In Part One of my interview with Dr. Treyzon, we explored gut health and chronic stomach conditions. Fortunately for us, Dr. Treyzon is an expert in nutrition, weight loss and weight management, and he's giving us the skinny (pun intended) on living a life in balance, and how to maintain a healthy weight for the long haul.
I've done my best to avoid ED triggers such as specific foods and calorie counts in our interview but if you are sensitive to ED triggers and/or early on in your recovery, please read with discretion.
Let’s talk a little bit about weight management. Because I know that’s part of your practice and that you refer out to nutritionists. What would you say in your experience – if people want to lose weight or just not gain weight as they go along in life and get older – what would you say are the top things that people can do for weight management?
That’s a really good question. I think most weight management is about discipline, and regimen, and staying consistent. So things that are proven to work are:
1. Chronicling, and
2. Self monitoring of food intake
Having some sort of system of awareness of how much you should take, and writing that down (food journaling), tends to be the #1 determinent of peoples’ overall health. It’s not about as much what you eat, it’s about setting a goal, and maintaining that goal and being accountable. It’s incredibly powerful. In fact, it’s almost guaranteed that without self-journaling, your likelihood of success is diminished significantly.
The second thing has to do with activity, and staying active. That’s not about food right there. It’s about movement and staying active. And it’s not so much about exercise either. It’s about how you live your life. If you walk vs drive. Take breaks, dance, engage in activities that are physically oriented. So we know that exercise doesn’t really make the biggest difference in acute weight loss, but it makes all of the difference in maintaining a healthy weight. And for someone who has lost weight, it’s probable that weight regain will occur without some sort of change in physical activity. And for some people that may be changing walking patterns, keeping track of how many steps they do per day, or maybe integrating exercise at the gym as part of their daily routine, or regularly dancing, or regularly taking breaks to do stuff.
The other thing that tends to be important is having a partner who is committed to their success with them. Someone they can check in with when things go awry, almost like a sponsor if you will.
For some people that’s a doctor and for some people that’s a Weight Watchers group for example, or it might be a friend, or it might be a spouse. Just someone who will realize when you’ve gone awry, and it’s a resource you can check in with.
So it sounds like accountability is a big part of it. One, the food journaling, and two having a community that can support you along the way if losing weight or maintaining a healthy weight is one of your goals.
And this isn’t just a thing in weight management. We know that people who have community around them tend to do better in all categories, whether it’s overall happiness, satisfaction, happiness, and fulfillment with their life goals. People in communities versus independent people tend to do better.
But getting back to the other detriments to long-term, successful weight loss. HYDRATION. We know that it’s harder to lose weight when you’re dehydrated. So that’s an easy fix. Meaning getting 64oz of water ingested per day, or liquid in per day through water, soup, drinks, things like that, is very important, and it’s an easy intervention. And it’s common reason why people don’t hit their goals.
That’s so interesting. Is there a scientifically proven reason behind this?
Yah. We know that metabolic rates are different when you’re dehydrated. We know that metabolic rates are different when you’re dehydrated. When we’ve run experiments on people, what their total body expenditure is, it’s much higher when you’re well hydrated than when you’re poorly hydrated.
Think about it intuitively. If you’re dehydrated you’re in a stress state. That’s an insult to your body. So your body goes into emergency mode, and it will not release energy. It will keep you cold as opposed to hot, it will keep your muscles not firing as opposed to firing, because it’s as if you’re in a war. That’s it’s natural reaction.
So, we know that staying hydrated is key.
The other relatively simple thing is staying well rested. So some people say that staying within 7-8 hours of restful sleep is also very important towards overall weight management.
So to recap, what we see is that regular activity, self monitoring, having a sponsor or partner invested in your health, adequate hydration, adequate sleep, and then having a balanced diet that’s sensible, these are the keys to weight management.
Also as you know, in order to lose weight, you have to cut calories. But it doesn’t have to be a drastic weight loss. In general, small base hits do better overall than big home runs. So that’s why THE BIGGEST LOSER doesn’t really work in real life. The key is small little adjustments in life, and maintaining consistency, and implement the strategies to maintain them. These people to best when trying to lose weight and them maintain a healthy weight.
And weight management is a long term issue. It’s sort of like earthquake insurance. You might have a great policy for one year, but it doesn’t really suit you well if that earthquake is five years from now. You want something that’s oriented towards long-term health. Similar for cholesterol management in a young person. You might lower your cholesterol significantly by doing some crazy diet that drops your cholesterol so well for you, but if a diet is not sustainable, it’s not pragmatic because we’re talking about a 20 or 30 year issue. So you really have to choose a plan that’s doable, realistic, and easily sustainable in one’s lifestyle.
So when you are dispensing these steps to a patient, do you have the conversation yourself, do you outsource to a nutritionist, and are either you or the nutritionist – when dispensing directives to a client such as “get more sleep”, are you breaking down for them how to actually get more sleep? Or drink more water for example.
The answer is yes. There’s usually a reason why these people are on a diet, and it’s not educational for most people. It’s hard. It’s hard in a busy life, when you’re a busy mom or dad to get 8 hours of sleep. So it’s about setting priorities. And helping them to realize the importance of implementing these steps in their life. That takes skill. That takes education. That takes awareness of where people falter too. I think that those things are THE most important aspects of weight management. Is helping people understand how to problem-solve.
The other really important thing is motivating people. Because I could spend all of this time teaching what’s important and giving the perfect solution to your problem, but assessing motivation is where a skilled dietician, nutritionist, doctor, healer, health care partner will excel. Because weight management – if you’re not motivated – you will fail. It’s just inevitable. In general 19 out of 20 people will fail in weight management unless they have a system in place that is proven to work, and that will work long-term.
So how do you motivate an unmotivated individual?
I think the key is helping them understand why they are there to see you in the first place. If their motivation is their partner in life saying “you have to go see so and so because so and so will change your life.” Well, advising to see that person is a really easy intervention. And it might solve someone else’s happiness, but it doesn’t really solve the problem.
Some people are motivated by fear – as in “I’m scared of getting cancer” or “my dad just had a heart attack” - and that kind of thing tends to wear off when the initial insult of that event wears off. Time heals wounds, and peoples’ motivation goes away. A frequent thing that we see is people coming in for colon cancer screening after the death of someone they know from colon cancer. They want to take care of it right away, but then may forget their 5-year follow up.
So it’s an opportunity and a liability. It’s a nice point in time to capture people’s attention and motivation and use that to help, but at the same time you have to recognize as a health care provider that they may not be this motivated long-term.
So what do we do? We are trained in motivational interviewing. We understand what people are good at and not good at. In general, men don’t really cook that well and prepare meals for their family as well as women do. It’s not an absolute rule, but it tends to be a pattern. So, recognizing that You can’t really give a man as much nutritional detail as you would for a woman, who tend to grasp these things better. So, a suggestion for the same amount of weight loss in a man or woman might be a totally different method.
Working around their busy life. Helping them find opportunities for fitness, mindfulness, awareness, setting up sponsorships, making sure that they follow up. One of the biggest things that we do in our important doctor-patientmeetings, as our first step, is determine when the next follow-up is, before we get caught up in all of the details of this food vs that food.
It’s the big picture goals have to be recognized. Follow up, movement, motivation, not giving up. Assessing peoples’ ability to persevere is really really important. It’s important in a lot of different conditions. I call it “What are you going to do when you have your fat attack?” What does that fat attack look like? Is it when you’ve had a heart attack? Is it when you’ve developed arthritis and need surgery? And I tend to pose to people that a fat attack is sort of like an asthma attack. Just like you have your inhaler when you start getting short of breath in asthma, your partner for a fat attack might be your Weight Watchers sponsor or your spouse that knows that you need to eliminate x food and will lock up the refrigerator.
Basically the pattern that I recommend to patients is, when you hit a 5% regain, it means you are calling for an appointment that week. When you have a 10% regain, you are walk into the office because you’re “having a severe flare of obesity”. So when you don’t fit into THAT pair of jeans, that means you call today. Sort of like how Amazon has those buttons you can click when it’s time to re-order Tide, I wish I could have a button in peoples’ button or something.
Let’s go back a little bit, I want to backtrack back to gut health. I would love to know, what are the key things – in your opinion – that patients’ need to implement for gut health.
I’m a big fan of probiotics. They have an important role in a lot of things. I think the concept that taking a probiotic or prebiotic as a daily supplement in order to ensure or protect for gut health has not been proven. AndI think that although we WANT to believe in something that simple, it isn’t that simple. And most diseases – and any disease to my knowledge – I don’t think that there’s any single disease that can be prevented by taking a probiotic.
I don’t think in 2017 consumption of probiotics will prevent any particular condition that I’m aware of.
With that said, there’s a tremendously important role for probiotics in non-wellness states.
Examples of which are chronic diarrhea , history of infectious colitis, and prevention of infectious colitis later, and there’s an evolving roll for them in lactose intolerance, there’s a role for them in irritable bowel syndrome, there’s a roll for them in inflammatory bowel disease, and there’s a role for probiotics and prebiotics in vaginal, reproductive health – aka gynecological health - and probably others too.
Thank you for all of this. I’d like to wrap this up with just one more question. I’ve always admired your dedication to fitness, you are very motivated, I’d love to know a little about your daily routine. Can you walk us through this? What daily steps do you take to feel your best self?
So first of all, I’m constantly learning about myself and what makes my body feel good. And I’ve definitely noticed changes in my tolerance of certain things later in life. Although I’m a believer that coffee is an addictive substance, I do start my day with coffee, and it gives me the energy to focus in the morning, and that’s the most important part of my day. So I start off with a cup of coffee – plain black coffee. Every once in a while, I’ll try a different diet, something that’s totally different than the way I’m eating and I’ll give it a shot just to see what I can lean from it and what I can learn about my body. And one thing I learned when I was alcohol-free, gluten-free, sugar-free, and dairy-free for one month, and I found that I actually don’t need the milk and I don’t need the sugar or the Splenda in my coffee for me to maximally benefit from the experience as I’m drinking the coffee. What I really want is the buzz and the clarity and the mental help that coffee gives me. So I was able to take the sugar and Splenda and milk out of that, and I have instituted that as a daily routine – whereas I would have never agreed that that was how I would prefer it. But it’s a small sacrifice for me.
I also noticed that I need carbs in the morning out of all meals. So that’s my opportunity to have my carbs for the day. So I’ll have a Thomas’s English muffin, toasted, I like it because it’s portion controlled, and that’s a good example. I try to leave my own influence out of it. Because if I’m given the ability to choose, I’ll choose big servings as opposed to small servings. So portion control for me is very valuable. So I pick a product where I know exactly how much it’s going to be.
Do you food journal and do you log your calories?
I realized that I’m not good at that. And I had to sacrifice on that part. There’s other things that I journal in terms of the fitness, and I do have other strategies that I have set up for emergency control for that but one thing I don’t do is journal.
So I have the English muffin with a little bit of cream cheese and salmon. So I like smoked salmon because it keeps well (doesn’t expire), it’s tasty, and it gives me the protein and omegas I like to have in my diet. And I love the carb of the English muffin, and it’s grab n go. It’s quick, I don’t need to cook things up, and that’s really important for me because I tend to get going early.
Sometimes I exercise before I start my day, like at 5:00 I’lll get up and do a class for example. And then I will tend to not be hungry if I’ve eaten that first meal of the day.
My second meal is around 12:00. And it’s usually catered food at my office, and I feel I’m extremely vulnerable to the ill effects of catered food. I actually consider it a liability to have those meals even though they’re extremely tasty and the best quality foods. They are not portion-controlled and when I’m distracted I notice that I tend to overeat. So what I will do now is I will deliberately avoid those meetings, I’ll eat in my own office where I have the power to determine my food choice. When I’m lucky I’ll bring food with me from home, and I have experimented with having a chef helping prepare foods, but the foods were so tasty I tended to over-eat in that situation too.
So now what I’m doing is I’m having a salad or soup for lunch and that’s pretty good for me. I’ll have a protein bar of some sort. I would love to shakes but it requires a blender and it’s hard for me to clean at work.
And then dinner meal is usually after a workout or with friends I’ll go out, and that’s typically where I’ll mess up. Is that meal But I’ll try to do carbohydrate-restricted. I’ve noticed that if I drink alcohol I’ll tend to make poor nutritional choices, so when it’s really important for me to stay lean, to eat healthy, I’ll deliberately select to not hang out with certain people. People that are prone to have drinks, or an event where I know drinks will come, and I’ll deliberately stay away because I know my will power is limited to a certain degree in that setting.
So that’s sort of how I live my life. I could do better in terms of not eating late at night. I could do better in portion control. And that’s it!
If you enjoyed this interview with Dr. Treyzon, please let me know by leaving a comment. And if you have any additional questions about weight loss, weight management, and/or gut health, I would love to hear from you in the comments below!