My specialty is diet and Polycystic Ovarian Syndrome. I was interviewed by Lisa Drayer, RD, for an article in Natural Health Magazine called “Weighty Matters” (Feb 2007 issue pg. 53). The article discusses the symptoms of PCOS as well as how to get diagnosed and treated. One of my patients with PCOS, Lise Coyle, a physical therapist, was also interviewed in the story. She told how the diet I tailored for her helped her to lose 40 pounds in 1 1/2 years. In the article, I discussed my dietary/lifestyle approaches towards treating women with PCOS.

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When you lose weight through dieting without exercise, you may be losing more than just pounds on the scale. A recent study has shown that losing weight through caloric restriction alone without exercise can cause a decrease in bone density. Decreased bone density can increase risk of osteoporosis. However when the participants of the study added in exercise, bone density was preserved. This is likely because exercise (namely weight bearing exercise as well as resistance training) stresses the bones which stimulates new bone production.
I see this as a concern for many women. I frequently have female clients who are great about sticking to the reduced calorie eating plan I prescribe,  however report having no time - or desire - to exercise.  As we know, exercise burns calories, builds muscle mass and speeds metabolism. We now know it has an added benefit of preserving bone mass while dieting. This is especially important for those women who are menopausal or who are at increased risk for bone fractures.
Bottom line, make exercise a part of your weight loss program. City girls have no excuse - even if you do not want to go to a gym, walk, walk, walk! Walking is an excellent form of weight bearing exercise.

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How many of you started a diet within the past month or so and have stopped seeing the scale move downward? You are being diligent with your diet and exercise plan and the weight loss has stopped. You are nowhere near your goal weight. One week, two weeks, three weeks (sometimes more) the scale does not budge. This is called a plateau and is experienced at some point by almost everyone trying to lose weight. Plateaus can be a very frustrating experience and can make you question your motivation for staying on the straight and narrow with your eating and exercise plan.

I get asked all the time “So why do plateaus occur? I have not increased my food intake or decreased my exercise”. Here are several possible explanations for plateaus.

A. Plateaus can occur after the first few weeks of a following a low carb diet. This is because your body initially lost a lot of water and now the body needs to “fix” its fluid balance. Keep in mind that it is difficult to lose more than 1-2 pounds a week of fat. If you lost 6 pounds the first two weeks of dieting, at least half of it was from water. Your body will hold back onto some water in the next few weeks. Therefore it is likely that you will not lose any more weight for 1-3 weeks. This is more like a mini plateau.
B. Secondly, the body does not always lose weight at an even pace. I have many clients who lose 2 pounds one week, no loss for 2 weeks and then lose two pounds again the following week. While this is not really a plateau, it can be very frustrating. I have no real explanation for this scenario (except that it happens!) Possibly a fluid balance issue again. You will just need to be patient and the weight will eventually come off.
C. Third, it is possible that you have become less diligent with your diet and exercise routine. It is common to lose a little focus after the initial  part of your weight loss plan. You may find yourself drinking an extra glass of wine or increasing your portions without realizing it. Perhaps you are not exercising quite as much as you did in the beginning. These small changes can slow or halt your weight loss.
D. Another reason for a plateau is that your body is adjusting to the new weight. My advice would be to stay focused with your diet and exercise regimen. It is common for dieters to get frustrated at this point and give up. What does it matter if I have this extra portion, I not losing weight anyway! If they had stayed patient for a little longer, the scale would have started to drop again.
Here are some tips for breaking through a weight-loss plateau
1. If you have stopped keeping food records (or never started!), it is time to start again. Weigh and measure foods. It is possible that your portion sizes are getting larger or you are unconsciously eating during the day.
2. Try to change your diet around a little. If you are eating three meals a day, try to eat 6 mini meals. If you are on a low fat diet, try a lower carb diet for a few weeks. If you are eating late at night, try to stop eating at 7-8 pm. If you are enjoying a glass of wine or two a day, try to cut out all alcohol for a few weeks. If you eat a light breakfast and a large dinner, try to reverse this.
3. Make some changes in your exercise program. Try one or more of the following tips:

Add in another day of exercise each week,

Make your cardio sessions 15-20 minutes longer than usual

Increase the intensity of your cardio sessions

Try a new form of cardio (i.e. spinning, kickboxing, etc.)

Work out with an energetic friend or personal trainer for a month.

Set a new exercise goal such as running your first 5 K race,

Add in weight training if you are not already doing so (aim for 3 sessions a week).

Try interval training: increase the intensity of your cardiovascular or aerobic exercise by adding short bursts of higher-intensity movement, such as sprinting. These intervals should last 30 to 60 seconds and be followed by less intense exercise for two or three times the length of the burst. Start by adding one or two of these intervals to your routine, then increase the number as you improve your conditioning.

In addition to working out at the gym start walking more. Walking a mile burns approximately 100 calories

4. Focus on how much healthier you feel after losing weight rather than focusing on numbers on the scale. See how your clothes are fitting differently. I actually think that it is best for some people not to get on the scale at all as they tend to become obsessed with numbers.
5. Lastly, be patient. Plateaus will almost always break. The trick is staying motivated long enough for it to break!

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Dating often means drinking. Whether you are meeting a blind date for the first time or going out to dinner
with your boyfriend, it is likelythat the majority of us will consume at least one alcoholic beverage at some point in the evening. Moderate consumption of alcohol should not have a negative effect on your health or weight. However, based on what I see in my private practice, many women consume more than a few drinks a week. Take the example of Mary (names always changed!), one of my private clients.

Mary came to my office seeking help in losing 15 lbs. She was a 25 year old female who had gained this weight in the past 3 years since moving to NYC from California. Her social life was contributing towards her weight gain. Mary had just joined 2 online dating services and was in dating overdrive. At least 3 nights a week she was out with men she had met on match.com or jdate.com.90% of her dates revolved around meeting guys for drinks. Add this to the night or two she went out with her friends. This added up to at least 12 alcoholic drinks a week. Not only was this adding to her caloric intake (1200-1500 calories!), it was also increasing her fatigue the next day and decreasing the time and motivation she had to exercise. Her alcohol intake was playing a major role in her difficulty losing weight.

My suggestions:

1. Meet her dates for coffee rather than drinks at least some of the time. This will serve 3 purposes:
you will save calories and the potential for a hangover if one drink ends up turning into multipleyou will still be able to go to the gym after work
you can make a quick escape if you do not like the guy
you will see your date more clearly. Dark lighting in a bar along with the slightly blurring effects of alcohol may make your date seem more desirable than he really is.
2. Limit the total number of alcoholic drinks you have a week. For example, let’s say your goal is to have no more than 5 alcoholic drinks a week. You will need to plan how you want to fit these drinks in.. Maybe a drink on Wednesday and Thursday and then 3 drinks out on a Saturday night. Why waste your drink on a date that ends up not even interesting you?
3. Have a night or two out with friends that does not include drinking, maybe a movie or a healthy dinner after the gym.
4. Try meeting guys in a different environment. Examples: the gym, a running club, dance lessons (this is big right now!)

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Sandwich Slimming Tips

City girls usually grab lunch on the run. The most popular choices salads, soups (more about those foods later!) and sandwiches. Sandwiches are probably the most convenient lunch because you can eat them quickly and they are sold almost everywhere… from your corner deli or gourmet sandwich shop. They can be a great choice, or the worst. Calories range from 375 - 800 plus!The problem with most deli or gourmet sandwiches is that they are overstuffed and contain high fat ingredients such as mayo, cheese, pesto, Russian dressing, etc. Some sandwiches are also made on breads that are deceptively high in calories.

Here are some quick tips to slim your sandwich:

Problem: Beware of high calorie high fat condiments. They can add over 300 calories to a sandwich. The following portions are the typical amounts added to a sandwich. For example:

cheese (2 oz) =200 cal / 18 gm fat

regular mayo (2 T.) = 200 cal / 22 gm fat

Russian dressiing (2 T.)120 cal / 10 gm fat

Solution:Try these low calorie low fat condiments instead: lettuce, tomato, other veggies, mustard - plain or flavored, BBQ sauce, ketchup, roasted peppers, hot peppers. Avocado is somewhat high in calories, however it is still a good choice as it contain heart healthy fats. If you love cheese, try to limit it on a sandwich to only once a week, or ask for only one slice (100 calories per one oz slice). Having lettuce, tomato and mustard instead of cheese and mayo can save you 400 calories and 40 grams of fat!

Problem: Many sandwiches are overstuffed and may contain 7 oz of filling (600 calories or more - not including the bread!).

Solution: Try to remove some of the filling or better yet, eat only half. Eating half of the sandwich will allow you to enjoy one of your favorite “fattening” sandwiches on occasion! A good compromise would be to order 1/2 sandwich and a low calorie soup.

Problem: High calorie breads

Solution: Select breads that are lower in calories. Here is a comparison of different breads:

2 slices of regular bread =160 calories **

bread =300 calories

wrap bread = 240 calories

Kaiser roll = 240 calories

Medium pita = 160 calories**

2 slices of light bread = 80 calories**

bagel = 320-500 calories (80 calories per ounce)

Cosi (one slice bread) = 265 calories

** Best low calorie choices

*Try to select whole grain breads if possible to increase your fiber and nutrient intake.

Problem: Do not let the name fool you! Sandwiches made with fish or chicken are not necessarily low calorie.Both of these Au Bon Pain sandwiches  - chicken tarragon with romaine sandwich and Arizona chicken sandwich on sundried tomato bread - pack in over 625 calories and 29 grams of fat.

Solution: Check out all the ingredients in the sandwich. If possible, try to obtain the calorie content on line. Healthy sounding sandwiches are not necessarily low in calories and fat!

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This was a crazy week. Monday I was interviewed for the cancer video. Tuesday I was interviewed by Katherine Chan from NBC: Your Total Health for a “mini-makeover” segment. The story is about how cholesterol can be lowered through diet and exercise rather than medications. I selected one of my “star” patients, Indra, to appear with me on the show. She was able to significantly lower her cholesterol through diet and exercise in the past 4 months. She is one of the most motivated patients I have had! I will tell you more about her story in Real Problems, Real Solutions.  Indra and I were filmed in a counseling session together as well as interviewed separately.

The show will air sometime in May.

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This was a busy week from a media standpoint… not my typical week. The New York Presbyterian Hospital is making a video on Diet and Cancer. I was videotaped along with several other registered dietitians on various topics on nutrition for cancer patients. While I have many tapes of my various media appearances, this will be the first “professional” video I have been on. It will be out in a few months. I will post the segment I did when it to comes out.

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