Bourdain calls out Deen

Paula Deen who crafted a remarkable, high profile career with her Southern style of cooking, delivered with Southern style charm, announced her diagnosis of  adult onset diabetes (type 2). Now the judgments are pouring in: her food and lifestyle led her to this diagnosis and the pundits are asking for her to “repent.”

As a physician let me be clear here:

Paula Deen’s diabetes is not a deserving fate for what she cooked, it is more a matter of genetics than anything else. For those who are unlucky enough to have the genetic code that predisposes them to diabetes, the odds are they will become its victim, as they get older.  Even the most “in shape” individual, who eats “right” who has the genetics for diabetes can no more avoid that than you can avoid a car accident  if someone misses a stop sign because they are texting.

Perhaps I am jaded – as someone who researches diets and performs weight loss surgery- I’m reminded that HL Mencken said that physicians are not suppose to offer repentance but absolution.  But a body never lies, and while we don’t know the “right” diet,  we do know that  certain foods can kill you.

While the news enjoys the pseudo-feud going on between Deen and one of my favorite writers-chef Anthony Bourdain, we in medicine hope that Paula Deen is using her celebrity to benefit millions who are diagnosed with diabetes. She is also cashing in a check from a sponsoring company;  isn’t that the American way?

The real quote from Bourdain is one anybody can respect, “Honestly, I have no ill will toward her personally. I respect anybody who’s had a trajectory like hers. But I don’t like the brand. If her shtick is food that’s going to rush you along your way to diabetes, then it’s not a brand I particularly like. I am the last person in the world to be advocating for any kind of healthy eating or lifestyle. The only distinction between us, actually, is that my show comes with a parental advisory and hers doesn’t.”

I won’t endorse Paula Deen’s cooking as “healthy” and most of it would cause blood sugar to rise higher than it should.  Food can kill you, but it cannot cure you. Hopefully Paula Deen will use her celebrity to advocate for diabetes education and awareness.  I also wouldn’t mind if she would come out with a few recipes that won’t raise the blood sugar as much as twinkie pie. And just to be fair– eating a little less of poison doesn’t mean it is being “moderate” it just means you are being less stupid. Besides- you can’t eat just one. So, Ms. Deen- lets see some new recipes.

Until then, I’ll be watching Bourdain eat camel cheeks in some far away place, wishing I was there with him.

]]> http://yourdoctorsorders.com/2012/01/paula-deens-diabetes-a-physicians-perspective/feed/ 2 http://yourdoctorsorders.com/2011/11/rack-of-lamb-with-dijon/ http://yourdoctorsorders.com/2011/11/rack-of-lamb-with-dijon/#comments Sun, 13 Nov 2011 06:14:27 +0000 The Doc http://yourdoctorsorders.com/?p=1479

Rack of Lamb is one of the easiest proteins to make- it is healthy and the flavor is great.

First start with a great Rack:

There is debate among people who like their lamb from New Zealand and those who prefer American. My good friend @DolceDebbie doesn’t like American lamb, while Chef Thomas Keller has all of the lamb for his restaurants raised in the United States. Those are complicated arguments- know that both have great lamb.

Ingredients:

1/2 cup of Dijon mustard

1/2 cup of Italian bread crumbs

1 Tablespoon of Fresh Rosemary or two teaspoons of dry Rosemary (get the fresh- it stores a long time)

1 teaspoon of minced garlic

The juice from one lemon

Preheat the oven to 450 degrees

Mix all the ingredients in a bowl and spread the thick paste over the loin (meaty) side of the lamb

Put the lamb bone side down  into a casserole dish or any oven safe dish, or a roaster (two sides to a rack – the meaty side should be up) -

If the oven isn’t ready- it is ok to let this to sit for a bit

Put the dish the center of the oven

Cook for 25 minutes. Then turn the oven off.  Leave in the oven  for another 20 minutes and take out.

Once it is out of the oven leave it on the counter to “rest” for ten minutes

Cut and serve

If the lamb is too rare for your liking – heat up a skillet to medium heat and sear them the lamb for 1 minute per side.

The internet is full of claims of individuals living longer because of some diet, lifestyle, or supplement living longer.  So let us start with this disclaimer:

Anyone who gives absolute statements about one person living longer because they only drink Yak milk, or eat raw foods, or are a vegan, or a pescetarian, or eat raw lion meat – etc. – are making an opinion, not based on data.

The classic example is studies done on Seventh Day Adventists in the 1960’s and 1970’s.  Seventh Day Adventists are vegetarians by choice. They also do not drink alcohol, and they do not smoke tobacco.  Their lifespan was longer when compared to non-vegetarians. However, the study did not adjust for variables such as smoking, alcohol, lower body mass index, and what is called the “healthy volunteer effect.”

In 1999 a metastudy combined data from five western countries and reported mortality ratios.  This broad study showed fish eaters (pescetarians) had a the lowest ratio of 0.82, followed by vegetarians at 0.84.  Occasional meat eaters were at 0.84 and vegans as well as regular meat eaters had a ratio of 1.0.  (The lower the number the longer the lifespan.) – American Journal of Clinical Nutrition Vol 70 (3): 516S-524S – September 1999.

Fish eaters seem to live the longest

One of the most commonly cited studies is the “China Project” where blood samples were pooled from 65 rural counties in China.  Their conclusion was that meat eaters lived less long than those who ate animal proteins.  However, analysis of the raw data from that study leads to the opposite conclusion.  Ultimately the China Study became a best selling book. The books conclusions are the opinions of the author T Collin Campbell, many of those opinions have been refuted by peer-reviewed papers based on the raw data in the study.  One study example came from examination of the stomach cancer data showing that there was an inverse correlation between meat and stomach cancer.  Cancer Epidemiol Biomarkers Prev 1992, 1: 113-118.

Recently reported was the risk of meat consumption and colorectal cancers. Previous studies have been inconsistent so a metastudy was performed and there was an increase in risk of colo-rectal cancers with increased consumption of meat—however, this was “processed” meat- defined as cured or nitrate, or sausages.  The study did not adjust for other dietary habits, lifestyle, or genetic factors.  It should be noted that nitrate cured meats have higher associations with stomach and colo-rectal cancers.

Processed meats appear to increase risk of colo-rectal cancer

Population studies are flawed, and sometimes, the author’s conclusions may not agree with the raw data. There is not clear evidence that one dietary lifestyle is going to significantly increase lifespan if one does not include obesity, smoking, or consumption of fish.

While there are thousands of internet sites concluding that vegans live much longer- there is no study that agrees with that conclusion. What conclusion can you come to? Probably that eating fish is a good thing- eating too much processed food may not be a good thing. Best to pick great parents, don’t overeat, and a bit of red wine and chocolate are not bad things.

Sometimes all you want for breakfast is a cup of coffee-- and that's ok

Everyone knows:  Always   eat Breakfast

There   are   a lot   of   variations   of   this   axiom.

“Breakfast   is   the   most   important   meal   of   the day.”

“Breakfast makes it so you won’t be hungry later.”

“Breakfast jump starts your metabolism”

“You need to eat a large breakfast”

“Breakfast   is   the   most   important   meal   of   the day.”

All of those are FALSE.

Breakfast is NOT the most important meal of the day- so don’t force it. The reality is that most people are not ready to eat breakfast when they first wake up.  So why does “everyone” say this? Some of this data was based on the Iowa Breakfast study- which was more than a single paper- but a group of observations made over a number of years and published. There have been a number of other studies showing that kids who eat breakfast do better in school than kids who do not. However, there are a lot of variables not accounted for in those studies.

In addition- a few other items were not taken into account: if you wake up at 4 am to do chores until 7 am, then have breakfast and go to school, you will do better in school than someone who wakes up at 4 am, does chores and doesn’t get breakfast.

Regarding most breakfast studies — funded by, and poor research  done, from cereal companies. Doesn’t mean they are bad studies- but they all fall into poor categories of evidenced based research.

“Breakfast makes it so you won’t be hungry later.”

A recent study showed that people who eat a large breakfast are not affected by how much they eat later in the day. Meaning that eating a large breakfast won’t keep you from snacking, or eating less the rest of the day.

You wonder where people come up with this idea– but when it is put to the scientific test- the breakfast you consume does not reduce food you consume later. Not one bit. No relation- no correlation.

Breafast buffet is not your friend

“Breakfast jump starts your metabolism”

They also found that eating less in the morning contributed to overall weight loss (if you eat less calories you will lose more weight).  There is a simple truth about weight loss – if you eat more calories than you burn, you will gain weight. If you eat big breakfasts and lots of other calories you will gain weight.  Breakfast does not jump start your metabolism- your body does that.

Again- how would you measure a “jump start” to metabolism? There are ways- but activity itself increases heart rate, breathing, and over all muscle activity. If you take comatose patients and measure their oxygen consumption and carbon dioxide production- and cycle feeds – the feeds do not increase metabolism. Another study took college football players and put them into a hospital and fed them. They were allowed to do a few walks- but not much more.  It was activity that increased metabolism- not food. Any food will increase some metabolism – but a breaking of the fast does NOT do any sort of jump start.

“You need to eat a large breakfast”

Want to just have a smoothie or yogurt or some oatmeal to start your day? Go ahead. You want to wait for a couple of hours after you get up before having something to eat- that works too. But if you eat a large breakfast – you still need to work off those calories.

You think this is an important meal?

The great thing about breakfast foods: You can eat them anytime! Who doesn’t like eggs for dinner? And after a long day- nothing is more refreshing than a blueberry smoothie to take the edge off hunger, and let you relax for a bit.  We have recipes for smoothies containing micronutrients, fibers, and supplements – a simple smoothie can be a pleasant treat after a long day of work, taking the edge off hunger so you can make a great dinner.

For the smoothie and other recipes go to terrysimpson.com

Breaking the chicken down into parts facilitates great cooking, because with such a method you can combine a bit of Sous Vide with some flash frying and have that perfect chicken. Or use it for anyone of a number of great recipes.

Sous Vide will cook the chicken perfectly- but you need to do a flash fry for the Maillard Reaction

It is keeping that chicken together- cooking it whole, making the chicken in such a way that the aroma from the chicken will permeate the house. The ultimate comfort food- and yet, too often when people cook it the chicken skin is soggy, the chicken meat is dry – and we look to sauces to overcome it.

When Jonathan Waxman was voted off Top Chef Masters – he had made chicken. The judges thought that the chicken was too simple, but it was done perfectly. Did those judges ever try to make chicken?
Some of my favorite restaurants for chicken include Zuni in San Francisco- the perfectly cooked whole chicken. That recipe was adapted in our recipe section http://terrysimpson.com/recipes.php – the key for that is salting the chicken a day or two ahead of time and allowing it to dry in the refrigerator. Ad Hoc and Bouchon – of Thomas Keller – who prefers to brine the chicken before roasting it (salting does the same chemical process without the messy brine). Tarbell’s has perfected the pan roasted chicken. Michael Mina’s Sous Vide Chicken provides an amazing flavor profile, that is difficult to  find in many restaurants.

Thomas Keller Knows great chicken- see our review at EatPackGo.com

Jeffrey Steingarten, the food editor for Vogue magazine, noted how the roto-broil 400 made the perfect home rotisserie chicken. It became my mission to find one- which I did, and he is right- this is the perfect rotisserie unit for people. The problem is they don’t make that unit any longer. I managed to find one on e-bay and had it refurbished – if you can find one – get it.  But to check the common ones available, I purchased the Ronco platinum unit (you may have seen Ron Propel’s set-it-and-forget-it infomercials). This produces a moist chicken, but the heat generated does not give the perfect crispy skin – still not a bad unit for the home cook.

The Roto-Broil 400 makes the perfect chicken

We go back and forth in our house- making the chicken on the rotisserie – which is simple, to the oven roasted whole chicken. Both have great qualities, and both leave the house with an aroma of the perfect comfort food. Try our recipes – and see – making a perfect chicken, and doing it well is a great skill. Perfect it over this month, and you will have many years of great dining – and chances are you will find very few restaurants that make chicken as well as you do.

Skin cut away to reveal the perfect chicken- crispy skin, moist meat

Artificial sweeteners are either the saving grace of America, or the devil. The first issue with artificial sweeteners came to light when cyclamates (the first marketed artificial sweeteners) were found to cause cancer in rats. So in 1969 cyclamates were taken off the market. Saccharin was the next agent, but many didn’t like its after taste. Then came aspartame (Equal). This had no bitter after taste and became the favorite until someone started a rumor that aspartame killed ants, and was originally developed as a rat poison – this is untrue on both counts.

First, aspartame was developed as an artificial sweetener and second, it does not kill ants (I tried it, as have a lot of others – sadly it doesn’t work). Splenda does contain calories (because of our FDA regulations it is allowed to be listed as “zero calories” but it is not). Splenda has 3.36 calories per packet (1 gram). It tastes like sugar and is generally easy to cook with – however; one package of Splenda is 600 times sweeter than an equal amount of sugar.

Two other sweeteners have joined the market in the United Sates. Stevia- is a product of several plants and was recently approved as a food additive in the United States, and Truvia (a proprietary blend of Stevia made by Coca-Cola and Cargill the Pepsi produce it PureVia). These are essentially all the same. There are some other sugar-alcohols like Xylitol that function as sweeteners.

The issue with artificial sweeteners has been getting use to the sweet taste, and thus an increase in appetite. In rats that are consuming artificial sweeteners there is an increase in their body weight over time as they increase the amount of food they consume. Not that we are rats – but avoiding the overly sweet taste is important. And there is no accident that while many of my weight loss patients consumes large quantities of “diet cola” – they still consume a lot of calories to go with them. It is also no accident that once our patients get off artificial sweeteners, they lose more weight.

People who drink sodas that have artificial sweeteners have a sixty percent increase in stroke and heart disease. Sixty percent!

How do you gain weight with artificial sweeteners? Since they are so sweet, you naturally want food to balance out the sweetness. Increasing the quantity of food allows you to increase the bitter, sour, and other sensations to balance the sweet taste. Remember, your palate always wants to return to a balance.

Overall –avoid the artificial sweeteners. Still- what is better than artificial sweeteners in soda? Simple water. It is free (unless you are in a city where the water tastes bad) and is regulated more tightly than most things

The rotisserie is one method to make perfect chicken. This unit is at Wm Sonoma

Such dry chickens are not only unpleasant to eat- but are the types of meats that can become stuck causing what we call a food bolus.  With a food bolus you feel as if you swallowed a golf ball. Nothing else will go down. Sometimes you can’t even swallow saliva.

You may have experienced a partial one of these when you swallowed a piece of meat and you could feel it go down.  When it gets stuck- big problem.  My patients with the LAP-BAND must have moist chicken- dry chicken will become stuck and make an otherwise pleasant evening turn into a retching mess.

Chicken recipes they strive for this nirvana of chicken – sometimes with complicated instructions – but there are two methods to cook the perfect chicken. One is cooking the chicken Sous Vide, and then you have the perfectly cooked chicken needing only a quick fry to make the skin crispy. For those who have skinless chicken breasts (no accounting for taste) – Sous Vide is the perfect method to prepare the chicken.

For those who, think that a crispy chicken skin represents the best pleasure – cook the chicken on a rotisserie.  You can buy rotisserie chickens from the supermarket- but often the skin is moist with fat, and the breast is overcooked, although not dry.   If you have a home rotisserie unit you can save this most delightful part for yourself (and once you have had perfect chicken skin, crispy- you will never want to go back.

For those who believe that chicken skin is evil- I would ask you to produce one scientific paper showing such- you can’t find one. The reason you cannot find one is because they don’t exist.  They don’t exist because there is nothing wrong with chicken skin – nothing. It will not raise your cholesterol it will not raise your low density lipoprotein (LDL- remember, bad is lousy – so lousy for LDL  and “happy” for HDL).  You might read “summary “ articles from National councils or consensus reports- but there is not one shred of evidence in the scientific literature that the skin of chicken is “bad” for you – in any manner, anywhere.  Or you can listen to Rocco – a chef with no medical training who wrote a best seller, or you can listen to Dr. Oz, who can’t cite a reference either.  Or you can enjoy chicken skin knowing that a guy who does weight loss for a living says you can eat it.

Buy a rotisserie unit.  There are a bunch of them out there- it is become quite popular,  although I cannot tell you the plus or minus of any one of those units- I can tell you that many do not make the chicken hot enough to crisp the skin.  What to do? Borrow one from a friend- ask around (most of them are in closets) and try one.  If a local fancy food store is demonstrating them- try their product.

I have a 1957 Roto Broil 400 – it is as old as I am but works great (like me).  There are a bunch of great brands out there today- and if any of you have them and they work- please comment.

My Roto Broil 400 was made the year I was born, 1957. Still works great

Until then- your mom was right- the best thing is in the skin  – but not the vegetable skin – it is the chicken skin (oh, and pork belly skin is pretty good too).

Recipe for these is pretty simple.  Have a fresh, whole chicken – remove all the giblets and other parts.  Rub the chicken with extra virgin olive oil. Season the chicken with salt, pepper, and garlic granules.  No need to stuff the chicken.

Truss the chicken- and place in the unit for 15 minutes per pound.  Warning- chicken skin is addicting.

If you have a home rotisserie unit and it works well for you – please comment! Let me know the name, the make and how you make your perfect chicken.

Margarine, vegetable oil, eating less animal fat – all were the fad in the late 1960’s and early 1970’s – and became government policy in 1976 to recommend that people eat less fat, especially animal fat and move to polyunsaturated fat.

Most of this was championed by Ancel Keys, a physiologist who did a “seven country study” showing that serum cholesterol was related to heart disease. Sadly, Dr. Keys ignored data that did not agree with his – including the “French paradox” where France has the highest per capita consumption of dietary fat and one of the lowest incidences of heart disease. He also based this on the erroneous conclusion that with the increase of dietary fat was correlated to the increase of heart disease in the US. In fact, during what Keys described as an “epidemic” of heart disease vegetable fat consumption in the US doubled per capita from 28 pounds post war to 55 pounds by 1976. Also, during this time animal fat consumption dropped from 84 pounds to 71 pounds.

Warning against all fats- he became the cover boy for Time in 1961

The Framingham study showed that dietary fat did not correlate with the cholesterol level or heart disease. In every population studied where diet, cholesterol, and heart disease were compared showed the same results—that dietary fat did not correlate with cholesterol level or heart disease.

We now know, from the science of how lipids are made – that diet has minimal influences in the serum levels of cholesterol, and that cholesterol itself is not the evil we once thought it was (in fact low levels of cholesterol are associated with an increased risk of cancer). Too much, or too little, of a good thing isn’t good (high levels of cholesterol >250 are associated with increased mortality, as are low levels of cholesterol <160).

One footnote to the seven-country study – the fat intake in Japan increased post World War from 6 percent of the calories to 22 percent of the calories – and the incidence of strokes decreased with no increase in heart disease.

Keys, however, was not stubborn, and in later years stated, “I’ve come to think that cholesterol is not as important as we used to think it was.” When examining the diets of some in Italy came to the conclusion that it was the types of fat – and became a proponent of the “Mediterranean diet.” The reason for this was that the paradox that Keys noted when in Italy- the high consumption of fat (olive oil) and the low incidence of heart disease.

Olive oil- buy local (US olive oils).

We now know, that the margarine I grew up on contains a lot of trans-fats that increase the risk of heart disease – by raising the levels of LDL-cholesterol (to get it straight think of LDL as “lousy” and HDL – the good stuff as “Healthy or happy”).

Bottom line- the evidence is pretty clear- you can enjoy the eggs, with yolks- you can enjoy olive oil – and the best thing you can do for your health is not go overboard with simple sugars, flours, and lose weight. I think this means that ice-cream is the perfect food, if only I didn’t have this allergy to it (I develop this hive, on my belly, that gets larger the more ice cream I eat and my pants don’t fit).

Julia Child was right- butter, in moderation – is a good thing. “If you are afraid of butter, use cream.”

Julia Child - cutting corners using butter

Enjoy the skin of the chicken (skinless chicken is just silly), forget about lean beef (it really isn’t all that lean) – and eat in moderate or small portions. When someone tells you to eat less animal fat- ask them to show you the evidence – because when the evidence for that is examined- it is nowhere to be found.

For those of you who would like a great comprehensive review of this data it can be found in the book “Good Calories, Bad Calories” by Gary Taubes.  I highly recommend it. Of course, my book will hopefully be out soon – where you can see how this foodie-MD will provide you with great food, and real science.

Part One of Appetite: true hunger.  Start with being hungry- real hunger. When you have real hunger you can be satisfied with a bit of meat, or Eggplant Parmesan. This type of hunger comes a complex series of hormones (ghrelin being the most common one named these days). Ghrelin is partially made by your stomach and also in the brain. If you were to eat a very large dinner, then given an IV of ghrelin you would feel quite hungry even though you have a very full stomach.

One of the popular weight loss operations, called a sleeve gastrectomy, removes much of the stomach, and is thought to remove the major source of ghrelin. But people who have the sleeve gastrectomy, even if over 90 percent of their stomachs are removed, will after a few months, produce as much appetite hormone as before (stomach is an amazing organ). Having hunger satisfied does not mean appetite is diminished however. There is always room for jello (or in my case, the perfect food: ice cream).

Part Two of Appetite: how much to eat.  What is the portion size that allows people to be satisfied until the next meal? How much portion satisfies has been tested finding that the more people are given, the more they will eat. If they are given less food, people report that they are just as satisfied, and they don’t notice a return of hunger compared to when given more to eat. In one study people were fed a ten-inch Sub they reported to be as satisfied as if they were given an 8-inch sub sandwich.

How much is eaten depends on several factors if a person has an unlimited selection (as most of us do), some tend to eat far more calories than they will burn over the next few hours. Some eat until they feel “full,” and some eat until they feel “something.” This is typically a formula for becoming fat. Others pay little attention to the meal and then are done (those people are called skinny).

Balloons placed in the stomach, to mimic a full sensation, have worked modestly well at decreasing weight. This works best for those who wish to stop eating when they feel a “sensation.” Most report that the balloon simply increased an uncomfortable feeling of nausea.

Part Three of Appetite: how fast you eat.  People who tend to eat fast don’t give a chance for those appetite hormones to dampen down, and tend to over eat. The appetite hormones take 15 to 20 minutes to diminish after the start of feeding – thus people who eat a lot quickly tend to over eat. This is far from universal, as slow eaters can plod along, consuming great quantities of food – much like the tortoise and hare.

Part Four of Appetite: time until hunger after eating.  Satiety. Then there is the time before you feel that hunger again – some think it is when they hear the stomach empty (it isn’t- that is a false signal that can happen many times in an hour). But when the hunger hormones peak depend on a variety of factors – how much bulk you ate, and the amount of protein or fat you ate. Small amounts of protein and fat can inhibit those hormones for as long as two hours (one scoop of chicken salad will prevent those hunger hormones from coming back for at least two hours). This is often referred to as satiety.

For some people eating a small quantity of food means they will feel hungry again in two hours, for others four. The LAP- BAND works mainly with this mechanism- allowing people to eat a small amount of food, but keeping the appetite suppressed for hours after.

Part Five of Appetite: variety and types of food. A variety of foods increases appetite. Think about trying to eat a lot of ice cream – after a few scoops of that perfect food it is tiresome to the mouth (for lesser mortals). Want to win an ice cream eating contest- eat saltines between the scoops of ice cream. Diet programs based on single food ingredients work, no matter what the ingredient- ice cream diet, steak diet, salami diet, cookie diet, you make up the food diet. The body tires of it and you eat less. But once you leave that diet- and add some more food, you will increase the appetite (I don’t recommend single food diets- if you want to lose weight on a permanent basis you need to change some things you eat on a permanent basis, not just diet for a season).

Did you know that after a number of research studies, it is fairly conclusive that artificial sweeteners, particularly when added to beverages such as diet soda, increase appetite? The more artificial sweetener a person consumes the more they tend to eat. The mechanism for artificial sweeteners increasing appetite is unclear.

Some of it is related to the high sweetness factor in many of the drinks. Most people require a balance in the food they eat. Balance sweetness with the other tastes (sour, bitter, savory, or salty). The more sweet drink, the more food it takes to compensate for the sensation to be overcome. Considering a teaspoon of sugar is a mere 15 calories. Splenda is 600 times sweeter than sugar, and Equal is 200 times sweeter, by weight.

People that eat protein for lunch, tend to eat less for dinner. For those who skip lunch and eat a large dinner, eating a bit of protein for lunch is far better. This does not mean a “high protein” diet, or a Spartan protein.

Liquids go through the stomach quickly, and the stomach processes liquids much differently than solids. While liquid protein diets may quench some phases of hunger, the stomach tends to empty quickly.

Increasing fiber in the diet does not increase the time between meals (satiety) but it does make people feel “full,” – which is again, subjective and does not relate to excess weight. Bulking up on salads never works (most salads contain more calories than simple cooked vegetables). The sensation of feeling full has little to do with weight loss, and a lot to do with weight gain.

Snacking, or the famous six small meals a day, never seems to work well. Snacking on high calorie items tends to increase appetite and hunger.

Fats tend to suppress hunger, but a high fat diet is high in dense calories, and tends, over time to increase caloric intake.

Carbohydrates are mixed with regard to appetite. Low glycemic foods, lentils, beans, tend to suppress appetite well. High glycemic items, most breads and grains, tend to cause rebound hunger in a short period of time. One cannot determine a complex carbohydrate from a simple carbohydrate – as glucose, the simplest carbohydrate and what is needed as a fuel source for the brain and body to work cause less rebound hypoglycemia than white bread.

Sadly this means an individual has two responsibilities: determining what they eat (being reasonable) and how much they eat. There is no way to get around that.  In summary: avoid artificial sweeteners, especially in liquid form. Do not skip meals, but do not over eat.  Snacking with high glycemic items increases appetite. Protein for lunch helps. Fiber is ok for “feeling full” but doesn’t necessarily equate to losing weight.