PERSPECTIVE

ramana — Wed, 26 May 2010 04:34:09 +0000

“When you have a hammer, everything looks like a nail!”

We have all heard of this saying, and all of us agree. A skilled laparoscopic surgeon plots to take out huge tumors and cysts through the keyhole method, while the dinosaur surgeon tends to think of employing his hands to remove organs (like the appendix) that may have been better left alone.

Let me tell you a small story about myself. Not too long ago, at a Bariatric Surgery conference three or some years back, I had a chat with a renowned endocrinologist who was known for his work in obesity and diabetes. At that time, I was 86 kgs heavy, and most of it was fat. A hard-working surgeon, I was in the peak of physical un-fitness and a heart attack waiting to happen. My resting heart rate was always around 100 and my blood glucose was similarly poised over the century mark. I asked this gentleman how I could improve my markers and lose my fat. I also didn’t want to become a diabetic, I said.

He told me what anyone in his position would have: take a metformin pill, and do some walking. If your sugar levels go up, we will add another drug, he said.

I thought long and hard over what he said. I embarked on a new journey in life: a life of health and fitness. I trained hard and started IF (Intermittent Fasting). After an year of blundering along, I found my groove and results came in: resting heart rate down to 6o, blood glucose and lipid levels normal, and body fat well down (BW now 75 kgs).

To come back to the point, the doctor I asked hit my problem with the drug hammer he was holding by default. I did the smart thing by trying something different. I now firmly believe that everyone should try healthy eating and exercise in order to improve health and reduce body fat. As bariatric surgeons, we should not use the surgery hammer to hit every obese patient. When there is clear burden of disease (diabetes, hypertension, sleep apnea, gallstone disease, etc.) and the level of obesity is such that it is statistically unlikely to come off with lifestyle regulation, we recommend bariatric surgery. Not otherwise.

In other words, as specialists dealing with obesity and related diseases, we should have a broad perspective. We are always in danger of using a narrow knife-wielder’s perspective and eyeing every patient as a potential victim. We must be very careful. At BMI, we never stop telling each other this.

In clinical practice, the psyche of the patient is very important. But a more important factor (and an often unrecognized one) is the psyche of the doctor.

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WHEN IS MEASURED EATING UNHEALTHY?

ramana — Wed, 12 Aug 2009 12:57:48 +0000

If you, like me, are interested in fat loss, you could do with a bit of calorie counting! If you don’t know what you are eating on a daily basis, the chances are you count yourself as one of those freaks of Nature who become fat in spite of eating ‘nothing’, someone who grows fatter with every glass of water s/he drinks!

I strongly urge you to maintain a food diary or journal where you can be judged as far as your nutrition is concerned. Various online journals like Fitday automatically and easily calculate your nutritional intake on a daily or even monthly basis, allowing yourself to judge where you are going wrong.

For example, you may realise that a lot of your calories are hiding behind the innocent biscuits and frapuccinos that you keep having, or the chips you absent-mindedly munched while watching TV.

Once you catch on to this, you can change your habits/eating style to effect a cutback in calorie intake. Similarly, you can detect the source of your caloric excess: usually they would be derived from carbohydrate sources like processed foods or sugary drinks.

So, I would say anyone keen on losing weight should first show me what they are eating. You really can’t plan nutrition unless you know the background of the patient.

However, at a point of time, calorie counting and portion watching and nutritional label checking grows to a point where people have an unguarded opinion that your sanity has taken a Southwards bend. Where you are actually a victim of orthorexia. When this happens, you have become neurotically obsessed about eating, health and getting thinner. This is also called OCE- Obsessive Compulsive Eating.

(image credit: awakeningcharlotte.com/…/ )

If you keep counting calories and macros (percent saturated fats, vitamin daily requirements, etc) to the point where you are using food as a capsule, not as a pleasurable source of sustaining your body’s engine, then you are losing out on life. You don’t want to end up unhappy and obsessed over crazy details. You want to get healthier and thinner without a ticket to the asylum.

There are ways to loosen up, enjoy life and food, and yet grow thinner. This can be achieved in various ways, which I will merely mention in this post. More detailed analysis will be separate posts for later.

1. Intermittent Fasting: If you fast for two days a week (for a full 24 hours each), you can lose 20% of your normal calorie intake in a week. Means losing fat. Provided you do some form of weight training, as you don’t want to lose muscle. You want to lose fat alone. There is growing research supporting IF.

2. The Warrior Diet: Popularised by Ori Hofmekler, the Warrior Diet also keeps you fasted through the day, and you end the day with a huge meal, eaten within a four hour span. This continues ad infinitum.

3. The Paleo Diet: More a lifestyle than a diet, the Paleo-philes advocate eating like Grok, the caveman. No processed foods, grains or dairy are allowed in this diet. It turns out to be a low carb, high protein and high fat diet. You can eat things like beef, pork, bacon, butter, ghee, etc. in plenty. If it is natural, it is likely to be Paleo. A great lifestyle, in my opinion!

4. The Cheat Diet: Not to be taken literally, if you eat sensibly through the week, you could have weekend cheat meals. This prevents uncontrollable cravings that generally destroy diets. It is considered important to give the patient some degree of flexibility in a diet.

5. Common Sense Approach: If you can eat sensibly, avoiding energy-dense foods like processed sugars, refined flour products, sugary drinks, and eat only when genuinely hungry, you can keep within reasonable caloric and nutritional balance. In this approach you eat natural foods as often as you can, but do indulge when you want to. If you are active physically, this might not get you into the gymnastics team, but you could manage in reasonable shape.

Too rigid a diet is counter-productive for several reasons:

* Dieters may go totally off the bandwagon if they succumb once to temptation. Studies back this up.

* They may decide the constant struggle for control is not worth it and give up.

* They may become orthorexic: constantly agonising over carbs, calories and other minutae.

* Not eating with other people (social eating) is a common phenomenon if you are very rigid about your diet. In this scenario, personality disorders can occur if you go overboard.

* Constant dieting may depress metabolic rate, something a cheat meal may kickstart. This may be a complex phenomenon acting through a leptin-mediated pathway.

Whichever diet plan you chose to follow, you must strike foot on rational ground, or you risk sliding into the morass of overating and bingeing with cyclical guilt trips, or becoming a Diet Nazi. Be careful!

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BMI » IF

PERSPECTIVE

WHEN IS MEASURED EATING UNHEALTHY?