WE ARE CHANGING

I just got back from a conference in Houston Texas, where I sat with 2000 other doctors in a large conference room, listening to lectures on the latest results of research on Obesity and Overweight. It was fascinating and amazing. The knowledge and understanding is evolving so fast, and with that how I treat my patients is changing.
Most weight loss programs are one of two types: there is the low calorie based program. The philosophy behind this type of program is that if your body uses, as an example, 1800 calories per day: if you eat less than this you lose weight, if you eat more than this, you gain weight. Very simple math; calories in versus calories out. Eat less, exercise more, and you will be thin. Wrong. It wont work. Why? All calories are not the same. Three hundred calories of chocolate ice cream does not affect your weight in the same way as 300 calories of grilled chicken. Overweight and obesity is not a problem of eating too many calories; it is a problem of too many calories going into the fat cells.

The other type of program is where they put you on an extremely low carb diet, mostly all protein and vegetables, and then give you an appetite suppressant so you don’t feel hungry. (I personally could stay on that program for about 2 days maybe. Some people stay on it longer.) The problem with this is that it is a quick fix, not a permanent fix. And it does not at all address the problem. Does the patient have high insulin, high progesterone, hi cholesterol. Each problem needs to be evaluated and treated individually. An extreme low carb diet is absolutely not sustainable, and who would want to live that way anyway. The minute you go off this, you gain all the weight back and more. You feel defeated and frustrated.

I use neither of these formulas. In fact I don’t use any formula at all for weight loss. WHy? It turns out that every person that is overweight does not have the same problem. In our program, I treat patients individually. I design their diet based on lab work, age, medical history, and other factors.

When I leave these medical conferences, like the one I was just at in Texas, I walk out with new information, and with this new medical knowledge, I have new treatment plans, both in terms of the understanding of the chemistry of food,the understanding and use of medications (no, every patient here does not get an appetite suppressant,many patients use no medication at all, while some patients get medications that help with weight loss but are not appetite suppressants) as well in terms of understanding how to treat individual patient problems.

Treating patients with the chronic DISEASE of overweight and obesity (yes, obesity and overweight is now considered a chronic disease, caused by both neurological and hormonal imbalances) is my interest and my passion. And I write this blog today to tell you that how I treated patients one year ago, is different from what I do now, because there is new information, new treatment options, and new understandings.

WHAT IS INSULIN RESISTANCE?

Insulin resistance is something you hear about every day, your doctor tells you that you have it, or that you are prediabeitc, or you read about it in magazines, or weight loss books..
Insulin resistance means your cells in many parts of the body do not respond to insulin. It is the reason most people struggle with weight loss and more commonly cannot lose weight.This is the most important concept to understanding weight and what makes it go up an down.
Lets do a basic review. When you eat any carbohydrate, not just starch, but fruit, milk, cookies, desserts, alcohol, these are all carbohydrates; they get made into sugar in the blood; Sugar triggers the release of insulin from the pancreas into the blood stream.
Once in the blood, the insulin travels to many places, like muscle cells, heart cells, liver cells, brain cells, and unlocks these cells; very much the way a key fits into and unlocks a lock. When the cells are unlocked, sugar can go into the cell and give it energy. This is the way it is suppose to work, in an insulin sensitive cell.
When you are insulin resistant, due to chronic imbalances in your diet (for most people) that lock is” rusty;” the key does not work well, the cell only partially gets unlocked by insulin.
As a result of a “rusty lock” the “door” gets opened just a “crack”, a small amount.this means, only a little bit of sugar can enter the cell and give it energy.
This is what insulin resistance means: which is that most cells cannot respond adequately to insulin, and because of this,much sugar that is in the blood stream cannot get into cells, Over time your blood sugar rises, and you become prediabetic and then diabetic.
What is the result of insulin resistance? the result is a lot of sugar is floating around in the blood and cannot get cells. So where does all this sugar go? It gets sucked up by fat cells, you gain weight, and the situation gets worse. You are fatter, and become more insulin resistant.

How do you fix this problem? You do NOT become less insulin resistant by eating less food, but by eating the CORRECT chemistry of food. What is the correct chemist try of food? This varies person to person, and this is why you need professional help. This is complicated, requires a thorough understanding of insulin, its chemistry, how to fix this, and all the many other hormones, not mentioned here that affect the interaction of insulin with cells in your body.(Examples; Resistin, Adiponectin, Cholecystikin, PYY, glucagon, and many others) I hope this gives you a glimpse of how all this works, and please come in and see us if you are ready for some expert help.

MESSAGE FROM A PATIENT ON MAINTENANCE

My goal with all my patients is always the same; Not only to LOSE the weight, but also to MAINTAIN the weight loss. Maintenance is the hardest part. It starts the day you hit goal, and ends the day you die. Hopefully that is a very very long time, but the triggers that got you into trouble (and made you overweight) are still out there calling your name.
We work very hard at maintenance in my office, we explain what is going to happen, and how to handle the many challenges. We have some follow up visits, further and further apart, until the patient feels confident that he or she can do this on his/her own. We support and help in every way we can.
We are very proud of our very high success rate on maintenance, which we estimate to be 92% to 95% at the 2 year after hitting goal mark. This means that most of our patients have made a life style change.
Here is an email I got, just a few moments ago, from a patient on maintenance:(patient lost 44 lbs.)

NAME REMOVED TO PROTECT THE PRIVACY OF THE PATIENT
To:
Dr. Winifred Constable

Apr 4 at 8:46 PM
Hi Dr. Constable,

I hope that you are doing well.
I was a patient of yours from January through August of last year and think you might be interested in an update on my weight loss.
At this point, almost eight months since I went on maintenance, I am a couple of pounds below my maintenance weight.
More importantly, as a result of the weight loss, my blood pressure is now down to low normal.
Even more exciting, I now no longer need to use the CPAP that I had used religiously for my sleep apnea since 1994!
So, thank you for your help in achieving this.

IT IS NOT HOPELESS

I remember the days when I was very overweight, and at times feeling so incredibly frustrated. I felt like nothing worked, no matter how hard I tried,I would never be able to get the weight off. After 15 years of struggling, losing some, then regaining, then partially losing the weight again, I gradually figured out how to lose weight and keep it off forever. It took hundreds of hours of studying, lights turning on in my head when I was learning biochemistry in grad school, going to medical school, seeing patients with the same issues, it finally happened. I lost my 90 pounds and kept it off for years, only gaining two to three pounds on occasions like birthdays. I was done.
A recent study by Time Magazine examined all the weight loss programs in the country, all the diets being followed in the last year, books on weight loss, doctors formulas, and finally the latest research conducted at large universities on obesity,and they concluded exactly what I tell all my patients.

And here it is:
1. There is no one size fits all diet that will work for everyone. People are very specific and varied in terms of what will make them successful at losing weight. A high fat low carb diet works for some, a very high in complex carbs and Balanced diet works for others, and so on.
2. Everyone that has lost a large amount of weight and keeps it off eats breakfast.
3. Everyone that has lost a large amount of weight and keeps it off exercises at least five days per week. It is not violent exercise. It is cardio.
4. Everyone that has permanent weight loss has a strong reason for wanting to be thin, and it is not just looks.
5. HERE IS THE MOST IMPORTANT MESSAGE:
EVERYONE WHO HAS LOST WEIGHT AND KEPT IT OFF DID NOT SUCCEED AFTER JUST ONE TRY. MOST PEOPLE TRIED AND FAILED AT LEAST SIX TIMES.

So, if you are reading this and have failed at several diets, and you really want to lose weight and be healthy and slim, please do not give up. If you keep trying, and you really care, you will at some point find the answer that is right for you, and you will achieve your goal. But please do not give up. Persistence is the key.

I DONT LIKE THE KETO DIET

Every week, every month, every year brings in a new diet idea, in this constant frenzied attempts to get control of our weight here in America. And no wonder, at least 70%, (and more by some figures,) of Americans are overweight, and at least 40% (or more of us) are obese. Everyone is trying to slim down.

The latest rage diet is the keto diet. What is this? It means eliminating almost all carbohydrates from your diet, such as cookies and ice cream, wine and bread, but also fruit and yogurt, virtually all foods that have carbohydrates. This means that your body will use fat as its energy source and you lose weight. In the process of breaking down fat, your body releases ketones into the blood.

Sounds great! Losing lots of weight, slimming down. But here is the problem. Every day that you are in ketosis, the body recognizes that you are in starvation mode, and it starts increasing the levels of a very powerful hormone called a ghrelin. This hormone goes to a very specific place in the brain called the arcuate nucleus of the hypothalamus. It triggers you to have hunger, cravings, and the “munchies.” The longer you are on the keto diet, the higher your ghrelin levels, and the stronger these feelings become. It is a matter of time before you are going to breakdown and eat some carb that is forbidden. And once you start eating carbs, it will be like an avalanche. You will find yourself spinning out of control, eating more and more.

The other thing that happens on the keto diet is that you body goes into starvation mode. In attempt to save itself, the body slows down your metabolism. You can burn 500 to 700 calories less per day than when you are not on the keto diet.
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So on the keto diet, you have very high ghrelins, you have slowed down your metabolism, and now you breakdown and start eating carbs. Result? You gain back all your lost weight and probably more (remember, your metabolism has slowed down). You feel frustrated, defeated, and locked into a weight you cannot seem to get under control.

My advice, it if it seems too good to be true, if it is the latest fad, it is probably not the right answer.

What is the right answer? A diet with the right kind of carbs and the right amount of carbs; but it has to be personalized to you, because we are not all the same. There is no one size fits all formula for weight loss, or for how many carbs you need to eat. And that is exactly what we do here at Balance Medical Weight Loss.