In addition to academic publications, her writing has appeared in USA Today, the A Cup of Comfort series, KevinMD.com, EmpowHer.com, Exceptional Parent, Parents Press, Sacramento Parent, and the Marin Independent Journal.

The post originally appeared on her blog, and she’s kind enough to share it here…

I lost 45 lbs this year and I did it by following evidence based medicine.

The #1 thing that I did was commit to weight loss journaling….writing every morsel down that goes into my mouth (helping me stick to my 1,500 calorie a day allotment that I needed to eat to lose weight at a safe rate). Studies tell us that people who journal every day lose twice as much weight as people who don’t.

One of the most important points about journaling is a defense against what we dieters call “bad” days. We shouldn’t be pejorative like that, but many people who are overweight have a black and white view of food intake (I did anyway). What I mean by that is, if the day is shot (e.g. I broke the bank by eating 4 slices of pizza or a piece of apple pie), well, in for a penny in for a pound and it dissolves into a belly-up-to-the-trough kind of day.

But journaling, I have found, can help even when you hit a rough patch….let me rephrase, especially when you hit a rough patch. It’s like a rip cord for your back up parachute. Because stopping to write things down helps you realize that

A) The situation may not be as dire as what you have worked out in your head

and

B) Honesty about what you eat is essential. Because if you are over weight (like I was) you probably lied to yourself about it, “I’m not that fat,” or “I’ve tried journaling/everything and it doesn’t work.”  These are the lies that keep us from losing the weight and trust me, you haven’t really tried journaling until you have honestly weighed and measured every scrap that goes into you mouth, written it down, and stuck to your daily calorie allotment.

Which brings me back to the holidays. Last week was a challenge for me. I only stuck to my maintenance calories (2,000/day) 2 of the 7 days. But I journaled. Every day. Even when it wasn’t pretty. Looking back, I realize it wasn’t the horror that I had concocted in my out of control imagination. And when I really wanted that desert on Friday, I looked at my journal and didn’t. And while it didn’t stop me from eating the 3rd piece of pizza on Saturday it did stop me from eating the 4th (and stopping my descent into pizza madness is no mean feat).

It worked for me and it will work for you. It is as much about being honest and accountable to yourself as it is about the calories. And the only thing you have to lose is the weight.

You can follow Dr. Jennifer on Twitter, too.

What we think we know about how the body reacts and what we really know are two different things – here are some popular myths through the years as they relate to diets.  The most dangerous assumptions about diets come from population studies, you have heard them,  this population did that, and here is why this diet is great…

Seven-Country Study:

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

From the 1960’s through the 1970’s the primary focus of the American Heart Association to the Congressional Paper by McGovern in 1976 was cholesterol.  It was wrong – but the ramifications of this public policy live on in many nutritional books today. Ancel Keys, a physiologist, promoted this based on the “seven country study” where he concluded serum cholesterol was strongly associated with heart disease, therefore a diet low in cholesterol would reduce heart disease. The statistical data did not back up his conclusion- he left out the “French” paradox – and ignored the Japanese increase in meats after he war with a reduction in strokes and heart disease. We now know the “epidemic” of heart disease was more related to the increase in cigarette smoking than diet changes.

Now we have science (and my previous post have discussed this particular diet) – and science has shown that it is not cholesterol, nor is it dietary cholesterol, nor is it even saturated fat that is the problem. We  have also discovered that margarine- which is trans-fat, is probably one of the worse things that a person could have.

Keys later in life said cholesterol wasn’t so important. He then discovered olive oil, and was one of the founders of the Mediterranean Diet. He lived to be 101.

The China Study

Colin Campbell pooled blood samples from 100 remote villages in China, and based on the data came to the conclusion (which he had come to before) that those who had vegetable proteins lived the longest, and animal proteins were the primary cause of heart disease, cancer, and halitosis (ok maybe not halitosis).

The data in his study did not support his conclusions (which were remarkably made into a best selling book).  In fact, most of the data in the study, when critically examined came to the opposite conclusion. For example – the one village with the highest consumption of meat (twice that of even US populations) had the lowest incidence of cancer and heart disease.

Another bit of data – the higher the processed wheat and sugar in the diets- the greater incidence of heart disease.

For those who live in China – including remote rural China- they eat everything- all proteins, from animals, to insects, to anything that moves, walks, and crawls. Ask them what they eat for protein – and well, another story.

This has become the calling card for vegans everywhere- stating that this shows that their diet will allow them to live the longest and healthiest life.  Sadly- the study is horribly flawed and bias. A great review of this work is done by rawfoodsos.com

The Norwegian Study

Norway was invaded by Germany in World War 2 – the Germans confiscated all animal proteins to feed their soldiers  and Norwegian mortality True,  true and unrelated. Animal protein went down, fish went up 200 per cent, and sugars, flours, and processed goods were highly rationed. The other problem – mortality dropped in 1941 and Germany invaded in 1942. Other issues- in wartime, deaths from other causes – trauma (guns), pneumonia, and other infectious disease increase before a person has a chance to choke off the coronary artery.

Paleo-Diet

Ok, there are a few of these people who gather and hunt left but what we cannot conclude is that they were disease free, that they had few dental carries (cavities) and they lived in the garden of Eden. This is made up- totally made up. Sells a lot of books though.

Strong Heart Studies – the Pima Indians

When I arrived as a vascular surgeon to Arizona, I was told that the Pima Indians had something about them because they didn’t suffer from heart disease. In fact, it was such a strong issue that a study was made up – the Strong Heart Study.  This was at odds with medicine since the Pima Indians have the highest rate of diabetes in the world. Turns out, as they examined them – most Pimas die of heart disease.  Simply put- their hearts were no different than anyone else’s and their rate of death from heart disease was higher than the population.

The lesson from the Pima Indians is this—even with NIH people, and fully staffed health service- the statistics kept were not that great. Imagine a third world country, or even a number of studies done years’ ago- the statistics about what causes mortality is quite suspect.

So here is what we know from modern science and diets:

Conclusions from population studies are often flawed by the people who study them – and they come to conclusions that are often not backed by the evidence. Filled with confirmation bias, these studies are all but useless for making any conclusions to how food will affect health. Some useful things – fish are good, lots of sugar not so good, meat is ok.

With Evo we will examine some simple variables—body fat, muscle mass – some lipids and some liver profiles. Based on that we will see how his body is reacting to this. If we see anything that worries us, we will stop.

Thankfully Evo will not drink bad beer – only great craft beers.  Besides sausages- I hope to have him over to my house for some Wiener Schnitzel (it is German – and Evo will bring the beer).

I don't know much about beer - but I'll bet Evo likes this one

Who knows- perhaps the world needs more of the “Evo diet.”

Physician disclaimer time: do not attempt this diet on your own. You need a physician supervision for something like this- unless of course Evo and I write the book- in which case we will happily autograph books of  ”The Evo Diet” – please order ten at a time.

You can follow Evo’s diet journey on his blog:

http://funanymore.com/2011/09/27/brewdiet-the-beginning/

Part One of Appetite: true hunger. Let’s begin by talking about 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.

A popular weight loss operation, called a sleeve gastrectomy, removes much of the stomach, with one of the intended results being 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 (the stomach is an amazing organ). Having your hunger satisfied does not mean your 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 sandwich, and they reported being 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).

Artificial Sweeteners: The Enemy Of Weight Loss

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.

Making changes in what you eat on a day-by-day basis can make a profound difference over time about how you eat. Here are a few examples of trading up for health:

Years ago I use to have a hamburger and French fries for lunch, almost every day. The first trade up was to get rid of the French Fries. That represented 600 calories a day. Over the course of 5 days that was 3000 calories – almost one pound of fat. In three months I lost five pounds. Eventually, the hamburger went, and was replaced with a home-made chicken salad, much healthier, because I was able to include items with increased micro-nutrients.

Another patient of mine struggled with weight loss and finally realized she was drinking wine every night: 3-4 glasses. First she dropped to no more than two glasses and over two months lost 6 pounds. This last year she changed her habit from having two glasses of wine a night. Here’s what she said:

“I would come home every night and want a glass to relax. Then you talked to me about smoothies, and making my own. So I started making a simple smoothie with berries, yogurt, some flax seed, and fiber. I noticed after I drank it I felt more refreshed, and was in a better place to make dinner. I had more energy – and best of all, I lost another 10 pounds in two months and have kept it off.”

She traded alcohol, and its calories, for berries rich in fiber, vitamins, antioxidants, and the flax seed with omega-3 fatty acids. It was also a way to get more fiber in her diet.

Trading up to better food, to better quality food, means that you can enjoy life more. It gives you a chance to incorporate some of the micro-nutrients that you might be missing. Ultimately you are empowering yourself for your own health.

Nothing tastes as good as healthy food, and nothing tastes as good as slender feels.

At the conclusion of the study, the low calorie diet group averaged weight loss of nearly 30 lbs and the higher-protein group lost about 12 lbs. The findings prompted the researchers to conclude that for diabetic obese men, quick diet-induced weight loss not only reduces systemic inflammation, but also improves sexual, urinary, and endothelial function. Dr. George Fielding, a leading bariatric surgeon in New York, commented that the study “highlights a very important, but not much talked about, issue for all obese patients, namely their sexual function. Many patients, even young people, hint at this problem, but it’s usually glossed over.”

Do Fiber Bars boost your metabolism? Do they help or hinder when it comes to battling weight loss? Dr. Terry Simpson reveals why they may not be so good for your health after all in this quick video.

When it comes to fiber – bars are not the best.  They are high in calories and they have less fiber than you typically need. If you want fiber, increase your fruits and your vegetables.  There are a whole lot of benefits to getting fiber from these “non-processed” items:

(a) The have fewer calories

(b) They taste better

(c) They have more vitamins and nutrients

(d) They will keep you feeling full longer

While fiber bars are quick and easy to pick up and eat — so is fruit – -and when it comes to meals- having a full cup of vegetables for dinner is important to your digestive health, to keep you trim – and to make you feel satisfied for a long period of time.

By the way- when I say vegetables I don’t mean the starchy ones like potatoes or rice, or corn — I mean green ones– and I certainly don’t mean salad. One further tip – why get frozen vegetables that you heat in the microwave? Get fresh vegetables – -they will taste a whole lot better.

So save some money- buy some fruit.  It will taste better — and treat your body better.

For a while it seemed that everyone was talking about the importance of fiber,  and its role in preventing a variety of diseases.  After much speculation, we now have a few answers about  what fiber really does, and what makes it an  important component of good nutrition.

Fiber is simply things that humans cannot digest.  Many vegetables and fruit have methylcellulose – the stringy stuff– and we, as humans cannot digest it.  Cows can, horses can, deer can – but not humans.  This is why it is better to cook vegetables – because by breaking down some of the fiber our bodies can get to the nutrients that are locked into the vegetables.

What we do with it is simply pass the material through our body.  If you don’t have enough fiber you can become constipated – and develop things like hemorrhoids or diverticulosis.  Fiber is also good if you have chronically loose bowel movements – it will help bulk up the stools.

Years ago a group of people thought increased fiber would lead to less colon cancer – -with the theory that fiber acts as a broom to sweep out the colon and thus keep the colon from being in contact with toxic stool.  Well- that has been tested in a number of places and just isn’t the case.  Even people with high fiber diets have no lower incidence of colon cancer than those with an average fiber diet.

Some thought fiber would increase the metabolism – so by taking more fiber in you would be able to loose weight.  That was proved to be incorrect also.

What is known is that the more bulk fiber you have- from fruits and vegetables- with higher fiber — the longer the sense of feeling full is.

This is why we recommend to patients to increase green vegetables, or squash, or beans – to increase their fiber – and to keep them feeling full for a longer period of time.

So- if you want to lose weight- increase your fiber and decrease your processed food.  If you suffer from chronic hemorrhoids – see your doctor- but before then start on a high fiber diet (I recommend to my patients they take a scoop of fiber in 12 ounces of water followed by 12 more ounces of water).

Find yourself hungry mid-afternoon — consider a high fiber snack – like fruits.

So fiber has a lot of advantages – and the best source of fiber — vegetables

www.234Slim.com

Anyone who has been in my office sees rows of diet books. Almost every new diet that comes along, I get the book to read about it, because at some point a patient will come in and say they’ve learned some nutrition when they were on some diet plan.

One of the most common bits of misinformation is that peanuts – and hence, peanut butter – is protein – or a healthy snack — or a complex carbohydrate. Book after book on my shelf lists peanuts as a great source of protein, and a “snack that is healthy for you.”

I wonder if they ever bothered to look at a jar of peanut butter? Of the 190 calories in two tablespoons of peanut butter, 140 of the calories are from fat. Two tablespoons of butter contain 200 calories – all of which come from fat. Basically, while there is a bit of carbohydrate and some protein – peanut butter is over 70% fat. A tablespoon of peanut butter isn’t much- seems to fit right on that celery stick– and four tablespoons of peanut butter — well, now you have just had more fat than in a Big Mac. A Snickers bar (not a healthy snack) has less fat than two tablespoons of peanut butter.

Fat is not, nor will it ever be, a healthy snack. Fat is a dense source of calories, and if you are thinking about losing weight – the last place you would want to get a snack from is a dense source of calories.

Now there are those who will tell you that fat does not make you fat (seriously, someone has this as the basis of their diet) – or that fat is healthier than bread (all I can say is they are nuttier than peanut butter).

If you want a quick, healthy snack  — think of an apple, or an orange, or almost any fruit (not fruit drink, not a fruit smoothie, but real fruit).  It will fill you, it has few calories, and will keep you satisfied for hours. If you think you need protein in a snack, think jerky (better yet make jerky), and there are a few more. But if you want to lose weight – don’t think of peanut butter.

One apple has 72 calories (only 2 of the calories are from fat).

Did you know if you cut down 96 calories a day, over the course of a year you would weigh ten pounds less?  This is the start of how to lose those ten pounds this year, and keep it off.

Today we will talk about simple change – instead of drinking some juice, drink water.

Many people think that juices are a great thing- and they are – but if you are thirsty, think of water– zero calories — zero.  So if you change that one habit- have water where you would have had juice– in a year, you will have saved ten pounds.

Now that could be ten pounds you don’t gain, or you may lose ten pounds from where you are now.  Using the power of 96 — lose the weight– painlessly.  We look forward to sharing more simple lifestyle changes with you, like the Power of  96.