It's BA-ACK! Halloween Candy

Despite the 90 degree days we are still having in Texas, the calendar tells me it is already OCTOBER. Of course, the grocery stores have been featuring HALLOWEEN CANDY for nearly a month already! Did you resist? Or are you tossing in a bag of bite-sized candy on impulse as you check out?

If so, it's high time to realize that we are now officially in what I call the "treat yourself" season, as we hit the trifecta of food oriented holidays: Halloween, Thanksgiving and Christmas/Hanukkah. We tend to celebrate with nonstop EATING, and then what do we do every January? That's right, make New Year's resolutions where LOSING WEIGHT tops the list!
This year, let's THINK AHEAD...

Let's SAVE THE HALLOWEEN CANDY for...yes, HALLOWEEN! Start in the grocery store. Do NOT BUY the candy till the DAY BEFORE Halloween. It's way easier not to eat it when it is still sitting on the shelf in the grocery store, rather than sitting on your desk at work or your kitchen counter top. We all grab a small handful of treats when they are openly displayed in front of us.

Do the calories add up? You bet. Here are some of my favorites: Snack Size Butterfinger: 170 kcal, Fun Size Kit Kat- 50 kcal, and ONE single, plain M&M-4 kcal. Now, if you stop at ONE, it's really no big deal. but if you eat a handful of M&Ms each DAY for the next few weeks, or grab a couple fun size chocolate treats, BOOM-you will gain a pound right there. (Remember one pound is 3600 kcal- do the math.)

BOTTOM LINE: Don't wait for NEW YEARS to make a resolution for better health- start NOW by limiting Halloween CANDY to HALLOWEEN DAY!

PS. It's a new month, so CHANGE THOSE AIR FILTERS!

Elect NOT To Gain Weight This Holiday Season

Happy November! In honor of election day tomorrow, let's ELECT NOT to gain the standard 7-10 pounds during the holidays this year. We have begun the eating trifecta...Halloween, Thanksgiving & Christmas/Hannukah. Americans love to celebrate these holidays with excessive amounts of high calorie foods- in large quantities. Can you enjoy the season and NOT gain weight? Of course! But yes, some discipline and primarily large doses of awareness are necessary.

Let's start with the Halloween candy. Most people have "leftovers" of snack-sized chocolates. We finish up our favorites (always the Reeses cups in our home) and then mindlessly polish off the less desired ones simply because they are THERE. Take a look right now at your candy bowl (if it is still sitting out). Grab a bag & toss the candy into it, and drop it off at your neighborhood food pantry if you don't want to "waste" it by throwing it away.

As we move into party season, be very mindful as you walk into each gathering. Often hosts are handing out a delicious alcoholic beverage as guests enter...which is a double whammy. Number one- high calories in sipping form. Number two- alcohol goes hand in hand with mindless munching, especially high fat or high calorie treats. SO- politely declare your thirst and ask if you can start with a glass of WATER, which will actually help fill you up and keep your head clear for healthier choices. Many studies have shown that simply drinking a full glass of water before meals cuts calories and promotes weight loss, so this is a win-win!

BOTTOM LINE: Be conscious of mindful eating (and drinking) as we begin holiday celebrations, and there will be one less New Year's Resolution on your list!

PS. Did you remember to change your air filter on November 1st?

7 Ways to Leave Your Cigarettes

SEVEN seems to be the magic number for habits of successful people, right? SO...smokers, step on up to the SEVEN choices to help with QUITTING SMOKING! QUITTING SMOKING is the single most important thing you can do to improve your health. In alphabetical order, here they are:

1. Bupropion SR (Wellbutrin SR)- this is an antidepressant that works via unknown mechanisms to decrease your desire for smoking; you start it a week or two before your quit date, and it significantly shuts down that craving for a cigarette.
Common side effects- insomnia and dry mouth.
2. NIcotine gum- do NOT chomp it like regular gum! It's chew, chew, stash it.
3. Nicotine inhaler- used every hour or two during the day; may cause throat/mouth irritation and cough
4. Nicotine nasal spray- 2-4 sprays per waking hour as needed; may cause local irritation in nose and throat
5. Nicotine patch (now OTC, but ask your doctor which dose)- may cause skin irritation; remove at night so no sleep issues
6. Nicotine lozenge- may cause mouth soreness and nausea
7. Varenicline (Zyban)- blocks nicotinic receptors and sharply decreases cravings; Common side effects: very vivid dreams and nausea.

Are they expensive? Puh-lease! Are cigarettes expensive? YES! These aids are money well spent, and will pretty much equal what you are already spending on your habit.

BOTTOM LINE: If you think you've tried everything to quit, double check the list and head to your doctor for a new cessation aid!

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!

WAIT! Weight...

Okay, this is a quickie blog entry, but here's the deal: I can count on one hand the number of patients that I have seen this month that have NOT gained weight. Yes, the average American gains around 10 pounds between Thanksgiving and New Year's Day, but this is not something we should be proud of! It is also a "tradition" to put weight LOSS at the top of everyone's New Year's Resolution list, right?

So, do yourself a favor, and simply pull out the scale today and step on it. And look at the number. This is NOT to chastise you or to make you feel bad, but to give you a quick reality check. If you are part of the majority who has been happily indulging in little extras at work, school, and parties this season, just be AWARE of that- and try not to add on between now and the end of the year. Kick up your exercise a notch, and remember these few party tips:

1. Eat something healthy before you go- grab a Honey Crisp apple (they are in season and delicious!) or a salad, or whatever healthy choice you have handy. Just do not walk in STARVING.

2. Start with a glass of water when you walk in to the party. Hosts love to hand out wine or champagne as you enter, which is lovely, but ask for a glass of water "to start".

3. At a buffet, fill your first plate with healthy choices, THEN go back and have your dessert sampler.

BOTTOM LINE: Let's step on the scale TODAY so we are NOT increasing our..."bottom line".

A WEIGHTy Issue- Quitting Smoking!

Why do people who quit smoking gain weight? Does it always happen, or can it be avoided? Do we really care that weight gain is really less detrimental to our health than smoking?
As a physician, I have found that women in particular choose to keep smoking because they simply do NOT want to gain weight. Period. I will confess that I will occasionally try to appeal to their vanity by discussing the yellow teeth or bad breath that tend to accompany cigarettes, but the reality is that what is important in this situation is helping patients understand why smokers gain weight with quitting, and how it can be avoided. So here are some things to remember:

1. Nicotine is an appetite suppressant, so obviously, when you initially take it away, your appetite is up.
2. Smoking KILLS taste buds, so just about the time the extra appetite from quitting is going away (around a week), suddenly food begins to TASTE better, because now you've actually got healthy taste buds!
3. Happily, ALL FOODS taste better, not only the high fat/high calorie ones.
4. Yes, oral gratification is a habit, so STOCK YOUR FRIDGE with some low calorie, crunchy and delicious snacks like carrot sticks with hummus, or apple slices, or ANY fruit or vegetable. Additionally, suck on sour hard candies the first week or two.
5. Don't forget EXERCISE! Getting and keeping your heart rate up for 30 minutes per day is equal to a low dose of an anti-depressant medicine, so exercise will not only balance extra calories consumed, but will make you HAPPY and less irritable!

BOTTOM LINE: As we approach New Years, move QUITTING SMOKING to the top of your list and know that weight gain is NOT inevitable.

Thankful for Special Holiday Dishes

Getting ready for Thanksgiving? I know I am. Today I was searching for my mother-in-law's fabulous fresh yam and green bean recipes, so I can begin to make some of "her" dishes. However, I am SO grateful that she is still here on earth to be on hand as I prepare them, because her quantities are usually measured by phrases such as "just enough", and "till it looks right", and "well, it depends!"

Isn't it amazing how dependent we've become on prepared mixes or at a minimum, google'd recipes? Truthfully, in the kitchen I tend to alter the vast majority of recipes that I use, even the first time. I substitute apple sauce for oil, or change up flours to make things gluten-free, or create some other "healthy" modification. When it comes to family traditions, though, I usually defer to the high-fat, full calorie version, which is FINE. Not EVERYTHING we eat needs to be pure nutrition! It's perfectly fine within the confines of healthy living to splurge on treats now and then. The trick is to remember that every day or week should not be "that" special occasion!

I have learned from my patients (by doing 24 hour dietary recalls) that what people believe is an unusual day is often a frequent occurrence. Do you grab fast food before every soccer practice or music lesson? Well, I'm guessing that is EVERY Tuesday (or whatever day or dayS your kids have that activity.) Look at your schedule now, and recognize those days that present a challenge every week, and then PLAN AHEAD. Sandwiches, slow cooked meals, and even "breakfast for dinner" might be healthier choices.

BOTTOM LINE: Enjoy your traditional holiday treats this season, but recognize patterns of unhealthy choices in your everyday schedule and make pro-active changes to improve your health!

What is BMI?

Yesterday, I mentioned that discussing your BMI with your doctor might be a less emotionally charged way to discuss your weight. Terms like "overweight" and "obese" tend to make us all shut down and stop listening, but it is really important to understand whether or not your weight is becoming a medical issue. The BMI is your "Body Mass Index", and it is a reflection of your relative body fat. Note that I said "reflection"- the BMI is NOT a precise measure of your body fat percentage.

BMI is simply calculated by using a person's weight and height. Specifically, BMI equals your weight in pounds multiplied by 4.88, divided by the square of your height in feet. There are charts to look at and on line calculators as well. Click on this link to the U.S Dept. of Health & Human Services' BMI calculator to see what YOUR BMI is today.

Now that you've got your number, what does it mean? Well, if you are less than 20, you are underweight. If you are between 20-25, you are considered healthy, or "normal" weight. Please pay attention if you are in the 25-29 segment, because you are overweight! If you are >30, you fall into the medical definition of obesity.

Why did I bold face that 25-29 segment? Because in my clinical experience, no one with a BMI of 30 or more is surprised that they weigh too much. However, I would estimate that over HALF of my patients who fall in the "overweight" category are shocked that they have a medical issue with their weight. After college, people often put on a couple pounds per year, very slowly creeping that scale. During that time, they may only go up a size or two in clothing, especially if they are buying more expensive clothes (which tend to run larger and larger.) Before they realize it, they weigh 20 or 30 pounds more than is healthy, yet they don't "feel fat". I don't care very much about cosmetic issues with weight, but I care deeply about increased risk of diabetes, heart disease, low back and joint pain, all of which come into play when your weight goes up.

BMI's are not flawless. If you are an "ARNOLD" with tons of huge muscles, your BMI will be falsely elevated. If you are elderly and frail, chances are good that your BMI underestimates your body fat. In general, however, the BMI is a great tool to assess your weight.

BOTTOM LINE: Take a moment and calculate your BMI, and take an honest look at your weight: 1/3 of Americans are overweight, 1/3 are obese, and only 1/3 are normal or underweight, so the odds are stacked against you.

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!

MORE Losing Holiday Weight

Tip number two for losing that holiday weight is another common sense solution- GET SOME REST! A study published in the Annals of Internal Medicine this year compared weight loss between a group that followed a low calorie diet and had only an average of 5.5 hours of sleep per night versus a group that followed the same diet and averaged 8.5 hours of nightly sleep.
It may surprise you that not only did the people with more sleep had more weight loss, but they also had greater reduction in body fat and in HUNGER.

Scientists are not sure of exactly how more sleep resets your hunger thermostat or changes your metabolism, but we certainly know that less sleep stresses your body, which is not conducive to better health. If you struggle with INSOMNIA as the reason for your lack of sleep, make sure you are having good sleep hygiene (keeping a regular bed time, not watching tv or doing computer right before bed, etc.) and limiting or avoiding caffeine and alcohol. Check out my blog on covering the clock, and make an appointment with your doctor if you cannot restore good sleep on your own.

BOTTOM LINE: Make sure you are getting at least 8 hours of sleep to maximize your success with losing those extra holiday pounds!

Calcium: Adequate serum calcium is needed for fecal fat excretion. Observational data has shown that those who supplement their diet with calcium have lower levels of body fat. This systematic review found supplementation of about 1,200 mg of calcium per day leads to an increase in fecal fat excretion. Obes Rev 2009; 10(4): 475-86



Sleep: A very small pilot study compared a low calorie diet and either 5.5 hours of sleep vs 8.5 hours over 14 days. Those who slept more had greater loss of weight and body fat, and, among other things, less hunger. The authors postulate it was due to the neuroendocrine changes decreased sleep induces. Ann Intern Med 2010; 153: 435-441

Chronic PPIs: When used chronically, PPIs are associated with pneumonia, C. diff infection and other problems. This case control study found obesity developed in patients with GERD who were treated chronically with PPIs vs other treatments World J Gastro 2009; 15(38): 4794-4798.

Losing that Holiday Weight

Borrowing from my editor-in-chief's blog (Dr. Frank Domino) at the 5-Minute Consult, I'd like to share some tips this week to help you lose that extra weight you picked up over the holidays. Remember, the average American unfortunately gains close to 10 pounds between Thanksgiving and New Year's, so if your pants are fitting a bit tootight, you are not alone!

First of all, a simple trick models have known for years: DRINK WATER!! A trial of obese adults (published in the journal Obesity this year) showed that people who drank 16 oz of water before each meal along with following a low calorie diet lost >4 pounds MORE than the group that simply followed the same low calorie diet.

Often, we think we are hungry when we are really thirsty, so focusing on this simple tip of drinking a couple glasses of water with each meal will help you recognize what your body is really craving.

BOTTOM LINE: Add TWO 8 oz glasses of water to breakfast, lunch and dinner to help lose some of that holiday waistline!