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Questions Index

Can you really do Atkins two days a week and lose extra weight?
Yes, it will work, but there are certain caveats. One of the mistakes that many people make upon finishing my book is to focus on one solution to their weight problem-the same thing they've been doing for years. If you don't first change some of your habits to speed up your metabolism, then doing Atkins only two days a week may slow your metabolism even further.


I tried eating five small meals a day and gained weight. Why didn't it work for me?
There might be several reasons. Remember, the study that was done comparing two groups of people eating the same amount of calories, but one group in five meals and one group in two meals. When you switched to the five meals, you may have inadvertently started eating more calories than you were in the two or three meals you were previously eating. Some patients have been dieting in one way or another for so long that their metabolism is so slow, that they only require 1200 - 1400 calories per day to maintain their present weight.


I have only been eating 1200 calories per day for almost a full year and I can't lose a single pound. Why?
Clearly your metabolism has been greatly slowed. In my office I have encountered a number of women with this dilemma. One young lady told me she even went to the gym everyday, but upon examination and measurement, she had far more body fat than expected. All her exercise was aerobic type exercise. Yes, she was burning calories at the gym, but not building muscle. The cost of a scale that measures body fat today is not expensive. After measuring your body fat, try to come up with a reasonable exercise program that is aimed at building muscle and then measure your body fat regularly. Begin eating five small meals a day, each one approximately 300 calories. The goal, initially, is not to gain any weight. As you gain lean body mass and your body fat decreases you should begin to lose weight. You must put your emphasis on changes in body fat in order to accomplish your goal. Once your metabolism begins to improve, but not until that time, you can speed up further weight loss with intermittent low carb or low calorie restriction.


I'm not the kind of person who can eat five meals a day. Is it really that important?
If you've been trying to lose weight for some time and have been unsuccessful or have succeeded only to gain it back again, then yes, small frequent meals are very important. The main reasons being:

  1. It increases your metabolism
  2. Prevents you from getting really hungry
  3. Helps prevent unhealthy snacking
  4. Generally keeps you in tune with your body
Yes, change is difficult, but everyone is capable of eating frequent small meals, regardless of career. You just need to use your intelligence to figure out how to make it happen, rather than rationalizing why you can't.


I always start out with good intentions, but after several weeks or a month, I lose my enthusiasm and end up right back where I started. What can I do to keep it going?
That is exactly why I wrote this book. You need to take it step by step, giving yourself time to develop habits. That way when your enthusiasm wanes, or you get too stressed to pay attention, you won't end up where you started. Remember Cheryl. She too, had her ups and downs, but backsliding was minimal because she had actually changed a number of habits.

Also, don't "bite off more than you can chew." Take baby steps, remember it took Cheryl over two years to lose all that weight. She didn't even start exercising until several months after she began drinking diet sodas. Make it easy for yourself. Take it slow and just make sure that each step you take is a correct one.


My girlfriend and I eat almost the same things and yet she's slim and I'm not-I just don't get it!
Clearly, you have significantly more body fat than your girlfriend. Remember your basic metabolism (calories burned without additional exercise) is calculated by multiplying your lean body mass by 12.5. Let's for argument's sake say that you weigh 180 pounds and your girlfriend weighs 140, and your respective body fat percentages and are 40% and 20%. That means that your lean body mass is 108 pounds (180 - (180 x .40)), and your girlfriend's lean body mass is 112 pounds (140 - (140 x .20)). So you're burning 1350 calories without any exercise and she's burning 1400 calories. That's why it is so important to reduce your body fat percentage through muscle building exercise.


Is it possible to lose weight without exercising?
Of course, you can lose weight without exercise. The effectiveness of dieting without exercise will be greatly dependent on your starting body fat content. I've always been jealous of men who could seemingly lose weight without much effort. In their twenties and thirties men have significantly more muscle mass than us women. But as they age, they too can develop large amounts of body fat. As your body fat content rises, you begin to reach a point of diminishing returns, like the young woman mentioned earlier, who was only eating 1200 calories per day. If you need to eat that few calories in order to eat less than your body burns, you're barely eating enough to maintain your present lean body mass, and you will continue to lose muscle. You may not literally increase your fat stores, but as your muscle mass declines you body fat percentage increases.


I eat very healthy organic food and I'm practically a vegetarian. Why do I still have trouble avoiding weight gain?
All the healthy, organic food you may be eating obviously comprises more calories than your body burns. So in spite of eating all healthy foods you still need to be careful of caloric intake and follow the basic tenets of this book. Pure organic fruit juice may be healthy with lots of vitamins and minerals, but it can have as many or more calories than soda. Drinking your calories does little to satisfy your appetite as we have already discussed. But I'm really glad that you asked this question because it helps me to clarify a very important point.

Eating to be thin is not the same as eating to be healthy! Nor would I suggest that thin people are necessarily healthier than those who are overweight. Look at Cheryl's mother. Her diseased lungs and failing heart kept her thin. I wouldn't call her healthy. I've known many smokers and alcoholics who were thin and ate incredible amounts of junk food. By the same token, as you have illustrated, you can eat all healthy food and still overeat. One can reduce caloric intake by eating fewer calories, but those calories may not necessarily come from healthy foods. Diet soda is not particularly healthy, but when one is first learning to avoid drinking calories, it is an appropriate choice. A healthier choice would be water.

Remember, climbing a ladder one rung at a time is simpler than jumping to the top. Small modifications that are easy, allow you to begin to establish better habits and then slowly build on these changes. Once you have learned how acquired taste works and have established a regime that allows you to maintain a normal weight, you can then go on to make further changes towards a healthier diet if you so desire.


Should I be eating differently than you suggest in A Novel Diet if I have high cholesterol?
High cholesterol puts you at greater risk for heart disease. Central obesity (that spare tire around your middle) puts you at greater risk for heart disease. All the advice I have given you is directed primarily at losing weight not at lowering your cholesterol. This will reduce one of your risk factors (central obesity). However, if you were to follow the caloric advice of five small meals a day with either 350 or 450-calorie limitations, emphasizing the low-density foods (foods high in fiber and water and low in carbs), you will have already reduced the amount of high cholesterol foods you've been eating. By their very nature higher cholesterol foods are more dense (more calories per volume measurement), and they are not ideal in creating a fully satisfying meal*. If you have been paying attention to the calorie content of each meal the higher calorie count fatty food portions of the meal will have gotten somewhat smaller. However, this alone will probably not lower your blood cholesterol sufficiently.

More current information regarding cholesterol emphasizes the importance of high levels of the "good" or HDL cholesterol as well as lowering the levels of the "bad" LDL cholesterol. All fat has the same amount of calories, but some fats are better for you than other fats when considering cholesterol levels. You can have the same amount of calories in a meal with one meal comprised of primarily good fats and the other with primarily bad fats. So if you have high cholesterol you should begin to take into account the types of fat that you include in any given meal.

All animal fats contain large amounts of cholesterol. So beef, veal, lamb and pork should be avoided as well as all fatted dairy products: butter, milk, yogurt, ice cream and cheese. If you want to eat a dairy product you should choose the nonfat version or at the very least the low fat version. Do not replace butter with a lower calorie spread that contains saturated or trans fatty acids. Choose a spread containing good fats (Smart Balance for example). If you want to eat a meat product then choosing the leanest version is better (i.e. pork tenderloin trimmed of fat, or veal as opposed to beef, or if beef, a flank steak that has much less fat than a rib eye or strip steak). Ideally, you should choose fish or poultry, rather than meat, more often than not. By doing the above you will automatically be reducing the amount of calories.

Eating foods high in fiber will help to reduce your cholesterol. These are the low-density foods we mentioned above: fruits and vegetables, high fibered grains, and legumes (all types of beans, & lentils).

What may be equally as important as avoiding the high cholesterol foods is actively eating foods that contain good fats in an attempt to raise the good cholesterol. Foods such as most fishes, canola or olive oil, walnuts, pecans & almonds contain good fats. Smart balance with Omega 3 fatty acids can be used as a spread instead of butter or margarine.

I realize that this is a great deal of information to absorb at one time. Under the heading Nutritional Information you will find a list of foods that are high in cholesterol, saturated fats and trans fats and should be avoided. There is also a list of foods that are high in good fats and should be eaten.

In summary, yes, you should be eating somewhat differently if you have high cholesterol, but please keep in mind some of the major tenets of this book. Small changes over time will be more effective changes, which are more likely to result in good habits. Learning to eat small meals more frequently has to be the primary first goal. As time goes on and eating those small meals has become more of a habit then making those meals healthier, one meal at a time, will be the most successful way to effect these changes. Do not try to do everything at once. It might then become too overwhelming a task. Remember you are not going on a diet. You are learning to change the way you eat. Your cholesterol rose over many years as did your weight. It's OK to slowly get the bad fats out and put the good ones in. It's even OK to put off making some of those changes until you are much more comfortable just eating within caloric range. It is, however, important for you to have the knowledge necessary to avoid making a change and developing a habit that might in the future need to be changed yet again.


Can you explain in simple terms the differences between LDL and HDL cholesterol?
Imagine a sports stadium with thousands of spectators. Many of those spectators are busily eating and drinking while they are watching the game. They are also discarding their trash on the stadium floor.

Now someone has to pick up that trash. Imagine that there are janitors walking around picking up the trash during the game.

Someone snaps a picture. Many people are captured in the photo with trash in their hands but are they picking it up or throwing it down?

When we talk about the different kinds of cholesterol we are really discussing the particular carriers that are attached to the cholesterol molecule. The janitors represent the "good" cholesterol and the spectators represent the "bad" cholesterol.

Needless to say the more janitors that you have the cleaner your blood vessels will be. Which is why we want to do all we can to increase our HDL and decrease our LDL.


What are Omega-3-Fatty Acids?
Omega-3 fatty acids are polyunsaturated fats that the body is not capable of manufacturing. We must obtain them from the foods we eat. The importance of these fatty acids is that they appear to encourage the formation of good cholesterol. They also have anti-inflammatory effects as well as anti-clotting effects.

These essential fatty acids are found in cold-water fish including tuna, mackerel and salmon as well as dark green leafy vegetables, flaxseed oils, canola and olive oils.

Fish oil capsules containing omega-3 fatty acids are available as supplements. Many who are interested in improving their HDL cholesterol can benefit from these supplements.


What are trans fatty acids?
Several decades ago when it was determined that saturated fats were not good for you, and polyunsaturated fats were, the food industry came up with a method to help solidify polyunsaturated fats in order to prolong the shelf life by hydrogenating them. These hydrogenated polyunsaturated fats were termed trans fatty acids. Unfortunately, over the following years it became apparent that these trans fatty acids increased both total cholesterol as well as the LDL, "bad" cholesterol. So in fact they turned out to be no better than the original saturated fats.

Recently, food manufacturers are now being required to label the amount of trans fatty acids found in any given packaged food. This ruling went into full effect in 2006. Most food labels then will alert you to the amount of cholesterol, saturated fats as well as trans fats. If you are watching your cholesterol you particularly want to avoid these fats.


Should I be eating differently than you suggest in A Novel Diet if I am diabetic?
The simple answer is "no"! The slightly more complicated answer is "yes"! If you are diabetic or at risk of developing diabetes, losing even small amounts of weight will improve your situation. I have seen over the years as a family physician that the better the weight control the more easily type II (adult onset) diabetes can be controlled.

More importantly, eating smaller amounts of food throughout the day will help to give your body a more even sugar load and help you to control your sugars. So eating the way we have discussed in A Novel Diet will definitely help you to gain control of your diabetes or help prevent the earlier onset of the disease.

The more you approach your ideal weight the easier controlling your diabetes will become. In some instances, patients of mine have been able to stop or avoid taking medications for their diabetes altogether.

Eating the way we have discussed so far, will only improve control of your sugars, however, I did mention that there is a more complicated answer. Earlier we mentioned the term glycemic index. Carbohydrates tend to cause your blood sugar to rise, albeit some more than others. The glycemic index is determined by how quickly a particular food makes your blood sugar rise. The higher the index, the more quickly your blood sugar will rise after eating that particular food. For example a baked potato has a GI index of about 85 whereas celery has a GI index so low it can't be measured. Sucrose (ordinary table sugar) has a GI index of 65 even lower than a potato. Staying away from high glycemic foods (foods with a GI above 55) will help to further your glucose control. Eating lots of foods with very low GI's will help even more.

What is important to understand is that when choosing foods to eat as a diabetic, it is important to try to choose foods with lower glycemic indices (or glycemic loads) to help further control your blood sugar. It would be foolish to investigate new and different foods and dishes, learn to like a particular food, and then find out that it has a very high glycemic index.

Generally if you stay within the calorie guidelines that I have outlined even if you eat a higher glycemic index food, the sugar load will not be so great as to cause your blood sugar to skyrocket, though it will go higher than if you stay away from these foods.

Starchy foods generally have higher GIs. However, if you pick ones that have more fiber in them then the GI will be lower. Multi-grained bread or rye bread is far better than white bread. Brown rice or Basmati rice is far better than white rice. Sweet potatoes or yams are better than white potatoes.

Your best bet is to go through the glycemic index list of foods and pick out all the medium and low category foods and try to use only these carbohydrates when you create your meals. Remember only carbohydrates will be found on this list as fats and proteins play no role in raising blood sugar.

Although this answer has been directed to the diabetic individual, following the advice contained within will further your efforts towards a healthier diet, an improved feeling of well being by avoiding the roller coaster highs and lows that can occur with sudden sugar loads, and speed your progress toward your ideal weight.


What exactly are glycemic index and glycemic load?
Although learning about the glycemic index and the glycemic load of certain foods is not absolutely crucial to healthy eating, it is very important. But like any job well done, the more you know and understand, the more likely you will have greater success.

On the following pages, you will find a clear definition of glycemic index and glycemic load. Elsewhere on this web site, under Nutritional Information, a complete glycemic index can be found. Use these lists regularly to help make better choices.

The glycemic index is a number that refers to how rapidly a particular food can raise your blood sugar. To better understand the concept, let me explain how it is calculated. Usually ten people are given exactly fifty grams of a particular biologically active carbohydrate. Then each of their blood sugars is measured over a short period of time to determine how quickly their blood sugar rises. An average of all the results is then calculated, and a single number is assigned. The quicker the rise in the blood sugar, the higher the number.

You are now probably asking yourself what I mean by biologically active? Remember in A Novel Diet when we discussed low-density foods, and I discussed fiber and water content as not having any significant calorie count because fiber is mostly not absorbed by the body and water has zero calories? Well, when we refer to a biologically active carbohydrate, we are talking about the portion of the carbohydrate that has calories. If we are going to place these foods in a meaningful statistical list, it is crucial that we compare the same amount of active ingredient from person to person so that we are not comparing numbers arising from different quantities ingested.

So for example if we were to measure fifty grams of carbohydrate in watermelon, that does not mean that the person has to eat fifty grams of watermelon. It means that they have to each eat 750-960 grams of watermelon (approximately three to four eight-ounce slices without the rind) to be eating fifty grams of carbohydrate, since there is about one and a half to two carbs for every ounce of watermelon. Put another way they would have to eat the equivalent of approximately four and a half to six cups of cubed watermelon. (The reason for the ranges given is that some watermelon will have more or less measurable carbohydrate, depending on the amount of water and sweetness. I point this out because when you look up these values in different books you will find different numbers. The small variation in these numbers should not make a big difference.)

Now if you tried to measure the glycemic index of lettuce, each person would have to eat twenty cups of shredded lettuce in order to achieve fifty grams of biologically active carbohydrate or to measure celery they would have to ingest eight cups of cubed celery. It would be unrealistic to try to measure the glycemic index of these foods.

What it does point out, though, is even if they were measured these foods would have very low glycemic indices. They are considered in some circles to be "free foods" with regard to raising the blood sugar. There are many foods that have very low to non-measurable glycemic indices. You will find these foods noted on my glycemic index under Nutritional Information.

glycemic load refers to the quantity of carbs that will enter the bloodstream with a given average serving of a particular food.

The difference here from the glycemic index is that we are now looking at how much an average serving might raise the blood sugar. The glycemic load is calculated by taking the glycemic index of a particular food, multiplying it by the actual amount of carbohydrate in a serving and then dividing by 100.

To better understand this concept, let's look at the glycemic load of some different foods. Let's begin with the example above, watermelon. Watermelon has a glycemic index of seventy-two. But remember that was determined by eating 750-960 grams of watermelon. Supposing you eat only four ounces (just under a cup of cubed melon) then the glycemic load would only be four to six, quite a different number than the glycemic index. glycemic loads below ten are considered low, and above twenty are considered high.

Now if we look at baked potatoes, depending on which reference you look at, there are six to seven carbs per ounce. If we consider a five-ounce baked potato an average serving then it will have thirty to thirty-five carbs per serving. Its glycemic index is about eighty-five (if served without butter). So if we do the math 85 X 30 divided by 100 we get a glycemic load of approximately twenty-five to thirty. If we add butter to the baked potato, it could reduce the GI to as low as sixty, because fat slows the absorption process (even though it adds a lot of calories). We then find that we have a GL of eighteen to twenty-one. Still not a low number.

What is important about the above information is the following: Low-glycemic index carbohydrates and low-density foods are basically the same types of food. Low-density foods should become a major part of your diet. Some foods even though they have a high-glycemic index can still be enjoyed on a regular basis because they have a low glycemic load. By utilizing the lists properly, you can expand your diet repertoire by choosing the right foods. Remember none of the numbers will be exact as you change references. There will always be slight variations. But low GI foods will always be low GI foods. High GI foods will always be high GI foods. Slight variation in numbers is not important

Low GL foods will only remain low if the portions are controlled. (eg. A small amount of watermelon is fine, a very large portion is not.)

The lower the glycemic load the lower the calorie count. Four ounces of watermelon only has about twenty-four to thirty calories. Two cups (around ten to eleven ounces) of cubed watermelon has closer to 100 calories.