Dr. Charles Lucas Show Segment
Q: The word on margarine versus butter. We keep hearing different things, butter's bad, now butter's good. Margarine's bad.
A: Well they're both bad. They're both bad. They're both saturated. When you take oil and you saturate it, you convert it into something like butter and so margarine, for example, will raise your LDL cholesterol. It'll lower your HDL cholesterol. Butter and margarine are both not necessarily good for you. There are some lower saturated margarines like the tub margarines, the more liquid margarines, they are a little bit better but really it's probably better to use vegetable oils particularly olive oil to cook with or to fry with.
Q: Now there's monounsaturated fat.
A: You can even put it on your bread.
Q: Like they do in the Italian restaurants now. They call it the Italian Butter.
A: Sure.
Q: Yes. The monounsaturated fats and the polyunsaturated fats, I've heard that the mono is better. Is this correct?
A: Yes, I think so. I think the, there's a lot of research which suggests that monounsaturated fats don't have the personagenic properties of polyunsaturated fats that begin with, just looking at Cancer alone, that the mono fats are probably a safer fat to eat from that viewpoint. They also have medicinal qualities in a sense that they prevent the cholesterol from the oxidize, they seem to decrease the likelihood that you're going to put cholesterol into your arteries because it protects the cholesterol from being oxidized and it has to be oxidized in order to be put into a, in an artery. Picked up and put into a, into a plaque for example. The, the other advantages are, and this is really not a very, this is a debatable one is that the, neither one of them will raise your cholesterol level for example. You can eat either corn oil, which is polyunsaturated or olive oil, they do not raise cholesterol like butter does, for example. The butter fat will raise cholesterol, these will not and there seems to be some word to suggest that the monounsaturated fat, the olive oil doesn't lower the good cholesterol as much as, in fact, it doesn't lower it while the polyunsaturated fat, like the corn oil, does lower the good cholesterol. So for lots of reasons, I think that the, the preferred fat is really olive oil and not corn oil.
Q: So how do we get the saturated fat out of our systems?
A: Well you don't eat it.
Q: So once it's in, if we've been butter eaters.
A: Well saturated fat is present, well saturated fat is, obviously, present in butter and it's present in steak and all the beef and lamb and pork. Saturated fat is the kind of fat that you can cut with a knife like butter, you see, or margarine, or the fat that's present in beef for example. You, you cut that with a knife or pork or lamb. That's saturated fat and also in, in, in butter fat as in, as in milk fat for example. If you eat ice cream, Haagen Daaz ice cream or any of those, whole mile or even 2% milk is all, all that is is saturated fat which can raise your cholesterol level.
Q: But if we've had a diet of this all our lives, meat eaters and then the doctor says, "Hey, you've got to cut it out, your cholesterol's too high." coronary artery disease, whatever, how do we get rid of that that's in our body? How do we get rid of that, of that plaque like.
A: I don't think you can worry about getting rid of something. What you really have to do is stop piling it on. The stuff that's in there already is already in your arteries. Chances are it's not going to come out of your arteries very much. There's a little bit of leaching that takes place, but it's minimum. What you really want to do is keep, stop from forming new lesions. It's the new, fresh lesions that kill people. Not the old ones that have been there for 20 years.
Q: I didn't know that.
A: It's the new ones. They are very, they are much more unstable and they are the ones that rupture and cause coronary disease.
Q: Milk, 2%, 1/2%, 1%, Skim milk. What type of milk do you recommend for us?
A: Well I think the lower the better. Certainly skim milk is less than 1% and that's the milk that I would favor for people to have.
Q: Buttermilk. I see the word butter and I go Aaaaagh. We shouldn't have that.
A: Well buttermilk can be skim milk too you know. Buttermilk is just looks like butter but it isn't really. What it is is it's cultured, bacterially cultured and therefore it thickens. But it can be made from skim milk.
Q: You have a program that you mentioned earlier about nutrition. Tell us a little bit about this.
A: Well in our program the nutritional part of the program is really for weight reduction but it's also for putting people on the right kind of diet if they've had a coronary and they want to, they want to prevent this, the lesions in their arteries or the diseased arteries from progressing because people who've had one coronary are much more likely to have a second one. It's probably, that probably occurs because they don't change their diet and their lifestyle. They get, they have the false belief that, that
Q: What type of things do you treat here nutritionally?
A: Well obviously, we treat weight, people who are overweight. We don't treat underweight, but we do treat overweight and we also treat people who have had a coronary. Who have had a coronary bypass. People who want to prevent the second one from happening. We treat diabetics. People with adult onset diabetes which is the most common form of diabetes who are generally overweight, under exercised, who eat too much carbohydrate. We have a diet that we use specifically for the Diabetic, it's also called Diabetic Diet which brings the blood sugar down and that's certainly important to the diabetic because the Diabetics are more likely to die early of coronary disease or blindness or gang green, kidney failure. We also treat some other things like, interestingly enough, some people with irritable bowel syndrome, people who have a lot of difficulty with gas and diarrhea habit because they eat foods which cause it and what we try to do is we try to eliminate those foods from the diet and select a diet for those people that isn't going to cause this problem. Sometimes diet, sometimes foods can also aggravate asthma or hay fever. They can produce migraine headaches. They can produce a whole host of problems that people have, even depression which seems to be related, to a great extent, to what people eat.
Q: How difficult is it for people to change their diets?
A: I think it's very difficult but generally what happens in our case when someone comes to us for diet, they've made up their minds that they're going to change. Now if we just took, you know, one person off the street at random and said, "We're going to change your diet." you know, that person would come up slugging, fighting, they're not going to let you change their diet. But if a person already knows that they need to change it because they've heard that, they've had a coronary or they want to improve their Diabetes, it's very easy because those people come prepared. All you've got to do is show them what you want them to do and they do it.
Q: If you have a patient who doesn't do what you tell them they have to do, how do you treat that patient?
A: Well, you know, I think it's pretty simple. Eventually that person realizes that they shouldn't be here and they, and they quite. We try to work with them as best we can to try, what we try to do is to isolate the reason they can't do it. It may be their job, it might be their own dislike for vegetables for example, because some people really don't like them and they had expectations when they came here which didn't include these changes in the diet. They, they found them too hard. So we just part company.
Q: What is our biggest fallacy in general, the public, about the fad foods and the foods that are being pushed upon us. Soybeans, whatever.
A: Well there are some fallacies and one of them is that you can get everything you want out of you taking vitamin pills. I think that that's a fallacy. Another fallacy is that complex carbohydrates are good for you and, and most people have the wrong impression of what a complex carbohydrate is. For example, complex carbohydrate is not bread. Complex carbohydrate is not cereal. Complex carbohydrates, the best example of a complex carbohydrate is a vegetable cause what it really represents is a, vegetables have carbohydrate in them and you don't, you wouldn't know it but they do. But they also come in a very complex bed of fiber and minerals and water and proteins and essential fatty acids so that's why we call them complex carbohydrates because they're really complex. When you talk about bread, you're really talking about carbohydrate with nothing else in it. There are a few, a few vitamins in them perhaps, but not an awful lot more. And so, therefore, it's really not a very nutritious food. That's, I think, a fallacy that you can eat a lot of bread and pasta and bagels and cereal and rice and then, that's all you really need to have. I think that's, that's a terrible fallacy.
Q: I know, Navatrilova, the tennis star, talked about the complex carbohydrate diet and she ate a lot a lot of pasta and ever since then I've heard, eat a lot of pasta, it's great.
A: See, I think that the, that's not really a complex carbohydrate, it's a, it's a starch. Pasta is basically a starch and what you do when you eat those foods, the reason you eat those foods is because you are a tennis player and because you are a long distance runner. Because if you don't eat them, you're not going to get enough calories. See, so you add these kinds of foods to your diet because you need them calorically. That's what the starches do. They are necessary for caloric expenditure. On the other hand, if you're not a big caloric spender and you're a sedentary kind of person, you really need to minimize the eating of those kinds of foods including fats.
Q: How else does someone get their calories? You mentioned that calories are important.
A: Well they're important that you eat enough calories but the big problem that we have in this country is that we eat too many. So a third of our populations is overweight because we eat too many calories. For that reason that we really need to be careful of the starches, the breads particularly and those kind of foods, and we need to be very careful about the fats. And, therefore, one should not overeat fats or bread starches. We like to, we like to tell our people to eat low starch vegetables, salads and soups and stews and stir frys and those kind of things with a minimal amount of fat and with some low fat meat rather than eating something with a lot of saturated fat in it. Turkey or chicken really, or fish, is very low in that regard. Some low starch, some low fat milk like, like skim milk and fill up the calories with the rest of the stuff. Your fruits, start with fruits and start with potatoes and start with starchy vegetables because they have a lot of other nutrients in them and then add some pasta and some, some bread and RIce and those kinds of foods which are really not as nutritious.
Q: So the total education is what you're looking at as far as your nutrition and then how to prepare their food wise important to eat.
A: Most people don't know this about food that I've talked about. They don't realize the nutrient value of vegetables, they don't realize how these other foods should be used and used to compliment vegetables. There's a tremendous ignorance about food and I think until we get rid of that ignorance, then people are going to be overweight and if you've got nutritionists and school teachers telling their kids to eat complex carbohydrates that that's really wonderful, then we sure going to have a fat country. You know, our fat intake in this country has gone down from 40% to 33% and we're getting fatter and that's because we're eating more junk food aren't we. We're eating more snack foods like, you know, whatever. Sugar Pops and cereal and bagels and those kinds of, pasta, and those kinds of foods. We're getting fat eating what, what people call complex carbohydrates.
Q: And especially moms they eat what the kids, the snacks the kids had, they are sitting around.
A: Sure. Sure. It's easy, you know, it's a easy thing to eat those kinds of foods they take, it's the easy way out isn't it. So it doesn't require cooking. I think in order to eat well you have to cook. So if you cook pasta and you put sauce on it and you mix it with vegetables and then you've really got something relatively nutritious. But if you eat macaroni and cheese, you're really, then you're, then that's not so good. Or if you eat crackers or if you eat bagels or if you eat, you know, crackers, Ritz crackers or not to pick a particular brand out but those kind, if you eat crackers and you eat bagels and you eat cereal and peanuts and those kind of foods, then you're really eating, I call then dry carbohydrates. I think if you should, if you eat carbohydrates, you should eat wet carbohydrates.
Q: You know it's interesting and I don't want you to misunderstand this but a lot of people say, "Oh doctors don't know anything about nutrition, they've never had a nutrition class in med school. Leave that to the Dietitians. And you are such a wealth of information on nutrition. How did you get involved in this, knowing it's important and really studying it?
A: I suspect a lot of it has to do with my, my southern European roots and because in southern Europe vegetables and endives and escarole and dandelions, those are foods that people ate and in this country I find that black people eat collard greens and the Indians from India eat, are pure vegetarians and they have to derive all of their good nutrition from, from primarily from vegetation so I think a lot of it has to do with the fact that, that, sure, that doctors do not have a good education in medical school. They do get some though and certainly Dietitians obviously are way ahead of everybody in the knowledge that they have. However, in terms of, in terms of treating patients, there's no question that physicians know more about what things work and what things don't work. So we, for example, know better what kind of diet to use for, physicians should, to lower the blood sugar of a Diabetic or to correct the problems of the patient with coronary Artery Disease.
Q: And if someone's going to a physician and he or she feels uncomfortable in their knowledge of nutrition, this is a clinic that one can go to, to learn about it.
A: Sure. Sure. But I think that, you know, you're program plate has a role, and the newspapers has a role and the problem is that, there's more than one message going out and you can, right, isn't that true, there's one, so you don't know what to really believe. There's a wonderful book that was written, it's called the Paleolithic Prescription. It was written by three doctors from Emery Konner and K-O-N-N-E-R was, I think, the lead author. You can, it's still in paperback and he talked about what primitive man ate. Paleolithic man. It's called the Paleolithic Prescription so twenty thousand years ago, what did people eat. You know, there was no bread, there were no crackers, there were no pretzels, there was no pasta. They ate wild game which is kind of like fish and chicken isn't it. And they ate lots of vegetation and lots of fruit and that's all they ate. And that was a very low, it was a relatively low fat diet but it was also a very high protein, high mineral, high vitamin diet because of all the vegetation that they ate. They ate potatoes, I'm sure they found root vegetables that they ate. The diet I think that we should try to favor is the kind of diet like that. That we should eat fish. That's kind of like wild game. That we should eat vegetation, we should eat fruit. We should try to eat foods that don't have a lot of fat in them. So when you drink milk, it should be skim milk. I'm sure that they probably began to find cattle that they could, they could herd and drink their, you know, the milk that they produced probably in later years, but, at any rate, that's what, and some primitive societies eat like that today. Eat tremendous, they eat tremendously different than we do. The nutrient intake of these primitive people and Paleolithic Man was infinitely better than our nutrition today in terms of the number of nutrients that they ate. We eat a nutrient poor diet cause we tend to eat foods which have very few nutrients in them.
Q: Did they do stool samples of primitive tribes in Africa to come up with any of this? Like what they're eating and.
A: Well, you know, there are still some primitive tribes living in all parts of the world. These are people that are headhunters and who live off the land and who, you know, eat wild game and vegetation. And people are still, you know, not too long ago, the Pein Indians from Arizona were living off the land. The native Hawaiians 100 years ago were eating off the land. They were eating bread fruits and picking it off trees and they were eating wild desert plants and they were eating wild game. That's the kind of stuff that, that is the kind of, you know, those are the kind of nutrients, foods, that have high nutrient value and those are the kind of foods that we should try to emulate more of.
Q: The success of your clinic. How successful has it been?
A: Sometimes it's better than others. We have done some surveys, I think, in general I would say, like, let me recall for you our three point three follow up. These are patients who lost weight on a, on a very low calorie diet so we took care of the weight loss part and now we're looking at what happened to them three, about three and a half years later. About 20% of this group on average regained their weight. All of it. So we have 100% regain. The weight loss was the equivalent of about 65 pounds. So 20% regained all their weight. On the other hand, 20% average of weight loss of about 100 pounds. That's three and a half years after weight loss. Overall, the whole group averages about 30 pounds of weight loss overall, the whole group and three quarters of them average 43 pounds of weight loss. So some people do extremely well and some people do rather poorly. If you look at long term, like at five year follow up, we find that only about a third of the patients were able to keep off about 20 pounds of weight loss. So with time, you see, with weight loss, there is a regain in weight and it's all very predictable. If you were to study someone three and a half years after weight loss, you'd find that the habits that they have at that time are going to correlate with their success. So the big exercisers and we'll hear more about that later today, keep their weight off and the people who also eat those foods which I talked about today, the good foods, are also going to keep their weight off. Those people who eat foods like fried foods or butter or margarine or peanut butter or sweets, or hard cheeses or red meats and ate snack foods like nuts and chips, those people are going to gain their weight back again. So the more, the more people adhere to the philosophy of the program, the better they're going to do. Now the question is, how do you get people to adhere better to the program and is there, is there kind of a component to the, to the overweight persons problem that they have no control over, much like a person with an addiction. We have people, for example, that can eat a pound of chocolates every day, not want to, but they still eat them. I think there is a biological component sort of driven by the Hypothalamus, the part of the brain that regulates appetite and that accounts for the failure of many of our patients and for that reason, in the last year of two we've been using appetite suppressant medications for, for failures. We call these the, when we begin to see failure, we want to jump right on it and treat it and right now I can't tell you, I can't site you any statistics because we're just beginning to collect those statistics but on an anecdotal basis I can tell you that these appetite suppressants in these circumstances worked very very well so I don't expect to see even, I don't expect to see those kinds of statistics that I just quoted for you where 20% of the people regain their weight. I expect to see much better statistics over the next few years.
Q: So not everything is motivation. If the patient does not, is not successful. I know you mentioned diet habits, exercise, but there is also this, this inherent appetite.
A: There's no question that there is a, there's a motivational aspect. You get people who, for some reason or other don't ever want to be heavy again. Someone with a crippling form of arthritis or someone who's almost died of a heart attack, who's almost died of some other obesity condition and you know that that event frightened the heck out of them and made them change their life forever. And there are some people who, for whatever reason are very strongly motivated internally who will make changes no matter what and there are some people who treat it a little bit more lightly if you will and they expect the program to do all of that for them. We always tell them that we're not McDonald's, we don't do it all for you. You have to do most of it yourself and so the appetite suppressants that we use in those kind of people that are sort of failing will work but only in those people who are strongly internally motivated. If you have a person who's not strongly motivated and they're failing, then these medications won't work at all.
Q: How successful are people who want to do their own thing as far as weight loss.
A: Well, some of the statistics show that people do lose weight on their own fairly well without a doctor's help or without a clinic's help. I think, we don't know the answers to that but there are some, some, some, there are some articles that have been published on that which say that, you know, that the bad statistics that you see don't apply to the average population because there are people who do it themselves. You know, I've had people that, friends of mine said, "You know, I've lost 30 pounds because I wanted to." and they didn't see anybody. They just did it because they just cut back and they cut out certain foods, they read the newspaper, they know that they shouldn't be eating a lot of fat, and most people, if they just cut the fat out of their diet would do very well. Even if they ate those complex carbohydrates they'd probably do OK. Better that they eat regular meals though. I think that eating regular meals and not snacking. I think that's the thing that I find that most people fail at is they tend to snack. It's almost like, like, you know, there's some, something missing from their, in, in, in their lives that they have to snack for.
Q: Are they aware that they're snacking?
A: Oh sure. Oh sure. Oh sure. Oh yeah. Although there is a night eating syndrome where people get up in the middle of the night and eat and then don't remember it.
Q: And those that like to say that's what they have. I don't remember it. I've heard people say, "I've tried so many weight loss programs and they just don't work and don't tell me about another weight loss program or clinic. I've had it." Where are they coming from? The Jenny Craig, Susan Powter, what's, I hear this all the time.
A: Well I think that there are, some people have false expectations of what they, of what to get, what they're going to get in a, in a weight loss program or you mean to say that I have to do this for the rest of my life. That's something that a lot of people don't expect. That you can't just lose weight and it will all of a sudden stay off. You have to buy in to a permanent lifestyle change. So if you don't buy into a permanent lifestyle change, it's not going to work so the first thing I ask you to do is buy into something permanent. That this is, that you're not going to eat any more fried foods, or fatty spreads, or butter or margarine or cheese or red meats. Or if you do, it's going to be on a very rare occasion. That you're not going to have cake every night or cookies. That you're going to do that on very rare occasions. If people are willing to make those kinds of changes, then you've got someone who's got the right orientation. The rest, I think the people that say what you just said are those folks who just haven't got the right orientation to begin with.
Q: How do you get someone who's motivated but realizes they have a real problem changing their lifestyle so they keep trying and trying but they say, "Doctor, I am, I really want to help but I'm telling you, I'm a bad candidate." How do you.......
A: Well some of these people, you know, it's amazing, some of those people will come in to our program and do very well here and maybe it is because we, we have a, we do have a diet that's for a lifetime and we do have a program for, we've been going on, this is 17 years this year this clinic has been open. And this is a permanent home for people. Once they go through our program, then they're here for the rest of their lives. We don't charge for maintenance, for example. We tell them that, you know, you can come here as often as you want for the rest of your life as long as you get through the program, which means that they have no reason not to come. In spite of that, a lot of people don't come because they don't want to face the music if you will. You know. They would prefer to take a vacation, a holiday from, from their diet and when they do that, they then begin, sometimes we even put them on appetite suppressants and they stop those so they can eat. Isn't that something. So you see, the, the brain, that person isn't ready. That person may never be ready. There's a famous psychologist named Pershaska who's a Detroiter who characterizes peoples behavior as to whether they are contemplators or, or are they an action. A contemplator is someone who thinks about changing and who has the, weighs the pros and cons every day. So when they go on a diet, they are still contemplating, you know what I mean. They really haven't made the decision to go into the diet permanently.
Q: Do you have any word of advice that you can give our viewers, like a final word, on nutrition and what they should be.....
A: Learn to like, learn how to eat vegetables. Learn how to like vegetables number one. Number two, certainly learn how to cook them because you're not going to get vegetables in a restaurant the way you want them. They're just going to give you the kind of things that the average person, Joe, wants which is a big piece of steak and a potato with some sour cream on the side and you're going to get a few little carrots on it and maybe there'll be a salad bar. But you certainly have to learn how to cook them yourself or you have to find restaurants which, which, which they are, you know, there are restaurants out there that, where you can buy, get vegetables as the main course. You can buy soups and stews and salads and wonderful. You know, Lebanese restaurants are like that, for example. Chinese restaurants, if you order smartly, can be like that also. Indian restaurants are like that. Greek restaurants are like that. And if you go to an Italian restaurant, you get, you know, of course, the vegetables in an Italian restaurant are the, it's the pasta sauce.
Q: The tomato sauce, yes. So the victory is through vegetables......
A: I think so. I think that you've got, right. Vegetables and you have to learn how to eat them and like them and make them tasty and you have to learn how to eat less fat in your diet by eating Turkey and Chicken more than beef. You have to cut out the butter and the margarine. You've got to eat Olive Oil. You've got to drink, you know, if you're going to have milk, it's got to be skim milk or low fat cottage cheese. It's not all that difficult, you just have to create a new way, a new mindset of that, of the way you're going to eat in the future and then you have to start doing it.
Q: Thank you Dr. Lucas. Appreciate it.
