Nutrition, Weight Control and Great-Tasting Food (cont.)

Dr. LaPuma: Good for you for wanting to make something the night before. I think that's fabulous. Would you like to be my patient? (Laughs!) Here's what I tell my patients to bring to work. First, I tell them to try to cook for the week instead of just the night before because it's easier to cook in quantities than one or two meals at a time. It only takes a couple minutes longer to make an extra serving or two. Second, I suggest that my patients bring containers of yogurt; containers of good microwaveable soups, grains, and stews (I like Nile Foods, and Fantastic Foods, and Dr. McDougal Foods); and whole fruits of any kind. Third, if you want to cook the night before, I would make a Boca burger on a whole grain bun with lots of arugula and catsup and onions. Or, some guacamole with tortillas and jicama. Or, hummus with extra lemon and garlic plus some pita bread. Or, a couple of baked potatoes with some roasted or grilled vegetables on the side.

tina_tomcko_webmd: I am 5'-4" and weigh about 126 pounds. I need to lose a good amount of weight and was wondering what kinds of food would help me do this?

Dr. LaPuma: I understand that you feel like you'd like to lose weight, but actually, your weight is really healthy right now. In fact, you're not even technically overweight, although I understand you may feel like it. If you would like to redistribute a little of your weight and convert some of what is probably a healthy amount of fat into even more muscle, you might begin (if you don't already) an aerobic exercise program. You should pick an activity that you really like, regardless of what it is as long as you'll do it regularly. There really isn't a secret or magical food to help anyone lose weight. It really comes down to calories in and calories out. As I said, you don't really need to lose weight, in my opinion. But if you wanted to build more muscle, that would be a goal that I could happily endure, and the best way to do that would be with more exercise.

janewilson_webmd: Right now everyone is saying how bad pasta is for you, but I love pasta! How can I eat it and still lose weight?

Dr. LaPuma: I don't think 20 million Italians can be wrong. And in Italy, there is both semolina pasta (refined wheat), and whole wheat pasta. In my opinion, pasta is not bad for you. It's how much of it you eat and what else you eat with it that can put pounds on (and make you feel sluggish, tired, older and like you have no energy). The way I would eat pasta (and actually do eat pasta) is mixed in with a lot of other foods. Roasted green and yellow and red peppers with wagon wheels; chunky tomato garlic sauce with radiatore; roasted garlic sauce with roasted onions for spaghetti and fettuccini. In fact, in the May issue of Health magazine, I wrote a recipe for Ratatouille Pasta. I used whole wheat spaghetti and summer vegetables, but I used twice as many vegetables as you'd expect for two ounces of pasta. And, two ounces expands to a lot once it's cooked.

marilyn21_webmd: How do you feel about high-protein, low-carbohydrate diets for diabetics?

Dr. LaPuma: High-protein, low-carbohydrate diets are effective in the short term in helping people lose weight (and as weight goes down, blood sugar does down, too). They work because the body draws on its own store of glycogen while it is getting very little carbohydrate to make more glycogen. As glycogen is burned up, the body sends out water to pass it through the kidneys. So low-carbohydrate, high-protein diets help you lose weight because you lose water, not because you lose fat and not because you can permanently control your blood sugar this way. High-protein, low-carbohydrate diets went out of fashion in 1971 (they were popular then) and I think the same will start to happen next year. The reason is simple. They don't work for the long term, and no one can stay on them (even eating bacon and burgers and cheese without a roll, corn or a piece of fruit). It gets boring.

Moderator: So these types of diets were in vogue previously?

Dr. LaPuma: Yes, the high-protein diet was popular in 1969 and it died out in 1971. It cycles out every 30 years.

al_pavy_webmd: What are most Americans doing wrong when it comes to diet?

Dr. LaPuma: The answer to this is really unhappily simple. We eat too many highly refined convenience foods and don't cook enough. I think if we just had a few more cooking skills and people would enjoy it more, people like to do more things that they're good at. And, in our clinic, for example, we give everybody a chef's knife and teach them how to use it. That way they become good at chopping and they want to do more of it. So there are other simple answers, too. We don't eat enough whole foods; we eat too many refined foods. There is a Burger King on every corner. But the real answer is that if we just knew a little bit more about how to cook in quantity and shop for foods that are in season, then it would be just as easy to pick up a pear as it is to pick up a Cinnabon.

Moderator: Do you see any way to solve this problem in the future?

Dr. LaPuma: Yes. Actually, I think cooking is coming back, and one bit of evidence for that is the proliferation of farmers' markets. There is one near my house that I go to on Saturday mornings. And, the growers and farmers are always answering questions about where their squash is from or how they grew their cantaloupe, or what type of corn they brought to market, or where the cheese maker lives. I think if we make it easy for people to have access to more fresh fruits and vegetables and offer people the skills they need to cook a little more, then we can control more of this in our own kitchens.

column_webmd: What size servings should people eat?

Dr. LaPuma: I tell my patients to use a nine-inch plate for dinner and a five-inch plate for a side dish. A nine-inch plate is now called a salad plate. But, as plates have gotten larger, servings have gotten larger too. In fact, some family restaurants don't have plates. They just have platters. So I think if a nine-inch plate is filled (don't use the rim, that's not what it's for), then it's a good indicator of what an average meal might be like for most people. The side plate should have chicken, or fish, or cheese, or even red meat if you eat red meat. Just by switching the two places -- by that I mean putting what we might consider a center-of-the-plate food on a side plate and side dishes in the center of the plate -- you can eat more of the right things and less of something that has more calories and often, for me anyway, a little less flavor.

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