Struggling with Food? Try the “Un-diet” Approach

Struggling with Food? Try the “Un-diet” Approach

Question:

I just started to go to LA Fitness. I’m a 23-year-old female, I weigh 205 lbs., and I’m 5’4″. I struggle with food. I’ve been on multiple diets, lost weight, restricted myself and end up giving up because it wasn’t sustainable, gaining it back. Calorie counting just seems very tedious and writing things down as well. Is there a way of eating that doesn’t involve measuring out everything in order to lose weight? Or any advice/suggestions?

– Marissa R.

Answer:

I agree that you should remove the focus on portions and calorie restriction. For chronic dieters, experts in weight management recommend making permanent lifestyle changes the goal. Creating realistic goals and developing healthy habits that last are key to an “un-diet” approach. No mention of calories or measurements in The National Weight Control Registry’s summary of its registrants’ four most common habits*: eat breakfast every day, weigh themselves once a week, watch less than 10 hours of TV per week and exercise about 1 hour daily.

Knowledge is power! I believe that a simple foundational understanding of nutrition can help frame your outlook and shift your thinking away from weight, towards nourishing your body. Have you read our Living Healthy articles on nutrition basics, weight loss tips, a Mediterranean style of eating, mindfulness, and social support? For more in-depth learning consider a mass open online course (MOOC) on nutrition fundamentals. Several are free (taken as an audit, not for credit) and available from trusted sources like respected U.S. universities with credentialed instructors.

*The NWCR is the largest prospective investigation of long-term successful weight loss maintenance. http://www.nwcr.ws/Research/default.htm  accessed 6/4/2019

Resources:

– Debbie J., MS, RD

This article should not replace any exercise program or restrictions, any dietary supplements or restrictions, or any other medical recommendations from your primary care physician. Before starting any exercise program or diet, make sure it is approved by your doctor.

Some questions have been edited for length and/or clarity.

Ask our Dietitian

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The Importance of Exercise for Cancer Patients: What You Need to Know

The Importance of Exercise for Cancer Patients: What You Need to Know

The term “cancer survivor” refers to anyone who has been diagnosed with cancer, no matter where they may be in their journey. With earlier detection and improvements in screening and treatment, cancer survivors are living longer. ACSM recommends for patients to aim for 150 minutes per week of moderate aerobic exercise with an additional two to three sessions of strength training (such as weight lifting) unless contraindicated. A 2017 systematic review suggests that there is sufficient research to support the promotion of exercise for adults with cancer, and some to support the promotion of exercise in group or supervised settings and for a long period of time to improve quality of life and muscular and aerobic fitness (1). Exercising at moderate intensities can be sustainable for longer periods of time and could encourage the formation of an exercise habit. It is important that an assessment be conducted to evaluate the effects of disease, treatments, and comorbidities and that a survivor receives clearance from their oncologist (1).

How cancer patients should approach exercise?

A patient’s approach to exercise should be rehabilitative and should consider their fitness level prior to diagnosis and treatment. The survivor will need to consider the recency of surgery, chemotherapy, radiation, hormonal therapy, and any side effects that may have occurred with each. The patient’s oncologist/physical therapist/trainer can be helpful in identifying side effects that could influence one’s performance and help them determine what modality of exercise could be the most appropriate to prevent injury. These health/fitness professionals should also work with the patient to come up with realistic activity goals. Having goals will increase motivation and facilitate a lasting behavior change!

Some of the best exercise for cancer patients – does this vary between those who are currently undergoing cancer treatment versus those in remission?

The best exercise is the one that fits the individual. Again, it’s important to consider any treatment-related side effects that may be present. This can serve as a foundation for tailoring the patient’s regimen. Common treatment-induced side effects that could have implications on exercise include neuropathy, lymphedema, and cardiotoxicity.

If the survivor is experiencing neuropathy (often referred to as chemotherapy-induced peripheral neuropathy (CIPN)), it would be best to steer away from high-impact free weights and aerobic exercises that require a lot of balance. Safer modalities would be low-impact exercises such as swimming and biking. For lower extremity neuropathy, patients should try to incorporate calf stretches, ankle circles, walking, leg lifts, and balancing exercises (2).

While most common in breast cancer survivors, lymphedema can be present in any part of the body that has been subject to surgery or radiation. It is essential to seek out care from a lymphedema specialist and resolve the issue. Contrary to popular belief, once the lymphedema is under control, it is safe to exercise at a slow and progressive rate (3). The survivor will need to pay close attention to any changes in the affected area. This can include swelling of part or all of your arm or leg including fingers or toes, a feeling of heaviness or tightness, restricted range of motion, aching or discomfort, recurring infections, or hardening and thickening of the skin (4).

For those experiencing cardiotoxicity after chemotherapy (in particular, anthracycline-based treatment) or radiation to the chest area, it will be important to get physician clearance before engaging in exercise. However, engaging in a low-to-moderate intensity exercise regime prior to or during treatments could potentially mitigate the severity of treatment-induced cardiotoxicity (5).


Why exercise is so important for cancer patients.

The benefits from exercise for this population are extensive. Cancer survivors are almost three times more likely to report fair or poor health after treatment and twice as likely to have psychosocial disabilities and physical and functional limitations as persons without cancer (6). In addition to the possibility of neuropathy, lymphedema, and cardiotoxicity as mentioned above, some other lingering effects of treatment include but are not limited to cancer-related fatigue, weight gain, weight loss, depression, anxiety, insomnia, altered body composition, and changes in bone mineral density. Of these, strong evidence suggests that exercise can directly improve fatigue, weight changes, depression, anxiety, and bone health (7).

  • Fatigue: Fatigue occurs in approximately 50-90% of patients undergoing treatment. While it may seem contradictory, exercise happens to be the number one non-pharmaceutical approach to combatting cancer-related fatigue. It can be hard to get started, but great benefits will be reaped if one can get going…even if it’s something as small as walking around the block for 10 minutes or doing house cleaning. A meta-analysis of 70 studies reported that exercise reduces fatigue by 32% during treatment and by 38% after cancer treatment [8]. Resistance, aerobic, flexibility and mixed training programs have all demonstrated improvements in fatigue levels.
  • Weight loss/weight gain: There are many mechanisms that can cause a patient to lose weight. One is associated with the side effects of chemotherapy such as nausea, vomiting, diarrhea, and anorexia. Another mechanism is the presence of an altered metabolism and increased inflammatory cytokines that speed up muscle degradation and can lead to a more serious condition called cancer cachexia (7). On the other hand, weight gain and/or increased fat-to-lean mass ratio can be caused by certain cancer therapies, especially hormonal therapies (7). Exercise can mediate inflammation and help maintain lean mass to help keep weight in check.
  • Depression/Anxiety/Insomnia: Some of us are familiar with the endorphins and serotonin increase that exercise brings on, but exercise is also associated with increased levels of endocannabinoids which have an anti-anxiety effect and promote a sense of well-being [9]. Physical activity also helps patients develop an increased sense of control in his/her own life. Exercise also reduces many negative emotions such as anger, contempt, disgust, guilt, fear and nervousness. The anti-anxiety and antidepressant effects of exercise has been demonstrated in patients undergoing treatment [10, 11] as well as cancer survivors [12]. Insomnia is often induced by increased depression and anxiety, so by treating the root of the problem (depression and anxiety), insomnia can be reduced.
  • Bone health: Bone density can be by hormonal therapies or by metastases to the bone. In those without mets, impact and weight exercise training are preferred to maximize bone health (7). Impact exercises include activities such as running and jumping. Weight and resistance training refer to activities that require the shortening (contraction) and elongation of muscles. By loading the bones through impact and weight bearing activity, you help to prevent further bone loss. If mets are present in the bones, you will want to be extra careful when choosing appropriate activities. As with other exercises, if a patient is experiencing bone metastases or a loss of bone mineral density, it will be essential to seek out advice from an experienced fitness professional.

How family and friends can help show their support (fitness and nutrition wise).

Encouragement! Exercise can be daunting for some. It is important to recognize the benefits of exercise and help your loved one find a good regimen that fits their needs. You may also consider exercising with them. That way you hold each other accountable and both get the amazing benefits of exercise.

Where our readers can go for more information.

Look for an ACSM Cancer Exercise Trainer in your area.

ACSM.org, WCRF/AICR


References:

  1. Segal, R., Zwaal, C., Green, E., Tomasone, J. R., Loblaw, A., Petrella, T., & Exercise for People with Cancer Guideline Development Group (2017). Exercise for people with cancer: a systematic review. Current oncology (Toronto, Ont.)24(4), e290–e315. doi:10.3747/co.24.3619
  2. Tips for Managing Neuropathy. (n.d.). Retrieved from https://www.dana-farber.org/health-library/articles/tips-for-managing-neuropathy/
  3. Lymphedema (PDQ): Health professional version. National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/side-effects/lymphedema/lymphedema-hp-pdq#section/all. Accessed Sept. 24, 2017.
  4. Lymphedema. (2017, December 21). Retrieved from https://www.mayoclinic.org/diseases-conditions/lymphedema/symptoms-causes/syc-20374682
  5. Chen, J. J., Wu, P., Middlekauff, H. R., & Nguyen, K. (2017). Aerobic exercise in anthracycline-induced cardiotoxicity: A systematic review of current evidence and future directions. American Journal of Physiology-Heart and Circulatory Physiology, 312(2). doi:10.1152/ajpheart.00646.2016
  6. Hewitt Maria, Rowland Julia H, Yancik Rosemary. Cancer survivors in the United States: age, health, and disability. The journals of gerontology. Series A, Biological sciences and medical sciences. 2003;58:82–91.
  7. Ferioli, M., Zauli, G., Martelli, A. M., Vitale, M., McCubrey, J. A., Ultimo, S., … Neri, L. M. (2018). Impact of physical exercise in cancer survivors during and after antineoplastic treatments. Oncotarget9(17), 14005–14034. doi:10.18632/oncotarget.24456
  8. Puetz TW, Herring MP. Differential effects of exercise on cancer-related fatigue during and following treatment: a meta-analysis. Am J Prev Med. 2012;43:e1–24. https://doi.org/10.1016/j.amepre.2012.04.027.
  9. De Moor MH, Beem AL, Stubbe JH, Boomsma DI, De Geus EJ. Regular exercise, anxiety, depression and personality: a population-based study. Prev Med. 2006;42:273–9.
  10. Mehnert A, Veers S, Howaldt D, Braumann KM, Koch U, Schulz KH. Effects of a physical exercise rehabilitation group program on anxiety, depression, body image, and health-related quality of life among breast cancer patients. Onkologie. 2011;34:248–53. https://doi.org/10.1159/000327813. [PubMed] [Google Scholar]
  11. Quist M, Adamsen L, Rorth M, Laursen JH, Christensen KB, Langer SW. The impact of a multidimensional exercise intervention on physical and functional capacity, anxiety, and depression in patients with advanced-stage lung cancer undergoing chemotherapy. Integr Cancer Ther. 2015;14:341–9. https://doi.org/10.1177/1534735415572887. [PubMed] [Google Scholar]
  12. Courneya KS, Friedenreich CM, Quinney HA, Fields AL, Jones LW, Fairey AS. A randomized trial of exercise and quality of life in colorectal cancer survivors. Eur J Cancer Care (Engl) 2003;12:347–57. [PubMed] [Google Scholar]
  13. Rizzo A. (2016). The Role of Exercise and Rehabilitation in the Cancer Care Plan. Journal of the advanced practitioner in oncology, 7(3), 339–342.

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Metabolism Advice for Those Over 50+

Metabolism Advice for Those Over 50+

Question:

I am a member at LA Fitness in San Antonio Texas, just signed up! Ever since I turned 50 I have been gaining weight with the same diet. I don’t drink sodas and I eat at home most of the time; lean poultry, tilapia, quinoa and sometimes rice. I try not to add too much salt to food. I have a busy life and I don’t have time to cook complicated meals or eat 8 times a day. Even though I hardly eat bread, I do like corn tortillas. Obviously, my metabolism has slowed down. 

– Rosa T.

Answer:

Sounds like the “same diet” you’ve followed isn’t working for you now. From what you describe, the lean protein and plain grains are okay if the volume is appropriate. Check your portions as you should target 3-4 oz. poultry/fish and ½-1 C quinoa/rice (or 2-3 corn tortillas) per meal. Look at all the other foods that make up your diet and compare to recommended serving sizes.

Consider filling up on fruits and vegetables which provide bulk with fewer calories. Great that you avoid soda, but make sure other beverages aren’t loaded with sugar either – particularly coffee drinks or juices/smoothies. Regarding your metabolism, remember that reductions in activity and lean body mass are usually to blame. Use your new membership by getting in both calorie-burning aerobic exercise and muscle-retaining strength workouts.

– Debbie J., MS, RD

This article should not replace any exercise program or restrictions, any dietary supplements or restrictions, or any other medical recommendations from your primary care physician. Before starting any exercise program or diet, make sure it is approved by your doctor.

Some questions have been edited for length and/or clarity.

Ask our Dietitian

Have a nutrition question? Our registered dietitian is ready to help!

Email nutrition@lafitness.com or submit your question below and it may be featured in an upcoming article!

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Advice from an RDN on How to Gain Healthy Weight

Advice from an RDN on How to Gain Healthy Weight

Question:

My name is Patrick. I am a new member to the gym since in January. Since joining, I go 4 times a week (Monday – Thursday) and want to optimize my results. I work out for about an hour and fifteen minutes each time, mostly focusing on the upper body and abdomen. I drink a protein shake every day and try to also eat an avocado. I have trouble it seems gaining weight even though I’m consuming 2,500+ calories a day usually. I also drink a Gatorade every time I go to the gym and try to eat a lot of nuts with my turkey at every meal. I don’t have a lot of time to prep food so like buying pre-packaged cold turkey. I can eat straight out of the package or pre-packed snack mixes of dried fruit and nuts. I have gained about 10 pounds in the last 5 months, but results are slow to come. I do the same workout every time hitting nearly every muscle group in my body sometime during my workout. What are the best workouts/machines to use for upper bodybuilding and what should I be eating?

– Patrick

Answer:

Ten pounds gained is a testament to your efforts thus far! Based on the loose description of your intake it sounds like you’re getting dense foods like nuts, dried fruit, and avocado in. You say you drink 500 calories worth and I’ll assume that is from the two beverages you’ve mentioned – a protein shake and Gatorade. Not bad. Hopefully, you are drinking other fluids! Make sure they also have calories like milk (alternatives) and juice.

For solid foods – even quick/packaged items – maximize every bite by making sure it’s topped, soaked or loaded with condiments. For instance, make instant oatmeal with milk instead of water and use extra mayo packets on a turkey sandwich or wrap. High-calorie ready to eat food includes cheese cubes, full-fat sweetened yogurt, potato salad, bars suitable for hiking, and shelf-stable meal pouches (though they may taste better heated).

Not fixing your own food is a disadvantage to healthier eating, as most other energy-rich items are loaded with sugar, salt and fat or contain few fruits and vegetables: canned chili, fried chips, fruit strips/leather, jerky, burritos, egg rolls, etc. Try to take time the night before to pack a small cooler of a few healthier staples. For example, hard-cooked eggs or a single-serve peanut butter tub with a bagel, raw apples or celery sticks as snacks.

– Debbie J., MS, RD

This article should not replace any exercise program or restrictions, any dietary supplements or restrictions, or any other medical recommendations from your primary care physician. Before starting any exercise program or diet, make sure it is approved by your doctor.

Some questions have been edited for length and/or clarity.

Ask our Dietitian

Have a nutrition question? Our registered dietitian is ready to help!

Email nutrition@lafitness.com or submit your question below and it may be featured in an upcoming article!

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Is There a Bad Time to Eat Fruit?

Is There a Bad Time to Eat Fruit?

Question:

I am trying to lose weight but have had no luck. I’m 44 years old. I’m somewhat athletic but have serious knee issues. I weigh 197 lbs., trying to get to 180 lbs. My question is: Is there a bad time to eat fruit? Is late in the day not a good idea? I like fruit as a snack, but I’ve heard that late in the day is not a good idea.

– Andy M.

Answer:

In twenty years as a dietitian, I rarely see an excess of raw fruit be the culprit in someone’s weight gain. The 10-20 grams of fructose bound with water and fiber from a serving of fruit isn’t a concern. It’s the other sources of fructose (sodas, sweetened teas, bakery desserts) that have added sugars which will prevent you from losing weight since they are usually excess calories.

Eating fruit in the evening as an alternative to higher calorie and fat desserts is ideal. As a snack, a 16 oz fruit smoothie is probably best earlier in the day – unless you’re using it as a recovery drink from a heavy afternoon workout. A plain apple with a few nuts or hard-cooked egg makes a great between meal snack!

– Debbie J., MS, RD

This article should not replace any exercise program or restrictions, any dietary supplements or restrictions, or any other medical recommendations from your primary care physician. Before starting any exercise program or diet, make sure it is approved by your doctor.

Some questions have been edited for length and/or clarity.

Ask our Dietitian

Have a nutrition question? Our registered dietitian is ready to help!

Email nutrition@lafitness.com or submit your question below and it may be featured in an upcoming article!

13 + 3 =


Recommended Reading - Q+A

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