Should You Be Gluten-Free?

I LOVE when patients ask me if they should be GLUTEN-FREE. Why? Because the gluten-free diet is inherently healthy (if you do it without searching out the elusive gluten-free twinkies) and because I have been following a GF diet for about seven years, so I have far more personal opinions and advice about this diet than your average non-GF doc.

Who NEEDS to be Gluten-Free? People with Celiac Disease. Anyone with this autoimmune disorder needs to COMPLETELY avoid gluten, which is a protein found in wheat, barley and rye. If they do eat gluten, their body basically overreacts and the inflammatory response in their gut damages the gut lining, which blocks absorption of important minerals and vitamins. Untreated celiac disease can lead to multiple complications, including anemia, a skin disorder called dermatitis herpetiformis, autoimmune disorders, neurological problems and some cancers.

Who MIGHT be helped from a gluten-free diet? People with autoimmune disorders. Gluten is pro-inflammatory, which means that it can stir up an overactive immune system by irritating the gut lining and triggering a whole body response, sort of poking the giant. With autoimmune diseases, the problem comes from too much immune response (too much inflammation) creating swollen joints, rashes, etc. The general concept is that if you remove gluten, that is one less thing to provoke your overactive system.

My most important advice about the GF diet: emphasize the natural foods that are gluten free- fruits, vegetables and protein sources (nuts, meats, fish, eggs, etc). If all you do is substitute the GF version of every bread, pasta, pizza, cookie, cake and twinkie for those things in your diet now, then yes, you will be GF but not necessarily healthy. And from the mental/emotional aspect, sometimes that's the easiest way to start GF without feeling deprived. But why not have those GF alternatives in moderation, while emphasizing the healthy wonder that is the colorful world of veggies and fruits? Your body will thank you for it.

Do I still seek out the best GF treats like pizza, calamari and brownies? You bet! Am I excited to find Udi's newest delicious GF multigrain bread? Of course! But my dietary GOAL remains focusing on more vegetables and fruits, always paired with a protein source.

BOTTOM LINE: Gluten-free diets are necessary for people with celiac disease, probably good for those with autoimmune disorders, and healthy for all of us as long as we "go natural". 

Facebook Diet!

Happy February! How are those New Year's Resolutions holding up for you? I hope at least a couple healthy choices are sticking with you...If not, I've got a social media suggestion that might just keep you on the straight and narrow. Meet the "Facebook Diet" concept!

Full credit for this idea comes from my high school friend, Anne White. In fairness, in her case, I should call it a FB Exercise Plan, but the concept is easily extended to other healthy choices such as pumping up your fruits and veggies, quitting smoking, or yes, exercise. Back to Anne. In December, she boldly proclaimed on Facebook that she was committing to 90 days of a very challenging exercising program called P90X. Each day, she posted a short blurb about what she did or what muscles were screaming, as the case may be. I am proud to boast that last I FB stalked, Anne was on Day #37, and going strong!

There are so many positives about this form of accountability: 

• Simply recording your action makes you accountable to yourself, and has been repeatedly shown to increase success of maintaining a habit. Recording it PUBLICLY adds the bonus of accountability to others. In the case of social media, MANY others!
• FB or other social network posting takes a tiny amount of time, and no travel.
• POSITIVE REINFORCEMENT- friends cheering you on is wonderful!
• 21 days to make a habit- so "they" say...so even if you only post for a few weeks, you may have done enough to create that new habit
• Inspiring others! Anne's pledge has motivated many of us to dust off our old P90X DVDs and "Bring It" once again. For non-P90X'ers, Anne has motivated them to pick SOMETHING to push their own bodies out of our comfort zones.

Anne has impressed me so much with this public declaration of prioritizing her health. When she got sick with the flu, she simply posted on FB that she was down a couple days, but then jumped right back in once she was physically able. 

BOTTOM LINE: If you use social media for fun and entertainment, why not use it for health? Set a goal, make it public, and let all those FB friends cheer YOU on to better health!

It's BACK- the Cursed Halloween Candy

Yes, we've just got our kids starting to settle into their school routine, and yet what has already appeared in the grocery stores? That's right- Halloween Candy. I swear this is the start of the fall fattening project...

Don't get me wrong, I love Halloween! I adore seeing all the kids in costumes and frankly, I pull out a witch or Mrs. Incredible costume for myself each year. But here is the catch- candy to the max on one night per year is no big deal (brush & floss those teeth afterwards, of course.) Unfortunately, what happens in many households and work sites is that those "sample size" candies start showing up in a convenient drawer near you, handy for daily snacks and pick-me-ups. Before you know it, you've got a candy habit that is truly tough to break, not to mention that the extra 500 calories per day that you are innocently consuming is adding on a full extra POUND per week!!

If you think I am exaggerating about this, check the calorie count and serving size on your favorite candy. Hershey's miniatures, for example, are only 42 calories per mini, but most of us don't stop at one- even the "serving size" is 5 minis at 210 calories.




BOTTOM LINE: If you don't want to literally increase YOUR "bottom line", save the Halloween candy for HALLOWEEN and don't buy it till October 30th. Trust me, the stores will still have it in stock.

What's YOUR Blood Pressure?

Today the Center for Disease Control and Protection (CDC) released their report "Vital Signs: Awareness and Treatment of Uncontrolled Hypertension Among Adults- United States, 2003-2010), and what did they find?

• 30.4% of American Adults have high blood pressure - over 66.9 MILLION of us!!!
• 14.1 million people HAVE high blood pressure, but do not KNOW it
• 
  Of those that have high blood pressure, over HALF are NOT CONTROLLED.
• 5.7 million people KNOW they have HBP but don't take medicine
• Of the 35.8 million people who have UNCONTROLLED high blood pressure, the VAST MAJORITY (89.4%) have a usual source of health care & (85.2%) have health insurance

The media is all abuzz with this information, and with good reason. Hypertension (high blood pressure) is a disease that is easily diagnosed- just a blood pressure cuff is needed. We have a plethora of medications that treat hypertension, the mainstay of which are older, effective drugs that should not be expensive. High blood pressure, however, is a silent disease- potentially no symptoms until that big heart attack, stroke, kidney or heart failure. It is challenging to convince patients to take a medication when they have no obvious symptoms that will improve by taking the medications. 

With one in three Americans being obese, it should come as no surprise that roughly that same number of Americans have high blood pressure. As a nation, we have got to start reversing these trends, and MEDICATIONS ARE NOT THE ANSWER. Yes, we need them to control pressures (and some hypertension exists in skinny, fit bodies, independent of weight), but the real focus should be on improving our exercise and food choices. The good news is that with even very modest weight loss (of as little as 5-10 pounds), much of high blood pressure resolves! So, back to M.O.R.E. on nutrition!

BOTTOM LINE: High blood pressure is a SILENT disease that will cause serious damage if not discovered and treated, so CHECK YOUR BLOOD PRESSURE today!

It's NOT the Carrots!

I've been practicing medicine for nearly two decades now, and I find it fascinating to see some of the persistent myths in medicine- most of which pertain to food/calories/weight loss. I find that people get very caught up in looking at specifics, and miss the big picture entirely. The classic example of this is CARROTS.

Many of my diabetic patients tell me that they are careful to avoid CARROTS, because they have such a high glycemic index. The same is true for fruits ("don't worry, Dr. Grimes, I KNOW not to eat bananas or apples!") Seriously? I believe with all my heart that everyone SHOULD know deep down that carrots and fruits are HEALTHY choices. Diabetic or not, these foods should be part of your healthy diet. Okay, yes, if eaten alone, carrots can transiently raise your blood sugar, but if you have adult onset diabetes, it is WEIGHT LOSS that will ultimately improve your blood sugars. I have yet to meet a SINGLE person who is overweight from eating too many fruits and vegetables. It simply does not happen.

If you are overweight, please take an honest look at what you are eating. In fact, write it down- all of it- for a few days. Perhaps the daily Starbucks muffin & latte have a little something to do with your extra calories...And while lettuce, carrots, tomatoes and cucumbers are all healthy, low calorie choices, adding tons of croutons, sunflower seeds, cheese and a generous amount of ranch dressing take a healthy salad and push the calories too high to help with a weight loss plan.

Carrots are a wonderful source of nutrition. They are packed with provitamin A, vitamin E and vitamin K. Carrots satisfy the need to crunch and work beautifully to scoop up hummus as an afternoon snack.

BOTTOM LINE: Recognize that no one is UNHEALTHY from eating too many fruits and vegetables. Ramp up these foods, limit processed "junk", and talk to a registered dietitian if you want to get serious about improving your diet!

Just One Meal...

January is a great time to focus on your health, as we all feel that sense of renewal and a "clean slate" start-over. Rather than jumping into a strict diet that consists only of twigs & berries, why not start with JUST ONE MEAL? We eat (in theory) twenty one meals per week, right? (As an aside, if you are skipping breakfast, please start with adding IN that meal before anything else.)

I would like to suggest that you commit to having ONE vegetarian meal per week, and ONE meal that includes FISH as an entree. Vegetarian meals do not need to be bland, by the way. Picture a delicious taco salad, but with beans instead of beef or chicken. I often have the do-it-yourself version of this at home by making nachos loaded up with beans, onions, lettuce & tomatoes. Or you might try a colorful collection of veggies sautéed in olive oil and serve them over a bed of pasta or rice. I find that keeping bags of chopped onions, shredded carrots and bite-sized tomatoes minimizes my prep time and therefore makes it far more likely that I will include them in my lunch when I only have ten or fifteen minutes to prepare & eat it.

BOTTOM LINE: Make permanent changes in your diet by starting with ONE MEAL per week...and then feel free to increase that frequency as you enjoy these healthy, delicious meals!

New Year's Resolutions- a WEIGHTy Issue

Happy New Year! Welcome to 2012, the year that holds the potential to be your HEALTHIEST yet! Virtually every list of top 10 New Year's Resolutions leads off with the battle of the bulge- whether it is "lose weight", "get fit", "eat healthy", "join weight watchers", "join a gym" or some other variation. With the vast majority of Americans falling into the "OVERWEIGHT" or "OBESE" categories, these resolutions certainly make sense. Unfortunately, many of us fight the SAME 10, 20, or even 30-plus pounds over and over again. We get motivated, make healthy changes, lose weight...and then gain it back. Ugh. What might we do differently this year?
Here is some food for thought...

1. Figure out the WHY of your eating behaviors, and learn to eat MINDFULLY. Dr. Michelle May's book "Eat What You Love, Love What You Eat" is a FABULOUS start- buy it today. Her focus is how to break the "eat, repent, repeat cycle". AMEN.

2. Speaking of buying- let's put our money where our mouth is- literally! I have heard over and over again that it's too expensive to meet with a dietician, join a gym, or eat fresh fruits & vegetables, or take up a new sport, yet these same people are spending far more discretionary money on their daily Starbucks, hair highlights or a round of golf. Seriously, we need to prioritize our health and be willing to pay for it!

3. Commit to ONE small permanent change each month. Experts say it takes 21 days to cement a new habit, so why not make 2012 the year to develop 12 new healthy habits? Start with something simple, like making sure you eat breakfast every day OR (assuming this was not part of your routine already.) In this case, it can be a granola bar or a cup of yogurt. Remember to keep it simple. If you try to make a change from no breakfast to cooking a veggie omelette and drinking freshly squeezed grapefruit juice- well, I'm not optimistic it will stick!

Whatever you choose, find a way to make yourself accountable. Make a deal with a friend, tell your co-workers, announce it to your family (if you have teens, they will HAPPILY hold you accountable), or simply record it on your smart phone, computer or an old fashioned piece of paper.

BOTTOM LINE: Make 2012 the year you make your New Year's Resolutions last beyond Janaury, and choose GOOD HEALTH!

25 Grams of Fiber? Yes, You Can!

"But Doctor, there is NO POSSIBLE WAY that I can eat 25g of fiber in one day!"

I hear this response frequently when I am talking to my patients about a high fiber diet. Yes, we recommend eating 25g of fiber daily. No, it is not impossible! In truth, most Americans average way less than 10 or even 5g of fiber in their daily diet, but that is a reflection of all the convenience food that we consume. If you have coffee & a donut for breakfast, burger & fries & soda for lunch, and spaghetti & meatballs & buttered white rolls for dinner, you don't need a calculator to figure out your fiber was <5g! The good news is that it's really not hard to bump up that fiber. Here are some "tricks" to raise it:

1. Focus on fruits & vegetables (yes, it always comes back to this!) Nearly every serving of these will be at least 2g of fiber. An apple or pear~4g, berries~4-5g, banana~ 3g, broccoli ~3g, carrots ~2g, and corn or a baked potato~ g. Obviously if you get your 5-10 servings of these per day, you've got your fiber covered before you add in ANY bran muffins!

2. Choose whole grains for your breads, pasta & rice (brown)- that will add a few grams of fiber per serving (check the label!)

3. Pick a high fiber cereal that doesn't taste like tree bark, and rotate that in to your diet as both breakfast cereal and snacks (toppings on yogurt or as "croutons" on salads.) Bran Buds, for example, pack a whopping 12g of fiber in 1/3 of a cup!

4. If you like tortillas (and who doesn't?) check out some high fiber choices for your breakfast tacos (instead of toast)- Mission Carb Balance, for example, has tortillas with over 10g of fiber each!

5. Include nuts & beans (think hummus!) in your diet, too- 1/2 c of most beans will be 6-8g of fiber.

High fiber diets help prevent (or treat) constipation, lower cholesterol and triglycerides, and improve your gut health. There is no need to subsist on stale high fiber bran muffins to easily maintain the recommended 25g of fiber per day. Even if you are gluten-free, you can see how this is truly "do-able".

BOTTOM LINE: Push up your vegetable & fruit servings and choose whole grain complex carbs, and soon you'll be on your way to better health through a high-fiber diet!

The ADRENALINE Diet

ADRENALINE- also known as epinephrine- is a hormone that is secreted by the adrenal glands in response to stress. ADRENALINE increases your heart rate, pulse rate, and blood pressure, and raises the blood levels of sugar (glucose) to prepare your body for that "fight or flight" response. So, ADRENALINE makes your heart pound like crazy, burning up calories by the second. What could be better to lose weight, then, right?

Am I suggesting that you head to your doctor and ask for an EPI-pen to kick off your diet? NO! An Epi-pen is an emergency dose of epinephrine that is used for severe allergic reactions. What I AM suggesting is New York Times Best Seller, ADRENALINE, by Jeff Abbott, for your summer reading...on your exercise bike! (or treadmill, or elliptical, if you can be smooth enough to read on them).

I am always looking for ways to entice people to exercise. One carrot that I use for myself is to get fun, gripping novels, and commit to ONLY READING THEM on my exercise bike. The better the book, the more I find time to squeeze in an extra workout session. My ultimate compliment for a book is that I have deemed it "exercise-worthy", meaning that it dragged me back to the exercise bike for at least a second session in a day. I'll confess that I read ADRENALINE in just a few days...but the last day, I biked over 30 miles, because I was so engaged that I had to see "who done it" and why! Jeff's fast-paced thriller probably would have had my heart pounding at a high rate anyway, but on an exercise bike I was oblivious to the fact that my legs were pumping faster and faster as the action heated up. Jeff Abbott's books always keep you guessing, as he manages to create truly unexpected twists in every plot. I also love how he quietly tucks in sympathetic, humane character details in even the most evil villains.

BOTTOM LINE: Improve your fitness, lose weight, and raise your own ADRENALINE this summer, by treating yourself to Jeff Abbott's latest thriller, ADRENALINE.

PS. Got a favorite GRIPPING book to suggest that is "exercise-worthy"? Share it with us here!

What a Chef! Sicola's in Austin

I need to take time today to have a "commercial" for Sicola's: A Culinary Experience in Austin, TX. Last night I was at a Journal Club meeting there, and the before our talk, the waitstaff was circulating with luscious looking appetizers. Since I am still GF (Gluten Free), I will admit to feeling a bit deprived as I politely passed them up. Not wanting to appear rude for turning down multiple choices, I told one of the waitresses that if I were not gluten-free, I'd grab them in a moment.

Within a few minutes, the same lovely waitress returned, letting me know that indeed, the rest of the evening's menu was completely GF. I was pleased she would go to that trouble, and happily sipped my wine. However, that was not all. A little bit later, another waitress came over and told me that the chef was excited to CREATE a GF appetizer just for me! Can you believe that? In the throws of preparing a gourmet meal for fifty people, he stopped and literally experimented simply to allow someone with a special diet to enjoy an appetizer. Amazing!

I wish I could tell you exactly what the appetizer was, but I CAN tell you that it involved goat cheese and a non-wheat crumb coating, and it was DELICIOUS! I have never felt so pampered. Apparently, Stephen Sicola (the amazing chef) is creating specialized dishes to cater for all kinds of special diets, including youth with diabetes. Very cool!

BOTTOM LINE: If you live in Austin and have a private dining party to plan, call Sicola's and book it now!
PS. If you follow a special diet, it never hurts to ASK for something a bit off the menu when you dine out, so give it a try!

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!

Realistic Resolutions for 2011

Welcome to the first Monday of 2011! Have you set any New Year's resolutions yet? Broken any yet? Let me encourage you to pick one or two HEALTHY resolutions that you can stick to-not just for 2011, but for your entire future.
Weight loss is a priority for the majority of Americans. However, often that means a strict, very low calorie diet (and the emotional misery that arrives as a side dish). Not surprisingly, this method rarely works. What might be a better choice?

How about committing to one of these simple changes:

1. Substitute a GLASS OF WATER for one other beverage (soda, coffee, etc.)
2. ADD one piece of fruit to your breakfast (a banana, or a handful of berries)
3. Eat FISH for at least one meal per week
4. Take a fruit or vegetable SNACK with you to work each day- and EAT IT (instead of vending food fare)

I realize these seem simple, but making these changes a HABIT will lead to a lifetime of benefit! For example, if you drink one can of soda per day, then swapping water for that can will create a caloric deficit that equals 14 POUNDS in one year! Now that is something to toast!

BOTTOM LINE: Set yourself up for success and make at least one CONCRETE HEALTHY CHANGE in 2011!

Amazing Weight Loss & the Acai Berry

Happy 2011! I hope your New Year's Resolutions include steps towards GOOD HEALTH this year! I am enjoying a snowy vacation in gorgeous Crested Butte, Colorado, this week. As I checked the weather report to decide on layers of clothing this morning, my attention was caught by a news headline by a Crested Butte health reporter.

The report was part of a series about effective weight loss strategies. I was immediately sucked in by the reporter's frank style and her admission that she was skeptical about different weight loss claims. She and the News 5 team decided to do their own trial, and guess what? She LOST 25 POUNDS in a MONTH, and looks slim and sexy with NO CHANGE in her diet! WOW!

Okay, wake up and smell the coffee! Of course, this is a SCAM and and AD to buy the berries. Unfortunately, it is SO CONVINCING that despite knowing the numbers and facts couldn't add up, I initially thought it was real, and that the reporter was simply exaggerating. The site looks amazingly valid, and she appears to be a legitimate health reporter. If you start to research the reporter, however, you quickly discover that no such reporter exists-ANYWHERE. This ACAI berry distributor simply created multiple websites under the names News5Health.com (and News6, and News7, etc.)

What is the truth?
1. You need a deficit of 3600 calories to lose a pound. Period. At burning (or not consuming) 500 calories per day, that is a pound of weight loss per week, which is terrific weight loss.
2. We do NOT have "gunk" lining our guts and creating "toxins". If we did, everyone who has a colonoscopy would be "cured" of obesity!
3. It's CALORIES IN vs. CALORIES OUT that creates weight loss or gain!

BOTTOM LINE: BEWARE OF WEIGHT LOSS SCAMS POSING AS NEWS REPORTS, especially the ACAI berry. Eat more fruits and vegetables and start moving more to lose weight in 2011!

Gluten-Free Decadence

After talking about gluten-free diets and celiac disease this week, I want to be sure no one is left with the impression that you need to feel completely deprived if you must be gluten-free (GF). Can you ever eat at a restaurant? Is every GF food expensive?
No worries, there are plenty of delicious and reasonably priced choices out there!

Primarily, I want to again encourage you to take advantage of EVERY SINGLE fruit and vegetable, all of which are completely and totally gluten-free! Have a banana smothered in ice cream and topped with whip cream for dessert- yummy! Gluten-free chocolates are a bit more challenging to find, but absolutely out there.

Dining out? Last night, I had a business dinner at a lovely French restaurant...where most dishes appeared to be topped with a white sauce (that usually has flour in it.) Yes, I had to pass up the fragrant loaves of French bread, but I simply enjoyed my glass of wine and ordered a salad by asking for lettuce, tomato and a vinagrette-no croutons- (which was delicious!) and trout grilled and topped only with butter and lemon. The waiter and chef didn't flinch a bit when I asked for these off-menu choices, and I think I was possibly the only one who left the table not stuffed to the gills! I also could have chosen the steak, and had a baked potato instead of the french-fried version. Admittedly, I passed up dessert, but could have asked for strawberries and whipped topping- but I was pleasantly full.

Craving pasta? This was challenging, but I found a spiral pasta that is a quinoa blend that I can truly say I PREFER to regular pasta. Pizza is still leaves a bit to be desired, but I have even found a delivery pizza service that has very passable GF dough for only $5 extra- well worth it for me, though I order regular dough for my family.

I have blogged earlier about some wonderful baking GF products and cookbooks, and without a doubt, you can find all sorts of GF bagels, donuts, cakes, cookies.

BOTTOM LINE: Never fear, you can consume deliciously decadent GF foods and drinks with a little thought and willingness to venture off the printed menu- ASK THE WAITER/CHEF!

PS. The chef in this picture, Michael Marchitelli, is ironically an ITALIAN chef in Crested Butte, CO- Eat at his Gourmet Noodle for some AMAZING food! I'm not promising GF pasta, but I can attest from my pre-GF days that every item on the menu is delicious, and there are definitely GF options!

Gluten-Free for Weight Loss?

Many people think going gluten-free is a great way to diet in order to lose weight. Not surprisingly, it can be a pleasant side effect if you are overweight and diagnosed with celiac disease. It makes complete sense that if you simply ELIMINATE breads, cakes, pastries, pastas, cookies and breaded or coated foods (think chicken nuggets, french fries, meatballs) your calories will shrink dramatically!

I would likely approve any diet that reduces processed foods and complex carbohydrates, but I am MORE excited about diets that not only decrease those items, but INCREASE fruits and vegetables. Here is the trick with not only a gluten-free diet, but a vegan or vegetarian diet. Keep it HEALTHY by upping the produce (veggies and fruit) and NOT merely replacing everything you are "giving up" with a manufactured version that is GF (or CF, or Veggie-free).

For example, there are many gluten-free breads, crackers, cookies and treats out there. Very few of them happen to be low calorie and/or "good" for you- BUT- saying gluten-free somehow implies healthy and nutritious, doesn't it? It's that health-food store seal of approval when we see labels proclaiming a food item is "free" of something "BAD".

Ultimately, however, in the battle of the bulge, it still comes down to calories IN vs. calories OUT, regardless of the quality of those calories. So, enjoy those GF pancakes and breads in moderation, but don't pursue the search for the GF Twinkie, okay? Push up the produce and reap the rewards.

BOTTOM LINE: Eating gluten-free CAN be an incredibly healthy diet, rich in nutrients from fresh vegetables and fruit plus a protein source and GF carbs in moderation, but gluten-free does NOT equal low calorie!

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!

Low-Fat vs. Low Carb Diets- the Results are In!

Here is a terrific study for the forty-somethings, recently published in the Annals of Internal Medicine. The Study is titled: Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate Versus Low-Fat Diet; A Randomized Trial. The trial took around 300 people in their mid-30s to mid-50s, and placed them all in a COMPREHENSIVE BEHAVIORAL TREATMENT for weight loss. Half the group consumed a low-carb diet with unrestricted fat and protein, and the other group ate a low-fat diet (<30% calories from fat.)

Their weights were measured frequently, but the end goal was weight loss maintained at two years. Interestingly enough, BOTH groups had the same amount of weight loss- a whopping 24.2 pounds at one year, and a respectable 15.4 pounds were kept off at two years. Both groups had improvements in their blood pressure and lipid levels (cholesterol), and the low-carb group maintained higher HDLs (the GOOD cholesterol that goes around the bloodstream and takes away cholesterol plaques) even at the two year mark.

Now, these participants started off "healthy"- no diabetes or scary cholesterol levels, but all were obese by BMI (body mass index) criteria. Not everyone finished the study, but those that did complete it had great health benefits.
Take home message for you?

BOTTOM LINE: Feel free to choose "low fat" or "low carb" if that helps direct you, but changing BEHAVIORS (see the "MORE" posts!) including more physical activity and more healthy food choices of fruits and vegetables are the most important component of ANY diet!

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!

VEGETARIAN does NOT equal HEALTHY!

How can eating "vegetarian" not be healthy? Is this a trick question? Absolutely NOT. When I see patients in the office, I frequently do a 24-hour dietary recall, which means I ask them to tell me every item (food and drink) that they put in their mouth the day before our visit. You'd be amazed at how often people are embarrassed (but honest!) with their replies.
What I have found is that many people who don't eat meats believe by default that their diet is healthy. However, chips, queso (cheese dip), sodas, french fries, pop tarts, and almost every dessert you can name are ALL "vegetarian"! You easily can go an entire day as a vegetarian withOUT eating a single fruit or vegetable.
BOTTOM LINE: Don't kid yourself that giving up meat makes you healthy- focus on eating FRUITS and VEGGIES to improve the quality of your diet!
PS. It's a new month, so CHANGE YOUR AIR FILTERS (See 2/1/10 blog entry)!