health

Instead of Dieting to Lose Weight, Focus on Long-Term Health

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | February 22nd, 2019

Dear Doctor: Yes, it's totally predicable, but my New Year's resolution was to lose 15 pounds. I wanted to do the keto diet, but my friend (a physician assistant) said to concentrate on healthy eating instead. What do you think? Does it really have to be a choice between weight loss or wellness?

Dear Reader: You're asking an excellent question, and you are far from alone in your quandary. Since the holidays, we've seen an increase in the number of stories on this very topic. Where once post-holiday diet discussions focused on austerity and sheer willpower, the conversation has shifted to health and well-being. Sure, restrictive eating plans like the ketogenic diet, which revolves around fat and protein, still hold sway. It's hard to argue with the allure of eating bacon, cheese, meat and butter and still losing weight. When you look at the history of dieting, which stretches back thousands of years, we humans have always sought one magic formula to make weight loss easy, fast and painless.

Now, however, the tide is turning. The term "wellness" has quietly migrated from the medical world and into common usage. Even Weight Watchers, the venerable diet company, has rebranded itself to WW, in one fell swoop erasing its decades-long connection to restrictive eating.

Still, simply switching to a healthful diet does not automatically translate into weight loss. The connection between how much energy we take in and how much energy we expend remains. Consistently overeat, even on a healthful diet, and you'll gain weight.

In our experience, the approach to weight loss that has the best odds of success is a plan that is gradual, deliberate and long-term. That's not nearly as gratifying as the high-protein blitz that sends the numbers on the scale into a nosedive, but it also has lower odds of the rebound weight gain that often leaves dieters heavier than when they started.

We agree with your friend that your initial focus should be on a healthful and well-balanced diet. But we don't think that when you get up tomorrow morning, you have to face a brand-new dietary landscape. Instead, start with a clear-eyed assessment of what you actually do eat. Keeping a food diary for one week -- a relentlessly honest one -- is an eye-opener. Write not only what you eat, but also how much and at what time. We guarantee that a pattern will emerge, including days and times that you find yourself most susceptible to poor choices. Once you know that the doughnut you easily ignored at breakfast sings a siren song at 3 p.m., you can plan ahead with a healthful substitute.

Make any dietary changes gradually. (And please, do add an exercise component to your plan.) Ease added sugar out of your life. Wean yourself from processed and snack foods. Focus instead on lean proteins, a wide variety of fresh fruits and vegetables, whole grains, nuts and legumes, and healthful oils. It can be tough, but make peace with the idea of incremental weight loss. With just 5 ounces of weight loss per week, you'll exceed your 15-pound goal by the time 2020 rolls around. And with the new habits you've developed, odds are you'll be able to maintain it.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

health

Readers Comment About 'Hanger' and Question Sugar's Role in Mood

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | February 20th, 2019

Hello, dear readers! Welcome to our next installment of your letters! You've kept our inboxes full with questions, comments and even some compliments (thank you!), so let's dive in.

-- We continue to get mail about the column about "hanger," the irritability that can accompany a drop in blood glucose.

"You didn't mention the possibility of a disease being the root of the problem," a reader said. "I am not sure about other diseases, but I know this can happen with diabetes as it happens to both my daughter and me. Eating will fix the problem for a while, but it will return. One thing that really helps when you're dealing with diabetes is to be careful to eat properly in the first place."

We think this is an excellent point. We've had several requests for columns about diabetes-related changes in mood and cognition and will indeed address that soon.

-- In a previous column a mention was made of seeking advice from a nutritionist. We would like to thank the registered dietitians who wrote in to point out that unlike a nutritionist, who requires no specialized training, a registered dietitian has a degree in nutrition and has successfully completed both an internship and passed a registration exam.

-- After a column about the use of fecal transplants to treat infection with the bacterium C. difficile, which can cause symptoms that range from diarrhea to life-threatening inflammation of the colon, we heard from a reader who successfully underwent the procedure.

"I had this transplant done two years ago at age 94," she wrote. "It worked well, and in two to three weeks, no more C. diff. I am now a healthy 96!"

-- We heard from several of you after a column about the flashing lights in the film "Incredibles 2," which caused seizures in patrons with a condition known as photosensitive epilepsy. Some theaters prominently displayed warning signs about this in their lobbies. But, as a reader pointed out, the same strobe effect can happen anywhere.

"A family member was driving along a road lined with trees," this person wrote. "The sun was shining between the trees, and the light and dark flashes caused a seizure! Fortunately, he was able to stop and lie down."

-- After a column about a study that linked a diet of high-fat junk food to weight gain and poor mood, we heard from a registered nurse who was disappointed that we didn't include the role of sugar in weight gain and depression. Although the specific study the reader had asked about didn't address sugar, we agree that sugar can also play a leading role in poor gut health, and we thank her for taking the time to point that out.

And with that, we've used up our allotted space for the week. We love your letters and hope you keep them coming. We look forward to discussing more of your questions and concerns soon.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

health

Most Cases of Scoliosis Have No Root Cause

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | February 18th, 2019

Dear Doctor: Can you please explain scoliosis? My 11-year-old daughter was recently diagnosed with it, and though it's mild, we're very worried. Why did she get it? Will she need surgery?

Dear Reader: Scoliosis is a condition in which the spine gradually takes on a lateral curve in the shape of either an S or a C. It can occur at any age, but scoliosis is most common in young people between the ages of 10 to 14. It's estimated that between 2 and 4 percent of youths will develop scoliosis during the growth spurt that accompanies the onset of adolescence. And while the condition is equally common in boys and girls, girls are 10 times more likely than boys to develop more severe spinal curvature.

Most cases of scoliosis are mild and require only ongoing monitoring of the existing curvature, making sure it doesn't escalate. In more severe cases, treatment with a brace or surgery is often required. For anyone who saw footage of her royal wedding last fall, the U.K.'s Princess Eugenie wore a low-backed dress designed specifically to show the scar from her own scoliosis surgery at age 12.

When someone has or is developing scoliosis, it becomes visible in their posture. Signs of the condition include uneven shoulders, visible differences in arm length, a shoulder blade that becomes more prominent than its partner, a tilted waistline, or uneven hips. In serious cases, the curving spine may cause the torso to rotate or twist. Since this affects posture, the condition can result in the rib cage pressing against the lungs and heart, which can interfere with breathing and cardiac activity. For adults who had scoliosis as children, chronic back pain can become a problem later in life.

The condition develops gradually and without pain, so it can be difficult to identify. Diagnosis typically begins with a neurological exam to assess strength and reflexes, and to check for numbness that occurs due to pinched nerves. This is followed by imaging tests to visualize the spinal structure.

The type of treatment depends on multiple factors, including the age and sex of the patient, and the location and pattern of the curve. For children with a mild curve and who are still growing, like your daughter, "watchful waiting" may be the most appropriate approach. In some cases, to prevent the condition from worsening, they may be fitted with a custom-made brace. In severe cases, when the spinal curvature is progressing rapidly or is causing pain or dysfunction, surgery may be required.

As for what causes scoliosis, the answer remains unclear. It has been associated with neuromuscular conditions like muscular dystrophy and cerebral palsy, can be a birth defect, and may occur as a result of spinal injury or infection. But the majority of cases are considered idiopathic, which means the root cause is unknown.

Emerging research suggests a link between some cases of scoliosis and a rare gene variant that may interfere with the absorption and use of manganese, a mineral required for growing bones and cartilage. Initial research, which was done on zebrafish, has been intriguing enough that further studies are already in the works.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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