Strategy to get through the holidays: lead with the PROTEIN!

We've all seen those silly pop-up advertisements encouraging us to "click here for one simple trick to lose weight".  Most of them are ridiculous gimmicks and scams. Would you like some real science to help you instead?

I recently attended the international obesity conference called ObesityWeek in Boston.  There were over 100 sessions,  and over 5000 researchers, physicians, and other weight management professionals participated.   (Check out the schedule here:  https://obesityweek.com/program/)  There was an astounding amount of information presented on nutrition, exercise, lifestyle counseling and medication, but out of the thousands of slides I saw, one simple slide stood out in my mind above all others.  It showed the effect of starting a meal with protein, instead of starting a meal with carbohydrate.

Long story short -  when we begin a meal with bread, our blood sugar spikes up - and stays up - which is unhealthy.  When we begin a meal with protein, our blood sugar stays smooth and controlled.  The ‘simple trick’ of starting a meal (or snack) with protein can help control blood sugar - AND can help control appetite, improve our energy level, even help our mood!   

Benefits of protein for those trying to lose weight:

1. Raises Basal Metabolic Rate (BMR, also called REE/Resting Energy Expenditure)  - you ‘burn’ more calories even when you’re not exercising - simply by increasing the ratio of protein to carbohydrate in your diet.  Research suggests that higher protein diets can help  ‘burn off’ 350 extra calories per day.

2. Improves Satiety/Fullness/Satisfaction - protein helps you feel more full on fewer calories, so it’s easier to stay on a lower calorie diet!  Protein can prevent the fatigue, and ‘hypoglycemia’ that people can feel on ‘old school’ higher-carbohydrate diets.   The ‘SAD’ Diet (Standard American Diet) - contains a mere 12% of calories from protein on average. Try raising your protein percentage to 20-35% and you’ll feel more satisfied.

3. Improves Blood Sugar after meals.   The effect is strongest when you START A MEAL WITH PROTEIN!  Protein has the functional effect of lowering the glycemic index.  The A.U.C. (Area Under the Curve) of the post-prandial (after meal) blood sugar stays ‘low and smooth’ if you start a meal with PROTEIN.

4. Preserves Muscle during weight loss - AND helps you build muscle more effectively during/after workouts, compared to a higher carb, lower protein diet.  In other words - protein helps you create and keep your healthy muscle during weight loss (which maintains strength, metabolism, bone strength, coordination, prevent falls, helps smooth the appearance of cellulite, etc.)

5. Improves mental alertness and sustained cognitive performance - as opposed to sugar/carbohydrate-heavy snacks, which give a temporary ‘burst’ followed by a ‘crash’.  Wake up in the afternoon with a PROTEIN snack.

6. Heal more quickly after surgical procedures - After surgery, our protein needs increase, and we will heal more quickly if we make sure our protein intake is adequate.

What kinds of problems can arise from a blood sugar level which spikes up - and stays up - after a meal?  All sorts of issues may be connected: insulin resistance, metabolic syndrome, inflammation, etc.   Forty percent of American adults have prediabetes or diabetes now - think about that for a second - 4 out of every 10 Americans have a problem with their blood sugar!  Controlling blood sugar through diet, exercise, and weight management is becoming more important than ever!  

So, back to “one simple trick”:  starting off a meal with  protein can help us control our weight, appetite, blood sugar - even our mood -  through the holidays and beyond.   

Many people find themselves strapped for time, and end up neglecting themselves while taking care of others.  Don't forget to take care of yourself!  If you need help improving your protein intake, give us a call.  You can also try our tasty protein supplements to help make it easier to stay healthy - and even lose weight - through the holidays!   (Visit SeacoastNutrition.com and HealthyWeightCenter.com) seacoastnutrition.com


Updated research link - the preliminary research I reported on was finally published July 2015: 

Food Order Has a Significant Impact on Postprandial Glucose and Insulin Levels

Alpana P. Shukla⇑, 

Radu G. Iliescu, 

Catherine E. Thomas and

Louis J. Aronne

:  http://care.diabetesjournals.org/content/38/7/e98.full

Flash Back Friday: 7 Tips to Survive the Holidays!

Here is an 'oldie but goodie' - time to remind ourselves of these holiday survival strategies!

Holiday Healthy Weight Challenges

by Jennifer Warren, M.D.

That cozy time of year is approaching, and family and friends gather for

good times and good food. The holidays can present some special challenges

for healthy eating and activity, but with a little care and attention, you

can soar through the season, happy and healthy! A few tips to help…

1. When it comes to Holiday foods, adopt a “Love It, Need It, or Leave It”

policy. In other words, save your “special treat” calories for foods you

REALLY love - don’t waste them on high calorie food that you can get any

time of the year, or treats that don’t taste really fantastic. Remember,

you can always be a “taster”; if you don’t love it, don’t finish it - leave

it!

2. Be careful to keep up your healthy basic eating this time of year - with

three meals of healthy lean protein, high fiber whole fruits, vegetables and

whole grains, and a little bit of “good fat” - you need these year round.

Do not skip entire meals to save calories - this can slow your metabolism,

and lead to out-of-control overeating later, often of the wrong choices!

It’s best to save special desserts and treats for AFTER a healthy meal or

snack.

3. Keep up with your routine exercise plan, despite temptations to “just

take a break” for the holiday season. Exercise can be the single most

important factor when it comes to your health during this time. In

addition to the calorie and metabolic benefits, exercise can help you relax,

control stress, re-energize you, and clear your head during the whirl and

confusion of the holidays. Make this a top priority for yourself and your

family - be a role model for them, and encourage them to participate. A

neighborhood walk can also be a great way to reconnect and bond with family.

4. Planes, Trains, and Automobiles - whether you are traveling to visit

family, or just heading to the mall for holiday shopping - plan ahead by

bringing healthy portable snacks for yourself and companions. Don’t get

“caught hungry” with only high calorie, nutrient-poor options. Bring along

a few healthy protein bars, some dried fruit and nuts, and bottled water -

examples of portable healthy options that can save you in a pinch.

5. Plan for Parties - here are the basic principles…Before the party, eat a

snack with protein - this can help you stay in control when faced with a

buffet. If you are bringing an item, make it a healthy choice such as a

fruit/veggie/ yogurt plate, or lean protein such as shrimp, chicken kabobs

on skewers, or vegetarian or turkey chili. Once you arrive - don’t head

straight to the food; find your hosts, and start with a low calorie drink

such as flavored water or a spritzer, and then socialize. Minimize the

alcohol - it can make you lose control with food, among other things! When

you do head to the buffet, choose a small plate, and scan for healthy

starter items, and then special treats(see tips one and two!). Enjoy!

6. When you are the host: Plan some non food-oriented activities such as

family walks to gather balsam, holly, and sea shells for wreaths, centerpieces

or crafts.  have an ornament painting party with simple wooden shapes

and acrylic paints.  Turn on music and encourage kids(and adults) to dance.

Play family games such as Pictionary, bingo, or hold a Yankee Swap.

And encourage guests to bring home leftovers.  You may want to invest in some

inexpensive containers to facilitate this!

7. Above all, take care of yourself, so you can enjoy time with others.

 If  you are over-tired and cranky, you won’t be any fun at all! Take some “down

time” for yourself - don’t over-commit - and make adequate sleep a priority.

Relax with whatever method works for you - meditation, yoga, stretching,

listening to music, dancing, reading, or being creative with arts and

crafts, knitting, writing, or painting, for example. If your family is

lucky, perhaps you’ll share some of these activities with them!

Decision Fatigue- Make Choices Easier!

Studies show that it is exhausting to make decisions all day.  The greater the number of decisions, and the more complex they are, the more ‘worn out’ we become - we become mentally fatigued. By the end of the day (or even the end of a tough morning) the mental fatigue leads to lower willpower, and poor decision-making. We tend to take ‘the easy decision’ when we’re tired, and if tempted by ‘junk food’ we find ourselves falling for it, with little power to step back and make the healthy choice.  What to do?  Try to simplify choices throughout the day, conserving energy (and willpower.)   Read these interesting excerpts from a New York Times article:

http://www.nytimes.com/2011/08/21/magazine/do-you-suffer-from-decision-fatigue.html?pagewanted=all&_r=0

“...studies show that people with the best self-control are the ones who structure their lives so as to conserve willpower. They don’t schedule endless back-to-back meetings. They avoid temptations like all-you-can-eat buffets, and they establish habits that eliminate the mental effort of making choices. Instead of deciding every morning whether or not to force themselves to exercise, they set up regular appointments to work out with a friend. Instead of counting on willpower to remain robust all day, they conserve it so that it’s available for emergencies and important decisions”...

We’ve heard that willpower gets stronger the more we use it - but actually, the opposite is true! From the article: “The experiments confirmed the 19th-century notion of willpower being like a muscle that was fatigued with use, a force that could be conserved by avoiding temptation.”.. What gets stronger (easier) with use is not willpower, but instead GOOD HABITS.   What we do NOT want to do is constantly throw off or challenge our good habits - instead, we want to reinforce them, not weaken them with temptations.    Planning ahead to make ‘the good choice the easy choice”, and then practicing the good routine, makes it easier to stay on track.

 

More from the article:  “The more choices you make throughout the day, the harder each one becomes for your brain, and eventually it looks for shortcuts, usually in either of two very different ways. One shortcut is to become reckless: to act impulsively instead of expending the energy to first think through the consequences…. The other shortcut is the ultimate energy saver: do nothing.”...Neither of these outcomes are good for weight management! This concept is crucial: we will do BEST when we decide IN ADVANCE exactly what we’re going to eat throughout the day, and when we’re going to exercise.  This ‘saves’ our mental energy and willpower, so we’ll feel stronger in the evening - and find it easier to make better choices.  We’ll also feel less fatigued at the end of the day - and wouldn’t it be nice to have a little more energy, and feel more relaxed?

 

Another issue is "blood sugar”:  “Even the wisest people won’t make good choices when they’re not rested and their glucose is low,” Baumeister points out.”  Eating a balanced meal or snack which contains protein, every three to four hours during the day, will help keep blood sugar at an optimal range - and help sustain your mental as well as physical energy.  You’ll also find that evening eating is more in control, when you’ve eaten properly all day.

 

How to implement a plan?  Work with us to help you get over the toughest part - weighing the options (for food and exercise) and MAKING the choices, in advance.  It’s MUCH easier to implement a plan that is ALREADY DECIDED in advance, with specifics.  We can help!  Stock up on healthy choices, so that the healthy choice is the easy choice- both during the day, and when you get home at night.

New Research: Save Your Brain with Lifestyle Change; Alzheimer's cognitive deficits reversed with a comprehensive lifestyle approach

Big news: a Medscape article just announced research from the University of California, Los Angeles:  “A novel, comprehensive lifestyle intervention has shown promise in reversing memory loss related to Alzheimer's disease (AD)...According to investigators, this novel intervention is aimed at "tweaking" the network of imbalances in the brain that contribute to cognitive decline.” 

http://www.medscape.com/viewarticle/832752)   

Original paper: http://www.impactaging.com/papers/v6/n9/full/100690.html

The study, published in the journal Aging on September 27,  notes that memory problems are due to a loss of brain ‘plasticity’ (the flexible learning abililty that is characteristic of healthy young brains).  Researchers believe that damage is due to a number of  assaults on the brain, including environmental, metabolic, hormonal, and lifestyle factors, which end up tipping the balance toward cell breakdown (neuroclastic signaling) and away from healthy cell communication (neuroblastic signaling.)  The neurodegeneration (breakdown of healthy brain cell function) is the end result of physiologic ‘attacks’ on the brain, including inflammatory mediators.  

The good news is that they were able to reverse this process, and improve cognitive function, with specific, focused, individualized, comprehensive lifestyle strategies. There is no one ‘magic supplement’ or ‘magic pill’ which yielded results; instead, it was a multifactorial approach which included dietary change, exercise change,  targeted supplements, stress management strategies, and ongoing counseling to help patients keep up with the changes.  

According to the article,  strict adherence to a low glycemic index, anti-inflammatory, low grain diet was key (the diet included eating non-farmed fish, avoidance of fatty beef, increased fruit and vegetables, and elimination of ‘simple carbohydrates’). Some patients were advised to fast for 3 hours before bed, for 12 hours total between the last meal and breakfast.  Exercise was another key component (taylored to individuals, but general goal was 30-60 min per day, 4-6 days/wk).   Meditation and/or yoga were used to manage stress.  Sleep was also addressed, with a goal of 8 hours per night (employing ‘sleep hygiene’ techniques, addressing sleep apnea, and utilizing supplements such as melatonin 0.5 mg before bed, and and Trp 500 mg 3 times a week if awakening).  Patients also took individualized supplements which varied depending on the patient, but could include vitamin D, fish oil, coenzyme Q10 (200 mg per day), melatonin (0.5 mg at bedtime as needed),  a form of vitamin B12 called methylcobalamin, alpha lipoic acid, vitamin C, and for some, pre/probiotics, and curcumin/tumeric, among others. In some cases women were advised to restart hormone replacement therapy.  Medical issues such as prediabetes/diabetes and hypothyroidism were addressed ‘aggressively’ with optimal management and blood levels.  Dental hygiene was addressed, to decrease inflammation. 

The article quoted researcher Dr. Dale Bredesen: "The program is not easy to follow...The important thing here is, we can alter cognitive decline by affecting each of these parameters...it appears we can correct this network imbalance by tweaking it at multiple sites." Good news - the results were obtained despite the fact that “none of the patients followed the entire protocol.”  In other words, you don’t have to be ‘perfect’ in order to gain significant benefit.  More good news:  the main "side effects" t of this treatment approach: improved BMI and overall health!! I wish more of our therapies had those kinds of side effects!

"Can Stress Make Me Fat?" The connection between stress and weight gain is multifactorial

 "Can Stress Make Me Fat?"

I hear this question frequently from my patients, and the simple answer is, yes, stress can contribute to weight gain.  The more complicated questions:  HOW does stress make us fat, and what can we do about it?

We've long known that stress can make us eat more - but now it appears that stress can actually slow down our metabolism.  New research from Wexner Medical Center at Ohio State University suggests there are multiple 'mechanisms' or ways that stress can contribute to weight gain. Their study showed that women who were under stress actually burned fewer calories than women who were not stressed  - 104 calories less, enough to cause 11 pounds of weight gain a year.  Eleven pounds per year - and that's just the metabolic effect alone, if the women did not also eat extra calories (and we know that people who are stressed also tend to eat more calories, and are drawn to eat sugary/fatty foods.)  If they ate more calories too, the weight gain could be much greater.  http://www.biologicalpsychiatryjournal.com/article/S0006-3223%2814%2900385-0/abstract

A key point is that the women in the study had not eaten more - the food was controlled,  so that was not a factor, not a cause of the lower metabolism.  It was the stress that changed the body chemistry. The women were given identical high fat meals. In addition to slower metabolic rates, the women also had higher levels of insulin in their blood after the meals.  Earlier research shows a similar effect in men.

In addition to the metabolic effect, we know that stress can lead to 'emotional eating' - and we can end up eating larger quantities of food, and reach for poor quality 'junk food' which has hundreds of empty calories in just a few bites.  Junk food tends to have high glycemic index carbohydrates and copious amounts of saturated fat - which can make us feel better in the moment, but much worse a while later, both mentally and physically.  These 'hyper-palatable'/super-tasty foods can cause a flood of 'happy hormones'  (dopamine in particular) in our hypothalamus, the reward center of the brain.  But the effect soon wears off, and we can feel even worse than when we started.  Excess saturated fat also can lead to inflammation and insulin resistance, with multiple negative effects on our health.

So, what to do?  Ideally we would reduce unhealthy stress in our lives, but that can be easier said than done!  We can improve our ability to cope with stress by taking care of ourselves with the following strategies:

1) Get adequate sleep (sleep can clear out or 'defrag' the brain, and help us feel stronger, more resilient.)  We need to employ 'sleep hygiene', which means keeping our bedrooms cool, dark, and quiet (or have 'white noise' or gentle music playing.)  Try to avoid screen time before bed, since blue light disrupts sleep quality, and stimulates wakefulness.  Many people thrive with 7 or 8 hours of good quality sleep. http://www.health.harvard.edu/newsletters/Harvard_Health_Letter/2012/May/blue-light-has-a-dark-side/
http://healthysleep.med.harvard.edu/healthy/getting/overcoming/tips

2) Get daily exercise (which can raise serotonin levels naturally, and can help us cope with stress.) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2077351/

3)  Surround ourselves with healthy food options, so the 'easy choice is the healthy choice'.   At the end of a stressful day, our willpower reserves are depleted, and we naturally reach for what is easiest.  There is a lot of new research about 'decision fatigue' - the fact that when we are exhausted from making too many decisions, that we have little energy left to make healthy choices.     As one patient said, "we eat what is there, and we do what is easiest" - so it's a smart strategy to acknowledge this aspect of human nature, and work WITH it, not try to fight it.  Supermarkets know we'll reach for what is at eye level - so use this strategy at home, and at work.  Keep the healthy foods front and center, make them 'easy to choose.'  Remove tempting 'junk food' from our immediate view (ideally remove from our environment, but at the very least, HIDE it.)  Make it harder to access the 'junk', and remember, if it's not there, you can't eat it. http://www.nytimes.com/2011/08/21/magazine/do-you-suffer-from-decision-fatigue.html?pagewanted=all

4) Start to explore other options for relaxation, such as meditation, or 'Japanese Forest Bathing' (basically walking in nature as a way to decrease stress.)  http://www.shinrin-yoku.org/research.html Research has shown that both traditional mediation and 'walking meditation' can be calming.  Many of us need more time alone, to decompress; we need to take care of our 'inner introvert'.  I'll write more on this subject, but the topic of 'unmet needs' is a major factor contributing to excess weight and poor health in our country.  We all have needs for things such as:  time alone, time socializing, spirituality, creativity, etc.  We can begin to explore our unmet needs by ourselves, during quiet walks, or with help from a good friend or counselor  - or even your favorite nutritionist or Obesity Medicine physician!

Morning Sun and Lower Weight

Can we lose weight by getting morning sunlight?

Well, the jury is still out on this one, but a new study suggests that there may be a connection between bright morning light and lower weight.  Here is the latest research: 

"Timing and Intensity of Light Correlate With Body Weight In Adults"  http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0092251

And here is a good article with an interview with the lead researcher:  http://healthyliving.msn.com/health-wellness/the-morning-light-may-help-you-stay-slim-1  

"We were very interested in looking at the relationship between lighting and how that may be affecting your weight," explained study senior author Dr. Phyllis Zee, director of the sleep disorders center at Northwestern University Feinberg School of Medicine inChicago….Zee said the strongest association was seen in people exposed to light that was at least 500 lux, which is the equivalent of a well-lit indoor room. Outside on a sunny day provides 1,000 lux or higher, while most indoor rooms are about 200 to 250 lux, according to Zee...But, the timing of the light also mattered. Those who were exposed to brighter light earlier in the day were the slimmest."

Previous studies have also shown a connection between light, appetite, metabolism, and weight.  From the PLOS ONE research article:  "Several studies now indicate that morning light exposure influences body fat [3], [4] as well as the level of appetite regulating hormones... leptin and ghrelin [5]...The results of this study demonstrate that the timing of even moderate intensity light exposure is independently associated with BMI….Our findings, similar to those from two different animal models [7], [8] found that changes in the timing of light exposure were associated with body weight independent of caloric intake. One possible mechanism linking light directly to BMI, rather than caloric intake may be the influence of light on the expression and secretion of hormones, such as melatonin."

So, the research is still in early stages, we are not quite sure which hormones are being affected, and how the light might lead to lower weight.  From a practical standpoint, should we do anything?


Well, it can't hurt to get out and get a morning walk in the sunlight.  Heck, it might even help!

Will Cutting Out Diet Soda Help With Weight Loss? My take on the Great Diet Soda Debate

"Doc, will I lose more weight if I cut out diet soda?"  I've heard this question many times, and this topic has been ALL over the internet since last week, when a new study came out about diet soda and weight loss.  I realized it's time for me to blog about the Great Diet Soda Debate.   

Diet soda (and artificial sweeteners) have become an emotional topic for some, and everyone needs to calm down, take a deep breath, look at what the study actually said, and then decide for themselves what they would like to do!

So, first of all, here are links to two good articles about the study:   http://www.wmur.com/health/diet-soda-sometimes-help-with-weight-loss-study-finds/26180506#!T1Hzd

http://www.sciencedaily.com/releases/2014/05/140527085124.htm

The new research was published May 27 in  Obesity, the journal of The Obesity Society, and was co-authored by James O. Hill, who is well-known for his work with the National Weight Control Registry. http://www.nwcr.ws/people/Hill.htm  To briefly summarize,  researchers took a group of  303 people who were ALREADY DRINKING DIET SODA on a regular basis, and then told half the group they could continue diet soda, and instructed the other half to switch to water.  They then followed them for 12 weeks, treating them with an 'aggressive' behavioral weight loss program, with intense counseling and guidance on nutrition, journaling, exercise, and behavioral strategies.  

At the end of 12 weeks, they compared the amount of weight lost in each group - Group A  who continued to drink their favorite diet soda, and Group B who quit diet soda, and switched to water. The results were surprising, to say the least.  Lo and behold , Group A - those who continued to drink diet soda - actually LOST MORE WEIGHT than Group B - those who had stopped the diet soda and switched to water!  Group A lost an average of 13 pounds, while Group B lost only 9 pounds. Group A - the diet soda drinkers -  lost 44 % more weight!

How could this be?  And why?   Well, first of all, NO ONE thinks that diet soda is a magic weight loss trick. And second of all, it's important to remember that Group A, the 'bigger losers' did not ADD diet soda to their diets, they were already drinking it in the first place - they were just allowed to continue it.  So, the suspicion is that Group A performed better, and lost more weight, because they were feeling content, satisfied that they could continue a favorite treat, so they AVOIDED A SENSE OF DEPRIVATION.  Group B likely felt deprived of their favorite treat, and research shows that if people feel deprived, they are less likely to adhere to a healthy overall plan.  

Dr. Hill noted, according the article on WMUR, "in his clinical experience, many people who have successfully lost significant weight "are heavy users of noncaloric sweeteners."...Cutting calories and boosting exercise takes a lot of willpower. Trying to simultaneously give up something else you regularly enjoy -- such as diet soda -- taxes your ability to stay the course. Most psychologists agree that our willpower is a limited resource…

"The most likely explanation was that having access to drinks with sweet taste helps the (artificially-sweetened beverage) group to adhere better to the behavioral change program."

Just how well did the group do who continued diet soda?  According to the Science Daily article:

"In addition to losing 44 percent more weight than the control group, the diet beverage group also:

• Reported feeling significantly less hungry;
• Showed significantly greater improvements in serum levels of total cholesterol and low-density lipoprotein (LDL) -- the so-called "bad" cholesterol; and
• Saw a significant reduction in serum triglycerides."

And "Additional research published in 2009 on weight loss maintenance, drawn from the National Weight Control Registry, found that successful weight loss maintainers drank three times more diet beverages than those who had never lost weight."

On the other hand, some research has shown a correlation - not causation, but 'association' - between the long term use of diet (and regular) sodas with kidney disease, heart disease, and metabolic syndrome, among other possible problems.  And some experts have speculated that drinking sweet tasting things might increase the desire/cravings for sweets (although this hasn't been proven for certain.)  

So, what to do?  It appears that if you are ALREADY using diet soda, and this is an important 'treat' for you, then it's probably not the best idea to try to cut this treat out while you are just starting a new healthy diet/exercise/behavioral weight control program.  The sense of deprivation may weaken your willpower, and you might find it harder to stay on track with the rest of your healthy choices. Later, once you're "on a healthy roll" with your program, you may want to cut out diet soda to gain additional possible health benefits (such as a possible lower risk of kidney disease).

But if you find that cutting out your diet soda leaves you feeling deprived, and then you go off the rest of your healthy routine, you might want to add back in the occasional diet soda treat, if it's important to you!  I just had a patient come in with this very problem.  She had been doing REALLY well with healthy diet, exercise, and weight loss, but derailed herself when she stopped diet soda and ended up feeling deprived.   She hadn't even heard about the recent study, but  was feeling frustrated and angry at herself, and wanted to know what to do.  We talked it through, and she is going to re-add the occasional diet soda - the 'risk' is certainly outweighed by the 'benefit' in her case!  

Remember, the goal is PROGRESS NOT PERFECTION when it comes to healthy lifestyle. The goal is to be GOOD ENOUGH to get the health benefits we seek -  NOT perfect.   If you try too hard to be perfect, and you fall short, you might end up giving up ALL the healthy changes you've already made - and that would be a disaster!  NO ONE is perfect (no one I've met anyway) and we have to pick and choose key healthy changes, and focus on those which are going to give us the 'biggest bang for the buck' in terms of health benefit.    Remember - "don't let perfection become the enemy of the good" - to misquote Voltaire.   

And don't let a SENSE OF DEPRIVATION DERAIL YOU!