THERAPEUTIC LIFESTYLE MODIFICATIONS
More than two-thirds of adult Americans claim to be trying to either lose weight or maintain their weight. However, only 20 percent are actually reducing calories and exercising 150 minutes per week, as is advised. There is an epidemic of both obesity (body mass index greater than 30) and diabetes across our nation. Between the years 2000 and 2004, the number of overweight children increased from 13.9 to 17.1 percent of our population.
Heart disease remains the number one killer of adults in the United States. While statin therapy (for cholesterol) has reduced this by one-third, lifestyle modification is important. The components of therapeutic lifestyle modifications are diet, exercise and behavioral change.
Healthy Living magazine recently assembled three Eisenhower Medical Center experts to discuss what is necessary to achieve a healthier lifestyle. The participants were Elizabeth Quigley, Registered Dietitian, Renker Wellness Center, and Carl Enzor, RN, Director, Renker Wellness Center. Philip Shaver, MD, Cardiology, served as moderator.
DR. SHAVER: There is a new Food Pyramid. The old one used to have the base of carbohydrates and proteins, and at the peak of the Pyramid were fats, which we were told to avoid. We seem to now have come to era where we think that there are both good fats and bad fats.
ELIZABETH: The Pyramid did change about two years ago, and it now includes exercise. It is a Pyramid with stair steps going up the side to emphasize the exercise. The new Pyramid now emphasizes the quality of the food within each of the food groups, for example in the fats, olive or canola oils are recommended. They’re also encouraging lots of color in fruits and vegetables.
DR. SHAVER: What do you think aids a successful diet whether it’s on a plan or someone who tries to do it on their own?
ELIZABETH: I talk to my patients about getting healthier, not just losing weight. If you’re working out and eating appropriately, your weight might stay the same, but your percent of body fat goes down and your clothing size goes down. You have to eat for the health of it, and that’s something that a book or meals in a box can’t do.
CARL: Most of us need to have some motivation, and that’s why many people don’t continue with an exercise program. They never knew what their motivation was in the first place.
DR. SHAVER: If you were eating 1,200 calories a day, would you lose weight?
ELIZABETH: The only true way to know how many calories you need is to test your metabolic rate. You only need to cut out 50 calories a day for a year — 50 calories is a teaspoon of butter; it’s not much — to lose five pounds in a year.
DR. SHAVER: Carl, how many calories does it take to gain a pound or to lose a pound?
CARL: Thirty-five hundred calories is equal to one pound.
DR. SHAVER: If you do burn 500 calories a day for a week, you could, theoretically, lose a pound a week?
assets/news/story/CFHLImages/200703/roundtable2.jpg CARL: Yes, you could.
DR. SHAVER: So, what activities burn calories the best, Carl? Aerobic? Resistive?
CARL: Aerobic activity such as biking, walking, hiking. Some people do rowing.
DR. SHAVER: How about exercises that are not as weight-bearing, such as water exercises and pool exercises?
CARL: Water exercise cools your body, so you don’t heat up your metabolism as fast as if you were walking on a treadmill or riding a bike. However, water exercise is excellent for those who have any type of orthopedic problems or for patients with arthritis.
DR. SHAVER: How much time, and how fast?
CARL: Initially, we recommend three days a week for about 15 to 20 minutes. I suggest that anyone who is over 40, check with their physician before starting an exercise program. "...foods that contain multiple nutrients - broccoli, spinach, berries...have been classified as ‘super’ foods."
DR. SHAVER: Optimally, once they are on their maintenance program, how much should one exercise?
CARL: 30 to 45 minutes a day, five or more days a week.
DR. SHAVER: If we want them to do 30 minutes a day, can’t they do 10- or 15- minute intervals?
CARL: Yes, 10- or 15-minute intervals are fine. But some individuals want to count every little step they take throughout the day and that just doesn’t work.
ELIZABETH: So for weight loss, you’re thinking — focus on aerobic exercise.
CARL: Yes. The whole reason the Renker Wellness Center’s cardiac rehabilitation program is 12 weeks long is that research has shown it takes eight weeks before you change anyone’s habits or behaviors.
DR. SHAVER: Let’s look at “triggers,” things that make people eat inappropriately.
ELIZABETH: Actually, at the Renker Wellness Center, we’ve started a 10-week weight management program. We use two books — one focusing on nutrition and the other on behavior modification with a selfactualization diary that helps you see where your triggers are so you can consciously make decisions to change them.
CARL: We tell our patients, “Everyone’s going to cheat!” If you want a particular item, make sure that for the rest of the day, your diet is clean.
DR. SHAVER: What about trans fats? Do we need them?
assets/news/story/CFHLImages/200703/roundtable3.jpg ELIZABETH: We don’t need trans fats. Trans fats are as bad as saturated fats in lowering the good cholesterol, HDL, and increasing the “lousy” cholesterol, LDL. They are found in very small amounts naturally, but the more man manipulates the fats, the more trans fats are created. One of my general rules with clients is to eat foods the way Mother Nature made them.
DR. SHAVER: It is recommended that we have less than one percent of our calories as trans fats, so that would be about two grams a day. Normally, Americans eat about six grams a day. If you just eat two packaged cookies that have trans fats, that will increase your heart disease risk about 23 percent.
ELIZABETH: It’s just shocking. It is important to realize that labels may show that a food item contains less than one half of one gram. However, labels are allowed to note “zero” trans fats. So if you’re not paying attention, the half grams can add up fast. You also have to look at what the manufacturers are using to replace trans fats — often it is saturated fats, such as palm or coconut oil.
DR. SHAVER: Please summarize for us “good” and “bad” fats. You said that saturated and trans fats are bad.
ELIZABETH: If you’re going to choose fats in a small amount, you want to use olive oils or the canola oils — preferably cold pressed. With the small amount of fat you’re supposed to have, I’d rather see you eat butter than margarine.
DR. SHAVER: Why is that?
ELIZABETH: Mother Nature made it. It’s not an invented fat. Most of our margarines are corn or safflower oil based, which have an inflammatory effect at the cellular level, which is a trigger for heart disease and diabetes.
DR. SHAVER: We have a lot of steakhouses in the Coachella Valley. Can you enjoy a filet if you maybe have half of it at the restaurant and save the other half?
ELIZABETH: In general, I tell people that if they cut their meat in half, double up on their vegetables and cut their restaurant serving size of starch in half, that’s about how much you should be eating. Most of us don’t need more than about eight to 12 ounces of meat or protein a day.
DR. SHAVER: What are your feelings about the so-called “magic” foods that we hear about?
ELIZABETH: I wish there was a “magic” food. The magic of food is the color of the food. Some of the most colorful have vital nutrients; they’re not vitamins or minerals, but they have health-promoting effects. There’s a book called "What Color is Your Diet?" by Dr. David Heber. You eat two red foods, two yellow foods, two purple foods…what is that? Fruits and vegetables. There are foods that contain multiple nutrients — broccoli, spinach, berries that have been classified as “super” foods.
DR. SHAVER: So eat foods that taste good and have good things in them.
ELIZABETH: Eat by color and spice it up. Turmeric that is in curry is antiinflammatory. It’s been shown to help rheumatoid arthritis just as well as some of the medications. Add more color and spice. Those are the magic bullets.
DR. SHAVER: Let’s turn to alcohol. Over and over again it is shown that moderate alcohol intake can be beneficial. Men have twice the allowance of women, as men have much better enzymes to break it down. So, two drinks for men or half of that in women seem to have some survival benefit, whether it’s antioxidants, or raises the good cholesterol. Where do you stand on alcohol?
ELIZABETH: Moderation is key because alcohol usually is empty calories. Also, when you drink more than that one or two drinks, you’re more likely to overeat because your inhibitions are dropped.
DR. SHAVER: Carl, what do you recommend to your patients?
CARL: That men limit it to two drinks per evening. However, the old martini glasses held 3 to 4 ounces, containing 1-1/2 ounces of alcohol. They need to limit their alcohol, such as martinis, Manhattans, margaritas, mixed drinks, because in our society, now, the Manhattan or martini glass has grown to hold six to 10 ounces, containing twice as much alcohol, 3 to 4 ounces. "...when we look like an ‘apple’ or have fat in our abdomens, this is a very malignant type of visceral fat."
DR. SHAVER: A few words about the different types of fat we accumulate in our bodies. There is visceral fat and there is gluteal fat. It has been analogized to looking like an “apple” or “pear.” Gluteal fat is what women generally have on the buttocks and hips, and is a “pear” shape, and seems to be a very benign fat. Whereas, when we look like an “apple” or have fat in our abdomens, this is a very malignant type of visceral fat. One thing our readers can do to gauge if they have an abnormal amount of abdominal obesity is to use a tape measure. The abdomen should be measured at its maximum, in other words, “the part that comes in the room first.” If it is greater than 40 inches in a man or greater than 35 inches in a woman, this is excessive. This may not apply to naturally thin individuals, for example Southeast Asians.
ELIZABETH: And liposuction will not take care of that. Liposuction is subcutaneous fat, not visceral fat.
DR. SHAVER: The good news is visceral fat does turn over quite rapidly. Unfortunately, gluteal fat doesn’t. What resources can readers utilize for more information?
ELIZABETH: The American Dietetic Association at www.eatright.org, and the North American Association for the Study of Obesity at www.naaso.org.
RULES OF NUTRITION The Food Pyramid