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.  

 

Silly Season

by Barbara Berkeley, MD

In January, the attention of Americans turns to weight loss.  Retailers exploit this interest, displaying towers of shiny new diet books.  The media pumps out stories, offers tips and guidance (the same tips as every other year) and earnestly discusses the ways to make our New Year's resolutions work.  Gyms fill will newbies.  Thankfully, it will all be over in a couple of weeks and those with the serious intent of changing their lives will be able to go back to work undistracted. 

January is an odd time for self renewal.  Yes, the calendar turns a page and we move into a new year.  The business cycle starts anew.  But for a good part of the United States, January is a cold, unfriendly month.  It's hot soup and mashed potato time, the very month when a little extra fat feels good.  In Cleveland, the prospect of heading out for a run through slushy streets covered by slate gray skies is a tough sell even for career exercisers.  

Of course January is weight loss month because it is preceded by the season called, "I Have to Eat It, It's the Holidays".  We have developed an unfortunate cycle of gorging and disgorging on a yearly basis.  This mirrors the shorter cycle we run more frequently throughout the year:  eat things we know we shouldn't, gain weight, then diet to get them off.   The problem, as we are all well aware, is that we eventually reach a point when we can't get the weight off anymore.  We burn out, allow the higher weight to become our new reality and start adding extra pounds to that new base.

I know that I am preaching to the choir, but the reason that weight resolutions and periodic diets don't work is that they have nothing to do with the real work of making oneself healthy.  That little chore requires commiting oneself to a new way of viewing food and to new personal and permanent rules about how to eat.  These rules include guidelines for such things as exceptions.  Over the holidays, some maintainers may allow themselves a certain amount of indulgence for example, where others may stick strictly to their daily plan. But it's programmed.  Flying by the seat of one's pants is a rarity among maintainers, who are well aware that the food winds blow with gale force.  Crashing is likely unless someone has a close eye on the rudder.

January, then, is the silly season for weight loss.   This month's People leads with the popular "Half Their Size" feature.  Here are the amazing before and after photos, the airbrushed picutres of beautiful women in their skinny jeans, and the tantalizing promise that anyone can lose a mere 100 pounds or so.  The guidance for wannabes?  One woman hung a bikini in her garage and looked at it while she worked out on the elliptical.  Another ate a lot of spinach; she suggests you take weight loss 5 pounds at a time. To People's credit, they do provide a section that features subjects of the Half Their Size issue in years past. These successful maintainers look inspiring, but the amount of useful information that accompanies their stories is miniscule.  How are they doing it and what made them able to do what they couldn't before?  That's the information that might help a curious reader, but it's not included.  These features are strictly about the photos.  There's no room for content.  

Us Weekly has a cover that touts "Diets that Work" and suggests that each of us can have legs like JLo and Rihanna's abs.  The diet guidance below each photo of skinny women in shorts and bathing suits is mostly useless. One woman did 2 1/2 hurs a day of karate and boxing while training for a movie (try that after getting home from a day at the office!), another does sessions that "shorten the muscle fibers", a third practices "portion control".  In addition to sparse information, the women in these photos are mostly in their mid 20s, a time when dieting tends to work. What does any of this mean for the 50 year old empty nester who has been struggling with slow and steady weight gain for ten years?  Here's my favorite quote from Us Weekly. It comes from Mariah Carey, who has been up and down the scale more frequently than Kirstie Alley.  Once again she is at a  smaller size and is now a spokesperson for Jenny Craig. Carey says of herself, "I'm extremely disciplined."  Hmmmm.  

Silly season tips abound.  The sillier the better.  Here are a couple of great ones:  Eat with large forks.  Spice soup with pepper.  Put coconut oil in your coffee to "increase metabolism".  Oh my.

If silly season has your head spinning, here's what I suggest:

1. Cover your ears and close your eyes.  There's too much information out there, most of which is ineffectual or just plain wrong.

2. Make a resolution, but not a weight loss resolution.  Instead, resolve to begin the process of making yourself an all around healthier person, someone who will feel good and live well over an extended lifespan.

3. Pick a time of year when you will begin.  It doesn't have to be tomorrow.  It does have to be a time when you won't have immediate challenges from food....challenges like weddings, cruises, or birthdays.  Give yourself a month when you aren't forced into situations when food is likely to win.  Start with some breathing room in front of you.

4. Resolve to try eating a diet of real food, pretty much as it comes from the earth or its animals.  Unless the food in a can or package is original and not adulterated with "stuff", don't eat it.  If you are looking for weight loss as a part of this renewal, stop eating sugars, potatoes, and starchy foods like grains and the things made from grains (cereal, bread, pasta, flour based baked goods).  

5.  Read books, articles and blogs that further your knowledge of eating style.

6. Start looking around for a kind of sustained physical activity that you think you would enjoy once you mastered it.  Start doing that thing at a beginner level and without significant challenge.  Work up.  If you do it for three months and don't like it, start over with something else.  

7.  Observe yourself and take note (either mentally or in written form) of your progress along the way.  Does your skin look better?  Do you feel happier?  Do you have more energy?  Are you less anxious?  These are all results that have been observed after changes in the way people eat and live.  

Silly season can be fun if you don't take it too seriously.  Within a week or two, most of America will be back to its predictable cycle of weight gain and periodic dieting.  Be bold, and head off in a different direction.  Happy New Year!

 

 

 

 

 

Getting Past the R Word

by Barbara Berkeley, MD

While I don't take as much of a beating on the internet as some diet writers do (thank you for that, readers!), most of the negative comments I get are directed at the fact that my diet recommendations are too restrictive.

Restrictive is the R word.

I think that we often confuse structure with lack of freedom.  As our society increases its amount of available choice, we tend to bridle at the idea that any of these options might be taken away.  And we particularly hate the idea of any authority regulating choice...most especially the government.  But until recently, we never lived in a world with such abundant choice.  Life might have been less interesting, but it was certainly easier to negotiate. 

I've written in the past about decision fatigue, a state that seems to occur when we are forced to make too many selections.  It appears we may only have so much organizational ability and will power.  Our constant exposure to choice (mocha or latte?  grande or venti? whip or no whip? skim or soy? ...and that's just Starbucks) wears us down and makes us anxious.  Certainly this is no more evident than in our exposure to an ever-expanding food menu.  Our only defense is to have our own rules and our own plan.  We can then approach the market, the restaurant, and the vending machine using those guidelines.  

Interestingly, there is little R word push back regarding vegetarian or even vegan diets.  By R word standards, these are extremely restrictive.  But they are accepted in our society because they've been around for awhile.  In addition, most people remain unthreatened by vegetarianism.  It has the feeling of an eating style that is chosen by a select few...and vegetarians tend not to be very militant about pushing their diet on others.  Lastly, vegans and vegetarians can still eat sugar and starch (grains and other starchy carbs). For most of us, these are the toughest foods to give up.  It's more radical to suggest cutting out rice, pasta, corn and potatoes than it is to advocate giving up fish, meat and turkey.   And those who do suggest such a change may be subject to R word criticism. 

Just as we negotiate buying choice by adhering to a budget, just as we decide which moral choices to make by adhering to religious guidelines, just as we choose from the endless careers available to us by figuring out where we fit...so too should we view how we eat.  Prior to the last 30 years, eating was less easy to do and foods with the potential to hurt us far less available.  Since the advent of instant eating opportunity throughout the day, we need to apply the same sorts of guidelines to food choice.

People who write about me being too restrictive have not read me very well I think.  I have made it clear that I believe in whatever works for YOU.  The diet that I propose is one with which I have many years of personal and professional experience.  Take that for what it's worth.  Explore other possiblities too.  Choose, based on who you are and what works best.  As long as you are maintaining your weight loss and keeping hypertension, hyperlipidemia and high sugars at bay you are doing a fine job.  

Occasionally I am asked to restate what I believe is the most effective diet.  With trepidation, I'll do it again here.  But please don't view it through the lens of the R word.   Eating this way is a choice based on my own guidelines.  I have no desire to legislate, push or otherwise force this way of eating on anyone.

I prefer-- and see excellent results from--- a diet that is composed of lean animal proteins, vegetables and smaller amounts of fruits and low fat dairy.  I try to stay away from legumes like soy and starchy beans although I personally don't completely exclude them.  While dairy is not a part of most paleo style diets, I include it because I have found that it doesn't affect weight in most of my patients and it gives them greater choice.  Watch dairy products to make sure that they are low in sugar.  Sugar and grains are the two major things I like to keep out of the diet.  One other thing that people complain about with my diet is that it's inconsistent with "true" ancient eating.  I'm not really about being a purist.  I'm about getting the job of weight maintenance done.  If this means using sugar substitutes and low fat dairy, I'm ok with it, because in my world keeping weight low is the primary goal.  Health follows from that.  For those who are uncomfortable with that compromise, there are endless ways to vary such a diet plan.  

As you all know, I call this plan a Primarian diet.  You can find more detailed information in my book, Refuse to Regain and in the archives of this blog.  The degree to which you need to be completely Primarian varies from person to person.  I recommend that you use it as your default diet...meaning most of the time.  We all "go off' here and there, but it works better if deviation is rare.  That's because I remain impressed with the ability of grains, starches and sugars to take over in the brain (or gut).  Those who regain their weight have almost always been co-opted by these kind of carbs.  I believe them to be a strong drug and one that promotes insulin production and fat storage.

If other variations of eating work for you in maintenance, that's excellent.  Please share.  Each of us is a different entity and contrary to what some some have written, I don't believe in a one-approach-fits-all.  What I do believe, however, is that having rules and plans for eating is vital for healthy survival in our current environment.  None of these plans is about Restriction.  Each is about creating a way to eat that allows us negotiate the hazards of endlessly offered food choice. 

 

 

 

 

 

Dietary Tribalism: Factionalism Goeth Before the Fall

by Barbara Berkeley, MD

 I started blogging about 3 years ago.  At the time I was a naive, starry-eyed newbie who couldn't wait to share my experiences and opinions with the world.  I had just written a book based on the experiences I'd had with patients over a period of nearly 20 years. As I sat, fingers poised over the keyboard for my first foray into the internet world, the prospect of getting my message out to a larger audience was thrilling.

Then....Whack Bam Boom!  Not a day after my first words hit the virtual page did I start reading that I was a useless dope, a fool who knew nothing and that my book and pretty much all of my thoughts were drivel.

I ran like a wounded puppy to my blog partner Lynn Haraldson who had been on the internet far longer than I.  She was sympathetic but slightly amused.  I got the message.  The internet is the wild west.  Better toughen up girlie.

So here I stand, ready to take your punches.  But really, why should we steel ourselves, waiting to be beaten up for ideas, beliefs and hypotheses?  The reason for these attacks is supremely ironic, especially for those of us who believe in Primal Diet, or returning to more of the behaviors we practiced in our ancient past.  This flinging of verbal barbs and arrows relates to an intense and ancient human desire to be tribal. Unfortunately, I fear that we will be destroyed by this same tribalism if we refuse to acknowledge and dismantle it. 

At its best, tribalism can be fun.  Cowboys and Indians. Color War.  We love nothing more than to divide ourselves into teams and cast the other group as the bad guys.  I can be playing doubles with one woman for two sets and hating the two ladies on the other side of the net.  Then we switch partners and suddenly my previous hitting companion becomes my sworn enemy.  And I really, really do want to sincerely beat her. 

Things ratchet up with professional sports.  Of course we know that Cleveland really doesn't hate Pittsburgh...(or do they??) Sometimes, it's hard to tell whether tribal enmities related to sports are silly or real.  When they explode into occasional violence at events or after championships, we see their actual potential for destruction. 

And then there's politics.  Why must all Democrats believe that all Republicans are useless idiots and vice versa?  We have all come to see the folly in playing the tribal game so intensely that not a single thing gets accomplished. 

Finally, we have the real deal.  Tribalism as it relates to countries, regions, religions and belief systems.  This is where we lose complete track of the idea that we are all human.  Each one of us might just as easily have been born into another culture and wound up on the other side of the fence...the enemy. But this never occurs to us.  For most of human civilization, indulging in our tribal nature simply meant losing a bunch or our men to spears, arrows and clubs.  As weaponry becomes more deadly and more available, the outcome of unbridled tribalism would seem to be obvious.  Yet we make no attempt to examine it or control it. 

Tribalism seems to be in our biology, but it is expressed as an idea.  The idea is that something about our tribe makes us better...more worthy.  It is usually connected to the belief that our tribe is in possession of the one and only truth.

So what does this rant have to do with Paleo/Primal diet?  In my recent forays into the world of Twitter, I've discovered a new and quite vocal community that believes in ancient diet.  Among this "tribe" I am dismayed to see that there appears to be a great deal of proclamation of truth and declamation against those who see things differently.  People with varying opinions are branded as "asshats" and "fools". This is not unique to the Primal Diet believers.  It is also on display in the writings of followers of other diets.  And yet, at least as I see it,  the truth about optimal diet remains the furthest thing from being settled.  It is as complex and elusive as a shadow that recedes into our endless human past. Does any group, whether it be the vegans, the vegetarians, the Primalists, the Mediterranean Diet followers...ad infinitum.... truly have the hubris to believe that they have completely solved the equation?   There is no diet on earth that does not eventually lead to death.  And if there is ever to be one it will have to come with the assist of modern science, since no living species has yet negotiated immortality.  Thus, we come full circle. We are each human and would benefit from listening to and respecting one another.  Of one thing we can be certain, no one of us has "the answer".  It is only together that we can create enough intellectual and spiritual firepower to push closer to real enlightenment.

 

 

 

 

 

 

Binge Eating: Eat Without Restriction or EWI?

Here's a question I ask all of my new patients:  "Are you a binge eater?"

About 80% of the men and women I see have to stop and think, yet they do not have anything resembling binge eating disorder.  Many of those who eat the SAD (Standard American Diet) feel that they are under the control of food.  Despite their best efforts, they may find themselves at the other end of an entire bag of Fritos or a full pint of ice cream.  They "wake up", trance-like, with a spoon in one hand and a dazed expression, like an alcoholic after a lost weekend.  Yet this is not binge eating disorder as experts would describe it.  The Fritos gorge is more of a normal variant of eating behavior in America.

The definition of a binger look like this (Wikipedia):

▪   Periodically does not exercise control over consumption of food.

▪   Eats an unusually large amount of food at one time, far more than an average person would eat.

▪   Eats much more quickly during binge episodes than during normal eating episodes.

▪   Eats until physically uncomfortable and nauseated due to the amount of food consumed.

▪   Eats when depressed or bored.

▪   Eats large amounts of food even when not really hungry.

▪   Usually eats alone during binge eating episodes in order to avoid discovery of the disorder.

▪   Often eats alone during periods of normal eating, owing to feelings of embarrassment about food.

▪   Feels disgusted, depressed, or guilty after binge eating.

▪   Rapid weight gain/sudden onset of obesity.

The difference between a normal, out-of-control American eater and a true binger is one of degree, compulsion and emotional tone.  Bingers describe feeling completely out of whack when binging.  They also often feel that they have an “on” and “off” switch.  When they are restricting food by dieting, they can be very, very good at it.  One bite of the wrong food, however, or one day of unbalanced emotion can throw everything off the rails. 

I specialize in treating obesity and not in the management of eating disorders, but inevitably…because of their weight… bingers make their way into my practice.   When I am successful at identifying them, I always recommend that they get counseling from an eating disorders program or specialist concurrent with our treatment.

Herein lies the rub. 

Most eating disorder therapists employ a form of dialectical behavior therapy.  This is a treatment based on helping patients to identify stressors and maladaptive behaviors and finding healthy alternatives.  At the same time, therapists usually advise patients that they must stop restricting food.  Learning to control intake naturally and accept the fact that they may never be as thin as they might like is seen as an important pillar of recovery.

But I have a question about this, and I ask for help from readers in sorting it out:

The on/off nature of binging makes me suspicious that there might be a physiological trigger.  Many bingers have described to me their intense compulsions to eat certain foods and the feeling of being utterly out of control after consumption.  While it’s certainly possible to see the compulsion to binge as a psychological problem, it’s not the only---or even the most logical---explanation.

When I was in my twenties and thirties, I routinely ate huge meals and consumed whole cheesecakes and loaves of bread in one sitting.  I ate whenever and whatever I wanted, in enormous amounts.  Yet no one suggested that I had an eating disorder.  Why not? Because I didn’t get heavy.   If I had been obese as a result of my eating, I would no doubt have developed shame, depression and an entire approach and avoidance cycle around eating.  I would likely have ended up in the office of an eating specialist. 

Recently, one of my patients who has BED was advised to entirely stop restricting food intake.  She gained an unacceptable amount of weight rather quickly.  In discussing it with her, I shared my discomfort with the direction to eat without restriction.  Because of our SAD food culture,  we are surrounded by dangerous food substances, some of which appear to be particularly toxic and addictive to certain people.  It seemed to me that telling such a person to eat whatever he wanted was tantamount to suggesting that he drive a car without regard to the consequences.   Go ahead:  Hit someone.  Crash into a store.  Run a red light if you feel like it.

I have always had a problem with critics of diet (the “diet is a four letter word” folks) because I think they base their objections on a misinterpretation of the idea of restriction.  Restriction has a pejorative feel.  It’s a tough word that doesn’t feel good to us.  But suppose we substitute the words “eat with intelligence”.  To eat with intelligence, one would need to know the foods that react well with ones body and those that are dangerous and destructive.  It would only make sense to avoid the latter at all costs.  Some would call that restriction, but I would call it EWI. 

Bingers, like all humans, undoubtedly come in many permutations.  For those whose binging is primarily emotional, based on previous trauma or an offshoot of significant psychological issues, an approach that asks the patient to learn dietary modulation without restriction may be appropriate.  However, I suspect that for many people binging may occur in those who are highly sensitive to the chemical reactions of certain modern foods in their brains. For these people,  learning to EWI rather than eat unrestrictedly would seem to be a much better treatment.

I am very interested in the experience of bingers and eating disorder specialists who may read this blog. Has DBT worked for you?  Have you learned to eat “unrestrictedly” while controlling your desire to binge?  I am completely open to having my theory taken down.  Let me know if I’m wrong or if your experience suggests I might be onto something.  Please write to me here or on Facebook at Refuse to Regain: Barbara’s World, or on Twitter at BBerkeleyMD.  

 

Chris Christie's Weight: We Have Met the Enemy and He Is Us

by Barbara Berkeley, MD

The past week has seen a (dare I say it?) feeding frenzy around the issue of New Jersey Governor Chris Christie's weight. With a possible presidential bid in his future, Christie's size has become the topic du jour. Is a corpulent candidate less fit for office than a lean one?  Does an overweight president better reflect who we are as a country in 2012?

While you'd have to be blind not to notice that Christie is a big guy, no one had called particular attention to it until Eugene Robinson of the Washington Post launched the first salvo this week.  Robinson's article, which linked Christie's weight with a lack of discipline and ended with the advice to "eat a salad and take a walk" was roundly criticized...even by fellow liberals.  Guests on MSNBC's Morning Joe who are normally sympathetic to Robinson piled on.  "This crosses the line", one complained.  But while Robinson's piece might be interpreted as a partisan low blow, it actually raised important questions about our perceptions of obesity. It also exposed the deep ambivalence we have about our growing national waistline.

In yesterday's New York Times, the admittedly weight-challenged food writer Frank Bruni added his voice to the Christie controversy.  Bruni vigorously wrote that a person’s size should not factor into decisions about his capabilities. “Girth doesn’t equal character”, he said.  Human beings have foibles after all.  Did Clinton’s womanizing or Obama’s smoking make them less effective as leaders?  If your answer is no, you can’t assume that Christie’s obesity will have any impact on his ability to act as President.  

A third, and more dismissive view of Christie’s weight came from Michael Kinsley writing for Bloomberg View.  Christie should be discounted, he wrote, “unless he goes on a diet and shows he can stick to it.”  What about the argument that all humans are imperfect?  He’s willing to forgive Obama and Clinton, but when it comes to Christie’s big belly he is less sanguine. 

So why should Christie’s weight be more than we can bear in a president?......One reason is that a presidential candidate should be judged on behavior and character, not just on policies

Controlling what you eat and how much is not easy, and it’s harder for some people than for others. But it’s not as difficult as curing a chemical addiction. With a determined, disciplined effort, Christie could thin down, and he should -- because the obesity epidemic is real and dangerous. And the president inevitably sets an example.

Spoken like someone who has never tried to lose 50 or 100 pounds.

More importantly, Michael Kinsley deployed the C-bomb: character.  Kinsley is not alone in believing that being overweight is a character flaw.  This is an awfully tough position to voice aloud.  To begin with, it defines 70% of America as weak-willed, food-obsessed incompetents.  Yet this is the guilty, politically incorrect belief of many people who have been lucky enough to avoid obesity.  Believe me, I know. As someone who is of normal weight but deals with obesity, I hear the voices on both sides of the divide.

Three very different voices.  Three different views.  Or are they?  What is most interesting about the Christie debate is the degree to which all parties agree.  It is within this area of agreement that we can find the true nature of America’s beliefs about obesity.  It is also within this area that tragedy lies.  The tragedy is that we so completely clueless about how to deal with such a major threat to the health of our country. 

All three authors use perjorative or dismissive language when describing obesity.  This includes Bruni, who defends and sympathizes with what he calls Christie’s “evident gluttony”.  Gluttony?  Isn’t that one of the seven deadlies?  Having Christie sit in the middle seat on a crowded airplane, says Bruni, “would be cruel to the people on the window and aisle” and “many voters aren’t going to want to look at him as often as they must look at a President.”  After recounting his own torturous experiences with weight control, Bruni concludes that the whole weight control thing is just too shallow and he’d rather have “a big, fat President”.   He mentions the possibility that morbid obesity could impact Presidential health only as an afterthought. I suspect that Bruni is like so many of my patients.  He understands the extreme difficulties of dealing with weight and hates people who are prejudiced against  the obese.  A guilty part of him, though, harbors the same feelings.  This uncomfortable truth is the topic of many of the discussions that take place in the group I run for weight maintainers.  They felt awful about being heavy and after losing the weight they often feel even worse when they find themselves judging people who are still obese.

All three authors believe that obesity is caused by a weakness.  In the case of Robinson and Kinsley, it’s a weakness of will; the inability to “just say no”.  In Bruni’s case, it’s a weakness caused by addiction and compulsion.  Whatever way you look at it, the obese are somehow flawed. 

All three authors buy the usual nonsense about obesity.  “Take a walk and eat a salad” is just another way of saying that anyone can control weight by eating less and exercising more or that moderate changes to lifestyle work.   According to Robinson: 

…. the science of weight control now takes into account the role that genetics might play, along with psychological factors that lie outside our conscious control. There are new options, including gastric surgery, beyond the dieting roller coaster — lose 40 pounds, gain it all back — that Christie says he has been riding for years.

What science is that?  The obesity epidemic is only about 30 years old, no where near long enough for 70% of America to undergo a genetic change!  And to which new options is he referring?  Could he be talking about the 3 or 4 new medications which the FDA declined to approve for physician use?  Or to the gastric bypass surgery which often fails to provide a permanent solution while exposing patients to significant operative and post-operative risk?

On the other side of the fence, Bruni is no better.  Remember his gluttony comment?  Here is his amplification:

Let’s talk as well about that gluttony. It may say much more about his (Christie’s) allotment or early rearing than his resolve. Over recent years, there has been more and more scientific consideration of obesity as an expression largely of hereditary and environmental factors beyond a person’s ready control, and there has been evidence that one person’s fatness versus another’s thinness may to a significant extent be foreordained.

I guess Bruni is reading the same science journals as Robinson.  I wonder what the Pima Indians would think of this.  Completely lean and without modern disease until they began eating sugar and flour and living on the reservation, the Pimas now have one of the worst health profiles of any ethnic group.  Were they genetically pre-ordained for obesity or did their perfectly functional genes run afoul of a sick and clueless food world?

Our 24-hour-a-day news cycle and our tabloid approach to politicians  is perfectly designed to make Christie’s corpulence the target of gossip, character assassination and schadenfreude.  But what if we lived in a  more perfect world? What if Christie turned his blunt, honest-to-a-fault style on his own weight problem?  What if this became the opportunity to discuss new and more effective solutions for our growing problem with fat and fat-created illness?

Here’s what I would tell Christie..or any politician (or columnist) who is willing to listen. 

We need to stop repeating the same old nonsense.  We won’t lose weight or become healthy again until we return to something close to our original eating patterns.  This will take a national effort that includes incentives and disincentives to major food producers and a simple and oft-repeated message.  In particular, we have to vastly decrease the amount of sugar and starch in our diet.  Apart from their extremely deleterious affect on fat storage, these foods are addictive. If we worked relentlessly on this message alone we would do more good than the past twenty years of telling people to eat less and exercise more.

We also need to educate our kids and ourselves about how our own bodies work.  We need to show people the graphic details.  How does sugar tear up our blood vessels?  How does the food we eat wind up as a gummy clot inside a major artery and cause a piece of our brain to die in a stroke?  What exactly is diabetes and why is it that we really, really don't want to get it? We can’t know this unless we know ourselves and right now, we understand our cars better than our own bodies.  Basic physiology and pathophysiology (the study of disease) should be a mandatory part of the curriculum of every grade school and high school in America.   

The obesity problem is not easy to solve but no one benefits from the advice to just be more disciplined.  If we all understood what is at stake---from a disabled and depleted population to the bankrupting effects on our medical budget---perhaps we could get serious.  Lest we forget, Chris Christie is us.  

 

You're On a Diet...So Why Aren't You Losing Weight?

by Barbara Berkeley, MD

This post is an update of a previous entry.  Hope our new readers enjoy it and our long-term readers will consider re-visiting these ideas. 

Refuse to Regain is primarily designed for maintainers--- that small and exclusive group of people who have managed to lose weight and are stabilizing (or stable) at their new size.  But comments to our site reveal that many of those who read us are still in the process of active weight loss.  As a result, I wanted to devote a full posting to a question I hear with great frequency:  Why is my weight loss diet not causing me to lose weight?

New patients to my practice often say that they can't lose weight no matter what they do.  They chalk this up to a bad metabolism or to something that must be extremely dysfunctional about them.  Over the years, however, I'm hard pressed to remember anyone who was not able to lose weight once they began an effective diet.  No matter how impossible weight loss once seemed, it became possible once the diet was properly adjusted.  Naturally, this result depends on the dieter following the diet exactly as prescribed. 

Why then the frustration? And why do many diets seem to fail?  Here is what I've come to believe (followed by some suggestions that may help):

1. Diets Fail Because We Fail to Understand What They Are

I like to think of dieting as an unnatural act.  (Strange that I would make my living by encouraging unnatural behavior, isn't it?).  But seriously, if you could revisit ancient times, you would not find any humans forcing themselves to lose weight.  Having a bit of extra fat would have conveyed a survival advantage, so why would anyone have wanted to get rid of extra pounds?  Our twenty-first century bodies still behave this way.  In fact, they seem to completely ignore weight as we gain it.  

Knowing the body's propensity to defend itself against harm, one would think that storing a lot of dangerous fat would cause the appetite to shut down, or perhaps prompt the release of a cascade of hormones to dissipate the excess. But that doesn't happen. We can carry even hundreds of pounds of extra fat without the body paying any attention.  Perhaps the reason is this: our ancient genes (the ones we still harbor) never thought we could gain a dangerous amount of weight.  Since it used to be a good thing to store some extra fat, our genes never developed a program for aborting weight gain.

Since the body ignores our fat, how do we create weight loss?  We do it by recreating an ancient situation...one that forced the body to notice its own fat.  That situation was a significant food shortage. In actuality, a modern weight loss diet is simply the process of tricking the body into believing that there is a famine in the outside world.  Once the body gets the idea that there is very little food coming in, it suddenly wakes up to the presence of stored fat and starts to use it up.   This state of awakening was doubtlessly designed as a survival response hundreds of thousands of years ago. Let's call this bodily state: "The Ancient Famine Response".

This response consists of two parts, one of which makes dieters happy and the other frustrated.  First, the body starts looking for energy to sustain itself in the face of famine.  It turns its attention to its own fat, recognizes it, and starts burning it.  Second, the body wisely decides to burn this fat as slowly as possible in order to outlast any extended food shortage.  It does this by slowing down its bodily processes, heating itself less, and using other tricks to conserve energy.  This is annoying to dieters, but is a built-in and unavoidable feature of the Famine Response.

Having discussed the reason we lose weight, let's next think about what would have constituted normal eating for the same ancient ancestors.  Since they hunted and gathered, they probably had days of ample food one day and days when food was scarce.  To adjust to this, human bodies likely developed a very flexible system for using food. If food is temporarily in short supply, the body can slow down , burn fewer calories, and be more efficient.  If we eat more, the body can speed up.   These mechanisms allowed our ancestors to stay at stable weight even when food intake fluctuated.  Let's call that the "Normal Ancient State".

Most of us start a diet with all intentions of following the rules exactly.  That works!  We lose weight because we are consistently telling the body that there is very little food coming.  We've mimicked the"Ancient Famine Response" or, as I sometimes tell patients, "we've turned on an emergency light in the brain".   But we soon start to get creative.  We eat things which seem to be minor but which aren't on plan Or, we don't eat on some days and we eat more on others.  All of these behaviors put us back into the "Normal Ancient State".  We can't figure it out, because when we look at the intake for a whole week, we ate very little...certainly many fewer calories than we used to eat before dieting.  Why aren't we losing???  It's because food intake is intermittent and not sufficiently restrictive.   The body adjusts to intermittent eating, lowers its burn, and keeps weight stable, just as it's programmed to do.

Suggestion:  Pick a diet that you can follow to the letter.  Stay as compliant as you possibly can.  Resist the temptation to go off the diet on some days and resume on others.

2. Diets Fail Because We Don't Have a Way to Get Calories Low Enough

In our practice, we create weight loss with a diet that has approximately 1200 calories.  Larger women and/or men may use 1500 calories or so.  This sounds simple, but it isn't.   Calorie counting is complete guesswork in the modern world.  Using packaged foods which have known caloric content can help.  Once you start eating out in restaurants, as most of us do, counting becomes impossible.   Although I do not like processed foods over the long run, dieting may be a good time to use them.  If you can construct a diet from bars, supplements, frozen diet entrees, low fat dairy products and other foods which have calories already listed,  you can be pretty sure of the number of calories you are getting. 

In our program, we use three diet shakes or bars (each 160 cals) per day and have patients eat a dinner which is composed of about 1/4 of a dinner plate of lean animal protein (chicken, fish, meat), a large mixed vegetable salad, a big portion of cooked green vegetables,  a piece of fruit, and a 100 cal fat free pudding.  You can work out your own plan, but knowing that you are getting the right calorie count is important. 

Suggestion: If you aren't losing, check your calories.   Make more use of foods which have calorie labels.  Try to avoid eating out if it is scuttling your weight loss. And of course, remembering the information above, remain consistent each day.

3. Diets Fail Because We Don't Get Our Insulin Low Enough 

Insulin is a mega-important hormone for dieters because it stores fat.  It not only puts fat away into the fat cells, but it also stands guard outside the cells to make sure the fat stays put.  Only by lowering your insulin levels can you break down fat.  Imagine insulin as a jailer that keeps fatty prisoners trapped on your body.  Put him to sleep and they can escape. 

Insulin is made whenever we eat starch or sugar because those two things turn into blood sugar once they are absorbed.  (Insulin's other job is to control the levels of blood sugar).  Dieters have already intuited the role of insulin. What is the first thing they do when they start a diet?  They begin with salad and chicken breast.  They eliminate bread, pasta, crackers, rice and dessert.  Insulin goes to sleep and weight loss follows.  But before long, their carb addiction begins to howl.  That piece of pita doesn't have that many calories.  That rice cake is a diet thing, right?  Wrong.  This part isn't about calories.  Wake up your insulin enough and you won't lose weight.

Suggestion:  Keep starch and sugar to a bare minimum when dieting.  (BTW, this works for maintenance too!).

4. Diets Fail Because We Rely Too Much on Exercise as a Weight Loss Tool

Exercise is great.  I love it!  But alone, it will not cause weight loss (unless you are running the ultra-marathon or something).    Remember the Ancient Famine Response: unless you create a consistent state of calorie reduction, you won't lose.   In my practice I have many skilled tennis players, marathon runners, volley ball enthusiasts, and other athletes.  If exercise caused weight loss, they would not be visiting me to get off the 30 extra pounds they've accumulated.   Be especially careful with the temptation to over-exercise.  This can create hunger and entitlement (as in, "I earned that bag of M and M's").  Exercise by all means, but during weight loss, put most of your faith in calorie reduction that is consistent and calculable. 

Suggestion: During weight loss, think of exercise as secondary to caloric reduction. 

Remember this:  magazine covers would lead you to believe that weight loss is simple and that pretty much everyone in America is having their pounds "melt off".  This is the big lie.  Weight loss is tough and takes a tough effort.  What remains true is that the rewards for this effort are great; the endpoint incredibly worthwhile.  So keep at it and always congratulate yourself for taking on such an important and challenging task.

 

Controlled by a Cookie: When Foods Become Drugs

by Barbara Berkeley, MD

Do you take medicine to treat your blood pressure?  Once you swallow your pill, can you control your blood pressure via sheer willpower?  While such feats of bodily control are reported by swamis and other advanced body-mind practitioners, they are not in the average person's repetoire.  And a good thing too, because the power of drugs to take over ailing body systems is the reason they work. Medicinal drugs are substances which enter from the outside and take control of inner processes.  They cause chemical changes that in turn change those who take them..hopefully with positive effect.  But, as we well know, drugs can have negative effects too, especially when their chemical properties are used to create pleasure.

Consider these two definitions of the word "drug":

1. a chemical substance that affects the processes of the mind or body.  

2. a substance used recreationally for its effects on the central nervous system, such as a narcotic.

 

Every overweight person I've ever encountered recognizes that certain foods have drug-like properties. During an intake visit, a new patient will generally put his finger right on the foods that are submarining him.  He or she will often use the language of addiction to describe these foods:  "I'm addicted to sweets",  "I'm a chocoholic", "I just can't stop eating bread."  It's not coincidence that such language should leap to the lips.   Foods DO alter the processes of the mind and/or body.  Foods ARE substances that are used recreationally and which do have effect on the central nervous system.  In fact, certain foods can be viewed very much as drugs.  Despite this, we believe that once ingested, we can control these particular "drugs" by sheer willpower. 

Perhaps you do not agree that food and drugs are similar.  After all, we are designed to eat food and even if ingesting food does cause changes within the body, they should be natural, expected changes.  Until recently, this has certainly always been the case, but let me suggest two reasons why things may have changed.

First: There can be no question that eating food is a natural behavior that provokes natural responses. I would make the case, however, that in a very real way we no longer eat "food".  Processed foods that are chock full of preservatives, colors, and chemicals have little resemblance to what our body is equipped to handle.  Foods that hit us with enormous punches to the insulin system---the sugar and starch foods---are also very new to human experience.   

Second: Many of us who eat the western diet or SAD (Standard American Diet) have developed inappropriate reactions to eating these newer foods.  This is especially true for those foods that turn into sugar after digestion (the sugars themselves and the starchy carbs like grain, cereal, pasta, flour based foods and potatoes).  If we have begun to develop a "broken" reponse...in the form of what we call insulin resistance... we will react in a new and negative way to eating.  We will experience more hunger, more craving and less ability to control these foods.

 

Recent research into the modern epidemic of insulin resistance suggests that those of us whose insulin is no longer properly interacting with our body may also have a problem with insulin's role in the brain. The brain's form of insulin resistance occurs when insulin-related signals which normally tell us to stop eating are blunted.  Thus, foods that cause insulin release are no longer equipped with the satiety safety valve that nature intended.  Indeed, these foods may make cause more hunger rather than less.   And who among us has not experienced the inexplicable carbohydrate craving that follows a day of bread, pasta and cookie consumption? 

 

Thus, my hypothesis is that foods become drugs when our body no longer tolerates them well.  As a child, you might have been quite able to eat a cupcake and simply stop.  As an adult, one doughnut might lead to an entire box.  When drugs are at the helm, you can forget willpower.  Be they medicines in pill form or cookies that are decorated like Grover, your physiology is co-opted and someone else is driving the bus.  

 

Sometimes I use the following analogy in the office:  think of your trigger foods as concealed aliens. Remember the movie Men in Black?  An innocuous shop-keeper might look harmless, but was actually a man-eating cockroach!  Drug-foods are like that.  They look attractive, luscious, and controllable, but allow them past your lips and you are under their control.  You can bemoan your lack of willpower all you want, but if you've given yourself over to the aliens you are likely to spend quite some time doing things you didn't intend. 

 

Many people simply can't understand how something as small as a cookie could cause them to abandon all resolve.  But there is the error!  A cookie isn't small at all.  The chemical signals and bodily changes that start the moment a susceptible person sees and smells that cookie are quickly overwhelming.  Eat that cookie and it is very possible that---diet-wise---all is lost. 

 

This illustrates  the problem I have with advice that suggests that it's ok to eat everything in moderation.  Yes, if you are a person whose food-processing systems are all in good shape, this may be a fine strategy.  In fact, if this works for you, you might well be unable to understand why it wouldn't work for everyone.  But most people who are overweight have gotten heavy because food has become drug-like for them.  To me, this is part of a larger picture which includes fundamental physiological changes in the way their body handles that food (mostly the starches and sugars).  If you have been wrestling with willpower and blame yourself for being weak, I advise you to start seeing the true nature of your trigger foods.  Start with a healthy respect for their power and a strategy of avoidance whenever possible.  Remember, if you don't take a drug it can't own you. 

 

 

 

Novak Djokovic: The Diet That Conquered Tennis

by Barbara Berkeley, MD

For those of you who don't spend your days watching Tennis Channel, let me bring you up to date.  

Since the current professional men's season began last year, Serbian tennis phenom Novak Djokovic has dominated his sport in a way that is nothing short of astounding.  He has won 64 matches (including last week's U.S. Open) and lost only 2 and has ascended to the number one spot in the world  (view Djokovic's website here)  What makes this so incredible?  He's done it in the very midst of the dominant era of unbeatable superstars Rafa Nadal and Roger Federer.  Federer and Nadal have controlled the two top rankings in tennis since 2005 and, until recently, Rafa appeared poised to claim his spot as one of the greatest ever as he took over from a slightly slower 30 year old Federer.        

Before this season began, Djokovic sat in the number three spot.  His tennis was strong and sharp, but he often struggled with breathing problems, what seemed to be an episodic de-conditioning, and a mental attitude that made him prone to frustration and breaking things. 

That Djokovic could so completely turn things around in one short season is mind-blowing.  Sports writers chalk this up to a new confidence, a stronger serve, and a better mental game.  Less frequently discussed is another intriguing factor:  before this season began, Novak Djokovic gave up carbohydrates.

A piece written in May for the Wall Street Journal (see previous link) mentioned the diet change in its title, but gave it short shrift when discussing possible reasons for Djokovic’s near-miraculous improvement.  Surely the change must have occurred because he gained confidence.  Surely the dietary contribution is nothing more than a placebo.  

The article quotes David Levinksy, a nutrition professor from Cornell: 

Levitsky said a gluten-free diet might have benefits for those with mild allergies, or even no allergy at all. "The other part of the story is, if you believe in a cause of your disorder, it becomes the cause," he said. "We see this in many different studies. If you believe it, you change your behavior in the direction of being cured."

This explanation seems odd, considering that it appears in an article entitled, “Starch Madness: Novak Djokovic’s Domination of the Sport Has Coincided with His Gluten-Free Turn”.   It’s as if the writer posed the question, but didn’t dare go after the answer.  Is it possible that, in fact, cutting out carbohydrates made Djokovic into a better athlete?  Is it possible that everything we've believed about the importance of loading our muscles with tons of starches is untrue?  Is it possible that we can play endlessly taxing endurance sports without jamming ourselves full of pasta and potatoes?  And is it possible that we might be better off for it?

It seems that world number 4 Andy Murray thought so.  He has adopted the Djokovic diet.  How much do you want to bet that others follow.  By the way, Murray just became the second person to beat Djokovic this year (although Djokovic did have a shoulder injury and was forced to withdraw after a set).  Commentators for the match remarked repeatedly about Murray’s fitness and ability to move around the court.  Coincidence?

I have held a consistent view on diet and it is a view that I believe holds up when one examines Djokovic’s transformation.  Rather than worry about individual dietary elements, we should attempt to eat foods that are most like the ones are bodies understand genetically.  Since our genes are thousands of generations old, we need to look at the foods that were prevalent in those times:  lean proteins, fats that come from natural sources (and thus have higher omega 3-6 ratios), vegetable and fruit matter, seafood, nuts and other naturally occurring plant foods.  Sugars and starches (including grain) were not a part of that original diet and are processed poorly or even cause overt harm in those of us who are more “original” genetically.  In addition, our body has certain fuel expectations.  Large amounts of carbohydrates as fuel seem to me to be inconsistent with what our body was fine-tuned to expect.  

In my own practice I treat many tennis players and runners who are significantly overweight despite many hours of intense exercise.  When they change their diet to one that is primarily Primarian, they not only lose weight but they become more efficient at their sports.  For those who are interested in pursuing very taxing endurance exercise like triathalons or marathons, I suggest reading the book Paleo Diet for Athletes by Loren Cordain and Joe Friel. This addresses the particular needs of those who require some additional carbohydrate when training for specific endurance events. 

In my own life, I attribute the ability of my 63 year old body to run a 5K, play hours of tennis, and do aerobic exercise at high capacity to the right mix of fuels.  I have no doubt in my mind that it is Primarian eating, and not placebo, that has kept me lean and strong. 

Dietary beliefs die hard and unfortunately, our unwillingness to give up the conventional wisdom leads to real death, the death of those who develop diabetes, heart disease and cancer as a result of the profligate consumption of insulin stimulating carbohydrates.

Is the Djokovic diet phenomenon real?  You bet it is.