Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
What is the role of diet in the treatment of obesity?
The first goal of dieting is to stop further weight gain. The next goal is to
establish realistic weight loss goals. While the ideal weight corresponds to a BMI of 20-25,
this is difficult to achieve for many people. Thus success is higher when a goal
is set to lose 10% to 15% of baseline weight as opposed to 20% to 30% or greater.
It is also important to remember that any weight reduction in an obese person
would result in health benefits.
One effective way to lose weight is to eat fewer calories. One pound is equal
to 3500 calories. In other words, you have to burn 3500 more calories than you
consume to lose one pound. Most adults need between 1200- 2800
calories/day, depending on body size and activity level to meet the body's
energy needs.
If you skip that bowl of ice cream, then you will be one-seventh of the way
to losing that pound! Losing one pound per week is a safe and reasonable way
to target off extra pounds. The higher the initial weight of a person, the
more quickly he/she will achieve weight loss. This is because for every
one kilogram (2.2 pounds) of body weight, approximately 22 calories are required
to maintain that weight. So for a woman weighing 100 kilograms (220 pounds), he
or she would require about 2200 calories a day to maintain his or her weight,
while a person weighing 60 kilograms (132 pounds) would require only about 1320
calories. If both ate a calorie-restricted diet of 1200 calories per day, the
heavier person would loose weight faster. Age also is a factor in calorie
expenditure. Metabolic rate tends to slow as we age, so the older a person is,
the harder it is to lose weight.
There is controversy in regard to carbohydrates and weight loss. When
carbohydrates are restricted, people often experience rapid initial weight loss
within the first two weeks. This weight loss is due mainly to fluid loss. When
carbohydrates are added back to the diet, weight gain often occurs, simply due
to a regain of the fluid.
General diet guidelines for achieving and (just as importantly) maintaining a
healthy weight:
A safe and effective long-term weight reduction and maintenance diet has
to contain balanced, nutritious foods to avoid vitamin deficiencies and other
diseases of malnutrition.
Eat more nutritious foods that have "low energy density." Low energy
dense foods contain relatively few calories per unit weight (fewer calories in a
large amount of food). Examples of low energy dense foods include vegetables,
fruits, lean meat, fish, grains, and beans. For example, you can eat a large
volume of celery or carrots without taking in many calories.
Eat less "energy dense foods." Energy dense foods are high in fats and
simple sugars. They generally have a high calorie value in a small amount of
food. The United States government currently recommends that a healthy diet
should have less than 30% fat. Fat contains twice as many calories per unit
weight than protein or carbohydrates. Examples of high-energy dense foods
include red meat, egg yolks, fried foods, high fat/sugar fast foods, sweets,
pastries, butter, and high fat salad dressings. Also cut down on foods that
provide calories but very little nutrition, such as alcohol, non-diet soft
drinks, and many packaged high-calorie snack foods.
About 55% of calories in the diet should be from complex carbohydrates.
Eat more complex carbohydrates such as brown rice, whole-grain bread, fruits and
vegetables. Avoid simple carbohydrates such as table sugars, sweets, doughnuts,
cakes, and muffins. Cut down on non-diet soft drinks, these sugary soft drinks
are loaded with simple carbohydrates and calories. Simple carbohydrates cause
excessive insulin release by the pancreas, and insulin promotes growth of fat
tissue.
Educate yourself in reading food labels and estimating calories and serving
sizes.
Consult your doctor before starting any dietary changes. You doctor should
prescribe the amount of daily calories in your diet.
Gallstones are stones that form when substances in the bile harden. Gallstones (formed in the gallbladder) can be as small as a grain of sand or as large as a golf ball. There can be just one large stone, hundreds of tiny stones, or any combination. The majority of gallstones do not cause symptoms.
High blood pressure, also known as hypertension, is a repeatedly
elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above
140 with a diastolic pressure above 90. There are two causes of high blood pressure, primary and secondary. Primary high blood pressure is much more common that secondary and its basic causes or underlying defects are not always known. It is known that a diet high in salt increases the risk for high blood pressure, as well as high cholesterol. Genetic factors are also a primary cause. Secondary high blood pressure is generally caused by another condition such as renal hypertension, tumors, and other conditions. Treatment for high blood pressure is generally lifestyle changes and if necessary, diet.
Gout is a condition that results from crystals of uric acid depositing in tissues of the body. Gout is a condition that can lead to abnormally elevated levels of uric acid in the
blood, recurring attacks of joint inflammation (arthritis), deposits of
hard lumps of uric acid in and around the joints, and decreased kidney
function and kidney stones.
Gas or "intestinal gas" means different things to different people. Everyone has gas and eliminates it by belching or farting (passing it through the rectum).
A skin tag is a small benign growth of skin that projects from the surrounding skin. Skin tags can vary in appearance (smooth, irregular, flesh colored, dark pigment, raised). Skin tags generally do not cause symptoms unless repeatedly irritated. Treatment for skin tag varies depending on the location on the body.
Hypothyroidism is any state in which thyroid hormone production is below normal. Normally, the
rate of thyroid hormone production is controlled by the brain at the pituitary.
Hypothyroidism is a very common condition and the symptoms of hypothyroidism are
often subtle.
Liver cancer is the fifth most common cancer in the world and the majority of patients with liver cancer will die within one year as a result. Patients with associated cirrhosis caused by chronic hepatitis B or C infections, alcohol, and hemochromatosis are at the greatest risk of developing liver cancer. Many patients with liver cancer do not develop symptoms until the advanced stages of the tumor which usually makes prognosis poor. The combination of an imaging study (ultrasound, CT, or MRI scans) and an elevated blood level of alpha-fetoprotein will most effectively diagnose liver cancer, while a liver biopsy can make a definitive diagnosis. Medical treatments, including chemotherapy, chemoembolization, ablation, and proton beam therapy, are not very effective. Surgical removal of the tumor or a liver transplant may be most effective in certain cases.
Pancreatic cancer is a malignant tumor of the pancreas. Pancreatic cancer has been called a "silent" disease because early pancreatic cancer usually does not cause symptoms.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Cellulitis is an acute spreading bacterial infection below the surface of the skin characterized by redness, warmth, inflammation, and pain. The most common cause of cellulitis is the bacteria Staph (Staphylococcus aureus).
Low testosterone can affect both men and women. Causes of low testosterone in males include undescended testicles and injury to the scrotum. Low testosterone in females includes ovary conditions. Treatment for low testosterone in men includes testosterone replacement therapy. Currently there is no FDA approved testosterone treatment for women.
A stroke results from impaired oxygen delivery to brain cells via the bloodstream. A stroke is also referred to as a CVA, or cerebrovascular incident. Symptoms of stroke include: sudden numbness or weakness of the face, arm or leg. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, or loss of balance, and/or sudden severe headache with no known cause. A TIA, or transient ischemic attack is a short-lived temporary impairment of the brain caused by loss of blood supply. Stroke is a medical emergency.
Though the cause of stomach cancer is unknown, risk factors for stomach cancer include diet, H. pylori infection, smoking age, gastritis, stomach surgery, family history, and pernicious anemia. Symptoms include stomach discomfort, feeling full after a small meal, nausea and vomiting, and weight loss. Treatment depends upon staging and may involve surgery, radiation therapy, or chemotherapy.
A pulmonary embolism occurs when a piece of a blood clot from deep vein thrombosis (DVT) breaks off and travels to an artery in the lung where it blocks the artery and damages the lung. The most common symptoms of a pulmonary embolism are shortness of breath, chest pain, and a rapid heart rate.
Cholesterol is naturally produced by the body, and is a building block for cell membranes and hormones. Low-density lipoprotein (LDL) cholesterol is the "bad" cholesterol, conversely, high-density lipoprotein (HDL) cholesterol is the "good" cholesterol. High cholesterol treatment includes lifestyle changes (diet and exercise), and medications such as statins, bile acid resins, and fibric acid derivatives.
Heart attack happens when a blood clot completely obstructs a coronary
artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical
instability of the heart.
There are several types of kidney cancer, including renal cell cancer (renal adenocarcinoma or hypernephroma), transitional cell carcinoma, and Wilms tumor. Symptoms of kidney cancer include blood in the urine, an abdominal lump or mass, chronic pain in the side, and tiredness. Treatment of kidney cancer--which may include surgery, arterial embolization, radiation therapy, biological therapy or chemotherapy--depends upon the stage of the disease and the patient's overall health.
Esophageal cancer is a disease in which malignant cells form in the esophagus. Risk factors of cancer of the esophagus include smoking, heavy alcohol use, Barrett's esophagus, being male and being over age 60. Severe weight loss, vomiting, hoarseness, coughing up blood, painful swallowing, and pain in the throat or back are symptoms. Treatment depends upon the size, location and staging of the cancer and the health of the patient.
Restless leg syndrome (RLS or restless legs syndrome) is a common cause for painful legs that typically eases with motion, and becomes worse and more noticeable at rest. This characteristic nighttime worsening can frequently lead to insomnia. Treatment of the symptoms of restless leg syndrome is generally with medication as well as treating any underlying condition causing restless leg syndrome.
Jock itch is an itchy red rash that appears in the groin area. The rash may be caused by a bacterial or fungal infection. People with diabetes and those who are obese are more susceptible to developing jock itch. Antifungal shampoos, creams, and pills may be needed to treat fungal jock itch. Bacterial jock itch may be treated with antibacterial soaps and topical and oral antibiotics.
There are many causes of scalp hair loss. This featured article covers the common ones such as patchy hair loss (alopecia areata, trichotillomania, and tinea capitis), telogen effluvium, and androgenetic alopecia (male-pattern baldness, female-pattern baldness).
Carpal tunnel syndrome is a condition in which irritation of the wrist's median nerve causes tingling and numbness of the thumb, index, and the middle fingers. This condition is known as tarsal tunnel syndrome in the ankles and feet. Treatment of carpal tunnel syndrome depends on the severity of the symptoms and the nature of any disease that might be causing the symptoms.
Polycystic ovarian syndrome (PCOS), also known by the name Stein-Leventhal syndrome, is a hormonal problem that causes women to have a variety of symptoms including irregular or no menstrual periods, acne, obesity, and excess hair growth. Treatment of PCOS depends partially on the woman's stage of life and the symptoms of PCOS.
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
Heart disease (coronary artery disease) is caused by a buildup of cholesterol deposits in the coronary arteries. Risk factors for heart disease include smoking, high blood pressure, heredity, diabetes, peripheral artery disease, and obesity. Symptoms include chest pain and shortness of breath. There are a variety of tests used to diagnose coronary artery disease. Treatment includes life-style changes, medications, procedures, or surgery.
Snoring, like all other sounds, is caused by vibrations that cause particles in the air to form sound waves. While we are asleep, turbulent air flow can cause the tissues of the nose and throat to vibrate and give rise to snoring. Any person can snore. Snoring is believed to occur in anywhere from 30% of women to over 45% of men. People who snore can have any body type. In general, as people get older and as they gain weight, snoring will worsen. Snoring can be caused by a number of things, including the sleep position, alcohol, medication, anatomical structure of the mouth and throat, stage of sleep, and mouth breathing.
The main features of metabolic syndrome include insulin resistance, hypertension (high blood pressure), cholesterol abnormalities, and an increased risk for clotting. Patients are most often overweight or obese. Lifestyle modification such as the Mediterranean diet, exercise, and quitting smoking are the preferred treatment of metabolic syndrome.
A pilonidal cyst is a cyst that forms near the cleft of the buttocks. The cysts are thought to be caused by the penetration of loose hairs into the skin. Symptoms and signs include pain, swelling, redness, warmth, and drainage of pus from the area of the cyst. Treatment of a pilonidal cyst involves incision and drainage.
Male breast cancer accounts for 1% of all breast cancers, and most cases are found in men between the ages of 60 and 70. A man's risk of developing breast cancer is one in 1,000. Signs and symptoms include a firm mass located below the nipple and skin changes around the nipple, including puckering, redness or scaling, retraction and ulceration of the nipple. Treatment depends upon staging and the health of the patient.
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