While this cascade emphasises the physical factors, the psychosocial factors also help to determine both the size of the meal (satiation) and the length of time before we next eat (satiety).

The stages involved in satiation and early and late satiety have been described as sensory, cognitive, postingestive and postabsorp-tive. In real life, these stages will overlap and their effects can combine to affect eating behaviour.

Sensory effects—are stimulated by the flavour of food. We are not sure how different people react to different sensory factors, but we do know that taste is a stronger predictor of energy consumed from foods than their perceived ‘fillingness’. Fast food manufacturers seek to create a ‘bliss point’ where their foods have maximum sensory desirability.

Emotional and cognitive effects—are the eater’s feelings and knowledge about the properties and effects of food Men and women may react differently, for example, in reaction to stress.

Women are perhaps more likely to react with increased appetite, whereas men may decrease their food intake.

Postingestive effects—reflect gastrointestinal signals, i.e. how full the stomach gets, how quickly it empties, the release of hormones to signal ‘fullness’ and the stimulation of physiochemically specific receptors along the gastrointestinal tract.

Postabsorptive effects—include nutrient, hormonal and metabolic signals, plus the possible effects of these on neurotransmitter function. This feedback mechanism probably gives the brain information on the body’s energy stores.

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By reading this crucial step: You’re educating yourself about the disorder. You know the dangers, you know the warning signs. You are also learning about treatment options. You know, too, that the end point of self-starvation or dietary chaos is chronic disability-or even death.

If your child has an eating disorder, you may feel you are helpless. Not true! You have more power than you realize. No matter how chaotic your family life, you are very important to your daughter. Use that importance, to assist your daughter in getting help. The same holds if you are the husband or roommate of the person with the disorder.

Sometimes, disturbed eating can actually be a cry for help. Does your daughter parade her skeletal form in front of you? Does she leave the table often during a meal to visit the bathroom, or does she “forget” to clean up after she vomits? She is sending a signal: Help me!

Children need limits. They trust parents to set limits, to reassure them that the world is a safe and loving place. Sometimes a girl is just waiting for her mother or father to confront her about her disorder, to ask what’s wrong and to insist on treatment. She can’t bring up the subject herself; she’s too consumed with guilt or shame.

That’s why you need to act. Sometimes just showing that you care enough to intervene can have a powerful therapeutic effect.

It won’t be easy. There may be denial, bitterness, angry confrontations. Expect these reactions. It’s natural that a threat to your daughter’s very identity should provoke resistance. But stay focused.

*50/35/5*

“Television programs and infomercials about weight loss would bring me to tears, but they couldn’t inspire me to get off the sofa and dosomething,” says the 36-year-old Los Angeles resident. “Then I happened to catch an Oprah Winfrey show in which Oprah was crying and talking about her lifelong struggle with her weight. I felt that she was talking directly to me, that she knew exactly how I was feeling. She motivated me to tackle my weight problem.”

The next day, Nica went to the nearest mall and headed straight for the video store. She scanned the rows of aerobic exercise videos and purchased a selection of tapes with workouts ranging from beginner to advanced. Every day for 4 months, in the privacy of her own home, she did a 45-minute video workout. “At first, I could do only about 1 percent of the routines. I felt like I was going to die,” she says. “But every time I thought about giving up, I remembered

Oprah’s words. I found myself going longer without a break and without feeling like passing out. Eventually, I could do my tape routines from beginning to end.” At that point, she felt confident enough to visit a gym.

With guidance from a personal trainer at the gym, Nica started lifting weights. Over time, she became an exercise fanatic, working out for 3 hours a day, 7 days a week. “I was obsessed,” she remembers. “But I had a goal to meet.” To help her get there, she also made some adjustments in her eating habits, giving up fried foods and filling up on fruits and vegetables. Within 7 months, she lost 135 pounds.

Satisfied with her new, slim physique, Nica began having second thoughts about going to the gym. She was tired of paying the high membership fee, fighting traffic to get there, and waiting in line for equipment. So she decided to create a gym at home.

Over a 2-year period, Nina invested in advanced aerobic exercise videos, sets of 5- to 25-pound dumbbells, and weight-training equipment with a stairclimber attachment. “My home gym definitely motivates me to stay fit,” she says. “Without it, I wouldn’t work out as consistendy or maintain my weight.”

Today, Nica works out for an hour, 4 or 5 days a week. She has maintained her weight at a healthy 135 pounds for 4 years.

WINNING ACTION

Build your own gym. If you’re not comfortable going to the gym, invest in some exercise equipment for your home. Start by purchasing aerobic exercise videos or a treadmill for walking or running. Then work your way up to dumbbells and weight-training equipment. You’ll have all the essentials you need to stay fit, without the inconvenience of packing a bag, jumping in your car, and driving to the gym. I invested in a treadmill, and I love it.

*104\89\8*

As Leo Burnett, the great advertising agent, used to say, “If you reach for the stars, you may not touch one, but you won’t come up with a handful of mud either.”
A Word About Water: Drinking plenty of water is an integral part of any healthy eating plan. But it is essential when you take Chitosan. In fact, this may be the only rule in this whole book that you should never violate. The reason is that, if you eat a lot of Chitosan and do not drink sufficient water, you may find that you are becoming quite constipated. If this is a situation which becomes extreme (which is very unlikely), you should just cut down on Chitosan.

Otherwise, a little constipation is merely annoying. But it should be avoided if possible. And 8 glasses of water a day, in addition to the other benefits it brings, should solve the constipation problem completely.

So, unlike everything you have tried or heard before, I say be very careful when it comes to restricting your eating too much. It’s not good for you, and it won’t work. Don’t get me wrong

I’m all for avoiding the pitfalls of obesity. I believe that maintaining a normal weight is crucial to good health. Still, I tell my patients that I’d rather see them carry a few extra pounds than resort to starving themselves or engaging in unhealthy eating practices. Up to now, this has been something of a dilemma: You want to control what you’re eating to some degree (by staying away from too much fat, sugar, salt; eating more vegetables and fruits; etc.) yet you don’t want to over control and wind up with a diet you cannot live with, or even with an eating disorder. So how can you walk the line?

Well, in addition to Chitosan, which is obviously your first line of defense, here are a number of other reasonable strategies.

First, only eat when you’re hungry. In particular, if you feel hungry between regular scheduled mealtimes, make sure it’s truly hunger that you feel—not boredom, a twinge in your stomach, or an unmet emotional need. When you first feel that you’re hungry between meals, wait ten minutes. Many times we confuse a brief pang with true hunger. If you’re still hungry ten minutes later, munch a little from your Chitosan bag. Then, if you’re still hungry or if you truly crave an occasional high-fat treat, take your Chitosan and eat it! Always listen to your body’s signals. If you’re especially hungry one day, go ahead and eat larger portions.

The same principle applies to your meals. By using your secret weapon when you need it, you can afford to eat that extra portion you really want. That way, you’ll be able to stay with a healthful eating program. On the other hand, if you’re not very hungry one day, eat smaller portions of lighter foods. But do make sure you always get the minimum recommended number of servings each day. You must have your three meals and two snacks, even if you’re not feeling very hungry and they are quite small. By all means, take smaller portions if that’s appropriate, but do eat. Your body needs the nutrients.

Second, realize that weight loss is not a race—the point is to keep moving in the direction of your ideal body weight. Even if you feel the urgent need to lose weight quickly, there is only so much you can do. And slowly losing weight is much better for your health. Your body is more likely to adjust to the new weight and you’re more likely to adopt gradually but permanently the new eating habits so that your weight will continue to decline until it gets to your ideal weight. That’s where it will stabilize. As long as you keep taking your Chitosan—and a little extra if you occasionally overindulge—there is no need to regain the weight you have lost—ever.

Eating disorders are, of course, a curse that comes with too much emphasis on losing weight fast, too many crash diets, and too much worship at the altar of unnecessary thinness. At their worst, true eating disorders destroy healthy living and can even lead to death. But they usually begin gradually, and the best time to deal with them is when they are just starting.

*57\29\2*

For each gram of Chitosan you consume half an hour before a meal, at least 3 grams of saturated fat—and as many as 6—will pass through your body undigested.

For simplicity’s sake, let’s assume that 5 grams of saturated fats pass through the body unabsorbed for every 1 gram of Chitosan that you take. Suppose your dinner normally contains 40 grams of saturated fat (a dangerously high amount). If you take 5 grams of Chitosan before that dinner, the Chitosan can pull away 5 X 5, or 25 grams of that fat, leaving only 15 to be

absorbed by your body. The 25 grams of fat that are attached to the Chitosan pass through your body as if you had not consumed them in the first place.

How helpful is not digesting 25 grams of fat? Well, 25 grams of fat contain about 225 calories. If you cut your fat intake by 25 grams, and normally consume 2,000 calories per day, you’ll be lowering your calorie intake by 11 percent. And if you use Chitosan before two fatty meals a day, blocking the same amount of fat with each meal, the numbers can double—50 fewer grams of fat digested per day. That comes to 450 calories less, or 22 percent of your daily caloric intake. Not only have you reduced your caloric intake, you’ve also reduced the danger to your health represented by that excess fat.

*40\29\2*

In other cases, a small blood clot which has formed in another part of the body may drift into the partially blocked artery and get stuck at the lump, blocking the blood flow. This occurs more often in the brain than the heart. (That would be like a
large truck getting stuck in a small tunnel, preventing any other cars from getting through.) Heart attacks can also be caused by stress-related arterial spasms. Muscles surrounding the coronary arteries may suddenly go into spasm and clamp down, stopping the blood flow. If an artery has already been narrowed by cholesterol/fat plugs, a minor spasm can be a major disaster.

Like cholesterol, fat participates in the making of the lumps that can clog arteries and block the flow of blood. And it has another way of causing trouble for the heart. If you have someone eat a very high-fat meal, draw a sample of their blood, set the blood in a test tube, and sit down to watch, you’ll eventually see the fat from the blood rise to the top of the tube, as the fat did in milk bottles in the days before milk was homogenized. It will be obvious; it’s the sludgy stuff. That same sludge clogs up your bloodstream, turning fluid that flows easily through the pipes, and some of the things in that fluid, into, well, sludge. For example, the red blood cells that carry oxygen are normally able to move easily through these blood vessels. But as the fat from the food gets into the bloodstream, the blood cells slush together, looking like a stack of coins. This is called the rouleau effect. Up to nine hours later, the blood cells may still be stuck together in misshapen clumps in the tiny blood vessels. How well can the red blood cells carry out their jobs when they’re bent out of shape and stuck together? Not very well. That’s why 4 or 5 hours after a fatty meal, when the blood fat levels have risen quite a bit, certain people have chest pains, abnormal EKGs, and possibly heart attacks. The fat also prevents the release of a substance called nitrous oxide, which relaxes and dilates the arteries.

I sometimes draw blood from my patients, then show them how milky and sludgy their blood looks (instead of fluid). I also have them look at a drop of their blood through a special dark-field microscope. They can see how their blood is filled with “snow,” which are white patches of fat. Later, after they’ve adopted a low-fat diet, they can see how clear and fluid their blood looks. It’s a great motivator.

*22\29\2*

At that time, some of my colleagues asked me to examine their secretaries in an effort to discover why they seemed to be constantly fatigued. One surgeon said, “Find out why she keeps walking into doors.” The culprit was usually a diet-related metabolic disorder. Some of them were eating nothing but rice or another single food for days and weeks at a time. Now, rice is a perfectly good food, but it does not contain all the nutrients and other substances that we need to thrive. I was actually astonished to see cases of beri-beri, replete with heart failure secondary to nutritional deficits, among the rice-only dieters. (Beri-beri, caused by a lack of vitamin B₁, had been all but eradicated in this country. It took fad diets to bring it back.) Another secretary told me that her new wonder diet consisted of nothing but carrots and enemas! It’s no wonder these women became ill.