• Archives
  • Oct27

    One of the most vexing things about trying to lose weight is your mood. In the beginning, my (adult) patients can be a little grouchy, even if they are losing pounds, not flavor, using culinary medicine.

    Even if they’re depressed, anxious, schizophrenic or bipolar and on prescription medication. And especially if their weight gain is from their medicine.

    Newer medicines like Seroquel, Abilify, Zyprexa and Risperadal are promoted because they have fewer medical side effects, like tardive dyskinesia, than older psychiatric medicines. And they do.

    But these newer medicines also have a higher cardiac risk than the older ones, and the leading cause of death in the mentally ill is heart disease.

    And the new medicines don’t have less weight gain for kids, as has long been known for adults.

    A recent JAMA report studied 255 students taking the drugs: they gained between 8-15% of their body weight in about 12 weeks…between 1 and 1.5# per week.

    The Biggest Gainer? Zyprexa. :(

    In adults, the superiority of these “atypical antipsychotics” over traditional ones for schizophrenia is debated, but the need for all adults to be a healthy weight is not.

    What to do?

    When I did an online forum with dr-bob.org on obesity from psych medication in 2003, the response was overwhelmingly interested and eager. These people really need help.And deserve it.

    It turns out that many of the same strategies and tactics help them as help other people keep weight off once they lose it.

    My favorite are these 4, from the National Weight Control Registry:

    “78% eat breakfast every day.

    75% weigh them self at least once a week.

    62% watch less than 10 hours of TV per week.

    90% exercise, on average, about 1 hour per day.”

    The bottom line? Don’t stop taking your medication. Find a clinician and trainer you can work with for a fitness program. Work with them. Keep at it.

    If your child is being treated for a mental illness, ask your psychiatrist if there are alternative therapies you can try: the long term risks are substantial.

    You can succeed if you plan, and if you believe. Even if it doesn’t seem like it, you can!
    John La Puma, MD

     
  • Sep1

    Terri is a 38 year old who traces her tummy problems back to high school. She has had off and on again fatigue, cramping, gas, bloating and mood swings. She has seen 11 doctors, and been told she is a “diagnostic dilemma” and has “atypical bowel syndrome.”

    No wonder. Terry has celiac disease, one of the few diseases that can absolutely be caused by—and cured by—what you eat.

    The protein called gluten (in wheat, barley, rye and several other grains) is the problem. In over two million Americans – 1 in 133 – gluten results in damage to the lining of the small intestine. That makes it hard for the body to absorb what you eat. Irritable bowel syndrome, Crohn’s disease and depression can mimic and mask celiac disease.

    The medicine? Savory, toothsome, gorgeous gluten-free pasta, nuts, vegetables, meats, seasonings and even beer. They can heal and reverse insomnia, depression and even osteoporosis in people with celiac disease.

    Terri re-discovered cooking and began to cure herself.

    She learned to simmer brown rice and millet in stock, toasting them first for a little nuttiness, and using the pilaf method for full flavors.

    She gave up oatmeal, so often processed on wheat-processing equipment, and discovered quinoa.

    Quinoa is an ancient, quick-cooking, high-protein whole grain with all 9 essential amino acids. You can use it as a side dish, as a bed for roasted vegetables and meats, or as a better-than-oatmeal hot breakfast cereal (see below).

    Terri did find gluten in everything—cosmetics, soy sauce, toothpaste. You’d think she might have just given up. But in fact, she found it empowering to discover what was in what she ate. And that good food, gluten-free, was the only way to heal herself.

    So she did. She filled herself with the best ingredients—for her. Food became a joy and pleasure, because she tasted it fully, and didn’t overeat. And it changed her life.

    Terri felt better than she had in 40 years! She dropped 15 pounds over four months. She learned that her son’s diabetes indicated his risk, so he had the celiac blood tests, which were normal.

    There is four times as much celiac disease in the U.S. as there was 50 years ago. No one knows why. Celiac disease is easy for doctors to miss: no one physician these days can often take the time to hear all of the patient’s symptoms. So nearly all of those who have Celiac Disease have not been diagnosed.

    Terri’s case inspired me to create Gluten Free Quiz (www.glutenfreequiz.com) a free, personalized self-assessment of your risk for celiac disease. The completed quiz and your Gluten Free score can be printed from the Web site for personal use and to discuss with your doctor.

    Could eating gluten-free really reverse Terri’s insomnia, anemia and fatigue? And taste as good as what she loved to eat, before she found food that her body would love?

    Yes it can, including my Warm and Nutty Cinnamon Quinoa Cereal…photo on 101cookbooks.com, and courtesy of Heidi Swanson!

    John La Puma, M.D., practicing physician and founder of The Santa Barbara Institute for Medical Nutrition and Healthy Weight, is a professionally trained chef and has pioneered culinary medicine. Dr. La Puma hosts “What’s Cooking with ChefMD?” every week on “Health Corner” airing Sunday mornings on Lifetime TV. He videoblogs on ChefMD and shares a new, fun, easy, healthful and quick recipe every week. You can follow him on Twitter, become a fan on Warm and Nutty Cinnamon Quinoa Recipe from ChefMD\'s Big Book of Culinary Medicine, and watch his videos on this site.
    Follow John La Puma, MD on Twitter: www.twitter.com/ChefMD

     
  • Apr17

    Your Financial Prescriptions: Seven Tips for Cutting Your Medical Costs (Wall Street Journal 04.07.09) completely missed the biggest potential tip of all: what you eat.

    The right health insurance? Check. Compare hospitals? Check. The right health insurance again? Check. Check your hospital bill? Check. Taking the meds you need? Check again.

    Food? Exercise? One line, out of hundreds.

    Dollars re-allocated from a conventional diet to a better one have been shown to deliver a significant return on investment. Not to mention a potentially tasty one.

    An Australian 2007 cost-effectiveness review of ten nutrition interventions found that each were more cost-effective per life-year gained than antihypertensive medications and the cholesterol-lowering medication simvastatin. Cost savings ranged from $1364 to $13,939 per life-year gained.

    A Swedish 2007 cost-effectiveness study found the Finnish Diabetes Prevention Study for men and women at risk to be “cost-saving from the healthcare payers’ perspective,” and increase survival by 0.18 years.

    A French 2006 cost-effectiveness study based on the randomized, controlled Lyon Diet Heart Study and conservative assumptions, found the Mediterranean Diet to be “highly cost-effective for persons after a first myocardial infarction and represents an exceptional return on investment.”

    But you don’t need to wait for better food in the cafeteria to lower your direct medical costs and improve productivity. Although that would help.

    Spend a little more at the grocer’s and you’ll spend a lot less at the doctor’s. And be happier, too.

     
  • Mar8

    I’ve promised to tell you what I tell my own patients in Santa Barbara.

    What I really do for my own patients is listen. A lot.

    What I am listening for is something that she is really good at.

    Is she a great communicator or does she talk to herself? Is she analytical in any way? Is she adaptable or does having more than one thing to do throw her for a loop? Is she a follower or a leader? Is she thrilled with aesthetics or does auto mechanics make her heart sing? How does she organize her day?
    Whatever your primary set of skills, it can be channeled into permanent weight loss. Learning to use your friendship, your chart-making, your creativity to lose weight and keep it off is how people succeed long-term.

    Of the thousands of people in the National Weight Control Registry who have lost an average of 66 pounds and kept it off over five years

    o 78% eat breakfast every day.
    o 62% watch less than 10 hours of TV per week (even my ChefMD show!).
    o 90% exercise, on average, about 1 hour per day.

    Every dieter knows that it’s not a ratio of carbs to fat to protein that matters most.

    It’s feeling full and fully satisfied. It’s making plant foods sexy. It’s having enough choice. It’s keeping and celebrating times to indulge. Try my Apricot Breakfast Polenta…and taste the magic!

    John La Puma, MD

     
  • Nov29

    The culinary medicine questions I’m asked most are about weight loss. And losing weight does help many medical problems: in fact, food can work like medicine in the body. The trick, often, is to make sure it tastes like food, not like medicine.

    Acne vulgaris–young adult acne–is very common. Skin pores become clogged and infected, and can too easily ruin self-esteem and self-confidence. Medication often helps, and should be used as appropriate.

    Foods that can help are those with lower glycemic loads. These foods improve insulin sensitivity, which slows acne growth. That means whole foods: more vegetables, whole grains, lean meats and poultry, fish and shellfish, nuts, and many fresh fruits, but not all.

    Foods to avoid are foods with higher glycemic indices: sodas, candy, cakes, fast food: ever notice the skin of kids hanging out at the convenience store? Not a coincidence. High GL carbs foods here increase insulin levels, decrease insulin sensitivity, and androgen in the bloodstream. Not a coincidence.

    Avoid lowfat and nonfat milk, which contain too much insulin-growth factor 1, which is out of balance with other dairy hormones: “consuming dairy products from pregnant cows exposes us to the hormones produced by the cows’ pregnancy.” Although this isn’t a recommendation for whole milk, at all.

    Of course, you want to eat recipes, not just foods. Try my Poached Salmon with Sauteed Kale and Warm Cherry Tomatoes: it’s easy, fast and delicious…and low GL.