Go Green: Greens Are Good For You!

How many servings of leafy green vegetables did you eat today?  There are so many to choose from, it’s easy to get some every day.  They are soooo good for you and tasty too!  At the end of the post I’ll share my favorite kale recipe 🙂

Why are green vegetables so good for you?  Pound for pound they have the most nutrition of any food on our planet.  They are low-carb, low-calorie and full of good stuff!

1.  Vitamins and minerals:  Vitamins K, E, C, and many of the B vitamins, as well as potassium, magnesium, calcium and iron.

2.  Powerful plant pigments that function as precursors to other vitamins and as antioxidants.  Beta-carotene, chlorophyll, zeaxanthin and lutein are some of the phytonutrients found in dark leafy green veggies.  The brightly-colored pigments in plants help fight cancer by acting as antioxidants.

3.  Green veggies don’t contain as much fiber as, say, beans or lentils or whole grains but they have SOME.  Kale, for instance, has 2.6 grams fiber per 1-cup serving.  They also have a small amount of omega-3 fatty acids.

Nutrition experts estimate that our ancestors ate five pounds of green leaves every day!  They were hunter-gatherers and hunting green leaves was a lot easier than hunting animals.  They didn’t get up and run away, after all!  When game was scarce they simply ate the plants all around them.

So what is the best way to eat your greens?  The same way our ancestors did!  Raw 🙂  You can also lightly steam or saute them.  DON’T boil them (it leaches away the cancer-fighting phytonutrients) and don’t overcook them because that begins to destroy the nutrition.

Try adding a big salad of leafy greens every day.  Mix up your leaves or combine them to take advantage of different flavors.  Use just a little dressing and it’s best to make your own dressings fresh.  If you have a food processor it’s easy to whip up a small amount of fresh dressing for your salad.  Combining different oils (like olive, sesame or walnut) with different vinegars (such as balsamic, red wine, rice wine, or apple cider) and different spices is much healthier than using mass-produced bottled dressings.

One of the most nutritious leafy green vegetables is kale.  Kale is bitter and many people don’t like eating it raw (including me).  I much prefer it sauteed.  Here’s my recipe!

Dr. Jen’s Sauteed Kale

Ingredients

  • 1 tablespoon extra-virgin olive oil or sesame oil
  • 1/2 onion, peeled and chopped
  • 2 cloves garlic, minced
  • 1 large bunch kale, washed, stems removed, and coarsely chopped
  • golden raisins soaked in hot water to plump them
  • Handful of pecans, chopped

Directions

  1. Drizzle a large shallow pan with oil and heat over medium heat. Add the onion and garlic and saute about 5 minutes, until starting to soften.
  2. Add a little water to the pan (for steam) then add the kale.  Cover and steam for about 5 minutes, then drain the oily water out.  Transfer the kale to a bowl and top with plumped golden raisins and pecans.  Enjoy!

Please feel free to play with this recipe.  There are so many fruits that you could use to add a little sweet to balance the bitter kale.  Toasted almonds, walnuts or sesame seeds could also be used for variety.

Want another easy way to get your greens?  Shaklee’s Organic Greens Booster has kale, spinach and broccoli in a form that’s easy to add to soups and smoothies.

For more information, check out 13 easy ways to eat more greens and Fitness Magazine’s guide to leafy greens.

QUESTION:  What is your favorite leafy green vegetable, and how do you like to eat it?

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3 Reasons You’re NOT Losing Weight

So you’re exercising 5 days per week, watching what you eat and not seeing success with your weight loss efforts. Trust me, I have these conversations with patients all the time. There are 3 main reasons why you’re NOT losing weight.

Diet Mistakes

Eating Too Much

It’s very easy to eat too much. Sitting in front of the TV snacking on chips or pretzels or popcorn. Eating out too much. Rewarding yourself with a treat after a good workout at the gym. Tracking your intake with an app like MyFitnessPal can help keep you mindful of “extras” that can sabotage your efforts.

Don’t forget your beverages. Soda is a waste of calories and promotes the development of fatty liver disease. Alcohol is also a very high calorie indulgence and hard on the liver too. The best beverage for those trying to lose weight is plain filtered water.

Eating Too Little

Over-restricting can sabotage your weight loss efforts because the body goes into conservation mode. If you’ve been tracking and very attentive to your intake and you’re not seeing success, try loosening up and adding an extra piece of fruit or two daily (about 100 calories each).

Eating The Wrong Foods

Too much protein, too much convenience foods, too much processed carbohydrates, too much saturated fat. All these can change the metabolic and hormonal state in the body towards storing fat instead of burning it. Remember that the best macro balance is 50% COMPLEX carbohydrates (like whole grains, beans, legumes and fruit), 30% healthy fats (avocados, nuts, seeds and oils that are liquid at room temperature) and 20% protein (plant protein is best for your heart). Tracking for a short while can help you adjust your macros to the proper balance.

Indulging in artificially sweetened foods and beverages also can work against your weight loss efforts. Artificial sweeteners increase insulin and have not been shown effective in promoting weight loss.

Exercise Mistakes

Undertraining

If I had a nickel for every time someone said “I don’t have time to exercise.” Or “I don’t like to exercise.” Or “I can’t exercise because my XXX hurts,” – with XXX being the body part of choice (knees, back, feet, etc).

In order to lose weight you have to move around. It is extremely difficult to have long-term weight loss success without some sort of fitness regimen. Now it doesn’t have to be going to the gym or paying a lot of money for a trainer, although that is a good investment. I’ve written before about different exercise options. Joint pain requires different choices, but our health depends on regular movement!

Overtraining

It’s also important to rest and give our bodies time to recover between training. It’s not good to stress or work the same groups of muscles two days in a row, they need time to recover and build new muscle tissue. Even runners and cyclists have rest days.

Not Sleeping

You’ve got to sleep. It’s just one of those things, our bodies and brains need to have enough sleep and if we go without it does a number of bad things to us. One of those things is weight gain. Chronic sleep deprivation is a known cause of weight gain. It also increases stress hormones like cortisol and decreases our resistance to snacking and poor food choices.

Most adults need 7-8 hours of sleep daily. You can get away with sleeping less for a little while but over time it will backfire.

If you’re trying to lose weight and not having success, first take a look at your sleeping habits. Then think about your eating habits and your exercise or lack thereof. The reason you’re not losing weight is probably there.

QUESTION: Did I miss anything? Did I miss an important reason why someone would have trouble losing weight?

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Healthy Cleanse Recipes

So in 2 days I’m starting my 7-Day Healthy Cleanse as part of my Prove it Challenge. I’ve done this Cleanse before – meaning I’ve used these products before. But I haven’t really done the Cleanse RIGHT. I’ve cheated.

This time I’m DETERMINED to do it right. I won’t cheat. I’ll eat fruits and vegetables that are approved for the Cleanse. I won’t eat soy. I won’t eat nuts. I definitely need help! Shaklee provides a LOT of support, and part of the support is a long list of suggested Cleanse recipes.

I was poring through the lists of approved Cleanse recipes to get ideas for low-carb, veggie and fruit recipes for breakfast, lunch, dinner and snacks. I know if I let myself get overly hungry it is going to be MUCH harder to stick to it and stay away from the no-no foods.

Here are the three Cleanse recipes I’m most excited to try, and most likely to keep using beyond the Cleanse.

Sweet Potato Breakfast Hash

INGREDIENTS

  • 1 Tbsp. Olive Oil
  • 1 Tbsp. rosemary
  • ½ red onion
  • 1 clove garlic, minced
  • 1 sweet potato
  • 1 jalapeno (optional)
  • 2 bell peppers
  • 2 green onions

DIRECTIONS

Heat olive oil in a large skillet over med-high heat. Add diced sweet potato, cover and let cook for approximately 10 minutes or until it begins to soften, stirring occasionally.

While the sweet potato cooks, dice the red onion and mince the garlic. Add to the skillet. Dice bell peppers, jalapeno, green onion and rosemary (if using fresh) and add to skillet. Cover and let cook for approximately 5 minutes, or until sweet potato is tender. Enjoy!

Tomato Bisque Soup

INGREDIENTS

  • 2 (28-oz.) cans whole tomatoes, drained of their juices
  • 4 Tbsp. olive oil
  • 4 carrots, peeled and chopped
  • 2 shallots, quartered
  • Freshly cracked pepper
  • ½ tsp. crushed red pepper flakes
  • 2 garlic cloves, minced
  • 1 Tbsp. tomato paste
  • 1 (28-oz.) can crushed fire roasted tomatoes
  • 1 cup + 2 Tbsp. low-sodium vegetable broth

DIRECTIONS

Preheat oven to 400 °F. In a mixing bowl, combine drained whole tomatoes, carrots, shallots, and 1 Tbsp. of the olive oil, and toss to coat. Season vegetables with pepper and place on a baking sheet. Roast until caramelized, about 30 minutes.

Heat a soup pot over medium heat. Add remaining olive oil and allow to warm. Add crushed red pepper flakes and garlic and sauté for 1 minute. Add tomato paste and cook for 1–2 minutes, then add 2 Tbsp. of vegetable broth. Cook another 2 minutes. Add roasted vegetables, crushed tomatoes, and remaining vegetable broth.

Season with pepper and simmer for 15 minutes. Purée the soup with an immersion blender until uniform in texture. Add more vegetable broth to adjust consistency if desired.

Cilantro Lime Cauliflower Rice

INGREDIENTS

  • 1 medium head (about 24 oz.) cauliflower, rinsed
  • 1 Tbsp. extra-virgin olive oil 2 garlic cloves
  • 2 scallions, diced
  • Pepper to taste
  • 1-½ limes
  • ¼ cup fresh chopped cilantro

DIRECTIONS

Remove the core and let cauliflower dry completely. Coarsely chop into florets. Place half the cauliflower in a food processor and pulse until the cauliflower is small and has the texture of rice or couscous—don’t over process or it will get mushy. Set aside and repeat with the remaining cauliflower.

Heat a large sauté pan over medium heat. Add olive oil, scallions, and garlic and sauté about 3 to 4 minutes, or until soft. Raise the heat to medium-high. Add the cauliflower “rice” to the pan. Cover and cook approximately 5 to 6 minutes, stirring frequently, until the cauliflower is slightly crispy on the outside but tender on the inside. Remove from heat and place in a medium bowl, and toss with fresh cilantro, lime juice, and pepper to taste.

I LOVE to cook but don’t usually make much time for it. I think one of the things I’m looking forward to with these Cleanse recipes is the opportunity to be more creative and intentional with my food! One thing is for sure – I’ll be eating healthy, and eating well 🙂

QUESTION: Do you have a favorite low-carb grain-free vegan recipe you can share with me?

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The Nutrient We Miss The Most

I spend most of my time (in a professional sense) talking to people about nutrition.  I encourage them to eat right.  To get plenty of fresh fruits and vegetables.  To skip the processed food, junk food and fast food.  To take a good-quality multivitamin.

But most people still skimp on one very important nutrient.  What is it?  What is the nutrient we miss the most?

It’s WATER.

Think about it.  Your body needs about one ounce of water per day for every two pounds of body weight (up to about 100 ounces per day).  For the average person that’s 60-80 ounces of water, or a half gallon or more.

Not coffee, not iced tea, not soda or lemonade.  WATER.

Water helps keep your blood pressure down.  It removes toxins and improves your digestion.  It fights fatigue and keeps your mind sharp.

When you’re a little thirsty, this can be interpreted by the brain in as hunger.  So staying well hydrated helps control appetite and promotes weight loss.

Every organ in your body depends on you staying well hydrated.  From your kidneys to your digestive system to your brain, water is critical for normal function.

So why is it so hard for us to get enough water?  I can’t speak for you, but I know why I have a hard time staying hydrated.

First of all, the most plentiful source of drinking water is the kitchen tap.  And tap water is NASTY.  Have you tasted it lately?  Ew!  It doesn’t help that I know more than is good for my mental health about what is actually in our tap water.  Pesticide runoff, pharmaceuticals, chlorine, substances like orthophosphate added during water treatment, and other chemicals interact to make me not want to drink straight from the tap (or from the garden hose, but that’s another story…).

Your local water department has water quality reports available for download at their website, for those who use city water.  Cleveland’s water quality report for 2018 is available here, if you’d like to see.

The second problem I have with getting enough water to drink is that when I drink the water I should, I have to pee.  A LOT.  When I’m in the office that’s inconvenient but manageable.  When I’m traveling or pressed for time it becomes difficult for me to get all the water I need.

Honestly, there isn’t a good fix for this problem, I just tell myself to suck it up.  Every time I go, I think of all the toxins being washed away and that makes it easier to just do it.

The last problem my patients report with drinking copious amounts of water is that it’s BORING.  “I don’t like water, it doesn’t taste good.”  Which is silly, because fresh clean water has no taste at all.  It’s clear and cold and wet and refreshing!

What people are telling me when they say they don’t like the way water tastes is that they have trained themselves to expect flavor from everything that goes in their mouth, whether it should have flavor or not.  What I tell them is that their tastebuds may not like it (for now) but their bodies certainly do like water.  In fact, they NEED it, and they do NOT need all the sugar and flavorings and additives in their usual beverage of choice.

So if our tap water is so gross, what water should we be drinking?

Bottled water?  No, that’s not a good choice.  For one thing, it’s expensive.  It also puts tons of unnecessary plastic in the landfill and isn’t necessarily cleaner or safer than drinking tap water.  Often we don’t know where the water comes from or what testing was done.

My choice for lots of fresh, clean drinking water is Shaklee’s tabletop pitcher filter.  It is certified to remove lead (most tabletop pitcher filters, including Brita and Pur, are not) and has a replaceable carbon filter so that everything else is reused.

Do you have a water filter at home?  You can check the Water Quality Association’s website to see what your filter is proven to remove from the water you drink.

And it’s CHEAP!  Just did a price check on Deer Park spring water at Giant Eagle.  Buying bottled water (this brand, anyway), costs $2.21 per gallon and leaves you with lots of plastic bottles to deal with.  Shaklee’s Year of Get Clean Water costs just 33 cents per gallon at member price, 39 cents per gallon at retail price.  And after the initial investment of the reusable plastic pitcher, replacing the carbon filters gives you clean, fresh water for only 25 cents per gallon retail price.

So what are you going to do about your hydration problem?  For me, there’s only one choice.  Saving money, drinking fresh clean water, and avoiding putting unnecessary plastic in the landfill is a win-win-win situation!

QUESTION: Do you drink enough water?  How do you get your drinking water?

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DON’T Exercise For Weight Loss!

Everybody promotes the benefits of exercise for weight loss.  And yes, becoming more active is one of the best ways to increase your day’s calorie expenditure if your goal is weight loss.  However, is weight loss a good motivator for getting someone moving?

Turns out, it’s not.  In fact, it’s one of the WORST motivators.  People who said their reason for getting active was to lose weight were LEAST likely to exercise consistently.

What motivates someone to lose weight?  The most common reason is to obtain someone ELSE’s approval.  You might want to look better in a swimsuit or put a spark back in your marriage, or bring your cholesterol test results or blood sugars under better control.  The sad truth is that weight loss is usually motivated by outside factors rather than by a true and pure desire to slim down.

So if weight loss isn’t a good motivator for exercise, what is?  Here are some suggestions:

1.  Pure enjoyment.  I take care of quite a few runners.  I am a runner myself.  I don’t run to lose or maintain weight (although it is a nice side benefit) but just because I love running.  Runners will run until their toenails fall off altogether.  (Unfortunately I have a case of plantar fasciitis right now that is keeping me from running.)

Those who love tennis will play through excruciating elbow pain.  Those who love martial arts or boxing will suffer all kinds of trauma.  Family doctors are well accustomed to having to put the kibosh on our crazy sports-injured patients’ plans to do further harm to themselves in their love of their sport.  We just do it because we love it!

2.  “Me” time.  So maybe there isn’t an exercise that you love like the fitness fanatics in #1 above.  There are ways to make your exercise a getaway as well.  For instance, I have taken to watching movies and TV shows on Netflix while I’m on the treadmill.  With my busy life, this is the ONLY time I get to watch any TV or movies.  So on those crazy days when you’re just too tired to climb on the stationary bike or treadmill, you can bribe yourself also with a good movie or TV show.

3. “Us” time.  If you have a workout buddy it’s hard to back out of a workout date.  Call a good friend and ask him or her if they would like to set up a regular time for a brisk walk or a fitness class.  Tell your buddy you could use a spotter for some extra-heavy sets.  Try a new form of exercise with your spouse.  My husband and I have practiced martial arts for years and now our boys do too.  Making it a family affair keeps us engaged and showing up even on days when ONE of us really doesn’t feel like going.

4. Health benefits.  Your body works better when you’re active.  Your digestion moves along better and you’ll have less problem with constipation.  Natural endorphins are released which relieve stress, anxiety and depression.  Sleep quality improves with exercise.  Lung function improves which means you’ll huff and puff less when chasing the kids and grandkids.

There are so many good reasons to get active and fit, you’re not limited to the promise of weight loss!  What will get you to the gym or motivate you to lace up your sneakers after a long day at work, when all you want to do is park yourself on the couch in front of the TV?  Be creative and find something you truly love!  If all else fails, create an irresistible incentive that will get you moving.

Guess what!  You’ll probably lose weight too 🙂

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Weight Loss Reduces Breast Cancer Risk

Are you tired of me talking about weight loss yet?  LOL!  I just came across yet another reason for women to lose and maintain their weight after menopause.  Weight loss reduces breast cancer risk!

There was an study recently published in Cancer that looked at breast cancer risk in women who gained weight, maintained their weight and lost weight after menopause.  The authors found that weight loss of at least 5% body weight after menopause did significantly decrease the risk of breast cancer over the 11 year follow up period.

In this study, women lost an average of 19 pounds.  While not a small amount of weight, it isn’t a crazy amount either.  They were able to maintain their weight loss for the most part too.

We know that breast cancer risk is higher in women who are overweight and obese.  Since over 1/3 of women in the United States are obese, this is a significant risk factor for breast cancer in this country.  According to NHANES survey data from 2013-2014, 40.4% of women in the US are obese.

Let’s do some math.  Approximately how many American women are obese?  In 2010 (according to census data) there were just under 157 million female Americans.  53.2 million were over 50, and 40.4% are obese.  That’s 21.5 million obese female Americans over age 50.  (Since we’re talking about breast cancer I want to focus on the population most at risk, and the study focused on women after menopause.)

In the study just published in Cancer, they found that 5.09% of women who maintained their weight got breast cancer, and 4.27% of the women who lost at least 5% of their body weight got breast cancer.  That’s an absolute risk reduction (ARR) of 0.82%.  This translates to a Number Needed to Treat (NNT) of 122.  (Remember that NNT = 1 / ARR)  This also assumes that the breast cancer risk reduction was caused by the weight loss.

If 122 obese women have to lose at least 5% of their body weight (and maintain that loss) to prevent one case of breast cancer…

That is over 176,000 women that could be spared breast cancer over approximately a 10-year time frame.  With about 266,000 women diagnosed every year with breast cancer, that’s a 7% reduction.

Will you be one of the women who suffers a potentially preventable case of breast cancer?  Now that you know weight loss reduces breast cancer risk, will you make sure to lose weight and get closer to your ideal body weight?  Your heart, your liver, your brain, your pancreas, your joints, your back, and even your breasts will thank you!

QUESTION: Do the numbers in this article surprise you?

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Less Saturated And Trans Fat Intake Recommended

What should we eat to be healthy?  This is the ultimate question that EVERYONE is trying to answer and nobody really has a good handle on it.

Our diets are getting worse and worse.  We are eating more processed foods, more convenience foods, more sugar and fat and salt.  Our risks of diabetes, heart disease and cancer are climbing.  Our kids are the first generation that has a shorter life expectancy than their parents.

The World Health Organization is intensely interested in these worrisome trends.  They are trying to analyze the confusing array of nutritional research coming out to make recommendations to help people all over the world live longer, healthier lives.

Recently the WHO came out with a report recommending less saturated and trans fat intake in the diet.  The goal is to reduce saturated fat intake to less than 10% of daily total calorie intake, and trans fats to less than 1% of calories.

Saturated fat and trans fats are both largely found in animal foods.  Animal flesh from all species, eggs and dairy are rich sources of both saturated and trans fats.  While many people know to avoid partially hydrogenated vegetable oils which are added to processed foods to make them taste better, surveys suggest that trans fat intake from animal foods is greater than that from industrial sources.

If you’ve been following my blog for any length of time, you know I recommend that the whole-foods plant-based diet is the healthiest diet for humans.  This type of diet has the best research showing reduced heart risk and reduced cancer risk.  It has been shown to decrease diabetes risk (a major risk factor for cardiovascular disease and cancer).  In fact, switching as little as 5% calorie intake from animal protein to plant protein reduced diabetes risk by 20-25%.  This translates to 25 grams of protein from plant sources rather than animal for someone who eats 2000 calories per day.

I get that not too many of my readers are going to switch tomorrow from a Standard American Diet to a whole-foods plant-based diet and never look back.  I’m about progress, not perfection.  Hey, my husband calls me “vegan-ish!”  I avoid animal foods as much as I possibly can but every once in a while I have ice cream or macarons for a treat.

So gradually substituting plant-based meals for ones with meat and dairy will reduce your heart and cancer risk.  Reducing animal foods to have less saturated and trans fat intake in the diet is a good step to take for improving your health.  You’ll feel better, and your body will thank you!

QUESTION: Do you try to reduce animal foods in your diet?

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Spring Exercise Tips

 

spring-into-fitnessHooray!  It’s finally spring!

How many of you out there love to work out outdoors?  I do!  I’m a runner and I’m really excited about getting back outdoors for a jog 🙂

So is there anything special about the springtime exercise transition that you should keep in mind?  Here are 3 spring exercise tips to be aware of.

1.  Dress warmly

It’s really NOT that warm out there yet.  Today’s temperature is in the sixties and I’m comfortable in jeans and a hoodie.  Of course I’m not running, but people tend to overestimate the temperature and UNDERESTIMATE how much clothing they need in the spring.

Layering is key.  You should dress so that you’re comfortable when you start AND so you can take off a layer or two as you warm up.  Also consider it tends to be windy in the spring.  Wind wicks body heat away quickly and can cause you to get cold especially when you’re sweaty.  Respect your body and dress properly!

2.  Train up slow

When you’re transitioning from indoor sport/training to outdoors, remember it’s not a simple switch.  Running on a treadmill or riding a stationary bike is different from road racing.  Hills, wind, traffic, uneven terrain and other factors make outdoor workouts different.

Make sure to decrease your intensity/mileage when you transition to exercising outdoors.  Take it slow!  If you’re training for a road race make sure to give yourself plenty of time for a leisurely and thorough transition.  Fast changes lead to injuries!

3.  Try something new

A new season is a perfect time to try a new sport or fitness activity.  Spend a little time thinking about what the best activities are for the current season.  Jogging and cycling are perfect warm-weather outdoor sports, but there are others too.

Hiking and climbing are popular in northern Ohio especially in the Metroparks.  Horseback riding is perfect for warmer weather (if you have a friend who owns horses or can take classes).  Rowing and sailing will be starting up soon.

Spring is a beautiful time of year, especially in a place that spends so much of the year buried under snow and ice!  Get out there and take advantage of it by taking the show on the road!

QUESTION:  What is your favorite form of exercise in warmer weather?  Are you interested in trying something new this year?

 

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Waist Circumference Predicts Heart Risk

When you step on the scale, do you see a normal weight?  When you check that BMI chart by the scale at the doctor’s office, are you reassured to see your score is under 25?  That means you’re good, right?

Not so fast.  There’s another measurement to take.  Your waist circumference also says a lot about your heart risk.

Carrying body fat around your middle, called abdominal adiposity, is a marker of higher heart risk.  For women, a waist circumference over 35 inches is a risk factor for heart disease.  (That’s assuming she’s not pregnant, of course!)  For men, the threshold is a waist circumference over 40 inches.

A study published recently in the European Heart Journal shared some interesting insights.  The authors analyzed data from almost 300,000 people to see what waist circumference and other measures of “fatness” tell us about heart risk.

They found that there was a linear increase in heart risk with increasing waist circumference.  Also, body fat percentage, waist-to-hip ratio and waist-to-height ratio also gave almost a linear increase in heart risk with increasing values.

BMI did NOT give a good correlation to heart risk.  I’ve always hated the BMI.  It’s stupid and doesn’t account for body composition.  Someone with a lot of muscle, like LeBron James, is NOT obese but you can’t tell that from the BMI.

So when you go to the doctor and he or she measures your weight and height, don’t stop there.  Ask to have them measure your waist circumference too.  Better yet, see if they have a body fat analyzer.  I have a handheld unit in my office that isn’t perfect, but it does give a much better estimate of whether someone is overweight or obese than BMI does.

When I am working on weight loss with patients, I target 30% body fat in women and 25% in men.  That’s just a starting point, people may need a different individualized target.

A third of Americans die of cardiovascular disease, and two thirds of Americans are obese or overweight.  Waist circumference can help determine whether you are at higher risk for a cardiovascular event.

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Food Addiction

Do you struggle with your weight?  Are you obese?  Have you tried again and again to lose weight, and had short-term success but then slip back into old patterns?  Have you lost weight only to find yourself gaining the weight back with interest?

As a physician who enjoys helping people lose weight, I am almost as frustrated as my patients when things aren’t going well.  One thing that makes weight loss particularly difficult is food addiction.

Food addiction is just starting to be recognized as a major underlying factor in overweight and obesity.  Just like alcoholism and drug addiction, there are changes in the brain in some overweight and obese people that make it difficult or impossible for them to lose weight without help.

Researchers at Yale developed a questionnaire, published in 2009, to assess food addiction.  This questionnaire, the Yale Food Addiction Scale, is a 25-question tool that helps dig into symptoms and behaviors of food addiction.

What is addiction?  Psychiatrists and psychologists recognize addiction as a persistent pattern of abnormal behavior that results in significant distress in the patient.  Abnormalities include

  • Tolerance (needing more of the substance in question to get the same effect)
  • Cravings and withdrawal symptoms when not using
  • Consuming larger amounts than intended
  • Unsuccessful attempts to cut down in spite of wanting to cut down or abstain
  • A lot of time spent using or recovering from use
  • Continued use or overuse in spite of known consequences
  • Giving up important activities in order to use

You may already recognize some of these markers in yourself.  I certainly do.  For instance, I have a really bad sweet tooth.  I sometimes find myself eating more sugar than I know is good for me.  If I stop eating sugar, I will have sugar cravings, headaches and body aches.  Sugar is addictive and I know I have withdrawal symptoms if I overuse it for awhile then stop.

The same group that developed the Yale Food Addiction Scale published an article looking at almost 200,000 people, and found that about 25% of people who were overweight or obese met the criteria for food addiction.  Food addiction was more common in women, those over 35 years of age and those with clinically disordered eating, like binge eating, anorexia and bulimia.

Addiction is a complicated topic and I could write for days about it.  A VERY over-simplified explanation of addiction is that the reward centers of the brain have low levels of dopamine, the pleasure hormone.  Using the drug of choice (opiates, food, sex, sugar, etc) raises dopamine levels in these areas.  Also, these substances interact with the endogenous opioid (endorphin) systems, giving a morphine-like “high.”

Taken together, the presence of the “high” with use and low dopamine levels without use make it very difficult to resist the urge to overeat and very difficult to stop overeating once started.

Do some foods trigger food addiction more than others?  Well sure, nobody really binges on green beans and broccoli, right?  So called “highly palatable” foods are much more likely to trigger overeating.  The food industry knows this, and adds saturated fat, salt and sugar to processed foods to create this super-tasty addiction trigger.  Chips, cookies, candy, soda, cheeseburgers, French fries, white bread and ice cream are examples of foods likely to trigger an addiction response and binge eating behavior.

My personal belief is that weight loss is much harder than dealing with alcoholism, smoking, even heroin addiction.  You can’t just not eat, right?  However, when you understand what foods and situations trigger addiction, you can avoid them like an alcoholic avoids beer and stays out of bars.

What about people who are motivated to kick their food addiction for good?  What is available to help them?  There are twelve-step programs for food addicts, similar to Alcoholics Anonymous.  One such program is Food Addicts In Recovery Anonymous.  (I have no experience with this program, I just know it exists.)  And like alcoholism and opiate addiction, medications can help.

There is a medication called Contrave which has been shown to promote weight loss.  When you understand food addiction, it’s easy to see how Contrave would be helpful.  Contrave is a combination of bupropion, which raises dopamine levels, and naltrexone, which blocks the endorphin response.

Bupropion, an antidepressant, is well known to help people quit smoking and is the only antidepressant that promotes weight loss.  Raising dopamine levels decreases the need to eat, or smoke, or do other things to raise these levels in the brain.  Naltrexone blocks the “high” from drinking alcohol, using opiates like heroin, or binge eating.

While Contrave is very expensive and only rarely covered by insurance, both bupropion and naltrexone are available in generics and are inexpensive to purchase if not covered.  GoodRx.com can give you an idea what prices would be like near you.

If you believe you may be a food addict, please print and fill out the Yale Food Addiction Scale and take it to your doctor.  You can also print out the scoring instructions, it’s a little tricky to score.  This will help your doctor help you.

Like many similar problems, a combination of medication and counseling is going to be the most effective way to deal with food addiction.  If you are overweight or obese and feel out of control with respect to your eating, don’t give up!  See your doctor and ask for help.  If he or she isn’t comfortable diagnosing and treating food addiction ask for a referral to a bariatric center near you.

Like alcoholism and opiate addiction, food addiction can impact every part of your life.  It can alienate you from friends and family, and can even take your life.  Proper treatment starts with recognizing the problem and asking for help.

QUESTION: Do you or someone you love have a food addiction?  Will you do something differently based on the information in this post?

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