Lose Weight Fast and Safely: A Strategy to Simplify and Get Back on Track

"Doc, how can I lose weight as quickly as possible, but still do it safely?!"

I've been hearing this call for help a lot lately, and I get it! While we all know it's important to establish sustainable healthy habits for nutrition, exercise, stress management, and a balanced life, we also can feel out of control right now, and desperate to get back on track as quickly as possible!

Research actually shows that rapid initial weight loss on a program is a good predictor of future success - so we are not wrong in wanting to "pull things together quickly". But we want to do this in a way that helps us preserve our muscle, our metabolism, our energy level, and our health - we do not want to go on silly starvation regimens which leave us feeling weak, shaky, foggy-brained, and our muscles starved for protein. We want to not only get on track quickly, we also want to set ourselves up for long term success. http://link.springer.com/article/10.1007/s12529-010-9092-y "Collectively, findings indicate both short- and long-term advantages to fast initial weight loss. Fast weight losers obtained greater weight reduction and long-term maintenance, and were not more susceptible to weight regain than gradual weight losers."

We also want to do this as simply as possible. Although some of us have dreams of cooking like Martha Stewart, few of us actually have the time in our lives to do that. Many of us suffer from something known as "decision fatigue" - we are so busy, so stressed, making so many decisions in our own lives, and taking care of others, that we have no energy left to make healthy decisions for ourselves. Simplifying our decisions can help decrease our stress, give us time to breath and think, and relax a bit. I've blogged about decision fatigue back in October: http://healthyweightcenter.blogspot.com/2014/10/decision-fatigue-make-choices-easier.html?q=decision+fatigue

If you are pressed for time, and need to simplify your life, one strategy is to simplify food choices. This can be done through regular grocery store or farmer's market foods, with careful planning to ensure the proper calories, protein, carbohydrates and fats, for your needs. This takes some time and planning, and we help patients set up their plans every day, in our clinic, or even on the phone or with virtual visits. Another strategy, which many find even easier when starting out, is to use a something we call the Rapid Reboot Fast Track.

Studies have shown more rapid weight loss success with medical meal replacements. http://www.ncbi.nlm.nih.gov/pubmed/12704397 "All methods of analysis indicated a significantly greater weight loss in subjects receiving the PMR (Partial Meal Replacement)  plan compared to the RCD (Reduced Calorie Diet)  group." Simply put, high quality protein meal replacements not only simplify your planning, but are likely to improve your success. After you develop a new eating routine, and gain a sense of control, you can transition back to grocery store foods, with all the support you need for continued success. The Rapid Reboot Fast Track Protein Supplements are medically designed to trigger a sense of fullness or "satiety", provide you with superior nutrition, and make it simple to control your calorie intake.

The Fast Track program may be particularly helpful for people who have trouble with portion control, very busy people, and those who are challenged by hunger and cravings. This program may also be ideal for people who are not candidates for appetite controlling medication, but have large appetites.

The foods, shakes, snacks and bars are delicious and affordable. We have evaluated and selected the "best of the best". Because we are independent, we are able to pick and choose the top products from all manufacturers, unlike programs which are bound by contract to offer products from only a single company. We have done the research - and the taste testing - for you.

You may choose to get a rapid "jump start" on weight loss by using the Fast Track for a few weeks, or, if you would like to lose a large amount of weight, you may choose to use the Fast Track throughout the entire weight loss phase of your program. Some people use the Fast Track intermittently - you can start and stop anytime, and start again when you need to get through a plateau. 

Below we have included an outline of how the program works, plus recipes for healthy protein shakes, snacks, fruit and vegetable list, and Six Minute Meals. We can help you select the best options for you - we enjoy getting to know people personally, and helping them make the best choices to fit their needs and preferences.  Feel free to give us a call: (603) 379-6500

Call us any time, and read more about our program here: healthyweightcenter.com, and our products here: seacoastnutrition.com

Below is a sample outline, keeping the calories above 1000 per day.  Your calorie needs may vary depending on your activity level, age, sex, and weight, and other factors.   We also recommend calling us for more personalized guidance.   

It is always a good idea before starting any program to consult with your primary care provider, and we recommend that you do this. This is particularly important if you have medical conditions or medications which can be affected by your diet. We have had excellent results in patients with a wide variety of medical conditions, including diabetes, and we have seen rapid improvements in blood glucose numbers so that patients have quickly found the need to decrease medications for their blood sugar. Please be aware that you may need a decrease in these medications, and please consult your medical caregiver. Our patients are obviously quite pleased when they decrease their need for medication!   

 Rapid Reboot: Phase One Fast Track Program  

No need to count calories.  It’s already done for your convenience.

Breakfast                                                   VHP Shake (plus fruit)

Morning Snack              1-High Protein Soup or Juice or Hot Chocolate or Oatmeal or protein bar

Lunch                                                        VHP Shake (plus fruit)

Afternoon Snack           1-High Protein Soup or Juice or Hot Chocolate or Oatmeal or protein bar

Dinner                                  Lean Protein/Entree  &  Garden Salad/veg with low calorie dressing                                                                (See Six Minute Meal Recipes)

Evening snack              1-High Protein Soup or Juice or Hot Chocolate or Oatmeal or protein bar

Instructions:

Eat: 6 x a day.  Do not skip a meal or snack.  No need to count calories. If you feel hungry on a particular day, you can simply have an extra healthy snack.

Dinner: 3-4 oz. lean protein (chicken or turkey breast without skin; seafood such as salmon, flounder, haddock, scallops, shrimp; grass-fed lean beef, buffalo/bison; pork tenderloin. Cooking methods: broiled, grilled, baked (avoid fried, or stuffed).

Vegetarian protein sources: fat free or 1% dairy (such as 0% Greek yogurt, fat-free or 1% cheese of all types), tofu, tempeh.

*See supplemental fruits and vegetable list for sides to have with dinner protein.
*See Six Minute Meals for dinner recipes.

It’s okay to switch lunch with dinner to meet your schedule and personal preferences.  Eat at regular intervals.  Consume all specified Phase One Fast Track High Protein meals and snacks as directed to maintain optimum nutritional intake for support of lean muscle and to curb hunger.

Below is the average daily nutritional breakdown for Phase One Fast Track Program:

Calories                    Carbs                    Fat                    Protein                    Dietary Fiber

1000-1200                 100 g                   10 g                     135 g                            16 g

Supplemental Fruit and Vegetable List

Lower-calorie fruits: Use in moderation.  ½ cup of berries (strawberries, blueberries, raspberries, etc), small clementine,  ½ orange,  ½ banana, small apple, ½ cup melon, grapes.  

Low-calorie vegetables: these can be eaten raw, as a large plate of salad, or may be steamed or roasted.  Try a large plate of greens (Romaine lettuce, spinach, radicchio, kale, swiss chard, beet greens, bok choy, endive).  Use any leafy greens you would like, and remember, the darker the color, the more rich in nutrients and vitamins it will be.

Try grape/cherry tomatoes, cucumbers, snow peas, green beans, broccoli, cauliflower, peppers (green, red, yellow), mushrooms, onions (red, yellow, white), zucchini, summer squash, spaghetti squash, brussels sprouts, shredded carrots, asparagus, eggplant, radish, turnip, celery, leeks, scallions, sprouts, water chestnuts, bamboo shoots, jicama, artichoke hearts (in water), roasted vegetables (asparagus), fiddleheads, sprouts, fresh herbs.

Additional salad veggies/fruits to use in moderation:    apple slices,  beets, pepperoncini peppers (watch the sodium),  black olives, baby corn

  

Cheese: use sparingly!  Try 1-2 Tbs of fat-free or 1% shredded cheese on salad (Kraft, Cabot)

You can create “zoodles” by using a device such as Veggetti, to create ‘noodles’ out of zucchini, summer squash, and spaghetti squash!  

Herbal toppings, low calorie dressing spritzes (such as Wishbone Spritzers), low/no calorie dressings (such as Walden Farms, maple grove farms), flavored vinegars may be used on salad or steamed vegetables.

Low sodium chicken or vegetable broth may be enjoyed alone, or low calorie vegetables may be added.  Look for boxes of low sodium organic broth (Trader Joe’s, Pacific Organic, Imagine Brand)

Ingredients to use sparingly, with CAUTION (they are calorie-dense, with a lot of calories per bite): avocado, nuts, seeds, craisins, raisins, full fat cheeses, bacon bits, no croutons

Recipes for Meal Replacement VHP (Very High Protein) Shakes

                                                                             

Coffee and Cream Frozen Delight

1 packet Vanilla V.H.P.

1 cup water

1 cup brewed coffee (Regular or Decaf)

5 ice cubes

Mix all ingredients together in blender until smooth.

Nutrition Facts (per serving): Calories 260, Fat 3 g, Carbohydrate 21 g, Protein 35 g

Mocha Latte Frozen Delight

1 packet Chocolate V.H.P.

1 cup water

1 cup brewed coffee (Regular or Decaf)

5 ice cubes

Mix all ingredients together in blender until smooth.

Nutrition Facts (per serving): Calories 260, Fat 3 g, Carbohydrate 21 g, Protein 35 g

Chocolate Dipped Strawberry Smoothie

1 packet Chocolate V.H.P.

15 oz of cold water

1/2 cup of Fresh or Frozen Strawberries

4 ice cubes (not needed if using frozen strawberries)

1 pkt of splenda or stevia to taste

Mix all ingredients together in blender until smooth.

Nutrition Facts (per serving): Calories 286, Fat 3 g, Carbohydrate 27 g, Protein 35 g

Orange Cream Smoothie

1 packet Vanilla V.H.P.

8 oz of Diet Orange Soda

8 oz of Cold Water, 4 ice cubes

Mix all ingredients in a blender on high speed until smooth.

Nutrition Facts (per serving): Calories 260, Fat 3 g, Carbohydrate 21g, Protein 35 g

Root Beer Float Smoothie

1 packet Vanilla V.H.P.

8 oz of Diet Root Beer

8 oz of Cold Water, 4 ice cubes

Mix all ingredients in a blender on high speed until smooth.

Nutrition Facts (per serving): Calories 260, Fat 3 g, Carbohydrate 21g, Protein 35 g

Your Favorite Flavor Smoothie

1 packet vanilla V.H.P.

8 oz of your favorite diet soda ( Cherry, Lemon Lime, Coke, etc)

8 oz of cold water, 4 ice cubes

Mix all ingredients together in a blender until smooth.

Nutrition Facts (per serving): Calories 260, Fat 3g, Carbohydrate 21g, Protein 35 g

Peach Smoothie

1 packet Vanilla V.H.P.

1 medium peach, peeled and sliced

8 oz of diet cream soda

8 oz of cold water, 5 ice cubes

Mix all ingredients in a blender on high speed until smooth.

Nutrition Facts (per serving): Calories 300, Fat 3g, Carbohydrate 34g, Protein 35 g

Fun Recipes for snacks and mini meals supplemented with High Protein Products

Protein hot chocolate or Protein vanilla cappuccino: (Instead of high calorie/high fat/high sugar coffee)  

1. Mix the PROTEIN HOT CHOCOLATE/VANILLA CAPPUCCINO  into COFFEE (decaf or regular) to replace fatty/sugary creamers with a delicious healthy PROTEIN  burst!
2. Add different flavor extracts TO the hot chocolate (try mint, almond, caramel, etc).
3. Sprinkle the hot chocolate powder on top of fat-free Greek yogurt - you double the protein, and make it a ‘rocky road’ yogurt!

Protein bars:

1. Cut bars into small sections to savor and nibble slowly (my favorite are the choc-mint bars).

2. Cut and sprinkle bars on top of Greek yogurt for a delicious topping with a protein boost.
3. Heat bars briefly in the microwave, and eating with a fork (try Cinnamon Raisin and Lemon Meringue)
4. Try freezing bars for a cool treat (Caramel Nut turns into a ‘Turtle’ Treat!)

Protein oatmeal:

1. Sprinkle  slivered almonds or chopped walnuts on top.
2. Top protein oatmeal  with fruit, such as blueberries, apple slices and cinnamon.
3. Spice things up with flavor extracts (vanilla, caramel, etc) or sugar-free syrup (such as Maple Grove Farms).

High protein Cinnamon swirls with chocolate bite:

1. Use as topping on Greek yogurt.
2. Try  as a cereal!

Protein chips:

1. Have with lunch to replace salty carby chips.
2. Take to the movie theater instead of fatty, high calorie popcorn.
3. Eat as a snack alone, or with a simple, high-protein dip:  mix  non-fat greek yogurt with ranch dip powder flavoring!

Protein soups:

1. top with fat-free mozarella cheese for a cheesy melty treat
2. top with a few protein chips, for a fun, tasty, healthy crunch!

Six Minute Meals

Lettuce Wraps with Choice of Fish

One 4-6 ounce pouch of light tuna or salmon (packed in water)

4 large lettuce leaves - hearts of Romaine, or butter lettuce work well

1-2 Tbs chopped onion (red or Vidalia)  

¼ cup chopped tomato (fresh whole, cherry or grape tomatoes)

1 tbsp. finely chopped cilantro (fresh is best)

1/8 tsp. chili powder

1/8 tsp. garlic powder

1/8 tsp. cumin

Low sodium seasong (optional)

Empty tuna or salmon into a bowl, and stir in all dry seasonings.  

Next stir in the cilantro, tomato, and onion.   

Spoon onto the lettuce leaves, roll up and enjoy!

Makes 1 serving: 200 calories, 5g carb, 1g fiber, 36 g protein

Alfredo Broccoli Slaw with Chicken

4 oz precooked chicken skinless breast

2 Laughing Cow Light cheese wedges

12 oz steamable bag broccoli slaw

2 T fat free sour cream

Garlic Powder

Paprika

Steam broccoli slaw until tender.  Stir in Laughing Cow cheese wedges and sour cream.  Microwave until melted, stir, and add in chicken.  Season with garlic powder and paprika.

Makes 1 serving:  315 calories, 18g carb, 8g fiber, 39g protein

Deluxe Turkey Sandwich and Salad

4 oz low sodium turkey breast

1 whole wheat sandwich thin, such as Arnold’s or Joseph’s

2 tsp light mayo or hummus

Lettuce

Tomato

2 cups side salad (lettuce, tomato, mushrooms, veggies - can pick up pre-made or at salad bar at grocery store)

2.5 tsp vinegar

½ tsp oil

Put turkey, lite mayo, lettuce, tomato on sandwich thin.  Add oil and vinegar to side salad

Makes 1 serving:  306 calories, 26g carb, 6g fiber, 30g protein, 9g fat  

 

Southwest Chicken and Vegetables

4 oz precooked skinless chicken breast

2 cups frozen stir fry-style vegetables

1.5 cups frozen broccoli florets

1 tsp olive oil

2 T southwestern style sauce (such as Lawry’s Santa Fe Chili Marinade)

Microwave stir fry veggies and broccoli.  Add chicken, southwestern sauce, and oil.  Mix together, heat, and enjoy!

Makes 1 serving: 290 calories, 24g carb, 8g fiber, 29g protein

Snap Pea Tuna Salad

5 oz pouch low sodium tuna or salmon in water

16 oz bag mixed lettuce (Romaine, baby spinach, etc)

1 cup sugar snap peas

1 cup sliced mushrooms

¼  cup black beans (can use canned)

1.5 T vinegar

1 tsp olive oil

Drain tuna and rinse beans.  Toss with lettuce, veggies, oil, and vinegar.  Ready to eat!

Makes 1 serving: 360 calories, 32g carb, 15g fiber, 51g protein, 6g fat

Quiche in a Cup!

½ c liquid egg whites

1 wedge LIGHT Laughing Cow Swiss Cheese

½ c chopped fresh spinach

2 Tbs diced tomatoes

2 Tbs diced avocado

May add ½ c chopped peppers (red or green) and ½ c sliced mushrooms

Nonstick spray

Spray microwavable cup with nonstick spray, then add spinach/peppers/mushrooms and microwave until soft (about 1 minute).  Pour off or blot excess water.

Pour eggwhites into cup, stir, and microwave 1 minute.

Add Laughing Cow wedge and tomatoe, and microwave 1 minute.

Top with cool avocado, and enjoy!  

Makes 1 serving: 140 calories,  7g carb, 2g fiber, 16g protein



REFERENCES

http://www.ncbi.nlm.nih.gov/pubmed/12704397

Int J Obes Relat Metab Disord. 2003 May;27(5):537-49.

Weight management using a meal replacement strategy: meta and pooling analysis from six studies.

"All methods of analysis indicated a significantly greater weight loss in subjects receiving the PMR (Partial Meal Replacement)  plan compared to the RCD (Reduced Calorie Diet)  group….Conclusion:  This first systematic evaluation of randomized controlled trials utilizing PMR plans for weight management suggests that these types of interventions can safely and effectively produce significant sustainable weight loss and improve weight-related risk factors of disease."

 http://link.springer.com/article/10.1007/s12529-010-9092-y

International Journal of Behavioral Medicine, September 2010, Volume 17, Issue 3, pp 161-167

The Association Between Rate of Initial Weight Loss and Long-Term Success in Obesity Treatment: Does Slow and Steady Win the Race?  "Collectively, findings indicate both short- and long-term advantages to fast initial weight loss. Fast weight losers obtained greater weight reduction and long-term maintenance, and were not more susceptible to weight regain than gradual weight losers."

http://www.nature.com/nrendo/journal/v10/n12/full/nrendo.2014.175.html

Personalized weight loss strategies—the role of macronutrient distribution 

Nature Reviews Endocrinology 14 October 2014

"Restriction of energy intake is the primary method of producing a negative energy balance leading to weight loss. However, owing to the different metabolic roles of proteins, carbohydrates and lipids in energy homeostasis, diets of similar overall energy content but with different macronutrient distribution can differentially affect metabolism, appetite and thermogenesis."

 

What is BMR (Basal Metabolic Rate)?

What is BMR (Basal Metabolic Rate)?

In theory, it seems so simple: the way to ensure weight loss  is to expend more calories than you consume. But how do we know how many calories your body needs and how can we determine the appropriate calorie level that will allow weight loss to occur for YOU, as an individual?  Everyone is different, and what may be an appropriate calorie level for one person may not work for someone else.  To determine where to start, we first calculate your Basal Metabolic Rate (BMR).

What is your BMR?

Your BMR is a measurement of the energy your body needs to support its basic functions while resting.  The “official” definition requires certain criteria to be met, such as being in a fasting state, in an environment with a controlled temperature, and in relaxed physical and psychological state.  Since that is not always possible, we will just keep it simple and call it the baseline number of calories your body requires to function at rest.

What factors affect BMR?

As always, nothing about weight loss is as simple as it seems.  Your Basal Metabolic Rate is not simply based on your body size or weight, it is also affected by other factors.  Some of these factors are listed below.

AGE
In general, the younger you are, the higher your BMR will be.  As we get older our BMR’s slow down with each decade.  This means we have to change our food strategies (adjusting our calories, and our balance of protein and carbohydrate), and adjust our exercise/activity as we get older, to compensate and succeed.  Hormone changes such as loss of estrogen or testosterone can also slow BMR, and we have strategies to address that.

GENETICS
Individuals may be born with genetic tendencies to have ‘faster’ or ‘slower’ metabolisms, and two otherwise identical people might have metabolisms that vary by 30%, simply because of genetics!  So-called ‘thrifty genes’ which slow metabolic rate, may have been inherited and switched on at some point in our development.  This may have been a great advantage for ancestors who faced food shortages, but can be a challenge in the modern world. People with thrifty genes may require targeted, specific food strategies in order to achieve and maintain a healthy weight.   

There is a whole new field known as ‘epigenetics’ which studies the effects the environment can have on our genes.  Our genes can be affected by what was happening in our mother’s bodies even before we were born (if our mothers were either overweight OR underweight, or were diabetic during pregancy, we might be at higher risk of weight gain due to epigenetic effects.)   Although we can’t change what happened before we were born, we CAN  compensate for it, and set up our future environment and lifestyle to help us succeed.   

PRIOR WEIGHT HISTORY / WEIGHT LOSS
They say “once we buy a fat cell, we own the fat cell” - in other words, when we  lose weight, our bodies may ‘fight it’ and  try  to regain back to our previous weight, by slowing down our BMR.

To illustrate what this means, if you have two people who both weigh 200 pounds, are the same age, the same sex, the same body fat, and otherwise identical, but person A used to weigh 300 pounds, and person B has never weighed more than 200 pounds, person A is going to have a lower BMR (a slower metabolism) than person B.  Not fair, and this can be frustrating, but we need to account for it, and plan for this, in order to succeed.  Specific food strategies and exercise/activity patterns can help combat this problem.

Another effect from prior weight loss attempts is possible  excess loss of muscle, due to poor diet strategies (and inadequate protein).  When people cut too much protein, they lose muscle, and lower BMR - NOT a good idea!  We will help you maintain proper protein intake to avoid this trap.   We can help you REBUILD your muscle - and your metabolism.  We can help you get the proper PROTEIN, at the proper times, along with proper calories for your needs. Studies suggest that two diets with the same calories, may have VERY different metabolic effects: the higher protein versus lower protein diets may increase the 'calorie burn' but 300 calories or more per day! Same calories "in", and extra 300 calories "out" - pretty impressive. People also feel less hungry on diets which have adequate protein.  

One more concern of many is a prior history of ‘yo-yo dieting’.  The bad news is that extremely low calorie diets can slow down BMR excessively.  The GOOD news is that we can FIX this problem with restoration of healthy eating and exercise patterns!  Don’t worry, you didn’t “break yourself” permanently!  

LIFESTYLE
Stress, and poor sleep quality/quantity can slow down or lower your BMR.  Both issues can affect multiple hormones, and end up not only lowering your metabolism, but also increasing your hunger and cravings.

SLEEP
Working on ‘sleep hygiene’ to improve your sleep quality:  keep your room cool, dark, and quiet (or use ‘white noise’ for background, such as a fan or ‘wave machine’).  Before bed avoid caffeine, fatty foods (which can lead to acid reflux), alcohol (which blocks REM sleep), excess exercise (which can trigger insomnia in some people), emotional conflict, and blue light from electronic screens.  Aim for 7 good hours of sleep.

STRESS
Unmanaged stress can lead to lower BMR, and studies have shown that short term stress can measurably slow metabolism!  Long term stress can lead to ‘burn out’ and exhaustion which can lower BMR (and lower our willpower and ability to cope and make good decisions for ourselves).  Many people use meditation (or ‘walking meditation’, also called ‘forest bathing’ by the Japanese, walking outdoors in nature) to help relax, and many use other strategies such as talking to a friend, getting support from a counselor, tai chi or yoga, or engaging in enjoyable hobbies such as music, reading, art, knitting, etc, to help relax.  It is important for us to try to meet needs in our life for relaxation, down-time, creativity, spirituality, healthy socializing - even healthy ALONE time, doing nothing at all sometimes!  

MEDICAL CONDITIONS
Health issues may lower our metabolism, such as pre-diabetes, diabetes, sleep apnea, depression, hypothyroidism, Vitamin D deficiency,  chronic pain, Cushing’s syndrome, and more.  It is important to identify and treat any conditions which may be lowering our BMR.  We commonly identify medical problems which have been either previously undiagnosed, or inadequately treated, which are slowing down metabolic rate.  

MEDICATIONS
There are many medications which can cause your metabolism to be slower, and lead to weight gain.  Common categories of medications which are culprits include over-the-counter antihistamines such as Benadryl/diphenhydramine (a common ingredient in over-slow sleep pills), and certain prescription medications for depression, high blood pressure, diabetes, and more.  We are often able to help patients switch to medications which work as well (or better) for medical conditions, but do not slow down metabolic rate.  

GENDER
Males generally have a higher BMR (faster metabolism) than females, for several reasons.  First, men tend to be larger on average than women, which means their bodies burn more calories, just to stay alive.  Second,  men tend to have more muscle mass, and higher muscle percentage, than women (even women of the same height and weight) -  and muscle ‘burns’ extra calories even at rest when we’re not exercising.  It is important to understand that men and women generally need different calorie levels for weight loss.

Both men AND women can build muscle - and improve BMR and insulin function - with proper diet and exercise strategies.

How do we calculate BMR?

There are various ways to do this,  from low-tech mathematical formulas, to high-tech devices.  In our office we use a method called Bioelectrical Impedance Analysis (BIA) to measure body fat percentage, muscle mass, and water, and the computer uses this information along with your height, age, and sex to provide a good estimate of BMR.  (Biolectric impedence sends a tiny electrical signal from one side of your body to the other,  and is able to estimate your body fat percentage by the speed the signal is transmitted, since the signal is transmitted at different speeds through muscle and fat.)  This method gives a good scientific estimate of BMR, but is not 100% accurate, since your individual genetics, medical history, stress level, and past weight and dieting history may also affect your current BMR.  Nevertheless, it is a great starting point in helping us establish a calorie range for you, to help you achieve your weight loss goals.   If you are not achieving the weight goals we planned, at a given calorie range, it may be a sign that your individual BMR is lower than predicted,  and we can adjust the calories at your next visit.  

Other ways to estimate BMR - Mathematical equations:

Harris-Benedict Equation

This equation uses your height, weight, age to determine BMR.

Men: BMR= 66.5 + (13.8 x weight in kg) + (5.0 x height in cm) - (6.8  x age in years)

Women: BMR= 655.1 + (9.1 x weight in kg) + (1.8 x height in cm) - (4.7 x age in years)

This can then be multiplied by “activity factors” to determine your calorie needs.

Note: this equation often overestimates BMR - see below for a different equation.

Mifflin-St. Jeor Equation

This equation also uses your height, weight, and age to determine BMR, however has been determined to be slightly more accurate than the Harris-Benedict Equation.

Men: BMR= (10 x weight in kg) + (6.25 x height in cm) - (5 x age in years) + 5

Women: BMR= (10 x weight in kg) + (6.25 x height in cm) - (5 x age in years) - 161

Katch-McArdle Formula

This equation takes into consideration your lean body mass (LBM) and body fat percentage.  It is the same for both men and women.

BMR= 21.6 x fat-free mass + 370

Fat-free mass = Weight - (body fat percentage x weight)

The good news is that our Bioelectric Impedence Device does the calculating FOR you, so you don’t have to!

There are other devices which measure BMR, but are cumbersome.  One is called direct calorimetry, which would be virtually impossible to do!  This involves putting you in an insulated chamber and measuring your body heat.  Not very practical!  Another method is called indirect calorimetry.  This involves hooking you up to a machine and measuring your inhaled oxygen, exhaled carbon dioxide, and excreted urinary nitrogen.  Again, time-consuming and not very practical, and unnecessary!  Our BIA device, plus followup consults, will give us all the information we need!

Learn more about our program at healthyweightcenter.com, and give us a ring if you'd like some help. That's what we're here for! (603) 379-6500. We now offer phone nutrition support, as well, and virtual nutrition visits, if you can't make it in to see us in person.

Today's blog was a team effort by Amy Buzzell, Cara Gourgoumis, and Dr. Jennifer Warren. Learn more about them here: http://www.physicianshealthyweightcenter.com/about_us

Free Group Nutrition Visit: Our First Was A Resounding Success! And more news: 2 books in the works: The American Viking Diet, and Healthy Weight Lifestyle Workbook

We have a lot of 'irons in the fire' at the moment, including TWO books in the works ("The American Viking Diet"and our "Healthy Weight Lifestyle Workbook"), AND our new group nutrition classes!  Those who follow us know we have also added online/virtual nutrition and lifestyle counseling, and are also offering private personal training sessions with our own Amy Buzzell.  This is all in addition to our  usual private, supportive one-to-one medical weight management program, which is science-based and individualized to each person's needs.

But back to our group program.  We are working on creating a series of interactive classes, which will be address a variety of topics including healthy nutrition, activity/exercise, lifestyle and behavioral strategies, and common medical conditions which are connected to weight and lifestyle. We are beginning by offering a free nutrition class once per month, which covers a wide spectrum of core nutrition concepts.  

We held our first class with Amy Buzzell last month, and it was a resounding success!  Here are comments from attendees:

"Very informative!"
"Amy was excellent - a lot of information, explained very well!"
"Amy had many suggestions about nutrition that I will begin to implement immediately.  Good job Amy!"
"Amy was very informative and easy to listen to.  She knows her stuff!"
"Amy was a great presenter.  Would like info on a program for diabetics, perhaps a specialized session."

All I can say is, "Wow!"  I agree with the attendees - great job Amy!  And this is just the beginning.  We are working hard on our class structure and content, and getting great feedback.

We will be offering another session next month, since we overbooked this one!  We will post a date soon.  Call for information, and if you'd like to reserve a spot:  (603) 379-6500.  Read more about our program at:  healthyweightcenter.com

And keep an eye out for our books!  I couldn't do any of this without my great team.  Beth, Amy, and Pat are working with me on The American Viking Diet, and Cara, Amy, and Pat are my teammates on the Healthy Weight Lifestyle Workbook.  And of course Ron and Shannon are keeping everything else together. Whew!  Hardly time to breath, but it's a lot of fun.

The American Viking Diet: the "new" diet for those who love, or love to hate, fad diets

The American Viking Diet: I'll admit the name started out tongue-in-cheek, poking fun at fad diets, and as an ode to human nature, specifically our nature to love new things, and to search for magic cures. But there is actually renewed interest in what is called the "New Nordic Diet" by researchers, and there are some impressive health gains in studies. We have our own resident Viking here at Physicians Healthy Weight Center, our chief nutritionist Beth Almstrom.  Beth has been an integral part of our program since we opened in 2004, staying on top of the latest research, helping fine-tune our program over more than a decade.      When people ask me to give a simple name for our nutrition program, I often jokingly call it our "American Viking Diet". But now we will make it the official name!  

Our philosophy at Physicians Healthy Weight Center has always been to acknowledge human nature and work with it, rather than try to fight against it. Humans have all sorts of quirky tendencies, and we've learned that denying their existence, or railing against them, is futile. Much better to study them, understand them, and channel them into healthy lifestyle choices. 

One quirk of human nature, shared by other animals such as dogs, is something called “neophilia”. This sounds like a disease, but it actually just means “love of or enthusiasm for what is new or novel” (http://www.merriam-webster.com/dictionary/neophilia). There is nothing wrong with this tendency by itself, and in fact we can see how it helped our ancestors survive. Neophilia has driven humans to search out new lands, new food sources, etc., which helped our species thrive. 

Another trait of human nature is the desire to search for simple solutions to problems, and to fix problems as quickly as possible. This tendency also helped our ancestors survive, by helping them focus their attention on important challenges, and not waste time or energy, in solving a crisis or problem. Those who addressed problems quickly and effectively moved on to live another day.

Although we can imagine how these two tendencies helped our ancestors to survive, we also know how they can backfire. Neophilia, the love of new things, can lead us to fall prey to unscrupulous people who can take advantage of this quirk, and con us into buying products or systems which have no scientific basis, or may even be dangerous. Even if unscientific products or systems are not physically dangerous, they may be dangerous to our sense of self-esteem, our belief in ourselves that we can take charge of our lives and improve them for the better. When we fall for a scam, we become pessimistic, suspicious, and jaded. We also lose faith in ourselves, in our ability to change our lives for the better. These are tragic consequences. Neophilia can also make us abandon successful strategies which ARE working, and jump to something new, just because it is new. New is not always better.

The second human quirk, the tendency to search for a simple ‘magic pill’ to solve complex problems, can backfire as well. When we oversimplify a problem, and ignore subtle, complex issues, we never learn from the past, and never come up with real solutions. When we fall for a ‘magic pill’, we become frustrated and angry, once we realize that this is silly and ineffective. We have to avoid our overeager nature to try to find one simple solution to a more complex problem. The reality is that a healthy lifestyle is not achieved with one magic pill, but is achieved through specific, science-based strategies for healthy nutrition, activity, lifestyle, and a logical approach to deal with medical problems. The goal is to simplify without oversimplifying our strategies. So what can we do to channel our tendencies of neophilia (the love of new things) and our search for solutions to problems, into healthy lifestyle choices? It is not an easy task, but we must keep an open mind, with a reasonable degree of scientific skepticism at the same time.

We must do our best to try to interpret the science, and we must avoid any program which shuns science in favor of a pseudo-religious fervor. Without naming any programs, I'm sure you can all come up with names of extremist diets which demand rigid adherence and are trumpeted by pseudo-experts who claim to be near-messiahs when it comes to their "program." As tempting as it can be to have blind faith in those charismatic personalities, deep down we feel something isn't right. When a so-called expert is not open to listening to new research, is overly rigid in their diet and lifestyle advice, and is not allowing for individual variation from one person to another, you know you have spotted a problem.

Now, all that said, what do we do? The reality is that most research-based weight management professionals agree on most diet advice. Let me repeat that, because it surprises many people: most real experts agree on most major points of advice for diet, exercise, and lifestyle. One expert to another may vary slightly on their advice, but the differences are actually quite minimal. You will repeatedly hear calls for eating a good balance of whole foods, adequate protein, whole carbohydrate-containing foods that match your individual energy needs, and some degree of "good fats". There will be some minor variation between experts, in terms of the best ratio of protein to carb and fat, the type of fats, and protein sources, but over all, there is far more agreement than disagreement.
This brings us back to the new "American Viking Diet". Our tongue-in-cheek name refers to the fact that Vikings were actually not rigid in their food choices, as they adopted healthy foods when they ventured out around Europe and even into North America. Historically, Vikings did eat a diet pattern that was high in fish, local produce, which provided a diet of healthy protein, carbohydrates, and fats. They were obviously very active, with intense physical exertion during both farming and fighting. Archaeological and anthropologic studies have shown that Viking warriors had much healthier bodies than other people in that time period. “Most were unusually large; an examination of the muscle-attachment areas of their bones revealed extremely robust physiques....The tests indicated that the men ate, on average, more fish and shellfish than did Anglo-Saxons.” (http://www.smithsonianmag.com/history/a-viking-mystery-59648019/?no-ist ) A group of people known as the Pict, located in what is now Scotland, had a healthy diet that was very similar to the Viking diet. Their diet included: fish such as salmon, shellfish, milk products, grass-fed pastoral meat and wild game, kale, cabbage, onions, carrots, leeks, wild garlic, nettles, watercress, peas, beans, turnips, beets, other vegetables, and whole grains such as flax, barley, rye, and wheat.

The modern Nordic diet has been the topic of research for over a decade, and something called the New Nordic Diet (NND) has been developed and studied in Nordic countries. Research has shown considerable benefit. Metabolic syndrome, blood pressure, weight management, and other health parameters may all improve with a Nordic diet.(http://sciencenordic.com/nordic-diet-lowers-cholesterol-%E2%80%93-even-without-weight-loss) The topic was addressed in multiple media outlets in 2014, and was the topic of Dr. Arya Sharma's blog post in January. (http://www.drsharma.ca/anti-inflammatory-effects-of-a-healthy-nordic-diet)

In the SYSDIET study, subjects ate either a control diet or the ‘healthy Nordic diet”, which consisted of whole-grains, fruits such as berries, vegetables, rapeseed oil, three fish meals per week, and low-fat dairy products, and avoidance of sugar-sweetened products. The control group was told to eat low-fiber cereal products, limit fish to the ‘usual’ consumption level, and use full-fat dairy fat–based spreads. Biopsies and gene analysis were then performed, which suggested that the healthy NND created an ‘anti-inflammatory’ effect. 

So what is our diet advice, Beth's "American Viking Diet"? We have always recommended the same basic healthy diet pattern: adequate amounts of good quality protein, balanced amounts of good carbohydrates, and emphasis on high quality fats, without eating too many calories for our needs. You could compare this in some ways to the Mediterranean diet, the anti-inflammatory diet, the Zone Diet, or the South Beach Diet. As I said earlier, most educated nutrition experts have wide agreement in their advice, and this is reflected in the common threads of all these diets.


Our "American Viking Diet" addresses those two parts of human nature: the love of something new, and the desire to have a simple system to help us solve problems. Stay tuned for more details on our diet, recipes, and more.

One more note - my Mom and Dad, my own personal Vikings, could not be more excited about this project! Mom wanted to make sure herring and sardines were on the plan, and Dad wanted to make sure Codfish and salmon were on the menu. They are indeed - with American flourishes, like a touch of maple syrup on the salmon, a nod to our American roots, too!  

Call us to learn more, and check out our website:  HealthyWeightCenter.com
(603) 379-6500
We offer private, personalized 1:1 visits in person, and now 'virtually' online!  Watch for our upcoming group classes.  



Sources:

http://www.pictishstones.org.uk/pictishstones/pictishstoneshome/aboutthepicts/society/lived.htm

https://prezi.com/qq_zkm0dusko/the-picts/

http://ajcn.nutrition.org/content/99/1/35.long

http://onlinelibrary.wiley.com/doi/10.1111/joim.12044/full

http://www.oecd.org/health/49716427.pdf 

 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3386552/

http://www.ncbi.nlm.nih.gov/pubmed/24664189

http://www.ncbi.nlm.nih.gov/pubmed/20964740

http://www.ncbi.nlm.nih.gov/pubmed/24129358

http://ajcn.nutrition.org/content/101/1/228.abstract

Foster, Picts, Gaels and Scots, pp. 49–61. Fergus Kelly,Early Irish Farming: a study based mainly on the law-texts of the 7th and 8th centuries AD (School of Celtic Studies/DAIS, Dublin, 2000. ISBN 1-85500-180-2) 

How to Exercise with a Leg Injury, Lower Body Injury or Pain

How to Exercise with a Leg Injury, Lower Body Injury or Pain

It can certainly be a challenge to stay active with pain or an injury involving a lower extremity, but depending on the type and extent of the injury, there are a variety of things you may be able to do.  First off, always make sure you clear an exercise plan with your medical provider before working out when you have an injured extremity.   

If you have an injury or pain associated with a joint, tendon, muscle, or ligament, you may be able to participate in physical therapy.  Generally your primary care provider or specialist will be able to arrange this for you if you request.  If you choose this option, be sure to ask the physical therapist for suggestions on how to maintain your cardiovascular fitness while you heal.  They will be able to show you safe exercises for both strength and aerobic fitness.

Other options are available in addition to formal physical therapy. If you have enjoyed swimming in the past, you may be able to join a water aerobics class, or swim laps, depending on the type of injury. (Obviously check with your health provider before starting exercise.)  Swimming is done primarily with the arms, but can be a terrific aerobic workout.  In many water aerobics classes you are supported by a flotation device, so you can limit the use of your legs; don’t be embarrassed about “being seen in a bathing suit” - people in these classes come in all shapes and sizes!  If you need the name of local pool facilities, we can give you some leads if you live here on the New Hampshire seacoast.  Other leads:  check your with local YMCA/YWCA, local hospital (many have connections with pools or water-based therapy), and your local town hall (some towns have their outdoor and even indoor pool facilities.)  If you need to have a knee or ankle relatively immobilized, you may be able to use a neoprene brace for support while in the water; check with your health provider.

Depending on the injury, you may be able to use your leg in a limited way with non-weight-bearing exercise such as stationary bike, either upright or recumbent (again, check with your health provider to see if you need a brace or support, if this is appropriate.)  You may be able to purchase stationary bikes for a surprisingly affordable price.  We can refer you to a Consumer Reports guide on the best exercise bikes for price and performance. In addition to local stores, check outlets (such as the Brookstone Outlet in Kittery, ME, for locals).  You may also find affordable stationary bikes at yard sales, on Craigslist, or other ‘want ads’ in your favorite paper or online.  Don’t forget to ask friends and family if they have any bikes “lying around” that you can borrow.

If you are unable to use your legs at all, there are other solutions.  One neat trick is to use a stationary “mini peddler” (also known as a ‘hand cycle” or “upper body ergometer”)  that is similar to a small exercise bike - but put it on a table and peddle it with your hands.  It sounds funny, but you can work up a sweat.  These are used often by physical therapists, but you purchase basic models for home use, for as little as $25 in some cases. You can find these mini-peddlers online (look on online pharmacy websites,big-box store websites, Amazon, Brookstone, etc), and you can  sometimes find them at local pharmacies or medical supplies stores, specialty stores,  or sports stores.  They are tiny and easy to store, and can be converted to leg use as well.

Another idea is to look into “chair exercise” videos.  Just as it sounds, these exercises are done while sitting in a chair.  Check out the offerings on collagevideo.com, where you can actually go online and SEE one minute clips of videos before you decide to purchase any, to see if you like the style of a particular video.  http://www.collagevideo.com/search?q=chair   Warning:  be prepared for some goofy music on some of them, but it’s all in fun!  One example: CHAIR DANCING:   “More Sit Down and Tone Up”  will give you a full body workout in just 20 minutes. Now you can sit comfortably on your chair, enjoy delightful music, and strengthen, tone and shape the muscles of your arms, shoulders and back. You’ll also firm your legs and flatten your stomach in just 5 minutes!” http://www.collagevideo.com/products/chair-dancing-more-sit-down-amp-tone-up

Hang in there!  It can be frustrating and discouraging to be set back by an injury.  Stay motivated by reviewing WHY you wanted to work on healthy activity in the first place - and use those reasons stay on track with healthy eating (SO important for healing), quality sleep, stress managment, and more.  Focus on goals such as: feeling better, stronger, healthier, happier, having more energy, overcoming fatigue or depression, lowering risk of disease (such as heart disease, diabetes, and cancer); avoding or minimizing the need for medications; seting a good eample for others in your life; feeling in control and confident; fitting back into clothes that are hiding in the back of the closet, etc.  Write out the goals that motivate you- list your top five “Motivators”- and post them in an obvious place, such as your bathroom mirror, or your refrigerator door.  And remember, you can always call us for support!  We can even do consults by phone, online, or ‘virtually’ on Skype.

Call at (603) 379-6500

Email:  healthyweightcenter@hotmail.com

Read more at healthyweightcenter.com

Inflammation: Key Tactics to Keep Your Body Healthy by Pat Pappal, APRN-C

Be informed, Some Key Tactics to Keep Your Body from Developing Inflammation

by Pat Pappal, APRN-C

INFLAMMATION- We know what inflammation is. An injury occurs and the body uses it’s resources to heal; the immune system kicks in, white blood cells are activated, macrophages rush to surround and destroy the intruders. The body has these healing processes, and they are very efficient, but in a state of chronic inflammation over time, the healing mechanisms may start to break down, setting the stage for chronic inflammation resulting in disease. The body may not be able to fully return to an optimal level of health; however, there are steps we can take to avoid inflammation and maintain our good health.

One of the keys in preventing an inflamed state in the body is choosing foods that are beneficial to maintaining health. Herbs particularly have been noted as high in antioxidants, which are an ally in the prevention of inflammation. Spices that have anti-inflammatory properties include: turmeric, ginger, thyme, rosemary, basil, oregano, and cayenne pepper.1 A sprinkling of these spices will add flavor without adding calories and may also contribute to continued good health.

There are additional foods that have been shown to contain anti-inflammatory properties. A partial listing of these foods includes oily fish, which are high in omega-3 fatty acids, such as wild salmon, mackerel, tuna and sardines. For optimal benefit prepare the fish by broiling or baking and eat fish at least twice a week. Dark leafy vegetables such as broccoli, spinach, and kale have disease fighting phytochemicals. Berries have particularly high levels of anthocyanins, which are anti-oxidants. All fruits, however, can be beneficial in the fight against inflammation. 2

Low-fat dairy products, such as Greek yogurt, which contains active live cultures, are also helpful in reducing inflammation. Other good food additives include olive oil and nuts. Just be mindful of the calories in olive oil, one hundred twenty calories in a tablespoon, a spray may be better than a pour. Nuts in moderation can also be part of a healthy food plan; walnuts are high in omega-3 fatty acids, just be mindful again of the calories, two hundred calories in 1/4 cup!

What we choose to put in our grocery carts and how food is prepared can factor into reducing or preventing inflammation. Shop in the periphery of the grocery store, limit processed foods, and select fresh fruits and vegetables as part of your food plan. Seasonally selecting foods from farmers’s markets or joining a CSA can be fun and allow the selection of varied fruits and vegetables. Try something new!

Food can definitely play a role in the reduction of inflammation, but there are additional factors that play a role, as well. Consider sleep. In this busy society, we can easily become sleep deprived. We are plugged into our devices, smart phones, and email is ever present requiring our attention. It may be challenging to unwind, unplug, and get a good uneventful nights rest. Chronic sleep deprivation can lead to diabetes, obesity, cardiovascular disease and even early mortality. 3  Leptin, the hormone that regulates satiety is reduced in sleep deprivation. Ghrelin, the hormone associated with hunger is elevated when sleep deprived. This occurrence can play a role in metabolic syndrome which is a precursor to diabetes. Elevated cortisol, the stress hormone, can lead to chronic inflammation when sleep is insufficient. Continued studies are being considered to evaluate the long term consequences of sleep deprivation and the physiological responses of the body to sleep loss. 4 The immune system may have difficulty over time in defending itself against disease with sleep deprivation, which may preclude to inflammation.

It’s recommended to obtain 7 to 8 hours of sleep a night in a darkened room. Light sources in the room, even with eyes closed, can be a deterrent in getting restorative sleep. Keep the sleep schedule the same, the body gets used to a routine.

Exercise has been known to lower an inflammatory marker in the blood known as C-Reactive Protein (CRP). This substance increases when there is inflammation in the body. People who engaged in moderate exercise for at least 2.5 hours a week had lower levels of CRP and other inflammatory markers, according to a research study. 5 This exercise can be divided up into increments of time that work with one’s schedule. Better yet, make exercise part of your schedule, your daily routine. Find an activity you like, whether it be gym activities, hiking, swimming, or dancing around to your favorite music. The exercise that is right for you is the one you have an interest in doing. Most likely sleep will be improved also.

Good oral hygiene can also play a role in the the prevention of systemic inflammation. The oral cavity had been described as a “front line shield” against inflammation but when compromised  can have an affect on diseases such as diabetes, obesity, rheumatoid arthritis, and atherosclerosis. 6  Continuing to follow up with regular cleanings and an oral exam from your dentist can be the first step in maintaining a healthy mouth. Remember to floss!

A holistic approach towards health includes healthy eating, exercise, and getting enough of that much sought after sleep. Take some time to reduce life stressors- yoga, meditation, and music can all help us to relax and maintain our optimal health. Remember to have fun, enjoy your loved ones, and life is a balance (not always a perfect balance), strive to do what you can to ensure a long, healthy happy life.

References:

1. Kuhn, M. ( 2015, May). What Is In Our Food. Paper presented at a conference sponsored by The Institute for Brain Potential.
2. http://the scienceofeating.com  Foods That Fight Inflammation
3. http://healthysleep.med.harvard.edu/healthy/matters/consequences    
4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3403737/
5. http://www.drweil.com/drw/u/QAA401189/Reducing-Inflammation.html
6. http://www.lifeextension.com/magazine/2008/9/disease-prevention-begins-in-the-mouth/page-01?p=1