Entries by Myo M Nwe, MD (33)
Maintaining lost weight !
It is important to stay steady on the diet plan, to keep the lost weight away. Naturally, as we age, we tend to gain few pounds a year. So weight maintenance becomes almost a life long effort.
Majority of the patients regain their lost weight within two years. Fifty percent of the lost weight can come back in the first year of weight loss. And 75% -100% can come back in 2 years.
Human body has high adaptability and memory to return to preconditions. Preconditions mean the condition before any event. If we cut our skin, it will try to seal it. If we break our bone, it will heal it. Similarly, if we lose weight, the body will try to regain the lost weight to our previous weight. The human body has the "memory". If we are overweight for a long period of time, it will think that is the normal weight and it will try to push you back to it.
How do we avoid regaining the lost weight?
We have to reset the memory of our brain. Our body (or brain) need to re-learn and remember the new body weight.
How do we reset this "old weight" memory with "new weight" memory?
It takes time for our brain to get used to the new weight. Until it does, it will assume the 'old weight' to be the normal weight.In simple terms, try to keep the lost weight for longer times by continuing your efforts.
There are some studies looking at the prevention of weight regain. Following are the the keys to maintain the lost weight, and proven to be true at my practice.
1. Staying longer in the weight loss program
2. Involve in behavioral therapy and group session bi-weekly or monthly after initial phase of weight loss program is over.
3. Join a peer support group. Make sure you have a good social and family support for your weight loss efforts.
4. Follow a structured exercise program.
5. Do not lose sight on portion control of your meal.
How long should weight maintenance phase of a weight loss program be?
I always answer to my patients, " I myself am still in my weight maintenance plan".
Health benefits of the exercise!
I am always told by many of my patients that they do not have time for exercise.
As I was growing up as an ambitious kid, I always think of why we only have 24 hours in a day. How would lives be if we have 48 hours in a day. Then, my mother told me to think "lucky us we have 24 hours in a day, not 12 hours. Twenty four hours is plenty if we utilize it well".
That is true! We have 24 hours and we should devote at least an hour just to take care of ourselves. In this golden hour, we can do a lot.
How to utilize this golden hour a day for the best of your life.
1. Make sure you put the high SPF lotion on the skin before you start your day
2. Wash the feet with soap and water at the end of the day
3. Take a multivitamin a day
4. Drink eight glasses of water a day
5. Take care of your teeth/ brushing, flossing
6. Eat breakfast.
7. Exercise / walk or leisure activity for at least thirty minutes a day
8. Do not smoke ( if you are currently smoking, think of quitting)
9. Make plan to eat healthy meals three times a day.
10. Make plan to see your doctor and dentist regularly.
As I am making diagnoses on the patients in the clinic, I always think how could we prevent from this condition for future patients. I make a check list of things to do for my golden hour everyday. It is just so simple and I am sure everybody already knows it. Just need to make it as your routine.
Make time for your golden hour for taking care of your self and you stay healthy and looking young.
Let me emphasize on of them is " regular exercise"
Exercising is a must-do, not a 'do-when-you-have-time' activity. Let's make a pledge, just like you do not go out without brushing your teeth, lets not complete the day without the exercise for the day.
Here are the benefits from the exercise.
1. Maintain you in the reduced body weight/fat
2. Prevents you from gaining weight
3. Decrease your blood pressure
4. Decrease your bad cholesterol and increase your good cholesterol ( keeping you with good heart & brain)
5. Keeps your diabetes in good control
6. Decreases cancer risk
7. Prevents you from osteoporosis and ensure your bone strength
8. Increases cardiac output and improve your endurance and stamina
9. Decreases stress, anxiety, depression
10. Maintains your lean body mass
11.Improves your lung capacity
12.Reduces your heart attacks
13.Reduces strokes
14. Improves immunity, so you do not get sick easily.
15. Keeps you healthy and looking young !
Nobody like to grow old because being old come with the negative effects like diseases, inability, impaired memory and decresed body capacity, fall and fractures of the bone, etc.
Although we cannot prevent ourselves from getting older, but we can choose to grow old with good mental and physical health.
Many a times, I am amazed by some of my elderly patients. They are in their 80s-90s. Travelling around the world, teaching young people around the world and doing so much more. Very smart, very sharp, and very experienced elderly people, doing more than todays youngsters, not having a minute to think of dying.
That is what I learn from these elderly healthy folks. They all take care of themselves since they were young. So they stay young.
GIVE A GOLDEN HOUR TO YOURSELF EVERYDAY.
Why am I so against cooking with butter?
See and compare the content of a cup of butter and olive oil.
Worse than the high calories is saturated fat and cholesterol content in it. Cooking a meal is everyday thing so as the eating a meal. If we eat our buttered meal everyday routinely, we are creating our circulatory systems (arteries) into a buttered one too.
Do you know what is a blocked artery?
Simply put, they are the arteries filled with cholesterol and blood clot.
What do the doctors mean, “you have a blocked artery”
If you find a blocked artery in one area of your body, that mean you have high chance of having multiple arteries blocked in different part of the body. Example, if you have blocked arteries in heart, you might as well have a blocked arteries in the brain, in the carotid arteries (larger Neck arteries), leg arteries, arteries going in to the kidneys, retinal arteries (eye arteries), etc.
What can we do about it? How can we prevent it?
Simple! Do not consume high cholesterol containing food: such as butter, cheese and cream.
Here are the devils to the arteries! So to our health!
Cheese:
Generally, all kinds of cheese have high content of saturated fat and cholesterol except mozzarella, ricotta, and cottage cheese. (But do look into the food label for detail, different preparation can change the individual content). Make sure you choose low fat or no fat version of the mozzarella, ricotta and cottage cheese.
Butter:
Generally, all butter are high is the saturated fat. You can use “I cannot believe it is not butter”. Again use sparingly, they do still have high calories.
Cream
Most of the cream whipped, sour cream are calories rich extra topping. Each tbsp will give you about 10-20 calories and use sparingly. Heavy cream, half and half are high cholesterol, artery-clogging devils! Stay away from it.
Cooking with butter does not taste better either. Let’s say no to cooking with butter for clean arteries. Replace your cooking base to olive or canola oil
Facts or Fiction of green tea.
What's up with green tea?
Tea drinking is the sweet tradition in all countries across the world. There are different varieties of tea across the world too.
Some of them are listed here.
Green tea
Black tea
Yellow tea
White tea
Spice tea
Herbal tea
Fermented tea
Mixed tea /flavor infused
These interesting varieties of tea have different proportion of antioxidant, caffeine and they come from different parts of the world.
My main post today is about the " Green Tea" and "Health benefits"
Green tea has been used in Asian countries since very ancients time, some say it has been used for 5000 years for traditional medicinal purposes. The tradition of drinking Green tea started from the east Asian countries (China, India,Japan and Thailand). It has been more popular lately due to multiple health benefits by drinking green tea.
Extensive research has been done regarding health benefit of the green tea world wide, including in the United States. But as of today, FDA has not approved on the health benefit claims of Green Tea.
What is in the tea?
It is derived from the plant called "Camellia sinensis". There are two types of tea: fermented and non fermented. But green tea is non fermented. It contains poly phenols (potent Antioxidant) and stimulants ( caffeine).
Among the poly phenols, the EGCG is the most popular for the health benefits and hence studied vastly.
During fermentation, the tea becomes more caffeinated and less filled with poly phenol. Among all the tea, green tea is not fermented, and it has the most poly phenols (EGCG) and the lesser Stimulants (Caffeine).
So green tea is better than other kinds of tea in terms of health.
The following are the potential benefits claims from consuming "green tea" and "its extract".
1. blood thinning effect
2. cholesterol lowering effects: increasing the good cholesterol and decreasing the bad cholesterol and Triglyceride
3. preventing dementia
4. weight loss effect by increasing fat burning and metabolism.
5. preventing the destruction of immune system by the human immunodeficiency Virus in HIV_ infected patients.
6.preventing the aging of the skin
7. preventing the certain cancers
So let's understand all the above benefits in the right way.
First , are the claims true?
The claims as above are probably true as most of the laboratory and animal studies shows that it is beneficial to health as described above. There are multiple human studies done across Asia and Europe, and proven to be of the health benefits.
So doctor why am I seeing you in your clinic? Let me go and get a cup of green tea.
In practicing medicine, there are two major tasks. Treatment and prevention.
For the purpose of prevention: I would say, it is good to drink 2-3 glasses of green tea a day.
But the purpose of treatment: green tea is simply not enough.
The amount of genetic factors, environmental factors, immunological factors, etc on a certain disease vary with the individuals. We just simply do not know as much yet to replace currently acting drugs. Plus, green tea is not a magic wand, it does not give you all these effects right away. It takes time to get health benefits as above.
So simply:
1. we cannot use green tea in replacement for the Aspirin for the heart disease
2. we cannot use the green tea in replacement for the HIV medications
3. Neither as replacement for cholesterol lowering agents
4. Nor instead of weight loss medication (phentermine, sirbutermine, etc)
5. so as the chemotherapy.
Where can we use the green tea if it is so beneficial to health?
In prevention of diseases.
We can drink green tea in replacements of the non- nutritive calorie yielding sodas and energy drinks. It will prevent us from gaining excessive calories from soda as well as give us increase metabolism and promotes fat burning from green tea poly phenols.
It may help reduce cholesterol, heart attacks, boost your immune system, liver toxicity and serve as antioxidant in the body. Also, it will satisfy your thirst.
So everybody is safe to drink green tea?
The patients on the blood thinner (coumadin) should not drink green tea. Pregnant ladies should avoid too.
So how much green tea should we drink per day?
Two to three cups of green tea a day is fairly safe to drink as daily routine.
Do I recommend green tea while someone is trying to lose weight?
Yes. Without added sugar or artificial sweetener, you can have three cups a day.
What to drink during a weight loss phase? Some cool ideas !
Here are some non calorie or low calories drinks suggestions, while you are in weight loss plan.
Obviously, the sweet (or sugar loaded) drinks gives you non-nutritive calories, which works against your weight loss plan. Multiple studies have shown that daily regular drinking of the sweetened drinks can alter your metabolism in a wrong way. In the long run, it can increase the chance of developing glucose intolerance (Also called pre-diabetes) , Diabetes and can even cause Metabolic syndrome.
So can we turn to diet drinks?. The diet drinks are the drinks sweetened with the artificial sweeteners. Saccharin, aspartame, sucralose, neotame, acesulfame potassium are used in food to sweeten the taste without adding calories. Diet drinks are not necessarily a better alternative to the non-diet drinks. Diet drinks may make you eat more calories even though it does not contain any calories by itself. It also shown that artificial sweeteners may increase your health risks if you consume them regularly.
So what we can drink when we are trying to lose weight?
Safely you can drink water, lots of water, during weight loss.
What if you are not a water person or just simply like to have some alternatives!
1. Green tea of different varieties in hot or cold is other alternative. Do not put sugar/sweetener in it.
I personally find that a nice cup of hot green tea is like a tasty glass of wine. It makes you feel warm, relax and pampered. I drink few cups of green tea throughout the day. It does not give me the high and low of sugar, no calories, nor the intoxicated feeling. Multiple health benefits related with the green tea has been seen. (I will go over facts and fictions of green tea's health benefits in another post.)
Do not put sugar in it. You will get used to its mild bitter taste like you get used to in wine and yet without intoxication.
2. My other favorite drink is "lemon water"
Once weekly, I would peel off the few lemons and make it as puree with the food processor. You can store it in the refrigerator for almost a week. At dinner, take out two spoons of the lemon puree in a jugful of cool water and mix in it. A pinch of salt add to it. A few very thinly cut pieces of lemon peel may give you an augmented digested effect to the meal.
It is refreshing and flavorful. And it is not fattening!
3. The fruit water/antioxidant drinks!
You can pretty much create any flavored water with your favorite fruits. All the fruits have fructose sugar in it. So it will give you some calories. But remember fructose is a better sugar. Roughly a cup size of low calories yielding fruits will give you about 30-50 calories. Low calories yielding fruits are watermelon, papaya, cherries, pear, apple, oranges, peaches, berries ( blueberries will give you more calories than strawberries and raspberries). Banana, mango, honeydew are higher in calories (100-200). Grapes, grapefruit, are in mid range, 60-70 calories.
Use 1 cup of fruit for two servings. If you have four family members, prepare two cups of fruit.
Here is some fruit waters that I like.
1. coconut water (not coconut milk)
2. cucumber water
3. watermelon water
I like the watermelon water a lot. The preparation is also simple. A cup of cut watermelon, ice, water blend into thin drinks. Chopped mints leaves, and a pinch of salt add to it.
You can create fruit water at dinner every night. They are fresh, give you healthy antioxidant, and yet small amount of calories. But remember 8 oz glass portion for each drink.
If you must sweeten your drink, just because you are a sweet person :)
A level teaspoonful of sugar(4 gm) add to your individual cup and make a point that you will do extra 3 minutes walking after your drink.
Then some of my patients ask me this question. "Can we get commercially prepare drinks labelled as fruit water?"
I prefer that you prepare it by yourself. It does not take time to prepare. It is fun. It is in your control. You will be proud that you are health cautious and care for yourself and your family. It will become a tradition of family members gather around the dinner. While preparing , it will burn some calories, too. Most of all, you will have control on the portion of your drink.
Do you know that it is the biggest issue with the commercially prepared drinks. Either diet or non diet, with the commercially prepare drinks, you lose your control on the portion. Do you see yourself leaving half of the can or bottle of the soda for next time?
Have fun making your fruit water and keep losing weight!
My opinion about ALLI for weight loss: New weight loss pill.
There are many of “weight loss claimed products” on the market. Everyday my patients asked me about these products.
One of the products is ALLI. The TV commercial caught my attention. “FDA approval”, “over the counter drug” and “fifty percent more reduction”. Congratulations to the ad creator.
Let me explain you what is the meaning of all the words.
First, Let me tell you what is the ALLI.
ALLI is the weight loss plan, which include a pill called “Orlistat” or trade name Xenical. Orlistat is one of the prescription drugs for the weight reduction. The prescription strength Orlistat is 120 mg three times a day. ALLI includes 60 mg of the orlistat three times a day.
How does it work?
There are several studies looking at the Orlistat (or ALLI for weight loss) as an inhibitor of fat digestion for weight reduction. Only one percent of the medication is absorbed into the blood stream and the rest works in the intestines. It blocks the digestive enzymes responsible to breakdown fat to make it suitable for digestion. The dietary fat is not absorbed into the system. Hence, reduced calorie consumption and reduce the body weight.
Is it effective?
Let’s quantify the weight loss effect by using the Orlistat (or ALLI)
*tid= three times a day
**Weight loss in kilogram X 2.2= weight loss in pounds
The studies look at the effect of orlistat in weight reduction phase and maintenance phase. In weight reduction phase, everyone who was on placebo or on Orlistat was put on lower calories diet. The studies were done over two years. First year is for the weight reduction and the second year is done for weight maintenance.
During the study 2, the orlistat 60mg (ALLI) three times a day was used for the maintenance phase where calorie restriction is omitted. The regain of the weight during maintenance in the orlistat 120mg and 60 mg group was 3.2 and 4.2 kg respectively.
The bottom line is: Orlistat 120 mg (three times a day) has shown to lose weight up to 4 kg (8.8 pound) than losing weight with diet alone. (10.1-6.9=3.2)
How much weight loss is needed to get FDA approval for a weight loss drug?
There is no set number for it. But there is a term called “medically significant weight loss” and a product must have “medically significant weight loss” to get FDA approval.
How much weight loss is “Medically significant weight Loss”?
Weight loss about “five percent” of initial body weight can improve your general health and cardiac risk. That is why even five percent loss from the initial weight is considered medically significant.
Ten to Fifteen percent loss is considered a success and more than fifteen percent weight loss is considered very good.
So how do you understand the TV ad for “ALLI”? Fifty percent weight loss!!
It sounds really good. (This TV ad caught my attention from the first time even while I was feeling sleepy). Do you understand the advertisement right? Refer back to table 2. The total weight loss by orlistat (Xenical) and diet is about 10 kg. Weight loss from calorie restriction (Dieting) is up to 7 kg. Fifty percent of the 7 kg is 3.5 kg.
So they claims fifty percent more weight loss with the ALLI.
It is not fifty percent of your body weight. It is fifty percent more with ALLI than Diet alone which is up to 4 kg (8.8 pounds)
What are the “side effects” of the Orlistat? (or) What are the “treatment effects” of the ALLI?
This is the main difference where the doctors and the product makers differ.
As a physician, the first thought that the Doctors have is what are the side effects of the drugs/products.
I guess that come from the rooted oath “first do no harm” from Hippocrates.
So as a doctor, I would not polish that as “treatment effects”. It is side effects/ undesired effects. I want the consumers to understand that these effects are supposed to be weighted against the potential benefits.
The listed side effects of the orlistat are as follow:
1. Intestinal borborygmi (rumbling of the stomach)
2. Abdominal cramps
3. Flatus
4. Fecal incontinence, oily spotting, and flatus with discharge
5. Potential Vitamin A, D, E, K deficiency because they need fat for their absorption.
The side effects occurrence is up to 30%.
Does Orlistat have any other benefit as fat blocker?
Yes, Orlistat can reduce cholesterol up to ten percent. But remember there are much more efficacious cholesterol lowering agents out there and it is not indicated to use solely for the cholesterol.
Do you really want to lose weight?
One of my obese patients told me that she does not want to lose weight. She was not kidding.
She does not want to lose weight any longer because she has tried to lose weight several times. And every time she lost weight, she gained much more back later. She is currently at 289 pounds.She said if she had never tried to lose weight before, she could have weighed less than 289 pounds now. And surprisingly I agree with her.
Here are the Dos!
1. Chose the right method of weight loss. Monitor which part of your body is losing, Fat mass or Lean mass. Measure body circumferences and make a journal to see the progress.
2. Do not go for a quick fix even if you have to lose only 10 pounds. Lose it over at least 10 weeks.
3. Do not cut out a food group completely. Don't go for no carb diet, no fat diet etc.
4. Remember you have to eat more frequently, at regular interval, but smaller portions.
5. Do it all inclusive: Diet, exercise, support, medication if indicated. I cannot stress this point enough. (learn about Synergy. )
6. Do it easy. But persistently.
7. Maintenance planning starts from the beginning, even before losing weight.
8. Do not attempt weight loss when disaster strikes in your life.
9. Prevention is always better. Assess yourself and start weight loss effort before it gets too far.
10. It should not be embarrassing to talk about your body weight among friends and family. Let them support you and do it together.
HCG injection and weight loss! Is it fact or fiction?
There is a lot of buzz about HCG (Human Chorionic Gonadotropin) use in the medical weight loss programs.
I am frequently asked this question; " Do you give the ( HCG ) shots in your weight loss program ?"
HCG injection use in weight loss was suggested a long time ago. Actually, there are multiple weight loss centers using the HCG injection outside the United States.
I decided to look into this hype. I did some searching in literature internationally and domestically. I found the following facts regarding the HCG. ( I will leave out the statistics for general population to understand it easier)
1. Using HCG injection for losing weight did not show any benefit in almost all of the studies.
2. Most studies did not show long term (more than few months) effects of weight loss either.
3. Most studies did not prove that desirable fat mobilization is achieved by HCG injection.
So what is all the buzz about HCG?
The original HCG protocol for weight loss was done in Very Low Calorie Diet (VLCD). Those individuals consumed maximum of 500 calories per day. And they are given HCG injection for approximately 1.5 months. They did lose weight significantly, but not more than the individuals on VLCD 500 Cal diet alone.
To simplify it: It is very likely that they did lose weight because of low calorie diet, not because of HCG.
Why there is conflict in the HCG use in weight loss?
The earth was considered flat once upon a time, till we looked at it from all different angles. But we now have the open media through which anyone can say whatever. They may read an old note saying " the earth is flat" and then blurt it out in the media.
So HCG injections are any good in weight loss?
The research found out that HCG gives you a sense of feeling good. While receiving the HCG and VLCD (500Cals), the subjects on the HCG could tolerate the misery of 500 Cals VLCD better.So it is a feel good hormone !
What about the body contouring fat loss with HCG?
It is not true. Multiple studies have looked at it and it does not mobilize the fat in the desired way.
Does HCG help prevent wrinkles in the skin after losing weight?
It does not tighten the skin.
So will I use the HCG in my weight loss clinic?
I will not use the HCG for losing weight for the following reasons:
- In my opinion,HCG does not help lose weight. Its possible benefit is to make you feel good when you are on VLCD.
- I do not support the Very Low Calorie Diet (VLCD) of 500 calorie a day ( Studies show that VLCD causes more loss of lean mass than fat mass)
- If weight loss is only temporary for 3 months or less, why bother putting you through with all extreme restriction and daily shots.
- We do not need to use the HCG for the "feeling good" benefit as nobody need to feel bad while trying to lose weight. "Feeling bad" comes from extreme restriction and it does not work for long term. If you are making it too hard to lose weight, you are doing it wrong.
Is Restaurant food healthier than Fast food?
I had a great dinner last night freshly prepared by a famous chef. I was with 8 other physicians at a special dinner, cook live in front of us by a famous chef.
The event is wonderful. The course of the meals is phenomenal.
How to determine the portion size ?
One of the other reason for increasing obesity prevalence in our country is we are double sizing our portion. We measure up daily calorie requirement as 2000 Kilo calories. It is OK for the six feet tall muscular man consuming 2000 Kilo calories but not a 30 years old female with regular activity, build will not need 2000 Kilo calories.
Salad for weight loss should not be boring! Salad Creation on Friday night.
Salad is a delicacy when you add few simple creations to it.
Preparing a simple healthy dinner on Monday
Let's have three courses for the dinner.
Let's cook a healthy simple meal
Let’s cook a healthy simple meal. I prepare the dinner in three courses. This is based on something that I learned from an old chinese man.
Lets get kitchen ready for the goal of losing weight.
I never had a formal training of the culinary school nor am a chef. In fact, it will make me nervous to prepare a meal for the larger crowd
The list of groceries shopping to go by for weight loss!
Here is the list! The list will tell you healthier version of commonly used food item at home. It will help you feel energetics and healthy.
Excuses that prevent us from losing weight and staying healthy.
Excuses that stop us from what we want to be. I am directly copying what my patients told me when they started the weight loss program.
Can medication gain you weight?
Yes! Common medications that can gain you weight are listed here.
Doctor, will you take phentermine if you were in my place?
Today, I had this friendly comment/question from a patient. Doctor, are you going to take phentermine if you are obese?
Myo M Nwe, MD
|
Post a Comment
|
1 Reference
| 
Email
Eating right with carbohydrates.
We are always concerned about eating carbs. Carbs (glucose) are needed by every tissue of the body especially the brain and Red Blood Cells. There are two kinds of carbs. Simple sugar and complex sugar (starch).
What is a good weight for you?
How do we calculate our ideal body weight? Calculation for over weight/obesity can be done as follows: