DEAR DR. ROACH: In a recent column, you said, “I don’t find simply telling people to eat less and move more to always be an effective therapy.” What do you suggest to patients wanting to lose weight? — C.N.
ANSWER: The vast majority of patients I see who are overweight know they are overweight, and have tried unsuccessfully to lose weight. Often, they have tried multiple different types of diets, sometimes having success in the short term but then having gained it back. “Eat less, move more,” while correct, doesn’t address the issues that are important for many people.
Although some of my colleagues will disagree with me, I look at the issue differently. I recommend that people choose a healthy diet. There are many healthy diets, and people can choose what they like, but I recommend plenty of vegetables, some fruits, and good-quality protein sources such as legumes or nuts and lean meats or fatty fish for those who eat them; processed foods, especially starches and processed meats, should be avoided. Along with these dietary changes, which are modest for many people, I advise increasing exercise, from wherever the person starts (within reason).My rationale is that “losing weight” often seems unattainable to people; however, eating better and exercising more feel like they are within one’s control. There is no doubt that people will be healthier with a better diet and with more exercise.
It is true that over a long time, most people who make those dietary and exercise changes will lose weight. But the primary goal is to improve health, even if the weight doesn’t come down.
Some people, especially those with medical problems due to their weight, need more-intensive intervention, and I am fortunate to have colleagues in weight management, both medical and surgical, for those who need it.
DEAR DR. ROACH: I went gluten-free four years ago for “health” reasons. I had no irritable bowel issues or celiac disease. After this amount of time, is it OK to reintroduce wheat and gluten? Does going gluten-free when you do not have celiac disease cause you to become more gluten-sensitive because its reintroduction would be like a foreign substance to your system? I fear I may have caused myself to become gluten-sensitive by avoiding it when I didn’t have to. Can you please advise? — L.
ANSWER: If you had no gluten sensitivity and no celiac disease, then you should have no issues with going back on a diet containing gluten, as far as I have been able to tell from my reading and my understanding of the condition. However, some people with celiac disease have extremely mild symptoms, such as fatigue or abdominal discomfort after eating, which are symptoms felt by nearly everyone from time to time. Nonetheless, making the diagnosis of celiac disease is important, even in people with minimal or no symptoms. People with celiac disease are more likely to develop autoimmune disorders, nutritional deficiencies and some cancers. Also, dietary intervention is critical in the case of women who might become pregnant.
If you truly had no symptoms at all before you went gluten-free, and still don’t once you restart, I don’t think any testing is necessary. However, if you notice symptoms, then a blood antibody test while on a diet containing gluten can establish the diagnosis.
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