The skinny on successful dieting
By Nicole Piscopo Neal, Palm Beach Post Staff Writer
Friday, January 2, 2004
Bring on the cheeseburgers and slosh some cream in the coffee, or stick to lean meat and low-fat milk?
Go ahead and eat carbs, or ban all bananas?
Count calories, or just pitch pasta and potatoes and pig out on everything else?
In time for those New Year's resolutions, we asked a local diet and weight-loss doctor what eating plan she recommends -- and how she stays so thin.
Dr. Daisy Merey, family physician and specialist in bariatric medicine (she also holds a Ph.D. in genetics and pharmacology, and serves as president of Women Physicians of Palm Beach County), has been working with overweight patients for more than 20 years.
Her new book, Don't Be A Slave To What You Crave, outlines a weight-loss plan that tackles the downfall of many a dieter: that yen for sweet or salty snacks, alcohol or caffeine. (She has also invented the "Eating Well Game" to teach children to make smart food choices.)
So does she recommend snubbing snacks? Steering clear of carbs? Avoiding fat? Merey shares her professional opinion and her personal struggle to stay slim.
Why did you decide to become a bariatrician (a weight-loss physician)?
As soon as I started my practice, I realized that many of my patients' complaints could be resolved by weight loss. Many could hardly walk to my exam room, because they were riddled by arthritis caused by their being overweight. They were very easily out of breath, and their complaints involved every organ system (acid reflux, high blood pressure, high cholesterol, diabetes, sleep apnea). Many ceremoniously dumped on my desk the myriad of medications they were taking for their hypertension, cholesterol, arthritis and diabetes. I felt then that the source of their illness had a common link: their overweight condition. I found the America Society of Bariatrics Physicians, went to the meetings, became board certified in bariatrics over 20 years ago and now teach other physicians how to treat obesity, which is quickly becoming a worldwide epidemic.
You're very thin and probably don't have to diet. Does that make it hard for patients to relate to you?
As a teenager I blew up to almost 180 pounds. (Merey, a fiftysomething grandmother, is 5-feet-4.) I ate poorly and did not exercise. I was the typical nerd, studying, sitting on my behind and eating. My appearance did not matter to me, only my grades, until I entered my mid-teenage years. Then I realized that to attract the opposite sex I needed serious trimming. I did not want to be the perennial wallflower at the dances. I customized for myself a weight-reduction program when I was 15. I also walked to and from the beach every day and swam during my summer vacation. By the time I returned to school, I had shed an impressive amount of weight. I looked tan and fit. However, with school demands the weight crept back a little. This paved the realization that I will always have to watch what I am eating and that exercise is a must.
When I arrived in the United States (she is originally from Morocco) to go to college, I was thin and maintained my weight. I even lost more weight due to the stresses of being in a new country and having to tackle a new language. I vowed never to go back to my obese self.
My husband, my children and my patients have never seen me fat! I chose the field of bariatrics to keep me on my toes. I may go up a few pounds, but I right away go on a stricter program. My husband and my daughter skip a meal and lose two pounds. My son and I have to diet a whole week to lose one miserable pound. The battle of the bulge continues, but I feel I am worth it.
What is your typical food intake?
For breakfast I have high-protein cereal (one she markets) and a cup of decaffeinated coffee with skim milk. I also take many vitamins and nutritional supplements in the morning. For lunch I have a salad with sardines and a balsamic vinaigrette dressing. In addition I have a few slices of low-fat cheese. For dessert I eat cut-up fresh fruit. For a snack in the afternoon, I have a high-protein cookie or bar. For dinner I prepare an egg-white omelet with spinach or broccoli, sprinkled with fat-free Parmesan cheese; a side salad with oil and vinegar; and some frozen vegetables. For dessert, it's fat-free plain yogurt or fruit. My only deviation from this program is a small piece of good dark chocolate. When I go out to eat, I always choose a salad and broiled fish with vegetables. I always pass on the bread and the starches -- rice, pasta and potatoes. If I am at someone's house and no choices are available, I opt for the fat-free rather than the carbohydrate-free food. This is how I maintain my weight of 115 pounds on a 5-foot-4-inch frame.
It's so confusing these days: Is it better to eat less fat and more carbohydrates or is a high-fat, high-protein, low-carbohydrate diet better?
In my opinion there is not one diet that fits all; however, I am very much against high saturated-fat consumption. Many studies have shown that after people eat a high-fat meal during holidays, the lining of their heart arteries swells up and inflammatory products are released. This does not mean that a high-carbohydrate diet is advantageous either. Since the low-fat concept was introduced here, people have compensated by eating more carbohydrates, with the result that America has never been fatter. The percentage of diabetic people, including children, has also grown exponentially. Therefore, there are good and bad fats as well as good and bad carbohydrates.
What are the good and bad carbohydrates?
Bad carbohydrates are the white- or beige-colored foods, like sugar, pastries, bread, bagels, crackers, pasta, white rice and white potatoes, which I consider like wallpaper paste with no nutritional value. These carbohydrates also raise insulin dangerously and increase the probability of developing diabetes. On the other hand, good carbohydrates are the colored vegetables: green, red, yellow and orange. They contain phytochemicals that are health-promoting. Also many contain fiber which calms stomach hunger and helps with diabetes and constipation. Fruit in moderation is advantageous. Fruit juice should be avoided, as well as too-sweet fruit (like watermelon, bananas, cherries and grapes) for weight-loss purposes. All other fruit should be consumed at the end of the meal to keep the blood sugar stabilized.
What are the good and bad fats?
I shun saturated fats contained in fatty meats, like beef, lamb, pork and some cold cuts, and in fatty dairy products like whole milk, creams and fatty cheeses. On the other hand, I recommend the addition of half olive oil and half canola oil in our daily nutritional intake. Fish, which contain healthy oils, are recommended, too. And some lower-fat nuts (almonds and walnuts are best; macadamia nuts and cashews are worst) can be eaten sparingly.
How many calories should one consume?
Calorie counting is passé. Also, calories are not created equal. The fewer calories one consumes, the better it is for health and longevity. People who are leaner live longer and have fewer health problems. Even a few extra pounds in the body release all kinds of inflammatory substances that are triggers for the development of illnesses like hypertension, stroke, heart disease, high blood fats (like high cholesterol) and finally cancer. Most cancers are stimulated by fat, and are more common in overweight people.
I hear a lot about the 'glycemic index' of foods. What does it mean?
Each food consumed raises blood sugar at a different number, table sugar being the yardstick at 100. Bread, pasta, potatoes and even carrots have high glycemic index. A more valid measurement is the glycemic load of foods, which is a ratio of the glycemic index divided by the amount of carbohydrate contained in the particular food. Lists of the glycemic index or the glycemic load of foods are available. High-glycemic-index or high-glycemic-load foods are detrimental for weight loss and diabetes and stimulate the aging process.
I know what I should eat, but when I see a chocolate cake or there is a box of ice cream in the refrigerator, I will eat these items until they're gone. What can I do about it?
I have divided hunger into two categories. Stomach or physiological hunger occurs during meal times. If a person eats too much at meal times, a fiber pill that expands in the stomach with water and numbs it is recommended before eating. However, if a person is hungry after a meal, this hunger is more psychological, and I call it head hunger. Depending on the foods craved, I give my patients different nutritional supplementation. If one craves chocolate, sweets, fats, salt and caffeine, a supplement containing tyrosine and 1-phenylalanine is to be taken. On the other hand, cravings for starches and for smoking and alcohol can be alleviated by taking a supplement containing 5 OH tryptophan, which increases serotonin in the brain. Ninety percent of the time, just nutritional supplementation with these amino acids will calm the cravings for certain foods. Also, carbohydrates are quite addictive for certain people, and their consumption must be curtailed in this case. Cravings for fats in combination with protein or carbohydrates can also occur. For certain people, appetite-suppressant drugs are necessary to help with overwhelming appetite or food cravings. (Merey has patented her neurotransmitter precursor formulas to control cravings.)
I lost my weight, but I'm afraid I'm going to regain it. What can I do about it?
Weight maintenance requires a lifestyle change -- not only through nutrition, but also through exercise and behavior modification. Exercise, which was not as crucial during the weight loss phase, becomes the key in weight maintenance. Also, one has to study the triggers for one's obesity. Did hunger play a role in keeping that person fat? Was stomach hunger or head hunger more dominant? One must continue using the nutritional supplements that help them the most. Foods that have a craving potential for that person should be used sparingly. Our nutritional regime is more relaxed during the maintenance phase than in the strict weight-loss phase. However, everybody should be on guard to prevent weight regain. (I devised a 5-pound weight regain rule that encourages my patients to return to us as soon as they have gained that much.) Weight regain should be nipped in the bud. I also have another rule: The day after an "indiscretion day," I recommend a stricter program. Only weight loss that is maintained is considered successful.