Holiday Weight Gain...Again!

Click! Step away from the Halloween candy. I repeat, step AWAY from the Halloween candy!

Okay, how many times have you walked past the leftover candy and snagged an extra treat today? It is so easy to keep it around just to "finish it off". I'll bet you're even down to the candy you don't even really like, yet you pop one in your mouth because, well, it's there. How do I know? Because I just ate a mini-Snickers, which is my least favorite candy. The Reese's cups were gone last week.

All kidding aside, please take stock of your health TODAY. We are already well into November, which is the heart of "stuff yourself silly" season. Treats and sweets abound, as well as extra adult beverages at every celebration- and those pack on the calories as much, if not more than the edible delicacies! At the office, we are already seeing the extra weight creeping up. The average American gains nearly 10 POUNDS during the holidays. And then what does everyone do? We make a New Year's Resolution to lose weight.

This year, let's be PROACTIVE! Start on that new exercise program right NOW! Take the stairs instead of the elevator. Park a little further away when you go to work or shop. Fill your party plate with healthy choices and eat them first before you head to the dessert buffet. Every bit you do now will make those New Year's Resolutions much easier.

BOTTOM LINE: Do not wait for New Year's to start thinking about improving your health!

A Step (or Pedal) in the Right Direction!

Good news! Americans are slowly but surely getting MORE mobile. Research studies utilizing national household travel surveys from the last decade reveal that we walked on average 9 miles more than we did back in 2001. We also biked about 5 miles more. I'm pleased to see that 8% are walking 30 minutes per day- that's my "magic number" for daily exercise, because 30 minutes of getting your heart rate up each day will give your heart, brain and body a boost. In fact, 30 minutes of daily exercise helps improve your mood as much as a low dose of an antidepressant!

I find it interesting that 75% of walking trips and 50% of biking trips in 2009 were purely a mode of transportation (to the store, school, see friends, etc.) rather than for the pleasure or intent of exercise. The wonderful part is that you get the same benefits of exercise, regardless of your intent when you are in motion. With gas prices going up through the roof, I hope we will see a continued trend that bicycling will be used in place of cars for short travel distances.

Why not take a step in the right direction and make a commitment to walk or bike to at least one nearby destination instead of driving? Perhaps your family could walk to a neighborhood yogurt shop or diner, or you could bike to the grocery store for those one or two forgotten items.

BOTTOM LINE: Congrats, America, we're starting to move MORE- keep it up! And please...WEAR HELMETS & visible clothing!

Top Two Secrets for Permanent Weight Loss

As the seasons change, and bathing suit season is staring us right in the face (or other, more sensitive body image spots), many of us are focusing on what we can do to make some positive and permanent dietary and lifestyle changes. Yesterday, I mentioned several successful strategies used by folks who have kept off over 60 pounds for many years. In my practice, the two most important strategies include eating breakfast each morning and exercising daily. Let me expand on these two points for a moment.

First of all, breakfast. Yes, your mom probably taught you that you must "put fuel in the tank" and that breakfast is the most important meal of the day. Guess what? She was RIGHT! When you get up in the morning and charge into your day without true nutrition (coffee does NOT count as breakfast), your body assumes there must be a food shortage and goes into conservation mode. To maximize your metabolism, you simply need to eat. Does it need to be a hot, four course meal? Nope! How about a cup of yogurt, or a banana with some peanut butter, or cereal with berries? In a hurry? Grab a granola bar (and a banana or other piece of fruit, in a perfect world.) It never ceases to amaze me that I have at LEAST one patient per month come in with impressive weight loss since their last office visit, and they tell me that the ONLY change they made was to start eating breakfast!

Okay, how about that daily exercise? Really, EVERY DAY? Yes, again. I prefer to think about it like brushing your teeth. Do you wake up each day and struggle with the decision of whether or not to brush your teeth? Do you really enjoy brushing your teeth? I'm guessing the answer to both of those questions is "no". Exercise should be the same deal. Again, it doesn't have to be fancy, just consistent. Pull on your sneakers & head out the door for a brisk walk, or flip on your tv and join in on an exercise program. If you start each day with a quick 30 minutes of some type of aerobic activity, I'd bet you'll find not only a much higher rate of consistency, but extra energy and a better attitude.

BOTTOM LINE: Commit to EATING BREAKFAST and DAILY EXERCISE to keep those extra pounds off for good!

How Do You KEEP the WEIGHT Off?

Many people lose the SAME 10, 20, or even 50 pounds over and over again. How frustrating is that? What can you do to PERMANENTLY lose weight, so you're not fighting that same battle? The first answer is obvious- stop DIETING. When you go on a super restrictive DIET, certainly you will lose weight, but if you never really look at your eating patterns and exercise habits, you are doomed to repeat the cycle.

I always encourage my patients to make changes they can live with for the REST of their lives. Typically this does not involve permanently eliminating ANY particular item from their diet- whether it's chocolate, butter, or even soda. Should you limit these high calorie items? Sure! But really, if you focus on MORE fruits and vegetables and water, then truly, you'll begin to notice you ARE eating less of these higher ticket items.

There is a wonderful website dedicated to people who have not only lost more than 30 pounds, but KEPT THOSE POUNDS OFF for at least a year- the National Weight Control Registry. In fact, the average weight loss is 66 pounds, and they have kept it off an average of 5.5 years! Both men and women are enrolled, with the average ages being 49 and 45, respectively. About half lost the weight on their own, while the other half joined programs. What do they have in COMMON?

1. 94% INCREASED their activity level, most commonly by WALKING
2. 78% EAT BREAKFAST daily.
3. 75% WEIGH themselves once per week
4. 62% Watch less than 10 hours of TV per week
5. 90% EXERCISE DAILY

BOTTOM LINE: If you want to stop battling the same pounds, take a look at the success stories of people who have KEPT their weight OFF, and see what simple changes you might be able to make to keep YOUR weight off.

What Works for Weight Loss? MORE!

MORE, MORE, MORE! That is chant I want you to hear in your head as you focus on FITNESS. Yesterday I talked about MORE fruit and vegetable servings- 5-10 per day. Today let's shift to MORE MOVEMENT.

Many of my patients started 2011 with the resolution to go to the gym EVERY DAY after work. Guess what percentage are still doing that? Hmm...not too many. Why is that? It is a setup for failure. While exercising EVERY DAY is absolutely possible, and indeed, what I do and what I encourage everyone to make a life habit, exercising in a specific place outside your home- like the gym- is very difficult. Say today you wake up and your child has a fever, so you can't leave the house. Tomorrow you have a business meeting in the evening (no time to workout, shower and clean up between work and that meeting) and boom, then it snows/rains/floods...you get the picture!

I think planning a day or two per week at the gym (or the track, or walking the mall) is wonderful, but please, set yourself up for success by having backup plans AT HOME. I am a big fan of exercise bikes and DVDs for this reason. Grab your tunes and/or your dog and head out the front door. Set a timer for 30 minutes, turn on some music, and dance! OR- I got this idea from another woman physician last October- set the timer for 30 minutes, turn on music, and CLEAN YOUR HOUSE- actively! Vigorously scrub the counters, alternate hands, squat up and down unloading the dishes, mop quickly, whatever it takes to keep your heart rate up. Which exercise is best? The one you will DO.
The main idea is to MOVE MORE. Check out my blog on PEDOMETERS- they work great, too!

BOTTOM LINE: Switch your focus to MORE: MORE movement, MORE fruits & veggies!

MORE Ways to Lose Weight in 2011

As promised, in keeping with the new USDA guidelines, I am returning to talk about my MORE philosophy that has helped many patients lose weight. When people decide they want to lose weight, what is the first thing that pops into their mind? DIET, right? So what's next- which foods am I going to cut out of my diet? Followed closely by feelings of deprivation, and then frustration and disappointment when they give in to a craving for that off-limits food.
What if, instead of focusing on LESS, you focus on MORE? I encourage my patients to simply INCREASE their fruit and vegetable servings. The goal is 5-10 servings per day, total, of either veggies or fruit. A serving is what comfortably fits in your cupped hand. Therefore, a salad like the one pictured here is roughly four servings- 2 handfuls of lettuce, one of shredded carrots and one of tomato. Easy, right?

What happens when you focus on MORE vegetables & fruit servings is no secret. You FILL UP on "nutrient dense" foods that are GOOD for you, and eat less of, well, everything else! It tends to be the complex carbs (think breads, crackers, muffins, cookies, chips) that pile on the calories, NOT the fruits, vegetables and protein.
Does this mean you are not "allowed" to eat those complex carbs? Absolutely not! What it means is that you will be focusing on MORE quality in your diet by pushing up those F&V servings, and that typically will automatically decrease your total calorie intake, which POOF- "magically" helps you lose weight.
BOTTOM LINE: It's not rocket science, my friends- simply consume less calories than you burn, and yes, you will lose weight. But do it RIGHT, and make sure you are not skipping any meals, and that you ARE eating foods packed full of vitamins and fiber...our friends, the fruits and veggies.

Do-Over! New Year's Resolutions: Take 2

Welcome to the second Monday in January! Have you "blown" your New Year's resolutions already? If so, you are not alone, and better yet: take a "Do-Over"! Why not let January 10th be another January 1st?

Quite honestly, I'd rather you start over EVERY Monday than simply chunk your resolutions. However, this time, really focus on something SIMPLE and CONCRETE that you can definitely attain. If you have been inactive, for example, don't commit to heading to the gym 5 days per week! Instead, if you have joined a gym, commit to going "on Wednesday mornings, with your buddy, who joined with you." Mind you, I'm not saying to AVOID the gym the other days, but make sure your resolution is something that is possible to keep, so you can feed on your success.

If weight loss is your goal, make sure that you have set realistic goals. It takes a negative 500 calories per day (either eating less or burning off more) to lose ONE POUND PER WEEK. And that is excellent weight loss! I can't tell you how many of my patients feel dejected if they "only" lose 2 or 3 pounds in a month, despite the fact that medically, this is terrific weight loss. Shows like "The Biggest Loser" are motivational, but realize that those participants are more than 100 pounds overweight to begin with, and have chefs and trainers round the clock. If you are only 20 or 30 pounds overweight, plan to lose that in ONE YEAR.

BOTTOM LINE: Keep prioritizing healthy food choices (MORE Fruits and Veggies) and MORE exercise, and 2011 will be a year of success and good health!

MORE Dieting Tips!

As we launch into 2011, many people are motivated to work on weight loss. Yesterday I mentioned a few simple dietary changes that can add up to BIG RESULTS when they become a permanent change. Today, I'd like to focus on my "MORE" concept. I have found that the majority of my patients (and friends and family) have an easier time improving the quality of their diet by focusing on INCREASING the amount of veggies and fruit they consume, rather than focusing on eliminating "bad" food.

Here is my specific recommendation:
Aim to eat 5 to 10 SERVINGS (what you can comfortably hold in your cupped hand) of vegetables and/or fruit per day.

That's it! Really, it's that simple. Don't freak out that there is "no way" to eat that many servings per day. I promise you that even young kids can easily follow this rule. Add in a banana or a handful of berries to your breakfast. Have your morning or afternoon snack include a serving (think an apple, carrots, raisins, etc.)
At lunch or dinner, include a generously portioned salad. If you have two handfuls of lettuce, plus one more handful of either tomato, shredded carrots, avocado slices, peppers, or your favorite vegetable, you've already got 5 SERVINGS! If you layer up the salad or simply add some vegetables to another meal (think yams, green beans, applesauce) then you are up to ten before you know it.

Ultimately, you'll begin to recognize that each meal should contain "color"- at least half the plate filled with vegetables and fruit. You end up filling up on these healthy choices, and eating less of all the extras (such as pasta, rice, bread) that have a much higher calorie count.

BOTTOM LINE: Focus on INCREASING your fruit and vegetable servings for a healthier 2011!

Gluten-Free Diet

This week I am talking about celiac disease, which requires a life-long commitment to a gluten-free diet. So, what the heck does that involve? Well, gluten is a protein found in all forms of wheat, as well as related grains such as barley and rye. What is made with wheat? At first glance, it feels like EVERYTHING has wheat.

Most cereals, breads, cookies, muffins, cakes, dough (think pizza), buns, and pastas, etc. ALL are classically made using wheat flours. Happily, though, there are more and more foods in these categories that are made with rice, corn and potato flours- all of which are gluten-free. In almost every grocery, there is a small (and ever-expanding) section of gluten-free "bread" products and mixes. Check out my "commercial" for delicious gluten-free pancakes, for example- yum! And rice-flour cereals such as Rice Chex are still on the menu, though ones like Rice Krispies that sound gluten-free (GF) may not be (because of additives like malt.)

More importantly, though, there are tons of delicious, healthy foods that are naturally gluten-free. Practically the whole perimeter of the grocery store: every fruit and vegetable (think MORE!), dairy, nuts, and meat are all GF. Our bodies don't NEED gluten nor any of the treats/sweets/doughs that our MOUTHS or minds may crave...

I think the biggest challenge of GF eating is baking. There does not seem to be a simple recipe substitute- at least not "replace one cup of wheat flour with one cup of brown rice flour" style. Because of the TEXTURE, you need to make blends involving rice flour, potato starch and tapioca flours, for example. I have found a great baking cookbook that I would recommend: Gluten-Free Baking Classics, by Annalise Roberts- try the delicious lemon pound cake!

If you are committed to a GF diet, make an appointment with a registered dietician to really learn all the nuances of this meal plan. Here in Austin, I recommend Daniela Knight, RD, to help you with this transition.

BOTTOM LINE: Gluten-free diets are rich in fruits, veggies and protein, and can be supplemented with carefully chosen gluten-free baked goods.

BYOB Until You Get One of THESE New Machines!

Yea! Let's here it for vending machines selling...brace yourself... HEALTHY SNACKS! I was delighted to see "The Great Banana Challenge: How to dispense healthy snacks from a vending machine: design a fruit elevator" in the Wall Street Journal this week. It's hard to imagine walking up to a vending machine and expecting food to be, well, FRESH- but that's exactly what happens in these new machines.

Apparently, they've developed technology that allows for different refrigeration temperature zones as well as gentle "elevators" to lower the food and padded retrieval bins to avoid bruising. New packaging for the fruit itself extends the shelf life to nearly double its life outside of the wrapping.
For all of us who do not have these delightful new machines yet, don't worry! When in doubt, BYOB...Bring Your Own BANANA, that is!

BOTTOM LINE: The MORE we demand fresh fruits, vegetables and healthy snacks, the more innovative solutions our free market will create!

But It's Too EXPENSIVE to Eat Fruits & Veggies!

Okay, this is one of the top excuses I get from patients when we start talking about improving their diet, and getting them to focus on MORE fruits and vegetables. (Keep in mind, our goal is 5-10 servings per day, and a serving is what you can hold in your hand.) So back to the discussion- is the perimeter of the grocery store really more expensive than the boxed, processed junk in the middle?

Of course, if you look at the BIG picture, it's easy to see that no matter what, you are better off buying the fruits and vegetables. Diabetes, blood pressure and cholesterol medicines cost a small fortune, even if you are "only" paying the co-payments. Part of the incentive to improve your health (and yes, lose weight in the process) is that MANY people can reduce or even eliminate these medications, which will save them a very significant amount of money!

In the short term, though, what is the cost? Obviously it depends on what you choose. My friend and excellent dietician, Daniela Knight, RD, recommends that her patients check out the weekly ads. "If bananas are on sale, load up on those and skip the $5 per carton blueberries that week." Lettuce, carrots, onions, apples, oranges and potatoes are typically inexpensive year-round. Frozen fruits and vegetables are packed with the same nutrients as fresh ones, yet often cost much less. Additionally, there is nothing wrong with canned vegetables or fruit, either, despite the incorrect notion that they are vastly inferior. Yes, watch for sodium in canned goods, but the nutrients are fine!

Daniela also reminds her patients that you can buy an entire BAG of potatoes for less than the cost of a bag of potato chips, which are up to $3-$4. Pre-washed, packaged vegetables like broccoli and green beans are simple to pop in the microwave, and now you've got quick AND reasonably priced veggies.

BOTTOM LINE: Fruits and vegetables are worth every penny for your health, and can save you money in BOTH the short and long term if you buy frozen, canned and seasonal fresh produce!

MORE- A Novel "Diet"

On this last day of the 2010 AAFP Scientific Assembly, I will be speaking about nutrition. As family physicians, we are all motivated to help our patients achieve the best health they can, and often the major issues stem from being overweight. We know excess weight leads to high blood pressure, elevated sugars and diabetes, and high cholesterol levels, which can lead to heart attacks and strokes. So why don't more family doctors talk to their patients about their weight?

Of course, there are many reasons, but here are a few:
1. The doctor doesn't want to insult or upset the patient by telling them they are overweight, especially if the doctor herself is overweight.
2. Weight loss counseling can be very time consuming, and we are already time pressured without opening this can of worms.
3. Many doctors lack knowledge or training regarding current nutrition, and are unsure of which "diet" to recommend.
4. Often patients want weight loss drugs, and most doctors are unsure of the risks and aware of the high percentage of relapse once the medication is stopped.

My goal today will be to teach primary care physicians some simple tools that they can use to help motivate their patients to lose weight. They will learn about BMI, 24 hour dietary recalls and exercise prescriptions, and learn about my MORE philosophy! We all know that MORE fruits and veggies will push us towards better health, but having a concrete plan for More fruits/veggies, Optimizing Snacks, Ramping up Fiber and Exercising daily will be a terrific start! In fact, our surgeon general, Dr. Regina Benjamin, emphasized that we need to stop focusing on what we CANNOT have/eat, and start focusing on what we can and should be eating, which is exactly the MORE message I have been sending the past few years

BOTTOM LINE: Focus on MORE fruits and veggies, MORE exercise, MORE fiber and stop the culture of restrictive dieting!

Shake Up Your Summer Habits!

Okay, we're nearing the end of summer- are your kids bored? Have they (or you) fallen into some poor habits? Time to take stock and be proactive! Let's start with activities.

What are you doing in your spare time? Hanging out and reading blogs? Turn off the computer (after you finish reading this, of course) and head out to your garage. In a minute or two, I'll bet you can find plenty of outdoor "toys" to get you moving. My garage had this: skates, volley balls, soccer balls, basketballs, croquet, bikes, jump rope, hula hoops, a scooter and golf clubs.

Now, what about food? Our kids realized they were falling way behind in the fruit and vegetable department, so we pulled out everything in the fridge (and a bunch from the pantry) to see what our choices were. Happily, we had the five ingredients for hummus, along with a fresh bag of baby carrots, so we whipped up that delicious snack first. The overripe bananas paired up with some frozen berries, peaches, and yogurt to provide smoothies, and we were back on track.

The next step? I asked each kid to be in charge the menu for three days this week. The rules are that we need ten servings of fruits and vegetables per day (a serving is what you hold in your hand) and that only one of the nine meals could be from a restaurant. I'll let you know next week how it went, but today was terrific!

BOTTOM LINE: Take stock of your dietary and exercise habits, and make sure you haven't fallen into the summer doldrums!

The Perfect Diet- What Healthy Seniors Know

After doing 24-hour food histories on my patients for over 15 years, I have seen many different consistent patterns. The "unhealthy vegetarian" one that I shared earlier this week is a classic example that was a surprise to me when I first began this practice. The one I'd like to share today is my personal goal. The majority of my healthy, active "seniors" (usually 60+years old) patients fit this pattern. Of course, there are variances, but a few common themes dominate:
1. A BIG breakfast- eat your largest meal first, then a smaller lunch, and smallest portions at dinner.
2. Very little processed foods of any type
3. An afternoon snack, typically including nuts
4. A dinner that includes primarily vegetables
5. Dessert (often just a piece of rich chocolate) and/or a glass of red wine

What does this look like specifically?
Breakfast- Egg or egg-white vegetable omelette (peppers, onions, mushrooms, tomatoes +/- cheese), beans, a bowl of mixed berries, whole wheat toast, and sometimes a slice of bacon or piece of sausage, juice or milk and coffee
Lunch- chicken breast, asparagus, carrot sticks, brown rice and WATER
Snack- an ounce of cashews or almonds (often they'll tell me a number- 22 almonds, or some fixed amount) and a sliced apple and water
Dinner- a large green salad with tomatoes and other veggies and a small portion of fish, completed with a glass of wine and a chocolate truffle

Notice there are not lots of chips, no fast food, and plenty of water.
BOTTOM LINE: While there is no "perfect" diet, look at the mature people around you who radiate health and energy, and ask them to share their dietary pattern with you. Let me know what they say!

MAY DAY, MAY DAY!

Isn't it funny that "May Day" conjures up some very conflicting images? Do you think of children dancing around a May pole, or a plane crashing? Hmm...it's all about half-empty or half-full, I suppose.
Let's think about the positive image of children dancing, flowers in their hair, and beautiful sunshine. That image reminds me of EXERCISE, POLLEN, and VITAMIN D. Okay, I know- a bit weird, but hey, it's my job and my passion!

#1- Exercise. It's now the fifth month of the year. Have you kept up your New Year's resolution for "MORE"? (See early January blog entries). If not, or if you did, but fell off the wagon, START OVER! Make another resolution today and start moving MORE.

#2- Pollen. It's the first of the month, so change those air filters! (See Feb 1st entry)

#3-Vitamin D- Get that sunshine vitamin in your system! Most people are deficient, so add 1000IU of Vit D to your diet, or have your doctor check your level to find out if you need more.(See The Sunshine Vitamin blog entry of 3/13/10)

BOTTOM LINE: Happy May Day! Today's reminders are about exercise, air filters and the sunshine vitamin.

Guilt-free "Do-Over"!

Happy Friday! Can you believe that it's already the last Friday in January? Where did the first month of 2010 go? Monday brings with it the start of Valentine's season, so here is my first Valentine to you: a free "do-over"!
If you started the year with wonderful intentions of healthier eating, movement, and lifestyle, but feel you've already fallen off the wagon, don't give up! Cut yourself some slack, and instead of lining up the excuses, do something today to make a positive change. Enjoy a fruit smoothie, walk your dog, jump back on the Wii fit- whatever sounds uplifting to you, and make a fresh start on Monday (or better yet, today!) Every day, truly, provides the opportunity to improve your health. Sometimes we get so sunk into the guilty or failure mindset that we need "permission" to set the reset button, so here it is!
BOTTOM LINE: Give yourself a big hug and celebrate your successful strides for "MORE" in 2010, and/or grant yourself a guilt-free new start today!