Sunday, May 17, 2009

"Full Effect" Foods

Have you ever noticed that eating certain foods seems to make you feel hungrier? Some patients tell me that they are not hungry until they start eating - but once they start, they can't seem to stop. Why is this? There are several factors.

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!

Naturally Skinny People

We all know a few of them. Those naturally skinny people who seem to be able to eat whatever they want, and never gain an ounce. Those people who can truly just "take a taste", and stop, without scarfing down the entire piece of chocolate cake. What is up with these people? Are they really different from the rest of us?

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

Dr. Mom

Well, it's Mother's Day, and what am I doing? Taking a few minutes for myself, to catch up on things, including my blog! A little peace and quiet, and time to oneself, can be a great gift to moms - and everyone else, really!

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: (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!