Week 4: Dr. Oz Diet Secret

Or at least that is my paraphrase of a Woman's World headline at the supermarket checkout. We expect miracles, and if it is in a pill ... so much the better. We know these headlines are false, but hope springs eternal in the human breast. By hope, I of course mean self-deception.

Or maybe the headline is "Cancer Cured by Asparagus." The person sharing this on Facebook will include a statement like,"Isn't God great?" Well, God is great, and asparagus is a great food that is an important part of my household's dietary choices as spring approaches and the price drops. But do we really expect a life long pattern of bad choices will be cured by gingko biloba and asparagus for dinner?

Based on the posts I read on forums or Facebook I can only conclude we do.

Or at least this is the lie we tell ourselves.

The truth is that we need to change what we eat, how much we eat, and where we eat it. We need to change our whole perception about food. We need to change where we spend our time, what we do with our time, and what we do with our bodies. We need to change our whole perception about our bodies and what to do with them. I can just see you cringing as you read this. How do I know this? I am cringing too.

The last thing I want to do is discourage you, or myself. But this is hard. 

We could blame our upbringing. "I can't help it, my mommy made me deep-fried banana peanut butter sandwiches." We can blame society. "Babylon the Great controls our food supply." We can blame advertising. "They're magically delicious." We can blame our metabolism. "I am hungry all the time." Or we can blame the person really responsible. Look in a mirror. I am not saying that all these excuses are not valid. They are. But ultimately who controls what you eat, what you watch, and what you do? You do. 

The last thing I want to do is discourage you, or myself. But this is hard.

But as The Sphinx said in Mystery Men, "If you doubt your power, you give power to your doubt."

Why am I giving you a pep talk in the blog post that is designed to discuss your blood lipid profile? The reason is simple. Your doctor might be suggesting you take a statin drug if your lipid profile is not quite right. Why do they do this? A lot of it is the modern philosophy of medicine--take a pill. But far more important is the attitude of the patient. The patient wants what the patient wants, and this is not to change their life. They want a Twinkie while watching football drinking beer with their statin. The doctor knows this. So out comes the prescription pad. You can't really blame him.

It is not in dispute that the most effective way to improve your blood profile is to lose weight. It actually does not matter how. But even more important is what you eat, although the dietary advice is not consistent. My suggestion over the next year is that you try various ideas out on yourself and see what works. Small incremental changes are best. 

Remember that all drugs have side effects, yes even vitamins. Statins have side effects too. For most people who refuse to heed the Santana song and "change your evil ways, baby," taking a statin may be for the best. Are you that person? I hope you are not. (Note that those with a history of heart disease might need a statin even if they change their evil ways.)

Note that I am not a doctor, nor do I play one on television or on the Internet. I am not giving medical advice. Obviously any change in medication must be done in consultation with your doctor. I sure consulted mine. He was quite helpful in gradually reducing my blood pressure medication as I lost weight. The side effects from my medicine, as I got healthier, actually went up and I needed to decrease my dosage to prevent fainting from low blood pressure. 

At my last appointment my doctor said that he had a different mix of patients as they were more willing to change. This is because we live in a mountain community where hipsters greatly outnumber rednecks. Hopefully I can eat properly and still not become a hipster!

My doctor also mentioned that there was a reason for someone to have high cholesterol. The body is producing it in order to fight inflammation. In my words, it is a sign of an underlying problem. There is nothing wrong with treating a symptom, but it is better if at the same time one treats the cause of the inflammation--what you eat, how much you eat, and your activity level. So if you and your doctor decide that statins are best, be sure to change your evil ways as well, but gradually over time.

I am not going to comment on your exact numbers. First I do not feel competent to do so. Secondly, get a print out of your lab results and that print-out will tell you the parameters for the various lipid types. The only one that may not be well understood is triglycerides. A much lower number may be optimal. This will be the subject of a future week. Note also that there is a difference between average and normal. This may skew the recommended numbers away from optimal.

The homework for this week is this presentation by Dr. Barron at UCSF obesity center.

Note that I think that LDL and HDL are good markers for lipid health, AboB and LDL particle number may be even better.

Week 4 Action Plan: This week continue writing down everything you eat. You have to know where you are to devise a plan to get where you want to be. Reduce/eliminate diet sodas and all caloric drinks of any kind. You want to change your taste buds as rapidly as possible.

If you have not done so, go ahead and make an appointment and get your blood lipid work done.

Week 3: Fat People Drink Diet Drinks

Think about the title to this week's health post. While I hope you will read and benefit from this post, if you meditate on the title you already have all the information you need on this topic. 

First let's talk about non-diet drinks. In a study of the obvious the following conclusion was drawn:

Researchers from the University of Virginia in Charlottesville surveyed the parents of 9,600 children born in 2001 from across the nation, asking questions about their TV-watching habits, socioeconomic level, and children’s consumption of sugary drinks. The completed study, published in this month’s issue of the journal Pediatrics, reported that five-year-old children who drank beverages sweetened by sugar every day were 43 percent more likely to be obese than those who drank the beverages less frequently or not at all. 

If you have young children what are they drinking? The answer for my household is mixed. My daughter has never drunk a soda. She does however use sweetened tea on occasion. She takes the sweet tea we buy and cuts it by 50% with water. So progress is being made. She is also gradually reducing the sugar she puts into tea. I am trying to lead by example by not drinking such items myself.

Note that an exercise in the obvious is beneficial. We often miss the obvious, at least I do. Most of what I will discuss over the next year is obvious, yet we as a nation do not do it! 

Why do sugary drinks have this effect? The reason may be that we do not fully register the calories when we drink something sweet. 

“Sugar provides empty calories, and sugary drinks are unnecessary calories which often do not register and help—children or adults—feel full,” Young tells TakePart. “We also usually eat something along with the drink, so it is getting a double dose of calories. This is a huge concern as they are forming habits, and drinking sugary drinks is a bad habit.” 

In addition the body has to process a sudden increase in sugar and a lot of insulin is produced. This will produce hunger later as blood sugar drops. Sorry, but fruit juices are not much better. 

Diet drinks have no calories so they must be all right, right? But remember my title. We all know it is true by observation, but it is also been studied. Here are the results of one study: 

Results. Overall, 11% of healthy-weight, 19% of overweight, and 22% of obese adults drink diet beverages. Total caloric intake was higher among adults consuming sugar-sweetened beverages (SSBs) compared with diet beverages (2351 kcal/day vs 2203 kcal/day; P = .005). However, the difference was only significant for healthy-weight adults (2302 kcal/day vs 2095 kcal/day; P < .001). Among overweight and obese adults, calories from solid-food consumption were higher among adults consuming diet beverages compared with SSBs (overweight: 1965 kcal/day vs 1874 kcal/day; P = .03; obese: 2058 kcal/day vs 1897 kcal/day; P < .001). The net increase in daily solid-food consumption associated with diet-beverage consumption was 88 kilocalories for overweight and 194 kilocalories for obese adults.

I am not a fan of such studies since the groups being compared are so very different. It may actually be that these people would be even heavier if they did not drink diet drinks. Maybe. But psychologically it may lead to eating more, with the internal self talk of "I had a diet drink so I can eat that dessert." 

The Arteriosclerosis Risk in Communities Study showed that diet soda drinkers were 34% more likely to have Metabolic syndrome.

Metabolic syndrome is a disorder of energy utilization and storage, diagnosed by a co-occurrence of 3 out of five of the following medical conditions: abdominal (central) obesity, elevated blood pressure, elevated fasting plasma glucose, high serum triglycerides, and low high-density cholesterol (HDL) levels. Metabolic syndrome increases the risk of developingcardiovascular disease, particularly heart failure, and diabetes.[1] Some studies have shown the prevalence in the USA to be an estimated 34% of the adult population,[2] and the prevalence increases with age.   

At the start of my journey toward better health I had all five of these. Now I have two, maybe three depending on what the cutoff for high blood pressure currently is. I will be talking about metabolic syndrome later. But note that the study did not really prove that diet drinks caused metabolic syndrome. It may be that those with this problem tend to use diet drinks, not the other way around. 

So should you be using diet drinks? While it may be coincidental, I can only point out that personally limiting diet drinks was to some degree associated with my weight loss. 20 years ago I used 8 8oz servings of diet drinks a day. Now I drink about 1 16oz serving a month. My goal is zero. 

I have noticed that my taste buds have changed with the elimination of diet drinks. I was crunching on a Brussels sprout and noticed how sweet it was. I was shocked. While you may never move Brussels sprouts to the top of your personal vegetable hit parade, without the overload of sweetness your perception of food will change. This is why I am suggesting limiting diet drinks so early in the one year journey we are on. The sooner you change your tastes the better. 

I have always had a nagging feeling about diet drinks, and asked myself, "What does the body do when it thinks you are drinking a large number of calories due to the sweetness in the diet drink?" If it produces insulin in response, then you will be hungry. Research tells us that I was not alone in wondering this. It is known that if you drink diet soda with a meal the artificial sweetener will cause more insulin to be produced. But it was not significant in one study. However, GLP-1 was increased.  Although as is normal for the health field, another study disagrees. 

Click here for a popular level discussion of these issues. This article is the first of your homework for this week. 

The second part of your homework this week is Dr. Hyman's presentation on diet drinks. I will be discussing all the diet gurus like Dr. Hyman later. I did find this presentation convincing and watching it led to my decision to reduce diet drinks. 

But you can't beat something with nothing so I suggest you try other drinks instead. The biggest problem for me is traveling. You may have heard of my first choice--dihydrogen monoxide. Another choice is a carbonated bottled water like Perrier. If you plan ahead, you can buy a 26 oz flavored Perrier for $1.50 at Walmart. 

You might try a soda stream machine. It makes carbonated water cheaper, but to my tastes not quite as good as the purchased product. Note that the link to SodaStream contains samples that I do not recommend. 

What I did at first was drink more coffee. I am backing off this and am trying to limit myself to two cups a day. I try to drink a minimum of four cups of green or black tea a day. There is good evidence that green tea is very good for you. This link is your final homework assignment for this week. 

No, do not take the green tea concentrate pill. The modern desire to think that we just need a pill to solve everything is one reason we are in the health crisis we are in. I will be talking about the pill mania for the next two weeks.  

Action Plan for Week Three: Dramatically reduce all sweet drinks, real or artificial. Replace them with dihydrogen monoxide and green tea. 

Remember the wisdom of Socrates, "The unexamined drink is not worth drinking."

Week 2: The Unexamined Food

As Aristotle should have said, "The unexamined food is not worth eating." We really do not know what we are eating. We coast through our dietary day without thought. 

I suggest you think. I know thinking is hard, especially about something we are not used to thinking about.  

The reason I know that diets don't work is from hard personal experience. I actually went on the medically supervised fast that Oprah went on--Optifast. I basically ate nothing but drank 600 calories a day for months. I lost 80 pounds. But of course I gained most of it back. The Optifast program tried really hard to teach us the right way to eat, but it did not work. 

But one of the most interesting, and for me helpful, memories from that period was that on the first week we did not fast. We ate normally. The only requirement for that first week was that we write down everything we ate. I am not sure why, maybe I was embarrassed to discover what I was really eating, but I lost the most weight that first week eating whatever I wanted. I lost 8 pounds. 

So the first step on our journey is to write down everything we eat. Yes, I hear what you are grumbling to yourself right now. I am not saying it is easy, but with modern technology with an iDevice or Android it is surprisingly easy. Here is a tutorial for the program I use, FitnessPal. 

FitnessPal does have some issues. Some of the entries have typos and are not complete in the nutrient information. But personally I have found no tool as helpful as keeping track of what you eat. If you don't have a portable device, the same thing can be done on the website. 

Do not at this time try to limit what you eat. The goal for the next week is to know what you are eating right now, to know what your problem areas are. Just set a higher level for your calories, and try to ignore FitnessPal's dietary recommendations as they assume you want to eat high carb/low fat. You may, but we will talk about this later.  

Knowledge is power. 

(If you have not yet gone to your doctor, do so.) 

Week 1: What's Measured Improves

The title is a paraphrase of a famous quote from management consultant Peter Drucker. He used it to show that if you measure the wrong things, yes, what you are measuring may improve, but the goals you are trying to achieve may slip through your fingers if you measure the wrong things.

So today, and every Friday hereafter, I will be making suggestions that I feel will help you become healthier. My first suggestion is that you make an appointment with your doctor for blood work. This will give you a starting point from which you can measure your progress.

What do you measure? This is where it gets a bit controversial. Many doctors do not realize that cholesterol does not matter. This is not some goofy idea that I have developed, this is the consensus view currently. I am not saying that the results of the blood lipid panel I am going to suggest has no value. On the contrarily, it is important. It is just that the measure of total cholesterol is not as valuable as the measure of the various sub categories of cholesterol. In particular it is what is called your LDL and HDL cholesterol that is important. LDL is commonly called "bad"cholesterol. It is not bad, but remember the adage I have already shared, "the dosage is the poison." It is too much that is bad. LDL delivers cholesterol to where the body needs it. Too much LDL carrying cholesterol is an indication that something is wrong. Too much LDL means that the risk of cholesterol being delivered to the wrong place increases. HDL looks for damaged cholesterol and removes it for disposal. So you want LDL low and HDL high.

Note that many typical blood panels do not actually measure LDL. I have always found this puzzling. Instead LDL is guesstimated. Ask your doctor for LDL to be measured, not calculated. When this was done for me my LDL went up to the moderate risk level. The guesstimate had been wrong. You might not be able to get this done. 

The reason cholesterol was used as a benchmark was that the chances are that if your cholesterol was high, so was your LDL. But LDL is a better measure. In the same way there may be a better measure than LDL. Here is where I enter an area where there is no consensus. The blood lipid that many prefer is called ApoB. A similar marker is to measure LDL particle number. Both may be better than LDL as an indication of cardiovascular health. So when you watch a health presentation and hear that your cholesterol level is important you are listening to old, obsolete information. 

An optional test would be to measure particle size. This test tells you how big your LDL particles are. Imagine the effect of a small, hard bowling ball being pushed around your blood stream, occasionally plowing into your artery wall. Now imagine instead it is a soft, large beach ball bounching off the arterial wall. Soft and large is healthier than small and hard. Size does matter. 

You also need to find out what your vitamin D level is. There is a blood test for that. It is estimated that 80% of the population is deficient.

Measuring the insulin level in the blood is another important test. In any event you should measure your fasting blood sugar as well.

I suggest you make an appointment with your doctor before your blood test. He might not be used to measuring some of the things you want to measure. That way you get what you want with no surprises.

Here is what you want. A blood lipid panel that actually measures LDL. You need to know your ApoB and/or particle number. You need to know the amount of vitamin D in your blood. You want to know your fasting blood sugar, and knowing your insulin level would be a nice bonus, although your doctor may not wish to order it unless your fasting blood sugar is high. Most panels measure homocysteine levels as well.

Your doctor should be your friend, not your enemy. No doubt based on his knowledge of your medical history he may want additional tests, a PSA test for men for example. For me it was a uric acid test because of my history of gout. (While I no longer have a constant twinge in my big toe after all my dietary changes, I still have elevated uric acid levels, and ocassionaly pain in my big toe. It is much improved)

I will be talking about the results of your blood tests in week 4, which will allow enough time to get back your results. Even if you are not going along this one year journey with me, the chances are you have not had a health exam for a while. Now is the time.

Remember that what you measure is what you will focus on, so be sure to measure the right things.

Diets Don't Work

Am I telling you anything you don't know?

I thought not.

One reason they don't work is that we have the idea that a diet is something temporary. We think, even if we know better, that this will be a short term change and after that we can return to having pop tarts. We can return to them if we wish, and we might, once the diet is over. (Can you tell that there are pop tarts in the house?) 

What is needed instead is gradual permanent change. Small changes add up. This is a sustainable approach and it is what I did. So, over the next year I will offer various suggestions to change what you eat. Most of them you already know, but don't do. By focusing on one change a week, "muscle memory" can gradually be built up.

If you make radical change all at once, there are several risks. First you risk confusing your body. If your body thinks you are starving, it will reduce your metabolism. This is why dieters rebound, often to a new higher weight. They have reset their "set point" at a lower level and if they return to their former habits, they gain weight. 

A diet may force you to permanently adopt your diet caloric intake to be your new intake--permanent misery. Instead I will propose that you eat what you plan to eat for the rest of your life. Thus the ultimate name for this series of blog posts will be "Plan What You Eat." So don't lose weight too quickly. In fact you should not try to lose weight. Instead eat what you already know you need to eat, and then, as a side effect, you lose weight.

There are several other negative possible consequences to losing weight too rapidly. There is a connection between rapid weight loss and losing your gall bladder. If you lose weight rapidly you might end up with Richard Simmon's problem. There is a reason he wears baggy clothes. He has a lot of hanging skin around his midsection. Losing weight slowly will not eliminate this, but it will help. The body also stores toxins in the fat. If you lose weight rapidly, you risk drenching you body with all these toxins at once. This cannot be good for you.

Do not go on a diet. Instead gradually change your habits until your habits are healthy habits.

Today's "homework" assignment is Dr. Barron's presentation on the myths of obesity. Dr. Barron heads the UCSF obesity center. He notes in the presentation that the level you set your calories on a diet will become your new permanent level if you want to avoid weight gain.

Be careful, do not diet.

Note that you need to use your own best judgment on any "homework" I assign.