"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!

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: delish.com (it's not Rachel Ray's site - and look for the low calorie recipe section or healthy recipes day to night:

www.delish.com/recipes/cooking-recipes/healthy-recipes-daily-meal-menu )

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!

Vitamin D: Low Levels can be a Health Risk

Vitamin D deficiency has become the "hot topic" in the news lately - and for good reason. There is mounting evidence that low levels of vitamin D may be associated with increased risk of obesity, weight gain around the waist, cardiovascular disease, insulin resistance, type I and type II diabetes, high blood pressure, arthritis, muscle and joint pain, autoimmune diseases, fatigue and depression, and other diseases, along with the more well known problems with bone density.

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."
http://www.familypracticenews.com/article/S0300-7073(09)70293-2/fulltext
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...

Want to lower your stress hormone cortisol? Try a Hug!

You've probably seen ads like these: "Lower your cortisol to lower your abdominal fat - use our Magic Miracle cortisol pill for only $200 per month."

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:

http://lifestyle.msn.com/relationships/articlematch.aspx?cp-documentid=17858326&gt1=32003

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...

Time for your Health and Beauty Sleep!

Sleep can be a wonderful thing. Our bodies and and minds can relax, recover, rejuvenate.
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:

http://diabetes.webmd.com/news/20090312/sleep-deprivation-linked-to-prediabetes

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:

http://www.webmd.com/sleep-disorders/news/20041118/sleep-more-and-you-may-control-eating-more

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!

The Worst Time to Exercise

People often ask "when is the best time to exercise?"

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!