BACK TO BLOGGING/HAPPY NEW YEAR

I have a calendar that has a page making fun of blogs. It says, "Blogging: Never before have so many people with so little to say said so much to so few." It's pretty funny, and sadly true.
There have never been a ton of readers of this blog, but I'm sure there were more (i.e. 2 or 3) back when I was updating the blog daily. That became a drag, and as a result the blog suffered.
So for 2009, I'm going to get Dr. Tofuhead going again, and set some reasonable goals. If the blog completely sucks please let me know, and I'll revamp the whole thing or shut it down.

NEW FEATURES FOR 2009:
1. The blog will be updated once a week.
2. As usual, there will be a new topic and also reader questions will be addressed as they come in. 3. If I'm lucky, my brother Randy will put up some photos.
4. There will be more of a focus on preventive health, i.e. keeping yourself healthy...and happy. I'm going to be combing the Mental Health literature for useful new tidbits.

TODAY'S TOPIC: USEFUL RESOURCES FOR YOU!
I get a lot of useful health information from sources that are not written for doctors; they are written for "lay people" like YOU. There really are some exceptional sources of health information out there, mixed in with a whole lot of crap. The Internet in particular has a wealth of useless and erroneous health information, and I am dismayed every time I do a general search about a disease using Google. So here are a few sources that are in print, that are readily accessible, and that are LOADED with useful health topics:
1. Harvard Health Letter: this is a monthly newsletter that is relatively inexpensive and loaded with good information from the folks at Harvard Medical School. It covers everything from exercise and nutrition to detailed reviews of new tests doctors use. For example, a recent issue covered cholesterol blood tests, how much sleep you need, what kinds of fish to eat, a review of topical pain creams, cardiac stress tests, and everything you need to know about ear wax. It's available online as well, though you need a subscription to access the current month, which I highly recommend. Check it out at: http://www.health.harvard.edu/.
2. The University of California, Berkeley Wellness Letter: similar to the Harvard Health Letter, this was the health newsletter that started health newsletters. I can't overemphasize how awesome this newsletter is. I can't think of a single health or nutrition-related topic they haven't covered in depth over the last 3 years. The issue on my desk covers generic vs. name-brand drugs, berries, motorcycle riding, organic vs. commercial produce, preventing and treating mosquito bites, exercise, and all the skin cancers you need to know about, plus more. If you have to spend a bit of money on just one source of health information, this is the one I recommend. Check it out at: http://www.wellnessletter.com/. Better yet, try it for a year- it's only 20 bucks.
3. Live Longer, Live Healthier, free online book: the website associated with this newly-published health book sucks. But check it out: the authors, 2 highly respected academic professors in Internal Medicine, want you to have their book, FREE. They are not publishing it for sale; rather, they put the entire book online and they invite you to download the whole thing, with no strings attached. That's a lot of paper, but the book is just over 200 pages and has gotten great reviews from some very tough reviewers, notably the editors of the New England Journal of Medicine.
The web site is new and I suspect you'll be able to search for individual topics at some point. For now, you can open the book in Adobe Acrobat and print just what you want, or you can print the whole thing. Check it out at: www.healthierlongerlife.org.

EAT LESS, DRINK LESS, EXERCISE MORE, LOSE WEIGHT

I didn't come up with this topic idea. The "Leather District Gourmet," who has a blog much better than mine, came up with it. But I like it. I actually think the topic could fill an entire book with hundreds of pages of useful information. So why don't I write that book? Because, in short, nobody would buy it. In America, lots of people need to lose weight, but naturally they don't want to do it the "old fashioned" way. Who likes to be told that they need to eat less, drink less, and exercise more? Answer: nobody. At least not in America. Americans want instant results, without having to do much work. Here are some examples of some potential weight-loss books that would sell like hotcakes:
1. Eat More, Drink More, Do Nothing, and Lose Weight
2. Binge Your Way to a Smaller Waistline
3. Why You Don't Need to Exercise to Lose Weight
4. The High-Fat, Low Activity Lifestyle to Lose Weight
5. Losing Weight by Watching TV
6. How to Take off the Pounds in Less than 2 Minutes a Day
7. How to Change Your Waist Size Without Changing Your Diet
Unfortunately, I'm not going to write these books; I'm going to tell you the harsh truth about weight gain and weight loss.

THE HARSH TRUTH ABOUT WEIGHT
We all know Einstein's wonderful equation, whether or not we understand it: E=mc(squared).
The equation for body weight, in my opinion, is just as sublime:
Calories consumed - Calories burned = Calories converted to body fat.
It's that simple. In other words, if you consume more calories than you burn off, those extra calories will be stored, usually as fat, and that fat will increase your body weight. Fortunately, your body already burns 1500-2500 calories just to keep you breathing and thinking, depending on your age, size, and daily activities. So you ARE allowed to eat SOME calories!

WHAT ABOUT MY METABOLISM?
Nearly every day, at least one patient comes in with a similar story: "I'm not eating all that much, and I exercise, and I keep gaining weight. So I know it's not my calories, I must have a thyroid/adrenal/glandular/diabetic/metabolic problem." And while it is true that some metabolic or hormone-related problems can cause weight gain, it's hard to emphasize how rare that circumstance is. In nearly 10 years of medical practice I have seen exactly 3 patients who had abnormal weight gain for hormonal reasons- all 3 had critically underactive thyroid glands. Most people who think they are gaining weight for hormonal reasons are still consuming more calories than they burn off. Once I have proven this to patients when their lab tests come back normal, I typically ask them to start keeping a "food and exercise diary," so that we can take an honest look at how much they are eating, and how often they exercise. The result is predictable: I never see those patients again. Because the truth hurts.
As for metabolism, there is no question that it slows as we get older. At age 25, for example, you can probably consume 2500 calories per day, or more, without gaining weight. At age 50, that exact same number of calories might add a pound per week to your body weight. I do not dispute that. But this slowing of the metabolism is not pathological, and there is no scientific medical treatment for it. Treating your slowing metabolism as you age is a matter of paying attention to it and respecting metabolic change. Unfortunately, that means eating less, drinking less, and exercising more! You'll find plenty of quacks willing to sell you expensive hormone products to "speed up your metabolism," and prove me wrong. But hormones are powerful substances- I don't recommend messing with them unless you absolutely have to.

CAN MEDICATIONS CAUSE WEIGHT GAIN?
Many patients blame their excess weight gain on medications they take, some of them rightly so. Unfortunately, they tend to blame weight gain on a whole host of medications which usually do NOT cause weight gain. Let me simplify the issue by giving you a list of medications which clearly DO cause weight gain, because it's a short list:
1. Steroids, such as prednisone.
2. Anti-seizure medications, especially Depakote (also used for bipolar depression).
3. Insulin.
4. Some of the oral diabetes medications, such as sulfonylureas and "TZDs" such as Actos.
5. The anti-depressant Remeron, which is used primarily in the elderly.
6. Topamax, a medication used for migraine headaches and seizures.
That's about it. I'm sure I'll anger many people by saying this, but guess what: oral antidepressant medications, anti-anxiety medications, and birth control pills do NOT cause significant weight gain. I know you gained 20 pounds when you started Prozac. But that's because you started eating more. Sorry.

I WANT TO LOSE WEIGHT: WHAT CAN I DO?
The bottom line: you need to burn more calories than you eat and drink. It's that simple. When you start looking at the different calorie types, it does get more complicated, as not all calories are the same. Dr. Atkins, Barry Sears, and their followers are probably onto something when they target simple carbohydrate calories as the most "fat promoting." But recent studies suggest that the extra fat-promoting qualities of carbohydrates are probably a bit overstated. That's because you can still put on plenty of pounds if you're on a carb-free diet and you eat more calories than you burn off.
Here are my basic tips:
1. Cut back on alcohol. Most alcoholic drinks have hundreds of calories, with very little nutritional value. As far as your body is concerned, a margarita is as good a source of excess body fat as a Big Mac. Like beer? Try to find one with less than 100 calories per bottle. They are out there.
2. Eat at least 3 meals a day. Studies have shown that people who skip breakfast, like me, more than make up for it with increased calorie consumption with their subsequent meals.
3. Avoid eating late at night. Your fat cells love a nice dose of calories at bedtime, when they know you won't have a chance to burn those calories off. That means: more fat for your body!
4. Join a gym. Better yet, buy a very nice treadmill or exercise bike for your home, so there will be no excuses. You'll be surprised how many calories you can burn while watching an episode of "Iron Chef" (if you're on a treadmill, that is).
5. Try a diet. Studies have shown relatively equal, if modest, weight loss in patients pursuing the Atkins Diet, the Ornish Diet, Weight Watchers, and the South Beach Diet. Personally, I think the Atkins diet yields the best short-term results, and the South Beach Diet or Weight Watchers are easier to stick with for the long term. These diets work- it's the dieters who fail because too often they "fall off the wagon." I'm not saying it's easy.
6. Get a good scale. You might "feel fat" one day when it turns out that you lost 3 pounds the previous week! Give yourself a chance to feel good about the numbers, and to catch yourself when things are going in the wrong direction.
7. Make slow and steady process and realistic goals. Many people say, "I need to lose 100 pounds," when they should be saying "I need to lose 3 pounds a month regularly." Doesn't the latter goal sound more realistic?
QUESTIONS? Post a comment!