“The key to losing weight is to cut yourself out from the outside world”. This is Esther’s quote of the week. She is entering into the 10th week of her weight loss journey and is a little disheartened with the slow down in her progress. Her weight is now 138 pounds, up from her low 2 week’s ago of 136 but still 10 pounds down from her initial weight of 148.

These past two weeks have been difficult as Esther has had more parties, family get togethers (including Greek restaurant!), work events, etc. She attributes her 2 pound weight gain in the past two weeks to more eating out.  In addition, she was sick which made it more difficult to get to the gym. Life gets in the way of losing weight! (Pic is of Esther and her friend Manny)

 (My apologies to Esther - I was on vacation last week so I didn’t post her progress report. Today’s post is combined from week 9 and 10).

My interview with Esther:

Martha: How did you do in the equinox contest?
Esther: I am waiting for a copy of the results,  I didn’t win or come in on the top but my trainer said I still did really well.  I will get a copy this week.

Martha: How are you doing with your exercise program overall? I see that you have been going on a regular basis for the past 8 weeks. 
Esther: Anastasia (Esther’s trainer) has been giving me a lot of positive feedback that I have been continuing to work out when I’m not with her which was not the case in the past.  When I trained with her in November I only went to her once weekly and did one pilates session.  Obviously that wasn’t enough.  I have been going to the gym from 4 – 6 days a week consistently now for 11 weeks !! Martha: Yeah!

Martha: Now that you are no longer dog walking (which caused her to walk an extra 2 miles a day), what have you done to increase your cardio? 
Esther: I added an extra day to my gym routine and am spinning a minimum of two days per week.  It has been too hot to walk home when I get out of work.

Martha: How did you handle your PMS cravings?
Esther: Handled cravings by only eating small portions of 100 calorie jello pudding cups, 100 cal snacks, and a lot of fruit.
 
Martha: Are there any potential problem situations coming up this week?
Esther: Paula’s Birthday dinner on Monday night - but all friends know I am on CGB and will keep me on track!  Otherwise I should be fine.  I am having lunch out with a client on Monday as well but will be sure to eat lightly.  (Esther enjoying a cocktail at birthday get together)

Did Esther meet her goals from last week?

Four Days of Esther’s Food Records:

Tuesday July 15    
Breakfast    
1 hard boiled egg  1 plum
Lunch    
1 chicken cutlet w/eggbeaters, breadcrumbs in pam    
w/ sm serving home made coleslaw, lite mayo, vinegar    
1 piece string cheese  1 pretzel rod  
pellegrino    
dinner    
3/4 pound boiled shrimp    
salad, romaine let, capers, feta 1oz w/oil&lemon    
1 tbspoon lite tarama (like hummus)    

Wednesday July 16  
Breakfast    
1 cup kashi cereal w/ skim milk    
Lunch    
grilled skirt steak    
plain salad    
3 tbl yellow rice, 1/2 cup black beans    
Snack    
6 rice crackers    
4 dried apricots    
dinner  
4 shrimp  
1 cup coleslaw (low fat mayo, vinegar)  
1 hagen daz yogurt sorbet bar 100 calories  

Saturday July 19
Breakfast    
iced coffee    
1/4 pound tuna salad *from Eli’s*    
5 wasa wheat crackers    
Lunch    
Kashi go lean entre 330 calories    
(chicken w/sugar snap peas, mushrooms & grains)    
Dinner
3 glasses white wine
1 shot size dessert wine
3 mini meatballs, 1 sm slice toasted bread
1/3 fennel, arugula salad w/cheese
4 olives, 2 pieces greek cheese
2 large grilled shrimp
1/3 appetizer grilled octopus w/capers
1/3 appetizer grilled cuttlefish
1/3 portion roasted lamb shank
1/3 portion grilled black sea bass
1 piece lemon roasted potato
3 sm greek cookies
1 bite of ice cream
 
Sunday June 21
Brunch at Atlantic Grill
Egg white omlette w/veg (brocoli,tomatoe..)
1/4 portion of the hash browns
2 tbspoons of ketchup
1 bite banana bread
club soda
Snack
1 nectarine
Dinner
sardines in soy oil 240 calories,
shirataki noodles,4 greek olives, 3 tbsp grated cheese
watermelon

My comments on Esther’s food records:1. She ate out more than usual these past 2 weeks. That obviously makes sticking to an eating plan difficult -hence her quote “The key to losing weight is to cut yourself out from the outside world”.
2. She had quite a few really low calorie days (~ 1000 calories) which helped keep her caloric average to 1400.
3. Esther needs to get back on track with her alcohol intake and limit it to 2 drinks a week. She was getting her best progress with a limited alcohol intake.
4. Keep up the good work with light dinners when you eat home.

Esther’s goals for this week:1. Continue with 1300-1400 calories
2. Continue with 2 personal training sessions, one pilates session and 3-4 intense cardio sessions. Continue to increase your walking
3. Two alcoholic beverages a week
4. Weigh your protein and measure your olive oil on occasion so I can get a more accurate calorie count for you
5. Be REALLY careful when eating out. Try to do less sharing of multiple appetizers and order more of your own “clean” food. Many of the appetizers that you share are healthy (ie. grilled octopus) but the olive oil can add up.

Good luck! You are doing great - averaging a one pound weight loss is right on track!

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Esther is down 2 more pounds for a total of 4 pounds weight loss! Her current weight is 144 pounds. Congrats Esther! She has told CGB that taking her weight loss journey public has really helped her as she feels more “accountable”. After all, who would want to report that they ate 1/2 pound of cheese with 4 glass of wine in a night! This past week was especially diifficult as Esther ate dinner out 4 times. And eating out usually means more drinks… however Esther met her goal of only 2 alcoholic beverages. 

Did Esther meet her goals for last week?

Here are 3 days of her food records:

Friday June 6   
Breakfast   
iced coffee   
2 eggs with humus   
Lunch   
cosi sandwich (1/2 bread, grilled chicken)   
Dinner   
Japanese Hibachi dinner: clear soup, salad   
grilled, steak, shrimp & vegatables.   
pellegrino water   
vita muffin   

Tuesday June 3   
Breakfast   
1/2 banana   
hard boiled egg   
iced coffee   
Lunch   
Kashi entree   
chicken florentine   
iced coffee   
Dinner   
6 sm veg dumplings   
9 steamed shrimp   
1 tps of lite tarama   
1 tps of olive hummus   
mixed nuts: sunflower, pumpik, almonds   

Thursday June 5
Breakfast
1/2 banana
2 oz peak protein bear naked
iced coffee
Lunch
1 popeye’s chicken wing
3 slices of turkey, 2pc string cheese mustard
water
Dinner
mixed greens w/ olive oil & lemon
steak ( on George Forman grill)
dried apricots ( 4)

My comments on her week:
1. She averaged 1300 calories. Keep in mind that my calories are estimations as I don’t know exactly what her portion sizes were in restaurants nor do I know how the food was prepared.
2. Esther handled her restaurant dining extremely well! She had more “plainer” types of food such as grilled fish, steamed shrimp, etc. versus food prepared with more fat (i.e. pita and dips). Eating out 4 times this week and still losing 2 pounds is quite an accomplishment.
3. My guess is that her decreased alcohol intake is contributing to her better restaurant choices. Most people tend to have less willpower around food after they have had a few cocktails!

Esthers goals for this week:
1. Beware of the PMS cravings and low energy levels. Esther reports she is already having to really push herself to get to the gym due to fatigue/PMS. I guess this 95 degree weather doesn’t help much!
2. Be careful at Father’s day cookout. We will discuss this later in the week.
3. 2 alcoholic beverages this week
4. Continue to be careful with choices in restaurants
5. I am curious as to what Esther’s portion sizes are with her protein at home. Please weigh your protein 1-2 times.
6. Calories in your nut mix can really add up. Can you weigh the total mix of nuts (sunflower, pumpkin, almonds) once and tell me what it is ? You also might want to look around for the 100 calorie packs of almonds.   
7. Continue with personal training twice a week, one pilates, and 3 cardio sessions (maybe 2 spin classes and 30 minutes on treadmill or eliptical).

Keep up the good work!

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Irregular periods? Trouble losing weight? Weight gain in the abdominal area? Hair growth on your face and/or body (where hair shouldn’t be growing)? Experiencing hair loss? If you are experiencing some of these symptoms, you may have a common hormone abnormality called polycystic ovarian syndrome (PCOS). It affects between 7-10% of women. Many women don’t even know they have it. If you have any of the above symptoms, take this PCOS quiz.

I have been working with women with PCOS for the past 10 years. Approximately 10-15% of my clients have PCOS. Check out my previous post for more info on PCOS. Through my experiences in working with these women, I have found the following lifestyle recommendations to be helpful to women with PCOS.

Lifestyle recommendations for PCOS:

 • No one diet works for everyone. Each plan must be tailored to suit the individual. In my experience, I have found that women with PCOS who are very insulin resistant, especially if they are obese, often have an easier time losing weight and feel better on a lower carb diet. However this doesn’t mean that every women with PCOS needs to be on a very low carb diet.  (Pic on the right is of me lecturing on Diet and PCOS to staff members at Reproductive Medical Associates - RMA- in NYC).

• Do not think of this as a short-term diet but rather a healthy eating plan to be followed for the long term. I don’t even like to use the word “diet” as it implies deprivation and something short- term.

• A priority in treating insulin resistance is weight loss. This is more important than the macronutrient composition of the diet. Even losing 5-10% of body weight will help decrease symptoms of PCOS.

• Exercise is a key factor in decreasing insulin resistance. The ideal program includes an aerobic and resistance training component. The resistance training component should focus on light weights and more repetition. 

• All calories count – whether from protein, fat or carbohydrate. This must be emphasized as it is common to see women who feel they can eat unlimited amounts of protein and fat as long as they keep the carbohydrate intake low. A hypo caloric diet must be adhered to if weight loss is to occur.

Use the following formula to determine your caloric needs:

For weight maintenance
- 10 calories per pound for women who are obese, very inactive, or chronic dieters 
- 13 calories per pound for women over age 55 who are very active
- 15 calories per pound for very active women
- If you tend to have a difficult time losing weight and are obese, very inactive, or a chronic dieter, it is possible that you may need to use 8 or 9 calories per pound.

For weight loss 
- To lose 1 lb a week, subtract 500 from maintenance caloric level
- So if your maintenance caloric needs are 2000, you should consume 1500 calories a day to promote a one pound weight loss a week.

• Select lower glycemic index carbohydrates (ie. whole grains, fruit, vegetables, legumes, milk) instead of higher glycemic index carbohydrates such as rice, potato, white bread.

• Consume balanced meals that contain protein/fat and carbs. This will help to control blood sugar, keep you feeling full longer and ward of carbohydrate cravings. For example, a slice of whole grain toast with some natural peanut butter may be a better choice for breakfast as compared to a bowl of cereal with fat free milk for some women. The higher fat and protein content of the peanut butter may satiate you more than the higher carbohydrate content of the cereal.

• Very low fat diets are not recommended as they can lead to increased cravings. In addition, they can worsen insulin resistance. On the other hand, you should not go overboard with your consumption of fats as they are high in calories. For example, 1 T. of olive oil contains 120 calories.

• Select healthy fats. Limit saturated and trans fats as these fats can increase risk of heart disease by raising LDL cholesterol. Substitute unsaturated fat for saturated fat and trans fats. Monounsaturated fats found in found in nuts and nut butters, avocado, olive and canola oil are especially healthy. Include omega 3 fats (found in fatty fish, canola oil, leafy greens and walnuts) in the diet to decrease risk of heart disease. These fats may also improve insulin resistance.  
• Identify problem behaviors and work on making permanent behavior changes. Make small changes at a time. Food records have proven to be a very useful tool in identifying problem behaviors as well as helping you to limit your calories. Who wants to write down that they had 5 chocolate chip cookies? Check out this link for more info on food records.

• Pay attention to how your body feels after eating various foods. Which foods set off cravings or decrease energy levels? Which foods make you feel energized? This is very important to help you determine what kind of eating plan will work best for you.

• Suggested vitamin / mineral supplements: B complex if you are taking metformin,  multivitamin with minerals,  calcium 1000 mg – 1500 mg  (if unable to consume enough from the diet). I would also recommend 1-2 grams of omega 3 fatty acids from a supplement if you are not eating fatty fish at least 3 times a week.

• Practice stress management. Being stressed can raise cortisol levels, which in turn, can worsen insulin resistance. I’m sure we have all heard of high cortisol levels linked to “belly fat”. And, no - those pills such as cortislim don’t lower cortisol levels nor do they get rid of belly fat!

• Get adequate sleep. Being sleep deprived can worsen insulin resistance, make weight loss more difficult and can intensify your carb cravings.

For more helpful info on PCOS, check out this book:  A Patient’s Guide to PCOS: Understanding–and Reversing–Polycystic Ovary Syndrome by Walter Futterweit 
I wrote the 2 chapters on diet and PCOS. Numerous meal plans are included.  

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Martha McKittrick, RD, CDN, CDE is a registered dietitian and certified diabetes educator. She specializes in weight control, cardiovascular health, polycystic ovarian syndrome, diabetes, sports nutrition and preventative nutrition. A staff dietitian at The New York Presbyterian Hospital for the past 22 years, she also counsels clients privately and is a consultant to physicians, corporations and health clubs. She was the nutritionist for the 1998 NYC Marathon. She was an exercise instructor in NYC health clubs for 15 years.

Martha has appeared on numerous television, radio and web cast programs. She lectures on a regular basis and has been interviewed and written for publications including The Journal of The American Dietetic Association, Dietitian’s Edge, Nutrition Today, Allure, Self, Family Circle, New York Newsday and Cooking Light. Martha is known for giving practical nutrition advice, both in her individual counseling sessions as well as group lectures. Two of her most popular lecture topics include “Healthy Eating on the Run” and “Tame Your Carbohydrate Cravings”.

Martha was a health expert on WebMD™s Diet and Nutrition Message Board for the past 7 years. She also developed and led Find Your Ideal Weight:12 Weeks to a New You weight control program on WebMD (with 42,000 registrants) for the past 7 years. In her free time, Martha is an avid cyclist, runner … and now a blogger.

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Check out Martha’s quote in Womansday.com        

Snack Off the Pounds
How to fit mini-meals into your weight-loss plan

Trying to lose weight? Snacking doesn’t have to be your downfall. In fact, having small, frequent meals can actually help you shed pounds. Not only does it rev up your metabolism so your body burns slightly more calories than it does when you eat less frequently, snacking also helps you stay in control so you’re less likely to overeat at lunch or dinner.

Don’t forget to keep calories in mind, however. “Many women who struggle with weight eat too many calories between meals, often without even realizing it,” explains Dawn Jackson, R.D., a Chicago-based registered dietitian and spokeswoman for the American Dietetic Association. “In some cases, snacks may pack in more calories than meals.”

How Many, How Big?
One midmorning snack and one afternoon snack, each containing up to 200 calories, will satisfy most people, suggests weight-loss expert Barbara Rolls, Ph.D., professor of nutrition at Penn State University and author of The Volumetrics Weight-Control Plan. Dr. Rolls says a daily diet containing about 1,600 calories, with about 400 for breakfast, 500 for lunch, 500 for dinner and two 100-calorie snacks, will promote weight loss among most overweight women.

“Snacks should also be planned,” adds Dr. Rolls. “Too often, snacking is mindless nibbling on whatever you have readily accessible in the refrigerator or cupboard. Before you know it, you’ve eaten five hundred calories’ worth of chips.” Instead, pay attention when you’re eating and don’t allow yourself to eat and read or eat and watch TV. When you’re eating, that’s all you should be doing.

The Right Snacks
The best snacks are those that are high in bulk and low in calories—essentially, foods that fill you up with the fewest calories. Ideally, a snack should contain carbohydrates, fiber and protein, with perhaps a small amount of fat.

Fruits and vegetables are among the best snacks of all because they’re rich in nutrients and fiber and low in calories. When you snack on most non-starchy vegetables, you don’t even have to account for them in your diet, says Dr. Rolls. Some vegetables that contain significant calories are potatoes, corn, beans, peas, lentils and winter squash.
Fresh fruit is a great option, too, because most women can have two or three pieces of fruit daily without worrying about gaining weight. Fruit juice and canned fruit in syrup are less filling and these should be limited.

Snack Attacks: Reality or Not?
Afternoon and after dinner are the times when most people have problems controlling what they eat, says Martha McKittrick, R.D., C.D.E., a registered dietitian and weight-loss counselor at the New York-Presbyterian Hospital in New York City. “Afternoon snacks are usually a good idea if there’s a long time between lunch and dinner, but most people can go without an evening snack. They’re eating more out of habit than because they’re physically hungry.”
Often, the desire for a snack comes from another emotion or from habit, not hunger, says McKittrick. Here’s what she has her patients do when they have a snack attack. Before grabbing something to eat, answer these questions: “Am I really hungry? Do I feel hunger pangs?” If the answers are yes, plan and eat an appropriate snack of up to 200 calories.

If not, you may be bored, stressed, frustrated, mad, worried or tired. If you can identify an emotion that is causing you to want to eat, find an appropriate way to deal with that emotion. Eating a snack cannot do anything to beat boredom or solve a conflict. Take a break, call a supportive friend, stretch or do something positive for yourself.
 

See my post on basic tips for snacks and suggestions for crunchy snacks (more ideas for snacks will be coming soon!)
 

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Martha McKittrick, RD, CDN, CDE is a registered dietitian and certified diabetes educator. She specializes in weight control, cardiovascular health, polycystic ovarian syndrome, diabetes, sports nutrition and preventative nutrition. A staff dietitian at The New York Presbyterian Hospital for the past 22 years, she also counsels clients privately and is a consultant to physicians, corporations and health clubs. She was the nutritionist for the 1998 NYC Marathon. She was an exercise instructor in NYC health clubs for 15 years.

Martha has appeared on numerous television, radio and web cast programs. She lectures on a regular basis and has been interviewed and written for publications including The Journal of The American Dietetic Association, Dietitian’s Edge, Nutrition Today, Allure, Self, Family Circle, New York Newsday and Cooking Light. Martha is known for giving practical nutrition advice, both in her individual counseling sessions as well as group lectures. Two of her most popular lecture topics include “Healthy Eating on the Run” and “Tame Your Carbohydrate Cravings”.

Martha was a health expert on WebMD™s Diet and Nutrition Message Board for the past 7 years. She also developed and led Find Your Ideal Weight:12 Weeks to a New You weight control program on WebMD (with 42,000 registrants) for the past 7 years. In her free time, Martha is an avid cyclist, runner … and now a blogger.

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