The Epidemic of Being Overweight and Undernourished

It sounds contradictory, but a significant number of people in the United States today are simultaneously under- and overnourished. How can that be? If you’re significantly overweight, surely you can’t be malnourished, right?

As a former overweight person myself, a registered dietitian who has worked with many people on weight loss issues, and an epidemiologist who studies the science of chronic disease and body weight regulation, I know firsthand that it’s all too easy to be both overweight and malnourished.

The key to understanding this paradox is to understand the difference between macro- and micronutrients. Macronutrients provide the body with energy in the form of calories. Think carbohydrate, protein, and fat. There’s also alcohol, which isn’t an ideal source of calories, but which provides them nonetheless. Being a fan of a nightly glass of wine or a beer, I’d be remiss if I didn’t mention that alcohol provides calories! One gram of alcohol provides 7 calories. This means that in terms of caloric density, your drink is roughly halfway between protein and carbohydrates (4 calories per gram) and fat (9 calories per gram).

Tiny Nutrients, Enormous Benefits

Micronutrients are indeed “micro,” meaning that we need them in small quantities for good health. This includes vitamins, minerals, and phytonutrients, which are non-vitamin/non-mineral plant nutrients. Examples include carotenes and flavonoids. Vitamins and minerals are vital for life – it’s right in the name – vitamins. Without them, we’d end up with a deficiency, and eventually, a deficiency of essential vitamins and minerals can lead to death. Fortunately, in this country, severe vitamin and mineral deficiencies are uncommon. Unfortunately, they are very common in parts of the developing world (I’ll be revisiting this important issue in a future post).

Phytonutrients are different than vitamins and minerals. For one thing, there are thousands of them, compared to just a few dozen essential nutrients. Many phytonutrients are found in vegetables and fruit, and they give these foods their bright red, yellow, purple, green, and orange colors. Most of us are familiar with the phytonutrient beta-carotene, the nutrient that makes carrots and sweet potatoes orange. Other important phytonutrients hide inside whole grains, beans, and nuts.

Unlike vitamins and minerals, phytonutrients aren’t vital for life: you won’t die of a beta-carotene deficiency. But if you don’t get enough phytonutrients, you can have major health problems, which can contribute to difficulty losing weight, and difficulty maintaining weight loss.

What’s the Connection?

Most people don’t give much thought to micronutrients and body weight. Many people figure if it’s not a calorie, it doesn’t matter. The truth is more complex. Sure, calories are one key to weight loss. But dig a little deeper, and you’ll see how adding in the right foods, rich in micronutrients, will aid weight loss, help your body function better, and may even help keep overeating in check. And this is no “diet.” This is how you want to eat. For the rest of your life.

Stronger and Leaner: Phytonutrients appear to help people maintain muscular strength, lean body mass, and muscle function. And if there’s one thing that anyone who’s tried to lose weight understands, it’s that more muscle means more calorie burning, even when you’re not moving. Who knew an apple, a blueberry, green tea, or broccoli could fuel your muscles?

Better Body Chemistry: Many obesity experts now consider obesity to be a state of chronic, low-grade inflammation. This matters a lot if you’re trying to lose weight, because inflammation makes it harder for you to shed fat and much harder for you to build lean, healthy muscle. It’s a vicious cycle: carrying extra body fat promotes inflammation, and inflammation makes it harder to lose weight.

Phytonutrients dampen inflammation. By including plenty of phytonutrient-rich, anti-inflammatory foods in your diet, you fight the low-grade inflammation that results from being overweight and that may be contributing to staying overweight. By dampening inflammation, phytonutrients appear to improve body chemistry, and improve the odds of weight loss success.

Less Overeating: If that’s not enough to convince you to change your dieting ways, consider this: noted nutrition experts now suspect that when we’re overnourished in terms of calories, but undernourished in terms of micronutrients, our bodies have a harder time judging how much food we truly require to satisfy nutritional needs.

We have basic needs for micronutrients – vitamins, and minerals, in particular, but likely phytonutrients, as well. Our bodies will tell us to keep eating until we meet those basic needs. If you eat foods that are low in micronutrients, which not surprisingly includes many “diet” foods, you need to eat more of them to reach the point where your body senses that you’ve gotten enough micronutrients.

Better Gut Health: The human “microbiome” is a hot topic right now. The microbiome refers to the collection of bacteria, fungus, and yes, even viruses, that reside in and on our body. These microbes appear to contribute significantly to health, and this is particularly true for gut health. In fact, the latest research has shown that some microbes in the gut may contribute to obesity, while others help keep us lean. But it’s a chicken and egg thing… which came first? Is a poor diet of unhealthy processed food the cause of “obesity-inducing” microbes? Or are “obesity-inducing” microbes present in higher numbers in the guts of some people, and this is what contributes to obesity, and inability to lose weight and keep it off?

The latest research on this topic came out just this week, presented on March 5, 2015, at the 97th Annual Meeting of the Endocrine Society in San Diego. Researchers studied people who had recently undergone bariatric surgery – the type of surgery used to induce rapid and dramatic weight loss in people who are significantly overweight (obese). Those people with the highest proportion of gut microbes that produce methane and hydrogen had the least weight loss. The researchers speculate that these methane-producing gut bacteria may be preventing or slowing down weight loss after bariatric surgery.

Other studies have shown that overweight and obese people have different combinations and numbers of specific gut bacteria compared with “lean” people. When you transplant microbes from obese people into “germ-free” mice, they put on weight, but the mice did not put on weight if transplanted microbes came from a lean person. Further, the “lean” bacteria can crowd out the “obese” gut bacteria, which prevents the mice from gaining weight… but only if the mice also ate a healthy diet.

Consider all of these facts together, along with the known gut health benefits of whole plant foods, and it makes sense that these foods can nourish our “lean” bacteria. These foods also may limit the number of “obesity-contributing” bacteria in our digestive tracts, helping us maintain a healthier body weight.

Go Low on the Food Chain

In order to nourish your body properly, you need to eat real food, not count calories. Eating “low on the food chain” gives your body the micronutrients it needs to build muscle, keep fat-promoting inflammation in check, and help you minimize the chances of overeating and bingeing. Of course, much of managing body weight is emotional, psychological, and mental. We know that binge eating disorder (BED) is a real medical condition, and using food to cope is very, very common. No amount of healthy eating will “fix” obesity without getting the emotional help and support you need.

However, once you begin working with a qualified mental health professional to address these very important mental health issues, food choices can help you move closer to your goal of a healthy, happy body, regardless of whether you shed a single pound. Yes, I’m a firm believer that everyone deserves to be healthy, and am a supporter of the Health at Every Size approach to wellness. Beating yourself up for “failing” diets is the last thing you need to do. Further, we live in a toxic food environment; people don’t fail diets, our toxic food environment – in which a bag of chips is cheaper than a bag of apples – fails people!

Now, getting back to eating “low on the food chain…” this means eating mostly whole, unprocessed, plant foods. The closer a food is to its natural form, or what it looks like when it comes out of the ground or off the tree or vine, the more micronutrients it contains. It’s also helpful, of course, that these foods tend to have the fewest calories per amount or volume of food. You get more micronutrients with fewer calories – a win-win all around.

I’m living proof this approach works, and I “walk the walk” every day. At my heaviest, I carried about 50 extra pounds on a 5’4” frame, which I lost for good about 114 years ago to reach a healthy body mass index (BMI) of 21.

Work with the Plate

To best understand the proportions of different phytonutrient-rich foods you need, visualize a typical round plate. Divide that into quarters. Three of those quarters should be filled with plant foods. Keep the balance tipped toward eating mostly vegetables, followed by slightly less fruit, and a very small amount of whole grains. It’s not that I don’t love whole grains, I do! However, between the bread, the bagels, and the cereal, most Americans do not need to be encouraged to eat more grains, whole or otherwise.

The other one-quarter is left for lean protein. Focus on plants – legumes (beans, peas, chickpeas), nuts, and seeds for most of your protein. Eat fish if you’d like, a couple of times per week.. Enjoy organic, free-range/grass-fed chicken, beef, or pork twice per week at most. And if you have a sweet tooth, save room in that last quarter for dessert!

References

  1. Kolehmainen M, Ulven SM, Paananen J, de Mello V, Schwab U, Carlberg C, Myhrstad M,…, Dahlman I. Healthy Nordic diet downregulates the expression of genes involved in inflammation in subcutaneous adipose tissue in individuals with features of the metabolic syndrome. Am J Clin Nutr. 2015;101(1):228-39.
  2. Hartstra AV, Bouter KEC, Bäckhed F, Nieuwdorp M. Insights Into the Role of the Microbiome in Obesity and Type 2 Diabetes. Diabetes Care. 2015;38(1):159-165
  3. Rebello CJ, Greenway FL, Finley JW. A review of the nutritional value of legumes and their effects on obesity and its related co-morbidities. Obes Rev. 2014;15(5):392-407.
  4. Farhat G, Drummond S, Fyfe L, Al-Dujaili EA. Dark chocolate: an obesity paradox or a culprit for weight gain? Phytother Res. 2014;28(6):791-7.
  5. Herieka M, Erridge C. High-fat meal induced postprandial inflammation. Mol Nutr Food Res. 2014;58(1):136-46.
  6. Kim H, Suzuki T, Saito K, Yoshida H, Kojima N, Kim M, Sudo M, Yamashiro Y, Tokimitsu I. Effects of exercise and tea catechins on muscle mass, strength and walking ability in community-dwelling elderly Japanese sarcopenic women: a randomized controlled trial. Geriatr Gerontol Int. 2013;13(2):458-65.
  7. Uusitupa M, Hermansen K, Savolainen MJ, Schwab U, Kolehmainen M, Brader L, Mortensen LS,…, Akesson B. Effects of an isocaloric healthy Nordic diet on insulin sensitivity, lipid profile and inflammation markers in metabolic syndrome — a randomized study (SYSDIET). J Intern Med. 2013;274(1):52-66.
  8. Willcox DC, Willcox BJ, Todoriki H, Suzuki M. The Okinawan diet: health implications of a low-calorie, nutrient-dense, antioxidant-rich dietary pattern low in glycemic load. J Am Coll Nutr. 2009;28 Suppl:500S-516S.
  9. Martin C, Zhang Y, Tonelli C, Petroni K. Plants, diet, and health. Annu Rev Plant Biol. 2013;64:19-46.
  10. Aoi W. Exercise and food factors. Forum Nutr. 2009;61:147-55.
  11. Mattes RD, Kris-Etherton PM, Foster GD. Impact of peanuts and tree nuts on body weight and healthy weight loss in adults. J Nutr. 2008;138(9):1741S-1745S.
  12. Coates AM, Howe PR. Edible nuts and metabolic health. Curr Opin Lipidol. 2007;18(1):25-30.
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6 responses

    • Hi jmgiles517,
      Thank you for reading my blog, and for commenting on it! I truly believe that people should eat animal proteins no more than a few times per week. So yes, I think having organic, free-range chicken only twice per week is a healthy choice. Americans tend to be obsessed with protein, and most people believe the only “good” protein is animal protein. Ample research supports that more than a small amount of animal protein is optimal. More animal protein in the diet is linked with higher risks of heart disease, diabetes, cancer, and mortality (death) due to any cause in American adults. Here’s an interesting tidbit: the current President of the American College of Cardiology, Kim Williams, MD, is a vegan. Not a vegetarian, not someone who “limits” animal protein, but someone who eats absolutely NO animal protein whatsoever. This is one of the leading experts on cardiovascular health, holding a very prestigious position, and he advocates that animal protein is unnecessary for a healthy diet, and eliminating it will improve health overall. I hope this is helpful.

  1. Thank you for your response. I am new to the world of animal protein. I was vegetarian for 15 years- Vegan for 5 and recently after some unfortunate events my brain spun a little out of control. During this time I was craving milk and chicken ( even though I had long forgotten the taste of both) . I gave into these cravings as I felt that I should honor my body as well as began taking an SSRI for uncontrollable OCD. This made me think about all the vegans/vegetarians I know who are probably not getting enough serotonin producing trytophan in their diets ( that would mean eating alot of bananas and pumpkin seeds). Do you see any correlations between the vegan diet and mental health concerns?
    thanks for your response.
    jenni

  2. Hi Jenni,
    You are very right in that diet can affect mental health in profound ways. I am not aware of any research implicating vegan or vegetarian diets in poor mental health outcomes, other than if someone is purely vegan and fails to get enough vitamin B12. That can be a serious problem, though it usually manifests as neuropathy (pain and burning – pins and needles – in the hands and feet), not as mental health and behavioral changes directly, such as you might observe with OCD, bipolar disease, depression, and related conditions.

    Tryptophan itself is actually not found predominantly in meat. In fact, if you pull food lists (based on the USDA database – not some random person’s opinion about tryptophan!) on the best tryptophan food sources, you’ll see that soy, spinach, seaweed, watercress, sesame seeds, and eggs all rank far above animal flesh. The only animal-derived foods that rank higher than soy for tryptophan content are sea lion kidney, sea lion meat, and elk meat. I don’t think too many Americans in the lower 48 are eating those foods all that regularly. Maybe the elk if you live in the west and hunt, but other than that, most people don’t eat these foods.

    So, it is a myth that people need to eat chicken, beef, pork, and other animal foods to obtain adequate tryptophan in the diet. That being said, I think that if you felt you needed to eat chicken and milk, then that is perfectly fine to do so!

    My comments about 100% plant-based diets being the healthiest option refers to general chronic disease risk. A plant-based diet is optimal for reducing risk of the biggest killers in modern society, mainly heart disease, cancer, diabetes, hypertension, stroke, dementia, and other chronic diseases.

    As for more immediate issues, including mental health, there aren’t good data to show that any one diet is better than another, other than the fact that a diet high in processed food is bad for mental health for a lot of reasons. Excessive sugar and refined and processed foods do seem to worsen mental function, anxiety, and a variety of mood- and mental-health related measures. Beyond this, we simply don’t know if any type of diet based around real food is better than another. So while I don’t believe people need to eat meat, poultry, or dairy for optimal mental health, if people feel this is helpful, then I certainly wouldn’t discourage them from doing so.

    However, there are two nutrients that are much more strongly implicated in mental health issues: Omega-3 fats and vitamin D. There was a recent article published in a mental health journal about this very topic: Vitamin D and the omega-3 fatty acids control serotonin synthesis and action, part 2: relevance for ADHD, bipolar, schizophrenia, and impulsive behavior.
    (http://www.fasebj.org/content/early/2015/02/23/fj.14-268342.abstract)

    Per this research write up, omega-3 fats and vitamin D are very important for serotonin regulation and production, and probably a lot more important than dietary tryptophan.

    Both vitamin D and omega-3s can be low in vegan diets, and for this reason, I encourage people following a purely plant-based diet to take an algae-based omega-3 supplement, and at least 1,000 IU of vitamin D per day. The omega-3 issue is interesting, because everyone assumes you have to eat fish to get the long-chain omega-3s, but the true source of these fats is algae. The omega-3s bio-accumulate up the food chain, so that predatory fish (certain types of salmon, for example) tend to have high amounts of omega-3s. However, these animals do not make omega-3s. They eat other animals, who’ve eaten other animals, and down the line, until you get to things which have eaten algae. It is the algae that makes this nutrient.

    It is true that the omega-3s found in plant foods aren’t converted very well in the human body into the long-chain versions found in algae and seafood (DHA & EPA), so if someone is concerned about omega-3s in the diet and doesn’t want animal products, an algae-based omega-3 supplement is a good option. I don’t think it’s likely that someone on a vegan diet will become deficient in omega-3s (the DHA and EPA – the ones from algae), as long as they are eating a varied plant-based diet with plenty of other sources of omega-3s (walnuts, flaxseeds, etc). As I said, these aren’t converted very well in the body to the longer omega-3s, however, there is some conversion, so an outright deficiency isn’t likely. However, for someone with mental health concerns, and who maybe would benefit from getting more EPA and DHA into the diet, the options are to either eat seafood, take a fish oil supplement, or take an algae-based omega-3 supplement.

    I wish you well and I hope you are feeling better and feeling that you have your mental health issues well-managed. Good for you for talking about this and bringing it up! There is still far too much stigma around mental health issues, but there shouldn’t be. They are no different from physical health problems, and should be addressed promptly and without shame when they occur!

  3. Thank you for your very informative response! and Yes- I am feeling much better (and taking a Omega 3 and Vitamin D supplement). I will be sure to read the article you shared and share with my vegetarian friends!

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