Refuse To Regain

MUCH ADO?

Yet again, the FDA is making noises about a new obesity drug. Locaserin, a purported appetite suppressant, has been recommended for approval by one of the agency's advisory panels. By the way, the FDA has not thus far decided to act on the approval of QNEXA, another drug which has passed muster at the advisory level.

Of note: trials have shown that weight loss with this drug (minimal by my standards) is regained when the drug is discontinued. I BEG THE FDA and THOSE WHO ARE DEVELOPING WEIGHT LOSS DRUGS TO CONSIDER THE OBVIOUS. WE DO NOT NEED WEIGHT LOSS MEDICATIONS, WE NEED WEIGHT MAINTENANCE MEDICATIONS.

QUICK POST from BB:

On Tuesday, the Institute of Medicine released a 478 page report on obesity. Perhaps it is finally starting to hit us that a predicted 86% overweight and 42% obesity rate by 2030 is not tenable for any society. This report gives me hope because it recognizes the fact that we cannot control food in a hyper stimulatory environment. Indeed, in such an environment food is bound to control us. The tension between the viewpoints of the IOM and those who make and sell food is perfectly illustrated by the following two paragraphs:

"People have heard the advice to eat less and move more for years, and during that time a large number of Americans have become obese," IOM committee member Shiriki Kumanyika of the University of Pennsylvania School of Medicine told Reuters. "That advice will never be out of date. But when you see the increase in obesity you ask, what changed? And the answer is, the environment. The average person cannot maintain a healthy weight in this obesity-promoting environment."

Shortly after the report was released, the Center for Consumer Freedom, which is funded by restaurant, food and other industries, condemned the IOM as joining forces with the nation's "food nannies." The Center said the IOM recommendations would "actively reduce the number of choices Americans have when they sit down to eat" and emphasized that "personal responsibility" alone was to blame for the obesity epidemic.

The battle lines are drawn.

For those of us who have long since figured out that the environment is toxic, cling fast to the "island", stay distant from the siren foods, eat like an ancient, and watch the fighting from afar.

The 27/9/3

by Barbara Berkeley, MD

You may have noticed that I've been absent from this blog for awhile.  The reason is that, until last week, I have been utterly absorbed in a political battle.  In early April, road crews appeared on my rural street and began pulling down trees without notice or consultation. (see previous post on this here).  It turns out that the township I live in had decided some months prior to turn our road over to the county.  They never bothered to inform us.  The rationale for the turn-over was this:  if the county took possession of the road, our township would no longer be responsible for paving it.  This would save an immediate $350,000.  But why would the county want a road that needed fixing?  The reason appears to be that certain roads which connect two counties can be widened to pre-determined specifications.  They then become federally supported and ultimately bring money into the county coffers.  Over time, our county engineering department had developed a pattern of finding such roads, offering to take them off township hands, and then widening them.  The problem was that many of these roads were not appropriate for a county highway system. Many of the targeted streets were narrow, rural thoroughfares filled with charm.  They just had the unfortunate characteristic of being connectors.  A pattern of “widening for dollars” had become established, and with each widening, trees, shrubs, fences and the essential character of entire neighborhoods was destroyed 

After our group (see our group's website) was told by those who should know that we could not possibly win the battle for our particular road, that no one had ever opposed the county engineer successfully and that the best we might achieve was a modification of the project, we went on to take back our road and achieve a victory.

 Last week, at a special meeting of our Township (see video of news coverage) over 100 very angry people confronted the County Engineer and asked for specific justification for his project.  Under intense questioning from citizens who had done their homework and were very well prepared, the Engineer was unable to give any real rationale for widening our road.  The trustees of our township, seeing the handwriting on the wall, voted unanimously to take the road back under local protection and the project was cancelled.  From this I learned an important lesson: we still have a participatory democracy and participating takes alot of hard work. 

The knowledge that creates a grass roots movement is not innate.  To find out how to start one, my group went to a pro: a local politician (let’s call him Tony) who has led many movements and run many campaigns.  He was kind enough to advise and mentor us, and in many ways this victory belongs to him

At one meeting in my living room, members of our group fell all over themselves presenting their thoughts and concerns to Tony.  We wanted to do so much, say so much.  We were intensely angry and emotional.  Tony listened to the whole thing patiently and with a slightly bemused expression.  After hearing us out he said, “This will never work.  What you guys need is a 27, 9,3.”

When we looked at him blankly, Tony explained that a 27/9/3 was a way of putting complex thoughts into short form.   

"When you knock on a door", he explained "or give a quote to the press, or talk to someone on the street, you have about 27 seconds of their attention.  In this time span, you’ve got to have 9 words that express 3 key concepts.  Any more and you’ve lost them.  And your 27/9/3 has to be standardized.  Every member of the group has to have the same mantra." 

We discovered that the issue of our own road widening touched three chords in the people whose support we needed. First, they all lived in our area because they loved the rural atmosphere.  The widening projects were threatening this.  Second, they liked township government because it allowed them to have direct local control over their lives.  Giving roads away to other entities made them worried about having a say in other matters.  Third, there had been enough roads widened that they were wondering about their own streets.  Thus, we developed our 27/9/3:

1.Preserve rural environment. 

2.Keep local control. 

3.Your road next?

We tried to keep our message consistent whether it was giving a newspaper interview or speaking with the township trustees.  This clarity of message led to success and kept us focused on the right end-points.

With our battle concluded, I have begun to think more and more about 27/9/3 in other areas of my life. Why do you support a particular political candidate?  27/9/3.  What are you goals for the next five years?  27/9/3.  What are the central tenets of behavior you want to convey to your kids?  27/9/3.  (My husband Don had unwittingly constructed a 27/9/3 years ago when he developed the following mantra for our two daughters: Be kind.  Do your best.  Never lie.) 

Since everything in my experience eventually makes me think about healthy diet, it occurred to me that Tony’s 27/9/3 might be a valuable tool for weight maintainers too.  No one really wants to hear about every morsel you eat, yet many people are deeply curious about how you maintain weight.  How about a 27/9/3 to trot out when you meet the old friend on the street corner or you get into a conversation with someone's wife over dinner?  What are the core principles of the way you maintain and of what you believe about food?

Here are mine:

My weight maintenance 27/9/3

1. Primarian 95%
2. No grains, minimal sugar.
3. Exercise daily.

Perhaps the essence of this exercise is to find the center of your belief system.  Things that have a center tend to have balance and vitality. 

What is your 27/9/3?

 

 

 

 

 

 

 

 

 

Extreme Weight Loss: Desperation reflects Misinformation

by Barbara Berkeley, MD

It has always been thus.

People wiring their jaws shut to prevent them from overeating.  Long lines at the bariatric surgeon's office, where guts are re-routed and stomachs cut in half.  The usual parade of ear beads, hormone shots, B12, herbal stimulants, and electrical belts that shock muscles into painful contraction.  There has always been weight loss desperation, but we may be descending to a new and even more depressing low.

Today's online Science Daily discusses a method for quick weight loss, an 800 calorie diet via feeding tube. It seems that some doctors (can we call them that, really?) are placing feeding tubes and giving patients the same treatment that hospital patients would do pretty much anything to avoid-- a nasty, painful plastic catheter down the nose.  Seems that this particular treatment is becoming a fad for brides who want to shed pounds quickly and has been around in Europe for awhile.  See an ABC news article  on the same topic, published yesterday.

Physicians take an oath to "do no harm".  It's a promise that we are not particularly good at keeping. Sometimes the calculus is difficult.  Is an invasive test more harmful than ignoring a little abnormaility you find on an x-ray, for example?   But where we do a particularly poor job in my estimation is in matters of basic health counseling.  Here, we err on the side of potentially harmful treatments such as multiple blood pressure meds, diabetes drugs and statins rather than exhorting and inspiring patients to make deep and meaningful dietary changes.  The latter are risk free.  Far from doing harm, they do immeasurable good.

The problem is misinformation, not malintent. Doctors believe what the general public does.  That weight loss is pretty much impossible and weight maintenance unattainable.  They also have little idea about good strategies for creating weight loss.  They are loathe to exhort patients to lose weight because they have nothing to offer except the suggestion.  This often causes patient resentment.  Can you imagine if your doctor's entire response to your diabetes was, "You've got to get rid of your diabetes?"

Diets that lower insulin to very low levels and are higher in protein are appetite suppressants.  No one needs a feeding tube to create this effect.  Simply go on the Atkins diet (no carbs) or eat lean meat, fish or chicken and salads for a few days and you will have the same experience.  The only thing that the feeding tube accomplishes is that it makes you squeamish about swallowing whole food while it's in.  At the same time, the possiblity of irritation or ulceration of the esophagus and stomach is very real. 

Weight loss requires significant calorie restriction, not cutting back 100 calories per day--another misinformed strategy we hear alot about.  This technique is not only ineffective, it is impossible to do since the diet varies from day to day. Try eliminating 100 calories and keeping everything else EXACTLY the same for more than one day.  The body must believe there is a food emergency if it is to have any urgency about burning stored fat.  This food emergency can be accomplished by following pretty much any good diet that is low in carbohydrate (100 grams per day or less and no processed carbs, just fruits and vegetables).  The trick is to find a diet which suits you so that you can be fully (as in 100%) compliant.  

Long term weight loss will continue as long as the amount of carbohydrate in the diet stays at the same level as it was during weight loss.  In other words, you have to keep doing your weight loss diet but with the addition of greater volumes of none carbohydrate foods to keep weight stable.  Some men and some younger women will need a small amount of additional carb to avoid continued loss.  But most won't.  This piece of the puzzle is the source of most misinformation.  Eating "moderately" will not keep weight off.

Ancient diets and their modern modifications (like my Primarian suggestions) are the best way to avoid regain.  They cut out not only excess carbs by eliminating grains, breads, pastas, potatoes and sweets, but they also eliminate processed foods.  The additives in processed foods, or even their packaging--who knows---may be contributing to insulin resistance and disruption of other endocrine factors that are required for weight balance. 

More extreme forms of weight loss treatment reflect increasing desperation with our nation's greatest health concern.  Desperation, though, reflects misinformation... the fact that we've done a poor job of educating people about what actually works.  The reason for the knowledge gap?  Most doctors (and in my opinion, dieticians) are still in the dark. 

 

 

 

 

 

 

 

 

 

Food Safety and the Larger Battle for A Recognizable World

by Barbara Berkeley, MD

I spent the greater part of this week being sucked into a vortex of politics and frustration.  It turns out that, because of money concerns, the beautiful country road on which I live has been handed over by local township government into the care of our county.  Shortly after the road transferred, the county--presumably money is also involved--decided to greatly widen the road, a project that will intrude on the properties of over 40 homeowners and threatens to vastly change the rural character of our lives.   Why is this being done? The reasons given include: safety (although our road has been extremely safe) and modernization (although none of the residents on the road want a change).  Since our street is used as a cut-through to a nearby town by many locals, the widening would attract even more traffic and higher speeds in addition to a likely destruction of trees, treelawns and fences.  But the county has an answer for everything:  studies which show that bigger roads with higher speeds have fewer accidents, for example.

Despite the fact that the final road project is not yet drawn out, the county has come through our road and pulled down dozens of large trees.  The reason? There is an endangered bat which nests in certain trees on our road and which will return to our area soon.  Once the bats nest, the county is prohibited from destroying their habitat.  So all of the trees have to be pulled down now, because by the time the road project is ready to go, the bats will be in residence.  In other words, the bats must be protected, but it's ok to destroy their habitat in advance of their return!  I have been fighting a battle to save a large maple that sits right in my fence line and is a favorite home for bluebirds.  At the same time, I have been sucked into a much larger fight to oppose this project along with the rest of a very angry neighborhood. 

Our street is just one battlefield that reflects a much larger question. What kind of change do we want to bring to our world?  Those who live in rural areas recognize that they accept certain risks.  They do this in order to live in less tame environments. We all know that a tree can fall on our car when we drive down a road in the wind, for example.  Should we cut them all down?  We can slide off a twisting country road in the ice.  Should they all be made as straight as a ruler?  What do we lose when we do these things?  And when we make change without regard to timeless values, changes that are made in the name of "greater", "more" and "faster"---do the results make us happier or safer?

In today's New York Times, Nicholas Kristof writes depressingly about something we already suspect: even food that we regard as safe probably isn't. Analysis of the feathers of chickens raised in large farming operations reveals that these birds have eaten things like tylenol, benadryl, prozac and arsenic.  Traces of these compounds still remain and we are undoubtedly consuming them.  Why were the chickens fed these things?  In the name of progress and production.  To calm them down.  To make them grow.  To produce more chicken.  At the same time as I am entreating patients to eat a primarian diet full of fresh produce, lean animal proteins and the like, I find that I am compelled to issue a warning.  Even food isn't food anymore.  Our food supply has become unrecognizable and in many cases, unsafe.  Are your vegetables full of pest-killers?  Is your meat fattened with grain and fed hormones?  Are your chickens laced with arsenic? It falls to each of us to try to decipher which food is cleanest and safest and that is no mean feat.

I am no Luddite and I appreciate the benefits of modern living as much as the next guy.  After all, what would life be without Dancing with the Stars?  But it seems to me that one of the central questions of the 21st century is whether humans beings can learn to be judicious, wise and responsible with the enormous technological advances and opportunities that are now part of our daily experience.  Will we radiate all our food just because we can?  Will we drop the bomb simply because we have it?  Will we implant ourselves with direct links to the internet and turn ourselves into the Borg? For those to whom much has been given, much is expected.  That includes using our heads about the central experiences of life that we want to preserve.  Food.  Air.  Environment.  Lifestyle.  And the essential elements of humanity.  

 

Mind vs. Body: Who's In Control?

by Barbara Berkeley, MD

Hi everybody!  I'm back from a couple of weeks of vacation in the sun and my solar batteries are feeling nicely recharged.  Thanks to those who wrote and asked about my absence.  All is well.

On my return, I found a long email from a reader (let's call her Ms.X) that piqued my interest.  She wrote about a phenomenon which she has dubbed "Passive Dieting" and which can be defined as the mistaken belief of some dieters that the body is in control and knows best. Her hypothesis is that Passive Dieters are hesitant to take the reins and thus control the process of weight loss and maintenance mindfully.  Here are some quotes from her email:

Passive Dieting is a way of removing yourself from the driver's seat and acting as though your body pilots itself. You're not in control; your body is in control--and it's a mysterious, fickle entity, operating independently from you, with its own agenda, its own demands, and its own will. You're just along for the ride.

I would guess you've encountered these types of attitudes:


"No matter what I do, the scale hates me. The scale is evil!"

"I'm craving _____. My body must be telling me I need it."

"I can't get any lower than this stalled 'set point', because my body likes this weight."

"Just let [whatever plan] work its magic!"

"My body must think I'm starving and that's why I'm not losing weight."

"I need to listen to my body and eat whenever I'm hungry."

"You need to eat more calories to trick your body into releasing fat."

"Even if you're not losing pounds, are you losing inches?"

To me, there is an irrational belief contained within this common type of "body talk", in which "your body" does things and you're at its mercy. Personally, if I "listened to my body", I'd probably still be extremely overweight. My body wasn't "telling me" what I should be eating or what my portions should be, or how a person at my current weight needs to eat. I had to dictate those things. 

My body never "liked" being at a heavier weight; bodies don't "like" things, and if they did, they wouldn't "like" being obese. No plan ever worked its "magic" for me while I sat back and let it work. I had to work it.

The Passive Diet Talk turns the process into something that is happening to us rather than something we are creating and actively fostering. This is just as important for the psychological components of weight loss as the physical actions, in my opinion. We create cravings and attitudes--and magnify them. We can learn to shut them down, even as persistent and annoying as they are sometimes. Your body is not "telling you" it wants fast food. My body doesn't "need" chocolate or ice cream just because I'm expecting my period. If I crave that stuff, that's because my mouth wants it or my thoughts are glamorizing it. 

These childish attitudes truly bother me, because we need to be in charge of our weight loss and maintenance--decisively and actively--rather than believing we are limited by the capricious will of our bodies.  

It's not "our bodies" that steer us wrong. Not on "their" own, anyway. It's our unwillingness to accept and inhabit the role of "pilot". It's the fears and excuses we hide behind, and the distancing mechanisms we use to protect ourselves.  That doesn't mean we're bad people; it just means we're a little deluded. I'm sure we all would rather avoid uncomfortable self-confrontation; it's not a lot of fun. But the answer is not to distance ourselves from "our bodies" and act as if "they" control us. 

Since Ms. X asked my opinion on these things, I will offer it here.  I hope that you readers will respond as well, because the interface between the body and mind is a truly complicated issue and the ability to (at times) willfully exert control over biological urges is definitely a key to success in weight maintenance.

There are a number of lessons I have learned during my journey as a doctor and counselor to those trying to lose weight.  The primary one is that there is quite a bit of biologic variability in the way our bodies react to an unhealthy food environment.  Secondarily, there is a wide degree of variability in the psychological elements that overlay weight problems.  Psychological tie-ins may be completely absent or may utterly dominate an individual's efforts at weight control.  I believe in the ability to exert control but I also believe that the body does "speak" to us with cravings and compulsions.  The intensity of this "talk" is highly individual and while no one has an easy time controlling it, some people are more able to find strategies that work to disable the dialogue.

Our ability to exert control over biological urges and to stay focused is not infinite.  Studies have shown that repeated attempts at exerting focused attention eventually break down.  So, I am a believer in the importance of devoting more early maintenance attention to creating a truly pleasurable new life that avoids old triggers.  We are safe on the maintenance island when movies are no longer linked to popcorn but feel just as good with grapes, or when the Pasta Alfredo on the menu just no longer looks as good as the Grilled Salmon Salad. The reason that I believe that we can get to this point is that I myself have experienced it.  In my life prior to weight gain I was a huge and uncontrolled eater who weighed 110 pounds at 5'6".  I loved nothing more than hot fudge sundaes, loaves of bread, cookies, pasta and french fries.  Today, after about 10 years as a 90% Primarian, I have no particular craving for any of these things but truly and honestly enjoy eating plain, clean, fresh, simple foods.  Like meditation skills,  success comes from the practice.  Continuing to eat this way and to associate it with pleasurable feelings of lightness, health, and attractiveness carves a deep path that no longer feels like a desperate trudge up a mountain.

Does our body "speak" to us?  Yes.  And is our body in control of us?  Ultimately, yes.  99% of our body processes run on auto-pilot, from keeping the levels of potassium, sodium and about 100 other elements stable in your blood, to telling you when to eat, when to sleep, when to breathe and when to eliminate.  We can temporarily override these messages, but eventually we do have to obey the body's imperatives.  But the body's messages are meant to help, not harm.  What is most important for us to understand, is that the body is no longer sending beneficial messages when we expose it to confusing and harmful environments.i These "wrong" messages are the ones we must tease out and learn to circumvent.

I've written before about my feeling that the body does not care about excess fat or even act as if it is aware of it.  Our bodies react swiftly and with stunning specificity to any threats to our health, creating rafts of antibodies to combat bacteria, sending complicated clotting cells and chemicals to staunch bleeding, and releasing a host of mind and body sharpening chemicals when we need to flee from danger.  Yet someone who is hugely threatened by a fat mass of over 100 pounds, does not benefit from bodily help.  The body is silent, almost uncaring.  It continues to send the same messages of hunger (or even more urgent messages) than it did before.  These messages are not right for the organism, but not because the body has made an error.  In my view, the confusin occurs simply because we were not genetically programmed during a time when massive fat storage was possible.  We don't have the programming to respond to it and so the succeeding messages are wrong.  Our bodies therefore behave as if fat didn't exist, and this vastly compounds the problem.  

The work of weight loss and weight maintenance is the work of putting our bodies in the position to give us the correct messages.  This means pulling ourselves out of the modern food environment and the sedentary world in which we live.   It is a tough task indeed, and one that involves accepting the role of "pilot" that Ms. X aptly describes.   But my argument would be that neither you nor your body is in ultimate control.  What ultimately controls us is the effect of the environment we live in.  Control your environment as much as you can and you will effectively control the messaging of your body, making the job of pilot a much easier one.  

I've often used the analogy of an island when I've talked about the life of successful weight maintainers.  To master weight once and for all, don't be a sometime visitor, pick up and move to the island with all your belongings and with a happy heart. 

 

Traveling Outside of Your Head and Into the Rest of Your World

by Barbara Berkeley, MD

It's my contention that most of us spend the majority of our time living in the small space above our neck. It's easy to do, since our brain and 4 of our 5 senses (sight,smell, hearing and taste) reside there.  But living in our heads is kind of like living in the capital of a huge country with beautiful and varied terrain...and never venturing out of the city.  

It's easy to govern badly, and if those of us who live in the capital don't understand the concerns of the working people out there in the rural areas, we are unlikely to serve them well.  Instead, we may simply send down edicts that suit us, but don't do a thing for them.  

I am generally loathe to inject politics into this blog, but occasionally the analogy is just too apt.  It's easy for male politicians to go on about the reproductive choices of women and for panels comprised solely of men to prattle about whether or not women should be able to make their own decisions about these complicated moral issues.  But they don't live in a woman's landscape. (Neither did the man who invented the mammogram or the endometrial biopsy, I'm pretty sure.) 

When you're living in the landscape of your head, it's similarly very easy to decide that the huge, cheesy, fatty meal you're about to eat looks pleasing without considering the effect on the rest of you.  When the folks out in the boondocks of your stomach and intestines start to complain, it's equally easy to send some antacid their way.  Their concerns don't affect you back there in the land of Above the Neck.  At least not until there is a major bodily revolution. 

I love modern medicine and I'm awed by and grateful for the opportunities it gives us.  But taking medicines for conditions that could be cured by eating and life habits simply reflects the choice to stay in the comfort of the capital city above the neck, while ignoring the real concerns of the rest of the country.

So what's the best way to learn about the whole land you live in?  Go on a road trip!! Once you've visited the mountains, the valleys and the plains; once you've met the good folks that send the product of their hard labor back to the capital day after day, it will be harder see the world as that small space within your skull.

Perhaps you have some favorite methods for staying in touch with the world below your head.  For me, the best method by far is physical challenge.  When I'm training for a run, trying to keep up with a 20-something in aerobics class, or ardently trying to put a tennis ball past the reach of a very fit opponent, the connection with my body is complete.  Purposeful exercise that tries for a goal asks for total cooperation between the brain and the rest of you.  Non-purposeful exercise, like watching TV while on the treadmill, is certainly good for your heart, but makes it easier to stay in that comfort zone above the neck.  Try training for something or working toward a goal and you'll see the difference.

At our last Refuse to Regain group meeting, we were treated to a presentation by a meditation expert.  For the past 30 years, this very evolved woman has been meditating and teaching others to do the same.  Her mission is to spread the benefits of this practice, something that she does by giving her time generously and at no cost.  Since attending her talk, I have started meditating again, something that I have tried periodically over the past 20 years.  I believe that it can be a powerful tool for connecting our head to our physical body.  Meditative practice involves being aware of breath, which immediately connects mind and the rest of us.  It cultivates a feeling of peace, spirituality and gratitude.  It is not until we recognize the value of the gift we have been given in the form of our physical body that we truly want to protect it.

Many of my patients tell me that they avoid looking at their whole body in the mirror.  Some don't even own a mirror that reflects their full length.  We spend our lives in modern America distracting ourselves with cell phones, TV, texting and almost constant connection to media.  We need to stop, look, and listen. Ignoring the mirror, the scale, and that recent photograph of yourself is a temporary fix, but ultimately it's just a way for the rest of your "country" to deteriorate further.

For all the books on diet and all the headlines about obesity, most people seem relatively disinterested in how to remake their lives.  They are willing to accept the conventional wisdom (eat less, exercise more) and when it doesn't work for them, blame it all on a bad metabolism.  One of the keys to treating your country well is to use your head to become fascinated with and involved in a grand experiment.  How can your country become the healthiest country in the world?  This life-work means casting off previous beliefs about food and diet and doing true research and field work.  Reading, exploring, and trying various practices and theories are key to this very important effort.  Those of you who read this blog are already doing this, and it's a great thing.

How do you connect with the larger world that is you?  Once you have made this profound connection, taking care of yourself is no longer a tiresome burden, it's an exciting and fascinating prospect and a source of great joy. 

 

 

 

 

The Menopause Myth: Why It Can Be EASIER to Lose Weight Later

by Barbara Berkeley, MD

It's always healthy to be skeptical, particularly where dietary pronouncements are concerned.  

In the past year, I've been asked dozens of times about HCG.  Everyone is talking. It's all over the media. Does it work?   The answer should be obvious to anyone.  If HCG was any kind of obesity cure, 3 out of 4 people you know would be taking it already.  The first pill or treatment that comes along and can really zap obesity will burn through America with such rapidity that we won't know what hit us!  Lesson?  Just because someone or some newspaper article says it's so, doesn't make it so.  Skepticism is healthy in the diet world.

What many years of obesity practice have taught me is that we should also be skeptical of what passes for conventional diet wisdom.  Alot of it is just plain wrong.  And because we accept it as fact, we lose out on many opportunities to change our lives.

One of my least favorite "wisdoms" is that weight gain is inevitable after menopause.   I wrote about this a couple of years ago in my post on weight loss after fifty.  As time goes on and I work with more and more peri and post menopausal women, I am more and more certain that lower weights can be maintained without difficulty despite age and hormonal status.  Further, I think it's often easier for women to get healthy when they are past 45. 

The key to weight loss and maintenance at any age is the same:  a complete overhaul of the foods you eat.  This seems so simple and obvious, but practically no one who goes on a diet does it.  The vast majority simply returns to a modified version of their original diet.  Because modern foods are addictive, this modified version becomes the full-blown version in very short order.

The key to weight control after menopause is the strict limitation of starches and sugars, and that includes grains, whole grains and the flour-based products made from them (pasta, breads, and so on).  As I explained in my earlier post, this is because we tend to be more insulin resistant as we age.  This causes us to make more insulin in response to these foods, which in turn causes easier fat storage and an inability for stored fat to be released.  If you can make the change to fruits and vegetables rather than grains, potatoes, breads and cereals (and you can learn how to do it in books like Refuse to Regain or others on Paleo or Primal diet) you will lose weight and your age will be immaterial.

But there are also reasons why weight loss and maintenance is actually easier for those who are post-menopausal.  

One of the major reasons is the empty nest.  Feeding growing children and ravenous teen-agers makes it extremely hard to adhere to personal dietary rules.  If you have kids but they are now out of the house, you will find it hugely easier to make your own plans and stick to them.  Most of my patients report (and this has been my own experience) that husbands are usually willing to be flexible about eating.  They will often follow along even if they've eaten differently at an earlier stage in life. 

A second reason that it's easier to make change is that social pressures begin to modulate.  A couple of years ago, Don and I took a trip to Las Vegas.  While sitting at one of the enormous breakfast buffets at the Mirage, I had to laugh.  All of the people under 45 were tucking into huge portions of bacon, eggs, danish, muffins and potatoes.  Those who looked to be over 50 were eating egg whites, little bowls of granola with skim milk, and prunes!  Getting further along in life puts you in mind of the final third of the journey.  You and your friends will start to be more conscious of health and longevity.  Sayng that you no longer eat foods that make you fat and that you want to reach 95 in good health will no longer elicit eye-rolls.  You'll be admired, not scorned.

Another factor that I mentioned in my earlier post is the greater ability to be yourself that comes at mid-life.  The opinions that others have of you matter alot less now, and your tendency to speak your mind and live life by your own rules increases.  Use this new freedom by declaring yourself and your rules for eating.  You've earned the right to make your own way.

If you no longer are feeding a family at home, it's a simpler task to clean your kitchen and vow never to allow fat-promoting starches, sugars and junk foods to enter.  The need to entertain and cook is often lessened.  You've probably had that role for many years and perhaps younger generations will take on all or part of it now.  Minimizing baking and complicated entertaining can be very helpful when you are trying to make permanent healthful changes.  Keep things simple for a while and see how much easier it is to control the food environment. 

Exercise is a vital component of health from mid life on.  You can get away with being sedentary when you're young, but it's for sure catching up with you by the time you pass 50.  The good news is that it's also a myth that exercise ability lessens with age.  While no one wants to get injured, many of us take to our couch at the first hint of soreness.  We are not as fragile as we think.  Unless you have a very real reason not to exercise, get out there and do activities that get you excited.  If this guy can run the marathon at 100, you can train to walk a 5K, shake your booty in a zumba class or conquer the downward dog.  

Finally, changing your life and eating habits requires belief in your ability to get things done.  That's not something many people have in their 20s and 30s.  But after you've built your career, your family, your life, you clearly know how to get things accomplished.  Make the same kinds of plans you did to get other important things done in your life and take on your goal with a passion.  This is an advantage for  mid and later lifers.  Use it.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Habit and Reward: Good for Target, Good for Maintainers

By Barbara Berkeley, MD

Here's an article everyone should read.  In yesterday's New York Times magazine section, there was a long and eye-opening piece on the science of consumer behavior.  It seems that we buy things because it becomes our habit to do so.  Marketers rely on this habit and try to create it.  There are times in our lives when we are more susceptible to changing habits.  Target has found that pregnancy is one of those times, and it has gone to great lengths to identify pregnant women and to market to them.

Research with rats gives us insight into our own behavior.  It turns out that habits have three components:  a trigger, a behavior, and a reward.  The brain is actively engaged only during parts one and three.  What makes the habit a habit is that the behavior component, no matter how complex, is run automatically.  In other words, once the habit is triggered, it’s on autopilot. 

I’m sure that many of you will be horrified, as I was, by the extent of mind-control and manipulation that goes into modern marketing.  But if we leave that aside, the information on habit formation gives us some powerful tools for changing things we may want to alter in our own lives.  Changing habits is arguably the most vital task for maintainers.

So, I see two avenues to explore.

First:  Since habits are so automatic and ingrained, and since powerful rewards like the pleasure of eating junk and sweets have carved habits deep into our neuro-pathways, we must consciously avoid putting ourselves in situations that pull the trigger.  We’ve discussed this many times here, most recently in the last post.  As much as we’d all love to eat controlled amounts of the modern foods that everyone else is downing, we’ve mostly learned that we can’t.  We’ve also observed that when we do indulge, we are punished by a return of cravings.  This is addressed in the Times article:

Habits aren’t destiny — they can be ignored, changed or replaced. But it’s also true that once the loop is established and a habit emerges, your brain stops fully participating in decision-making. So unless you deliberately fight a habit — unless you find new cues and rewards — the old pattern will unfold automatically.

“We’ve done experiments where we trained rats to run down a maze until it was a habit, and then we extinguished the habit by changing the placement of the reward,” Graybiel told me. “Then one day, we’ll put the reward in the old place and put in the rat and, by golly, the old habit will re-emerge right away. Habits never really disappear.”

 Habits never really disappear.  Words to live by.

Second:  Since habits are created all the time and since we know their components, why not create our own?  Rather than let someone else manipulate us with their chosen reward, how about deciding to reward ourselves? When I think about my own maintenance, I realize that I’ve set up many of these loops and that they are what keep me going.  Weighing myself every day is a reward in maintenance.  When I have to lose some weight because I’ve edged up a little, the scale is both my trigger to lose and my later reward.  I’ve learned to get pleasure out of the feeling of being hungry on days when I have to bring my weight down. How have I done that?  I associate that feeling with a pleasant day I’ve set up. I follow a pre-set reversal plan that I enjoy---usually to have a non-fat, skim mocha for both breakfast and lunch, a nutrition bar at 3 and to try to do some shopping if I can, which is fun and which distracts me. Then I have a huge salad and some protein for dinner.  I look forward to these days rather than dreading them.  The scale on the next morning’s weigh-in is a further reward.

I find that my Primarian eating style has become a reward in itself.  After forcing myself to stay away from starches and sugars for many years, I now truly enjoy eating chicken, fish, nuts, veggies and fruit with some low fat dairy mixed in.  I look forward to these meals and they have become their own reward.  Each day, the pleasure that comes from eating this simple good food ingrains the habit more deeply.  I have no doubt that if I started eating Mallomars again, I would immediately re-activate my chocolate cookie circuits.  Why do that?  I simply don’t want to.  

One of the toughest jobs I have is to convince non-exercising patients that fitness has rewards that are as strong as bread, chocolate cake and pasta.  I never used a muscle until I discovered aerobics in my late 30s.  Within a month or so, the music and the energy took over from the pain of using those veal-like structures for the first time.  Now, years later, I’ve found that I can create the same high from running to Michael Jackson’s “Jam” on a sunny day or playing a great set of doubles in tennis.  Nothing beats a high-energy, dance-y aerobics class though.  For me, the pinnacle is exercising when I am in the Bahamas: a place where dance, party and exercise all exist in one class at one time.  When setting up your new reward circuits, don’t forget to search for the bliss that is found in physical challenge.

The Times article makes the point that rewards can be subtle.  You are rewarded for backing out of your driveway successfully simply by the fact that you achieved that tricky maneuver.  A reward doesn’t always have to be a treat.  It can be a sense of balance, completion or satisfaction.  The trick with food is to eliminate the over the top rewards of drug-like sugars and starches.  It’s hard to compete with the hit of a drug to the pleasure centers, and these foods come way too close to that experience.  Don’t put them in competition with other rewards because lesser rewards will lose out.

In essence, the Times article leads to conclusions that are just the opposite of those in my last post (Tied to the Mast).  The two go well together because they demonstrate the two opposite faces of maintenance.  The first:  studious, focused avoidance of things that others find pleasurable.  The second:  the creation of a brand new world of habit and reward, based on one’s own rules…not those of the culture at large. Part Two completes Part One.

After all, there is no point in getting past the Sirens if you land in a grim place that no one would want to inhabit.  Make it beautiful and you will want to stay. 

Creativity is the basis of all art, even the art of maintenance.  

 

Tied to the Mast

by Barbara Berkeley, MD

 Odysseus, the wandering protagonist of Homer’s Odyssey, had a healthy fear of temptation.  In Greek mythology, sailors were regularly lured to their deaths by Sirens, creatures who sang a beautiful and irresistible song.  Entranced by the song, these sailors steered toward the call and were dashed to pieces on the rocks.  

 In order to avoid this fate, Odysseus ordered his crew to plug their ears with beeswax and to tie him firmly to the ship's mast.  On hearing the Sirens' song, Odysseus himself could not resist and begged to be untied, but since he had instructed his crew to ignore him, they refused his pleas.  Thus, the ship was able to sail safely past danger; but only because Odysseus was smart enough not to underestimate the power of temptation.

The Odysseus story is mentioned in a recent article that detailed the effectiveness of offering restaurant-goers the choice of smaller servings.  I loved the analogy. 

Negotiating the modern food world so often seems like sailing through Siren filled waters.  The call of the brownie is so sweet, the bowl of M & Ms looks so jolly, the Ben and Jerry’s packaging is so alluring…and that  fresh baked bread?  It’s the staff of life, isn't it?

Until we crash into the rocks. 

As our doctor reveals that our fasting blood sugar is now above 100 and pulls out the prescription pad to treat our rising blood pressure and refill our Lipitor, we may suddenly realize that we’ve been had.  Lured like bugs on sweet sticky-paper, devoured by the fragrance of the Venus fly-trap…

The work of maintenance, the life work of maintaining, is to learn to navigate these waters and, to some degree, to discover how to bind ourselves to the mast.  Temptation will always surround us and we need to find a way to deafen ourselves to the call.  But how?  Perhaps you will add your own perspectives, but these are some of the ways I have found to be effective:

1. Temptations lose potency when they are not reinforced.  For this reason, I advise most people to practice avoidance of trigger foods and to do this as completely as possible.  Don’t make exceptions for birthdays, retirement dinners and cruises.  The more you exclude triggers, the less power they will have over you. 
2. Reduce exposure to the Sirens by avoiding the places where they live.  Don’t detour unneccessarily into the cookie aisle or start a long conversation with a friend in front of the bakery window.  Avoid restaurants where the main thrust of the menu is food you can’t eat. 
3. Ban the Sirens from your presence.  Do this by not inviting them into your home, by asking that they be taken off desks that adjoin yours at work or removed from plain sight in break rooms.   
4. Finally, tell your crew not to listen to your pleas.  Make it clear to friends and relatives that you simply don’t eat certain foods.  They will be embarrassed to serve them to you and you will be embarrassed to ask for them in their presence.  Enlist those who are close to you in supporting your goals.  If you plead for cake, make sure that your allies remind you that you'd really rather not.

How do you avoid being dashed on the rocks?  Send me your strategies.