Considering Total Calories First

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^jQOli Wanda B. Thinner, age 46, was a new type 2 diabetic patient who came to me because of high blood glucose levels, some blurring of her vision, and some numbness in her toes. She was 5 feet 5 inches tall and weighed 165 pounds. She was taking pills for the diabetes, but they were not helping. Her doctor had told her she needed to lose weight but gave no further instructions. I started her on a diet based on the principles in this chapter. She was willing to follow the diet and lost 20 pounds, which she has kept off. Her blood glucose is now in the range of 110 most of the time. She no longer suffers from blurred vision, and her toes are beginning to improve. She is not taking the diabetes medication and feels much better.

No matter how you slice it, your weight is determined by the number of calories you take in, minus the number of calories you use up by exercise or loss of calories in the urine or bowel movements. If you have an excess of calories coming in and have insulin with which to store them, you gain weight. If you have fewer calories in than out, you lose weight. (See Chapter 7 if you're not sure how much you should weigh.) If you are overweight, you will benefit from even a small weight loss:

i Weight loss markedly reduces the risk of developing type 2 diabetes.

i Weight loss prevents the progression of prediabetes (see Chapter 2) into type 2 diabetes.

i Weight loss can reverse the failure to respond to drugs for diabetes that develops after responding at first (see Chapter 10).

i Weight loss reduces the risk of death from diabetes.

i Weight loss increases life expectancy in patients with type 2 diabetes.

i Weight loss has beneficial effects on high blood pressure and abnormal fats (see Chapter 7).

In an article in the International Journal of Obesity in June 2006, the authors from the University of Alabama and the University of Wisconsin offered ten other reasons that may be playing a role in our obesity epidemic. They are worth noting and considering for the possible role they play in your overweight condition:

1 Reduced length of nightly sleep: There is an inverse relationship between weight and hours of sleep. People are sleeping less than they did before.

i Hormones and other substances in food: Substances like estrogens, which are put in animal feed to fatten the animals, do the same to the humans who eat those animals.

i Decreased exposure to high and low temperatures: High temperatures cause sweating and low temperatures cause shivering, both of which contribute to weight loss. Modern heat and air conditioning diminish our exposure to extremes of temperature, which is actually good for us.

i Decreased smoking: This is a good news, bad news phenomenon. Obviously cigarette smoking is the greatest public health menace that exists, but smokers do tend to be leaner than non-smokers.

i Use of drugs that cause weight gain: Many of the drugs used for mental states like depression and high blood pressure cause marked weight gain and even diabetes.

i Increases in age and ethnic groups that tend to be more overweight or obese: Hispanic Americans, who are increasing in the population, have a much higher obesity prevalence than Caucasians. At the same time, the general population is older.

i Increasing age of new mothers: Older mothers tend to produce more obese children.

1 Effects in the uterus: Maternal obesity may cause changes in the growing fetus that promote obesity.

1 Heavier women have more offspring: These offspring, in turn, tend to be heavier.

1 Humans tend to choose heavier mates: Heavier mates have reproductive advantages.

One or several of these explanations may play a small role in your overweight condition, and several may interact, but the overall effect is a significant increase in weight.

Portion sizes have increased significantly both in restaurants and at home. Here are correct portion sizes for several foods:

1 Three ounces of meat is the size of a deck of playing cards.

1 A medium apple or peach is the size of a tennis ball.

1 One ounce of cheese is the size of four dice.

1 One-half cup of ice cream is the size of a tennis ball.

1 A cup of mashed potatoes is the size of your fist.

1 A teaspoon of butter or peanut butter is the size of the tip of your thumb.

1 One-half cup of nuts is the size of a golf ball.

The reason the French, with their much richer diet, may be leaner than us is that they eat significantly smaller portions.

To have an approximate idea of how many kcalories (kilocalories) you need each day (not calories, which are much smaller), you need to figure your desirable weight. Using the method describe in Chapter 7, a 5-foot 6-inch male with a moderate frame should weigh around 142 pounds. To find the number of kcalories needed:

1. Multiply your weight times 10. In our example, this gives a value of about 1,400 kcalories.

2. Add kcalories for your level of exercise:

• A sedentary male adds 10 percent of the basal kcalories.

• A moderately active male adds 20 percent.

• A very active male adds 40 percent or more, depending on the length and the degree of exercise.

If the male in our example is moderately active, he needs 1,400 kcalories plus 1,400 times 20 percent (or about 300) more for a total of 1,700 kcalories.

These formulas are true for women as well, but women usually require fewer calories to maintain the same weight as men. Be aware that this is an approximation that differs not only for different people but even for the same person on different days.

Caloric needs are different for people of different ages and different levels of activity. A woman that is pregnant or breastfeeding obviously needs more kcalories. If a person is trying to lose weight, reducing the total kcalories per day can help to accomplish this. I say a lot more about this in the section on weight reduction in this chapter.

After you've calculated your kcalorie needs, you need to try a diet based on those needs, and you need to be willing to modify that diet if you don't have enough energy or aren't maintaining your desired weight. Especially if you are very physically active, your extra caloric needs may be very large and will quickly be noticed because you will lose weight.

When you determine the total kcalories you need, the question becomes how to divide the calories among various foods. Basically, three types of foods contain calories: carbohydrates, proteins, and fats. Within these foods, you have many variables, which I explain in the following sections.

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