2008-08-28T01:54:25Z Judith J. Wurtman, PhD and Nina Frusztajer Marquis, MD Copyright 2008, Judith J. Wurtman, PhD and Nina Frusztajer Marquis, MD SPHPBLOG A few days ago we purchased a portable GPS. As someone with no sense of direction and a tendency to get lost, even in department stores (I can never find the down escalator), I look upon this support system with great anticipation because the system always knows where you are, even when you don’t. And although I have not tested it yet on some complex maze of roads to get me home, according to the promotional material it will.

Wouldn’t it be wonderful if there were a GES or Good Eating System to tell us what to eat, what to avoid, warn us about eating obstacles ahead such as all-you-can-eat brunches, fried clam shacks, and fair grounds with fried dough and corn dogs? Better yet, if the system were somehow attached to some yet to be identified metabolic site in our body, it could sound an alarm when we exceeded our calorie allotment for the day.

Actually, such devices are being developed as hand-held weight loss counselors. One I have heard about is in use and undergoing improvements as more is known about how well it works. It is programmed with information about eating and exercise habits, caloric and nutrient needs, and life-style demands. If you commute to work and are used to stopping and buying a doughnut and coffee before getting on a commuter train, the device will warn you to take breakfast with you and skip the doughnut. With information about your evening nibbling habits, you might get a message around 8PM as you head off to the kitchen for some ice cream to get on the treadmill instead. And if you are sitting in a Chinese restaurant trying to decide whether to order battered dipped chicken in a salty sauce, you might be steered to steamed vegetables and tofu instead.

Will this GES work? Like my GPS, if the directions are followed, the answer is yes. If I am lost and want to find my destination, I am obviously going to follow the directions I am given, even if they seem contrary to what I would do on my own (which would keep me lost, of course). And if I am wondering what to order in a restaurant or forget to eat vegetables at lunch, this weight-loss aid will tell me what I should do. It really is similar to being lost and then finding your way again with the help of a Global Positioning System. When that happens, the adrenaline stops pouring out and there is a profound sense of relief and comfort in knowing that you will eventually get to where you want to go. Use of a GES has to bring about the same sense of security, comfort and achievement.

But it does have limitations: It can be turned off, left at home, or thrown away. Instead of being perceived as a help, it can be thought of as a nagging relative who thinks you are too fat and doing nothing about it. Its usefulness really depends on how much you want to lose weight and learn how to keep it off.

What about the long-term use of either of these devices? Will I always need my GPS to find my way to the library or home from visiting a friend? Past experience has shown me that eventually even my directionally-impaired brain will get me home by myself when the way is familiar.

The answer to the long-term reliance on a Good Eating System device is not known. If practiced long enough, new habits and changes in lifestyle do take hold and stick. Perhaps weeks of specific advice concerning meal and snack choices, sleep, exercise, and relaxation will also leave an imprint on the brain so that whole-grain cereal, rather than a doughnut, will be the default breakfast choice and a day without exercise seem uncomfortable.

And who knows? Someday my GPS, which directs me to restaurants in the area, might be programmed to direct me only to restaurants with healthy food. And perhaps if I am in the car too long, it will tell me to stop driving and get out and walk.

]]> http://serotoninpowerdiet.com/blog/index.php?entry=entry080826-122706 2008-08-26T00:00:00Z 2008-08-26T00:00:00Z
An article in by Ellen Tien in the September 2008 O magazine discussed the reluctance of people to state directly what they want. She was not talking about ordering a meal in a restaurant or buying items from the Web. She was referring to women and men being unable to confront others, such as their spouses or other members of their family, with their real desires. According to her, we tiptoe around our desires because guilt at wanting something is stronger than expressing our wishes directly.

As I read this, I wondered if we tend to reach for food rather than what we really want because eating is simple. Eating does not have to involve anyone else. Seeming to satisfy some needs within us, it can be done privately and in secret. And, for a very brief period of time, it seems to quell the “I want” feeling.

This came to mind when I recalled a sad story of a secretary whose husband was emotionally abusive. Because she had four children and very little education beyond high school, she felt incapable of leaving him. “We had a pantry in our basement,” she told me. “After my husband and kids were asleep, I would go down there, open up a box of crackers or cookies and eat them while reading some trashy novel. It was the only time I could do something without my husband screaming at me.”

She wanted her husband to change, she wanted to finish her education, and she wanted independence. But there was no way she could express or act on her wants so she ate instead.
A client in one of our weight-loss groups told us why she gained a great deal of weight as a child. “My mother worked at home and we were trained not to disturb her. But she would stop working if we wanted a meal or snack. So I used eating as a way of getting her attention. I didn’t want the food, I wanted her. But it was the only way I could get her attention.”

One of the hardest things about losing weight is keeping it off. The reasons are as numerous as gnats on a warm summer evening. But among the many pesky causes of weight gain after a diet is the failure to recognize your real wants. No matter how much you want to lose weight, you are not going to stay thin unless you confront your other wants. And the optimal, indeed critical time to recognize these wants is while you are dieting. Waiting until the weight goal is reached is too late.

Before starting on a diet, it would be useful to identify situations in which a “want” is translating into eating. Here are some examples. I want:
• To stop working and go home.
• A baby sitter so I can have some time for myself.
• My spouse to talk to me during dinner.
• My mother-in-law to understand how frazzled I am so she won’t stay with us for 3 months.

While you can’t always get what you want, knowing what your wants are is half the battle in controlling weight gain. Eating won’t change the wanting; it will only allow you to deny or mask what you want.
As Ms Tien says in her article, the solution is to act on your wants. In her words, “What you want isn’t merely what you get. It’s where you’ll be. It’s who you’ll be.”

And one of the things you will be will be thin.
]]> http://serotoninpowerdiet.com/blog/index.php?entry=entry080819-181047 2008-08-20T00:00:00Z 2008-08-20T00:00:00Z The Center for Science in the Public Interest, a nutritional watchdog organization, reported recently that the special “children’s meals’” offered in fast-food restaurants are extremely high in calories, saturated fats, sugar and salt. This news should not be surprising; meals consisting of chicken nuggets, French fries, cookies, and chocolate milk or pizza and soda are certainly going to be nutritionally deficient and excessive in all the unhealthy substances all of us should be avoiding. The article went on to point out the rising number of obese children and blamed this in large part on the enormous number of calories these kids’ meals contain.

What the article did not say was that this would not be much of a problem if kids ate fast food very rarely, say once or twice a year. If, the rest of the time, their meals were well balanced and nutritionally complete, how much harm could these meals do?

I suspect that way back when the product managers of fast-food restaurants tried to figure some way of enticing families to eat in their franchises on a regular basis, they came up with the idea of special foods for kids. It makes sense: Chicken nuggets and French fries are more fun to eat than a grilled chicken salad, and chocolate milk or soda is tastier than low-fat milk.
However, I doubt that 25 or more years ago or whenever Happy Meals entered the American food vocabulary, one could have predicted that these food combos would become standard weekly fare for kids, not only in the restaurants but at school and also at home.

Obviously these extremely high-calorie, nutrient-poor meals are affecting the health and even the longevity of our children. But fast-food franchises are only the most obvious culprits in the deterioration of our children’s diets. There are many reasons why our children may not be getting fewer nutrients, and more calories, than they need; the causes are just not as obvious as the nearest McDonalds.

Do you know what your kids are actually eating? Think about the places where children are getting their food from a very young age: daycare centers, preschool and nursery schools, day and overnight camps, public or private schools, shopping malls, baby sitters, grandparents, school and team trips, and sleepovers. The list goes on and on. It might be interesting to figure out how many times during the week children eat a meal at home.

How do you make sure that your children are eating foods that nourish them, that are acceptable calorically for their size and activity level, and do not contain excessive amounts of substances like saturated fats that may affect their health later on?

It is not as easy or simple as it was years ago when most meals were eaten at home, at least until kids went to first grade. Even then only lunch, if that, was eaten away from the kitchen.

There are two solutions to this problem. One is to supply, for as long as possible, foods that you want your children to eat away from home. The second is to teach your children which foods are, and are not, acceptable to eat. So sending lunch and snack foods to the day care center or preschool, along with the beverages you want your child to be drinking, removes the problem of a graham crackers, mac and cheese and apple juice diet that many day care centers seem to promote.

However, getting your children to make the right food choices takes more effort than that and has to begin very early in a child’s life, preferably when the word “no” creeps into the vocabulary of the toddler.

Children can be taught at a very young age about what foods are acceptable and which are not. I have seen this in the household of neighbors whose kids obey the Jewish laws of keeping kosher. Even before they can read, they know how to look for the small symbol that signifies whether a food is kosher or not. They also know how to look for an additional letter that tells them if the food contains dairy products like milk powder solids. (Since they cannot mix foods containing meat and milk, this is also very important.) The effect of this very early training allows them to say “no, thank you” to foods that they know they are not supposed to eat. Children brought up brought up in vegetarian households, like those of Seven Day Adventists, do the same.

When our children were young, I had just started writing about nutrition and wanted to make sure that I was practicing what I was writing in my own house. Junk foods, including soda, were banished and our kids were served only nutritious foods, even if there was a fight about their eating it. But it paid off. When our younger child went on a class trip at the beginning of middle school, he always asked for water, low-fat milk or orange juice in restaurants. He told me that his classmates teased him for doing so. But his attitude was that his class mates could fill their bodies with junk but he wasn’t going to.

Nonetheless, raising children in a nutritionally-healthy environment has its costs. Some nutritionally healthy foods like fresh fruits and vegetables, chicken, fish, whole grain cereals , yogurt and cottage cheese may appear more expensive than a meal of chicken nuggets and French fries. But it turns out that preparing foods at home and making meals that stretch like soups, stews, meat loaf, pasta or rice and chicken and vegetables is less expensive for a family than individual servings of happy meals or cheeseburger combos. After all what you pay for in any restaurant is more than the food: you are paying for labor, electricity, rent, and the cost of those cardboard boxes and packets of ketchup.

But for some the bigger cost is that older members of the family also have to follow the rules for making healthy food choices. You can’t tell your kids to eat their broccoli while you are munching on a pepperoni pizza. It also takes time to pack lunches and snacks, shop for food and prepare meals. Picking up take-out or dropping in at the local fast-food franchise may seem tempting after a long week of juggling work, family, and household obligations.

Is it worth doing? Is there any choice? We know that more and more children are suffering from obesity and that their childhood diets may cause adult problems like diabetes, heart disease, and even decreased longevity. So save the Happy Meals or pizzas for very special occasions. If your children get used to eating well, they may want to go out for sushi instead.
]]> http://serotoninpowerdiet.com/blog/index.php?entry=entry080819-134839 2008-08-19T00:00:00Z 2008-08-19T00:00:00Z
When our hospital based, weight-loss clinic first opened, we asked new clients to fill out a questionnaire about the kind of physical activity they did. Included were activities such as carrying toddlers or their strollers up and down steps, bringing groceries into the house, walking or stair climbing as part of their job, and of course “regular” exercise (running, morning or evening walks, working with a trainer, etc). We also asked whether our clients would engage in a regular exercise routine if they were not concerned about losing weight.

We learned two important things: Most people overlooked the exercise they did as part of their daily life. One client worked in a law office spread over three floors of an office building. She climbed up and down the stairs several times a day to go to meetings, or speak with other lawyers or her clients. She overlooked this frequent form of physical activity because it “was just part of the job.” The second thing we learned was that the primary reason our clients would commit themselves to an exercise program was (no surprise here) to lose weight. Fitness, bone strength, improving their heart health, even decreasing the possibility of late-life memory loss, were regarded as unimportant reasons. “I will exercise if it gets my weight off faster” was the typical response on our questionnaire.

How can people be convinced that regular physical activity is something which should be part of their lives, regardless of whether weight loss is also on their agenda? Most fitness or obesity experts will say that it takes months, maybe even years, for new habits to develop. Consequently, a lot of positive “nagging” is necessary to get people to stick with an exercise routine. Many experts say that they don’t have much success in making this happen.

However. I think what is overlooked in getting people to put exercise into their lives as a given, as routine as brushing your teeth or paying the cell phone bill, is to point out that most of us do physical activity as part of our lives. And maybe the easiest way to start increasing exercise is to put more of it into our daily routines.

A mom whose 7-pound infant is now a hefty 28 pounds or more is obviously becoming more and more fit every time she bends down to pick up her child. Someone whose arms ache after raking the lawn or shoveling the driveway in early fall or winter is going to develop arm and back muscles by the time the last tree sheds its leaves or spring finally comes. I saw a sign in an office building announcing that the elevator is REALLY SLOW and recommending the stairs be taken instead. Climbing the stairs is hard if you don’t do it often but sooner rather than later, your legs become stronger, your breathing easier and eventually you do it faster and with less effort.

Many years ago my husband and I lived in a part of Switzerland at the edge of the hills that eventually become the Alps. All the shops were dotted along a very steep hill, and I had to climb up and down them to do my food shopping. And, as our kitchen refrigerator was more suitable to a dollhouse than an apartment, I shopped very often. One day, soon after our arrival, I watched in amazement as an old woman climbed up the hill carrying two sacks filled with large glass bottles of water. I was puffing and panting after my short climb without any groceries in my hand. But, within a few weeks, I could do the climb without my breath coming in gasps and my hands feeling as if they would fall off from the weight of my bundles. Looking back on that time, I realized that I was doing the equivalent of stair climbing in a gym with heavy weights in my hand. Would I have done that in a gym? I doubt it. But in Switzerland, I did it or we would have had an empty refrigerator.

So maybe one answer to the exercise question is that in many cases, it is the only way we can get through life. And if we take on the challenge (or perhaps can’t avoid it) of increasing the intensity or duration of our daily physical activities, we will emerge the healthier for it.

A neighbor who recently moved from a house in the suburbs to an apartment in the city told me that she is much healthier now. “My bone density has improved, as has my resting heart rate,” she related. When I asked her how this came about, she told me that she has to walk all the time. “If I take my car to get groceries, it takes longer with traffic and parking than if I walk. And the cost of parking the car is about half the cost of my food. So I walk and lug home what I need. Also, we live on the 3rd floor and although there is an elevator, it is really old and slow. So I walk up the steps. We have a dog and no backyard. So I walk even more. After we first moved, I would lie in bed at night and my legs would ache from all my exercise. But now I never notice it. I am really stronger.“
There is an old expression which I probably heard first from my grandmother, which was, “ Live and be well.” It is the “be well” that we have to work on. If exercise is part of the living, you will be well.
]]> http://serotoninpowerdiet.com/blog/index.php?entry=entry080811-134646 2008-08-11T00:00:00Z 2008-08-11T00:00:00Z Most, if not all, medications have the potential to cause side effects. These may range from annoying, such as feeling slightly tired to fatal (toxic chemotherapeutic agents). However, we usually don’t think of obesity as a side effect of taking medicine. But it can be. Antidepressants, anti–anxiety drugs, mood stabilizers and antipsychotic drugs (used for bipolar disorder and schizophrenia) are linked with moderate to dramatic increases in weight.

“I gained 25 pounds on my antidepressant in just three months,” a new client told me. “I ate and ate. Since I am in my office all day, I did most of my eating at home. I had always been thin but within a few weeks on the drug, I ballooned up so quickly. And the worse thing about was, I didn’t care. The drug took away all my feelings of anxiety, or guilt, or horror at what I was doing. I just felt as if I was on a cloud watching myself stuff cookies and chocolate into my mouth.” When I asked her why and when she realized that she had gained weight, she told me it occurred when not one piece of clothing in her closet fit.

Another wrote to me in despair because her doctor told her that she had to go back on an antidepressant she had taken several years earlier. She had gained forty pounds but managed to lose it after going off the drug. Now she was being told to take it again and as she told me, “I feel as if a judge has just condemned me to obesity. It is so unfair. I worked so hard to lose the weight I gained the last time and now I am doomed to gain it all back.”

Weight gain as a side effect is not limited to drugs used to treat brain-based emotional disorders. A drug to treat fibromyalgia has recently been approved and it is the first (although several others may appear soon) to help people with this chronic disorder. The drug does help with the pain and other symptoms but like the antidepressants, it is already known to cause substantial weight gain. This is a particular hardship for people who already may have difficulty moving because of pain from the disorder. Gaining weight may make physical activity even more painful.

There is nothing mysterious about why weight is gained. Ask anyone who has had this annoying side effect. More food is eaten on meds than off. “It doesn’t matter how big my dinner is,” a client told me. “I still want to eat as soon as I get up from the table. My head keeps telling me to put food in my mouth.”

One theory is that the antidepressants and other drugs that cause this overeating are doing something to the neurotransmitter histamine (neurotransmitters are chemicals which transmit messages from one brain cell to another). Some allergy drugs (the anti –histamines) block histamine. Several years ago some scientists observed that anti-histamines are associated with overeating. Perhaps, the theory goes, antidepressants, mood stabilizers, and drugs for the pain of fibromyalgia might change histamine activity so that a feeling of wanting to eat never goes away.

Fortunately serotonin, the brain’s “feel good” neurotransmitter, also acts as a brake against the overeating caused by the drugs. If you think of these drugs as a car going too fast down a street, the serotonin, which slows down the eating and causes it to stop, acts as a speed bump. And the easiest way to provoke this “serotonin-speed bump” is simply to eat a therapeutic amount of carbohydrate so serotonin is made.

Recently I learned about a new drug that causes weight gain from an e-mail sent to me from someone who had bought our book, The Serotonin Power Diet. The sender has Parkinson’s disease and is taking a medication that increases the activity of another brain neurotransmitter, dopamine. The symptoms of her disease are caused by inadequate amounts of dopamine and medications that increase dopamine’s activity have been available for several decades. One side effect of medications for Parkinson disease has been compulsive activity such as gambling. However, this writer told me that she binges compulsively. She really did not want to overeat but felt driven to do so and gained a substantial amount of weight. At her suggestion, I read comments about the side effects of this drug and found others reporting similar abnormal eating behavior. She told me that she gained weight on two nationally known weight-loss systems and her second nutritionist (the first had given up on her) was having no success in controlling her eating.
As the medication is helping her control her illness, she is obviously going to stay with it. There is a good chance that increasing serotonin will put a brake on her bingeing as it does with other types of overeating. But the verdict is not yet in as she has just started on the diet.

Weight gain does not have to be the unavoidable side effect of medications which treat brain based illnesses. As long as we can depend on serotonin to shut off overeating, we can enjoy the benefits of medications that help pain, anxiety, and depression and restore us to a state of well-being.
]]> http://serotoninpowerdiet.com/blog/index.php?entry=entry080731-163705 2008-07-31T00:00:00Z 2008-07-31T00:00:00Z

Several days ago, many newspapers reported the results of a two-year weight-loss study published in the New England Journal of Medicine. The study, which took place in Tel Aviv, followed males and a handful of women for 24 months to see which of three kinds of diet program would produce the most effective weight loss. The three diets were low fat (similar to the American Heart Association diet), a somewhat healthier version of the Atkins (the participants were kosher and did not eat bacon, ham or pork or add cheese or butter to their meat products), and the Mediterranean diet (this used much more olive oil and fiber than either of the other two diets). The participants had similar and comprehensive support from dieticians and even their spouses were educated on how to help the dieters follow the program at home.

The participants were all obese; they had a body-mass index (BMI) around 31. To give you some idea of what these means in pounds, a woman who is 5’5” would have to weigh 185 pounds and a man of 5’11” would have to weight 225 pounds to have a BMI of 31. None were morbidly obese but they had to lose at least 50 pounds or more to get back in the normal weight category.

The study has generated an enormous amount of discussion on various blogs. One that I checked posted almost 200 messages from people proclaiming support or criticism for either the low-fat, low-carb or Mediterranean diet based on the success or failures of the subjects. Indeed, some of the exchanges were quite heated as the writers shared their own experiences.

So what is all the fuss about? Was one of the diets so effective that the participants attained their goal weight? Did another diet leave the participants heavier than before? Should we throw away every diet plan that exists and go with the winner of this study?
The results might surprise you.
The biggest weight loss was seen on the modified Atkins diet—but this was true only of the men. The few women (about 10% of the sample) did best on the Mediterranean diet. And the results were as follows (drum roll, please):

In two years the group as a whole lost about 6.6 pounds on the low-fat diet, 8.8 pounds on the Mediterranean diet and 9.4 pounds on the modified Atkins diet (or low carb).
Most of the weight was lost in the first 6 months. During the remaining 18 months, participants either gained back some weight, leveled out, or both.

Any weight loss is good and what this study shows is that with a really good monitoring and support system, it is possible to lose weight and keep it off. There was a significant difference in the effectiveness of the different diet plans although the differences are tiny when you consider how much weight the participants really had to lose.

Did the study answer the question what is the best type of diet? Yes and No.

For men, the low-carb, modified Atkins diet did work best. Many men have been able to lose considerable amounts of weight following a relatively high-fat, high-protein diet.

But the study did not answer these questions: What is the best kind of diet for emotional overeaters who do so because they need to use food to feel better? And what about people whose brains force them to overeat because they are taking medications that affect their food control system?

None of the diets were designed to use carbohydrates to improve mood, curtail appetite or halt the effect of medications that cause overeating. Exercise was not a major component of the weight-loss program, nor was counseling to identify triggers that caused weight to be gained initially.

The best kind of diet is one that allows you to lose weight steadily, makes you feel comfortable while doing so, motivates you to become more fit and gives you the chance to figure out how to prevent yourself from gaining back the weight when the diet is over.
And that diet is really a way of life.
]]> http://serotoninpowerdiet.com/blog/index.php?entry=entry080728-164513 2008-07-28T00:00:00Z 2008-07-28T00:00:00Z Have you noticed how difficult it is to eat while you are laughing? Unlike talking and crying, it is almost impossible to chew and laugh at the same time. This came to mind when I received an e-mail from a friend who had gone to see this summer’s funny movie, “You Don’t Mess with the Zohan.” She writes:

“You know I am always complaining about how hard it is to go to the movies and not munch on nachos and cheese, a tub of popcorn or one of those gigantic boxes of candy. So until I lose my weight and, I hope, my desire to eat these foods, I have been avoiding the big screen. But my husband dragged me to the Zohan movie and promised me that I would not miss munching my way through the story. He was right. I laughed so hard that my stomach hurt afterward. I was so busy laughing that I never thought about munching. If I could laugh my way through every meal, I would be skinny by next week.”

She is right about laughter taking away the desire to eat. Her letter made me think back upon countless dinners with friends in which we would sit around the table telling funny stories. If the stories started before dessert, the food would be forgotten while we would hang on the sometimes interminable stories with the absurd endings.

One of the problems with going on a diet, or trying not to gain back lost weight, is that we often forget to laugh. This may be especially true when people go on diets that decrease their brain comfort chemical, serotonin. A dear friend e-mailed me yesterday saying that his wife was put on a high-protein, low-carbohydrate diet and is now very grumpy. She was a very funny woman, full of sparkle and a way of turning every day events into a vehicle for amusing stories. Now, according to my friend, she rarely laughs and has turned into a glass half-empty sort of person. “Sally has lost her sense of humor along with her weight,” complained my friend. “I told her that a few bowls of pasta might restore her good humor without the weight but she only snapped at me.” Privately I am afraid he is in for a long humorless summer as her lack of carbohydrate is decreasing her brain’s level of serotonin, and her good mood will continue to suffer.

Perhaps the next generation of weight-loss books, support groups and diet foods by mail order will provide humorous books, comedy DVD’s and stand-up comedians to help the dieter. Wouldn’t it be fun to go to a Weight Watcher’s meeting and spend an hour laughing instead of hearing, once again, what to do with leftovers? Instead of reading lists of calories and vitamins and minerals on a package of diet food, how about reading a funny cartoon instead? When you feel like a treat because you are bored or disappointed or feeling tired, how about taking out a book like Plato and the Platypus (a book of philosophy and the funniest jokes I have ever read) and indulging in one or two of the funny stories?

It has been said that laughter is the best medicine. It seems to be the best way to also lose weight.
]]> http://serotoninpowerdiet.com/blog/index.php?entry=entry080720-051557 2008-07-20T00:00:00Z 2008-07-20T00:00:00Z
Even though clothes sometimes come with a label saying ”One size fits all” or as a friend says, “One size fits no one,” the same cannot be said of a diet plan.

The Serotonin Power Diet, however, does fit everyone’s brain by making sure that you are making sufficient serotonin to keep your moods steady and appetites under control. But Nina, my co-author, and myself believe that the foods on the plan are suggestions, not demands, and certainly not engraved on a stone tablet. Sure, we want the dieter to eat some protein for breakfast along with toast or cereal. And we do insist that protein be eaten at lunch time as well. The dinner for the first two weeks of the program is basically carbohydrates and vegetables in order to boost serotonin, through that meal as well as the snack that precedes and follows it. But we realize that the foods we suggest as protein or carbohydrate foods or the vegetables and fruits listed on the page may or may not be acceptable to the dieter. Moreover, the portion sizes that may be work for a woman who wants to lose 40 pounds may be too small for someone who has to lose 240 pounds and is hungry at the start of the diet. For her, we suggest following the men’s diet until she finds it is too much food.

Recently, a woman in Australia wrote to us asking about snack foods, since many of the foods we suggested were not available in her supermarket. (I suspect, though, that she had access to some foods, like kangaroo, which we had not listed as a protein option.) After a few e- mails, we were able to work out some substitutes that seemed similar to some of the snacks on our American list.
Then there are vegans. They do not eat any animal products, including eggs and dairy products. Breakfasts of cottage cheese and lunches of grilled chicken breast won’t work for them, so it was necessary to see what soy or bean-based foods might work as substitutes. And we recommend calcium supplements in case the foods they did eat are not rich enough in that critical mineral.

But most of our queries are not so much about the food itself as how to fit the diet into the dieter’s lifestyle. And this is probably the most difficult aspect of following a diet. Food lists, recipes, menu suggestions, and food shopping and preparation tips may simply not work for the dieter who works a midnight to 8 AM shift, or for someone traveling from city to city or even from office to office within the same city. One client said that she would be happy to eat a hot lunch but could do so only by giving up her day job. “I am always in the car because I work as a visiting nurse,” she wrote us. “On occasion I may be able to stop the car and eat my lunch by a park. But there is no place I can get a hot lunch on my route and nowhere to heat up food I bring with me. Can I eat a sandwich for lunch? If I am driving to a client at least I can manage to eat and drive.”

Obviously the answer was yes—with the suggestion to pack a lot of napkins.

Another client who worked the midnight shift had a problem following the diet because the hospital cafeteria was closed, vending machines were useless as a source of nutritious foods and often her break time was spent catching up on computer entries. This is what we worked out:
Sleep: 9 AM to 4 PM
Breakfast: 5 PM
Lunch: 9 PM (this was her big meal because she could eat it at home. She ate about 5 ounces of protein with 1 cup of rice, potato, or pasta, along with vegetables.)
Work: 11 AM
First snack: 1am She loved cherry Twizzlers.
Dinner: around 2 AM. It was quiet then and she could microwave a potato or some hot cereal and fruit
Second snack: 5-6 AM. She usually ate graham crackers and had her fruit at this time. It was important that she eat a snack before leaving for home an hour later so she would not be tempted to stop for some fast food breakfast on the way home.
She arrived home at 8 AM and we told her to eat an English muffin or some toast and juice if she felt hungry. But the snack satisfied her and relaxed her enough so she was able to sleep soon thereafter.

It is important to make your diet fit into your life rather than the other way around. After all, the diet and all the changes in eating and exercise that it brings into your life should, ideally, continue after you have lost the weight you want to lose. Obviously you don’t have to diet any longer. However, all those pesky logistical problems that caused you to reach for fast food, or lunch on a diet Coke and a large bagel, are going to return unless you have figured out, during the diet, how to make those life style changes stick.

This may be why diet spas, diet foods in a box or pouch, or daily monitoring of what you are eating really doesn’t work in the long run. You have to work out the best way to eat the foods that you need for physical and emotional nourishment while juggling and balancing the sometimes overwhelming demands of daily life. And if you make a mistake, so what? You can start all over again tomorrow.
]]> http://serotoninpowerdiet.com/blog/index.php?entry=entry080714-052052 2008-07-14T00:00:00Z 2008-07-14T00:00:00Z
One of the stories about the effects of high gas prices mentioned the increase in candy bar sales at gas stations. Apparently after paying upwards of $40.00 for gas (and sometimes much more) people pay another dollar for a candy bar. It is unclear whether the reasons are: a) What is an extra dollar?
b) I need a treat after the shock of filling the tank or c) I guess I will be doing a lot of walking so I can afford the calories.

Whatever the reason, it is interesting that despite all the negatives written about candy, people still eat sweet snacks. I was thinking about this today during my town’s 4th of July parade. It is a tradition for the people on the floats, along with the guys driving the fire engines and police cars, to throw wrapped candy at the spectators. Tiny Tootsie Rolls were the most abundant but some other wrapped candies were also thrown. We were sitting on the sidewalk next to a group of kids and most of the candy was thrown in their direction. However, all the adults around us scrambled to get their share as the pieces landed around them. Pretty soon, the whole street was happily munching away. Fortunately, there was no float hauling the “wicked witch of the low carb world” to warn us of the perils of eating something with sugar in it.

What is amazing is that there still are many people who believe that eating anything with sugar will be devastating to their health, both physical and mental. They regard a miniature Tootsie Roll, or a dollop of ketchup, with horror. “ It has sugar, sugar is bad for you, I never eat anything with sugar,” they will cry.

Obviously, a diet loaded with sugar is bad because sugary foods usually lack the vitamins, minerals and protein that nourish us. They also tend to be low in fiber and high in fat. Think of cookies, doughnuts, chocolate bars, brownies, ice cream and sheet cake with frosting. They may be more appealing than broiled halibut, Brussels sprouts and brown rice but contain nowhere near the nutrient value. Indeed, they have just about no nutrient value at all.

But sugar is not without its virtues. To begin with, sugary foods taste good. That is why having a Tootsie Roll thrown at parade watchers rather than a turnip is so appealing. Sugary foods are also treats. Treats are not a steady diet; they are foods dolled out for special occasions or after certain chores or tasks are completed. Birthday cakes tend to be sweet, as do wedding cakes.

Sugar does the same thing for the brain as starchy foods. When eaten, it gets the brain to produce the brain chemical serotonin. And serotonin helps us feel better, calmer, more focused and, just as important, less hungry.

We hear all the time from nutrition people and health professionals that we should eat a variety of foods and eat everything in moderation, from wine to wieners. And it should be the same with something containing sugar. A small piece of candy at a parade, or a small candy bar when you fill up the car (and if you walk more, you will fill it up less often), is certainly not overdoing the sugary snacks. And if it makes you feel less grouchy about fuel prices, it might be worth it.
]]> http://serotoninpowerdiet.com/blog/index.php?entry=entry080707-152943 2008-07-07T00:00:00Z 2008-07-07T00:00:00Z
Earlier this month, the Journal of Clinical Endocrinology Metabolism published a review article by Dr Daniel Bessesen on the best approaches to help obese individuals. There was a lot of “good news” in the paper, especially the report that the number of people becoming obese in the United States seems to have hit a plateau. So it is possible that attempts to get people to eat better may be having some effect. Aggressive treatment of diseases like diabetes and coronary heart disease means that people suffering from these obesity–linked disorders are living longer. And your chances of becoming obese are decreased by 43% if your friends are thin. Still, parts of the article could have been written 50 years ago. It says that weight comes back after the diet is over unless changes are made in eating and exercise. Anyone who has been on a diet and gained back weight could have written that section. Were any new ways of getting the dieter to maintain a changed lifestyle mentioned? No.

But the paper also pointed out, as have previous reviews, that overall mortality is much higher among obese individuals and even among people with only a modest increase in weight.

And you can’t blame obesity on your genes. Although research with animals seemed to point to a connection between some abnormal genes and the tendency to gain weight, the amount of weight gained was small. We are far from claiming that our overeating is due to our DNA.

One intriguing research direction is looking at the bacteria that live in the intestinal tract. Obese animals and humans seem to have more of one type of bacteria and much less of another than normal weight animals and people do. And if the bacteria from an obese mouse is put into the intestine of a lean mouse, the lean one gains weight. The opposite is true as well; when obese people lose weight, their intestinal bacteria look like that of thin people. So one could daydream about eating slimming bacteria (certainly better than eating tape worm eggs) and losing weight. But don’t look for this in your supermarket any time soon.

Fitness is always a component of weight loss and maintenance but seems to take a back seat to dieting. It shouldn’t. Even moderate amounts of exercise have some impact on reducing mortality. One study showed that individuals with large amounts of abdominal fat were at no higher risk of dying than people who were thinner—if the obese individuals were fit. So dust off those weights and oil that treadmill.

Drug therapy may offer some promise of making weight loss easier (although there are no drugs for weight maintenance). Unfortunately, a drug that did produce more weight loss for the people being treated than those getting placebo won’t be available in the United States. There was concern about an increased incidence of depression and anxiety among individuals receiving medication. But there is an enormous amount of effort to find new compounds by drug companies and the National Institutes of Health, so we may be seeing some effective agents in the near future.

In the meantime, there is surgical intervention. It works. A large study compared over nine thousand patients who had bypass surgery to a control group who started out at the same weight. After seven years, the researchers found that mortality among the surgically treated patients was 40% less than the untreated control group. There was a 92% reduction in death due to diabetes and 60% reduction in death due to cancer.

As with every disease or disorder, the best treatment is prevention. Surgery has risks, and there are deaths associated with the type used to help the obese lose weight. Also, by the time people are ready for the surgery, they may have already developed diabetes, heart disease, and bone and joint problems, just to mention a few of the medical problems obese individuals face.

The most important message from this current review is that curing obesity is not a simple problem. Losing weight is not just a matter of pushing yourself away from the table while you are still hungry and then exercising like a lumberjack before going to bed. The article never mentioned weight gain due to antidepressants or inactivity because of a bad back or prolonged stress. Effective treatments, hopefully available in the near future, combined with an understanding of the complex reasons for overeating, may be the ultimate obesity solution.
]]> http://serotoninpowerdiet.com/blog/index.php?entry=entry080630-054830 2008-06-30T00:00:00Z 2008-06-30T00:00:00Z