Wednesday, January 16, 2013

Exercise your right to ...

Once again, I find myself confused. I was listening to quite a number of speakers, of various backgrounds and years of experience, summarize the value of exercise in achieving weight loss.

And once again, before I continue on, I want to remind everyone that the benefits of exercise are NOT by any means measured solely in terms of changes in weight. And I will discuss this later. But for now, allow me to address the "exercise-weight loss" connection.

So, as I listened to all of these speakers, I heard over and over again that exercise does NOT help you lose weight. At best, exercise will help you maintain your lower weight once you have dieted down. But exercise alone will not help one lose weight.

And this is where I get confused. IF, as so many still argue, that a calorie is a calorie and that obesity is simply "calories in versus calories out", then how can it be that exercise does not make you lose weight?

Let's say that you are eating 1500 calories a day and your weight is stable. NOW, you join a gym and according to the counter on the treadmill/elliptical/bike/ CIA-super secret training system, you have just burned 250 calories. So you have to lose weight, right ?  Those 250 calories had to come from somewhere. Now it's true that your body might break down muscle, instead of fat, to generate those 250 calories. But this would still mean a loss of weight. And usually when you exercise, there is a stimulation of your muscles which tells your body NOT to use muscle for energy. So, if you keep up burning 250 calories extra a day, then you will eventually lose a measureable amount of weight, and at least SOME of it will have to be fat.

The only way for this NOT to happen would be for your body to burn LESS energy during the rest of the day. I have heard a psychological side to this, that people who exercise are consciously less active the rest of the day because "I already did my workout". But if this is true, from a purely weight loss point of view, you would have to be crazy to exercise. If taking off an hour, going to a gym and getting all sweaty is not going to help at all, then why do it? IF your only thought is about weight loss, then really, why do it?

Another way for exercise NOT to cause a weight loss would be for the person to eat more. This could happen because the exercise stimulates an increased appetite, or because exercising people allow themselves more food because they are "burning it off". But again, IF someone is really watching every bite that is going into their mouths, then how could exercise NOT make you lose weight. Or, if your body is going to drive you crazy to eat more because of the exercise, then why exercise ??

Here's another question. I hear lots of experts say how muscle mass burns more calories than fat. So, if someone adds muscle to their bodies (by weight lifting or similar exercises), then they need more calories to support this extra muscle. And if they do NOT eat extra calories despite working out, then how come they don't lose weight? if someone adds 5 pounds of muscle to their body, they MUST lose weight because their body needs more calories. The only explanation would be the same as above - that their body slows things down ("lowers the metabolism") or drives them to eat more. So one last time - if the only reason to exercise is to lose weight, WHY EXERCISE ??

OK, last one. Have you ever heard someone say "if he stops playing football/basketball/etc. but keeps eating as before, then sure he will gain weight". And I think it is pretty well accepted by all the "experts" that someone who used to exercise aggressively must reduce their food intake when they stop exercising. But that means that exercise affects your weight !! And if stopping exercise makes you gain weight, then starting to exercise must make you lose weight.

The truth, as always, is somewhere in the middle. Yes, exercise burns calories. And yes, if you exercise enough, you will lose weight. But what happens is that many people do not burn that many calories when they do exercise. After an hour of walking, even if you build up a good sweat, you can eat back all the calories you just burned with a chocolate muffin, or a cup of ice cream. You would have to exercise alot, or add a lot of muscle. to make a significant change in the long term in your weight. So, in practice, what you need to do, is both. You need to eat properly and appropriately AND you need to exercise, to attack your excess fat from both sides.

But the real message is that exercise has many health benefits that go beyond your weight on the scale. And we will talk about these next time.

Thanks for listening

Tuesday, January 8, 2013

Tortoise and the Hare

How many times have you been around people who have spoken about how quickly they have lost weight on a given diet ?  How often have you seen these very same people a few months later and then noted that they gained the weight back ? (How many times have you secretly and evilly laughed to yourself when you did see this ??)

As will appear SO many times in this blog, I repeat my disclaimer that better health is NOT about a number on a scale. So please do NOT interpret what I say below as meaning that your focus should be how quickly or slowly you lose weight. Your focus should always be about proper diet and activity which as a byproduct leads to weight loss.

But it is legitimate to ask why. Why is focusing on weight loss so bad? Why not try to lose weight quickly in order to get over the "hard part" and then you can focus on just the maintenance. And if there is a diet plan that says that you can lose 20 pounds in two weeks, why not use it ?

The simplest way to answer these questions is to say that our bodies need time to adjust. Imagine walking into a gym and trying to lift a 200 pound weight, when you have never exercised in your life. For most people, this would end with a big thud, a broken toe (and bruised ego) and a request for a refund on the gym membership. On the other hand, if you start with a 20 pound weight and slowly build up, then over the course of months (to years) you will be lifting the heavy weights. Even amongst professional athletes, it can take years to reach their full potential. So, time and patience are critical. The rewards are clear.

When it comes to weight loss, the same is true. Sudden drastic drops in caloric intake will be met by your body's resistance. Your body will play with your metabolism and general well being and appetite in order to get you to either eat more or be less active (in order to conserve energy). And for most people, the resistance can be SO dramatic, that they give up soon after starting. This leads to a sense of failure and can cause a boomerang effect where the person eats more and gains more weight.

It takes time for your body to get comfortable with a loss of fat. It takes time for your system to adjust to the change in diet and physical activity. But once you "hit your stride", you will see your weight drop. How fast ? Well, this is very individual and will greatly depend on how hard you push yourself. But you will hear "1/2 to 1 pound a week" thrown around alot. And if someone can maintain this rate of loss over time, it adds up to ALOT of weight loss over the months.

Still, there will come a time when you will stop losing weight. And this will also very much depend on your individual physiology and genetics. And yes, there are some people who are thin and lose weight easily when they do gain. That's life.

One factor that interferes with weight loss, is the side effect that eating less has on muscle mass. When your body is stressed because of low calorie intake, it will not ONLY eat up fat stores, it will also eat away at your muscle mass. Muscle demands alot of energy. So unless you are really using your muscles, your body will extract energy from them. And as your muscle mass drops, your body's baseline energy needs will also drop. That means that as you diet, your need for calories will go down. And yes, you can get to a point where you still have a good amount of fat on you but your body's caloric needs are quite low. This also makes it relatively easy to gain weight back, if you start taking in more calories.

Is there a way to stop this loss of muscle ? Exercise. But not any exercise. You need to do exercises that stimulate your muscles to grow. These kinds of exercises are usually called "resistance", meaning that the exercise puts a pressure on you that your muscles need to resist. The classic way to do this, is to lift weights. And before anyone panics. we are NOT talking about training sessions that would put bodybuilders in the hospital  It is possible to benefit greatly from resistance exercise without being extreme. And we will talk about this next time.

Thanks for listening

Monday, January 7, 2013

He who lives by the cucumber ...

I was watching a lecture on the merits of a vegetarian lifestyle. I then followed the links to lectures on vegan diets and discussions on the value of the entire vegan lifestyle. I heard well presented material backed by solid data, extolling the tremendous health benefits over alternate diet plans, specifically those that were animal protein based (i.e., those that included red meat, chicken, and depending on the lecture, even those that included milk and eggs).

My next step was to search online for the keywords of vegan, vegetarian, heart disease, cancer and more. And what I found was a great deal of conflicting information on the benefits (and risks) of plant based diet plans.

I think this is a perfect example, once again, of the tremendous confusion that faces anyone and everyone trying to make proper food and lifestyle choices.

First of all, and this is very important, when trying to compare the benefits of one diet plan to another, you have to be VERY specific in what you are actually comparing. Let's say we want to compare the typical Western diet to a non-animal protein diet. Well, this is still actually very vague. Just as I noted above, does "non-animal protein" exclude milk and eggs as well ? There is a MAJOR difference between "vegan" and the sometimes more loosely used term "vegetarian". As such, if I find a study that shows the benefits of certain diet, I need to know exactly what the diet includes. Otherwise, I literally would be mixing apples and oranges (and broccoli and celery and ...)

Secondly, you must always be careful when people compare any diet to the typical Western diet. If "typical Western" includes regular visits to the fast food chains in the neighborhood and is almost entirely based on processed foods, then it actually would NOT be hard to prove that ANY diet is better.

There are questions whose answers could help clear up at least some of the confusion. For example:

  • if I eat meat BUT i also eat fish and vegetables on a regular basis, is that enough to give me all the protection of a plant based diet ? People tend to assume that eating meat and other animal proteins is SO bad for you, that there is no minimal safe amount. And they quote the benefits of a more vegetable based diet as proof. However, it could very well be that people who eat lots of meat tend to ignore fruits and vegetables. So the real question is, is meat SO bad, or are vegetables SO good. And if the answer is that vegetables are SO good, then the key is to get people to eat their steaks and fish and eggs and milk with a side order of a big salad. This might very well be the way to "have it all".
  • is the diet plan I am investigating good for me at all stages of my life including youth, middle age, old age, pregnancy, post menopause, when I am ill or when I am VERY ill ?  Young people clearly have special nutritional needs because of their speed of growth. An older person might suffer from a poor appetite and as such, might need calorically dense food in order not to become malnourished. And when someone is ill, they may simply not be able to tolerate certain foods. So, for all of these states, one must have specific answers about all of the various diets.
  • are there special issues if I will follow the given diet plan, such as having to watch out for certain nutritional deficiencies ? If a person refuses to eat ANYTHING from the fruit and vegetable groups of foods, they could suffer certain vitamin deficiencies. And the same holds true for those who will eat no animal-based foods. These issues are not insurmountable. But you need to know very specifically what effect each diet will have on your overall health, definitely not just on your weight.
I know vegetarians who are well into their 70's and look great. And i know meat-eaters who are just as vibrant. To really know which lifestyle is better, you need to do careful studies on large groups over long periods of time. But these are hard to do, OR when you do collect such data, are still are often open to interpretation. 

I would dare say that there is not one answer for all people. Some people will respond well to certain diets and others will react badly to them. Mixing and matching has its benefits and there is a lot to be said for people who eat a bit from column A and then some from column B. Your doctor can also help guide you by letting you know how your diet plan is affecting your blood work.

For myself, my low carb (not zero carb) diet includes fruits and vegetables alongside my fish and meat. This works for me, both in terms of my general sense of well being and my test results. You will need to explore and try different things and come to your own conclusions. While this sounds tiresome, the reward is finally finding a diet plan that works for you. And once you have this, you may very well never need to ask all of these tricky questions again.

Thanks for listening

Thursday, January 3, 2013



I hope I inserted a sufficient number of exclamation points above. In the last couple of days, a study published in one of the top medical journals is challenging the foundation of what we consider to be healthy weight. To summarize, it seems that there is an advantage to be what is now classified as overweight and even mildly obese. I repeat - ADVANTAGE.

I think everyone will agree that, if this is accepted as true by the medical community, this will be nothing less than a revolution in our approach to obesity. Note how I say "if this is accepted" because, and this should be no surprise to anyone, there are many who are challenging the conclusions of this study. There are in fact many ways in which to challenge these conclusions and they all come down to basic principles in how research is done. The point is that there is now a solid argument for reconsidering what constitutes a healthy weight.

Now, the BIG concern of the medical community is that people will read this report and abandon healthy lifestyle practices. And this would be a disaster. Because all this new study argues is that weight ALONE (or the famous BMI which is a way to compare weight amongst people of different heights) is not the KEY factor in health. And the truth is, we have known this for a long time.

We have known for a long time, based on many studies, that even a small weight loss (as little as 5%) can dramatically improve the health of a person. So, a patient who weights 250 pounds (but "should weigh" 150), can still achieve dramatic health improvements by losing as little as 12.5 pounds. Now clearly, losing this little amount of weight does not make the person skinny. But it does have a positive health effect, that is actually difficult to explain. One explanation is that it is NOT about weight at all and that the health benefits come from the lifestyle changes. So whether a person is of lower weight or mildly obese, as long as they eat right and exercise regularly, they will all be as healthy as the other.

The truth is always somewhere in the middle, and there probably is an ideal weight range for best health BUT we don't seem to know what that is yet. Also, you have to treat extremes as a whole separate issue. The 500 pound patient and the 75 pound patient both have issues related specifically to their weight and these must be addressed. BUT most people do not suffer from such extremes. And the message of this new study is that their focus, as far as health is concerned, must be on staying fit and eating healthy. Hopefully (but I am doubtful), people will stop obsessing about a number on the scale and instead will focus on their blood sugar, cholesterol, fats and blood pressure. If all of these factors are within the normal range, then it is very possible that losing weight will not improve health.

Of course, the focus on weight is for many an aesthetic issue and has little to do with health. And I do not expect the diet industry to go bankrupt overnight because of this study. But I do hope, at least in the doctors' offices, that there will be a different mood when dealing with overweight and low grade obesity.

I want to also raise the point here that as one ages, the rules also change. Older studies have shown that older patients (above 65) benefit from having "a few extra pounds". Whether this is because of the extra fat, or extra muscle mass, that comes with being heavier, no one knows. But the idea that a BMI of 20 is not ideal for everyone is actually an old concept.

I hope that more studies like this are done and that they continue to relax the pressure on people who are overweight. And maybe, just maybe, this will be the first real step to all of us becoming healthier.

Thanks for listening.

Wednesday, January 2, 2013

Laughter confuses medicine

I want to share with you a pet peeve of mine, which I believe undermines far too many critical discussions on a whole range of topics. What ticks me off is when one of the participants in a debate laughs in a deprecating manner, with the clear intent to mock the opposing opinion. What really irks me is when the "know it all" who is laughing, has no right to, based on the evidence.

I was watching a talk show hosted by a physician. The physician was hosting one of the low-carb evangelists. The host himself was of the low fat camp. In order to "introduce" the topic to the audience, the host demonstrated a meal plan from each camp. He started with his regular breakfast which was based on "clean carbs" like granola and yogurt. To demonstrate the low carb option, he presented a greasy plate covered with bacon and eggs. He continued to make such comparisons for lunch and dinner. All along,  laughter from the audience was was ever present. The presentation was very effective. It made it look as if the low carb diet plan was SO ridiculous that no person in their right mind would ever consider it.

This whole presentation was totally unprofessional. If in fact, the host, as a physician, wanted to discuss the options of various diet plans, then the debate would have been welcomed and more so, been productive. However, the host, in my opinion, was so defensive and unsure of his position of proper eating, that he needed to resort to mockery in order to win public opinion. The audience, which were clearly adherents of this host, also chimed in to the laughter at the appropriate cues. When the guest began to present his view, he was already at a clear disadvantage. And in my opinion, he was far too polite in his response to all of the challenges.

A doctor, no matter how many years in practice, MUST stay humble. There are endless stories of the medical community totally missing the mark. In retrospect, we could easily laugh at their naivety and blindness to the facts, just as they laughed at anyone who challenged their ideas at their time.

And when a physician is engaging in a debate, keep it focused on the facts. On the TV show, it was clear that an effort was made to make the low carb meals visually unappealing. Who would want a soppy plate full of grease ? On the other hand, a low carb meal could just as easily be a piece of beautiful salmon and a salad and a big glass of water. And one could just have easily presented a doughnut and cup of coffee for the low fat group. The only stipulation would be that the rest of the day would compensate for the fat and sugar in the doughnut. But even on a low fat diet, you could have a doughnut. Would anyone now say that a doughnut and coffee is better than salmon and salad ?

Another fascinating point that was totally ignored, was that the host, as he went through the meals, was clearly full and effectively lost his appetite as the day wore on. he nevertheless forced himself to continue. But one of the key principles of the low carb diet is that you get satiated and STOP eating before you have consumed too many calories. So the low carb is self regulating. And the host of this show, who intended to mock low carb diets, actually proved their effectiveness.

SO my general message is simple. Do not laugh at opposing ideas. And when you hear someone make their argument by speaking WITHOUT facts, but with denigrating statements intended to embarrass the opposing camp, be VERY suspicious. He who laughs has something to hide and may very well not have anything of value to teach you.

Tuesday, January 1, 2013

Eat Eat My Child

The dream of many people is to eat as much as they want and to still be thin, with rippling stomach muscles. Notice already though that the key term here is "as they want". People do not generally compete on eating more calories than all of their friends. It is not challenge to see if one person can get away with eating 1,000 calories more than everyone else. What people really want is to feel satisfied. They want to leave the table having tasted a range of flavorful foods AND feeling full. There is also definitely the visual experience of the food. This is important to recognize, because there is truth to the phrase "his eyes were bigger than his stomach". So, in fact, food for many people is not at all just energy to fuel their bodies. It is an experience. It is emotional. It frames the events you share with family. So, when speaking about being satisfied with a meal, it is critical that people realize how much of eating has nothing to do with suppressing your immediate hunger. And it is often this realization that helps many people deal better when trying to get healthier and lose weight in the process.

I remember when I first heard about the Atkin's diet. The tag line I heard repeated by so many people was "eat as much as you want and lose weight". This started a LONG debate as to whether there was a way to eat an elaborate amount of food, albeit low carb, and still lose weight. The immediate challenge to this argument came from the medical establishment that argued:

  1. if you truly eat excessive quantities of food, where do the calories go? The calories cannot vanish. They either have to be burned up or stored in the body (most often as fat). There is one other option: that they never get absorbed. In other words, if you truly could eat as much you want and lose weight, it might be that your body doesn't succeed in breaking down the food and just let's it pass out through your intestines and ...
  2. In diets like Atkin's, your diet becomes much more based on animal proteins and fats. Especially 30 years ago, the idea of eating MORE fat was heresy. The medical community as a whole believed that such eating.would increase the risk of heart attacks, stroke, cancer and more.
  3. This is a non-sustainable diet. People will not manage to stick to such a low carb diet for very long. In the meantime, they will have developed "horrible" eating habits.
This is not a complete list but you get the picture. And the arguments are good ones. Let's work through them and try to get a perspective on the whole idea of satiety (satisfaction from a meal) and food quality (can you be healthy while eating steak all the time).

First of all, it is very hard to ignore the great number of testimonials by people who have switched to low carb diets and managed to lose weight. On the other hand, you have to be VERY careful with testimonials. EVERY diet and exercise plan will find a 100 people who have succeeded with it. And when you hear 100 people one after the other say "it works", it is hard to ignore. But the real question is how many TRIED these plans. If 10,000 tried a plan and only 100 succeeded, then that means that 99% failed !! Nevertheless, there are quite a number of research studies published in respected medical journals that have noted the success of low carb diets. So, it is fair to say that there is at least some basis to the argument that low carb works. So this brings us back to the original question: if you can eat endlessly, where do the calories go ?

Another point I want to raise harks back to the theory behind low carb diets like the Paleo diet. The argument here is that we have been genetically selected to eat as did the cavemen. But something seems strange about this argument. In a harsh reality of dinosaur filled streets, it was critical that food never got wasted. There was no refrigeration so it was hard to store up for the winter or for periods of famine. So, if cavemen could eat low carb diets, as much as they wanted, and never gain weight (i.e. not put on fat), then all of the food they caught would be mostly wasted. They could potentially eat an entire T Rex yet have not stored any of the extra calories for times when T Rexs are in short supply. Evolutionary speaking, this would be terrible. So, it MUST have been possible to eat excessively when food was available and then to store the excess calories at least to some extent, as fat, for times of need. 

There have been formal studies trying to see where the calories go when people eat low carb diets. Some studies did NOT show any real difference in metabolic rate, i.e., our baseline burning of calories when we are not actively exercising or being active. In other words, there was no evidence that low carb diets made you burn more calories (and thus did not store them as fat). A recent study that made quite a few headlines DID show that patients on low carb diets burned more calories at rest. So, it DID seem that eating low carb has a benefit in reducing calories available for storage as fat.

The answer to the benefit of low carb seems, at least partially, to be due to the effect of such eating on one's appetite. Almost everyone has experienced days when they just had no taste for any food. Looking at a doughnut made them queasy and smelling a steak made them run. So imagine if a style of eating suppressed your appetite to such a point that you would lose the desire to eat after eating a relatively small amount of food. Or better, what if you walked around all day feeling "full". Would it matter if you had eaten 2000 calories or 10,000 ? 

What does appear to be true is that low carb eating decreases appetite. So, when you tell a low carb eater to eat all they want, they do. But the lack of carbs in their diet seems to suppress appetite to such a point that they eat much fewer calories overall, without really noticing and more so, without counting calories. Most importantly, this type of eating less does not cause hunger or cravings. 

Why is this ? Many believe that it is our old friend Insulin that is responsible for a good part of this. When we eats carbs, it spikes our production of Insulin which then triggers our bodies to shuttle the sugar into our cells. However, there seems to be an overshoot effect such that big spikes in Insulin, triggered by high sugar loads, cause a bounce back effect where the blood sugar levels dip too low. And THIS triggers a hunger response leading the person to eat more food. 

Of course, if this is the whole picture, then one could play with their diets in such a way that the carbs eaten lead to smaller spikes in Insulin. And there is no reason why this approach would not work, according to the same logic as above. The low carb camp would argue that trying to keep Insulin minimally stimulated requires the abandonment of carbs. And from here, you can already see why there is such a fundamental dispute amongst the different carb camps.

Let's also be clear that low carb diets are NOT magic. There are many people who fail to stay on them. Cravings for carbs is real and there are some people, no matter how low carb they go, who will simply not be able to resist a doughnut. This is NOT a will power issue. There is something that we still do not fully understand that makes certain people react to food in the same way as drug addicts respond to their drugs. And we need to recognize this and respect this point before announcing that low carb diets will save the world. 

What about the long term effects of eating steak every day ? Before I address this, I want to remind everyone that the message of low fat has not seemed to stem the growth of obesity and diabetes. So, no matter what the theory, we have to be open to the possibility that low fat diets are problematic and perhaps even at the core of our obesity. This means that the question is NOT "are steaks bad". The question is "are steaks worse than our present eating habits". And in fact, there is solid research that shows that low carb (hi fat) diets actually improve our blood levels of cholesterol and fats, and help control our blood sugar levels. Could it STILL be that steaks are bad for us, EVEN when our blood tests show we are healthier ?  Sure, it's possible. But this is a difficult argument to make. And it is very hard to justify switching someone off of low carb when their cholesterol and blood sugar are all good.

We do not have all of the answers. But the truth behind the magic of low carbs seems to be a combination of things. Most importantly, for some people, it is a way to partake in foods they enjoy while not feeling guilty or hungry. And that really is an achievement. 

One thing that we should ALL refrain from is laughing at the theories of the different diet camps. And on this, I will speak next time.

Thanks for listening