While there is a lot of controversy about what diet is best for a long and healthy lifestyle- there is no doubt about things that you can do to stay healthy into the golden years. We want them to be golden years, not rusty years.

So here are things that all of the medical community agrees with- and things that my 87 year old father do:

Lose weight– as you age most appetites decrease a bit, and habits change. If you lose weight it is a lot easier on your joints, your heart, and your back. Take advantage of the diminished appetite – my parents skip dinner most nights, or just have a snack. My dad has gone from 185 pounds when he worked to 150 pounds now — a nice slow weight loss over the last twenty years.

Exercise – one simple thing- walk every day. Thirty minutes – it makes a big difference. When I visit my parents my dad can out walk me. Both of my parents are as sharp as ever.

Keep your mind occupied. The golden years do not mean settling down and watching television. Keep up with something- my parents have a wide range of interests, my dad still serves on a board – and they always discuss politics (I might disagree with their views at times).

Simple formula: Eat less, walk a bit, and keep your mind occupied.

I’m glad my parents are happy and pretty healthy for being in their 80′s, and my son (18 months old now) has a great set of grandparents to enjoy (he’s their first grandchild).

My 87 year old dad, and his first grandson -JJ- keeps you young

There is always another “fad” diet out there- and the HCG diet hopefully died when the Food and Drug Administration (FDA) and the Federal Trade Commission (FTC) issued letters to companies warning them that selling “homeopathic” HCG weight-loss drugs was not FDA approved and that there was no evidence of the claims, thus violating FTC rules.

HCG is a hormone that is produced by the human placenta during pregnancy. Clinically HCG is used as a fertility treatment, and can lead to increase in progesterone and testosterone, which have consequences of their own including deep vein thrombosis (a clot in the veins of the lower extremity) leading to pulmonary embolism and even death. This is not a benign hormone, and should only be used under the strict supervision of a physician – who knows what they are doing, not a naturopath or homeopath, or chiropractor. HCG is also elevated in some cancers, and we follow HCG levels to determine how effective our cancer therapies work with some tumors. This is also the hormone most use to determine if a person is pregnant.

This fad diet started in the 1950’s when Albert Simeons, a physician working in India, noted that pregnant women on a low-calorie diet lost fat rather than muscle and the fetus was protected. He hypothesized that the HCG reprogrammed the brain to lose fat rather than muscle, thus protecting the body against loss of muscle. Simeons went on to become an entrepreneur founding weight loss clinics, manufacturing centers, and having widespread use of his product. There was no evidence for HCG working and the diet died in 1976 after an article in JAMA showing that there was no difference between patients who received HCG and those who received a placebo. In 1976 the FTC ordered the Simeon Weight Foundation and HCG Weight Clinic Foundation to stop claiming the HCG was safe and effective, and the FTC has required labeling and advertising of HCG to state:

Albert Simeons- went from working in India to making a fortune in weight loss

HCG has not been demonstrated to be effective adjunctive therapy in the treatment of obesity. There is no substantial evidence that it increases weight loss beyond that resulting from caloric restriction, that it causes a more attractive or “normal” distribution of fat, or that it decreases the hunger and discomfort associated with calorie-restricted diets

HCG was reborn in 2007 with the book, “The Weight Loss Cure They Don’t Want You to Know About,” by Kevin Trudeau (if you watch infomercials you have seen him – the infomercial guy). Shortly after the FTC charged Trudeau with violating a court order and misrepresenting the contents of the book on his infomercials. He was ordered to pay 37 million dollars for violating their order.

This silly book resurected a bad diet

Still, that started a new industry with companies manufacturing products that could be sold out of major drugs stores, injections given in drive-by diet centers, and lots of people touting this as the cure to obesity. The manufacturers decided if they would slap the “homeopathic” label on it, they could get by with selling this over-the-counter and make even more money off consumers. The FDA stopped this nonsense- not only because this is a potentially dangerous hormone, often given without strict medical supervision, but because the very low calorie diet that goes with it should be done under the supervision of a physician also.

The reason we won’t see the HCG end is because physicians can still prescribe injections of HCG – even though this is not a diet that will work. There are still unfortunates who think getting an injection of this hormone will work- and as PT Barnum once said “there is a fool born every minute.”

The HCG proponents are filled with confirmation bias.  They lose weight, so they assume it is the HCG that suppresses appetite – although there is no evidence it does.  They then will cite articles in non-peer reviewed journal  such as Dr. David Bryman, an osteopath from Scottsdale, who published a non-randomized study with a higher protein low calorie diet- showing the HCG had more weight loss (The Bariatrician – 2010 Vol 25, page 11) . The problems with this study are several: first there is no randomization, second there is no control, third there is no blinding, and fourth there is a clear bias.  To put this in perspective- this study has less validity to it than a noted expert opining.  This study does not rise to acceptable levels of Evidence based medicine. Sadly, the HCG proponents, including health care professionals, do not understand the value of the evidence based medicine that clearly demonstrated no efficacy of HCG in any study in a peer reviewed journal.

http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm281333.htm

The action of chorionic gonadotrophin in the obese. Simeons ATW. Lancet 2:946-947, 1954.

Chorionic gonadotropin in weight control. A double-blind crossover study. Young, Fuchs, and Woltjen. JAMA. 1976 Nov 29;236(22):2495-7.

Who would have imagined that my patient, Evo, would have lost 14 pounds on the “beer and sausage” diet (now called the Evo diet).

From the medical side there are two other benefits — his triglyceride level dropped by half, his cholesterol dropped by a third, and his “good” cholesterol increased.  There was never an increase or a blip in any of the liver enzymes.  His fat mass dropped, the only non-fat mass of his that decreased was that tissue associated with and supporting the fat mass (I know, sounds complicated).  His muscle mass maintained itself.

One important lesson learned: we do not know enough about science and medicine and diets to be able to say anything to anyone about which diet is healthy and which is not. But let me give you an example – we had more data points for this one month of the Evo diet than Ornish had for his diet program.

The famous Ornish line is that his data showed a decrease in “Plaques” of patients who had heart disease. This was based on less than 20 patients, including the control group.  He has since gone on to show poor data with prostate cancer, as well as aging. The data that Ornish has isn’t good, and when you look at the data we generated in one month from the Evo diet, one could assume that we would find people would do better not doing the Ornish diet and following the Evo diet.  This is said with a smile, because never has a “lifestyle” and diet – such as Ornish, been propagated with less data and more press.  Ok- there is also the China Project (a single misuse of data to say the same thing).

The second important part of Evo’s diet was this: there was a simple and yet profound control of the portion sizes that he had. It was measured, it was regulated to around 1500 calories per day.  Based on that,  Evo lost more than we would expect him to have lost. Why? No clue.

What can you take away from this: First, if you want to have a diet begin by strictly regulating portions. Portion control is a key for any weight loss, including weight loss surgery.  Limit your portions, and thus your calories, and you should lose weight.  The advantage of beer and sausages is that they come in nice units that you can measure.

Processed meats appear to increase risk of colo-rectal cancer

What you should NOT take away from this: beer and sausage are not “diet foods.” Beer and sausage were, in this case, a tool for great portion control. And Evo ate more than just sausage. He ate what came with it.  When I cooked for him he had the peppers and onions that went with my famous recipe (recipe will be on terrysimpson.com later). He had bread (yes, I know some of you think bread is the devil’s tool) – if it came with the sausage.

The final message is most important- We don’t understand food as well as Ornish, Atkins, or pick some diet guru would have you believe.

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.

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

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

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/

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.”

Heart disease happens when the arteries feeding the heart become infiltrated with plaques – and these plaques happen to contain fat, cholesterol, white blood cells. If the plaque builds up slowly the flow of blood to the heart diminishes and people develop chest pain or angina. If that plaque ruptures and causes the artery to close- that is a heart attack or myocardial infarction.

Plaque formation was thought to be because of a person’s diet – since the plaques had high levels of fat and cholesterol, it was thought that a diet that was low in fat and cholesterol would minimize a person’s risk of heart disease. Sometimes that is true- but not always- as the French have shown us- with a diet high in fat and cholesterol and one of the lowest levels of heart disease in the western world.

It turns out the instigator of plaque formation are the lipo-proteins that carry cholesterol and triglycerides. Think of LDL, HDL, VLDL, and IDL (low density lipoprotein, high density lipoprotein, very low density lipoprotein, and intermediate density lipoproteins) as boxcars that carry cholesterol and triglycerides. Those lipoproteins set off an inflammatory reaction in the blood vessel (they become oxidized) and that leads to plaque formation. The more of those proteins a person has, the higher the likelihood that they will develop heart disease.

Think of LDL as “lousy.” The HDL levels are associated with fewer tendencies for heart disease – but they still can cause inflammation of the artery, and a problem. Hence, artificially raising HDL levels causes more issues with heart disease (as was recently discovered in the niacin trials). HDL levels are seen in people who have more omega-3 fatty acids in their diets, but increasing their levels is still harmful.

The more lipoproteins your body makes the higher incidence of heart disease you will have.

It has only been recently that science has recognized that one must measure the lipoproteins directly. Not indirectly by measuring cholesterol – as the laboratories do today. In the recent article from the Journal of the American Medical Association, they measured LDL-cholesterol in people placed on diets rich in soy proteins, fiber, and walnuts – showing a decrease in the LDL-cholesterol – a classic mistake. LDL-cholesterol does not measure the total number of lipoproteins. The amount of lipoproteins one has depends on how much cholesterol and triglycerides the lipoproteins have to carry. If a person has a lot of cholesterol and/or triglycerides in the blood the body will make more lipoproteins. If you have too many, those lipoproteins will get into the wall of the artery and lay down their cholesterol and triglycerides (which are fats).

If you have a lot of triglycerides it will bump off the cholesterol and you will make more proteins to carry the triglycerides. Your cholesterol level will be low, but your number of lipoproteins will be high- and thus, even with low cholesterol you will have a high incidence of heart disease. This explains some of the seemingly contradictory data of people who had low LDL-cholesterol levels but a higher incidence of heart disease – when that blood was looked at later they were found to have a high level of the LDL proteins.

We still don’t understand everything about the biology of the formation of plaque but we do know this: genetics determines most of the level of cholesterol, and if your level is high reducing it with medication will reduce the incidence of heart attacks and strokes. If you have genetically high triglyceride levels, the same applies.

In terms of diet- dietary cholesterol has minimal impact on blood cholesterol. Triglyceride level can be greatly impacted by diet – however.

To reduce triglycerides in your diet, here are some suggestions:

* Eat fewer calories if you are overweight. Excess calories are converted into triglycerides and stored as fat.
* Avoid trans fats, found in some fried foods and commercial baked products.
* Replace saturated fat (found in animal fat and some tropical oils) for mono-unsaturated fat (found in olive/canola/peanut oils, etc.).
* Consume at least 2 servings of cold water fish each week, such as salmon, mackerel, tuna, lake trout, herring, and sardines (all of which are high in omega-3-fatty acid). *Include into your diet other foods high in omega-3 fatty acid, such as ground/milled flaxseed, walnuts, almonds, canola or soybean oil, etc.
* Avoid refined foods and foods that contain sugar (such as white flour, desserts, candy, juices, fruit drinks).
* Choose carbohydrates that have 2 grams fiber or more per serving, such as brown rice, whole wheat bread, and whole grain cereals.
* Consume at least 2-3 cups of vegetables and 1 cup of fruit each day.
* Follow your doctor’s advice regarding alcohol. Alcohol increases triglyceride levels for some individuals. If you have high triglycerides and do consume alcohol (such as red wine), it is recommended to limit intake to 5 ounces per day or limit it entirely.
* Exercise to burn excess calories, aiming for at least 30 minutes of physical activity on most days of the week.

Medications
People who have high triglycerides and low HDL or high LDL levels may require medications as well as diet modifications. Patients with triglycerides in the very high range (over 500 mg/dL) generally will require medications, because triglyceride levels this high may cause an acute inflammation of the pancreas.