Refuse to Regain
 

I’ve just finished reading Refuse to Regain! 12 Tough Rules to Maintain the Body You’ve Earned! by Barbara Berkeley, M.D. Berkeley is an internist who runs an obesity specialty practice (which includes the Optifast program), and is a 5 year maintainer of a 20 lb weight loss and seems well qualified to write a book like this. My very long review follows along with some questions for discussion to those of you who've also read the book.

First, a summary of the book. Refuse to Regain is a book designed to provide a weight maintenance plan to new maintainers, who Berkeley calls Maintenance Juniors (after Just Reduced, J.R.) to enable them to beat the often-quoted long odds on maintenance. The book is divided into four major sections. The first is Ten Foundations which introduces the challenges of maintenance and lays out the social, biochemical, nutritional, and emotional environments that maintenance must successfully navigate—the facts on the ground, so to speak. This includes an extensive discussion of an eating style Berkeley calls Primarian, which is essentially a Paleo diet with the addition of low- and non-fat dairy and a few modern “treats.” The second section is a discussion of the 12 Tough Rules themselves, and the steps to take to understand and implement them. The rules are as follows.

1. Be Tough, Not Moderate
2. Commit yourself to a 3 Month Opt out Period
3. Weigh yourself every day
4. Reverse small gains immediately
5. Eat Primarian 90 percent of the time
6. Eat one major meal a day
7. Perform a daily “Scan & Plan”
8. Stop eating at 8 pm
9. Eat from a limited menu
10. Have one acceptable treat per day
11. Have a love affair with exercise
12. Maintain with support and support others

Section 3, Five Lives in the Balance, gives several successful Maintainer’s stories, and Section 4 provides Primarian meal plans and recipes.
Berkeley’s plan is very heavy on her Primarian approach, so named so that Maintainers can give name to a diet of conscience, and their choices will therefore be respected similarly to those following, say, vegetarian or Kosher diets. The description of the diet, the reasons for avoiding all “S foods” (starches and sugars—including whole grains, tubers, and legumes) make up a large portion of the book.

I ordered this book after finding the Refuse to Regain blog (co-authored with Lynn Haraldson-Bering), which discusses many of the issues associated with maintenance, with interaction from readers, and thought provoking questions and issues. I was surprised to find that the book and the blog were completely different beasts. The book is a prescription on how to maintain weight loss, and a detailed plan is given to the reader. If you do this, you’ll maintain the weight loss. No thoughts on how to create your own plan, or what to do if something about the prescription doesn’t work for you, just be tough, do this, and you’ll keep that weight off. I did find two places in the book that acknowledged that people have to find a way that works for them, and if something in the book doesn’t work, discard it, but I had to look hard for that, and there were no answers on how one might go about finding that something that would work instead.

I found the Primarian eating approach a bit strange. I do find the Paleo diet concept interesting and logically somewhat compelling. People did not evolve in an agricultural world where grains and milk were readily available and it makes sense that the addition of these foods to the diet in large quantities could potentially cause people issues including weight gain, and moving closer to this primitive diet could improve health and well being. However, Primarian isn’t Paleo in that it allows dairy as well as non-starchy modern foods like sugar free Jello, Lean Cuisines, or diet Coke. But it doesn’t make sense to me either to outlaw all grains, including whole, low glycemic load varieties and preparations, just because wheat can also be used for cake, and corn can end up as gummi bears. I just don’t believe there are that many of us that got fat, stayed fat, and got fat again because we ate a portion-controlled bowl of oatmeal in the morning. I was also a bit put off that I was being asked to tell my friends that yes, I was following an ancient diet of conscience called Primarianism, so don’t question my refusal of your whole grain bread, and could I have a diet Coke with that. Huh? But it is hard to argue that eating lots of fruits, vegetables, and lean protein sources is bad, and avoiding junk food is the right thing to do, and if you can get past the grains/tubers/starchy legumes thing, it doesn’t appear to me that this is an unhealthy plan, just one that is hard to live with in our culture. And, yep, I’m a 6 year maintainer come December, if not a perfect one (who is?), and I eat carbs and lots of them, trying to get whole grains as much as possible and limiting added sugars. I know a lot of us have issues with carbs, and we should respect that, but Primarian eating is not a one-size-fits all approach.

There is a list of other disagreements I had with the book, including its assertion that counting calories is essentially useless and no one does that anyway (I know lots of us do here), arbitrary rules like don’t eat after 8 pm, and the notion that somehow after a year that you just kind of get Maintenance and it gets easier (graduating from a JR to a SLIM, Senior Level Maintainer).

My last major issue was that the book had no footnotes, for fact checking, monitoring changes as time passes and such. It did have an extensive bibliography, but footnotes are better for those of us who actually go to the original literature from time to time. Yes, I’m a geek.

The Maintainer stories were nice, but not especially compelling (perhaps because of the Maintainer’s board here at 3FC where we have living examples), and I just don’t do recipes so Section 4 was wasted on me, but probably useful if you want to give the Primarian thing a go.

There were several things I liked about the book, including the fact that there is a Maintenance book out there. The book emphasizes the difficulty of the task, the need for planning, the difficult food culture (think marketing) that we live in now, and other tidbits like sabotage by friends, family and coworkers. It also called out the need for support and exercise as very important, but didn’t spend a lot of time with either of these factors.

So would I recommend this book? Maybe to someone who didn’t want to put much thought into their Maintenance plan and wanted a lot of guidance, and a switch from the plan that got them to their goal weight. But probably not to most people. I believe that what we need to do to have long term success is something that we all have to figure out for ourselves and not something that can be handed to us. 3FC has shown me that without a doubt, we have common threads, but we are all doing this differently. While the book has a few interesting ideas, and the occasional good point, it does not include the tools for making that individual plan and the strategies that support it. Personally, I probably follow about half of the rules. I have a handful of books I return to (including the excellent Thin for Life) and Refuse to Regain won’t be on that shelf in my library. My recommendation is to bookmark the excellent blog, and leave it at that.

I would love to hear from the other Maintainers here.

How many of the rules do you follow?

What do you think about the low-starch (low carb?) approach of Primarian eating?

Do you, and if so, how do you control “S Foods,” starches and sugars in your diet?

If you’ve read the book, was there any particular idea that really resonated with you, perhaps an “aha!” moment?

Do you feel like you are a Junior or Senior Level Maintainer and why?

Anne

Thanks for the detailed review!

I really agree with that. I think one particular value of a book like this, even if you don't quite (or even much) agree with its details, is as a model. I think it is a very valuable thing to put your maintenance approach, whatever it is, into black and white.

(Not quite at maintenance yet, but it's very much on my mind these days!)

Appreciated reading the review
 

I appreciated the long and detailed look at Refuse to Regain that was reflected by the review above. I wanted to respond to the way the book was perceived(and I undoubtedly should have made this message clearer when I wrote the book)...

I wrote Refuse to Regain in order to attempt to open up the discussion of maintenance. There have been very few books written on the topic. In my view, a new focus on maintaining lost weight is the most important shift we can make over the coming years.

The book was written to provide just one view of how to achieve success. But just as with the weight loss phase itself, finding a plan that works for each individual is key. While I do believe that significant limitation of sugars and starches makes sense biologically and physiologically, each person can tailor this approach (or any other) to fit his or her own profile. Maintenance is really an ongoing personal science experiment and each maintainer is doing the research. What I've found is that those people who become most invested in figuring out their personal requirements are the ones that do best. This kind of intense commitment is reflected in the posts of maintainers on sites like this one. They are really exciting!

So, to sum up: I am not one of those people who feels that I have all the answers or that any one plan is right for everyone. I do, however, believe that intensity and consistency and learning about every detail of your own response to food is key to success. Let's hope that there will be many more books suggesting all kinds of approaches to maintenance from here on in. And thanks to all!

Dr. Berkeley, I have so many questions for you. I hope you stick around here because in your profession as an obesity specialist you have a unique perspective that most of us here don't.

I guess my main question is why did you approach your book in this way? I really like your blog, and it is obvious from reading it that you really get the ambiguity and constant struggle that maintainers have. I guess most of us here on this board could fall into that 5-20% of successful maintainers, whatever successful means, and so may not be your primary audience? And everything you say in your post is indeed in your book somewhere, but it was just dominated by the 12 Rules.

I find myself wanting to have a more in depth discussion with you to ask more followup questions, because it is obvious from the bits and pieces that I did really like that you have a lot more information there. What if this doesn't work, or what then? I guess that is where I found myself frustrated. Perhaps it is the nature of a book, which is a static thing written for a specific audience, and the information presented must be selective, versus a blog, which is often more interactive?

My second question would be, do you really see such a drastic difference in weight loss and maintenance in your practice? That really surprises me--it is so alien to my own experience and I know some people around here have modified their plans, but your book seems to call for such an abrupt shift.

I must thank you for thinking about maintenance and making the effort to write about it. It is a topic that is so often ignored, and I think it is so important.

Anne

Happy to continue the conversation
 

Hi Anne,
I just finished writing you a detailed answer and it somehow didn't get posted! So here I go again.

I appreciate the opportunity to answer some of these questions. I'll do the best I can.

The format of the book, in terms of the Rules and focus on Primarian plan, was what I needed to do in order to get it published. When I first tried to sell the idea of a maintenance book to agents, they said it would never sell to a publisher. The reason was that publishers (according to knowledgeable agents) would not take a book that did not address a perceived problem. In their view, people who had completed a diet did not feel they had a problem any more!

This argument ran completely counter to my own professional experience. I interview new patients every week, and almost without exception they have lost and regained weight many times. They are completely frustrated by their inability to maintain. I was finally able to convince a book agent on this point. I then presented the book at a writer's conference for physicians in Boston. I was advised by publishers there that the book needed "rules". I guess there are certain formats that seem comfortable to buyers from their point of view. Since my main goal was to get the topic of maintenance into public view, I worked to create a book that would be saleable.

As it turns out, the rules I went with actually do form the backbone of the maintenance plan I advocate. However, there are many other rules and behaviors that are kind of buried in the text.

In terms of making a drastic change from the weight loss diet to maintenance, that's actually not the case for the patients I treat. We reduce them with a combination of liquid supplement during the day and a Primarian meal at night, plus snacks. They are already comfortable with this style of eating and we simply add back more Primarian-type food when they enter maintenance. In truth, a Primarian diet is not as drastic as you may think. I have suggested that people choose basic (non S foods) 90% of the time That means, most-- but not all by any means. I picked 90% because I find that a tough message means that maintainers give more thought to their departures. I completely understand that people will add back bread, pasta and even sweets. But I really want them to think about it and to realize that the potential for re-triggering of their old eating patterns lie mostly in those foods. I also firmly believe that the tendency to overproduce insulin and therefore store fat more avidly, remains in POWs (previous overweight people). If you give yourself too much of a chance to slip back into the insulin cycle, you'll start gaining.

You astutely have observed that this book is really not targeted at those who are already successful in maintenance. You, and many of your readers, have already figured it out and so merit the title of experts! Success is the real marker of good maintenance and any program that works for an individual is acceptable, as long as it's healthy. The next book should look at all the different takes on maintenance that individuals have developed. Maybe you'll write that one!

Lastly, your question about 'what if this doesn't work?' The answer is: this is just one approach. If this were a weight loss diet, someone could put this book down and go read Ornish, Atkins, Agaston, Dr. Phil, Suzanne Somers...etc, etc... Unfortunately, maintenance plans are currently few. But I hope that this will be just one of many books to come on the topic. In the meantime, we all have to continue to do our own personal science, as i mentioned above. Let's all work together!

Barbara

Welcome to the Maintainers Forum, Barbara! We're honored to have you join our little outpost of maintenance!

It's tremendously exciting for us to have you as a resource, especially while so many of us are in the process of reading your book. We all appreciate you taking the time to respond in such a detailed and understandable way and to share your many years of expertise with us. I know that all of us felt lost once we entered the maintenance phase of weight loss for precisely the reason you mentioned -- there's nothing out there for us! I'm saddened but not at all surprised by the response you got from publishers about there being no need for a book about maintenance, so huge thanks for stepping into the breach.

I'm looking forward to joining in the discussion as soon as I finish the book. :)

I was sort of wondering if this might be the case. This must be frustrating to fit your experience and advice in a short list adapted to someone else's format and I'm sorry you had to do so for your publishers to feel your book would be commercially successful. I rarely find mainstream diet books that I find helpful, since I can barely follow my own plan and never anyone else's. On the other hand, I really enjoy the kind of dialog that this thread has evolved into, and I'm grateful that you are taking the time to talk with me/us, especially since I expressed some difficulties with your book.

I do have another question about the use of artificial sweeteners in a Primarian diet, which as I alluded to in my original post I find counter intuitive. I've heard a lot of people here discuss how they also trigger cravings for additional sweets and junk foods, even though they don't (we think) trigger an insulin response, they do trigger a psychological one. Have you found that to be the case in your practice?

Anne

Anne, Barbara, and others - thank you for your posts. This has been and informative and interesting thread! As a new maintainer, I am fascinated by the topic and information presented.

Thank you!

Another voice of gratitude here! Thank you so much, Barbara, for presenting weight mainenance as a seperate, vitally important phase in the persuit of a healthy lifestyle. Your book , blog, and other work bring a great deal of medical credibility to this young field. And, Anne, thank you for the thoughtful, insightful review and follow up questions. I also feel that this plan is probably not one that would easily fit into my own life, but I am so glad that the door has been opened for (hopefully) a flood of other valid, well researched maintenance strategies! Bring on the knowledge!

More on this
 

Hello to all and thanks for following the conversation. I did not respond sooner as I subscribed to this thread but did not get an email that there were further posts. I'll check periodically.

First of all, I hope that those of you who have not read the book will do so. There is alot of information in the book which is not part of a "program". And, as I've said, any program should be looked at as something that can be modified and adapted to individual needs.

In terms of the artificial sweetener issue, I would say the same thing. In my experience, both personal and with patients, artificial sweeteners don't seem to cause a problem. I have not seen convincing evidence to suggest that they are dangerous, so i consider them a useful aid in weight reduction and in maintenance. If, on the other hand, any individual finds them overly stimulating to their appetite, I would tell them not to use them. My approach is always a pragmatic one. I think I'm going to blog about this soon actually. The diet that I suggest is not necessarily "pure" or "perfect". I 'm just trying to get as close as possible to what I believe we were best tailored to eat. I take into account the fact that we don't live in the paleolithic (thank goodness!), and try to incorporate things that make it a bit easier to stick mostly to Primarian types of food.

I also have to say, that many maintainers who post on the internet say that they are having success eating smaller amounts of what they did before. Many seem to be able to get along without restricting certain types of food. In my practice, however, I find that the vast majority of people fall off the wagon as soon as crackers, bagels, cookies, bread, etc...make a re-appearance. For those of you who are able to deal with S foods in smaller amounts, you are luck and you have the best solution to maintenance. I believe, though, that you are unique and are probably in the minority. Another explanation may be that early maintainers need to be tougher until they learn skills that they can later adapt.

This is a very interesting discussion.

I bought the book, but have yet to find any time to crack it open. I did hear on a previous thread that the gist of the book was to follow the Primarian diet which was rather like the Paleo diet. At that point I had to look up the Paleo diet to see what it was. What I found was that it seems to be the diet that my doctor has recommended that I follow (via the use of the book Dr. Gundry's Diet Evolution). Although in his diet, Dr. G does not allow the use of artificial sweeteners (except stevia).

I like the concept of following the Primarian diet 90% of the time. I've really had a hard time wrapping my head around the no grains, even if it is whole wheat concept. But I've been trying. Really hard. I've managed to forgo breads and pastas for breakfast and lunch about 13 days out of 14. And the same with dinner--I have pasta or bread only once or twice a month (and then it is only whole wheat). Besides, a lot of us maintainers have a deep belief that if you are forbidden to have something ever again that you will crave it and possibly cave in and binge on it. Everything in moderation is my motto! (Now if I can get my doctor to believe me!)

Thanks
 

Yes. This is a lower carbohydrate type diet (it does still include the carbs in fruits and vegetables of course). The 90% number simply means that you choose this type of food most of the time. I don't expect anyone to really tally out how much they eat off the menu and the amount that you are able to depart without regain is a function of your individual physiology.
Having been on this type of diet for about five years now, I find that I always know I can eat grains or potatoes or bread or whatever if I want to. But after choosing not to so often, I don't really care about them that much. I must add that I used to eat huge amounts of sweets, bread and pasta, so that this was a big change. Once again, I am so enjoying all of your questions and conversation. So let me ask all of you a question: Do the maintainers out there ever find that eating grains, breads, potatoes, pasta other starches cause you to gain weight or crave more? Or have you found ways to incorporate them without a problem?

For me, grains, breads, potatoes, and pasta that are whole grain don't cause me any problems. Refined grains and starches will cause me to crave more.

I've incorporated whole grains every day into my plan, and continue to do so to maintain. For me, meals tend to follow that iconic "Meat/Vegetable/Starch" pattern, albeit in non-typical portions (small meat, small starch, heaping pile o' vegetables). I get whole grain varieties whenever possible, but I don't avoid, for example, white potatoes. I figure that if I eat things mostly the way they grew, with minimal processing, it'll all work out for me in the end. And it has worked through loss and a year of maintenance - though I'm NO expert after just a year!

I do not believe it is grains that have caused my problems. I don't over eat any grains. In fact, sometimes I would prefer my burger sans bun or my sandwich open faced. I believe I only crave the grains because they have been deemed "forbidden." Also, I don't eat a lot of sweets and I don't crave them (except for an occasional desire for oatmeal raisin cookies which I STILL have not gotten around to buying/baking or eating!).

There are certain starches that cause intense cravings for me if I eat them. They include:
White rice (brown to a much lesser degree)
Popcorn
Potato chips
White breads like French.

I have never had a problem with potatoes, although I almost always have them with the skin, so maybe that helps. Pasta doesn't give me problems either.


I got my copy of the book today!

Although I don't eat white potatoes or white rice, I do eat grains like couscous, quinoa and, occasionally, brown rice. These don't cause me to gain weight and, in fact, when I became a vegan, I lost weight. Whole grain breads don't bother me either.

Baked goods, however, are another story. It's the sugar. Once I have it, I want more in whatever form I've eaten. Zucchini bread, even made with no oil or eggs, can be a trigger food. Peanut butter, the staple of many a vegan diet, is also off limits to me, although I found one that my DH likes and I don't so that's working quite well. Thank you, Costco. :)

Being a vegetarian for 26 years, I can't imagine maintenance without breads, pastas and grains. They are a daily staple for me. That being said, like Sheila, I eat whole grain varieties whenever possible. I make my own breads, and use my rice cooker to prepare brown rice, couscous, lentils, split peas, quinoa, etc. I also like sweet potatoes and use them in vegetable bakes quite often.

I try to keep a 40/30/30 balance to my eating, with 45 percent of my calories coming from carbs fairly often. I have found that I can't eat carbs alone. I must balance every eating occasion - not just strive for an overall daily balance. Carbs alone definitely trigger binge eating.

I ate something resembling the Primarian diet when I was losing weight originally, although it did have starches, just very controlled portion sizes. I had to add more carbs back in when I started running, because I felt like **** all the time and was starting to binge pretty regularly on sugary things. Moderating that intake got me back on track. I do have trigger foods, and some are sugary/starchy, but they are very, very specific. For example, Reese's Peanut Butter Cups will set me off every time, but I can just eat a single "fun size" Snickers with no problem. Of course strawberries and (separately) shrimp also have no stopping point for me, but who cares?

I can (not that I do) eat nothing but sugary candy for lunch and feel fine after, no crashing, no cravings. My blood sugars were perfect when I was 300 pounds. I know I'm lucky, but that's how I am. I am a classic pear shape and my waist measurement is in the normal healthy range, even if my BMI is on the high side.

These days I try to get my carbs in unrefined form as much as possible, starchy vegetables, potatoes with skins, whole grains, but I can't seem to give up regular pasta and reasonably healthy breakfast cereals and don't really want to. I'm also known to eat sugary stuff as well, gummi bears, jelly beans, and yes, chocolate, preferably dark. BTW, I'm pretty hard over on making sure all this stuff is portion-controlled. I measure the 1 cup of cooked pasta I get, or weigh the 2 oz of dry. I put 31 grams of Special K w/ 15 g of Fiber One in my bowl. I count the jelly beans. This is not so much because these thing trigger cravings, but because they are caloric and I get a bad case of portion creep, 2 cups starts to look like 1 cup in a short span of time. Yeah, even after 6 years. It isn't so big a deal.

My DH, a maintainer of about a 30 lb loss for about 4 years now, lost most of his weight simply by giving up Pepsi and cutting back on junk food. He still eats almost every kind of junk under the sun, and as much of it as he wants, at least while he's running (he's become quite the marathoner), with PopTarts themselves being almost an entire food group. No vegetables to speak of, unless I force him. His bloodwork is beautiful though. Great sugars, triglycerides, cholesterol. If my resting HR wasn't lower than his, I'd be jealous.

My stats since I don't dwell on them or keep a ticker: Max weight 289, maintenance weight in the 170s. I'm currently working on getting back there after a difficult pregnancy and have about 35ish pounds to go. Going slow now because I'm still breastfeeding, but its coming off steadily. I'm confident I'll be back there because 1) the alternative is unthinkable, and 2) I returned to that weight after similar circumstances with my first child. I'm also a distance runner/triathlete in all my spare time.

Anne

Although I've recently added a couple of pounds (still hoping that it is muscle from increasing my exercise regime in both time and intensity-ha!), I am lucky in the fact that I do not seem to have food related triggers which lead to excessive eating. My issues seem to be all emotionally related. I keep my breads whole wheat, and usually stay with flaxseed enriched, low-carb products such as the Joseph's brand pitas and lavash breads. But, ice cream has certainly remained a staple of my diet. Artificial sweetners are what keep me sane, and I add a Nutrasweet Vanilla Syrup to... almost everything, really. I count calories, (I have for the last 2+ years, and expect to forever) and measure food with a measuring cup and spoons, as opposed to by actual weight. Hope that my experiences add to the general pool of knowledge!

I haven't read the book (and judging from my to-be-read stack probably won't be able to for awhile) but I feel the need to comment anyway.

It is correct that publishers look for a hook or a twist for books. I used to follow a blog of a woman who was an intern for an agent and she would blast query letters for weight loss books that alluded to "eat right & exercise". Publishers buy books that they think will sell and your average every day "eat right & exercise" does not spur the American consumer to spend $$ on books. They want a secret or a trick or the next new diet.

But I am pleased that the topic of maintenace has found its way to publishers in this way.

As for carbs, like Anne, I run and bike some distances and I do eat carbs. I typically control the serving size, quality & number of serving sizes. I choose whole grains, beans, & oatmeal usually. I rarely eat pasta and rice, but I do like my flour tortillas. I find that if I run or cycle longer than 45 minutes and I have NOT had a carb serving prior to the exercise, I hit a major wall. Oddly, I ran on an empty stomach this am and hit that wall at about 30 minutes. Heck if I know why. I should have had some peanut butter toast before I ran.

I do focus on protein, healthy fats, and lots of fruits & veggies as well. My fitness goals include both distance running events & weight-lifting. Sometimes my nutrition plan seems to be at odds with attempting both of these goals. I probably eat more carbs than other weight lifters and more protein/fewer carbs than other distance runners, but it's not like I'm looking to be a world class athlete in either. I eat healthy foods in appropriate amounts and do the types of exercise I enjoy.

Carbs do not seem to be a trigger for me. Now, I LIKE a lot of foods that are carby and I can and will eat more than I should cause I like the taste and mouth feel. But my triggers really seem to be fatigue and stress, so as long as I keep a handle on those things, I am fine.

I don't do grains. Just doesn't work for me. I just can't/won't/can't? do grains moderately. No brown rice, whole wheat breads or pastas or nothing.

When I started my weight loss journey I did eat whole wheat pita bread and brown rice. But for me, being a calorie counter first and foremost, I simply found I was not getting enough volume, and therefore *satisfaction* out of the grain products. 1/2 cup of brown rice just doesn't do it for me. I would rather have an entire head of cauliflower for the same amount of calories.

Although I'm pretty sure that the grains in and of themselves don't *cause* me to gain weight. It's the fact that I want to and DO tend to overeat them. In other words, if I was still consuming the same amount of calories while eating grains, chances are there would be no difference in my journey.

And I'm with Circebee. I use artifical sweetners. Splenda. I'm sure I eat waaay too much of it. But it does help me to stay on plan. And for now, I'm just not getting rid of it.

This is a very interesting thread and discussion. Thanks Anne for starting it, and Barbara for sharing your insights.

I don't find that starches cause me to gain weight or crave more. I do tend to overeat them because like Midwife, I like them. But as long as I eat a measured portion, they cause me no trouble. Sugars, esp in the form of candy is a much larger problem. Once I have one piece, I want more, and more, til it's gone. Interestingly, I can resist chocolate easily, as well as ice cream and baked goods. It's things like skittles, good & plenty, or Anne's favored PB cups that do me in. If I just say NO the first time, I'm fine. I just can't start. :)

I've read too much about artificial sweetners to use them much, besides I don't like the aftertaste. I grew up with soda being only an occasional treat, and so I've never really had a habit of drinking them. I will occasionally drink a diet coke/pepsi, but less than once a month. I don't like yogurt with AS either. I prefer to buy plain and add my own fruit.

I lost 70 lbs doing WW, and learned early on that eating whole foods gave me a lot more food for my points. I did eat grains and starches throughout though, and also still drink a glass of wine several times a week. Interestingly, I have a sister who was probably more than 50# heavier than me at our highest weights, chose to have lapband surgery. While she's lost a lot she can't eat much, and she often chooses foods that would be better avoided. She's not finished her WL journey, and I'll be interested to see what happens when she's where she and her doctor want her to be. I am glad however, that she chose the lapband over the bybass surgery.

Okay, I'm wandering now. Just wanted to say thanks for this thread, and to respond to the starches question.

I haven't read the book yet but I love whole grains (and sweet potatoes and beans) and I ate them while I lost weight and I eat them to maintain. I do manage these foods - I always measure pasta or brown rice.

Whole grains don't seem to trigger cravings like processed, refined grains. I can eat a portion of brown rice with stir fry and be fine. If I eat a plain white flour Saltine cracker - mmmm, it's like the best cracker ever and I want 10 more!

Great discussion
 

Hello to all. Just want to ask you what I'm doing wrong. i asked to follow this thread but after i get one notification or so that there's a post, I don't seem to get any more. Forgive my amateur status, but should I be doing something else?

Anyway, i have been fascinated by all of your replies. If you guys do wind up reading the book, please be sure to note that I don't ban grains or starches or even sugar. I just recommend that you be careful with them. The "rule" I use in the book is that you eat foods that were original to the human diet (lean animal protein, veggies, fruit, nuts, eggs, seeds, berries) 90% of the time. Since no one can really judge what 90% is, that simply translates to: choose those kinds of foods most often. Each individual will be different in terms of response to grains. I find that those who have had elevated blood sugars or elements of the metabolic syndrome are most vulnerable. The reason, i believe, is that both starches and sugars wind up as simple sugar in the blood (glucose). Glucose triggers insulin and in those who are insulin resistant, ALOT of insulin. Insulin stores fat and creates hunger. This is the reason starches often lead to weight gain and to hunger as well. This is not true for everyone. For those who can add back grains while maintaining, there is probably no reason to avoid them. Except for two possible concerns. There are some scientists who are worried about the role of grain in causing possible autoimmune problems. Why? There are proteins in grains that look alot like some human proteins. The body responds to these as antigens (invaders) and in sending an immune response against them, may get confused and send the same response against its own tissues. We know for sure that this happens in people who have sprue, which is a sensitivity to gluten. The question is, could grain cause similar problems with other tissues.? Some gastroenterologists are endorsing a grain free diet for inflammatory bowel, as it seems to lower inflammation in this disease. What about other autoimmunes? Still unknown.
A second issue is the phytates in grains. Phytates are compounds which bind minerals in other foods and so prevent absorption. They are called antinutrients because they lower the nutrients absorbed. There is also another interesting issue: no primate eats grain in the wild, and we are primates. For all of these reasons, there is a red light blinking in my head about grain. But it's too early to know for sure. The lines of inquiry I've discussed above are not included in my book. They are still too uncertain. But I do feel very comfortable saying that we know that foods that humans have always consumed do not cause a problem. That's the reason I mostly endorse those foods.

For the moment, the issue is keeping off the weight. If you can do it while eating grain, I think you're lucky. Wish i could!

Barbara:

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I find the possible connection to autoimmune disease fascinating. I have fibromyalgia, IBS, insulin resistance and a suspected autoimmune connective tissue disorder (respiratory tract). Like many with fibro, eating too high a proportion of carbs (especially flour and sugar) seem to worsen or trigger pain/fatigue/memory problems. With the insulin resistance, I definitely have noticed the carb hunger cycle. When I do not control carbs, I experience a literally constant hunger that is unbearable. I continue to feel starved even when I've eaten to discomfort (and this has been true all of my life, since before my first "diet" at age 5. For as long as I can remember, I could never eat enough to feel full).

Since discovering that reducing carbs helps control my fibro and hunger,
I've focused on the number of carbs and eliminating refined carbs, but
I've never thought of eliminating grains altogether, but I think it's definitely worth giving a shot.

Barbara, this is very interesting! Do you some references for this? I have a friend who has these kinds of issues (unrelated to weight loss/maintenance) and would be interested to learn more about this. Yes, we're both recovering scientists and go to the original peer-reviewed literature when possible, so please don't take this request as a challenge, just a request for more information. She is quite fluent in the medical and biological literature; I, sadly, much less so.

Thanks,

Anne

I'll be back
 

Hi Anne,
A recovering scientist, eh? Why do you need to recover?
At any rate, I'll get back to you shortly with some references. I also find this potential link fascinating. There seems to be an incredible amount of autoimmune disease developing. The NY Times ran an article last week about the increase in rheumatoid arthritis in women. We've seen a great deal of this in our area, also including psoriatic arthritis and other connective-tissue-like syndromes.

Once more on a technical note: I'm still not getting notification of posts. When I click on the thread tool it just says "view printable version" or "email". I assume that's because I've already subscribed to the thread. Is there any way to resubscribe?
Barbara

I haven't read the entire discussion but I've read some of it.

When you are discussing grains, do you also mean things like quinoa and amaranth? I had heard that they are grain like but that they really aren't a grain and so are sometimes referred to as a pseudo-grain.

Barbara, I checked and your account settings had been set to not subscribe to threads so I fixed it. You now should be getting an email notification when there are responses to this thread. If it still isn't working, let us know and we'll figure it out. Thanks for being so patient! :)

This is an interesting thought: I used to work with a guy who had lost a considerable amount of weight (over 100 pounds) and had maintained the loss for at least 5 years. His diet, 90% of the time, consisted of steamed vegetables and dry whole wheat toast. He said he had that for lunch and dinner unless he had something special planned (like our weekly pizza night at work). His steamed vegetables were a mixture of Brussels sprouts, cauliflower, broccoli, carrots, etc. He'd eat about 2 cups of that for dinner and at least 4 slices of dry (no butter, etc.) toast. At that time (over 20 years ago) he said it was a diet recommended by the American Heart Association. I don't know if their recommendations have changed, and I'm sure they have to some extent. What do you think of this?

Well, I don't want to downplay anyone's successful weight loss and maintenance, but that just sounds awful to me. Which is hypocritical of me, since I eat a lot of the same foods everyday. But damn, steamed veggies and toast, twice a day, for life?

At the time I thought it was rather strange, too. But he did have at least one or two nights a week where he and a friend would create a gourmet meal. And then there was pizza night at work. He never turned down a treat. I think this was his way of managing his weight. I guess it's a matter of "whatever works for you."

On the IBS side, I have a staff member who manages hers by eaing about 95% grain free - she does eat oats. She uses nut/rice flours, and eats a ton of veggies, and very little meat. (She is also skinny, and always has been)

I'm with Glory - veggies and dry toast, ick. :lol: I know it's "whatever works for you" but boy, that wouldn't work for me. But I've also seen bodybuilders in their preparing-for-competition stage and I couldn't eat like that either.

I know that if I plan a meal/snack that is someting I really don't like, though it fits into my desired plan, I'll either skip it, or worse eat some of it and then go get something I'm trying to avoid. I'm much better off planning foods that I like in proper amounts.

Barbara, we seem to be on the same page about eating grains and weight loss/maintenance.

But I know there are plenty of folks who do just fine with them. Many of them right here at 3FC. For me, sadly, I don't think I will ever be able to include them in my everyday menu. But I'm okay with it and accept it. Afterall doing without some grains is better then being morbidly obese. And I really do love all the veggies and proteins that I eat.

We all do what we have to do. Of course now that the weight if off of me and I know what I need to do, that's "easy" for me to say. Not so sure I could "do" steamed veggies and toast day in, day out. In fact, I'm pretty certain that I couldn't :dunno:. Luckily, there IS more then one way to do this "right".

Edited to add: Wait come to think of it, I do eat a bit of grains. Not much, mind you, but a bit. I eat 1/4 of a cup to 1/2 cup of Fiber One cereal with my yogurt. Hmmm......

I think that too often in research and in popular weight loss books, all weight issues are treated with a one-size-fits-all approach. In a sense, it's like treating all headaches the same, whether they're caused by stress, lack of sleep, migraines, viral infection, high blood pressure, sinus infection, allergies, head injury or brain tumor. I think it's partially a human natural tendency to want a simple explanation/solution. Also, of course publishers want books that will appeal to as many people as possible, so anything that implies "this may not apply to some of you," is seen as a defect rather than a strength.

I think eventually, if the many factors are identified and studied, we will be able to customize treatment and do it earlier with greater success. For now, most of us end up having to be our own scientist and lab rat (not the ideal research model).


I don't know if carbs/grains are a problem for all people or even most people, and I don't think they're equally problematic for all people, but I do know they are a very serious problem for me. If I hadn't found the hormone and carb connection, I have no doubt that I would have continued, despite dieting (or maybe because of it) to gain weight rather than lose it. However, if the hormonal and carbohydrate (or perhaps grain) connection would have been discovered before or shortly after puberty instead of at 41, I may never have hit the 200 lb mark, let alone the nearly 400 one. (I had severe and extreme PMS/PMDD symptoms from my first menses at age 9 or 10, so the hormonal issues may have been there from the start also).

Even at 5, I knew that I wasn't like anyone I knew (not even any overweight person I knew). I didn't know why food was always on my mind, or why I felt like I needed to eat, even when my stomache hurt from eating too much. My grandmother and mother were significantly overweight, but their food choices and quantities weren't really abnormal. They ate too much and exercised too little, but they still had a hunger "off" switch, which I never seemed to have.

Maybe there is a genetic component (I was adopted as an infant). Without meeting my bio-family, I can't know for sure, but I do suspect. No one in the family I was raised in had childhood weight issues (or the strange drive to constantly eat), whereas I was overweight since age 5 and morbidly obese by 5th grade. None of the women in my family had the hormonal or significant PMS issues either, so I felt like a freak all the way 'round.

I do feel I'm starting to get myself figured out, it just does sometimes seem a bit sad that it took me four decades to do so.

I'm not denying personal responsibility, but because my experience has not been a normal or typical one (though as I would discover, not particularly rare either) - I became fascinated by all of the different factors that affect the development and course of obesity (not just my own). In graduate school (developmental psychology), I badly wanted to focus on the treatment and psychology of obesity, particularly childhood obesity, but I was too ashamed to write even a single paper on the subject, because of my weight. So while I did do quite a bit of study, I mostly kept it to myself out of embarassment. I just felt that my credibility would suffer if I pursued it as career or a field of study while still being fat (not to mention, the professional and personal ridicule I would receive).

Yes, this is 95% accurate for me.

I cannot say I am a maintainer. I will say I am someone who has gotten to goal and is struggling to stay here.

As mentioned, currently I am struggling with the above. In my way of eating I try to avoid most grains and do best while following the Primarian diet you have described. This has been accepted. Except for when I "give it another try." Then I stumble.

I seem to fit your prototype. Or could it simply be that I am so new to maintenance?

Just another two cents. I'm not to goal yet, but getting close :D.

I never gave up grains in the first place, and here I am almost 50 pounds lost later. I *did* reduce quite a bit. I don't have 3 bowls of cereal for breakfast, or 4 pieces of bread with dinner. I'm definitely someone who likes her carbs the best of all the macros. But I have a good-sized serving of oatmeal most every morning, and pancakes on Sunday. Lately I've had yogurt with granola every morning for a snack (small serving). I have some serving of grains with most every meal. Rice, pasta (not so much, just because it's not my favorite), toast, pita or tortilla. I may have only 1/2 to 1 cup, instead of 2 or 3 cups worth, but it's a very far cry from low carb. 3-4 fruits per day. Probably 150 net carbs on an especially *low* day. I do have very little sugar, and only whole grains (when I can control it, which is usually).

So I'm pretty sure I'll maintain with pretty liberal grains, since I'm losing on it ;). Many cultures have or had low obesity rates with liberal grain intake. Clearly they also have other differences to culture in the U. S. But clearly grains alone aren't the problem.

I do really appreciate any inroads made in getting maintenance help out there in print.

Ah, well, long story short. I fell in love with astronomy and astrophysics, but the hours were long, the pay was short, and the jobs scarce, and when all was said and done, I wanted to live on the same continent as my husband. So after the PhD was in the bag, I took a job as an engineer, which gives me a lot more personal flexibility, if perhaps not the same level of job satisfaction. Unfortunately old habits die hard, and my first instincts are always to hit the library (now electronic) and dig out the original literature. My friend has a similar story in neurobiology, so we trade physical and biological science papers as needed. My training has also made me incredibly skeptical of everything, since I've seen firsthand the garbage that can make it through peer review, and that's only (theoretically) the good stuff.

Thanks in advance for the refs. I forwarded to my friend a couple from the paleo diet sites your book references, but the ones I found were maybe pushing a decade old. I'm guessing things have progressed a lot in 10 years.

Anne

refs
 

Hello Anne,
I have a couple of things for you to look at. Unfortunately, I can't provide a link, because I am too computer illiterate to figure out how to do that on this site.
"Modulation of Immune Function by Dietary Lectins in Rheumatoid Arthritis", British Journal of Nutrition (2000) 83, 207-17.
Also: "Do Dietary Lectins Cause Disease?" British Medical Journal, 4/17/99.

I have also written to Loren Cordain who is one of the major Paleo Diet advocates and who has researched extensively about the original human diet and its medical implications. I have asked him whether he is still on the trail of the lectin connection and whether the potential link to autoimmunity is still a viable hypothesis. I'll get back to you on that one.

In my view, science is vital to medicine. I hate junk science. But unfortunately, science isn't particularly well tailored to shed light on issues of diet and weight. Too many confounders. Too many contradictory studies on just about everything. So observation takes on an enhanced role. it's the Solomon I use to help me decide between the two sides of everything. Sometimes I just have to go with my gut. Not perfect, but....