Dr. Rachman's Blog

My Blog Has Moved...

2010-02-09T21:03:00.000-08:00

the new home for my blog is: http://www.trim360.com/connect360/blog360/doc-talk/home

Look forward to seeing you there.

Feel Free To Extend Your Life - The Story Gets a Little Fishy!

2010-01-25T09:34:00.000-08:00

Higher concentrations of marine fish oils in people's blood have been shown to correlate with slower cellular aging. The study published in the Journal of the American Medical Association demonstrated that telomere shortening (a marker of cellular aging) was reduced in people whose blood had higher concentrations of marine omega-3 oils. Besides the obvious potential benefit of slowing down aging, these findings may explain the interesting phenomenon of these omega-3 oils being protective against obesity-related diseases, such as diabetes, atherosclerosis and elevated cholesterol.

Bottom Line: take 2-4 grams of omega-3 fatty acids daily if you are consuming less than 2 servings of cold water fish per week.

Pass (On) the Salt, Please...

2010-01-11T20:59:00.000-08:00

There's a very curious story in today's newspapers - the biggest food manufacturers are gradually reducing the amount of salt in some of the most popular items sold in our supermarkets. Through painful experience they found that cutting salt content too quickly produces dissatisfied customers, who find less-salty foods are too bland to enjoy. We all really have to compliment them for doing the right thing and doing it so smartly. Our brains don't like stark contrasts - going from something very warm to very cold, very sweet to unsweetened, etc. By reducing the salt content over a period of time, our brain gradually learns to perceive the less-salty foods as equally enjoyable.

As I've always believed, there are very few intrinsically bad companies, just bad incentive systems. And once the public opinion and market forces demanded the lower salt products, the industry has indeed figured out and the smartest way possible to deliver. Once again, a little knowledge on the part of the public goes a long way to improve our health and the quality of life.

Bon apetite!

DIET OR EXERCISE? WHICH IS MORE IMPORTANT FOR WEIGHT CONTROL?

2009-10-29T15:31:00.000-07:00

The answer to this question became quite obvious to me after taking my daughter to a very popular restaurant chain last weekend.

Each entree contained at least 900 calories (with most salads exceeding 800 calories per portion).
Knowing that we burn about 15-20 calories per minute doing the most strenuous types of exercise, I asked myself how long would it take me to burn off those 1000 calories. 1000 divided by 20 comes to 50 minutes of running (!) for every lunch entree on the menu in front of me. And that's just not to gain weight! Imagine how much more exercise it would take to actually lose weight! For some reason, i lost my appetite at that point and ordered 1/2 a serving (with 1/2 the calories).

So, the simple point is that our modern servings come in such huge sizes that it is unrealistic to hope to burn that energy off by exercising. Please, don't misunderstand me here - exrecise is very important to for health, but obesity is primarily caused by excessive calorie intake (and treated by reducing that intake).

Bon appetite.

GETTING PERSONAL...

2009-10-13T17:30:00.000-07:00

What do I see when I go get my cup of tea in the break room?! Warm, freshly-baked danishes! The overpowering aroma instantly called out to me, drawing me closer, tempting with every calorie-packed bite. BUT, I did not panic. I knew I had only several minutes to come up with an alternative or my willpower was going to be crushed by the temptation in front of me. Luckily, I always keep around a low-calorie protein-packed snack to rescue me in situations like this one. I ran for my Trim360 oatmeal (130 cal), which instantly soothed my hunger and gave me great satisfaction at saving myself from an avalanche of danish calories (~ 380 cal).

Am I the only one fighting these battles on a daily basis? Can you share your battle scars?

PORTION SIZE IS IMPROTANT, BUT...

2009-09-29T11:13:00.000-07:00

Portion control is unquestionably important, especially with high calorie-density foods. You have more flexibility to consume larger portions of foods that have fewer calories per gram, than those that pack a lot in each little bite.

That's why a huge bowl of green salad with one scoop of canned tuna or chicken breast (all of ~360 calories with olive oil dressing) is much more filling than one sandwich or burrito, which may have 600-900 calories.

So, the answer is to use both portion control and content control to stimulate you brain's satiety (or fullness) center.

HOW MUCH DID THAT LUNCH REALLY COST?

2009-09-22T22:24:00.000-07:00

If you still measure your food in dollars instead of calories, I hope you have enough money to waste. Here are 3 bite-sized thoughts to chew on:

1. Do you REALLY think that the 950-calorie fast food lunch with 1000mg of sodium only cost you ~ $3.99?! Did you add the $20 co-pay for that cholesterol, high blood pressure or diabetes medication?

2. What makes you sick - excessive calories or dollars? Do you know the real value of your food?

3. Would you throw away $2000? That's exactly what people with Type 2 diabetes, high blood pressure and other weight-related problems do every year by not taking control of their weight. Hmm... $2000 - could have been a nice vacation.

IT TAKES COURAGE TO SAVE OUR KIDS!

2009-09-22T15:12:00.000-07:00

After my daughter's soccer game last Saturday, I almost fainted when one of the parents whipped out cupcakes as a post-game snack. You can imagine my shock and horror seeing my daughter struggle with the impulse to have a bite of this "nicely" decorated cupcake with all the attributes of food coloring rainbow and 'slightly' sweetened frosting. And this is the child who knows that sugar is an addicting substance and knows how unhealthy this food is and my feelings towards it.

Do you think I confronted that parent on the spot? Did I raise a stink that my parental rights were being trashed and openly sabotaged?! Nope. I quietly hissed at my daughter to toss the cupcake into trash, while she was begging me for "just one lick". My wife had to drag me off the field as i was turning red. The thing that was bothering me the most really was that even the briefest of exposures to the very sweet stuff almost instantly resets the threshold for satisfaction of what's called a "sweet tooth". So it will take more of that sweet stuff to satisfy you in the future.

1 week later, my wife received an email from one of the parents on our soccer team which said: "CALL ME A CRAZY SOCCER MOM, BUT PLEASE TRY TO BRING REGULAR WATER, FRUITS AND VEGETABLES AND OTHER HEALTHY SNACKS FOR OUR KIDS"!

We were both happy and somewhat moved by the courage of this person and the realization that it takes some one to take a stand (even for something as natural as keeping our kids healthy).

Are your kids safe?

WHY I DO WHAT I DO!

2009-09-22T13:07:00.000-07:00

My patient, whom i treated over 2 years ago, returned to jump start his weight control program yesterday. Ever since his original weight loss of ~ 35 lbs and getting off 2 diabetes and 2 hypertension medications, he's been very vigilant about his eating patterns and exercise routine. As soon as he noticed a consistent weight regain, he took tangible steps to prevent falling back into the same destructive pattern and the exacerbation of his medical conditions.

So gratifying to see that now he looks at his health as something that's under his control,, something he can manage. (Of course, not having $100's in medication co-pays doesn't hurt either).

Do You know how to positively affect Your health?

JUST DO IT?!

2009-09-17T21:32:00.000-07:00

Today, i spoke with my long-time patient who came back to restart her weight loss program. We chatted a little about our summers, kids and the importance of keeping positive outlook; not doing anything out of fear, but rather to preserve or improve our sense of well-being. Suddenly, she looks right at me and just says - sometimes YOU JUST HAVE TO DO IT. Funny, i thought to myself - that's exactly the only thing I can't do for my patients - actually take the all-important first step. I can provide all the education and motivation in the world, but it is the person across from me who should eventually take action for any change to happen.

So, what ever made You just do it?

IT PAYS TO STAY IN SHAPE

2009-09-16T11:25:00.000-07:00

You and your primary care doctor may be your best financial planners! Why? How long you live and how healthy you are when you age are directly related to how fit you stay. Gaining too much weight and not exercising will surely cost more in medications and medical care for high blood pressure, diabetes, high cholesterol, arthritis and others.

So, it really does pay to stay fit.

LAUGH TO LOSE WEIGHT!

2009-09-16T10:17:00.000-07:00

Positive emotions block the stress hormones that breakdown our muscles and deposit fat around the midsection. The easiest (and, possibly, the most enjoyable) way to fight visceral fat accumulation is to focus on positive emotions and consciously block the negative feelings. As silly as it sounds, even forcing yourself to smile will send a positive message to your brain and will cause the reduction in stress hormone production. The more muscle mass you retain, the higher your resting metabolic rate is (and the more calories you will burn, even at rest).

So, cheer up and enjoy your day.

Walk to fight diabetes

2009-08-21T12:32:00.000-07:00

American Diabetes Association is sponsoring nationwide walk for diabetes.

Check it out: http://stepout.diabetes.org/site/PageServer?pagename=OUT_lm_wherewewalk

Whether you participate yourself, give money or just encourage someone else to participate, this is such an important cause that affects so many people around us.

Don't Skip Breakfast!

2009-08-21T08:09:00.000-07:00

We have long known that people who regularly eat breakfast tend to control their weight better over the long term. A new study shows that regular breakfast eaters have less intra-abdominal visceral fat (the "bad kind"; highly related to coronary artery disease and other metabolic problems) than people who don't eat or skip breakfast.

Point: Start your day with a healthy breakfast. It will keep you from snacking on empty calories and keep your insulin from spiking, leading to less fat deposition. It is easier to control the volume and contents of your breakfast at home than whatever comes your way in the snack room at work or on your way there!

Source: Obesity (2009) 17 8, 1528–1533

Why Diets Fail

2009-07-02T09:40:00.000-07:00

Diets fail because they don't relieve hunger. The sense of satisfaction after eating comes from 2 sources - stretching of our stomachs by food contents and the specific nutrients telling our brain to turn off the hunger stimulus. The main nutrient that tells our brains that we are full is protein. Hunger is one of the most basic human sensations and if not satisfied will cause people to continually seek food. The most important point to remember that it's not the amount of calories that make us feel full, but the volume of the food consumed and the protein content of the food itself. Fiber also contributes to the meal bulk and promotes satiety. Learn to modify your food content to ensure high fiber content (for volume) and enough protein (for satisfactioin) for a worry-free, long-lasting weight control.

3 Predictors of Successful Weight Loss

2009-04-12T22:24:00.000-07:00

The largest published study to date, not surprisingly, showed that the 3 main predictors of success were:

The amount of self-reported weekly exercise (minutes per week)
The compliance with educational session attendance (just over 30 sessions/year)
The number of meal replacement consumed. Weight loss was greater with greater number of servings consumed.

The study, published in Obesity (2009) 17 4, 713–722, assigned over 2500 people into 2 groups. One received an intensive lifestyle interventions (ILI) with educational sessions and meal replacement and the other a currently used diabetic self-education curriculum. The ILI group lost significantly more weight, with improvements in all the markers of weight related problems, such as blood pressure, cholesterol and blood sugar.

This, once again, underscores the importance of having a system in place that will keep You motivated and compliant with Your nutrition and exercise plan.

How Outside World Makes Us Overeat

2009-04-10T15:21:00.000-07:00

I am very concerned that the most important point in the discussion of obesity causes and weight control strategies is getting lost- the abuse of our brain reward systems by external marketing forces.

Specifically, research shows that environmental factors cause us to overeat, oftentimes without even realizing it.

A recent article in Diabetes Journal cites several human characteristics that can be exploited to cause you to overeat:

1. Food and images of food cause automatic secretion of chemicals in our brains creating desire to eat. We are surrounded by abundance of food images in our daily lives via billboards, store shelves and other marketing venues.

2. Inborn preferences for sugar and fat cause people to reach for foods that provide immediate calories during stressful times, especially given the easy access and availability of high-sugar/high-fat foods and snacks. These high impulse items are typically placed at the end of aisles and inside check-out centers, responding to the human trait of being unable to resist innately desirable foods for extended periods of exposure (e.g. waiting in line).

3. Built-in survival mechanisms automatically respond to food abundance and variety by greater consumption. The increasingly greater variety of food on store shelves and restaurant menus, without regard to their calorie or nutritional value, results in calorie over-consumption without nutritional benefits.

4. What's in YOUR dinner?
Sorry to tell you, but biologically speaking, none of us have the capacity to detect with precision the calorie load we are consuming during our meals. Our satiety mechanisms are not very exact and usually turn on much slower than the time it takes us to gobble up a good chunk of calories. Plus, thanks to the marvels of modern food science, quite petite portions of many marketed items contain a pretty good density of calories (usually in the form of fat and carbohydrates). They look very small (and so appetizing and cute), yet pack quite a punch (to the visceral gut). So, next time you are taking a trip to your local grocery store, check out the calories/serving of most foods in the middle section. More importantly, ask yourself - would consuming 1 serving of this product satisfy my hunger? If the answer is no - perhaps, avoiding that isle next time would be an easier way to get out of the store unharmed.

5. Laziness (energy preservation) is in our genes!
In the nature's game of survival, a species' success depends on its ability to preserve energy for absolute essentials. We were bred for millions of years to make the best use of the available energy sources. Everything was going according to plan, until...we developed a refrigerator. That singular invention has essentially turned the entire "survival of the fittest" concept on its head. We now have the unlimited access to food, any time - day or night, winter or summer, and so on. The only problem is that we unfortunately, did not leave our biology behind and have continued to try to minimize our energy expenditures in anything we do. So, why schlep all the way to the farmers market and buy fresh vegetables (which then need to be washed, chopped, mixed with olive oil, etc) when i can just swing buy my corner convenience store and pick up my favorite snack and enjoy the afternoon?!

Out of curiosity, when was the last time You saw a an advertisement for fresh veggies on TV? ...and for potato chips?

6. It's OK 'cause they are all doing it too!
Weight gain is a team sport. Recent medical study showed that the person's weight was highly correlated with the weight of his social network. We tend to imitate behaviors of others around us. So if something is OK to do at your friends' house, why should You deprive yourself? I am not saying you should get new friends or be less accepting of them, I just want you to be able to decide for yourself which behaviors are truly your own and which are just imitations. So, the next time they are having their cheesecakes, maybe you could enjoy that fruit salad?

Weight Maintenance... Exposed!

2009-04-09T09:34:00.000-07:00

"How do I maintain my weight loss once I go off your program?" That is THE question we get asked every day in our clinic, by all our clients. Let me use my favorite format of top 3 things to remember:

1. Know thy metabolism - all theoretical things aside, you need to know what your average resting metabolic rate is (RMR) - i.e. how many calories your body burns on a daily basis at rest - to know where your target calorie intake should be. Knowing this number alleviates any sense of ambiguity and anxiety over the insidious and uncontrollable nature of gradual weight regain. To get an idea of this value go to http://www.shapeup.org/interactive/rmr1.php and plug in your height, weight and sex. By adding the amount of calories burned via physical activity to the RMR, you can easily decide how many calories you can safely consume daily without gaining weight.

2. Know thy cues - it is important to recognize all possible internal and external cues stimulating eating behavior. You need to know which ones are particularly troublesome for you, because that's where your locus of control will reside!

For example, one of the instances where i start seeking food is boredom. Whenever I have down time, my hand unconsciously reaches for that bag of popcorn or a cereal box. Am I hungry? You know the answer (1 hour after lunch!). Knowing this has taught me to keep more fresh fruits and veggies around and less of the stuff i can't resist; to arrange my leisure time to be spent in settings without easy access to food, such as libraries, parks and gyms.

3. Know thy muscle - Yes, get to know, love and "grow" your skeletal muscles. Consistent moderate resistance training will result in increased lean muscle mass, which burns more energy per unit time. In such a way, you essentially, increase the amount of calories burned per day even while at rest. This does not require a very strenuous work out routine putting your joints at rest - these simple exercises will do: push-ups while standing on your knees, gentle squatting (even without any weight), walking up hill for 15-30 min. Do 3-5 sets of 12-18 repetitions for each exercise 3-4 times per week. Engage in aerobic activity for 15-30 min/day 5-6 times a week. Be honest with yourself - if this activity is not "scheduled" or otherwise not incorporated into your daily routine, it is not going to happen! After a few weeks, you will be glad you did this and will not want to miss a session as it will make you feel more energetic, happier and relaxed.

The Devil is in the ...Calories.

2009-03-02T16:43:00.000-08:00

It doesn't matter what type of low calorie diet it is - they all work the same, as long as the people are motivated to follow it.

That's the conclusion of the recently completed study of more than 800 people who were followed for 2 years on 4 different diets - combinations of low fat, low carbohydrate and protein levels (NEJM 360:9, 2009).

Out of all the factors considered, the only consistent predictor of the weight loss success was the adherence to the follow-up group sessions. In other words, the longer people stay motivated to follow the healthier lifestyle, the longer they will be successful at it. No particular kind of diet was any better than another (i.e. low carbohydrate or low fat or high protein)

The bottom line is, seek out a program that will keep you motivated over the long term and don't worry about missing out on latest trends and hottest fads. Relax, pre-plan your meals for days and weeks ahead and enjoy the calorie-controlled life.

(check out a complete set of support and information tools @ www.medicalweightlossla.com/support)

Bigger Belly, Shorter Lives

2008-12-20T11:04:00.000-08:00

Waist size was strongly associated with the risk of death, according to a recent study (The New England Journal of Medicine 2008, 359:20). The risk of death was 2 times higher in people with highest waist circumferences (even with normal body weights!). This was a very elegant and clear demonstration of the importance of controlling and prevention of abdominal (or visceral) obesity.

Why should we care?

($$$ Unless you enjoy wasting money, you should).

Because people will have to accept the notion that overeating relative to the calories burned through physical activity leads to premature aging, illnesses and death. Also, there is the issue of the ever-expanding arsenal of medications being offered to treat all of our weight-related problems; these medicines come with co-pays, lab tests and other medical care (i.e. co-pays, deductibles and other out-of-pocket expenses). So, even if you are not motivated by some remote and vague goal of health, cutting your present medical bills might motivate a second look at a salad bar instead of a higher calorie option.

Bottom line:

Seek out calorie-controlled meal alternatives, which will provide you with quality nutrition without the extra calories. This way you will minimize the risks of gaining the unwanted poinds, especially around the all-important midsection.

Add regular exercise to your weekly schedule (which will double as the best stress-management technique) and enjoy a long and healthy (i.e. less money wasted on medical expenses) life.

The Obesity Scare

2008-11-26T16:22:00.000-08:00

Another day, another scary problem overtaking the american citizenry. If it wasn't the financial debacle, it's the obesity tsunami! Healthcare costs going up, incidence of diabetes and high blood pressure are skyrocketing with no end in site. What are we to do? Since I can't help you with your upside down mortgage, let me try to at least reduce your medical costs. In the ensuing posts, I will try to present some simple ideas that could help people shave off good chunks of their monthly medical expenses.

P.S. Since this is my initial post, let me be clear right of the bat - our present healthcare system is quite dysfunctional and is unlikely to survive in its present form. (and this is the polite version coming from a practicing physician).