Carbophobia Part 2

Carbophobia

Part II

Good Carbs, Bad Carbs

Carbohydrates are found in a wide array of foods - bread, beans, milk, popcorn, potatoes, cookies, spaghetti, soft drinks, corn, and cherry pie. The most common and abundant forms are sugars, fibers, and starches.  The basic building block of every carbohydrate is a sugar molecule, a simple union of carbon, hydrogen, and oxygen. Some contain hundreds of sugars. Some chains are straight; others branch wildly.  The digestive system handles all carbohydrates in much the same way - it breaks them down (or tries to break them down) into single sugar molecules, since only these are small enough to cross into the bloodstream. It also converts most digestible carbohydrates into glucose (also known as blood sugar), because cells are designed to use this as a universal energy source.

Carbohydrates are not the root of all evil. They are needed as a chief source of energy and nutrition. But what type of carbs are you eating and how much? Fruits, vegetables, and whole grains are necessary and crucial to consume.  Refined grains offer very little in the way of nutrition and can cause insulin resistance over time. Whole grains digest slowly and therefore insulin is secreted in a slow and even way. When we eat too many white-flour or refined-sugar products, we cause insulin spikes. Too many years of poor diet and little activity and exercise will lead to type 2 diabetes, something becoming all too common in today’s world. This disease was once known as mature onset diabetes since it occurred later in life. Today this is no longer the case, and it is even being diagnosed in kids in their early teens and younger.  Don't be misled by fad diets that make blanket pronouncements on the dangers of carbohydrates. They provide the body with the fuel that it needs for physical activity and for proper organ function, and they are an important part of a healthy diet. But some kinds of carbohydrates are far better than others.  Here are a few tips from the Harvard School of Public Medicine on how to include carbs in your day:

1. Start the day with whole grains. Try a hot cereal, like whole oats, or a cold cereal that lists a whole grain first on the ingredient list and is low in sugar. But finding sugar in cereals takes a bit of detective work. Learn how to be a savvy reader of breakfast cereal labels.

2. Use whole grain breads for lunch or snacks. Confused about how to find a whole-grain bread? Look for bread that lists as the first ingredient whole wheat, whole rye, or some other whole grain - and even better, one that is made with only whole grains, such as 100% whole wheat bread.

3. Bag the potatoes. Instead, try brown rice, bulgur, wheat berries (the entire kernel is intact), whole wheat pasta, or another whole grain with your dinner. 

4. Choose whole fruit instead of juice. An orange has two times as much fiber and half as much sugar as a 12-ounce glass of orange juice.

5. Bring on the beans. Beans are an excellent source of slowly digested carbohydrates as well as a great source of protein.

For most people, weight gain happens over a long period of time.  It’s not difficult to consume 50 calories a day more than you need or than you use. That will give you a 5-pound gain per year. Keep that up for a number of years, and you will be obese. For example, in 20 years, that will give you a 100-pound weight gain.  If we have determined that the low-carb, high-protein routine is not only ineffectual, but also possibly unsafe, how do we go about this daunting task of losing weight?

Naturally, each person has his or her own individual tendencies regarding weight loss.  But the general rule to follow is this: fewer calories in and more calories expended. Let’s take the case of a client of mine (name has been changed).  Shira led a very sedentary lifestyle. At five feet two inches, she weighed almost 250 pounds. Driving almost everywhere, opting for the elevator instead of stairs, and choosing to stay inside after her long day at work instead of walking, Shira was only burning as many calories per day as her body used for basic functions (resting metabolism).  Besides all that, she was eating large amounts of food, and the foods she chose to eat were calorie dense. Realizing she was slowly destroying herself, she came to us and began a weight-loss, physical-fitness program.

Shira began with a twenty-minute walks each day.  At the same time, she cut her caloric intake and made healthful choices for her meals and snacks.  Her food program was balanced and included mostly fruits, vegetables, whole grains, healthful fats and lean protein choices.  Keeping up this routine and refining and intensifying it as she became more fit and able to do more, she lost 115 pounds over eighteen months. Today (almost 8 years later) Shira’s body mass index, the index most widely used by doctors to measure overweight and obesity, is just within the healthy range.  At the same time, all of her nutritional requirements are met on a daily basis.  And she eats carbs while doing it!

To recap: Fad diets just don’t work. Any diet or food program that is based on the elimination of entire food groups and obsessively eating only certain foods is harmful to you, and for most people in the world, it is unsustainable.  Eating right is hard work. So if you don’t want to be one of those people who lose significant weight and gain it all back and more, it is worth the effort, as the rewards of good health and longevity are certainly well worth it. 

Alan Freishtat is an A.C.E. CERTIFIED PERSONAL TRAINER and a LIFESTYLE FITNESS COACH with over 17 years of professional experience. He is the co-director of the Jerusalem-based weight loss and stress reduction center Lose It! along with Linda Holtz M.Sc. and is available for private consultations, assessments and personalized workout programs. Alan also lectures and gives seminars and workshops. He can be reached at 02-651-8502 or 050-555-7175, or by email at alan@loseit.co.il   Check out the Lose It! web site - www.loseit.co.il    US Line: 516-568-5027

Carbophobia

 Part I

A World of Extremes

We live in a world of extremes.  For those who want to follow the Rambam’s sensible way of living, the middle path in terms of diet and exercise seems elusive.  In the last few years, we have been treated to low carbs, high protein, low fat, low sugar, no sugar, high carbs etc.  It’s as if the quick fix is the only way to achieve what we want.  But the statistics are telling us that most people who are trying all these radical approaches to diet are not achieving much of anything.

Let’s look at the facts.  Ninety-seven percent of people who are following an organized diet plan based on a book or program of some kind without making any other lifestyle changes will fail. Yes, many will lose pounds while on their program, but a few years down the road they will either weigh in at close to their starting weight, or even more.  The Western world is obsessed with weight loss. In the United States alone, individuals and companies are spending more than $60 million per year on weight loss products and programs - yes, you have that correct, 60 million dollars on programs the mostly don’t work in the long term. Yet the amount of overweight or obese people continues to rise.  Remember the low-fat diets we were bombarded with a few years ago?  Everything on the supermarket shelf was marked in big, bold print “Low Fat” or “No Fat.” The result was that Americans continued to get fatter. Dr. Atkins made a revolution all right.  Everyone stopped eating things that were good for them, and then lost weight until they couldn’t stand it anymore. And then they ended up eating every carbohydrate in sight, in addition to steaks, eggs, cheese and burgers.

Reverse Results

After the 1972 Olympics, physical fitness became popular.  By 1978, according to U.S. News and World Report, America was in the midst of “fitness mania.” But it was also about this time that obesity rates began the rise that continue to this day. Yes, there is a genetic predisposition for many, which makes them more prone to being overweight, and some people do have a naturally faster metabolism, but basically, weight gain works like this: if we consume more fuel than we burn, we get fat.

Does this happen from the occasional binge, the extra slice of pizza or the extra scoop of ice cream?  Not really.  Weight gain is really a slow and gradual process.  Let’s say you eat 2,300 calories a day and use only 2,000 or so.  Every day you are left with 300 extra calories that turn into extra pounds every few weeks. Driving instead of walking twenty minutes every day means a gain of five pounds per year.  Drinking a single can of Coke every other day will add another four pounds. As you see, it's just a few extra grams a day and a few pounds a year, but that’s enough to create the epidemic which includes a wide range of disease and illness and kills 350,000 per year just in the United States.

Low-Fat, No-Fat

It is no accident that about the time that this epidemic started, the low-fat and no-fat phenomena began.  People think that just because their food is lower in fat, they can eat as much as they want.  Not true.  You can get fat on brown rice and whole wheat bread if you eat enough of it, let alone reduced fat cookies, frozen yogurt and dietetic cakes.  These foods tend to have more sugar and can even be high in calories than their non-dietetic fatty counterparts. (The American Heart Association has adopted this position.) Now let’s talk about these not-so evil carbs.

In our eternal search for the perfect diet, carbohydrates became the culprit. It is estimated that up to 20 percent of Americans are participating in a low-carbohydrate diet for weight loss or maintenance.  In these diets, carbs are shunned while protein consumption is encouraged.  The two of the more popular low-carb diets are the Atkins Diet and the South Beach Diet, but there are many variations.

Does it work?  The National Weight Control Registry is a long-term study of individuals 18 years and older who have successfully maintained a 30-pound weight loss for a minimum of one year. Currently it has about 4,500 members. An analysis of the diets of close to 3,000 people listed in this registry found that fewer than 1% who had maintained at least the 30 pounds of weight loss for a year or more followed a low carbohydrate diet (with less than 24% of the daily calories from carbohydrates). Because so few dieters following Atkins were found in the registry, which includes only long-term dieters, researchers concluded that very low-carb diets do not offer any weight loss advantage over the long term.  In addition, not eating enough unrefined carbohydrates carries certain health risks because they contain nutritional value and energy that we need.   

There is no diet worth going on if it compromises your health. Whether it is Atkins, Sugar Busters, Protein Power, South Beach, or any other variation on the high protein theme, there is scientific evidence than ever that a diet high in fat and animal products is strongly linked with heart disease, prostate cancer, breast cancer, type 2 diabetes and other diseases.  “Even if you manage to lose weight and keep it off on an Atkins diet, you may be mortgaging your health in the process,” says Dr. Dean Ornish, author of Eat More, Weigh Less.  Some late research has now shown that a high-protein diet also prevents maximum absorption of calcium into the system, leading to osteoporosis. Additionally, people with even slight abnormal kidney function can be harmed by high-protein diets. Liver disease and gout are now found to be more common in those doing the high-protein, low-carb fad diets. Low-carb diets tend to be very unbalanced and prevent the consumption of necessary vitamins, minerals, and nutrients.  If all carbs are bad, then the consumption of basic foods such as fruits, vegetables, and whole grains becomes minimal.  This is what deprives the dieter of essential vitamins, minerals, and nutrients.

Now that we’ve established what isn’t good for you in the long run, stay tuned for Part II, where you’ll learn about the many benefits of consuming the right carbs.

Alan Freishtat is an A.C.E. CERTIFIED PERSONAL TRAINER and a LIFESTYLE FITNESS COACH with over 17 years of professional experience. He is the co-director of the Jerusalem-based weight loss and stress reduction center Lose It! along with Linda Holtz M.Sc. and is available for private consultations, assessments and personalized workout programs. Alan also lectures and gives seminars and workshops. He can be reached at 02-651-8502 or 050-555-7175, or by email at alan@loseit.co.il   Check out the Lose It! web site - www.loseit.co.il    US Line: 516-568-5027

All Those Numbers

You weigh 176 pounds.  Your BMI is 26.6.  Your waist to hip measurement is 0.8.  Your body fat is at 24%. What is one to make of all this?  First, let us deal with the scale which will give you your weight in pounds or kilo. And that is all it tells us.  It doesn’t tell you how much of that weight is because you are big or small framed (boned) and it certainly can’t differentiate between how much is muscle (healthy) and how much is fat weight (unhealthy).  The number on the scale gives us a good idea about our health and weight, but it isn’t the whole story—at all.  Numerous times I have witnessed my clients walking in and getting ready for a weekly weigh in.  They feel so much better in how their clothes fit (the belt went in a notch this week) but the scale is still in the same place.  That is the displacement of lost fat by new found muscle from the person’s working out properly. So even though the person lost no weight on the scale that week, they lost centimeters around their waist and that is far more important to your health. 

BMI--I am a BMI Basher.  The BMI, short for Body Mass Index, is an index used to measure our health risk by calculating height and weight.   It was devised between 1830 and is defined as the individual's body mass divided by the square of his or her height. The formula universally used in medicine produces a unit of measure of one’s weight in kilograms divided by their height in meters, squared.  In 1927, the BMI became a main measure of evaluation of one’s body mass.  For the last 25 years, it has been used by most health providers and doctors to assess their patient’s health risks vis-à-vis their weight.  When you read the all too frightening statistics about how much of the population is overweight and obese, these are based on BMI readings.  Here is how we interpret BMI results:

BMI	Weight Status
Below 18.5	Underweight
18.5 – 24.9	Normal
25.0 – 29.9	Overweight
30.0 and Above	Obese

The BMI is very easy to use, and that is one of the reasons that doctors like to use it.  It is simply using height and weight measurements which are relatively easy to obtain.  But the accuracy of the BMI  in terms of measuring overall health risk is questionable.

A 2010 study that followed 11,000 subjects for up to eight years concluded that BMI is not a good measure for the risk of heart attack, stroke or death. A better measure was found to be the waist-to-height ratio.

BMI is particularly inaccurate for people who are fit or athletic, as the higher muscle mass tends to put them in the "overweight" category by BMI, even though their body fat percentages frequently fall in the 10-15% category, which is below that of a more sedentary person of average build who has a "healthy" BMI number. Body composition for athletes is often better calculated using measures of body fat, as determined by such techniques as skin fold measurements or underwater weighing and the limitations of manual measurement have also led to new, alternative methods to measure obesity, such as the body volume index.

BMI also does not account for body frame size; a person may have a small frame and be carrying too much excess fat, but their BMI reflects that they are "healthy". Conversely, a large framed individual may be quite healthy with a fairly low body fat percentage, but be classified as "overweight" by BMI.  A further limitation of BMI relates to loss of height through aging. In this situation, BMI will increase without any corresponding increase in weight.

But to put it in simple terms, the BMI doesn’t measure important aspects of healthy living.  There is no calculation that includes how much exercise a person does or whether or not you include healthful foods in your diet.  A person with a 22-23 BMI may look good in the eye of the examining doctor, however, if this person happens to have a fast metabolism, eats unhealthy food and doesn’t exercise, he may be a lot less healthy and much more at risk for sickness and mortality than a person with a 27-28 BMI who exercises daily and tries to consume healthy foods. 

There is no question that the BMI can be an important calculation to help us have an idea of how our health is affected by our weight, but unlike the impression given by our public health officials, it is certainly not the beginning and end all of measurements related to our weight and health.  As I advise my clients all the time, if you need to lose weight, every pound and kilo that you lose is a pound or kilo improvement in your health and if your weight loss is coupled with doing even minimal exercise, then in spite of a BMI that may be higher than 25, you are doing wonders for your health.  The best measure of how you are doing is probably more how your clothes are fitting than anything else, because that is the best indication of fat-weight loss.  The BMI is probably heading the way of the original food pyramid which did more harm than good to the public health.  New and more accurate measures, that are not difficult to use, are on the way.

Your weight and BMI are important, but they are not the bottom line in assessing your health risk. If you keep doing what you need to in terms of proper eating and exercise, you will be doing wonders for your health.  Keeping your weight in check and exercising daily will “add hours to your day, days to your year, and years to your life.” 

Alan Freishtat is an A.C.E. CERTIFIED PERSONAL TRAINER and a LIFESTYLE FITNESS COACH with over 16 years of professional experience. He is the co-director of the Jerusalem-based weight loss and stress reduction center Lose It! along with Linda Holtz M.Sc. and is available for private consultations, assessments and personalized workout programs. Alan also lectures and gives seminars and workshops. He can be reached at 02-651-8502 or 050-555-7175, or by email at alan@loseit.co.il  Check out the Lose It! web site - www.loseit.co.il    US Line: 516-568-5027

Your Brain Too!

The benefits of exercise and good nutrition are certainly well known.  Not only can a balanced and consistent exercise program and healthful eating lead to a better quality of life and even lengthen your life, some recent research indicates that it is also great for your brain, especially in avoiding and curing depression.

Depressive disorders affect approximately 18.8 million American adults or about 9.5% of the U.S. population age 18 and older in a given year. Everyone will at some time in his or her life be affected by depression -- their own or someone else's, according to Australian Government statistics. (Depression statistics in Australia are comparable to those of the US and UK.).  Anti depression medication, such as Prozac and Zoloft, are the most prescribed class of drugs in the United States today.  In 2005, 115 million prescriptions were handed out.  We don’t know yet how and why these medications work and they can be quite expensive, especially when coupled together with psychotherapy.  But there seems to be a simple and inexpensive alternative.  Have you ever noticed how much better you feel about life after a brisk half-hour walk?  Recent studies have shown that exercise is just as effective at fighting depression, as anti-depression drugs are.

Our brains are composed of nerve cells known as neurons.  The gaps between these neurons are bridged by chemical neurotransmitters such as serotonin and dopamine, also known as the “mood” chemicals.  These are the chemicals in the brain that effect alertness, vitality, tranquility and euphoria and more importantly, they stave off depression. 

A recent study lead by Dr. Monika Fleshner at the University of Colorado at Boulder has shown that exercise works to improve depression and that it increased serotonin and dopamine levels in the brain. And for those who must take medications, exercise in conjunction with anti-depressant drugs seems to cause the drugs to work more effectively. 

Exercise also helps the brain in other ways such as cognitive functions.  Children who engage in aerobic exercise score higher on tests, says Dr. Charles H. Hillman at the University of Illinois at Urbana.  In addition, he also discovered that aerobic exercise not only increases the levels of serotonin and dopamine, but also actually increases the size of your brain, particularly the hippocampus, which is the part of your brain that controls emotion.  Also, it seems that exercise allows the brain to retrieve latent memories.

Anyone who has exercised knows how much better you feel after a session.  The “runner’s high” is a well know phenomenon that distance runners can often experience. It is difficult to know exactly how much exercise we need to do in order to achieve these positive feelings and effects, but Dr. Fleshner feels that 70% of the program should be cardio (aerobic), 20% strength training, and 10% flexibility training (stretching). 

Looking at the nutrition side of this equation, we know that just like poor eating can harm normal blood circulation to your heart, the same is true of the brain. The better blood flow is up to your brain, the more oxygen and nutrients are available in order to sustain itself.  Therefore, an eating program that is vegetable and fruit dense and low in trans fats and saturated fats, and yet includes monounsaturated healthy fats will help keep your arteries from clogging.  But there is even more.  Lately, vast amounts of research has been done on the effects of omega 3 oils on brain function. 

A 2005 study showed that adequate nutrition is needed for many aspects of brain functioning. Poor diet quality, ever-present in the Western World, may be a modifiable risk factor for depression. Insufficient omega-3 fatty acid status particularly increases the risk of depression. Historically, the ratio between omega 3 and omega 6 was 1:1.  In today’s western diet, the ratio is 1:10 or even as high as 1:20.  There is a much lower instance of depression amongst Asians where fish consumption is higher, giving the body more Omega 3 than amongst those of us in the West.  Today’s consumption of Omega 3s is about half of what it was before WWII and it is precisely from that period that the rates of depression have gone up considerably. A lack of Omega 3 might also explain why one in ten postpartum mothers experiences depression.  Since Omega 3 fatty acids play a major role in building the brain and maintaining its balance, these fats are the principle nourishment the fetus takes in through the placenta.  That is also why the mother’s reserves, which are already low in our western style diets, drop dramatically in the last weeks of pregnancy, often leading to post partum depression.   Omega 3 rich foods are Fatty fishes like salmon, sardines and tune, flaxseed, canola oil and walnuts.

We all know that the sedentary lifestyle of the last two generations has brought on a whole host of medical problems. It seems that this lifestyle is partly responsible for the increase of depression in the world as well.  So, get off the couch and away from the computer, put on those running shoes, get outdoors and go for a walk, do some strength training and start to feel great about life!  Keeping your brain in shape as well as the rest of your body is another way to “add hours to your day, days to your year, and years to your life.” 

ALAN FREISHTAT is an A.C.E. CERTIFIED PERSONAL TRAINER and a LIFESTYLE FITNESS COACH with over 16 years of professional experience. He is the co-Director of the Jerusalem-based Lose It! The Center for Health and Wellness along with Linda Holtz M.Sc. They have begun working with Dr. Michael Bunzel, M.D., a psychiatrist in Bnei Brak, Israel on incorporating exercise as a therapy for Stress, Anxiety and Depression.  Lose it! can be reached at 02-654-0728 or 050-555-7175, or by email at alan@loseit.co.il. You can also visit the Lose It! website at www.loseit.co.il

U.S. Line 516-568-5027

Predisposed? Work around your Genes

Genes-a word that can be used to define our genetic makeup or a convenient excuse?  They can give us a predisposition for heart disease, cancer, or a shorter or longer life. I often hear from my clients; “I would love to do your weight loss program, but it is a waste of time.  These are the Genes that G-d gave me there is nothing I can do about it.”   We have all used or heard the standard reasons for not exercising and eating right—“It takes too much time”, “I can’t afford they gym or healthy food”, “I’m too tired and busy”, lately, I have been hearing more of the “I inherited this” excuse than I used to.  Yes, there is definitely some predisposition for having more fat cells or less fat cells in your body, having high cholesterol, high blood pressure or diabetes, but so what!  The question is, can we do anything to counter the family in inheritance and if so, what?

First of all, most of what we call “genetic” isn’t really.  As we grow up, we develop various behaviors, both good and bad, based on what we see and imitate around us.   If we grow up and are raised in an environment where overeating and a lazy lifestyle are prevalent, we internalize that and imitate it, without genes playing a particular role. New studies suggest that exercise and a healthful diet can override the harmful effects of some "bad genes" and boost the beneficial effects of others in all areas of health.

In one example, scientists at the University of Kuopio, in Finland, found that people with particular variants of three different genes stand a greater risk of developing type 2 diabetes. But when people with these variants exercise regularly, they lessen the danger. Although the studies didn’t look at why, scientists have shown that exercise helps improve insulin sensitivity and blood-sugar levels.

Exercise can also amplify the effects of "good genes." For example, people with one variant of a gene that controls cholesterol metabolism, typically have elevated levels of good HDL cholesterol. When those with this lucky gene variation exercise, as researchers at the Steno Diabetes Center in Gentofte, Denmark, reported recently, they get an even bigger boost in HDL levels.

Sedentary lifestyles, on the other hand, may make bad genetic interactions even worse. Growing evidence shows that certain variations of a gene called FTO are associated with being overweight or obese, for example. Research reported in the journal Diabetes earlier this year suggests that when people with these "fat" forms of the gene skimp on physical activity they are even more likely to accumulate fat. Fortunately, exercise can overpower the effects of this fat-accumulating gene variant, according to a study of 704 adults published in the Archives of Internal Medicine in September. Findings like these aren’t surprising.

A wealth of epidemiological studies already show that physical activity reduces the risk of heart disease and diabetes. The good news: even if you inherit an unlucky roll of the genetic dice, there’s plenty you can do to improve the odds.

  

And your diet can also help you overcome genetic factors.  We know that eating a very healthy diet appears to make heart disease less likely, but now that even goes for people whose genes put them at a higher than normal risk of heart trouble. A diet high in fruits and vegetables appears to mitigate the genetic risk of a heart attack,” says a professor of medicine and epidemiology at McMaster University in Hamilton, Ontario, Canada. This finding could affect many people at risk for heart disease because of a genetic variant that researchers have only recently linked with heart attack. It could also call into question the suggestion that you can’t help your genes.

The studies used different dietary information. For one study, the researchers drew up a prudent diet score based mostly on raw vegetable and fruit intake. The score also took into account”risk” foods, such as fried foods, meat, and salty snacks.

For the other study, the score was based on intake of fruit, vegetables, and berries. Those who ate at least two out of those three foods daily earned the prudent rating.

The risk of heart attack for those with the bad genes who ate the least prudent diet was increased about 30%. “The risk of heart attack of those with the bad genotype who were in the high prudent diet group was not increased. This suggests that diet can weaken the effect of the genetic variation, the researchers say.

The study findings suggest that lifestyle does matter, no matter what your genes have dealt you. This suggests you may be able to do something about bad genes if you follow a prudent diet that is rich in fruits and vegetables. The worse the diet, the higher the risk of heart attack. The better the diet, the lower the risk.

In spite of a less than favorable predisposition, eating properly and exercising have been shown to “add hours to your day, days to your year and years to your life.” 

Alan Freishtat is an A.C.E. CERTIFIED PERSONAL TRAINER and a LIFESTYLE FITNESS COACH with over 16 years of professional experience. He is the co-director of the Jerusalem-based weight loss and stress reduction center Lose It! along with Linda Holtz M.Sc. and is available for private consultations, assessments and personalized workout programs. Alan also lectures and gives seminars and workshops. He can be reached at 02-651-8502 or 050-555-7175, or by email at alan@loseit.co.il  www.loseit.co.il

USA Line 1-516-568-5027

Strike up the Band?

In all of my years as a personal trainer and my involvement in the weight loss industry, I think that the single most frequently asked question today isn’t “What piece of exercise equipment should I buy”?...and this was definitely THE question for many years.  But lately, it is much more the question, “What do you think of getting the band for weight loss?” 

The overweight/obesity epidemic is out of hand. The situation has now reached a point that the harm to the public health, which translates into harm for quality of life and definitely harm to everyone’s wallet has reached epidemic proportion, and the situation is not improving. 

Recent studies tell us that if the obesity trends continue as they are now, by 2030 nearly half of all Americans will be obese.  Consequently there will be an additional 6-8.5 million cases of diabetes, 5.7-7.3 million more cases of heart disease and stroke, and up to an additional 669,000 cases of cancer.  Now get this—treatment for all preventable diseases will increase by $48 billion to $65 billion per year by 2030.  We fully understand the problem and the terrible consequences of not reversing this trend.  Nevertheless, instead of taking responsibility for ourselves and taking concrete steps to help ourselves, we still search for some easy way out.  Taking a pill to lose weight would certainly be the easiest solution, but every weight loss pill to date has ended up with side effects so pronounced that they had to be pulled from the market. Out of desperation, we look for something invasive, such as bariatric surgery or gastric banding.  However, even that is showing mixed results.

A new study done in Europe has questioned the long-term effectiveness of the LAP banding device, finding that many patients suffered major complications and half of them eventually had the device removed. The report, published Monday in the Archives of Surgery, focused on 82 surgeries performed between 1994 and 1997. Even though patients reported losing significant weight, complications such as band erosion and infections led researchers to conclude the surgery had "relatively poor long-term outcomes."  Four patients have died within the last two years following Lap-Band surgeries performed in Southern California, prompting medical malpractice lawsuits and investigations by the Medical Board of California. None of the patients involved in the European study died as a result of the surgeries. But 32 of 82 reported major complications, and 49 of them had additional surgeries, either to correct problems or because of a lack of weight loss.

What are the possible complications of the banding? 

·         Infection and migration. An infection may develop either in the port area or in the abdomen, and in some instances this may cause the band to migrate into the stomach.

·         Leakage.  Leakage from the SAGB or from the connecting tube between the balloon and the port may require reoperation. The balloon is made of fragile material, and leakage can occur either shortly after surgery or many years later.

·         Slippage of the band and pouch dilatation. The band may slip, and the pouch (the part of the stomach above the band) may become too enlarged, and a reoperation may be necessary.

·         Punctures in the silicone band and port dislocation The injection port may dislocate and

when injecting into the port, there is always the risk of puncturing the silicone tube.

·         Patients may vomit or feel pain after food intake. This can be caused either by a poor eating behavior, or by the narrowing of the SAGB following the injection of fluid into the balloon.

 

One more thing, nobody on the band will lose all the weight they may need to.  They may lose enough weight to make a huge positive difference in their health, but you can’t lose it all that way. 

 

If you your doctor suggested this procedure to you, be sure you have really tried everything else first.  Have you done a course of behavioral therapy coupled with exercise and proper diet under strict supervision from qualified professionals?  And just as important: HAVE YOU STAYED AWAY FROM THE WEIGHTLOSS GIMMICKS THAT PERMEATE OUR LIVES THROUGH ATTRACTIVE ADS BUT DO NOTHING FOR LONG TERM WEIGHTLOSS?  An effective program to lose weight has you losing your extra kilos (pounds) at a slow, but steady rate.  Extremely low calorie programs, supplements in the form of pills and hormonal injections just don’t do it—even if they tell you otherwise. 

 

Invasive procedures into the body of any nature carry risk.  But then again, so does being obese.  But when “weighing” this decision, consider another finding from a study last year done in Holland.  Adjustable gastric banding achieves only modest weight loss, and even that benefit deteriorates over time in most patients. Edo Aarts, MD, reported at the American Society of Metabolic and Bariatric Surgery meeting that five years after surgery, about two thirds of patients maintained 25% excess weight loss. At 10 years the success rate dropped to less than a third (31%). Using 40% excess weight loss as the standard, resulted in a five-year success rate of about 50%, which declined to 20% at 10 years.

So if you are viewing this as an automatic fix to your weight problem, don’t.  Fortunately, there is a risk-free and safe solution to the obesity epidemic.  It takes longer and requires hard work but can reverse this dangerous trend permanently.  And if you have a positive attitude towards it and have the patience it takes, then losing weight without the band might be the better way to go.

Alan Freishtat is an A.C.E. CERTIFIED PERSONAL TRAINER and a LIFESTYLE FITNESS COACH with over 16 years of professional experience. He is the co-director of the Jerusalem-based weight loss and stress reduction center Lose It! along with Linda Holtz M.Sc. and is available for private consultations, assessments and personalized workout programs. Alan also lectures and gives seminars and workshops. He can be reached at 02-651-8502 or 050-555-7175, or by email at alan@loseit.co.il  www.loseit.co.il

USA Line 1-516-568-5027

More on Risk Factors

Some time ago, I wrote an article on the top risk factors for heart disease (almost all risk factors for heart disease apply to other areas of health as well).  That article was based on research that was current at that time.  Everything in that piece is still relevant.  However, some fascinating new research has come out over the past year which now attributes a much higher importance to one risk factor in particular in comparison to all the others, and that is something called low Cardiorespiratory Fitness (CRF).  Cardiorespiratory Fitness is the ability of respiratory, circulatory and muscular systems to consume, distribute and utilize oxygen during continuous activity.  . 

Let’s put this in perspective.  If we look at two different cases, we have two males in their upper 40s who both see their physician for standard checkups.  A. is a little bit over weight (BMI of 26) and his cholesterol is slightly above 200 and his blood pressure is 124/84.  A. is an exerciser who does 30-35 minutes of brisk walking or slow jogging every week.  He is also careful to use the stairs insteadof the elevator unless he has heavy packages and tries to walk, whenever possible.  B. has cholesterol of 187 and even his ratio of HDL (good cholesterol) to his overall cholesterol is very good.  His blood pressure is 118/78 and his weight is normal (MBI of 23.5).  But B. has leads a sedentary lifestyle and doesn’t do any formal exercise.  He uses elevators, parks as close as possible to his destinations, and sits in his office all day long on the computer and telephone.  Who has the higher risk of heart disease and who has the higher risk of all-cause mortality?  You might be surprised, but B. is probably in more trouble that A. 

As I have stated previously, we have all heard about the risk factors for heart disease and coronary artery disease.  There are about 20 together, and we can certainly control most of them (although some are beyond our control).  Every hour of every day, we are all aging; we can’t turn back the chronological clock or change our family history. And if we were born with a low birth weight, there isn’t much we can do about that either. We can do something about most risk factors, and not necessarily with drug intervention. Case in point: a smoker can stop smoking. But there are many misconceptions when it comes to risk factors, and often, those things that really matter the most are not necessarily diagnosed through a blood test. Consequently, the underlying issue is that we have don’t always have accurate information as to what those risk factors actually are.  CRF is one of the risk factors that we most certainly can do something about at just about any point of our lives.  To simplify this, if you have trouble walking up hill or stairs, or even walking a reasonable distance on a flatter surface, you probably have this risk factor.

Unfortunately, when we go for a check up to the doctor, the emphasis is put on other risk factors like high blood pressure, diabetes, high cholesterol or weight.  But those are easy to measure through blood tests, a blood pressure cuff, or a scale.  Assessing our level of Cardiorespiratory Fitness is a little more difficult to measure accurately outside of the laboratory.  Nevertheless, even an informal measure would tell us a lot. 

Lee, D., et al investigated several research studies in 2010 that demonstrated beyond a doubt that moderate to high levels of CRF are associated with reduced risk of Cardiovascular disease (CVD).  In 2009, Kodama et al. reviewed 33 investigations into this topic.  They found that each MET (a unit of measure of energy expenditure) more that a person expends in exercise is worth a 13%-15% reduction in all-cause mortality and for the chance of having a cardiac event.  The main finding however is everyone, regardless of age, gender, smoking status and weight (as measured with BMI) has reduced mortality rates from all causes, the more fit they are.  One study found that even small, incremental improvements reaped large benefits. 

But why is the level of CRF so pronounced as a risk factor?  One of the most marked ways is that being fit reduces insulin resistance and allows your cells to use glucose as fuel better, and it prevents diabetes.  Also, higher CRF shows a lower risk of all variables in metabolic syndrome (waist circumference, triglycerides, HDL-cholesterol, fasting blood sugar).  Also, we know that people who have a higher level of Cardiorespiratory Fitness tend to have lower blood pressure.  A study several years ago in Japan showed a direct correlation between lowering of blood pressure and people who walked to work- the longer the walk, the lower the blood pressure. 

In order to increase your CVF, you don’t need to join a gym or go to exercise class.  It’s free.  Begin a walking program (okay, spend money on a good pair of running shoes) and start out slowly—even 3, 10 minute increments is useful at the beginning.  But slowly build up your stamina and your distance.  Remember, over time, if you can begin brisk walking, power walking or even some jogging, you will definitely reap even more benefit.  This is less expensive than all the medications you may have to take if you don’t do this, and it is more beneficial in the long run (pun inteneded!). 

The American Heart Association wants to improve the cardiovascular health of all Americans by 20% by the year 2020 while reducing deaths from cardiovascular diseases and stroke by 20%.  All the “wonder drugs” that have come out in the last 30 years for cholesterol and blood pressure and diabetes haven’t really made much of a dent in the realm of public health.  Could it be that we all just starting taking care of our fitness (and make a few subtle changes in our diets) that it will make a difference?  I think so!

Becoming fit and bettering your Cardiorespiratory Fitness is another way to “add hours to your day, days to your year and years to your life.” 

Alan Freishtat is an A.C.E. CERTIFIED PERSONAL TRAINER and a LIFESTYLE FITNESS COACH with over 16 years of professional experience. He is the co-director of the Jerusalem-based weight loss and stress reduction center Lose It! along with Linda Holtz M.Sc. and is available for private consultations, assessments and personalized workout programs. Alan also lectures and gives seminars and workshops. He can be reached at 02-651-8502 or 050-555-7175, or by email at alan@loseit.co.il  www.loseit.co.il

USA Line 1-516-568-5027