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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is Your Irisin A'Risin?

by Barbara Berkeley, MD

The latest chemical substance to get scientists into raptures is irisin, a hormone that is produced in muscle cells but exerts its effect on fat.  We've all figured out that exercise and weight are somehow tied together and that this means that muscle and fat must communicate. Unfortunately, we've showed a woeful lack of imagination in tryng to come up with the mechanism. For decades, we've persisted in trying to jam the same puzzle piece into a space that doesn't fit.  We are determined to prove that the connection is calories.  It seems so logical.  If we burn calories through working out we must lose weight, right?  And yet the evidence that this is so remains annoyingly equivocal.  

While readers will occasionally write to me about great weight loss successes from becoming physically active, it is rare to observe this in clinical practice. The more common experience is to see people who have added exercise, but have not achieved anything more than a minor result.  As I've mentioned in the past, I have taken care of many very athletic people, even marathoners, who were clinically obese.  Could they have just been eating enormous amounts of food?  Of course it's possible.  But most of them were trying to lose weight by modulating their diet.  One would think that these prodigious amounts of exercise would force weight loss, but in their cases it did not.

On the other hand, it is observationally obvious that maintainers who exercise have a higher rate of success at keeping weight off.  This observation has been confirmed by data from the National Weight Control Registry, a large study which monitors those in maintenance.  While the NWCR subject pool is limited to maintainers who volunteered themselves (and thus are probably highly motivated), the data shows that successful study maintainers are exercising a lot (on average, about 1 hour daily). 

Irisin is a hormone that is produced from the breakdown of a protein that is produced when muscles are exercised.  In rodents, it's injection appears to turn white fat into the more metabolically active brown type.  Humans do not have very much brown fat, so it is difficult to speculate whether this finding is meaningful for us.  Even rats who made more brown fat did not lose weight when injected with irisin.  So why the flurry of interest?  Because high levels of irisin appear to improve the way the body metabolizes food, making it less insulin resistant and more weight stable.  The following is from a recent NY Times article on irisin:

But while irisin appears to have a critical impact on metabolism, it does not appear to play any discernible role in the effects that exercise has on the heart or the brain. And various issues remain unresolved. Why, for instance, if exercise increases levels of irisin and irisin increases the body’s stores of energy-burning brown fat, does exercise so rarely produce significant weight loss? The mice injected with irisin lost little weight. On the other hand, Dr. Spiegelman notes, they resisted weight gain, even on a high-fat diet, and their blood sugar levels remained stable. So it would seem that exercise, through the actions of irisin, can render you healthy, if not svelte.

As I have repeatedly said in this blog, research results only become important when they are repeatedly reproduced.  The irisin story is obviously in its very earliest chapters.  But the existence of such a hormone may well help to explain why exercise is so important during maintenance, and relatively ineffectual during weight loss.  For those who are currently losing weight, I don't discourage exercise, but I ask you not to rely on it.  Weight loss is about forcing the body to burn itself (which it would prefer not to do) through caloric restriction.  Think of your exercise as a way of rebuilding and retuning your muscles for later use.  Once you reach maintenance, these irisin producing factories will be fired up and ready to go--giving you a much improved shot at maintaining the body you've earned. 

Got Eudaimonia? Beyond Diet and Lifestyle Change

by Barbara Berkeley, MD

" The ancient Greeks called it eudaimonia, and positive psychologists have adopted the term to refer to the kind of profound satisfaction and meaning one derives from raising children, training for an Olympic event, completing a college degree or helping your neighbors rebuild after a disaster. " ( NY Times, "Get A MidLife", 1/8/12)

 

It's a gift from the ancients!  Today's New York Times introduced me to a word I've needed and searched for; a word to take the place of the weak and poorly descriptive phrase:  "lifestyle change".  One of my early blogs on this site complained about the fact that dieters dutifully repeat a rote phrase when asked why many diets ultimately fail, "It can't just be a diet," they say, "it has to be a lifestyle change."  

Whatever that means.

 While every successful maintainer I've every met has definitely altered his/her lifestyle, the phrase "lifestyle change" is not sufficient to describe the accomplishment, nor does it provide any specifics about what that change included. Some time ago, I asked readers to come up with words that better described the experience of maintenance and that included the profound sense of transformation and accomplishment that seems to go with it.  But no words seemed strong or specific enough.

Today's NY Times has an article about modern middle age, it's drawbacks and it's benefits.  Among the good things middle-agers experience is more frequent EUDAMONIA: a sense of having accomplished something truly profound.   Bingo!  I believe that eudamonia is what separates those who just diet from those who become different people at the end.

Look at the Silly  Season ads that currently fill our airwaves and magazines.  What's the message?  That diet is about fitting into smaller clothes.  That dieting is painless and can be accomplished by eating the very same foods that the SAD equates with pleasure. (Nutrisystem: Features "butternut squash ravioli", "double chocolate almond cookie").  Who are the spokepeople?  Often, they are celebrities who have long histories of gaining and losing weight.  Chances are you wouldn't believe that Oprah or Kirstie Alley had found the secret to weight loss unless they had managed to stay at lower weights for a very significant amount of time.  What are the attractions?  Women in tiny jeans and lots of makeup.  It's pretty superficial when compared to the significant tasks that anchor weight maintenance. 

What creates eudaimonia?  Achieving something big, meaningful, and real.  To do this, we need to go several steps past the usual suggestions.  Here's an example:  a weight loss tip from US magazine: "When baking, replace oil with applesauce".  The same tip for those in pursuit of eudaimonia:  "Stop baking.  Guess what? You'll live."

You can find the comments of eudaimonic maintainers scattered throughout the responses to most online articles on diet.  They generally will describe how they lost the weight and their long term regimen for keeping it off.  There is always a simplicity to it and a pride.  They worked it out!  This has created a deep satisfaction.  

As I always like to say,  losing weight is no more nor less than throwing out the trash at home.  It's great to get rid of it, but it's not a cause for intense, deeply-felt pride.  But if you can turn that nice, clean home into a showplace, a thing of beauty, a place that anchors the neighborhood...now you've got eudaimonia.   

 

 

 

 

 

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!

 

 

 

 

 

What Causes Weight Gain? My Take

by Barbara Berkeley, MD

How do we lose weight?  The answer is--- cut calories until the body is forced to burn itself for energy.   This is so intuitively obvious that the converse would also seem to be true: if we lose weight by cutting calories, we must gain weight by accumulating them.  But is this true?  Perhaps weight loss has nothing much to do with weight gain.   Perhaps they are two quite different things.  '

For some time, I have been giving an introductory talk to new patients who enter my practice.  I wanted to record it so that they could hear the talk again if they chose, or share it with those at home.  At the same time, I thought that readers of this blog might find it interesting as well.  While I can't claim to know the ultimate truth, I have found that the model of weight gain I describe in these videos works well as a basis for treating most of the overweight patients I've encountered.  I hope you find it interesting.

 

 

 

The Last Twenty Pounds: A Common Dieter's Dilemma

by Barbara Berkeley, MD

Here's something I can tell you.  Pretty much no one is happy at the end of weight loss.  And that makes me sad. Of course there is the occasional person who loses 100 pounds easily, never has a bad week, and ends up wearing size 4 jeans.  That same person looks as if she had never been overweight, has no hanging skin and no extra pouches of flesh.  She's happy alright, but she's also vanishingly rare.

Why is it so tough to get the final pounds off?  And should we even try?  Let's talk.

The first thing to consider is the fact that a weight loss diet is nothing more than you forcing your body to run an ancient starvation program.  For more on this, you can read my earlier post on why weight loss diets stop working.  Because weight loss occurs as a protective mechanism (your body burns itself in order to avoid starving in a famine), it triggers other protective responses at the same time.  Most importantly, the body turns down its rate of calorie burning in order to keep you alive as long as possible.  You become the equivalent of a house in winter whose owner is trying to save money on heating oil.  The owner turns down the heat, closes up rooms that aren't essential and battens down for a long cold spell.  So too your body.  When calories are scarce, the body turns down the heat, stops doing things that aren't essential and generally settles in for a famine of uncertain length.  This is an elegant and lifesaving response engineered by your brilliant genes.  But it drives dieters crazy.  They've all been conditioned to believe an amazing array of nonsense by listening to "experts", watching extreme and unsafe weight loss journeys like those on The BIggest Loser, and reading magazine covers.  We're supposed to MELT!  Instead, we find that we are more like stubborn wooden sculptures whose outines can be chipped away only through very hard work. 

At the end of a weight loss run, the body is at its most efficient...trying hard to keep you from wasting to nothing.  At the same time, the dieter is likely at his least efficient.  He's tired, sick of it all, and burned out.  His dietary rules have gotten a bit broader and he may be doing what one my patients calls, "coloring outside the lines"...in other words, getting creative with the diet plan.  This combination leads to a plateau.  The weight loss stops. 

Another issue with the final twenty is that the last pounds may be relatively unimportant.  As I've written in the past, it's been my experience that people who were once overweight are "denser" after they lose.  By this I mean that they weigh more on the scale than they might expect at a given size.  They may look like a size 8 and fit in size 8 clothes, but still have a scale reading that they consider unacceptably high.  When we gain weight, our body is forced to create millions of new fat cells to accommodate the fat that fills them.  These cells look just like balloons and they swell when fat stuffs them.  They then get smaller when fat is released.  The question is whether these fat cells disappear after weight loss.  I believe that they don't.  They may remain as emptied tissue that is left behind.  Perhaps the body will eventually resorb them and then again, it may not.  But that empty tissue weighs something and it's my hypothesis that this is the reason that dieters often wind up being 20 pounds heavier than they think they should be.

Here's another important question.  What are you using as a reference for goal weight?  I don't like BMI charts because they are not based on the weights of people who were once overweight and are now reduced.  We don't know what optimal weights for that population look like, so why do we encourage POWs (previously overweight people) to get into the "normal" zone for NOWs (never overweights).  In my own case, after gaining 20 pounds and then reducing, I was never able to return to the weight I had been for most of my 30s and 40s.  Yet at my current weight I am quite thin.  On our recent trip to Asia, my distrust of some of the food sources combined with jet lag caused an 8 pound weight loss.  I was back at my "original" weight.  I looked really bad. Way, way too thin.  Now I've regained to my new normal and this is most certainly the correct weight for me as a POW.

What are our expectations of a weight loss? It's been my experience that they are usually more than a loss in pounds can bring. Even the most physically blessed of us is not perfect and all the evidence points to the fact that most people are tormented by the feeling that there is always something else to correct.  All we need to do is look at the gorgeous celebrities who continue to  "tweak" themselves with plastic surgery, body contouring and the like.  Where do we stop, get comfortable with our imperfections and let out a sigh of acceptance?  Lynn and I started our very first blogs with a discussion of this. Basically, we wanted to make the point that the body we come to inhabit after weight loss has its dings, scratches and non-working parts.  Like the Velvteen Rabbit, we must come to love it simply because it has lived and bears the marks of living.  As we approach the final pounds of weight loss, this is worth considering.  If our body is objecting before we reach some "perfect" number, are we perhaps done? 

What I've learned is that the biggest problem with weight loss is the perception that it's somehow done when the scale registers a certain number.  As this blog has reiterated ad nauseum, initial weight loss is simply the price we pay for admission to the rest of a newly designed life with food.  Once your body has stopped losing, it may well be time to start working on maintenance.  Since you are going to vastly change the way you eat and move around, and since this is going to be a lifelong project, there is no hurry.  Many people continue to lose as they learn to maintain.  Perhaps that will be the better way to go.  I know that this is anathema to those who want to be done...and for whom done means a particular number on the scale.  To them I gently say, "What's the hurry? You've done wonderfully well and you have a lifetime to figure out your final equilibration."

If none of the above convinces you that it's ok to stop active dieting before goal, let me offer a few suggestions for getting the rest of the way:

1. Since you are so efficient at this point, you will have to force your body to give up calories.  This means an increased focus on exercise toward the very end of your diet.  Aerobic exercise is better for this than weights.  Power walk, power swim, run, or do calorie burning activities like intensive yoga, assuming these are safe for you.

2. Take a look at your weight loss plan.  Most people have loosened up on the rules by now.  Go back to complete adherence.  If there are still starches and sugars in your diet, remove them now.  You may have been able to get by with weight loss before while eating them, but if you are producing alot of insulin now, your loss will stop.  The same goes for salt.  Take it out of your diet.  You'll find that it's often coming from restaurant meals, so if you're truly serious, you may want to stop eating out until you're at goal.  I would also suggest that you eat plenty of non starchy vegetables but that you limit your fruit at this point.  You don't need fruit and the sugars may be causing a problem.

3. Many people use a multiple-small-meal approach to dieting.  It's my feeling that we don't spend enough time in the non-eating state.  It's the time between meals and the hours of sleep that allow our body to switch over to the burning of stored fuels.  Try to cut down on frequent snacks and get two to three hours between episodes of eating.  This may help to move the scale downwards again. 

4. If you are using a calorie approach, make sure you are really getting the calories you think you are.  For the last part of your diet, I would suggest using more products that are calorie labeled.  As unpopular as this suggestion always seems to be, using meal replacements like shakes and bars is really effective. Its the approach I've used very successfully with hundreds of patients.   Remember that you are not doing this for a lifetime, just to get where you want to be.   I suggest that you use meal replacers during the day and eat a healthful, Primarian dinner. 

And finally, if you are reading this post as someone who is close to goal, I want you to know that you have done an amazing job.  Losing weight in the midst of the SAD is much more difficult than anyone leads us to believe.  You have had the dedication to do it.  You've put in the work.  Bravo!!  Now.....the only thing I ask of you is that you please, please refuse to regain!

 

 

 

 

 

Halloween to New Year's Day: Joy, Anxiety and Overeating

by Barbara Berkeley, MD

Why do we eat?

In the America of 2011, we eat for the same reasons we buy new TVs, redo our kitchens or replace our perfectly functional cars.  We eat not because we need to, but because we can.  Eating is cheap, pleasurable and soothing.  It's kind of an adult "blankie". 

With that in mind, let's look at when we need a blankie most.  We want to be soothed when we are stressed, when we are reminded of unhappy memories, when the skies are dark, when winter descends, when we feel tired and overwrought.  

In the America of 2011, a supermarket is like a wonder-world of shiny new toys, each one affordable and promising a thrill.  The packages say "Fun! Fun!Fun!" while the labels say, "Heart Healthy" and "Cholesterol Free".  It's ok to be seduced, it's ok to give in.  Heck, it's even virtuous.

Combine these two stimulants to eating and you have the dangerous food period between Halloween and January 1st.   As the skies darken (at least in Ohio) and the leaves fall from the trees leaving depressing skeletons, the food intensity ratchets up.  Seasonal foods make their appearance.  Starbucks puts peppermint back on the menu, along with gingerbread.  Cooking magazines, newspapers and food channels exhort us to bake, bake, bake...as if this will somehow stave off our anxiety.  As we get older, the holidays remind us more and more about our own mortality.  They are still a wonderful time, but we remember how many of these holidays there have been and how many of those we loved are now gone.  Our kids may have grown up and live far away.  They return for the holidays, but no matter what we do, we can't return to the time when they ran down the front steps dressed as ghosts and princesses. We compare today's holidays to those past and to the celebrations of others.  Anything that reminds us of the passage of time tends to make us introspective and unsettled.  

So...let's eat!  Let's drink! 

How do we successfully negotiate such a difficult period and not regain?  The answer lies in creative thinking.  Maintaining a new, healthier body requires a new, refreshed look at life. Instead, most of us tend to repeat the same patterns.  Left unexamined and unchallenged,  life tends to break people down.  But it doesn't have to.  If you as an individual keep creating, keep innovating and keep expanding, the things life removes will have a lesser impact.  You will be more expansive.

Here are some questions for those who want to maintain from now until 2012:

Do you REALLY need to bake this year?  If baking gets you out of control, are you willing to take the daring step of experimenting and letting someone else make the cookies, cakes and pies?  What would happen?

Suppose you didn't have a single piece of Halloween candy this year?  Would your life be different?  Or would it be the candy manufacturers who suffered most?

Imagine that you designed a completely Primarian plan for Thanksgiving and decided that you would fill you plate with turkey, salad, veggies and maybe a dab of cranberry sauce.  Suppose you vowed not to have dessert this year, except for coffee and fruit.  Would your enjoyment of Thanksgiving be less?  

Suppose that you decided to do something really radical this year and ban non-Primarian foods from your home over the holidays.  Suppose that you decided to give yourself a much bigger gift than that new IPhone you've been eyeing?  Imagine that you daringly and creatively decided to stick with a primal eating plan with extremely minimal starches and sugars.  Would you have lost an entire year of holiday joy?

I can answer these questions because these are changes that I made personally almost 10 years ago.  Here are the answers.

The holidays are just the same.  It's still great to see everyone and it's still sad to miss Uncle Monroe, Uncle Aaron and Aunt Ellie.  It's still great fun to smell the peppermint and have an occasional gingerbread latte (with Splenda).  It's still a thrill to see the holiday decorations go up and to enjoy the lights, the music and the sentiments.  It's still wonderful to eat dinners with friends and family, and not a soul cares that I don't have the brownies or the stuffing.

And here's what's different.  For the past ten years I have not had to worry about my weight, my blood pressure, my blood sugar or my cholesterol.  My weight and health have allowed me to live so much more creatively...running, spinning, tennis.  Sometimes I'm just so grateful that I can easily squat down and pick up something I dropped.  Alot of people my age can no longer do something so simple.  Being lean and eating the right foods means that you are quicker and more efficient in every way.  My brain works better without the S Foods, which means that I can take up Chess, learn how to use Twitter and blog to the point where you are probably sick of me.

These are the greatest gifts.

So as you approach the holiday season, think bold.  Uphold your chosen eating plan..whatever that may be. Consider the possibility that our holiday eating may be motivated less by happiness and tradition than by habit and anxiety.  Enjoy and celebrate by continuing on your journey of self-creation.  To life!

 

 

 

Getting Fat: What You've Been Told Is Wrong

by Barbara Berkeley, MD

If you listen to the loudest voices repeating the most conventional wisdom, getting fat means that you simply eat too much.  It also means that you are a slovenly slug, sitting around when you should be doing something strenuous.  In addition, you are psychologically damaged and using food to salve your painful problems.  Finally, you are a weak-willed incompetent who can't control a simple thing like food. What does getting fat mean?  If you believe what you hear, it means you are a failure.  Not just at one thing, but at many.

This is a great big, destructive, lie.  (OK, let's give the wisdom-spouters the benefit of the doubt and say that they are not lying, just laboring under a major misconception).  

Suppose we consider a complete shift in the way we look at weight gain.  Just hear me out on this.

Suppose that we start to get fat because we have developed an intolerance to certain foods in our diet? Imagine it's akin to an allergy.  You can develop an allergy any time in life, so why couldn't you develop a reaction to certain foods after years of eating them? Let's call these foods PTFs for "Poorly Tolerated Foods".  

Now imagine that you are born with a normal body mechanism that knows just how to handle food.  Your body has mechanisms to handle just about any perturbation.  If you eat 5 bunches of bananas today for example, the potassium load won't kill you.  A neat body mechanism will take care of excreting the excess.  We don't think about how to heal a cut, send antibodies to fight a bacteria, or adjust our body temperature.  Under normal circumstances, we shouldn't have to worry about how to keep our weight stable either.  We are designed with a mechanism (I call this IBM or Intake Balance Mechanism) that does this automatically whether we eat more or less, exercise alot or a little.  While some people have a weight problem from a very young age, many overweight people remember an earlier life stage during which they could eat what they wanted and exercise minimally. What happened to those halcyon days?  Their IBM stopped working when they lost their tolerance to certain foods. The PTF problem messes up the function of your IBM.  It no longer balances intake, but sends these foods to fat storage. 

Now let's further hypothesize that one of the side effects of this intolerance is that these PTFs  provoke a hunger reaction.  In other words, eating a PTF disturbs the normal balance of hunger and satiety so that it feels like taking a shot of hunger hormone. It's demonic, but the effect of eating a PTF is to make you want more of it.  And that craving is a strong one.  At times, almost impossible to control by force of will. 

Finally, let's imagine that most people have no idea of the PTF hypothesis.  With the best of intentions, they suggest that you control your weight by eating exactly what's causing the problem: PTFs.... but by controlling the size of your portions.  They also suggest that you exercise like mad..something which has very little to do with the PTF problem.  So you go on eating these foods, getting more and more intolerant to them and gaining weight.  You exercise like a fiend but don't lose anything much.  You feel hungry all the time and can't understand why you can't control yourself.  You resort to the default explanation:  "I must have a slow metabolism".  Neither you nor any scientist can fully explain or yet define the complete metabolic processes of the body.  But every magazine cover says that diets and exercise can do all kinds of things to your "metabolism", so you believe that this amorphous thing called metabolism is at fault. 

This is,in fact, the scenario that I see each and every day in my weight loss practice.  My PTF hypothesis (which simplifies what I believe about more complex issues involving insulin, insulin resistance and fat storage) is part of a growing movement to understand obesity in a different way, one that is more intuitively obvious and yet still fits with our current knowledge of science. 

The foods that most of us become intolerant to are the very foods that are new to the human diet.  No human being consumed large amounts of starchy carbohydrates and sugar prior to quite recently.  Is it overconsumption of these foods that disturbs the automatic mechanism that stabilizes weight? Who knows? The initial insult might come from food additives, background radiation, plastics in our containers, or just about anything you can posit.  For the moment, what starts the process is less important than this:  if you are gaining weight and your body is not preventing that gain, you have almost certainly developed an intolerance to starch and sugar.  These foods are no longer handled properly by the IBM.

But what of overeating?  Don't we eat way too much?  There are two points to be made.

1. There are people who simply overwhelm the normal balance mechanism by eating SO much that the mechanism can't handle it.  Remember the banana analogy?  If you inject potassium directly into the body in high concentration, you have the Jack Kevorkian scenario.  You'll die, because the normal corrective mechanisms are simply overwhelmed.  This is true for those who overeat massively like some with binge eating disorder or people who attain weights in the high triple digits.  However, even for them, avoidance of PTFs may be a crucial element in recovery.

2. Yes, we eat too much.  But in my view this is happening largely because we eat so many PTFs and they make us hungry.  Those who cut out these foods have no trouble controlling appetite (or much less trouble, anyway).  They are still challenged by seeing, smelling and being offered food, but not by the internal gnawing that says, "Let's EAT" 24 hours/day.

The PTF hypothesis is what underlies the growing Primal/Paleo diet movement. I've been an advocate of ancient eating for years and have practiced a form of it myself ever since I gained 20 pounds in middle age. For years, this change in my eating has allowed me to maintain a weight of 123 pounds on a 5'6'' frame.  I'm not excessively hungry like I was in the days when I used to inhale cookies and York Peppermint Patties.  At 63, I take no medicines, have no joint problems, can exercise with the 20 year olds and no longer fear the tendency to coronary disease that I've probably inherited from my Dad.  I am confident that my arteries were not meant to be clogged.  If I eat the diet that was eaten by people prior to the advent of coronary disease, I feel very certain I will be protected. 

The intuitive part of the PTF hypothesis is the connection to ancient diet.  I made this connection on my own while on a trip out of the country about 10 years ago.  At the time, I was struggling with my weight and had been for several years.  I had the sudden thought that perhaps I wasn't eating what I was evolutionarily attuned to...what my genes expected to be food.  I put myself on what I thought would approximate a hunter-gatherer diet.  I immediately lost 20 pounds and the hunger that went with it.  I then started checking around to see if any one else had figured this out.  At the time, the community of ancient eaters was smaller, but still quite active.  Once I had my personal epiphany, this connection seemed to me so intuitively obvious that I was startled that so few were exploring it.  Is it completely correct?  I can't say.  What I can tell you is that it works.  Amazingly well.

I have now treated hundreds of patients with primal diet variants.  The plan is simple.  Eat what you think a hunter gatherer could have eaten.  Don't eat starches or sugars except for those in fruits (non tropical) and vegetables. Don't eat GRAIN or grain products!  Do eat low fat dairy (that's my variation on strict Paleo) if your weight tolerates it.  I call this variant a Primarian diet. Tailor your Primarian plan to yourself to keep weight stable.   

There.  Your PTFs are gone.  Your balance is restored.  And suddenly you're not a failure anymore! That's because you never really were. 

 

 

 

 

 

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.

 

The Tag-a-Long Phenomenon: A Healthy Contagion

by Barbara Berkeley, MD

 You may have read the headlines awhile back in your local newspaper.  Obesity is contagious. 

Based on data emerging from several large scale clinical studies, researchers announced that those of us who socialize with, or live with those who are obese have the tendency to "catch" it, making obesity into a sort of fatty measles.

This news made all the major papers and media outlets and of course led to the obvious and unfortunate conclusion that obese people were to be avoided just as we might give those with strep throat a wide berth.  As with many pieces of research that are trumpeted with great fanfare, this one is now being called into question.  Unfortunately, the media spotlight rarely catches up with the reviews and criticisms that occur after an announcement is made.

A  recent article in the New York Times  pointed out the shortcomings of this research.  Basically, it's extremely difficult to separate contagion from other phenomena.  Perhaps overweight people tend to cluster together because they choose friends who have similar lifestyles or because watching the behaviors of close friends and family tends to normalize those behaviors in their minds, making them more acceptable.  

The jury is out.  

However, I think that this controversy gives me the perfect opening to discuss one of my favorite related phenomena:  the fact that those who develop new, healthy, lifestyles seem to have a strong influence on those around them.  In fact, a large percentage of my successful patients report that someone in their life,  a spouse, friend, or child, will have lost significant weight and changed behaviors as a result of watching their progress.

I call this the Tag-a-Long Phenomenon and I believe it demonstrates the same principles documented by the researchers on obesity contagion:  but in reverse.  

A friend of mine developed an autoimmune disease and was overweight.  As a result of knowing and observing me, she adopted a grain-free diet and became a 90% Primarian.  She lost all of her excess weight and had a marked decrease in the symptoms of her disorder (which had reached the point where she was about to begin steroid treatment).  About a year later, her overweight son adopted the same diet and normalized his weight.  Sometime after that, her husband, who had been highly skeptical of dietary change, began to eat the same way. 

Our practice treated a man who had been told he needed gastric bypass to control a new case of diabetes.  After losing all of his weight and becoming a Primarian eater, his wife came to us for similar treatment.  We then treated their children.  Friends who knew the family turned out to have been influenced by their results.  Some came to us and some adopted similar eating principles on their own.  This single man's food conversion has now effected upwards of a dozen people.

We work with the president of a major company.  After losing significantly and becoming a runner and primarily Primarian eater,  our patient noticed that members of his management team began to show similar inclinations.  One became a marathoner and others lost and maintained weight.  The change in their lives has led to an interest in new programs and healthy initiatives throughout the company.

What is contagion?  In my view, its definition is clinically unimportant when it comes to behaviors.  Whether we call it contagion, influence, or modeling, it is obvious that human beings closely observe one another and learn from what they see.  If eating too much is the norm in your circle, it will be harder to avoid it.  However, if you make the effort to be someone who changes and has a true shift in belief and behavior, there will be many people around you who will watch and perhaps mimic your efforts. 

Because behaviors get into the cultural atmosphere and have the ability to spread "virally",  it is important to create an environment that values health more and relies on medicines less.  We all have a bit of the lemming in us.  But given the chance, it's as easy to follow the one who's ascending to the mountaintop as it is to pursue the one who's headed off the cliff.