Read an Excerpt
The No Time to Lose DIETThe Busy Person's Guide to Permanent Weight Loss
By Melina B. Jampolis
Nelson BooksCopyright © 2007 Melina B. Jampolis, M.D.
All right reserved.
Chapter OneNo-Time-to-Lose Basic Principles
WL is a sixty-eight-year-old man who came to see me last year at his doctor's recommendation. He needed to lose weight, had significant heart disease, and had just undergone angioplasty in January. He also had issues with chronic pain, which severely limited his ability to exercise, and he felt that his new pain medications had caused him to gain forty pounds. He had "been on every diet on the face of the planet," and he was very skeptical that I would be able to help him lose weight permanently. He explained that he lived alone and did not cook at all. In fact, he used the inside of his oven to store papers. He was very clear that if my program required cooking, it would not work for him. He also defiantly told me that he loved cookies and often ate entire bags in one sitting. He laughed when I asked him about his daily exercise regimen, insisting that his pain made even walking for more than ten minutes virtually impossible.
I remember listening to WL that first day and thinking that I was just not going to get through to him; he was simply too set in his ways. I actually told him that I was not sure I could help him as I wasn't certain that he was open to being helped. We even discussed his signing up for only one visit instead of a full program and if he did not perceive value in my suggestions that we part ways. I did not want to battle him weekly for the next six months.
He agreed to follow the program, and we began working together the next week. WL preferred simplicity in his eating plan, which I find to be the case with most men. The first week he cut his eating dramatically and lost four pounds eating mostly protein, vegetables, and protein bars. He felt great, but I did not want him losing weight so quickly, as I wanted to preserve his muscle mass as much as possible, especially with his limited exercise ability. I insisted that he add at least one serving of fruit, replace one of his daily protein bars with yogurt as a snack, and add beans to his salad to increase his fiber intake and slow his weight loss a bit. He continued losing weight steadily, averaging about two and a half pounds per week. After one month, he hit a plateau and did not lose weight for two weeks. This is very common among dieters, and I find the first plateau to be a critical time because most people give up in frustration if they feel they are working hard to lose weight, but the scale is not responding.
At this point WL surprised me. While he was disappointed, rather than becoming frustrated and giving up, he decided to add exercise to the equation. I told him that I thought resistance bands might be easier on his joints. He could do a few exercises when he felt up to it, and quit if it became too painful. I also encouraged him to aim for five- to ten-minute walking bouts whenever he felt able. He came back the next week with a three-pound weight loss and reported walking four times and exercising his upper body with the resistance bands fifteen minutes a day. He was happy about the weight loss but decided that he was bored with breakfast and wanted a change. I recommended that he alternate his usual protein-bar breakfast with a whole wheat English muffin and peanut butter.
Every week WL would come in with restaurant take-out menus and grocery-store flyers and we would find one or two healthy options to add to his diet to prevent boredom. Six weeks later, WL hit another weight-loss plateau after one of his doctors started him on a new pain medication. This time, he was not disappointed at all. He told me that he knew he was on the right track, he was happy with what he was eating, and he was confident that he would begin losing weight again when the medication issue was sorted out. The next week, down twenty-eight pounds at this point, he got some great news from his doctor: his triglycerides had dropped 30 points (a 21-percent reduction), his bad cholesterol had dropped 23 points (a 31-percent reduction), and his good cholesterol had increased an incredible 27 points (a 61-percent increase).
Inspired by his success both in weight loss and general health, WL sailed through Thanksgiving and Christmas with ease, treating himself to small portions of anything he felt like, including a Christmas cookie or two every now and then, but filling up with the healthier options, like turkey and vegetables.
I'm happy to say that six months after that initial consultation, during which I never in a million years would have guessed that WL would be one of my most rewarding successes, he is down fifty-four pounds and is now at 18 percent body fat. He will be celebrating his seventieth birthday next year in the best shape of his life. He calls me his miracle worker, but the reality is that he was ready to lose weight for good this time and was completely committed to making a permanent lifestyle change. I simply gave him the tools to succeed and a healthy dose of moral support along the way.
* * * Now that you have a bit of inspiration, let's get started with the No-Time-to-Lose principles that were so successful for WL. These principles address the three basic components of successful weight loss: nutrition, exercise, and behavior. It is important to remember that these principles are not rules set in stone, but rather guidelines upon which you will build your own unique weight-loss program. I describe them to my patients as the infrastructure, or foundation, of a successful, realistic, time-efficient, long-term weight-loss program.
No-Time-To-Lose Principle 1: Try to eat some form of protein with every meal and snack
Eating protein with every meal and snack is one of the keys to successful weight loss and maintenance, for three important reasons: the metabolic effects of protein, blood sugar stabilization, and hunger control. I will explain all three in detail below, and you will notice that I refer back to these points throughout the book.
Maximizing Metabolism with Protein
Let's start with the metabolic effects of eating protein. The direct advantage is due to a small but important component of your metabolism, called the thermic effect of food, which is the amount of calories used in the digestion and absorption of food. The thermic effect of food makes up about 10 percent of your daily calorie requirements. The higher the thermic effect of a particular food, the more calories you burn simply processing that food. Protein has the highest thermic effect, followed by carbohydrates and then fat.
One study showed that the thermic effect of a higher-protein meal was approximately double the thermic effect of a high-carbohydrate meal. While overall this effect is relatively small and its importance in dieting widely debated, even a modest increase in the number of calories burned can have significant effects, both short-term and long-term, on weight loss.
Another research study found that people burned an additional twenty-five calories after consuming a high- versus low-protein drink. This may not seem like much on its own, but if you ate a higher percentage of protein at most meals and snacks, that alone could burn up to 100 extra calories per day, which could help you lose twelve pounds per year. In addition, it could also help offset the 5- to 10-percent drop in metabolism that often accompanies dieting.
More on the Metabolic Advantage of Protein
Fat is the body's most efficient fuel. Your body does not utilize a lot of energy (calories) to turn the fat you eat into the fat you use or store in your body. While carbohydrates have less than half the calories per gram of fat, they, too, are relatively efficient fuel sources and require a fairly small amount of energy to be converted into a form your body can use.
Protein, on the other hand, is not as efficiently used by the body. Significantly more energy is required for the breakdown and rebuilding of proteins and for the conversion of protein to carbohydrates. Therefore, a higher-protein diet has a greater calorie cost. While this effect is not large and depends on everything you eat, not just the amount of protein, it can add up to a metabolic advantage for weight loss.
But before you speed off to your local butcher, this does not mean that you should consume huge amounts of protein at each meal to get an even bigger boost to your metabolism. This will not work. Eating more calories than you need at any meal will far outweigh the modest increase in calories burned eating protein.
Maximizing Metabolism Through Muscle Mass
You have probably noticed that when you diet, you don't just lose fat-you lose muscle mass, water, and even a small amount of bone mass. It's just one of the harsh realities of weight loss. You may think this is not a problem, since the scale is dropping, but one pound of muscle burns approximately thirty-five to fifty calories per day, while fat burns very little. So when you lose muscle, you lower your metabolism. Again, this may not seem like a lot of calories, but it can add up over time and is one possible explanation for weight-loss plateaus and weight regain during maintenance. The most effective way of preventing muscle loss and maintaining your metabolism is by using your muscles in weight training or exercise and by not losing weight too quickly. Research also shows that a higher-protein diet, especially when combined with exercise, is much better at preserving muscle mass. This effect may be even more important as you age since protein is absorbed less efficiently and muscle is harder to build due to hormonal changes.
Hopefully, I have convinced you that moderately increasing your protein intake has significant metabolic advantages that play a primary role in weight loss. Here's more on metabolism:
MORE ON METABOLISM
What is metabolism? Metabolism is your body's total daily energy requirements. Total metabolic rate (TMR) is essentially made up of three components: resting metabolic rate (RMR); physical activity, including both exercise and general daily activity level; and calories required for digesting and absorbing food (also known as the thermic effect of food).
Resting metabolic rate (RMR). The rate at which you burn calories at rest, RMR is the minimum number of calories your body needs to keep you alive through breathing, brain and heart function, and more. RMR makes up 60 to 75 percent of your daily caloric requirements. RMR has a strong genetic component, but several things can affect it; some you can control, and others you can't. It is important to understand what you can control and do everything you can to maximize and maintain your TMR while losing weight.
Lean body mass (LBM) (muscle, bone, tissues, water). Greater LBM results in higher RMR. Since men generally have more muscle mass than women, their metabolism is usually 10 to 20 percent higher too. It is important for dieters, especially women, to try to increase lean body mass or, at the very least, minimize the loss of LBM by losing weight more slowly. This is the most variable component of RMR and, therefore, the area in which you have the most control.
Age. RMR decreases with age. This is due to natural changes in your body's physiology and its loss of muscle mass. Physical activity also decreases with aging, so you often get a double hit to your metabolism. Women, on average, lose about 3 percent of their LBM per decade. Research shows that it is never too late to build muscle, so it is critical to incorporate strength training into any permanent weight-loss program.
Crash dieting or severe undereating decreases RMR. If you drop your calories significantly below your basic requirements, your body will slow your metabolism 5 to 10 percent within forty-eight hours. Your body may also be forced to use muscle for energy, which can also lower your metabolism.
Hormones. During the second half of the menstrual cycle, hormonal changes cause a slight increase in RMR, which is why many women often feel hungrier during this time. It's OK to eat a little more before your period.
Thyroid disease. An underactive thyroid (although not as common as most would like) lowers RMR and is one reason some women have difficulty losing weight. If you are struggling with weight loss, have your doctor make sure that your thyroid function is normal.
Medications. This area is less understood by physicians, but there are several medications that may affect metabolism. Talk to your doctor about any medications you take that may be affecting yours.
Physical activity level (PAL). PAL represents 15 to 25 percent of your TMR and is the most variable component. It is also the area where you have the most control day by day. In very active people, PAL accounts for a larger portion of total metabolic rate. PAL includes more than just exercise. If you are active at work-for example, a teacher who stands most of the day-you will have a higher PAL than someone who sits at a computer all day. It is important to increase PAL as much as possible during weight loss and maintenance.
Thermic effect of food is approximately 10 percent of total metabolic rate, so the mere act of eating plays an important, albeit smaller, role.
The Importance of Blood Sugar Control in Weight Loss
The second reason for eating protein with each meal or snack is that protein stabilizes blood sugar. Why is this important for weight loss? Keeping blood sugar relatively stable helps you control hunger and cravings. Foods that are broken down quickly into simple sugars cause a rapid rise in blood sugar, followed by an equally rapid fall. Low blood sugar triggers hunger and lowers energy (and often mood) levels. This can lead to sugar and carbohydrate cravings since sugary foods raise blood sugar most quickly. You have probably experienced this effect after eating a high-sugar or high-carb breakfast, such as a bagel or donut and orange juice. Your energy likely peaked initially due to the large "sugar rush" but probably dropped just as quickly, leaving you counting the minutes until lunch or taking several trips to the coffee cart to keep you awake and alert.
Food Combining for Optimal Blood Sugar Control
While the type of carbs you eat is one of the most important factors for stabilizing blood sugar, the combination of foods can also play an important role. By combining a high-carbohydrate food that raises blood sugar quickly with a high-protein (or -fat) food that raises blood sugar much more slowly, your blood sugar will rise and fall more gradually, decreasing hunger and cravings. The low-carb diet craze focused on cutting carbohydrates as much as possible to stabilize blood sugar. This approach does work, but life without carbohydrates can be difficult to maintain and can leave you feeling tired and depressed. Eating some form of protein with every meal and snack is a much simpler and healthier way of achieving the same goal.
The Key to Hunger-Free Dieting
The final benefit of eating protein with most meals and snacks addresses a problem many dieters often face: hunger. Calorie for calorie, protein appears to be more filling than carbohydrates or fat. Research has shown that people living in the real world, not research labs, eat less and feel fuller when they eat a higher protein diet. This effect may be especially significant with a higher-protein breakfast. The reason for this increased fullness with protein relates in part to the effect of protein on blood sugar but probably more importantly involves hormones in your gut and brain that trigger the sensation of fullness.
More Protein = Better Maintenance
Research shows that protein not only helps people losing weight to feel less hungry, but it also helps with weight maintenance. In one study, people who ate a higher percentage of protein during maintenance regained much less weight, and the weight that was regained was mainly muscle, not fat. Don't forget that balance is important. Do not eat only protein-you need carbohydrates for your body to function optimally, and healthy fats to make many of the hormones essential for living and abundant health.
Excerpted from The No Time to Lose DIET by Melina B. Jampolis Copyright © 2007 by Melina B. Jampolis, M.D.. Excerpted by permission.
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