Regaining Weight after Dieting: Pounds versus Body Fat

A new study, published in the New England Journal of Medicine, deals with a frustrating situation familiar to many dieters:  regaining weight afterward, sometimes with additional pounds as well.  A year after losing weight subjects in the study reported being as hungry as they had been immediately after losing the weight and hungrier than they had been before they started the diet.

I have been on many diets and been through this cycle many times.  During the past ten years, though, I’ve had more success at keeping the weight off.   In 1998 I had my body fat percentage measured at our local Y; it was 38, well into the too-fat category.  After that I started working to reduce body fat as well as weight and to improve muscle strength. 

When my body fat percentage got down into the mid-20’s an interesting thing happened.  I found that I was not getting hungry as often but when I finally did, it really hurt instead of just being mildly uncomfortable the way it had been before.  I started carrying protein bars around in case of emergency. I am now wondering whether there is something about losing weight without losing body fat that sets you up to regain. 

In order to burn fat I have to do cardio and lift weights at a fairly intense level; walking doesn’t work for me.  To strengthen my muscles for these workouts I started taking a protein supplements and proteolytic enzymes.  Stronger muscles and harder workouts burn both calories and fat, helping the entire process along. 

Why aren’t researchers on obesity paying more attention to body fat?

No Body's Perfect

Everyone has areas in which they are particularly capable or talented.  Little children, as they develop, experience the delight of acquiring one skill after another. “I can walk!”  “I can talk!” “I can ride a bike.”  As they spend more time with interacting with other kids, they make comparisons and discover where they excel:  running faster, telling funnier stories, winning at computer games.  When you’re starting out in life, it’s fun to learn about and dwell upon your strengths.  In the long run, though, there is more to be gained by studying your weaknesses because those are the traits that are most likely to get you into trouble.

I have strong, flexible muscles in my legs.  My knees are still in good shape for a 65-year-old.  Where I fall down, sometimes literally, is balance.  In 2001 I decided to challenge my sense of balance by learning how to rollerblade.  I’ve never become very good at it but I’ve definitely improved and it gives me satisfaction to be able to do it at all.  Rollerblading has also helped me to fall down better.  One late afternoon in winter I went out the side door of our house and started down the limestone steps, not noticing a patch of ice near the bottom.  Over I went, but I managed to turn as I fell and came away with only a small bruise on one arm.  Our local Y gives balance classes; if liability weren’t a consideration it might be more useful to have classes in falling down.

The same goes for mental faculties.  I have never been quick at math.  I understand the basic concepts but I do arithmetic calculations slowly and make lots of mistakes.  I studied math during the ‘50’s and ‘60’s, before calculators became ubiquitous so my grades in these courses were mediocre.  When I got older and started having to do taxes I always put it off until the last minute because I knew it would be a mess.  Finally, I took a more mature approach and enrolled in the H&R Block tax preparer’s course, one of the best investments I’ve ever made.  Learning about tax law and analyzing the forms not only gave me more confidence in doing my return but also opened up whole new areas I had known nothing about.  At that point it became clear to me how much real estate ownership, including investment real estate, is favored by the tax code.  As a result, my husband and I got into the business of buying, fixing up, and renting out houses, which worked out very well for us.

Adults tend to forget how hard it was to acquire all the skills they learned in childhood:  little fingers trying to use a pair of scissors for the first time or struggling to hold a pencil or fork.  As grown-ups we like to feel competent and in control.  We avoid situations in which we might seem clumsy, stupid, or inept.  I believe that, once in a while, it is important to put yourself into such a situation, to experience the awkwardness of learning a difficult skill and the increased confidence that comes from mastering it.  Chinese general Sun-tzu said, ”Keep your friends close and your enemies closer.”  I say, “Know your strengths well and your weaknesses better.”

Protein 2

Presto at  Six Weeks, 7/1989

The first one in our family to take proteolytic enzymes was Presto, our late and much-loved cat.  Presto was a barn cat from Ellettsville, the next town west of Bloomington.  Our friend who owned the barn said that we should take him even though he was only six weeks old because his mother wasn’t feeding him enough.   When we got to the barn the other kittens ran away but Presto came right over to us.  He was so tiny and thin I was not sure he would ever be healthy but we took him anyway. 

As a kitten Presto was friendly and playful but he got sick a lot.  In adulthood he was mostly healthy until about age 10 when his condition started to fall off a bit.  The vet recommended that he take Pancreaved (now Pancreazyme), a pancreatic enzyme that would help him to digest protein, which is sometimes a problem for older cats.  After taking it for a couple of months Presto looked like a different cat.  His coat, which had always been a bit skimpy, became thick and shiny and he had more energy.  He lived to the ripe old age of 17.

Several years back my husband and I used to play racquetball.  One day while we were playing I pivoted sharply and my shoe stuck to the floor.  Instant agony! Nothing was torn or broken but something below my right knee was severely pulled.  It was bad enough that I walked with a cane for the first week or so.  I didn’t go to a doctor because I already knew what I’d hear:  rest, ice it, and take an anti-inflammatory.  I did get acupuncture right away which probably helped to cut down the swelling.  I also looked in the supplement section of our local food co-op for something that might help.  A man I’d never seen before said, “I’ve heard that these are pretty good.” 

That was my first introduction to Wobenzym, a proteolytic enzyme supplement invented in Germany in 1960 and used by German athletes like Boris Becker and Steffi Graf to help in healing injuries.  I began taking it and got better quickly.  When we started playing racquetball again I noticed that I was running faster and hitting the ball harder.  “This is good stuff – you should take it too,” I told my husband.  These days we each take four a day, in the morning because it can keep you awake if you take it at night.  When I do get an injury I find that it goes away in a day or two.

I believe that, like Presto, I had trouble digesting protein.  When I started exercising more in the early 2000’s I would go as fast as I could on the cross trainer and not break a sweat; my heart rate stayed around 125 bpm.  I think my muscles simply weren’t strong enough to do anything more.  Between the protein supplement and the Wobenzym I’m now the strongest I’ve ever been in my life at age 65.  These days I average 138 bpm and I’m soaked by the time I finish.

Here is the reasoning: 

In order to be in shape you need to get a good workout.

In order to get a good workout you need to have strong muscles.

In order to have strong muscles you need to get enough protein.
In order to get enough protein you need to have enough of the right enzymes to digest it.

Presto at 14 Years, 05/2003

Small Celebrations

I love Italy. One of the things I especially

appreciate about Italian culture is the way everyday events – meeting a friend on the street, drinking a cappuccino at your neighborhood bar, or buying a new pair of gloves – are treated as special occasions. The exquisite desserts in the photo above were displayed in a pasticceria in the small town of Urbania, not far from Urbino, birthplace of Raphael. In spite of the attention lavished on them, these little works of art were probably not destined for any gala event but for a dinner at home or at a friend’s house.  Teachers of yoga and acting classes tell you to “be in the moment” but nobody does it with more élan and more style than the Italians.

Some days I arrive at the breakfast table with my bowl of cereal and my cup of tea and stop for a moment to appreciate the fact that I am still here, healthy, with good food to eat, and a comfortable, safe place to sleep. I’m not conventionally religious – the religion gene passed me by – but maybe this is a form of prayer.

Update: You can preview my book of black and white photographs of a famous garden in Italy at this link: http://bit.ly/2fClmm7

Depression and Anxiety

Depression and anxiety run on both sides of my family but I got off lightly with only a few minor phobias.  I’m afraid of falling down; this one has some basis in anatomical fact, see “Respect the Feet.”   I don’t much like climbing up ladders.  I also have paruresis or bashful bladder which means I can’t produce a urine specimen on command.  I believe that the circumstances of a person’s birth can have a profound effect on their temperament and overall experience of life.  I was born immediately after World War II when my parents were probably happier than they ever were in their lives.  Perhaps it rubbed off on me.

Until I was five we lived in Gardner, a small town in northwestern Massachusetts where things were probably pretty quiet and my first brother was born.  Fine up to that point.  Then we moved to Meriden, Connecticut, a small city, a lot more stress, and another birth – twins this time.  Before I finished high school there were two more moves, to progressively smaller houses for our growing family and progressively more tension for all of us. 

My father, always an anxious person, became more rigid and more distant (even though he often worked at home); my mother tried harder to smooth things over.  We should probably all have been in family therapy but this was not workable for several reasons.  First, my parents’ Anglo values called for toughing it out during bad times, being strong and not acknowledging a need for help.  Secondly, my father was a clergyman and we were supposed to be the perfect family, at least in public.  Finally, resources for dealing with such problems were not nearly as plentiful in the 1950’s and ‘60’s as they are now.

Ten years ago when I was trying to decide what to do with the rest of my life I used to drive by myself to Indianapolis to see a therapist, a wonderful woman named Lee Verner, retired now, alas.  One of the memories that surfaced during those sessions was of how I spent my time as a child.  From the age of eight or nine I was constantly reading.  In our difficult family situation reading was my refuge and my drug of choice.  No problems here!

As the daughters of alcoholics often marry alcoholics so I, the daughter of a depressed, anxious family, have tended to have depressives as friends and romantic partners.  I spent six years in academia, a veritable hotbed of mental illness, especially depression.  I married an academic who also had depression on both sides of his family.  Finally, effective treatment arrived!  My husband and I began seeing a psychiatrist, sorting out the tangle of circumstances that were threatening to overwhelm our marriage.  We’ll never be perfect people but at least we know what we’re dealing with.

When a depressed person commits suicide it is a tragedy for the immediate family and close friends but a person walking around with depression and anxiety can do even more damage.  Anyone in his or her path is at risk: servers in restaurants, fellow drivers on the road, co-workers, not to mention friends and family, who often bear the brunt of the person’s negative emotions.  These days I try to be careful not to inflict my impatience or worry on innocent bystanders.  I make a particular effort to be cordial to the young people in Mumbai who help me with computer problems.  Imagine what their day is like!

In contrast to the 1950’s, today’s medical scene offers a wide array of options for dealing with depression and anxiety, from the minimally invasive ones like cognitive therapy to the medications for depression and anxiety that work very well for many people.  I’m not in favor of going out and medicating yourself every time you have a fight with your boss.  I also think that there are times in your life when it’s important to really feel your emotions, as painful as that may be.  On the other hand, I do take synthroid for my hypothyroidism and I think it makes sense to get treatment for depression if it is having a negative impact on your life.  Treating depression may also bring collateral benefits for the person’s health.  A long term study of twins showed that depression almost doubles the risk of heart disease. 

British actor Hugh Laurie, who portrays quintessential depressive Dr. Gregory House, has spoken of his own battles with depression.  This is a quote from his Wikipedia bio, “[Laurie} stated in an interview that he first concluded he had a problem while driving in a charity demolition derby in 1996, during which he realised that driving around explosive crashes caused him to be neither excited nor frightened, but instead bored.   "Boredom," he commented in an interview on Inside the Actors’ Studio, "is not an appropriate response to exploding cars.”  Bravo, Hugh!

Pain is a Good Teacher

I was brought up in a family with Anglo values; we children were encouraged to be brave and ignore minor aches and pains. I now believe that, except for endurance athletes and soldiers on the battlefield, this is not good advice. Pain is your nervous system telling you that something may be wrong.

People who are serious about fitness become connoisseurs of pain. There is the muscle soreness that lets you know that you’re actually challenging the muscle and making it stronger; there are the nasty little twinges when you’re pulled a tendon a little too much; the more ominous, raw sensation of a sprain; and so on. Noticing these and applying a remedy if it is needed are part of treating your body with respect. Sore muscles can be stretched or massaged with a foam roller. Pulled tendons and sprains can be treated with heat and ice.

When a little pain is ignored it can turn into a serious problem. I have thin skin, literally; the corneas of my eyes are thin too. In winter I will often get a little cut or nick on my hand. If I put a band-aid and antiseptic on it right away, it heals quickly. If I don’t, it will turn into a persistent sore painful enough to keep me awake at night. When I was about thirty I used to get a creepy little pain in my lower back, no big deal; I never went to a doctor about it. I now believe that this was when my reproductive system was beginning to self-destruct.

Strength Ball Training

These days a lot of interesting work on health and fitness is being done in Canada.  Strength Ball Training, by Lorne Goldenberg and Peter Twist, builds on this work.  I started using SBT a couple of years ago when I was no longer making progress with my workout at the time, a challenging program involving fairly heavy weights, stretching, and aerobic exercise.  I especially wanted to work on my core, which had been helped, but not completely shaped up, by ab machines at the Y.  (This was before I knew about Ab Ripper X.)

The exercises in this book employ stability balls, medicine balls, weights, and occasionally weight machines.  The program particularly emphasizes core work and balance but all major body parts are covered.  Because of the element of instability introduced by the ball the exercises get into little in-between areas that weights and weight machines don’t touch.  On a recent trip to Vancouver I visited Twist, an exercise facility owned by Peter Twist.  Its main clientele is hockey players so the emphasis on core work and balance makes sense.

What first impressed me about SBT was the quality, the amount of care that has gone into every aspect of the book and the accompanying DVD.  The introduction explains the approach and cites recent research. The instructions and photo accompanying each exercise are clear and helpful and the beautifully produced DVD demonstrates proper form for many, though not all, of the exercises.
Exercises are arranged in categories depending on the part of the body being worked and a sixteen week program is included in the back. 

When I started using SBT, I tried the sixteen-week program and saw dramatic changes not only in my core but also in my upper arms and legs.  I'm now following the same pattern, selecting eight or more exercises from different parts of the book and changing the selection every four weeks.  The instructions for each exercise have advice about progressions, so the possibilities are really endless. Some strength training programs are illustrated with photos of people who look like the Michelin Man. The people in this book look like regular people in very good shape. That's how I want to look.

My Possessions

In his book The Feeling of What Happens neuroscientist Antonio Damasio makes the interesting point that each of us has one and only one body.  I believe that the only things I truly own are my physical body and my time.  I do not own another person (and Sadie Pearl the cat would be the first to tell you that I don’t own her either).  The books, clothes, and other stuff that I normally think of as belonging to me will be mine only while I am here to use them.  When I came into this world, small and naked, I had only my body and my time and those will be mine until I leave it.

Stretching

When I was in elementary school we lived next to a library and I would often go to look around at the books and pictures that were there.  One day I found a book with pictures of a thin, brown-skinned man bending and twisting his body in extraordinary ways, an exotic sight to my 1950’s-little-kid eyes.  My mother told me that that was yoga.

Fast forward forty years.  I am lying on my back in savasana (“Corpse Pose”) on the floor of a large high-ceilinged room in a commercial building in downtown Bloomington, Indiana.  Sunlight streams in on the worn and faded colors of Oriental rugs that carpet the floor.  A tape of Enya plays softly in the background.  I re-discovered yoga in my early forties as a respite from the rush and stress of a busy real estate career and for years I went to classes several times a week.  Some yoga practitioners believe that yoga is the only exercise you need.  For me, cardio and weight-lifting turned out to be essential so there was no more time for yoga classes

Breathing is one of the central concerns of hatha yoga, the inward, invigorating inhalation and the relaxing exhalation, which is often twice as long in breathing exercises.  When I was in my thirties I was always trying to do things more quickly, to make my body go as fast as my thoughts.  In my forties I discovered that relaxing, letting go, was the essential other side of the coin, to slow the thoughts down to the pace of the body. 

I don’t go to yoga classes but I’ve incorporated some good yoga habits into my life.  If I’m in heavy traffic I try to pay attention to my breathing and make the exhale twice as long as the inhale.  When I got frozen shoulder, yoga stretches helped bring it back to normal.  And, in the evenings after I’ve done a heavy workout, I stretch, usually the resistance stretching I learned from Anne Tierney and Steve Sierra, a system similar to yoga. 

Some recent studies seem to cast doubt on the benefits of stretching.  Athletes used to be told to stretch before and after exercise to improve performance and prevent injuries.  Acute stretching immediately before exercise actually diminishes performance in some tasks.  Some researchers also question whether stretching has any effect on exercise related injuries.

If exercise doesn’t improve performance or prevent injury why bother? Because exercise improves flexibility and helps you to relax.  When you do strenuous exercise you break the body down a little so it will build itself up stronger.  The rebuilding process comes when you rest.  When I’m trying to sleep I sometimes use a yoga technique:  I slow my mind down enough so I can feel the little pulses in the tips of my fingers and just pay attention to those…

Statistics and the Twenty Year Rule: Why the Old Standbys May Be Safer Than Newly Approved Drugs

For much of my adult life, twenty-five years, I had the same doctor. She was a fine internist who took wonderful care of me whenever there was a crisis but we had our differences. In 2000, when my cholesterol was high, she wanted me to take a statin. Instead, I opted for changes in diet and exercise. A couple of years later when a DEXA showed osteopenia, low bone density, she urged me to take a bisphosphonate. I said “No, thanks.” to that too and increased my intake of calcium and vitamin D.

As I told my doctor, my resistance to taking new medications has partly to do with my medical history. In the mid 1940’s when she was pregnant with me my mother took diethylstilbestrol (DES), which was thought at the time to prevent miscarriages. By the 1970’s DES was found to be associated with an increased risk of cancer in girls prenatally exposed to it. In 1978 after I had a complete hysterectomy my doctor at the time said, “Take estrogen or you will get osteoporosis.” So I took estrogen. In 2002 a large Women’s Health Initiative (WHI) study associated hormone replacement therapy with an increased risk of heart disease, stroke, and breast cancer. If I started taking statins in 2000 at the age of 54, I reasoned, new research in the 2020’s would show why that had been a bad idea. By then I would be in my 70’s and I would not be amused.

How can a person weigh and evaluate the benefits and risks associated with various options? An excellent  article in the September 24-25 Wall Street Journal addresses that very topic. In “Designing a Smarter Patient,” Drs. Jerome Groopman and Pamela Hartzband discuss ways to help a patient make wise decisions about whether or not to accept particular treatments. A patient is told that a particular statin will reduce her risk of a heart attack by 30%, which sounds impressive. Then she goes to a government-sponsored web site and calculates her risk of getting a heart attack, which turns out to be 1%. So taking the statin will lower her risk from 1% to .67%, not much of a benefit considering the monetary cost and possibility of side effects.

In my case, the Cleveland Clinic’s Stroke Risk Calculator indicates that my 10-year risk of a stroke is 3%. Based on the WHI study, my increased risk of a stroke because of taking estrogen is .00012 (12 in 10,000 additional strokes), increasing my overall risk to 3.0036. I’m going to keep taking the estrogen to protect my bones.

New medications come on the market constantly. A recent study showed that many Americans believe that drugs approved by the FDA are “extremely effective” and have no serious side effects.  In fact, FDA approval only means that the benefits outweigh the risks, based on the research that has been done up to that point. There may be products already on the market that are more effective and safer. The risks (and benefits) of the new drug may not show up for years until a larger population of patients has tried them.

Should I Be Taking This? 3

BONIVA can cause serious side effects including problems with the esophagus, low blood calcium, bone, joint or muscle pain, severe jaw bone problems, and unusual thigh bone fractures.

Before starting BONIVA, tell your doctor if you have problems with swallowing, stomach or digestive problems, have low blood calcium, plan to have dental surgery or teeth removed or have kidney problems

Stop taking BONIVA and tell your doctor right away if you have pain or trouble swallowing, chest pain, or severe or continuing heartburn, as these may be signs of serious upper digestive problems. Call your doctor immediately if jaw problems, hip, groin, or thigh pain develop, or if you have symptoms of low blood calcium such as spasms, twitching, cramps in your muscles, or numbness or tingling in your fingers, toes, or around your mouth.

BONIVA is a prescription medicine used to treat or prevent osteoporosis in women after menopause. BONIVA helps increase bone mass and helps reduce the chance of having a spinal fracture (break).

Respect the Feet

Feet are the Rodney Dangerfield of the human anatomy; their health tends to be ignored until there’s a crisis, like diabetes or advanced arthritis. I was lucky enough to get started earlier in the cycle. I could never have reached my present level of fitness if I hadn’t had my feet fixed.

In 1994 I had started walking around the track at the Y and I noticed little pains on the sides of my feet. When Dr. Hoffman first looked at them he said, “These are pretty good feet but they’ll stay good longer if you get orthotics and wear them.” “That’s for me,” I said, and began a relationship that has been long, successful, and slightly weird. Casts were made of my feet and were sent away to the orthotics-works. A pair of plastic inserts came back and I started to wear them. Dr. Hoffman said, “If you feel any pain, come back.”

Things went along pretty well until about 2000 when I started exercising more and spending hours working in a darkroom with a cement floor. During this period I noticed a very painful spot at the back of my right hip. I went back to Dr. Hoffman and he adjusted my orthotics by filing down the plastic or gluing on little pieces of cork. He said, “If it’s not right, come back.” We repeated this process many, many times; the pain just wasn’t going away. I started experimenting myself, taping on little bits of cardboard to the orthotics to see what would help. Usually I ended up with cardboards taped to the orthotic on the right side rather than the left.

Finally, Dr. Hoffman identified the source of the problem: my right leg is about ¼” shorter than the left. When you’re young, you easily compensate for such minor asymmetries. As you get older, especially with the exercise I was doing, a little flaw can mean big trouble. Dr. Hoffman built up the orthotic on the right side and the pain went away.

In my post, "An Unfashionable Body", I talked about how I seem to have inherited my paternal grandmother's physique. In old age my grandmother had terrible trouble with her left knee and had to have cortisone shots to deal with the pain. I suspect this was because she had the same short right leg; the left knee got crunched together for all the decades of her life, including five pregnancies, and nobody ever spotted the real problem.

I still get pains in my feet sometimes. Oddly, they usually come not when I’m walking around but in the evening when I’m lying in bed. These days it’s likely to be a consistent dull ache in some small spot. When that happens I try taping cardboard pieces to the corresponding spot on the insert.  Sometimes the lumps of cardboard get pretty big. When I think I’ve got it right, or when the “edits” have gotten way too complicated, I take the orthotic in to Dr. Hoffman and he laughs. Then in three or four minutes he comes up with a rational solution, taking away the cardboards, filing, and gluing on cork. It’s a good thing he’s patient and has a sense of humor.

This experience has taught me that foot problems can cause knee, hip, and back pain. If that pain goes on for a long period it will damage or destroy the affected bones. I wonder how many knee and hip replacements could have been headed off if the underlying foot problems had been corrected in time.  Note to insurers, legislators, and anyone else wanting to cut health care costs: recommend that everyone over forty have their feet checked by a podiatrist at least once.

The pictures below show my orthotics, top and bottom. The right side has “edits” by Dr. Hoffman and by me.