Refuse To Regain

Is "Intuitive Eating" Possible?

by Barbara Berkeley, MD

It is a reoccuring theme, always pitched as a brand new idea:  in order to lose weight we simply must stop dieting and eat "intuitively".  

Recently Lynn Haraldson's Facebook page featured a post on intuitive eating.  The Intuitive Eating school of thought holds that we will do better if we learn the proper signals of satiety sent by our body and if we face our "demons" by exposing ourselves to the foods we fear...in other words, our trigger foods.  

For those who prefer the Cliff Notes, here's a summary of the article Lynn posted:

1. The idea of anti-dieting is "new thinking".  (This is not true, by the way, this school of thought has been around for a long time.

2. The basic principles are to eat only when hungry, stop feeling guilty about food, and eat whatever the body tells you to eat.

3.If you stop focusing on eating less, you'll actually eat less.

The article gives an example of allegedly successful intuitive eating.  Jill, 36, was addicted to a certain flavor of Ben and Jerry's ice cream.  Instead of avoiding it, she stocked her entire freezer with ice cream and gave herself permission to eat as much as she wanted.  While she ate too much of it in the beginning, she eventually grew sick of it.  To quote Jill, "It lost its sparkle," she said. "I knew at that point that ice cream -- or any food -- no longer had an unhealthy grip on me." The article goes on to enthuse, "Jill ended up dropping 50 pounds -- without trying!"

Dear readers, let's be honest with one another.  There is a reason that Americans spend millions each year on HCG drops, garcinia cambogia, electrified tummy belts and raspberry ketones.  Despite our knowing very well that there are no easy cures for obesity, it's hard to stop believing.  As a clinician, I put intuitive eating into the same category I assign to other miracle cures.  It simply doesn't pass the common sense test.

The principles of intuitive eating are based on the idea that the obese person has an unhealthy relationship to food (so once again, it's all the fault of the overweight person) and that this relationship can be altered by "understanding" the signals of the body better.  But there is a major flaw in this seemingly straightforward reasoning.  Suppose it is the body's signals that are damaged and not the "relationship with food" at all?  We have every reason to believe that this is the case; that the biochemical and hormonal milieu of those who gain weight easily has been altered and is no longer normal.  How then are we supposed to rely on signaling if the signals themselves are crossed?  This is akin to asking someone to get to California by simply following a road map and then giving them a road map with routes that lead to New Jersey.  When you are significantly overweight, your body is unable to tell you when you are full and when you are sated.  Your body is unable to give you the right information to make healthy choices.  In short, your signals are messed up.  Moving yourself onto a clean, healthy diet and avoiding triggers allows your vision to clear and your signals to start healing.

Intuitive eating is a good strategy for those whose physiology has healed, usually after weight has been lost.  This return to normal does not happen for everyone.  There are many weight maintainers who would not dream of exposing themselves to trigger foods, even long after weight has stabilized.  In my own life, I am maintaining a fairly modest weight loss and have normal eating urges.  Yet I am uncomfortable when in the presence of a great deal of modern food.  It very definitely encourages hunger and craving.  I much prefer to eat from my own menu.  The idea of bringing bread and Mallomars into my house borders on the insane.

 Which brings me to another hole in Jill's story above.  Even if she did find that, after drowning herself in Ben and Jerry's, her favorite ice cream no longer looked good, how does that translate to exposure to Doritos, cupcakes and cinammon buns?   There is always another trigger food out there.

While a couple of the commenters to Lynn's post say that the intuitive approach worked for them, most say that it either does not work or they would be afraid to try it.  Of course they are afraid.  What is novel about exposing oneself to dangerous foods 24/7?  We call that America, and we've all been there, done that.

Eating intuitively is an advanced skill for those who have already done the difficult work of stabilizing their weight.  It is a way of looking at eating that may be helpful to employ here and there along the way.  And of course, there will be some people for whom it works.  My suspicion is that that number is small.  I'm sure you will let me know about your personal experiences.

 

 

 

Primal Diet, Primarian Variants and Weight Maintenance 2013

by Barbara Berkeley, MD

As each year begins, I try to reclarify my own position on healthy diet.  I encourage you to do the same.

We are all experts when it comes to our own bodies, yet we often cede responsibility to others:  nutritionists, food bloggers, even doctors like me.   The most important advice I can give you is to remind you that there is likely no one dietary truth.  For those of us with an interest in how eating dovetails with health, learning is an ongoing process.  We should read with curiosity and "try on" different ideas to see if they fit.  What I believe may be diametrically opposed to what another "expert" espouses.  Your choice of belief is up to you.

As 2013 begins, I am still firmly in the Primarian camp.  For those of you who are new to this blog, let me briefly explain that Primarian diet (my particular take on a Primal eating style) is a slightly more permissive form of Paleo diet.  It includes low fat dairy (if tolerated) and also advises the consumption of lean animal protein rather than fatty meats. Primarian eating, as laid out in my book Refuse to Regain, is a default diet that should be practiced 90% of the time.  In not requiring or expecting perfection, I may be seen as less fervent than many Primal eating advocates.  

I am not a dietary purist.  There are three basic reasons for this.  

1. All protestations to the contrary, no one knows for sure what constitutes the healthiest human diet.  There may be many possible variants.  I suggest that you look with suspicion on those who claim to have an absolute corner on the truth (that would include me in my more strident moments).  

2. There are realities involved in eating in the modern world.  While extremely devoted paleo practitioners may never deviate from plan, I have found the most people are unable to be so perfectly consistent.  It seems far easier to become a vegetarian, which still allows the consumption of lots of carbs, then to become a Primal practitioner, giving up sugars, legumes, grains and milk.  

3. We need to figure out what we want from a diet.  No diet is able to deliver perfect health, a guarantee of longevity, or freedom from ever developing a cancer.  So we should focus on what diet can do: keep weight stable, create healthy levels of cholesterol and lipids, reduce blood pressure and prevent high blood pressure.  On a more global level,diet can make us feel healthy and give us a sense of well being.  

Every human being is slightly different and what may work for one dietarily may be completely ineffective for another.  Each of us will find that we are able to make tweaks around the outlines of the dietary worldview we choose, but we can only do this if we approach diet with a keen sense of self-observation and purpose.  A complete failure to look at diet criticially is, in my view, responsible for many of the modern ills of the late 20th century.

So where do I,  just one person...one voice, stand today?   Here is where I am and why.

1.  I believe in returning to largely unprocessed, more primal foods.

My reasons:  It is probably true that humans can eat foods other than those in the original human diet.  We may have become adapted to many new foods in the 10,000 or so years since we discovered agriculture.  Nevertheless, we are going through a period where food and eating habits have begun to create disease.  We can't be sure which elements are causing the problem.  As a result, retreating to an approximation of the original human diet would seem to make sense.  In practice, those I treat do better with weight loss and weight maintenance when they adapt more primal eating styles.  I personally believe this is due to the elimination of the excessive carb burden in the SAD (standard Amercian diet).  It may also be due to cutting back on fats, boosting protein intake, removing high fructose corn syrup and other additives, and/or increasing vegetable consumption.  

2. I believe in diets that allow for compliance.

In my particular world, primal variants (Primarian diet) work well.  I take note of the fact that a great many of the people on primal websites are young, athletic and highly motivated.  It is not coincidental that Paleo diets have become associated with physical conditioning programs like Crossfit.  It is appropriate and expected that young people lead the charge, introducing new ideas and practices.  In the subculture of obesity medicine, however, we must deal with different realities.  People who gain weight easily have generally been exposed to many highly restrictive diets.  If they are to maintain weight permanently, it is crucial to identify a way of eating that can be practiced over the long term...among friends and family who will inevitably be eating quite differently.  The additon of low fat dairy items, the acceptance of 90% compliance, and the advice to add back (with great caution!) small amounts of non-triggering carbohydrates, do not appear to adversely affect maintenance success.  Indeed, these accommodations may make it more likely.  And success, after all, is what we are about.

Having said all of this, I must reiterate that one of the major themes of my book, Refuse to Regain, is that maintainers should be "tough and not moderate".  By this I mean that once someone has identified the diet that keeps them at optimal weight, staves off modern ills, and gives them a sense of general well-being, they should practice it religiously and defend it against all challenges.   What is that diet for you?  I suggest you start with a primal or paleo diet and work forward...slowly and deliberately.  That is a project for 2013 and also for a lifetime.

To see more posts on Primal diet, select Primarian/Primal Diet under the "Categories" list in the bottom left margin of this page. 

 

 

 

Our Seasonal Mantra: No Holiday Weight Gain. Stick With Me!

by Barbara Berkeley, MD

With Thanksgiving receding in the rear view mirror we now enter the most challenging time of the weight loss year: December.  The obstacles for maintainers are obvious: temptation, memory, comfort, emotion, celebration and anxiety.  Put them all together and you have the perfect recipe for 5 to 20 pounds.

While no one knows exactly how much Americans gain over the holidays,  I do subscribe to the belief that whatever is put on is rarely lost.  This appears to be true for most adult weight gain.  Whether the weight comes on during pregnancy, at the menopause, or little by little each holiday season, it often creates a new body benchmark.  Despite efforts to get rid of it, that weight will want to come back.   Readers of this blog can testify to the fact that maintenance is a skill that needs to be practiced religiously and consistently.  The one thing we DON'T want to do is add to the burden of weight that needs tending.

To this end, I'm going to try to post more frequently until the New Year.  Let's all pull together and support each other through December. 

I would welcome hearing from those of you who have figured out clever tricks (or just ways to grind it out!)  for avoiding holiday weight gain.   Here are some of the things I suggest to my patients and that I practice in my own life:

1. Become even more religious about daily weighing during December.  If you are gaining weight, do not hesitate to institute your reversal regimen until weight gets down below Scream Weight. The holiday period (or any stressful or exciting time) encourages us to avoid the scale (as in:  "I won't look today!").  Don't give in to this temptation.

2. Conceptualize the goal of maintaining your weight as a gift you are giving yourself this season.  Whether you want to lose weight or avoid putting it back on, your goal is long-lasting health.  This present to yourself is worth far more than any piece of pie or sugar cookie.  Don't pull the gift away before you get it!

3. Declare your intention rather than camouflage it.  If you tell people at that cookie exchange that you are determined not to gain this season, it will be harder to gorge on cookies that afternoon.  It's ok to be proud that you've lost weight and to make it plain that you are working on making things permanent.  Trying to blend in by pretending that you are doing what everyone else is will probably lead to disaster.

4. Stick with your normal, everyday plan.  Don't make holiday exceptions unless they are extremely limited and really, really worth it.  If you do eat off-plan, return to your everyday eating regimen the very next day and be very tough about sticking with it.

5. Enter holiday events with a "scan and plan".  That means that you should anticipate situations and challenges before you go to the event and should plan a specific response to each one.  See how many you get right and take stock of how many hurdles you successfully jumped after the event is over.   

6. Take careful note of whether you enjoy holiday events just as much if you don't include the usual sweet eating and overconsumption.  Coming to realize that there's still alot of fun and meaning without the usual junk foods is a key step in staying a permanently lower weight.

7. Wear your "revenge clothes".  Dress for success takes on a whole new meaning over the holidays.  Dress in form fitting clothes that make the most of the smaller you.  This will make you proud, but will also make it more possible for you to achieve successful control over eating.  Tighter clothes make you more aware of even small food deviations.

8.  Dilute alcohol.  Remember that alcohol has 7 calories per gram, almost as many calories per unit as fat.  It also disinhibits you and makes you more likely to eat too much.  Mix wine with seltzer or liquor with water so that you can consume less alcohol in a larger volume.

9.  This tip, which I've mentioned before, is one of my favorites and comes from a successful maintainer.  Set a goal of finding out at least one fascinating new thing about each person you talk to.  This puts you in interview mode, involves the person with  whom you are speaking, and presents a fascinating challenge.  Nurse a diet soda or wine spritzer while you roam the room. 

Please send me your tips.  Keep weighing and watching.  And enjoy the season AND your continued success!!!

 

 

When Carbs Look Bigger Than They Really Are

by Barbara Berkeley, MD

As those of you who routinely read this blog know, I spend a great deal of my time advising people to get rid of the carbs in their diet.  Not all the carbs, but specifically sugars, grains and grain based products.  When I suggest this to patients at our first meeting, I am met with blank stares or with outright resistance.  I expect this.  The idea of vastly curbing carbohydrates is overwhelming to most American eaters. But I also know that a great many of those who follow the advice to quit carbs will eventually report an indifference to them.   It is almost as if these foods recede into the background, or go from hugely important to minimally so.  It is hard to imagine this happening with foods other than carbs.  Quitting meat, chicken, fish or vegetables seems much less onerous from the outset.  Approximately 7.3 million Americans are vegetarian.  While giving up starch and sugar is viewed as "extreme", removing the entire food group consisting of animal products is a well accepted dietary strategy.  This is because most people don’t feel that they simply can’t live without animal protein.  They do, on the other hand, feel like life will be impossibly bleak without a bagel, bowl of pasta, or a chocolate chip cookie.

I would submit that substances that people "can't live without" take on a dysmorphism or type of inflated distortion.  This makes these substances seem much larger than they really are.  We are all familiar with this distortion in people with addictions.  While an occasional cigarette might mean nothing to one person, it has an intense and driving importance for another who is hooked on nicotine.  Alcoholics feel that they cannot live without alcohol and drug addicts can't imagine surviving without drugs.  I believe that this same dysmorpism holds true for sugars and starches.  A clue to the fact that we view S Foods dysmorphically is the fact that we feel the urge to consume them multiple times each day.   While many of us could easily go days without a fruit or a vegetable, few of us can go days without sweets, bread or potatoes.

In the Wizard of Oz, Dorothy and her friends the Scarecrow, the Tin Man and the Lion stood trembling before the great and powerful wizard whose voice shook the very foundations of his palace.  As we all know, however, that wizard turned out to be nothing more than a snake oil salesman working some dials behind a curtain.  It’s the same with modern carbs.  Getting them out of your life allows you to pull the curtain and see them for what they really are.  In a short time, those great big influences  shrink to normal size and when they normalize it is much easier to simply ignore them. 

How is it done? Here are some of the ways in which I have greatly decreased my own exposure to carbs: 

When I eat breakfast out, I order a small applesauce instead of the potatoes and toast that usually come with eggs.

Instead of eating sandwiches or wraps, I take out the middle and eat whatever is in the center.  I always ask for extra slices of tomato and a slice of onion if they have it.  Or I order a tuna salad, egg salad or chicken salad plate with plenty of vegetables on it. 

I love bagel and lox, but guess what?  I have found that this dish tastes just the same without the bagel.  I just put a shmear of cream cheese on the side, and eat the lox covered with tomato, onion and some capers.  Great!

I eat ice cream pretty much every evening, but alternate between sugar free and diet varieties.  I also only eat ice creams that come in single wrapped servings like pops or bars.  I found that taking servings out of a tub meant eating more than I intended. 

My standard dinner is a huge plate filled with salad, steamed vegetables,  salsa, sliced fruit, a little cranberry sauce, and some kind of chicken, meat or fish.  I eat practically no red meat.  I don’t have a problem with red meat itself,  I am just suspicious of the way we feed cattle so I personally avoid it. 

Here are the S Foods I continue to eat:   I use our practice's Optifast bars as snacks (20g carbs) here and there.  I have skim milk in my breakfast mocha.  I  eat a lot of grapes, which are pretty sugary.  I eat a diet ice cream every day.   I often have a small side of cranberry sauce (which contains HFCS) with dinner.  If I use applesauce, I get a no-sugar-added variety.   

My excluded foods (except for an extremely occasional exception) are bread, pasta, rice, potatoes, things made with flour, cookies, muffins, bagels, crackers, chips, cereal, popcorn and any dessert other than those mentioned in my S Food list.  

Carbs used to be enormous in my life, close to a raison d’etre.  Ten years ago I couldn’t imagine a life without candy, cookies, bread or pasta.  For me, a diet was eating a baked potato with sour cream for lunch.  French fries and hash browns were my drug.  Bread was my foundation.  Chocolate cookies and candies were the friends that comforted me.  

But here I am and those carbs have gone away.  I remain at normal weight and I really love the way I eat.  If you have not tried getting rid of the carbs, including those whole grain products, please humor me.  Once you have moved on and they are far down the road, they look a whole lot less important.  And you know what?  They really are.  

Mayor Bloomberg's War vs. The Freedom to Eat Whatever

by Barbara Berkeley, MD

It's the debate du jour.  Should the government step in to control health behaviors or do such measures represent the dreaded "Nanny State"?   In the past week, Mayor Michael Bloomberg announced his latest front in the battle on obesity.  First it was the banning of trans-fats from restaurant kitchens, then menu labeling.  Now Bloomberg is going after liquid calories with a ban on sugary drinks that exceed 16 ounces.  This has raised many concerns, among the fear of continued banning.  Clearly there are endless unhealthy products in the marketplace.  Once the precedent for food bans is set, the possibilities are infinite.  While this is a point worth debating, it is not the issue I want to speak to today.

  The response to government intervention in eating behaviors always comes down to a defense of individual freedoms, a sacred cow to most Americans.  Can we force people to do things that are healthy or are we abridging a basic right to live freely in doing so?   If the issue were simply this, the answer would be an easy one.  Individual rights are paramount. But the issue is not simple at all.  Unhealthy behaviors are turning us into a sick, obese, diabetic society with health care costs that are untenable.  We all suffer the burden of these costs, so the issue is no longer individual, but collective.  The very future of our nation is impacted.  This,too, is an important point for discussion.

But I want to talk about something else.

Has if occurred to you that the food freedoms we so long to protect may be something quite different?What happens if we are actually NOT free to choose at all, if in fact the freedom we believe we are protecting is simply the defense of a gripping addiction?  Suddenly, the argument changes.  Should we protect the right to choose something that is, in fact, not freely chosen?  This is how I see this issue and it is a perspective that I have not heard discussed. 

An increasingly significant line of research confirms the fact that sugar and the things that become sugar after digestion (i.e. grains and starchy carbs) are addictive.  In a recent segment on 60 Minutes, Dr. Sanjay Gupta subjected himself to an MRI while sipping Coca Cola.  The MRI shows an immediate hit to the brain's pleasure centers, the very areas which are stimulated by drugs.  Animal behaviorists confirm the fact that animals will choose to overconsume pleasurable substances both in the lab and in the wild.   Like other species, we are suckers for a food high.  Once hooked, we can't figure out why we keep going back for more.  Our world has started looking alot like a lab in which we are drenched in a bath of addictive foods and observed by those who create them.  The foods are then tweaked to provide further "irresistibility".  It is the "right to choose" these foods that we fight for.  Is it really a choice?  Is free will really involved?

I am always struck by the following observation: suggest that people become vegetarian and they are quite willing to consider it.  This eating style eliminates an entire food group, yet it falls within the range of possible diets for most people.  On the other hand, ask someone to eliminate carbohydrates other than fruits and vegetables and you will be accused of nutritional extremity.  A life deficient in bread, cake and pasta seems like a punishment.  I submit that the inability to imagine life without carbs testifies to the degree of pleasurable addictive response created by these foods.  The problem is not that we need freedom to choose any foods we like, it is that foods we like choose us..and addict us....to our great detriment.

I don't think we need worry that wholesale food bans will pop up across the nation like so many McDonald and Burger King franchises.  I do think we need to worry, however, that we will go on blissfully ignoring the damage being wrought by addictive pleasure foods, and even fighting to defend our right to eat and be consumed by them.  Mayor Bloomberg's gutsy initiatives are important and to be commended.  Individually they will not solve the obesity problem of course.  But they call national attention to the degree to which we have fallen under the spell of modern sweet and starchy food.  They give cover to companies like Disney who has now called for a ban on the advertising of junk food on its cable channel.   They get headlines and start conversations.  And perhaps they open a few eyes to the idea that the foods that are killing us have so seduced us, that we may need a "nanny" to remind us of the truth.

 

 

The Menopause Myth: Why It Can Be EASIER to Lose Weight Later

by Barbara Berkeley, MD

It's always healthy to be skeptical, particularly where dietary pronouncements are concerned.  

In the past year, I've been asked dozens of times about HCG.  Everyone is talking. It's all over the media. Does it work?   The answer should be obvious to anyone.  If HCG was any kind of obesity cure, 3 out of 4 people you know would be taking it already.  The first pill or treatment that comes along and can really zap obesity will burn through America with such rapidity that we won't know what hit us!  Lesson?  Just because someone or some newspaper article says it's so, doesn't make it so.  Skepticism is healthy in the diet world.

What many years of obesity practice have taught me is that we should also be skeptical of what passes for conventional diet wisdom.  Alot of it is just plain wrong.  And because we accept it as fact, we lose out on many opportunities to change our lives.

One of my least favorite "wisdoms" is that weight gain is inevitable after menopause.   I wrote about this a couple of years ago in my post on weight loss after fifty.  As time goes on and I work with more and more peri and post menopausal women, I am more and more certain that lower weights can be maintained without difficulty despite age and hormonal status.  Further, I think it's often easier for women to get healthy when they are past 45. 

The key to weight loss and maintenance at any age is the same:  a complete overhaul of the foods you eat.  This seems so simple and obvious, but practically no one who goes on a diet does it.  The vast majority simply returns to a modified version of their original diet.  Because modern foods are addictive, this modified version becomes the full-blown version in very short order.

The key to weight control after menopause is the strict limitation of starches and sugars, and that includes grains, whole grains and the flour-based products made from them (pasta, breads, and so on).  As I explained in my earlier post, this is because we tend to be more insulin resistant as we age.  This causes us to make more insulin in response to these foods, which in turn causes easier fat storage and an inability for stored fat to be released.  If you can make the change to fruits and vegetables rather than grains, potatoes, breads and cereals (and you can learn how to do it in books like Refuse to Regain or others on Paleo or Primal diet) you will lose weight and your age will be immaterial.

But there are also reasons why weight loss and maintenance is actually easier for those who are post-menopausal.  

One of the major reasons is the empty nest.  Feeding growing children and ravenous teen-agers makes it extremely hard to adhere to personal dietary rules.  If you have kids but they are now out of the house, you will find it hugely easier to make your own plans and stick to them.  Most of my patients report (and this has been my own experience) that husbands are usually willing to be flexible about eating.  They will often follow along even if they've eaten differently at an earlier stage in life. 

A second reason that it's easier to make change is that social pressures begin to modulate.  A couple of years ago, Don and I took a trip to Las Vegas.  While sitting at one of the enormous breakfast buffets at the Mirage, I had to laugh.  All of the people under 45 were tucking into huge portions of bacon, eggs, danish, muffins and potatoes.  Those who looked to be over 50 were eating egg whites, little bowls of granola with skim milk, and prunes!  Getting further along in life puts you in mind of the final third of the journey.  You and your friends will start to be more conscious of health and longevity.  Sayng that you no longer eat foods that make you fat and that you want to reach 95 in good health will no longer elicit eye-rolls.  You'll be admired, not scorned.

Another factor that I mentioned in my earlier post is the greater ability to be yourself that comes at mid-life.  The opinions that others have of you matter alot less now, and your tendency to speak your mind and live life by your own rules increases.  Use this new freedom by declaring yourself and your rules for eating.  You've earned the right to make your own way.

If you no longer are feeding a family at home, it's a simpler task to clean your kitchen and vow never to allow fat-promoting starches, sugars and junk foods to enter.  The need to entertain and cook is often lessened.  You've probably had that role for many years and perhaps younger generations will take on all or part of it now.  Minimizing baking and complicated entertaining can be very helpful when you are trying to make permanent healthful changes.  Keep things simple for a while and see how much easier it is to control the food environment. 

Exercise is a vital component of health from mid life on.  You can get away with being sedentary when you're young, but it's for sure catching up with you by the time you pass 50.  The good news is that it's also a myth that exercise ability lessens with age.  While no one wants to get injured, many of us take to our couch at the first hint of soreness.  We are not as fragile as we think.  Unless you have a very real reason not to exercise, get out there and do activities that get you excited.  If this guy can run the marathon at 100, you can train to walk a 5K, shake your booty in a zumba class or conquer the downward dog.  

Finally, changing your life and eating habits requires belief in your ability to get things done.  That's not something many people have in their 20s and 30s.  But after you've built your career, your family, your life, you clearly know how to get things accomplished.  Make the same kinds of plans you did to get other important things done in your life and take on your goal with a passion.  This is an advantage for  mid and later lifers.  Use it.

To view another post on weight loss after 50, select "menopause/after 50" in the categories list in the bottom left margin of this page.  More detailed information about Primarian Diet and weight loss can be found in my book:  Refuse to Regain: 12 Tough Rules to Maintain the Body You've Earned.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Habit and Reward: Good for Target, Good for Maintainers

By Barbara Berkeley, MD

Here's an article everyone should read.  In yesterday's New York Times magazine section, there was a long and eye-opening piece on the science of consumer behavior.  It seems that we buy things because it becomes our habit to do so.  Marketers rely on this habit and try to create it.  There are times in our lives when we are more susceptible to changing habits.  Target has found that pregnancy is one of those times, and it has gone to great lengths to identify pregnant women and to market to them.

Research with rats gives us insight into our own behavior.  It turns out that habits have three components:  a trigger, a behavior, and a reward.  The brain is actively engaged only during parts one and three.  What makes the habit a habit is that the behavior component, no matter how complex, is run automatically.  In other words, once the habit is triggered, it’s on autopilot. 

I’m sure that many of you will be horrified, as I was, by the extent of mind-control and manipulation that goes into modern marketing.  But if we leave that aside, the information on habit formation gives us some powerful tools for changing things we may want to alter in our own lives.  Changing habits is arguably the most vital task for maintainers.

So, I see two avenues to explore.

First:  Since habits are so automatic and ingrained, and since powerful rewards like the pleasure of eating junk and sweets have carved habits deep into our neuro-pathways, we must consciously avoid putting ourselves in situations that pull the trigger.  We’ve discussed this many times here, most recently in the last post.  As much as we’d all love to eat controlled amounts of the modern foods that everyone else is downing, we’ve mostly learned that we can’t.  We’ve also observed that when we do indulge, we are punished by a return of cravings.  This is addressed in the Times article:

Habits aren’t destiny — they can be ignored, changed or replaced. But it’s also true that once the loop is established and a habit emerges, your brain stops fully participating in decision-making. So unless you deliberately fight a habit — unless you find new cues and rewards — the old pattern will unfold automatically.

“We’ve done experiments where we trained rats to run down a maze until it was a habit, and then we extinguished the habit by changing the placement of the reward,” Graybiel told me. “Then one day, we’ll put the reward in the old place and put in the rat and, by golly, the old habit will re-emerge right away. Habits never really disappear.”

 Habits never really disappear.  Words to live by.

Second:  Since habits are created all the time and since we know their components, why not create our own?  Rather than let someone else manipulate us with their chosen reward, how about deciding to reward ourselves? When I think about my own maintenance, I realize that I’ve set up many of these loops and that they are what keep me going.  Weighing myself every day is a reward in maintenance.  When I have to lose some weight because I’ve edged up a little, the scale is both my trigger to lose and my later reward.  I’ve learned to get pleasure out of the feeling of being hungry on days when I have to bring my weight down. How have I done that?  I associate that feeling with a pleasant day I’ve set up. I follow a pre-set reversal plan that I enjoy---usually to have a non-fat, skim mocha for both breakfast and lunch, a nutrition bar at 3 and to try to do some shopping if I can, which is fun and which distracts me. Then I have a huge salad and some protein for dinner.  I look forward to these days rather than dreading them.  The scale on the next morning’s weigh-in is a further reward.

I find that my Primarian eating style has become a reward in itself.  After forcing myself to stay away from starches and sugars for many years, I now truly enjoy eating chicken, fish, nuts, veggies and fruit with some low fat dairy mixed in.  I look forward to these meals and they have become their own reward.  Each day, the pleasure that comes from eating this simple good food ingrains the habit more deeply.  I have no doubt that if I started eating Mallomars again, I would immediately re-activate my chocolate cookie circuits.  Why do that?  I simply don’t want to.  

One of the toughest jobs I have is to convince non-exercising patients that fitness has rewards that are as strong as bread, chocolate cake and pasta.  I never used a muscle until I discovered aerobics in my late 30s.  Within a month or so, the music and the energy took over from the pain of using those veal-like structures for the first time.  Now, years later, I’ve found that I can create the same high from running to Michael Jackson’s “Jam” on a sunny day or playing a great set of doubles in tennis.  Nothing beats a high-energy, dance-y aerobics class though.  For me, the pinnacle is exercising when I am in the Bahamas: a place where dance, party and exercise all exist in one class at one time.  When setting up your new reward circuits, don’t forget to search for the bliss that is found in physical challenge.

The Times article makes the point that rewards can be subtle.  You are rewarded for backing out of your driveway successfully simply by the fact that you achieved that tricky maneuver.  A reward doesn’t always have to be a treat.  It can be a sense of balance, completion or satisfaction.  The trick with food is to eliminate the over the top rewards of drug-like sugars and starches.  It’s hard to compete with the hit of a drug to the pleasure centers, and these foods come way too close to that experience.  Don’t put them in competition with other rewards because lesser rewards will lose out.

In essence, the Times article leads to conclusions that are just the opposite of those in my last post (Tied to the Mast).  The two go well together because they demonstrate the two opposite faces of maintenance.  The first:  studious, focused avoidance of things that others find pleasurable.  The second:  the creation of a brand new world of habit and reward, based on one’s own rules…not those of the culture at large. Part Two completes Part One.

After all, there is no point in getting past the Sirens if you land in a grim place that no one would want to inhabit.  Make it beautiful and you will want to stay. 

Creativity is the basis of all art, even the art of maintenance.  

 

Silly Season

by Barbara Berkeley, MD

In January, the attention of Americans turns to weight loss.  Retailers exploit this interest, displaying towers of shiny new diet books.  The media pumps out stories, offers tips and guidance (the same tips as every other year) and earnestly discusses the ways to make our New Year's resolutions work.  Gyms fill will newbies.  Thankfully, it will all be over in a couple of weeks and those with the serious intent of changing their lives will be able to go back to work undistracted. 

January is an odd time for self renewal.  Yes, the calendar turns a page and we move into a new year.  The business cycle starts anew.  But for a good part of the United States, January is a cold, unfriendly month.  It's hot soup and mashed potato time, the very month when a little extra fat feels good.  In Cleveland, the prospect of heading out for a run through slushy streets covered by slate gray skies is a tough sell even for career exercisers.  

Of course January is weight loss month because it is preceded by the season called, "I Have to Eat It, It's the Holidays".  We have developed an unfortunate cycle of gorging and disgorging on a yearly basis.  This mirrors the shorter cycle we run more frequently throughout the year:  eat things we know we shouldn't, gain weight, then diet to get them off.   The problem, as we are all well aware, is that we eventually reach a point when we can't get the weight off anymore.  We burn out, allow the higher weight to become our new reality and start adding extra pounds to that new base.

I know that I am preaching to the choir, but the reason that weight resolutions and periodic diets don't work is that they have nothing to do with the real work of making oneself healthy.  That little chore requires commiting oneself to a new way of viewing food and to new personal and permanent rules about how to eat.  These rules include guidelines for such things as exceptions.  Over the holidays, some maintainers may allow themselves a certain amount of indulgence for example, where others may stick strictly to their daily plan. But it's programmed.  Flying by the seat of one's pants is a rarity among maintainers, who are well aware that the food winds blow with gale force.  Crashing is likely unless someone has a close eye on the rudder.

January, then, is the silly season for weight loss.   This month's People leads with the popular "Half Their Size" feature.  Here are the amazing before and after photos, the airbrushed picutres of beautiful women in their skinny jeans, and the tantalizing promise that anyone can lose a mere 100 pounds or so.  The guidance for wannabes?  One woman hung a bikini in her garage and looked at it while she worked out on the elliptical.  Another ate a lot of spinach; she suggests you take weight loss 5 pounds at a time. To People's credit, they do provide a section that features subjects of the Half Their Size issue in years past. These successful maintainers look inspiring, but the amount of useful information that accompanies their stories is miniscule.  How are they doing it and what made them able to do what they couldn't before?  That's the information that might help a curious reader, but it's not included.  These features are strictly about the photos.  There's no room for content.  

Us Weekly has a cover that touts "Diets that Work" and suggests that each of us can have legs like JLo and Rihanna's abs.  The diet guidance below each photo of skinny women in shorts and bathing suits is mostly useless. One woman did 2 1/2 hurs a day of karate and boxing while training for a movie (try that after getting home from a day at the office!), another does sessions that "shorten the muscle fibers", a third practices "portion control".  In addition to sparse information, the women in these photos are mostly in their mid 20s, a time when dieting tends to work. What does any of this mean for the 50 year old empty nester who has been struggling with slow and steady weight gain for ten years?  Here's my favorite quote from Us Weekly. It comes from Mariah Carey, who has been up and down the scale more frequently than Kirstie Alley.  Once again she is at a  smaller size and is now a spokesperson for Jenny Craig. Carey says of herself, "I'm extremely disciplined."  Hmmmm.  

Silly season tips abound.  The sillier the better.  Here are a couple of great ones:  Eat with large forks.  Spice soup with pepper.  Put coconut oil in your coffee to "increase metabolism".  Oh my.

If silly season has your head spinning, here's what I suggest:

1. Cover your ears and close your eyes.  There's too much information out there, most of which is ineffectual or just plain wrong.

2. Make a resolution, but not a weight loss resolution.  Instead, resolve to begin the process of making yourself an all around healthier person, someone who will feel good and live well over an extended lifespan.

3. Pick a time of year when you will begin.  It doesn't have to be tomorrow.  It does have to be a time when you won't have immediate challenges from food....challenges like weddings, cruises, or birthdays.  Give yourself a month when you aren't forced into situations when food is likely to win.  Start with some breathing room in front of you.

4. Resolve to try eating a diet of real food, pretty much as it comes from the earth or its animals.  Unless the food in a can or package is original and not adulterated with "stuff", don't eat it.  If you are looking for weight loss as a part of this renewal, stop eating sugars, potatoes, and starchy foods like grains and the things made from grains (cereal, bread, pasta, flour based baked goods).  

5.  Read books, articles and blogs that further your knowledge of eating style.

6. Start looking around for a kind of sustained physical activity that you think you would enjoy once you mastered it.  Start doing that thing at a beginner level and without significant challenge.  Work up.  If you do it for three months and don't like it, start over with something else.  

7.  Observe yourself and take note (either mentally or in written form) of your progress along the way.  Does your skin look better?  Do you feel happier?  Do you have more energy?  Are you less anxious?  These are all results that have been observed after changes in the way people eat and live.  

Silly season can be fun if you don't take it too seriously.  Within a week or two, most of America will be back to its predictable cycle of weight gain and periodic dieting.  Be bold, and head off in a different direction.  Happy New Year!

 

 

 

 

 

Getting Past the R Word

by Barbara Berkeley, MD

While I don't take as much of a beating on the internet as some diet writers do (thank you for that, readers!), most of the negative comments I get are directed at the fact that my diet recommendations are too restrictive.

Restrictive is the R word.

I think that we often confuse structure with lack of freedom.  As our society increases its amount of available choice, we tend to bridle at the idea that any of these options might be taken away.  And we particularly hate the idea of any authority regulating choice...most especially the government.  But until recently, we never lived in a world with such abundant choice.  Life might have been less interesting, but it was certainly easier to negotiate. 

I've written in the past about decision fatigue, a state that seems to occur when we are forced to make too many selections.  It appears we may only have so much organizational ability and will power.  Our constant exposure to choice (mocha or latte?  grande or venti? whip or no whip? skim or soy? ...and that's just Starbucks) wears us down and makes us anxious.  Certainly this is no more evident than in our exposure to an ever-expanding food menu.  Our only defense is to have our own rules and our own plan.  We can then approach the market, the restaurant, and the vending machine using those guidelines.  

Interestingly, there is little R word push back regarding vegetarian or even vegan diets.  By R word standards, these are extremely restrictive.  But they are accepted in our society because they've been around for awhile.  In addition, most people remain unthreatened by vegetarianism.  It has the feeling of an eating style that is chosen by a select few...and vegetarians tend not to be very militant about pushing their diet on others.  Lastly, vegans and vegetarians can still eat sugar and starch (grains and other starchy carbs). For most of us, these are the toughest foods to give up.  It's more radical to suggest cutting out rice, pasta, corn and potatoes than it is to advocate giving up fish, meat and turkey.   And those who do suggest such a change may be subject to R word criticism. 

Just as we negotiate buying choice by adhering to a budget, just as we decide which moral choices to make by adhering to religious guidelines, just as we choose from the endless careers available to us by figuring out where we fit...so too should we view how we eat.  Prior to the last 30 years, eating was less easy to do and foods with the potential to hurt us far less available.  Since the advent of instant eating opportunity throughout the day, we need to apply the same sorts of guidelines to food choice.

People who write about me being too restrictive have not read me very well I think.  I have made it clear that I believe in whatever works for YOU.  The diet that I propose is one with which I have many years of personal and professional experience.  Take that for what it's worth.  Explore other possiblities too.  Choose, based on who you are and what works best.  As long as you are maintaining your weight loss and keeping hypertension, hyperlipidemia and high sugars at bay you are doing a fine job.  

Occasionally I am asked to restate what I believe is the most effective diet.  With trepidation, I'll do it again here.  But please don't view it through the lens of the R word.   Eating this way is a choice based on my own guidelines.  I have no desire to legislate, push or otherwise force this way of eating on anyone.

I prefer-- and see excellent results from--- a diet that is composed of lean animal proteins, vegetables and smaller amounts of fruits and low fat dairy.  I try to stay away from legumes like soy and starchy beans although I personally don't completely exclude them.  While dairy is not a part of most paleo style diets, I include it because I have found that it doesn't affect weight in most of my patients and it gives them greater choice.  Watch dairy products to make sure that they are low in sugar.  Sugar and grains are the two major things I like to keep out of the diet.  One other thing that people complain about with my diet is that it's inconsistent with "true" ancient eating.  I'm not really about being a purist.  I'm about getting the job of weight maintenance done.  If this means using sugar substitutes and low fat dairy, I'm ok with it, because in my world keeping weight low is the primary goal.  Health follows from that.  For those who are uncomfortable with that compromise, there are endless ways to vary such a diet plan.  

As you all know, I call this plan a Primarian diet.  You can find more detailed information in my book, Refuse to Regain and in the archives of this blog.  The degree to which you need to be completely Primarian varies from person to person.  I recommend that you use it as your default diet...meaning most of the time.  We all "go off' here and there, but it works better if deviation is rare.  That's because I remain impressed with the ability of grains, starches and sugars to take over in the brain (or gut).  Those who regain their weight have almost always been co-opted by these kind of carbs.  I believe them to be a strong drug and one that promotes insulin production and fat storage.

If other variations of eating work for you in maintenance, that's excellent.  Please share.  Each of us is a different entity and contrary to what some some have written, I don't believe in a one-approach-fits-all.  What I do believe, however, is that having rules and plans for eating is vital for healthy survival in our current environment.  None of these plans is about Restriction.  Each is about creating a way to eat that allows us negotiate the hazards of endlessly offered food choice. 

 

 

 

 

 

Dietary Tribalism: Factionalism Goeth Before the Fall

by Barbara Berkeley, MD

 I started blogging about 3 years ago.  At the time I was a naive, starry-eyed newbie who couldn't wait to share my experiences and opinions with the world.  I had just written a book based on the experiences I'd had with patients over a period of nearly 20 years. As I sat, fingers poised over the keyboard for my first foray into the internet world, the prospect of getting my message out to a larger audience was thrilling.

Then....Whack Bam Boom!  Not a day after my first words hit the virtual page did I start reading that I was a useless dope, a fool who knew nothing and that my book and pretty much all of my thoughts were drivel.

I ran like a wounded puppy to my blog partner Lynn Haraldson who had been on the internet far longer than I.  She was sympathetic but slightly amused.  I got the message.  The internet is the wild west.  Better toughen up girlie.

So here I stand, ready to take your punches.  But really, why should we steel ourselves, waiting to be beaten up for ideas, beliefs and hypotheses?  The reason for these attacks is supremely ironic, especially for those of us who believe in Primal Diet, or returning to more of the behaviors we practiced in our ancient past.  This flinging of verbal barbs and arrows relates to an intense and ancient human desire to be tribal. Unfortunately, I fear that we will be destroyed by this same tribalism if we refuse to acknowledge and dismantle it. 

At its best, tribalism can be fun.  Cowboys and Indians. Color War.  We love nothing more than to divide ourselves into teams and cast the other group as the bad guys.  I can be playing doubles with one woman for two sets and hating the two ladies on the other side of the net.  Then we switch partners and suddenly my previous hitting companion becomes my sworn enemy.  And I really, really do want to sincerely beat her. 

Things ratchet up with professional sports.  Of course we know that Cleveland really doesn't hate Pittsburgh...(or do they??) Sometimes, it's hard to tell whether tribal enmities related to sports are silly or real.  When they explode into occasional violence at events or after championships, we see their actual potential for destruction. 

And then there's politics.  Why must all Democrats believe that all Republicans are useless idiots and vice versa?  We have all come to see the folly in playing the tribal game so intensely that not a single thing gets accomplished. 

Finally, we have the real deal.  Tribalism as it relates to countries, regions, religions and belief systems.  This is where we lose complete track of the idea that we are all human.  Each one of us might just as easily have been born into another culture and wound up on the other side of the fence...the enemy. But this never occurs to us.  For most of human civilization, indulging in our tribal nature simply meant losing a bunch or our men to spears, arrows and clubs.  As weaponry becomes more deadly and more available, the outcome of unbridled tribalism would seem to be obvious.  Yet we make no attempt to examine it or control it. 

Tribalism seems to be in our biology, but it is expressed as an idea.  The idea is that something about our tribe makes us better...more worthy.  It is usually connected to the belief that our tribe is in possession of the one and only truth.

So what does this rant have to do with Paleo/Primal diet?  In my recent forays into the world of Twitter, I've discovered a new and quite vocal community that believes in ancient diet.  Among this "tribe" I am dismayed to see that there appears to be a great deal of proclamation of truth and declamation against those who see things differently.  People with varying opinions are branded as "asshats" and "fools". This is not unique to the Primal Diet believers.  It is also on display in the writings of followers of other diets.  And yet, at least as I see it,  the truth about optimal diet remains the furthest thing from being settled.  It is as complex and elusive as a shadow that recedes into our endless human past. Does any group, whether it be the vegans, the vegetarians, the Primalists, the Mediterranean Diet followers...ad infinitum.... truly have the hubris to believe that they have completely solved the equation?   There is no diet on earth that does not eventually lead to death.  And if there is ever to be one it will have to come with the assist of modern science, since no living species has yet negotiated immortality.  Thus, we come full circle. We are each human and would benefit from listening to and respecting one another.  Of one thing we can be certain, no one of us has "the answer".  It is only together that we can create enough intellectual and spiritual firepower to push closer to real enlightenment.