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Tag Archives: bariatrician

Overeating…How Common Is It?

Posted on October 28, 2019 by

We’re all guilty of overeating. Overeating is eating more than what’s on your diet plan. Or, it can be just eating more than what you had planned. It’s also when you continue to finish your meal even though you feel full partway through it. Binge eating is different. It’s an extreme form of overeating. It’s eating an abnormally large amount. For someone who has a normal size stomach and hasn’t had weight loss surgery, that would be consuming around 5000 calories.  It means you are feeling out of control and you should see a mental health professional. If you have a small stomach from weight loss surgery then you can’t really ever binge eat, right?! The issue isn’t the amount. It’s the feeling out of control with your eating. If that is the case you need to seek professional help. It’s out of the scope of this discussion.

Sometimes we “justify” overeating. When you go out to eat, you want to get what you’ve paid for. Maybe you’re celebrating a birthday or anniversary.  When you go on vacation and let loose. Someone might be urging you to eat. Another justification is that the food is free.  When this happens we often get into the mentality of, “Since I’ve strayed, I might as well just keep eating.” “I fell off the wagon and ate the candy bar. I might as well eat the whole bag of candy bars.” We discourage that type of “all or nothing” thinking.

There are lots of different causes of overeating. Some of the common causes are: stress, irritation, frustration, habit, boredom, overwork, and worry. Often it has to do with some type of emotion. We’re going to go over 10 common “triggers” for overeating and also what you can do about them.

The first common “trigger” for overeating is boredom. It leads you to TV watching (TV commercials) which leads you to the refrigerator/pantry. What can you do? You can watch commercial free TV and prepare healthy snacks to keep on hand (cut up veggies are a good choice).

The second “trigger” is feeling deprived. This tends to come about by completely avoiding certain foods. We talk a lot here about avoiding simple carbohydrates and processed foods. We’re trying to avoid a whole category of foods. It’s easier said than done. It’s difficult for an extended period of time. I’m not a big fan of true “deprivation diets.” It’s the thinking that, “I can never have this again because I’m on a low-carb diet.” “I can never have ice cream.” You want to focus on a balanced diet and healthy eating and exercise habits.  We also need to have that portion control. “I’m just going to have this little bit…” Deprivation doesn’t work very well. There is an exception to that. The exception is if you have a true trigger food. That means if you have one piece of that trigger food I’m going to eat the whole bag. You need to avoid those foods.

The next trigger for overeating is feeling self-disgust or hating your body. What you’re really doing is focusing on what’s wrong with your body and some societal ideals. We often see the societal ideals on TV. Realize your body is only a portion of who you are. Your body is just a part of you. It’s not all of you. If this is a significant problem you should seek professional help.  I see this in many patients who have lost a lot of weight. They still see themselves as who they were, not who they are.  It usually fixes itself over time.

Carbohydrate sensitivity or glucose intolerance are the next common trigger. This means you’re prone to big blood sugar swings. This is a true physiologic trigger. Blood sugar swings lead to insulin swings resulting in hunger/cravings. It’s really hard to ignore this. If it comes from blood sugar swings, the answer is to avoid blood sugar swings. Avoid simple carbs and increase your protein intake. If you’re having carbs they should come from vegetables. Chromium is a mineral that helps with blood sugar swings. Usually you need to take it three times a day for the blood sugar swings.

Another trigger is Habits. It’s what “you’ve always done.” It’s like when you go to the movies and always have a tub of popcorn. Try to engage your mind and hands in some type of new activity. It could be as simple as reading a book or playing an instrument. You need to break the habits or break the routine.

Next is depression and/or lack of energy. You often turn to food as that “pick me up.” Yes sugar is an energy source. Your body has plenty of energy. You just need to access that energy that’s there, meaning the fatty tissue. In order to accomplish this, the carbohydrates need to be low. The food gives you a pick me up but it’s not a long-term answer. Try to identify those low energy times of your day and take a brisk walk. Don’t ignore depression. It can happen frequently in a weight loss plan. Don’t ignore it. It tends to be relatively fleeting. It’s very real for someone who’s losing weight fairly quickly that they get a chemical imbalance. Seek professional help.

Needing comfort is the next trigger for overeating. There are pressures at work and home. There’s lack of appreciation. Everyone tends to have their favorite comfort foods. Baked potato to pizza to ice cream. How do you beat it? Take some time out for yourself. Go get a massage for pedicure/manicure. Make sure you schedule “me” time.

Feeling overwhelmed can be a trigger. It happens sometimes a couples times a day for me. You have too much to do and not enough time to do it in. Realize you can only do so much. To get a project done we have to make the first step. The 2nd and 3rd steps will be easier. We all have a lot to do and can’t get it all done. It’s often prioritizing.

More common trigger: being emotional. Emotions tend to bring on eating; being upset, hurt, anxious, stressed, sadness, or happiness. Go outside for that quick walk. Remove yourself from the situation if it’s a negative emotion.  Deep breathe/stretch.  Exercise is a great stress reliever.

Lack of willpower is a common trigger for overeating.  Willpower is like a muscle. We can train ourselves to use and slowly improve on it. Exercise your will power. It will get stronger.  How many times have I heard, “Gee I don’t have any willpower?” Everybody has willpower, it’s just how much.  Every Wednesday I was fasting. I did some videos on fasting. It works. After a while you get used to it. Anything we practice we get better at. Fasting got easier for me as time went on. If you think about it, we make thousands of food decisions just about every day. When to eat? How much to eat? What to eat? Is it time to eat yet? Fasting frees up a lot of time and energy. There’s no thinking about food because it’s not happening. You just have to figure out what the best times are for you to do those things. I did videos on Losing Weight USA as well as our YouTube site. It can be very helpful with weight loss. Time yourself. I assure you no one has ever starved in a few hours.

Here are some tips to avoid overeating. These are things we should ask ourselves all the time.

Get in the habit of asking yourself 2 questions: why am I eating and am I still hungry? Part of it may be that it’s time for lunch. Maybe you haven’t eaten all day. Literally bite-to-bite you can ask yourself, “Am I still hungry?” You want to stop when you feel satisfied. Make sure you’re avoiding the “overeating” foods; simple carbs. If you’re going to overeat, have more protein.  The simple carbs are like a drug. If you have a little bit, you’re going to want more. You’ll crave more. One of my favorite eating rules is eat only when seated at a table. The other eating rule is always use utensils and a plate. That’s gets away from wandering through the pantry and grabbing something or eating something over the kitchen sink. It doesn’t necessarily mean it will change what you’re eating. It will change what you’re eating if you have to be seated at a table and use utensils and a plate, it gets rid of a lot of the eating on the fly. There are a lot of decisions that have to be made when you eat that way.  For example, if you grab a handful of M & M’s. You put them on a plate, get a spoon and you sit down at a table to eat them. By the time you actually do that, you may not even eat them. If you just walk by and grab a handful, you’re likely to eat more because you’re eating them “on the fly.” It’s an eating rule that is very simple but effective.

Avoid “family style” eating. This means bringing all the food to the table and passes it around until it’s all gone. You need to leave the food in the other room, make your plate, and go sit down and eat it. You can still get more but you have to physically get up, go into the other room, stand there and figure out what you’re going to put on your plate, and walk back to the table and eat. This is better than having a person pass you the food dishes at the table. Little things might be what the difference is between being successful and unsuccessful. Use small plates and small utensils. Remember propinquity. It’s about shaping our environment for success. Measure your portions. You will likely be at least 30% off when “eyeballing.” We all tend to drift with portion sizes. Eat slowly. Chew slowly and set your utensils down between bites. Give your body time to tell your mind that you’re done.  Wait 10-15 minutes before you get more. Ask yourself, “Why do I need more?”

For cravings use distractions. You need to use that willpower muscle. Change your activity. Distract yourself until the cravings go away. Chromium can help. You usually have to take it 3 times a day. Practice! Always leave a little food on your plate. If you’re out at a restaurant and you leave some food on our plate, typically people aren’t going to be bugging you about bringing you more food. Finally, a carb blocker can be helpful. Also an appetite suppressant, especially for cravings.  The FDA regulates appetite suppressants very carefully.  So there are a number of hoops to jump through, but they’re all very doable.

Remember, you do NOT have to be a member of the “Clean Plate Club.” It’s really not going to help any starving children anywhere!

Questions? “What’s a good snack food to avoid blood sugar swings?” Well anything that has carbohydrates will typically cause blood sugar swings. Simple carbs are much worse than complex carbs. It depends on what you tend to drift toward. The snack should be low-carb. That can be meat, cheese, or eggs. A lot of that is snack-worthy. Nuts are OK as long as you limit them. Be careful there. Cut up veggies are good. The flip side is that any food potentially can cause a blood sugar swing, even something with 0 sugars in it. I see this all the time with diabetics drinking why protein shakes. Typically 95% of my surgical patients are really sensitive to carbohydrates. Whey is efficiently absorbed. If you drink a whey protein shake that’s filled with amino acids and your body doesn’t need all those amino acids at that one time, your body will just convert it to sugar. Your body is good at doing that. Protein with any carbohydrate will smooth out the blood sugar somewhat too.

If you think of other things, just give us a yell 757-873-1880. Stop by and get your body comp done. Remember!  It’s your life. Make it a healthy one! Have a good evening everyone. Take care!

The Top 10 Dieting Mistakes

Posted on October 07, 2019 by

We all make mistakes, especially when we’re trying new things like weight loss. With weight loss people have typically tried many things. These are going to be some of the more common mistakes. You need to see it as an opportunity to change, and hopefully for the better.

Mistake #1 is “kinda” working on weight loss. Kinda working on weight loss does not work! We often want that quick fix. We have to learn the skills over a period of time. If you’re just going to “kinda” work on it, it isn’t going to work. Skills have to be learned. Then, they have to be ingrained and become habit.  They have to be practiced over and over and over again so they can become lifelong habits. Think about a serious athlete trying to make the Olympics. They can’t just “kinda” work on it.  Commitment is absolutely essential. You can’t expect perfection. We’re going to make mistakes.

Mistake #2 is making weight loss too complicated. Yes, weight loss is hard, but you really need to stick to the basics.  The basics are: dietary changes, behavior/habit modification, and increased activity and fitness. Those are the basic concepts. It sounds easy, but obviously it’s not so easy. I put together a webinar about a month ago that went over some really important concepts about controlling weight. It really boiled down to controlling insulin levels. It was about all the things you need to do to control insulin levels. Diet has to be the cornerstone of all that. Slowly work on all the basics and you will continue to make progress. With any type of change you need to ask yourself two questions: Can I do it? Is it worth it? If you can’t answer yes to those two questions you’re going to struggle and not make that long term change.

Mistake #3 is not exercising!  Exercise does not make you lose weight faster. So many people come in and say they’d be losing weight faster if they were exercising. It’s probably not true, but it’s still very important. It’s absolutely essential to preserve lean body mass. The natural part of aging is losing lean body mass at a rate of 1% a year.  LBM is what drives your overall metabolism. Simplistically speaking, a pound of muscle burns a lot more calories than a pound of fat. It’s actually a pound of well-trained muscle (think of the Olympic athlete) burns calories like crazy versus a pound of fat. You want to have a fuel-burning machine.  Muscle does that. Our overall metabolism is dependent on how much lean body mass we have. The better trained the lean body mass, the higher the metabolism will be. You can increase your metabolism with better trained muscle. It burns a lot more calories than untrained muscle. So exercise is extremely important. It doesn’t make you lose weight faster. It makes you lose weight longer and makes it so much easier to keep that weight off.

Mistake #4 is avoiding the scale. I’ve said many times that the scale is the best monitor we have. Patients often say they don’t weight themselves routinely.  They only weigh when they come into the office. Why would you think that’s a good idea??! I’ve said many times that you need to stand on the scale every day. The best time to weigh yourself is early in the morning. It’s the most accurate. If you forget to weigh yourself in the morning, just wait until the next day. Your weight will go up during the day. Make that part of your morning routine. The reason is to reflect on the previous 24 hours. What was different about that previous 24 hours? You’ll figure out the little things that matter. It may be as simple as you had to much salt or you didn’t have a bowel movement. Those little things that we typically eat really matter and will show up on the scale.  Once a week doesn’t work.  How many of us can look back on a week and figure out what we did differently during that week versus the previous week? Literally two days I can’t remember what I did differently. Looking back on 24 hours is relatively simple. What worked? What didn’t work? You’ll figure those little things out that affect day to day weight.

Mistake #5 is believing that genetics is responsible for your weight. Genetics does influence our weight. But if we are using genetics as a reason for our weight that’s just an excuse. When you really look closely at that thought process, weight is more likely contagious than it is inherited.  We tend to do the things we surround ourselves with. If everyone in your family is overweight it is slightly genetics but it’s very likely what they’re eating and doing. It tends to be contagious. We do the things that the people we hang around do. That’s true in our family and social life. It’s going to be a very rare situation where genetics is truly the reason. Weight is more likely contagious rather than inherited.

Mistake #6 is giving in to saboteurs. Friends, family, and acquaintances will all try and sabotage you. They will say the following:  “You deserve this.” “A little won’t hurt.”  “It’s the holidays!” There will be saboteurs. Be prepared to say, “No thank you” in multiple different ways. Deflect the comments by changing the subject. Explain to them the importance of this and that you want to recruit them to help. Tell them you value their support. You want them to help you rather than hinder you. Sometimes they don’t realize they’re sabotaging your progress.

Mistake #7 is being inconsistent. It’s that mentality of, “I’ve been good all week. I’m going to take the weekend off.” “I deserve this vacation because I’ve been so good.” Consistency goes along with commitment. Ask yourself those questions: “Can I do it?” “Is it worth it?” A bad weekend can undo 2 weeks of hard work. You tell yourself that you can slide just a little bit. You’ll find that you’ll slide a lot. It’s really easy to gain weight. It’s incredibly easy to gain weight. Write down your motivations for weight loss and review them often. “Why am I doing this?” “Where do I want to go with this?” Hopefully you’ll realize being consistent is worth it.

Mistake #8 is not eating enough. The common thinking is less is better. The reality is starvation has never been a good weight loss plan. Starvation is cutting way back but history has shown that it isn’t successful for weight loss. Fifty to sixty years ago some semi-starvation experiments were done. Around WW II there were contentious objectors. These people refused to join the military so they were asked to help by being put on semi-starvation diets. They found that if you cut those calories in half of what someone normally would be eating, people didn’t actually lose weight. They lost weight for a while but their metabolism slowed way down to make up for the calorie deficit. Part of the problem with just decreasing calories, and to continue to decrease calories, is that it only tends to work for a short period of time. Your body adjusts fairly quickly and it will slow your metabolism way down. It can slow it down to almost 50%. That is your body’s survival mechanism which is good if there truly is a famine. However, most of us aren’t living in a famine. Part of the issue with the semi-starvation diets is they cut their protein way back. If you’re getting sufficient protein, typically your calories will be decent.  Weight loss will become more difficult. It will also become really easy to regain weight.

I had written that mistake #9 was skipping meals. It’s actually not such a bad thing because intermittent fasting works really well. Intermittent fasting is just skipping meals. I do encourage people to eat breakfast for a couple of reasons. There are also reasons to skip breakfast. There isn’t a right and a wrong here. I’ve become convinced about that. Some of it depends on what you’re eating for breakfast. If you tend to eat a high carbohydrate breakfast, studies show you’re going to be eating 300-400 calories a day extra because you tend to be hungrier. If you’re going to eat a high protein breakfast you tend to stay full longer and you eat about 200 calories less a day. Most people don’t wake up starving. For certain individuals, skipping meals can actually work nicely. Skipping meals can actually be a good thing.

The NEW Mistake #9 is thinking that meal “timing” doesn’t matter. It DOES matter. The same meal late in the evening has a greater insulin response.  If you eat that meal earlier it will have a different insulin response. This goes along with skipping meals. Some people do much better with eating 2 meals a day. We already talked about intermittent fasting. It works. There’s no doubt about it. Insulin is key to weight control. The longer time you can spend with lower insulin levels, the easier it is to lose weight. The concept of eating multiple small times throughout the day will never work well. If you’re sensitive to carbohydrates or somewhat insulin resistant, the small meals throughout the day will never work for you. The reason is that, no matter what, whatever we eat will raise insulin levels. Carbohydrate just does it the most. You want to spend as much time as possible with low insulin levels. Skipping meals will give you more time with lower insulin levels.  Eating the same amount of calories but spreading it out throughout the day is asking your body to stimulate insulin levels multiple times throughout the day. That concept doesn’t have a whole lot to do with how many calories you’re eating. It’s just a pattern of eating. Timing matters. It’s a really rare person that controls their weight well by eating a little bit multiple times throughout the day. That’s just not my patient population. That’s not who I see. There are some individuals who aren’t that sensitive to carbohydrates. Those people will be fine eating small meals throughout the day.

Mistake #10 is having that “All or None” mentality. It’s feeling that you’re either doing everything great, but if you make a mistake you’re all done and throwing in the towel. This is a learning process. We’re human and we won’t be perfect every day. Accept the mistakes and move on. You didn’t gain the weight overnight. It didn’t happen with just one meal or one bad day. When you have that bad day, chalk it up to a learning experience. Figure out what you’re going to do differently when you’re in that same situation next time. Figure out those tools you can utilize to prevent you from falling off the deep end and get back on track for the next meal. Don’t beat yourself up.

In summary, to err is human but it does not define your destiny. Don’t let mistakes derail your weight loss plan. Dust yourself off and keep going. At CFWLS this is what we do. We’re here to help you. If you need some help just give us a yell. If you have any questions give us a yell here at CFWLS. Call, send an email, or walk in the door.  You should be checking your body comp. Make sure you’re losing fat not lean body mass.

If you would like weekly weight loss tips and recipes and a chance to ask me questions, subscribe to Losing Weight USA!  Remember it’s your life! Make it a healthy one! Have a good evening everyone.  Take care!

The Skinny on Ketosis and Low Carb Diets

Posted on April 15, 2019 by

Low Carbohydrate diets actually have a lot of misconceptions. So we’re going to go through a bunch of them. Let’s start out with the first two I hear most commonly.

The first misconception: Ketosis is dangerous.

The second misconception: Low carb diets make you lose bone mass and are bad for your kidneys.

Ketosis just means you have ketones in your bloodstream. We have ketones in our bloodstream all the time. It’s just the level of ketones.  Ketones are really just an energy source. They come from the breakdown of fat. Isn’t that what you want in a weight loss plan? You want to have some ketones in your bloodstream so you can use them as an energy source. Ketosis is often confused with diabetic ketoacidosis, and that’s a completely different thing. That occurs when the ketones get about 10 times the level of what would happen in a low carbohydrate diet. Ketosis by itself is not dangerous at all. It’s just an energy source.

Initially in low carb diets we saw that there was some extra calcium in the urine. But long-term we found that we actually absorb more calcium. So for a little bit of calcium that’s lost in the urine, there’s still a positive calcium there. We don’t actually lose bone mass. We can actually improve bone mass. Kidney failure doesn’t happen. There’s a difference between kidneys that can have low carb diets and kidneys that shouldn’t have low carb diets. What I mean is, with kidneys that are normal, there’s no problem with having a low carbohydrate diet. Kidneys that are abnormal should not be on a low carbohydrate diet. Typically, on a low carbohydrate diet, you’re going to have a little more protein, and it’s the protein that’s the problem.  It’s the extra nitrogen in protein that kidneys can’t handle if you’ve got bad kidneys. If you have normal kidneys, it could actually improve kidney function.

Remember-it’s your life. Make it a healthy one!

Do Fat Blockers Really Work?

Posted on April 01, 2019 by


Fat blockers are out there.  You’ll see them on the internet.  You can buy them over-the-counter.  Do they work? Can they be helpful a weight loss plan? The short answer is potentially they really can be helpful.

What are fat blockers? There are two different fat blockers out there. They’re the same generic medication called orlistat. Orlistat can be found over-the-counter as Alli.  It also can be sold in prescription strength as Xenical. They’re the same thing. But what they can do is block 25%- 1/3 of the fat that you eat. By doing that, it can decrease the amount of calories that are absorbed.  You have to be very careful because if you’re not absorbing that fat, it’s going to run through you.

Potentially, fat blockers can cause significant gastrointestinal problems. You might get bloated or have cramping. Eventually, it’s coming out the other end. If you eat too much fat it might be coming out the other end sooner than you thought.  So, you’ve got to be careful.  But it can be helpful. If you’re doing the right things like a good diet and exercise, cutting back on fat can decrease some of the calories you’re eating.

Remember, it’s your life!  Make it a healthy one!

Getting Off of a Weight Loss Plateau

Posted on March 25, 2019 by

One thing that is inevitable during your weight loss journey is a weight loss plateau.  This is very frustrating and often results in a setback or response such as “Why am I working so hard when I am not seeing progress?”  If you don’t understand how to manage a plateau and actually believe this statement, it can be a recipe for disaster!  You must not take an expected plateau and turn it into a big relapse or an excuse to abandon all weight loss efforts!  Instead, follow these suggestions to keep you moving in the right direction- towards the health goals you desire and deserve.

First, if you haven’t been exercising – START!  If you aren’t sure how to start, there are many resources available to you – contact one of our experts at the Center for Weight Loss Success to set up a program that is safe and will work for you, start a walking program with a friend or join an exercise program at a local gym.  If you have incorporated exercise into your daily routine – GREAT JOB – it’s just a matter of shaking it up a bit.  Follow the FIT ideas we promote at CFWLS.   You can change the Frequency (i.e. exercise 4 times a week instead of 3), Intensity (i.e. add some hills to your walking program), or Type (add resistance training or swim instead of walk) of workout you perform.  All of these will challenge your muscles and potentially increase your lean body mass and improve your metabolism.

Second, modify your eating.  Change your meal frequency, make sure you are getting in enough calories and make sure you are eating enough lean protein and controlling your carbohydrate intake.  Journaling is a great way to track what you are eating in order to identify key areas that require modification.  A weight loss coach can be key in identifying areas of concern and developing a realistic plan to keep your weight moving in the right direction. The Baritastic app is free and makes it easy & fun!

Finally, don’t forget your weight loss personality and how it may affect how you handle a plateau.  If you tend to be impulsive, you might see a tempting food and grab it so it is important for you to remove temptations.  You may eat mindlessly.  In this instance, you need to set limitations for availability of food while reading or watching TV.  Decide only to eat at the table and limit snacks.  Some of us eat because we are anxious, nervous or depressed.  Recognize your emotions and find something you enjoy doing such as listening to music or reading a good book.  Keep your weight loss goals in mind and have a vision of success.  Your mind is a very powerful tool so you need to use it to achieve success.

CFWLS is your solution to weight worries with everything you need – all in one place!  Get started today with a Free Consultation!  Call to schedule 757-873-1880 🙂

Optimizing Weight and Health by Controlling Your Insulin Levels

Posted on March 25, 2019 by


Today I’m going to give you a talk about some of my thoughts about weight loss and also some of my thoughts optimizing health in the long term. My concept of this has evolved over a number of years. This discussion is pertinent for anybody looking to improve their health or looking to lose weight (whether or not you’ve had weight loss surgery).  This is not just about losing weight. This can pertain to anybody. Hopefully this discussion will help many people.

We’re talking about optimizing health and optimizing weight loss. It’s a new year, so all of us have that somewhere in out “to do” list somewhere.  The essence of any weight loss plan (of health plan) will always be behavior modification.  If we don’t change our behavior then literally nothing will change in our life. We have to do the changing. It can’t be that we’re waiting for everybody else to change for us and that will change our life. That just doesn’t work very well.  We have to change behavior. Change is not going to occur unless you change your behavior! It really is up to you. No matter how you look at it, it’s still a personal responsibility. That’s true for me. It’s true for everyone.

This is an overview. I also call it an Over Simplification. Controlling weight and health, I’ve become convinced, is controlling insulin levels. If we control insulin levels, we control weight and health.  Insulin is a hormone. Its main function is to control blood sugars. When blood sugar goes up, insulin goes up to help keep our blood sugars controlled.  Insulin causes a lot of other potential problems.  It causes the following: water retention, increases B/P, increases chol/TG’s, increases inflammation, increases heart risk, and turns on fat storage (weight gain). If we can control insulin weight and we can control health.  The real question is how do we control insulin??? It’s a hormone you can’t live without. I’m digressing a bit. But if you look back 100 years ago before insulin was available as a medication Type I diabetics (they make no insulin) were pretty much given a death sentence because it was a slowly wasting disease. We want the insulin numbers as low as possible because it worsens so many other health problems. We can control blood sugar somewhat by getting rid of anything that raises blood sugar; keeping calories low, keeping carbohydrates really low and a modest amount of protein.  Subsequently we can control the blood sugars ok without any insulin. Without insulin, you can’t store fat. So, 100 years ago, people with Type I diabetes would just keep losing weight.  Zero insulin is a bad number.

Controlling weight and health is controlling insulin levels.  How do you control insulin? There are 4 ways. There are actually two more that I’m not going to get into too much. We need to control stress and get quality sleep. When we are highly stressed and suffer from poor sleep, cortisol levels go up which results in higher insulin levels. Control stress through deep breathing, exercising, warm bath, or whatever.  But there are four main ways of controlling insulin. Number one is low calories. Insulin levels will come down if you lower your calories. The issue is, if we take calories too low, over time your metabolism will slow down significantly. Cutting calories way back long term isn’t necessarily a doable thing and might not lead to as much weight loss as we would like because of slowing of metabolism. Exercise can be very helpful. The more intense the exercise, the better it works. That’s where high intensity interval training and the weight training comes in. The more active you are, the more controlled your insulin will be. Anyone that has Type II Diabetes should absolutely be exercising. Low carb has got to be the cornerstone of an eating plan to control insulin levels. It’s carbs that influence insulin the most. If you ignore eating low carb, it’s going to be next to impossible to control insulin levels. How low is low? I’ll get into that later. But it is somewhat based on the individual. The fourth way to control insulin levels is intermittent fasting. It works the very best to control insulin levels.  Intermittent fasting means not eating. Two of the reasons it works is because it’s both low calorie and low carbohydrate. There are lots of other reasons it works too.

How do you actually implement these ways to control insulin levels?  Three out of the four have to do with eating.  You can say that diet trumps everything else. We still have to really work on our diet. Words to live by:  eat a small amount of good food slowly. Make that your mantra! If you do that you’ll typically be eating healthy. When I say “good” it doesn’t necessarily mean it tastes good like a candy bar. By good, I’m talking about quality food. Tape it to your refrigerator door or make it your screen saver.

Let’s talk about the “concept” of eating.  This is your overall thought process of eating.  “How little can I eat and be satisfied”, NOT “How much can I cram in there…”  The difference between those two statements is generally a good 20-25%. That’s the mindset. Then we need to look at the “pattern” of eating.  The pattern of eating is the simplest thing to change.  When we’re eating has nothing to do with what we’re eating. I like for people to have a good pattern of eating. That doesn’t necessarily mean it’s a regular pattern. It can actually be an irregular pattern. If you think about it, throughout history it typically has been an irregular pattern. For some individuals, it works really well eating every few hours. I assure you that’s not my patient population.  Forty to fifty years ago that was the norm. The pattern of eating was typically 3 meals a day. That was it. There weren’t a whole lot of snacks because you didn’t want to “ruin your appetite.” Obesity and these health issues weren’t nearly as prevalent. That also meant there were 12 hours after that 6:00 supper. Fasting was typically part of a normal eating pattern 50 years ago. Thousands of years ago fasting was a huge part of it because food wasn’t available. You were lucky if you got one or two meals a day!  It’s figuring out a pattern that’s good for you. Again, it doesn’t necessarily have to be a regular pattern. It might work well for you, but other people not so much. For the surgical patients we often tell them they should eat breakfast each day. There is some rationale to that. But for long term most people get beyond the surgery and feel good and it’s not necessary. But you need to get your protein and hydration in. It’s really hard to do right after surgery. It’s not hard to do long term. Eating when you’re not hungry is probably not such a great idea. Skipping meals is ok unless you just had surgery. Some people need a snack. Others don’t need a snack.

Remember that what we’re trying to do is control insulin levels. It doesn’t matter what you eat. Anything you eat will make insulin levels go up. You need to have time for insulin levels to go back down. If you’re eating every couple of hours, insulin levels never go back down. There is good evidence that the same size meal taken late in the evening versus earlier in the day will stimulate a much more dramatic insulin response.  A much more dramatic insulin response is going to turn on fat storage that much more. Literally the same calories eaten at a different time can affect us significantly. With the Mediterranean diet they have the big meal mid-day and typically light eating in the evening. In the US we have that backwards typically. We’re often having our latest meal later into the evening. If it’s really getting later into the evening you’re getting a much bigger insulin response which turns on fat storage and turns on all the other problems. The pattern of eating is something we have to figure out. It’s simple to change. You’re either eating or you’re not eating. When you make the decision to eat, there are so many other decisions that have to be made; what are you going to eat? How much? What’s the makeup of all this stuff?  The pattern of eating is the simplest to change. But simple doesn’t mean easy.

What should a meal be? A meal size should be a small plate size. It’s true whether you’ve had surgery or not. A small amount of good food slowly. The best food has no labels (non-processed food). That means we prepared it ourselves.  It’s the processing that causes a lot of these problems. Try to avoid processed foods. Purchase it yourself. Prepare it yourself. Get it from the edges of the supermarket.

So what am I going to eat? This is where we have lots of decision making and lots of shades of grey. The basics of any eating plan is looking at three things:  how many calories, how much protein, and how much carbohydrate you’ll be sensitive to. I didn’t say a whole lot about fat. Fat will influence your calories. Fat also has minimal influence on insulin. I don’t recommend “high protein” diet. High protein actually stimulates insulin levels significantly.  The trick is figuring out the numbers. There’s always a calorie ceiling. If we go above a certain number of calories (for every person it’s different-no matter what you’re eating) you’re not going to lose weight. There’s always a calorie ceiling.  No matter what we eat it will influence insulin levels.  But carbohydrate raises it the most. Just because you stay below that calorie ceiling doesn’t mean you’ll lose weight. It just means you’re not gaining weight. That’s all.

We can’t survive without protein. Your body is utilizing it second to second, day to day for everything that’s happening.  It’s used for heart beating, digestion, breathing, growing hair, etc.… If we don’t take in enough protein each day, your body is going to steal what it needs from your lean body mass. If you’re breaking down lean body mass, you’re slowing your metabolism down.  Lean body mass is what drives our overall metabolism. The more lean body mass you have, the higher your metabolism.  How many calories does a pound of muscle burn? It depends on how well trained it is. In an elite athlete, a pound of muscle is burning calories like crazy. World class athletes can eat 7-8000 calories a day.  Couch potato muscle doesn’t burn much! Muscle burns more calories than fat. The better trained the muscle mass, the higher your metabolism.

Everyone has a carbohydrate “tipping point.” That means that at a certain level of carbohydrates your insulin levels will jump up. When insulin levels go up, you retain water and store fat like crazy. It turns on fat storage. When you turn on fat storage you’re not going to lose weight. You can figure out what your tipping point is, but it’s not easy to do. The healthier the carbohydrate and less processed, your tipping point will be higher.  If you’re exercising your tipping point will be higher. If you’re not very carbohydrate sensitive you’re tipping point will be higher. There are people who aren’t carb sensitive who eat a lot of carbs and don’t gain weight.  They just have a more efficient physiology. If it only takes a tiny amount of insulin to make your blood sugar decent then you’re not going to turn on fat storage.

Here are some things to “chew” on. “Kinda” working on weight loss does not work. You need to be all in. If you’re only going to do one thing—count your carbohydrate intake. It gives you the most bang for your buck. There’s no such thing as carbohydrate deficiency. Since carbohydrate is not an essential nutrient and they do significantly influence insulin, try to get the carbs as low as possible. 2/3 of the population is carb sensitive.  Close to 95% of my patient population is carb sensitive. Many of those people are also insulin resistant. It’s like a stepping stone; Carbohydrate sensitivity to insulin resistance, to diabetes type II. This means when you eat just a little bit of carbohydrate you tend to get very large blood sugar swings. What should happen is the blood sugar goes up a little bit after eating carbs. The insulin levels only go up a little bit. If your carbohydrate sensitive, what tends to happen is a delay with the insulin.

It’s supposed to kick in but it doesn’t. Subsequently, you get a huge blood sugar swing. Then the blood sugar plummets. The insulin is chasing the blood sugar around all day. The blood sugar swings tend to cause symptoms: headaches, irritability, not thinking clearly, and weight gain. Weight gain comes from the blood sugar swing up which causes a big release of insulin. Insulin turns on the fat storage. The treatment is to not get the upswing. If you don’t get the rise up, you don’t get the fall. People who are fasting keep their blood sugars rock even. It’s only when you start eating that things get out of whack.

Many doctors, clinicians, and dieticians don’t understand this probably because they haven’t thought about it. The concept is very straight forward.  A blood glucose of 100 is the highest end of normal. Ideal range is 65-85. If your blood sugar is 100, what does that actually mean as far as how much sugar is in your blood? It’s only a tiny amount. We each have about 5 liters of blood in us. So if we say your blood sugar is 100, how much sugar is in your entire blood stream? The answer is 5 grams. That’s a miniscule amount. It’s the amount in a sugar cube. If you’re sensitive to carbohydrate, it only takes a tiny amount to get a blood sugar swing. 5 grams is ½ an Oreo, 1 Triscuit, 1/5 of a banana, ¼ apple, or ¼ slice of bread. If you have just one of those food items, you’re potentially doubling your blood sugar. A tiny thing can have major implications with your health. If your blood sugar is 80, that’s only 4 grams. If you eat ½ an Oreo, you’ve more than doubled your blood sugar. If you’re sensitive to carbohydrates (2/3 of the population is), it only takes tiny amounts to throw this out of whack. This turns on all those health problems.

The “core” of the eating plan is what you need to concentrate on.  The best food has not labels. We fix it ourselves. We get it from the perimeter of the grocery store. Eat just 3 things.  Number 1 is hydration. Water is the best thing to drink. Get rid of almost everything else. Number 2 is good protein sources. We would die without protein. The best sources are meat, seafood, cheese, and eggs. They are protein with no carbohydrates. This is considered adequate, not high protein. High protein will make insulin levels go up high. The whole concept is preserving lean body mass that keeps your metabolism decent. Number 3 is the vegetable/ salad stuff. It’s unprocessed food. No one ever gained 100 pounds eating too much broccoli. They’re low calorie, nutrient dense, and fairly low in carbohydrate. If it falls outside the “core”, don’t eat it! Easier said than done. The concept is simple but not easy to do.

The other end of the spectrum is the processed carbohydrates. This is the low carb diet simplified (LCDS). There are 3 things: the starches, the crumbly carbs and fruit. Fruit can be the downfall of many weight loss plans. It’s not because it’s not healthy, but it has a lot of sugar. It can turn off weight loss because it can affect insulin. Remember that eating healthy doesn’t correlate with weight loss. They’re two different things. The starches are potato, rice, pasta, bread, and corn. You really want to avoid the processed foods. The crumbly carbs (what I call the 6 “C”s). They are chips, cookies, crackers, cereal, cake, and candy. Get rid of them. Simple to understand, but not easy to do.

I’m going to give you the Basic Health Strategies that I encourage everybody to do. I try to do these things myself but I’m not perfect at it. I’m not willing to tell you to do something that I’m not willing to do.  The first is monitoring.  The scale is the best monitor we have. Weight yourself routinely. I encourage people to weigh themselves daily. I know everyone else out there from your dietician to your other physicians say not to weigh yourself every day because weight fluctuates up and down and you don’t want to be disappointed. The best time to weigh yourself is early in the morning. Get in the routine of weighing yourself every day. The reason is not to just look at the number, but you need to reflect on the past 24 hours. What happened or what did you do differently the past 24 hours that affected your weight? It’s relatively easy to look back on 24 hours. It might be as simple as you ate more salt the day before or you didn’t have a bowl movement. Very likely it could be too many carbohydrates which caused too much of an insulin response. The insulin caused you to retain water. It’s more difficult to reflect on a week or two.

The second basic health strategy is eating. Think “how little can I eat to stay satisfied”, not how much can I cram in there! Everyone has a carbohydrate tipping point where they struggle. The core of your eating plan is hydration (water or something that’s natural with no artificial sweeteners or flavors), protein, and veggies. Significant evidence has shown that diet sodas (even without carbs) will make you gain weight because there’s a significant insulin response. It’s not that it affects your calories or blood sugar necessarily, but what does it do to insulin? The insulin effect is the key.

Exercise absolutely helps with controlling insulin levels. The more intense, the better off you are. The biggest misconception is thinking that you need to exercise longer. But you need to increase intensity, not duration. You can get a tremendous workout in 20 minutes. There are a lot of examples out there. Nobody has to go to the fitness center for 1 ½ hours. This can be done at home in your own time.

Sleep is important because of cortisol levels. If you have poor quality of sleep, you’re typically going to struggle. Control stress. When it is out of control we struggle with our weight and health.

Intermittent fasting (IF) can be a tremendous addition to any health plan. Fasting is not starvation. They’re two different things. Starvation is something forced on us that we don’t choose to do and we don’t know where our next meal is coming from. Fasting is something we choose to do. We know when our next meal is coming, we just choose not to have it. Your body’s response is completely different. The hormonal changes that happen with IF actually work to improve health and decrease weight. Growth hormone goes up. The reality is we all fast when we go to sleep at night for about 8-10 hours. The world record for fasting is 382 days. The point is that it can be done safely and for an extended period of time. The question for each individual is how long to do it and how often. I can help you figure that out.

The final health strategy is personal responsibility. No one can do it for you. You have to decide you’re going to do this and then actually do it. It’s nice to talk about it and have support but you have to do it.

A few resources before I wind this down.  The Art and Science of Low Carbohydrate Living is a good book about how carbohydrate works.  It’s written by Stephen Phinney and Jeff Volek. Stephen is a physician and PhD. Jeff is a researcher and he’s at the University of Ohio. They’re very smart guys who live this stuff. Dr. Phinney has studied this for 30 or 40 years now! They have a second book called The Art and Science of Low Carbohydrate Performance. This book looks at how you can actually improve athletic performance with low carb. 15 years ago we talked about carb loading. But you don’t need to. You can improve athletic performance with low carbs. A very good book by Dr. Jason Fung is The Complete Guide to Fasting.  You can get them on Amazon.

If you think of questions, just pick up the phone and call the office (757-873-1880). Don’t hesitate to send us an e-mail. Our address is:  www.cfwls.com  If you’re contemplating surgery know that more occurs than just having a smaller stomach. There are hormonal changes. The ghrelin levels go down which helps with controlling insulin levels.

Our nutrition store is open to the public. Come by and see us. Thank you for listening. Hopefully this was helpful. I apologize for dragging on a lot longer than I thought I would. This is important stuff. This is an overview of weight and health. Controlling weight and health long-term is controlling insulin levels.  Thanks for listening. I’d love to hear from you. Take care. Have a good day.

What If Your Doctor Doesn’t Agree with Weight Loss Surgery?

Posted on March 19, 2019 by

Has your doctor mentioned weight loss as a solution for your ailments, aches and complaints? If obesity related diseases are problematic or your body mass index exceeds a healthy range, your doctor may refer you to a weight loss specialist or nutritionist.  You, like the majority of people with weight issues have tried numerous diet plans, most resulting in failure at long-term results. You’ve possibly even considered weight loss surgery. Do you know if your doctor is on board with surgical weight loss options?  We receive patient referrals from many practices but not all doctors are in favor of the surgical option. Their bias may be based on lack of research or experience with patients who have had successful weight loss procedures. Seeking a second opinion is common-place in the medical field. Don’t be afraid to keep looking.

At CFWLS, we encourage people considering weight loss surgery to be their own best advocate for personal health. Gather the information necessary to have an educated discussion with your doctor. Watch our Weight Loss Surgery WebClass or attend one of our free Weight Loss Surgery Seminars  to get started.

The medications that are prescribed to combat high cholesterol, diabetes, hyper-tension and other conditions often simply mask the symptoms while failing to get to the heart of the problem. Losing weight and keeping it off may result in eliminating these medications from your daily routine! The benefits don’t stop there, you may notice less joint pain, more energy, better sleep and a host of other positive outcomes!

Finding an experienced, board-certified Bariatric Surgeon who can answer your questions and explain your options to you is imperative. A comprehensive post-surgical follow-up plan will provide your best possible long-term outcome. Your search may be over. Dr. Thomas W. Clark is double board certified as a surgeon and Bariatrician. He has performed over 5,000 weight loss procedures and has dedicated almost 25 years to helping people lose weight and learn how to keep it off for life. His experienced staff will guide you and help you enjoy the process along the way!

Having a supportive doctor is important, but ultimately, it’s your body and Weight Loss Surgery is a personal choice. Do your research and obtain all pertinent information. Weigh the risks versus the benefits. Make an informed decision. Schedule a call with our office manager, Cat Williamson, to discuss your next step.

Phentermine – Could it Help You Lose Weight?

Posted on February 21, 2019 by

I’d like to talk to you about Phentermine. Phentermine is an appetite suppressant. It’s been around for a long time. Appetite suppressants are really carefully regulated by the FDA, so there are some hoops to jump through for those people utilizing them, but it’s very doable.  Potentially it can be helpful from a weight perspective, but also from a hunger/craving perspective.  It works very well for cravings.

A lot of appetite suppressants have come and gone.  There have been a number of them over the last 20 years or so. They got approved by the FDA, were around for a few years, and then gone.  One of the reasons is because the drugs were causing other problems.  There are a couple of newer ones in the last few years.  None of them really work any better than phentermine.  The new ones can be really expensive.  Phentermine has been around for about 60 years now. It can be very helpful.  And it’s very safe. We’ll talk about the risks, which are something we do have to keep an eye on. It can help with any medical weight loss plan. You have to be doing the right things. Phentermine will not make up for a bad eating and exercise plan.  It’s very closely monitored by the FDA. Part of that is because back in the 90’s they had phen-phen. It was a combination medication of phentermine and also phenfluramine. They put two medications together and it worked wonderfully. Unfortunately, the phenfluramine ended up causing heart problems. It was taken off the market.  Because phentermine was associated with it, it’s very closely regulated. Overall, it’s a very safe medication.  It has stood the test of time.  It can actually be used long-term but it needs to be monitored.  There can be some potential side effects. You do have to watch blood pressure. It’s rare but not impossible.

The clinical indications for using phentermine are a BMI over 30 or BMI over 28 with medicals problems.  It’s similar to having weight loss surgery.  Generally what they’re talking about mostly are sleep apnea and diabetes.  Chemically, phentermine looks like amphetamine. Because amphetamine can cause all kinds of problems, and can be addicting, it was thought that phentermine was in the same class as amphetamine, and therefore just as dangerous. It was more regulated by the FDA. A lot of those theoretical problems really never panned out.

I’ve been utilizing phentermine in the patient population for about 15 years now. Just like surgery, it’s a good tool. It’s just another tool in the toolbox. There’s nothing magic about it. It can be a good additive tool along with the surgery. All it really does is takes the edge off hunger.  It really takes the edge off cravings. It won’t prevent you from eating. It can also help with carbohydrate withdrawal. Most of our patients are very sensitive to carbohydrates. If they fall off the wagon and start eating too many carbs and then try to cut them back again they’ll go through withdrawal. Carbohydrates are like a drug. The phentermine can help with the carbohydrate withdrawal symptoms.  We have found that phentermine can give you 8-12 pounds of extra weight loss. It’s the same with our surgical patients. If they feel like they’ve stalled out, the phentermine can give them some more weight loss.

If you are keeping your carbohydrates down while utilizing phentermine, you can lose a tremendous amount of weight. The weight loss from phentermine will vary from person-to-person depending on age, genetics, sex, and other health problems.

There are potential side effects. You absolutely need to have an EKG done prior to starting phentermine. You want to document that your heart is fine. It’s not going to cause a heart problem. But if you’ve already got a heart problem, it can worsen the problem.  Almost everyone starting phentermine gets a dry mouth. Make sure you’re drinking a lot of water. It can make you feel slightly jittery. It’s kind of like having a few cups of coffee. They typically fade away in about 7-14 days. It’s a side effect. It’s not how the medication works.  I tell people that if it makes you jittery and it bothers you, then quit taking it. The medication will be out of your system within 12 hours. One of the uncommon side effects of phentermine is insomnia. If you take it too late in the day you might have a hard time going to sleep. But that typically over time goes away. Other uncommon side effects are tremors, dizziness, and high blood pressure. It’s really rare for blood pressure to go up, but that’s one of the reasons why we have to monitor it. Theoretical potential problems (which are related back to the phen-phen) are heart problems and addiction/withdrawal. You can get used to the medication, but that’s not necessarily addiction. You can build up a tolerance to the medication where it stops working as well. But you can’t go through withdrawals.  You don’t have to wean off the medication. You can just stop taking it.

There are some real reasons to avoid phentermine. If you have an allergic reaction to it, obviously you shouldn’t take it. If you have a history of heart problems (no matter what it is), I would discourage you from taking it. You shouldn’t take it if you have high blood pressure that’s poorly controlled.  You can take it if your blood pressure is well controlled. Theoretically you should avoid phentermine if you’re taking antidepressants. Because of the chemical make up of phentermine, there was a thought that there would be a cross over, and some antidepressants would make this exacerbate heart problems. It would make antidepressants not work as well or the antidepressant would make it exacerbate heart problems. But it’s absolutely fine to take it with antidepressants. There is actually some antidepressant affect with phentermine.

Legally I have to have a discussion about the” art” of taking phentermine to a patient if they’re going to be taking it. I have to talk about the potential side effects as well as the” art” of using the medication. It tends to last for 10-12 hours. So, since most people don’t wake up starving, don’t take it first thing in the morning.  There’s no sense in taking it then.  Take it mid to late morning.  Play with the timing. If you find you’re having a hard time getting to sleep, then take it earlier. If you have a lot of hunger and cravings right before bed then you need to take it later.  It’s one of those medications that work if you take it.  It doesn’t work if you don’t take it. You don’t have to build up to it or wean off of it.  Therefore you can use it intermittently. It’s fine to use it certain days of the week. We typically write it as a daily dose but there’s no reason you need to take it every day.  Take it as you need it. It can be used long term. It originally was written in the PDR to be used for only 8-10 weeks. They originally said that because the original studies were only done for 8-10 weeks.  It was then approved by the FDA but never approved for long term use.  It has been used for long term use for many years the PDR has never been changed. So most physicians only prescribe it for a few months. It’s kind of silly to think we can fix something in a couple months. I’ve had people on phentermine for 10-12 years. It just has to be monitored. We’re making sure there aren’t any blood pressure problems, ensuring it’s still helping, and make sure there are not side effects bothering you. If it’s not helping, you shouldn’t be taking it anymore. There is evidence that if a person is taking it long term that if they stop it every few months for 7-10 days, and then it tends to work better.

There are some cautions about phentermine. Sometimes it may work so well that you don’t eat. We’ve talked about intermittent fasting and how that works.  The problem with skipping meals and intermittent fasting are two different things. If you’re just skipping means, then it was unintentional. Fasting is intentional. You don’t want to be skipping meals all the time. If you’re doing intermittent fasting for a day or two, you can take phentermine. It’s another tool in the tool box. Starvation has never been a good weight loss plan. Phentermine won’t stop you from eating. If you’re eating for many reasons (not hunger), then it’s not going to help you. You need to take a good look at the behavior side of things.  Why are you actually eating? Work on solving those problems. Without a good nutritional and exercise plan, any weight loss with the phentermine will likely be temporary.

In summary, phentermine has been around for a long time. It has stood the test of time. It can be very safe. It can be very helpful, especially for cravings. But it still needs to be used with a good diet and exercise plan. It doesn’t work to fix a poor life plan. You need to have a normal EKG. We have to monitor your blood pressure as well as side effects.

Come in and get your body composition done.  Make sure your losing body fat and not lean body mass.  Remember it’s your life! Make it a healthy one!  Take care everyone.

Weight Loss Surgery Success – Your Core Eating Plan Simplified

Posted on December 10, 2014 by