TO SUM IT ALL UP
Altering Your Food Environment
Dr. Lustig gives a number of pages on "A real verses Processed Food Shopping "
As he states it is based upon four principles:
1. Low sugar
2. High fibber
3. Low omega-6 fats
4. Low trans fats
THE LAST PART OF THE CHAPTER STATES
As real food costs more than processed food, many will view these recommendations as paternalistic and pejorative against the poor. However, only 19 percent of all money spent on food in the United States is for the food itself. The other 81 percent is for packaging and marketing. This is one hell of an up-charge, especially on the poor. If and when all America gets tired of paying it, maybe the food industry will rethink its strategies. (Occupy Nabisco, anyone?) In the meantime, they're going to ride this gravy train.
How to Eat Without Cooking
Not everyone can, has time to, wants to, or knows how to cook. While these people are at a minor disadvantage in eating real food, it's not impossible. The first rule is, stay out of fast food restaurants at all costs. No good can come of them. Beware packaged products, even those claiming to be organic. Many of them contain the same amount of sugar as their commercial counterparts. If you're buying a dish at a coffee shop or diner, make sure it has something green in it. Second, don't buy anything you can eat while standing up, because then you're not thinking about your food, and you're likely using your hands (which means more processed carbohydrates), not utensils. Sit down, enjoy it, make it a meal. Third, make sure it has some sort of protein—anything from sliced turkey to natural peanut butter is okay, just don't go for a baked good, which is just fat, carbohydrates, and sugar. Lastly, no smoothies or Frappuccinos!
How to Survive a Restaurant
This chapter is about controlling your food environment. Restaurants are the ultimate loss of control. You have no control over what goes into the food, portion sizes, how quickly the food arrives, or whether there are bread or tortilla chips placed on the table before the meal. Plus, you must solve the immediate intellectual/emotional dilemma of volume versus taste versus price. No wonder buffets are so popular. So, does this mean you can never go to a restaurant again?
Portion sizes served at fast food restaurants have increased significantly since the 1970s. Sodas have increased by 49 calories, French fries by 68 calories, and hamburgers by 97 calories. Frequent fast food eaters consume more calories per day on average than non - or infrequent fast food eaters. Pricing and packaging encourage larger portions. In an experimental restaurant setting, customers who were served a larger portion ate 43 percent more. Children who eat at fast food restaurants twice a week increase their obesity risk by 60 percent, and those who frequent one three times a week, 300 percent.26 There is a wide discrepancy between the number of calories customers expect to find in a fast food meal and the number they actually consume.27 In addition, customers overestimate the healthfulness of fast food items that carry health claims. While salads and apple dippers are on the McDonalds top-ten list along with the Big Mac and French fries, most customers are not able to accurately assess the true caloric value of these so-called "healthy" options. Lastly, even when they rate a serving as too large, people will finish a larger portion merely because they've already paid for it.28 Even having eaten more than they wanted, customers still see these "extra-value" meals as a good deal.
The rules for dealing with restaurants are very simple.
1. If the food comes in a wrapper, the wrapper has more health benefits than the food. Fast food restaurants are the antithesis of real food.
2. Whatever you do, don't order soda.
3. Ask the server not to put bread and chips on the table.
4. If you've already had dessert this week, don't make this your second.
So What's the Answer?
Do we need to avoid restaurants and supermarkets like the plague? Do we need to eat what our ancestors did or eschew all carbs? I would propose that all we need to do is eat "safe carbs." That means low sugar to prevent insulin resistance, and high fiber to reduce flux to the liver and prevent insulin hypersecretion. And while we're at it, eat "safe fat," that is, real fat rather than synthetic fat (such as trans fats, which can't be metabolized). Michael Pollan, in his New York Times article "Unhappy Meals," exhorts us to "Eat food. Not too much. Mostly plants." That's seven words; I'll reduce it to three: eat real food. The "not too much" will take care of itself. And the "mostly plants" isn't a worry if you eat the plants as they came out of the ground, or the animals who ate the food that came out of the ground— because they ate plants. The point missing in the various diet plans just explained is that all real food is inherently good. It's what we do to the food that is bad. Keep the food intact—you can steam, boil, or grill it. Food processing is the Mr. Hyde of this obesity pandemic. And the way to reverse it is to do the opposite.
Of course, this means major changes in the ways that both we and the food industry do business. But remember the early 1980s. The food industry had to overhaul its entire operation to adhere to the low-fat guidelines. It can do it again. One food industry executive told me, "We can change, with two provisos. We won't go it alone"—meaning the rest of the industry will need to follow suit—"and we can't lose money." Well, today, both of those are non-starters. No doubt such changes would affect food prices. But it doesn't mean that everyone will have to pay more at the store. It all depends on how the U.S. government chooses to respond (see chapters 21 and 22). The battle against obesity must be waged on two fronts: at the individual level and at the public health level. Until the food industry, the grocery industry, and the restaurant industry realize that it is not in their best interest to provide our current processed food choices, don't expect our global food environment to improve anytime soon. Educating yourself as to what's in your food and what it does to you is half the battle to control your and your children's personal food environment. Educating government to improve everyone's food environment will be covered in detail in chapters 20-22……..
1. Get the insulin down—to reduce your body fat and improve leptin resistance.
2. Get the ghrelin down—to reduce hunger.
3. the PYY up—to hasten satiety (the feeling of being full).
4. Get the Cortisol down—to reduce perceived stress and hunger, and reduce deposition of energy into visceral fat……
Get the Insulin Down: Eat Fiber, Reduce Sugar, Exercise
For almost everyone, reducing insulin is the linchpin to success. Less insulin means less shunting of energy to fat cells, improved leptin sensitivity, and a lower appetite. It also means more energy available to muscles, which improves metabolic health and quality of life. How to get insulin down? That means reducing insulin release or improving insulin sensitivity, or both.
The best way to reduce insulin release is to limit the exposure of the pancreas to the agent that drives insulin up, which is glucose. This means cutting back on refined carbohydrates. Improving insulin sensitivity means improving hepatic, or muscle, insulin sensitivity, or both. And each one is accomplished differently. Improving hepatic insulin sensitivity means limiting the production of liver fat, which requires limiting your livers exposure to fat and carbohydrates together (this is why most popular diets work, see chapter 17). The best way to do this is to reduce your sugar consumption, since this is always fat and carbohydrates combined. The easiest means of accomplishing this feat is to remove sugared beverages from your house: soda, juice, Vitamin Water, all of it. Stick with water and milk. A sugar-addicted parent (see chapter 5), similar to one who is drug addicted, will act as an "enabler," "co-dependent," or "apologist" for her child. The job of the parent is to convert the house from a minefield into a safe house for the child.
Another way to lower your insulin is to eat more fiber, which reduces flux to the liver and the insulin response (see chapter 12).
Opt for brown foods: beans, lentils, whole grains, nuts, and other legumes. And eat the real stuff: the whole fruits and vegetables rather than their processed or juiced derivatives.
White food—bread, rice, pasta, potatoes—means the fiber is gone (or, in the case of potatoes, was never there in the first place).
Finally, improving muscle insulin sensitivity is very simple—only exercise will do it, because once muscle fat is stored, the only way to get rid of it is to burn it off. Plus, exercise will burn off liver fat as well.
Get the Ghrelin Down: Eat Breakfast with Protein, Stop Nighttime Bingeing, and Sleep More
Reducing ghrelin, the hunger hormone (see chapters 6 and 11), will diminish total food intake at any given meal. And the best way to do so is to eat breakfast. If you don't eat breakfast, you don't ratchet up your thermic effect of food (see chapter 13), ghrelin levels keep rising as the morning drags on, and you will eat more at lunch, dinner, and into the evening. Eating breakfast is part of the equation, but what you eat makes a huge difference. A high-protein load has been shown to reduce ghrelin more than a meal high in fat or carbohydrates,3 so you will burn more just sitting. Plus protein has a higher thermic effect, meaning it costs double the energy to metabolize protein versus carbohydrates. Plus protein doesn't generate nearly as high an insulin response as do carbohydrates, and doesn't lead to your blood glucose crashing down, which makes you hungry sooner. Bring on the bacon and eggs.
WELL NO….. NOT BACON [GOD'S RULES ON DIET….IT'S UNCLEAN. YES GOD HAS CLEAN AND UN-CLEAN FOOD LAWS] - EGGS INDEED; OR GRILLED CHEESE ON A SLICE OF WHOLE WHEAT BREAD; AND HOW ABOUT A GLASS OF ORGANIC MILK - Keith Hunt
Some people with very severe insulin resistance, caused by overcon-sumption of sugar, are enormously hungry—so hungry that standard mealtime changes won't cut it. The hallmark of this pattern is nighttime bingeing.4 When these patients awaken, they are not hungry and usually go without breakfast (which is a warning sign for big indiscretions later in the day). Indeed, they invariably eat before bed; some of them even awaken from sleep to eat. Eating after dinnertime is problematic for everyone, because any energy consumed that late will have no chance to be burned. It will find its way either to the fat tissue or to the liver, making the patient even more insulin resistant. Some of these patients also have obstructive sleep apnea, and virtually all of them have metabolic syndrome. They are enormously fatigued and can't find the ability to exercise, due to both the excess insulin and the lack of sleep.
In order to improve their leptin resistance, which means improving their insulin resistance, they must break this vicious cycle of nighttime eating and energy storage. The only hope these patients have is to readjust their mealtimes. This means eating a sensible breakfast and lunch with no snacks added, and dinner must consistently occur a good four hours before bedtime. Any late dalliances with food will only make matters worse. These patients must also get consistent sleep, which can be very difficult due to problems in their airways while sleeping (called obstructive sleep apnea). Patients who snore (and in this category they all do) may need to see their doctor to get a Bilevel Positive Airway Pressure (BiPAP) machine to hold their airway open while sleeping. Some patients may need a tonsillectomy and adenoidectomy to create a larger airway for better sleep.
Get the PYY Up: Eat Appropriate Portions, Wait Twenty Minutes for Seconds, Eat Fiber
A kid eats a whole plate of food and says to her mother, "I'm still hungry." Mom doesn't want her kid to starve, certainly doesn't want any whining, and serves up another portion. You parents out there, how many times has this happened to you? Every day? Every meal? For adults, why do you devour a second hamburger immediately after scarfing down the first? There is a huge difference between the phenomenon of satiety versus the phenomenon of lack of hunger (see chapter 12). Putting food in the stomach lowers your ghrelin, but that doesn't stop you from eating more. The signal for satiety—the switch that turns off the meal—is peptide YY. Between the stomach and the PYY cells are twenty-two feet of intestine. It takes time for the food to get there. Give it a chance. The Japanese have a saying, "Eat until you are 80 percent full." This is very difficult to do in America. The key is to wait twenty minutes for second portions. Also, make sure your first portion is an appropriate size—even if you don't go back for seconds, you're going to do damage if you've supersized your meal. The best way to get your PYY up is to make the food move through the intestine faster, and that's the job of fiber (see chapter 12). And the best way to get fiber is to eat real food.
Get the Cortisol Down: Exercise
Now here's the hard one. Cortisol is your short-term friend and your long-term enemy. Keeping Cortisol low, which means keeping stress down, is virtually impossible. There are more stressors today than ever before, and no natural way to deal with them. Our ancestors may have run away from the attacking lion, but it is considered poor form to bolt full speed from your yelling boss. Stress-induced eating may be one of the toughest challenges to overcome. First, because it's not the stress, it's the response to stress that matters (see chapter 6). This may be either genetically or prenatally determined (see chapter 7), and unlikely to respond to simple willpower. Second, since excess Cortisol drives visceral fat, insulin resistance, and further food intake, it's the triple whammy for metabolic syndrome.
Finally, Cortisol alters the output of the amygdala in a positive feedback, or vicious cycle, manner, so that more Cortisol results in more amygdala activation, resulting in more Cortisol the next time, and so on. Since nobody's stress is going away in this lifetime, the overeating won't go away either. If you've got poor coping mechanisms and everything in life is chaotic, it's pretty hard to ignore your troubles, and they tend to multiply.
There is one simple, cheap, and effective way to reduce your Cortisol: exercise.
Although exercise raises your Cortisol while you're doing it (to mobilize glucose and free fatty acids for energy), it reduces your Cortisol levels for the rest of the day. It burns off fat in your muscles to improve muscle insulin sensitivity, and in your liver to improve hepatic insulin sensitivity. In our clinic, the rule is to buy your screen time with activity. Every hour of TV or computer games means an hour of playing sports. This is the hardest for families to do, because parents tend to use the TV as a babysitter, and modern children tend to prefer playing sports with a joystick.
Many parents start dreaming about what college their child will attend before the kid is out of the womb. Your children feel that stress—which affects their mood, their actions, and their studies. The pressure on children today is enormous. Where can they find the time for everything? Here's perhaps the most important idea in this book for raising children. If your child lays off the soft drinks and exercises, he will create time. If he exercises vigorously for one hour, his five hours of homework will take only four hours because he will be more focused and efficient. He will have created time. There are numerous studies from around the country documenting that increasing exercise improves kids' school performance and behavior. Parents, creating time is what life is all about in the twenty-first century. You can't increase the number of hours in the day, but you can increase your child's productivity.
Sadly, your kids' school doesn't get it. They're saying, "We have to teach to the test, otherwise No Child Left Behind will pull our funding." Teachers, here's what you need to know: No Child Left Behind is really No Child Moving Forward and No Teacher Left Standing. Teachers, exercise your kids during the school day. Lose forty-five minutes from the daily schedule and devote it to real huffy-puffy, sweaty exercise. The kids will do better in school and exhibit better behavior.
The Way We Need to Be
Processed food altered our current environment. All the pieces are available for us to retool.
For example, how about crockpot dinners made that morning? Salads don't need cooking—just be careful about the ingredients in the processed dressings. Kids need to bring lunch from home and not purchased at school, where, with a few notable exceptions, the food is highly processed, sugar-laden, frozen (so, it contains no fiber), shipped cross-country, and just plain nasty. Like DeShawn's mother, take the soda out of the house. Try to ensure that your child doesn't eat the home and school lunch or trade it with a classmate. Talk to your school principal about the food served at school; the school can do better.
Make sure the convenience food trucks don't line up outside the school waiting for kids to exit with dollars in their fists. If your kid is old enough, how about having her cook for the family? She needs to learn sometime, or in college the freshman 50 will no doubt replace the freshman 15. Of course, these changes are applicable only to the middle and upper classes of society. The poor still do not have access to healthy foods or areas in which to exercise. This is one of the many reasons that public health solutions are also necessary (see chapters 20-22).
It's the Hormones, Stupid ……
There are two ways to look at how our environment relates to obesity.
The first one says that genes and behavior interact to drive weight gain. But both genes and behavior are unalterable; so in this paradigm, all is lost.
The second says that behavior is the output of hormones (see chapter 4) and hormones are responsive to the environment. Obesity is a hormonal problem, and hormones are alterable, so in hormones there is hope.
In this chapter, I've provided the rationale and methods to alter the environment, for even the most recalcitrant of patients. But that doesn't mean it will work. The precepts will work for 60-70 percent of the obese population. Sadly, genetics, epigenetics, developmental programming, and environmental obesogens can overwhelm any environmental alteration. Sometimes medicine and surgery are necessary.
AND YOU MUST TAKE INTO ACCOUNT METABOLISM…… IT CAN BE DIFFERENT IN DIFFERENT PEOPLE. YOU'VE HEARD THE PHRASE "I JUST LOOK AT FOOD AND GAIN AN OUNCE/POUND." WELL IT REALLY MEANS DIFFERENCE IN METABOLISM. AND METABOLISM CAN CHANGE. I COULD EAT 3 GOOD HEALTHY MEALS A DAY AND NOT GAIN AN OUNCE FROM MY MIDDLE TEENS TO AGE 40. AFTER AGE 40 A WHOLE DIFFERENT STORY UNFOLDED. I JUST HAD TO EAT LESS, MAKING SURE IT WAS STILL GOOD HEALTHY FOOD; HAD TO CUT OUT WHOLE GRAIN FLOUR PRODUCTS, BREADS, POTATOES. NEVER WAS INTO EATING PIZZA OR SPAGHETTI. CUTTING DOWN ON SUCH ITEMS I INCREASED VITAMIN/MINERAL SUPPLEMENTS. SO IT IS FOR ME AND MANY OTHERS AFTER A CERTAIN AGE, A LIFE STYLE LIVING TO ADJUST TO WHAT YOU HAVE TO ADJUST TO, IN ORDER TO KEEP YOUR WEIGHT WITHIN IT RANGE, FOR YOUR HEIGHT AND BONE STRUCTURE. WHY MANY CANNOT KEEP THEIR WEIGHT UNDER CONTROL, IS BECAUSE THEY CANNOT LIVE WITHIN A LIFE STYLE, THAT KEEPS THEIR WEIGHT UNDER CONTROL. THEN THERE IS WHAT IS RECOMMENDED BY DR. MERCOLA - INTERMITTENT FASTING; MISSING A MEAL HERE AND THERE. I DO IT ABOUT 3 TIMES A WEEK, REPLACING THE MEAL WITH A GLASS OR TWO OF ORGANIC WHOLE MILK.