The G-Index Diet

This book contains numerous case histories. In order to preserve the privacy of the people involved, we have disguised their appearances, names, and personal stories, so that they are not identifiable. As with any diet book you should consult your health professional before commencing a nutritional regimen.

All information contained in this book regarding brand name products is based on research by the authors which is accurate as of June 30, 1992.

If you purchase this book without a cover you should be aware that this book may have been stolen property and reported as "unsold and destroyed" to the publisher. In such case neither the author nor the publisher has received any payment for this "stripped book."

WARNER BOOKS EDITION

Copyright © 1993 by Richard N. Podell and Inkslingers, Inc.

All rights reserved. No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission in writing from the publisher, except by a reviewer who may quote brief passages in a review.

Cover design by Diane Luger

Meal Plans and Recipes Developed by Johanna C. Burani, M.S., RD.

Warner Books, Inc.

Hachette Book Group

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Visit our Web site at www.HachetteBookGroup.com

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First eBook Edition: March 1994

ISBN: 978-0-446-54998-1

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ALSO BY RICHARD N. PODELL, M.D., F.A.C.P.

Doctor, Why Am I So Tired?

Primary Prevention of Coronary Heart Disease

Physicians Guide To Diabetic Patient Self-Management

Physician's Guide To Compliance In Hypertension

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ACKNOWLEDGMENTS

Our most heartfelt thanks go to our literary agents Herb and Nancy Katz, whose professional wisdom and hard work were and remain indispensable. A special thanks is due to Nancy for her dedicated attention to culinary details.

Our editor, Susan Suffes, and her associates at Warner Books were unfailingly astute and supportive during the editorial process.

Several distinguished medical scientists have enhanced our understanding of the principles of weight control and metabolism through their publications, correspondence, or conversation. Our thanks to James Anderson, M.D.; George Blackburn, M.D.; George Bray, M.D.; Janette C. Brand, Ph.D.; Jeffrey Fisher, M.D.; David J. A. Jenkins, M.D., Ph.D.; Jean Mayer, Ph.D.; Judith Rodin, Ph.D.; Lawrence Stifler, Ph.D.; Albert Stunkard, M.D.; Thomas M.S. Wo-lever, Ph.D.

We thank Liz Fisher for her creative advice and enthusiasm. We appreciate the well-stocked shelves of King's Supermarket in Short Hills, New Jersey, and of Nature Food Centres in Livingston, New Jersey.

My thanks to Larry Hite for helping to sharpen my focus.

The staff and associates of Overlook Hospital and the Overlook Center for Weight Management have been extremely helpful. They include Jack Scharf; Lynn Lind, R.N.; Joyce Jukofsky, R.N.; Dolores Phillips; Shelly Beck; Beverly Licata, R.N.; Diane Powers; Mary Sealer; Nicholas Yatrakis, M.D.; Glen Landesman, M.D.; Ken Storch, M.D., Ph.D.; Ray Buch, M.D.; Janice Baker, M.D.; Gary Weine, M.D.; Ron Cobo; Connie F. Williams.

Our associates in private practice have provided unfailing support and loyalty: Jodi Geller, R.N.; Nancy Carter, R.N.; Linda DeCorso; Sandra Kearney; Andrea Shenocca; Peggy Stiner; Lori B. Katz, R.D.; Nora Cielo, M.S.; Jackie Massa; Mary Lou DiBari; Karen Croswell; Terry McGuirk; Robin Ford; Sally Karas, R.N.; Marjorie Knickerbocker, R.N.

A special thanks goes to my partner David K. Brown, M.D., for his enthusiasm and encouragement.

And of course, we are grateful to our families, who have supported us through this project: Patricia, Carrie, Lisa, and Tracy Podell; Pam and Michael Proctor; and Sergio, Matt, and Paul Burani.

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CHAPTER ONE

The Solution to the Seesaw Syndrome

Although there have been many breakthroughs recently in our understanding of diet and nutrition, a major element has been missing in most weight-loss programs: a way to take weight off and keep it off—permanently.

The dismal fact is that about 95 percent of people who lose weight gain most or all of it back in less than a year. In fact, millions of people on popular diet programs end up heavier than they were when they started. Perhaps you are one of these people, just as I was.

The recent emphasis on low-fat eating is certainly a step in the right direction. But a low-fat diet isn't the sole solution to the problem of weight gain after weight loss.

The main difficulty is that countless people still remain hungry or dissatisfied as they diet on a low-fat regimen, and also after they lose their excess weight. So, they slip off the diet, and before long, they put that weight right back on.

Up until a few years ago, I was subject to the "seesaw syndrome" or "yo-yo effect"—lay terms for the never-ending cycle of losing weight and then regaining it. Indeed, I lost thirty pounds on one low-fat diet, only to see my success disappear within months. Staying with the diet over the long term just took too much effort and willpower.

I almost never felt satisfied on a weight-loss program. Within hours of eating, my appetite would return with a vengeance. If a meal was delayed, I'd become lightheaded and jittery. I craved breads and crackers, and would gulp them down by the box when my resolve failed. As I began to eat more fat, I started to feel better. But I also regained my lost weight.

I sensed there had to be a better way, and I committed myself to finding it. Recalling lessons I had learned at the Harvard Medical School and the Harvard School of Public Health, I began an intensive, even obsessive exploration of the research that had been done on how specific foods alter our appetite control and influence how we feel.

Soon, I found the answer—the missing piece in the dieting puzzle. Specifically, I put together a food program based on the concept of the Glycemic Index (a rating system indicating how different foods affect the rise in blood sugar).

As powerful as the concept is, the basic premise is simple: Foods that have a low Glycemic Index (GI) are best for dieters because they promote a slow, moderate rise in blood sugar and insulin after a meal— factors which help keep hunger in check. These same factors also encourage the body to dissolve body fat by converting it into energy.

In contrast, high GI foods cause sudden, unstable swings in blood sugar, first with very high sugar and insulin surges, then with a crash of the sugar toward excessively low levels. The end result is increased appetite and irritability—and a greater tendency to convert food calories into body fat.

In short, the goal of the dieter is to build a food plan around low Glycemic Index foods. This way, hunger is minimized, and there is less tendency to overeat. Consequently, the dieter can continue to lose weight— or to maintain an ideal weight once the excess pounds have been lost.

This G-Index Diet, as I call it, has worked beautifully for me.I lost my excess 25 pounds in less than three months, and I didn't gain it back. As the medical director of the Overlook Center for Weight Management in Springfield, New jersey (a program of Overlook Hospital, a teaching affiliate of the Columbia University College of Physicians and Surgeons), I also have put hundreds of my patients on the diet. It's worked as well for most of then as it has for me. They've taken the pounds off. Just as important, they haven't put them back on. Now, people who have been struggling with weight fluctuations can achieve stable weight reduction permanently through the G-Index program.

Here are a number of other exciting, compelling features of this revolutionary diet:

•   The 21-day menus—including detailed recipes, shopping lists, and step-by-step instructions—are set up to make your dieting job as easy as possible. There's nothing to figure ort. Almost everything has been done for you— except the eating!

•   The program uses food—not a special liquid solution or other short-term dietary elixit—to help you eliminate excess weight.

•   You can actually increase your caloric intake— and at the same time lose more weight than through deprivation.

•   The diet is based on a well-researched, thoroughly documented, but often overlooked scientific fact: not all carbohydrates are equal for purposes of losing weight.

Some carbohydrates, which I call the "bad" diet foods, actually increase your hunger. Carrots in quantity will increase your hunger. So will popcorn, along with honey, baked potatoes, oat bran flakes, most whole wheat breads, shredded wheat, watermelon, raisins, and lima beans.

In contrast, the "good" diet foods, which we describe in detail later in this book, are not that way simply because of their low caloric value, thought obviously my diet is a controlled-calorie one. Rather, they are good because the body uses them to actually regulate hunger through a metabolic process that has been known in medical circles for decades. The concept just hasn't been applied to ordinary weight-loss diets until now.

The G-Index approach is entirely consistent with the low-fat, low-cholester0l, high-fiber principles demanded by recent medical and nutritional research. But this diet features a strategic use of fats. Specifically, certain fats, such as cheeses or peanut butter, eaten at the right time and in limited amounts with the right combination of other foods, not only help you feel more satisfied—they also promote better weight control.

Selecting the best foods for weight loss and designing a daily G-Index Diet are simple matters for people who use the food ratings, food exchanges, and model menus and recipes contained in this book.

In the following pages, you'll learn how to move beyond the commonplace and often erroneous wisdom of weight loss. You'll be shown not only how to lose those extra pounds, but also how to cure the hunger problem and end the seesaw syndrome forever.

HOW DOES THE G-INDEX DIET WORK?

After you eat, the level of sugar (glucose) rises in your blood-stream. Some foods—those with a high Glycemic Index—make the blood sugar increase more quickly and to a higher level than other foods. This rise in blood sugar leads to a corresponding sharp rise in insulin, which the body releases to regulate the blood sugar.

Unfortunately, that flood of insulin has negative side effects. High insulin levels stimulate the appetite by directly triggering the brain's appetite center. Furthermore, excess insulin can cause the blood sugar to "crash," setting off a chain of hormonal events that lead to irritability, fatigue, and even more hunger.

So a process that begins with a rise ends with a fall—and with heightened craving for food. As a result, your hunger intensifies and your body begins to insist, "I need more to eat—now!" Overwhelming hunger takes over, and overeating results.

There's also another weight-control connection: Insulin influences the ability of the body to burn calories. When insulin levels are high, fewer calories are burned and more calories are transformed into fat. Conversely, when insulin levels are low, more calories are burned, fewer calories turn into fat—and body weight tends to decrease.

To make the best use of this phenomenon, a wise dieter must learn to identify and choose foods with a low Glycemic Index (GI). That's the secret to keeping blood sugar stable, insulin low, and hunger in check. In this book, comprehensive food listings and GI values for different foods have been included to assist you in selecting the best hunger-averting foods.

Among other things, you will learn how to apply principles like these:

•   Not all sugars are alike.Fructose (the sugar in fruits) and lactose (milk sugar) are excellent low G-Index foods. Even table sugar (sucrose) is not as bad as has often been supposed. For example, it doesn't drive up the Glycemic Index as quickly as do some other sugars, most breads, or many breakfast cereals.

On the other hand, honey is terrible. With its high Glycemic Index, honey drives up blood sugar and, as a consequence, draws insulin to a high level. This action paves the way for a crash in blood sugar and intense hunger pangs.

•   Some fat can help promote weight loss. Every responsible, knowledgeable physician these days advocates a low-fat diet to keep blood cholesterol down, cancer risk at a minimum, and excess weight off.

But there's an important variation on the low-fat thesis Using small amounts of fats prescriptively, at well-chosen times during the day, actually can help stave off hunger. The reason? A limited amount of fat taken at the right time during a meal or as a snack can prevent the body from craving high-calorie between meal or bedtime snacks.

•   Low GI foods provide the dieter with a "200-calorie advantage" in losing weight. In effect, low GI foods raise the body's metabolism by about 8 percent because they are able to keep insulin levels low. I call this edge the "200-calorie advantage" because that's the average number of extra calories that can be burned each day if you choose more foods with a low GI.

This means that an overweight patient on the G-Index Diet can lose 15 pounds or more, even if he or she continues to consume the same number of calories! That's because the diet raises the body's metabolic rate and stimulates a more rapid burning of calories.

WHO SHOULD USE THE G-INDEX DIET?

As I've already indicated, the g-Index Diet has two major uses. First, you can lose excess weight simply by eating more foods with a lower Glycemic Index, even without lowering your daily intake of calories! Second, you can use the GI approach to maintain lower weight achieved initially through liquid diets or other weight-reduction programs.

I've discovered in my clinical practice that people with nearly every type of dieting problem can be helped by the G-Index program. These include:

•   People who l hate to go on diets because they become almost intolerably ill-tempered or anxious. The G-index Diet has proved to be fan ideal program to lower anxiety and irritability. When blood sugar crashes after the intake of high GI foods, the body releases adrenaline to limit the drop in sugar. The extra adrenaline is one of the factors that make hungry people edgy, jumpy, and angry. By keeping blood sugar more stable, an individual can ward off many attacks of anxiety and irritability.

•   Dieters who are making the transition to regular food from a low-calorie liquid diet. For many of these patients, the return to solid food heralds the beginning of unstoppable weight gain. Yet I have successfully used liquid diets, followed by a permanent G-Index Diet, with patients needing to lose 50 pounds or more. They have continued to maintain their lower weight because the "natural" G-Index Diet has regulated their blood sugar, short-circuited their hunger surges, and allowed a choice of satisfying foods.

•   People who have managed to reduce down to within 10 to 20 pounds of their desired weight, but who somehow can't make it the rest of the way. This situation, which confronted a woman named Sally, is typical of hundreds of people who have succeeded on our weight-loss program.

Sally—Whose Last 15 Pounds Were the Hardest

Sally had been on a diet for as long as she could remember. At 5-feet, 3-inches, her desired weight was 120 pounds, but she consistently tipped the scales at between 135 and 140. She constantly counted calories and tried one weight-loss program after another. But nothing worked. Granted, she would sometimes manage to lose about 5 pounds, but then she would gain it right back.

A person with tremendous self-discipline, Sally was very careful about what sne ate. Often, she'd have just coffee and a few crackers for breakfast. But then, she would snack later in the morning on whole wheat bread, carrots, and low-fat meats like turkey and lean beef. Some times, she would even try a baked potato or some watermelon.

Obviously, she wasn't eating junk foods. In fact, many of the items on her diet were consistent with most diet programs because her meals were low in calories and fats. But that wasn't enough to keep the weight off because Sally constantly had to fight feelings of hunger, and like most of us, she eventually lost the battle.

Her problem was that she was following religiously the traditional weight-loss wisdom that says all that's necessary is to keep calories and fats to a minimum. Yet that isn't enough for a permanents program. Those old, established dietary ideas didn't prevent her from becoming ravenous within hours of a meal or snack. As a consequence, she ate so many "diet foods" that her weight regularly stayed 15 to 20 pounds above her target.

After taking a careful medical history, I performed a complete physical and found that Sally's metabolism was a little one the low side. This made it especially difficult for her to lose those last 15 pounds. But the real problem was her diet.

An analysis revealed that Sally's carbohydrates were not Well chosen. She ate only modest amounts of low Glycemic Index foods and kept herself going with the wrong, high GI foods. Breads, carrots, and watermelon were her undoing! All of these foods trigger high blood sugar and insulin. Ironically, even her pure protein snacks—turkey and lean beef—were bad choices because pure protein eaten without other foods stimulates insulin as much as pure sugar. As a result, her hunger stayed high and she failed to lose weight.

So I put her on the G-Index Diet, with these specific recommendations: A snack of sliced pears and apples (or strawberries in season) late in the morning or in the middle of the afternoon would abolish her hunger pangs far better than either crackers, bread, or turkey, and help her feel. far less famished by mealtime. Also, a couple of thin slices of skim-mile goat cheese would help if she felt the need for anything a couple of hours after her evening meal. Lastly, throughout her daily menus, she would exchange high GI foods for low GI fare.

Free from the vicious GI cycle, Sally lost 8 pounds in six months without really dieting. Though she eats as much as before, her food selections have improved her metabolism by allowing her body to burn more calories. She's never hungry, yet the pounds continue to come off. From the look of things, Sally will continue to lose weight until she reaches her goal.

HOW CAN THE G-INDEX DIET WORK FOR YOU?

In the following sections of this book, I will lead you systematically through the information you'll need to apply the Glycemic Index concept to your own diet program. Here are some of the highlights.

The Scientific Basis

Medical investigators, especially those concerned with diabetes, have uncovered information with important implications for all dieters. Among other things, you'll see how:

•   Foods that stimulate insulin surges in the body can cause people to eat 60 to 70 percent more calories at the following meal.

•   People who consume foods relatively high in glucose (such ass white bread, most commercial whole wheat bread, and raisins) eat an average of 200 calories more at the next meal than those who eat fructose (a sugar found in most fruits).

•   All high-fiber foods are not equal as far as dieters are concerned. For example, pineapple, instant or one-minute oatmeal, oat bran flakes, and most whole wheat breads—even those containing relatively high amounts of fiber—may nevertheless stimulate hunger. In contrast, hunger can be suppressed with apples, orange juice, non-sugared yogurt, regular oatmeal, whole-grain rye crackers, 100 percent stone-ground whole wheat bread, and European-style pumpernickel bread.

•   Some low-fiber foods—such as pasta (even pasts based on whiteflour)—may actually be better for dieters than certain high-fiber foods, such as most commercial whole wheat breads and breakfast cereals.

•   Certain ethnic cuisines, like Indian and Greek, which often contain lentils and other low GI foods, have proved to help dieters avoid hunger pangs.

•   Low GI foods (good for dieting) can be mixed with modest quantities of high GI foods (worse for dieting, though they may satisfy certain tastes) without losing their hunger-reducing effect.

•   Combining small amounts of fat with high GI foods will reduce the appetite-stimulating effect of high GI foods.

•   Eating a low GI snack two hours before dinner can reduce your appetite at supper. Also, eating low GI foods at dinner can reduce your appetite at breakfast the next morning.

•   The best sweetener for hot or cold drinks is fructose, a fruit sugar that is available in most supermarkets. It's also acceptable to use small amounts of sucrose, or table sugar say, one or two teaspoons. That's because sucrose has a moderate GIvcemic Index. Please don't overdo it but modest quanties of sugar are actually less damaging to your diet than are higher GI carbohydrates such as most commercial bread.

•   There is evidence that low GI foods, such as spaghetti and dried beans, reduce the level of blood cholesterol and triglycerides.

•   Eating three large meals a day stimulates insulin production—and hunger—more than small, more frequent feedings.

•   Substituting low for high G-Index foods can increase your metabolism and inprove your body's ability to remove fat and burn calories.

After you've been introduced to such scientific findings and concepts, you'll next see how they have been applied successfully to help; a wide variety of dieters.

A Diet for All Seasons—And All Sorts of Weight Problems

We explore how people with various needs have succeeded in losing weight and keeping it off by employing the scientific principles on which the G-Index Diet is based. The case studies include the following types of dieters.

•   People who have lost 50 pounds or more on liquid protein diets—and then have used tae G-Index Diet to achieve successful long-term weight maintenance.

•   People who have lost modest amounts of weight—averaging about 20 pounds—using only the G-Index Deit.

•   People who have been totally frustrated by not being able to take off—and keep off—an extra 5 to 7 pounds around the middle and hips. They broke through this weight barrier by employing the GIycemic Index approach

•   People who have been fighting excess pounds since childhood.

•   Sweets and salt cravers who have been unable to conquer their drives and stay on a long-term weight-loss regimen.

•   People who have suffered chronically from the seesaw syndrome—with many ups and downs on different programs—until they went on the G-Index Diet.

•   People who have used the G-Index Diet to conquer emotional problems that often emerge during a weight-reduction program, such as increased irritability and anxiety.

As you learn how these people have accomplished long-term weight loss, you'll be introduced to some practical techniques and tactics that will help you succeed on your own weight-reduction program.

Tactics to Protect Yourself from Hunger

A number of practical approaches to weight loss and maintenance have worked for my patients—and should also work for you—in the battle against the seesaw syndrome. For example, you'll be introduced to such techniques as:

•   Eating low GI foods at your most vulnerable and tempting times of the day, such as late morning, late afternoon, and late evening.

•   Using small protions of fat to promote weight loss (though the total fat consumed each day will usually stay below 25 percent of total calories).

•   Identifying and always keeping on hand four or five favorite low GI goods to stave off hunger.

•   Intelligent eating plans for restaurant dining.

•   Ways to translate many of the GI scientific concepts into practical meal planning in the kitchen.

G-Index Diet Menus, Recipes, and Food Exchange Lists

The detailed meals and recipes presented in Chapter Five are the heart of the program. You'll be presented with a model food plan designed as follows:

1. Recommended foods have been selected according to their low rating on the Glycemic Index. These low GI foods provide a slow, input of sugar into the blood and avoid disruptive swings in blood sugar and insulin, which can trigger hunger.

2. For ease of evaluation and selection, both recommended and nonrecommended foods have been classified in groups numbering 1 through 4. Foods that are in categories 1 and 2 are low on the Glycemic Index and should be preferred by all dieters. Those in categories 3 or 4 should generally be avoided, though I've allowed for some strategic "cheating" on occasion.

3. Fat intake is low, usually constituting less than 25 percent of total calories each day. This guideline is consistent with current advice about keeping blood lipids, such as cholesterol, at a low level. Also, there is a need on any weight-loss diet to limit fats, which have more than twice as many calories as the same weight of either protein or carbohydrates.

4. The model menus involve three weeks of meals at different calorie levels, depending on whether you want to lose weight or maintain your present weight. People on the 1,200calorie weight-loss plan can expect to lose 2 to 5 pounds per week, and do it on their own, without medical supervision.(Of course, people with liver or gall bladder problems, kidney disease, metabolic disorders, or other medical conditions should check with their doctor before making any changes in their nutritional programs.)

After the excess weight has been taken off, the 1,500 and 1,800-calorie menus will enable you to maintain the new, lower weight level that you've achieved. Guidelines help you choose the menus appropriate for your particular weight-control needs. To accommodate the demands of busy and varied schedules, there's also a program for restaurant eating.

5. The comprehensive food exchange lists in Chapter Eight have been set up so that you can adjust the model diets to your special tastes. Or using the low GI approach, you can employ the lists to design a completely different set of menus for yourself.

As with any weight-loss program, you should consult with your physician before embarking on the G-Index Diet.

Now, with this in mind, you're ready to take your first step: a look at how different individuals with different weight-loss problems and objectives have all succeeded on the G-Index Diet. If your experience is similar, you'll find that these real-life stories will soon lead you to a major, highly satisfying transformation in your life and your appearance.

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CHAPTER TWO

A Diet for All Seasons