Goodbye Paleo! Until We Meet Again...

by Laura Burton

It’s been 13 days since the 30-day Paleo experiment. If you haven’t read my first post, you can read it here. Let me catch you up on the past 23 days.

The last 10 days of the Paleo plan were overall a little easier than the first 20. I had gotten in the groove of meal planning and snack-packing, and I was becoming accustomed to saying a simple ‘no’ to my cravings (which were becoming less frequent, by the way).  It’s funny - my mind actually felt a great deal clearer since I wasn’t spending mental energy combating the grasp of cravings against good sense, or bargaining with myself for little everyday treats. Certain foods were off-limits, and that was that. As restrictive as that sounds, it was surprisingly freeing.  

But let’s get to Day 30 – the eve of the eagerly anticipated ‘eat what you want’ day (which felt strangely similar to Christmas Eve, if that gives you any idea how excited I was). I spent the majority of this day contemplating what foods would be really worth indulging in the next day. I woke on Day 31 with an extra pep in my step – cereal! I fixed my bowl of Fiber One mixed with Cinnamon Life and frozen blueberries and prepared myself for an awesome experience. But to my surprise, the cereal was just okay. As I started packing that day’s snacks and lunch I instinctively went for the almonds, the chicken breast with tomatoes and slaw, and strawberries – all Paleo foods. “Are you kidding me?!” I thought. “I can eat anything I want today but my body is actually craving lean protein, vegetables, and fruits? This is nothing short of a miracle.”

Since then, I’ve had my share of sweets, margaritas, and bread. And don’t get me wrong – I’ve enjoyed them. But I feel less-connected to those foods. I have found a satisfying balance between the strict rules of Paleo and the freedom to eat what I want. I have incorporated low-fat dairy, peanut butter, and beans back into my regular diet. I eat probably 2-3 servings of whole grains a day, which seems like a good balance for me. Diet drinks are back in the game, and they’re not going anywhere any time soon! For the most part, I'm eating the foods that make my body feel good and function better.

The post-Paleo me is more comfortable with hunger (not stomach caving in, give me food or I might get violent hunger – because there is nothing comfortable about that, and I try to avoid this intense hunger at all costs). I plan my meals and snacks in 3-hour increments, and usually I get a nudge of hunger about 2 hours after I eat. Previously, and especially if I was stressed, I would almost panic, thinking “What can I snack on until I can get to my lunch in an hour?” or “What can I munch on while I’m cooking dinner?” Since I didn’t have a whole lot of options for extra snacks on the Paleo plan, it trained me to sit in my hunger until my planned meal or snack time rolled around. It taught me to feel and appreciate hunger – not hate it. 

To sum it up, I’m thankful for the experience, and yes, I would do it again! I think it’s healthy to challenge ourselves every now and then; we need reminders that we can still be very much in control of our health. But let’s not make this out to be bigger than what it was: simply a series of small, consistent, smart decisions. That’s the key to good health – Paleo or not. 

Moving Marbles and Realizing Success

Everyday we're bombarded with so many stories about the hopeless nature of our unhealthy lifestyles. This is usually compounded by the stories that remind us of how difficult it can be to shed the pounds once you've gained the weight.

However, for me, I'm also reminded each day that success is easily realized and comes in all different flavors.

For example, I had a patient tell me about the thrill she had from being able to give blood for the first time because her blood pressure is now adequately controlled as a result of losing weight and living a healthier lifestyle.

One of our patients described the thrill of not having to use extra insulin throughout the day to cover her previously out of control blood sugars. Several others this week have talked about not having to take any medications for diabetes at all!

For those who have dealt with the limitations that being overweight can place on you, being able to do things like cross your legs or sit in an airline seat comfortably (all things we can take for granted) are major accomplishments that deserve celebration.

I was inspired yesterday when one of our patients told me how she marked her progress and celebrated each weekly victory. She used a jar of marbles to symbolize her extra weight that she wanted to lose, and each week as she lost weight, she moved those marbles to another jar to mark the accomplishment. All at once, she reminded herself of how far she had come and where she didn't want to return.

What marbles have you moved this week?

Goodbye Processed, Hello Paleo!

by Laura Burton

Well, I decided to give it a go. After several weekends of weddings, new cities, and social events, each boasting an array of culinary treats (that this foodie gladly took advantage of), I could tell my body was seeking a respite from some of the processed, high-sugar foods I had been so graciously feeding it.

I stumbled across a blog where the author announced she was starting “Whole30” that day. I was curious, so I looked into it. Whole30 is pretty much a 30-day “Paleo Diet.” This plan requires that you eliminate certain food groups that could be having a negative impact on your health and fitness. What’s allowed? Meat, seafood, eggs, vegetables, fruit, and good fats from fruits, oils, nuts and seeds. What’s NOT allowed? Added sugar, artificial sugar, alcohol, grains, legumes, dairy, carrageenan, MSG, sulfites, and white potatoes. Oh, and no paleo-fying dessert or junk food choices, which means no paleo pancakes…(sigh). The idea is to focus on making good food choices for 30 days with the purpose of feeling and performing better. The dietitian in me was intrigued! The food lover in me was terrified.

Today is Day 20. 

My body began to feel differently from day 1. The first few days I had a mild headache, which I attributed to my body mourning the absence of its regular pick-me-up: sugar.  I immediately felt that my energy level was not only higher, but more consistent throughout the day. No more ups and downs based on my blood sugar. I began sleeping better and feeling more hydrated within days. To my excitement, my stomach felt more full after eating since my intake mainly consisted of high-volume foods: fruits and vegetables. Pleasantly surprised, I forged on with a sense of confidence that I might actually be able to do this!  

Mentally, I realized that this would be no easy feat. First, I longed for those foods I couldn’t have – and not just sugary treats. I remember at one point standing in front of my pantry, staring at the Fiber One box (Fiber One of all things!) nearly in tears as I realized I would spend the next twenty-something days eating eggs and fruit for breakfast.  [Confession: I might have an unhealthy attachment to cereals of all kind.] Second, I quickly learned that planning ahead was essential. I had to thoughtfully plan every meal and every snack to be sure I was getting the nutrients and energy I needed. 

It quickly became evident that my thought processes regarding food were really changing. I became more aware of impulses to eat throughout the day, and rather than feeding my ‘cravings,’ I analyzed them. I was becoming a more mindful eater! I noticed that the complete removal of large food groups really works to my advantage since it eliminates the option of coming up with creative excuses to eat this or that, thus making food choices easier and helping me achieve compliance. Furthermore, the paleo diet got me out of my food comfort zone and forced me to experiment with different foods that I have come to love. Spaghetti squash has surprised me – I feel like I am enjoying a big bowl of pasta! Crunchy carrot chips with “Wholly Guacamole” is my new snack of choice. The other day I tried my hand at homemade slaw made with beautiful red cabbage, julienned carrots, cilantro, and a delicious, simple dressing of canola oil and lime juice. I have actually started to enjoy the process of preparing my foods because there is such purpose behind it. Sure, it takes more time. But I'm doing something good for myself.

From a dietitian’s standpoint, I have some reservations about the paleo diet. Vegetable protein sources like soy and legumes, which are off-limits on the paleo diet, are a heart-healthy way to get protein. In addition, whole grains can be a very beneficial part of a healthy diet when eaten in moderation. I question how realistic and healthful this type of plan would be long-term. But I can say with confidence that the past 20 days have shaped my relationship with food for the better, and that this experience will foster a more thoughtful approach to feeding my body for years to come.

I'll check back in in another 20 days to let you know how things are going post-Paleo...

Lights, Camera, Action

When most people begin thinking about changing their response to stress, they often start in the middle by trying to change the behavior. You actually need to start at the beginning by managing the trigger or cue.

Cues are the initial event that set into motion a series of behaviors that lead to some type of reward. That reward can be pleasurable or avoidance of some type of threat. But, without the cue to initiate the process, you can't get to the reward.

One of the biggest misperceptions about cues is that they can't be managed. It is true that you can't control a number of things that can be cues for habits you'd like to change; however, you do have a lot of control over things that influence your perception of that cue. For example, seeing the commercial for the latest fast food concoction when you're very hungry can prompt you to decide that is a decent choice for all types of reasons that you can seem to easily justify at the time. When you are not mentally and physically at your best, you can be much more susceptible to cues that prompt you to engage in behaviors that have short-term benefits but long-term negative consequences. Poor sleep, a lack of physical fitness, and irregular eating patterns set you up to be emotionally vulnerable to engage in poor habits, especially in stressful settings.

The other big thing that people don't understand about cues is that they can often be imperceptible. When this happens, we tend to chalk it up to a "craving." I have yet to come across a medical reason why your body needs to crave chocolate or crunchy snacks. We often just don't see how we are being prompted to indulge. For example, it's no accident that about 3 pm every afternoon, you start to have a hankering for some chocolate. It just happens to be around the time you've got to pass by the office that has candy on the desk to complete some routine task. While you just chalk it up to a routine craving for chocolate, it doesn't seem to happen on the weekend when you're at home or when you're traveling during the week. The jar of candy is always there...it's practically part of the landscape. However, it doesn't jump out at you or call your name (at least not literally), so you don't think much of it. But every time you pass by there at 3 pm, it sets up the cue followed by the routine (eating the candy).

Think about the cues that you deal with on a regular basis. Can you be better prepared to handle them this week? Are there cues that you didn't quite know were there? Once you're aware of those cues, how can you handle them differently?

Your Stress Response

Stress is the cue that causes you to have a predictable response. Do you know what your response is to stress? For a lot of us, it involves eating. You can alter that response if you begin to understand the cue and the reward.

Humans do things for one of two primary reasons: to avoid a threat or to get some benefit. I know it sounds primitive or even crass to think that all of your actions are dictated by these two basic emotions--fear and pleasure. But trust me, it's basic nature and allows us to survive and thrive. When something happens in our environment (at work, home, school, etc), we take in that information and process whether our response needs to be defensive to protect ourselves from a perceived threat or to react in a way that allows us to take advantage of a potential benefit.

Stress is a perceived threat for us. Overtime, we develop ways of coping with that stress. Some of these ways can be really healthy ways of decreasing the threat we feel-- taking a walk or doing some other type of exercise, meditation, engaging in a hobby, or doing something that allows you to escape for a while. Other times, we do things that are not always in our best long-term interest but nonetheless, help us feel safer or provide a sense of pleasure if only for a brief moment. Stress eating falls into this category. As we learn to associate a sense of pleasure with the foods we consume during stressful periods, it becomes a type of reward that reinforces the behavior. So at the end of a long day at work that was really taxing, you decide that you deserve to have that extra serving of food or that second glass of wine as a reward for dealing with your crazy boss. When this becomes a habit, meaning that it begins to happen almost involuntarily, then it becomes a real problem. How do you know it's a habit? When you find yourself finishing the bag of chips and you don't remember what was happening while you chomped away, that's what I mean by almost involuntary. Your brain is working on autopilot and going into "Soothe Me" mode. You've come to learn that salty, crunchy things take your mind off of your troubles for a while and magically make you feel better. So instinctively, when you feel bad, you start to crave these things and find yourself foraging for chips.

Next week, we'll get into that instinctive response and see if we can retrain our brains.

Beating the Stress Cookie Monster

Remember Cookie Monster from Sesame Street? Do you ever feel like attacking some chocolate chip cookies with the tenacity that he does? Most of us have probably felt that way on a very stressful day-- just let me at 'em! Last week, I blogged about how stress leads to weight gain. Now, we'll take a look at how to handle that stress differently.

The first key is hidden in the last sentence of the previous paragraph. It's the recognition that you will have to deal with the stress. It's an active proposition; stress can't handle you-- you have to handle stress. For some of us, we feel utterly helpless, and the stress of life can be as terrible as the poor cookies must feel as the Cookie Monster is ripping through the package. This feeling of helplessness causes us to hope for some period where our lives will be stress-free and go according to our perfect plan, but generally speaking, this never happens. Stress can ebb and flow, but it seems to always be there. Understanding that you can deal with it effectively is the first step to being effective in dealing with stress. As many others have said in the past, if you don't think you can, you probably won't.

The other equally critical component that people fail to consider in dealing with stress is the perception of stress. Do you realize that you actually create stress for yourself! Things happen to you all the time...what you do with that information and how you process those events leads to the feeling of stress and thus your emotional, physical, and behavioral response.

There is no denying that your perception is your reality, so you should work on shaping your perception so that your reality results in less stress in your life. It's really the classic glass half full or half empty issue. Some of us look at the upside of everything while others of us look at the downside. If you feel stressed and out of control, take a minute to see how you interpret the things that are happening around you. Contemplate the things that you can control and for those things that you can't control, let them go. When everything in your world seems out of control, food is one of those things that you can exert some control over. So you decide to "reward" yourself by making the choice that you want no matter what anyone says. You have the power to do that with so many other areas of your life! Why exert that control to only hurt yourself more? Don't be afraid to exert that power to do something good for yourself.  You'll find that the Cookie Monster can be tamed, and that he likes other things besides cookies.

In your journal this week, identify things that caused you to feel stressed. Try to figure out why you perceived it as stressful, how much control you had in that situation, and what types of choices you made as a result of the control you had. I'll be interested to hear what you find.

Running from Tigers and Bears

At least 75% of our patients identify stress as a major factor in causing weight gain for them. Dealing with stress effectively can make a huge difference in your ability to manage your eating behaviors and your weight. A lot of the solution boils down to being able to self-soothe without food.

Why does stress lead to weight gain? The basic explanation is that we are hard-wired to respond to stressful situations in a way that makes us ready to defend our lives. Back in the day, our stressors were things like tigers and bears. Nowadays, our stressors are unreasonable bosses and crazy family members. While we don’t have to outrun them or get into physical fights (or least we try not to), our bodies still respond in a way that makes us feel like we need to be prepared for that possibility. To be prepared, our bodies get signals from hormones and chemicals that we synthesize to fuel up for the impending danger. However, we our access to food is ever-present and much more calorically dense than when we were running from tigers and bears. So instead of foraging for nuts and berries, we forage at the vending machine, choosing the 650 calorie honey bun and the 200 calorie soda to get through the afternoon.

Another part of the explanation of how stress leads to weight gain is the behavioral reinforcement to which we unknowingly fall a victim.  Remember when you had a bad day at school and your mother offered you a piece of cake to “make it all better”? That type of experience conditioned you to associate feelings of comfort and solace with cake. The cake didn’t necessarily have anything in it that was a mood altering substance—I don’t think she would have slipped you some Prozac; however, your mother’s comfort and concern for you were linked to the cake. We have the ability to associate memories and emotions with inanimate objects like food. This is especially true for food because the sight, smell, and taste can be an incredibly powerful stimulus.  So now as an adult 40 years later, you’re still looking for a piece of cake when you get home from a tough day at work or after arguing with your significant other.

So if we know all of this, why can’t we simply change how we respond to stress and stop eating? This is a central question to why obesity is so challenging to treat effectively. Food is powerfully consistent in its effects on your brain. Part of this is due to the fact that a lot of our manufactured food is designed to be exactly the same bite after bite. So you know that the last bag of candy you ate is going to taste just like the next one. Even though you intellectually understand that you shouldn’t go for the chocolate just because you are upset, you still do it because you can count on it making you feel a certain way, even if only temporarily. Until you can identify something that helps you soothe yourself and relieve stress as reliably and immediately as food, it’s hard to beat the feeling you get from that food.

All hope is not forsaken though… 

Don't Get Pinched this St. Patrick's Day!

St. Patrick’s Day is right around the corner. Wearing green will prevent a pinch on the arm but eating green can prevent a pinch at your waistline! There are TONS of great green vegetables. To name a few: broccoli, spinach, green beans, peas, asparagus, brussels sprouts, and cabbage…and the list could go on. The good news is that you can eat large amounts of green veggies for very few calories. One cup is only about 25 calories! Now, that’s a big bang for your (calorie) buck!

This St. Patrick’s Day I’d like to highlight three green superstars--kale, artichokes, and edamame.

Kale: This leafy, green vegetable is loaded with vitamins A, C, and K. It’s also stacked with minerals like potassium, iron, manganese, and calcium. It can be cooked many ways including baked, steamed, and boiled. Check out the recipe for Kale Chips below. You can’t get more festive than that on St. Patty’s Day!

Homemade Kale Chips
Prep: 5 minutes
Cook: 12 minutes
Yield: 4 servings

Ingredients
3 cups fresh kale leaves
2 tablespoons olive oil
1/4 teaspoon sea salt
1/4 teaspoon freshly ground pepper

Preparation
1. Preheat oven to 450F.
2. Place kale on a large lightly greased cooking sheet. Drizzle with olive oil and sprinkle with salt and pepper. Bake in preheated oven for 6 minutes; toss gently. Reduce oven temperature to 300F and bake 6 minutes more. Let cool and serve immediately. Enjoy!

Artichokes: This unusual looking veggie is filled with magnesium, folate and potassium. One medium artichoke contains 10 grams of fiber! [Note: We should shoot to eat 25-30 grams of fiber per day]. You may have passed artichokes in your grocery store and thought, “what in the world do I do with those!?” Check out http://www.youtube.com/watch?v=_FT8iSDxFq0 for help on how to clean and prep your artichoke for baking, steaming, grilling, or boiling. Once you’ve prepared and cooked your artichokes you can add them to soups, salads, or roast them with spices and herbs! Delish!

Grilled Artichokes:

Ingredients
6 artichokes
1 tablespoon plus 1/2 teaspoon salt
1 lemon
3 cloves garlic, minced
3 tablespoons olive oil
2 tablespoons lemon juice
1/4 teaspoon pepper

Preparation
In a large pot, bring 1 to 2 inches of water to a boil. Add 1 tablespoon salt, the juice of 1 lemon, and artichokes; cover and steam until artichoke bottoms pierce easily, 20 to 40 minutes. Drain artichokes. When cool enough to handle, cut each in half lengthwise and scrape out fuzzy center. In a bowl, combine garlic, olive oil, 2 tablespoons lemon juice, 1/2 teaspoon salt, and pepper. Brush artichokes with garlic mixture and set, cut side down, on a grill over medium heat. Grill, turning once, until lightly brown, 8 to 11 minutes.

Edamame: AKA soybeans or “branched bean”. These little pods make for a fantastic snack or side dish. A ½ cup serving has about 60 calories and they are loaded with protein (about 12 grams/cup), fiber (5.7 grams/cup), and B-vitamins. They are easy to cook and mix well with other veggies. Shelled edamame is a wonderful addition to salads and pastas and it’s a killer addition to succotash. You can find edamame in the freezer section of your grocery store either shelled or in the pod—it’s your choice! Your next snack is waiting…

Steamed Edamame:

Ingredients:
1 package frozen edamame in the pod
Your favorite low-sodium spice blend (I love The Delicious Dietitian spice blends because they have no sodium—check them out at http://www.thedeliciousdietitian.com/lindseylee/).

Preparation:
Place edamame in a microwave safe bowl. Add 2 tbsp water. Sprinkle with your favorite, low-sodium spice blend. Cook on high for 2 minutes. Enjoy!

I hope you are a lean, mean, green-eating machine this St. Patrick’s Day!

In the words of one of my favorite bloggers...until next time...."Healthy Eating!"

Lindsey

The Battle between Consistency and Perfection

In the journey to lose weight and adopt better lifestyle habits, perfection is NOT the goal. Consistency, however, IS the means and the end.


In working with one of my patients this week, I noticed that she was apologizing throughout our session. We were reviewing her food journal, and every time we came across a food she deemed "unacceptable" she apologized for "messing up" or making a "mistake." This is not an uncommon experience—patients tend to approach weight loss as if there are hard and fast rules that can't be violated. In the worst form, people give up after breaking these rules or "cheating" as most people call it. They find that they can't get back on track because they only anticipate that they will find themselves breaking the rules again very shortly.


The All or None way of thinking can dominate your approach to healthy lifestyle behaviors, and when you're on track, you feel invincible and incredibly focused. However, when you're off track, you're a train wreck full of despair. The All or None approach may be helping you in some aspects of your life. For example, you may be able to block out distractions and have laser-like focus on work projects. This can lead to you being incredibly successful and accomplished, but it won't help you when you're trying to modify your lifestyle.

Sometimes, you may miss the mark. Just keep aiming in the right direction

Why can't this approach work? Healthy living and losing weight is not governed by some set of rules and regulations. Despite what some people may have you believe, there are many effective strategies to achieving a healthy lifestyle and weight. You have to find a way of doing things that works for you, based on your situations and unique challenges. As you develop this approach, your goal is to implement it consistently. You also have to take ownership of the actions and choices you make using a framework other than "cheating." You're not cheating anyone if you eat the chimichanga and your original intent was to get the grilled fish. That was a choice you made, and you should own it. When you own it, you have to then understand why you made the choice and how you can make other choices that are consistent with your goals the next time.


Liberate yourself from the unattainable goal of perfection and go for consistency. See how much easier that feels already!

Dear Dr. Benjamin

I had the privilege to hear and meet our Surgeon General, Dr. Regina Benjamin, at UAB yesterday as we kicked off National Nutrition Month with a great event sponsored by the Department of Nutrition Sciences. In one of the introductions describing the wonderful person that she is, Dr. Benjamin was described as the health care Santa Claus for the nation. She has been preaching a message of joyous health and working hard to bestow the gift of healthiness for all. As the nation's doctor, she has worked to deliver a message that our health care system should be focusing on health promotion and prevention of disease just as much as we focus on developing the best medical technology in the world for treating disease. Since we were there to focus on nutrition, a lot of her remarks dealt with obesity. I figured that I might follow up with a Christmas list of things I'd hope to see as we all try to fight the obesity issues we face.
My list for healthcare Santa Claus:

1. Prescriptions for healthy eating- as a primary care trained internist, I know and appreciate the benefits of modern medicine. Prescriptions for medications to control acute and chronic diseases are wonderful to have available; the insurance coverage for these medications is even better (when available). I would like to see us use prescriptions for healthy foods in a similar way. Let those of us with the appropriate training (physician nutrition specialists, dietitians, nurses, etc) prescribe healthy food options for those at risk for or those who have preventable diseases. The prescriptions would provide a voucher or some discount on the prescribed foods (primarily low energy dense fruits and vegetables, lean protein, nuts, beans, and healthy fats). By paying for these foods, we may save money on medications that don't prevent the conditions or expensive procedures that are needed because the conditions are out of control. We have an exercise is medicine movement that has been active for some time now…I see food as medicine as the next step.
2. Provide insurance coverage for obesity treatment by obesity specialists- I know that Medicare has announced that reimbursement for obesity counseling will be provided to primary care practitioners in the near future. Most of us still doubt that this will lead to effective treatment because the primary care practitioner has little training and fewer resources to deliver the type of therapy that has been shown to be most effective. With all of the great resources I have at my disposal and the primary focus of my career being obesity treatment and weight management, I still find it challenging to do the things we do. I would like to be able to prescribe the most effective treatment for my patients, regardless of considerations about the patient's ability to pay, but I can't because all of the effective medical therapies we have available are not covered by insurance. So, those who often need it most are forced into an alternative that may be less than ideal, even when they have good insurance. I'm not suggesting that primary care practitioners shouldn't be involved…I believe they play a critical role in raising awareness, helping patients make the connection between body weight and health issues, and providing referrals to credible treatment options. However, we need to develop medical and behavioral specialists (physicians, psychologists, dietitians, exercise therapists, nurse practitioners, PAs, etc) who can treat complicated obesity just in the same way as the surgical field has the bariatric surgical specialist.
3. Get rid of the junk- My last wish is for Santa Claus to get rid of the snake oils and phony treatments being peddled as "cures" for obesity. If we could limit the amount of time and effort being put into these supposed treatments that have no scientific evidence as being effective, our patients would save a lot of time and money. This time could otherwise be focused on developing the skills and knowledge necessary for people to take better care of themselves and develop healthy lifestyle habits. We've finally gotten the FDA to declare HCG treatments for obesity as fraudulent. Hopefully, this trend will continue, and we can elevate the practice of obesity treatment to a higher standard. I think my wish list item #2 is critical to seeing the evolution of treatment and disappearance of the snake oils.

Things you learn in the grocery store: 3 common mistakes made in the gym

I have a knack for choosing the longest, slowest line at the grocery store (please tell me I’m not alone in this feat).  This rainy, dreary afternoon was no different, but I did overhear a couple discussing their frustration with weight loss and how exercise just "doesn't work."  I tried not to eavesdrop, but honestly I was hanging onto every word they said.  I wasn't getting any closer to checking out, so we stood in line, they discussed, and I listened. 

There are several different directions to go with this topic, but I chose to tackle (in my own head of course) the top three mistakes people make in the gym with exercise.  First, the body responds to change, and it is all too common (and easy) to start an exercise program and the next thing you know time has elapsed and you are doing the exact same thing over and over again.  Not only is this monotonous and mundane, but you won’t be optimizing the many benefits of physical activity.  There is a term in exercise world referred to as the 'overload principal' that simply states you have to be constantly thinking ahead and looking for the next step.  Take for example, walking for 30 minutes on a treadmill.  You will get a lot more out of this activity if you give yourself permission to push buttons.  Try mixing up the speed/grade/intensity.  Try a different exercise all together.  You may find you can decrease your time while increasing intensity, and who wouldn’t want more time on their hands. 

Second, one of my favorite adapted sayings in the gym has become “you have to straighten before you can strengthen.”  I find this especially true of people beginning an exercise program.  Keep in mind we learn to crawl before we walk and walk before we run; the same holds true with focusing on proper form and technique.  This statement encompasses a broad spectrum, but if you are not completing full range of motion on a bicep curl or maintaining proper posture on the elliptical machine you may be in fact setting yourself up for injury.  Maybe even more common, I run into a lot of people with back and neck pain.  There could be a lot of reasons for this, but if you are not addressing the potential postural problems with flexibility, and proper weight training, you could end up aggravating a problem.

Third, when I finally made it out of the grocery store, I hear my new friends say, “I want to get rid of these love handles and I do over 100 sit-ups every day.”  Wow, where do I start?  They have the strongest abs of anyone I know but it’s all behind a layer of fat.  We all know what love handles are, and we all want to get rid of them.  The question is how do we do it?  The ‘love handle’ is basically a build up of fat around the waist, and all the crunches, twists, and sit-ups in the world won’t get rid of them.  The answer to getting rid of fat throughout the body requires a combination of cardio, resistance training and a solid diet plan that leads to a calorie deficit. 

While exercise is something that feels natural (at least to some), there is a right way and a wrong way to approach it. Set yourself up for success by staying informed. Let’s get moving together!

Hurry up!

Sometimes our patience can wear thin, especially when our expectations aren't met. In the process of losing weight, patience truly is a virtue.

When most patients come to our program, they focus on what they want at the end of the process. They have a specific goal in mind which is usually a certain number of pounds they would like to weigh. The idea of reaching that goal is often singular in their mind. By this, I mean that instead of seeing a number of different behaviors that have to be done to achieve the goal of losing weight, they think of it as one simple thing.

However, anyone who has done it successfully knows that losing weight is a function of doing several things together. And, if you're doing it correctly, there is benefit from each of the things that you are doing even if they don't individually lead to weight loss. For example, being physically activity on a regular basis is good for your weight, but also lowers blood pressure, cholesterol, and improves your mood. All of these are beneficial for you, even if you don't lose a pound from being physically active.

The process of losing weight is not linear-- you can't predict with any consistency what will happen with your weight on a day to day basis even if you repeat the same exact behaviors every day. If you are not patient, this can be frustrating and you begin to wonder, "What did I do wrong?" If you have been maintaining the healthy behaviors that are part of your new lifestyle, you've done NOTHING wrong. In fact, you've been practicing the behaviors that are going to keep you healthy lifelong. When you take this perspective, your weight loss is a nice by-product of your healthy lifestyle, not your singular focus.

Now you can save your patience for something else...like traffic on highway 280!

Rethinking Exercise

-Brooks Wingo, PhD

For many people, the thought of exercise brings up of pictures of pounding away hours on some form of immobile gym equipment while staring blankly into a TV screen that you can’t really hear.  How can anyone love exercise so much that they spend an hour a day on the treadmill; especially with having to work, raise a family, and maintain some form of social life?  This sounds like a bit of an exaggeration, but my point is that many times the thought of exercise is more difficult to overcome than the physical exertion we dread so much.   In this post, I want to address 3 common mental errors that people often have when trying to initiate a new exercise plan.

The first mental error is failing to plan.  The old adage “failing to plan is planning to fail” definitely holds true for establishing a good exercise routine. One of the most common reasons people fail to get in enough exercise is time.  Most of us have so many responsibilities that it feels like there is no way to fit in one more thing.  Sit down on a Sunday afternoon and look at your calendar for the week.  Find any available blocks of time and plan your exercise during those times.  Write it on your calendar, just like a dentist appointment.  Then each evening, pack your bag for the next day’s work out.  10-15 minutes of planning ahead can lead to hours more exercise, and much less guilt about missing workouts. 

The second mental error is all or none thinking.  If I can’t spend an hour exercising, it’s not worth going at all, right? Wrong.  When it comes to weight loss, a calorie is a calorie.  You can burn calories by taking the stairs instead of the elevator, walking around the block during a 10 minute break or walking across campus rather than driving around looking for a good parking spot.  There are all different levels of activity and exercise, and each has a role in weight loss and health.  To lose weight and establish a healthy lifestyle you don’t have to spend hours in the gym, just find a healthy balance between daily activity and a few longer exercise sessions during the week.

The final mental error brings us back to the treadmill (or mouse wheel, as many of us think of it).  When it comes to exercise, think outside the gym.  Go for a walk, or a hike, sign up for a flag football or kick ball team.  The point is to find something you enjoy.  I have never met someone who enjoys the treadmill so much that they spend hours a day on it.  I have met many people who love running, cycling or hiking so much that they spend hours doing these things.  Look for something that you can do with family or friends to make exercise more social.  Or if you need to relieve stress, take up yoga or Tai-Chi to help calm you mind. 

The take home message here is that if you can begin to think of exercise as something you plan to do for yourself-rather than one more thing you have to get done, it takes much of the drudgery out of the process.  

Is that ALL I lost this week?!!!

If you have tried to lose weight before, you probably uttered the dreaded "P" word-- PLATEAU. A plateau, otherwise known as the lack of weight loss after doing a plan for a period of time, is not inevitable, if you're working with someone who knows how to guide you.

But this post really isn't about how to beat the plateau. It's more about how to not freak out if you think your weight loss is slowing down. Many of my patients anxiously compare week to week weight loss numbers, calculating every ounce of lost weight since the last encounter with the scale. I encourage everyone to weigh themselves regularly, especially if you are attempting to lose weight. Once weekly is good enough in my opinion. However, I don't want my patients to get overly concerned about the week to week difference.

Why not? The patient's job is to focus on implementing the weekly plan; my job is to focus on making sure we have the right plan that gets results. Try as you might, you can't control the number on the scale. Even if you do the same thing every day from one week to the next, the weekly weight loss will be different. This is due to a number of factors that are out of your control like how much water you retained that day, various hormonal levels, and metabolic changes occurring as a result of your ongoing weight loss. Unfortunately, losing weight is not a linear process.

As long as the average weight loss remains good, you know you're doing the right things. And those are the things you should continue to focus on-- daily food journal, consistently meeting your exercise goals, and achieving a good eating structure.

Don’t Let that Gym Membership Keep You from Being Active

Is your gym membership holding you back? Have you ever considered this question…it could be keeping you from being active on a regular basis.

Don’t get me wrong; having a gym membership is a perfectly reasonable way to gain access to a place that will allow you to exercise. But having the membership does not automatically imply that you will use it. The gap between ownership and usage is pretty large. There's a large group of people who are nodding their heads in agreement with me on this. These are the people who started 2012 with great intentions of getting into better shape and losing weight. Their first move was to jump on that local gym membership special. It seemed like such a good idea at the time, and it worked out well for the first month.

Then there was the change in the schedule for the daughter's dance lessons; or there was the unexpected job assignment that required some later hours; or (you fill in the blank).

Now it’s been 3 weeks, and you pass by the gym on the way home but haven’t graced them with your presence. In the meantime, you opt to do nothing until you can get back on track. After all, you are paying for this membership and you plan to use it…sometime. One of my patients once explained it to me like this—why go out and walk around the neighborhood or do something at home when he had this perfectly good gym membership that he should be using. He would feel guilty for cheating on the gym by exercising elsewhere.

Physical activity and exercise need to be SIMPLE, structured to MEET YOUR LIFESTYLE DEMANDS, and ENJOYABLE enough for you to look forward to the time. Trying to do the latest fitness craze won’t be successful for you if it’s too complicated for you or you loathe the idea of turning on that DVD. Feeling that you have to meet a pre-conceived idea about what physical activity or exercise is can hold you back from doing anything at all. If the gym membership isn’t working for you, don’t be afraid to drop it and find something you can do. Invest that money in a good pair of shoes and start a walking program or a Couch to 5K program.

This week, devise the simplest plan you can think of to get some higher levels of physical activity. It could be a 10 minute walk at work or a quick loop around the block before you head in the house upon your return home. Let's work on this for the week. Continue your daily journal and keep track of your activity levels. We'll come back with more on exercise this week.   

Smoke and Mirrors

Ok, the third week of our program is here. Now it's time to talk about food.

You've completed a food journal on a daily basis for the past 2 weeks and are starting to recognize some patterns by now. You understand that for every ACTION you take, your body responds with a REACTION that should be fairly predictable, now that you have some data. If you skip breakfast, you're starving by 1 pm. If you wait too long to eat, you make poorer choices. If you're really tired, you graze to keep yourself awake.

So what should you be eating? I'm going to suggest that for now, we ignore the number of calories that you should eat. Again, I'm not crazy, just evil. Here's the rationale for ignoring calories for now. I want you to focus on how to fix the structure of your eating, and this is NOT dependent on calories. As you may have noticed, the days that you consumed fewer calories and didn't starve yourself, you were more regular in the timing and spacing of your meals. Your portions were probably more consistent, and you likely avoided extremes of hunger and fullness.

We've become so calorie focused in our efforts to lose weight that we lose focus on what's important. We begin to implement smoke and mirror tricks to say we can eat whatever we want as long as we don't go over the calorie limit for the day. We trick ourselves into saying that we're "saving up" calories like we're about to make a down payment on a new car. As a numbers game, it may work for a while. Then the weight loss stops and no amount of manipulating those calories from the candy and ice cream will work to get it going again.

Rather than give you a calorie target to manipulate, I want you to use a simple method to get started with your plan of what to eat. Start by adding fruits and vegetables to your day based on the table below. 

Current number of fruits and vegetables per day	Number to add per day
< 2	2
2-4	3
5+	4

Add the fruits and vegetables in place of the highest calorie items you consume (for most of us, it's fried potatoes, juices and other sugar beverages, and desserts). Ideally you should have 5 eating episodes per day. If you have spaces in your day where you were not eating, add the fruits and vegetables there as well.

If you start here, this will naturally lower your caloric intake and keep you more satisfied throughout the day. You are simply swapping higher energy dense foods for lower energy dense foods, reducing calories without trying to cut the amount of food you are eating. Simple how it works...almost like magic!


Keep journaling to see the results...

Never Enough to Lose Weight

Routinely, I ask my patients what they need to be successful with losing weight. Invariably the responses include two things you will never have enough of—motivation and willpower. If you're banking on this to help you make a lifestyle change, you're setting yourself up to fail.
Why do I feel this way? Motivation can be misplaced and fleeting. Willpower by its very nature is inconsistent at best. When these two factors are the things you call upon to help you make better decisions and make changes in your lifestyle consistently, you will find that consistency is hard to achieve.

Let's deal with willpower first. The battle of willpower is something you will always lose. It's like gambling…you may get on a good roll, but if you do it long enough you lose. A misperception I hear all the time is that some people must have incredible willpower to stay thin or not eat certain foods. More likely is that these individuals manage their environment and avoid tempting themselves repeatedly with the things they are trying to limit. If I like to eat chocolate cake (and I do), and I only want to allow myself the option to eat it once a week, it makes no sense for me to bake a cake and leave it sitting on my counter top all week. Every time I walk past the cake, I'm going to think about it and have to expend mental energy to not have some. I may be able to do this when I'm at my best, but the next time I'm upset or really hungry or tired from working all day, I'll probably give in and make an exception. However, as soon as I finish that last bite, I'll resolve to NEVER DO THAT AGAIN.

Motivation is necessary, but only as a means to get you to reorder your priority list. Your motivation becomes sustained when you can recognize how the benefits of your lifestyle change outweigh the benefits of doing your default. When this happens, you make time for meal planning or exercise. You find ways to pack your exercise clothes for the business trip. You spend your time and effort doing the things that you care about most. If doing the things that are needed to make a lifestyle change and lose weight isn't important enough, you won't do it. The key phrase here is that you need to care about DOING THE THINGS. You have to care about the PROCESS just as much as you do the OUTCOME.
Losing weight is a challenging proposition for many, but very doable. Set yourself up for success by valuing the benefits of the small lifestyle changes you make (walking, eating better choices, journaling, good sleep) and by managing your environment.

 

Self-Evaluation- Form Follows Function

In the first week of your program, I asked you to complete a basic but critical exercise as you begin to lose weight—self-monitoring. The primary purpose of self-monitoring is to provide an opportunity for you to examine your current behaviors, increasing your awareness of what you are doing currently in your daily lifestyle.

Now the second week of your program is about evaluating what you've recorded and making plans for how to move forward. In many instances when we ask people to journal their food intake the week prior to coming to the EatRight clinic at UAB, people will start to recognize patterns and areas for improvement in their typical intake. By the time our team of clinicians meet with them, they have diagnosed many of the problems that are making it difficult for them to manage their weight successfully.

What have you noticed about your week of journaling? Common patterns of eating that I see frequently include skipping breakfast, irregular spacing of meals, unplanned snacking, and grazing. Each pattern of eating has an underlying cause—I skipped breakfast because I stayed up eating "unmentionables" until midnight. So of course, I wasn't hungry at 7 am! Or I graze in the afternoons because I worked through lunch and didn't take the time to get a balanced meal.

I'm almost done with this post, and I still haven't said anything about WHAT you ate. And, I won't. This is all about understanding your structure of eating. In the design world, the phrase "Form follows function" describes a principle that the design of an object should be consistent with the intended purpose or use of the object. Your "FORM" of eating has a lot to do with the "FUNCTION" of your weight. You can't eat in a pattern designed to promote inconsistency and high calorie intake and expect to lose weight in the long-term. It just won't happen.

So for week 2, I want you to review your food journal from week 1 and identify any structural changes that you would like to make. Think about timing and spacing of meals and snacks (ideally every 3 hours); think about triggers that make you inconsistent; think about how the previous meal sets up the next meal. Figure out what you need to do to be consistent with your "FORM" of eating on a daily basis in the setting of your lifestyle. Continue journaling daily on your road to success.

A Case for Cooking

-Laura S. Burton, RD

As a dietitian, I have noticed that the number of people I see who cook regularly is dwindling rapidly. When individuals disclose how often they eat out, immediately a long list of excuses as to why cooking is not an option for them ensues. The top 5 reasons are as follows: 

1. “I can’t cook”
2. “I don’t have time to cook”
3. “I don’t know what to cook”
4. “Planning meals is overwhelming”
5. “It’s hard to plan healthy meals that will please everyone in my family”

I can relate!  Now although there are tips, shortcuts and resources that can make cooking much easier and more enjoyable (which I’ll share with you in a minute), I won’t argue that the drive-thru isn't still the easiest, quickest option. So what are the benefits of cooking and are they enough to get Americans back in the kitchen? Is cooking really worth it?

Cooking allows you to take control of what goes into your body. When we eat out, our health is at the mercy of food manufacturers, and all they’re concerned with is achieving maximum flavor and maximum shelf-life at minimum cost. Even grilled fish and chicken at restaurants can be loaded with sodium and smothered in high-fat sauces. We must start caring more about what goes into our food, especially when it comes to weight and disease management. Has your physician or dietitian recommended a reduced-sodium meal plan? With cooking, you can easily limit the amount of salt in your foods. Do you have trouble with high blood sugar? Cooking allows you to easily half the amount of rice or pasta in a casserole…and double the amount of vegetables! Heart disease or high cholesterol? You can still enjoy a burger when it’s made at home from extra lean ground turkey breast.  And the best part is that you can customize it based on your taste! Give it some Greek flair by mixing in breadcrumbs, red onions, reduced-fat feta cheese and dill. Be creative!

Set a good example for your family. The kitchen can be such a fun place to bond with your spouse or kids. Children who help their parents in the kitchen will not only develop cooking skills to carry into adulthood; they’ll learn about choosing healthy foods, learn to follow instructions, and realize that putting a little time and energy toward something often results in a great outcome. Cooking will likely foster a child's appreciation of teamwork, as well as give them a sense of ownership over the meal (which may make them more willing to eat it!)

It’s clear that cooking can be beneficial for a multitude of reasons.  But let me also suggest that cooking doesn’t have to be as daunting a task as we make it out to be. In fact, here are a few tips that might just change the way you think about cooking. 

1.  If you can read and follow directions, you can cook! Sure, cooking requires some basic knowledge of measuring, mixing, and heating techniques, but your faithful friends Google and SIRI are always there and willing to help. Simply type in those terms you don’t quite understand, or ask them how to “fold in the egg whites,” for example. Like any new practice, this may require a little extra time in the beginning, but you’ll find that once you understand the basics and get some practice under your belt, cooking will begin to come naturally for even the most anxious beginner chefs.

2. It may be worth it to spend a little extra money on shortcuts. If you’re low on time, purchase the pre-chopped onions rather than a whole onion (it’ll save you time and tears!). Or instead of buying the boxed rice that requires boiling, save time by purchasing the 90-second microwave brown rice in-a-bag.

3. Short on good, healthy recipes? Explore EatRight by UAB’s Nutrition Guidance System. With lots of healthy, easy, and kitchen-tested meals, our recipe collection won’t disappoint. In addition, the Nutrition Guidance System has teamed up with Piggly Wiggly to offer nutrition guidance as you shop! Watch a short promotional video here. Or sign up for one of EatRight by UAB's monthly cooking classes to learn new recipes as well as healthy cooking techniques.

What will you fix for dinner this week?

My $0.02- Leveling off of obesity in US

Last week there was a lot of news around the fact that obesity rates seem to be leveling off in the US (http://www.npr.org/templates/story/story.php?storyId=122536128). Generally speaking, this is good news. No one really knows why this is the case, especially since we continue to find creative ways to eat butter at every turn (Exhibit 1: see Paula Deen's Fried Butter Balls).

If you take your own weight as an analogy for what's happening to the country, we might be able to understand some of the dynamics at play here. If you're newly married or just got a nice job, you will likely have more access to food, eat out a bit more, and have less time to exercise like you did before you had a partner or were expected to show up somewhere on time. The adjustment to this new lifestyle can take some time. In the meanwhile, you put on a few pounds until your new level of activity balances with the new pattern of eating you've established. This might be where we are as a country. Our new lifestyles, filled with computer screens, mobile phones, 3D televisions, and food anytime and anywhere, have caused us to put on some weight while we're reaching that new balance. Perhaps, that leveling off time has occurred.

However, the natural course of weight gain suggests that we shouldn't become content. We know that kids who are overweight grow up with a higher chance of being overweight as adults. We also know that we continue to gain weight with age; this is already evident in the fact that median body mass index is shifting higher already. And, we know that the environment will continue to produce more devices that promote sitting and highly palatable foods.

Two things buried in this story that most concern me: a lot of the health consequences are yet to be realized and not everyone has leveled off at the same spot. The pending diabetes epidemic that is soon to follow because of obesity will blow the lid off of health care costs in this country, and unfortunately, a lot of that burden will be in low-income and/or minority communities where obesity rates are as high as 56%, nearly 20% higher than the general population.

We've still got work to do.

Self...Meet Self

Most of my patients have a pretty good idea of the issues that have contributed to their weight gain or inability to keep it off after losing it a few times over. One of the biggest reasons they often identify is themselves.

The first step I recommend that you take in your plan to get to a healthier weight is to learn more about yourself. Why is that you ask? Because despite all of the suggestions about genetic predisposition or the influence of the environment, we have to look at ourselves as the final decision maker in the choice between having seconds or putting the food away; between taking the walk (even when it's cold outside) or watching television and snacking. If you don't understand your own tendencies and inclinations, you won't be able to critically address the issues that plague you. For most of us, we are creatures of habit and respond to a stimulus in a fairly predictable way. That response may be programmed by years of conditioning (if I say "birthday" you think "cake") or naturally selected because it brings a survival advantage (the taste of sweetness signals us to eat more-- a useful trait when you're a caveman, not so much when you go to Krispy Kreme).

What does any of this have to do with your weight? Everything.

The key is to stop approaching your weight as simply a function of the number of calories you eat and how many minutes you can get in on the treadmill. You need to understand why you eat, when you eat, and how you  eat to be a healthier person. You need to understand if you move, when you have time to move, and how you move to be a healthier person. These issues represent your habits and tendencies that will either need to be overcome/modified or propel you on your way to a healthier lifestyle.

Week 1: Keep a journal for the next week, recording everything that goes in your mouth. Don't record calories (that's right, I said it)! However, do record the time you ate, what you were doing while you ate, where you ate, and your portions. Also make note of your mood and your mental and physical appetite [your mind is saying you could go for something to eat vs. your stomach is saying you need something to eat]. Think about your activity level as well. If you don't have a pedometer, now is the time to buy one.

This is your work for week one. As you jump in, we'll start to talk about some of the patterns that emerge and approaches to change your lifestyle.

Every Super Villain Has a Story

After having my name bantered about the blogosphere by several people, I figured it was time for me to take control of my story and tell my side of things.

You see, a couple of years ago I got labeled as the Evil Dr. Ard by a young man who shall remain nameless (to protect the identity of minors). However, his grandfather (Dean Harold Jones) is primarily responsible for initiating my turn to the "Dark Side." As I recall the story, he and his grandson were playing with action figures and Dean Jones, who had recently started the EatRight program at UAB, prompted him to come up with some nicknames for me. I'm sure his grandson said things like "Really Great Doctor" or "Super Man", but not being satisfied with those depictions of me, Dean Jones pushed for something a bit more sinister. Hence, you have the creation of the Evil Dr. Ard. (If you're interested in the whole story see Dean Jones is Losing It )

Well, being the popular guy that he is, Dean Jones got this nickname spreading around pretty fast. He told all the staff at EatRight and many of the other patients. He even paid Shonnie Wilson, one of our many outstanding OPTIFAST patients and author of another great blog- Diary of an Angry Fat Woman, to adopt the name. No matter how I try to shake the name, it seems to be sticking.

So, when you can't beat'em, you join'em. I'll be using my Evil Dr. Ard blog to share strategies to help you lose weight and keep it off. We work with individuals in the Birmingham, AL region on a daily basis in our award winning EatRight by UAB program, so I know that the fight to lose weight is a challenge. However, it's one that can be overcome with the right help. Our philosophy is that there is no magic bullet or one-size fits all approach. Everyone is different and may require some unique approaches based on those differences. We focus on the best medical evidence and technology to stay above the fray of fly-by-night weight loss plans that have no chance of working. What I plan to do with this blog is give you access to my expertise and opinion about how to tailor a plan for yourself.

The staff at EatRight will be assisting me with topics from time to time. We have a great team of professionally trained dietitians, exercise specialists, behaviorists, nurses, and physicians who provide a comprehensive perspective on what you need to build a successful weight loss plan. Please follow along and send your specific questions. I may be evil, but I'm always happy to help!