Weight Loss Key Principles
I used to base all of my advice on weight loss on calories. If we take in more calories than we use on a given day, the body tends to store the excess calories as fat. The opposite is also true -- if we use more calories in a given day because of our metabolism and/or exercise, our body will burn fat, and we will tend to lose weight. One pound of fat is 3500 calories, roughly. Portion control is obviously a key issue. However, calorie counting is difficult.
The basic advice regarding weight loss that I now use is based on the “Glycemic (sugar) index” of foods. Basically, what this means is that certain foods turn into sugar more quickly and, if taken in significant amounts (called the “glycemic load”), our bodies turn the excess sugar into fat. Therefore, it matters how quickly the food is turned into sugar and also how much of it we take at a given time that determines how much fat we add or lose.
Simply stated, it is better to take numerous small amounts of low glycemic index foods throughout the day rather than taking only one meal a day or taking higher glycemic index foods.
Now to the practical points:
1. All liquids consumed should be diet or no calories. Alcohol, all fruit juices, non-diet soda all have lots of calories and a high glycemic index. You can drink pretty much any diet drink you want or skim milk in moderate doses and you'll be fine. The fabled “healthy” glass of orange juice is almost pure sugar water (avoid it). Coffee and tea (all types) are okay as well as green tea as long as they only have artificial sweeteners and/or a small amount of skim or nonfat milk. It is important to drink lots of liquids while you are trying to lose weight and you should have a water bottle with you at all time with either water or your favorite diet drink. If possible, you should drink up to 8 cups of water or diet drinks per day.
2. All sweets, candies and gum have a high glycemic index and should not be eaten. Even diet candies and sugar-free gum have virtually no nutritional value and do increase weight gain. You must avoid things with dextrose, fructose, dextran, cane sugar, honey, corn syrup, maple syrup and obviously sugar itself.
3. Avoid starches and starchy vegetables as much as possible. Avoid wheat, cereal, pastries, rice (white rice is worse than others and, surprisingly, rice cakes, have a high glycemic index which is bad). Avoid all potatoes, chips, pretzels, corn and popcorn(even air popped), all bread (even whole wheat but whole wheat is better than white), rolls, crackers, cookies, cakes, beans, squash, pumpkin, peas, and parsnips. Even carrots should be off your list.
4. Avoid oil and fats even including margarine butter olive oil, cannola oil, and virtually all salad dressings except as discussed below. Using Pam spray is okay.
5. Certain fruits should be avoided including grapes, tangerines and oranges, pineapple, kiwi fruit, bananas, raisin, mango, watermelon and all dried fruits.
6. Low glycemic index fruits (meaning OK to eat) include apple, cherry, half a grapefruit, strawberries, apricots, blueberries, blackberries, cranberries, lemons, passion fruit, and plum and tomato (which I think of as a vegetable but apparently is really a fruit.).
7. Low glycemic index vegetables (meaning OK to eat) include lettuce, asparagus, cucumber, green beans, broccoli, cauliflower, spinach, cabbage, eggplant, celery, mushrooms, radishes and onion. With vegetables, it is important to make sure that they are not in cream sauces or cheese sauces which will radically alter the number of calories and the glycemic index. For salads, I recommend wine vinegar with perhaps a small amount of Splenda, Equal, Truvia (stevia), or Xylitol. Almost all salad dressings have lots of calories – even the ones labeled “low fat” or “diet”.
8. Proteins - the first issue with protein is portion size. For meats, fish and fowl, a single portion is considered about the size of a deck of playing cards or roughly 3-1/2 ounces prior to cooking. Acceptable choices include chicken without the skin, turkey with excess fat removed, veal, and lean cuts of beef including tenderloin and sirloin. Non-meat proteins that are OK include non fat yogurt, non fat cottage cheese, and egg whites. The use of soy protein is somewhat tricky and also somewhat debatable. Some soy products may be low glycemic and some can be high glycemic index.
9. Fish that are OK include pretty much any white fish or shellfish including bass, cod, grouper, halibut, crab meat, roughy, scallops, shrimp, snapper, swordfish, trout, whitefish, haddock, tilapia, tuna steak. However one needs to be careful about how they are prepared and not use things like butter or margarine et cetera.
10. For seasonings - Mrs. Dash (a brand of food seasonings) is widely available. Avoiding salt is a particularly good idea for those with high blood pressure. The weight will come off quite quickly if you avoid salty foods and salt in your food but some of this will come back if you reintroduce salty foods. Most of the acceptable foods listed above are naturally low salt. Assuming you do not add salt food to these items, you will be on a reasonably low salt diet. Pepper (all types), garlic, and other dry condiments such as rosemary, thyme, basil, onion powder, paprika, ginger, curry, et cetera are okay but look at the bottle and avoid many bottled seasonings such as soy sauce, steak sauce, ketchup, barbecue sauce et cetera. Many of the barbecue dry seasonings also have lots of salt. Using “No-salt” is okay unless you have problems with your kidneys or high potassium. Monitor your blood pressure while you are losing weight and make sure that your blood pressure does not go consistently below 100 systolic (the top number of the blood pressure). If it does it may be time to lower your blood pressure medicines - call the office to see if this should be done. Lemon and lime juice are fine for use.
11. Miscellaneous – peanuts are OK in moderation. Hummus (ground chickpeas aka garbanzos) make a reasonable dip for vegetables such as cucumbers or celery. Be careful with soups – especially canned. There are lots of calories and salt in many soups. On the other hand, soups made at home from the “OK to eat: vegetables, proteins, fruits and seasonings listed above are great
Diet pills are potentially dangerous and I do not recommend them For those who are over 100 lbs. overweight, I typically recommend bariatric surgery, which is now being done by laparoscopic techniques.
Ultimately, diabetes, cholesterol, blood pressure are improved by maintaining a good body weight. We talk about the “body mass index (BMI)” and try to get patients below a BMI of 25. This is the key to longevity. It is rare to see people over the age of 75, who are overweight, without major medical problems such as severe arthritis, etc. If you look around, you'll see that is rare to see people over the age of 80, who are fat. This should tell you something. 80 may look like a long way away now, but people are routinely living into their seventies and I wish I had a nickel for all the people who tell me ”if I knew I was going to live this long, I would've taken better care of myself." For heart patients, maintaining a BMI of less than 25 is literally the difference between life and death! For diabetics, I shoot for a BMI of 22.5.
For details on the glycemic index and glycemic load of various foods, you should Google the food you are interested in along with the words “glycemic index “or “glycemic load.”