2. Tease out factors enhancing appetite such as social custom, food availability and restrained eating, and encourage an awareness of these for modifying eating behaviour.

3. Encourage slow eating to give the body a chance to recognise that feeding is taking place.

4. Graze rather than gorge so as not to risk periods of intense hunger. Snacking every 3-4 hours (using low-fat, sweet foods such as fruit) can promote satiety and reduce possible dietary compensation that may occur at a 5-6 hour time period.

5. Differentiate between biological and emotional hunger and rate levels of hunger to reduce unnecessary over-eating.

6. Wait 15 minutes before eating to see if a craving is physiological or emotional.

7. Reduce availability of high-fat foods. Sensory properties may influence susceptible individuals.

8. Choose high SI foods where possible to maximise satiety, e.g. All Bran, porridge, untoasted muesli, pasta, fruits, beans, lentils, spaghetti and potatoes.

9. Where possible, include high-fibre foods at each meal to help maximize satiety throughout the day.

10. if alcohol is consumed, there should be an awareness of the possible increase in food consumption due to reduced inhibition and possible higher intake of fatty foods .

11. The use of artificial sweeteners or fat substitutes may provide benefits to some individuals but requires individual monitoring.

12. Be aware of the nutritional limitations on fat loss and advise clients to avoid food restriction beyond their individual threshold of hunger.

*125\186\4*

Studies show that two MAOIs, phenelzine and isocarboxazid, effectively reduce or eliminate bingeing. The dosages are the same as those used in treating depression. Drugs of this class pose a somewhat greater risk of side effects, such as lower blood pressure, agitation, or sleep disturbances, than do the TCAs.

There’s another problem with MAOIs. Because they interfere with enzyme action, they affect the body’s ability to break down an amino acid called tyramine. Too much tyramine floating around in the bloodstream can cause problems related to high blood pressure, such as excruciating headaches, internal bleeding and even death.

Certain foods contain high amounts of tyramine. The list includes cheeses, wines, beers, pickled herring, liver, yeast extract (including brewer’s yeast), salami, pepperoni, bologna, yogurt, and fava beans. A patient should only take an MAOI if she understands the risk involved and agrees not to eat any foods containing tyramine.

*62/35/5*

Each day, Regina rises at 4:30 A.M. for a 5-mile walk. In the evening, after work, she packs herself and her kids in the car and drives 30 miles to a gym. While she lifts weights for an hour, her kids do their homework.

“Yes, I’m obsessive. But at least the whole exercise thing is a healthy obsession for me. That hasn’t always been so,” says Regina, a 46-year-old housing director from Eustis, Florida.

Indeed, before Regina latched on to exercise, she was eating too much and abusing sleeping pills—her ways of coping with the emotional strain of a difficult marriage. Turning her life around required that she pursue health as obsessively as she once had those destructive behaviors. “I needed to do something positive, and I needed to do it wholeheartedly,” she says.

She began by taking long walks around a lake near her home. During those walks, she thought about her problems and her desire to change. Within a few months, she was averaging between 8 and 10 miles a day. She began eating better, too, by reducing her fat intake, restricting sweets, and learning to control her compulsive snacking. She took up weightlifting and studied to become a certified trainer, which she now does as a sideline.

“To succeed, I knew I had to go at it full force,” she says. “Later, my motivation came from seeing my body go through this incredible transformation. I got leaner and fitter.

“Once that started happening, my workouts became something I needed to do,” she says. “Now, if I don’t get my workout in, I don’t feel like my day is complete.”

WINNING ACTION

Work with your personality, not against it. Concentrate on turning negative obsessions and behaviors into healthy passions and choices. Be obsessive, but in a positive way, if that suits your personality. If you’re more laid-back, focus on making small changes. Find the style that works for you.

*116\89\8*

Everybody knows that high blood cholesterol is a risk factor for heart disease. Cholesterol is a major component of plaque, a substance that contains fat and accumulates on the walls of

arteries, clogging these vessels the way hair clogs up bathroom pipes. And remember when you pull the fat out of plaque, the body can do a better job of dilating the blood vessels.

About 75 percent of our blood cholesterol is manufactured by the liver, with the other 25 percent coming from the foods we eat. The major dietary cause of high blood cholesterol is saturated fat. If you’re following the Fat Blocker Eating Program, you’re eating only reasonable amounts of lean meats, poultry, and fish, and many of your dairy products are low or nonfat. More important, you are also blocking a large percentage of your saturated fat with Chitosan. As a result, saturated fat intake shouldn’t be a problem for you. But for some people, blood

cholesterol increases when
they eat cholesterol-containing foods, even ones that contain

relatively little saturated fat. Among the biggest offenders are egg yolks, organ meats (liver, kidney, heart, brains, sweetbreads), and certain shellfish (shrimp and oysters).

One egg contains as much cholesterol (300 mg.) as you actually need in a day. So try to limit yourself to no more than one egg per day, and no more than three eggs per week. This can be difficult since this includes eggs in baked goods or other foods. However, if you exceed your limit, don’t worry too much. Now that you’re on a Chitosan diet, at least you know that you’re not building more cholesterol from absorbing excess saturated fat.

Also, it’s useful to take some other precautions against taking in excess cholesterol. For example, I eat only the whites of the eggs to ensure that I consume no cholesterol. I love a simple omelet made with egg whites, vegetables, and spices. It tastes excellent and requires virtually no fat to cook, thus letting me save Chitosan for other things that do require fat. Also, when I eat a high-cholesterol meal, I try to make the rest of the meals that day vegetarian. Even if you don’t quite succeed in this, the attempt is worth the effort. For remember, you are not expecting to instantly achieve the ideal diet, only one that is a step closer to the ideal than you were yesterday!

High-sodium diets can contribute to another heart disease risk factor—hypertension, better known as high blood pressure. Called the silent killer because it produces no symptoms in the early stages, high blood pressure can exert enough pressure on your arteries to cause tiny cracks to appear in their walls. Clots and plaque can form in the cracks, and before you know it, you’ve got the makings of a heart attack or stroke. Sodium in excessive quantity can cause blood pressure to rise in certain sensitive individuals, eventually leading to heart enlargement and congestive heart failure. We doctors have many medicines to lower blood pressure, but they all have side effects. Perhaps the best medicine is to avoid the problem altogether by reducing your salt intake. As I described earlier, if you do this very gradually, it is not hard to do.

Some diets recommend lowering your salt level by going cold turkey and just throwing your salt shaker away so you won’t be tempted to add salt to your food at the table. If that works for you, great. But if it doesn’t, the slow-and-easy method described earlier works, too. And it’s in line with my thinking about Chitosan. It’s better to go real slow and easy, making tiny changes regularly and helping yourself along with Chitosan, than it is to take huge steps only, inevitably, to stumble and fall.

Whether you use the gradual or the cold turkey approach to cutting down on salt, sooner or later you will want to keep the salt you use in cooking to a minimum. Put in half the amount the recipe calls for, or even less. Stay away from salty foods such as smoked, pickled, or cured foods, canned soups, frozen dinners, salad dressings, catsup, baked goods, crackers, chips, or salted popcorn. Eat fresh vegetables and fruits, not canned. After a while, you’ll find that your old favorites suddenly taste much too salty. And you’ll discover the more delicate, true tastes of food.

*86\29\2*

We know that populations consuming large amounts of fiber do not suffer from the age-related rise in blood pressure seen among those eating low-fiber, high-fat diets. We also know that adding fiber to the diet lowers elevated blood pressure—it can even lower it in those with normal pressure readings.²⁴

The British Medical Journal²⁵ reported on a study looking at the relationship between fiber and blood pressure. Ninety-four people ranging in age from 18-60 were grouped according to their fiber intake. Those who consumed high-fiber diets had lower blood pressure than those who did not. To test the immediate effect of fiber on blood pressure, 11 of those who normally ate a high-fiber diet decreased their fiber intake. Four months later, their blood pressures had increased. Meanwhile, 31 people who normally consumed low amounts of fiber began eating more fiber. Four months later, their blood pressure levels had dropped.

In the stomach Chitosan turns into a gelatin-like substance that grabs on and holds tightly to saturated fat. Stuck in this Chitosan gel by the electrostatic “cling” between its positive charge and the fat’s negative charge—very much in the way lint sticks to wool-the fat cannot be absorbed. Instead, it is carried through the upper and lower intestines and right out of the body. It is as if, suddenly, the fat became as nondigestible as Olestra (the new nonabsorbable fat, which recently became available for use in
some snack foods). Fat attached to Chitosan has as much impact on the body as fat left on the dining room table!

Early impressive evidence that this phenomenon really works came from a series of animal experiments. At least 18 such studies have been conducted at research centers in various

countries. The first major study² was conducted by J. L. Nauss, J. L. Thompson, and J. Nagyvary of Texas A&M University in 1983. In a carefully controlled project, these three scientists proved that for each gram of Chitosan a group of rats ingested, they excreted 4-5 more grams of fat than the control group.