I am having a real weight problem and would like your advice on the best diet.?




Both of us are hesitant to answer this one because we struggle too. You have probably heard of all kinds of diets, and when subjected to a comparison study, much difference did not seem to exist between the Atkins (very low carbohydrates), Zone (low carbohydrates), and Ornish (very high carbohydrates, low fat) diets.
 
Weight loss appears to be more rapid with the Atkins diet, but a year later, things seem to be much the same among different groups.
 
In reality, the secret to losing weight can be summarized in two words: “Eat less.” Gimmicky dietary manipulation is not likely to have “staying” power.
 
Portion sizes are major problems in many parts of the world. Eating between meals is a big problem. Failure to eat with the family at the dinner table is an additional problem. Eating slowly, so as to allow a sense of satiety to kick in, is important. We know folk who can devour 2,000 calories before their stomach can signal “Enough!”
 
Another key point to consider is that a person has to be aware of the caloric value of foods, so as to understand the number of calories in a given treat. Chocolate bars and many other snack bars, for example, are full of calories; most ice creams are just loaded, too. Many of us like a treat, but we sometimes treat ourselves too often.
 
A very interesting article in The New England Journal of Medicine (October 12, 2006, p. 1563) reported a study that divided into three groups some 314 people who had lost more than 40 pounds. One group had regular face-to-face interaction with a therapist; the second had Internet interaction; the third received a quarterly newsletter. The face-to-face group kept their weight off the best. One interesting result was that daily weighing predicted better outcomes; consequently, programs such as Weight Watchers would seem to us to be a good idea.
 
  


What are your thoughts on supplements?




We are both vegetarians and consequently are aware of potential deficiencies in the vegetarian diet. In particular, we are concerned about vitamin B12, as this comes from animal sources. We strongly believe, however, that the diet is to be the main source of our nutrients.
 
As we have repeatedly stressed, variety and whole foods will supply most of our nutrient needs in abundance. We all need small amounts of regular sunshine for vitamin D. The vitamin B12 story means that vegetarians should take either dairy or a dairy equivalent. That “equivalent” is found only in “fortified” soy or rice “milks”--homemade varieties do not make the grade. We need to take three glasses of milk or milk equivalent a day.
 
The idea that supplements--particularly antioxidants--might protect against such things as cancer is attractive but not supportable with the facts.
 
Patients with a variety of chronic diseases have not been benefited by supplements; in fact, some have been harmed by them.
 
In an analysis of more than 60 randomized trials involving nearly a quarter of a million persons, vitamin supplements were tested, both singly and in combinations.
 
In the 47 studies with the best methodology, beta carotene, vitamin A, and vitamin E, given either singly or in combination, were associated with between a 4 to 16 percent higher mortality. Vitamin C and selenium had no effect on mortality risk.
 
These are relatively small risks, but they do suggest we have no basis on which to promote such supplements.
 
Once again, we recommend spending your money on good wholesome food rich in taste, color, and variety. God is the best nutritionist available.
 
  


I have osteoarthritis and find Celebrex really helps. But I am frequently told it’s not good for my heart. What do you recommend?



Celebrex is a very good pain reliever for osteoarthritis. It may be important as an agent to reduce polypi in the colon, but as is often the case, the story is not all good.
 
Celebrex, like Vioxx, which has been withdrawn from the market, inhibits an enzyme with a long name: cyclooxygenase-2. Renamed “cox-2 inhibitors,” this group of medications blocks the inflammatory response and, consequently, the pain associated with arthritis.
 
Unfortunately, the endothelium, or blood vessel lining, also has metabolic processes that help dilate blood vessels, which need this enzyme action. When the enzyme gets blocked, the blood vessels are also hampered in their reactivity; an increased risk of heart attack results.
 
Another area of concern with Celebrex is risk of stomach bleeding. This increases some 260 percent over study controls, and if aspirin is also used, goes up to about 370 percent.
 
It is difficult to know what to advise someone with severe osteoarthritis, but being aware of the risks will help you be cautious with the medication.
 
In your column on intermittent claudication (Adventist Review, March 22, 2007), you didn’t emphasize the role of tobacco. Why not?
 
The question didn’t come quite like this; it came from a medical doctor who took us to task for not talking about the dangers of smoking in peripheral vascular disease.
 
First, we want to thank the doctor for pointing out our extremely biased “Adventist” outlook and answering as though every Adventist doesn’t have or hasn’t had a problem with tobacco. Second, he was right. Peripheral vascular disease is usually caused by atherosclerosis, but tobacco is a major, major cause of atherosclerosis and intimately related to other vascular problems, too. Of course, we don’t claim to be experts on everything, but we want to correct our omission.
 
  


In your column on intermittent claudication (Adventist Review, March 22, 2007), you didn’t emphasize the role of tobacco. Why not?



The question didn’t come quite like this; it came from a medical doctor who took us to task for not talking about the dangers of smoking in peripheral vascular disease.
 
First, we want to thank the doctor for pointing out our extremely biased “Adventist” outlook and answering as though every Adventist doesn’t have or hasn’t had a problem with tobacco. Second, he was right. Peripheral vascular disease is usually caused by atherosclerosis, but tobacco is a major, major cause of atherosclerosis and intimately related to other vascular problems, too. Of course, we don’t claim to be experts on everything, but we want to correct our omission.
 
Some people think smoking fewer cigarettes is safer than smoking more--but in the case of vascular disease, cutting down doesn’t help. A 20-year study of 51,000 smokers found those cutting down from 20 to 10 cigarettes per day had the same death rate from heart disease as those smoking 20 per day.
 
Tobacco is a major cause of coronary artery disease, sudden cardiac arrest, stroke, and peripheral vascular disease. Quitting completely reduces the risk.

Thanks, Doc, for making this point!
 
  


My husband is a real couch potato. How can I get him active?




We suggest you have a nice, friendly, and supportive chat with your husband. Tell him you love him, want him around a long time, and are interested in participating in activities with him. Activities like what? Well, a daily walk for starters. Then you could garden together or--depending on your age--develop some exciting and health-promoting activities. Exercise doesn’t have to be boring.
 
Swimming, or better yet, diving or snorkeling, offers a change; canoeing or kayaking, bike riding, hiking, taking the dog for a walk--all are different and better than sitting on the couch all day.
 
We recently read about a study reported in The Journal of the American Medical Association as a letter (April 25, 2007, p. 1772). The researchers took a dozen healthy, older adults and put them to bed for 10 days. They were allowed up to go to the bathroom, but did little else. These folk showed a large loss of skeletal muscle, but the loss actually occurred during the last five days.

The older we get, the more important it is to remain active, and weight-bearing exercises assume even greater importance.

So “chivy” that husband of yours, and get him active!
 
 


 
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