Refuse To Regain

The Wind Beneath My Bike Pedals and Hiking Boots

By Lynn Haraldson-Bering

As you know – and why Barbara and I write this blog – it’s not easy finding people who can relate to weight maintenance. Like many of you, I’m more than familiar with reaching goal. I’ve done that dozens of times in my life! But I’ve always been a big rubber ball, bouncing back up the scale the minute I hit that magic number. “I can eat again!” was always my mantra.

Why this time at goal is different has many aspects, but one of the most important reasons is that maintenance inspiration is right here in my own house. My husband is maintaining a 22-pound loss since July 2005, and has introduced me to a way of life I never aspired to: fitness. 

Larry’s story is a familiar one. Thin – as in really thin – in high school and college, he gained more than 20 pounds when he went to graduate school. He says it was a change in metabolism, but he also had quit smoking and wasn’t as active as he’d been before. At 23, he took up running (a little known sport at the time) and Purdue had an indoor track (which saved him from freezing to death during the winter). Within a year, he was an avid runner. It was his legs that first attracted me to him in 1996. I’d known him for several years, but didn’t realize he was hiding such bodacious legs under his professor style Land’s End khakis until he ran past my apartment one afternoon. “Damn…he looks good!” I thought as I watched him until he turned the corner.

Fast forward several years.

A study in the New England Journal of Medicine  found that our risk of obesity increases 37 percent if our spouses are overweight, 57 if our friends are overweight friends and 40 percent if our siblings are overweight. I don’t know if any of my friends or siblings can “blame” me for being overweight, but Larry certainly could. As my weight increased by leaps and bounds from 1999 to 2004, his crept up, too. Much more slowly, but an increase nonetheless. By the time I began losing weight in January 2005, I’d gained more than 100 pounds and he’d gained 25.

Bending over was tough, he said, because he could feel the weight in his mid-section. He went from a 31-inch to 34-inch waist. Unbeknownst to me, he declared his gain “ridiculous” at the same time I started losing weight. We never talked about my weight and I didn’t share with him that I was losing weight until I’d lost 15 pounds (which, starting at nearly 300 pounds, wasn’t noticeable). When he “confessed” that he wanted to lose weight, too, he started eating like me.

Six months later, he was down 22 pounds and back into 31-inch jeans.

Larry and I had a few things in common, but no real uniting or consuming interest. Losing weight together brought us closer and eventually we turned into the one thing I never envisioned myself to be a partner to. We became a “fit couple.”

Before 2007 (well after I’d started this journey), if someone had told me I’d look forward to physical activity as a couple’s pastime, I’d have said, “Exercise? Together? Larry and me? Blech!” Being together meant dinner, a movie, a party. Vacation was spent with my butt firmly planted in a lawn chair. But two years ago when he got me in a canoe for the first time since summer camp in 8th grade, and especially when he bought me my first bike in 28 years when I reached goal, our relationship changed from “You go your way, I’ll go mine and we’ll meet back here in a few hours” to “Let’s hit the trail!”

Now we plan our weekends around the North Country Trail. We’re hoping our next big vacation will be a return to the Adirondacks where rather than me sitting on shore watching him fish in a boat, I’ll be in the boat with him AND accompanying him on the mountain trails instead of driving all around them.

Me capable of maintenance? Me an avid hiking and biking enthusiast? These are things I never thought myself capable of or interested in. But I have a secret weapon.

I’m glad they flashed to Larry’s smiling face during my appearance on the Today Show last week. He deserves every bit of recognition for my success. He is my hero and maintenance inspiration.

It Takes Two

By Barbara Berkeley

I don’t know how many of you make it a habit to follow the glut of weight-related research studies that are released each day. I try to hone in on those studies that seem novel or important. Despite trying to be selective, I am often rewarded with a DUH! experience. So many of these studies seem to ask the same questions and come up with the same conclusions. It makes me wonder why we are spending so much money to prove the obvious.

Here’s an example. This week, a study from the University of Houston reported that fitness levels decline after age 45 (big surprise, right?), but that people who stay at normal weight, don’t smoke and are physically active stay substantially more fit. Researchers looked at data on 3,429 women and 16,889 men collected between 1974 and 2006 before releasing the following conclusion: "These data indicate the need for physicians to recommend to their patients the necessity to maintain their weight, engage in regular aerobic exercise and abstain from smoking," Excuse me, but….DUH!

While the conclusions of the Houston study seem obvious, they still present a problem. In my world view, it’s simply not enough to tell people to exercise and maintain weight. Let me digress for a moment to explain why.

Recently, I rejoined a gym. I’d been absent from this particular gym for quite a while after leaving to follow my favorite aerobics instructor, Joe, who had decided to work at another place. But when Joe decided to move out of town several months ago, I rejoined the original facility. It had been eight years since I’d been there, and when I returned, I discovered a mini research experiment laid out before my eyes. The women who had been in my classes eight years before were now almost all overweight and were significantly less fit. These women are all avid exercisers. They still take multiple aerobics classes weekly. Despite this, a significant majority no longer look fit, weigh much more than they did, and can no longer exercise at high intensity. I suppose you could look at the Houston study and predict this decline, except for one thing. This decline has not been true for me personally. I still run, play singles tennis, and take aerobics classes that are as vigorous as the ones I took 10 years ago. My weight has not increased. From this, I must deduce that a deterioration in fitness and an age-related increase in weight are NOT inevitable. (At least not up until age 61…my current age). What to make of this?

I believe that this is a case of “It takes two.” During weight loss, many of my patients will do everything that is asked of them to control food, yet will refuse to exercise. In the case of the women at my gym, they were happy to exercise, but probably were not vigorously controlling the foods they ate. Some exercisers simply “lean” too much on exercise. By this, I mean that they have the unsupported belief that exercise is a cure-all. Others believe that restricting calories is a cure-all. There is, indeed, a cure-all, but it is the consistent combination of proper fuel with proper body tone. These two elements are actually one. They cannot be separated. Because maintenance is supported by two equal pillars, it isn’t enough to counsel patients (as suggested by the Houston study) to exercise more and “maintain their weight.” For people like my gym companions maintaining weight equates with exercising more. This advice essentially gives the same direction twice. Long term fitness requires a tough two-pronged attack. Proper fueling. Proper exercise. Got to have both.

While the Houston study made me yawn, a second study that appeared this week provided the “Wow” experience. This fascinating research from the University of Alabama reported that as few as 80 minutes of either aerobic or resistance exercise stopped the reaccumulation of the specific kind of fat you want to avoid—visceral fat. Visceral fat is the highly dangerous adipose that accumulates inside the abdomen and lives around and inside vital organs. It is visceral fat that produces dangerous chemicals and which sends fatty acids into the bloodsteam. It is visceral fat which is responsible for the byproducts of obesity: hypertension, hyperlipidemia and diabetes. In this study, a group of 45 white women and 52 African-American women were treated with a weight loss diet and either aerobic, resistance exercise, or no exercise. After weight loss was achieved (about 24 pounds on average), the two exercise groups were instructed to continue their activities at a rate of 40 minutes twice weekly and the non-exercisers were told to continue being sedentary. At the end of one year, those who continued exercising (either resistance or aerobics) had regained ZERO visceral fat (!) Those who quit exercising, or never exercised to begin with had regained about 33 percent of their visceral fat.

It is worth noting that there was some regain even in the exercisers (perhaps related to the lower levels of exercise required by the study), but that none of it was inside the abdomen.
Once again, the case can be made that exercise is a vital element in weight maintenance. But it is not the only element. It takes two. We tend to rely too much on one side of the weight loss/maintenance equation, a rookie error that can lead to disaster. A balanced approach is needed because nature has designed us with bodies that seek balance. Proper Fuel. Proper Tone. It’s a beautiful thing.

Ignore It and It WON'T Go Away

By Lynn Haraldson-Bering

When I was a kid, my mother’s advice whenever I’d come home upset after some boy teased me was, “Ignore him and he’ll go away.” Unfortunately I applied the same advice to a lot of worrisome things in my adult life, including my weight. When I paid attention to it for a few days, I’d actually lose a few pounds, but soon after I’d ignore whatever diet I was on and just hope the pounds would magically go away.

When I began my rapid 100-pounds-in-four-years weight gain in 1999, I was afraid to ask the doctor, “Why am I gaining so much weight?” Maybe I had some dread disease or maybe being on an antidepressant, that’s just how life was going to be from then on? Instead of asking the question, I ignored the weight and hoped it would just go away.

If it’s not edited out, that’s one thing you’ll hear me say on Monday during my “before story” on the Today Show when I’m inducted into the Joy Fit Club. 

I was one of several people featured in Joy Bauer’s book, “Joy LIFE Diet,” published in January. Joy Bauer is a dietician and nutritionist and is regularly featured on the Today Show, especially twice a month when she inducts someone who has lost more than 100 pounds through diet and exercise into her Joy Fit Club. On Monday, I will be the latest inductee.

My segment will air during the 10 a.m. hour, called the “Fourth Hour” of the Today Show, but not shown in all markets at 10 a.m. For instance, in Pittsburgh it airs at 2 p.m. and in Minneapolis it airs at 11 a.m. I’m sure it will be on the MSNBC website at some point and I’ll post a link to it when I find it.

Anyway, back to what I was saying before about ignore it and it will go away. I know I’m preaching to the choir here, but surprise, surprise! Excess weight – especially hundreds of pounds – doesn’t just go away. It takes complete and total concentration and commitment, which I was able to accept and envelop once I stopped ignoring the problem.

I have a history of ignoring problematic issues, particularly as they pertain to my body. Take last Saturday for instance. I was painting the hall stairs and my knee popped. As you know, I have severe osteoarthritis in my knees and they need to be replaced, so it’s a common thing to have one of them pop out of place. But this time was different. The pain shot up to my right glute and stayed there for days.

I was afraid I had a bulging disk or had developed more arthritis or bone spurs. For days my mind went wild thinking, “What could it be?” I dreaded another “You need surgery” diagnosis. (To-date, I’ve had eight surgery diagnoses. It would take me years to recover if I had them all! LOL) But rather than ignore it and hope it would go away, I got curious and began by seeing my chiropractor. Twenty minutes later, she had a spot-on diagnosis: I had an inflamed tensor fasciae latae muscle that was pulling the tendon on the outside of my thigh, thus causing the knee joint to dislocate. She did some (yow!!) massage and ultrasound, showed me some stretches, and told me to massage the muscle and tendon with a tennis ball and Styrofoam roller a few times a day and apply heat to the area.

Twenty-four hours later, I’m a new woman. I slept well last night, not only because the pain had subsided, but I was emotionally relieved that I didn’t have to solve the problem by going under the knife.

Isn’t it usually the case that what we fear is more daunting than what is real? I knew the last time that if I was going to lose weight, my attitude and many of my behaviors had to change or I’d gain it all back. Ignoring that reality and allowing those feelings to sit in the periphery of my mind made the concept more scary than it turned out to be in real life. Once I faced my fears head on, and dissected what it was I really wanted and what was important to me, I was able to lose weight. Same thing with my tensor fasciae latae muscle and a few dozen other things in the last few years. I’m trying to be confrontational tonight, too, as I anticipate the whole Today Show thing on Monday. “I won’t say something stupid. I won’t say something stupid,” is what I keep telling myself. Again, the future is scary. The unknown is unnerving. But just knowing that is a huge step in the right direction, the direction of change.

Natural Remedies: Who’s Watching the Store?

By Barbara Berkeley

Let’s have a show of hands. How many of you have a history with dietary supplements or “natural” remedies? Ever tried that miracle pill for weight loss that beckons so alluringly from the pages of your favorite magazine? What about Metabolife? Hydroxycut? TrimSpa? Colon cleanses? Weight loss vitamins? Supplements for sexual enhancement? Natural remedies for menopause?

These products are sold over the counter and over the Internet. Because a doctor’s prescription isn’t necessary, they appear to be safe. But are they? The fact is that there is so little oversight of natural and herbal products that it’s impossible to know.

According to a Harris poll, the majority of American consumers believe that over the counter dietary supplements are monitored by a government agency like the FDA. Two thirds of consumers believe that supplements are required to carry warning labels about harmful side effects. Neither belief is true.

Physicians are also relatively uninformed about supplement safety. About one third of medical residents in one survey were unaware that herbal remedies were unregulated and the majority did not know that it was their job as physicians to report suspicious side effects to the FDA.
In 1994, Congress passed what many believe to be an unfortunate piece of legislation. Called DSHEA (the Dietary Supplement Health and Education Act), this act removed much of the FDA’s power over supplements. Prior to this time, herbal products were treated as food additives and manufacturers were required to show proof of safety. With the advent of DSHEA, over the counter supplements were assumed to be safe and therefore to require no governmental regulation. In other words, it was now the responsibility of manufacturers to police their own products.

The politics which led up to the passage of DSHEA are compellingly documented by NYU professor Marion Nestle in her book, “Food Politics.” This is a weighty book, but one that I heartily recommend to those of you who are interested in the powerful interests behind the foods we eat. Suffice it to say that, in the case of DSHEA, those with a financial interest in keeping supplements deregulated won the day. Now, in an era when big bucks can be made from treatments for obesity, erectile dysfunction and other lifestyle related conditions, we have a growing and largely uncontrolled problem.

According to an October 15 editorial in the New England Journal of Medicine:

“…a wide range of dietary supplements have been found to be contaminated with toxic plant material, heavy metals, or bacteria. Of particular concern are the dozens of dietary supplements that are contaminated with prescription medications, controlled substances, experimental compounds, or drugs rejected by the FDA because of safety concerns.”

Weight loss remedies and sexual performance drugs are among the top candidates for potential contamination. As of July , the FDA had an alert on 75 contaminated weight loss supplements. And the tampering was not minor. The NEJM article cites a natural remedy which actually contained over three times the recommended daily dose of the prescription drug Meridia. Other drug contaminants included unapproved anorectics, diuretics, antidepressants and tranquilizers.
A major concern for patients taking contaminated supplements is drug interaction. When physicians prescribe medication, pharmacies and doctors check to make sure that patients are not taking drugs that can be harmful when used together. Because so many of those looking for weight loss also suffer from hypertension, elevated sugar, cholesterol problems, GERD and the like, this population is often taking other medications when they add a supplement. This puts overweight supplement users at increased risk for interaction with hidden drug contaminants. Drug interactions can be very serious. In the Fen-Phen days, for example, we learned that the combination of two relatively benign weight loss medications led to irreversible heart valve damage.

In order to evade the FDA, supplement manufacturers have turned to doctoring their supplements with drugs which have been slightly altered so as to avoid chemical detection. The problem with these newly altered compounds is that they have not been previously tested for human use. According to the NEJM for example, a changed form of fenfluramine (a diet medication) found in supplements was linked to severe liver failure in various reports.

I have always been puzzled by the public’s willingness to take over-the-counter remedies and supplements. Recently, a company that I’d never heard of sent me some sample diet cookies. They came in a box, each one in an open cellophane sleeve along with a little printed information sheet. Forget it! I wasn’t eating those nor would I allow any of my staff to consume them. I’m probably on the extreme end, but I am suspicious enough of the safety of plain old food without adding unknown substances to my diet. My gastroenterologist husband is always taking care of people with salmonella, e. coli and other forms of food poisoning. And those are from foods that ARE regulated (although not enough…a subject for a future post).

Whenever we swallow something, we are giving that substance a pass key to our bloodstream, our heart, our brain. Should we really trust pills and potions whose provenance is uncertain at best? Even in the best of circumstances, natural does not mean innocuous. Remember that many potent medicines are herbal, including digitalis which helps the failing heart contract, and yew which yields a potent cancer chemotherapy. Add to this the issues of uncertain quality control and hidden contaminants and we have an industry in dire need of regulation. In this cynical age we must consider the possibility that some supplement providers may be more interested in our dollar than in our health. At this moment, there is little guidance to help us distinguish the good from the bad. Unfortunately, it appears that the bad can be very bad indeed. Until the current regulatory situation changes, the burden is on each of us as individuals to take a long, critical look at the “cures” we choose to swallow.

Maintenance: The Lovely, Strange and Unique

By Lynn Haraldson-Bering

Barbara asked in her last blog, “What lovely, strange and unique things have you discovered as a result of your own maintenance experience?” I’ve been thinking about my answer to this all week, but realize I don’t have much to add to what so many of you already wrote.

I’m working on losing a few pounds I’ve gained, so I could totally relate to Claudia who has gained back some of her weight loss. Rather than ignore it, she’s tackling it. When I’d gotten to some illusive weight “goal” in the past, I always regained because I went back to my old way of eating, just like Barbara wrote: “Most people who finish a weight loss return to a modification of old habits. Habit is the operative word. If your previous dietary style made you fat, it is likely to do so again, even with modifications.”

Gee, and I thought I was the only one! Oh the emotional pain I put myself through when I couldn’t maintain a weight loss. But I had no tools! I honestly had no idea how to do it. I didn’t ask questions or even know who to ask. I just figured I’d lost weight so I could go back to eating again. But like Judy said, “To keep it off, eat the way you ate to lose it.” Sounds so simple, but if you lost weight by starving yourself or depriving yourself of everything you like, chances are you’re not going to keep eating the way you did while you lost weight. That was always my problem before.

It’s only when I got curious about what makes my body tick that maintenance became more fun than tedious. As SueT wrote: “Gathering this scientific information about ME, knowing MY body and MY idiosyncrasies, has set me free.” Set me free. I like that phrase. I was a slave to the scale for so many years, a prisoner in my own body, both when it was heavy and when it was thin, because I didn’t understand it. My mind short shrifted my body, saying, in a way, “Just feed it and it will be happy! Now move on to more important thoughts!” But so many of my thoughts and subsequent actions revolved around the fear and loathing I had of my body. Still, it took me years to understand that I had to consult my body, and to understand what it needs and doesn’t need in order to be “set free.”

Linda made a great analogy about the kind of commitment it takes to maintain: “Weigh maintenance is like marriage. You don’t make the commitment once, but you re-make it every day. You make it a priority in your attitude and behavior…You re-make the decision every day, or several times each day.” Or several times each day. We’re not only confronted with but bombarded daily by refined, processed, and non-nutritional foods and its advertising. People bring it to share at work, it’s in restaurants and grocery stores, and so much of it tastes great and for a split second (or perhaps many split seconds) I might think, “If only I could have just one bite…” But instead of impulsively caving, I think, “Is this worth it? Do I really want to eat this?” Even if the answer is yes, the fact that I thought about it is a far cry from the days of eating whatever whenever.

Something Sharilyn wrote really struck home. “It’s sort of lonely,” she wrote, “but I must view this as an investment in my future.” Lonely. I guess because there are so few of us who choose to eat and live the way we do in reduced-weight bodies that it is often lonely and isolating. Many people just don’t “get it.”

I used to make excuses for how I eat, apologizing almost for refusing to consume something offered me at a restaurant or party. But I found my voice and gave myself permission to be my own boss and to stick up for my dietary needs. I’m not rude or overly demanding, but I inquire about the way foods are prepared, and I’m completely comfortable saying “No” to food that is not part of my plan, even if it was “made for” me. If someone really knows me, they know NOT to make me food unless they’ve discussed it with me first. Not even cupcakes made by a sweet, adorable child.

A few years ago I read a thread on the Weight Watchers board in which a woman posted that she just “had” to eat a cupcake made for her by her niece. I wrote back that no one “has” to eat anything they don’t want to eat. If you want to eat it, eat it, but be honest with yourself. If eating that cupcake is going to make you feel bad about breaking the promise you made to yourself to eat healthy, then don’t eat it. Eating it because you’re afraid of hurting someone’s feelings is not staying true to yourself and it’s not going to solve the problem in the future. There WILL be more cupcakes sooner or later.

Food should not equal guilt. If my niece made me a cupcake, I’d thank her and then tell her why I don’t eat cupcakes. There are plenty of tactful ways of saying no to food. Just ask the Girl Scouts who knock on my door every year!

Still, it can be lonely always sticking up for your food choices. Not many people understand. But that’s why maintenance is, as Barbara said, a whole other ballgame. And the lovely, strange and unique things we learn about ourselves is an ongoing education. 

Maintenance 101: What Did YOU Learn?

By Barbara Berkeley

On Saturday, I had the opportunity to meet hundreds of people with diet and weight issues at the opening of the new TriPoint Medical Center in Concord, Ohio. The community open house for this gorgeous facility was attended by approximately 7,000 people. As medical director of weight management services for the hospital system, I was there to lecture and to encourage visitors to register for our weight loss programs.

Whenever I talk with people about weight issues, I come away with impressed with two things. First, I am amazed at how interested people are in learning more about nutrition. Despite the glut of information in magazines, on TV and on the web (or perhaps because of it), most people are deeply confused about what to eat. The second thing that always impresses me is how few dieters are able to keep the weight off permanently. Of course helping with that issue is the purpose of this site. I hope that some of those I spoke with on Saturday are reading our site today and that they will become part of our internet community. Refuse to Regain is a blog about maintenance, but it is meant for anyone with a weight issue, whether they are just beginning to lose pounds or have kept them off for years. If you are new to us, Lynn and I hope you will explore our site and become active contributors!

The first year or two of maintenance is like a course in yourself. It can yield fascinating and very specific information if only you decide to show up for school.

Most people who finish a weight loss return to a modification of old habits. Habit is the operative word. If your previous dietary style made you fat, it is likely to do so again, even with modifications. If you couldn’t control the elements of your eating plan in the past, re-exposure to those elements will probably lead to a similar fate in fairly rapid order.

During the weight loss phase, most of us are very wrapped up in our progress. This self-examination is often lost once the weight comes off. I tell my patients that the principles of weight loss are pretty much the same for everyone: 1. Reduce calories enough to force the body to burn what it has in storage, and 2. Reduce insulin enough to facilitate that process. Maintenance is a different ballgame. The rules vary widely. The only way to discover what works for you is to discover YOU.

For this reason, I suggest that new maintainers think about the first couple of years as a basic science experiment. Experiments require staying educated on your subject, close observation, recording of results, and a well-planned way of changing variables. Research also works best when it is dispassionate. By this I mean that your maintenance experiment needs to avoid emotion. If a scientist does an experiment and gets an unintended result, he or she does not indulge in agonies of self-blame. In maintenance, it’s important to look at results with curiosity but not with frustration. If one method isn’t working, draft another strategy and record results.
If you are just beginning your maintenance experiment you may be uncertain as to how to proceed. Here are a few suggestions. No doubt our experienced readers will offer others.

1. Work on the type of structure you need. Do you do best with Points, calories, portion control, or simply with diet changes based on daily weighing?

2. Identify your trigger foods. These are the foods which you really must avoid. Most people find that there are certain things they simply can’t eat moderately and that they feel a sense of peace once they are eliminated.

3. Tread carefully around your food addictions. Foods that you have eaten for pleasure can be addictive, but they are not always triggers. You may be a chocoholic but actually be able to control chocolate consumption. On the other hand, bread may cause you to fall off your diet.

4. Observe your reaction to salt. Salt acts like carbohydrate does in causing water retention. It can cause unintended weight gain that is hard to get rid of. The most common source of salt is restaurant food (have you ever really tasted the soup in most restaurants??) If you note that you are gaining after eating out, be careful of foods that may be hiding salt.

5. Pre-plan your reversal strategy (and refine that strategy if it doesn’t work). Every maintainer needs a way to quickly reverse small regains. What will that be for you?

6. Observe the effect of exercise. No one knows exactly how much will help to keep you stable. So keep a log that includes your activity, frequency of exercise and weight response. If walking is doing the trick, you don’t necessarily have to escalate to running. It is probably also possible (although not recommended) to maintain without exercise.

7. Set up some personal dietary rules. Maintainers often bristle at the idea of rules preferring to say that they will never rule out any particular food. OK. That principle can be part of your rule package, but what’s the rest of it? No one says you have to follow your own rules – after all, you created them – but having rules gives you a plan to shoot for. Follow, then observe the result. If the plan isn’t working, it’s time for an overhaul.

8. Observe the situations and environments that cause trouble for your diet. One of the most powerful tricks a maintainer can employ is keeping physically away from food. You may observe that being at home is toughest because food is always as close as your kitchen. Work on physically removing yourself from food by asking that food be kept away from you at work and bringing nothing into the house which triggers you.

9. Keep a number of basic, “safe” meals in your rotation. Feel free to eat these frequently and to experiment only when you feel quite anchored in maintenance.

10. Most importantly from my point of view, do all that you can to keep insulin stimulators low. Insulin stimulators are the starch and sugar foods including whole grains, pasta, cereal, bread, potatoes, rice and sweets. Insulin is the fat storage hormone. As long as it is not deployed, you can’t store fat. When it IS deployed, you can’t break down fat. So keep the carbs (except for fruits and veggies) LOW.

If you are a successful maintainer, please help us by sharing the things you’ve found out about yourself. The more models we have, the more possible paths we all have to try. While the basic outline above is a general scaffold, it says nothing about individual experience. What lovely, strange and unique things have you discovered as a result of your own maintenance experience. We would love to hear. Leave a comment or send us an email at refusetoregain@gmail.com.

Let’s Talk About Grocery Carts

By Lynn Haraldson-Bering

A few days ago I went grocery shopping. It was an ordinary shopping trip. Bought the usual – veggies, fruit, beans, yogurt, and a (fabulously priced ginormous) pack of fresh chicken breasts for my husband. When the cashier rang up my order, she said, “That’s the healthiest cart of groceries I’ve checked out in a long time.” Immediately I thought, Cool! Someone noticed! A few seconds later, however, I thought, Oh, how sad. Someone noticed.

What was in my cart should be in everyone’s cart.

I’ve been called judgmental by RTR readers when I say things like that, but I assure you my attitude is not holier than thou. I truly and sincerely feel bad when I see carts loaded with pop, frozen pizzas and ice cream, and pushed (or in many cases, driven) by someone 50 or 100+ pounds overweight and often with an overweight child riding in the seat. This is a typical scenario here in western Pennsylvania. Money plays a huge role in what groceries people buy, but so, too, does convenience and lack of real nutritional education. 

We can talk all day about “personal responsibility.” I mean, most people should just “know” that a quarter pounder with cheese and a super-sized fries isn’t as healthy as a grilled chicken sandwich and an apple, right? But in observing the food buying habits of the general population, it’s clear that the bombastic nature of food advertising and the convenience of fast food and packaged meals that raw fruits and vegetables, bags of beans, and cartons of yogurt really don’t stand a chance. Especially when foods like yogurt get dressed up as “healthy.” When manufacturers add crushed Oreos, M&Ms and Gummy Bears to the carton, is it any wonder people would say “I had yogurt for breakfast!” and really think they ate something good for them when in fact, they ingested a ton of sugar and very little protein or calcium?

Hmmm….

How can someone embrace personal responsibility for their food intake and the repercussions of its consumption on their health when advertising and simplicity (zap it in the microwave!) trump solid nutritional information sources? Nutrition labels are confusing and quickie news reports (let’s face it, we’re a nation of “news in a minute”) of fats and carbs and the newest food trends are confusing.

So how do we get more fruits and vegetables and lean proteins into the carts of Americans?

I know we’ve discussed elements of this topic before, but I’m curious how you decided to get educated and how you know now what foods are best for you? What sources do you rely on for solid nutritional information? Are articles like this one from Yahoo helpful (8 Foods That Fight Fat) or do you find them simplistic and condescending?

My own nutritional education started years ago and is ongoing. I don’t jump on the latest trends or believe everything I read, but I am often as confused as the next person as to what foods or components of food are “good” or “bad.” However, when the cashier at the grocery store calls my cart of food “healthy,” it bolsters my enthusiasm for nutritional knowledge and staying the course. So, too, do moments like today when I was at Sage Meadow, our local health food store, buying low-sodium vegetable broth. Pat, the owner, only had two boxes on hand and another customer showed me the vegetable broth cubes. While I like the cubes, I told her, I use them sparingly because they have substantial fat in the form of palm oil. I didn’t say it in a snotty way, but I still felt like I was being judgmental and so I said to Pat, “But you know me, I’m always watching that kind of thing.” Pat said, “Well, that’s why you’ve kept your weight off.”

Bingo. She was absolutely right. I have to look out for myself because no one else will. It takes a lot of reading and planning and education to keep 170 pounds off. But being realistic, I know most people don’t have the time or energy to invest in nutritional education as I have. So how can it be more accessible? How do we make veggies, fruits and proteins "normal" in the American grocery cart?

Surprise! Re-Creation vs. Reactivity

By Barbara Berkeley

Whenever possible, I am for re-creating health rather than of reacting to it with medications. The difference goes something like this: Say you have a house that doesn’t suit you. It leaks, it’s drafty and the walls are unstable. One approach to the problem is to patch the plumbing, inject insulation and shore up the walls. A more drastic, but more profound solution is to tear down the house and create another one. The new house can have only the best materials and can be built to reflect everything that is known about keeping houses strong. Although it’s a lot more work, most of us would choose the rebuilt house anytime. Patching will always be patching.

Having said this, Don and I choose to live in a 150-year-old home which is in constant need of repair. Recently, an underground pipe broke and was reconnected by a new length of PVC and some expensive clamps. After the entire area was recovered and re-seeded, water began to well up through the ground. Much to the surprise of the plumbers (who had spent days digging up the site), the leak was coming from a completely different area. The break which had been repaired probably had nothing to do with the original flood, but had occurred as a side effect of the excavation.

Then there was the tale of the 220 electric line that supplies our house, also underground. That got cut during some yard work. Rather than run an entirely new line, it was repaired in a way that was meant to be permanent. A year later, steam began to rise from the area. The line was leaking electricity into the dirt and steam cooking it. Electricity was also being transmitted through the ground to pipes entering the basement and giving us shocks when we turned on the shower. The electricians were surprised. How did that happen? Plumbing and electrical work should be fairly straightforward, but even they are a little more complicated than they might appear.

How about the human body?

The human body is a universe unto itself, stunningly and endlessly complex. The degree of technological sophistication we’ve now achieved makes it seem as if we know a lot about ourselves. But we’ve only just scratched the surface. Putting a patch on bodily problems leads to a lot of “surprise” moments and some of those moments can be a lot more painful than a spark from the shower handle.

Take the diabetes drug Avandia. By 2007, this drug had been on the market for 8 years and had been used by over 8 million people. Surprise! It turned out that the drug raised the risk of heart attack by 43%. Avandia was a medication that helped sensitize the body to its own insulin. Since we know that diabetics have a vastly increased risk of heart disease, it only seemed to make sense that improving insulin would make heart disease better. In the case of Avandia, it didn’t.
How about all those antioxidants we’re taking? Up until now, the science has seemed to be simple. Our body produces molecules called ROS (reactive oxygen species) in response to all sorts of stressors. These ROS act like small bullets, bouncing around the body and damaging healthy cells. Anitoxidants disable ROS. Therefore, the logic: ROS bad, antioxidants good.
But fruit fly research at UCLA recently revealed that ROS have an additional function. Elevated levels of ROS serve as a communicator which signals blood cells to responds to an immune threat. The investigators expressed surprise.

"On the one hand, it's good to have antioxidants to reduce the amount of reactive oxygen in our body that causes DNA damage," the investigators said. "But if we find that those blood stem cells aren't primed to respond because the ROS levels are reduced, that would not be a good thing. Our findings raise the possibility that wanton overdose of antioxidant products may in fact inhibit formation of cells participating in innate immune response."

And here’s a third example. The ACCORD study was a comprehensive study of type 2 diabetics. The study was out to prove what seemed to be the obvious: that lowering blood sugar aggressively prevented diabetic complications. Instead, the glucose-lowering part of the study was halted early due to an increase in cardiovascular deaths among those with the most tightly controlled sugars.

Cleveland Clinic cardiologist Steven Nissen was quoted as saying: “This result really does defy conventional wisdom. I suppose it wouldn’t have been a major surprise if there was no effect, but to show harm is really a big surprise. This effect could have been due to some of the drugs being used to lower glucose levels, which may have other effects that cause harm.”
Surprise yet again!

We do not read about increased risk in people who rebuild their houses. The data on eating diets which are primary in form (based on foods that are not altered, but come directly from nature) are uniformly positive. I have yet to see a study that decried the effects of increased exercise. We are able to easily measure improvements in blood pressure, lipids and insulin resistance in people who lose weight and keep it off. The data on the consumption of fruits and vegetables as natural antioxidants and nutrients is convincing, whereas little benefit has been shown in virtually any of the trials done with vitamin supplements.

I am a doctor and I believe strongly in the benefits that modern medicine can bring. I am not anti-medication. But we have come to rely too much on medicines and to use them to the exclusion of the therapies which might truly work…lifestyle therapies that we ourselves must administer. We have come to believe too much in our ability to understand the intricacies of the human body, a hubris which can be costly. The task for each of us, patient and doctor alike, is to decide when medicines are helpful and necessary and, when we use them, to follow the physician’s dictum to “do no harm”. Wherever we can, we should choose to create health by rebuilding and perfecting our own physical bodies. In the case of life re-creation, we not only do no harm, we also build a stronger, safer house; one we can live in confidently for a lifetime.

Insulin and Dementia: Taming the Spider

By Barbara Berkeley

It’s funny how we tend to think of the brain as a different kind of organ, one that has jobs that are quite distinct from the activities going on in the rest of us. But nothing could be further from t truth. The brain is fed by the same blood vessels and blood supply as the rest of the body. It is completely and intimately connected to the moment to moment choices made by that body. If you don’t believe me, just think of what happens a few minutes after you take a shot of tequila. The alcohol started in your stomach but suddenly it’s right there in your brain urging you to join the conga line.

In the same vein, we tend to believe that Alzheimer’s disease is a mysterious ailment that appears out of the blue and has no connection to the rest of our body. After all, it’s a brain disease, and in our conceptual framework the brain is mysterious, foreign and disconnected.
Recent research refutes this idea and forces us to look, yet again, at the effects of the Standard American Diet (SAD) on every aspect of our human form. This time, the subject is dementia. Researchers at the International Conference on Alzheimer’s Disease held in Vienna predicted that by 2040 one third of the 81 million expected cases of AD will directly result from obesity and the diabetes it spawns.

Let me digress here for a moment and give you my thoughts about diabetes. We waste far too much precious time setting cut-offs for where diabetes begins. We pay far too little attention to warnings about diabetes if we have normal blood sugar. Any time we become insulin resistant (meaning that our insulin system stops sending effective signals and begins to compensate with insulin overproduction), we are part of the diabetes continuum. This is true whether blood sugar is “normal” or not. Millions of people have insulin resistance with normal sugars and are never even labeled pre-diabetic. This situation can go on for years while they continue to eat insulin stimulating diets and do untold harm to their bodies. Insulin resistance is likely if you are overweight or have been overweight. It also becomes more common as we age. The SAD encourages and promotes this problem by asking our body to secrete so much insulin so constantly (in response to the massive amount of starch and sugar we consume). So let’s look at the research below in the following light; if you are reading this as a dieter or maintainer, there is a good chance that you are or have been insulin resistant.

Here’s what was reported by Dr. Susan Craft, an AD researcher and what you need to know:

“A large body of work now suggests that insulin resistance increases the risk of Alzheimer’s by multiple mechanisms, Dr. Craft said. Far from being active only in the periphery, insulin binds to receptors located throughout the brain….High levels of insulin in the brain can induce a brain insulin-resistance by removing the insulin receptors from the nerve cell membranes.”

In the rest of the body, insulin resistance starts off a cascade of problems that affect the health of blood vessels. It’s not surprising that recent findings point to the same phenomenon in the brain. Brain insulin resistance seems to lead to vascular dysfunction. Blood supply to all tissues is critical, but particularly so to the brain, where blockages in the delivery of oxygen via the blood stream can lead to multiple small mini-strokes. These small areas of damage can add up to a larger picture of dementia.

Dr. Zaldy Tan of Harvard Medical School reported additional startling findings at the Alzheimer’s Conference. Subjects with insulin resistance and elevated insulin production had decreases in the actual volume of their brains. These decreases were equivalent to 6 years of brain aging!These subjects didn’t have to be technically diabetic to show such changes.

If you are an RTR reader, you’ve undoubtedly noted my preoccupation with what I call “S Foods” (starches and sugars) . This preoccupation is really just another way of saying that I’m very, very fixated on insulin. And for good reason. Read any research on obesity, diabetes, cholesterol, heart disease, cancer and the word INSULIN will be present. Insulin is a spider sitting in the middle of the web of modern disease. Modern eaters have a problem with insulin and they certainly don’t need any more of it. Eating excessive starches and sugars asks the body to continue deploying the struggling insulin system. It’s simply foolish. And foolhardy.

This discussion also gives us the opportunity to revisit the vital importance of exercise in a maintainer’s life. We all should recognize that exercise sensitizes muscles to insulin, allowing a fragile system to work better. Says Dr. Craft, “Exercise is the most potent insulin-sensitizing agent we have. A single bout of aerobic exercise improves insulin sensitivity for 24 hours. It’s much more potent than any medication.” She goes on: “Caloric restriction also lowers hyperinsulinemia and improves insulin sensitivity.”

So what can we do to protect ourselves from Alzheimer’s Disease? We can eat small amounts of high quality foods. We can make sure that these foods are quite low in starches and sugars. We can exercise. Sound familiar? It should, because the same prescription could be given to prevent and defeat diabetes, high cholesterol, heart disease, stroke, obesity, high blood pressure, premature aging, increased cancer risk and most of man’s other modern diseases. Maybe we could put it this way: we simply need to tame the spider. It’s all quite simple and elegant, not the twisted conundrum that optimal diet is made out to be. Luckily, all of the things that we maintainers are doing to keep weight at bay turn out to have the added benefit of chasing away our other metabolic demons. It’s a nice little extra, isn’t it?

The Duplicity of Exercise

By Lynn Haraldson-Bering

I’d like to continue the discussion about exercise that Barbara started in her last entry (“The Baby. The Bathwater.”), mostly because when I first read the Time magazine article Barbara referred to (“The Myth About Exercise.”) I wasn’t sure how to think about it.

If exercise alone OR in addition to lowering calorie intake doesn’t (the experts believe) help us lose weight, then if I take that theory one step further, I could surmise it does nothing to help maintain weight loss, either.

Both arguments make me the odd man out – an aberration – because exercise definitely played a roll in my weight loss, and exercise keeps me at my maintaining weight.

I didn’t begin a formal exercise program (or even walking further than I absolutely had to) until I weighed about 187 pounds (down from 300). So yes, I was able to lose 110 pounds without exercise. But at 187 I had small, weak calves, a flabby stomach (underneath the fat that still covered the surface) and a lower back prone to aches and pains even when working under the least amount of stress. The arthritis pain in my knees was just as bad, if not worse, than it was when I weighed 300 pounds.

I began walking for exercise in April 2006 and my measurements were 44-38-49. In September, five months later and just before joining the gym, they were 41-36.5-45.5 and I weighed 164. Two months later, after adding strength training to my routine and upping my cardio routine by implementing the elliptical and bike, and by walking at higher inclines on the treadmill, my measurements were 39-33.5-42.5 and I weighed 152.7. Eight inches in five months and an additional 7.5 in two months. I was NOT seeing those kinds of results just by restricting my food intake. Not to mention my overall well being – physically and mentally – was much more positive.

But here’s the kicker. What makes me (at least according to the experts) “different” from the average loser is this: exercise doesn’t make me hungry AND it doesn’t make me feel entitled to eat a donut or french fries after a workout. I eat the same amount of food every day, regardless if I work out or not. Only if my body says it’s hungry after a particularly strenuous workout/hike/bike ride/what-have-you do I eat more than I normally would, and then what I eat is healthy. No donuts or french fries, bagels or chocolate cake. Just fruit or Wasa or egg whites or a salad.

This is why what Barbara wrote in her last blog makes so much sense to me: “The fact that exercise alone does not cause weight loss says absolutely nothing about the value of exercise to dieters and maintainers. In my experience, exercise is absolutely vital to successfully flipping the lifestyle switch.”

So how do we get the rest of the weigh-losing public to balance exercise with caloric responsibility?

I have no clue. I only know what worked for me: Death. Or at least potential early death.

Do I “love” to exercise? Most days, no. There are times (more than I care to admit) when I’d rather write/play WordTwist/vacuum/just about anything other than exercise. I’m not fond of sweat. It itches. Makes me look awful. But damn if it doesn’t clear out demons, make the back ache go away, the flab around my middle tighten up, the knees move more fluidly. That’s more important than any donut.

Reader Dee knows what I mean. In a comment to Barbara’s last blog she wrote: “…I find I can't live without exercise for other reasons, a main one is that I am prone to "moodiness", and without fail, exercising at least every other day keeps the moodies away. Your explanation helps me realize I don't have to be confused, just keep exercising and keep paying attention to what I eat.”

The equation is so simple, yet implementing it is hard. There’s no doubt about that.

So let’s talk about this. What was your switch? How does exercise impact you in maintenance?

I fear that as more research emerges negating the effects of exercise on weight loss, fewer people will exercise. They will lose out on all its non-weight-loss benefits: feeling better, being more toned, and if arthritis is the issues, feeling less pain.

This is something our obese nation can’t afford.