What is good food?

I made a pledge to be a motivated patient. I want this journey called life to be extended. A little surgical intervention has provided me with the bus ticket but the state and condition of the actual bus is now up to me.

Change the things you can change and accept those you cannot.

Dr Ross Walker  has provided a framework to assess my existence to get the bus back in order. I have looked at exercise and am happy with my step programme. It is certainly not arduous as my work provides a good amount of exercise. If and when I retire my exercise regime will need a review but I relish that as the time then will be mine to spend at my will. Exercise I can see then as a joy rather than just something else to be crammed into the day.

I have reviewed my weight, honestly. Okay, there is a reduction required, a burn off,  but that is okay.The energy consumed versus the energy output approach really is simple. You have to expend more energy than you consume to lose weight and keep the energy consumption energy output equation equal to maintain weight. You can either expend more energy you consume by exercising more or simply consume less energy. How straightforward is that?  Weight loss for dummies!

The next subject to consider, over which there is a huge amount of personal control,  is what to eat to obtain the energy needed.  I mentioned a great web site previously. This gives a window into what energy input is required to feed the  metabolic rate that is you just by existing, or your basal metabolic rate(BMR). It will then illustrate the extra energy required to do nothing and in stages right up to performing strenuous exercise.

https://www.walkingwithattitude.com/fitness-tools/basal-metabolic-rate

My personal daily recommended intake is 9,000 kilojoules (or calories, you can find out either measurement on the calculator) just to exist and a further 2,000 kJ if I want to sit on my backside and watch television all day.  I want to exercise moderately so I need to add around 4,000kJ or thereabouts added to the requirement set by my BMR.

1 calorie is equivalent to 4.2 kilojoules

1 gram of fat contains 37kJ of energy
1 gram of alcohol contains 29kJ
1 gram of carbohydrate contains 16kJ
1 gram of protein contains 17kJ

I could consume this energy in many different ways. Presuming I was to exercise moderately as is my norm,  I could consume six Big Macs for the day to consume my 13,000kJ quota. ( Aussie Big Macs contain according to McDonalds, 2060 kJ. A US Big Mac contains 2,300kJ.)  However that would give me 162 grams of fat of which 66 grams would be saturated. It would also shunt  5154 milligrams of sodium into my system.  So what?

The dietary guidelines for Americans advises 20 to 35% of ones energy can come from fats but that no more than 10% should be saturated. Fats are high in energy and saturated fats are heavily linked to heart disease. The current recommended maximum daily allowance for salt or sodium is 2300mg.

Back to the Big Mac. Assuming I am exercising and require around 13000kJs for the day, fat consumption should be in the range of 2600 to 4550 kJ. Saturated fat should be no more than 1300kJ based on the recommended guidelines. Sodium should be no more than 2300mg. The breakdown for the Big Mac is 5994kJ of fat of which 2442kJ is from saturated fat and the amount of sodium is 5154mg. All figures are well over the recommendations.  The point of this analysis is not to slam Maccas but simply to make the point not all food is the same. Energy intake needs further thought than merely how much to consume. There is more that comes with food than just energy and kilojoules.

Here is where it gets difficult. Whilst the energy in versus energy out equation is real basic, the rest of it can and does get complicated. If we let it.

If you read the dietary guidelines as laid out in the publication by the Australian Government, you will be lucky not to fall asleep. You might get some information but you will have to squeeze it out like juice from a wizened old orange that has fallen to the back of the fridge for a few months. I found most guidelines were similar in their complexity. I want something simple that is easy to follow and does not require to cart around with for the day a calculator and a set of scales.

The guidelines are under attack anyway. With regards to the amount of fat we should consume a new review reports that not a single randomized, controlled clinical trial backed the advice when the recommendations were issued in 1977 in the US and in 1983 in the UK. The review believes the dietary fat recommendations should never have been introduced in the first place.

The senior investigator Dr James DiNicolantonio (St Luke's Mid America Heart Institute, Kansas City, MO) says that instead of arbitrarily focusing on limiting one macronutrient perceived to increase the risk of heart disease, individuals should simply eat real food. By reducing the intake of one so called baddie the tendency is to replace it with something else which may in fact be worse for our health. To simply highlight saturated fat as the main dietary villain for cardiovascular disease has distracted from the risks posed by other nutrients such as carbohydrates.
There are other studies to support this and a host of diets and celebrity chef money makers that exploit the dietary insecurity that has been created by "problem" foods. There follows of course special diets and the "miraculous" super foods with claims that can cure all ills. There is also the cookbook, TV show, apron, sunglasses, DVD and yes we do take all major credit cards.
The complexity about what to eat has left so many people bemused. They are then sucked in by simple fix all solutions that leave their wallets panting for a rest.

The recommendation by Dr DiNicolantonio;  "The main message is to eat whole foods and stop taking on a single macronutrient, especially one that comes from a whole food."

A spokesperson for the American Heart Association, Dr Alice Lichtenstein (Tufts University, Boston, MA), says they no longer recommend individuals consume a low-fat diet. Instead, they recommend a moderate amount of fat intake, with approximately 25% to 35% of calories coming from fat. The reason being was that people were substituting simple, refined carbohydrates for fat, which in turn led to dyslipidemia, an increase in triglyceride levels, and a reduction in HDL cholesterol.  All bad.

Dr Rajiv Chowdhury (University of Cambridge, UK), says based on an analysis of a huge range of studies;

"If the saturated fat is lowered by replacing the calories with carbohydrates, you're not going to see a benefit," she said. "If the saturated fat is replaced with polyunsaturated fat, there are numerous studies showing there is a clear advantage in terms of cardiovascular disease risk. . . . There are different biological effects depending what you replace the saturated fat with."

So how do you get the right food and therefore energy to consume?

Just because fat is off the radar when it comes to heart disease now, this does mean it is wise to ignore the consumption of fat. As Dr Lichtenstein points out;

 "People ate more real food, as opposed to processed food, in the 1960s, and we had the highest rates of cardiovascular disease then. We also had high rates of saturated-fat intake. Real food can be butter, cream, and cheese, and very fatty meats."

The recommendations now is to emphasise a dietary pattern rather than focusing on individual foods. The advice is;

• To eat more real food. Processed and packet foods were once called convenience foods but they have become mainstream. Return them to the convenience section in your mind to be used on a limited basis. 
• Beware of fast foods. One store bought pizza supplies half of the energy intake required for a day. When they can sell me a pizza for less that what I can make it for, I am suspicious as to its goodness.
• A healthy food choice is a diet rich in fruits, vegetables, whole grains, fish, legumes.
• Reduce the amount of red meat you eat. 
• In 2011, Australians consumed around 111kg of meat per person. UK-based World Cancer Research Fund  and the American Institute for Cancer Research say you should eat no more than 500 grams of cooked red meat a week, which is equivalent to around 750 grams of raw meat. Thinking of portion sizes, 80 grams of cooked meat is about the size of a deck of cards. That is to reduce your risk of developing bowel cancer.  
• The same applies for coronary heart disease.As reported by the Health Hub from Cleveland clinic in the US researchers have found that when we eat red meat, there is a set of reactions mediated by microbes in our gut. These gut microbe reactions are triggered by carnitine, a nutrient found in red meat. The study found that these reactions, which were previously unrecognized, contribute to the development of heart disease. 

As the celebrated Australian celebrity chef Mathew Evans says, who pushes a diet with no miracle cures,
"A balanced diet, where you have a mixed intake of all food groups (moderation, just like your mother told you), is the key."

Phew, see simple isn't it! Well it is at least clearer to me. I don;t have to do without but I need to reduce the amount of meat I eat and when ever I want a snack, grab a carrot or stick of celery.

Fat, fatter, fattest.

Some times you just have to stand in front of the mirror and be honest with yourself.

" You my lad are overweight!"

There we are, that was not too hard.

A quick way to verify the fact is to use an on line calculator of BMI, or Body Mass Index. For my height and weight my number is 26, when it should be between 20 and 25 to be a "good" weight. By playing with the weight number on the BMI calculator I can see if I lose 10 kgs, I currently sit at 106kgs, then my number drops to 23.5.

If I dropped 15kgs my BMI number would be 22.3 and I can assure you, I would look quite unwell although the number itself would place me in a very respectable zone of the BMI index. BMI is a measure for sure but it is a little crude as we all have different bone structures, shapes and so on. But it at least confirms what I have already told myself. An independent source has confirmed my suspicions that I am overweight and I am a little annoyed as it means my wife was right!

If you Google the question, "What is my ideal weight?" you will be provided with a number of answers. The site  www.calculator.net/ideal-weight-calculator.html  suggests a good range of weight dependent on the original researcher that devised the calculation method. It provides a wide target to aim for if you are thinking of losing weight. It will hopefully keep you in weight loss sanity mode rather than the stressed out, exercised out, starved, objective obsessed nutter space we are all unfortunately familiar with, if not from our own circle of friends family or work colleagues, then at least from the regular parading of these characters in the media.

But yes, I do need to and I do want to lose some weight. It will be a positive thing for both my mind and my body and importantly my heart. I am a committed patient from now on. I have had advice, well to be truthful I discovered advice as previously blogged, and I will act on  it bit by bit. not bite by bite. 

The bit by bit aspect is important when it comes to losing weight as I have  discovered previously. Fads, fasting, flogging and forgoing do not work in the longer term. Weight loss or weight management strategies have to be sustainable and the more normal the process, the more likely is success predictable for the future.

It is unnatural to starve oneself. Quoting from a 1997 publication titled; “Handbook for Treatment of Eating Disorders” by D M Gardner, it states, “One of the most important advancements in the understanding of eating disorders is the recognition that severe and prolonged dietary restriction can lead to serious physical and psychological complications.”

One of the breakthrough pieces of research is a story in itself. One of the problems of looking at eating disorders and diets is the people under observation often have issues and so cannot be considered to be a normal cohort of subjects to observe. However, during the Second World War an experiment was undertaken. A group of thirty six healthy, psychologically normal men underwent a restricted calorie diet for six months.

Initially they were fed normally, for three months, whilst base data was collected. For the next six months, the men were restricted to half of their previous food intake. At the end of six months, the men were slowly brought back to so called normal levels of food intake.

This group of so called normal men had varying responses to the lack of food .The stand out change in the subjects was the huge increase in a preoccupation with food. Men would dream about food, asleep and awake. They would talk about food, collect recipe books or food related items like coffee cups and kitchen utensils. Many would hide food and consume it over long hours away from others. They took on hoarding behaviours even to hoard things that were not related to food. During the rehabilitation phase, these new behaviours did not miraculously disappear. For a number, binge eating continued well after the restrictions to food intake were removed.

There were other changes in their emotional states, personalities, social interaction and how they thought and functioned.

The starvation experiment or the Minnesota experiment, is an interesting study for anyone having difficulty with their attempts to diet.

There is a very simple basic formula for weight loss;

Energy in must be less than energy out.

However simple that fact is, simple is not always straight forward.

To get an idea of what energy you should consume in a day, the website below  is a good start.

https://www.walkingwithattitude.com/fitness-tools/basal-metabolic-rate

It is straightforward and  easy to select metric or imperial measurements and daily activity level. Looking at your sedentary energy requirement is worthwhile for those days where you do struggle to do much and compare the energy needed for those days where you are on the go.

There are plenty of calorie or kilojoule calculators out there to assess how much you might be consuming with your eating pattern at the moment. If you are motivated you will have the motivation to work it out. For your interest though, type ""What does 100 calories look like" into your search engine, the images are interesting.

images courtesy of sparkspeople.com

In short, there are some really simple food choices that can be made to make you feel full or satisfied that have very few calories e.g celery, carrots

But back to weight loss there are some pretty useful things to consider that might help.

You are you and do not try to pretend to be otherwise. There are some foods that maybe you should not eat but really you will feel you are starving yourself if you do without them. There are some food rules that unwittingly you live by.  You have to abide by yourself. Go back to the starvation diet, it ain;'t going to work and you are setting yourself up for failure if you do not take these into account.

Make a list of the foods you love and could not do without, the foods you could do without and the ones you can take or leave. There is likely to be a scale of “Yum” to “Yuk!”

What rules do you live by? “I always have a take away food on Friday nights.” “I like to have a snack when I watch television”. “I must have a cake with my coffee”. There will be a host of things you like and a raft of things you would not like to go without.

When you know what you can’t live without, don’t try to, you are highly likely to cheat, deny  and fail.

Do you love a snack after meal time as you watch television? Make the snack smaller in volume and substitute where you can, healthier alternatives- a piece of fruit, a vegetable stick. But you still want your biscuits too don’t you? Instead of three biscuits, have one and make it a beauty. Boy, does it taste good! Instead of a bar of chocolate why not try one piece but of the most expensive chocolate, lip smackingly good chocolate, the sort you could easily club your partner on the back of the head to get to first.

The answer is to make diet part of a lifestyle option, a positive move that does not see you flogging yourself for being the miserable weak piece of filth that magazines and the media try to push you feel about you. Increase your energy output.again by appreciating the sort of exercise you could see yourself doing and knowing which ones you know you would never do. Don’t bother  buying the full set of Lycra swimwear or cycle wear if you hate swimming or cycling.. Do something you like and start off gradually so you will continue to enjoy it. Exercise does not just mean running, swimming, gym, aerobics, cycling and the like. I feel tired just thinking of those things. What about walking, gardening, dancing to music, shopping. Yes shopping! Maybe park your car a little further away next time. Hate mowing the lawn? Make it one of your exercise options. Mow, one two three, Mow one two three…. 

There will be something that works for you but you need to understand what you really like and what you can forgo, in order to make the necessary changes.

If you want to lose weight, you will do so. If you feel you should, you will not. Make the change because you want to and it will work. The key to dieting is it has got to be easy. Punishment only works in the short term.

Slowly does it. Slowly is like the tortoise and the hare, the slow and steady wins and sustainably as it is more like a lifestyle plan rather than a prison programme. Once you know your own daily energy requirement, if you eat 500 calories less than that requirement, you will lose 500 grams or one pound of weight per week. That is a huge change but one that is manageable. 

It is the HOW not the WHAT.

Reading from the Heart Foundation brochure they gave me whilst I was in hospital, " Coronary angioplasty and stents";

Coronary angioplasty is not a cure.

Okay I get it, it only treats the area of blockage or narrowing and it may happen again and it may occur elsewhere. So it advises you have to reduce or remove your risk factors. Reading again from the brochure;

The most important things that you can do are to:

• take your medicines as prescribed
• be smoke free
• enjoy healthy eating
• be physically active
• control your blood pressure and cholesterol
• achieve and maintain a healthy body weight
• maintain your psychological and social health.

Gosh, that makes it so easy, NOT! I could enjoy eating by wacking down three cheeseburgers and a double order of fries, all done with a healthy appetite! Going to get the cheeseburgers is exercise. Thinking about the cheeseburgers and then getting them is good for my psychological health. It does not tell me how only what to do.

It took me until now to read the damn thing, that shows you how easy it is. Mind you, I do consider myself at least somewhat informed. I did have a mother who was diagnosed with heart issues at 45 years old which means I have been living with at least a passing knowledge since I was about  eighteen.

Mind you you can imagine what a young person did with all the knowledge bestowed from on high, nothing! Partied hard!  Smoke, drank, stayed up late, ate shit, standard stuff and all so predictable. If my heart disease is at least in part genetic, is it not a shame some of the wisdom is not inherited too. Why is it us humans have to relearn all the stuff it takes a lifetime to learn that our grandparents and parents kept telling us about?

Funny how things sometimes happen at the right time or the time when you need them to happen. I stumbled on a book in a second hand shop, local author, a prominent cardiologist called Dr Ross Walker.

"If I eat another carrot I'll go Crazy-The Five Point Plan to a Healthy Heart."

His recommended five point plan is not so didactic and is expansive. It certainly makes me think a little more outside the realms of living a  monastic life of abstinence and punishment.

His plan is as follows as quoted from his book;

1. Physical: How you eat, how you exercise.
2. Mental: Acquisition of knowledge; how stimulating do you find your job?
3. Emotional: Do you value your relationships with those close to you? Do you feel happy, how often do you laugh?
4. Sensual: Is your life very mechanical and concrete or do you look for the beauty in life and nature?
5. Spiritual: Do you have a sense of inner peace? Do you have a belief system that allows you to strive towards higher goals?

"It is the combination of all of thee factors that leads to health" he says. But his next statement is the one that makes me take notice and take heart, no pun intended.

" In my practice, I have witnessed two separate types of patients, the motivated and the unmotivated. I can barely remember one truly motivated patient who required repeat coronary bypass grafting. On the other hand I can remember numerous unmotivated patients whose grafts blocked within a few years"

The motivation he reflects is the motivation to change your lifestyle. "A global approach involving how we eat, how we exercise and how we manage our day to day stresses."

Whilst that appears to be more difficult it provides a meaningful path forward. The framework permits variance to suit the individual and in so doing allows effort in the areas that personally a person feels most confronted by. Finally it is a positive message which gives impetus to action. There is hope with action. What is now provided is a how, not just the what needs to be done. The how relates to your whole being not just one aspect of it. Time for a few more questions on oneself...