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

There is a difference between craft beers, and subpar-hoppy-inferior-tasteless ( SHIT ) domestic beers. But that difference isn’t just taste – it may be the way the body will process different beers.

Think of craft beers as whole wheat and the SHIT beers as white flour. A person who eats white bread develops a rapid rise in blood sugar, followed by the body responding with high levels of insulin—all of which serve to convert to fatty acids that end up as fat. When a person consumes less processed foods- the rise in blood sugar is much less allowing the body to utilize it as fuel, instead of fat.

Wheat berry to flour

Craft beers are less about broken down overly processed ingredients, and more about enjoying the refined taste – hence, our theory is that the body doesn’t quickly process the craft beers as quickly as SHIT beer. For a better discussion about beers that Evo drinks- see his posts at funanymore.com

There has been a controversy about beer for years.  In the South Beach Diet (another silly diet plan) they said beer-contained maltose—it doesn’t – that is long gone by the time it gets to your lips. Doesn’t it amaze you that so many diets are based on things people make up (no it doesn’t surprise me, they all are pretty awful).

Another diet NOT based on "science"

Oddly- no one has tested the glycemic index of beer – so Evo and I will be doing this. Under physician supervision we will perform the glycemic index of a proper craft beer and a SHIT beer. After all – this is science, and we are up to the task. I am speaking for Evo here, and he doesn’t realize I am going to be getting blood samples from him every fifteen minutes—don’t tell him, just say it is for science, and we will keep giving him beer.

For years beer has gotten the bad rap with every diet known to man. Starting with at the turn of the century when diabetes was blamed because of beer. One hears about the “beer gut” – and all assume it is the quantity of beer that is consumed- without thinking that the other items that are commonly consumed with beer might be the cause. In this case we know what Evo will be consuming with his beer – not pizza, but just the sausage.

Beer gut? Nope- probably pizza gut

Evo is all smiles after losing another two pounds of fat

Fat mass is what we want to lose on any diet. The scale may have stayed the same, but his fat mass, which we measure at each visit, has decreased and this is the stuff that causes the problems- not just cosmetically, but inside.

Sometimes a doctor should know better: last week, while in Mexico I had a bad clam. Now the clam was in the version of clamato that has fresh clam, shrimp, octopus, clamato juice, and beer.  What is the point? Well, that diet worked well- but if I were on the Evo diet, and just had a beer- I would not have spent a day in front of the toilet.  Bottom line- beer is highly processed, filtered, and far more healthy than many drinks you can obtain (including bottled water) from many sources.

Beer beats a bad clam

Bottom line ( I say that a lot because for most people they want to lose weight from their bottom – I could say belly line for some of us) – as with most “diets” you can and will lose some weight.  Evo is doing this under my care – which means we are keeping him out of trouble.

Since my friend Evo has started his fun diet- seemed like a good idea to show why diets work – and why they don’t. What is real and what is not. Hope you enjoy this– and my humor –TLS

A number of my patients, when deciding to get to their goal, ask, “Should I go back on Atkins or go to Weight- Watchers?” The answer is no, and the reason is simple:

Those are diets, not lifestyle changes. Sure, some of those do proclaim that they offer changes in lifestyle, in their own way, but they are really a diet. If diets worked, would we need weight loss surgery? Ask the famous question, “How does that work for ya?”

Often times we don't know we gained the weight

Diets are a set of rules imposed on you by someone else. How do you respond to someone telling you what to do? I was in a restaurant a number of years ago while on the Atkins diet when they offered me some of their fresh bread.  My response was, “No thanks, I am on Atkins.” It felt good to say that because I was following a rule-bound diet and doing a good job—but I missed the bread. I was following someone else’s rule for a diet that makes no sense. It is far better to adopt a healthy lifestyle with healthy choices.Those choices are not strange, they are simple.

The one food or one food group diet

The most famous diet, at least today, is the Atkins diet. It has been almost universally tried by all of my patients and misunderstood, perhaps even by the Atkins folks themselves. Robert Atkins made a great deal out of the body going into “ketosis” where it burns fat instead of turning food into fat. He had a complicated set of theories. None was ever proven, in fact, the reason you lose weight on that, or any low carbohydrate diet is fairly simple: you eat less. The Journal of the American Medical Association published a study showing that the average consumption of calories in low-carbohydrate diets is much less than other diets, and hence they are successful at losing the weight.

I gained weight on Atkins

—or, biology does not overcome the laws of physics

How can you gain weight on a diet that promises that you will lose weight if you avoid carbohydrates and eat meat? Because if you eat enough calories you will gain weight. Meat—or protein—contains calories, and your body is perfect at counting calories. Your body doesn’t care where the calorie come from, it will count every calorie even better than you will, and if you eat enough protein or fat, or drink enough alcohol, or eat enough carbohydrates, you will gain weight.

Most weight loss surgery patients have been on this dietor a variation of it and they know—given their pre-operative anatomy—that they really did gain weight on a diet, without cheating. After all, when you have a stomach that can hold a small mammal, you know you can eat your way into ketosis and weight gain on the Atkins diet. Simply put, a calorie is a calorie is a calorie. It doesn’t matter if you get the calorie from meat, from figs, from bread, or from alcohol. If you get a bunch of calories together you will store them, and if you store them, you will store them as fat. Eat enough steak and you will gain weight.

The Cavemen

The famous caveman diet- life wasn't so simple

Then there is the old “when we were cavemen” theories. They show how back in the old days when men hunted the wooly mammoths, lived in caves, and didn’t shower, that they were thin (now how do they know we were thin?). Back in those days, as this theory goes, we ate meat (lots of it), and didn’t gain weight. Well, there were a few other things in “the good old days” that we might want to think about—the cavemen hunted to get their meat, which meant exercise. The cavemen had famines and for long periods couldn’t eat, and the cavemen didn’t have refrigerators to store the meat so when it went bad, it went bad. If you want to go on a caveman diet, or think that eating one thing will make you lose weight, think again. The body is designed to store excess food as fat, and the body doesn’t care if those excess calories come from donuts, wooly mammoths, prime rib, tofu, or corn—the body was built to withstand a famine.

Our biology was not designed to eat just meat or just vegetables but to eat a variety of food types. So were our taste buds. Give us a single food and we will get sick of it. Sure, we might have to eat the Wooly Mammoth to survive, but can you imagine the kids in the cave, “Ah come on, dad, Wooly Mammoth again? Can’t you go get a Saber tooth tiger?”

Okay, imagine living in a cave:

Husband comes home proudly dragging the dead Wooly Mammoth, “Honey, I am home, and brought dinner. Barbecue tonight.”

“Don’t drag that thing in here, I just cleaned the cave.”

“Okay, but help me cut these ribs.”

“Cut your own ribs, I have to feed the children their ribs first.”

Days later.

”Get that old carcass out of here, it smells, and while you are at it stop drawing on the cave wall and get us some more dinner.”

“But honey, that was the biggest one I got, I want to paint this on the cave wall for all to know what a great hunter I am.”

“You will be a hunter without a cave if you don’t get that smelly carcass out of here. Why can’t you stay home and plant like the other cavemen? Why do you have to go out and bring these dead animals home? Grog stays home, he plants, their family eats, and it is easier to throw out grain that is bad than that large ugly animal.”

“But we can keep warm with the skin, and it shows my skill as a hunter, and I can provide for the whole village. We grow fat on the wooly creature but their crops fail.”

“Speaking of fat, I think it is time you stop eating all that meat and go hunt some gazelles. At least you will get some exercise. You must have put on five pounds this week. And brush your teeth, all four of them.”

Variety can lead to excess

If you are given only a single food, even if it is a food that you like, you can eat only so much of it before you don’t want anymore. I love steak—put a 16-ounce steak in front of me and I will consume 10 ounces of it and bring the rest home for my dogs. After 10 ounces I am done with the steak, can’t eat anymore. So, if I am on a low carbohydrate diet, you can bet that I am done with dinner. But, if

I am not on that diet and you put a bunch of French fries with the steak, not only will I have my 10 ounces of steak, but also I will have eight ounces of fries and maybe even think about dessert. Let us not forget the glass of wine before dinner, the glass of wine during dinner, and the after-dinner drink (since we just called a cab).

Another example of getting sick is eating ice cream. There use to be an ice cream restaurant that had a dish called “the zoo.” If you could eat it, they would not charge you for it. Try to eat twenty scoops of ice cream, it isn’t easy. But you can do it if you eat a few saltine crackers with it. The variety of flavor (salt contrasting with the sweet) allows you to eat more. Again, variety can lead to excess.

Here is the problem—if with a single food diet you lose weight, when you add variety you are less likely to moderate the food that allowed you to lose that weight. In other words, you might think of steak as being “okay” because It is a diet food. You might be under the impression if you eat this food and expand your diet that this food won’t count for calories. Most of us know that too much red meat, with its fat, is not a healthy choice. However, seeing weight loss by eating steak leads one to think it is okay to have as much as you want because one incorrectly believes it is the carbohydrates, not the steak, which causes weight gain. But let’s just put that little theory to the calorie test:

One Steak—Porterhouse of course, 442 calories

French Fries, 154 calories

Salad with blue cheese dressing, 339 calories

One big slice of bread, 80 calories

One cup of broccoli, 77 calories

One real glass of wine, 127 calories

Fat is the most dense of all macronutrients

This meal was 1219 calories—and the majority came from things allowed on the Atkins diet (Steak and salad were 781 of the calories). Of the non-allowed items—the French fries, the bread, and the broccoli—you have just over 300 calories. Now, we are not advocating white bread or French fries at all—just pointing out the majority of calories from this meal come from the meat and the fat, not from the carbohydrates.

An Atkins lover would be inclined to add more fat, more meat, and less white bread. We like the less white bread, less fat, less processed foods, but adding red meat with fat is just not a great option. The point is simple: variety can lead to excess, or variety can lead to good flavors. However, single-food diets, while controlling calories, can lead to a false sense that these foods are “okay,” that they are “diet” foods. Fat is not a diet food.

Here is another example: If you get a cheeseburger and you substitute lettuce leaves for of the bun, you have a meal of 330 calories instead of 400 calories. The bun is just 70 calories! Yet so many people think they are helping themselves by eating something that is filled with fat (about 18 grams) and avoiding a bun. It is the calories that the body counts, not where they come from.

Single-food or food-group diets are simply a complex way to control portions. If you control portions then you will consume fewer calories. If you consume fewer calories then you will lose weight.

Surgery is the most radical of portion controls. Whether you had surgery and stretched your pouch, or your stomach has grown, if you limit portions, which is not difficult, you will lose weight. How much you lose is determined by the number of calories that you eat.

We do not like single-food diets for our patients because, more than anything, we want our patients to have a variety: you deserve a lot of fine tasting food and a variety of foods tends to have a variety of nutrients. Single-group diets are probably not going to work in the long run. They become a burden even if you like the food group you try. After a year on the Atkins diet, I couldn’t look at a steak, which was good, because I stopped the Atkins diet before I went to Europe at the height of the Mad Cow infestation.

Week one:

Down six pounds- two of it fluid. One week- beer and sausage.

My assessment: he is healthy, fit, full of energy. Evo is working hard at keeping his beer and sausage calorie consumption to less than 1500 calories a day. Since he burns around 2100 a day- he should lose at least a pound a week -or over the course of the month- four pounds.

Why the big drop? Two pounds of it are from total body water – and that might be the diuretic effect of the beer. His fat loss is also about two pounds.  Those numbers are somewhat exact – the weight loss is real.

Will this “diet” work?  Yes,  much like a thousand other diets, limit your calories, use just one food group or a couple, and you will be fine.  Lets add a bit of fine print here: we are following Evo’s cholesterol level, liver chemistries, and a number of other tests to make certain he isn’t getting into trouble.  He is also going to be taking a multivitamin daily. Also some fiber daily. If “German” things come with the sausage – he can eat that.  Sausage and Peppers – for example, or sauerkraut - he can have those.  What he can’t have are the side dishes that are processed – no breads, no potatoes, no rice, no pasta.

Today in the office we discussed the huge difference between this and the Paleo-diet.  In the days of the caveman they drank water- most illness was transmitted through water. Beer is highly purified, has nutrients in it- and while some will say it is evil – it really isn’t. I suspect those who say it is evil are those who are the “pure food” people- similar to “raw” or “vegan” – there is a self-righteous superiority about people on diets.  So- if Evo drank water from the streams (we live in Arizona, so that is difficult) he would probably become ill. Sausage – another processed food- which is meat. While “processed” has a bad name (as bad as an Atheist naming their son Christian) – think about cavemen and meat.  You haul in this big bison, wildebeest, or huge creature– most of it will become rancid and cause more illness quicker. But then we became smart and learned how to process and preserve meats. We have eliminated another cause of early death of the paleo-types – death from botulinum toxin, or salmonella (much worse in those days than today).

So Evo’s diet will lead to a longer life than if he followed a true Paleo-diet. Later in this series we will take a skeptical eye to that particular diet and its failures as well as its good points.  For now- take this as the humor it is meant to be — a caveman in Phoenix would lose more weight on the Paleo-diet than Evo will because they would become sick and die.  We will make certain that doesn’t happen to Evo.

Good job, Evo- first week. Great weight loss, more than expected.

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

Imagine a way that the government could reduce the level of obesity and it would cost nothing.  The government had that chance- and they blew it.

The US Department of Agriculture denied a request by New York State to run a pilot program where the city of New York would not allow people to purchase soda, or other sugar sweetened beverages, using food stamps. There are at least seven other states requesting such pilot programs.

It is not surprising that the opposition to this proposal came from the beverage industry who said, “It’s another attempt for government to tell people what they can and can’t drink. Singling out one specific item is discriminatory and unfair.”

Really? No one is saying they can’t drink soda – simply that the government won’t purchase items that are not in line with the intent of the food stamp program which is, “to provide for improved levels of nutrition among low-income people each month.”

The USDA said that city retailers would not be prepared to implement the new policy.  The food stamp program is run with a debit-style card. If a beneficiary is purchasing items from the grocery store not covered by food stamps, such as tobacco or alcohol, the cashier collects the money for those items after the food is deducted.

The original Food Stamp Act prohibited purchase of “soft drinks,” but that was changed because of regulatory issues-, which are now overcome thanks to technology. In fact, New York City officials stated that the “program’s electronic benefit card looks and acts like a credit or debit card” and that it only covers “some of the items in a typical s hopping cart, so program participants are already accustomed to supplementing their purchases with personal funds.”

The USDA also said “the proposal lacked rigorous methods to asses changes in sugar sweetened beverage consumption resulting from the new policy and the effects of those changes on obesity and health.”  A pilot program doesn’t have to prove that sugar sweetened beverages are not “food.” Even the original act prohibited these items.

The government purchases millions of gallons of sugar laden drinks for food stamp holders every day. Obesity is the number two killer in the United States – and by denying this simple pilot program are paying for obesity.  Preventing obesity costs nothing – paying for the effects of obesity costs everything.

References:

US Department of Agriculture. The Food Stampe Act of 1964. http://www.fns.usda.gov/snap/rules/Legislation/pdfs/PL_88-525.pdf.

Jessica Shahan, Associate-Administrator, Supplemental Nutrition Assistance Program, USDA, to Elizabeth Berlin, Executive Deputy Commissioner, New York State Office of Temporary Disability Assistance. August 19, 2011.

Scott-Thomas C. Food stamp soda exemption in NYC is discriminatory, says industry. Food Navigator-USA. May 5, 2011. http://www.foodnavgator-usa.com/Business/Food-Stamp-soda-exemption-in-NYC-is-discriminatory-syas-industry

JAMA, September 28, 2011 Vol 306, No. 12 page 1370-1371

This Sunday in the New York Times, Sept 25,2011, Mark Bittman showed that it was not cheaper for a family to eat out at Fast Food places. And it also costs them in terms of calories, sodium, and the quality of food.  We want to expand that to not only fast food restaurants, but common chain restaurants.

Cooking at home is less expensive – less for food costs, less for calories, less for sodium.  Eating out at chain restaurants often have more calories than even fast food places – for example:

Most salads at TGIF’s are 1200 to 1500 calories.  That is as many calories as most individuals should have for an entire day!  One of the least calorie items there is their burger – at 800 calories, and can be split between two people.  Thankfully TGIF’s puts calories on their menu.  Not meaning to pick on TGIF’s – we have found the same looking through the menus of Applebees, Red Lobster, Rubios, Village Inn, and other chain restaurants.

Santa Fe Salad 1500 calories

Eating out at most chain restaurants is not avoiding calories, or getting better food quality than at Fast Food- in fact, the calories are more.

The bottom line: home economics – it is cheaper and healthier to learn to cook, and to learn to cook at home. We have lots of recipes, and techniques to help you (cook book coming soon).

If you do want to eat out- there are some great restaurants that we highly recommend: not only does the food taste great, but it is prepared from fresh ingredients – and have fewer calories.  In Phoenix, Tarbell’s, in New York any of the restaurants by Gordon Ramsay, Thomas Keller, Bobby Flay, or Morimoto.

Food made fresh is great. Like Ramsay demands

For many the issue comes down to cooking. Cooking at home is daunting for some individuals – they never learned it, they think it is difficult, and we have lost an entire generation of people who cook. There are now five fast food places for every supermarket. So what causes people to not eat at home:

(a) Time – hard to imagine this one. As a busy surgeon I have the time to cook for myself and my family. It is a lovely hobby, and when I go home I like to get into shorts, flip-flops, and relax cooking making a great meal.

(b) Cooking skill – this is not a difficult but it is thought of as difficult. We spend a great deal of time teaching our patients to cook (we do weight loss surgery). Our recipes, videos are all designed to show that it takes less effort to cook than one can imagine.

(c) Perceived food costs – we have fixed that myth. It really costs more to eat out, than eat at home

Some blame the effective job of marketing that chain restaurants and fast food places have done. But, we are not robots- and those who wish to improve their health, will learn to cook. Most simply need to know that cooking is a great hobby. For the single men, let me quote you from my favorite dating expert, “If you cook dinner for your date, be careful, you will probably end up cooking breakfast.”

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.

YourDoctorsOrders.com – Salads are the Enemy! from TweetMeTV on Vimeo.