Refuse To Regain

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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Habit and Reward: Good for Target, Good for Maintainers

By Barbara Berkeley, MD

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

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

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

So, I see two avenues to explore.

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

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

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

 Habits never really disappear.  Words to live by.

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

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

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

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

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

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

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

 

Tied to the Mast

by Barbara Berkeley, MD

 Odysseus, the wandering protagonist of Homer’s Odyssey, had a healthy fear of temptation.  In Greek mythology, sailors were regularly lured to their deaths by Sirens, creatures who sang a beautiful and irresistible song.  Entranced by the song, these sailors steered toward the call and were dashed to pieces on the rocks.  

 In order to avoid this fate, Odysseus ordered his crew to plug their ears with beeswax and to tie him firmly to the ship's mast.  On hearing the Sirens' song, Odysseus himself could not resist and begged to be untied, but since he had instructed his crew to ignore him, they refused his pleas.  Thus, the ship was able to sail safely past danger; but only because Odysseus was smart enough not to underestimate the power of temptation.

The Odysseus story is mentioned in a recent article that detailed the effectiveness of offering restaurant-goers the choice of smaller servings.  I loved the analogy. 

Negotiating the modern food world so often seems like sailing through Siren filled waters.  The call of the brownie is so sweet, the bowl of M & Ms looks so jolly, the Ben and Jerry’s packaging is so alluring…and that  fresh baked bread?  It’s the staff of life, isn't it?

Until we crash into the rocks. 

As our doctor reveals that our fasting blood sugar is now above 100 and pulls out the prescription pad to treat our rising blood pressure and refill our Lipitor, we may suddenly realize that we’ve been had.  Lured like bugs on sweet sticky-paper, devoured by the fragrance of the Venus fly-trap…

The work of maintenance, the life work of maintaining, is to learn to navigate these waters and, to some degree, to discover how to bind ourselves to the mast.  Temptation will always surround us and we need to find a way to deafen ourselves to the call.  But how?  Perhaps you will add your own perspectives, but these are some of the ways I have found to be effective:

1. Temptations lose potency when they are not reinforced.  For this reason, I advise most people to practice avoidance of trigger foods and to do this as completely as possible.  Don’t make exceptions for birthdays, retirement dinners and cruises.  The more you exclude triggers, the less power they will have over you. 
2. Reduce exposure to the Sirens by avoiding the places where they live.  Don’t detour unneccessarily into the cookie aisle or start a long conversation with a friend in front of the bakery window.  Avoid restaurants where the main thrust of the menu is food you can’t eat. 
3. Ban the Sirens from your presence.  Do this by not inviting them into your home, by asking that they be taken off desks that adjoin yours at work or removed from plain sight in break rooms.   
4. Finally, tell your crew not to listen to your pleas.  Make it clear to friends and relatives that you simply don’t eat certain foods.  They will be embarrassed to serve them to you and you will be embarrassed to ask for them in their presence.  Enlist those who are close to you in supporting your goals.  If you plead for cake, make sure that your allies remind you that you'd really rather not.

How do you avoid being dashed on the rocks?  Send me your strategies.

 

 

 

 

 

 

Life on the Island

by Barbara Berkeley, MD

No man is an island entire of itself; every man is a piece of the continent, a part of the main….. John Donne, 1572-1631

As John Donne famously observed, each of us is connected to the other and to the larger world.  In free societies, our belief in personal liberty often obscures this point.  We are free to choose, or so we believe. But our freedoms are enormously affected by the influence of the culture in which we are immersed, by the very connections that make us human.  Are we choosing or are we being led?  At no time is this question more pertinent than in an election year.  Our political choices are based on the information we learn from PACs, Super PACs, newspapers, TV pundits, the opinions of friends, and finally...our own observation.  How free is our choice?  Pure freedom of choice depends on the degree to which we want to unearth and establish the unvarnished, un-spun truth.  This kind of fact-finding requires a serious amount of focus, time, and commitment. 

And so it is with our dietary choices.  We may feel that we have the freedom to choose how we eat.  We are certainly told that we do.  If we choose to eat badly, it’s our own fault isn’t it?   But I observe a quite different reality.  In fact, our freedom is severely tested and influenced by the enormous weight of a food culture that condones, encourages, and normalizes a quite different message.  Eating is a sport, a right, an ultimate enjoyment to which we are all entitled.  Further, modern food is not bad... it’s GOOD.  It is only our choice that is poor.  Swimming away from that cultural current can be like opposing the force of the ocean.   The water looks calm, but we are actually caught in a rip tide.

This is the reason that making an analogy between successful maintenance and life on an island so appeals to me.  In order to avoid the influence of the food culture, we have to absent ourselves from it.  We have to live, to some degree, outside of it.

How is this done?  Some do it by becoming fierce proponents of diets that don't look anything like the modern American plate: vegan, vegetarian, paleo.  Others become immersed in the world of nutrition and fitness.  They blog, take courses, become trainers, write books, become experts.  But for the vast majority of maintainers, it's a matter of applying a set of mental blinders.  They doggedly focus on the road ahead, follow their plan, and try not to be overwhelmed by the flood of food messaging.

Maintainers can feel both proud and lonely.  They sit on an island while the rest of the world swims in a sea of food all around them.  Often, it’s hard to avoid jumping back in the water.  It looks like so much fun that it’s easy to forget what it took to get up on dry land.  It's hard to remember that we once felt like we were drowning. 

Since we are social beings, connected to one another whether we want to be or not, it’s easier to stay on our island if we know that we are not alone.  Those who belong to a diet subculture (like the vegans, vegetarians and primalists referenced above) have websites, books, and mentors to follow.  But for all maintainers, a vital task is finding other people who live on the island.

As you know, I run a monthly group for maintainers in the Cleveland area.   After a couple of years of meetings, those of us who participate have discovered that we never run out of things to say.  For many in the group, the maintenance of a significant weight loss is the defining challenge of their lives.  They never tire of discussing the process.  They also enjoy sharing their observations of what’s going on off-island. Viewed through the eye of the group, the behavior of the rest of the world seems nonsensical at times, almost incredible.

Month after month we repeat the truth to one another.  It’s the truth of our island culture, not the truth of the world according to the Food Network.  We congratulate each other, support each other when we venture a bit to close to the water’s edge.  It is an enterprise that I highly recommend to those of you who are maintaining out there on your own.  I offer my support if you would like to try starting a group in your area.  Email me and I'll help as much as I can. 

Form a group.  Define your culture.  Meet your neighbors.  An island can be a pretty beautiful place to live, as long as you are not alone.