Integrative approach to weight control

Dealing with Weight Control Concerns

Principles and Resources

Introduction:

The problem: 60% of Americans are now overweight or obese. Children are especially hit hard by this epidemic, and are acquiring ‘adult’ obesity-related diseases such as Type 2 diabetes mellitus at an early age unheard of even 30 years ago. Obesity is now by some calculations the number one preventable cause of disease and death in this country.  Many of those suffering from obesity spend their lives going on or off various diets in a desperate attempt to finally keep off the pounds. Such attempts are ultimately futile, since ‘diets’ (defined as any unusual way of eating that is non-sustainable and will eventually be abandoned) have been shown scientifically to  not work. If ‘diets’ don’t work, what does?  Why is losing weight so difficult?  

Weight control on one level is simple – just take in fewer calories than you expend and the laws of thermodynamics guarantee you will lose weight.  However, simple does not necessarily mean easy. Many aspects of our society predispose to excess weight gain. These include:

  • Ubiquitous advertising and easy accessibility to high calorie but low nutrient-dense foods. 
  • Distortion in portion sizes is a major problem, with excess serving sizes that have often doubled in the last 20 years. 
  • More Americans are eating out – restaurant food is generally designed for entertainment, not health. Portions (and calories) are often excessive.
  •  Low fiber foods and completing a meal faster than 20 minutes prevent proper feedback from the stomach and brain of when to stop eating. 
  • Fast absorbed (high glycemic index) carbohydrates which induce overeating.  
  • A sedentary lifestyle also impairs the body’s ability to balance calories. 
  • Excess stress and lack of life balance predispose all of us to ‘emotional eating’ of ‘comfort foods’ that pack in the calories. 
  • Cultural attitudes towards food, especially early childhood experiences can deeply embed behavior that is resistant to future change. 
  • A family tendency towards obesity (genetic and congenital factors) is often expressed in an environment of excess. 
  • Only uncommonly does an undiagnosed medical problem such as hypothyroidism turn out to be the cause of the weight gain. Certain medications however can predispose to weight gain – ask your doctor.

 The totality of all these factors makes it very difficult for most people to lose and then maintain proper weight. Excess weight is a symptom of unhealthy eating/ lack of fitness. Focus on changing the underlying cause, not on the weight itself. When fitness is restored and sustainable health eating patterns are established, the weight will come down naturally.

The solution is simple (but not necessarily easy): adopt a whole foods style of eating high nutrient/calorie ratio (i.e. mainly plant) food and exercise at least one hour daily or almost daily, and do this for the rest of your life.

 Details on this healthy lifestyle are listed below. Only scientifically validated concepts are included in the specific food recommendations listed in this section:

□    Eat mainly whole foods that are rich in low calorie, nutrient dense foods such as vegetables and whole fruit. A whole food is any food as it is found in nature with no or minimal processing, or traditional foods like bread whose ingredients are minimally processed. Examples: 

Whole foodPartly Processed food (eat sparingly)Heavily processed food(avoid)
Apple, other whole
fruit
Apple juiceApple Pop tarts, etc.
100% stone-ground or sprouted grain whole wheat (or other grain) breadWhole grain bread  (that is finely milled & feels ‘squishy’ when compress it)White bread, bagels, pastries, many commercial breakfast cereals
Brown riceWhite riceRice pastries
Whole vegetables like broccoli, spinach, yams, etc.Veggie smoothiesVeggie chips or
sticks, Nutraceutical or food bars
Lentil (Dal), whole
soybean & other bean
dishes
Foods made with
processed soybean, e.g.
‘textured vegetable
protein’
 Bean chips and
similar snack foods

□    At least three quarters of your plate should be plant food, (≤ 1/4 animal products), and should include at least 3-6 servings of vegetables (1 serving = 1 cup raw or ½ cup cooked) and 3-4 whole fruit per day:

□  Eat as many raw vegetables (such as in a salad) as you can every day. Eat these first in all meals. Use only a small amount of low fat dressing.

□  Eat liberal amounts of cooked vegetables, including at least 1 serving of cooked greens daily, e.g. kale, collards, spinach, broccoli.

□  Eat at least 2 whole fruit (not fruit juice or drink) per day

□  Practice cooking vegetarian main dishes, so you reduce reliance on animal products. See below ‘Vegetarian cooking for everyone’ and similar cookbooks.

□  Always spend at least 20 minutes eating all meals. This allows time for the stomach to feel full.

□    Include moderate amounts of low glycemic index, high fiber carbohydrate sources such as beans, squash and whole grain cereals (as opposed to finely milled flour products, potatoes and white rice). (See separate handouts). Keep average glycemic index < 60.  Avoid all white flour products whenever you can.

□    Avoid excess and unhealthy Trans and saturated fats: Limit frying. Trim visible fat from meats and choose only the leanest varieties (e.g. those that end with ‘-loin’). Avoid ‘industrially produced’ meats, such as ‘corn-fed steers’. Cows are designed to graze, not stand in a crowded feedlot and eat corn, which makes them (and you!) fat and sick. If you do decide to eat animal products, choose white meat of poultry without the skin. Fresh fish is a healthy choice. Use cheese only as a condiment, not as a central part of a meal. Use butter and margarine sparingly. Limit heavy sauces and gravies. Limit even low fat beef and poultry to one or two servings a week total. Fish can be eaten up to 4 servings per week.

□    When eating out, choose the ‘Heart healthy’ or ‘low fat’ offerings. Avoid cheap fast food restaurants and ‘all you can eat’ buffets. Even salad bars can lead to overdoing the calories if you pile up your plate with non-vegetable offerings and dressings. If the portion is excessive, have the excess packaged for a second home meal or give some to a companion before you start eating.  (See separate handout on tips for eating out healthily)

  • Re-train yourself to eat proper serving sizes of all foods (besides vegetables & whole fruit, which should be eaten in abundance).  This is necessary because of the ubiquitous ‘portion distortion’ that has normalized excess portion sizes in our society.
    • Obtain a portion-control diet plate set by going to www.thedietplate.com or calling 1 800 665-7652. Use it.
    • Take the ‘Portion distortion’ quizzes: http://hp2010.nhlbihin.net/portion/
  • Calorie awareness – learn to make low calorie but high nutrient choices
    • The best references to learn this are the following books: ‘Picture Perfect Weight Loss’ and accompanying cookbook (see below). Teaches scientifically sound Food Awareness program using mainly pictures.
  • Adequate fiber/ bulk. This happens almost automatically if you eat whole foods.  ‘Volumetrics’ is an excellent reference to support this concept (see below).
  • Pacing of Weight loss: 0.5 to 2 lbs/week. One needs to have a daily calorie deficit of 500 kcal to lose 1 lb. in a week. Trying to lose >2 lbs. /week is a recipe for failure and increases chance of inadequate nutrient intake. An exception is very low calorie diets done under professional guidance in a structured program.
  • Avoid ‘dieting’. There are new diets every week, with periodic fads such as Grapefruit diet, Vinegar diet, etc. Healthy nutrition is all about balance, variety & moderation. Especially avoid any diet that labels any one nutrient class (such as carbohydrates) as either ‘bad’ or ‘exclusively good’. No unsustainable diet works, and they should all be ignored.
  • Decide on a reasonable quota of sweets and treats servings to eat per week (such as 3 to 5) and stick with it. (A serving is 1 slice of pie or cake, or 2 medium cookies). Make a little ritual out of eating these, doing nothing else at the time so you can savor your treat slowly and mindfully without any guilt.
  • Consider taking a multivitamin/multimineral daily supplement to ensure adequate nutrients while losing weight (scientific benefit not proven).
  • Exercise for at least 60 minutes daily or almost daily. Regular exercise has been demonstrated to be crucial for maintaining weight control. (see exercise handouts)
    • This should include at least moderate level aerobics (at least at the level of brisk walking – not just strolling).
    • Should include strength training for at least 20 minutes at least 2 – 3 alternate days/week.
  • While education on proper eating & exercise is important, this is often the easiest aspect of lifestyle change. To accomplish all the above, you need also to proactively organize your life to allow adequate time to shop for, prepare and enjoy healthy food as well as to exercise.  (See separate handout on food shopping tips). This usually means that you will have to give up something else, which in turn means you need to adjust your value system of what is important to you. 
  • Consider taking a Plant based whole foods cooking course. This may be one of the most valuable endeavors you will ever do in your life for both yourself and your family!
  • Develop the mental habit of planning how you are going to eat well and exercise at the beginning of every week, with a quick review at the beginning of every day.
  •  Such a change in values and lifestyle often demands an entire repertoire of ‘meta-skills’, which may include the following:
    • Assertiveness – the ability to say ‘no’ in a healthy way to people and situations that are not in line with your new healthy lifestyle.
    • Self-awareness – the ability to monitor how balanced your life is every day and, just like a musical instrument, to ‘re-tune’ your life on a regular basis as the need arises. Staying centered helps one stay on goal.
    • Positive attitude – the ability to tackle the inevitable challenges, obstacles and set-backs involved in any lifestyle change with constructive action (or if this is not possible, then graceful acceptance).
    • Self-acceptance – the ability to unconditionally accept all sides of yourself while at the same time not indulging or getting lost in unhealthy emotional states that lead to counter-productive behaviors. This includes forgiving any lapses, instead spending your emotional energy getting back on track. 
    • Healthy skepticism – the ability to critically assess the barrage of questionable health claims aimed at consumers, to detect ‘saboteur foods’ that pretend to be healthy but aren’t and to cut thru market hype.
    • Self-discipline: the ability to resist ‘comfort food’ and sedentary temptations of the moment and keep a long view of what you really want.
  • Given all the skills required and the societal predisposition to weight gain on multiple levels, we should not be surprised that weight loss, while simple, is also difficult. So if you fall off your healthy lifestyle, don’t get down on yourself. Give yourself a break and just get back on track as soon as you realize the need to do so. Do something positive for yourself everyday, even if it is not perfect.  Reward yourself in a healthy manner for your efforts. Enlist the moral support and coaching of trusted friends. Systems like Weight Watchers may help.
  • Dedicate at least ½ hr. but better 1 hr. per day of guarded time each day to lifestyle change. 
  • The secret is that there is no secret. There are a large number of skills you will have to learn to accomplish your goals of improved fitness and healthy eating. When you accomplish these, the weight will normalize by itself.  Accomplishing your goals requires discipline, hard work and sacrifice – don’t let anyone tell you otherwise! Yet it can be immensely satisfying and fun.  Break it down into manageable short-term goals. Small but consistent steps are more important than brief intense efforts to change. Have a professional monitor your progress. Utilize the skills of qualified specialists such as Personal trainers, Wellness coaches and Nutritionists.  Don’t try to go it alone, for the same reasons you would not try to become a pianist or a doctor on your own. A support network of friends with a healthy lifestyle and professionals is often crucial to success.
  • Recommended Readings: 
    • Eat to Live by Joel Fuhrman, MD. Little, Brown & Co. 2003. Focuses on Nutrient/Calorie ratio as a key to successful weight loss.
    • The Volumetrics Weight-Control Plan by Barbara J. Rolls, Robert A. Barnett. Harper Torch Publishers 2000. Very good book to understand how to use low calorie dense foods to lose weight and control hunger. 
    • Picture-Perfect Weight loss (& cookbook) by Dr. Howard Shapiro. Warner Books publisher. 2000. Teaches calorie awareness thru pictures!
    • The Omnivore’s dilemma and In Defense of Food by Michael Pollan Penguin Books. These books explain where our food comes from and the strengths, weaknesses and toxicities of American food culture. 
    • Glycemic index cooking made easy by Jennie Brand-Miller, Kaye Foster-Powell & Joann McMillan-Price. Rodale Inc. 2007. Helps one put the Glycemic index concept in action, with lots of delicious recipes.
    • Vegetarian Cooking for Everyone by Deborah Madison. Publisher: Broadway Books, 1997.  An excellent guide to cooking vegetables in interesting and tasty ways that can be used by vegetarians and non-vegetarians alike.
    • Fast Food, Good Food by Andrew Weil, MD, 2015. Publisher: Little, Brown and Company. Addresses the issue of preparing quick and easy healthy meals when life is too busy
    • The China Study Cookbook: Over 120 Whole Food, Plant-based recipes by LeAnne Campbell, 2013. Recipes are based on the landmark research of T. Colin Campbell as presented in The China Study (also recommended reading). While not all will commit to a pure plant based, completely animal product free diet, and there is still honest differences of opinion in the nutritional literature on this approach, the rationale for eating more plants in unassailable. 
    • Mindless Eating by Brian Wansink, PhD. Bantam Books, 2006. Explains how we all eat for reasons other than to satisfy hunger and what to do about it.
  • Long term goals: 
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  • Short term goals:
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© Alan Remde MD     3/ 2008      Revised 4/2011

Glycemic Load Worksheet

GLYCEMIC LOAD WORKSHEET

 PRESENT DIETLOW GI IMPROVEMENTSCOMMENTS
BREAKFAST     
LUNCH     
DINNER     
SNACKS & BEVERAGES     
    
BREAKFAST     
LUNCH     
DINNER     
SNACKS & BEVERAGES    
    
BREAKFAST     
LUNCH     
DINNER     
SNACKS & BEVERAGES     
    


BREADS – Examples of lower GI breads (40 – 50’s):

  1. Ezekial (Food for Life) sprouted grain breads 
  2.  Shiloh Farms cracked wheat & 100% whole grain wheat
  3. Pepperidge Farms sprouted Wheat
  4. Whole grain Pumpernickel bread (41)
  5. Whole wheat Pita bread (57)
  6. Sourdough breads (~52)
  7. Dave’s Killer Bread

BREAKFAST CEREALS

Hot:

  1. Quaker 100% Old-fashioned oats (42)
  2. Muesli (~ 45)
  3. Oat bran (55)

Cold:

  1. All-Bran (30 ~ 45)
  2. Kellogg’s Bran Buds with Psyllium (45)
  3. Special K™ breakfast cereal (54)
  4. Mini Wheats™ breakfast cereal, whole wheat (58)

DAIRY

  1. Milk (31)
  2. Yoghurt (~35)
  3. Custard (35)

FRUIT

  1. Most temperate fruits have low GI value (~20 – 60)
  2. Tropical fruits a little higher (50~60)

GRAINS

  1. Barley (GI=25)
  2. Bulgur (48)
  3. High amylose rice: Basmati (58) or Uncle Bens Converted rice (44)
  4. Oat bran (55)
  5. Rice bran (19)

PASTA

  1. Generally medium to low GI (~40’s). Use whole grain

LEGUMES

  1. Most low GI.
  2. Soy (20)

VEGETABLES

  1. Almost all low GI except white potatoes & beets. Other starchy vegetables:
  2. Peas (48)
  3. Corn (55)
  4. Sweet potato (44)

NUTS – All low GI

PROTEIN FOOD such as Beef, Poultry, Seafood, Eggs, Cheese have almost 0 GI.

TREATS

  1. Cookies & Crackers (40 ~ 70)
  2. Ice cream (~38 for high fat to ~40’s for reduced fat to ~60’s for regular)
  3. Potato & Corn chips (40~50’s)
  4. Honey – Use in moderation (55)
  5. Table sugar – Use in moderation (61)

CONVENIENCE FOODS

  1. Pizza – choose whole grain with veggies (30~60’s)

AVOID OR MINIMIZE:

  1. Finely milled flour products such as Breads, Bagels, Croissants, Muffins, Donuts, Scones, Pastries, Waffles, Pancakes
  2. Most Commercial Cereals such as Cornflakes, Total
  3. White potatoes & Low amylose (esp. ‘sticky’ or Jasmine) rice

Healthy eating summary

BASIC HEALTHY EATING

This way of eating, though near optimal for most persons, is best individualized to fit the needs of each person’s situation.  While this way of eating can be used as a good starting point for most people, if you have a chronic disease, (such as diabetes), you should seek guidance of a health professional to help you tailor your eating pattern to your specific needs. It is based on years of clinical experience and study of the nutritional and medical literature.  If you find that this way of eating is far from how you are eating now (an experience shared by many persons!), don’t be discouraged. Pace yourself as you learn to change your relationship to food, allowing at least several months to accomplish the necessary changes. You will be learning how to change your eating culture.  Because none of us are perfect, and our life situations are not perfect, if you are like most persons your eating will not always be perfect.  That’s ok – there’s no need for guilt or forcing.  Rather, if and when you are ready, start making small steps towards a healthier lifestyle, allowing yourself enough time to accomplish each small goal. Most people find this is best done with the supervision of a professional with expertise in clinical nutrition and a health coach.  If you take small steps regularly, over time you will finally reach the summit of good eating!

HEALTHY EATING:

  • Eat a variety of foods that you both enjoy and are healthy for you.  Most foods should be from localsources so that they are freshminimally processed and safeFreshness is crucial especially for foods containing perishable oils such as whole grain flour products and highly unsaturated vegetable and fish oils.  Food grown in third world countries may have unrestricted pesticide applications.  Though not mandatory, ideally try to obtain Organic produce, or at least that grown using Integrated Pest Management (IPM) methods, which minimizes pesticide use.
  • Give the selection, preparation and eating of food the value and care it deserves.   Rediscover the joy of the simple act of preparing and eating wholesome food.  Include children and family members in the preparation of food to build a healthy food culture. We all rely on ‘Convenience foods’ occasionally when our schedule is hectic, but over reliance carries a heavy price not only in lack of balanced nutrients but in lack of the meaning of food.  Don’t eat ‘on the run’.  Brown bag a lunch if there are no satisfactory choices where you work.
  • Do NOT skip meals.  Spread calories out more or less equally throughout all the meals of the day.
  • Do NOT ‘go on a diet’.  Diets, if defined as a particular way of eating for a temporary time, in general do not work! Changing your awareness and relationship with food does.
  • Be clear if you are eating ‘Celebration food’ or daily healthy food. Celebration foods are a major pleasure in life, and are consistent with health if they are occasional (e.g. once or twice a month). A quota of a small serving of a sweet (e.g. two small cookies or a small chocolate bar) a few times/week is ok, though. Celebration food includes anything deep fried (e.g. French fries, chips), pastries, sodas, sweets. Except during celebrations, eat enough to satisfy hunger but not more.  While this may seem self-evident, few of us do. This requires taking at least 20 minutes to eat to allow time for the body’s satiety (fullness) feedback and listening to this feedback.
  • Avoid processed, prepackaged and ‘convenience’ foods in general – these tend to be of poor quality and deceptively flavored to mask their lack of nutrients. Fat, salt and sugar are strategically manipulated in processed food to maximize craving (potential for becoming habit forming & addiction).
  • Any food that has ‘Partially hydrogenated vegetable oils’ (a source of unhealthy trans fatty acids that have been linked with many diseases) is usually of inferior quality and should be avoided.  Develop the habit of reading the labels of anything you buy.  Avoid fats that contain these such as margarines or commercial shortening.   Added mono- or diglycerides should also be avoided, as they are usually composed of trans fatty acids.
  • Sugar or salt in modest amounts are generally O.K.  However if sugar or salt (or one of their equivalents) is within the top few ingredients, generally avoid the food.   They are both used frequently in processed foods to compensate for poor quality and create cravings.  Sugar equivalents include sucrose, fructose, glucose, mono- and disaccharides, natural cane sweetener, cane juice, honey, molasses and high fructose corn syrup.  Even so called ‘Health food’, such as some forms of Granola or granola bars, and various ‘nutrition bars’ may have excess sugar & calories.  Buzzwords such as ‘Natural’ are often used to entice consumers to purchase poor quality food that is loaded with empty calories. 
  • Avoid ‘Industrially produced’ red meat – (the meat one encounters in most supermarkets). This usually contains excessive and poor quality fat.  If you do eat meat, do so sparingly (1 – 3X/wk.) and use free-range beef (e.g. Coleman brand), bison (buffalo) or other livestock instead.  Wild game such as venison is excellent if you have access to it.  If you must use industrially produced meats, at least choose ‘Select’ grade cuts with ‘loin’ in them (e.g. sirloin) – the leanest variety and trim away visible fat. Even better is plant sources of protein:
  • Dark leafy greens have an excellent nutrient/calorie ratio and are an underutilized source of protein. Try to eat at least ½ – 1 cup a day.
  • Soy products such as tofu/soy milk/cheese/burgers (fortified with calcium best), preferably from organically grown soybeans and traditionally made.
  • Legumes (use ‘Beano’ on these once cool enough to eat if gas is a problem).
  • Whole grains + legumes = high quality protein. These don’t need to be eaten at the same meal, just within 24 hours of each other. Examples: [brown rice or whole grain tortillas/bread/pasta] + [beans or lentils or peas].
  • Wild cold-water fish from unpolluted waters – this is an excellent source of omega 3 fatty acids (which many peoples have a relative insufficiency of).  Be sure is fresh – if it smells or tastes ‘fishy’, its not! 
  • White meat of poultry without the skin, preferably free-range can be eaten up to 2 or 3 times per week.
  • Eggs in moderation are O.K., e.g. 4 per week, preferably from free-range hens.
  • Low fat (e.g. skim or 1% milk or yogurt) dairy, preferably from cows raised on organic farms allowed to graze on grass.   Use Lactaid© drops or pre-treated milk if you have trouble digesting it. There is no requirement for dairy products in a healthy diet, but in moderation can be used.

Total amount of high protein foods per day is generally 6 to 7 exchanges per day for most people, and should be mainly from plant sources.  (Remember, an exchange is counted as only 1 oz. of lean meat, so 3 exchanges = 3 oz. of meat = the size of a deck of cards = 1 small hamburger = 1/2 of a whole chicken breast = 1 fish fillet = 1 1/2 cup tofu or beans.) View animal products more as ‘garnishes’ rather than the centerpiece of a meal.

  • Be sure to get 2 to 3 exchanges of a high calcium food.  Vegetarian sources include dark leafy greens of the Brassica family (e.g. kale, collards, bok choy & broccoli), calcium-fortified soy products, corn tortillas processed with lime and dried beans, nuts and seeds (almonds, brazil nuts, sesame seeds). Note: certain vegetables high in oxalic acid such as spinach actually impair calcium absorption. Low fat dairy has high amounts of calcium. Fish with small bones such as salmon & sardines are a good source. Teens, young adults and pregnant or lactating women need 3 exchanges per day.
  • Include cultured foods in your diet. These contribute probiotics (‘friendly bacteria’) to the gut, which appear essential for health. Examples: Live culture yoghurt, kefir, tempeh, miso, etc.
  • Try to eat a minimum of 3 but better 4 to 7 exchanges of vegetables per day.  (This is in addition to fruit!). Choose vegetables that are different colors – this will help ensure you receive the range of nutrients they offer.  Include at least 1 exchange of a dark leafy green vegetable each day.  These include Kale, Collards, Chard, Spinach, and Broccoli. 
  • Fruit is best eaten whole (better than juice or ‘juice drinks’). Minimum is 2, but 3 – 4 whole fruit exchanges/day are optimal for most people.
  • Carbohydrate (starch) sources should be unrefined and complex with low to medium glycemic index, so they are absorbed gradually into your system and don’t lead to insulin surges.  Examples of these include:
  • Legumes such as beans & lentils (also double as protein source)
  • Whole grains such as brown rice (basmati rice is good), wheat or oat berries, 
  • Whole grain sprouted or 100% stone ground flour products (avoid finely milled white or ‘enriched’ or even whole wheat flour products in general, as these have a high glycemic index).
  • Starchy tubers – e.g. yams & squash. Potatoes are less nutritious – eat less often (<3 X/week).  Starchy vegetables are best if eaten whole, rather than in their more processed forms such as commercial French fries or chips.
  • Have 1 – 3 carbohydrate exchanges/meal. You can be more liberal with carbs if you exercise after eating them, or within 2 hours post-vigorous exercise. Vigorous exercisers who need to maintain or gain weight may need even more.
  • ‘Healthy fats’ include:
  • For any use involving heating, use OliveCanola or Sesame oil in small amounts only. (Extra virgin, expeller- expressed best for all oils).  Never overheat any oil (i.e. until it smokes)!  A small amount of butter, lard or coconut or palm oil can occasionally be used, but do not overuse these saturated fats.
  • For unheated purposes such as salad dressings, use Polyunsaturated oils such as Sunflower, soy or nut oils.  Even ‘healthy oils’ are a refined food with high caloric density, so use only in small amounts. Keep in refrigerator and use within a few weeks to ensure freshness.  Avoid cottonseed and peanut oil.
  • Flaxseed oil or freshly ground flaxseeds are a source of the essential omega 3 fatty acid linolenic acid.  Many persons have a relative insufficiency in omega 3’s.  Use in salad dressings or for any unheated use.  Buy this very perishable oil in smallopaque bottles that are ideally nitrogen packedand stabilized with antioxidants such as Vitamin E.  Try to use it up within a few weeks.  Keep flaxseed oil in the refrigerator, not in a cabinet.  Keep flaxseeds in a small container in the freezer door and get in the habit of freshly grinding them and sprinkling them on salads, cereals, etc. Fresh flaxseeds are in general preferred to the oil, since they also contain healthy substances such as lignans.
  • Fish oils as noted above.  These also must be very fresh and protected from oxidation like all highly unsaturated oils.
  • Spectrum spread’ or similar brands can be used as a fat spread instead of butter or margarine.  This is found in health food stores.
  • Nuts & seeds or ‘butters’ made from these in moderation are a source of both protein and fats.  
  • Drink plenty of fluid –8-glasses/day– water or ‘flavored waters’, or teas are better than fruit juice, juice drinks or sodas.
  • Observe the following maximum limits per day:
  • Coffee or strong tea:  Two cups (8 oz. each – not large mug size!) total
  • Sodas:  One 12 oz. can (best to avoid completely)
  • Sweets:  1 serving (e.g. slice of pie or cake or 2 small cookies). Eat sweets slowly and mindfully so you can savor and really enjoy them.  Do not eat sweets while distracted with something else such as watching TV, as this often leads to eating a much greater quantity.  Do not deprive yourself of sweets/ deserts – doing so often triggers a reactive eating binge later.
  • If you do drink, do so in moderation: Maximum of 2 drinks/day for men and 1 drink/day for women.  Pregnant & lactating women should not drink any alcohol.  1 drink=12 oz. can of beer, 4 oz. of wine or 1 oz. (1 shot) of distilled spirits.
  • Avoid going to fast food/ cheap restaurants such as McDonald’s©, Burger King©, Wendy’s©, Friendly’s©, Pizza hut©, Taco Bell©, etc., since the food is generally low quality and is designed to create cravings that are habit forming. 

COOKING METHODS:

1.  Vegetables:  Best is steaming or light sautéing.  Microwave ok.  Avoid boiling (loses a lot of the water-soluble vitamins).  Try to eat both raw and cooked veggies.

  • Meats:  Boiling, baking or light sautéing ok.
  • Generally avoid grilling, charbroiling, or deep fat frying.  Marinating meats in a vinegar or lemon juice – based marinade and avoiding ‘flare-ups’ or high temperatures will minimize cancer-causing substances being formed if you want to grill.

STORAGE METHODS:

  • Fresh is always best, but freezing is next best.  Be careful of excess sodium in canned foods.

1 ‘EXCHANGE’ =

  • Carbohydrates: 1 slice of bread, or 3/4 cup dried prepared cereal or 1/2 cup cooked cereal, pasta or grain dish, or 1 small cooked potato or corn on the cob or 1 small fruit (fruit counts as both a carbohydrate and a fruit exchange).
  • Vegetables:   1/2 cup cooked or 1 cup raw (e.g. salad).
  • Fruit:  1 medium apple or similar fruit, or 1/2-cup fruit juice.
  • High protein foods: 1/2 cup of cooked beans, peas or lentils or tofu or 1 oz (~28 grams) of fish, poultry, red meats, cheese or 1 egg.
  • Soy/ Dairy: 1-cup soy/ rice milk or dairy milk or yogurt or 1 oz. cheese.
  • Sweets/ treats: 1/2-cup ice cream or 2 medium (2 – 3” diameter) cookies or small wedge of pie/ cake.
  • While supplements have their place, they should always be a far second to eating real whole foods. Very few supplements have been shown in scientific studies to improve health. Some exceptions in certain situations include multivitamins, Vitamin D, Fish oil (omega 3 fatty acids), Calcium, Magnesium and Iron (especially in women). Even these are better obtained naturally if possible. Relying on supplements is a form of reductionism – the opposite of holism. Seek competent medical advice before using supplements.
  •  Nutrients in foods work together, analogous to musicians in a symphony working together to create beautiful music. When you take a single nutrient, or even a collection of similar nutrients, especially if you mega dose, the result may be analogous to the oboe in the symphony playing 10 times louder – it does not necessarily help the music!  Even a mixture of supplements cannot possibly hope to simulate the vastly complex interactions inherent in whole foods.
  • Avoid any health care practitioner or health advice resource that makes promoting or selling supplements (or drugs/ procedures for that matter) a centerpiece of their advice instead of prioritizing whole foods and a balanced lifestyle. 


FURTHER READING:

  • American Wholefoods Cuisine (Plume Publishers) by Nikki & David Goldbecks. Excellent basic guide on how to create appetizing whole plant based meals. 
  • The New Laurel’s Kitchen (Ten Speed Press Publishers) by Laurel Robertson, Carol Flinders, & Brian Ruppenthal..  A vegetarian approach, but helpful for everyone who wants to learn how to prepare these foods in a delicious and healthy manner. The introduction has a nice primer on basic good nutrition that can be useful for even non-vegetarians.
  • Picture Perfect Weight Loss  (Warner Books) & Picture Perfect Weight Loss Cookbook (Rodale) by Dr. Howard M Shapiro. Excellent, scientifically sound Food Awareness program and accompanying cookbook useful for all, not just those who want to lose weight.
  • Amazing Soy (William Morrow Publishers) by Dana Jacobi.  If you want to include healthier and delicious soy based foods in your meals, this book will show you how.
  • Vegetarian Cooking for Everyone by Deborah Madison. Publisher: Broadway Books, 1997.  An excellent guide to cooking vegetables in interesting and tasty ways that can be used by vegetarians and non-vegetarians alike.
  • The Omnivore’s dilemmaIn Defense of Food Food Rules by Michael Pollan.  Penguin Books. These books explain where our food comes from and the strengths, weaknesses and toxicities of American food culture. 
  • Eat to Live by Joel Fuhrman, MD. Little, Brown & Co. 2003. Focuses on Nutrient/Calorie ratio as a key to successful weight loss. Useful to all to further understand a healthy diet.
  • Mindless Eating by Brian Wansink, PhD. Bantam Books, 2006. Explains how we all eat for reasons other than to satisfy hunger and what to do about it.
  • Salt, sugar, fat: how the food giants hooked us by Michael Moss. 2013 Random House Publishing Group, NY. Primer on processed food defense.

GOALS TO WORK ON:

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Copyright 2003 Revised 9/2019 Alan Remde MD, FABFM , Fellow and board certified in Integrative Medicine

Assistant Director SLUHN FP Residency @ Warren

Coventry Family Medicine, 755 Memorial Pkwy #300, Phillipsburg, NJ 08865

OFFICE Tel: 908 847-3300