In Savor, Harvard nutritionist Dr. Lilian Cheung says the Buddha holds the secret to enlightened minds and lighter bodies.

When Lilian Cheung first met Zen Master Thich Nhat Hanh (known as “Thay” to his millions of followers) she thought she had found the fountain of youth. “Thay is 85 years old, but his mind is so lucid. He was exposed to agent orange for years in Vietnam, but he looks incredible. On his retreats he wakes up at 5:30 and leads a morning exercise of Thai Chi. A lot of the younger folks can not keep up with him!” Thay’s secret, according to the book, is mindfulness, an ancient Buddhist practice that can help you finally stick with healthy habits such as eating right and exercising. FOF spoke with Dr. Cheung about Savor and her own quest to become “a part-time Buddha.”

• FOF: You’ve been a nutritionist at Harvard for many years. How did you get involved with Thich Nhat Hanh?
  • Dr. Cheung: I attended his first retreat in 1997 in Key West. I got a brochure in the mail at home. The subject of the retreat—Touching More Peace and Joy in Your Life–was very interesting to me. It was a hectic time in my personal and professional life. I have three kids.
• FOF: You’re a busy FOF.
  • Dr. C: Yes. So I went to the retreat. Over nine hundred people attended.
• FOF: Wow.
  • Dr. C: We spent nine days together and half of the retreat was in total silence. We practiced mindful eating, mindful walking and mindful breathing. Thay was teaching mindfulness in a very experiential way.
• FOF: What exactly is mindfulness?
  • Dr. C: Being aware and present in the moment so that we can focus on the truth.
• FOF: Can you give a real-word example?
  • When you’re walking somewhere, you’re probably thinking about your work, or your kids or your next appointment. When you walk mindfully, you focus just on the walking. You connect your body and your mind together through breathing.
• FOF: I think I get it.
  • Dr. C: Thay is very good at teaching you to integrate mindfulness into the most mundane, everyday routines. In the book we have the traffic jam meditation; the grocery line meditation—even the email meditation. Before you send an email, take three deep breaths to so you can calm down and focus on the task at hand. That way, you don’t make any mistakes like sending to the wrong person!
• FOF: I love that. How does this apply to eating and diet?
  • Dr. C: As a nutritionist, I know how to tell people to eat more fruits and vegetables, but the difficult part is sticking with it! Through mindfulness, we can actually change our brains and maintain these habits.
• FOF: Okay, so how would you incorporate mindfulness into how you eat breakfast in the morning
  • Dr. C: When you prepare your breakfast, just do that one thing. Cooking is a great way to practice mindfulness, because if you use a knife and you’re not mindful, you’re going to hurt yourself. When I sit down to eat, I stop and meditate on the “Five Contemplations” that we feature in the book, including “This food is the gift of the whole universe: the earth, the sky, numerous living beings, and much hard, loving work.” Make sure you chew well and you don’t serve yourself too large a portion. Then, engage your five senses while you eat.
• FOF: What do you eat for breakfast?
  • Dr. C: When I’m in a hurry: whole grain bread with almond butter, finely shredded fresh mint and blueberries sprinkled on top.
• FOF: That sounds delicious.
  • Dr. C: When I have more time, I make cooked cereal–oatmeal or barley. I add a little miso for flavor, wakame seaweed and nuts. I pour the hot cereal into a bowl with some mint leaves swirled in sesame oil.
• FOF: That’s a nice ritual.
  • Dr. C: Yes, choosing the food, appreciating it, and using my five senses are all part of mindfulness. When people eat in front of their desks or even at a “working lunch,” they are not savoring or appreciating the food. In order to feel satisfied, you need to take time to savor.
• FOF: What would you say to a woman who only has time for coffee?
  • Dr. C: Get some nuts and an apple. That gives you healthy fiber and healthy fats, plus it’s delicious.
• FOF: What about if you love your chocolate croissant?
  • Dr. C: Portion size is important. Just don’t eat a giant croissant. It’s okay, you’re not supposed to be so pure all the time. I would suggest supplementing it with some nuts if you’re on the run.
• FOF: How do you stick with this program and stay mindful?
  • Dr. C: The best way to break a bad habit is to have a buddy who is already practicing mindfulness. Support is very important. Thay has Sanghas—groups of mindfulness practitioners–all over the world. There’s a directory on his site. You can look up a sangha in your area and just go to a meeting. People there will be open to being your buddy. These are very thoughtful people. And there’s no charge.
• FOF: It’s cheaper than Weight Watchers!
  • Yes! And it’s so nourishing because the atmosphere is very compassionate.
• FOF: Are there things you can do on your own as well?
  • Dr. C: You need to set up triggers to catch yourself in a moment. At Thay’s retreat center at Plum Village, every time the phone rings, you take three breaths and wait three rings before you pick it up. There’s a mindfulness clock on our website that you can download and it will ring on your computer.
• FOF: That’s very cool.
  • Dr. C: Most importantly, don’t judge yourself if you don’t do everything right. It’s not an all-or-none phenomenon. When I started in 1997, I would say my “Buddha-hood” was about 5 percent. Today my Buddha-hood is more like 70 percent, because I am more conscious about the practice. The Buddha is 100 percent, but it’s okay to be a part-time Buddha. Just keep going in the right direction.
• FOF: You have a very soothing manner.
  • Dr. C: When you increase your mindfulness, people see it and feel it. The wonderful thing is, you look different, and you behave different, and people want to be like you because you exude calm.
• FOF: You’re making me calm! What would you love to tell a room full of FOFs just like you?
  • Dr. C: They may think that because they’re over fifty, it’s not possible to change. That’s not true. Any moment is an opportunity for change, because in Buddhism nothing is permanent. I want to offer you these words of wisdom from Thay: ‘The past is already gone. The future is not yet here. We only have the present moment. If we miss the present moment, we miss our appointment with life.’
• FOF: That’s great.
  • Dr. C: Isn’t it wonderful?
• FOF: It’s making me think, oh no, I missed that appointment.
  • Dr. C: Ha! And you wouldn’t miss a doctor’s appointment.

Author

Dr. Lilian Cheung Director of Health Promotion & Communication at HarvardDr. Lilian Cheung is a Lecturer, Director of Health Promotion & Communication, and Editorial Director of The Nutrition Source website at the Harvard School of Public Health’s Department of Nutrition. Her work focuses on translating nutrition science into multimedia resources and community programs that help children, adults, and families lead.

Dr. Derrick Cetin says there’s no “miracle drug” for weight loss, but appetite suppressants can help.

What’s your experience with weight loss pills? Tell us by commenting below.

• FOF: It seems easier to gain weight and harder to lose weight after age fifty, why is that?
  • I’m not sure that we really know. Some people blame menopause and the lack of estrogen. I blame menopause but it’s not just that. We are in the middle of an obesity epidemic. My patients who are going through menopause are eating 300 to 400 more calories a day than women were eating in the 1970s.
• Do you prescribe estrogen for weight loss?
  • I don’t routinely give people estrogen because I don’t do primary care—a gynecologist or a primary care physician should really prescribe estrogen. It is a very controversial drug because it’s linked to breast cancer.
• Do you prescribe weight loss pills for women over 50?
  • I do use prescription “appetite suppressants.” (I use this term because patients are often resistant to the word “pills.”) There are only two that have been proven successful by randomized control trials: Xenical and Meridia. There are also several amphetamine groups of medications, like Phentermine and Adipex that I may use. But they are controlled substances so they have to be carefully watched and monitored.
• How do appetite suppressants work?
  • They increase chemicals like serotonin in the brain, so the body feels full.
• Would you give them to anyone? Who’s a good candidate?
  • Appetite suppressants are really for people who need to lose 20-40 pounds. And I don’t generally start people on them right away. First a patient will start a program where she sees a dietician, keeps a journal, exercises and does behavior modification. Six months into that program, we’ll have a conversation about appetite suppressants. If she’s the type of person who loses weight and then gains it back, or if she’s still stress eating or eating late at night then we’ll try the medications.
• If these “suppressants” work, why is it necessary to do the other stuff?
  • The pills don’t work by themselves; studies show that over and over again. They’re successful in conjunction with diet and exercise. Even commercials for over-the-counter drugs—like Dexitrim—tell you that it only works if you are very active and eat a healthy diet.
• If someone is slightly overweight–let’s say ten pounds–would you recommend appetite suppressants?
  • I had a young girl come in the other day, her Body Mass Index (BMI) was 25.5 and her mother wanted her on an appetite suppressant. She was really mad at me because I told her ‘No.’ We only use appetite suppressants for a person with a BMI between 27 and 30 and at least one comorbidity–hypertension, high cholesterol, apnea or diabetes. If you have a BMI over 30, you can use an appetite suppressant even if you have no comorbidities.
• Why don’t you give appetite suppressants to just anyone? Are their side effects?
  • For the ones I prescribe, you have to watch blood pressure and heart rate because that can go way up. You should lose roughly two to four pounds a month on it. If a patient doesn’t lose weight in the first two months, their blood pressure is high or there are other side effects, I usually stop it.
• How much can you expect to lose on appetite suppressants?
  • On average, we can only expect someone to lose 10 percent of their overall body weight. Some people are going to gain weight. Some may lose 20 percent of their weight, some may lose 1 percent. It’s an average.
• How long is too long to be on it?
  • We try to regulate the amphetamines so that people aren’t abusing them – three months on, six months off. Trials of Meridia have shown that you can use it up to two years. I had one woman on Meridia for two years who lost 98 pounds. She spent a year off of it and only gained two or thee pounds back. She’s got the diet and exercise all figured out now. She doesn’t need the medication anymore. The problem is, it’s a very costly medication—upwards of $1.50 to $2.00 per capsule.
• You talk mostly about appetite suppressants. What about fat absorption inhibitors?
  • Those are Xenical and Alli. They block an enzyme that breaks down fats so it doesn’t get absorbed in the small intestine. I write very few prescriptions for them. They’re not real popular because of the side effects – diarrhea, fatty or greasy stools. Less than 10 percent of the calories you eat can come from fat. Last time I put somebody on it, the women yelled at me because she got diarrhea. I asked her what she had for dinner the night before and she said a couple of burritos. She didn’t realize that her dinner had probably ten times the amount of fat she was allowed to have.
• So there’s no such thing as a miracle weight loss drug?
  • No—there’s no such thing as a pill that can make your obesity go away.
  • At some point you have to make some behavioral changes. All those factors that caused the weight–going to McDonalds, stress eating, eating the wrong calorie foods, not getting three vegetables and two fruits per day–could be resumed on a pill. If they resume those activities, they gain the weight back.
• What’s in the future for weight loss drugs?
  • There are a lot of drugs in stage-3 trials, such as Qnexa and Excalia, that work by using two medications combined in much lower dosages. They have been very successful in trials showing that people are losing more than 10 percent of their weight with less side effects. I’ve been waiting for a long time for a really good new medication to come out.
  What’s your experience with weight loss pills? Tell us by commenting below.

Author

Derrick Cetin, D.O. Cleveland Clinic, Bariatric and Metabolic Institute (BMI)Dr. Derrick Cetin, D.O., practices at The Cleveland Clinic Center in the Bariatric and Metabolic Institute. He is board certified in internal medicine. His specialties include bariatric medicine, medical weight management, nutrition sciences, weight management, Asthma, Diabetes, Hypertension, Metabolic Syndrome, Obesity, Prediabetes, hypertension and obesity management.

Dr. Maged Rizk, a gastroenterologist with The Cleveland Clinic, has noticed an increased interest in “cleansing,” a restrictive diet that proponents claim removes toxins from the body and aids in weight loss. Celebrities from Madonna to Denzel Washington have reportedly tried it. Some alternative practitioners even call it a cure-all for illnesses such as ulcers and asthma. Is this really a panacea—or just a passing fad? Dr. Rizk weighs in.

 

What’s your experience with cleansing? Comment below.

• FOF: Why is cleansing on the rise?
  • Dr. Rizk: Fads ebb and flow. A lot of it has to do with the late-night type of Hugh Downs infomericals with guests selling “cures.” Just like the Atkins diet was hot 10-years ago, I’d expect this trend to ebb and flow as well.
• What are some popular methods of “cleansing?”
  • Most cleanses involve some sort of organic ingredient taken over a long period of time—usually 2-4 days—that causes the release of large amounts of fluid from the all over body into the colon. So for example, the Master Cleanse is a lemon juice-based cleanse. Usually people throw in some organic maple syrup and ground cayenne pepper as well. The Blueprint Cleanse is juice-based–all sorts of different juices. Again, it’s relying on an osmotic effect.
• Why do people do cleanses?
  • There’s a lot of hype about the idea that chemicals and material within the colon can be harmful to the body. Some people believe these chemicals have oxidative effects that increase one’s risk of cancer. They believe that by cleansing, you can regulate your bowel habits and remove some of the “harmful” chemicals. People also feel that cleansing increases their energy–they feel lighter and more energetic.
• Are these claims true?
  • There’s no literature or scientific evidence to support this. In my practice, we will only cleanse the colon under certain indications such as chronic constipation, abdominal pain due to pre-colonoscopy, constipation, gastrointestinal motility and fecal impaction. Otherwise we don’t recommend it.
• Why not?
  • It can cause an imbalance in the electrolytes and the kidneys. When you take something that is highly sugary or highly salty–such as any of these “cleansing” solutions–a large amount of fluid moves from all over the body into the colon. When that happens, there’s a risk of dehydration. Modern cleanses have gotten better. In the past, patients simply drank a bottle of magnesium citrate or engaged in enemas. Both had an immediate effect. The juice-based cleanses are less harsh and take a longer period of time to work. The amount of liquid is not as extreme, but there’s still a risk of imbalance.
• Are there any other side effects of cleansing?
  • A few different things… if you are ingesting something acidic such as the lemon juice in the Master Cleanse, you can develop acidosis, where the blood in your body becomes acidic–a serious issue. Headaches, muscle pains, weakness, mental status changes and heart wave abnormalities can happen as side effects of electrolyte imbalances, dehydration, and acidosis.
• What sort of cleansing do you use on your patients for special cases such as pre-colonoscopy?
  • We use a non-digestible, non-absorbable, osmotically-balanced, laxative lavage. In other words, a liquid that has the same electrolyte balance as the body, and thus does not cause major fluid shifts. To accomplish this, it typically can’t be absorbed or digested by the body.
• Do the Master Cleanse or the Blueprint Cleanse fit this criteria?
  • No. There are tons of these different fad cleanses. I would highly doubt that any of them fulfill that criteria or that they have been tested to fulfill that criteria. I’m not aware of anything on the market like this but it doesn’t mean it doesn’t exist.
• Are there alternatives to cleansing if you feel irregular or as if your diet is leaving you ”toxic”?
  • Keep yourself regular–then you don’t have to go through “cleansing” processes. Eating between 50 and 75 grams of fiber per day can improve your bowel habits, facilitate a fuller evacuation and reduce the amount of remnant feces in your body. Regular exercise, staying hydrated, drinking at least eight cups of water a day, also helps. Some medications help, but we don’t like to use them just for cleansing.
• So ultimately, you wouldn’t recommend it?
  • Right. Patients will often say, “We understand you don’t recommend it, but if people are doing it anyway, what do you recommend?” It becomes such a hairy issue because you can’t monitor them. A person drinking twelve cups of lemonade–that’s no good. A person drinking a ton of juices over a week–that’s not good either. The only thing I can tell you is, for it to be safe it must be a non-digestible, non-absorbable, osmotically-balanced laxative.

Do you agree with Dr. Rizks assessment, or do you have your own cleansing experience? Let us know by commenting below.

Author

Dr. Maged Rizk, M.D. Cleveland Clinic, Gastroenterology and HepatologyDr. Maged Rizk, M.D., is gastroenterologist who practices at The Cleveland Clinic Center. Dr. Rizk is board-certified in internal medicine-gastroenterology. His specialties include chronic abdominal pain, patient-reported outcomes and quality in endoscopy. He is a member of the American Society for Gastrointestinal Endoscopy, American Gastroenterological Association and American College of Gastroenterology.

Dr. Tanya Edwards reveals the vitamins every over-fifty woman needs to feel truly fab.

(We’ll have a shopping list for you at the end.)

 

The Multi

• What’s the most important vitamin that everyone should be taking?
  • A multivitamin. Because none of us get 100 percent of everything that we absolutely need. Our standard American diet is grossly lacking in so many things.
• Are all multi-vitamins the same?
  • I prefer a whole food multi vitamin. They’re made from food as opposed to synthetics. The theory–and this is based on theory and not necessarily clinical trials–is that whole food vitamins are in the proportions that you find in food and contain enzymes to help those vitamins work together. More like nature wants it.
• How do you know if a vitamin is “whole food”?
  • If it doesn’t say it right on the packaging, then it’s not.
• What if you’re a very healthy eater—do you still need supplements?
  • Even if your diet has plenty of fruits and vegetables, there have been so many changes in our U.S. farming practices, that often the soil is depleted of the minerals you need.
  • The other issue is, much of our produce is shipped from far away. When produce is shipped, it has to be picked before it’s ripe, so it doesn’t have all the nutrients that it should. If a banana ripens en route to your grocery store, it’s not gaining the nutrients that it would have gained if it were ripening on the tree.
• I’ve noticed some multis have iron and some don’t—does it matter?
  • If you are over 50 and still menstruating, you should take a multi with iron. If you’ve stopped menstruating, you should take one without iron—as long as you’re not anemic. Most multis with iron contain the recommended daily dose–18 milligrams per day.
• If you take more than the recommended dosage of something, is that bad?
  • It can be for a lot of vitamins, including iron. Having extra iron in your body can act as a catalyst for oxidation–the production of free radicals. Those are the bad guys that cause disease. So having exactly the amount of iron that you need–no more, no less–is really important.

 

Fish Oil

• Why should we take fish oil?
  • Because we are all deficient in omega 3 fatty acids.
• What do those do?
  • Omega 3s are one of two essential fats our bodies need. The other is omega 6. We get way too many omega 6s in our diets and not nearly enough omega 3s. That tips the balance and causes inflammation. Omega 3s are highly anti-inflammatory.
• Where do we get all these omega 6s?
  • Omega 6s are found in many nuts and seeds and also vegetables, vegetable oil and corn oil. Thirty years ago, when we were told to stop using lard in cooking, we all switched to vegetable oils. Now we have a lot of vegetable oils in our diets.
  • That’s not to say that omega 6s are not important. Our immune system uses them to mount a response and kill off viruses, bugs, cancer cells and those kinds of things. But omega 3s are your counter balance. They help to dampen the immune response. If you are eating way too many omega 6s and not enough omega 3s, your inflammatory response goes unabated.
• And what happens in your body?
  • You have inflammation, which has proven to be the underlying cause of just about all of the diseases that we suffer from: heart attacks, strokes, cancer, high blood pressure and diabetes.
• So I better run out and get this fish oil.
  • Absolutely.
• What about flax seed oil? Isn’t that omega 3?
  • I don’t recommend flax seed oil as your omega 3. That’s the short chain omega 3; you need the long chain that is found only either in fish or algae.
• Algae?
  • My vegan patients take an algae supplement, otherwise I recommend fish oil.

 

Vitamin D

• Tell me why people need D.
  • D comes from the sun, but in the last 50 years our society has gone indoors. We were supposed to be outside, scantily clothed. As we’ve moved further away from the equator and indoors, we are not getting nearly enough. Fifteen years ago we thought vitamin D was only related to calcium in bone density, but now we know it’s related to hundreds of diseases. If you’re deficient, you have an increased risk for heart attack, Parkinson’s disease, Alzheimer’s, autism, high blood pressure…
• But you wouldn’t develop autism as an adult, would you?
  • No, no, no. But if you are pregnant and vitamin D deficient, you never know . . .
• So should everyone be taking a vitamin D supplement?
  • No. You should get your blood tested first to find out how deficient you are. Then have it retested every three months so that your doctor can make sure the supplement you’re taking is exactly the amount you need to take all year round, regardless of the season.
• When I get a full blood workup, is my D level automatically tested?
  • Probably not. It depends on how enlightened your physician is.
• Oh my God, I’m calling him immediately.
  • Your vitamin D level needs to be between 50 and 80.
• How many milligrams should we be taking?
  • It has to be tailored to you. I have some patients whose levels are maintained on 1,000 units a day. Other patients require 10,000 units a day.
• Could too much vitamin D hurt me?
  • It could, depending on how much you take. If you’re taking 1,000 or 2,000 units a day, I wouldn’t worry about it. But more than that, and you could become vitamin D toxic. The symptoms of too much vitamin D are abdominal pain and lethargy.
• So if I don’t have either of those I shouldn’t worry.
  • No.

 

Calcium

• •   All women over 50 need 500 milligrams of calcium twice a day, preferably with food.
• Why twice a day as opposed to all at once?
  • Your body won’t absorb more than 500-600 milligrams of calcium at one time. If you take them both at the same time then you will poop out the rest.
• If you eat a lot of dairy in your diet, do you still need calcium?
  • If you’re getting a lot of dairy in your diet–which by the way I don’t necessarily recommend–add up the milligrams of calcium that you are getting from food. Maybe you don’t in fact need extra calcium. You would need about three servings of a dairy product everyday.
• What’s the recommended daily dose of calcium?
  • 1,000mg. Unless you have osteoporosis, in which case it’s 1500.
• If you start taking calcium when you’re 60 will it mean you won’t get osteoporosis?
  • No. But it may decrease the progression of your osteoporosis.
• If you start taking calcium when you’re 30, does that help you prevent getting osteoporosis?
  • Yes, it does. I recommended that all adults, period, get about 1,000 milligrams of calcium, whether it’s in your diet or as a supplement everyday.
• So my daughter, who is 28, doesn’t eat cheese, she may drink a little milk, she doesn’t eat ice cream. I better have her start taking calcium.
  • Yeah. In addition to dairy products you can get calcium from other foods as well. Dark green, leafy vegetables have calcium.
• She doesn’t eat those either. Her diet is god-awful.
  • Broccoli is one of the best non-dairy sources of calcium.

 

Magnesium

• Why magnesium?
  • 85 percent of Americans do not get enough magnesium in their diets.
• What does it come from?
  • The best source of magnesium is a grain called amaranth. One serving of amaranth per day provides your recommended daily allowance of magnesium. Two servings of pumpkin seeds or sunflower seeds, also provide that dose.
  • Dark green, leafy vegetables and whole grains and nuts are also sources, but they give you about 1/10th or 1/15th of your recommended daily allowance, so you’ve got to eat a lot.
• What’s the recommended daily dosage?
  • 400.
• What happens with a low magnesium level?
  • Symptoms of decreased magnesium are headaches–particularly migraine headaches–Charlie horses, fatigue. Other symptoms are constipation and elevated blood pressure.
• Can I get it from a supplement?
  • Check your multivitamin. Most don’t have it. If that’s the case, just take it separately. If I have a patient with symptoms of low magnesium. I usually recommend about 500 milligrams at bedtime because magnesium will help you sleep.

 

Resveratrol

• And what is resveratrol?
  • Resveratrol is one of the newest kids on the block. It’s the antioxidant in red wine.
• Is that something you’d recommend people take?
  • I’m seriously thinking about it. There are some very compelling new resveratrol studies showing decreases in oxidation, cholesterol and abdominal fat. In a study a year or so ago, rats who took resveratrol lived significantly longer than rats who didn’t, and they did not age the same way as the rats who didn’t take it. I think more information needs to come out–large studies on humans.
• But you’re looking at it?
  • Oh yeah, seriously.

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• Whole food multi-vitamin: Remember, our diets can’t provide it all
• Fish Oil: Nothing fishy about this. We need it since we don’t get sufficient Omega 3.
• Vitamin D: If your level isn’t between 50 and 80, this is essential.
• Calcium: You can never hear enough times about the value of calcium for strong bones.
• Magnesium: If you’re in the 15 percent of Americans who actually get enough of this, good for you.
• Resveratrol: Lots of chatter about this in the medical community. We say it’s worth a try.

Author

Tanya Edwards, MD Cleveland Clinic Center for Integrative MedicineTanya Edwards, MD, is a Family Physician who consults at the Cleveland Clinic Center for Integrative Medicine. Dr. Edwards teaches complementary and alternative medicine at Case Western Reserve University School of Medicine where she established the Area of Concentration for Alternative Medicine. Her expertise includes inflammation, nutrition for the prevention and treatment of chronic illness, the clinical use of nutraceuticals, as well as mind-body therapies.