Conquering Hunger

A couple years ago I implemented an eating plan of two days a week with virtually no carbs and the rest of the week a Mediterranean diet consisting of few carbs, many vegetables, lean meats and fish, and small amounts of unsaturated fats as recommended in the book The 2-Day Diet: Diet Two Days a Week, Eat Normally for Five, by Dr. Michelle Harvie and Professor Tony Howell. Over the course of several months of following this regimen more or less (I became less strict about portion sizes over time), I lost 30 pounds. The book recommended maintaining the eating plan, but dropping the two days of zero carbs to keep weight off, but to go back to it if need be. Though I largely stuck to a Mediterranean diet, I fell back into some bad habits regarding carbs, eating whole wheat crackers and cheese as a snack, and allowing myself a glass or two of wine at dinner and to browse the snack tables at parties. As of January of this year, I had added back 15 pounds over the last year and a half.

While I was following the plan, I had largely learned to control my hunger, at least compared to any other time in my life. I learned to become much more aware of levels of hunger, and began to separate the feeling of an empty stomach from a feeling of hunger. The book explains what I had learned but never quite internalized: carbs are addictive, especially “simple carbs”: sugars, potatoes, and refined grains, also known as foods with a. high glycemic index. Foods with a lower glycemic index (this is something that diabetics learn about, but is also important to the rest of us) take longer for the digestive system to turn into a form we can use—sugar. When we eat high glycemic index food our blood sugar levels spike. It doesn’t take long before it dives, and when it gets low our body starts craving more food. This process can make us binge, or at least it can cause us to eat more and more often than we should.

Having this knowledge, and even having had the experience of losing the weight, did not make it easier for me to hold the line and return to the 2 Day Diet eating plan, though I tried a few times. I needed some inspiration, and after hearing a radio program, “The People’s Pharmacy,” featuring a scientist describing his research on dieting, I bought his book, Always Hungry? Conquer your cravings, retrain your fat cells, and lose weight permanently, by Boston Children’s Hospital and Harvard Medical School endocrinologist Dr. David Ludwig.

His approach is very similar to Harvie and Howell’s, especially regarding the role of carbs in weight gain. As you might surmise from the title, he promises that following his plan will teach you how to reach your “set point” or healthy weight, by controlling hunger rather than counting calories or measuring food portions. As with any good book that purports to help people eat a more healthy diet that will help them lose excess weight, he offers a lot of advice about recognizing and implementing habits and behaviors that trigger overeating and might undermine your efforts. I am at a point where I don’t feel I need that help. What I found most helpful was the detailed science that he provided.

Ludwig explains that we need body fat. (I’m going to do my best to summarize the science, but I may get some details wrong). Our large brains use about 1/3 of the energy we consume, even when resting. If we had no reserves, we would lose consciousness and die in a relatively short time. So our body relies on stored fuel, and fat cells are the containers. Fat tissue contains about 3,500 calories per pound, while carbs and protein (found in liver and muscle) have only about 600. Fat cells take up excess calories when we eat and release them for use when they’re needed.

Insulin is the hormone that orchestrates this. It is the insulin level in the blood, or lack of it, that creates hunger. Insulin levels rise as we eat to do their job: they regulate the metabolism, the rate at which our body uses the available sugar in our blood, sends it to storage in fat cells, or frees it from fat for use. When we eat high glycemic index foods, the pancreas produces too much insulin, which triggers fat cells to hoard their stores—they shouldn’t be needed since there is so much sugar in the blood. So when the blood sugar level drops quickly and we get hungry, the fat cells don’t release their stores, and now our body tells us to EAT or DIE! If we don’t eat, if we exercise amazing will power, the fat cells will eventually respond and release needed stores, but how many of us will wait? No, those of us susceptible to these carb cravings (and judging by obesity rates, it must be well over 50% of us) are much more likely to have a little snack—some chips, candy, a cookie, crackers and cheese. 

For dieters who try to restrict their calorie intake and/or increase their activity, Ludwig has some bad news, especially if you’re eating processed carbs, even the ones made from whole grains. If you’ve experienced the thrill of starting a diet and losing a few pounds in the first days or week and then hit a wall despite not increasing your food intake, he confirms that your body can and will slow down your metabolism to protect its fat stores. The cycle of peaking blood sugar, insulin production, and the extreme hunger that follows he says produces stress hormones in an effort to unlock fat stores, but “if these cycles occur frequently, our metabolism suffers a slowdown, which can make weight loss nearly impossible.”

His recommendations: at least for a time, cut out all carbs from processed foods, including whole grain products from flour. Stick to whole or mostly whole grains themselves, like brown rice, bulgur wheat, quinoa, steel cut oats. Avoid all “fat free” products, because they often add sugars. Eat seeds, nuts, whole fat dairy products like yoghurt and cottage cheese (all in moderation, of course). Use olive oil or other mono- and poly-unsaturated fats, and for a sweet treat, eat dark chocolate with at least 85% cocoa (15% or less sugar). 

His promise is that this will end the carb addiction cycle. His book includes 3 phases, or levels, of carb strictness to begin your journey, but as I’ve been practicing a diet so similar for a few years, I don’t feel a need to follow his specifics or use his recipes and behavior logs, etc. But if much of this is new to you, I recommend following his plan. For the past couple weeks, I’ve cut out the bread, crackers, and “fat free” foods I had been eating and have found my appetite reduced to a level in which I can even comfortably well past noon or six pm without feeling like I need a snack to “hold me until dinner.” If, like me, those words are part of your daily vocabulary, you may be a carb addict as well. 

Lose Weight Permanently? We'll See

In November 2013, a little over 2 years ago, I embarked on a change in my eating habits, following the recommendations of a book called, The 2 Day Diet: Diet Two Days a Week, Eat Normally for Five by Dr. Michelle Harvie and Professor Tony Howell. This is where I started.

Beginning weight 11/3/13: 209

Height 5'8" Age: 61

Beginning waist size: 43 in.

By reducing carbs and increasing vegetable and protein intake severely two days a week and more moderately the rest of the week, over the course of eight months, I lost about thirty pounds and five inches in waist size. I continued eating a maintenance version of the recommendations, but over time slacked off and allowed more carbs into my diet. Gradually pounds started accumulating. A few time since then I have made feeble attempts to return my weight to 180, or 185, or 190 pounds, but each time after a losing a few pounds, weight loss eluded me, and I decided to be happy with the new weight and just hold the line. So here I am today, at 197, having gained more than half of the initial loss back, and imagining the possibility that I will soon be back where I started and no longer able to fit into the new jeans I bought when I reached my low point. 

For those of you who know me or followed my blogging back then, I was posting my progress several times a month and wrote about learning to control my hunger, getting over my carb addiction, and how much better it felt to conquer the cravings I used to feel. So why am I back where I was? 

Partly, it is the insidious addiction that carbs encourage, but, due to a new book I am reading: Always Hungry? Conquer your cravings, retrain your fat cells, and lose weight permanently by Boston Children’s Hospital and Harvard Medical School endocrinologist Dr. David Ludwig, I now believe that there’s been something else at work—my own metabolism and the uncanny ability of the human body to store calories in order to preserve fat. 

Surprisingly, one of the reasons I may have had trouble keeping my weight off may be that I tried to eat not only fewer carbs, but also lower my fat intake and eat low fat foods. Dr. Ludwig recommends eating butter and other ‘healthy’ fats, like nuts, and warns that low fat substitutes often contain hidden carbs. Though I haven’t yet started implementing the recommendations in this book, I look forward to losing this weight again and keeping it off.

While I won’t post weekly “weigh ins” as I did last time, I will keep you posted on my progress. Wish me luck!

Yoga: How Far Can I Go?

Does anyone get through life without back pain? 50% of Americans experience back pain each year! My back problems are probably relatively small. Sometime in my twenties I strained it pretty badly. Since I was living in poverty at the time, it took me awhile to see a doctor, and when I did, I took the meds he prescribed, stayed off my feet as much as I could for thirty days, did some of the exercises and got over it…more or less. Apparently what I actually did was to start favoring one side of my body that didn’t hurt as much, and over the next fifteen years I had a couple recurrences, for which I sought help from a chiropractor.

That provided relief, but finally, at the age of forty-two I went down. Literally. On the floor of my classroom. During the pledge of allegiance. I’d been taking increasingly higher doses of ibuprofen for a few weeks, going to a chiropractor for the past week, and had been squatting to try to stretch out the spasmed muscles of my lower back, and on that morning they said, “No more.” I curled up in fetal position, motioned for one of the fifth graders to bring me pencil and paper, and wrote a note to the school secretary to call an ambulance. Another teacher came, took the students to the playground, and I was carried out on a stretcher. With a month of sick days, the help of codeine, valium, and a fantastic physical therapist, I learned how to start strengthening the muscles of my lower back and abdomen, especially on the side that had become weak from my efforts to protect myself from pain. Luckily, my problems were with muscles, not discs.

Fast forward to age 62 and retirement. I have had no relapses since then. I’ve maintained my physical condition through bike riding and using the Nautilus machines at the YWCA a couple times a week.

But I would never claim to be limber. I am flexible…to a point. Which, I guess is true of everyone. Over the last five years or so, I’ve dabbled a bit with Yoga. I participated in a couple sessions at a resort and found out what it was – basically stretching and breathing mindfully, and I bought a DVD by Lilia of PBS fame and have used that off and on for the past couple years. But Lilia was a bit too easy on me – she didn’t push me to go farther than what I was already able to do, and consequently, I made little progress.

I recently attended a Yoga class while in New York City from a young man who showed me a bit more about what a true practitioner of yoga does. Of course, I knew that people who “practice Yoga” do amazing things, turning themselves into human pretzels, but I have never pictured myself attempting that.

Now I’m not so sure. Or, at any rate, now I’m open to stretching my body…pushing my body to stretch to new limits.

When I returned home I started with another PBS yoga program, this one called Priscilla’s Yoga Stretches, which airs on our secondary PBS channel (Suddenlink channel 5 from 6:30-7:00 am….I use the DVR). Priscilla does things that are far beyond my capability, but she says that if you keep trying, you will make progress.

When I say I’m not limber, I mean I can’t even squat comfortably. I can barely sit cross-legged, let alone do a half lotus (one foot on the other thigh) where the knees rest on the floor as Priscilla does. I can’t hang one hand behind my head and bring the other one up from below to clasp hands…not even close. So if I’m going to make real progress with Hatha Yoga, I realize I’m going to have to stretch some muscles and ligaments to “open my hips” and “open my shoulders”.  

Many people reject Yoga without trying it because of its exotic name or because they believe it is a religion. Many practitioners report benefits that have some of the earmarks of religious claims: connecting the mind and body, opening up of energy centers (chakras), and such. While I’m not seeking benefits greater than a more limber and presumably longer lasting body, I am open to the possibility that restoring my body, and most importantly, my spine, to a healthier, straighter, more limber and resilient condition while breathing in ways that lull my mind into a hypnotic or meditative state might over time improve my mood or even result in what are sometimes called transcendental experiences.

As I did with my weight as I changed my diet and dropped thirty pounds (of which I have now gained back several) over the past year, I may report my progress in this space from time to time. If I open any chakras (or learn what they are), I’ll let you know, too.

Diet Milestone: 33 pounds gone 11 to go, 3/4 of the way to goal.

My 2-Day Diet Progress Week 29, May 25, 2014 

Beginning weight 11/3/13: 209 lbs.

Height 5'8" Age: 62

Goal weight: 165 lbs.

Total loss goal: 44 lbs.

Beginning waist size: 43 in.

Current waist size: 38 in.

Weight end of this week:  176 lbs.

Gain/Loss this week:  -1 lb.

Total Gain/Loss:  -33 lbs.

This week, 7 months into my physical transformation through change in diet, I’ve reached a milestone. I am three-fourths of the way to my goal of reducing my weight to 165 pounds from 209 pounds since I now have “lost” 33 pounds. Go to a gym and pick up thirty-three pounds of weights--it's the equivalent of a cinderblock or a small microwave oven. It’s significant. I have not weighed this little for at least twenty-five years.

When I reach my goal of one hundred sixty-five pounds, I will still be as much as ten pounds overweight, depending on what measure of healthy weight you use. My doctor, an internist, recommended not losing any more than that. He says that when his patients reach my age, he wants them to have ten to fifteen extra pounds, so that if they get ill and lose some weight, they have some fat to lose. Otherwise, they may lose muscle mass, which is harder to regain as you age. At any rate, I am already quite happy with the way I look. For those of you who have been reading my blog, I’ve said before that I always felt pretty good about the way I looked in a mirror, but I also know that pictures don’t lie. And now when I see pictures of myself, I’m amazed at how much better I look, the stronger, leaner face, the lack of a potbelly, and a general look of fitness. Yes, under all that blubber I really did have quite a bit of muscle from all the bike riding and regular workouts at the YWCA.

An Op-Ed in the New York Times last week by medical researchers Dr. David Ludwig (Harvard School of Medicine) and Mark Friedman, a physiologist and psychologist, entitled, “Always Hungry? Here’s Why,” and a wonderful interview I heard on the NPR program, People’s Pharmacy, with Dr. Robert Lustig, a neuroendocrinologist and Professor of Pediatrics at University of California, San Francisco, who wrote a book called Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease (link to radio show and podcast) both reinforce the science behind my experiences during my journey to a healthier body weight (I’ve lost thirty-three pounds since November 2013).

Ludwig and Friedman note that scientists studying weight loss and nutrition have often gotten it wrong in their understanding of the correlations between calories and weight loss or gain. A calorie is a measure of energy in food. It seemed logical that the number of calories you consume minus the amount of energy measured in calories that your body expends should determine whether you gain or lose weight. But some research now indicates it’s not that simple for multiple reasons, including the way our bodies adjust metabolism depending on the types of foods we eat and even the proportion of fat and muscle in our bodies, squeezing more energy out of calories in some instances and passing calories out of our systems unused in others. To make losing weight more difficult for people with excess fat, Ludwig and Friedman found that fat cells require more calories to maintain than other body cells. They postulate that fat cells ‘grab’ incoming calories, causing the body to need additional food to do other necessary tasks such as nourishing muscle and organ cells and performing necessary body functions.

This creates additional hunger, seemingly caused by the existence of fat itself. Compounding that are the effects of the consumption of sugars and other foods with a high glycemic index, which I think of as the “white foods”: white potatoes, white bread, white rice, and anything made with white flour including regular pastas, most cereals, and in addition, all corn and corn products. Among the sugars are honey, corn syrups, fructose, and even fruit juices. And these days almost all processed foods have added sugar in some form, often "high fructose corn syrup."

When I searched for Glycemic Index chart I found wildly
different numbers in different charts. This one seemed
to match what I believe is true, though it has fruit juices
classified at the high end of Low.

If you got thrown by the words, “glycemic index,” let me give a brief explanation of this important concept. For diabetics, knowing the glycemic index values of foods is critical to their ability to control blood sugar levels because of their lack of insulin production. All food must be broken down to its most basic element, glucose, a form of sugar, for your cells to absorb its energy. Sugars and the white foods are the easiest foods for the body to convert to glucose, which spurs insulin production. Insulin helps our cells absorb the sugar, getting it out of our blood stream. We want it out of our bloodstream because high blood sugar levels cause the blood to be ‘sticky’ and not circulate well, causing cholesterol to build up in the cell walls leading to increased risk of heart attack, stroke, and various other ailments. 

 

The lower glycemic foods make the body work harder and take longer to break down into sugar. Lustig’s research and work with obese children has led him to discover that hunger decreases dramatically when the white foods are eliminated and carbs in general are reduced, and blood sugar levels remain steadier. This was my experience when I reduced carbohydrate intake following the recommendations in a book called the 2 Day Diet: diet two days a week and eat normally the rest of the week, by Dr. Michelle Harvie and Professor Tony Howell.

But why? It’s because high glycemic index foods cause blood sugar levels to spike, spurring glucose production, sending the sugars to the cells and a quick drop in blood sugar. In other words, the spike is followed by a dip, and the low blood sugar levels cause your body to cry out for more food. It is a classic addiction pattern, compounded by the fact that no one can live without carbohydrates. You can’t completely remove carbohydrates from your diet; you would starve. I used to snack on corn chips between meals. Of course this was just keeping the roller coaster going. It's funny how obese people like I was don't stop to ask ourselves, "Why am I hungry?" We know our bodies don't "need the food," after all, we're carrying enough fuel in the form of fat to keep the engines of our bodies running for months. And, in most cases, obese people get hungry every every or two. And not just a little hungry, desperately hungry. Well, it's not for most of us a case of some basic flaw of character or terrible childhood trauma, it's body chemistry. An addiction to simple carbohydrates.

What you can do to break the addiction, however, is avoid high glycemic index foods and replace them with low glycemic index foods: low fat meat and fish in reasonable quantities (4 oz. or less), nuts, low fat dairy like low fat cottage cheese and nonfat yogurt (without the syrupy fruit—use fresh or canned fruit); all the green vegetables you can eat of any kind, including tomatoes (yes, they turn red, but start green, just like peppers), eggplant, summer squash. Sweet potatoes and winter squash, lima beans and other beans are in the medium range and fine in limited quantities. Vegetarians will depend on them for protein. Whole grain (make sure its 100% whole grain, though, and doesn't have added sugar) foods like oatmeal or Cheerios, whole wheat bread and pasta, brown rice and such are relatively low in their glycemic indexes, but should not be overeaten. A tennis ball size serving (about ¾ cup) or one or two slices of bread constitutes a serving. I have had many satisfying lunches of just half a sandwich, an open sandwich, or a light wrap made with a small "light" tortilla (or on a low carb day that the 2 Day Diet recommends twice a week, I might use a piece of lettuce or cabbage as the wrap).

For me, that diet, described as a Mediterranean diet in the 2 Day Diet book, has become a way of life. I no longer have to measure portions or keep track of how much of each food group I eat, because basically I now eat as much as I want. It's just that I don’t want very much. My appetite has been reduced so that a salad with a few ounces of canned tuna, sardines, smoked oysters, or a small piece of salmon, chicken, or a couple thin slices of turkey is a satisfying meal. A couple tablespoons of cottage cheese with some canned peaches or pears, fresh strawberries and couple walnuts…a great breakfast or snack between meals. 

One small serving of brown rice with as much broccoli or stir-fry veges as I want, and the equivalent of a small pork chop, chicken thigh or fish portion makes a great dinner. And yes, I sometimes have beef as well if that’s what I want. And if I’m at someone’s house and they serve a rich lasagna dripping with fat and cheeses, I don’t decline it, I just take a portion that is half or less of what we’ve come to think of as a normal serving: about ½ cup in volume. Then I eat it very slowly and eat a lot of salad or other green vegetables. And if they don’t serve any green vegetables, fine, I eat some when I get home.

One food that most people have a hard time believing is not part of a healthy diet is fruit juice. Dr. Lustig recounted a really smart demonstration he and his colleague, a nutritionist, do on visits to schools. They give two students six oranges each. One is given a juicer; he uses the six oranges to make a 12 oz. glass of orange juice, drinks it down, and says, “Now what’s for breakfast?” The other student starts eating oranges. By the time he finishes orange number four, he’s so full he feels like throwing up. In other words, according to Dr. Lustig, though some fruits are considered medium or high glycemic index foods, they have a self-limiting ingredient that keeps us from overeating if we eat the whole fruit: fiber.

I love that science explains why I’ve been successful on this diet. And if you struggle with your weight, there’s one takeaway I hope you get from reading this; it’s that I didn’t succeed because I have superior willpower. I’m succeeding because I stopped feeling hungry all the time. Yes, I did need some willpower in the first month or two. You can go back and read about how I held myself back at parties…or didn’t, and if I didn’t, I forgave myself and started fresh the next day. But as I learned when I (finally after many tries) quit smoking 20 years ago, breaking an addiction takes at least a month. But once you break your carb addiction, you’ll be home free. Go for it!