The relationship between appetite and the commonly reported ‘carbohydrate addiction’ is less clear. This dietary phenomenon supposedly occurs because of a central imbalance in the metabolism of the neurotransmitter seratonin. The consumption of carbohydrate-rich foods is believed to boost seratonin levels, promote satiety and induce a mood calming effect.

Based on this hypothesis, all carbohydrates should be able to satisfy uncontrollable cravings (a baked potato should do the job just as well as a doughnut). However, this is not the case according to Professor Adam Drewnowski from the University of Michigan. He suggests that it is the ‘powerful hedonic synergy’ of fat and sugar that forms the basis of food cravings. In an interesting study, he discovered marked differences in food preferences between men and women. When males were asked to list 10 of their favourite foods, they expressed preferences for meat, fish and eggs. Obese women rated ice cream, chocolate, cookies, dough-nuts and pies high on their list. He concluded that whilst men prefer protein-rich foods, women’s desires tend toward mixtures of sugar and fat. This finding indicates that the term ‘carbohydrate addict’ may be a misnomer and the term ’sugar-fat addict’ may be more appropriate.

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As a doctor, I try to plant the seeds of success during those first, critical moments. If I create an atmosphere of trust, of caring, then there’s hope. If my tone is judgmental or threatening, then the process may be doomed.

The next step is to meet with those involved. If the patient herself asked for help, then the first appointment is with her; when the parents make the call, I may ask to see them first. In other cases it may be best to see everyone at the same time.

The initial evaluation may take one or more meetings. However, if the situation is life-threatening and the patient needs to be hospitalized, I don’t wait.

Every situation is different. If in your search for help you don’t feel the caregiver is responding to your needs, discuss the problem with him or her. If you are still not satisfied, keep looking.

The Initial Assessment

I perform a complete assessment of the problem before the patient and I agree on a plan for treatment. Too many professionals say, in effect, “Welcome to our facility, here’s how we’ll treat you, now tell me all about your problem.”

Typically I start by asking, “How may I help?” Patients often seem surprised that I play the role, not of adversary, but of collaborator on a joint project-as indeed I am.

The patient’s initial response is most revealing. Here are some examples drawn from recent cases:

“You can’t help me. My parents are the ones with the problem.” This comment is typical of anorexics, who feel they aren’t sick at all and have come just to get people “off their backs.”

“My father called me fat, so I started losing weight.” People with low self-esteem are very sensitive to such remarks. One fifteen-year-old patient, inspired by the Olympics, demonstrated a gift for gymnastics. When her coach said she might do better if she “lost a little weight,” she began to diet. Unfortunately, she focused on weight loss at the expense of everything else. If starvation had been an Olympic event, she would have qualified for a medal.

“/ look in the mirror and I get scared. I want to find some peace inside.” Some patients know they are hurting themselves and want help in stopping. Especially in anorexia, the more distress the patient feels, the more motivated she is to get treatment.

Follow the Leader

In conversation I follow my patient’s lead. Following someone’s concerns, hopes, and resistances is more productive than a mechanical, by-the-numbers interrogation.

Sometimes when I ask, “How can I help?” she replies, “You can’t help. I don’t want to be here.” I may then say, “Well, someone is concerned enough to insist that you come here. Maybe we need to look at what’s going on in your life that makes you feel you need to starve yourself almost to the point of death.” Or she may say, “I don’t think you can help-nothing has worked so far.” I might then ask, “What have you previously tried?” and explore why other efforts have failed. And because words mean different things to different people, I would explore what she means by certain terms. Does “desperate,” for example, mean “confused” or “suicidal”?

Many times, the most telling clues come from something a patient avoids saying, or hesitates over. If a patient tells me something is none of my business, I’ll respect that. But later, when we’ve established a higher level of trust, I may ask again.

Trust is crucial. It takes time to build trust, to demonstrate concern and show that my intention is to heal, not to harm. When I show a patient that I accept her feelings as valid-although I don’t necessarily accept her way of dealing with those feelings-I send the message that the patient herself is worthwhile.

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“It never failed,” says the 42-year-old writer from Kansas City, Missouri. “In mid to late November, I’d start gaining—usually about 10 pounds, 15 at the most. Then in April, I’d start losing.”

While Karen came to expect these seasonal ups and downs, she didn’t welcome them. Eventually, she made up her mind that they had to stop.

“It was fall 1996,” she recalls. “Winter was approaching, and I could feel the pounds creeping on again. I started thinking about how I never felt as well in the winter as I did in the summer, and I blamed the extra weight.” On the spot, she resolved to maintain her “summer weight”—142 pounds on her 5-foot-8′/2-inch frame— throughout the year.

A vegetarian and healthy eater, Karen knew her problem was a her activity level. “I’m a compulsive gardener,” she says. “In the spring and summer, I’d work outside until nightfall. But I couldn’t do that in fall and winter.” Likewise, she’d run 5 miles two or three times a week in nice weather. But once the temperatures dropped, she’d pack up her running shoes.

Karen realized that she had to stay active year-round. So she began changing activities with the seasons. When the weather put an end to gardening and running outdoors, she moved her exercise indoors, swimming at the local YMCA and working out on a cross-country ski machine at home. “It took some effort on my part,” she says. “There were days when I got home from work and all I wanted to do was eat dinner and lie on the couch. But I’d remind myself that if I didn’t want to gain weight, I had to move.

For Karen, staying active year-round made all the difference. She hasn’t noticed any seasonal fluctuations in her weight since 1996, when she launched her fall and winter fitness program. To this day, she maintains her weight at a healthy 142 pounds.

“I try to stay active, even though it’s much harder during the winter,” Karen says. “I just tell myself that as soon as spring comes around, I’ll be outdoors, doing all of the activities that I love.”

WINNING ACTION

Keep moving, no matter what the season. It’s a fact that we humans tend to be less active during the fall and winter months, when the temperature drops and the weather turns nasty. Just like bears, we want to hibernate. Don’t let your fitness program falter at this time of year. Invest in some home exercise equipment or join a health club. If there’s a college in your area, find out whether its gym facilities are open to the public. Or take up an outdoor activity such as cross-country skiing, ice-skating, or snowshoeing, all of which are wonderful winter fat-and-calorie burners.

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The Grain Group: (Bread, Cereal, Rice, and Pasta): 6-11 servings—The basis of any good eating plan, the grain group provides carbohydrates, energy, fiber, B vitamins, and sometimes iron. Although 6-11 servings sounds like a lot, a typical serving is just one piece of bread, half a cup of cooked rice or pasta, or ½-1 cup of cereal. I always tell my patients to eat whole-grain breads and cereals rather than refined products since they’re so much more nutritious and contain a lot more fiber. It’s particularly important that you get yourself good, high-quality bread, since most people get the bulk of their grain servings from bread. Check the label to make sure that the first ingredient is either whole wheat or whole wheat flour. If it says anything else, including enriched flour, find another product. I prefer whole wheat bread with at least 2 grams of fiber per slice. Read the nutritional information on the side of the wrapping. Some brands have as many as 5 grams of fiber per slice. But, of course, if you are eating a lot of Chitosan, you may need less other fiber, and as a fringe benefit of the plan, you may therefore be able to indulge your taste for that crispy French baguette—at least occasionally. After all, there’s nothing better than the taste of fresh-baked bread—except maybe the aroma!

Actual Weight.

Actual total cholesterol

Actual HDL. Actual LDL

Actual VLDL.

Actual triglycerides.

Ideal Weight.

Ideal cholesterol: 100 plus your
age

Ideal HDL: 50 or more

Ideal LDL: less than 100 Ideal VLDL: less than 20

Ideal triglycerides: less than 100

Now call your physician and ask for the results of your latest blood test. Specifically, you want to know your total cholesterol, HDL, LDL, VLDL, and triglyceride (blood fat) levels. If they are not available, or are more than a year old, arrange to have another test as soon as possible. Write your results below in the left column. Ideal levels are listed in the right column.

Now that you know where you are and where you want to be, tailor eating and exercise programs that meet your own personal needs by following the guidelines in this book. They are simple not only to understand but to stick to, because Chitosan makes a gentle, nonrigorous, weight-loss program as effective as a tough, almost impossible one.

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The results of this “Chitosan Biscuits” study were impressive and again, whet the appetite for more studies. The researchers noted that “When 3-6 grams a day of Chitosan were given in the diet to 8 healthy males, total serum cholesterol significantly decreased. . . .” But when the young men stopped eating the Chitosan biscuits, their cholesterol levels quickly jumped back up to where they had been. Not only that, but the amount of bile acids they excreted increased when they ate the Chitosan biscuits. This is important, for the body uses bile acids to make cholesterol. When there are fewer bile acids present, the body manufactures less cholesterol, so pushing out excess bile acids is important for good heart health. (The authors of this study theorized that Chitosan combines with the bile acids, preventing the body from reabsorbing them and using them to synthesize cholesterol. By tying up bile acids in the intestines, Chitosan may also help to reduce the risk of cancer of the colon.)

Chitosan’s ability to lower cholesterol in humans is supported by animal studies, including a 1989 study published in the Journal of Nutrition⁹ in which Chitosan was compared to cellulose and guar gum. Of the 3 fibers under examination, Chitosan “most effectively lowered cholesterol absorption.”

But in the study with the 8 young men and the biscuits, Chitosan did more than push down the total cholesterol: It also caused the good HDL cholesterol to rise. HDL (high-density lipoprotein) cholesterol is the helpful cholesterol that carries plaque and debris away from the artery walls and to the liver for disposal. While we want our total cholesterol levels to be low, we want our HDL levels to be high. During the course of this study, Chitosan increased the HDL levels from an average of 51 to 56—a 10 percent increase, which is both significant and healthful.

♦ Breast cancer—From the Journal of the American Medical Association comes a report¹ pointing out that information from animal experiments and human correlation studies strongly supports the hypothesis that dietary fat causes breast cancer.

♦ Breast cancer—From the Journal of the National Cancer Institute comes a review² of information taken from 12 case controlled studies. The authors of the review conclude that the rate of postmenopausal breast cancer could be cut some 25 percent if fat intake was reduced.

♦ Breast and colon cancer—A 1991 study³ reported in the American Journal of Clinical Nutrition reported that “Evidence relating dietary fat to cancer at sites such as the breast and colon is provided by experiments showing that animals fed high-fat diets develop cancer at these sites more readily than do animals fed low-fat diets, and by epidemiological data from different countries showing strong positive correlations between cancer incidence and mortality, and level of dietary fat. . . . The weight of evidence continues to indicate that long-term adherence to a low-fat diet can reduce the risk of some common types of cancer.”

♦ Colon cancer—A prospective study involving 88,751 women ranging in age from 34-59, found a positive association between dietary fat and the risk of colon cancer.⁴

♦ Colon cancer—When the past lifestyles of 906 Chinese patients with colorectal cancer were compared to those of 2,000 controls, researchers found a strong link between intake of saturated fat and the cancer. Those who ate the most saturated fat were 4 times as likely to be stricken as those who ate the least.⁵

♦ Ovarian cancer—For this study, ⁶ the dietary histories of 455 Italian women suffering from ovarian cancer were compared to those of 1,385 controls. A high-fat diet was found to be the riskiest, while one filled with green vegetables, whole grains, fish, and carrots offered the most protection.

This evidence associating excessive fat intake to various forms of cancer is overwhelming. On the one hand, that’s bad news. But on the other hand it’s good news, for it points us toward an easy solution. We have the wonderful opportunity to help reduce the incidence of cancer for ourselves, our loved ones, and all of society simply by reducing the amount of fat we take, and keep, in our bodies.

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One answer lies in products like Olestra. This is a “fat” that cooks and tastes like any other fat but the body cannot assimilate because its molecules are too large to be absorbed into the

bloodstream through the walls of the stomach and intestines. Instead, it passes right through the gastrointestinal tract. For example, if we consume potato chips made with Olestra, they taste generally the same as the regular chips and the potato portion is absorbed by the body in the regular way. However, the Olestra passes through our bodies without adding to our fat buildup.

But, of course, we cannot make every fatty product with Olestra. Meat contains its own fat. So do nuts, olives, avocados, and a thousand other foods. When we eat them, we are forced to eat fat. Moreover, if we eat out, we are fed huge quantities of fat of which we may not even be aware. Many salad dressings contain as much fat in a single serving as we need all day.

Dishes such as scrambled eggs get as much as half their calories from fat. Chocolate is mostly fat. A Quarter Pounder with cheese contains about 28 grams of fat. And remember, a gram of fat has more than twice the calories of carbohydrates.

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