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updated 1/28/2004 7:15:31 PM ET 2004-01-29T00:15:31

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So many diets, so little success! Americans are more overweight than ever, but it's not for lack of diets to choose from: high protein; low fat; detox; grapefruit; fat burners. Dr. Lisa Sanders, has looked at more than 700 diets and knows what works and what doesn't. We talked to her about weight loss and her book, The Perfect Fit Diet.

Moderator: Welcome to WebMD Live, Dr. Sanders. Your book is hot off the presses, so some folks might not know what it's all about. Let's start with a synopsis of The Perfect Fit Diet. Did you really research 700 diets before writing this book?

Sanders: Yes! I did read all those studies. I read them for a research project that I was working on with several doctors at Yale and at Stanford. We were comparing the efficacy and safety of low-carbohydrate diets to other types of diets.

It was in the course of that research that I came to see that all these different diets worked for some people and more important, or just as important, none of these diets worked for everyone. That led me to realize that it was really the match between the dieter and the diet that determined success. When I think about it now, it seems like, "no, duh!" But at the time to me it seemed quite an unusual thought, and I think it still is, at least for doctors.

When I realized that, I put together a series of questions that would help define that fit between dieter and diet. That was the genesis of this book.

Member question: What is the Perfect Fit diet? Does it vary from people to people?

Sanders: Absolutely. Basically I tried to use information about the individual dieter to help direct them to one of three basic diet types:

A low-carbohydrate diet A low-fat diet A low-calorie diet

Other information that you provide in the questionnaire in the book allows me to direct you towards ways for you to customize the basic diet template to fit you better. The questionnaire depends on information you provide to help you decide which diet and how you should customize it. This would be information including:

Your food preferences likes and dislikes Which types of food make you feel full How your lifestyle interacts with the way you eat How your medical history affects the way you should eat and need to eat

This is the basic type of data that I require from the dieter to assign them to a diet. Each of these three diets is described in my book in detail and sample menus are provided.

Moderator: Any idea what most people will end up with at the end of the questionnaire?

Sanders: I'll tell you my prejudice and experience. My experience is that people's craving for variety is so strong that diets that seek to limit your food choices are not as popular, ultimately, as diets that give you a wide variety of food to choose from and limit portion size.

I think most people will eventually end up on a diet that will allow them to count calories directly. This gives people the most control over their diet. However, there are people who do extremely well on diets that limit your choice.

Member question: Can you only pick from one of those three diets? Can you do a combination of both, like a low-carb and low-fat?

Sanders: I think a low-carb and low-fat diet would be very difficult to pull off. However, I think combining a low-calorie and low-carb, or low-fat and low-calorie is possible. What I try to do in my version of the low-carb diet is to direct people toward good fats, that is vegetable fats like olive or corn oil or the omega oils, omega fats found in seafood, as opposed to the saturated fats found most commonly in meats.

Moderator: So for those of us that prefer salty snacks and sodas and don't go for veggies very often, are we hopeless? Are we doomed to never find the weight loss that fits us?

Sanders: Well, of course not. You have to work with what you can. It's hard for me to believe that someone has given vegetables a shot if they think that they really don't like all vegetables or any vegetables. The vegetable group of foods is one of the most varied and diverse food groups on the planet -- much more diverse than, say, meats or fruits or grains. I really think that for the most part, there's something there for everyone, but you might have to look for it. What commonly happens, especially, is that people are exposed to only a few vegetables and in those few vegetables they don't find any that suit them, so they conclude they don't like vegetables.

I have two more thoughts on that: First, I would encourage finding vegetables that they enjoy, because first of all, I think they're good for you. What can I say? They make you feel good, they make your body work well, and they prevent disease. So it's certainly, in the long run, good for your whole body, and not just your weight, to find some vegetables that you enjoy.

Second, many people who say they don't like vegetables carry a gene that makes their taste buds very sensitive to the bitterness in foods, especially the bitterness commonly detectable in some vegetables. It's not an uncommon gene; maybe half of the population in this country has it, possibly more. This may mean that you, like the former President, are genetically programmed not to like broccoli. But that's OK; there are other vegetables out there.

One last thought. I would say, though, if you're not a big vegetable fan, a low-fat diet ain't going to cut it for you.

Member question: Does the questionnaire cover "emotional" eating patterns?

Sanders: Absolutely. I think emotional eating is a very big problem in this country and a big part of why many people are overweight. I think for many people dealing with this is a key to their achieving a weight they feel good about.

The first thing I have my patients do, and my readers, is to keep a diet diary for a week. In that diary they are to write down everything they eat and drink, when they ate it, and why they ate it. It's true that sometimes we eat because we're hungry. But often we eat for other reasons, as well. You need to know what all those reasons are.

Then we need to address the issues that cause you to eat when you're not hungry. Sometimes just recognizing those issues can be helpful; frequently it takes more than that. I think either a support group, where you're with people who are also dealing with this kind of problem, or individual therapy may be helpful. On the other hand, it's possible that just a substitution is helpful, substituting something for eating in the face of these emotions. The thing I recommend most is exercise.

Before you moan, let me say that exercise is probably the activity we were designed to do when faced with emotion, or some sorts of emotions like stress or anxiety, or even unhappiness or loneliness. But we've gotten away from that. It actually didn't used to be called exercise; it used to be called "work" or "life." But our lives have gotten much kindler and gentler, and so has our work. Now we have to import activity in the form of exercise. The natural response to stress and the hormones it releases is activity. Now that our life has changed, we have to provide ourselves with that activity in a more artificial way.

Moderator: After looking at 700 diets some must have really turned you off, or you found them to be downright dangerous. Are there any diets you simply would not recommend?

Sanders: Absolutely. Diets that reduce the number of calories you take to less than 800 are not terribly effective and can be dangerous. Diets that limit you to only a very, very narrow range of foods are also not very effective and can be dangerous.

I don't worry about these so much, because it's very hard for the vast majority of us to adhere to a diet like that. But those are the kind of diets that I steer people away from, not only because they're dangerous, but because the diet you find is the diet you should be ready to live with for the rest of your life.

In my book I try to change people's relationship to their diet in a constructive way. I like to argue that an extreme fad diet is like the people you date; my diet is like the people you marry. You're looking for different things. You're looking for a long-term commitment. And fad diets can't provide that.

Moderator: There's been quite a war of words the last few years over the classic low-fat, low- calorie diet camp and the increasingly large Atkins-type diet camps that tout low carbs as the solution. What's your take?

Sanders: I think the research is clear, mine as well as other physicians. A low-carb diet is just as effective as a low-fat or a low-calorie diet -- no less effective, but no more effective.

The other concern about these diets is safety. Just based on what we think we know about the food we eat and what it does inside out bodies, we've worried that eating a diet that's high in protein, high in fat, would make your cholesterol go up and maybe hurt you in other ways. The cholesterol question I think has been laid to rest. In study after study most people's cholesterol improves with weight loss, even if they're on a low-carbohydrate diet. There are still other issues about safety, but so far it appears it's a pretty safe way to eat.

I feel that you have to go where the facts lead you, even if it goes against what you thought you knew. I think the data shows this is a safe and effective diet for many people. Now the question ought to be is this an effective diet for me or for you, and that is what my book tries to address.

Member question: Have you heard of the eating for your blood type method, and on what facts and research is it based on? What are your views on this method?

Sanders: I've read that book and I find it interesting that this complimentary medicine doctor should be the first to suggest what we all know to be true: one size cannot fit all. He was using his background and his type of medicine to try and come up with a rationale and diet that varied based on something that was measurable. I think that was an impressive beginning.

On the other hand, I don't know of any real evidence in Western medicine, or any physiological rationale in Western medicine, that would support his theory.

However, if it works for you, great. If in there he has a diet that matches you, the theoretical underpinnings are totally irrelevant.

If the diet fits, wear it. But remember, we're talking marriage, not dating. It's got to fit for the long run.

Member question: What happens when you switch from a low-carb diet to Weight Watchers? I have been on Curves' weight-loss program and I am beginning to feel very sluggish and always constipated. Time to switch. Taking laxatives everyday is not my thing.

Sanders: Absolutely. I don't know the Curves diet, but you describe it as a low-carbohydrate diet, and I know those diets well. Constipation is a problem for many people on a low-carbohydrate diet, simply because they don't get enough fiber.

There are a couple of ways that you can address this. First you can increase the amount of allowed vegetables in the low-carb diet to increase the fiber. In most low-carbohydrate diets, you're allowed unlimited amounts of some vegetables, usually greens and lettuces. I encourage you to eat a good amount of them to add roughage to your diet. The other way you can deal with that, while sticking with a low-carb diet, is to take a fiber supplement like Fibercon or Metamucil and add fiber to your diet that way.

Of course, if you're on any kind of low-carbohydrate diet, or any diet, you should be drinking lots and lots of water. If you decide to leave a low-carbohydrate diet and start on a low-calorie, low- fat diet, like Weight Watchers, I think you can do that, of course. If you've been keeping a very strict low-carbohydrate diet with less than, say, 50 or 60 grams of carbohydrates a day, then you may gain a couple of pounds when you reintroduce carbs into your diet, as you reestablish the stores of sugar that you have when you eat a diet that has a normal amount of carb in it. This is not real weight, or rather, it's not fat you will gain; this is water weight.

Before you make any switches, let me suggest that you should think about the way you want to eat for the long run. Let that guide you as to which diet you should follow.

Member question: My overall cholesterol is over 200 for the first time, and I have a history of heart disease in my family. However, my ratio of good to bad cholesterol is still good according to my doctor, but he wants me to lose 15 pounds. What kind of diet is appropriate for me? I am considering the South Beach diet.

Sanders: Well, I'm glad that your HDL, or good cholesterol, is high. That's a very important health factor. If you're trying to bring your total cholesterol down I think any diet that helps you lose weight will do that. Overall, cholesterol decreases as your weight does. Usually, especially if you continue exercising, your total cholesterol to good cholesterol ratio improves.

The South Beach diet is, I think, a terrific diet, if a low-carbohydrate diet is what appeals to you. It's a low-carbohydrate diet that directs you towards vegetable oils and unsaturated fats and directs you towards complex carbohydrates. I think that it would work very well if it lets you eat in a way that satisfies you.

Member question: With so many kids obese I have all four of mine eating healthy with me, but it's getting really expensive and doesn't always look good to a 4-year-old. Do you have any suggestions?

Sanders: I think you're doing an incredible job teaching your children to eat well right from the start.

Sometimes it can be expensive to include so many fresh fruits and vegetables in your diet and in the diets of your children, and many pre-prepared foods are cheaper than foods you prepare yourself, because they're mass-produced. Nevertheless, I think that it's essential that we teach our children a way to eat that will keep them healthy throughout their lives. We like what we know. If they know good foods, they'll like good foods. So good job, mom or dad.

As for your 4-year-old, no matter what you feed kids this age, I think they'll have a problem with it, because rejecting food is one of the few ways they have of exerting control over their lives. In the long run, in a couple of years, you will see that your children will naturally prefer, or at least accept, fruit over candy and good foods over mediocre foods.

Member question: Is there a natural, effective way to reduce or eliminate cravings without taking supplements or medications?

Sanders: Everyone has cravings. Some of that's natural. We all have a built-in desire and need for variety. So often when we crave something it's because we haven't had it, or something like it, in a while, and it seems appealing to us.

What I suggest for my patients who have cravings, which is virtually all of them, is they keep a diary of what they ate when, and so forth, and then when they have a craving, write down what the craving was for, what time was it, what was the circumstance, and see if we can get a better understanding of what the craving is really for.

The last thing about cravings is that often they originate in our mouths, especially ones that come for a desire for variety. Those sensors in our mouth have no capacity to know quantity. So a small amount of something you crave is likely to satisfy that. As soon as we taste a food, no matter how much we love that food, our desire for it diminishes. If you know that then you can use that to satisfy cravings by giving yourself a taste of them. So sometimes the best way to deal with the craving is to give in to it.

Member question: Is it unhealthy for a male of 52 years of age to be at or below 10% body fat? I have achieved this goal, but have been told it is unhealthy because of my age. I feel great and my medical numbers are excellent.

Sanders: I know that for women there are physiologic problems in maintaining body fat less than 10%. It interferes with sex hormones and estrogen. I'm not familiar in any problems having men maintain a body fat less than 10%.

When you look at a population and its relationship between weight and health, it is a J-shaped curve. That means that the healthiest state for most people is in the middle: not too skinny, not too fat. That's for the general population.

My only concern would be that you not limit your diet in an unhealthy way. If you're eating a well-balanced diet and getting a good amount of exercise, and if you feel great, it's hard to criticize that; it's hard to improve on that. If your doctor likes the numbers he sees and you feel good and you're healthy, then you may very well be at the right weight for you.

Member question: I am currently 135 to 139 pounds and at a height of 5 feet 6 inches. My goal weight is 130 but it seems that I have become stuck at the weight of 135 to 139. I have lowered my caloric intake to 1300 cal/day and run two miles four days a week and do weight training three days a week. I started off at a weight of 155 and have gotten down this far, but I can't seem to get the last five pounds and I am afraid to cut my calories back any farther. Do you have any suggestions or insights?

Sanders: You sound like you've done a really great job and I'm so impressed with your commitment, both to your exercise and your diet. So I'm not sure the best way for you to do it. It doesn't sound like you can increase your exercise, so that means your only alternative is to decrease your calories, or to learn to love those five extra pounds.

It's possible that 100 calories more will ease you down there. When you reduce your calories, however, make sure not to short yourself on the protein you eat. It's an easy way people think to cut calories, and yet it costs us in muscle mass.

The other thing you should consider is whether you've started to have "portion creep." That's where your portion size, which started off fabulous, starts to get larger and larger, because we're surrounded by restaurants and people who super-size everything. It's possible you're no longer eating only 1300 calories a day.

Moderator: Do you have any final words for us, Dr. Sanders?

Sanders: My last comment is that we are all on a diet. A diet is simply what you eat, and that diet either works for you, allowing you to achieve and maintain the weight you feel the most comfortable at, or it doesn't. I think our job, as healthy humans, is to create for ourselves a diet that works for us, one that's wholesome and satisfying and allows us to achieve and maintain our proper weight. That's what I try to help people do in my book. So good luck to you and thank you for all your terrific questions.

Moderator: Thanks to Dr. Lisa Sanders, for being with us today. For more information on finding the right way to lose weight, pick up her new book, The Perfect Fit Diet. You can also get the skinny on losing weight at the WebMD message boards, where you can post questions and comments for fellow WebMD members and WebMD health professionals.


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