Refuse To Regain

Sweet 100: Counting Carbs for Weight Loss

by Barbara Berkeley, MD

Since my world view revolves around insulin, I believe that the final common pathway for weight gain and weight loss is carbohydrate consumption.  Carbohydrates trigger the release of insulin and cause fat storage in those who are so pre-disposed.  Eliminating carbohydrates stops any significant insulin release and allows fat to be burned as fuel.   

An insulin-centric world view in no way denies the myriad other contributors to weight gain.  There is no doubt whatsoever that neurotransmitters, food additives, endocrine disruptors, gut micro-organisms and a whole host of other factors are involved in the perfect storm that creates fat.  But I believe that everything has to channel through insulin ultimately.  Control insulin and you control your fat destiny. At least that's how it appears to me as of this writing.  

With this in mind, keeping carbohydrate consumption low is vital to successful weight loss.  Last December I blogged about dropping carb consumption to 50 grams to reverse holiday weight gain. Now I want to share the success that one of my patients is achieving by assiduously counting carbohydrate grams and keeping the total below 100. 

Miss B. is a 240 pound woman who has had lots of problems losing weight and whose issues are compounded by the need to take several weight promoting medications.  She was not doing particularly well on our standard diet, which combines meal replacements with a Primarian dinner meal.  Because of issues with insomnia,  Miss B was feeling hungry at night and was often choosing to depart from the diet.  Several months ago, I presented Miss B with the option of going on a full food diet that counted carbohydrates.  We generally get good weight loss with about 100 grams of carbs per day, so that was the figure we picked.  Miss B is facile with the internet and likes tracking things.  She became quite good at figuring out her daily carb count and this enterprise became something of a motivating game for her.  She has done extremely well achieving weight losses of between 2 to 3 pounds per week using this strategy.  In addition, Miss B has encouraged several of her friends to go on the same plan.  All appear to be losing weight. 

While I mostly discourage counting things as a long term weight maintenance strategy, keeping track certainly has its place.  First, there are some people who simply feel more in control when they count.  Second, counting allows the dieter to reach a specific goal each day and this can provide daily motivation.  Third, counting is a learning tool.  Within a short period of time most dieters will have internalized the counts of foods they commonly eat.  At that point, they will know what to do without calculation and this kind of knowledge is necessary for long term success.

If you would like to try the hundred carb count (C100), simply carry a small notebook or scrap of paper with you throughout the day.  Make sure you have access to a counting book (like the one made by Calorie King) or website (My Daily Plate, Calorie King).  Alternatively, you can just google your food by entering something like "number of carbs in one slice of bread".  Look up any food that you are not sure of.  For example, a grande skim latte has 16 ounces of fat free milk, but that adds up to 24 grams of carbohydrate, something that may not be intuitively obvous.

Here are a few additional suggestions:

1. Don't bother counting non starchy vegetables  (DO count the carbs in peas, cooked carrots, corn and potatoes)

2. Make use of foods that are already labeled.  It saves time and makes your count more accurate.  You will already know, for example, that one of the OPTIFAST bars we use in our practice has 20 grams of carbs or that a an Oikos pineapple yogurt has 19 grams.   For diet products, I prefer that you use the total carb count rather than the one labeled "net" carbs.  Err on the side of the larger number.

3. Don't use salt and avoid foods that are salty in restaurants.

4. Don't forget to count carbs in salad dressings and don't use restaurant dressings unless you know the count.

If anyone out there decides to do a couple of weeks (or more) on 100C, please be kind enough to send me some feedback.  I would like to see if this is an effective strategy for weight loss in the general population (in other words, for those who are not seeing a doctor or dietitian or are in an organized diet program).  I would be interested in knowing about ease of use, hunger levels, degree of weight loss and anything else on which you'd like to comment.   Good luck!

 

 

 

 

This Pill Guarantees Weight Loss

by Barbara Berkeley, MD

It's unfair.  I got your attention with the title of this post, and now I must deliver the blow.  There is no such pill.

But I was driven to write this post after following a link for yet another one of those clever pop-ups that promise "the hormonal secret to weight loss".  This particular one...you may have seen it....claims to be posted by a physician.  He even touts his impressive credentials.  He tells you that he will deliver his secrets for free, out of the goodness of his heart.  And he seems to begin that way, treating you to a long, cleverly animated discussion about weight related hormones.  But at the end of the day, the solution to controlling these rogue hormones comes in a little bottle, actually a few little bottles, in the form of yet another magic formula for weight loss.   There is plenty of opportunity to key in your credit card.

Googling reviews on this product turns up very little in the way of positive experience.  Oddly, the pills come with directions to eat an incredibly strict diet.  Those few who do report weight loss are smart enough to wonder whether the diet, and not the pills, might have caused it.  

This is the same technique used by the purveyors of HCG, another miracle cure that has no science whatever to back it up.   Several years ago, my husband and I went to a tennis camp out west for a few days.  The camp was part of a spa and we ate in a communal dining room with those who were seeking balance and rejuvenation.  (We, on the other hand, were simply trying to play as many hours of tennis a day as possible.)  This created a bit of a problem because the spa food which was served was so spare.  After running around in the desert sun for five hours, we needed food and fluid.  Seriously.  We found ourselves making after hours-raids on the kitchen in search of the few scraps left over from meals.   Starving even more than we though, were the small band of people who were staying at the spa for HCG treatment.  These folks sat at their own separate table, got daily HCG injections, and were served a 500 calorie per day diet.  For this privilege, they paid over $3000 per week.  Think they were losing weight?  You bet.  They were miles from civilization and I can tell you, there was nothing in that refrigerator!  Weight loss retreats are yet another form of "miracle cure".  I'm thinking of starting one at my home.  All I would need to do is lock people in the house, feed them very little (a great savings for me!) and have them do all the work  around my property.  Come to think of it, haven't I just described the Biggest Loser?

The problem with miracle cures for obesity is that they are strictly about weight shedding and not about weight permanence.  Most of them don't even work to speed weight loss.  But the worst part of miracle cures is who they target.  These cures sell because people who are suffering are vulnerable.  I am continually impressed with just how vulnerable they are.

In my own practice and via my blog and facebook page, I am frequently asked about various products, treatments and devices.  Those doing the asking are smart, educated people.  But their judgement has been subverted by the enormous desire to believe.   Maybe just this once it will turn out that this newly discovered herb from the magical tree in Peru really "melts" away fat without effort.    Maybe this berry, this belt, this injection, this body wrap, this suction procedure, this way of thinking, this vitamin combination, this herbal brew of the ancients will end my problem with food for good.

Here is my simple, foolproof way of vetting such treatments, devices and claims:  If the cure you are investigating has not gone viral on the internet, it doesn't work.  

Our modern hyper-connected world insures that good news (and bad) spreads fast.  You can be sure that any weight loss intervention that succeeds "miraculously" would be the subject of every headline on every mass media site faster than you can say "egg mc muffin".   Those things that do work pretty well, like supervised diet programs, Weight Watchers, anorexic medications, surgery and so on are already well documented.  They are not the subject of viral enthusiasm because they all require hard work and commitment and have problems with achieving long term weight maintenance.  That is the state of obesity treatment in 2013.  We can create weight loss but can't assure it will stick.

Thus this blog for those of you who want to prove that paradigm wrong.

If you are someone who finds yourself going all starry-eyed over the latest raspberry ketone, please stop and think before you open your wallet.  Here are a few suggestions:

1. If it's slick, it's probably schtick.   

    Highly produced commercials and weight loss sites have invested money in their product and expect to make it back.  They are counting on you.  Real and helpful weight loss information often comes in a low-tech package.  See, for example, Robert Lustig's You Tube Sugar: The Bitter Truth  (or my own What Causes Weight Gain)

2 Look for 80% positive reviews      

    When Googling reviews of any product or process, you will always find positive endorsements.  Many of these are planted.  A treatment that truly works will have an overwhelmingly more positive endorsement profile than one that is a fake. 

3. Inspect the package      

    Is the pill or procedure accompanied by incredibly strict diet or exercise regimen?  If so, consider the possibility that it is these interventions, and not the ones that cost money, that are causing any change.

4. Whatever the level of endorsement, do your own thinking 

    Many of the current weight loss fads (none of which work by the way) became popular through the endorsement of TV personalities, celebs, etc...  Remember that TV and mass media gobble up information at a breakneck pace and always need new stories.  Anything that relates to weight sells, so new pills, products and cures get reported on even when there is no science to back them up.  Regardless of who tells you this product works, please step back from your wallet, take a deep breath and make sure this "cure" passes the smell test. 

 

 

 

 

 

 

 

 

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.

 

 

 

Drop and Give Me Fifty!

by Barbara Berkeley, MD

It's December 8th.  How are you doing so far holiday maintainers???   Don't forget, I'm with you and there are thousands of us trying to do the same thing:  avoid regain between now and January 2.

The biggest threat to our best intentions in December is Food Creep.  This is the tendency for small amounts of trigger foods to wind up in our mouths almost without our knowing it....and certainly without our explicit permission.  

December is the most important month to remember that it's all about insulin.  Insulin sends the body's strongest signal to prevent fat breakdown.  If you are making insulin, you are in storage mode AND you can't be losing fat.  You are making insulin if you are eating little bites of cookie dough, a few of those festively wrapped Hershey kisses, or if you are drinking a caramel brulee latte.  In addition, trigger foods which are so ubiquitous at this time of year set off the body's addiction pathways.  Sugar gets into your system and it stages a take over.  Before you know it, there's been a coup and you are no longer in control of your eating, sugar is.

You know how drill sergants handle behavior that's out of line.  They have the offender drop and give them fifty pushups.   If your eating plan has gone AWOL it's time for you to take the drill sergeant role.

Your insulin levels will plummet if you bring your carb consumption down to 50 grams per day for a brief period of correction (a day or two).  To do this, you need to be aware of which foods are carbs.  For the purposes of this exercise, you do NOT need to count:

1. Any animal product except milk (milk does have carbs).  2. Any green vegetable. 3. Any lettuce and any raw vegetable (but remember that legumes like peas, beans, chickpeas and lentils which are often found on salad bars are starches and do need to be counted).

To drop to fifty, you will have to avoid cereals, grains, baked goods, added sugars, dried fruit, pasta, and any sweets that have found their way back in.  You should also be aware of the carb counts in fruit, especially the sweet fruits like banana and pineapple. 

Buy yourself a small carbohydrate counter book, or use the internet to check out the amount of carbs in the other foods you are eating.  Create a day's worth of food that keeps carbs below 50g.   I often advocate the use of protein shakes or low carb bars as meal replacements on days like this.  I realize that these foods are  not "natural" foods, but they have a place because they limit food stimulation and take away choice. 

Try dropping to fifty as a way to get yourself back on track or to shake the carb controllers out of your brain.  

Keep the faith! You can have fun over the holidays without kicking yourself in January.  Enjoy the smells, the lights, the presents and the excitement.  They have no carbs. 

 

 

Waiting for Gateau: Will a New Weight Loss Drug Let Us Eat Again?

by Barbara Berkeley, MD

This week saw the approval of a new weight loss medication by the FDA.  It is the first time in 13 years that  a drug for obesity has been green-lighted.   Lorcaserin (lor cah SAYR' in), which will be marketed as "Belviq" (which sounds like birth control pill or a hearing aid to me), clawed its way to an FDA go ahead after initial rejection on safety grounds.  The door may now be open for other hopefuls like Contrave and Qnexa.  Investors certainly hope so, because with obesity dogging one in three Amercans, weight loss drugs can explode out of the gate with a consumer market like no other.  It wouldn't be a stretch to imagine that a reasonably effective weight loss pill could become the best selling drug of all time.

An understanding of this dynamic is what has led the FDA to be circumspect in its consideration of new meds.  It has already been necessary to unring the bell with Phen-Fen and Meridia and the huge potential distribution of any new anti-fat pill means that millions are immediately exposed to any unknown risks.  In fact, the FDA has asked Arena Pharmaceuticals to conduct a number of studies on heart and stroke risk after the drug is in use.  Those who take these drugs should be aware that they are essentially part of a huge, ongoing clinical trial.

Having said this, there is a risk to any new drug.  As we know so well, medications that seemed safe in pre-market testing and later enjoy years of use can turn out to be bad actors.  This was true of the anti-inflammatory Vioxx and the widely prescribed diabetes drug Avandia, both of which were pulled from the market due to heart risks. 

But let's get to the heart of the matter shall we?  Can diet drugs work and should we take them?

Like most questions that involve obesity, the answer is complicated.  

If we assume that a safe drug could be developed, we are still left with a central problem: treatment with medication for obesity is based on a concept that (in my opinion)  is wrong.  The principle? That weight loss itself is the endpoint.  Weight loss interventions that target only the acute state (weighing too much) are useless.  Obesity represents a metabolic dysfunction or dysregulation that occurs when a susceptible person eats the modern diet.  This dysfunction is not eliminated or even made better by loss of weight.  The formerly heavy person feels better, but this state is temporary since the problem remains and quickly reasserts itself.  Thus, the need for books, blogs, and an ever-increasing focus on weight maintenance.  This seems obvious to me, and probably to you as well (since you are reading a maintenance blog), but it is not obvious to anyone else. 

Weight maintenance, and not weight loss, remains the true problem for our country.  Yet we continue to devote millions to the development of drugs that promote weight loss.  It's nonsensical.  Even treatments that last beyond the initial loss like surgery, lose effectiveness when the ability to eat the modern diet returns. 

You will note that Belviq, like other weight drugs before it, will carry the restriction that it be used only in those who have a BMI of greater than 30 or of 27 with co-morbid conditions.  This means that it cannot be used in those who successfully lose weight.  If the drug is the primary intervention, the reward for exposing oneself to medication risk is very likely to be regain. 

Drugs are not meant to work as social agents which block the consequences of behaviors that are harmful to us.  We could, for example, try to develop drugs that mitigate the harm of smoking so that we could keep on puffing away if we wanted to.  But no one suggests that.  There are so many potential harms to smoking that a single drug that protects us would be unlikely.  More to the point, it seems senseless to try to make a bad habit healthier.   We can extend this to weight loss medications.  No single drug is likely to protect us from the consequences of eating a diet to which we are intolerant.  Yet this is what we all seem to be seeking: a pill that both lets us have our cake and stop worrying about it. 

Belviq is a minimally useful agent for weight loss if studies prove to be correct.  It's not going to be the magic bullet.  Yet it might have been a useful drug for solidifying a year or two of weight maintenance, perhaps cutting appetite enough to allow maintainers to establish new habits during a treatment phase.  Unfortunately, the drug is already being heralded as yet another way to shrink without thinking.  

As if that were enough. 

 

 

 

 

 

 

What Causes Weight Gain? What I Believe Today

by Barbara Berkeley, MD

I have now been specializing in obesity for close to 22 years.  With each passing day I become more certain that the endlessly repeated weight "truths" are utterly wrong.  We are doing irreparable harm to ourselves and our society by believing in them.  These supposed truths?  Overeating makes you fat.  Exercise makes you thin.  Calories are the be all and end all of weight control.  People who are overweight lack willpower.  Obesity is, in some way, a moral failing. 

The body is far too complicated for such (excuse me) dumb explanations. 

I don't claim to have all the answers, but I know that the answers we've been giving (eat less and exercise more) are leading us down the garden path.

Here's where I stand today.  

The entire body is built on homeostasis, (simply a fancy word for balance).  This balance is achieved automatically through hugely sophisticated systems which monitor each aspect of our biology and keep each controlled within a narrow range.  Small perturbations in normal are enough to make us very ill indeed, as for example when the ph of our blood becomes too acidic, or the calcium levels get too high.  To kill someone, we need only overwhelm the capacity of our body to balance potassium.  Inject enough of it and death will quickly ensue.  

There are many people in the world (and each of you knows several) who can eat without much thought and exercise sporadically or not at all, yet remain thin.   This is as it should be.  The process of staying at stable weight is another one of the homeostatic mechanisms of the body.  Under conditions of normal balance, your body knows who to choose to either burn food or store it in order to keep you at a stable weight.  Just as you do not have to run to the gym and sweat to burn off the salt you ate at the local deli, you don't have to run to the gym to correctly apportion food so long as balance functions are working. 

Thus, I see weight gain as a dysfunction of the normal balance apparatus for fat storage.  This leads to two interesting questions:  

1. Where is this balance mechanism located?  

2.  What might be the reasons the balance function is injured or broken?

 

I believe that the answer to question one is most likely the insulin system.  We know that insulin controls fat storage and that excessive insulin produced when the body starts to resist normal levels leads to obesity.  We know too that the elimination of carbohydrates, as demonstrated by diets like the Atkins diet, Primal diets, and low carb plans that go back as far back as the Banting diets of 19th century England, cause and preserve weight loss.  Carbohydrates call for insulin, where animal proteins ask for very little.  Thus these diets lower insulin.  Low levels allow for fat burning rather than fat storage.  In truth, most standard diets also vastly reduce carb consumption because they rely on calorie cutting.  If you are only eating 1200 calories per day, the total carbohydrate consumption cannot be very high.   There may be many other pieces and parts to this explanation, but why bother about them?  Controlling carb consumption works.  Eating diets that are made up of natural carbs like low sugar fruits and vegetables and high quality animal proteins work exceedingly well for weight loss and maintenance.   I believe we have made an end run around the broken system when we eat this way.

The answer to the second question is much more problematic.  We may have become increasingly broken in the insulin department as a result of chemicals in our world.  We are certainly exposed to enough of them.  And we know that certain drugs, like SSRI antidepressants and many antipsychotics are strong promoters of weight gain.  If these chemical compounds can make us fat, why not others?  

Another explanation may be simply that we have passed a crucial limit of tolerance for insulin stimulating foods.  Children born since the second half of the 20th century have been exposed to increasing levels of carbohydrates in utero.  Perhaps we have created a number of generations who are already weakened in the insulin department.  Further repeated stimulation of this system by eating carbs multiply at every meal and snack for years on end leads to its destruction.  

A combination of the two elements is most likely.  And there are many other potential explanations.  

However, knowing the reason we break does not necessarily help us.  There are no drugs in the pipeline and no particularly promising lines of research at the moment.  What does help us is an understanding of what is broken and how we can work around it.  I have described that above and in my book.  

What about overeating?  Well, just like the ability of a potassium infusion to kill you, any homeostatic system can be overwhelmed by enormous overconsumption.  There are some obese people out there who fit this description.  These are people who are consuming 30,000 calories a day, or who have binge eating disorder, or have other derangements of normal eating.  However, the vast majority of patients I see and overweight people I speak to, eat within normal American limits.  That is, they eat too much but not at a level that should explain their degree of overweight.  They often eat similar amounts of food to what is consumed by thinner friends.  They describe gaining weight when they "just look at" certain foods.  In other words, they pay more for what they eat.  I theorize that these people have broken weight homeostasis. 

It is not easy to become a Primal or Primarian eater at first.  But I assure you that with each day that you eat this way, it will become easier and more preferred.  The power of making that end run around what is malfunctioning is intense, and the freedom that comes from eating without gaining weight is completely delightful.  Finally, as you know, I believe that the original diet of humans is the healthiest diet we can adopt.  Without the modern elements, your diet will allow your body to run on the proper fuel for the first time.   

The voice inside of you that says that you can't give up bread, cereal, rice and cake is not you talking.  It is the voice of the food itself.  Try purging yourself of these things and you will be amazed that in the ensuing quiet, you will be able to hear your own healthy inner voice for the first time. 

 

 

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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is Your Irisin A'Risin?

by Barbara Berkeley, MD

The latest chemical substance to get scientists into raptures is irisin, a hormone that is produced in muscle cells but exerts its effect on fat.  We've all figured out that exercise and weight are somehow tied together and that this means that muscle and fat must communicate. Unfortunately, we've showed a woeful lack of imagination in tryng to come up with the mechanism. For decades, we've persisted in trying to jam the same puzzle piece into a space that doesn't fit.  We are determined to prove that the connection is calories.  It seems so logical.  If we burn calories through working out we must lose weight, right?  And yet the evidence that this is so remains annoyingly equivocal.  

While readers will occasionally write to me about great weight loss successes from becoming physically active, it is rare to observe this in clinical practice. The more common experience is to see people who have added exercise, but have not achieved anything more than a minor result.  As I've mentioned in the past, I have taken care of many very athletic people, even marathoners, who were clinically obese.  Could they have just been eating enormous amounts of food?  Of course it's possible.  But most of them were trying to lose weight by modulating their diet.  One would think that these prodigious amounts of exercise would force weight loss, but in their cases it did not.

On the other hand, it is observationally obvious that maintainers who exercise have a higher rate of success at keeping weight off.  This observation has been confirmed by data from the National Weight Control Registry, a large study which monitors those in maintenance.  While the NWCR subject pool is limited to maintainers who volunteered themselves (and thus are probably highly motivated), the data shows that successful study maintainers are exercising a lot (on average, about 1 hour daily). 

Irisin is a hormone that is produced from the breakdown of a protein that is produced when muscles are exercised.  In rodents, it's injection appears to turn white fat into the more metabolically active brown type.  Humans do not have very much brown fat, so it is difficult to speculate whether this finding is meaningful for us.  Even rats who made more brown fat did not lose weight when injected with irisin.  So why the flurry of interest?  Because high levels of irisin appear to improve the way the body metabolizes food, making it less insulin resistant and more weight stable.  The following is from a recent NY Times article on irisin:

But while irisin appears to have a critical impact on metabolism, it does not appear to play any discernible role in the effects that exercise has on the heart or the brain. And various issues remain unresolved. Why, for instance, if exercise increases levels of irisin and irisin increases the body’s stores of energy-burning brown fat, does exercise so rarely produce significant weight loss? The mice injected with irisin lost little weight. On the other hand, Dr. Spiegelman notes, they resisted weight gain, even on a high-fat diet, and their blood sugar levels remained stable. So it would seem that exercise, through the actions of irisin, can render you healthy, if not svelte.

As I have repeatedly said in this blog, research results only become important when they are repeatedly reproduced.  The irisin story is obviously in its very earliest chapters.  But the existence of such a hormone may well help to explain why exercise is so important during maintenance, and relatively ineffectual during weight loss.  For those who are currently losing weight, I don't discourage exercise, but I ask you not to rely on it.  Weight loss is about forcing the body to burn itself (which it would prefer not to do) through caloric restriction.  Think of your exercise as a way of rebuilding and retuning your muscles for later use.  Once you reach maintenance, these irisin producing factories will be fired up and ready to go--giving you a much improved shot at maintaining the body you've earned. 

Got Eudaimonia? Beyond Diet and Lifestyle Change

by Barbara Berkeley, MD

" The ancient Greeks called it eudaimonia, and positive psychologists have adopted the term to refer to the kind of profound satisfaction and meaning one derives from raising children, training for an Olympic event, completing a college degree or helping your neighbors rebuild after a disaster. " ( NY Times, "Get A MidLife", 1/8/12)

 

It's a gift from the ancients!  Today's New York Times introduced me to a word I've needed and searched for; a word to take the place of the weak and poorly descriptive phrase:  "lifestyle change".  One of my early blogs on this site complained about the fact that dieters dutifully repeat a rote phrase when asked why many diets ultimately fail, "It can't just be a diet," they say, "it has to be a lifestyle change."  

Whatever that means.

 While every successful maintainer I've every met has definitely altered his/her lifestyle, the phrase "lifestyle change" is not sufficient to describe the accomplishment, nor does it provide any specifics about what that change included. Some time ago, I asked readers to come up with words that better described the experience of maintenance and that included the profound sense of transformation and accomplishment that seems to go with it.  But no words seemed strong or specific enough.

Today's NY Times has an article about modern middle age, it's drawbacks and it's benefits.  Among the good things middle-agers experience is more frequent EUDAMONIA: a sense of having accomplished something truly profound.   Bingo!  I believe that eudamonia is what separates those who just diet from those who become different people at the end.

Look at the Silly  Season ads that currently fill our airwaves and magazines.  What's the message?  That diet is about fitting into smaller clothes.  That dieting is painless and can be accomplished by eating the very same foods that the SAD equates with pleasure. (Nutrisystem: Features "butternut squash ravioli", "double chocolate almond cookie").  Who are the spokepeople?  Often, they are celebrities who have long histories of gaining and losing weight.  Chances are you wouldn't believe that Oprah or Kirstie Alley had found the secret to weight loss unless they had managed to stay at lower weights for a very significant amount of time.  What are the attractions?  Women in tiny jeans and lots of makeup.  It's pretty superficial when compared to the significant tasks that anchor weight maintenance. 

What creates eudaimonia?  Achieving something big, meaningful, and real.  To do this, we need to go several steps past the usual suggestions.  Here's an example:  a weight loss tip from US magazine: "When baking, replace oil with applesauce".  The same tip for those in pursuit of eudaimonia:  "Stop baking.  Guess what? You'll live."

You can find the comments of eudaimonic maintainers scattered throughout the responses to most online articles on diet.  They generally will describe how they lost the weight and their long term regimen for keeping it off.  There is always a simplicity to it and a pride.  They worked it out!  This has created a deep satisfaction.  

As I always like to say,  losing weight is no more nor less than throwing out the trash at home.  It's great to get rid of it, but it's not a cause for intense, deeply-felt pride.  But if you can turn that nice, clean home into a showplace, a thing of beauty, a place that anchors the neighborhood...now you've got eudaimonia.   

 

 

 

 

 

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!