Category Archives: Advice on how to Lose Weight

Will Watering Your Stomach Increase or Decrease Food Intake?

His water glass at dinner needed constant refilling, and I was worried that he had some sort of metabolic condition. But that was not the case. My relative by marriage said he always gulped water with every bite because it decreased his need to chew his food. “I swallow faster so I can eat faster,” he told me. Growing up in a family where there was competition for seconds, he learned that if he was the first to clean his plate, he got the remainder of the food on the table. The habit never left him.

Using water to lubricate swallowing is also behind the success of competitive eaters. Such people’s ability to consume enormous amounts of food in short periods of time made overeating into a sport. They train their stomachs to accept 30 hot dogs or chicken wings in the amount of time it takes to unfold a napkin. An interview with Yasir Salem, a competitive overeater ranked #10 in world competition by Erin McCarthy on the Internet site, “Mental Floss,” revealed his use of water in his training. He stretches his stomach by drinking daily a gallon of water after eating several pounds of a bulky vegetable, e.g., broccoli. And during a competition, he dunks hot dog rolls into warm water to soften them, so they can be swallowed quickly and with little chewing.

Competitive overeaters, as well as members of a family competing for the last chicken leg, are not the only ones who use water to eat quickly. Binge eaters will also drink water or other liquids to make it easy to consume large amounts of food in a small period of time. Indeed, many of us probably drink water or soda with our food when we find ourselves needing to finish eating in a hurry.

Drinking water with food to increase the amount of food eaten contradicts general wisdom about the use of water during a meal to decrease food intake. The use of water to fill up the stomach before the meal begins has been recommended for decades. ”Drink one or two large glasses of water before you sit down to eat,” say most weight-loss advisers, “and you will find that you can’t put much food in your stomach.” This is contradicted by Mr. Salem, who told his interviewer that he drinks a gallon of water before starting the eating competition, to effectively flush out his digestive system and make it ready for large quantities of food.

Similarly, drinking water with every bite of food, or at least after two or three bites, is strongly recommended as a way of slowing food intake. If, as the theory goes, you have to put down your fork or spoon, pick up your water glass, take a sip or two, put down the water glass, pick up the eating utensil and start eating again, the rate of food intake will slow considerably. Unlike my relative or Mr. Salem, the food is presumably chewed and swallowed before the water is imbibed. The water is not a lubricant to make swallowing faster and easier, but instead as a “time-out” from putting more food in the mouth.

Drinking more water also completes the end of the meal. If the plate is cleaned, but the eater does not feel full, diet coaches recommend drinking one or two large glasses of water at the end of the meal to convey the sensation of fullness. Carbonated water may work even better because if enough bubbles are swallowed, the stomach feels bloated and incapable of receiving more food. Carbonated drinks such as beer or sugar-filled sodas are not recommended because they deliver excess calories.

Obviously water can increase or decrease food intake depending on how it is incorporated into the eating process. And since most people attempting to lose weight are not going to be competing for seconds or entering an eating competition, drinking water before, during, or after the meal will, hopefully, decrease food intake. The water intake between bites is supposed to slow eating sufficiently so the brain will signal to the eater to stop before the stomach is totally filled up with more food than necessary.

But curiously, this seemingly innocuous recommendation has met with some resistance by those who claim that drinking water with a meal decreases the ability of the stomach to digest food. Water will dilute the enzymes in the saliva that start the process of digestion, and then further dilute the stomach enzymes that work to break the food down more before sending it to the small intestine; so claim the anti-water folk. Although debunked thoroughly by scientists, the recommendation to avoid water during a meal continues to circulate.

One of the problems with relying on water to confer satisfaction and fullness after consuming less food than desired is that water doesn’t stay in the stomach very long. It passes through much more quickly than food and, once gone, may leave a sense that now there is room for more food. If the eater wants to eat less without using will power to do so, then the most natural, drug-free way is to increase the serotonin levels in the brain. This is accomplished by eating a pre-meal snack of about 20 grams of a starchy carbohydrate such as a small roll. Twenty minutes later, the brain will make new serotonin and this neurotransmitter will convey a sense of fullness or satiety to the roll eater.

Starting the meal with the feeling of not being very hungry is helpful to slow your eating. If you are feeling somewhat full, you are more likely to eat slowly and eat less—and leave the seconds to someone else

 

Does Halloween Begin the Trifecta of Weight Gain?

Soon after Labor Day, almost before the bathing suits of summer have been put away, bags of miniature Halloween candy begIn to appear on supermarket and drugstore shelves. Those tiny candy bars will be devoured to celebrate a holiday that has nothing to do with candy, and the hundreds of calories they contain will initiate the fall season of weight gain. Soon the black and orange wrapped candy will be replaced by chocolate turkeys for the national binge day, Thanksgiving, and then towers of green and red wrapped candies, cookies, and cakes will be displayed for the December holidays.

It is understandable how Thanksgiving and Christmas became holidays characterized, in part, by excessive consumption of special foods that are usually replete with cream, butter, sugar, egg yolks and chocolate. In the old days, these holidays represented the few times a year when expensive, scarce food stuffs like sugar, chocolate, costly cuts of meat, and exotic fruits like oranges, and special alcoholic drinks were served in liberal portions.  Religious and national events like Christmas, the 4th of July, or the yearly fair have always been celebrated with copious amounts of food.  Often guests contributed their own special recipes to a gathering, and it was not unusual to have several main dishes, many sides and a large number of desserts. No one worried about how many calories were eaten because food intake was frugal and, for some, even scarce for the rest of the year.  But now, of course, the caloric excesses that begin with devouring miniature candy bars and end with New Year’s Eve buffets may not be compensated with frugal eating the rest of the time.

But how is that Halloween, a holiday which originated as a religious event, has metamorphosed into the opportunity to eat excessive amount of sugars, fat, artificial flavorings and color while wearing a costume? And how is it that the attempt by some food companies to reduce sugar content in many of their products is being offset by large confectionery companies marketing Halloween candy? And how, as our nation becomes fatter every year, are we going to continue to allow this?

Collecting, counting, and collating the candy gathered during an evening of trick or treating is a relatively new phenomenon. To be sure, hordes of face-painted or masked kids have been roaming the streets on Halloween, ringing doorbells and asking for handouts for many decades. Mid-20th century, the handouts were rarely commercially packaged miniaturized candy bars. Treats like cookies, popcorn balls, Rice Krispy squares, brownies and fudge were often homemade. Candy corn, invented in l880, Hersey’s Kisses in l907 and M+M’s in l941, along with a smattering of regular size candy bars, were available as treats, but competed with homemade chocolate chip cookies. Then we became scared of anything that was not made and sealed in a factory. The appearance of razor blades in apples and the possibility of toxic ingredients in homemade baked goods frightened us into allowing our children and ourselves to accept only commercially produced, sealed snacks like miniature candy bars and tiny bags of candy corn. And the confectionery companies responded. Any candy that could be shrunk, wrapped in Halloween colors, put in a large bag and sold in bulk, was.

Of course, the calories per candy item were also shrunk because the candies were one big bite.  Alas (and the candy makers know this), we think, “They are so small, how could they be fattening?” and pop three or four tiny Snickers or Butterfinger bars into our mouths.  The little candies can be stashed in drawers, brief cases, knapsacks, glove compartments, pocketbooks and pockets and constitute an almost endless supply of sugary, high-fat treats—and calories. And so the season of fattening ourselves up begins.

The over-consumption of sugary treats falls at the time of year when we may be feeling stressed because of after-summer vacation workload for adults and for kids, homework.  Are we craving candy because as darkness increases, our good moods decrease? Would chewing through a mound of candy corn be as appealing in the middle of July as it is at the end of October?  We know that the good mood brain chemical, serotonin, is made when any carbohydrate (sugar, starch) other than fruit is eaten. Is candy more appealing than a bowl of oatmeal that brings about the same feelings of calm and comfort?

It is hard to find any good reason for children or adults to consume mounds of candy. In an ideal world, the plastic bags of miniature candy bars would be replaced by bags of vacuum-packed apple slices, or oranges or baby carrots. Treats might also include pretzels, popcorn, miniature protein or high fiber, high-energy bars or breakfast bars. These have the virtue of being low or fat-free, have some nutritional value, and, after the holiday, can be put in a lunch box for a daily snack.

But how are we going to stop the avalanche of fall candy consumption? It means pushing back against the confectionery companies so that like the large soda manufacturers who have reduced sugar in their drinks, they see a profit in offering healthier Halloween treats. It means working within neighborhoods and schools to convince everyone to resist dumping handfuls of candy bars into plastic pumpkins held by seven year-old trick-or-treaters. Perhaps people can be convinced to donate some of the money that would have been spent on candy to a local food bank and contribute the rest to the local school or neighborhood center for a Halloween party.  Halloween is a holiday made for fun, and surely we can figure out how to have fun without the candy calories hanging on our hips the next day.

Can You Lose Weight If You Don’t Know How to Diet?

Our formerly thin, physically active friend had gained close to 80 pounds following two years of debilitating orthopedic problems that left him with chronic back pain. His previous constant exercise, which included tennis, skiing, long bike rides, hiking, and running had kept his weight normal, but became no longer possible. Now he was able to move only with the help of a back brace and two hiking sticks that he used as canes.

“I am trying to lose weight,” he told us, “but it is slow going.”

When we were guests at his home, it was obvious how physically impaired he was as well as how hard it was going to be for him to attain a weight that would help relieve his back pain. The one day he walked on his long hilly driveway to point out a particularly beautiful landscape, he paid for it in increased pain the next morning. Simply moving from living room to dining room was difficult for him. He talked about how he never needed to diet before he developed a back problem because his level of physical activity kept his appetite down and burned off excess calories. A review of the relationship between physical activity and weight change confirms his experience. (“The Role of Exercise and Physical Activity in Weight Loss and Maintenance,” Swift, D., Johannsen, N., Lavie, C., Earnest, C., Church, T Prog Cardiovasc Dis 2014, Jan-Feb; 56 (4): 441-447.)

Routine physical activity like the type my friend used to do slows, or even prevents weight gain, without any change in calorie intake. And the long duration of many of his physical activities may even have dampened his appetite according to a very recent study published in the Journal of Endocrinology. (“Acute effect of exercise intensity and duration on acylated ghrelin and hunger in men,” Broom, D., Miyashita, M., Wasse, L., Pulsford, R., King, J., Thackray, A., Stensel, D., J Endocrinol. 2017; 232 (3): 411-422.)  Now, however, the beneficial effect of exercise, when added to a reduced calorie diet on hastening weight loss is out of reach for him.

Told by his physician that a substantial weight loss might lessen his back pain has motivated him to decrease his calorie consumption. His strategy, as he told us, is to consume less than he had been eating.  But he has lost very little weight over the past few months of attempting to do just this.  His lack of success may be due to his inexperience in dieting. He doesn’t know how much he is eating, nor does he know whether what he is eating is particularly high or low in calories (he does know the difference, however, between salads and cake.)  Another family member, who has never had a weight problem and likes to cook dishes containing high calorie ingredients, prepares his food. Butter, heavy cream, and cheese are routinely added and her sweet tooth motivates her to bake or buy cakes, cookies, pies and other desserts that are offered to our friend.  Eating in restaurants for dinner (and occasionally both lunch and dinner) occurs frequently, and this adds to the uncertainty of how many calories are being consumed. Overly large restaurant portion sizes, and the habit of chefs to add butter or oil to food to keep them moist, also inadvertently boosts his calorie intake. And, unlike experienced dieters, he has not developed an eye for judging portion sizes and not eating the entire amount if it is too big.

None of this would matter if losing weight were for cosmetic rather than medical reasons. However, when weight loss is crucial to improving health, and, in his case, restoring lost freedom of movement and removing his pain? Dieting must be done with the same care and knowledge as any other intervention to improve health. The approach cannot be casual or haphazard, and would probably benefit from the professional services of a dietician or nutritionist. The type of diet must also be sustainable and balanced nutritionally for the many weeks it takes to lose the necessary weight. Many alleged quick weight-loss diets, so tempting because results after only a few weeks are supposedly so dramatic, often lead to weight gain as soon as the diet is over. (Remember the Oprah Winfrey’s famous fast weight-loss from a low calorie liquid diet, and the subsequent rapid regain several years ago?) Regaining weight is not an option when it may bring about a return of the medical problem like intolerable back pain. Thus the diet plan has to be malleable enough to change into a long-time maintenance program to keep the now lower weight stable.

Being honest with family and friends about how hard it is to lose weight and consequently asking for help will improve the chance of success. Imagine how much more weight our friend would have lost if his meals had been significantly lower in calories and size. Preparing meals at home that that could be made without the addition of fat-dense ingredients such as cheese would help reduce the calories he was eating. If others wanted to add more cheese to their dishes, for example, they could do so after the food was prepared.  His problem in reducing calorie intake in restaurants could be solved by either eating in establishments that served normal-size portions, or ordering appetizers for a main dish or splitting an entrée. The temptation to eat dessert would disappear if it were not on the table in front him.

Dieting is like any new activity. As it is with playing the piano, speaking a foreign language, or planting a successful garden, it has to be learned. Instruction is needed, along with patience, the willingness to practice and make mistakes, and encouragement from others. And like taking on any new activity, even small successes are worthy and worth striving for.

With Whom You Eat May Affect How Much You Weigh

Two weeks ago we were dinner guests at an expensive steak restaurant. Our hosts, who were celebrating their anniversary, urged their guests to order the restaurant’s specialty steak: twenty-four ounces of aged beef.  Everyone, except for another guest and I, complied (we both ordered fish.) Many side dishes were ordered by the hosts to be passed around family style: a dish of fried potatoes oozing butter, asparagus coated with a creamy sauce, and broccoli covered with melted cheese. Despite protests of feeling stuffed, we were told to indulge in dessert: soup bowls of creampuffs filled with ice cream and drenched in hot fudge sauce.

As we waddled home I remarked that it was a good thing we didn’t eat like this more than once a year, if that. Working off all those calories would take hours at the gym, and a frugal meal plan for a few days.  My husband agreed. “I really didn’t want to order such a large piece of meat but since our hosts were so insistent, and everyone else was ordering it, I felt that I should, too. And I wasn’t hungry for dessert, but it was hard to refuse. “

Last week we experienced an opposite social pressure on how we should eat.  Invited to a buffet dinner following a lecture at a local museum, we were offered poached salmon, baked chicken, marble-size boiled potatoes, salad and rolls. No butter was served. The plates tiny, somewhat smaller than salad plates, and once a lettuce leaf, tomato slice, and a minute piece of fish or chicken was placed on it, there was barely room for one potato.  No dessert was available or, if it was, it was hidden in a remote part of the dining area. As one of the guests with whom we sat remarked, “I guess I don’t have to worry about eating too much at this meal!“

These two eating experiences confirm anecdotally what many studies have shown. Social eating can influence the amount and type of food we consume.

Indeed, web sites focused on helping dieters stay motivated suggest choosing eating companions who reinforce healthy, calorie-conscious food choices.  Eating with friends at a restaurant that offers low-fat, non-fried foods, including a variety of whole-grain and vegetable options, makes it so much easier to stay on a diet than eating at a place where the food is batter-coated, or sauced with cheese.  Conversely, going with others to a massive brunch buffet, or a clam shack known for its tower of fried clams, coleslaw drowning in mayonnaise, and unlimited French fries makes it extremely hard for the dieter to say no to these temptations or, in some cases, such as the clam shack, even find something diet-worthy to order.

However, it is not necessary to become an “eating hermit” in order to lose weight. Many restaurants post their menus on their web sites so it is possible for the weight or health conscious to see ahead of time whether there are calorically appropriate meal options. Admittedly, it is difficult to tell friends or co-workers that you prefer not eating at a particular place because you won’t find anything to eat (like at a fried clam shack) that is appropriate for your diet. But these days it may be easier to do so as now that so many have specific food restrictions.  Friends or family, one hopes, would not invite a Moslem or kosher Jewish guest to a barbecue place featuring pork, or suggest going out for pizza with someone who has gluten sensitivity. Since it would be fitting to suggest an alternative restaurant for someone who can’t eat gluten or pork, it is appropriate to identify a restaurant with choices compatible with the caloric needs of someone on a diet or trying not to gain weight.

A little discussed but annoying problem of social eating is the nosy invasiveness of eating companions who feel they have the right to make remarks about the type and amount of food you are eating. Too often comments will be made about portion size: “Is that all you are eating?” or lack of fattening ingredients: “That salad looks inedible without any salad dressing!” or a rejection of dessert: “You never eat it, do you?”  People who would never urge someone in alcohol recovery to “just have one drink” will cajole a fellow dinner who is attempting not to gain weight to “C’mon! Enjoy some of that chocolate cake; it won’t kill you!” It is rarely possible to respond by pointing out the rudeness of the remarks or offering unflattering comments about the speaker’s size or eating habits. Avoidance and seeking out like-minded eaters is probably the only solution.

And that may not be so easy anymore, because the world is getting fatter. A recent report found that 10% of the world’s population is now obese. One consequence is a global eating environment where dishes containing excessively fattening ingredients or mega-sized portions are becoming normative. The gigantic, but apparently typical portions of steak we encountered at the anniversary party are likely to become more common than the meager portions of the museum dinner.  If we succumb to accepting that we are expected to eat portion sizes inappropriate for healthy calorie intake, then we risk increasing our own size a few pounds every year until we are overweight, or even obese. And even worse, if everyone around us is larger than they should be and consuming portions much larger than they should be eating, who will notice?

Obviously, it is rarely possible to restrict the people with whom you eat to those who will reinforce your weight and heath goals. But it is important to resist the pressure of fellow diners to eat promiscuously, to choose food without heed for calories or saturated fat or sugar that have negative effects on health. It is important to realize that after the meal is over, only you will be standing on the scale.

Getting the Super Obese to Lose Weight: It May Take a Family

Anyone who ever saw any of the television programs focused on the attempts of individuals 600 pounds (or heavier) to lose weight often wonders why their family members are enabling the obesity. The viewer watches the mostly bed-ridden obese individual demanding food, lots of it, and then being served large portions of whatever has been requested. The camera lingers over the individual crunching potato chips, spooning up macaroni dripping with melted cheese, or eating a gallon of ice cream. It is possible that the television crew doesn’t film the subject of the show when he or she is eating kale salad, or fat-free cottage cheese, so we get the wrong impression. But given the stated food demands of the obese individual, the viewer has the impression that if kale salad, or indeed anything resembling low-calorie healthy food were offered, he or she would be in the unique position of saying no to the food. The occasional trips to the supermarket by some of these TV stars who are able to ride in car (and use a motorized shopping cart) also focus on the purchase of junk food. Although it is obvious that some nourishing foods must be bought and eaten to avoid nutritional deficiencies like scurvy or anemia, the healthy menu items are rarely, if ever, shown being consumed.

The viewer wants to shout at the family members bringing food to the massively obese person, “Why are you enabling this?” Indeed, in one particularly poignant episode, a father buys a large pizza for his son who has been told he must lose 60 pounds before weight-loss surgery can be performed. The son has demanded the food and as the father watches the son gobble the entire thing, he asks for a piece for himself. “No,” was the reply, “I am going to eat the entire thing.”

Internet comments predictably share the bewilderment over the enabler function of family members as depicted on the show. As the fattening foods are prepared and served, the enabler expresses concern on air about the likelihood that the obese family member will die in a few years from the massive weight gain. And yet the food is served, and the concerned warning is absent. But to be fair, perhaps saying something is useless. The obese individual expresses concern over the pain caused by living in such a large body, and also worries about dying. So what good could it do if a family member states the obvious? It may even have the opposite effect. But still, we the viewers still wonder why the family members enable the continued weight gain.

What if the family member was a chronic alcoholic and developing liver disease, collapsing from frequent blackouts, and cognitive impairment? Would the same restraint be used, that is, “Don’t criticize, nag, cajole and threaten?” Would family members buy alcohol for the abuser who might be too drunk to get to the store?  Or drive the alcoholic to the nearest liquor store?

People say that one can’t compare alcoholics to excessive overeaters because the latter have to eat to live, so they cannot be abstinent. True, but one can live quite nicely without consuming highly caloric food in mega quantities, and drinking sugar-filled soda and juices.

Nevertheless, it is hard for family members to take corrective action alone. Professional help is needed, yet there is no process by which a concerned parent, for example, can force the adult extreme overeater to see a physician, dietician and/or therapist. Medical privacy laws forbid sharing the information with healthcare providers unless written permission from the family member is given. But waiting for the heart attack, stroke, skin infection, or cancer to occur in order to obtain medical intervention to start the weight- loss process is hardly an option either.

Family members of an alcoholic often turn to Al-Anon, whose meetings offer advice and support. Inpatient rehabilitation facilities often insist that family members be present for some of the therapeutic sessions to support recovery.

O-Anon is a spin-off of Al-Anon and runs with the same rules of privacy and espousal of the twelve-step process. But is this enough? Can a family take upon itself to provide only healthy, portion-controlled meals and beverages without medical and nutritional advice? Can the family handle the emotional fallout when the obese individual no longer has access to foods that for many are the only reason for living? What happens if anger, anxiety, and depression follow the imposition of a new eating regimen? Must someone be home all day to prevent fattening foods from being delivered, or the obese individual from finding these foods hidden in the house?

It is hard not to notice that often family members on the show are also obese, but may be 100 pounds overweight rather than 600. Will these folk be willing to change their eating habits to support the dietary changes they are imposing?

It may be as hard for the family to change its role with the patient as it is for the patient to lose the weight. In an ideal television series or world, such issues would be raised and solutions found. The bariatric surgeon would insist that both patient and family members meet privately, and as a group with a dietician, therapist, and even personal trainer instead of telling the patient to go home and lose sixty pounds.

People don’t gain 500 pounds simply because they like doughnuts or French fries. Their reasons for their morbid weight gain are complex, and their success in losing weight permanently depends on the family with whom they live and eat understanding these reasons. Maybe the producers of these television shows ought to realize this, even if it doesn’t make such interesting viewing.

Eating Your Meals at Restaurants May Decrease Loneliness (But Increase Weight)

One of my neighbors, widowed about three years ago, never eats at home but goes to specific restaurants for breakfast, lunch and dinner. “I don’t want to sit in my kitchen and eat a microwaved dinner while watching the news,” she told me.

“Eating in restaurants makes me feel less invisible.”

Her social objectives to meet people and not eat alone are being met. She has made friends from the neighborhood who eat at the same restaurants, and she is less lonely.  But the cost of eating all her meals away from home has been a marked increase in her weight.  Never slim, she now had gained so much weight that her already compromised knees and back have made walking difficult without a  walker, and she is short of breath.

Her weight gain from eating in restaurants puts her in good company. It is thought that the doubling of the prevalence of obesity in the U.S. over the last 35 years is due in large part to the increase in meals eaten away from home. Fifty years ago, 30 percent of the food budget went toward meals at restaurants. Now it is almost 50 %.

Not all restaurants, of course, generate weight gain. But chain restaurants in particular promote calorically dense foods: fried chicken, chicken nuggets, double or triple cheeseburgers, meatball subs covered with cheese, sandwich fillings that are more mayonnaise than protein, and high fat salad dressings and special ‘sauces.’ Some food items may contain enough calories for the day, not just one meal.

But my friend, who after all had cooked for a husband and children and then grandchildren for decades, knows enough to avoid fried chicken, French fries, and a salad limp under a quarter of a cup of salad dressing. She thought she was making nutritionally wise food choices. The problem, when she asked me how to start losing weight, was that neither she nor I had much of an idea of what the foods she was eating contained.

“I try to avoid foods that I think will have too much salt or sugar but who knows what is in the food?, she told me. I try to pay attention to the calories if they are listed on the menu, but it is confusing. I don’t mind eating a lot of calories if they are from good protein, but what if the calories are from butter or mayonnaise, or some fatty meat like bacon? “

Jane (not her real name) did not want to stop going to restaurants and begin to eat at home in order to lose weight.  The cost of doing so would have been social isolation and even depression. The solution was to find out what she was eating, and to make some informed choices.

The solution: we spent a cold rainy afternoon in front of the computer looking up the nutrients and calories in the foods offered at the restaurants where she was eating. We were surprised at what we found. Oatmeal for example: She liked oatmeal for breakfast, and I couldn’t convince her to eat it at home. “If I don’t get out of the house when I wake up, I feel depressed,” she told me. She had been going to Dunkin Donut for coffee and a cup of oatmeal. The calorie content of the oatmeal was reasonable, 310 calories, but we were shocked to see that it contained more sugar than oatmeal: 40 grams of sugar and about 26 grams of the starchy carbohydrate. Choosing the flatbread veggie-egg white sandwich with diced pepper and cheddar cheese? She would be getting 18 grams of protein (the oatmeal had very little protein), and only 5 grams of sugar.  Had she gone instead to Au Bon Pain, a block away, for her oatmeal she would have eaten about the same number of calories, but only 1 gram of sugar.

On the other hand, when we checked the calorie contents of some calorically innocent sounding Au Bon Pain sandwiches, we were surprised at how many calories they contained.  A chicken sandwich which should have been a relatively low calorie option contained high fat ingredients like avocado and bacon and clocked in at more than 600 calories.  Other chicken or turkey sandwiches were also calorically high, especially for someone as sedentary as Jane.

“What about a roasted vegetarian wrap?” asked Jane, peering at the computer screen, “It sounds healthy.”  But that came through with a whopping 700 calories. Fortunately, half sandwich options were available, and if combined with a low calorie vegetable soup, this seemed like a good lunch option.

Eating dinner at a restaurant forestalled Jane’s returning to an empty apartment too early in the evening, so that meal became even more socially important than the previous two. Unfortunately, her favorite eating place served gigantic portions, which Jane tended to finish because she hated to waste food. She thought a solution might be to share an entree with a friend who also lived alone, and if her friend was not available, asking the waitperson for a half size portion. “They don’t have to put so much food on my plate,” she said. “Look, if you can ask for salad without dressing, or a dish without nuts or bacon or cheese, why can’t you ask for less food on the plate?“

The financial and caloric costs of eating away from home are higher than eating in one’s kitchen. But the social and mental health benefits, as in Jane’ case, are compelling.  If we can make nutritional information about restaurant food easier to obtain, portions smaller and healthier, then the choice does not have to be eating a lonely meal at home, or eating with the company of others away from home.

Asking Why You Can’t Lose Weight After Your Medication?

The media is glutted with advertisements for weight loss: after all, this is January. And it is assumed that by denying calories and increasing physical activity, some weight will be lost by March at the very least. This assumption is based on the belief that the weight was gained because excess calories were consumed, and physical activity minimized.

But what if you were thin, fit, ate healthful foods, loved to exercise, and never been on a diet? Then sometime in 2016 you started on antidepressants for a variety of reasons: depression, anxiety, grief, fibromyalgia, or menopausal hot flushes. The medication helped, but there was a problem. Six weeks or so after starting treatment your clothes started to become tight. You no longer were satisfied with normal portions, but started eating larger amounts at meals. And, horrors of horrors, you could not stop snacking. Your physical activity decreased because the medication made you tired.  You ended up 23 pounds heavier at the end of 2016 than you were the beginning of last year.

So now you are off your medications, and you try one of the various weight-loss programs advertised. But weeks go by and you have lost practically nothing, even though you follow the plan exactly and exercise. Your distress is like someone who became bald during chemotherapy, and months later is still hairless.  You assume that like everyone else who is trying to lose weight in January, you should be successful. In fact more so, because unlike other dieters, you never had an overeating problem until you started taking antidepressants!

Help will not come from the people who develop the diet plans because the regimens are for the ordinary obese individual who gained weight the traditional way. Help won’t come from weight-loss support groups for the same reason. And so far no department of psychiatry has a weight-loss program for its patients who have gained weight on their medications, even though such programs are sorely needed.

So you alone are going to have to figure out how to lose the weight the medications caused you to gain.

Here’s what you need to know: Some medications stay stored in the body for some time after they have been discontinued. You can determine whether the medications are still affecting your appetite and physical activity even though you have stopped taking them; simply ask yourself if you are eating larger portions than you did before you started on the medication.

If you were craving and eating sugary, high-fat snacks when you were on the meds (cookies, cake, ice cream) do you still have these cravings?

Do you find it hard to feel satisfied even when you are eating enough food to make your stomach feel full?

Is your body still fatigued from the meds, or even from a residual depression? Does this make it hard to exercise with the same intensity and duration you had before you went on the medication?

Do you think you have lost muscle mass?

If you detect a lingering effect of your medication on your appetite and physical activity, then consider this one possible reason why it is so hard to lose weight.

Forget what the advertisements for weight-loss programs promise. They are not directed toward people whose appetite control and ability to exercise have been hijacked by their medications.

Instead, give yourself more time to lose your weight. If carbohydrate cravings persist, satisfy them with fat-free, healthy carbohydrates like steamed rice, oatmeal, whole grain pasta, polenta (an Italian version of grits, but without the cheese and butter), popcorn, pretzels, and whole grain bread. You need to eat only 30 grams of such carbohydrate on an empty stomach two or three times a day to take away your cravings, and increase your sense of being full.

And you may have to increase gradually your workout time and intensity since your body may not be able to jump into the type of exercise you did so easily before you took the antidepressants.

Be patient. Eventually the residual medication should leave your body, your control of appetite and ability to exercise will return, and you will lose weight.

But, if none of the above applies to you, seek medical advice. Before meeting with your health provider, accumulate data to show that your inability to lose weight is, a) not your imagination, b) not due to overeating and not admitting it, and c) not related to a sedentary lifestyle.

Keep a food log and exercise log. If possible, use apps that will do it for you and allow you to print out the results. The results will look more impressive than some pieces of paper covered with food stains or sweat. Allow at least three or four weeks of record keeping before presenting them to your physician. That is a long enough period of time to lose one or two pounds and if you have lost none, you can make a convincing case for something being wrong. At the very least, the health care provider should investigate possible reasons for the weight refusing to be lost.

Enough people have experienced difficulty in losing weight after they discontinued their antidepressants to make this a not rare occurrence. So far there has been mainly silence from both the psychiatric and obesity communities in response in part because of the belief that it should be possible to lose weight after the drugs are stopped. Presenting evidence that pounds gained during treatment are not lost with dieting after treatment is stopped, may indeed generate research to find a solution to this unwelcome side effect of antidepressants.

How To Stay Full In 2017 When You Are On A Diet

January can be depressing. The predictable cold, snow, ice, wind, and bills are accompanied by, for many, the need to go on a diet. It is hard to ignore the pounds you’ve accumulated since Thanksgiving, and even if you do try to disregard them, advertisements for weight-loss programs won’t allow you to.

Diets tend to be dismal, adding to January gloom, and they are often boring. If someone suggests that we have been all wrong in eating X and avoiding Y, then there is at least the possibility of talking about a novel approach to dieting. But, alas, a quick survey of the diet books appearing now indicates that most of them are still promoting low-or carbohydrate-free diets (ho-hum).

Promoting a low-carbohydrate weight-loss regimen while one is enduring the long hours of winter darkness seems somewhat counterproductive. Such diets exacerbate the toll the lack of sunlight takes on serotonin levels and the grumpy moods, excessive sleepiness, uncontrollable food cravings, and lack of motivation to exercise that may consequently follow. And most relevant for the dieter is the absence of a sense of satiety, or fullness, also conveyed by serotonin.

Eating carbohydrate is the only way the brain makes more serotonin, and a diet that denies or limits starchy carbs like potatoes, pasta, bread, cereals, rice, beans, lentils and corn meal will leave the brain serotonin deprived.  It is a better plan to wait until May or June to stop eating carbohydrates in order to lose weight. The days at this time of year are so long that serotonin levels are not affected by carbohydrate depletion.

But, New Year resolutions being what they are (here today, gone tomorrow), many people feel that they’d better grab onto their will power and start dieting immediately.

So if you can’t eat carbohydrates because the diet books tell you not to, then you might consider an extract from a magical fruit called Garcinia Cambogia. (The name sounds a new dance step.) If you missed hearing about this fruit whose extract not only melts away extra pounds but, based on pictures on the Internet, leaves dieters looking as if they have had head-to- foot plastic surgery, then here is the information.

The fruit is tropical, apparently shaped like a pumpkin but grows on a tree, not on the ground, and is also known as the Malabar tamarind. Its popularity as a promoter of weight loss has shifted on and off for the last 20 or more years and had a resurgence this past year. Its virtues were extolled by the television medical personality Dr. Oz a few months ago, and like dandelions after the rain, companies sprang up to sell a particular ingredient in the fruit. Carcinia Cambogia contains hydroxycitric acid, aka HCA. Rodent studies done many years ago suggested that HCA might cause weight loss by blocking chemical reactions in the body that transform glucose into fat.

Fat or triglycerides are composed of two parts: glycerol, which makes up the backbone of the molecule and three fatty acids. So if your body produces fewer fatty acids, then fewer fat molecules are produced. This is what HCA seems to accomplish. It decreases the conversion of glucose  (all carbohydrates are digested to glucose) to acetyl-CoA. Acetyl-CoA is the building block of fatty acids.Rat studies found that when a high carbohydrate diet was eaten, HCA prevented some of the glucose from being changed into fatty acids. Moreover, as a value added sort of feature, people claim that HCA gives them a feeling of fullness or satiety, so they eat less. Serotonin, the neurotransmitter responsible for satiety, is thought to be increased by HCA, but there is as of yet no evidence for this.

A couple of pesky problems are associated with using Garcinia to lose weight: cost and sketchy purity. It is not cheap. One company is selling the extract HCA at a cost of $50.00 for 60 caplets and since it is recommended that a dose be taken before each meal, the cost can add up. The quality of the preparation is inconsistent among brands. ConsumerLab.com analyzed the content of hydroxycitric acid in several supplements and found the actual amount far less than claimed on the package label. Moreover, the HCA seems effective only when a very high carbohydrate diet is eaten.

There is a much cheaper way to prevent the transformation of carbohydrates into fat, while increasing satiety. It’s simple….eat only moderate amounts of carbs so what is eaten is used for energy, not to build up the fat cells. And consume some of those carbs, such as a half a cup of oatmeal or a toasted English muffin, about a half an hour before meals. Serotonin will be made naturally, the appetite will be decreased naturally, and you will lose weight naturally. Stay on this plan and the weight will even stay off long after the snow has melted, and the rest of the New Year’s resolutions have been forgotten.

Strolling: Good for the Mind as Well as the Body

Walking has become the default mode of exercise. If going outside to walk is not convenient, then a walking treadmill is available for year-round use. You will get nowhere, but you will use up calories. We are exhorted to walk to lose weight, to avoid gaining weight, to refresh our minds, to unstiffen our muscles.  As someone whose steps per day are counted by an app on my cell phone, I am pleased when my daily walking miles increase. “Look at all the calories I am using up!“ I think when a congratulatory computer-generated message appears on the phone.

But before walking was reserved for burning calories, it used to be the predominant way of reaching a destination. Those who still depend on walking, rather than a car or public transportation, often find it a more efficient and cost-effective way of getting somewhere.  When the roads are clogged with traffic, it is a delight to realize that walking to a destination is faster than driving.  And in some situations like a mall, museum or zoo, walking is the only option other than a wheelchair. Tour buses get drive a sightseeing group to the ancient castle or botanical garden, but seeing it requires legs not wheels.

However, there is an aspect to walking that seems to have been forgotten or disregarded in an attempt to make more people move more. Walking is good for the mind, for thinking, daydreaming, and becoming aware of the details of our environment.  Indeed, those who meditate sometimes do a walking meditation in which the body, breathing, and mind become one. Usually too impatient to contemplate anything but a robust pace while walking, recently I have been forced to slow down because of my dog. He is almost blind due to a genetic problem associated with his breed. Fortunately, his hound genes allow him to sniff his way through the world as if there are eyes at the end of his nose; but his pace is about 90% slower than when he could see.  As I am at the other end of the leash, I too have slowed down my pace. 

Our walks have now become a stroll, a leisurely perambulation around the neighborhood. But as the number of miles we used to cover diminishes to a few blocks, moving slowly has the positive effect of increasing my awareness of the surroundings: There are fewer ducks in the pond today; the yellow leaves of the birch tree highlighted by the sun look painted; that trash can needs to be emptied; the moon is almost full tonight; the leaves on the sidewalk crunch delightfully when I scuff through them. Casual conversations with other walkers occur frequently, as I stop to allow the dog to smell his way to the next tree. But the best aspect of these leisurely strolls is giving me the time and privacy to think, to indulge in memories, even to daydream.     

A constant complaint of our over-committed lives is the absence of time to restore and renew ourselves.  We must always get to the next thing on our list. One of my friends jokingly told me that as she is lowered into her grave, she will toss out her ‘to -do’ list. Strolling gives us permission to forget the list, to stop temporarily multi-tasking and strategizing about how much we can accomplish over the next 24 hours. Ambling gives us the respite from the constant demands upon us. It gives us time to indulge in our private selves without having to worry about how we present ourselves to the world.  Strolling, if we think about it, should even make us aware and grateful that we can walk and see and hear.

Exercise is important; indeed, it is essential to good mental and physical health. But as my dog has taught me, sometimes a gentle walk can truly enhance our well-being.    

Lactose Intolerance: Can It Cause Weight Gain and Weak Bones?

I hadn’t seen my neighbor for several weeks, but we’d just met again while walking our dogs.  When I commented on how well she looked, she patted her mid-section and said, ”I finally got rid of my big stomach.” (that she had a large stomach was not apparent in our previous encounters.)  When I murmured something to that effect, she went into a long discourse on how she managed to vanquish her perceived girth by radically changing her diet.  She told me, “I cut out all dairy and carbohydrates, and I eat only protein and vegetables. But it’s strange. I haven’t lost any weight. I just lost the bloating.”

My nutritional antennae went up when she mentioned her dietary changes.  Further questioning revealed that she really hadn’t stopped eating carbohydrates, and had enjoyed an excellent pasta dish the previous night at a local restaurant.  But no dairy products had been eaten for weeks. “And as soon as I stopped putting milk on my cereal, and cut out yogurt and cottage cheese, my bloating stopped,” she proclaimed, patting her flatter stomach. “So obviously the dairy products were making me fat.”

As our dogs settled down on the grass, we continued talking. “ So maybe you have lactose intolerance,” I suggested. “That would account for the bloating after you eat dairy. “

She was unaware that as people age, the enzyme lactase that breaks down lactose, the sugar naturally found in milk, disappears or becomes much less active. Consuming milk and sometimes other dairy products such as ice cream, yogurt, cottage cheese, cheese and even butter (it contains milk solids) causes gas, bloating and diarrhea. This is due to bacteria in the intestine interacting with the undigested milk sugar. The intestinal discomfort is accompanied by cosmetic discomfort; skirts or pants strain to fit over a bloated stomach, and the abdomen may not retract to a flatter shape until all the lactose has been expelled.

“You can get lactose-free dairy products,” I told her. “Also, often the bacteria in yogurt have already broken down some of the sugar, so regular yogurt may not cause bloating. And you can take pills that contain the enzyme lactase. You chew them right before eating any dairy products. “

“Well, maybe I do have lactose intolerance… but it doesn’t matter,” she responded. “Why go back to eating dairy? I drink almond milk and eat broccoli. “ She bent down to pick up her dog who was eating grass. “I get all the calcium I need. “

I felt as if I was making a nutritional nuisance out of myself, but asked anyway, “ Didn’t your doctor tell you a few months ago that you may be developing osteoporosis? You were worried that calcium in supplements was not being absorbed as well as calcium in food. Are you sure you are getting enough calcium now?”  Her dog started barking, and she looked as if she was going to bark at me so, letting our dogs pull us in opposite directions, we parted company. But as I walked home, I wondered whether she could get enough calcium from almond milk and broccoli. She needed to get about 1200 mg of calcium daily.

She was right about the almond milk. Eight ounces of calcium-fortified milk contains as much of this mineral as cow’s milk: 300 mg.  But would she drink 4 glasses a day?  Yogurt has 400 mg of calcium, but because eating it supposedly made her fat, it was not on her allowable food list.  What else could or would she eat? Canned salmon or sardines with bones? Probably not, or only rarely. Vegetables? She said she ate broccoli.  Could vegetables provide the calcium she needed?

Broccoli is not a good option, unless she eats a bucket full.  A cup contains at most about 65 mg of calcium. Steamed kale, bok choy, turnip greens, and spinach are good sources (a relative term as they contain only about 100 g per cup of calcium) but there is a problem. These dark leafy vegetables have a pesky substance called oxalic acid that attaches to the calcium, and prevents the mineral from being absorbed from the intestine into the circulation. In fact, oxalic acid can even prevent the calcium in milk or yogurt from getting into the blood stream if these dairy products are eaten along with dark leafy vegetables.

What about orange juice? Calcium-fortified OJ is as good a source of calcium as milk, and has about the same number of calories as whole milk. But will my friend, worried about the size of her tummy, fret about the calories?

Maybe she could swallow 2 tablespoons of blackstrap molasses every day (400 mg). And she could eat chickpeas, black-eyed peas, soybeans, tofu processed with calcium sulfate, figs, and instant oatmeal fortified with calcium.

Bones are an excellent calcium source, but I suspect only her dog chewed on those. (These cook down in the canning process of sardines and salmon to boost calcium.)

So it seems that dairy products are the best natural sources of this essential mineral. But will my friend be willing to try lactose-free dairy products and/or the lactase containing pills so she can consume them? Maybe so, if her stomach remains flat.  Perhaps it will require another   walk with our dogs to convince her.