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A few days ago I met a friend hobbling down the sidewalk. When I asked if she had injured herself, she told me that she had spent the entire weekend picking blueberries and could barely straighten her back. “Our blueberry patch is on a very steep hill and so I have to balance myself so I won’t slide down. And the berries that are hidden from the birds are very low to the ground so I am constantly bending over. I thought my husband would need a hoist to get me out of the blueberry patch after two hours of picking.” Then, showing me how loose her jeans were she added, “But I have been losing weight without even trying. The work of going up and down the hill is worth hours on the elliptical trainer at the gym.” My friend had a point. This season of the year lends itself to easy weight loss because the extended hours of daylight and moderate temperatures (at least in some parts of the country) motivate us to spend more time moving. Kayaking, swimming, biking, hiking and other outside recreational activities work out muscles that may be unused at other times of the year. Outside maintenance does the same. Pushing a wheelbarrow, pulling weeds, digging and planting, or sanding and painting outdoor furniture works our muscles and may build them as well. And often we spend much more time in this sort of physical activity than we would in a designated workout session. As the same friend told me, “When I am in the gym my eye is on the clock to see how soon I can stop exercising. But when I am picking blueberries or weeding, I lose track of time.” And certainly no one stops biking, paddling a canoe or swimming because the allotted thirty or sixty minutes exercise time is up. Summer foods also make spontaneous weight loss more likely. The abundance of locally grown vegetables found in farmers’ markets makes eating salads and cooked vegetable dishes a pleasure. What packaged snacks can compare with the taste of a warm ripe tomato, sweet corn, just-caught fish or plucked juicy peaches? It is not necessary to cover these local foods with high-fat sauces or sweeteners. They are good as they are. But summertime eating has its pitfalls as well and may contribute to pounds gained rather than lost. Tourist foods may be lethally high in calories. Day trippers who come to the town where we have a summer home seem to eat their way from one end of the shopping district to the other. Fried dough, fried clams, fudge, pizza, French fries, fried onion rings, and gigantic ice cream cones seem to be the menu items of choice, for many equate a summer holiday as a holiday from caloric restraint. Blankets on the local beach are filled with people eating bags of salty chips or munching on large cold-cut sandwiches. A quick survey of the food choices of people sunbathing this past weekend revealed a total absence of any unprocessed food like vegetables or fruit. And although drinking of alcoholic beverages is prohibited, I suspect that some of the extra calories being consumed were in liquid form. The problem with summer is that it is followed by the short days of fall and winter. The lack of daylight in these coming seasons provokes overeating and physical inertia and inevitably leads to weight gain. So it is important to take advantage of this natural time to lose weight. Eat the low calorie, high-flavor foods grown near you and go outside and play. | permalink | related link |   ( 3 / 129 )If you have been a normal weight all your life and find yourself gaining weight while on antidepressants, how will you know if or when your medication may make you obese? It is doubtful that your doctor will tell you; he or she usually does not have a scale in the office or a height/weight chart on the wall. The well-known side effect of antidepressant-associated weight gain is often not even mentioned by the prescribing psychotherapist lest it discourage the patient from starting or continuing the medication. Ideally, preventing the weight gain at the beginning of treatment should be part of the management of the emotional disorder. As we mention in our book, The Serotonin Power Diet, it is not difficult to follow a dietary regimen that eliminates the overeating and cravings most antidepressants cause within weeks of starting treatment. However, in most cases, weight gain is discussed only when the patient brings it up and this may be only after a substantial amount of weight has been gained. How do you get your physician to take your concern seriously? One way is to document that the pounds you have added as a result of the medication. A client at our weight-loss practice told me the following. “I would go into my shrink’s office and show her how tight my skirt was or how much my thighs were bulging in my jeans. She would shrug, tell me that I looked healthy and not to worry about it. But I was worried and found a BMI chart on the Web that put me into the obese category. The next time I saw my doctor, I showed her the chart and told her my weight was making me unhealthy and she had to do something about it.” As this client found out, she had to figure out herself whether her weight gain made her obese and as a result more likely to develop type II diabetes, heart disease or orthopedic problems that often follow from substantial weight gain. But these days, looking at a chart or a scale may not be the best way of determining obesity. There are three types of measurements used to determine if someone is of normal weight, or overweight or obese. The simplest and the one around the longest is the height /weight chart. Pediatricians use such charts from birth on and your doctor uses the same charts, adjusted for age. Weight-loss organizations and health clubs use them, too. The charts are generous in the range of weight you can have for a given height and make allowances for age. If you are over 50 you are allowed to weigh more for the same height. But as a friend told me, “I am shrinking and my former weight when I was two inches taller is no longer healthy.” A seemingly more sophisticated method using your height and weight is called the BMI or body mass index. To figure this out, you multiply your weight in pounds by your height in inches squared (height x height). Then you multiply this figure by 703 to convert it to a metric number, as the BMI is not based on inches and pounds. Most surveys on the percent of obese people in a population are based on the BMI. If you try this calculation then the following chart will tell you whether you are underweight, ideal, overweight or obese. Below 18.5 underweight 18.5 to 24.9 ideal 25.0 to 29.9 overweight 30.0 and above obese The problem with this method is that your weight consists of more than just the fat in your fat cells. You already know that water retention can add or subtract pounds to the scale. But did you know that your bones and muscles contribute to much of your weight? Bones are more dense than muscle and muscle is more dense than fat. A frail 83 year-old who has lost most of his muscle mass and has thinning bones may have a lower BMI than someone with large bones and well- developed muscles. In fact, years ago when we did a study among women smokers, we found to our astonishment that their BMIs put them in the ideal or even underweight category. But when they had a body scan of their bones and fat mass, it turned out that most of their weight was from fat; they had very little muscle and their bones were thin. The best way of figuring out whether you are falling into an unhealthy weight because of your medication is to use a tape measure. These days something called the waist—hip ratio is being used to determine whether the size and location of your fat stores are normal or likely to lead to diabetes or cardiovascular disease. You don’t need a scale for this measurement, and it will not be affected by whether you just drank a large glass of water. Stand in a relaxed pose and measure your waist at its smallest place, which is at your navel. Then measure your hips at their largest spot, which is over your buttocks. Divide your waist measurement by your hip measurement. A ratio above 0.8 for women and 0.95 for men is considered unhealthy and associated with obesity-related diseases. The reason for concern if your ratio is higher than recommended is because fat stored over your abdomen has been found, in many studies, closely associated with those diseases that affect the quality of your life and may shorten it. It would be a good idea to make baseline measurements before you start on your medication or if you are switching from one medicine to another. If you find the ratio going up, then bring it to the attention of your physician. Pop a tape measure in your purse or briefcase in case your doctor wants to verify the numbers on you (or check his or her own measurements). Fortunately, you do not have to go off your medications to reduce the size of your waist. Simply eating therapeutic doses of carbohydrate that boost the appetite- suppressant effects of the brain chemical serotonin will allow you to eat less and not feel hungry. Add an exercise regiment and you can turn back into your formerly thin self. | permalink | related link | ( 3 / 102 )I contribute to a website that offers to answer questions about the best way to lose weight. Several times each month someone writes in to find out how he or she can lose 15-40 pounds in the next two to three weeks. It seems as if the writer, having decided to go on a diet, wants the results instantly. And I suspect that TV and magazine advertisements promising fantastically quick weight loss make this goal seem possible. There are ways of losing weight quickly but they involve surgery, serious illness and/or parasitic infestation, famine, or being stranded in a remote wilderness with nothing but two packages of gum and a tube of toothpaste for sustenance. Less drastic quick-loss methods are usually in the form of very low-calorie diets consumed in the form of 800-calorie a day shakes or meal bars. Oprah followed a famous regimen several years ago. At its conclusion, she appeared on her show dragging a wagon with 67 pounds of fat in plastic bags that represented the fat she had lost on this low calorie, quick weight loss diet. There are some advantages to losing weight quickly. If someone is obese and needs surgery, then weight loss enhances recovery time and indeed even survival. The husband of an acquaintance was told to lose 15 pounds before surgery to increase the rate of his recovery. The surgery was delayed for a month so he could do this. Type II diabetes often disappears in association with the rapid weight loss that occurs within a couple of weeks following bariatric surgery. People who have this type of surgery, which severely reduces the amount of food that can be physically consumed, find that their blood sugar levels are normal by the time they have lost more than 15 or so pounds. However, it is not clear if weight loss per se is improving blood sugar levels or there are other causes, for instance in the way food is digested and absorbed after this form of surgery. And presumably, film stars who must abide by production schedules soon after giving birth must get themselves into shape before their babies are even sleeping through the night. However, for the rest of us, losing weight too quickly may not bring about the results we want. A normal weight loss is about 1-2 pounds a week. There are some exceptions to this. If carbohydrates are removed from the diet at its beginning, about 6 or 7 pounds can be lost right away but this weight loss does not represent any fat loss. It is simply the water that is stored along with carbohydrates. As these carbohydrates are used up and disappear from their storage places, the water leaves the body. Moreover, if the person starting the diet drops his or her calorie intake from several thousand calories a day to around 1400-1800, which is typical for most diets, then large amounts of weight will be lost in the first few weeks of the weight-loss program. Eventually, weight loss settles down to about one or two pounds a week. There are several reasons for this. The body adjusts to the lower calorie intake and tends to be careful about not wasting the calories that are being consumed. Metabolism slows slightly due to the inevitable loss of muscle during a diet. As muscle is the major user of calories, even a small decrease in muscle mass means fewer calories are needed every day. And of course once you lose weight, your body doesn’t have to work so hard to carry yourself around. This too decreases the calories that are being used up. Unless only a few pounds need to be lost, a diet should be considered something you live with for several months or even a couple of years, depending on how much weight has to be lost. The people who do this, those who have the patience to stick with the diet, are the ones who succeed in the end in losing all the weight they want to lose. This past month, I spoke with two people I know who lost large amounts of weight slowly but steadily over more than a year. Both developed their own diet program and although they do not know each other, they both had similar approaches. High-fat foods were eliminated, as was alcohol intake. Both bought and used scales to measure their food, as they did not trust their eyes to assess quantities accurately. One, a woman who liked to cook, planned her meals a week at a time and checked the calories of these meals against tables put out by the USDA. “ I always knew what I was eating,” she told me. “ I couldn’t fool myself into thinking something had fewer calories than it did. But what was just as important, I made all the calories count, nutritionally. Since I was eating so much less than before the diet, I couldn’t waste my calories on junk food.” The other, a man, never cooked; he stored his income tax records in his oven. But he knew enough to order healthy foods in restaurants and would bring his scale along with him to make sure he was staying within the portion size he had set for himself. What was so remarkable about both of these people is how unhurried they were about their weight loss. The woman told a group of us that sometimes two or three weeks would go by and she would lose only l/2 a pound. “But I was never worried about losing my weight. I knew that my body would catch up with the diet and the pounds would come off eventually. And they did.” The man who had lost 80 pounds in one year told me, “ I have another 70 to go and I will get there. Now that I am so much thinner, I can exercise longer and I am accustomed to eating frugally. I see no reason to stop the diet and I am content to wait even another year before I lose all my weight.” Unlike those who must find a quick way of losing pounds or else won’t bother, these two individuals embraced a slow and steady decline in their weight. As time passed, their new life style became familiar, comfortable and habitual. Neither would consider ever going back to the way they used to eat because their bodies were used to their yearlong healthy eating style. Neither would consider stopping exercise; that too became as much a part of their daily routine as brushing their teeth. I asked my male friend whether he became frustrated at how long it was taking to reach his weight loss goal. “ Listen,” he told me, “ I used to go on those quick, very low-calorie diets and drop 20 pounds in just a few weeks. But it was unnatural, I never felt well, I was too tired to exercise and I know I lost a lot of muscle. So I would cheat, the weight loss would stop and then, of course, I gave up. And like what happened to Oprah after the liquid diet, the weight came right back again.” Thus, as much as we all want to acquire a skinny body by 9 AM tomorrow, it is not going to happen. Just as in the fable of the tortoise and the hare, the prize of permanent weight loss will go to those who plod along, slowly and steadily through their diet program. If you keep your eye on the next pound that is being lost, eventually, like the tortoise, you will arrive at your goal. | permalink | related link |  ( 3 / 148 )“How many ways can I eat cottage cheese? “ Laura, my neighbor asked me. “My doctor told me the results of my bone scan. I have lost 18% of my bone density in the last five years. She told me to increase my calcium and vitamin D over the next year to see if it would help my bones. If it doesn’t work, I am going to have to start on one of those medications that makes your bones stronger.” My neighbor was lucky. Her doctor had scheduled routine bone scans for her when she was relatively young and was able to pick up changes in her bone health before she developed osteoporosis. My neighbor was 51, petite and with a fair complexion. As she told me, she was a perfect candidate to develop this disease of thinning bones because she was slender, had small bones and avoided the sun because she was so fair. “I was probably a perfect set-up to develop weak bones,” she said.” I hate milk, rarely eat yogurt or cottage cheese and don’t take calcium supplements. I burn when I sit in the sun so I always cover myself up when the sun is strong. I guess my body never had a chance to make vitamin D from the sun and my doctor says that vitamin D is needed to make new bones. And she said that since I just went through menopause my hormones are no longer helping my body make new bone tissue. Oh, did I mention that I hate to exercise? I have never had a weight problem so I figured I would never have to bother with a gym or regular work-outs. If I keep this up, my bones are going to be so weak, I better order my wheelchair now.” I assured her that her bones were not going to dissolve into something resembling overcooked pasta but that she really needed to follow her doctor’s recommendations immediately so her bones would regain their former strength. Laura ‘s situation is unfortunately quite common. Menopause, a slight build, avoidance of calcium-rich and vitamin D rich foods, along with lack of weight-bearing exercise, may account for most of the bone loss seen among women middle-aged and older. Bone loss is also caused by heavy smoking and/or alcohol use, treatment with prednisone or other steroids for asthma, rheumatoid arthritis or psoriasis, severe weight loss, exposure to radiation and a genetic history of osteoporosis. If your mother and other female relatives has this disease, there is a good chance you will as well. Given all these factors that promote bone loss, it should be no surprise that 1.5 million fractures per year are caused by decreased bone density. In fact, when Secretary of State Clinton fell and broke her elbow, my first thought was that she may be suffering from fragile bones. Building up bone density before developing osteoporosis is not difficult but it does require, as Laura found out, changing her food choices and starting to do exercise. Her doctor told her to consume about 1.5 grams of calcium a day and 1000 IU (international units) of vitamin D. Eating enough cottage cheese to do this was going to be difficult; even people who feel passionately about cottage cheese would have trouble consuming enough to meet their calcium intake. And if she relied on milk for her calcium, Laura would need to drink about four glasses of milk daily as she needed more than someone who still had healthy bones. Relying on these and other dairy products like yogurt was not realistic because Laura did not think she would consume them regularly enough to give her the calcium she needed. Sardines, a good source of calcium, are not a personal favorite of most people (including my neighbor) and she told me that she rarely, if ever, eats enough of another calcium source, that is, dark green leafy vegetables such as collard greens, bok choy and spinach. So for her as with many others, calcium supplements fortified with vitamin D were the best alternative. But her doctor told her to eat more dairy products anyway as they were the most natural source of this mineral. Incorporating exercise into her life was going to be even harder than eating cottage cheese. Laura and her husband had a successful store in a summer tourist town. Both worked seven days a week during the season and spent what little free time they had with their college-age children. As Laura tried to figure out where she could find that 25th hour in the day to exercise, she told me that she would simply have to make the time. “I am going to be no use to anyone if I fall and break something. “ She decided to work out with a trainer at a nearby gym so she could learn what exercises to do to increase her bone density. “And I will take long walks with the dog on the days I am not in the gym. Our store doesn’t open up l0 AM and I can manage to exercise an hour early in the morning. My doctor told me that I should have been worrying about my bones when I was in my early thirties. Why didn’t anyone tell me then to eat more dairy and to go to the gym?” “Would you have listened?” I asked her. “Oh probably not,” she said with a smile. “Fortunately it is not too late. And maybe I will try that cottage cheese with pineapple. I heard it was good.” | permalink | related link | ( 3 / 245 )Carbohydrates have been regarded as comfort foods long before anyone understood how they comforted. When people think of what they want to eat when they are upset, they almost invariably think of starchy foods like cookies or potatoes or sweets such as ice cream or cookies. Very few people when stressed will turn to roasted chicken, broiled fish or cottage cheese to comfort themselves. There are several misconceptions as to why carbohydrates are used to calm ourselves when we are stressed. The most common one is that our mothers fed us sweets when we came home from elementary school and were upset. So when we grow up, we turn to carbohydrates simply out of habit because we associate these foods with our parent’s attempt to make us happy. But we should ask ourselves why our moms gave us cookies rather than cheese when we failed an arithmetic test or were bullied in the playground. The answer is that sweet and starchy foods made us less upset, and the cheese or other protein foods like cold cuts had no effect on our mood. Another explanation as to why we turn to carbs when we are stressed is that their taste makes us feel better. Although many carbohydrates do taste really good, it is hard to see how the few seconds of great taste can have a long lasting effect on mood. It is like saying that when people drink alcohol, they feel the effects on their mood because of the taste of the wine, beer or whiskey. And another reason given as to why we choose carbohydrates as the edible tranquilizer of choice: There are more carbohydrate snack foods. But if eating carbohydrate snacks have no effect on mood, why would we continue to seek them out over and over again? If we need to take over-the-counter medications for headaches or allergy symptoms or acid reflux, we will buy the appropriate preparation for our problem. We don’t buy pain medication for acid reflux just because it is available. We buy the preparation for acid reflux because it works and ibuprofen does not. Carbohydrates reduce stress because when they are digested, they increase the production of serotonin, the comfort chemical in the brain. Protein foods do not lead to serotonin production; indeed, they prevent this brain chemical from being made. Interestingly, one category of carbohydrates, fruits, have no effect on serotonin production, which may be why eating an apple a day will not make the stress go away. Unfortunately, there are still many people who look at nature’s own tranquilizer, carbohydrates, with suspicion and distrust. They reject and even fear eating these foods because they assume they will become instantly obese if a piece of bread crosses their lips. And there are others who can’t keep themselves from eating carbohydrates but feel horribly guilty after they do so. What the carbo-phobic folk don’t realize is that avoiding carbohydrates will only increase their stress. As serotonin levels drop due to the non-eating of carbohydrates, stress levels will rise. Serotonin acts as a buffer to take the sharp edges off of anxiety, depression, worry and frustration. Without sufficient serotonin, we confront stress without any brain support to help us cope. The answer is to turn to the foods that have comforted us for centuries. The most effective way of getting the carbohydrate to soothe us is to eat it with no protein, little or no fat, in moderate amounts of about 120-140 calories and on a relatively empty stomach. The effect is consistent and predictable: Emotional tiredness goes away, calmness returns and coping with your problems seems doable. Not bad for a baked potato. | permalink | related link | ( 3 / 234 )Back Next |
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