Thursday, November 19, 2015

12 Tips for Avoiding Holiday Weight Gain or "Attack of the Killer Stuffing!"

The holidays are fast approaching, and while we look forward to spending time with family and friends, we don't look forward to holiday weight gain.  We eagerly anticipate the stuffing, but not stuffing ourselves into our clothes.  Is there a way to stay healthy and still have fun?  If we use  a little strategic planning, and new research, the answer is yes!
First of all, let’s start with a “hit list” of my patients’ biggest concerns, fears, and questions:
How do I deal with rich desserts?  Stuffing, potatoes, and starchy carbs?  What about alcohol?  Is there a way to have fun with the family besides eating?  What do I do about sweet treats at work?  How can I stay active when there is no time to do a full workout?  

Here are some strategies - some classic ‘tried and true”, and some brand new, based on new research:

1. Be a little bad.  It’s no surprise that people really like this strategy!
What do we mean by “bad”?  We mean have a little fun, let yourself feel like you’ve indulged a little.  Like you’ve “gotten away with something”.  This strategy is actually based on research which shows that people can only stand feeling deprived for so long… then they ‘act up’ in some way.  If they are on a very tight financial budget, they tend to overindulge in unhealthy foods.  And if they “treat themselves” in a non-food way (indulging in some retail therapy, sneaking away to a bookstore or cafe, stealing some me-time with a favorite hobby, a quick spa treatment, or a warm bath) they may find it easier to control their eating, and stay on track with healthy food patterns.

People often feel rushed, stressed, and over-stretched during the holidays.  It can feel self-indulgent, “bad”, simply to sneak away and get some privacy.  DO IT!  Whenever you can.  You’ll recharge your batteries, have more fun and BE more fun when you are in large gatherings.  And you won’t feel as much urge to ‘emotionally eat’ to calm yourself down after that certain relative stresses you out.

2. 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!  We call that "sumo dieting”, because it has been rumored that this is a strategy used by sumo wrestlers in order to GAIN weight.  Not what most of us are trying to do during the holidays.  

Research shows that eating a high protein breakfast - particularly one with 35 gram of protein - can help control your appetite all day - even into the evening.

3. Have your stuffing for dessert.  In other words, eat protein at the beginning of the meal, and your carbohydrates later in the meal (“for dessert”).  Saving stuffing (or bread, or dessert) for the end could help you control your blood sugar after the meal, which may help your waistline.   It’s best to save special desserts and treats for AFTER a healthy meal or snack.  
So much for my parent’s family tradition of having apple pie before the turkey!  We’ll switch that back around this year, and have at least a few bites of protein before stuffing, bread, mashed potatoes, etc.  

Protein also creates a low glycemic effect, and helps keep blood sugar from ‘spiking’.  Given that 50% of all Americans have blood sugar problems which qualify as prediabetes or diabetes, this is an important strategy for health for so many people!  

Think of it like this:  protein enters your stomach, triggers fullness hormones to close the ‘exit valve’ to the stomach, so food leaves your stomach very slowly.  So, if you start a meal with protein, your stomach HOLDS ONTO FOOD LONGER (the medical term is ‘delayed gastric emptying’) so you STAY FULL LONGER.  Carbohydrate you eat AFTER the protein ALSO stays in the stomach longer, and is released more slowly and gradually after the meal.  Your body is more likely to ‘burn’ those carbs when they are absorbed gradually into the bloodstream.  If, on the other hand, you start a meal with rapidly digestible carbs, they can ‘spike’ your blood sugar up quickly and high - and your body will tend to store them quickly as fat, rather than burn them off as energy.  So remember, lead off the meal with protein to ‘slow down’ your meal, so you have time to ‘burn’ those calories, instead of storing them as fat!

To summarize, starting a meal with protein, rather than carbohydrate, leads to better “postprandial glucose” (blood sugar numbers after the meal).

4. Think before you Drink.  Patients have been telling me that they know they will be drinking more during the holidays than they regularly would, and asking if that could be problematic.  Unfortunately it can, and drinking alcohol in excess can create a dangerous problem called “Holiday Heart Syndrome” - in short, you can give yourself a cardiac arrhythmia by drinking over the holidays.  No one wants to be in the emergency room having treatment for atrial fibrillation if they can avoid it, and keeping control of alcohol is one way to prevent that from happening.

Alcohol can also contribute to weight gain beyond just adding empty calories - alcohol actually impairs fat breakdown.  To quote the book Best Weight by Sharma and Freedhoff,  “At 7 kcal per gram, one large glass of wine a night adds up to 65,700 kcal per year (the equivalent of nearly 9 kg [20 lbs] in weight gain), and has no effect on satiety.  In most situations, there is no compensatory reduction in other calories consumed.  Alcohol can produce a positive fat balance, as it has a sparing effect on fat oxidation and promotes fat storage. Alcohol is also an appetite stimulant, often used as an aperitif, and has a tendency to reduce a person's resolve.”

So, what can you do?  Limit overall intake, eat first before drinking, alternate with non-alcoholic options, and be aware that many medications such as antidepressants can increase the impact of alcohol -so one drink might ‘feel’ like four!

5.  Remove and Replace.  How else can we “splurge” without overindulging in fatty, sugary excess?  By using the “Remove and Replace” technique.  Swapping a healthier version of an old standby.  This strategy is a cousin to the “Be a little bad” tactic, since it involves indulging your sweet/fat tooth/carb craving without making yourself feel sick. My husband used to turn up his nose at this idea...until he started making Hungry Girl’s Wayne's Pumpkin Smash instead of pumpkin pie. It’s like a crustless pumpkin pie, but it’s so high in protein, we can use it as a healthy snack.  And it’s delicious!  He’s hooked.

And here is our favorite light Eggnog recipe from Hungry Girl!  My daughter Olivia especially loves this one:

Other swaps:  protein bars instead of candy (I have my favorites), yogurt with fun toppings instead of pudding (yes, I’m a maniac for chocolate, so I drizzle Trader Joe’s Organic Chocolate Moo syrup on my fat-free Greek yogurt, and sometimes put a little light Cabot whipped cream on top), frozen yogurt pops such as Yasso or Enlightened instead of ice cream, fat-free Greek yogurt instead of sour cream in dips and other recipes, and mashed cauliflower instead of mashed potatoes. That’s just to name a few!  There are many great websites with recipes, and we’re working on our own recipe book.  If you’d like a sneak peak, email us at  My husband checks all the emails; tell Ron that Dr. Warren sent you.

6.  Adopt a “Love It, Need It, or Leave It” policy.  This one comes under the “tried and true” category - it was feature in a prior blog called, “Flash back Friday: Tips to survive the holidays!”
In this strategy we recommend you 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

7. 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 fruit/veggie with yogurt dip plate, or lean protein such as shrimp cocktail, chicken kabobs on skewers, or vegetarian/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!

8.  Walk it off - Even before you eat!   A quick 15 minute walk - brisk is best - before and after a feast can help improve insulin function - so you ‘burn’ those calories more effectively, and ‘store’ fewer!

Walking  can also destress you - the Japanese call the technique “forest bathing” - shin rin yoku - and research shows walking outside can lower stress hormones.  Walking may also raise serotonin as much as Prozac - which can help lower stress and improve mood.  So yes, do it!

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, 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.

9.  Play with the Family!  This is another the ‘tried and true” technique - also in our prior blog.  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!

By the way, the Scandinavians are really into creating ‘coziness’ through the holidays, and even year round.  They call it “hygge”.  You can read about it here:
10.  Don’t try to be perfect - but try to be good enough! If you are able 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'll feel much better, and glide right over the occasional indulgences.
11.  Indulging a little is better than indulging a lot.  Quantity is key - too much fat/sugar can trigger an addictive response - the ‘ice cream brain effect’.  So keep the treat as small as possible, and you’ll save yourself three days of headache.

12. 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 nuts and dried fruit, and bottled water - examples of portable healthy options that can save you in a pinch.  This is another oldie-but-goodie strategy, and a simple one but we sometimes simply forget what works!  

Above all, take care of yourself, so you can enjoy your 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!

Would you like personal help getting on track and staying on track? We can help! Check out our website:, and call any time: (603) 379-6500. We offer personal, custom, one to one support in person, on the phone, or online!

Thursday, November 12, 2015

Dear Siri...

Dear Siri, your voice recognition sucks. Nothing personal, it's all business.
As a normal adult trying to communicate with other normal adults, it is exasperating beyond belief to be hampered by a voice recognition on my iPhone 6 that dumbs my speech down to the level of an eight-year-old. No insult meant to eight-year-olds, but most of them don't hold down a full-time job, and are not trying to communicate about complex matters to an adult. And in fact eight-year-olds shouldn't be on an iPhone at all, give that thing back to your parents and get outside, get a little sunshine and play in the yard.
So back to what vexes me. As a physician, I find it hard to believe that the average person using an iPhone does not know what antibiotics are . Siri and her voice recognition seem to think that the average person using an iPhone calls them anabiotics, and she helpfully AutoCorrects antibiotics to anabiotics on a regular basis. Anabiotics aren't a thing Siri, they don't exist. Stop making things up! Please for the love of all things holy, stop taking perfectly articulate, literate human beings, and turning us into babbling idiots.
And please stop taking the name of one of the most commonly prescribed drugs in America, metformin,  and turning it into some guy named Matt Foreman. I have no idea who Matt Foreman is, maybe I should ask some eight-year-old.
Okay, back to our regular programming.

Thursday, November 5, 2015

Hedonic Hunger: Food for Fuel versus Food for Fun. Yahoo article featuring Dr. Jennifer Warren, M.D.

When we feel hungry, how do we know if we really need to eat?  Yahoo News writer Jenna Birch contacted me with that interesting question.  There are actually two primary types of hunger - homeostatic hunger (when we need food as "fuel") and hedonic hunger (when we want food for "fun").  We spent several days emailing back and forth, and talking on the phone.  She also interviewed Dr. Michelle May.  Jenna's complete article is here:

Excerpts from the article are below, along with new additional commentary added in bold.  

By Jenna Birch

Understanding Hunger:  the feeling of hunger is actually even more nuanced than most realize. Researchers are now focusing on two main kinds of hunger, according to Obesity Medicine specialist Jennifer Warren, MD, Medical Director at Physicians Healthy Weight Center.
“These two types are homeostatic hunger and hedonic hunger,” Warren tells Yahoo Health. (Food as fuel vs food as fun.)  “You can think of one as physical hunger, ‘stomach hunger’ or the need for calories. The other is emotional hunger, ‘head hunger,’ or the urge to eat food as a reward.”  (One patient calls it “cookie hunger”, controlled by the “cookie center” in the brain.  Pretty accurate, really!)
Warren says research is finally figuring out the biological basis for both. And both types of hunger have helped keep humans alive for, well, as long as we’ve been around.
Homeostatic hunger deals with your drive to fill basic calorie needs, or as Warren puts it, your body’s way of telling you that you need food as fuel. “This is the need for calories and nutrients, which help keep the body in a balanced – or homeostatic – state of health,” she explains. “We recognize this type of hunger when our stomach is grumbling and feels empty, when we feel lightheaded, or spacey.” Your blood sugar is dropping, and you know it.
In the case of homeostatic hunger, you’re famished, and you’re not very picky about food choices. “Any food looks good, even food we wouldn’t normally consider that tasty,” Warren says.
On the flipside, there’s hedonic hunger, which Warren describes as our body’s need for food as fun. “This hunger originates in the hypothalamus, otherwise known as the brain’s reward center,” Warren says. “With that, hedonic hunger tends to push us toward ‘hyperpalatable’ foods – the sweet, starchy, creamy or fatty stuff.”  (This food can actually have an “addictive” effect in some people, and our cravings can worsen when we are under stress, exhausted, or otherwise not having our basic life needs met.)
Back in our ancestors’ day, Warren says that scientists think hedonic hunger arose out of a need for the highly-palatable foods of old, like sweet berries for key antioxidants and fatty foods to instantly meet caloric needs. But today? This hunger can be problematic for a very specific reason: “We have an endless supplie of delicious, high-calorie foods,” says Warren. “It can overwhelm us, turn hedonic hunger into a feedback loop – and we can end up eating more than is really healthy.”
While fighting off hedonic hunger might seem like a battle of willpower, it runs deeper than that. “Multiple chemical signals in the brain can increase this drive to eat for pleasure, so there is a real, biological basis for hedonic hunger,” Warren says. “That rush of ‘feel good’ neurochemicals after eating these foods can be addictive.
Controlling Hunger:  Controlling hedonic hunger starts by controlling homeostatic hunger, says Warren. If you don’t, your whole hunger system will start getting out of whack. “If someone is lacking in calories or nutrition, that can light the fire of hedonic hunger and set it ablaze,” she explains.  Suddenly, everything starts to look good, and you reach for whatever’s most readily available – chips, cookies, Twinkies, whatever else you probably shouldn’t be eating.
So, control your basic nutritional needs first with three balanced meals, never going more than three to four hours without eating. “At the core, we control homeostatic hunger by eating healthful, balanced snacks with protein on a regular schedule throughout the day, meeting our need for nutrition without going too long without it,” Warren says.
And keep in mind, hedonic hunger itself isn’t bad hunger. You should feel free to indulge that smartly and occasionally, says Warren. “Enjoying food is part of a healthy, fulfilling life,” she says. “We just have trouble if our hedonic hunger is too high, because pleasure-driven hunger isn’t pushing us to binge on veggies. It pushes us toward calorie-dense, high-fat and high-glycemic carbs.”
So start by controlling your homeostatic hunger. Then, if that’s not enough, you have to address other sources of “hunger” or start paying closer attention to what your body’s cues are telling you about need fulfillment.  (If you are using tasty food to meet emotional or other needs, to ‘self-medicate’ anxiety, depression, winter blues, etc, you may need help to find healthier ways to address these issues.  Some people may unconsciously use carbohydrates to raise serotonin levels, to calm themselves, since carbohydrates open the blood-brain barrier to a rush of the amino acid tryptophan, which can temporarily sedate us...this can happen with a stuffing and turkey dinner, for example.  While an occasional small dose of calming carbs is not a bad thing, a dose which is too frequent or too large, or is used as a substitute for healthy coping strategies, is not a good thing!  I will write a separate blog about healthy ways to improve serotonin, such as proper eating patterns, exercise, sunlight, sleep ‘hygiene’, counseling and calming behavioral techniques, and more.)  
Reading Your Body’s Hunger Cues and Countering Cravings:  Sometimes hunger is confusing. To eat without overdoing it, you have to address the right dietary needs at the right time, separate the difference between needing food (for fuel) and simply wanting it (for fun),  and realize that you can hunger for something that’s not food at all.  (Other needs can also make us think we are hungry)...Thirst, anxiety, boredom, fatigue, lack of sleep and painful situations are all reasons you may want to eat, but eating won’t fill that hole.
(How do we figure it out?)  
Track your intake:  If you’re craving uncontrollably, make sure you’re eating normally. This should equate to a meal or snack roughly every three to four hours, says Warren, making sure you’ve eaten a good balance of protein and carbohydrates, meeting your calorie needs and hydrating to make sure you are not simply thirsty. “If you are not sure about your nutritional needs, journal for a few days with one of the great free apps, such as MyFitnessPal,” says Warren. “Maybe run it by a dietician or Obesity Medicine specialist. Once you know you are getting your nutritional needs met, for both calories and macronutrients, if you are feeling ‘hunger,’ it’s likely another need you’re trying to fill with food.”
Honor your introvert needs.
Warren says one of the most common reasons people overeat for pleasure is because they aren’t taking enough time for themselves, and food then becomes the reprieve. “We need to honor that need to be alone and recharge, and if this need goes unmet, we often feel an increased drive to eat for pleasure to counter that anxiety,” says Warren, who says to take a timeout from social obligations to “honor our inner introvert” – so you don’t overeat at every party or cookout (or overeat at night to “de-stress” after a long day of dealing with other people!)  
Avoid a state of decision fatigue.
Another reason we overeat? We’re tired. So tired, in fact, that we enter a state of “decision fatigue,” says Warren. “It’s the end of a busy day, we’re beat, and we have very limited energy left to make healthy food choices. Instead, we reach for what’s quick, tasty and fun.” This is where pre-planning comes into play. Put a healthy dinner in the crockpot before work. Make up measured bags of healthy trail mix as a snack. Always have cut-up raw veggie and fruits on hand to grab n’ go. Be smart when you’re not too tired to default to bad decisions.
Seek help.
Sometimes, out-of-control cravings may seriously be beyond your control. “Inherited genes may lead to excessive hedonic hunger, turned on during phases of life,” says Warren. “It could be the result of hormone changes, pregnancy, medical conditions, medications, poor sleep, poor diet, sedentary lifestyle, and so on. All may amp up hedonic hunger, and it can be tough to bring the ‘fire’ back down to a normal range.” Therapy, medication and lifestyle changes all may help, so talk to your doctor if you can’t seem to calm your cravings and eating. If you would like help setting up your own personal environment so it is "safe for healthy living" - give us a call any time! Our goals are to help people establish simple, realistic, healthful lifestyles which make it easier to make healthy choices every day. Read more about our program: Call any time: (603) 379-6500.

***Update January 2017: we are offering a New Year special free first visit for new patients who sign up for our Jump Start Program. Call now to reserve your time. Happy New Year!