• Archives

  • May13

    Feeding Tube Diet: Unhealthy or Usual Business?

    Posted in: Obesity and Weight Loss, Wellness and Health

    2 weeks after the New York Times broke this, it’s still here: covered on 20/20 Friday and Forbes still has it front and center (my comments are highlighted): 10 days of fat and protein or just protein, 800 calories, 24/7 insertion, $1500 (not including the “trade secret” formula) and bam- 20# off. Or your money not back.

    Only organized medicine seems uninterested, despite documented and numerous side effects (sinusitis, aspiration, misplacement, puncture) of this medical device.

    It’s easy to gasp at the expense, at the brazen short-cut, at the lack of interest in getting to the root cause, at the water weight loss, at the disassociation of bare nutrition from flavor (really!) and from legitimate medical uses. (I have taken care of many people with feeding tubes who wish they didn’t have to have them, and certainly did not seek one out).

    But it’s also easy to appreciate the pressure people feel to lose weight, to see that they are burning fat and do lose their appetite, to empathize with people who often wish for another life and see this as a way to gain access, to invest in the marketplace of weight loss commerce, to try something new. The diet/exercise as it is often pitched often fails, so if this fails, all you have lost is money, time, a little dignity.

    Is this worth standing up to and saying: why not just use a piece of duct tape?

    Or is it not worth getting worked up about?

     

  • Feb6

    Overweight but Malnourished: How? What to Do?

    Posted in: Common Conditions, Obesity and Weight Loss, Wellness and Health

    TOTAL CALORIES: 24,375 TOTAL GRAMS OF FAT: 1,285 TOTAL COST: $86.47

    My patients eat a lot of calories, but are actually malnourished.

    Your brain doesn’t count calories–it counts nutrients. But there are few (worth absorbing), and it’s hungry for more.

    Your stomach is empty and growling but you just ate.  Too many calories, too few nutrients. Brain poop. (Conversely, a low starch, higher healthy fat Mediterranean diet seems to fight brain damage).

    Belly fat is toxic, and sugar and starch cause its accumulation, not fat.

    Belly fat lies adjacent to the liver, mainlines fat there and you end up with foie gras as a liver.  Which is still illegal in my sweet home Chicago, a true paradox.

    The kidneys get squeezed, and you get high blood pressure. The number one hormonal organ in your body, if you’re overweight, may well be your belly fat.

    80 million Americans are diabetic, or pre-diabetic. That epidemic is going to destroy our health as a country.

    Doctors treat with medicine, because those are the weapons that we were trained to offer.  But they’re only band-aids, and as effective as French Fries on a heart patient’s hospital menu.

    Diabetes medicines often cause more weight gain. So do some common high blood pressure medicine–beta blockers, for example, slow down your pulse and with that, y0ur metabolism.

    But there is hope.  Nearly 90 percent of type II diabetes are reversible.  Having high cholesterol is often reversible, without statins. Controlling high blood pressure with your lifestyle and healthy self is within your reach.

    The environment takes decades to change.  But you can change your own habits tomorrow.  One small step at a time.

     

  • Nov8

    Research on Men: Why They Don’t Go to Doctors (and what might help)

    Posted in: Aging and Costs of Aging, Common Conditions, Obesity and Weight Loss, Wellness and Health

    At KevinMD, Dr. Joel Sherman writes smartly about why men avoid going to the doctor.  One reason: it reminds them of mortality. A second reason: a potential prostate exam. A third: they have to wait, a lot. Plus, telling a female receptionist about a male-related problem is not great.

    Note to middle aged men: erectile dysfunction is an early warning sign for heart disease, until proven otherwise.

    Men get more heart disease and die younger than women. Going to the doctor is usually an event (a screening exam, unable to move because of back spasm or broken limb) rather than a process (cancer prevention, for example).  Research on men backs this up.

    In my office, men often come in for lifestyle advice, weight loss help or nutrition consultation if they have a close friend or relative who recently became ill. Say, someone who had a high calcium score (over 400) or had a heart attack or prostate disease diagnosis.

    That’s especially true in men under 60; men over 60 know they need to protect their health. And they know that seeking help is an acceptable behavior, as is staying healthy.

    Sometimes another doctor requires them to come in, or a wife/girlfriend/mother/daughter/lover makes them. It takes courage to come in.

    45% of men don’t have a primary care physician, and 10% can’t remember when they last saw a doctor. 9% would avoid doctors even if they had blood in urine or semen.

    On KevinMD, above, a nurse writes about her husband: “He’s a little overweight (20lbs).  He says, “I’ll go when I lose weight”.

    It’s understandable that men feel that way.  But not necessary. What if it was a game, or competitive, or there were rewards involved, or it was actually fun?

     

  • Oct28

    Weight Regain: Not Your Fault. It’s Your Hormones. But Which?

    Posted in: Child Obesity, Obesity and Weight Loss, Wellness and Health

    34 people whittled down from 50 were followed over 16 months after a 10 week crash diet and lots of counseling: they lost 29# on average, and gained back 12#. Their hormones (leptin, peptide YY, cholecystokinin, insulin, ghrelin and gastric inhibitory polypeptide) continued to scream…eat!

    And they were hungry, thought about food, and wanted to eat way more than when they started.

    This is a very small study with no control group: it’s not the last word, except that maintaining is harder than losing.

    But it’s getting lots of attention, because it proves something every dieter hopes: it’s not my fault. And that’s right: keeping weight off is not about willpower: it’s about planning.

    It’s not my fault that I started eating tortilla chips, fudge ripple and layer cake. It’s not my fault that I feel like eating and I’m hungry all the time.

    My take: Yes, your hormones are screaming. And yes, you can plan for it. Thousands already have, and won.

    Over 5500 people nationally have shown that you can lose 66 pounds on average, and keep it off for an average of 5.5 years.

    I’m proud that some of my patients are in that group. And you can be too–it takes being accountable, and taking a first step.

    Two quick reality checks: first, the researchers didn’t measure estrogen and testosterone: I think these hormones, especially for men, figure in to weight loss and maintenance.

    And second, your hormones are not destiny. You are not your pancreas, or adrenal or thyroid, or inner GI track: after 50, your health is mostly your choices, not your genes.

     

     

  • Sep13

    Belly Fat for Women: the Dr. Oz 5 Step Plan

    Posted in: Aging and Costs of Aging, Common Conditions, Obesity and Weight Loss, Wellness and Health, Wine and Tea

    Dr. Oz debuted his 5 Step Plan for Women Over 40 Who Need to Lose Belly Fat last night, and I spoke with Shirin Rafaee of KEYT, our ABC affiliate, about it.  No surprise here: women’s needs are different from men’s weight loss needs.

    Belly fat in men and women poisons your liver, blocks muscle from using sugar, and squeezes on your kidneys.

    And the perimenopausal loss of testosterone, thyroid hormone and melatonin make it harder for women to build muscle, burn calories and sleep well.

    His 5 step plan:

    1. Eat dinner for breakfast (i.e., eat more calories in the morning than late at night):

    The usual pattern is runway eating: start off with a small meal, and eat all your calories at the end of the day.

    2. Have a glass of red wine daily (i.e., the resveratrol may interfere with fat synthesis, and other red wine polyphenols may inhibit aromatase, an enzyme made by belly fat that converts androgens to estrogens).

    Men typically add alcohol to what they eat, whereas women are more likely to substitute alcohol for food.

    3. Get 25 grams of mixed fiber daily: psyllium husk, oranges, bananas, Kashi cereals.

    Men need 38 grams per day. Both men and women need a lot of water to hydrate that fiber, so it’s not concrete.

    4. Use a belly band (aka tape measure) to get your waist under 32″: inexpensive on ebay.

    For men, the optimal number is 37″.

    5. Confuse your muscles (aka mix it up: Tuesdays for arms and Fridays for legs dumbbells; a few weeks later, use kettle bells or resistance bands; a few weeks later, pilates)

    In women, the loss of estrogen is the main reason it’s hard to lose belly fat after 40: plus, your metabolism winds down 5% every 10 years, unless you work at it.

    But with a systematic, structured program, belly fat can be belly flat.

     
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