s study is that only a quarter of the supplements taken by adults were recommended by their health-care provider. This can be dangerous because of potential interactions of supplements, prescribed medications and other therapies. Your health-care provider should be asking about your supplement use, but if he or she doesn’t, bring it up.

Bailey and Offit agree that most people who are healthy and eat healthfully don’t need a multivitamin or mineral supplement. Offit’s suggestion: Start by eating sufficient fruits and vegetables. They’re low in calories and packed with nutrients.

The Academy of Nutrition and Dietetics, in its position on nutrient supplementation, concurs with this food-first approach. However, the academy and experts agree on this important caveat: Some people, based on their nutrition intake, medical issues and other circumstances, may need to fill nutrition gaps with supplements. Consider women of childbearing years, women who are pregnant, people who are vegan or strict vegetarians and people who don’t consume sufficient calories, to name a few.

When it comes to choosing the foods you eat, make your calories count.

For a trusted source on supplements, visit the Web site of the Office of Dietary Supplements at the National Institutes of Health: ods.od.nih.gov.

Warshaw, a registered dietitian nutritionist and certified diabetes educator, is the author of numerous books published by the American Diabetes Association and the blog EatHealthyLiveWell found on her Web site, www.hopewarshaw.com.

Have a nutrition question? Send an e-mail to localliving@washpost.com. Put “Nutrition Q&A” in the subject line and tell us where you live.

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Two cups of hot cocoa a day could keep the dementia away, neurologists say

Want to stave off dementia?

Drink two cups of hot cocoa each day, neurologists say, in a new study published in the American Academy of Neurology.

The study included the participation of 60 people who had an average age of 73 and were never diagnosed with dementia. They drank two cups of hot cocoa each day for a month, while simultaneously abstaining from ingesting any other forms of chocolate, The Times of India reported.

During the test period, they also participated in various memory and thinking tests, while researchers tracked and monitored their brain blood flows with several ultrasounds.

Their findings: Eighteen of the 60 test subjects who had impaired blood flow to their brains at the beginning of the study experienced an 8.3 percent improvement by test’s end. Those with normal blood flow at the outset of the experiment did not see any improved blood flow.

Those who experienced the improved blood flow also saw their memory test results improve significantly, The Times of India reported. And once again, those who had normal blood flow at the beginning of the study did not see any improved memory test results at the end.

“More work is needed to prove a link between cocoa, blood flow problems and cognitive decline,” said Paul Rosenberg, of the Johns Hopkins School of Medicine in Baltimore, in The Times of India report. “But this is an important first step that could guide future studies.”

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What are the different types of breast cancer?

What are the different types of breast cancer?

There are many types of breast cancer. Some are more common than others, and there are also combinations of cancers. Some of the most common types of cancer are as follows:

Ductal carcinoma in situ: The most common type of noninvasive breast cancer is ductal carcinoma in situ (DCIS). This type of cancer has not spread and therefore usually has a very high cure rate.

Invasive ductal carcinoma: This cancer starts in a duct of the breast and grows into the surrounding tissue. It is the most common form of breast cancer. About 80% of invasive breast cancers are invasive ductal carcinoma.

Invasive lobular carcinoma: This breast cancer starts in the glands of the breast that produce milk. Approximately 10% of invasive breast cancers are invasive lobular carcinoma.

The remaining breast cancers types are much less common and include the following:

Mucinous carcinomas are formed from mucus-producing cancer cells.

Mixed tumors contain a variety of cell types.

Medullary carcinoma is an infiltrating breast cancer that presents with well-defined boundaries between the cancerous and noncancerous tissue.

Inflammatory breast cancer: This cancer makes the skin of the breast appear red and feel warm (giving it the appearance of an infection). These changes are due to the blockage of lymph vessels by cancer cells.

Triple-negative breast cancers: This is a subtype of invasive cancer with cells that lack estrogen and progesterone receptors and have no excess of a specific protein (HER2) on their surface. It tends to appear more often in younger women and African-American women.

Paget's disease of the nipple: This cancer starts in the ducts of the breast and spreads to the nipple and the area surrounding the nipple. It usually presents with crusting and redness around the nipple.

Adenoid cystic carcinoma: These cancers have both glandular and cystic features. They tend not to spread aggressively and have a good prognosis.

The following are other uncommon types of breast cancer:

• Papillary carcinoma
• Phyllodes tumor
• Angiosarcoma
• Tubular carcinoma

Picture of the anatomy of the breast
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Breast cancer facts

Breast cancer facts

• Breast cancer is the most common cancer among American women.
• One in every eight women in the United States develops breast cancer.
• There are many types of breast cancer that differ in their capability of spreading (metastasizing) to other body tissues.
• The causes of breast cancer are not yet fully known although a number of risk factors have been identified.
• There are many different types of breast cancer.
• Breast cancer is diagnosed with physician and self-examination of the breasts, mammography, ultrasound testing, and biopsy.
• Treatment of breast cancer depends on the type of cancer and its stage (the extent of spread in the body).

According to the American Cancer society:

• Over 200,000 new cases of invasive breast cancer are diagnosed each year.
• Nearly 40,000 women are expected to die of breast cancer in 2012.
• There are over 2.5 million breast cancer survivors in the United States.
• The recommendations regarding frequency and age when women should get screening mammography differ slightly between different organizations and task forces.
• Between 40 and 50 years of age, mammograms are recommended every 1 to 2 years (National Cancer Institute). After 50 years of age, yearly mammograms are recommended (American College of Obstetrics and Gynecology).
• You should discuss with your health care professional the screening frequency that he or she recommends and what guidelines they follow.
• Patients with a family history or specific risk factors might have a different screening schedule including starting screening mammograms at an earlier age.

What is breast cancer?

Breast cancer is a malignant tumor (a collection of cancer cells) arising from the cells of the breast. Although breast cancer predominantly occurs in women it can also affect men. This article deals with breast cancer in women.

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