Link

Red meat & mortality & the usual bad science

This is a great explication by Zoe Harcombe of the article in Archives of Internal Medicine released March 12 reporting the teeny association between eating meat and premature death. Skip the numbers if you want. The “meat” of her summary is in the first 2 points:

“1) This study can at best suggest an observed relationship, or association. To make allegations about causation and risk is ignorant and erroneous.

2) The numbers are very small. The overall risk of dying was not even one person in a hundred over a 28 year study. If the death rate is very small, a possible slightly higher death rate in certain circumstances is still very small. It does not warrant a scare-tactic, 13% greater risk of dying headline – this is ‘science’ at its worst.”

If you are so inclined, also read the rant on Gary Taubes’ blog post, Science, Pseudoscience, Nutritional Epidemiology and Meat

Relapse Is My Middle Name

Those who remember my technical blatherings about the Stages of Change Model describing how people voluntarily change behaviors know that I have tried to relate my journey from merely thinking about eating healthy, to seriously planning, to acting on the set of behaviors, and then integrating the mechanisms (processes) of change to help me keep going. (Fifty-word sentence, good grief.)

Relapse is one of the stages, and I am in it. “Don’t despair,” I tell myself because this is normal. There is always something to be learned from a setback. And, recycling to a later stage of change means not starting all over. I do not need to build motivation. I do need to re-establish my ability to shun certain trigger foods. Regain my self-efficacy/confidence. This is especially hard given that I have a binge eating disorder. Yep, depression, anxiety, PTSD, BED. One wonders how I ever functioned so successfully in academia. Here’s a secret. I almost ate myself to death. I gained 150-pounds and no one talked to me about it. If I had reeked of alcohol think someone might have initiated an intervention? Yep? Do I harbor some anger at those charged with my training during medical residency, those who supposedly valued behavioral sciences yet ignored my tremendous weight gain during my residency? You bet. Time to let that go.

I have returned to the world of the present by being open with my family about what has been going on. Sought support from key friends and loved ones. Agreed to not eat in private. Talked with my long distance shrink who is an incredible sounding board. Finally, I stepped into my tightest jeans and found they were almost too tight to wear. Reality check.

Losing weight and maintenance are difficult enough without adding a binge problem. I don’t expect sympathy. It’s a real disorder that I magically thought had disappeared. Nope.

Ever vigilant without obsessing is a fine line. I’m back in the saddle and wearing my tight jeans.

My ABC’s

This post idea is stolen from Karen @ Waisting Time. Why? Because it is such a great idea, and I am in a creative funk. Here is my alphabet soup of eating, food, and other related themes.

A is asparagus, lightly mixed with olive oil, tossed with sesame seeds then broiled.

B is for berries, straw, blue, Marion, black…

C is cruciferous veggies such as broccoli and cauliflower dusted with a bit of cheese.

D is for doggies that beg for leftovers. The chi-terrier mix loves coffee and veggies!

E is for eggs. Hardboiled, soft-boiled, poached, scrambled, omelet-ized, over easy in olive oil.

F is for fish, which I do not eat enough. Fresh haddock is a favorite. Smoked salmon is a speciality of a local pricey market. Shellfish would be high on the list if I had not developed an allergy 😦 in the 1990’s. What is your favorite fish, and how do you prepare it?

G is for grapes that meet my desert and snack needs wants. Any food that you allow for snacking?

H is for Honey Baked ham with the fat and sugary coating trimmed off.

I is for the cast-iron skillet that we use so frequently.

J is for jogging that I learned hurts my knees.

K is for the Kashi cereals I no longer eat because I don’t “do” grains anymore. (Read Wheat Belly for good reasons to remove most grains from your diet.)

L is for lean protein. Cannot get enough. What is your favorite source of protein?

M is for maintenance. I cannot wait!

N is for nut, almonds and walnuts, please. Although macadamia nuts are my faves.

O is for organic. I’m still on the fence about which products to buy and which are not worth the extravagant cost. Recommendations?

P is for the produce section at Sunflower Market. Love it! Do you have a Sunflower near you?

Q is for quince – something I have never tried, although I have only seen it in New England as a jelly or jam. Anything in your alphabet list that you are curious to taste?

R is for my Mom’s roast brisket. I have tried to duplicate it with horrid results.

S is for steak. OK, I am a carnivore. We do limit beef consumption to once or twice a week. Anyone feel embarrassed about eating meat these days? (Those big ol’ cow eyes with long lashes…)

T is for toxins that lurk in our water and food supply. Without public health oversight from the government (local and federal), we could expect food borne illnesses to increase. Watch how your Congress person votes.

U is for getting unstuck. I could give many excuses why my weight hasn’t moved in the last several weeks, but that’s all they are, excuses.

V is the vitality that I feel when eating healthy and being physically active.

X is for xylitol, which is used as a sugar substitute. What, if any, sweeteners do you use? I put Truvia in my protein berry shakes.

Y is for yogurt, specifically Fage non-fat used for protein smoothies.

Z is the end. OK, that was a cop out. Zero grains. I’m serious. Zero ice cream. What foods are on your absolute NO list, if any?

Two Years Ago…

We hosted a Labor Day barbeque. I ate my usual large amounts of fatty food (nothing wrong with fat in food) and the next day had to face what Sue and I had known for a few years – I had gallstones. A surreptitious ultrasound had shown them earlier, but I rarely experienced symptoms. Post Labor Day binge, I had excruciating pain that took me immediately to my primary care doc then for an ultrasound later that week to reconfirm what we already knew.  Within 2 days of seeing one of Sue’s favorite surgeons, I was scheduled for surgery. Terrified, on September 16, 2009, I had a laparoscopic cholecystectomy. Just one little incision under my umbilicus (sorry, it’s hard for me to say “belly button”), and 30 minutes later 3 large stones and my gallbladder were removed.

My post-operative course was a little rocky with a small bile leak that did not require surgery but caused a lot of pain. My incision took forever to heal. And, I had no appetite combined with tremendous, um, disturbance in my gut. Couple little intake with tremendous output and one gets a 30-pound weight loss in a month. Sue and I had been contemplating a joint weight loss program prior to Labor Day. During my post-op misery we discussed that this was the perfect time for me to get healthy and continue the weight loss in a rational manner.

So, this 2-year journey was kick-started by a health crisis. Methods have been adjusted as I learned what worked and didn’t for my body. I choose a hiatus after the death of my mother, focusing on maintenance. Frustrated by repeated plateaus (damn post-menopausal state), I read all I could find on different methods of losing fat. Thus was born the totally new approach in January, 2011, of no starch, sugar, grains combined with watching calories. A little breast cancer got thrown in this Spring. Exercise (I prefer to call it physical activity) continues to be a struggle given my recent surgery, but I enjoy challenges.

Suddenly I weigh 138 pounds less, am 2 years older, maybe a little wiser, and have met so many wonderful people by writing about the process. Thank you all for blogging, inspiring me, letting me comment on your thoughts, giving me a place to lend support and write things that I would never post on my own blog.

Here’s to health, writing, and connections.

138 pounds later picture

September, 2011 - 167 pounds

July, 2009 - 305 pounds

Carbs, Starches, & Grains Denial

Here is an update after almost 2 months of cutting out the above mentioned nutrients (?) as I attempted to keep my insulin response under control (remember, no diabetes here) and push my fat cells to deplete their supply. First the hard part, bread and potatoes were sorely missed by my brain. My family continues to shake their collective heads that one can go without eating any type of grain, refuses dishes made with flour, laughs in the face of fresh sourdough (sigh), or can sit and watch them eat fresh cut french fries from In-N-Out Burger. That leads me to the other hard part, eating so radically different from those around me. I am not low-carbing, or doing Atkins, or eating primal (still enjoy some dairy), so folks find it hard to pigeon-hole my plan. Plus, I still count calories since I don’t care how much fat I eat and want my body to chew up its own fat stores, not live off of what I ingest.

Now the easy part. Eating this way is easy. I am never hungry. Variety is limited only by my lack of originality in cooking. Eating out is easy since most restaurants will happily leave off side dishes even if they won’t substitute fruit for potatoes or give me an extra side of veggies. Besides, we rarely eat out except for breakfast and eggs are so on my plan.

So what am I eating and how much of what? Looking back at the last month, my carb intake per day has ranged from 9 grams to 87 grams with an average of 55 grams/day. The highest day came from an intended splurge of a mocha coffee. So much for no sugars, huh? That was my only refined sugar source the entire month. Protein mainly comes from lean sources such as fish and roasted chicken breasts and eggs, although I do eat more red meat now than I did last year when I had this strange aversion to meat sources from animals with eyelashes. The can of whey protein sits languishing in the pantry for a desperation snack when I am too lazy to eat real food and need some calories. I eat no more than 2-3 servings of fruit per day – always berries except for the occasional fresh pineapple. Eggs – I love eggs! I always keep a few hard boiled ones hanging around, again so I know there is acceptable food available. But, I prefer my eggs freshly cooked and usually with some Canadian bacon and maybe a touch of Tillamook extra sharp cheddar cheese and mild green chiles and whatever else I can throw in to spice ’em up. Raw almonds and walnuts are other acceptable food sources as long as I measure them out. Salads, you bet – with oil and balsamic vinegar dressing. One food I have to be careful with is Greek yogurt. I buy non-fat Fage and add my own berries, but sometimes it reminds me too much of ice cream. Plus, the whole question of dairy in one’s diet is still bouncing around in my head. Although, I refuse to give up my 2 tablespoons of half-n-half with my morning coffee and the occasional bit of cheese. Veggies, I need more veggies – working on that.

Exercise… I am still on the very, very slow track of walking because of my statin-induced myopathy. Enough said or I just will start whining.

Supplements: Because of my damn myopathy and overall attempt to lower inflammation (which is unrelated to the myopathy), I am now taking Vitamin D3 5,000 mg/day, fish oil 3 gm/day, L-acetyl carnitine 500 mg/day, some multi-vitamin with a bunch of stuff in it (helpful, right?), and CoEnymeQ10 300mg/day.

I’ll end here with a fun side-effect of CoQ10 that few people experience – photosensitivity. I never, ever sunburn. But in Hawaii after 2 hours in the sun I developed a blistering burn on my chest that lasted for 3 weeks and a lovely spotted reaction on my arms and legs (where the skin wasn’t so virginal).

Oh, yeah – I lost 10 pounds.

sunburn

CoQ10 Photosensitivy Reaction

USDA Dietary Guidelines – BAH

I must say I had a good laugh when these were announced 1/31 – then I got frustrated. The message is simple and supposedly evidence-based. The guidelines were written by lipophobes and the calories in/calories out believers.

Here is the summary for consumers (a new food pyramid will emerge soon, oh joy):

• Enjoy your food, but eat less.
• Avoid oversized portions.
• Make half your plate fruits and vegetables.
• Switch to fat-free or low-fat (1%) milk.
• Compare sodium in foods like soup, bread, and frozen meals – and choose the foods with lower numbers.
• Drink water instead of sugary drinks.

Yay, eat less. Who doesn’t know that and why has it taken so long for the USDA and HHS to come right out and suggest it? So why didn’t the guidelines address the food industrial complex that forces supersize portions on us? Yes, the entire guidelines are directed at the individual, as if we each live in a vacuum.

Look deeper at the executive summary, which will be translated into consumer messages, and these are some examples of what you will read:

•Reduce daily sodium intake to less than 2,300 milligrams (mg) and further reduce intake to 1,500 mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease. The 1,500 mg recommendation applies to about half of the U.S. population, including children, and the majority of adults.
•Consume less than 10 percent of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids.
•Consume less than 300 mg per day of dietary cholesterol.
•Keep trans fatty acid consumption as low as possible by limiting foods that contain synthetic sources of trans fats, such as partially hydrogenated oils, and by limiting other solid fats.
•Reduce the intake of calories from solid fats and added sugars.

How is the average American going to calculate their daily intake of sodium and saturated fat? Well, except the low percentage of us already trying to be good doobies and are using food tracking software. Is there really strong evidence for limiting dietary cholesterol when most of our cholesterol comes from internal production and the link between total cholesterol and heart disease not that strong.  (Answer: NO) Won’t people see the mixed messages about limiting cholesterol yet using eggs and shrimp as “good food”? (And they are good foods.)

Who is least served by these new guidelines ? 1) The poor, who already have difficulty finding affordable lean protein; when more affordable food is higher in salt and sugar; who are assaulted by the fast food industry (Micky D’s anyone?) and are not be reached easily by generic guideline messages. 2) The obese who don’t lose weight on the “one-size-fits-all” diet of limiting calories. 3) Medical professionals looking for something to tell their patients/clients other besides “eat less, enjoy it more”.

I will be interested to see the new food pyramid, how the guidelines are translated in public health messages, and how the specific messages about what to consume are disseminated to those most at risk, i.e., the poor, the obese, those who do not trust the government.

My overall reaction is that was a colossal waste of government money and until Big Food industry is targeted, as well individuals, the country will not be served well by the USDA.

End of rant.

Diet Revolution

To be precise, I should say that over the year my diet way of eating (the dieter’s PC phrase) has gradually evolved. While I remain committed focusing on behaviors around health (eating, physical activity, paying attention to my body, etc.), over the last 3 months what I eat has shifted. Time to revise my behavioral goals around food to reflect what I have learned as I went through a prolonged plateau, a battle with severe side effect from a statin medication that left me inactive for weeks, and a reconsideration of the role of cholesterol as a risk factor for me individually.

Going back to January 8, 2010 here were my behavioral goals:

  • restricting my calories to 1500kcal/day on average in a week
  • aiming for a balance between protein, fat and carbs
  • spreading out my food intake throughout the day, which means eating breakfast
  • no food after 7pm
  • no red meat
  • no ice cream (the ultimate trigger food for my binging)
  • minimal refined grains and grain products
  • adding at least 3 fresh fruits/vegetables per day
  • shopping only for fresh produce
  • limiting what is in the cupboard/frig to what is acceptable to eat
  • no artificial sweeteners or drinks with artificial sweeteners – sweet stimulates me to eat more sweets
  • monitoring everything calorie that goes into my mouth (I use the Livestrong.com site)
  • charting my weight twice a week
  • being physically active 30 minutes a day, beyond job and household activities

I believe that insulin is the big drive behind fat – getting fat and staying fat. There is much scientific evidence for support, and as a physician who believes in evidence-based medicine* I am not one to follow fads. My personal experience over the years has shown how sensitive my hunger, eating, and ultimately my weight are to foods (starch, sugar) that increase insulin. I cannot change my genetics, but I can change my food intake so fat is able to get out of my body easier and stay out forever. Also, I want to choose foods that decrease inflammation (because of family history of heart disease and because fat tissue produces inflammatory molecules); and I probably need nutritional supplements with vitamins given that I will still count calories.

Why count calories and not just low carb it? Theoretically one could just eat fat and eat little to no carbs, but eventually their body would stop drawing from fat reserves and use just what is provided in their diet. So calories do count when trying to lose weight  – it is the quality of calories that count for mobilizing fat and maintaining fat loss.

Given all of the above and more information circling in my brain, here are my revised behaviors in an attempt to change the regulation of my fat tissue:

  • No wheat, sugar (except that in natural foods), starch, or grains
  • Emphasize quality protein
  • Aim for ratio of 50:30:20 protein:fat:carbs in 1200 calories
  • Limit fruits to 2 servings a day – mostly berries
  • Veggies are unlimited (potatoes are not a veggie)
  • Monitor all intake daily using software to account for above and review macronutrient intake every week
  • Eat breakfast, ALWAYS
  • Ice cream will always be off-limits, and the only off-limit food
  • Eat if I am hungry – and figure out why I let myself get hungry
  • Have acceptable snack foods available
  • Weigh no more than once a week
  • Engage in fun, physical activity at least 30 minutes/day
  • Supplement with vitamins as needed to reduce inflammation
  • Review the above list every week after weighing

Sound restricted? Yes, it is now because I have another 50 or so pounds to lose. Will I occasionally eat cake (or potatoes) – you bet, but just a taste and only in celebration. Should I exercise more? This is all I can manage now because of the myopathy from taking statins. My goal is to be able to do whatever I want without restrictions because of my weight and to keep my health optimal.

*Evidence Based Medicine is the integration of the best scientific evidence available with clinical expertise and patient values to reach optimal decisions for individual patients.