Sunday, May 17, 2009
Not all foods are the same. I don't just mean in terms of nutrition or calories, but also in terms of what I call the "Full Effect". Some foods keep you full and satisfied, while others seem to ironically make you want to eat more.
Let's start with the "Empty Effect" - foods that make you hungrier. Refined carbohydrates which have had the fiber stripped out (like bagels, white bread, white rice, sugar, soda, fruit juice, etc) are prime offenders. These are easily and rapidly digested, and quickly raise your blood sugar. These are known as "fast sugar" foods, or high glycemic index foods. These may temporarily make you feel full, but they cause your blood sugar to surge, followed by a surge in insulin. What goes up quickly comes down quickly, and the rebound crash of blood sugar makes you feel even hungrier. You actually crave more carbohydrates, and can end up on the "sugar roller coaster", gaining weight all the while.
Other “Empty Effect” foods are saturated fats and trans fats. Saturated fats are from animal and dairy sources (beef, full fat cheese, butter, etc, along with a few “tropical oils”), and trans fats are those “partially hydrogenated oils” you’ve been hearing about for a few years. These fats actually make you feel hungrier, apparently by almost immediately raising inflammatory mediators in the bloodstream, and blocking the effect of a natural “fullness hormone” called leptin.
Now let’s get to the “Full Effect” foods. Our brain receives many chemical signals from our bodies to tell us when to stop eating; it makes sense to use the right foods to trigger a sense of fullness and satiety. Number one is PROTEIN. Studies have shown that LEAN protein (without much fat), helps to trigger a sense of fullness that persists long after a meal. Some experts recommend starting with at least 30 grams of protein in breakfast, in order to best achieve appetite control throughout the day. One of the worst breakfasts, in terms of appetite control, would be a high carbohydrate breakfast without adequate protein (such as oatmeal, cereal, bagels, etc). Protein keeps us full by multiple mechanisms - it slows the surge of blood sugar, and keeps it smooth after the meal is done. It also triggers fullness signals in our brain, and helps protect our muscles during weight loss, keeping our metabolism higher.
Other “Full Effect” foods are those with a lot of volume, and a lot of weight, but low in calories. This would include foods with a lot of fiber and water such as whole fruits, vegetables, soups, beans/legumes, and salads. These foods tend to take a little longer to eat, allowing your brain to know it’s getting full, and they stretch and weigh down your stomach, turning down the hunger hormone ghrelin. The fiber also slows down absorption of carbohydrates, keeping blood sugar smoother, and controlling insulin and appetite.
Finally, let’s get to fat. Some fats are much “heart healthier” than others, and it is important to have some omega -3 fats (fish oil, flax seed), and “MUFA’s”, or monounsaturated fatty acids (nuts, olive oil, etc) in your diet. These are important in controlling inflammation in your body, among other needs. However, it is important to watch the portion size of even these “good fats”, as they do not quickly tell your brain you are full, and you can easily eat too much, and have too many calories. 1 Tablespoon of oil has about 120 calories; one Tbs of peanut butter, around 100. Be careful!
Remember, it’s not just calories that count - it is also the QUALITY of those calories. Some foods will keep you full and happy, and make it easier to stay in a healthy calorie range! We want you to be healthy AND happy!
The answer is yes, they really ARE different. They are a genetic variant, and they make up less than 30% of the population. And they make the rest of us feel guilty for struggling with our food intake, because they just don't understand that we are biologically wired differently. They say things like "Just listen to your body," and they don't realize that we ARE listening. It's just that our bodies, and their bodies, are not saying the same thing.
We make literally hundreds of conscious and unconscious decisions every day on eating. Naturally skinny people don't have to think consciously very much about this, because their bodies are giving them good, reliable signals on when to eat, how much, and when to stop. There are many chemical signals involved in feeling full and satisfied, including leptin, insulin, ghrelin, CCK, GLP-1, dopamine, and Peptide YY. Naturally skinny people have appetites that are like fine-tuned machines - it is relatively effortless for them to control their food intake, because their appetites are on "auto-pilot" - it simply isn't that hard for them. For the rest of the population,it is not so easy. Even minor "malfunctions" in our fullness signals mean that we can unconsciously eat a few more calories; small calorie increases over time can lead to big weight gain. Weight gain itself can "snowball", since excess weight itself can lead to further "malfunctions" in our ability to regulate intake.
Human eating behavior is very complicated. Hunger and fullness (or "satiety") is controlled by numerous chemical signals in our brain, gastrointestinal tract, and fat cells. These signals can be affected by genetics, environment, types of food eaten (some foods make you HUNGRIER, ironically), exercise, stress, sleep, psychological factors, medications, illness, and other factors. This is a lot to look at, a lot to control. It is tough to do on your own; that is why people come to our program for help.
The next time someone tells you to "just push away from the table", tell them to just hold their breath for sixty seconds. It won't kill them, of course, but the physiologic drive to take a breath will be almost overwhelming. They probably won't understand that you face a similar physiologic drive to eat, but hey, it will be fun for a minute to watch them struggle with something for a change! But don't despair -there are MANY tactics to help you control your appetite and drive to eat. There are specific ways of eating, exercising,and lifestyle measures, and sometimes medication changes, and different ways of addressing medical issues, that can make the battle much easier!
Sunday, May 10, 2009
Almost everyone I know feels stressed these days, with the state of the economy, and uncertainty about where things are going. Stress can make it hard to take care of ourselves, and derail our healthy habits, just when we need them the most! To make matters worse, many people feel GUILTY about getting off their usual exercise and healthy nutrition routines. They can become angry at themselves, or feel a little overwhelmed. If this sounds like you, it is time to STOP, step back, and take a slow, deep, relaxing breath. Stop beating yourself up (there are plenty of other people and circumstances to do that for you -don't add to it!)
When it comes to taking care of yourself, it is important to get back to the basics. You don't have to be perfect, just try to take a few healthier steps. Go back to clean, basic eating (cut any extra "junk" you've added lately in a failed attempt to comfort yourself!) Make a basic menu, shopping list, and go stock up. If you've lost your exercise routine, go back to a LITTLE exercise daily, nice and easy! No jogging to make up for lost time. A brisk, daily 15 minute walk may be the best way to get back into the groove (of course, check with your physician if you have any health concerns which interfere with exercise.) Try to get at least 7 hours of sleep per night (what the average person needs - individual needs may vary-get what you need to wake up feeling refreshed.) If you are feeling overwhelmed and don't know where to start, call your physician (or of course call us!)
And don't forget to splurge on yourself, a little. You read that correctly. Studies have shown that if people feel overly restricted in spending money, they will tend to over-indulge in food. And vice-versa (over-restricted in food, then they'll spend more money.) Hmmm, interesting conundrum, isn't it? Obviously, we don't want to FEEL overly restricted in food, or money, so what do we do? Try to feel indulgent in both areas! How do we do that on a limited financial budget, and limited calorie budget? Tricky, I know, but this is where creativity comes in.
If you are severely financially restricted, try to figure out how much, if any, "play" money you can sneak away for yourself. If you have $5, maybe a magazine (gossip, fashion, sports, hobby - your choice!) Or maybe a flavored lip gloss - you get the idea. Something you don't really "need", but something that is fun. Depending on your budget, maybe a CD or DVD, or a new scarf or belt - something that won't break the bank, but will make you feel like you "splurged", or "got away with something." If you really don't even have a spare $5, then try to "steal" some time away for yourself. Sneak off to the bookstore, or go for a walk in a new place, or watch some "junk" on tv, or read online. The point is to do something you don't HAVE to do, so you feel like you "splurged" on yourself! For all you moms who feel locked up at home with the kids, try to find someone to swap kid-watching duties, so you can get away for a bit!
In terms of food, do NOT go on a lettuce diet. Or cabbage diet, carrot diet, rice diet, or whatever other over-restricted food plan of the week is touted in those magazines you just picked up! Yes, it is good to break free from your current routine, especially if it is boring you, or unhealthy. HOWEVER, healthy food can be FUN and taste delicious, even indulgent. I've previously mentioned some websites to find recipes: delish.com (it's not Rachel Ray's site - and look for the low calorie recipe section or healthy recipes day to night:
and I mentioned the book Hungry Girl by Lisa Lillien (quick and easy healthy updates on comfort foods.) There are MANY great lower calorie recipe books available (and for those of you who are already my patients, I know, sorry, our book is still in the works!)
So Happy Mother's Day! Enjoy and indulge!
Friday, April 24, 2009
According to this article from the April 15th issue of Family Practice News, "(a)recent analysis of data collected by the National Health and Nutrition Examination Survey (NHANES) during 1988-1994 and 2001-2004 even suggests that an epidemic of vitamin D deficiency may have hit the United States."
The article further notes that the "Institute of Medicine is reviewing its 1997 guidelines for vitamin D intake, and will likely recommend increased supplementation when new guidelines are published in 2010..."
Another article in the same issue emphasizes that even teenagers can experience health risks associated with low vitamin D: "Low serum levels of vitamin D were linked to increased blood pressure, hyperglycemia, and obesity in an analysis of more than 3,500 American teenagers, a link previously seen in adults." http://www.familypracticenews.com/article/S0300-7073(09)70296-8/fulltext
According to the article, Dr. Jared P. Reis, a researcher in the School of Public Health at Johns Hopkins University, Baltimore, analyzed data from adolescents aged 12-19 during 2001-2004 in the National Health and Nutrition Examination Survey (NHANES), run by the National Center for Health Statistics, and found that teens with the lowest vitamin D levels were more than fivefold more likely to have a BMI at the 95th percentile. They also " had a significantly higher rate of low levels of HDL cholesterol, high triglycerides, and metabolic syndrome, compared with the teens in the highest vitamin D quartile." Dr. Reis explained that "Vitamin D reduces activation of the renin-angiotensin system, thereby lowering blood pressure. It also reduces insulin release from pancreatic beta cells and raises insulin sensitivity. Low vitamin D levels produce opposite effects, activating renin-angiotensin to raise blood pressure, boosting insulin release, and lowering insulin sensitivity."
How did this "epidemic" come about? What has changed in our lifestyle in this country, that would lead to a widespread lack of vitamin D? The answer may be more simple than one might expect.
Vitamin D comes from three main sources: diet, sunlight, and supplements. Many experts believe that we need 1000-2000 I.U.'s of vitamin D per day, just to keep up a normal D level in our bodies. A glass of milk only has about 100 I.U.'s of vitamin D (and even that amount is destroyed if it is exposed to light). Most people do not drink 10-20 glasses of milk per day, so we can't get all of our D from milk! Very few other foods have a large amount of vitamin D. According to the first article above, “you cannot eat enough vitamin D-containing foods to get anywhere near 1,000 IU of vitamin D per day,” according to Dr. Weaver, who served on the IOM committee for the current guidelines.
So our next option is sunlight. Our skin IS capable of producing vitamin D from the sun, but this ability is blocked if we wear sunscreen. Our skin is also less capable of producing vitamin D as we age, gain weight, or have darker skin tone. Add this to the fact that very few of us spend much time outdoors hunting or gathering anymore, and we have the scene set for vitamin D deficiency.
So the final, and ultimately best option, is going to be supplementation. Many multi vitamins have between 400 and 800 I.U.'s of vitamin D. Calcium and D combination supplements may have anywhere from 100 to 500 I.U. of vitamin D. And there are plain old vitamin D supplements, all by themselves. I do NOT advise trying to guess, all on your own, how much vitamin D you need. It IS possible to take in too much vitamin D; it is fat-soluble, and can build up over time, with high doses. The best route is to check with your primary care physician, and ask about his or her approach to vitamin D. Ask if he or she is aware that the Institute of Medicine is reviewing its 1997 guidelines, and will likely be changing them with the new 2010 guidelines (oh boy, your doc will love me for this one!) Ask if you need to have a blood test to determine your current blood level of vitamin D, and if you need treatment. Be aware that there is no widespread consensus on ideal levels and treatment courses - there is wide variation among physicians. Also be aware that certain people can be at risk of overtreatment with vitamin D - people with hyperparathyroidism, or sarcoidosis, for example.
I will keep you updated, as more information becomes available...
Tuesday, March 17, 2009
Well, you may have guessed, there are better ways to lower your cortisol.
New research from the University of Zurich shows that each minute you spend hugging, kissing, holding hands, or even having sex can translate into decreased stress, and lower cortisol. And the more minutes, the more you lower the cortisol. Here is a link to an article about the study:
Snuggling can erase tension after a tough day at work - or even PREVENT you from experiencing a cortisol surge in the first place.
Only a couple of catches here. Not just any old snuggle counts - it has to be with a person who makes you feel good in the first place. "Angry hugs" just don't work. Another catch - you need to "stock up" fresh each day; you can't save up the benefits for tomorrow.
So, what do you think about the new "Miracle Cure" for lowering cortisol? And its free...
Monday, March 16, 2009
Lack of sleep can be horrible - even painful at times (memories of sleep deprivation during residency still make me shudder.)
A new study shows that lack of sleep can also lead to illness - specifically a problem called "pre-diabetes." Check out this article on msn:
To summarize, a study was presented this week at the American Heart Association's Annual Conference which showed that "short sleepers" - people who slept 6 hours or less per night - were more likely to develop elevated fasting blood sugars than people who slept 6 to 8 hours per night. Once people develop pre-diabetes, they are much more likely to go on to develop full blown Type II diabetes.
Previous studies have shown an association between lack of sleep and weight gain:
This article talks about a 2004 study in the The Journal of Clinical Endocrinology & Metabolism which showed that sleep deprivation can cause the lowering of a "fullness" hormone called leptin. After sleep deprivation, the low leptin levels "tell the brain there is a shortage of food and increase appetite...some volunteers were asking for up to 1,000 calories more per day..." Other studies have shown an association with higher BMI and getting less than 7 hours per night of sleep.
So, back to your Health and Beauty sleep. How much sleep should YOU get? According to a number of studies, many people seem to benefit from around 7 to 8 hours of sleep - but individual needs will, of course, vary.
In general, in an ideal world, you should wake and feel refreshed; you shouldn't have to hit the snooze button 10 times! If you are not feeling refreshed, and you HAVE gotten regular sleep, lasting 7-8 hours per night, then you should contact your primary care physician to make sure there isn't a problem, such as sleep apnea.
If you are like me, on the other hand, and tend to web-surf into the wee hours - cut it out, for your health's sake!
Tuesday, March 3, 2009
The answer of course, is not a simple number on the clock. The best time for each person will vary depending on that person's lifestyle, temperment, and preferences. Each person has to be realistic, think carefully about his or her daily schedule, and decide when it will be "easiest" to keep up with a daily routine.
Several studies DO shed some light on successful tactics, however. In general, people who exercise first thing in the morning are most likely to keep up with exercise long term. I always suspected that this is because there are fewer interuptions first thing in the morning - fewer phone calls from friends, fewer last minute "homework emergencies" from the kids, fewer "work emergencies", etc. A new study shows there may be an additional reason (more on this later...)
Anyone who knows me, knows for sure that I am not a natural "morning person" - yet I absolutely HAVE to work out first thing in the morning, because realistically I just won't get to it at night. When I work out in the morning, I am still half asleep - which is great, because by the time I fully wake up, my workout is over!
A new study shows that one of the worst, most painful times to exercise is AFTER you have performed a long, complicated mental task. A study published in the March issue of the Journal of Applied Physiology found that people who performed a mentally taxing chore BEFORE exercise, didn't exercise as long, and reported feeling much more exhausted, compared to people who watched a movie before exercise.
In other words, mental fatigue makes the same exercise feel harder and more exhausting, and can cut into your exercise time. If you are doing challenging mental work all day, exercise after work can feel tougher than the same workout done first thing in the morning.
Check out this article on WebMD: http://www.webmd.com/fitness-exercise/news/20090227/mental-fatigue-can-make-exercise-harder
So what does this mean to you? Well, if you happen to have a mentally challenging, taxing chore to perform, you might want to exercise BEFORE you do it. Hey, sounds like a great reason to procrastinate, and put off that chore while you work out, doesn't it? When it comes to sneaking in exercise, give yourself whatever excuse you need!
Monday, March 2, 2009
But calories are sneaky little devils. They can crop up in the most unexpected places. And trying to balance them can be a bit confusing.
Here are a few common mistakes, and how you can avoid them.
1. "All natural, healthy food is low in calories." Don't make this mistake. As I mentioned in my last post, "healthy foods" like granola and olive oil can be FULL of calories. It is easy to quickly consume large numbers of calories unconsciously if you do not pay attention. Fat and processed carbohydrates may not immediately lead you to feel full, and you may accidentally take in more calories than you need.
2. "If I eat sugar-free or low-fat foods, I don't need to count calories." Don't make this mistake either! Studies have shown that people actually tend to OVEREAT these foods precisely BECAUSE they think they can get away with it. They may actually eat MORE calories! Always check the calories in your portion size.
3. "If calories are the only thing that matters, I'll just starve myself all day to save up the calories for a really big dinner." NO! Don't make this mistake. Studies have shown that starving yourself all day will INCREASE your hunger hormones at night, leading to overeating. Furthermore, this practice may actually slow your metabolism during the day.
One more problem with this approach - overeating a huge dinner at night can leave you too full to eat breakfast the next morning - so you end up setting yourself up for the same vicious cycle. Start your morning off with a healthy breakfast - you may have to force yourself at first, to break the cycle. Your body will thank you.
4. "I don't really eat that much - just a little grazing here and there. I don't know why I'm gaining weight." Studies have shown that when people "graze", without any planning or formally keeping track of what they are eating, they end up eating a LOT more calories than they realize. Other studies have suggested that people actually burn more calories when they eat on a regular scheduled basis, rather than randomly snacking. The best way to avoid "overgrazing" - plan ahead what you're going to eat for the day, then keep track of it in a journal.
5. "I want to lose weight quickly now by eating less than 800 calories per day, and then I can just maintain my weight loss later by eating my usual calories." Um, can we say Oprah's 1980's diet? Starving your way to rapid weight loss might sound great to some (not to me!), but this approach is FULL of PROBLEMS. For one thing, your body ends up burning up its nice, lean muscle, not just fat, if you starve yourself. Secondly, starving yourself just plain doesn't work very well for long term success. Cutting your calories to the "Very Low Calorie" level will slow your metabolism down - so when you go back to a more normal calorie level, your weight will yo-yo through the roof! A much better, kinder, and more successful approach is to find out your current daily calorie needs, and then cut calories and increase exercise to end up with a "deficit" of about 500-1000 calories per day.
This will result in a one to two pound weight loss per week (you lose one pound of fat for every 3500 extra calories burned - do the math. Cutting 500 calories per day, times 7 days, equals 3500 calories, or one pound lost.)
Doesn't sound like a fast enough weight loss? That adds up to between 50 and 100 pounds lost in a year. There, that's a little better, isn't it?
If you really want to lose more than 1-2 pounds per week, it is possible, depending on your weight, healthy, and medical factors, under the supervision of a physician and nutritionist.
6. "Once I reach my goal weight, I can go back to my old habits, and the weight will just magically stay off." Sounds ridiculous when we say it that way, doesn't it? Yet so many people end up acting as if this was true!
The reality is that long term weight loss and maintenance requires some ongoing work. Simple as that. That said, the reality ALSO is that it is actually EASIER TO MAINTAIN, THAN IT IS TO LOSE. That is good news, backed up by long term studies of successful people. But it doesn't mean that you can become completely oblivious to calories, and exercise. The reality is that you CAN eat more calories at maintenance, but you can't forget about calories completely, or you risk excess "calorie creep". You also need to maintain regular exercise. Maintenance is an art itself, but it is an art that you get better at, as you practice. Long term success is also tied to long term support, and accountability.
The reality is that our society does not make it easy, or "automatic" to continue healthy habits. You'll need support from somewhere, to "fight back" against all the unhealthy influences in our society. Most of our long term successful patients check in periodically, just to keep themselves on track!
And then there was the fifty-something gentleman with a similar story; after a successful fifty pound loss, he "mysteriously" gained 7 pounds in one month...
What did these two patients have in common, that threw off their weight loss success? Answer: they added some "healthy" food to their diets.
Yes, you read that correctly. "Healthy food" lead our two patients to gain weight.
Our successful lady had gone to the "health food store", and picked up some "natural granola". She had no idea how many calories, how much carbohydrate, how much fat, and how little protein were in the granola...but she was adding it to her yogurt, her cereal, and munching on it for snacks. Our nutritionist Beth did her best to guestimate the extra calories...and it was clearly the one change that had thrown our successful patient off track. No problem...with a few tricks and healthy substitutions (we switched our patient to a tsp of slivered almonds and a tsp of Nature's Path Granola to top off her yogurt), and in one month our patient had LOST all the weight she gained, plus extra.
Our successful gentleman had read that olive oil was healthy. He proceeded to pour olive oil over his salads, and into many of his lunches and dinners. He had no idea that ONE TABLESPOON of OLIVE OIL had about 120 calories. He was eating about TEN to TWELVE TABLESPOONS per day! Do the math - that is 1200 to 1440 EXTRA calories per day! Yikes - it is amazing he only gained 7 pounds!
Too much of any food - even healthy food - can lead to weight gain. This highlights the need to be aware of calories.
A recent study in the New England Journal of Medicine comes to the conclusion that CALORIES are critical to weight loss: http://content.nejm.org/cgi/content/full/360/9/859 It is an interesting study which varied the amounts of protein, carbohydrates, and fats, in different test groups. In the end, the most important factors for successful weight loss were CALORIES, and ongoing support. All groups, regardless of percentages of protein, carbs, and fats, followed "heart healthy" guidelines in terms of healthy fats, and high-fiber whole fruits, veggies, and grains.
What does this mean for you? It means that while HEALTHY FOOD is important to your overall well-being, you also need to become aware of the calories in your food in order to achieve substantial weight loss. It also means that there is no one, magic "formula" for all people, such as "high carb, low fat", or "high fat, low carb".
To be healthy, and successfully lose weight and keep it off long term, your diet will have to be individualized to your needs. For example, some people absolutely NEED to have a fair amount of healthy fat in their breakfast, in order to feel full. Others need very little fat in order to feel full. Research is just beginning to identify the genetics associated with this need - but don't waste your money on the phony tests you see advertised - real tests are not yet available to the public. With a little journaling and experimenting with different ratios of protein/fat/fiber, it is easy to figure out what you need, no blood tests needed!
Other people need much less fat in the morning, but more carbohydrate (this is often true for people who perform intense cardiovascular excercise in the morning.) But even these people generally need to have adequate amounts of protein, to balance the carbohydrates (and allow their muscles to rebuild), in order to keep full and feel satisfied!
Sound complicated? Don't worry! Its not as bad as you think. The bottom line is that calories are key to weight loss, and the balance and quality of your food are key to health and satisfaction. Once you find your "success formula", don't be afraid to stick to it! This is what we help people find, every day.
This article, run in the "O" magazine in February, makes an attempt to clarify the "best diet" for weight loss, breaking the categories into Low Fat, Low Carb, Zone, Mediterranean, and Ornish. The article very briefly summarizes (read: oversimplifies), three studies done in the last few years which attempt to compare some of the diets.
Let me point out a few problems here...
First of all, the studies vary on how to define "low carb", "low fat", even "Mediterranean". And the devil CAN be in the details. One person's low carb diet can be considered moderate carb by someone else.
Some of the studies also admit that the study participants did not necessarily even comply with the diet they were supposed to be following. If participants aren't even following the diet carefully, how can you make any judgements about the diet?
I won't go into details pulling apart and analyzing each study - that would probably take about 5o pages of analysis (I was a philosophy major in college, and also worked in neuroscience research - so don't get me started!) Believe me, there are many, MANY issues.
But the really important question is this - what do ANY of these studies mean to YOU, as an individual?
The answer: probably not that much.
In fact, the research studies, and the "O" article which very briefly describes them, may actually leave people MORE confused than they started. Studies and articles like these tend to obscure a very interesting, very important fact:
MOST EXPERTS DO TEND TO AGREE ON THE BASIC ELEMENTS OF HEALTHY EATING.
Sorry about the caps, but this is a really important point!
Many studies and articles tend to focus on the MINOR differences between expert's dietary advice - making it seem like there is no common ground. This needlessly confuses people. The good news is that experts actually do have more advice in common than you might expect.
It is understandable that people want "rules" and "guidelines" to follow. If you are trying to lose weight, and eat more healthfully, you want to plan how to do it, with some concrete guidelines. But here is the problem with a "one size fits all" approach - EACH PERSON IS AN INDIVIDUAL, with different physical, emotional, medical, and lifestyle challenges. Trying to wedge a square peg into a round hole - good luck with that! (Even if you could force it, it would be uncomfortable!)
So what DO most experts agree on? We ALL need some protein, carbohydrates, and fats. Experts vary on the percentages of each, but all agree that we all need some balance of all three "macronutrients." Little secret - how much of each YOU need will vary on your age, genetics, and current activity level, among other factors. At our program, we work together with our patients to find the best balance for each person, at each point in his or her life.
Experts also agree that losing weight will only happen if you are "burning off" more calories than you are eating. Not all diets recommend counting calories, but most experts admit that calories, in the end, are crucial for weight loss.
Most experts also agree that physical fitness is absolutely critical for health, and maintenance of weight loss. There is some variation on when, what type, and how much exercise is best - but another little secret - no matter what the experts say is "ideal", the REAL ideal for each person has to be individualized to that person's life and needs!
And finally, most experts admit that it is not easy in our current society to achieve and maintain a healthy weight. This should be obvious to any one who looks around - 75% of the American population is now overweight or obese! That means it is now "normal" in this country to have trouble controlling weight. People should not feel guilty for needing help to stay healthy, and reach a healthy weight. It takes work and focus - and SUPPORT.
Success comes from understanding your individual needs and challenges - physical, medical, emotional, social - and then learning IN DETAIL what you need to do to take full care of yourself. It also takes a specific action plan - and the ongoing support to get it started, and keep it going. Don't be confused by what seems to be conflict between experts, all "fluffed up" by the media. Don't be fooled by people who say it is impossible to be healthy in our current society. It does take work, and focus - but with the right support, you CAN succeed!
Sunday, February 15, 2009
Luckily, a new study show a simple "trick" we can use to keep our blood vessels flexible, resilient, and happy - simply eat at least five servings of fruit and vegetables, ideally spread throughout the day.
A recent well-designed study presented at the American Heart Association scientific sessions demonstrated that in overweight people with slightly elevated blood pressure, EACH serving of fruit or vegetables per day gave additional improvement in how our arteries functioned under stress. This study backs up another study of 257,000 people which showed a whopping 26% reduction in stroke risk among people who ate five or more portions of vegetables per day! You can read about these at:
The good news is that it can be pretty easy, with just a little planning, to get in at least five servings of fruit and vegetables. Fresh, organic veggies are great, of course, but for people who have trouble getting to the Farmer's Market, it is good to know that frozen vegetables, and even dried fruit, are an inexpensive, convenient, and healthful way to get your servings!
Frozen berries (with no sugar added) can be added to breakfast smoothies, cereal, yogurt, or served as dessert with a little low cal whipped topping.
Frozen vegetables can be added to egg white omelets, or for dinner, into stir-fry, tomato sauce for pasta, hidden as an extra "health boost" into many dishes.
Organic dried fruits with no sugar added can be used as part of your snacks throughout the day. Try Newman's Organic raisins, organic mango, apricots, etc (I choose organic to minimize the pesticide residue.)
Last night my husband Ron tossed together a quick little delicious vegetable side dish, made from frozen "California stir-fry" mixed vegetables (the kind with no sauce added from the store). Here is the simple, healthier way to make your own sauce:
1 Cup low sodium chicken broth (I like Pacific Organics Free Range Chicken Broth, which comes in a convenient resealable box you can keep in your fridge.)
2 Tbs Light Mayo (I really like Hellmann's Canola Oil Mayo)
1-2 Tbs Minced onion (fresh, or dried herb in a jar)
1 Bag of frozen vegetables.
Put the chicken broth and mayo into a saucepan over medium to medium high heat and stir. Once smooth and blended, add the minced onion. Continue to cook until onion is soft; finally add frozen vegetables. Cook and stir over medium heat until vegetables are coated, and most of liquid is absorbed - then enjoy!
This is so easy, I could almost cook it myself (but thanks Ron!) We had this with some easy frozen salmon filets from a "big box store", cooked on the "George Foreman" style grill. Inexpensive, easy, healthy, and delicious.
Friday, February 13, 2009
This is a very extensive paper on exercise, including links to guidelines ("2008 Physical Activity Guidelines for Americans" (www.health.gov/PAGuidelines)), a fitness test(http://www.adultfitnesstest.org/.), the American College of Sports Medicine's fitness planner (www.myexerciseplan.com/assessment), a NIDDK guide to overcoming exercise barriers (http://win.niddk.nih.gov/publications/tips.htm), the ACSM's tip sheets on exercise issues related to physical activity, including Alzheimer's disease, blood clots during exercise, anxiety and depression, heart conditions, cancer, low-back pain, and visual impairment www.exerciseismedicine.org/public.htm, and more!
From the HHS guideline for medical professionals (http://www.health.gov/PAguidelines/factsheetprof.aspx)
Children and Adolescents (aged 6–17):
60 minutes or more of moderate or vigorous physical activity every day.
They also should do muscle-strengthening and bone-strengthening activity on at least 3 days per week.
Adults (aged 18–64):
Moderate-intense aerobic activity 2 hours and 30 minutes (150 minutes) a week, (that comes out to a 30 minute workout 5 days a week) OR
Vigorous aerobic activity 1 hour and 15 minutes (75 minutes) a week (that comes out to 15 intense minutes per day, 5 days a week).
Aerobic activity should be performed in episodes of at least 10 minutes, preferably spread throughout the week.
Adults should also do muscle-strengthening activities that involve all major muscle groups performed on 2 or more days per week.
Older Adults (aged 65 and older)
Older adults should follow the adult guidelines. If this is not possible due to limiting chronic conditions, older adults should be as physically active as their abilities allow. They should avoid inactivity. Older adults should do exercises that maintain or improve balance if they are at risk of falling.
For all individuals, some activity is better than none.
People with diagnosed chronic conditions (such as diabetes, heart disease, or osteoarthritis) or symptoms (e.g., chest pain or pressure, dizziness, or joint pain) need to consult with a health care provider about physical activity.
Adults With Disabilities
Follow the adult guidelines. If this is not possible, these persons should be as physically active as their abilities allow. They should avoid inactivity.
I will soon post a reprint of my WebMD University interview on starting an exercise program...don't be discouraged!!! Even 10 minutes a day of exercise will begin to improve your health!
The simple answer: VERY IMPORTANT.
There was confusion last spring when one study (the ACCORD trial), seemed to suggest that people were better off if they did NOT keep their blood sugars at the "normal" range. This made no sense to physicians, and indeed, after looking more closely at the data, it appears that early, tight control of blood sugars gives substantial health benefits. Experts now agree that the best approach is to INDIVIDUALIZE the treatment of patients with Type II diabetes (imagine that!). There are many health benefits from "tight", careful control of blood sugars, as long as dangerously low blood sugars are avoided, and intolerable medication side effects are avoided.
The new study results are fascinting. You can read an abstract of the article published by the New England Journal of Medicine at: http://content.nejm.org/cgi/content/abstract/359/15/1577
To summarize, this study began with 4,209 patients with newly diagnosed diabetes, and then broke them into groups, with different treatments. One group received only dietary restrictions, another group received insulin or an older type of oral medication known as sulfonylureas, and a third group (who were overweight) received an oral medication known as metformin (or Glucophage.) To make a long story short, both medicine groups were much healthier in the long term than the diet-only group, and the metformin (Glucophage) group was healthier than the sulfonylurea/insulin group.
"In the metformin group, significant risk reductions persisted for any diabetes-related end point (21%, P=0.01), myocardial infarction (33%, P=0.005), and death from any cause (27%, P=0.002). "
Harvard has a nice online discussion of this study, and optimal management of Type II diabetes at:
Highlights from this article: "In the past, doctors usually have told newly diagnosed patients with type 2 diabetes to try diet and exercise first to bring down their blood sugar. Now that should change. They should immediately begin taking medicine. This doesn't mean that diet and exercise are not just as important as before. As blood sugar gets under control, medicine can be tapered. In some cases, it can be discontinued.
For most, metformin should be the first medicine. This is especially true if the person is obese...There are exceptions. People with impaired kidney function probably should avoid metformin. Caution is advised with heart failure and some types of severe liver disease...Whether you were diagnosed with type 2 diabetes yesterday or 20 years ago, you want your blood pressure less than 130/80. Your LDL cholesterol should be less than 100 (preferably closer to 70). Achieving these goals clearly decreases the risks of heart attack and stroke and helps protect the kidneys.
Some doctors already advise their patients to start metformin if they are at high risk for developing diabetes. This would include obese patients with high normal blood sugar who have a strong family history of type 2 diabetes. Research is under way to help answer whether starting medicine even before the onset of diabetes improves results."
As always, discuss all treatment options with your own physician.
Sunday, January 25, 2009
Here is a link to an msn article that discusses the study:
If you struggle with your weight, do not despair. This study does NOT mean that all hope is lost! It does mean that you will have to take extra care with your environment, so you are not surrounded by "cues" that lead to overeating. At Physicians Healthy Weight Center we help our patients uncover factors that lead to unhealthy choices; we create specific plans to overcome these challenges, and then we help put the plans into action. Planning, preparation, and practice will help you succeed.
Sunday, January 18, 2009
Does caffeine cause hallucinations? (Only in susceptible people.)
Does coffee prevent dementia? (Maybe.)
Does caffeine interfere with verbal and motor learning? (Only if it prevents proper sleep necessary for memory consolidation after learning a task, by keeping brain acetycholine levels artificially elevated.)
The bottom line: if you are drinking moderate amounts of coffee (less than five cups per day), don't drink them too late into the day, and are experiencing no side effects (such as anxiety, palpitations, racing heart, or unexplained elevated blood sugars as a stressed person with diabetes), then don't worry! Worry more about what you PUT in the coffee - go easy on the fat and sugar.
Does Caffeine Cause Hallucinations?
In short, no. In people who are already susceptible to hallucinations, however (about 3% of the population), caffeine may increase hallucinations. Researchers postulate that since caffeine increases cortisol release in people already under stress, that somehow the combination of caffeine, stress, and cortisol, leads to the findings.
It is important to note that caffeine on top of stress causes increased cortisol release. This could explain why some patients with diabetes note increased blood sugars after caffeine consumption. As noted below, however, some studies show DECREASED risk of type II diabetes with daily coffee consumption.
Can Coffee Ward Off Dementia?
From the article:
“Drinking coffee in moderate amounts during middle age may reduce the risk of dementia and Alzheimer's disease in the elderly, according to a new study.
Researchers in Finland and Sweden examined the records of 1,409 people whose coffee drinking habits had been recorded when they were at midlife.
Those who drank three to five cups of coffee per day in midlife were much less likely to have developed dementia or Alzheimer's in follow-up checks two decades or more later, the researchers say in the January issue of the Journal of Alzheimer's Disease…
…In the study, participants were asked in 1972, 1977, 1982, or 1987, when they were all in midlife (average age 50), how much coffee they drank. Then they were split into three groups: low coffee drinkers (zero to two cups per day), moderate coffee drinkers (three to five cups per day), and high coffee drinkers (more than five cups per day).
After an average of 21 years, 1,409 people between ages 65 and 79 were re-examined. A total of 61 were classified as having dementia, 48 with Alzheimer's…
The study showed that coffee drinkers at midlife had a lower risk for dementia or Alzheimer's later in life than people who drank little or no coffee at midlife. The lowest risk was found among moderate coffee drinkers. Moderate coffee drinkers had a 65%-70% decreased risk of dementia and a 62%-64% decreased risk of Alzheimer's compared with low coffee drinkers, the researchers write…
The researchers note that previous studies have shown that coffee drinking improves cognitive performance, and caffeine reportedly reduces the risk of Parkinson's disease.
The researchers say it's not known how coffee would offer protection against dementia, but that coffee drinking also has been associated with a decreased risk of type 2 diabetes, which is a risk factor for dementia.
The authors speculate that the effect may have something to do with coffee's antioxidant capacity in the blood.
The study also showed that tea drinking was not associated with a reduced risk of dementia or Alzheimer's disease.”
Caffeine No Substitute for a Nap to Enhance Memory
Equivalent of 2-3 Cups of Coffee Worsens Motor Learning and Word Recall
Bottom line: after learning something new, take a nap! It helps your brain “consolidate” the new memories, so you keep them for the long term. If you have caffeine, it may impair the “memory making” process.
From the article:
“Ninety percent of Americans use caffeine daily, some substituting it for sleep. While the stimulant enhances alertness and concentration, it's been unclear whether it also helps learning and memory. By contrast, daytime naps, like nighttime sleep, benefit both alertness and memory…
Evidence suggests that caffeine interferes with tasks that require processing explicit, as opposed to implicit, information - like recalling a specific word, versus remembering how to type or ride a bike. Studies show that consolidation of such explicit verbal memory during sleep depends on lowered levels of the chemical messenger acetylcholine in the brain's memory hub. Yet, by blocking activity of a natural sedative chemical, caffeine boosts acetylcholine in this hub.
"This increase in acetylcholine by caffeine may impair the consolidation process by blocking replay of new memories," proposes Mednick.”
No caffeine before bed or naps, if you want to learn most effectively.
A new study in the December 2008 edition of Psychological Science shows that people are more likely to procrastinate when they think of things in an abstract way, rather than focusing on concrete, specific tasks. The study also suggests that people are more likely to get started if they focus on HOW to do something, rather than WHY they should do it. And finally, people are more likely to get started if they have a deadline.
WebMD interviewed researcher Sean McCrea about the study. From the online article: http://www.webmd.com/balance/news/20090115/concrete-ways-to-beat-procrastination
“Procrastination is a costly psychological trait that almost all people share, but it may be possible to conquer it, says Sean McCrea of the University of Konstanz in Germany, who led the team of psychologists that studied the phenomenon…
The study shows that students who answered the more abstract questions were much more likely to procrastinate -- that is, delay their answers. The researchers found that students who were focused on the concrete technicalities of a task, such as how to open a bank account, answered more quickly.
The study suggests it's easier to handle a question of how than one of why. "Merely thinking about the task in more concrete, specific terms makes it feel like it should be completed sooner," which reduces procrastination, the researchers write.
An approaching deadline can spur procrastinators into action. "It may be only when a deadline is looming that they first consider the specifics of a task, including what will be required to complete it, the context in which it will take place, and other details," the researchers write. "If thinking about a task more concretely enables people to get started, manipulating this variable directly should affect when they are likely to complete the task.”
When it comes to weight management, the old-fashioned medical approach of “scaring people straight” - by warning them all the of the dire consequences of their weight - is not as effective as focusing on the specific things that should be done. The other old-fashioned medical approach - just telling patients to eat less and move more - also would appear to be an ineffective way to help motivate people.
A better approach, supported by this study, would be to get to know an individual’s unique needs, then create very specific, detailed goals. The next crucial step is to set a follow-up appointment to create a “deadline”, to help motivate people to adopt a healthier lifestyle.
This is the approach that we have found works best with our own patients at Physicians Healthy Weight Center. Broad, vague advice to “eat less and exercise more” is next to useless. On the other hand, concrete, personalized advice, tailored to the individual, helps people get started. Having support at a followup visit is also critical to our patients’ success. Many patients admit that the positive, supportive “accountability” is a key factor in helping them improve their lives.
Lifestyle change is not an easy process, but it an achievable goal!
Sunday, January 11, 2009
Many people notice that it becomes more difficult to control weight as we grow older. Here is a nice quick interview with Pam Peeke about goals/needs for the 40+ crowd: http://www.webmd.com/diet/guide/expert-qa-fighting-midlife-weight-gain-pamela-peeke
Dr. Dean Ornish is well known for extensive scientfic documentation that lifestyle and diet can can reverse even severe heart disease. His advice (very low fat, unprocessed diet) has been criticized, however, for being too difficult for many people to follow. His recommendations have changed slightly over the years, to include more omega three fats. Here is a great interview with Dean Ornish -including a nice discussion of good fats vs bad, good carbs vs bad:
From the article:
"The truly good fats are not so much the unsaturated fats as the omega-3 fatty acids you find in fish oil and salmon and in some plant-based foods like flax. Part of the problem when you eat unsaturated fat is that much of the unsaturated fat people consume is rich in the omega-6 fatty acids, which promote inflammation and autoimmune responses. The truly good fats are not so much unsaturated fats as omega-3 fats.
And you don't need that much of it. You can take 3 or 4 grams a day of fish oil and that is really what most people need. And you can also buy the fish oil that has all the bad stuff in fish removed -- the omega-6, the PCBs, the dioxins, and the mercury. Then you get all the benefits of eating the fatty fish but without the extra toxicities that are found in most fish these days."
And about fiber:
"Soluble fiber, in things like oat bran, is important for lowering cholesterol levels. It has a direct effect on cholesterol metabolism in your bile and in your liver.
Insoluble fiber is important for two main reasons: First, because it helps to push food through the intestinal tract faster. Second, fiber affects your blood-sugar levels.
The difference between refined carbs and complex carbs is that the complex, fiber-containing carbs aren't just not bad for you -- they are truly good for you. When you go from white to brown rice or from white flour to whole-wheat flour, you are going from bad carbs to good carbs.
That does two good things from a weight standpoint. You fill up before you get too many calories. And you slow the absorption of foods into your bloodstream.
If you eat high-fiber carbs, your blood sugar level goes up a little and stays there -- so you're getting a good source of energy. But bad carbs get absorbed very quickly. Your blood sugar is going to zoom way up. Your pancreas pumps out insulin to bring it back down, and the insulin accelerates the conversion of sugar into fat.
This causes all these swings in energy. Your blood sugar doesn't just go back to where it started before it got too high -- it goes way down. That increases your carb craving, and you're stuck in a vicious cycle.
It is not necessary to avoid bad carbs altogether, but to limit them and use them in combination with other foods. If you're going to have dessert, have it after a high-fiber meal. Don't have it on an empty stomach."
At Physicians Healthy Weight Center, we bring you the latest research on nutrition and health, provide you with a range of choices, and work WITH you to develop the best eating plan for YOU. The good news is that even moderate movements toward healthier eating, exercise, and lifestyle can significantly improve your health and life!
Friday, January 9, 2009
5 Tips for Eating, 5 Tips for Exercise, and 5 Tips for Lifestyle...
Studies have shown that some ways of eating will help keep you full and satisfied, and will naturally control and suppress your appetite. If you have medical conditions which require a special diet, please follow the guidelines by your healthcare provider; in general, however, these tips can be useful for almost everyone.
1. Eat breakfast. Studies have shown that eating breakfast which contains low fat or fat-free protein, can help you feel more full all day. Include plenty of fiber (found in WHOLE grains, vegetables, and whole fruit - not just the juice), and you will stay even more full. Include a small amount of "good fat" for extra appetite control.
Examples: whole grain cereal, skim milk, blueberries, and some chopped walnuts; fat-free Greek yogurt with raisins and slivered almonds; egg white scramble with vegetables, and a side of whole wheat toast with Benecol or Take Control spread.
2. Plan ahead for your meals and snacks, and bring them with you so you don't have to raid the vending machine, or eat out in a place that doesn't offer healthy food. Eat healthy meals and snacks throughout the day, and try not to go longer than four hours without eating. This will keep you from getting too hungry, and overeating later in the day. Make sure each snack and meal has some protein (at least 10 grams per snack), and ideally some fiber.
3. "Don't invite the enemy to the table." Or to your car, or your desk... If you know that certain foods or snacks "trigger" you to overeat (think potato chips), keep them away! Don't try to challenge yourself to see if your willpower will win - why make life more difficult?! If a family member or co-worker keeps unhealthy "trigger" food around, try to hide it from your sight. You can put it away on a top shelf, tie it in a white plastic bag so you can't see it, or just stay away. Remember, if you can't get to it, you can't eat it! Studies have shown that people eat less candy when they merely push the candy dish out of reach on the other side of a desk!
4. Eat the healthiest foods first. Start your meals with lower calorie, higher volume foods, that ideally contain fiber and protein. Examples are soup (broth-based, low sodium), chili, or a green salad with grilled chicken. Studies have shown that people who start meals with broth based soup eat 30% fewer calories during the rest of the meal, without even trying! Fiber, high-water content foods, and lean protein actually signal your brain to eat less. These can act as natural appetite suppressants.
DO NOT start your meal with refined carbs (like white rolls or low fiber crackers) and saturated fat (like butter) - you'll end up eating much more!
5. Pay attention to how much you are eating. It is possible to eat too much of a good thing! If you are trying to lose weight, total calories DO count, and people who count calories (along with paying attention to balanced eating) are going to do the best. If you are not ready to count calories, at least portion your meals out on your plate - 1/2 the plate with non-starchy vegetables (or some fruit), 1/4 of your plate with whole grains or starchier vegetables (like sweet potatoes), and 1/4 of your plate with lean protein. Don't overload your plate - you can always go back for seconds if you are truly hungry.
DO NOT eat out of a box or bowl- you'll have no idea how much you are eating, and will likely overeat. Other tactics to stay aware: eat with the lights on so you can see your food, and avoid distractions such as television. You will actually experience your food, instead of unconsciously scarfing it down!
Of course, check with your health care provider before starting any exercise program. For healthy people with exercise clearance, exercise can do more for your health than almost anything else! The trick is to start gradually, find something that doesn't hurt, that you don't dread, and then make activity part of your day, almost every day!
1. If you are sedentary, or do not have a formal exercise program, begin by adding a minimum of 10 minutes per day of "scheduled" exercise, like walking, riding an exercise bike, dancing, swimming, etc. It doesn't sound like much, but studies have shown it WILL give you health benefits! Before long you will notice it gets even easier, you'll begin to have more energy and endurance, will feel better, and will find yourself adding a little more. If possible, try to get 10 minutes in first thing in the morning - everyone is an individual, but studies have shown that people who exercise in the morning are more likely to keep up with it long term.
2. Long term exercise goal: "heart pumping" exercise 30 to 60 minutes five or more days per week. You can achieve maximal health and weight control by gradually building up your time - but the good news is that you can break your exercise into three 10 minute sessions, or two 15 minutes if that is easier! "Heart pumping exercise" is any activity that gets you breathing a little harder. Check with your doctor, but generally you can use the "talk test" to see if you are working out properly. You SHOULD be able to talk in full sentences without gasping, but should be working hard enough that you would rather not have a deep conversation!
3.Your next goals are to add strength (resistance) exercise, and balance exercises. If you are new to these, do not try to do them on your own. A personal trainer or physical therapist are great resources, or you can purchase a video if you have some previous experience and know proper form.
Check out collagevideo.com for videos.
4. Get active with your family. It is fun and healthy for everyone to get active together! In the winter you can build snow forts, snowshoe, sled, skate, or ski. In the warmer months you can play ball in the yard, bike, hike, play frisbee, etc. Even washing the car can be healthy and fun with the whole family involved.
5. Variety is the spice of life. Try new activities to keep it fun, stay well-rounded, avoid overworking any joint, and keep up your calorie burn. There is something called the "FITT principle" of exercise - you can break through a weight loss plateau by changing your exercise Frequency, Intensity, Time, and Type.
It is one thing to "know what to do", and another thing to keep doing it! Here are some tactics that have been shown to help people stay on track.
1. Pay attention to "triggers" that push you toward unhealthy choices. Most of us who struggle to stay on track with healthy eating and exercise have factors in our life which push us toward unhealthy behavior. Keep a journal to start to learn about your "triggers". A trigger might be the sight or presence of junk food, a stressful person or situation in your life, some basic need not being met in your life (lack of sleep, all work and no play, lack of creative outlet, social outlet, spiritual need, or some other basic need), loneliness, boredom, disruption in your routine, lack of planning, etc. Look at times that you HAVE been able to take care of yourself - and then try to figure out what threw you off track. Often it is one particular trigger, over and over. Once you know the trigger, you can start to plan to deal with it.
2. Make yourself a priority, and TAKE time to take care of yourself. Remember, you can't take care of everyone else, if you are unhealthy. Besides, you DESERVE to take care of yourself!
3. Do what you can to lower stress during your day. Time out for yourself, exercise, slow deep breathes, meditation, self-hypnosis, calling a friend, laughing, just taking a break and getting away from whatever is stressing you can all help! Don't feel guilty - just do it!
4. If you feel a craving coming on - distract yourself, and quickly! Get out of the room, away from the "danger", go out for a walk, call a friend, put on music and dance or clean your house, run an errand, hop on your exercise bike, etc. You get the idea. Try to do something that is a "non-compatible activity with eating" - you can't easily ride a bike and eat a hot fudge sundae at the same time. Another trick it to distract your mouth - with a piece of minty gum, Listerine Pocket Paks Breath Strips, or Sugar-Free Halls Mentho-Lyptus cough drops. Snacks won't taste quite so interesting after these!
5. Pat yourself on the back every time you make a healthy choice. Whether you have shopped and stocked up on healthy food, planned out your healthy meals and snacks, laid out your sneakers to work out first thing in the morning, or successfully distracted yourself from your cravings, stop for a minute and say "Darn, I'm good!" Get good at patting yourself on the back! Take yourself out for some new clothes, CD, craft supplies, sports equipment, or jewelry to celebrate your successes!
Tuesday, January 6, 2009
In order to control our weight for the long term, we need to become aware of our challenges in each area. Once we identify our individual factors, we can create a plan to address them, and move forward toward a healthier life. Let’s take a look at common challenges, breaking them down into the categories of Biological, Psychological, and Social.
1. Biological (the Body).
This category includes many factors that can affect weight: genetics, metabolism, medical conditions (insulin resistance, hypothyroidism, etc) , medications (some of which slow metabolism and promote weight gain), body type (apple or pear shape), body composition (amount of body fat vs lean muscle), genetically influenced appetite/food preference, nutritional issues including deficiencies (such as vitamin D deficiency) and imbalances which may worsen appetite or insulin resistance, etc. This category of challenge is best examined through a full medical and bariatric evaluation, including analysis of family history, personal history, medications, medical conditions, physical assessment including vital signs, measurement of BMI, body fat percentage (different from BMI), physical exam, and bloodwork.
In my practice I have found many patients with undiagnosed or undertreated hypothyroidism, insulin resistance, pre-diabetes, diabetes, vitamin D deficiency, hypertension, metabolic syndrome, depression and anxiety, among other problems, which may contribute to further weight gain and illness if not treated. I have found many patients taking medications which can lead to weight gain. Often other medications are available which do not contribute to weight gain, and may even help patients lose weight.
Some primary care physicians are trained to perform these assessments, although according to Dr. Oz and Dr. Roizen in “You On a Diet”, many primary care physicians are not prepared to be bariatricians (weight management specialists). “ Many primary care doctors aren’t specialists in weight control and often cannot devote adequate time to the issue. They have also been discouraged by talking with patients about weight loss and not feeling that they’ve made a difference…If you feel you’re not getting anywhere with your primary doc and need further medical advice, see a weight specialist (called a bariatrician).”
It is also important to learn how to control the appetite center in your brain, by making certain food and behavior choices. Eating the right foods, at the right times, can control your appetite almost like an appetite suppressant! Appetite hormones such as leptin, ghrelin, and CCK can all be affected by your choices. It can sound complicated, but is actually quite easy to put into practice. The key is to create an eating plan that is “easy and automatic”. Our nutritionist helps our patients do this every day.
2. Psychological (the Mind).
This complex area includes self-image and self-esteem; body image; mood; emotional eating; stress and skills for stress management; developing an awareness of current habits, and learning how to make and solidify new habits. Important issues include: positive self-talk versus a negative attitude (your internal dialogue); breaking the behavior chain that leads to poor choices; recognizing sabotage from friends/family/co-workers, identifying any fears (such as fear of food deprivation), and recognizing tendencies to regress to old habits when under stress. Once we become aware of these influences, we can gain control over our lives and choices.
Unfulfilled spiritual or creative outlets, lack of sense of belonging or contributing to society, loneliness, or lack of direction can also lead to overeating, and poor health. Once these issues are identified, steps can be taken to fill these needs.
3. Social (the Environment).
This vast realm includes all the influences and challenges an individual faces when interacting with the environment. The simple reality is that some environments make it easier to stay at a healthy weight than others. Negative, unhealthy environmental influences include:
a) “External cues to eat” such as food advertisements everywhere, junk food within arm’s reach, the sight/smell of junk food, lack of easy, healthy foods; co-workers or friends eating junk food; tv ads pushing unhealthy food. These can lead to almost unconscious eating. It is important to recognize, then remove or control these “eating triggers.“
b) Stressful Environments. High levels of family or work stress can lead to compensatory, “comfort” eating. Financial stress, lack of sleep/exercise/recreation/private time to recharge the batteries, overwork, the care-taker role, or lack of control in life can increase the drive to eat. Once the environmental challenges are identified, plans can be made to either change the environment, or develop healthy coping mechanisms to deal with the environment.
c) Lack of activity in daily life. In the "good ol' days" children played outdoors, while adults stayed active by hunting and gathering! In modern society, children are often locked inside for safety, tight school budgets have limited sports and activity, and adults are trapped for long hours at their desks, in their cars, and then collapse into their armchairs at night, exhausted. Each individual has slightly different circumstances, but most people now have to actively take charge of their exercise, and schedule it intentionally into their lives. Starting with 10 minutes of "heart pumping" exercise per day, and building gradually to at least 30 minutes, five or more days of the week, has been shown to be a remarkable health "pill". The trick is to find an activity that is relatively convenient and relatively enjoyable (well, at least not miserable and painful!) There are actually many options... from walking, biking (outdoors or stationary), DVD's, classes, team sports, even the new Wii Fit, there is really something for almost everyone!
d) Family, workplace, or society ideas about what is “normal”. Certain ideas about eating, relaxing, work, etc, can be carried over from childhood or teen years, and can negatively affect health behavior. Ideas such as “cleaning your plate”, starving yourself to stay thin, or other extreme, irrational, unscientific ideas can become deep rooted. As an adult, certain workplace or society “norms”, or assigned family roles and expectations may make it difficult for people to take care of themselves properly. People may be encouraged by employers to abuse themselves by overwork , rushed or poor eating, etc. People may be encouraged by families to sacrifice their own health for the “good” of others. It is important to identify these influences, challenge their flawed logic, and make plans to “fight back.”
You CAN succeed, by getting to know your challenges, setting realistic goals, and being kind and forgiving to yourself. You will need a concrete, specific, realistic plan, and LOTS of support and accountability. It is important to play to your strengths, instead of focusing on weaknesses. Progress not Perfection is the road to success!
You can read about our program at healthyweightcenter.com
Here are some simple moves that can be done almost anywhere, almost anytime, that will tighten and tone your muscles, boost your energy level, and increase your metabolism. Start out doing these once per day; you may build up to three times per day. (Since you are not lifting heavy weights, you do not need to skip a day between exercises like you would with heavy weight training.)
1. Sit-Stands. Move to the edge of your seat, then tighten your abs, put your hands on your hips, and simply stand up. Lower yourself back to your seat. Repeat 10 times.
2. Seated Ab Curls. While sitting, cross your arms over your chest, and sit up straight. Pull your abdominals in, then curl forward, pulling your shoulders gently downward toward your hips (this will pull the bottom of your ribcage toward your hip bones). Hold for one second, then straighten back up. Repeat 10 times.
If that move isn't quite enough, try the Seated Ab Recliner instead. Sit up straight in a chair (the best chair for this is one without a backrest), raise your arms straight out in front of you, then slowly lean back as far as you can comfortably without your feet coming off the floor. Pause, and then return to an upright seated position. Repeat 10 times.
3. Desk Pushup. Stand up, and place your hands shoulder width apart on a stable surface (such as your desk, a chair, or the wall). Tighten your abs to keep your back straight, then bend your elbows to perform a slow, steady pushup. Pause when your elbows are fully bent, and then again when extended. Repeat 10 times.
Friday, January 2, 2009
First, for very easy, very basic, and HEALTHY versions of comfort foods, the best book I've found is The Hungry Girl by Lisa Lillien. I keep a copy of this book at my office, and many patients run out and buy a copy after looking through mine! Lisa also has a great website with many tips, tricks, recipes, and "weekend survival strategies": http://hungry-girl.com/chew/index.php
Another great online resource for recipes is Delish.com:
This site is terrific; it allows you to create your own online recipe book, foodfile, and shopping list.
Look under two sections: Healthy Meals from Day to Night, and Low Calorie Recipes.
Recipes are gathered from Good Housekeeping, Eating Well, and Redbook, and range from simple and basic, to quite elaborate. Here are some of the recipes I've collected from the site, and keep in my own online recipe book:
Turkey and White Bean Chili
California Roll Salad
Healthy Makeover Meatloaf
Vegetarian Hot Pot
Easy as Tortilla Pie
Peanut Tofu Wrap
BBQ Chicken Sandwich
Roasted Broccoli with Lemon
Elise's Sesame Noodles
Almond-Crusted Chicken Fingers
Scallop and Cherry Tomato Skewers
Turkey Cutlets with Nectarine-Arugula Salad
Wasabi Salmon Burgers
Happy New Year everyone! Eat up and enjoy!