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Forget Everything You Know About Nutrition

Letter to NY Times in Response to “The Fat Trap”

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Gifts on Valentine’s Day

Why is it hard to get rid of clothes when you (make that I) lose weight? I’m  not that frugal, so it isn’t the, “Oh my gawd look at the waste!” aspect. I’m not a hoarder – really, honestly, OK, so I have a few textbooks that are 30 years old… I am not keeping any clothes around in anticipation of a regain.

There is nothing I would like more than to see a woman with fewer resources wearing some of my beautiful suits. So, why the heck am I dawdling getting rid of the poundage of clothes in my closets? Yes, closets – plural.

Lazy, perhaps. Overwhelmed at the prospect of cataloging several hefty bags of clothes for a tax deduction, yeah. But deep down, I’m having trouble letting go of my fat. My body image still is nebulous. Viewing pics of me at my fattest (and I will NOT post them here), I can’t believe that’s me. Viewing pics of me in 1992 at a size 6, I can’t believe that is my body. Looking at my sagging skin, I just want to scream it away. I can’t accept that my arms look like my great-grandmother’s or my thighs resemble an elephant, even as some muscle starts to show through. (Hmm, both of those are very strong images…) Do I want to be fat again and smooth out the wrinkles and sags? NO. I wouldn’t mind be 20 years younger though 😉

Rather than continuing to perseverate about the clothes, my fat, this strange sadness when I look in my closets – I am celebrating this Valentine’s Day with a gift to myself and to large women who shop at Goodwill by finishing the task;  emptying my closets;screw the cataloging; putting on some happy music. (Live radio from the Big Island for our upcoming vacation) And, some private writing about these reactions to changes in my body.

Happy Valentine’s Day.

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.