In the February 8, 2006 issue of the Journal of the American Medical Association (JAMA), three articles on the Women’s Health Initiative Dietary Modification Trial pointed to the failure of a low fat diet to prevent heart disease, breast cancer and colon cancer in postmenopausal women. Publication of these findings led to a burst of media reports around the globe, many of which challenged the wisdom of current dietary guidelines that encourage a reduction in dietary fat and an increase in fruits, vegetables and grains. These reports have left many people confused about what constitutes a healthy diet.

First, it’s important to realize that although there were three published papers, this is actually one study undertaken by the Women’s Health Initiative, not three studies. In this large study, more than 48,000 overweight postmenopausal women between the ages of 50 to 79 were divided into two groups: an intervention group that was asked to make dietary changes, and a control – or comparison – group that was not. The study was carried out in 40 clinical locations throughout the U.S. and the prescription in the dietary change group was to reduce fat to 20% of calories, boost fruit and vegetable consumption to at least 5 servings a day, and increase intake of grains to at least 6 servings a day.

Since the intervention failed – the dietary changes did not reduce the incidence of heart disease or breast or colon cancers – many people were left wondering what went wrong – was it the study or was it the dietary change prescription? In my opinion, it was the study. The study examined whether a low fat diet, instituted relatively late in life in a large group of overweight women, could reverse the damage of 50 years of dietary indiscretion, in the absence of any other healthy changes in lifestyle. The women were not asked to lose weight, nor were they given an exercise regimen. This was a study of the ability of dietary, not lifestyle, change to reduce the occurrence of disease. The study had three dietary goals:

1. Fat: Habitual consumption of a high fat diet was a requirement for inclusion in the study. Women consuming less than 32% of calories as fat were excluded from the study. The researchers aimed to reduce total fat consumption to 20% of daily calories in the intervention group and presumed that if that goal was achieved, the amount of saturated fat would be reduced to 7% of energy. Total fat consumption was 38% in both groups at the start of the study, and fat intake did significantly decrease in the intervention group. However, in 8 years of follow-up, neither the 20% total fat goal nor the 7% saturated fat goal was attained. So, the key dietary change was less than desired and the difference in fat intake between the two groups was smaller than the study designers intended. Furthermore, the difference in fat intake between the two groups narrowed as the study progressed through the years.
2. Vegetables and Fruit: Another goal was to boost vegetable and fruit consumption to 5 a day in the intervention group. This group did increase their vegetable and fruit intake to 6.5 servings a day at the end of year 1, but the control group intake at that time point was 5.5 servings a day. So, both groups met the 5-a-day goal and the difference in intake between the two groups was only 1 serving per day.
3. Grains: The third goal was to increase grain intake. [Note: There was no distinction made in the report between refined grain and whole grain intake.] The intervention group did achieve a modest increase in grain consumption but the small difference – half a serving – between the intervention and control groups varied throughout the study and it “appeared to decline as the study progressed.”

Breast Cancer Findings: Despite these inadequacies in study design and execution, the breast cancer incidence was 9% lower for women in the intervention group. This reduction missed achieving “statistical significance.” However, in a subgroup of women in the intervention group who adhered to the diet, the incidence of breast cancer was significantly reduced. The benefit of fat reduction appeared to be greatest in women whose fat intake started out at the highest level. Also, there was some evidence that the dietary intervention may have had a beneficial impact on reducing the number of certain types of tumors. Although all of these benefits must be considered tentative, they point toward a protective effect of dietary changes initiated after age 50 in preventing breast cancer.

Colorectal Cancer Findings: The dietary prescription used in the intervention group did not reduce colorectal cancer risk. The findings of this study combined with an earlier study (The Poly Prevention Trial) suggest that the dietary changes intended to prevent this type of cancer may need to be initiated earlier – possibly much earlier – in life.

Cardiovascular Disease (CVD) Findings: The dietary intervention did not reduce the risk of coronary heart disease or stroke. The women in the study were overweight (average BMI was 29.1), which may explain the failure of the intervention to reduce risk. Weight loss and physical activity, both of which can influence CVD risk, were not part of the intervention design. Women who achieved the lowest intakes of saturated fat or trans fat showed “positive trends,” namely, lower levels of LDL cholesterol (“bad” cholesterol) and reduced rates of coronary heart disease.

At Shape Up America!, we believe that disease prevention starts well before age 50. Indeed, it starts PRIOR to conception and continues during pregnancy and throughout life. Low-fat eating and boosting vegetable, fruit and fiber intake are important disease prevention strategies, along with increased physical activity and weight management –including weight loss when needed. Our take on the results of the Women’s Health Initiative Dietary Modification Trial is that it failed to address a healthy lifestyle in a comprehensive manner. A healthy diet is certainly important, but it is not enough to optimize health. It must be augmented by physical activity and weight control.

1. Lifting weights makes you “bulky.” This is probably the oldest weight-lifting myth around. “Bulk” is basically muscle mass under excess subcutaneous body fat – the fat layer just underneath your skin and above the muscle. Resistance or weight training can help you achieve a firmed and toned muscular body. To properly tone and strengthen your muscles, you should use less weight (and more repetitions) so that you remain in control and maintain proper form as you execute the entire movement. Proper technique will exercise the entire length of the muscle, not just the “belly” of the muscle. By coupling proper technique with a sensible diet, you will burn calories to reduce body fat while toning and building muscle. This is the way to improve your quality of life, not get bulky.

2. Spot reduction is possible. The myth of spot reduction will probably never go away because of all the fitness infomercials trying to convince you that it’s true. Spot-reduction hype would have you believe that if you want to lose body fat in a particular area (e.g., the stomach), then you simply need to work the muscles in that area (e.g., do crunches or situps). Unfortunately, it doesn’t work that way. Your body – your hormonal milieu, physiology and metabolism – decides what body fat gets burned first and from where. Anyone telling you otherwise is probably trying to sell you something.

3. “I don’t have enough time to exercise!” The time and training demands of professional and Olympic athletes do not apply to the average person trying to improve health and manage weight. The key is to find time throughout your day to include physical activity. It is OK to grab 10 minutes here and there; you don’t have to exercise continuously for it to count. You can accumulate several exercise bouts in the course of your day. Here are some goals:

Purpose	Daily Goal	Source
For general health	30 minutes a day of moderate intensity activity (e.g., walking at a brisk, but comfortable, speed of 3 to 4 miles per hour)	1996 U.S. Surgeon General’s Report on Physical Activity and Health; 2005 U.S. Dietary Guidelines and MyPyramid (mypyramid.gov)
For prevention of weight gain	60 minutes a day of moderate intensity activity (see above) or shorter bouts of more vigorous exertion (e.g., jogging 30 minutes at 5.5 mph)	2001 Institute of Medicine Report on Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids; 2005 U.S. Dietary Guidelines and MyPyramid (mypyramid.gov)
For Sustained Weight Loss	60-90 minutes of moderate intensity activity	2005 U.S. Dietary Guidelines and MyPyramid (mypyramid.gov)

4. Exercise sweats off fat. When sweat is pouring off your body, you may feel like you’re literally sweating off some fat. After a hard workout, you might even step on the scale and see that you’ve lost weight! But the weight you’ve lost is just sweat – which is almost entirely water and a tiny bit of salt – and not fat. Fat loss is a relatively slow process. However, exercise does burn calories and those calories over a period of time will add up to significant fat loss.

Don’t let fitness myths get in the way of achieving your health and fitness goals. Next month we’ll go back to introducing more exercises that you can do at your home with little or no equipment or expense.

INGREDIENTS:

• 1 tsp. olive or vegetable oil
• ½ pound chicken breast, sliced
• 4 scallions (green onions), diced
• 1 cup low-sodium chicken broth
• ½ cup canned mandarin oranges, drained and rinsed
• ½ grapefruit, peeled and sliced into small pieces, with pith removed
• 1 (5.7 oz.) box cous cous, cooked (follow instructions on box)
• 1 Tbsp. sliced almonds, toasted*

DIRECTIONS:

1. In a large pan on medium-high heat, heat oil and then add chicken slices. Brown them lightly on all sides. Make sure they are cooked throughout, then remove and set aside.
2. Add scallions to pan and sauté for 5-10 minutes until tender.
3. Stir in broth and bring to a simmer. Stir in orange segments, grapefruit segments, and chicken, and simmer for 5 minutes until all ingredients are heated throughout.
4. Add cooked cous cous and stir well. Sprinkle with toasted almonds, and serve.

Nutrition Information Per Serving: 550 calories, 7.1 grams total fat, 67 milligrams cholesterol, 6.1 grams fiber, 123 milligrams sodium

Source: Produce for Better Health, 5 A Day recipe, http://www.cdc.gov/nccdphp/dnpa/5aday/recipes