Excerpts for Tell Me the Truth, Doctor : Easy-To-Understand Answers to Your Most Confusing and Critical Health Questions


Tell Me the Truth, Doctor

Easy-to-Understand Answers to Your Most Confusing and Critical Health Questions


By Richard Besser

Hyperion

Copyright © 2013 Richard Besser
All rights reserved.
ISBN: 978-1-4013-2483-4


CHAPTER 1

ARE DIETS THE BEST WAY TO LOSE WEIGHT?


A couple of years ago I did a segment for Good Morning America in which I presented a panel of nutritionists with some of the latest, hottest celebrity diets: A raw food diet, a blood-type diet, a macrobiotic diet, and the master cleanse. Their job was to tell me which was the best, which was the worst, and which might be downright dangerous. I knew what I thought were the correct answers, but I wanted to see if they agreed. Turns out they did.

All of the diets resulted in weight loss for a simple reason: They restricted calories. Some eliminated whole categories of food; others used pseudoscience to tell you what to eat. While a macrobiotic diet can be a healthy approach to eating if done carefully, none of the diets was a healthy approach to weight loss. I view a diet as a "quick fix" when you need to lose an extra pound or two after a weekend splurge or to kick-start swimsuit season. As a long-term approach to weight loss diets just don't work. You can't stick to them forever, and with some diets it would be dangerous to do so.

The diet industry is huge, and Americans spend billions of dollars a year trying to lose weight. For some reason we continue to believe that the answer to losing extra pounds has got to be the newest diet book or product. When that fails, we try the next one. The result is yo-yo dieting or weight cycling: Your weight goes down due to severe, unsustainable caloric restrictions and then it comes back up, usually to a point higher than where you started.

This country is in the middle of a health crisis. More than one-third of adults are obese. Another third of adults are overweight but not yet obese. The impact on our health is deadly: Heart disease, stroke, type 2 diabetes, and certain types of cancer, all increased by obesity.

I firmly believe that the only meaningful way to lose weight is to make long- term changes to your eating habits and incorporate more activity into your days. It all starts with small steps. Even a modest weight loss will provide important health benefits. Don't get discouraged if it takes a while to see dramatic results. Chances are you have put on your extra weight over the course of years. It could take that long to get it all off.

There are a million weight loss strategies; you can check them all out on the Internet. For me it boils down to three rules:

• Eat less.

• Eat differently.

• Move more.


There's nothing fancy or complicated. This isn't a short-term change where you eat something crazy for a week. It isn't about eliminating foods you love or training to be a triathlete. It is about small, livable changes that become habits. It is as much a mental adjustment as a physical one.


Eat Less

You need food to fuel your body. Food gives you the energy to do what you need to get done. But there's no way around it—you may be eating too much. Portion size has exploded. Everything is supersized. Remember what a bagel, a muffin, or even a fast-food hamburger looked like twenty years ago? Now they are two or even three times as large. We need to get back to healthy portions and the right balance of foods.

Cut back gradually. When you serve yourself, start by taking only three-quarters of what you would normally eat. After a month or so, do that again. Fill your plate with veggies and whole grains first, then add lean protein. Learn to eat only when you're hungry. How many times have you gorged yourself only to think, "I didn't even really need that"? Be conscious of when you are eating and learn your triggers for overeating—for some it's boredom, for others stress.

Don't be afraid to use a visual reminder. Put a big sign on your refrigerator—"Stop. Are you really hungry?" or tack up a photo of yourself at a former weight or someone at a weight you want to achieve for inspiration. Maybe you have a goal. Put a picture of someone doing an activity you hope to do, an athlete you admire, or a reward, like an outfit you want to fit into. Motivation comes in all forms.

Eating is also a social activity and no one wants to give up those get- togethers. Unfortunately, research shows that most of us eat more when we're with others than when we are by ourselves. Find additional ways to socialize, preferably ones built around physical activity. Even going to a movie or strolling around the mall with a friend is better than always meeting for drinks and nachos.

The number of calories you need depends on your size and your amount of activity. Two helpful tools for assessing your needs are the Centers for Disease Control and Prevention's adult BMI calculator, www.cdc.gov/healthyweight/assessing/bmi, and the U.S. Department of Agriculture's ChooseMyPlate.gov site, which offers the new governmental food guidelines to help you make healthier choices, www.choosemyplate.gov/weight-management-calories.html.

Keep a diet diary and then go online to figure out how many calories you are consuming right now. Then look at ways to make a change. If you take in five hundred calories less each day than you burn up, you will lose around a pound per week, a realistic goal. This can be split between eating a bit less and exercising a bit more.


Eat Differently

In a 2007 New York Times article, the food writer Michael Pollan gave simple but accurate advice: "Eat food. Not too much. Mostly plants." I couldn't agree with him more. Eat food your great-grandmother would recognize—fruits, vegetables, and products with ingredients you don't need a degree in chemistry to understand. Start fresh. I like to say there are no bad foods, but I make one exception: Soda. Get rid of it. Sure, you can have one occasionally, but best to get it out of the house so it's not there to tempt you. It's just empty calories that have absolutely no nutritional value. Cut back on other sweetened beverages. Say good-bye to the chips and all the other junk food that is going to sideline you. I'm not saying you should never eat processed food, but if you don't keep it around, it will be easier to regulate. Save it for a treat when you are dining out. You'll also be less tempted to indulge if it's not in your cupboard. You might need to "retrain" your palate to enjoy less sugary and salty snacks. Replace junk food with healthier options. Instead of processed food snacks, keep dried fruit and nuts for munching. Keep a bag of baby carrots in the fridge but get rid of the ranch dressing.

These steps aren't easy to do, so here's my advice: Do it gradually. As a pediatrician, I often help parents wean their toddlers off juices. We start by mixing the juice with a little bit of water, then gradually increase the water and lessen the juice. After a month or so, the children are drinking water and enjoying it. You can go the same route. Gradually wean yourself from sodas, juices, and snack foods. If it's too hard for you to eat a sandwich without chips, try the baked variety and eat half of what you normally would. I like to put a serving on my plate and put away the bag so I'm not tempted to go back for more. Fill up your plate with a side salad, carrots, or sliced apples, so you don't feel deprived. Trade half-and-half in your coffee for milk, and go from full-fat dairy to lower-fat options.


Move More

I'm not even going to say exercise more. Just move. Take the stairs. Go for a walk—two or three times a day if you can, even for five to ten minutes: Before you start your day, at lunch, and after work. It doesn't have to be far, but just start somewhere. Once you are walking for a while, try seeing if you can walk faster, longer, or even jog a little. Ask a friend to go with you. Join a gym. Get a trainer, anything to get you to stick to it. That's all it takes, little steps that become bigger ones.

Changing your lifestyle to lose weight permanently is not going to be easy. You are not going to be perfect. You shouldn't be. Just forgive yourself and get back on track if you get derailed. Food is something we should enjoy. Losing weight will never work if you equate it with punishment. Think of all the benefits of being healthier, instead of fixating on what you are giving up. It's all about balance.


DR. B'S BOTTOM LINE:

Dieting is not the best way to lose weight. Unfortunately, there is no magic to weight loss. To lose pounds and to keep them off, you need to make a lifetime commitment to get your weight under control through healthy choices. Eat less, eat healthier foods, and move more. Your body will thank you for it.


MY TOP 3 TIPS FOR LOSING WEIGHT CAN THE SODAS

Replace your daily twenty-ounce soda with water and you could lose twenty-five pounds in a year, or try sparkling water with a splash of juice instead.


TAKE IT HOME

It is so hard to watch what you eat when you dine out. Restaurant portions have ballooned. At the start of the meal, ask for a takeout container and only leave on your plate what you want to eat. It is harder to resist overeating if you wait until the end of the meal to pack it to go.


BUY NEW PLACE SETTINGS

Studies show that people take smaller portions if they are given smaller plates and bowls. Look in your cupboard and think about downsizing. Also, color matters. If you serve your food on plates that contrast with the food color, your portion will look larger and you will eat less.

CHAPTER 2

WILL EATING SIX SMALL MEALS A DAY INSTEAD OF THREE BIG ONES HELP ME LOSE WEIGHT?


Six meals instead of three? As my kids would say, "Sweet!" Who wouldn't want to eat twice as often? Why stop at six? Eight is even better. Or is it?

With all the diet books and various weight loss strategies, it is so hard to convince my patients that losing weight is all about taking in fewer calories than you burn off. It doesn't matter if you eat three meals or ten—if you consume the same total number of calories and types of food over the course of the day, your weight loss or gain will be the same.

What got everyone talking was a 2001 study in the British Medical Journal that found that people who reported eating six small meals each day had lower cholesterol than those who said they ate one or two. Suddenly experts were weighing in on why smaller meals were better. Some supposed they helped to keep your metabolism revved up. Others thought with constant grazing, overeating from hunger would be less likely than when you had a longer span between meals. But when all was said and done, there was no consensus on whether you were metabolically better off eating three or six meals.

A 2010 study finally addressed this head-on. Two groups went on a weight loss plan, consuming the same calories. One group ate three meals and the other ate six. At the end of the study, there was no statistical difference between the amounts of weight lost by the two groups.

Now, I do need to throw a bit of a wrench in the works when it comes to "a calorie is just a calorie." There are new data that suggest the type of calorie does have some impact on how you burn it, by changing something called your metabolic rate. The higher your metabolic rate, both while exercising and at rest, the more calories you will burn up. Ever know someone who can eat as much as he wants and never gain weight? This may be due to his metabolic rate being higher. Researchers at Harvard studied people on three types of diets of equal calories: A low-fat diet, a low-carbohydrate diet, and a diet low in fat but rich in complex carbohydrates. They found that those on the traditional American Heart Association low-fat diet had the biggest drop in their metabolic rate. They just did not burn up calories as fast. Those on the low-carb diet had the smallest drop, with those on the complex carbohydrates in between. While they didn't follow people long term, this suggests that what type of food you eat—in addition to the total number of calories—may have an impact on how easy it is to lose weight and keep it off. Stay tuned, as this is a hot area for ongoing research.

But back to six meals. I'm not saying that this style of eating is wrong or harmful. The important thing is finding what works for you. If you frequently get hungry, or are afraid of being deprived while losing weight, having smaller "meals" might work better for you. Remember, these six "meals" should each have about half the calories of traditional meals. They should also be nutritionally balanced. For others, such a small meal is just not satisfying.


DR. B'S BOTTOM LINE:

Assuming you eat the same types of food and take in the same number of calories over the course of the day, whether you eat six small meals a day or three larger traditional meals, you will gain or lose the same amount of weight.


SNACK TIME

Here are my favorite healthy, well-balanced mini-meals. Try one the next time you're hungry.

• Cheese, apple slices, and whole wheat crackers

• Peanut butter on a banana with raisins

• Hummus on whole-wheat pita and carrot sticks

• Greek yogurt, fruit, and granola parfait

• Half a whole-wheat bagel with tuna salad and tomato

• Half a turkey, avocado, and tomato sandwich on multigrain bread

• Multigrain waffle with almond butter and strawberry slices

• Smoothie made with yogurt, frozen fruit, and fruit juice

• Quesadilla with cheese, black beans, chopped veggies, and salsa

CHAPTER 3

ARE JUICE FASTS GOOD FOR ME?


My wife is a yoga enthusiast. At her favorite yoga studio, not a month goes by without someone sponsoring a juice fast. When she's asked if she'll participate, she replies, "No thanks." She, like I, believes that eating sensibly is the best way to stay healthy and maintain a desired weight. When she questions her fellow yoginis why they are partaking or asks what they know about the actual product, she's usually met by silence or phrases like "flushing toxins" and "cleansing systems." No one really knows why they are shelling out hundreds of dollars not to eat, instead of spending a fraction of that amount buying healthful foods.

Fad diets, including cleanses, seem to be contagious. You hear of celebrities dropping scores of pounds for a role by drinking some horrifying lemon and cayenne pepper concoction and think, "Well I can do that, if I will look like them." I'm not sure why many dieters are willing to go to those extremes, but when it comes to maintaining healthful eating habits, day in and day out, it seems too difficult.

The Academy of Nutrition and Dietetics (formerly the American Dietetic Association) recommends staying away from fad diets. If you lose weight too quickly, you'll lose muscle, bone, and water and be more likely to regain the pounds quickly afterward.

The argument for juice fasts relies on two important misconceptions: That our digestive system needs a reprieve from solid foods and that nutrients in liquids can be more easily absorbed than solids. There is no scientific data to back either rationale. Unless you have a problem with your digestive system that prevents you from breaking down solid food, there is no need for a liquid diet.

When it comes to toxins, your body has quite wonderful systems for handling them. Your kidneys and liver work to remove and excrete them through bodily waste. Some toxins get deposited in your bones and other tissues and take time to be excreted. However, there is nothing to suggest that drinking liquids helps liberate these toxins from your body any faster. Similarly, colonics do not cleanse your colon any better than normal digestive function and in fact, can cause injury if incorrectly done.

A juice fast isn't even guaranteed to make you lose weight. If the juices are low-calorie, you will lose weight, but some juices have added sweeteners, which could actually deliver the opposite effect. You will lose or gain the same amount of weight, calorie for calorie, whether you ingest it as a liquid or as a solid. By juicing your fruits and vegetables you are also losing out on the nutrients found in the skin and pulp and are more likely to feel hungry faster because you are missing the fiber. There's just no good reason not to simply eat what you think you are drinking. That way you know exactly what you are ingesting and you're doing it in its purest, unadulterated form. Another reason to look at the ingredients: Some cleanses contain supplements and herbal products that can be dangerous.


(Continues...)

Excerpted from Tell Me the Truth, Doctor by Richard Besser. Copyright © 2013 Richard Besser. Excerpted by permission of Hyperion.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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