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Fibre probably has an important effect on satiety. In one study researchers showed that a high-fibre breakfast, including 20g of soluble and insoluble fibre, significantly suppressed ad libitum lunch energy intake 4 hours later when compared with a low fibre breakfast. There was, however, no significant effect on total energy intake for the day.

Other studies have found increased feelings of fullness for 3-4 hours after eating high-fibre breakfast cereals. The highest scores always corresponded to the highest fibre content. Because fibre does not seem to limit consumption at the test meal it seems that the appetite benefits of eating fibre emerge at the next meal rather than the current meal. That is, fibre has a bigger effect on satiety than satiation. However, simply adding fibre supplements to a high-fat diet is not likely to have the same effect as eating a selection of high-fibre foods. This is because the fibre in supplements is not ‘bound’ to the nutrients in the food consumed.

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After basic demographic questions-age, family status, and so on – I ask about eating behaviors. I also explore her social life, sexual history and attitudes, and her use of illicit drugs or alcohol. In later conversations we take a closer look at her answers.

Weight: One important area to explore is the patient’s weight history. I ask patients about their “desired weight.” When a patient who weighs 150 pounds says her ideal weight is 110, I will pursue the matter, asking how realistic she thinks that goal is. Often she responds, “Well, I’d like to hit one hundred and ten, but probably the best I could hope for is one hundred and twenty-five. I did get down to one hundred and twenty once, but only for three days. I felt miserable when I started gaining again.”

Patients often recount their weight history in enormous detail, which is not surprising considering they focus on eating every waking moment. Actually, the ability to recall weight history often provides me with a vital number for anorexics: the weight at which they stopped menstruating. In restoring weight, the target weight needs to be above this level if patients are to overcome their phobia about resuming menses.

I also want to learn about her attitudes toward weight. Does her family comment frequently on weight and appearance? One patient traced her disorder to the fact that whenever her father saw a fat woman he said, “Look at that tub of lard!” She was so concerned he would say that about her-and thus stop loving her- that she began to starve herself.

And what about mealtime behavior? What is dinnertime like? Who is present? What turns does the conversation-if any-take?

I also explore her attitude about her body. What is her body image? Is it accurate or distorted? Does she focus on a particular area? Is there a clash between perception and reality?

Behavior: Next I’ll look at the patient’s behavior related to food and eating. What about dieting? Are certain foods “forbidden”? What are her attitudes about weighing herself and looking in the mirror?

Historical context: In family therapy, it is sometimes said that the calendar tells the story. I look to see how the problem evolved over time, and to find events that might have triggered the disorder. These events may include a loss (death of a relative), change (divorce, relocation), or rejection (breakup of a romance). Some details may emerge in conversations with parents. This isn’t to say that the adults’ perspective is better or more accurate than the patient’s. Both points of view are often needed.

Family: I also want to know the patient’s family background. Does she view her parents as strict or uninvolved? Is she starving for attention? Have there been traumatic events-death, separation, loss of a parent’s job?

Thinking patterns: People with eating disorders often display black-and-white thinking: Everything is all one way or the other, with no room for subtle shadings. During the assessment, I listen for such clues so I can orient therapy to correct distorted ways of thinking.

Social milieu: How well does the patient function outside the family? Does she get along at school or on the job? Does she have friends? A lover? What else is there in her life besides the eating disorder? Obviously, if there is nothing else, giving up her behavior will be that much harder.

Substance abuse: Use of illicit drugs and alcohol severely complicates an eating disorder. I will always ask: Do you use alcohol or drugs? How often? How much? I try to avoid sounding like a prosecutor, but I have to know the facts if I am to be of any help. Detoxification is a critical element in managing eating disorders.

Suicidal feelings: As with substance abuse, if a troubled patient doesn’t bring up the subject of suicidal thoughts, then I will make a point of asking about them directly.

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In 1996, when Linda Christopher began walking during her lunch hour, she didn’t foresee the profound impact that it would have on her life. Sure, she lost weight—her real purpose from the start. But along the way, she reconnected with nature, reaffirmed her faith in God, and rediscovered herself.

Back then, Linda was grappling with a lifelong weight problem that seemed to grow worse as she got older. She was fed up with dieting and with losing and regaining the same pounds. “I stopped weighing myself when I hit 184 pounds,” says the 41-year-old teacher from Garwood, New Jersey. “But I know that I got even heavier, because I could barely fit into my size-18 clothes.”

Her too-small wardrobe only reinforced Linda’s dissatisfaction with how she looked and felt. It gave her the incentive to make some positive changes in her life.

“I just reached a point where I couldn’t handle it anymore,” she continues. “Instead of dwelling on weight loss, I shifted my focus to a healthier lifestyle.”

With that goal clear in her mind, Linda began to improve her eating habits. She tried hard to rein in her stress-induced binges. And if she felt that she had to eat something, she chose crunchy carrots or an apple instead of cookies or chips.

For exercise, she swam a couple of times of week at a local YMCA. And every day on her lunch break, she took a 20-minute walk through a nearby park. Those walks evolved into mini-spiritual journeys as Linda found herself using the time to commune with nature. “I had always enjoyed being outside, but between work and other activities, I had gotten away from it,” she ^ explains. “Those lunchtime walks helped me rediscover my love of the outdoors. There were so many sights and sounds and smells that I had forgotten.”

Amid all of that natural splendor, Linda experienced a sort of spiritual reawakening. Her faith in God deepened, and she felt more at peace with herself. “Walking was as good for my mind and spirit as for my body,” she says. “I felt so much better, and in ways that I never expected.”

Linda came to treasure her lunchtime walks so much that they gradually stretched from 20 minutes to an hour. Within 6 months, she lost more than 30 pounds. Out went those size 18s, replaced with size 12s.

Linda has maintained her weight at a healthy 154 pounds ever since. She has become such an avid outdoorswoman that she leads hikes for her local YMCA. Every Sunday morning, she spends at least an hour wandering the woods near her home—reconnecting with nature, with God, and with herself.

“I feel much better physically—and as a bonus, I’ve gotten back in touch with my spirituality,” she says. “That has made all the difference in my health and my life.”

WINNING ACTION

Transform your walk into a moving meditation. Walking is a wonderfully simple exercise for losing weight and getting fit. With its rhythmic pace, it can become meditative, especially when you’re alone. Use that time for personal reflection and renewal. It not only makes your workout go faster but it also mentally and spiritually rejuvenates you.

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4-5 servings—Vegetables add lots of important elements to our diets, including beta carotene (the plant form of vitamin A), vitamin C, folic acid, and other vitamins, plus several minerals and that all-important fiber. Vegetables also contain disease-fighting substances called phytochemicals.

One serving of vegetables is made up of either 1 cup of raw vegetables, a half cup of cooked vegetables or ¾ cup of vegetable juice. (Juice should only be counted as 1 serving per day, for it lacks much-needed fiber.) Remember that if you are going to cook your vegetables, you should steam or microwave them lightly (they should still be slightly crisp when served).

Raw vegetables make excellent snacks. I always keep my Chitosan bag in full view on my desk to remind me to munch throughout the day.

Unfortunately, some of us get bored with just vegetables. And boredom is a killer. Soon, to overcome our distaste for the same old thing, we find ourselves substituting chocolate truffles or macadamia nuts for carrots and broccoli—and while that dispels the boredom, it does nothing good for our waistlines!

The answer is to make the veggies a little more interesting, at least from time to time, by combining them with a little dip. Excellent low-cal, fat-free dips exist both ready-to-eat in stores and in many good cookbooks. Go ahead, indulge yourself! The extra treat may not be up to the excitement level of a hunk of cheese, but it’s very tasty and not hard to live with. (And if you do go for the cheese once in a while, just remember to take some extra Chitosan with it to mitigate its negative effect.)

Average calorie amount per vegetable serving: 25

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You should begin by following Plan I, which gives the minimum amount of servings from each food group. If you find that you’re just too hungry, add an extra serving of one or more food groups. Don’t try to cut down too much. If you’re hungry all the time, you won’t stick to your diet. So, just cut down a little bit. However, do remember not to exceed the maximum amount of servings. You’ll have the most leeway in the grain group (between 6 to 11 servings a day) and the least in the extra group (which should be limited as much as possible). Naturally, the more servings you add, the slower your weight loss will be. However, it’s better to eat enough to feel comfortably full, than to feel constantly hungry and then inevitably binge.Take your other supplements as necessary—To ensure that the Chitosan does not interfere with the absorption of any fat-soluble nutrients, take half of them with breakfast (when you do not take Chitosan), and the other half before going to bed (several hours after your dose of Chitosan). Discuss your supplement needs with your physician.

Some people have questioned Chitosan’s usefulness, pointing out that in some people it may only push the cholesterol down or increase the good HDL cholesterol by a few points. Fortunately, a few points can make a big difference. For example, every time your total cholesterol drops 1 percent, your risk of a heart attack drops by 2 percent. This means that when your total cholesterol falls by 5 points, your risk of a heart attack is automatically 10 percent lower—and that’s pretty significant. Let’s look at one case study.

I hadn’t seen John, a 60-year-old businessman, since he’d moved away 10 years before. Then one day he returned to my office to tell me that his cholesterol was high. “My doctor did a duplex ultrasound of my neck. It showed that my neck arteries are narrowing, and I’m more likely to have a stroke. He’s got me on all kinds of medicines to lower it, but they’re not lowering anything except my health. The medicines have made me tired and nauseated, and my liver is sick.”

John’s total cholesterol was 247, which is way above the ideal of 160 (100 plus his age). His LDL was also elevated at 170, at least 70 points too high. Meanwhile, his HDL was very low at 25. It should have been 50 or more. (The National Cholesterol

Education Program states that an HDL of 35 or less should be considered an independent risk factor for coronary artery disease. I like to see my patients’ HDLs at 50 or more. By either standard, John’s HDL of 25 was clearly a danger sign.) These figures suggested that serious trouble lay ahead.

When I told John about Chitosan, he asked to start right away, even though his weight was not a big problem. He began by taking 1 gram before lunch and another gram before dinner. Four months later we rechecked his cholesterol. The results were gratifying.

Although his blood profile was not yet ideal, the Chitosan had helped him take giant strides in the right direction. You can see how well it worked by comparing his before and after CADRF1 ratios:

Before: CADRF1 = 247/25 = 9.9 This puts him at great risk of heart disease.

After: CADRF1 = 195/50 = 3.9.

He already has less than one half the standard risk of suffering from heart disease. The lower the CADRF1 continues to drop,

the better.

John was overjoyed at his new numbers. He promised me, “Doc, I’ll never let these numbers rise again.”

Chitosan’s health-saving abilities were further documented six months later when another ultrasound of John’s neck showed less narrowing in his arteries. In other words, Chitosan helped widen the highway to his brain, markedly reducing his risk of a stroke. When fat gets pulled out of the plaque, the body is better able to dilate those arteries, which also widens the highway.

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We get fat in our diet from four sources:

♦ Saturated fat from beef, pork, lamb, veal, butter, milk, cheese, eggs, and other foods that come from animals. Coconut and chocolate are also high in saturated fat, as are margarine, cocoa butter, and palm oil.

♦ Polyunsaturated fats, which come from fish, poultry, vegetables, and vegetable oils (such as corn oil). Polyunsaturated fats are more fluid at room temperatures.

♦ Monounsaturated fats, found in olives and olive oil.

♦ Hydrogenated fats. These are fats or oils taken from vegetables and then artificially converted into solid shortening or margarine by adding hydrogen to them. In this process polyunsaturated fats are converted to saturated fats.

The fats from our foods get into our bloodstream, where they can cause the red blood cells to clump together. This can severely reduce the blood flow and oxygen exchange in certain parts of the body, leading to angina (chest pain) or a heart attack if the oxygen exchange is totally cut off. And if the arteries are

not already clogged, they can become so as the fat we eat is deposited onto the artery walls. The accumulation of plaque in the artery walls makes these pipes narrower and more rigid. It’s harder for the heart to pump blood through these narrowed, rigid pipes. It takes more pressure to keep the blood moving, and so the heart has to work harder.

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One of the several popular new prescription drugs that inhibit appetite. The two most popular are Redux and its predecessor, Phen-Fen (named for the combination of the drugs phentermine and fenfluramine). Both Redux and Phen-Fen work by speeding up the mechanisms by which our brains normally tell us we are full and should stop eating. Specifically, they signal the neurons in the brain. The “Phen” part increases norepinephrine and dopamine, and the “Fen” increases serotonin in extra large quantities. The serotonin works on the receptors of adjacent neurons to inform the brain that our stomach is full before it really is. In this way, the feeling of hunger and the desire for food is cut off and people quit eating much sooner than they would naturally. In principle, there is nothing wrong with this approach.

Pulmonary hypertension, a dangerous disease of the blood vessels in the lungs and heart, rises from 2 to 46 cases per million after 3 months of Phen-Fen usage. While this is still a minor risk, it is illustrative of the potency of these drugs, and certainly suggests that they are not harmless. Even Redux, which seems to be milder than Phen-Fen, is known to cause fatigue, diarrhea, unpleasant dreams, and daytime mood swings.