Ask the Doc: Weight Loss

Written By:
Corey Hilmas, M.D., Ph.D.
View more articles in:
share

In “Ask the Doc,” I hope to take on all of your food and dietary supplement related questions or entertain whatever you’ve always wanted to ask your primary care physician.

In this inaugural column, I was asked about my thoughts concerning weight loss. Weight loss is the topic du jour after celebrity doc Mehmet Oz was honey oven-roasted by the Senate for his touting weight loss products as “miracles” and “lightning in a bottle”. I think it is safe to say that Dr. Oz won’t be walking the yellow brick roads of Washington to the Russell Senate Office Building any time soon. While Dr. Oz, beset from the barrage of Senatorial jabs, looked stunned at times, he would have fared better to discuss the importance of supplements in combination with healthy diets and exercise from the outset. My answer for healthy long-term weight loss is actually eating healthy foods, increasing exercise, and taking dietary supplements.

People might automatically assume that a medical doctor would push prescription drugs as the answer to weight loss. If there was even one drug on the market I thought was both effective and safe for your organs, I would share it here. The problem is that we are no closer to making the magic bullet capsule for weight loss than we were decades ago. I have seen dangerous weight loss drugs come and go in a short time. The short lifespans of both Fenfluramine/phentermine (Fen Phen) and Sibutramine are all too familiar.

I love food, which is a problem I share with most Americans. What makes it worse is my genetic predisposition to retain every ounce in anticipation of cold weather and my passion to play football … as a lineman. I also know something about weight loss, as I have had to shed pounds quickly prior to long-distance running events.

The Science of Weight Loss

Three basic principles govern the laws of weight control, other than gravity.

weight loss = caloric intake < caloric burn

carbohydrates > fat > protein

Greater calorie restriction = decreased energy expenditure + sluggishness

First, weight loss occurs when caloric burn is greater than caloric intake. I think most people understand that axiom of nature. Second, there is an order to which our body burns calories to produce energy. If all three (carbs, fat, protein) are abundantly present in the diet, carbohydrates are used preferentially first, followed by fat, and lastly by protein. The body generates the most ATP from fat, and therefore fat evolved as the preferred form of energy storage. Carbohydrates (sugars, starches) are stored in limited quantities for a period of 1-2 days as glycogen by the liver. Consumption of excess carbs beyond that 1-2 day storage capacity is converted into fat for long-term storage. Proteins are critical building blocks for organs like muscle and brain and thankfully they are used last.  Third, long-term caloric restriction will force your body to shut down and couch surf. It is therefore important during caloric restriction, fasting, or when switching to a vegan or vegetarian lifestyle to supplement your diet.

Supplementation. Dietary supplements serve an even greater importance for dieting and weight loss. During fasting and caloric restriction, our bodies still require the vitamins, minerals, and essential cofactors required for the various biochemical processes in the body. Vitamins A, B6, B12, E, and K are critical to take during a fast. You also need to add thiamin, riboflavin, niacin, folate, biotin, iron, and calcium as well. Thiamin is a necessary coenzyme in the breakdown of sugars and amino acids and used to make critical neurotransmitters in our body. Riboflavin is a vital component for the metabolism of carbs, fat, and protein. The body uses niacin to make coenzymes involved in a wide variety of processes from DNA repair to generation of energy from carb, fat, and protein metabolism. Folate is a necessary cofactor for fundamental biochemical reactions and used in DNA repair and DNA synthesis (rapid cell division and growth). Biotin is used to fortify nails and hair, which can become weakened during a fast. Biotin also helps metabolize fat, which is useful in any program designed to switch your body from carb burning to fat burning. The benefits of iron and calcium are well known. Vitamin D can be generated from sun exposure, but vitamin D supplementation might be necessary in those with darker-colored skin, older individuals, and during the winter months when daylight is shorter. 

Other Dietary Ingredients. The list here is extensive, but I will mention a few. I would start with fish oil. It seems that there is a study every month about the importance of fish oil. Most of us don’t eat enough fish in our diet. The latest study released last month extols the virtues of fish oil to protect our brain. A combination of fish oil, vitamins, minerals and other cofactor supplements are an essential minimum to keep the biological and enzymatic processes in our bodies working efficiently. Irvingia gabonensis (African bush mango) and Garcinia cambogia (tamarind) can be useful botanical adjuncts. While some reports suggest a benefit for weight loss and appear promising, other studies have been inconclusive. We have yet to see a large clinical trial where volunteers consume these botanicals in combination with vitamins, many of which serve as necessary cofactors for our fat burning machinery. Botanical adjuncts may not work as effectively unless you have all the parts (vitamin coenzymes and cofactors) of that machinery present. It is also prudent to research the clinical efficacy data behind each dietary ingredient you wish to supplement your diet. And if you are still not sure, talk to your health care provider. Medical institutions are recognizing the importance of dietary ingredients as hospitals are now carrying more dietary supplement products in their formularies.

Strategize

Make the Pact.  Physicians are taught to make a contract with their patient toward the goal of weight loss. It is not so much a contract with your physician you need to make as it is one you need to make with yourself. People will tell you that you are not alone in losing weight. Don’t believe them. You will be tempted to break your pact during your solitude of silence more often than in the chorus of friends.  Losing weight is both a lifestyle change and a promise to oneself. While promises should never be broken, remember that you are human. If you fail at any point along the way, you need to get back on the plan. 

Plan Ahead. Everyone needs a plan. An ounce of planning is worth a pound of weight loss. Before you set off on your plan, you need to know how much weight you want to lose in a week and overall. A half to one pound per week of weight loss is typically cited as safe. While the human body is capable of more, just allow yourself time to achieve your goal for realistic success. You also may decide to commit to a vegan or vegetarian lifestyle after years of indulging as a carnivore to keep the weight off. Be prepared with a mental strategy. A football coach once said that 95 percent of football is half mental. I would argue that weight loss is 100 percent mental and the rest physical discipline, which sounds just as preposterous.

Fasting. Talk to your physician. While controversial today, mankind has always fasted. Humans were hunter/gatherers, often traveling for extended periods without food. The lack of refrigeration will do that to a person. While it is not for everyone (i.e., insulin-dependent diabetics), and no one ever agrees on a healthy length, fasting can jump start weight loss. Fasting cleans the arteries and allows the body to detoxify even after years of eating poorly. Your taste buds will also come back. A limited fast can also help your mind overcome psychological addictions to food. I am a proponent of fasting, starting either on an extended holiday weekend so you are not cranky to co-workers or continuing the fast from a religious holiday observance.

More Planning. Whatever the length you decide, be prepared for a mental battle lasting about 72 hours. Plan activities away from the house on a weekend to serve as a mental distraction during your fast. Your brain will want to forget about your diet, and you will find your hand on the refrigerator door often during that period. Attach a bracelet to your wrist to help remember your diet and promise. Your stomach and brain relax after 72 hours, and you will experience tastes that you forgot about. I do not recommend prolonged fasting, because your energy expenditure will decline to compensate for your lack of caloric intake. While calorie restriction has consistently been shown to produce weight loss, as well as delay the onset of age-related diseases, most overweight individuals are unable to sustain weight loss from caloric restriction. Eventually, our energy level will plummet to offset the absence of food.  So eating and exercise become critical after the fast.

Cues of Information. Your brain likes to see familiar objects in the house (i.e., bread box, food cupboard, refrigerator door handle, the plastic rings binding 12-ounce cans at the bottom of the pantry, and restaurant billboards). Each visual image cues our brains and serves as a reminder of how much pleasure we derive from food. You need to have a plan in place to handle cues of information. I used to tie a string around my wrist to remind the hand on the refrigerator door that I was fasting or cutting caloric intake. Some people leave the house or go on a walk if they touch the pantry door. Whatever your food strategy (vegan or vegetarian or limited intake), have a plan to remind yourself and avoid the pitfalls of your old eating habits and lifestyle. Have a plan in place for when you cheat on your diet. Have a plan in place to deal with cravings. Have a plan in place to deal with headaches as a result of weaning off sugars.

Eating to Win/Eating to Lose (pounds)

While it may seem an oxymoron, you have to eat in order to have the energy to burn calories.  A dear friend of mine used to say we should eat a variety of colors every day. Considering that most of the processed food we eat is beige, I think that is probably sound advice, but it doesn’t mean you have to give up eating bread and carbs altogether. I do recommend eating a multigrain cereal with or without milk, depending on whether your diet or allergy allows for dairy. I prefer cereal and milk to end a fast because milk proteins fill me up more than a salad. Vegetable medley soups are also great to break a fast because you may notice your taste buds have returned from a state of slumber. I don’t think there is a clear cut rule about what foods to introduce next, but I do see the merits of eating protein over carbohydrates. The only problem is that eating dietary protein on a chronic basis may pose a major nitrogen burden on your kidneys. Eating protein exclusively is not a healthy long-term solution for any diet, including Atkins, and it is not a good choice for those with an elevated renal (kidney) or liver panel. They key is portion control, moderation, and taking in less than you burn through exercise.

Exercise to Exorcise Those Demons

The first two steps you take outside of your residence are the hardest two steps to take. If you are set on making exercise a routine, the most successful promise keepers are the ones who exercise in the early morning hours.  How often do you see the same person running in the late afternoon or evening? Don’t try to run immediately because you will tear something that will prevent you from exercising. Start out walking and bicycling, until you build up the leg strength required to run, and replace your sneakers often. Trail running is better on your feet than pavement and will cause fewer stress micro-fracture injuries to the foot bones in your later years.

And finally, remember this last point:  it is never too late to start!

Let me know how you are doing.

Comment below with your questions and comments. Or, email them to KaylynnEbner@wfcinc.com.

All the best,

Corey J. Hilmas, M.D./Ph.D. “The Doc”

Corey Hilmas, M.D., Ph.D., is the Natural Product Association's Senior Vice President of Scientific and Regulatory Affairs. Dr. Hilmas oversees the development and implementation of all educational, scientific and compliance programs at NPA, and provides guidance on clinical issues, public health, ingredients and regulatory compliance. Dr. Hilmas is a medical doctor with a degree from the University of Maryland School of Medicine. He also holds a doctorate in pharmacology and toxicology. He joined NPA after having served as chief of the Dietary Supplement Regulation Implementation Branch within the Division of Dietary Supplement Programs at the U.S. Food and Drug Administration (FDA) for more than two years.

published 7/23/14

Comments

I am very happy to read this. Very informative post thanks for sharing this with us I highly appreciate you for this information. I appreciate this post.

I am so happy to read this. It is really difficult to get this kind of with useful information. Keep up the interesting work!

Post new comment

The content of this field is kept private and will not be shown publicly.
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
  _               ____    __             ____  
| |__ ___ / ___| / /_ _ __ | _ \
| '_ \ / _ \ | | _ | '_ \ | '_ \ | |_) |
| | | | | __/ | |_| | | (_) | | | | | | _ <
|_| |_| \___| \____| \___/ |_| |_| |_| \_\
Enter the code depicted in ASCII art style.