THE HEALTH CRISIS
The Unique Challenges You Face
The Biology of Weight and Sex
Why a Generic Weight-Loss Approach Does Not Work for You
When I first met Brad, I realized his health concerns might have become mine if I had not changed the course of my life years earlier, when I was in my early thirties and was accelerating along the fast track of my medical career. I was flying high professionally, but I wasn’t taking care of myself. I inhaled highly processed foods mindlessly at work: bags of bagels and pints of cream cheese, egg rolls, doughnuts, pizza. I grabbed whatever I could eat and kept moving.
I tried to weekend-warrior my way out of my weight, but that of course didn’t work. So there I was: 35 pounds overweight, with many of the early symptoms of aging. I noticed newly sprouting gray hair, I had a big gut, and I didn’t like what I saw in the mirror. My uncle had died of diabetes at age 48, and I was starting to pee more and felt hungry all the time. I knew I could be developing diabetes and that what I was eating was aging me, physically and mentally. But I didn’t know how to stop the process, let alone reverse it.
On top of wanting to change for myself, I also felt a responsibility to change for my patients. How could I help them effectively when I couldn’t make improvements in my own life?
The Fat Doctor Paradox
Ever been startled by the sight of a doctor lighting up? I have. But does the sight of an obese doctor give you the same jolt? It should.
Researchers with Johns Hopkins University’s Bloomberg School of Public Health revealed in a study that a physician’s weight can impact the type of care and information he or she issues to patients. After surveying doctors across the country, they found “normal-weight physicians” were more likely to discuss weight loss, diet, and exercise with their heavy patients. Only 7 percent of overweight physicians (individuals with a body mass index, or BMI, of 25 or more) recorded an obesity diagnosis on any patient versus 93 percent of normal-weight doctors.
My own research in this area reveals that doctors face huge challenges in the workplace. Free meals are in constant supply at many hospitals. Nutritional quality is not always considered—and I am being generous in my assessment here. To be more accurate, most hospital food seems designed to cause heart disease and other illness, not to prevent it.
By no means does this cancel out the care you receive from an overweight doctor or a fast-food-franchise-hosting hospital. But it does bring to light the fact that doctors are far from perfect, and that acquiring or building upon your self-care survival skills is never a bad idea.
I knew enough about the science of aging and weight gain to recognize that nutrition (or lack of it) had landed me in my current state, so I went straight to the source: food. But I didn’t want to simply put on my medical scientist’s hat. I wanted to learn a new skill: to understand food from a tactile sense, to see natural ingredients in their natural form. I wanted to approach food as a chef would, so I did the most obvious thing: I went to cooking school.
In cooking, I finally found a professional niche that also helped serve my personal goals. I was eating better than ever—in both taste and nutrition—and my body, appearance, and energy level reflected this change. I lost most of my big gut, and many of the external signs of aging that had begun to reveal themselves prematurely retreated. I felt my sense of purpose renewed.
Soft, smooth skin and diminished underarm hair can signal low testosterone.
From there, and with my friend Dr. Mike Roizen, I became the first physician to teach nutrition and cooking together in a medical school. We went on to research and co-write a popular book, The RealAge Diet.
I took this momentum to re-invent my individual practice, Chef Clinic®, where I began to offer patients my hands-on, strategic plan for achieving better health through weight loss. I started collecting good stories, and writing down the details of my calls from patients. They were losing weight and doing things that they had never thought about doing. A few examples:
•A 72-year-old from Washington, D.C., called me after reaching the bottom of the Grand Canyon, over nine miles from where he had begun.
•A 54-year-old let me know he no longer needed to use seat belt extenders, and had to push his car’s driver’s seat forward because it was too far from the steering wheel.
•A 48-year-old had to take two links out of his metal wristwatch because it became too loose; he noticed this when the tan line around his watch began to show—it was the tan line that caught his eye.
•A 39-year-old reported being able to pull the airplane tray table down without hitting his stomach.
My professional and personal passions united in my practice. I could now blend the pleasure of writing recipes on prescription slips with the chance to empower motivated people to transform their lives.
As I continued work in my practice, I began to see a pattern emerge—it was mostly men who were coming to me, and they were achieving knockout, sustained results.
I knew this was a statistical anomaly. Men notoriously shy away from “diets” and balk at traditional dieting rules. Counting points or calories, eating smaller portions, and consuming low-fat, low-sugar, low-flavor versions of everything aren’t concepts that bring most men to the table. But something about my approach was not only bringing them to the table, it was helping them embrace this gut-free, pain-free, ready-for-action solution. And sometimes, they got to leave behind the pill bottles they no longer needed.
Losing just 10 pounds can lower your blood pressure. Track your pressure at home and show your doctor the numbers. Decide together whether you can adjust your medication.
In writing this book, I went back and re-read and analyzed the file of every man I’ve treated over the last fifteen years, paying attention to what worked for each and what didn’t. I analyzed thousands of peer-reviewed clinical reports in metabolism and endocrinology to find the science behind the most successful strategies. I read all of the comments on my ChefMD® and Paging Dr. La Puma blogs and the recipe postings from over 30,000 subscribers. (Join them! Sign up at www.refuelmen.com for tools and advice.)
After all that research, one fact struck me immediately: there is no such thing as a unisex diet. If a man wants to lose weight, a diet designed to help women will not usually work.
When it comes to the subject of weight, men and women couldn’t be more different. Not only do men feel differently about food, we metabolize it differently, carry our weight differently, store our fat differently, and burn fat differently and at different rates with exercise. We have completely different attitudes toward and expectations of weight-control programs.
Men who went to exclusively male weight-loss meetings lost twice as much weight as those who attended co-ed meetings.
These differences are obvious when you look at many current diet books and programs. Nearly all popular diets and diet books have been written for women. Almost no programs have been created just for men to meet their distinct medical, physiological, and behavioral needs. That is, until now.
Men generally have greater muscle mass and lower body fat than women. More muscle and less fat means men need 10 to 15 percent more calories than their female counterparts to maintain their weight.
What you’re looking at in this book is a scientifically sound and clinically proven weight-loss and weight-maintenance program designed specifically for men. It makes guys feel better, right away. It shows them how to ratchet their efforts up to the next level, without cutting out whole food groups as fad diets do, and without getting overwhelmed by a lot of the science that is not all that relevant to the subject at hand.
The program sticks to the science you actually need to keep you on track, to catch you if you fall, and to let your body work efficiently so you can lose the gut. The program is also about self-improvement: it allows your inherent but occasionally dormant confidence in yourself and your life purpose to re-emerge.
Before I dive into the details of the program, let’s rewind for a quick macro view of men’s health today. You will see, if you don’t already do so when you look in the mirror, why it’s more important than ever that you reprogram your body and recharge your life.
The Epidemic of the Mid-Waist Crisis
Throughout the United States, nearly three out of four men are at an unhealthy weight. In fact, there are more overweight and obese men in every state than there are overweight and obese women. The numbers not only travel across state lines but also across ethnicities; only Asian and Pacific Islander men have overweight numbers below 50 percent—and even then, 42 percent of them are overweight or obese. Across the board, men are quite literally being weighed down by their weight, and they are paying the price of lost strength, stamina, and energy.
Even more concerning is where the excess fat tissue shows up on a man: the gut. And that’s when a major genetic disadvantage emerges. The type of weight gain that men experience gives them the “gut” or beer belly, and earns them the nickname of “Santa” or “Buddha” or “Big.” This situation has contributed to what I refer to as the “mid-waist crisis” that millions of men are experiencing today. Worse than a mid-life crisis, the mid-waist crisis can attack your body from the inside and bring you down—as deep as six feet under.
The Evolution: A Mid-Waist Crisis
In 2008, researchers came to a frightening conclusion after monitoring nearly 360,000 men and women for ten years: increased abdominal fat had doubled their risk of premature death. To those of us in the medical field, this study confirmed a theory that had been developing for decades. To the general public, it scientifically defined a new public health enemy: belly fat.
How Much Is Too Much?
More than total weight or body mass index (BMI), your waist circumference is the simplest and most efficient gauge of your metabolic and hormonal health. Here are three methods I suggest my patients use for measuring belly fat:
1.Take a tape measure and wrap it around your bare-skin abdominal region right at your belly button. Suck in and check the number. What is it? Anything over 40 inches is too much. For a woman, 35 inches or less is the goal.
2.Stand naked in front of a full-length mirror. Turn sideways and look at yourself in the mirror. For men, which is farther out—your stomach or your penis? If it’s your stomach, it’s too big.
3.Still naked and standing, tilt your head back and look at the ceiling. Now, bring your head forward and put your chin on your chest. See anything below your belly? You should. If you don’t, there’s a problem. (In other words, #cycyp—can you see your penis?)
Belly fat, also known as intra-abdominal fat and scientifically referred to as visceral fat, is more than just an unattractive gathering of fat cells covering your abs. It is an insidious, metabolically active type of fat that deposits inside and around your organs. It’s more than just unappealing to the eye—it can be deadly. Once entrenched there, visceral fat spews out hormones and toxins that disrupt your natural biological functions.
While its first course of action may be to ding your self-confidence, visceral fat goes on to do much greater damage inside your body. Admit it: when your stomach has prevented you from giving a full embrace to an attractive individual, you may have sucked in your gut or hugged the air, Hollywood style.
This type of fat has also been linked to an ever-growing list of metabolic disturbances and diseases, including diabetes, endothelial dysfunction (a rusting on the inside of your arteries and a precursor to heart disease), erectile dysfunction, heart disease, high cholesterol, hypertension, insulin resistance, and colon cancer. As one researcher claimed, “Visceral obesity does seem to be truly evil.”
Men gain this dangerous type of fat first, whereas women are more inclined to gain subcutaneous fat tissue—the squishy, pinchable type of fat. Visceral fat is dense and firm to the touch. No, that’s not muscle pushing your stomach out beyond your pants; it’s packed-in visceral fat.
Women can gain up to 44 more pounds of body fat than men, on average, before they experience the same severity of risk factors.
The Journal of Clinical Investigation published a study evaluating each gender’s metabolic risk profile at the same level of body fat. Men had higher total cholesterol, triglycerides, and blood sugar than did women, and lower levels of high-density lipoprotein (HDL)—what’s considered to be the “good” or “healthy” cholesterol. Talk about being set up for failure. But wait, the plot—not just your blood—thickens.
When the researchers sat these men and women down for a meal and then measured their metabolic responses, men continued to be worse off: they showed higher levels of triglycerides and lagged behind in ability to clear out the triglycerides quickly. Triglycerides are a form of troublemaker fat in your blood—like teenagers drinking beer in front of your house, you don’t want them loitering around. Chronically elevated triglycerides have been linked to coronary artery disease, a condition significantly more prevalent in men, and to small, beady, dense LDL cholesterol.
Visceral fat was to blame for these stubborn triglycerides, and labeled the “best predictor” of the delayed ability to clear out fats from the blood. The study left little room for doubt: men have more visceral fat and it doesn’t just sit idly by. It gets involved, and not with good intentions.
Visceral fat likes to nestle itself around several important organs and settle close to the portal vein, which drains from the small intestine into the liver. What researchers have found is that visceral fat will dump inflammatory proteins and hormones into the portal vein, sending them directly down to the liver. That is, visceral fat is your polluting neighbor who dumps paint thinner and motor oil on the ground . . . to leach into your water supply.
Excerpted from Refuel by John La Puma, M.D.. Copyright © 2013 by John LaPuma. Excerpted by permission of Harmony, a division of Random House LLC. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.