Dr. Dennis Gage says dieters need to find what works for them
1. I am pleased to welcome to the "Livin' La Vida Low-Carb" blog today an internist named Dr. Dennis Gage. Dr. Gage is one of the world's leaders in educating and empowering people to live healthier lifestyles by helping them lose weight through workable long-term solutions. Thank you for joining us today, Dr. Gage! Share with my readers a little bit about who you are and how you got interested in the subject of obesity in the first place.
It is interesting how I got into the field of obesity. Originally I went into Endocrinology because of an interest in thyroid disease but after training at St. Luke's-Roosevelt Hospital, I did research on obesity subjects and was involved with a vast number of patients in a research grant. Then I became intensely interested in Insulin Resistance Diabetes and Obesity.
2. You have been actively involved in several research projects involving coming up with treatment options for people battling obesity over the years. Tell us about your involvement in those and how you have been able to practically apply what you have learned in real people struggling with their weight.
I have seen literally hundreds of patients over the last twenty five years in clinical practice. I have found that most patients are able to lose weight by restricting calories and increasing physical activity. The problem that occurs is most of these patients have "yo-yo'ed" back up in weight. I see the most difficult subject in obesity as "closing the back door," that is, preventing people from regaining their weight.
Most people are very enthusiastic on diets and are successful, however as the struggle increases and the amount and intensity of work remains high, most people fatigue out and start to return to their old habits. It is "closing this back door" and having these patients being able to sound a "Red Alert" that differentiates success in the long run. My philosophy is to support my patients in their weight loss endeavors and I have created a web site that offers newsletters and information to readers to help them feel empowered.
3. You have written a book and created a program around a concept you call the The Thinderella Syndrome (TLC). The motto of this plan is "don't just do a diet, live a diet." That is certainly something I discuss quite often here at my blog. What are the basic principles of "Thinderella" and how has it worked for your
patients willing to give it a go?
The Thinderella principles are explained in my book. Most patients are successful in their initial weight loss phase. We call this the "motivator phase" because we use a structured diet that is relatively low in carbohydrates, high in protein, and structured--we call this the "water wings of weight loss."
When patients start their diets using "Dr. Gage's Motivator medical food," they are much more able to succeed and therefore they get positive feedback right away. Patients then go through a behavioral program called The Thinderella Lifestyle Change Program for approximately fifteen weeks where they are taught eating techniques and behavior modification. Finally all patients are assigned a "Red Alert Number," a weight gain number that indicates the patient must return to my office for re-motivation.
4. We are a nation of "yo-yo dieters" as the obesity statistics seems to keep getting worse and worse. Most statistics show that people who lose a significant amount of weight will gain it all back within 1-3 years. But that's where your plan comes into play with the unique "defensive eating style" techniques. Can you share a little bit about how this works with us?
My "Defensive Eating Style" techniques are discussed in my book. Patients are asked to sound their Red Alert if they hit a specific number which is approximately three to five percent above their final successful maintenance weight. We call the weight in between their successful weight and the Red Alert number, the "Buffer Zone" just like in battle. If you are in the buffer zone, you are still safe. If you cross the demilitarized zone which is the Red Alert Number, all Hell breaks loose. That is why all patients are required to come immediately back to the office if they hit their Red Alert Number.
5. Weight loss isn't the issue for most people, it's keeping the weight off permanently that is the hard part. This is something you are almost a lonely voice of reason about because you don't hear too many people discussing weight maintenance. What I have found after losing nearly 200 pounds in 2004 is this becomes more of a mental battle rather than a physical one. How do you help people build up their emotional toughness to ward off the "Red Alert?"
The reason my TLC Program works is because patients are successful in sounding a Red Alert when they have only gained several pounds in weight and therefore if they come back to my office, it is not too difficult to restructure their patterns of eating, re-motivate them, and get them back on track. There is no doubt that people who have maintained their weight are working much harder and intensely to keep their weight off.
Dr. Rena Wing has studied many patients in the National Weight Control Registry and has found that most patients who are maintaining their weight off for greater than two years and not regaining have been successful. Being someone who has lost forty pounds myself, I always keep track of my weight and make sure that I don't hit my Red Alert Number. Sometimes the continuous exercise seems to be a drag, but most of the time I enjoy it and since I have learned how to sound a Red Alert and know how to get back on my Motivator diet if I do hit it, I feel pretty comfortable with this.
6. You are a big believer in people taking the right kinds of supplements and to avoid the mistake of misusing vitamins. What supplementation do you recommend people following a healthy lifestyle to take for optimum health?
Supplementation for patients on diets is critical. Many patients go on their own diets and may be lacking minerals, vitamins, and fiber. In my office, we have "Dr. Gage's Motivator" medical food which is a healthy diet low in carbohydrates and it is nutritionally sound.
When patients go on other types of diets, for example, their own diets that are basically not going to necessarily have all nutritional supplements, we give patients a specific number of multivitamins specifically high in B Complex and we also supplement them with other substances that help with fat burning capacity.
Ultra CLA and Hydroxycitrate certainly stand out as possible items and can be used but in general we make sure that the patients are covered with all the nutritional requirements. Fiber is a big one because it is required for healthy intestinal function and is usually lacking in the diet.
7. Exercise is another key component in your plan to help people with their weight and health. Is there a certain amount of cardio and/or resistance training that you recommend for people to strive for?
Exercise is certainly a critical component in weight loss but is a much more of a major component for weight maintenance. In most studies exercise has only had a moderate effect for weight loss. But what has been shown is that patients who have lost weight successfully require a fair amount of moderate exercise approximately one hour a day to help maintain weight off. This is where the exercise has its payoff.
8. You're the first person I've ever met who calls himself an "expert diabetologist," but I like that title! We need more people committed to this subject since it has become a twin epidemic in conjunction with obesity. What do you think about all of the research that has been published over the past year from researchers like Dr. Mary C. Vernon and Dr. Eric Westman on the low-carb treatment options for diabetics? Have you seen greater improvements in your diabetic patients placed on a low-carb diet as opposed to a low-fat diet?
Diabetology is an interesting field. Since 95% of our diabetics are Type 2 diabetics and are generally significantly overweight, there has been an epidemic of diabetes and obesity which have grown together. There is no doubt in my mind that the low-carbohydrate diets are optimal for these patients.
Patients who are on low-carb diets statistically not only lose weight but have a dramatic improvement in their Insulin index, their blood sugars, and their sense of well-being. Diabetics have clearly done much better on these kind of diets and this has been documented in our practice for more than twelve years.
9. You are also heavily involved in a brand new venture I recently blogged about called "Project PCOS." This is another condition that the low-carb lifestyle has been shown to help improve in those suffering from it. What role are you playing with this web site and what are you hoping to accomplish with it?
I am the medical advisor for this new campaign for women/girls with PCOS at ProjectPCOS.org. I am helping to advise women about the intensity of work needed to overcome a condition called Polycystic Ovary Syndrome.
Unfortunately these women seem to have an added amount of Insulin Resistance and the intensity of low carbohydrate diet, exercise, and work involved to overcome this without using medications is pretty high. There seems to be an inability to shut off Insulin stimulation and of course these women are going to be craving carbs and having a little more difficulty in staying on low carbohydrate diets and high protein diets but what we have done is to start a website to help women and girls address the issues of PCOS and understand that it is not in their mind but is actually a real syndrome.
As the syndrome develops, we realize that the intensity of Insulin Resistance seems to be very high in these women and indeed the abnormal menstrual cycles, hair growth, and other features seem to all be linked. I have had many patients who have successfully lost weight on extraordinarily low carbohydrate diets and have improved their entire metabolic situation including their Testosterone level.
10. THANK YOU again for sharing a few moments with me and my readers today, Dr. Gage. I am thrilled to know there are people like you out there attempting to help overweight and obese people not just lose weight, but get healthy once and for all. Do you have any encouraging comments for those who may be reading this interview right now and feel like they don't have any hope they will ever be "normal" again.
I think most people set up unrealistic goals for themselves and of course if they don't meet these goals in weight loss, they immediately give up. I will be coming out with a paper in May in a major medical journal where I discuss the issue of failure spirals and setting yourself up for failure. I think one of the most important things to ask yourself when you are living a diet is, can I live the patterns that I have set up for myself (not so much, can I do a diet) but can I live a diet and can I accept certain basic patterns.
For example, strict avoidance techniques during the day, such as eating things like protein bars or Atkins bars or perhaps a salad and fruit and not getting the typical American sandwich which is loaded with carbs, salt, and sugar. If you set up realistic goals and you are willing to work hard to maintain your weight off and understand that this is not automatic, then I think you are going to be much more successful.
You can e-mail Dr. Dennis Gage at email@example.com.