Each client will discover what she/he has to do (nutritionally) to control body fat. The key is getting the maximum benefit from minimal change. Each individual will need to set dietary priorities, a process which requires a brief explanation.

Although eating for fat loss requires a reduction in energy intake, counting calories is likely to be counter-productive. It is the source of calories which is important and there is a hierarchy for dietary restriction of specific sources. Fat, with the greatest energy content (9 kcal/g) is a suitable first target for dietary modification. Alcohol has 7 kcal/g and is a secondary consideration. Next on the list is carbohydrates as sugars (4 kcal/g), finally followed by carbohydrate as starch (still 4 kcal/g). If body fat goals are met by targeting fat intake alone, then less emphasis on decreasing other energy sources is required.

If clients cut back on fat, alcohol and sugar and still want to get more off their waistlines, the only thing left is to reduce starchy carbohydrate foods like bread, pasta, rice, potato and corn. This last modification will markedly decrease the volume of food intake, but will challenge hunger and appetite regulation. Severe restrictions in food intake may trigger binges and result in a situation.

Worse than existed initially. This will signal that dietary efforts have been too drastic.

This explanation shows that there is a method for success and that at some stage the limitations of dietary change will be experienced. Going short on the body’s preferred energy fuel (starchy carbohydrates) has its hazards. It is important for clients to be aware of this risk and to put effort into increasing their level of movement Increasing energy expenditure will allow them to eat more, giving flexibility to their eating program.

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Of course, because of her purging, a bulimic patient may have trouble keeping anything in her stomach. Medicine won’t do any good if it doesn’t get absorbed. I therefore ask my patients to take their medication just before bedtime, so the drug has time to work.

Sensible practice means giving the lowest dose of medication that still has a chance of producing benefit. Doing so minimizes the risk of side effects. If the patient doesn’t seem to be responding, I gradually increase the dosage. We usually see results within a week or two, but, as in treatment for depression, an adequate trial of these medications often needs a good six weeks.

During the course of therapy it’s necessary to monitor the levels of the medication in the patient’s body. We do so by analyzing blood samples. This step is important because different people metabolize medications at different rates. Two people on the same dosage regimen may show very different plasma levels, and may thus have completely different responses to the medicine. We try to achieve the same plasma levels in bulimics as we do in depressed patients who use the medication.

Getting the right concentration of the drug can mean the difference between therapeutic success and failure. One study showed that a group of patients with a plasma level of desipramine that was below the therapeutic range noticed no improvement in their bulimia. But when the concentration was raised, four out of six patients stopped bingeing.

Some patients incorrectly think that “if a little medication works, then taking more should work even better.” Nortriptyline (another tricyclic), for example, has what we call a “therapeutic window.” This means there are both minimum and maximum levels of concentration that will provide benefits. Above or below those levels, the drug loses its effectiveness.

I also discuss the possible side effects with my patients before I write the prescription. Doing so helps prepare them for any problem they may have with the medication. This in turn improves compliance. If the patient is suicidal or psychotic, or if she abuses drugs or alcohol, antidepressants must be used with extreme caution.

As I’ve said, medications are just part of an overall treatment plan. Prescribing antidepressants without setting up a solid psychotherapeutic relationship with the patient may hurt her chances of getting better.

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So began a 20-year struggle with eating disorders that dragged Carol through episodes of anorexia, bingeing and purging, excessive dieting, and compulsive exercising. “I felt awful about myself and what I was doing,” says the 57-year-old Downingtown, Pennsylvania, resident. “But I couldn’t stop myself. I was out of control. I was determined to not be fat, regardless of the price I paid.” I

It took the demise of a troubled first marriage, and the understanding and concern of the man who would become her second husband, to finally free Carol from the eating disorders that had plagued her for so long. With encouragement from her new partner, jshe sought counseling to help her deal with the issues that had skewed her self-image and her attitude toward food and eating.

Through her counseling sessions, Carol came to understand the reasons for her eating disorder. She learned that she had to take control of her eating habits rather than let them control her. She gradually adapted to eating three healthy meals a day and exercising regularly—not compulsively.

“During my recovery, one of the most important things I did was allow myself foods that I had always considered off-limits,” Carol says. “That empowered me because I realized I could choose what to eat and what not to eat.

“There’s dignity in choice,” she adds. “It explodes self-imposed boundaries. It puts you in charge. It gives you freedom and power over food. For someone with an eating disorder, that’s a life-altering and often lifesaving revelation.”

It certainly had a profound impact on Carol. As she made peace with food, her self-image improved. She began to heal, physically and emotionally. And, to her pleasant surprise, she lost 20 pounds over the course of 2 years.

A few years later, in the mid-1980s, Carol enrolled in college to earn certification as an eating disorders counselor. “I was so grateful for my own recovery that I wanted to help others,” she explains.

“My life changed dramatically when I finally stopped my power struggle with food,” Carol says. “I was able to focus on being healthy instead of on what I was or wasn’t eating. That has made all the difference.”

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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.

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Diet plays a distinct role in the development of gallstones, those “rocks” made primarily of cholesterol that grow in the gallbladder, causing pain, nausea, vomiting, jaundice, infections, and other problems. It’s clear that high-fat, high-calorie diets that are bereft of vegetables increase the risk of developing gallstones, as do diets high in fried or other fatty foods.²⁰

While fatty foods, excess calories, and a lack of vegetables are all risk factors for gallstones, that risk drops when we eat lots of fiber. The protective effects of fiber were noted as far back as 1969, with the publication of a report that compared 101 people who had gallstones to another 101 who did not. The study found that those who did not have the stones ate more vegetables and fruits, suggesting that the fiber in these foods protected against gallstones. Other investigations have confirmed these early results.²¹

The Fat Blocker Program clearly fits the requirements of an antigallstone regimen. It encourages you to eat more of the fiber-filled foods that help keep your gallbladder free of painful stones while helping you to reduce your weight. And, as a side benefit, this same regimen helps prevent the formation of kidney stones. Studies have shown that eating a high-fiber,²² low-fat²³ diet also guards against this excruciating but common ailment.

Thus, here again Chitosan, which provides both the mechanism for reducing fat and the extra fiber that is called for, represents as close to a magic bullet as we are likely to see. Moreover, it works its magic without any of the side effects that drugs usually have.

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Fill your Chitosan bag with raw lettuce, broccoli, celery, parsley, snow peas, carrots, and other green vegetables. A second bag can be used for fresh fruits such as apples, peaches, oranges, or anything else that’s in season. Put your bags in your briefcase, lunch pail, desk, or car—wherever they’ll be handy—and munch on the vegetables during the day. Carrying these bags can help you lose weight by constantly reminding you of your goal while giving you a nutritious, low-calorie alternative to fattening foods. Nibbling from your Chitosan bags also takes the sharp edge off your appetite, so you won’t be ravenously hungry and likely to overeat.

In fact, in many of my patients, I have found that just this simple trick coupled with Chitosan is all it takes for them to lose weight. At the very least, eating extra fruits and vegetables—and reminding yourself to do so in this way—means that you won’t be tempted to eat more just because the Chitosan lets you do so. It’s obvious that if you take Chitosan to block the fat, but then eat a whole lot more, you will not lose weight. But we are strange creatures, and sometimes we have to remind ourselves of the obvious!

osteoarthritis is simply to get the patients to lose weight. For most people, arthritis care begins with weight loss.

I’ve also noticed that low back pain is especially prevalent in people who have “apple” shapes, with their excess fat stored in and around their belly and abdomen. All that weight in the abdomen causes the center of gravity to change, affecting both the position and posture of their back. This, in turn, can lead to back pain. Many times, I have been able to help patients ease back pain to the point where they could throw away their pain medications just by helping them lose weight. Excess weight in the chest and upper back can also make breathing difficult, which is why so many overweight people are short of breath (dyspnea) after just a little exertion.

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