Transformative Principle #4: Release the Death Grip, Restore the Humor
These Transformative Principles are part of a series on achieving permanent health change that began on March 21. The "principles" are not meant to be gospel. They are simply thoughts of mine that are based on observation of successful maintainers, personal experience and--to some degree-- my own conjecture. I hope they provide some food for thought as you continue your own quest for health transformation.
It seems to me that many people who are trying to transform have the feeling that they are holding on for dear life. It's not uncommon for maintainers to write about their "white-knuckled grip" on new behaviors. Constant vigilance, which is necessary
What strange beings we are. Here we are trying to accomplish something that must rank up there with one of the most difficult challenges in the world, yet we don't want to give ourselves any credit for the attempt. Only success will do. We find ourselves clawing at perfection and hating ourselves for failure.
Transformation is a process of shaping; of getting closer with each new try. I once had a friend whose child was having many difficulties. She told me that a psychologist had described her child's trajectory by comparing it to the course of an airplane. A plane doesn't actually fly in a straight line, the therapist had said. At any given moment, it veers off course a bit with the prevailing winds. It goes slightly too high, slightly too low, this way and that, and then corrects. The point is that it eventually gets to its intended landing spot.
Health transformation won't work if you allow each deviation to provide a reason to quit. If you give up because you get blown off the path, the journey stops there. But since deviations in the trajectory are normal to development, it does us no particular good to grip the process with clenched hands. Relax.
Remember to laugh.
In my book, I write about intensity. I talk about being a "warrior" and being "tough, not moderate" in your approach to transformation. I still believe in those principles and I will write about them later in this series. But let me add another analogy, this one from the tennis world. (I really like analogies!)
My tennis coach was recently teaching me how to hit a volley. The volley is a shot that's hit directly at you when you are standing up at the net. Because you are so far forward in the court, that shot comes at you fast. You must block the ball with your racquet quickly to avoid getting hit right in the nose. It's scary standing up there with someone on the other side gunning for you. As a beginner, your tendency is to hold onto the racquet for dear life. Your hands are clenched so tightly that they can hardly move. Your eyes look like saucers. Your jaw is tight. All the muscles in your body are tensed with anticipation. There's only one problem. As soon as you tighten up, you can't react to the ball. So my teacher taught me a technique. Keep everything loose and relaxed. Force yourself. As the ball approaches, THAT is the time to squeeze the racquet using a firm grip. Relax. React. Firm Up.
And when the ball hits you in the nose, shake your head and laugh at your imperfect game. Once, just a few years ago, you couldn't even contact the ball with your racquet.
You can be tough, determined, in fact a better warrior if you learn to relax. You're on a journey. It's strange, funny, human, and beautiful. Enjoy the ride.
These Transformative Principles are part of a series on achieving permanent health change that began on March 21. The "principles" are not meant to be gospel. They are simply thoughts of mine that are based on observation of successful maintainers, personal experience and--to some degree-- my own conjecture. I hope they provide some food for thought as you continue your own quest for health transformation.
Transformative Principle #3: Find Others Who Have Transformed
Many of my maintenance patients seem to relate to the following analogy:
Everyone you know is having a great time swimming in the ocean. The only problem is that the ocean is terribly polluted. Large blobs of chocalatey brown oil are bobbing all over the surface. People are swimming in it, swallowing it and inhaling the fumes, yet they claim they are enjoying themselves. You see this going on and become increasingly concerned about the danger. Suddenly, you see a beautiful island. Exhausted from the drag of the oily sea, you pull yourself up onto the shore. Like a pelican in the gulf, you are coated in oil. You set the work on the laborious task of cleaning it all off. Finally, spent but relieved, you turn to look at the beautiful place where you've found rescue. There's only one problem: you are all alone on the island.
Almost everyone who tries to accomplish transformation feels like the odd-man out. Eating mindlessly while complaining about health and weight is a cultural norm. We are social beings and living life in another permutation ostracizes us to some degree. It becomes increasingly difficult to avoid the pressure to return to the fold.
Successful transformation is infinitely easier if your island is populated. Thanks to the internet, this is a lot easier to do now. After losing over 100 pounds, Lynn began a chat room relationship with a group of women who call themselves "The Maintaining Divas". Years into the process, they remain close and even travel to reunions so they can talk face to face.
One of the best pillars for transformation is having another like-minded person in your household. Generally, this is a spouse or significant other.
These Transformative Principles are part of a series on achieving permanent health change that began on March 21. The "principles" are not meant to be gospel. They are simply thoughts of mine that are based on observation of successful maintainers, personal experience and--to some degree-- my own conjecture. I hope they provide some food for thought as you continue your own quest for health transformation.
Transformative Principle #2: Transformation requires re-engaging with your body.
As people gain weight, they often create a separation between themselves and their bodies. The mirror may become their enemy. Clothes that define their shape may be passed over in favor of garments that conceal. They may not want to exercise because they are afraid of how they may look.
It's surprisingly easy to live entirely in your head, blocking out not only visuals but the messages that your body is sending. Modern medicine is a terrific thing, but sometimes we cede control to doctors as a way of further distancing ourselves from our own physical aspect. It's easier to have a cortisone injection in your knee than to heal that knee yourself. It's scientific and unemotional to swallow cholesterol medicine. It's messy to look at the way you've been eating and try to turn it off.
Those who have undergone transformation still see their flaws. They may not like them (see Lynn's piece on The Green House), but they are looking and they are connected.
Transformation is about wanting to take care of yourself in a deep and permanent way. It's impossible to care for something that remains shrouded from view. So start looking.
I don't believe in platitudes like "You need to learn to love yourself" or "You just need to do more for YOU". Wanting to transform is not a switch you can flip from off to on. Working on inhabiting the part of you that lies below your collar bones is part of the long and scary process of changing.
This is where physical activity can be very helpful. Movement, exercise, things that force the body into action put you into direct communion with your muscles, bones and organs. This part of the transformation prescription need not be strenuous. It might be Tai Chi, walking in the park, or slow stretchy yoga. It might be quiet meditation with deep, complete breathing. It might be private time with a "Sweatin' to the Oldies" DVD. Or it might simply be more time looking at yourself and passing over your faults in favor of reminding yourself of your body's amazing potential for rebuilding and recovery.
E.M. Forster begins his celebrated novel Howard's End with a single phrase…."Only connect….." The meaning of these words has been debated ever since the book's publication. Some think it refers to the inability of certain characters to relate to other people. Whatever it's intended meaning, it remains an emblem of Forster. These two words shimmer because we all understand that we are nothing without connection: whether it is with our friends, our children, our spouses, or our world. And that connection begins with an appreciation for our very selves and for the bodies that have been gifted to us. Connect with that body and it can begin to heal.
Transformative Principle #1: Transformation is about belief. But belief can develop through habit.
To be transformed in your relationship to food and health, you must deeply believe that eating and living in a particular way are central to who you are. That is quite different from understanding intellectually that eating well is good for you. No one who begins the process of transformation has yet developed this connection. The journey toward developing it is the soul of what we call "maintenance".
In my office, a common refrain from patients is, "I really, REALLY want to lose 30 (50, 80, 100) pounds." Another is, "I really, REALLY want to keep it off this time." Unfortunately these "wants" are easily subverted by other cravings. Those who are still simply dieters and not yet transformed still also want to live life as they did before. This is natural. They still want to eat spaghetti dinners and have dessert. They still would like to find a place for fast food. They believe in some deep recesses of their minds that there is a bargain that can be struck that will allow them to resume a controlled version of this life after weight loss.
Transformed maintainers generally find eating and being the way they were distasteful. This isn't to say that a piece of cheesecake doesn't still look good, but through the daily practice of new habits they have come to appreciate what it feels like to live in health. The balance has shifted. They don't want it to change.
No one who is new to the process of transformation can expect to feel this way at the point that maintenance begins. The good news is that practice, leading to habit, can create this new belief. I think the Nike people really knew what they were doing when they designed their "Just Do It" logo. When you "Just Do" something long enough, its value starts to make a deep imprint.
Transformation occurs via doing and initially that doing has to be a conscious effort. You will have made the quantum leap when you go from wanting to stay away from unhealthy foods to really not wanting to eat them anymore in some visceral way. Patience and practice is key.
Nothing in our lifetime reminds us as strongly about the forces of nature than recent events in Japan. Earthquakes, storms, and tsunamis make it abundantly clear that we humans do not control our world despite a strong desire to believe differently. The earth is constantly transforming itself. Some of this activity is chaotic and unpredictable (like the Japanese quakes) and some is cyclical and regular. March 20th marked the vernal equinox; the moment when the sun crosses the equator and night and day are equal in length. For our northern hemisphere, the equinox marks a welcome slide into spring. The earth will transform, and we, as part of nature, will go where it goes.
Yet despite the transformative patterns of our planet, many of us see life as a long, slow decline. While it is true that life's end is inevitable, we too can reassert ourselves and bring a fresh spirit at any point along the way. We forget that we have bodies which are self-renewing and capable of miraculous self-healing. We only need to get out of our own way.
When Lynn and I first started this blog, we were struck by the inadequacy of the word "maintainer" to describe someone who had found a new way to manage food and weight. We asked readers to contribute better descriptors, but there seemed to be none. After thinking about this for some time, it occurred to me that the reason is simple: we were looking at wrong process. Successful maintenance actually has very little to do with registering the same number on a scale day after day. It has everything to do with transformation.
The people I've met who have put overweight behind them have transformed the way they look at life. This process takes some time and it is not always successful. The vast majority of dieters never set out to achieve transformation. Without it, they are almost certain to grow fat again.
What are the elements of transformation? I cannot claim to have an absolute corner on this knowledge. I can only contribute the benefit of observation and experience. As a result, I have decided to launch a Refuse to Regain Season of Transformation which will coincide with the coming of spring. Over the next month, I am going to post a daily (or almost daily!) transformative principle on my Facebook page at Refuse to Regain: Barbara's World. I will post the same principle on this blog. Some of these will be accompanied by explanations and some may speak for themselves. None of them are absolute truths or perfect rules. They are simply the elements that I have observed in those who have accomplished dietary and weight transformation. You may have heard many of them before but I believe they bear repeating. Some of these principles are my own personal beliefs and may be subject to your modification. Others are more universal.
As the seasons change, we are often stirred to action. Some basic instinct pulls us along with the changing world and we feel a new desire to re-invent ourselves. I hope that the thoughts that appear over the coming month will help those of you who want to transform but haven't quite made the leap.
As always, I welcome your ideas, comments, and personal transformative principles. Happy Spring!
Nathan Pritikin: 69. Robert Atkins: 72. Roy Walford: 79. Adelle Davis: 70. Aveline Kushi: 78. Marjorie Shostak: 51. Jack LaLanne: 96. Ancel Keys:100.
David Murdock is a billionaire who believes that he knows the formula for the perfect diet. Not only has he built his own research institute to refine his theories, but he is confident that his food choices will keep him alive to the age of 125. This would seem to be quite the claim since the longest documented lifespan is currently 122, it was a woman, and it occurred only once. Nevertheless, Murdock is dismissive of those who eat differently. According to an article by Frank Bruni in the NY Times:
In restaurants Murdock will push the butter dish toward the server and say, "Take the death off the table." He will ask employees or friends who are putting sugar in coffee or milk in tea why they want to kill themselves and will upbraid people leaving healthful food unfinished about the vitamins they're squandering.
While Murdock's judgmental bent has doubtless reduced his list of lunch companions, his dietary certainty is by no means rare. There are any number of books, blogs, eating experts and devoted disciples out there who purport to know the "truth."
Here's my message. If you are looking for the one true diet........caveat emptor.
While we can safely say that diet is important and a strong determinant of health, there is no one diet that has the corner on perfection. In fact, history shows that strict adherence to specific diets does not guarantee the avoidance of medical disaster; no matter how much one "believes". Since this is so obviously true, we all need to be careful about those who claim to represent the one true path.
Nathan Pritikin founded an institute based on his beliefs about a diet that was high in natural foods and very low in fat. This diet is similar to the diet that Dr. Dean Ornish advocates today. While Pritikin's own heart disease appeared to regress on this diet, he died of leukemia at the age of 69.
Robert Atkins claimed that eating a diet that was very low in carbohydrates but included saturated fats would protect people against obesity and heart disease. He died at 72 after a fall that was never fully explained. Rumors persist of a cardiac history. No autopsy was ever performed.
Dr. Roy Walford was one of the founders of the CRON movement which believes that extreme longevity can be achieved by long term caloric restriction. The movement persists, despite the fact that Walford developed ALS (Lou Gehrig's disease) and died at age 79.
During the 60s and 70s, healthy eating was defined by the work of Adelle Davis, a nutrition activist and author who advocated whole unprocessed foods and avoidance of food additives. She died of bone cancer at 70.
Aveline Kushi was the wife and partner of Michio Kushi, one of the founders of the macrobiotic diet. This strict eating plan is often suggested to cancer patients. It advocates high fiber, low fat, primarily vegetarian foods with an emphasis on soy. Despite adherence to this plan, Aveline Kushi died of cervical cancer at age 78 and her husband developed colon cancer in his 80s.
Marjorie Shostak and her husband Dr. Melvin Konner were instrumental in researching and popularizing the Paleolithic diet. Both were anthropologists who studied the diet of ancient peoples. While Konner is still living, his wife succumbed to breast cancer at age 51.
Heloise Menell was my aunt. She played bridge, often forgot to balance her checkbook, had her nails and hair done religiously and did no exercise. Her diet was heavy on hamburgers and other types of meat. She liked a good stack of onion rings when she could get one. Her refrigerator was always filled with chocolates. She died at 101 after a brief bout of pneumonia.
Ray Kurzweil is an author, brilliant futurist and eccentric who believes that we may by nearing the time when man will merge with machine to make humans essentially immortal. In order to assure that he lives long enough to benefit, Kurzweil eats no sugar, few starches and small amounts of lean protein. He also takes approximately 150 supplements orally and receives IV infusions of others. He is currently in his 60s and claims to be in excellent health.
Ancel Keys was the man who changed America's view of fat. His seminal Seven Countries Study purported to show that those who ate fat got heart disease, while those who abstained did not. The study has been widely dissected and criticized over the years, especially because of data that was conveniently excluded. Nonetheless the study launched America on a low fat, high carbohydrate course that is believed by some to have triggered our current obesity epidemic. Keys later became an advocate of the Mediterranean diet. He lived to be 100 and was very physically active late into life. When asked whether his diet had contributed to his lifespan, he wisely replied, "Very likely, but no proof."
The basics of Jack LaLanne's plan for longevity boiled down to complete avoidance of sugar, lots of raw vegetables and fruits, lean animal protein (not red meat), many supplements, and a great deal of exercise. LaLanne lived to 96 and was healthy in his later years.
Jerry Berkeley is my father. He eats a low fat diet, a ton of bread (none of it whole grain) and a large serving of fat free ice cream with chocolate syrup every night. His vegetable and fruit consumption is minimal. He walked daily for many years after having a heart attack at the age of 50 but is now prevented from doing so by arthritis. He is an amazingly youthful 97.
Go figure. The point of this exercise is not to depress you or to prevent you from working on a clean diet. It is, rather, to relieve you of guilt. No diet is bomb proof and no one has a corner on the truth. Each one of us must find the diet that makes us feel best and which, in our view, gives us the best shot at health and happiness. We can greatly reduce our risk of heart disease, diabetes, cancers and other ills with diet, but we can't eliminate these risks. Will we live longer if we eat better? It's impossible to know.
Given these truths, here are my suggested guidelines for finding the right diet for you.
- Your diet is good if it is helping you achieve normal blood sugar, decent cholesterol readings, low triglycerides and a good blood pressure. If you already have some of these problems, your diet is a good one if it is lessening these markers or allowing you to decrease your medications.
- Your diet is good if it is allowing you to stay a a good weight. That weight doesn't have to correspond to a perfect BMI, but it should be as low as you can comfortably maintain and should stay relatively stable.
- Your diet is good if your energy is good. If you are sluggish or have no energy to get out and move around, look at making a dietary change.
- Your diet is good if it exposes you to the fewest carcinogens. We get enough exposure to cancer causing chemicals in our air, plastics, x-rays, and modern products. Avoidance of processing and additives is the basis for every healthy diet whether it is Primarian, Pritikin, Vegetarian or an Atkins variant.
- Your diet is good if you can believe in it and stick to it. If you are simply eating reflexively, without any specific thought, it's unlikely that your diet is healthy. The reason is simple: we are presented with few good choices. In order to eat well, we have to eat mindfully. On the other hand, exceptions like my aunt Ellie prove the rule.
- Your diet is good if you wake up without guilt.
- Your diet is good if eating it makes you not only healthy...but happy.
This is the best we can do. But even this is a lot. In the meantime, don't waste your time feeling badly about the fact that you don't eat perfectly. Find your own way. Clean things up as much as you can and enjoy the process of personal discovery. And by the way, (note to myself!) when you do find the diet that fits like a glove, avoid the temptation to proclaim that it is the one and only truth.
I was very disturbed today when I read of an Oregon study which is forcibly making monkeys fat. The study, which is being conducted at the Oregon National Primate Research Center, attempts to reproduce our obesogenic western lifestyle. In so doing, it encourages monkeys to eat as much as they want of high fat, high carbohydrate foods, and forces them to be sedentary. The description of these primates becoming obese, diabetic and atherosclerotic while being trapped in single cages is painful.
Animal research is undoubtedly important, but it is often difficult to defend ethically. Most of us have made our peace with studies on mice and rats, but grow uncomfortable when the animals in question are those to which we can more closely relate. When I was in medical school, I used to have to walk past the dog lab every day on my way to class. One of the dogs scheduled for some experiment or other was a big shaggy thing that seemed so sweet and so doomed. For months, I fantasized about breaking into the lab at night and setting him free. One day, though, his cage was empty. The best I could do was refuse to participate in dog labs myself. These were classes during which we learned to do surgical techniques using anesthetized pups. The animals were later killed "humanely".
Apart from what in my opinion are the cruelties of the Oregon study, there is another more ironic corollary to be examined. It's just odd that it seems abusive to feed primates food that purposefully makes them sick and to prevent them from normal play and movement, when we do the same thing to ourselves and our children every day. We laugh about it, make funny TV commercials about it, and vilify anyone who suggests that we should live differently. We immediately begin talking about our freedoms. Yes, we vociferously defend our right to choose the very life that the Oregon monkeys are forced to live. It is really only when we see our habits through the eyes of these monkeys that we can see how damaging, how sad, and how unnecessary they are.
But the Oregon study includes something that should give us even more pause. Many recent lines of research have pointed to changes that occur during the fetal development of children born to overweight and obese mothers. As a result of sacrificing some of the Oregon monkeys and looking at fetal brain tissue, researchers concluded that the future lives of offspring were impacted by what their mothers chose to eat. We may go to the grave defending our right to choose, but do we have the right to choose for our children as well?
And take special note of this quote included in the same article:
"Dr. Grove and researchers at some other centers say (that) high-fructose corn syrup appears to accelerate the development of obesity and diabetes.
“It wasn’t until we added those carbs that we got all those other changes, including those changes in body fat,” said Anthony G. Comuzzie, who helped create an obese baboon colony at the Southwest National Primate Research Center in San Antonio."
Before we vilify high fructose corn syrup as a peculiarly destructive agent, please remember that HFCS has the same chemical composition as table sugar. The only major difference is the fact that its glucose and fructose molecules are free, whereas they are bound together in sugar. The point remains, that without the addition of excess carbs it is difficult to make monkeys fat. It's not much of a leap to believe that the same thing goes for humans as well.
In a recent post to my Facebook page at Refuse to Regain: Barbara's World, I showed two pictures of our beloved orange tabby cat, Charley Muffin. The first is his winter picture: fat, fat, fat. He lazes around the house and eats from the cat food dish which is always kept full. Our other cats remain lean, while Charlie gets progressively more rotund throughout the cold weather months. The second picture shows Charley in his summer mode. Out all day and eating mice. On the "ancient diet of cats" Charley is trim and healthy, a veritable Jack LaLanne of felines.
Perhaps one day, the Oregon studies and others of the same ilk will yield invaluable information for obesity treatment. As of today, though, it seems that we are going a very far way to establish principles that have always been true. We are healthy when we follow the dictates of our biology. So are cats. Horses. Monkeys. And our own children.
Being on a weight loss diet can be annoying. It's tough to have rules to follow, frustrating to face restrictions, and maddening to cheat when you promised yourself that you wouldn't. But as annoying as that diet can be, it can also provide an underlying sense of relief. Once you hit your stride, you are following a plan. The anxieties caused by an overwhelming number of food choices are tamped down. You've got a roadmap to follow.
In my medical practice, we offer the option of beginning weight loss with two weeks on a diet of pre-made liquids and bars. Although we don't push for this choice, most people elect it. They tell us that they have a feeling of freedom when they don't have to make any food decisions at all. They also enjoy a sense of putting distance between themselves and the way they used to eat. They like having a plan, even a very restrictive one.
Studies show that weight loss is achievable on virtually any diet, as long as that diet is followed very consistently. This conclusion might lead you to believe that all diets are equal. But there is an important piece of information missing. What allows consistency to happen? Is it possible that some people can't follow a given diet because it does not fit them properly? We know that this is true. For example, people who are pre-diabetic or insulin resistant may find the Atkins diet easy to follow because it takes insulin out of the picture. Smaller people with normal insulin, on the other hand, might find it very difficult to adhere to a diet that is so low in carbohydrate.
Each of these points, the importance of having a roadmap and the importance of that map fitting your personal needs, has major implications for your success…not only during weight loss but after weight loss as well. Once you enter maintenance, experience has shown that you are headed for failure if you don't have a well thought-out plan and if that plan doesn't match up with your needs.
Most people don't like to think of themselves as continuing "on a diet" after they finish losing weight. (And by the way, no one ever thinks they are finished losing or is ever completely happy with the weight they've achieved. So let's just say we are talking about a plan you need once your body has given up whatever weight it is able to get rid of at this particular time). Since in America we use the word “diet” to mean weight loss, we have to give the post weight-loss plan another kind of name. Let's call it a personal Food Constitution.
Unlike diet books, Food Constitution books are not to be found 50 deep in your local Barnes and Noble. No one cares much about publishing something about how to construct this most important of documents. (Refuse to Regain is one exception. You might also look at the Thin for Life books for ideas) As I was told by my book agent, publishers are only interested in books that solve problems. Once weight is lost, she said, most people think they don't have a problem any more. At first, I didn't believe her. But now I do. We still have a lot of work to do in order to convince people that the heavy lifting begins with the end of dieting.
So, you will have to be your own Thomas Jefferson figuring out the self-imposed rules and safeguards that keep your personal union strong. Like the framers, you should seek to produce a plan that can work for many years, albeit with a few amendments. And the plan should make you proud.
So how to begin? Here are my suggestions, but remember, each plan will be different and personal to your needs:
1. Start with Your Endpoints
What do you want to preserve and protect? It may be weight. But it also may be a new, lower Hemoglobin A1c, a life without blood pressure medicine, a commitment to supporting local agriculture, or a desire to be more organic. Your constitution is not just a way of eating, it's a way of being which will reflect who you are for some time to come. When you defend this plan to others, you want to be proud of what it says about you.
2. Look to the Diet That Created Your Weight Loss
In general, the diet that got you to the dance is the one that, with some tweaks, will work to maintain your loss. This is not to say that you can't go a completely different way in maintenance, but this is an easy and reasonable starting point. Spend several months expanding your weight loss diet slightly and gradually. Be extremely careful about carbohydrates. I'm not going to reiterate my personal biases in detail, but suffice if to say that carbs create insulin which creates fat and many carbs tend to trigger addictive food responses.
Create default menus, meals which you know you like, which don't cause weight gain and which you can make easily. While working on these basic menus, consider food timing as well. Are you someone who needs frequent snacks to get through the day? Slot them in. I personally recommend creating some food-free periods each day that last at least 2-3 hours. This allows the body to use some of the food you've stored. If you decide to do this, figure out when these periods fit best for you.
If you don’t like your weight loss diet or feel it is unhealthy to continue, see the next suggestion.
3. Start Spare
If you are starting from scratch, start basic. In the beginning, eat mostly vegetables, low fat animal proteins (lean meat, poultry, fish, eggs and low fat dairy), fruits and nuts. Make the vegetable part bigger than the animal and fruit part. Practice eating this way and see if you can get comfortable right there. If not, experiment with some add-ons. Be very careful with adding back if you are someone who had any of the markers of insulin resistance. These include: weight mostly in the belly, high blood pressure, borderline or high blood sugar, high triglycerides, low good cholesterol. People who are insulin resistant should really, truly stay away from starches and sugars lest their problem swiftly recur. Similarly, if you are someone who has had an inflammatory condition (like rheumatoid arthritis, inflammatory bowel or multiple sclerosis for example), I would think twice about the re-introduction of grains. If you do decide to broaden your diet, start with beans, lentils and other legumes. Try a sweet potato here and there. See if the scale stays stable. It’s hard for me to give you direction on grains as I am not a fan, but if you go that route, watch the scale closely and look for any inflammatory issues like eczema, joint aches, etc. There are certainly those who can tolerate grains, but I’m not convinced that people who have been overweight in the past are among them. If you are doing fine and staying weight stable, then grains would seem to work for you.
4. Consider the Use of Calorie Labeled Foods and Meal Replacements
While I advocate a maintenance diet that avoids most processed foods, there are still benefits to using pre-labeled foods in your daily plan. Many people take one meal out and replace it with a yogurt, nutrition bar, or liquid supplement. These foods allow for complete control of calories and knocking one meal out makes life a lot easier.
5. Find Your NTTs
Non Triggering Treats are foods that are sweet, savory or even a bit salty that feel like fun but don’t throw you under the bus. A regular ice cream bar might send you off on a binge, but a Weight Watcher’s ice cream sandwich might not. You might concoct your own NTT (one of my patient’s loves smooshing frozen blueberries in low fat creamer and splenda) and discover that it does the trick when you simply have to eat something during American Idol. Every long term eating plan needs some NTTs. Work on a list.
The most important tip I can give you for how to eat after weight loss is this one: Do it With Conviction! Successful maintainers have, for the most part, undergone what I call a Food Conversion. They believe something different about how to eat than they did before and the change is pretty radical. The period directly following weight loss is critical, because new maintainers do not have this sense of belief just yet. It’s something that comes as you learn to enjoy your new diet and see its benefits: sort of like an arranged marriage that blossoms into love. So don’t go running back to your old lover---the standard American diet---just yet. Give the new one a chance. He or she may look a little geeky right now, but there’s a powerful magic lying beneath that unassuming exterior. Don’t you want to find out what it is?
Since 1980, the US Department of Agriculture has been producing dietary guidelines for the American people. These guidelines and the infamous "Food Pyramid" which illustrates them serve as the backbone for our country's dietary advice, a kind of gospel of nutritional correctness. The guidelines are announced every five years with great fanfare (2010 Guidelines). The committee cites the latest research and announces its findings with great seriousness. This task has taken on an even greater urgency in recent years. The reason is simple. In the 30 years since the first Dietary Guidelines were released, Americans have become alarmingly more fat and more sick than at any time in their past.
Those food geeks who (like me) watched today's press conference were treated to the opening remarks of Secretary of Agriculture Tom Vilsack, who immediately stated that prior to getting his current job, he had never read the dietary guidelines personally. He then solemnly confessed that having read the guidelines, he and his wife had experienced a life change. Following this bit of revelation, he proceeded to state with great certainty that weight is controlled by one thing: calories in/ calories out. I counted six repetitions of this mantra during his several minute introduction. It was clear from the very outset where we were headed.
And indeed, that's exactly where we went. In 2010, the USDA has come to the stunning conclusion that we should eat fewer calories than we burn. Further, we can achieve this by eating less and exercising more. In addition, we should eat less saturated fat and trans fat, more fruits and vegetables, fewer sweets and more whole grains. We should eat no more than 300 mg. of cholesterol daily. We should choose more low fat dairy products. About the only thing that is actually new in the 2010 Guidelines is a tougher recommendation on salt restriction: 2300 mg. per day for those under 50 and 1500 mg. per day for those over 50 or with high blood pressure.
Yet reading the reaction to these guidelines, one would think that the USDA had done something cataclysmically. Here's what the LA Times reported:
"I’m in shock," writes Marion Nestle, an author and New York University professor who has followed these proceedings and written about the politics of them for years:
"The new guidelines recognize that obesity is the number one public health nutrition problem in America and actually give good advice about what to do about it: eat less and eat better. For the first time, the guidelines make it clear that eating less is a priority."
Yes dear readers, sadly it is amazing that the USDA suggested that we actually eat less. Previous committees have been so influenced by the food industry that they were afraid to come right out and suggest we should cut back on food. That's why earlier guidelines were heavy on language like, "choose more fruits and vegetables" and light on recommendations like "stop with the Ring Ding already". So OK, I get it. Marion Nestle is stunned that the USDA finally had the guts to suggest we cut back. But let me ask you; is there anyone in today's America who doesn't actually know that we have to eat less? Was this a revelation to Tom Vilsack when he saw those guidelines for the very first time? I mean, honestly!
Instead of being impressed by the oh-so-subtle changes in the new guidelines, we should be taking a good hard look at why no one pays any attention to them. Maybe it's because they are ponderous, over scientific, impossible to follow, boring, and ultimately don't lead to dietary success (at least as far as weight control is concerned).
Our dietary guidelines show an enormous lack of imagination, both in the way that science is interpreted and in the way they are marketed to the public. What follows is my own (admittedly highly biased) critique of selected sections and some thoughts about how to make dietary information more relevant.
The report which accompanies our new guidelines begins this way:
"Although there is no single “American” or “Western” diet, average American food patterns currently bear little resemblance to the diet recommended in the 2005 Dietary Guidelines for Americans."
In other words, the recommended guidelines have been completely ineffective. Rather than simply restating the guidelines, we should be asking why they don't work. I believe there are several obvious reasons. The first is that the extremely seductive messages sent by the food industry (continually and at great expense) have won out. Food is fun and Americans are simply not convinced in any serious way that their habits are extremely dangerous. While the USDA timidly suggests that we should eat less, they take but a tiny swipe at the food industry, it's practices and it's methods. There is a small section on the "Obesogenic Environment" and it opens with the following statement:
"Ultimately, individuals choose the type and amount of food they eat and how physically active they are. However, choices are often limited by what is available in a person’s environment, including stores, restaurants, schools, and worksites."
There follow two paragraphs, one about the increasing calories available in our food supply and one about the research suggesting that BMI increases with the number of fast food meals eaten weekly. That's it. Ultimately, as the lead-in states, it's up to the individual. The continued refusal of the Guidelines committee to lay any blame at the feet of the food industry weakens their conclusions. I think we all realize that, other than lack of willpower, there is another, enormous, overwhelming influence on why Americans eat poorly that is never discussed.
A second reason that the Guidelines are ignored by most Americans is that a lot of them don't translate in the real world. Here, for example, is one of the Key Recommendations:
Consume less than 10 percent of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids.
I talk to people about how they eat every single day. I can assure you that not a one is actually figuring out how many calories come out to 10 per cent of their total and then further calculating how to replace their saturated fatty intake with polyunsaturates. No one lives this way. Haven't we figured that out by now??? If you actually decided to read the guidelines, you'd be skipping advice that read this way.
Here's another example. The committee writes of their decision to give up the concept of "discretionary calories", a term that was part of the 2005 Guidelines:
"The 2005 DGAC defined the term “discretionary calorie allowance” as “the difference between total energy requirements and the energy consumed to meet recommended nutrient intakes” (DGAC, 2004). Discretionary calories were intended to represent the calories available for consumption only after meeting nutrient recommendations and without exceeding total energy needs. Unfortunately, this concept has been difficult to translate into meaningful consumer education".
Gee. You think?
The third reason that I think the Guidelines fail to be compelling is that a great many Americans do not actually feel that they need better nutrition. On the whole, we are a pretty well fed country. What many would like to get from the Guidelines, however, is a way to control their weight. On this point, the Guidelines are a failure and so, in my opinion, many people ignore them. (Just to clarify: Obviously nutritional guidelines are important on other levels. I am not suggesting we abandon them.)
Here is a dream I have. One bright day, a bunch of nutritional thinkers wake up each with the same thought. ‘You know, we've been telling people to eat less and exercise more for 30 years and we've got a hugely overweight country. Everyone is coming down with diabetes. The kids are fat. Heck, even our pets are fat. Wait a minute! Wait a cotton-picking minute!!! Maybe we're giving the wrong advice. Maybe we should think about other explanations, other reasons we might be gaining weight, other ways to solve the problem.’ They convene a summit and brainstorm for weeks on end. Then they try something different.
Just a dream.
Instead, here is what we get:
"Calories consumed must equal calories expended for a person to maintain the same body weight. Consuming more calories than expended will result in weight gain. Conversely, consuming fewer calories than expended will result in weight loss. This can be achieved over time by eating fewer calories, being more physically active, or, best of all, a combination of the two."
Where have I heard this before? It would be great if it were true. Unfortunately, the efficiency of the body prevents this from being more than a short term solution. This simplistic statement completely avoids the real truth which is that almost everyone who loses weight regains it. It does not take into account the fact that it is the automatic caloric balancing mechanism of the body that decides about weight. We are for the most part unable to balance our calories by force of will. How long can you breathe willfully before the automatic mechanism designed into your genes takes over? In my world view, we need to heal the mechanism that balances our calories naturally, not try to overwhelm it with counting and marathons.
As our country ages, more and more of us have gotten fat and have tried to lose weight. The simple "solution" above rings hollow. It hasn't worked for most of us, yet we keep being told that it must and if it doesn't, the fault is ours. Interestingly, soon after making the statement above, the Guidelines Report voices this vexing contradiction:
"Maintaining a healthy body weight and preventing excess weight gain throughout the lifespan are highly preferable to losing weight after weight gain. Once a person becomes obese, reducing body weight back to a healthy range requires significant effort over a span of time, even years."
If it is true that weight loss is simply a function of cutting calories and exercising more, why does it become more difficult after one has been obese (as it surely does)? The fact that this is true suggests that something becomes disordered or "broken" once weight is gained and that it is this process, and not simple calorie balance, that is at the heart of the problem. This is what I personally believe, but this possibility is rarely discussed.
So we are left with this summary Key Recommendation:
"Maintain appropriate calorie balance during each stage of life—childhood, adolescence, adulthood, pregnancy and breastfeeding, and older age."
Since these ineffective suggestions for weight reduction have been available in every issue of Family Circle for the past 25 years, it is no wonder the 2010 Dietary Guidelines for Americans are kind of a snooze.
How then to improve matters?
Short of having my dream become reality, I have a few ideas.
1. Get the Guidelines out of the hands of the USDA.
Since major criticisms have always involved the fact the USDA supports agriculture and therefore cannot honestly produce tough guidelines, why not move this task elsewhere? How about the Department of Health or the NIH? The NIH especially has a reputation for good science and protecting the public welfare. And they don't have to worry about what the milk or beef industry has to say.
2. SIMPLIFY. A LOT.
I hate the fact that eating has become about counts, percents, and nutrients. You know, it's really just about food. Detailed info is fine for dieticians, nutrition enthusiasts, and researchers, but the rest of us need simple rules. You already know what I would say: Eat like your ancient ancestors did. Therefore, whenever you can, avoid things made in factories. Eat mostly lean animal meats and poultry, fish, seafood, eggs, vegetables and fruits, nuts and berries. I prefer to emphasize the plant side of that equation. If you tolerate dairy and don't gain weight, it's probably ok. Minimize grains or avoid completely (including things made from grain flour like pasta and bread, cakes and so on). Beans and other legumes depend on what they do to your weight. Don't eat sugar. Someone else could make up a similarly simply set of rules. They might not be mine, but they'd be easier to follow than what we've got.
3. Make Being Healthy Compelling
We can't convince people that eating well and staying lean is important unless they truly understand the dangers associated with bad eating. The internet could be a great and inexpensive educational tool for showing what livers full of fat look like, how fatty liver leads to scarring and cirrhosis, what happens to the inside of your blood vessels when your sugar gets too high, and how fat in the gut gets invaded by nasty inflammatory cells and pours out deadly chemicals into the blood. Kids should get this information in school and it should be repeated periodically. I will always remember that in medical school, the few students who still smoked dropped the habit pronto after we saw actual samples of lungs filled with tumors and emphysema. Our body remains a mystery because the interior is hidden from view, but now we have the tools to show people what is actually going on inside of them. We should use them.
4. Take on the Food Industry
These guidelines are tedious because they only talk about the many things that we must do. Balance this, get enough of that, reduce something else. It's like being told you should be well-behaved and polite when you know that the moment you leave school the class bully is going to beat you up. Worse, when you tell the teacher, she blames YOU! If government agencies are going to tell us what to do, they have to tell the food producers what to do as well. There's no point in trying to play the game on a playing field that isn't level and I think most of us are tired of it.
Phew. It felt good to get that off my chest. Now that I'm done ranting, I'm off to eat some grapes. I have no idea how many calories I ate today, yesterday or last week. I only know that since I stopped eating sugar, starch and processed food, my weight balances itself and my nutrition seems to be very comfortably on auto-pilot.
Let's get the off-putting facts out of the way first. Metabolism slows down with age meaning that your body burns fewer calories each day. Prior to menopause, estrogen directs fat storage into the hips and thighs. Once estrogen is gone, storage can occur preferentially in the belly creating the famed "mena-pot".
While these things are true, they don't have to mean anything. Is it possible to lose weight and keep it off later in life? Absolutely.
Over the years, some of my most successful long term weight patients have been over 60. When new clients tell me that they are worried about their inability to lose because of age, I show them a picture of my mother who had a major weight loss in her mid 80s and continues to control her weight now at 92. Because of two bad knees, exercise was out. She also has an under active thyroid. Weight loss has always been tough for her. Nevertheless, she did it without a problem.
The post-fifty weight loss issue is only a challenge if you misunderstand the basics. If you believe that weight loss and maintenance is achieved by starving and running the marathon, you will be justified in seeing major impediments at older ages. Many people give up on trying to stay at a healthy weight because of just such thinking. It's common to hear this one: "Oh well. I'm in menopause now so weight gain is inevitable."
Let's return to the basics, because these fundamentals become even more important when someone is older or post-menopausal. Overweight occurs when your body stores fat (that's a normal physiologic function) and then is unable to burn it off again (that's not normal). If everything is going just right, your fat cells should be open at all times, able to store fat and then release it again when it is needed for momentary energy needs. If you are making a lot of the hormone insulin, your calories will go into fat storage but they won't be able to get out. It's a one way valve. If you drop insulin levels, fat flows freely out of the fat cells. (And let me remind you once again that what starts insulin going is eating sugar, starches or grain).
One of the most important considerations for those over 50 is not lowered metabolism, but that fact that we become increasingly insulin resistant with age. Insulin resistance means that we make more insulin when we eat carbs than we used to and that insulin levels tend to stay higher throughout the day. Thus, more trapped fat; more difficulty losing.
For those with weight problems over 50, the adoption of a diet that eliminates carbohydrate (except for fruits and vegetables), is key. Understood this way, you can see that the number of calories burned a day (metabolism) is secondary to the way calories are utilized. Essentially, you cannot utilize calories properly is you are making alot of insulin. Similarly, the fact that excess fat in post menopausal women lands in the belly is unimportant. Our aim is to avoid storing excess fat in the first place. Thus, where is goes is immaterial.
Here's one piece of very good news. I have found that it is often more possible for my patients over 50 to make the necessary changes in their eating habits than it is for younger patients. If you have been eating bread, pasta, potatoes and sweets for a whole lifetime, it's often now possible to take a "been there, done that" attitude. At 50 plus, all of us become concerned about our longevity and more specifically, about living out the rest of our years in optimal health. With the greater knowledge we have, and with a lifetime of having accomplished things already behind us, it suddenly becomes ok to try something new. Then too, the more mature we are, the less interest we have in conforming. This makes it easier to tell friends and family that we simply don't eat certain foods any more.