Michael Anchors, MD, PhD Teaching is the hardest thing in the world. Having lost no weight, some patients come back proud that they cut out fatty foods and joined a gym. I didn’t tell them to do any of that! How could they think such ideas work after hearing the First Visit Speech? Because they weren’t listening, and few read the manuals I give them. They think the pills will do it all.
During my speech I say “Eat less sugar, the sweeteners and white flour”. The patients ask me, does that include Stevia? Does that mean no sugar at all, ever? Can I eat rice if it’s brown? Examining rationally what I said, none of these questions needs to be asked. Or I tell them “Stop snacking” and they ask does that include fruit? What does fruit have to do with stopping snacking? Or I say “Eat less at night” and they ask what is the latest time they can eat? The only way you can understand this is to assume they thought I meant “Don’t eat late at night”. Because they have heard that often, from other people. But hell, the skinny French eat dinner at 10:00 PM. Obviously people tend to hear what they expect to hear regardless of what was really said. And they hear what they want to hear. And as a famous man once wrote, “People tend to believe anything they hear often”. The famous man was Adolf Hitler. Wrong about everything else, but he was right about that.
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Michael Anchors, MD, PhD One of my secretaries asked me to sum up myself in a single word. I won’t tell you what word I chose. It’s a ridiculous exercise. Well, it is and it isn’t. There is a place in the Bible, Matthew 7:12 where Jesus says, “So in everything, do to others what you would have them do to you, for this sums up the Law and the Prophets.” I am not a Christian; I am just a reader. It’s a good exercise to try reducing your doctrine to a single sentence.
So here I reduce everything I teach to this. DO NOT EAT IF YOU ARE NOT HUNGRY. Find something else to do. I said something like this before, and ran into problems with the fact that many patients cannot distinguish between hunger and cravings. And there’s the issue of continuing to eat fast, beyond the point when hunger would have ceased if we just ate slower. But as a single sentence to keep in mind as you go through the day, “do not eat if you are not hungry” might be easier to remember than the Ten Orders. By Michael Anchors, MD, PhD I have read, but seen no scientific proof, that emotional stress itself can make people gain weight. The proposed mechanism is that stress makes the adrenal gland produce more cortisol. Cortisol causes the liver to release more glucose. Elevated glucose triggers insulin. High insulin causes obesity.
It might be true. At least, stress is a distraction from the Ten Orders. A big part of what I do in the office is to reduce people’s stress. I do so by listening and applying my experience. I was a family doctor for 35 years, married and a father for forty years. I have experience. When I decided to stop trying to make people skinny and set the healthier “overweight” category BMI 25-30 as the goal, I expected many patients to stop coming back. But most of my patients come back. For two reasons . . . First, as you read in the current TIME magazine, no matter what diet you pick, some people lose and some don’t; some keep weight off, others gain back. Second, people need help with stress. The main printed tools I use are the Seven Agreements and the Ming Lo Speech, both available from my office or on this website. A new thought occurred to me, giving a toast at the wedding of my daughter last week, that married life is different from single life. For marriage to last and be happy, people must seek out and prefer compromise to getting their own way. Saying we will do it my way this time and your way the next doesn’t cut it–real compromise is needed. And you should prefer it, not just tolerate it. I got a standing ovation. In the week after the wedding, I enlarged my understanding to see that the inability of Americans to compromise is at the root of the recent collapse of our democracy. Congressmen, too, must have the feeling that compromise is winning, not losing. By Michael Anchors, MD, PhD Late last year I changed order #3, which used to read “Eat less starch and sweets”. I was embarrassed about that order because I knew it can’t be right. In China and India, the two leanest nations, people eat lots of starch in the form of rice and potatoes. They just eat few sweets. So non-sweet carbs by themselves must be okay.
The thing to really avoid is (1) sugar and (2) sweeteners regardless of calories and (3) white bread, because these things vigorously drive up insulin without satisfying hunger. Fatness is not about calories, friends; it is about insulin. Read The Obesity Code by Jason Fung MD. What about white flour? If you’re going to cut back on white flour, how will you manage a sandwich or a piece of toast? The answer is Dave’s Bread. It is delicious and contains no white flour. Almost all brown or whole wheat breads must contain some white flour or the dough won’t rise. But somehow, baker David Dahl of Portland, Oregon, gets his 100% whole wheat bread to rise. Go to www.daveskillerbread.com, put in your zip code and the website will tell you which grocery stores near you sell Dave’s bread. Dave makes many types of bread, but you should look for Good Seed in the yellow wrapper. Power Seed and 21 Grain Bread are a second choice. The whole time that you eat Dave’s Bread, you will never be constipated, ever; Dave’s bread contains so much fiber. A good thing if you are taking phentermine, which tends to be constipating. By Michael Anchors, MD, PhD Last week an article in the New England Journal of Medicine furnished evidence that yo yo dieting increases the chance of a heart attack or stroke. You should not believe this right away because the data were epidemiological, i.e. there was an association between yo yo dieting and heart attack, but association does not prove causation. It might have been for instance that yo yo dieters ate more sugar than no yos or did less exercise. The “dieters” may not have even been dieters at all; the study wasn’t even about yo yo dieting; the data were extracted from a study of Lipitor’s effect on heart disease. The authors merely remarked that people in the study whose weight varied a lot were more prone to heart attack. But weight can vary for many reasons other than dieting.
Nevertheless, it is beyond doubt that each time you lose weight and regain, it is more difficult to lose weight the next time. Yo yoing leads to insulin resistance. Sometimes patients, returning many times, complain that the phen-pro medicines aren’t working like they used to. Usually the problem is not the medicines; it’s yo yoing. By Michael Anchors, MD, PhD I have two dogs of the same breed, Sam and Lulu. Sam is 8 years old, Lulu 3. Sam weighs 88 lb. He is overweight by the charts. I can’t feel his ribs, a standard way to tell if a dog is overweight. Lulu weighs 50 lb, normal by the charts; I can feel her ribs. Sam gets more exercise than Lulu. I feed Sam 50-70% of the amount I feed Lulu at each meal, using the same food. They have no other source of food. Their relative weights are not changing. Neither dog is sick, and their blood tests are normal.
What can you learn from this true story? The answer is not a trick, and you ought to understand it after reading the two previous MOWs. By Michael Anchors, MD, PhD The books I’ve recently read have made me aware, again, how complex obesity is. My god, there are viruses that may make you fat, genes, bacteria, ethnicity, age, gender. Most of my patients lose some weight and keep it off, but there is variation. Some lose a lot, some lose a little, a few lose none. Some keep it off, some regain. Some are not following my Ten Orders, others are. Some ‘fess up, others lie. Some think they are not following the orders even when they really are. They assume that if they are not losing weight, THEY must be at fault.
They might be. They may not be. It may even be MY fault. It’s just all so darn complicated. As a matter of policy, I never judge people. I always liked what Jesus said. “Judge not that you be not judged.” I have doubts about the grammar of that sentence, but you know, English was not Jesus’ first language. “Judge not.” So smart, you know, because you never know the whole story. And you haven’t read the next, good scientific book. The best research isn’t done yet. So give people the benefit of the doubt. Why hurry to judge? Time will always tell. No secret is ever kept. By Michael Anchors, MD, PhD When people walk into my office wanting to lose weight, almost everything they know about fat is wrong. Their first article of faith is that fat is bad for you, either as a food or on your body. WRONG. The second article is that to lose weight you must either eat less or exercise more. WRONG. If you gained weight back, it was because you ate more or stopped exercising. OFTEN WRONG. The whole matter is so much more complex. Read The Secret Life of Fat by Sylvia Tara or The Obesity Code by Jason Fung. Read something. Your doctor hasn’t read anything, because they are not paid to study, don’t expect to, and don’t know how to. The drug companies rule.
My principal role is to teach. To read and study, and teach. I am not trying to make people skinny. You shouldn’t be skinny–it isn’t good for you. Studies such as Flegal et al 2005. The lowest mortality rate was in the “overweight” people BMI 25-30; NOT in normal people BMI 18-25 and for sure not in underweight people BMI < 18. Indeed their mortality rate was the highest. Fat is an important organ of the body, elaborating many hormones that control other parts of the body. You need some fat. As you age, you will acquire some fat in some places and there is bupkis you can do about it. So get used to it and stop trying to look 20 years old when you are 50 years old. There is so much more fun and interesting to do in life than dieting. Now granted you shouldn’t be very obese either. But very obese people seldom come to my office. I wish more would; I would relish the challenge. I will give them phen-pro and teach them the Ten Orders (men need only the first Eight). I will get them off drugs that make them fat. If all that doesn’t work, I will check their HOMA-IR, a blood test to see whether they are insulin-resistant. If so, I will start metformin and initiate a program of fasting four days a week from supper until lunch to restore their insulin-sensitivity. By Michael Anchors, MD, PhD While on phentermine, patients should not drink regular coffee. Phentermine is a stimulant and caffeine is a stimulant. Taken together, they increase the chance for nervousness, palpitations and poor sleep. Besides that, people tend to put a lot of sugar or sweetener in coffee, and we were trying to cut down on sugar. That’s was the main point these days.
I don’t care about the caffeine in tea or chocolate. There is so much less caffeine in brewed tea. Interestingly there is just as much caffeine in an ounce of tea leaves as in an ounce of ground coffee beans; but you use so much less tea leaves to make a cup of tea than beans to make coffee. You may drink decaff coffee. Here are some things I have heard patients say. “But doctor, I heard that decaff coffee still contains caffeine.” I answer, “Er, uh, no it doesn’t. If you heard that, it was an alternative fact or fake news.” “But doctor, I need the caffeine to wake me up in the morning.” I reply, “Phentermine will wake you up.” “But doctor, I don’t like how decaff coffee tastes.” “That’s baloney. Here’s a riddle for you. Why do plants make caffeine? They don’t have a brain or nervous system. They don’t need caffeine to wake up. Why do they make it?” . . . “I will give you a hint. All the plants making caffeine originally grew at the edge of a desert.” . . . “Another hint. Plants make caffeine for the same reason cactuses make thorns.” . . . “Okay here is the answer. The biological purpose of caffeine is to have a bitter taste, so animals don’t eat the plant to get water. Hence there is no way caffeine improves the taste of coffee.” “My wife Laurel swore she could tell the difference. So I made two pots one decaff, one regular, same proportions and temperature. Five cups had decaff, five regular. The cups were identified only by a number. I asked my wife to taste each cup and tell whether it was regular or decaff. She was sure she knew the difference, but I showed her she was guessing randomly.” Michael Anchors, MD, PhD When asked to give examples of fattening food, most patients list “fast food” first, meaning things such as KFC and McDonalds. I bet most of my patients have a fast food meal once or several times a week. When I pass such places on the road, there are always long lines of cars in the take-out lane. I assume most of these meals are eaten in the car.
When I ask patients why fast food is fattening, their first answer is because it contains so much fat. Even people coming for a fourth visit, people who have been told many times that it is sugar, sweeteners and refined (white) flour that cause obesity, they still make the mistake of blaming fat. Old (mental) habits die hard–if ever at all. All of you should be reading The Obesity Code by Jason Fung MD. I don’t know of any prospective studies testing whether fast food is fattening, but assuming it is, I lay the fault to the following . . . (1) People eating fast food restaurants always eat the whole thing. Especially in the car, because there is no easy way to dispose of the extra. And left-over fast food kept in the frig tastes gross. (2) Fast food is always eaten with a big soda. They don’t sell small sodas. Sodas contain far too much sugar or sweeteners. (3) Any food eaten fast is more fattening than the same food eaten slowly. Even–listen–even if it is the same amount of food. I know this is true, but I am not sure why it is true. I assume that food eaten fast stimulates more insulin secretion than the same food eaten slowly. So if you are going to eat at a fast restaurant, get a smaller portion. If it has to be big, don’t eat the whole thing even if it means you throw some out. Wasteful of course, but it’s not your fault. Food doesn’t become unwasted just because you eat it. When a fat person eats food they don’t need, it’s still wasted. It’s the restaurant’s fault not yours. Skip the soda and drink water, or don’t drink the whole soda. |
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