Archive for the ‘Dieting’ Category

When all else fails

Tuesday, December 7th, 2010

Most of my posts are written for those of us who are of normal weight and want to stay there or those who are overweight and would like to lose a few pounds or twenty or forty. As of this morning, for example, I'm twenty-four pounds under my May 2009 peak and sixty-five under my obese 1970 lifetime maximum.

It's the holiday season with Thanksgiving and Hanukkah and Christmas thrown in to a jumble of other parties, gourmet club dinners, symphony events and theatre events. I'm at my upper limit of 153 pounds and have to really watch carefully to avoid all the temptations.

Many of you are in the same mode, I bet, but overall doing okay with your weight.

Then there's an entirely different group. I saw an article on Lap-Band surgery for those people who are obese and haven't managed with diets, counselling, support groups and perhaps even medication to lose the pounds they desperately need to shed.

Does this man need Lap-Band surgery?

Now I'm an Internal Medicine doc and a retired one at that, so I looked at the Mayo Clinic website, an Australian website, one for a nearby hospital and MedlinePlus, an online information source sponsored by the NIH and the National Library of Medicine. I wanted to know more about this surgical strategy for the obese.

First off it's not cheap with prices varying from $13,000 to $25,000 in the United States. Some people go south to Mexico where the prices are lower, but I wouldn't be likely to do that if I were seeking out this procedure.

It's done under general anesthesia using a laparoscopic approach. That means several small incisions are made in the abdominal wall and a small camera in inserted to allow the surgeon to see what he or she is doing. A band is then positioned around the stomach so that the upper portion of that organ forms a small pouch with a narrow opening to the rest of the stomach.

It doesn't require internal staples or cutting and, if the surgeon is experienced may take only 30 to 60 minutes. The 2,700-person Australian series I read about reported no deaths.

Lap-Band surgery has been restricted to the very obese with a Body Mass Index over 40 (mine is 20.5), or the fairly obese who have complicating diseases such as diabetes, heart disease or sleep apnea.

But, after the surgery people have to stick to a diet and should exercise. Plus there are complications with half the patients in one large series reporting nausea and vomiting, a third having reflux, a quarter of the bands slipping and requiring repositioning and perhaps 10% experiencing some blockage near the band.

The band is adjustable; the physician can tighten or loosen the stricture by adding or removing saline.

And this is the least invasive surgery for severe obesity. I also read where some proponents (and the company that makes the device) want to loosen restrictions on its use. They'd like it to be approved for use in people with a BMI over 35 or over 30 with complicating diseases. That would include over 25 million Americans.

I'll certainly stay out of that debate and stick to my diet and exercise concepts.

Two successes, one failure and a lesson

Friday, December 3rd, 2010

My newest reminder card

Travel is tough on my dieting, but, I've learned recently, so are the events I go to. I had weighed 153 when we left for our trip to Texas where friends hosted dinners, fed us well, too well. I returned at 157 pounds, four over what I now consider my upper limit. I know that I re-started my diet at 177 in May of 2009 and so I'm considerably slimmer, but 157 annoyed me.

So I was concerned; we had Thanksgiving dinner, a series of parties, a Thank the Donors event for the capital campaign I've been running and then would come some holiday events. What could I do to not only lose the four pounds at least, (my real goal weight is 149-150), but to also avoid gaining more. I needed a gimmick.

One of the background books I've been reading is on "mindless eating," the kind of frenzy of ingestion I recognized well. I used to get into this pattern frequently, forty years ago in when I weighed 218.

What I needed was another STOP sign. I already had my red 1/3 cup measure sitting on my kitchen island. Now I needed something for events and occasions. And, when I thought about it, one of those is my weekly writers' critique group. Most of us bring something edible to share and sometimes I get hooked on cookies or something else I wouldn't normally eat.

So I took two three by five inch cards and wrote "Don't Snack!" on one of them and "Don't Eat or Overeat" on the other.

my other card

One card leans up against my popcorn holder which itself is surmounted by the red measuring cup. Eating at home hadn't usually been a problem, but it wouldn't hurt to have an extra reminder.

The other I put into the cup holder of my car. I'd look at it just before going into a house where we were joining an ongoing party or before entering, twice this week alone, the local country club, where we were attending a luncheon for symphony donors and, later in the week, the Thank the Donors event.

Oh, and there was one more event, a baby shower I wouldn't normally have attended. In this case it was for the wife of a young relative. We hadn't seen him since his high school graduation and I felt it was important to go to his spouse's shower.

So here's my score card and the lesson I learned. I looked at the card in my Prius just prior to entering the country club for the luncheon. I ate three fourths of my salad and half my entree and said, "No thanks" to the dessert. I did even better at the donor event. I pre-ate a bowel of cereal and a piece of fruit. At the event itself I ate nothing and drank one third of a glass of Merlot.

But the shower, held at a pizza parlor, was another matter entirely. I didn't remember to look at the card hat evening, shared an appetizer with my nephew and his fiancee and had three large slices of pizza, even eating the dry crusts.

Actually the donor event was last night and today I'm down in my safe zone again. I'm going to lunch with friends at our favorite Thai restaurant, but before I leave my car I'll look at the card.

Lesson learned. I'll bring the "Don't Snack" card to my writers' group next week and look at it just before I leave my car.

Water, water everywhere and how much should we drink?

Monday, November 29th, 2010

My wife was really looking out for me yesterday. She read and clipped out an article from USA Weekend's HealthSmart section with the title "4 crucial tips for managing

A standard eight-ounce glass of water

your weight." They came from THE DOCTORS, a daytime TV show I've never seen (I don't watch much TV anyway).  The show apparently has four physicians, a pediatrician, an Ob-Gyn doc, an ER doc and a plastic surgeon.

The tips seemed reasonable: drink water; stay consistent; get good sleep and log on to keep pounds off. I've written a post on sleep and weight, believe in consistency (but it's my one sore spot, especially on vacations ), keep a record of my weight on a regular basis (but not online) and drink lots of water.

Now that one caught my eye; I drink three very large glasses (30 oz each) of lime water a day and often drink water before starting to eat. I've read that some think that even the standard recommendation of eight glasses a day is excessive, but my habit started when I had vocal cord issues and a senor speech therapist suggested I drink a large quantity lime-flavored water every day.

my 30-ounce glass next to the standard one

Now there's some data to support my idiosyncrasy of having some water at the start of a meal. A study done by researchers at Virginia Tech and reported at a recent national meeting compared two groups of subjects aged 55 to 70. Both groups were on a low-fat, low calorie diet. The research subjects in one group drank two cups of water before each meal; those in the other group didn't.

This was a twelve week study and the water drinkers lost more weight. Then the scientists followed their progress for a year. Not only did they keep weight off, they even lost a little more.

There's a catch; this doesn't work for young dieters. The speculation is that older people's stomachs empty slower and I'd tie that in with feeling full and choosing not to eat more.

Several other university groups commented on the subject. One said that those who drink water don't drink sugar-filled beverages and, on the average, consume 75 to 90 calories less a day. That adds up over the course of a year; 100 calories less a day would equal a little over ten pounds of weight loss. The other wondered if people who aren't on an actual diet would keep up their water-drinking pattern longterm.

So far I have, for twelve years, but for different reasons. I think I'll be more deliberate in my pre-meal water drinking and see how that helps.

Don't overdo this if you try the idea; too much water intake can be dangerous. Two cups before meals sounds reasonable, but my large water intake isn't for everyone.

Miscellaneous ramblings, centered on portion size and vacations

Tuesday, November 16th, 2010

Today I read a book on "Mindless Eating" and eventually I'll write more about it. But first off it rang a cord for me with a section from a Harvard Health Publication on cutting down on salt. We eat too much salt, too much sugar and too much fat. One of the simplest ways to cut down on those is to diminish your portion sizes.

I don't weigh in on any of the fad diets except to say they won't solve the long-term problem that two out of every three of us have in the United States. I think eliminating something you like won't work very well over the years. So instead, I diet by cutting off a portion of everything on my plate. I can still have a small amount of almost anything; I just don't overeat..except on vacations.

We spend six days on a trip to Texas recently. Our surrogate dad had turned 90 and we wanted to visit him. So part of that trip was with an elderly couple living in a retirement community. Part of it was visiting other friends. Everyone wanted to make sure we were well fed.

We went to restaurants, clubs and dining facilities in the retirement village. There were abundant choices and generally quite good food (though I did miss our fresh fruits and vegetables from our CSA). The problem was my lack of the ability to say NO.

I left home at 150.6 pounds, well within my comfort zone. I returned at 157 pounds and have had to play catch up ever since. I'm almost back to where I started at. I do fine at home; I even mamage local parties and restaurants without a problem. So what happens with a trip?

Ah, I think I have figured out some of the issue; we were with good friends who wanted to treat us to their favorites places to eat. Or, in the case of our older friends, we were eating buffet style. Both situations are diet traps. They require some extra punch in my diet resolve.

So one of my coping mechanisms, one that I have to strengthen for vacations, is portion control. I really didn't eat anything on this trip that I wouldn't otherwise; I just ate more. I have a four by six card that says "Don't overeat." It may appear a little silly, but it's saved me countless times at home or in our area. Even that simple device makes me pause, eliminate the extra scoop of frozen yogurt or the second piece of bread with butter and jam. it's time for the card to be on my packlist.

The pause is the real necessity. In the book I was reading today, just moving a dish of food a distance away, or as we do serving everything in the kitchen so seconds require a trip back from the dining room can help.

Dieting or, in my case, maintaining a weight you've worked to get at, requires some thinking. The pause can let you move away from the mindless eating trap.

Does sleeping longer help us lose more fat?

Wednesday, October 20th, 2010

I read an intriguing article in the 5 October, 2010 edition of Annals of Internal Medicine, then saw the accompanying editorial. The article was titled "Insufficient Sleep Undermines Dietary Efforts to Reduce Adiposity" and was densely scientific, even for me; the editorial was titled "Sleep Well and Stay Slim: Dream or Reality." I decided to start with the commentary and then return to the study itself.

Having read both in detail, I'm comfortable with what's said and what the limitations of the study, done at the University of Chicago and the University of Wisconsin, might be. So let's start there.

The researchers put newspaper ads in local papers to recruit a small number of subjects for a short-term study. They ended up with ten volunteers who didn't smoke, were overweight, but otherwise healthy. The study protocol was detailed ,but basically each of the subjects was on a two-week diet with eight hours or sleep and another similar period with five and a half hours of sleep.

They lost similar amounts of weight in both study periods, but lost more fat during the time they when they dieted and slept well. So sleeping less and dieting resulted in the loss of "fat-free body mass." In other words they lost more fat and less muscle when they slept longer and vice versa when they slept less.

How does this apply to the rest of us? Well there is some data linking a decreased sleep duration with an increase in obesity rates in larger groups. There are rodent studies supporting the theory. There are some larger human studies showing shorter periods of sleep are associated with changes in two hormones that affect appetite and one that showed an association between snacking and less sleep.

So there's a lot of data accumulating that strongly suggests, but does not yet, from a strictly scientific point of view prove, that if we need to lose fat we should diet and also get adequate amounts of sleep.

It makes sense to me. I wouldn't hold my breath waiting for large studies in general populations that confirm this small-scale research. We are a chronically under-slept nation, a number of sources have proclaimed, and I think they're right.

So cutting your hours of sleep while you diet appears to be self-defeating and sleeping a full eight hours, give or take a little, is probably better if you want to lose fat.

Should you go on the HCG diet?

Tuesday, September 28th, 2010

A friend told me how much weight she had lost on the HCG diet and I have to admit I was impressed. She mentioned others people I know who also had been trying the program.

So I tried to find out more about the diet, which more appropriately should be called the hCG diet. Human chorionic gonadotropin was first discovered in urine samples of pregnant women in 1927 and it plays a number of roles as a hormone in pregnancy. One is making sure the fetus gets the calories needed for growth and development.

The peak level of hCG in the serum of a pregnant woman is found relatively early in the gestational period, usually at nine to twelve weeks after the last menstrual period. Many women are unaware they are pregnant at this point and may not be "eating for two" (I put this in quotes because I'm certainly not an Ob-Gyn physician and I'm unaware of what current dietary recommendations are for pregnancy).  Fat is released from storage areas (hips, buttocks, thighs and abdomen) when hCG is present and, if the Mom-to-be isn't eating enough for normal fetal growth, the fat calories and other nutrients can sustain fetal development.

From there it was only a step to the research of Dr. A.T.W. Simeons showing that daily injections of hCG might result in weight loss when accompanied by a severely calorie-restricted diet (500 calories per day). I'll paste in the original diet from Dr. Simeons.

Breakfast:Tea or coffee in any quantity without sugar. Only one tablespoonful of milk allowed in 24 hours. Saccharin or Stevia may be used.

Lunch: 1.    100 grams of veal, beef, chicken breast, fresh white fish, lobster, crab, or shrimp. All visible fat must be carefully removed before cooking, and the meat must be weighed raw. It must be boiled or grilled without additional fat. Salmon, eel, tuna, herring, dried or pickled fish are not allowed. The chicken breast must be removed from the bird. 2.    One type of vegetable only to be chosen from the following: spinach, chard, chicory, beet-greens, green salad, tomatoes, celery, fennel, onions, red radishes, cucumbers, asparagus, cabbage. 3.    One breadstick (grissino) or one Melba toast. 4.    An apple, orange, or a handful of strawberries or one-half grapefruit.

Dinner : The same four choices as lunch.

Simeons  published a 1954 article in the British medical journal the Lancet reporting on a group of patients who followed his program for forty days and lost twenty to thirty pounds. He stated 70% had maintained their weight loss after finishing his diet.

Now things get convoluted with many controlled studies over the next forty years denying Simeons' findings and position papers from major medical organizations against the hCG diet.

But in 2007 a popular book was published that rejuvenated interest in the program and ever since then it has received enormous amounts of public attention and hCG clinics have become widespread. There are both injectable and, now, oral forms of hCG advertised on the Web.  Programs with the injectable form run from 26 to 43 days, with daily injections on all but three of those days.

Incidentally the author of that book has served jail time for fraud, was sued by a number of states for running a pyramid scheme (he and his company settled the suit with the states for $185,000)  and, in 2004, agreed to a lifetime ban on informercials, excluding his books. I've just watched "20/20" interview with him and would not buy a used car from him.

So that's the background I've been able to find on the hCG diet. More to come, I'm sure. My real question is what happens after the program is finished? I want to see if the weight loss can be maintained. At the moment I'm a skeptic.

low-carb and low-fat diets

Friday, August 27th, 2010

I just finished reading a study which came out in the American College of Physicians journal, the "Annals of Internal Medicine." I must say I'm a bit underwhelmed. A little over 300 obese subjects without diabetes or high blood pressure were followed for two years at three academic institutions. bout half were put on a diet similar to the Adkins diet, starting out with eating a small amount of low-glycemic index vegetables (I'd include spinach, broccoli, radishes and asparagus in this group, and not corn, squash, potatoes or yams), in other words foods your body can't rapidly convert to sugars. Later they got more veggies and some fruit and finally added whole grains and dairy products.

The other group got a calorie restricted diet and limited their fat intake. Both groups received behavioral therapy in groups. A multitude of measurements were made at intervals (lipids, weight, blood pressure).

At the six month mark, the low-carb group had more adverse, but relatively minor symptoms (bad breath, constipation, dry mouth, hair loss). At the one year mark the average weight loss in both groups was the same (11%); ditto at two years (7%). The low-carb group had increased HDLs averaging a 23% increase after two years.

So why am I somewhat underwhelmed? I guess I'm happy that the low-carb group raised their HDL (good lipid) numbers, but other than that there wasn't much difference between the two groups. Both regained weight in the second year, ending up roughly 15-16 pounds down from their starting weights of about 220 pounds. Yet this was in a closely followed bunch of folk with academic centers doing the study, and, for that matter, excluding obese subjects with the obesity-related diseases we worry about.

So I don't think we're there yet, in terms of helping the third of our population that is obese and not being taken studied in this detailed fashion. I was frankly hoping for more.

Gluten-free diets for weight-loss? Not unless you've got Celiac Disease!

Tuesday, August 24th, 2010

We know several people who are on gluten-free diets for Celiac Disease (CD), but until this morning I hadn't been aware that others regarded this as a weight-loss method. So let's go back to what gluten is and what problems it causes.

Basically gluten is a protein from three grains, wheat, barley and rye. It's often found in baked goods. Many people, in fact apparently an increasing number of people, are sensitive to gluten and should avoid consuming gluten-containing products. An article in the Journal "Gastroenterology" July 2009 by a Mayo Clinic group headed by Dr. Joseph Murray found a four-fold increase in undiagnosed CD between groups tested ~1950 and current age-matched groups.

But it's considerably more complicated than that. Some people are extremely sensitive to gluten. If they ingest it in any form, and gluten is ubiquitous, found in lip gloss, on envelope flaps, in soy sauce and ketchup, they develop an autoimmune reaction and are said to have Celiac Disease. Three million Americans are felt to have this entity which can lead to a multitude of very serious complications.

But, like those of us who say we're lactose sensitive, there are at least three varieties of what people think of as gluten sensitivity. Perhaps twenty million in the US are felt to have milder gluten issues without full-blown Celiac Disease; not a lot is known about this group. In a similar fashion, I'm lactose intolerant, but, I can drink a small amount of milk without developing major problems.

Then there's a smaller number who are actually allergic to something in wheat and can develop severe symptoms, including asthma or shock, after eating wheat products. Again, I know individuals who, after drinking milk, end up with severe problems; they're actually allergic to another milk protein.

So recently there's been a host of gluten-free products developed; those are very helpful and appropriate for people with CD, but others have seized upon the concept of using these foods as a weight-loss tool. The short answer is Don't! Many of the new gluten-free food products are high in carbs, fat and calories and relatively low in fiber, iron and vitamins.

There's an excellent review of CD in "Scientific American, July 27,2009, that I was able to print out from an online source. The author is Dr. Alessio Fasano who heads the University of Maryland Center for Celiac Research. His group has found a substance called zonulin that increases gut permeability and is working with tests for an antibody that may be a biomarker for gluten sensitivity.

So the gluten-free diet may not be the only answer for patients with CD and researchers are working hard to find other treatments. In the meantime, for the rest of us, that diet is clearly not the way to lose weight.

The China Study; time to change my diet?

Wednesday, July 21st, 2010

We were on a trip recently and stopped for three days to visit some relatives we seldom get to see. He's a physician, past department chair at a highly regarded clinic/academic center and is working on a major research project in four countries, one of which is China. They've altered their dietary pattern in a very significant manner since we last saw them, four years ago. I asked for the background data on their new diet and purchased two books, the first of which is "The China Study," by T. Colin Campbell, PhD and his youngest son, Thomas M. Campbell II.

Dr. Campbell, an emeritus named-chair professor at Cornell, has been a long-term major figure in the area of nutrition and was involved in a large-scale research project involving scientists from China, the US and England. They did blood-work and gave out questionnaires to 6,500 adults in rural and semi-rural areas of China as well as performing urine tests, three-day dietary measurements and analysis of food samples.

The resultant book emphasizes health differences between people in China on a mostly to exclusively vegetarian diet and those of us who eat what has been termed the Western Diet, one rich in meat and dairy products, relatively low in vegetables and fruit. Dr. Campbell strongly advocates our switching to an exclusively plant-based diet and details how the "Diseases of Affluence," especially heart attacks, diabetes Type 2, some cancers, and obesity are related to nutrition.

I also looked at Dr. Campbell's impressive bio and, as well, read some of the critiques of his conclusions. I think the book is well worth reading and enjoyed Dr. Campbell's article in "The Huffington Post," published today (7-21-2010). In it he calls for an NIH Institute of Nutrition. I would agree that our Western Diet, rich in fats, sugar and salt, is a major cause of overweight and many assocated diseases. I would disagree that some of the specific conclusions in "The China Study" have been conclusively proven. I'd love to see a new NIH branch which could fund studies to prove or disprove those conclusions.

I'd recommend you read the book and judge for yourself.

The 2010 Dietary Guidelines

Wednesday, June 16th, 2010

I was reading the papers this morning (our local newspaper + "The Wall Street Journal" + the New York Times breaking news) and saw an interesting article in the local paper titled "Four Steps to Fighting Obesity." It even had a box titled "Putting limits on sodium." Well that certainly got my attention and led me to a great website:

It seems a 13-member advisory committee (called the DGAC) of health and nutrition experts was set up by the two relevant government agencies, the Department of Agriculture (USDA) and Health and Human Services (HHS). They've been working a couple of years and their charge was to update, if necessary (and I'm sure it is) the 2005 Dietary Guidelines.

The website led me to a very large document and thus far I've read the nine-page Executive Summary and printed off another thirty-two pages on "Sodium, Potassium and Water." I'll read that section later, but the overview made me decide to pause in my posts on Omega-3s and point you toward the 2010 guidelines. At this stage the public has thirty days to comment on them before it's made final. I doubted it will change much, but a professor of nutrition posted on "The Atlantic" website some comments that made me wonder.

First this set of dietary guidelines has to be reviewed every five years, by Congressional fiat. Then the professor, Marion Nestle, has written a book titled "Food Politics: How the Food Industry Influences Nutrition and Health." I just ordered a paperback copy of her revised edition and also a copy of her book, "What to Eat." She doesn't think the guidelines change much from version to version

I'll await the final version of the 2010 DGAC Report, but in a nutshell they're recommending we get our dietary sodium intake way down (70% of us need to go to 1,500 mg/day), eat less saturated fat. exercise more, avoid junk food, and follow Michael Pollan's advice: "Eat food. Mostly plants. Not too much."

I'm doing that already; we got our first "Couple Veggie Share" delivery Monday from our local CSA
and will soon be starting on our "fruit share." What I want to see is the final ideas on how the vast majority of us can also eat healthy, affordable fresh fruits and vegetables. Now if the committee can solve that quandary and convince Americans to follow the Dietary Guidelines, we may get somewhere.

So here's the problem (and perhaps the answer): We've got to do something and soon. The issue starts with kids and what they eat; if we don't find a way to change that, we're not doing our primary job as parents and grandparents and citizens.