Obstacles To Weight Loss: What Gets In The Way? (cont.)

Katz: There are no universal health problems associated with drinking cow's milk. For people not intolerant to milk, I recommend regular consumption of low or preferably non-fat dairy. There is, in fact, evidence from clinical trials such as the DASH study, which stands for Dietary Approaches to Stop Hypertension, of unique benefit from diets that include non-fat dairy. Certainly the calcium is beneficial to bone health. However, there is some evidence to suggest that introducing cow's milk early in life, within the first year, may contribute to food allergies and might even contribute, through an immune system effect, to the risk of diabetes. These effects are uncommon, but among other things argue for human breast milk whenever possible for the first nine to twelve months of life.

Many adults are deficient in the enzyme lactase, and as a result experience discomfort when they consume milk or other dairy products. For people in this category substitution of soy milk for cow's milk is a particularly good idea. For most others it's fine but not necessarily worth the effort, for as you point out soy milk may be much harder to find.

Member: When I eat, I like to drink wine with my meal. They say alcohol is bad for weight loss, but how true is it? Can you give me enough reason to quit drinking?

Katz: I like to drink wine with my meal, too, so I won't try to talk you out of it. There is convincing evidence that approximately one glass of wine per day for a woman and up to two glasses of wine per day for a man lowers cardiovascular disease risk. There is a tradeoff with regard to calories. Let's talk about calories: Carbohydrates provide 4 calories per gram. Protein provides 3 to 4 calories per gram. And fat provides 9 calories per gram. This, by the way, is why most nutrition experts agree that some restriction of dietary fat is so important to lifelong weight control. Alcohol provides 7 calories per gram, placing it toward the high end of the spectrum. These calories however will not make you gain weight if they are instead of, rather than in addition to, other calories consumed that day.

Life is made of choices and tradeoffs. If you are struggling with your weight it might indeed help you to cut alcohol out of your diet. But there are doubtless many other places in your diet those calories could come from. If your glass of wine is a priority for you find someplace else of lesser priority from which to cut those calories. L'Chaim!

Member: Thank you for being here! I'll be getting a copy of your book!

Katz: Thank you.

Member: I am 42 years old and female. I have no health problems. I have been following a low-calorie diet for about three weeks. The first week I lost 4 kilos with 1,000 calories, the second week I lost just one kilo with an 850 calorie diet, and the third week I lost only half a kilo with a 750 calorie diet. Can you tell me why I stopped losing weight despite having a small amount of food?

Katz: Yes, I can. But before I do, let me suggest to you and everyone else that I actually don't think rapid weight loss diets are such a great idea. If I had to guess, I would guess you have "been there, done that" before, and the reason you are doing it again, is because the weight loss before has been re-gained. I actually recommend to people that they never go on a diet again. Instead, if you learn to eat well, for the rest of your life, you can optimize your weight without that exasperating up and down, roller coaster ride.

Now to your question. You are hitting a weight loss plateau. This occurs because most of our calories are burned in basal metabolism, which is simply the work required to keep all of our cells alive. Basal metabolism is directly related to body mass. So in other words, the calories required to maintain your weight will go down as your weight goes down because there is less of you. When calories are cut from the level required to maintain weight, weight loss occurs. Weight loss continues until a new equilibrium is reached, where the number of calories you are now consuming is sufficient to maintain your new, lower weight.

The only way to lose additional weight is to do what you've done: Cut out even more calories. The scenario then repeats. It often ends when you reach a level of calorie intake you simply can't tolerate, and then go off the diet altogether. Don't let that happen to you. Work on optimizing the way you eat and your activity level. And then don't let the scale tell you that you're not succeeding. Making such changes is success. It will lead to better weight control. It will lead to improved health. It's definitely the way to go.

Lastly, I would add that 4 kilograms of weight loss in a single week very strongly suggests the loss of body water as well as fat. This often occurs right at first when calories are restricted. Once body water is lost it's lost and that weight loss will not continue. This may be another reason why your weight loss dropped off so much between the first and second weeks.

Member: What is your suggestion, Dr Katz, about losing weight gained from being in a hypothyroid condition?

Katz: My suggestion is that you should not remain in a hypothyroid condition. It's very important for overall health that thyroid function be normal, because thyroid hormone regulates so many aspects of our metabolism. For most people, difficulty with weight control has nothing to do with thyroid dysfunction. But thyroid dysfunction can certainly lead to difficulty with weight control. Your doctor can very readily check your thyroid function with a test called, "TSH." This stands for thyroid stimulating hormone. If this level is clearly normal, so, too, is your thyroid function.

If the value is in the normal range but on the high side many physicians are now willing to try low-dose thyroid supplementation to achieve a value in the lower end of the normal range. So if concerned about your thyroid function address it with your doctor, ask about your TSH, and discuss the value to make sure that hypothyroidism is not further complicating the already difficult challenge of weight control.

Member: But if it is treated, then what? Would a regular diet work or would anything special be necessary to get a proper metabolism to be normal? (I gained 125-150 pounds or thereabouts from being undiagnosed hypothyroid for two years).

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