Monthly Archives: December 2017

Will Reducing Your Dress Size Reduce Your Bone Size?

“She got so thin!” a friend whispered to me, pointing to a mutual friend we had not seen for several months. The thin friend came over, and when complimented on her size, she told us she had lost weight following a diet than eliminated most food groups. “It was easy to lose weight,” she said, “because all I could eat were lean proteins and vegetables. I think I will stay on this diet forever!”

“You might want to add some dairy products to your diet,” I murmured. “You know, osteoporosis and all that.”

“Oh, I get plenty of calcium from vegetables,” she answered, “and anyway, dairy is fattening.”

Feeling like the bad witch who predicts dire consequences, I restrained myself from pointing out that she was a perfect storm for losing bone mass and breaking bones. She was beyond her menopause, which meant that the protective effect of estrogen on bone density was no longer functioning. It was unlikely that she did weight-bearing exercise to increase muscle mass and subsequently bone mass. Her arms and legs showed no obvious muscular development; they were visually just skinny tubes. Vitamin D intake, the last piece of the triad of interventions that support bone density, was probably also lacking, as the foods she ate were not fortified with vitamin D.

At her age—she was almost seventy—she should have been consuming about 1200 mg of calcium a day and 600 IU (international units) of vitamin D to maintain her bone mass.  But because of her weight-loss diet, she wasn’t.

After a several month struggle to lose weight, it seems unfair that my now thinner friend is vulnerable to this debilitating disease. But she fits the profile of people likely to develop osteoporosis even without her weight loss. (Osteoporosis can occur in both men and women but women are more likely to have it. White and Asian women are most at risk that also increases with age.) If she had a family history of osteoporosis, smoked, consumed excessive amounts of alcohol, and had been severely underweight as an adolescent when bone mass is rapidly expanding, she would be facing an even greater chance of developing the disease.

It is not possible to diagnosis osteoporosis without a bone density scan. Despite her skinny appearance, her bones may have been fine. But the only way to tell is to have a type of x-ray called dual-energy x-ray absorptiometry (DXA or DEXA). Many women ten years or so beyond menopause will have the test so their physician can have a base line measurement of their bone strength. If the results indicate that osteoporosis may be developing, then the patient will be told to consume calcium-rich foods like milk, cottage cheese, yogurt or some vegetables such as kale…and also may be told to take a vitamin D supplement. Exercise is also important to promote bone density.

There are several drugs now available prescribed for osteoporosis but they have substantial side effects. The drugs are called bisphosphonates. Fosamax and Actonel are taken daily or weekly and another, Boniva, is taken monthly. One, Reclast, is given intravenously once a year; for those who have the early signs of the disease, once every two years. Most of the side effects, i.e., nausea, are tolerable, but a minority may developed osteonecrosis of the jaw or jawdeath. Fosamax and Boniva have been associated with this problem in which the bones in the jaw don’t heal after a minor injury like having a tooth pulled. Another equally rare side effect is a particular kind of fracture in the femur, the long bone of the leg.

Why drugs that promote bone growth and density should have the opposite effect on specific bony areas in the body is not yet known.The incidence is 1 in 1,000. It happened to an acquaintance of mine who had been taking one of the bisphosphonates.  She had a dental procedure, and a few weeks later experienced severe jaw pain that was finally diagnosed as osteonecrosis. Now she was faced not only with osteoporosis, but also the fact that she could no longer take the drug that was supposed to halt it.

Preventing, or at least decreasing, the possibility of developing osteoporosis has to begin in adolescence but it is hard, if not impossible, to convince an 18 year-old to drink more or any milk or eat more, or any, yogurt or cottage cheese or kale. The American Academy of Pediatrics has warned that children are not consuming enough calcium during puberty when most bone growth occurs. Young women who are anorectic, or because of excessive exercise and low body fat stop menstruating, are at risk for developing bone loss at a young age. Teens should be getting 1000 to 1200 mg of calcium daily. This amount of calcium is not difficult to obtain with fat-free or low-fat dairy products, or calcium-fortified milk substitutes like soy or almond milk, which are also fortified with vitamin D.  Unfortunately, a diet drink, instead of milk, is often the beverage of choice.

It seems as if the most compelling motivation to consume enough calcium and vitamin D in an effort to prevent osteoporosis is having a relative who fractured a hip or wrist because of this disease. There has to be a better way of promoting concern about this problem than the broken hip of an aunt. Bone density tests are expensive, time consuming and rarely offered to patients before menopause. What is needed is a simple, inexpensive test that detects the early stages of the disease, so nutritional intervention can start decades before the disorder develops—and perhaps an ad campaign showing that life can be “magical” after drinking milk.

 

Losing Weight in a Weight-Loss Resort: Will It Stay Off?

The New York Times recently reported on the change of ownership of one of the better-known weight loss/fitness resorts, Canyon Ranch. The article described the resort’s comprehensive program for those who want to lose weight and improve their fitness. Like many other facilities frequented by those who can afford both the very high price and the time off from work, Canyon Ranch offers more than well-prepared low-calorie food and exercise opportunities that include hikes, exercise classes, a fitness center, and individual training. Massages, lectures on stress-reduction/mindfulness, consultations with nutritionists and physicians, and even wrinkle-reducing treatments prepare the guests for entry into the real world in a much-improved physical and mental state. Sometimes people will stay at facilities like Canyon Ranch or others such as Hilton Head for weeks if they have a considerable amount of weight to lose. Some places stress hours of strenuous exercise and all restrict portion size and variety of food. No alcohol, of course, is allowed.

It is hard to obtain information on whether, after returning home, participants are able to maintain their lower weight, increased fitness, and decreased stress. The article mentioned that at least half of the people who go to Canyon Ranch have gone there before; one woman had visited the facility more than 100 times. No information was provided as to whether she needed to return frequently to maintain her weight and fitness status, or because she simply loved the facility or both.

The transition from staying in a facility detached from the realities of daily life (some forbid the use of electronic devices, television, and newspapers) to the real world may jolt the individual out of his or her newly found healthy lifestyle and make the return to old eating and exercise habits unavoidable. The weight-loss resorts don’t have satellite ‘drop-in centers‘ to reinforce what was learned and practiced while participating in the residential program. Few can maintain the four or five hours of daily exercise in which they engaged while at the resort; at least, not without giving up their day job. Reproducing the low-calorie meals with their emphasis on vegetables, grains, and lentils takes more effort than ordering takeout. And eating away from home at work, meetings, social occasions, and while traveling limit further the ability to obtain the foods offered at the weight-loss facility.

In short, taking on and keeping new habits requires time and effort. Plunging immediately back into the life led before going to these weight-loss resorts may shatter the new lifestyle acquired there.

People whose weight-loss efforts begin at home with dieting, and perhaps some exercise, are familiar from the very beginning of their diet with the struggles they must overcome to lose weight. They are dealing with all the stress triggers- temptations to overeat, work, family matters, exhaustion and lack of time, that may have contributed to their gaining weight.

Those who opt for stomach reduction surgery face an additional struggle because they cannot overeat without making themselves sick, and yet may also face all the factors that caused their weight gain. In contrast, people whose path to better weight and fitness starts in the otherworldly atmosphere of a residential weight loss and fitness facility are helped enormously by the elimination of triggers to overeating.

That is, until they leave.

However, there could be an enduring positive effect to losing weight and becoming more fit as a result of participating in a residential weight-loss facility. Success at seeing oneself thinner, even if it is only by a couple of pounds, and gaining stamina and strength, could motivate and reinforce further weight loss and fitness efforts. Many people don’t start diets or refuse to do any physical activity because they assume they will fail, at one or the other, or both. Stories of people self-identified as unfit, who go to one of the more physically demanding weight-loss programs and find themselves able to hike four or five hours a day, and then participate in hours more of physical training, are often shocked at their ability to do so. People who at home have not been able to give up their high-calorie foods and instead resist eating “healthful” foods, learn to enjoy varieties of grains and vegetables at these facilities and may try to continue eating these foods when they return home.

Could they have initiated these activities and changes in food choices without going to a weight-loss resort? Of course. But at home, they have a choice not to. At the resort, they either do or do not eat what they are served and participate in often grueling physical activity programs, or drop out of the program.

Most adults will never have the opportunity to go to a resort where food, physical activity, stress, sleep, and pampering are designed to make them feel optimally healthy. But might it be possible to take some of the effective programs at these facilities, such as healthful menu selections, opportunities for recreational exercise, e.g., hiking, stress reduction techniques, and introduce them into the workplace for everyone?

These methods of weight loss and fitness seem to be reserved for the few who can afford them. But like many things in our society, from indoor plumbing to cell phones, eventually they become available for most. Perhaps someday, strategies to eat healthful foods, maintain a normal weight, and achieve fitness will be available without staying in a weight-loss resort.

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