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Low Carb diets and Diabetes

Tue, 15 Jan 2008 12:22:45 -0500

American Diabetes Association Backs Low-Carb Diets  By Christine Many Luff  The American Diabetes Association (ADA) has for the first time voiced its support of low-carbohydrate diets for weight management of people with diabetes. The endorsement was part of the ADA’s recently published 2008 Clinical Practice Recommendations, which are intended to guide diabetes health care providers.  In the past, the ADA has supported low-fat, calorie-restricted diets as a weight loss method and didn’t recommend low-carb diets because of a lack of evidence supporting their safety and effectiveness. The new guidelines state that both low-fat and low-carb diets are equally effective at helping people lose weight over a year. However, the ADA recommends that low-carb dieters make sure their blood lipids (cholesterol and triglycerides), kidney function, and medication levels are monitored.   “We recognize that people are looking for realistic ways to lose weight,” said Ann Albright, PhD, RD, president of health care and education for the ADA in a prepared statement. “The evidence is clear that both low-carbohydrate and low-fat calorie restricted diets result in similar weight loss at one year. We’re not endorsing either of these weight-loss plans over any other method of losing weight. What we want health care providers to know is that it’s important for patients to choose a plan that works for them, and that the health care team support their patients’ weight loss efforts and provide appropriate monitoring of patients’ health.”  The ADA’s announcement is a major breakthrough because the group is the first of major health organizations (such as the American Medical Association, American Heart Association, etc.) to give any support to low-carb diets. Yet, while long-time advocates of low-carb diets say the recommendations are a good start, they’d like to see them go further.   “We’re pleased that they’re willing to move away from an entrenched position and look at the science,” said Mary Vernon, M.D., C.M.D., chairman of the board, American Society of Bariatric Physicians, and author of Atkins Diabetes Revolution (Morrow, 2004). “But it’s not enough and it isn’t respectful enough of how effective this is as a change in patients.”  Vernon would like to see more recommendations about patient monitoring and continuing education for physicians. “Most doctors aren’t familiar with using this technique because they’ve been told not to do it up until now,” she said. “You have to be educated about how to use it.”  She warned that people with diabetes could experience bad outcomes if their doctors don’t have the right information. “If you drop your carbs and don’t change your medication, it’s very likely you’ll have too much medicine for your body and you’ll have side effects,” she said. “Then the diet gets blamed when it’s not the diet’s fault at all.”  Vernon would also like to see the ADA back off their restriction that people stay on low-carb diets for no more than a year. “What happens if, after a year, your blood sugars are good — should you quit?” she said. “We don’t take people off their medicine if it’s working. It’s not fair to hold this diet to a standard that nothing else is held to.”   Sources 1. American Diabetes Association. January 2008. Nutrition Recommendations and Interventions for Diabetes. Diabetes Care, Volume 31: S61-S78. 
Last Modified Date: January 8, 2008

Low B12 increases risk of cognitive decline

Sat, 15 Dec 2007 07:41:21 -0500

Low vitamin B-12 status and risk of cognitive decline in older adults

Robert Clarke, Jacqueline Birks, Ebba Nexo, Per M Ueland, Joern Schneede, John Scott, Anne Molloy and John Grimley Evans
1 From the Clinical Trial Service Unit, University of Oxford, (RC), Division of Clinical Geratology, Nuffield Department of Clinical Medicine (JB and JGE), University of Oxford, Oxford, United Kingdom; Department of Clinical Biochemistry, AS, Aarhus University Hospital, Aarhus, Denmark (EN); Section for Pharmacology, Institute of Medicine, University of Bergen and Auckland University Hospital, Bergen, Norway (PMU); Department of Clinical Chemistry, Umeå University Hospital, Umeå, Sweden (J Schneede); and Department of Biochemistry, Trinity College, Dublin, Ireland (AM and J Scott)

Background: Elevated total homocysteine (tHcy) concentrations have been associated with cognitive impairment, but it is unclear whether low vitamin B-12 or folate status is responsible for cognitive decline.
Objective: We examined the associations of cognitive decline with vitamin B-12 and folate status in a longitudinal cohort study performed from 1993 to 2003 in Oxford, United Kingdom.
Design: Cognitive function was assessed with the Mini-Mental State Examination on 3 occasions during 10 y and related to serum concentrations of vitamin B-12, holotranscobalamin (holoTC), tHcy, methylmalonic acid (MMA), and folate with the use of linear mixed models in 1648 participants who provided blood in 1995.
Results: Cognitive function declined abruptly at younger ages in some participants but remained intact in others until very old age. In multivariate regression analyses after adjustment for established risk factors, concentrations of holoTC (a marker of reduced vitamin B-12 status), tHcy, and MMA predicted cognitive decline, but folate did not. A doubling in holoTC concentrations (from 50 to 100 pmol/L) was associated with a 30% slower rate of cognitive decline (–0.137 to –0.083), whereas a doubling in tHcy (from 10 to 20 µmol/L) or MMA (from 0.25 to 0.50 µmol/L) was associated with >50% more rapid cognitive decline (–0.090 to –0.169) and (–0.104 to –0.169), respectively. After adjustment for all vitamin markers simultaneously, the associations of cognitive decline with holoTC and MMA remained significant.

Conclusions: Low vitamin B-12 status was associated with more rapid cognitive decline. Randomized trials are required to determine the relevance of vitamin B-12 supplementation for prevention of dementia.

Food Labels New and Improved??

Mon, 3 Dec 2007 14:05:47 -0500

December 1, 2007

Is It Healthy? Food Rating Systems Battle It Out
By ANDREW MARTIN

At the grocery store, shoppers confront a dizzying array of labels promoting whole grains, reduced fat, antioxidants or vitamins. Some foods are said to be “Smart Choices,” while others are a “Sensible Solution.”

Amid the confusion, how can consumers tell whether Cheerios, say, are better or worse than Special K? Is light mayonnaise more nutritious than regular? Which are worse, Nilla Wafers or Chunky Chips Ahoy?

Suddenly, after years of chaotic, conflicting health claims on food, various groups are rushing to create systems that are supposed to make sense of it all. And grocery chains are starting to line up behind one system or another. Within months, shoppers across the country may find numerical ratings, star ratings or letter grades plastered on the shelf next to virtually every product in a store.
“We know that our customers are looking for answers in how to make their diet better,” said Ric Jurgens, president and chief executive of Hy-Vee grocery stores and chairman of a cooperative that has endorsed one system. He says it “provides a revolutionary and simple way to assess all the foods in our stores.”

But consumer advocates worry that the sudden flurry of rating systems could add to shopper confusion, not ameliorate it, at least until one of the systems wins out and becomes a national standard. Moreover, determining what foods are healthier is as much art as science, requiring judgment about how much value to attach to various scientific findings about diet and health.
The ratings systems under development all use government dietary guidance as a starting point. Then they consider various nutrients and give them scores to compute a single rating that is supposed to reflect the aggregate nutritional value of a food.

The groups developing these systems claim they will be a simplification over the nutritional labels required by the government and the plethora of logos and slogans meant to signify good nutrition.
In Washington yesterday, Dr. David L. Katz, director of the Yale-Griffin Prevention Research Center in Connecticut, unveiled a rating system called the Overall Nutritional Quality Index, or ONQI for short. The Katz system will evaluate all foods in a grocery store on a 1-to-100 scale, with 100 being the healthiest.

The cooperative that Jurgens heads, which includes regional grocery chains, has bought a stake in Dr. Katz’s algorithm, and some of the stores plan to begin using it on their shelves next summer.
Earlier in the week, the Hannaford Brothers Company, a Maine grocery chain, announced that it would license its “Guiding Stars” rating system to other grocery chains next year. Started a little more than a year ago, the Guiding Stars system was developed by a team of academics and rates food from zero to three stars, with three being the healthiest. Hannaford says higher-rated packaged goods are selling more briskly.

Finally, a noted University of Washington nutritionist, Adam Drewnowski, said he, too, planned to unveil a scoring system that could be translated into numerical scores or letter grades.
Prof. Drewnowski said the problem with many of the health logos in stores was that they focused on negative attributes like sodium and saturated fat but did not account for positive attributes.
“It’s not enough to come up with a score that spinach is healthier than potato chips,” said Prof. Drewnowski, director of the university’s Center for Public Health Nutrition. “What happens to the vast majority of foods in the middle of the range? How do they compare? Ours does that.”
Professor Drewnowski’s scoring system will be published in academic journals. The other two systems are proprietary, prompting some experts to complain that their merits will be hard to evaluate.

The scoring scramble comes at a time when food manufacturers, grocery stores and the federal government have acknowledged that the profusion of labels on food packaging might confuse consumers.

Many food companies have their own logos and criteria for better-for-you foods, including Kraft’s “Sensible Solutions,” Pepsico’s “Smart Spot” and Unilever’s “Choices.” Those that do not have such logos have nonetheless festooned their packages with labels advertising less salt, more fiber, more calcium and so on.

The labels have gotten so out of hand that the nation’s top food manufacturers and grocers have been meeting regularly to come up with a uniform label for healthy food, something that is being tried in Europe with mixed results.

The Food and Drug Administration, meanwhile, held a two-day hearing in September on the proliferation of health-related labels and how they influence consumer decisions. The meeting was held at the behest of the Center for Science in the Public Interest, a nutrition advocacy group, which argues a government-sanctioned nutrition rating system is warranted.

“With Hannaford giving a food no stars but it has the American Heart Association logo on it, what is a consumer supposed to make of that?” said Michael F. Jacobson, the group’s executive director. “I think we are going to have competing systems until the federal government steps in.”
Federal officials said they were gathering public comments after the hearing and had not reached any conclusions. Many grocery stores have not yet bought into the idea of a single rating system, either.

“We would want to see good consumer testing and know that it doesn’t confuse consumers more than it helps them,” said Jane Andrews, corporate nutrition manager for Wegmans Food Markets, a grocery chain based in Rochester.
Dr. Katz said the impetus for developing a rating system for groceries was his real-life experience as a doctor and father of five children. His patients and his family struggled to interpret the labels on food packaging.
For instance, a consumer may think that Hellman’s Light Mayonnaise is healthier than the company’s regular mayonnaise. In fact, it has less saturated fat than the regular mayonnaise but more sodium; over all, by Dr. Katz’s calculation, the regular mayonnaise is healthier.
“The public is just too befuddled,” Dr. Katz said.

He gathered a panel of academics that weighed nutritional factors ranging from vitamins and bioflavonoids to trans fatty acids and sodium in their algorithm. So far, they have scored 20,000 foods and will have 50,000 done by the time the rating system appears in stores next summer.
Where Hannaford’s system assigned stars to 28 percent of the food items in the store, meaning that 72 percent got no stars, Dr. Katz said his system would provide more specific guidance for every food item in a store.

A preliminary ranking of foods found many predictable results, but some that were surprising. Cocoa Krispies scored last for nutrition among breakfast cereals, and salmon was tops among meats. Kiwifruit rated at the top among fruit.
Oh, and Cheerios, by Dr. Katz’s method, are better for you than Special K. Chunky Chips Ahoy turn out to be slightly worse than Nilla Wafers.

Copyright 2007 The New York Times Company

How to eat during the Holidays

Wed, 21 Nov 2007 17:28:07 -0500

Successful Holiday Eating
Some Unexpected Advice
David B Chauvin, DO FACEP
Board Certified Bariatric Medicine
www.roundtablewellness.com

Perhaps this might surprise you, but my advice for Thanksgiving and Christmas dinner is to enjoy yourself. You can’t get fat in one day!!!

The real key to losing weight and keeping it off is to develop an eating plan. Psychology and emotions play a huge role in consistent weight loss and maintenance strategies. Trying to exercise restraint when a holiday feast is spread out before you is psychologically unsound, to say the least. Turkey, mashed potatoes, gravy, stuffing, sweet potatoes, pumpkin pie – makes my mouth water just typing the words. Who’s kidding who? Denying yourself on such occasions is bound to bring on the mother of all binges. And you’ll be eating your head off for a week to make-up for depriving yourself on that special day.

Enjoy yourself, but use a little common sense. If you handle it correctly, your weight will be back to normal in three or four days. Try to eat your food slowly and while sitting down. Don’t take any food home. If you’re eating at Grandma’s house, politely refuse the offers to take leftovers home. If you’re eating at home, get rid of the festive fare immediately after the meal. Give it away, throw it away, give it to the dog. Do what you need to do to get it out of the house and out of sight.

The real danger are the days in between Thanksgiving and New Year’s. Holiday food is everywhere at office parties, get togethers and family events. The temptation to have just “one” can be overwhelming. Before you know it, you have consumed a significant number of extra calories per day and that’s when you find those holiday pounds clinging to your thighs.

Here are some suggestions.

Never ever skip breakfast. Even on Thanksgiving and Christmas. Eat a breakfast with at least 15 or 20 grams of lean protein and low in carbohydrates. When you skip breakfast your appetite and cravings are enhanced. A good choice would be a protein drink, lean turkey, or chicken breast. Yes.. you can eat turkey and chicken for breakfast.

Avoid Carbohydrates before 12 noon. Carbohydrates eaten during the morning can trigger cravings in the afternoon and increase the likelihood of making bad food choices.

Watch out for that finger food. Its EVERYWHERE. Most people are unaware how much they are eating when food is presented in a large bowl or buffet. Try to use a small plate which will seem like you are eating more than you are and you will be satisfied sooner.

Try to cut out excessive “craziness” during the holidays. Keep your work schedule as light as possible. Do you really need to mail EVERYONE you know a Holiday card?

When going out to a party, try to eat at least 15 to 20 grams of protein one hour before. Fatty fish like salmon and cod would be a good choice. Already having food in your stomach will allow you to make better choices.

Don’t give up on your exercise routine. BUT... exercise not to burn calories, but to change your metabolism from a sugar burner to a fat burner.

Schedule at least 15 minutes of “me” time per day, especially during the holidays. Quiet reading, listening to music, praying or mediating are good examples.

Get at least 7 hours of sleep per night.

A pound of fat contains about 3500 calories, which represents a lot of food. Although it is almost impossible to gain a pound or more of fat in one day, those holiday stealth calories can really add up.

So on Thanksgiving and Christmas eat up. Enjoy yourself. Then go back to healthy eating – and exercising!!

Food Diaries

Mon, 12 Nov 2007 18:45:29 -0500

Is being Overweight ok??

Wed, 7 Nov 2007 07:14:26 -0500

Overweight? Study Finds In Your Favor
ASSOCIATED PRESS
November 6, 2007 9:48 p.m.; Page D8
CHICAGO -- Being 25 pounds overweight doesn't appear to increase your risk of dying from cancer or heart disease, a new government study says.
The findings may comfort some who can't seem to lose those last 15 pounds. And they hearten backers of a theory that it is possible to be "fit and fat."
But the news isn't all good: Overweight people do have a higher chance of dying from diabetes and kidney disease.
And obese people -- generally those more than 30 pounds overweight for their height -- have a higher risk of death from a variety of ills, including some cancers and heart disease.
However, having a little extra weight actually seemed to help people survive some illnesses. "This is a very puzzling disconnect," said JoAnn Manson, chief of preventive medicine at Harvard's Brigham and Women's Hospital.
It was the second study by the same government scientists who two years ago first suggested that deaths from being too fat were overstated.
The new report further analyzed the same data, this time looking at specific causes of death along with new mortality figures from 2004 for 2.3 million U.S. adults.
The study, appearing in today's Journal of the American Medical Association, analyzed the body-mass index of people who died from various diseases.
Copyright © 2007 Associated Press

Cod and Diabetes

Thu, 1 Nov 2007 14:19:04 -0400

Dietary Cod Protein May Help Prevent Type 2 Diabetes
News Author: Laurie Barclay, MD 
October 31, 2007 — Dietary cod protein improved insulin sensitivity in insulin-resistant individuals and could help prevent type 2 diabetes by reducing the metabolic complications related to insulin resistance, according to the results of a randomized, controlled trial reported in the November issue of Diabetes Care.

Study Highlights

After a 2-week run-in period, participants were randomly assigned to a cod protein diet or a diet containing BPVEM (lean beef, pork, veal, eggs, milk, and milk product) for 4 weeks. After another 4-week washout period, subjects received the diet they did not consume in the first testing period.

Both diets derived 51% to 52% of their total energy from carbohydrate, 18% to 19% from protein, and 32% from fat. A proportion of 58% to 68% of daily dietary proteins came from cod fillets or BPVEM food products (lean beef, pork, veal, eggs, milk, and milk product). Cod liver oil was added to the BPVEM diet to provide similar amounts of n-3 polyunsaturated fatty acids in both diets.

The cod diet improved insulin sensitivity by 29%, whereas the BPVEM diet reduced insulin sensitivity by 3%. There was no correlation between weight change and changes in insulin sensitivity.
Subjects with a low insulin sensitivity at baseline derived the greatest benefit with the cod vs BPVEM diet

Can't Sleep? Sleep Expert Has The Answers

Wed, 31 Oct 2007 08:21:27 -0400

28 Oct 2007

Ever wonder why you are fatigued during the day when you thought you slept throughout the night? Why your spouse snores so much? Whether your sleep problems might be related to other health issues? Dr. Aparajitha Verma, neurologist with the Sleep Disorders Center at the Methodist Neurological Institute in Houston, Texas, is here to answer those questions and help you get a good night's rest.

Q&A

Q: How do I know if I'm having serious sleep problems?

A: If you cannot fall asleep within 30 minutes of lying down, if you have excessive daytime sleepiness, or if you sleep for seven or more hours and still wake up tired, you may have a sleeping disorder. We recommend people with these symptoms undergo an overnight sleep study at a center that is accredited by the American Academy of Sleep Medicine, such as our center at Methodist.

Q: My spouse tells me I snore loudly or I sometimes stop breathing during the night. What could be the cause?

A: Snoring can be a symptom of obstructive sleep apnea (OSA) which, if left untreated, can be life threatening. If an overnight sleep study results in a diagnosis of a sleep disorder, we follow the philosophy that the patient should be given the option to choose. For example, good candidates for continuous positive airway pressure (CPAP) treatment include patients with sleep-disordered breathing - upper airway resistance syndrome, OSA, and central sleep apnea. The C-FLEX with CPAP is a good option for patients who have a hard time exhaling or who complain that "air is getting stuck in my chest or throat."

Q: I sleep all night and still wake up in the morning tired. Sometimes I even fall asleep at work or, worse, while I'm driving. What's wrong?

A: This could be a sign of OSA or narcolepsy, which is a chronic neurological disorder caused by the brain's inability to regulate sleep-wake cycles normally. Some patients with narcolepsy also experience cataplexy, which is a condition featuring loss of muscle function, ranging from slight weakness (such as limpness at the neck or knees, sagging facial muscles, or inability to speak clearly) to complete body collapse.

Q: If I have a sleep disorder, am I at a higher risk of other health issues?

A: People with sleep disorders, such as sleep apnea, are at a higher risk for stroke and transient ischemic attacks (TIAs, also known as "mini-strokes"), coronary heart disease, heart failure, irregular heartbeat, heart attack, and high blood pressure. Although there is no cure for sleep apnea, successful treatment can reduce the risk of heart and blood pressure problems.

Q: Is there a relationship between sleep deprivation and weight gain?

A: The risk of gaining weight increases as the number of hours a person sleeps each night decreases. If you sleep less than six hours a night, you are 50 percent more likely to become obese than someone who is sleeping seven to eight hours a night. Two hormones play a role in weight management. Leptin is associated with appetite control and ghrelin has been identified as an appetite stimulant. During sleep deprivation, leptin levels fall and ghrelin levels rise, which leads to an increased appetite.

Q: What are some tips I can follow to help me get a better night's sleep?

A: I tell patients that good "sleep hygiene" is just as important as diet and exercise:

-- Sleep in a quiet and dark environment and set the thermostat at a slightly cooler temperature

-- Don't allow pets in the bed

-- No reading, eating or watching TV in bed

-- Don't watch the clock

-- Set a "wind down" time prior to going to bed

-- Don't take over the counter sleep aids, as these can disrupt sleep stages Instead, try drinking warms teas or milk to increase your body temperature, which helps induce and sustain sleep

-- Exercise is good for sleep, however not within two hours of going to sleep

Methodist Hospital, Houston
6565 Fannin St.
Houston, Tx 77030
United States
http://www.methodisthealth.com

Mindless Eating

Thu, 25 Oct 2007 08:27:07 -0400

Book Excerpt: 'Mindless Eating'
Why We Eat More Than We Think
Oct. 23, 2006 —

In his new book, Brian Wansink, a food psychology professor at Cornell University, explains why we eat with our eyes and not with our stomach, and how this can affect our weight.
The following is an excerpt from "Mindless Eating."
Chapter One

The Mindless Margin
Did you ever eat the last piece of crusty, dried-out chocolate cake even though it tasted like chocolate-scented cardboard? Ever finish eating a bag of French fries even though they were cold, limp, and soggy? It hurts to answer questions like these.
Why do we overeat food that doesn't even taste good?
We overeat because there are signals and cues around us that tell us to eat. It's simply not in our nature to pause after every bite and contemplate whether we're full. As we eat, we unknowingly -- mindlessly -- look for signals or cues that we've had enough. For instance, if there's nothing remaining on the table, that's a cue that it's time to stop. If everyone else has left the table, turned off the lights, and we're sitting alone in the dark, that's another cue. For many of us, as long as there are still a few milk-soaked Fruit Loops left in the bottom of the cereal bowl, there is still work to be done. It doesn't matter if we're full, and it doesn't matter if we don't even really like Fruit Loops. We eat as if it is our mission to finish them.

Stale Popcorn and Frail Willpower
Take movie popcorn, for instance. There is no "right" amount of popcorn to eat during a movie. There are no rules of thumb or FDA guidelines. People eat however much they want depending on how hungry they are and how good it tastes. At least that's what they say.
My graduate students and I think different. We think that the cues around us -- like the size of a popcorn bucket -- can provide subtle but powerful suggestions about how much one should eat. These cues can short-circuit a person's hunger and taste signals, leading them to eat even if they're not hungry and even if the food doesn't taste very good.
If you were living in Chicago a few years back, you might have been our guest at a suburban theater matinee. If you lined up to see the 1:05 p.m. Saturday showing of Mel Gibson's new action movie, Payback, you would have had a surprise waiting for you: a free bucket of popcorn.
Every person who bought a ticket -- even though many of them had just eaten lunch -- was given a soft drink and either a medium-size bucket of popcorn or a large-size, bigger-than-your-head bucket. They were told that the popcorn and soft drinks were free and that we hoped they would be willing to answer a few concession standrelated questions after the movie.
There was only one catch. This wasn't fresh popcorn. Unknown to the moviegoers and even to my graduate students, this popcorn had been popped five days earlier and stored in sterile conditions until it was stale enough to squeak when it was eaten.
To make sure it was kept separate from the rest of the theater popcorn, it was transported to the theater in bright yellow garbage bags -- the color yellow that screams "Biohazard." The popcorn was safe to eat, but it was stale enough one moviegoer said it was like eating Styrofoam packing peanuts. Two others, forgetting they had been given it for free, asked for their money back. During the movie, people would eat a couple bites, put the bucket down, pick it up again a few minutes later and have a couple more bites, put it back down, and continue. It might not have been good enough to eat all at once, but they couldn't leave it alone.
Both popcorn containers -- medium and large -- had been selected to be big enough that nobody could finish all the popcorn. And each person was given his or her own individual bucket so there would be no sharing.
As soon as the movie ended and the credits began to roll, we asked everyone to take their popcorn with them. We gave them a half-page survey (on bright biohazard-yellow paper) that asked whether they agreed to statements like "I ate too much popcorn," by circling a number from 1 (strongly disagree) to 9 (strongly agree). As they did this, we weighed their remaining popcorn.
When the people who had been given the large buckets handed their leftover popcorn to us, we said, "Some people tonight were given medium-size buckets of popcorn, and others, like yourself, were given these large-size buckets. We have found that the average person who is given a large-size container eats more than if they are given a medium-size container. Do you think you ate more because you had the large size?" Most disagreed. Many smugly said, "That wouldn't happen to me," "Things like that don't trick me," or "I'm pretty good at knowing when I'm full."
That may be what they believed, but it is not what happened.
Weighing the buckets told us that the big-bucket group people ate an average of 173 more calories of popcorn. That is roughly the equivalent of 21 more dips into the bucket. Clearly the quality of food is not what led them to eat. Once these moviegoers started in on their bucket, the taste of the popcorn didn't matter. Even though some of them had just had lunch, people who were given the big buckets ate an average of 53 percent more than those given medium-size buckets. Give them a lot, and they eat a lot.
And this was five-day-old, stale popcorn!
We've run other popcorn studies, and the results were always the same, however we tweaked the details. It didn't matter if our moviegoers were in Pennsylvania, Illinois, or Iowa, and it didn't matter what kind of movie was showing, all of our popcorn studies led to the same conclusion. People eat more when you give them a bigger container. Period. It doesn't matter whether the popcorn is fresh or fourteen days old, or whether they were hungry or full when they sat down for the movie.
Did people eat because they liked the popcorn? No. Did they eat because they were hungry? No. They ate because of all the cues around them -- not only the size of the popcorn bucket, but also other factors I'll discuss later, such as the distracting movie, the sound of people eating popcorn around them, and the eating scripts we take to movie theaters with us. All of these were cues that signaled it was okay to keep on eating and eating.
Does this mean we can avoid mindless eating simply by replacing large bowls with smaller bowls? That's one piece of the puzzle, but there are a lot more cues that can be engineered out of our lives. As you will see, these hidden persuaders can even take the form of a tasty description on a menu or a classy name on a wine bottle. Simply thinking that a meal will taste good can lead you to eat more. You won't even know it happened.

As Fine as North Dakota Wine
The restaurant is open only 24 nights a year and serves an inclusive prix-fixe theme dinner each night. A nice meal will cost you less than $25, but to get it you will have to phone for reservations and be seated at either 5:30 or 7:00 sharp. Despite these drawbacks, there is often a waiting list.
Welcome to the Spice Box. The Spice Box looks like a restaurant; it sounds like a restaurant; and it smells like a restaurant. To the people eating there, it is a restaurant. To the people working there, it's a fine dining lab sponsored by the Department of Food Science and Human Nutrition at the University of Illinois at Urbana-Champaign. The Spice Box is a lab where culinary hopefuls learn whether a new recipe will fly or go down in flames. It's a lab where waitstaff discover whether a new approach will sizzle or fizzle. It's also a lab where consumer psychologists have figured out what makes a person nibble a little or inhale it all.
There is a secret and imaginary line down the middle of the dining room in the Spice Box. On one Thursday, diners on the left side of the room might be getting a different version of the shrimp coconut jambalaya entrée than those on the right. On the next Thursday, diners on the left side will be given a menu with basic English names for the food, while those on the right will be given a menu with French-sounding names. On the Thursday after that, diners on the left side will hear each entrée described by a waiter, while those on the right will read the same descriptions off the menu. At the end of the meal, sometimes we ask the diners some short survey questions, but other times we carefully weigh how much food our guests have left on their plates. That way we don't have to rely on what they say, we can rely on what they do -- which version of shrimp coconut jambalaya they polished off.
But on one dark Thursday night in the first week of February 2004, something a little more mischievous was planned for diners who braved the snow to keep their reservations. They were getting a full glass of Cabernet Sauvignon before their meal. Totally free. Compliments of the house.
This cabernet was not a fine vintage. In fact, it was a $2 bottle sold under the brand name Charles Shaw -- popularly known as Two Buck Chuck. But our diners didn't know this. In fact, all the Charles Shaw labels had been soaked off the bottles and replaced with professionally designed labels that were 100 percent fake.
Those on the left side of the room were being offered wine from the fictional Noah's Winery, a new California label. The winery's classic, italicized logo was enveloped by a simple graphic of grapes and vines. Below this, the wine proudly announced that it was "NEW from California." After the diners arrived and were seated, the waiter or waitress said, "Good evening and welcome to the Spice Box. As you're deciding what you want to eat this evening, we're offering you a complimentary glass of Cabernet Sauvignon. It's from a new California winery called Noah's Winery." Each person was then poured a standard 3.8-ounce glass of wine.
About an hour later, after they had finished their meal and were paying for it, we weighed the amount of wine left in each glass and the amount of the entrée left on each plate. We also had a record of when each diner had started eating and when they paid their bill and left.
Diners on the right side of the room had exactly the same dining experience -- with one exception. The waiter or waitress's carefully scripted welcome introduced a cabernet "from a new North Dakota winery called Noah's Winery." The label was identical to that on the first bottle, except for the words "NEW from North Dakota."
There is no Bordeaux region in North Dakota, nor is there a Burgundy region, nor a Champagne region. There is, however, a Fargo region, a Bismarck region, and a Minot region. It's just that there are no wine grapes grown in any of them. California equals wine. North Dakota equals snow or buffalo.
People who were given "North Dakota wine" believed it was North Dakota wine. But since it was the same wine we poured for those who thought they were getting California wine, that shouldn't influence their taste. Should it?
It did. We knew from an earlier lab study that people who thought they were drinking North Dakota wine had such low expectations, they rated the wine as tasting bad and their food as less tasty. If a California wine label can give a glowing halo to an entire meal, a North Dakota wine label casts a shadow onto everything it touches.
But our focus that particular night was whether these labels would influence how much our diners ate.
After the meals were over, the first thing we discovered was that both groups of people drank about the same amount of wine -- all of it. This was not so surprising. It was only one glass of wine and it was a cold night. Where they differed was in how much food they ate and how long they lingered at their table.
Compared to those unlucky diners given wine with North Dakota labels, people who thought they had been given a free glass of California wine ate 11 percent more of their food -- 19 of the 24 even cleaned their plates. They also lingered an average of 10 minutes longer at their table (64 minutes). They stayed pretty much until the waitstaff starting dropping hints that the next seating would be starting soon.
The night was not quite as magical for those given wine with the North Dakota label. Not only did they leave more food on their plates, this probably wasn't much of a meal to remember, because it went by so fast. North Dakota wine drinkers sat down, drank, ate, paid, and were out in 55 minutes -- less than an hour. For them, this was clearly not a special meal, it was just food.
Exact same meals, exact same wine. Different labels, different reactions.
Now, to a cold-eyed skeptic, there should have been no difference between the two groups. They should have eaten the same amount and enjoyed it the same.
They didn't. They mindlessly ate. That is, once they were given a free glass of "California" wine, they said to themselves: "This is going to be good." Once they concluded it was going to be good, their experience lined up to confirm their expectations. They no longer had to stop and think about whether the food and wine were really as good as they thought. They had already decided.
Of course, the same thing happened to the diners who were given the "North Dakota" wine. Once they saw the label, they set themselves up for disappointment. There was no halo; there was a shadow. And not only was the wine bad, the entire meal fell short.
After our studies are over, we "debrief" people -- often by e-mail -- and tell them what the study was about and what results we expect. For instance, with our different wine studies, we might say, "We think the average person drinking what they believe is North Dakota wine will like their meal less than those given the 'California' wine." We then ask the kicker: "Do you think you were influenced by the state's name you saw on the label?" Almost all will give the exact same answer: "No, I wasn't."
In the thousands of debriefings we've done for hundreds of studies, nearly every person who was "tricked" by the words on a label, the size of a package, the lighting in a room, or the size of a plate said, "I wasn't influenced by that." They might acknowledge that others could be "fooled," but they don't think they were. That is what gives mindless eating so much power over us -- we're not aware it's happening.
Even when we do pay close attention we are suggestible -- and even when it comes to cold, hard numbers. If you ask people if there are more or less than 50 calories in an apple, most will say more. When you ask them how many, the average person will say, "66." If you had instead asked if there were more or less than 150 calories in an apple, most would say less. When you ask them how many, the average person would say, "114." People unknowingly anchor or focus on the number they first hear and let that bias them.
A while back, I teamed up with two professor friends of mine -- Steve Hoch and Bob Kent -- to see if anchoring influences how much food we buy in grocery stores. We believed that grocery shoppers who saw numerical signs such as "Limit 12 Per Person" would buy much more than those who saw signs such as "No Limit Per Person." To nail down the psychology behind this, we repeated this study in different forms, using different numbers, different promotions (like "2 for $2" versus "1 for $1"), and in different supermarkets and convenience stores. By the time we finished, we knew that any sign with a number promotion leads us to buy 30 to 100 percent more than we normally would.
After the research was completed and published in the Journal of Marketing Research, another friend and I were in the checkout line at a grocery store, where I saw a sign advertising gum, "10 packs for $2." I was eagerly counting out 10 packs onto the conveyer belt, when my friend commented, "Didn't you just publish a big research paper on that?"
We're all tricked by our environment. Even if we "know it" in our head, most of the time we have way too much on our mind to remember it and act on it. That's why it's easier to change our environment than our mind.
Copyright © 2006 by Brian Wansink, Ph.D.

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Tue, 23 Oct 2007 20:32:31 -0400