Category Archives: fat loss

BLOG VACATIONS AND JETLAG

The Sixpack Doc explains why this blog has been unattended for so long, and what changes have elapsed in the interim. Check out his post on ‘Random Thoughts on an Unfit America‘. More later!

THE MAY CHALLENGE!

My brudder, the Six Pack Doc, has issued a May Challenge that calls for a 10 lb fat loss in one month while getting stronger.
Is that even possible? I think you can either lose fat or gain muscle, but not do both at the same time.
Check it out yourself then!

COMPENSATING A BAD MEAL

Over at his blog, the Six Pack Doc talks about balancing caloric intake after you have had a bad nutritional day, pigging out on food and causing nutritional havoc.
If you want to share the gory details of his nutritional excesses, please go there, and spare me!

THE 7-DAY CHALLENGE

Over at the other blog, the Sixpackdoc throws the 7-Day Challenge at you:
“A lot of people need a kick on a part of the body occupied by the gluteus maximus muscle in order for them to do something good.
People like these (and include me in this august majority) can’t change anything in life, including the way they feel and look. Unless severely provoked. In such circumstances, ordinary people do extraordinary things.

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(pic: http://1stepcloser2im.blogspot.com/2008/05/cda-bike-course-computrainer.html)

This post is for those of you who need to shed fat. I am throwing this challenge to all of you:
Starting this Monday (or any day of the week), can you go for one week (seven days, or one hundred and sixty-eight hours) without eating one milligram of bad food?
Specifically, do you have it in you to do ALL of the following, for one full week, no excuses?

If you want to know if you have it in you to take up the challenge, read on and do it!

HOW TO STAY FIT IN RECESSION

Over at my new blog, I posted on the above topic, something I put in for DR of Health Habits.
I was among an elite group of health and fitness bloggers (from whom I learn on a daily basis) contributing to Fitness Guru DR at his blog Health Habits.
This is my contribution, and check out those of others by clicking this link:

The intro:
“Indians are always geared to recession, though you may not understand that from the media reports of a resurgent and shining India. Indians are generally conscious of not wasting money, especially while giving it off to people (ask me, I have to take my fees out from my patients through their body orifices!). But, in these difficult times, being careful with your money is a policy that resonates easily with everyone here. We are all finally in one recession-hit global village today!
I have some suggestions:”
Go there if you want to read it.

WHY NANDAN CANNOT FIND INDIA ON A MAP

I have not had any urge to write all these days, and I can’t say I am in the best of mindsets to do a good job. However, here is a small essay written, with my active help, by my son. I hope you tolerate me for this. You cannot find a drier piece than this, I am sure.

I live in the city of Kolkata, surrounded by dusty buildings, most of them made of bricks, and some of them of a mix of thatch, wood, mud and plastic. The latter type of building makes for the shanties that freely thrive in my neighborhood.
In one such shanty lives Nandan. I have been seeing him for the last two years. Nandan does not study in my school. He works in a garage next door, by the side of the street.
At those times when the ball flies out of the building walls and lands in the garage (whenever we play cricket in our compound), Nandan is found ready with it, handing it over to us reluctantly. I have sometimes heard him being rebuked by his master for wasting time looking for the ball beneath some damaged car or the other.
Nandan looks like a grease monkey. Really. He works on his back, lying on the rough muddy ground and hands over tools to the car mechanic who is his teacher and mentor. As the day goes by, the muddied lubricants from the spare parts of the cars find their way from his hands to his face and neck. The only thing the black paint cannot hide is his brilliant smile. But that is something I have seldom seen.
Nandan does not play with us, as he is busy at work. When we are at school, he is at the workshop, and when we are playing, he is right there. We got talking sometimes, but not much.
While me and my friends are getting plumper watching TV and playing on the computer, he is thin as a rail. He cannot even find his country on a map, I found! He told me one day that he wanted to learn English and maths, and asked about how my school looked. I don’t know whether he believed me when I told him how grand and old my school was.
At home, Nandan gets to eat with his brothers (while I have none), but his mother is too busy with household work to talk to him or put him to sleep. Or else she is too busy fighting with other ladies in the shanties over whose turn it was at the toilet or the water pump. I have seen this many times from my verandah, high up in my building.
I am sure he must be getting bitten all over at night by bugs, while I sleep in comfort a few storeys above him. I sometimes wonder whether I deserve being better off than him, but then, this is not the age when I need to handle tough questions!

THE FAT LOSS PLATEAU AND BEYOND

Long post alert!

Many of you may not have realised (as I have not) that this blog has become one of the most Googled sources of fat loss info in the web.

Oh, sorry! I had initially set for this intro to the post to appear in 2025, so let us not move that far ahead. Restart (not you, moron)!

I am writing on fat loss because of the insistent demands of many of my wild-eyed fans like her. “Rambodoc”, they say in different accents, “When will you shine the light on my fat? When will I lose that handle around my waste waist so that I can start looking as young as you, you delishius hunk of meat, you..” And many, many words to that effect. No, Rads did not say any of this, but we can all expect her, as a mark of her eternal gratitude for this post, to send me one of her used 7-series BMWs or, if she feels cheap, the keys to a property in Manhattan (such low prices these days!) or somewhere. Anywhere, actually.

Okay, let us now get serious here. Restart.

Fat loss stops after the initial effort in a program of diet and/or exercise. This is common knowledge. Let us first see what are the reasons for the fat loss plateau:
1. You are not working out the right way.
2. You are working out the right way (maybe you even have a great coach) but you are not eating right.
3. You are eating less calories, working out long, but your metabolism is too slow, i.e., your body burns calories slowly. A common ‘note to self’ by women, men, older men and women, hypothyroid men and women, post-menopausal women, and some other groups we may have forgotten about.
In the next few thousand words (kidding!) I will give you the juice from the research of around 935 (again!) research articles without boring you to death with the sources.
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(Fat people are easily seen everywhere even in India)

Let us simplify issues: if your body needs 2000 calories as its basic metabolic demand (known as BMR or Basal Metabolic Rate), and if you spend another, say, 400 calories in your activities, then you would need to eat less than 2400 calories a day consistently to run a calorie deficit. Right? Many of us know that you will lose a kilogram of fat if you run up a calorie deficit of around 7000 calories. So, a 500 calorie deficit a day should result in the loss of one kilo of fat in two weeks. A pound a week. Clear?
There are lots of compounding issues to this simple equation, but you still have to keep touching base with this simple reality to achieve fat loss:
Calories burnt must be greater than calories eaten.
The most important way to accelerate fat loss is to eat less calories. Not in working out. Trainers are fond of saying that “you can’t out-train a bad diet”. Very true. Unless you are Michael Phelps who, at last Census, was not known to have met a fat loss plateau.
“Oh, no! He is going to talk of diets? Not again?!” Was that you saying that? Can you see me nodding my head sympathetically, like a politician at election time?
Some more basic truisms:

All diets work. But only for some time.
Diets don’t work by themselves in the long run.

What do we do then? Studies show that only 5 percent of people on a supervised diet manage to sustain weight loss. The rest fail. That includes you and me. Let us, therefore, rephrase this:

Diets don’t work; lifestyles do.
If you do lifestyle, you never feel that you are doing something special or stressful. It comes naturally.
What is this stupid, airy, hair-splitting, you ask?
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(a typical dinner of mine, and ALL mine!)

Many people (author included) follow a lifestyle where you mimic the lifestyle of primitive man (an animal who probably did not have obesity). Which means:
* Eat whole foods that are available in nature.
* Don’t eat processed foods (meaning colas, diet colas, bread, cake, pasta, noodles, biscuits, etcetera).
* Avoid grains (rice, wheat, corn, etc.) and artificial sugars.
* Don’t eat meals at a religious rhythm (like 3 meals a day or 6 meals a day).
* Mimic the movements of primitive man (imagine Caveman Rambo with a pointed object hunting a bore boar): sprinting, waiting, sprinting again, crawling, pulling, pushing (imagine wrestling the boar before killing it finally), lifting heavy weights (taking the hunt back to the cave) and then eating it. If he fails to kill it or find some other source, he starves till the next time.
How will you do this in your 9 to 5 life in the US, UK or India?
Easy. Try these:
1. Don’t jog or walk. Sprint (as if chased by a wild dog in heat) for a few short seconds (take 20-30). Rest for a while (as many seconds as you ran or even a minute). Repeat ten times, or six, depending on your ability. That, ladies and gentlemen, is called High Intensity Interval Training (HIIT) or the Tabata workout (Tabata kept a work:rest ratio of 2:1).
In other words, stop wasting time on those cardio machines in your gym or at home. Four to twenty minutes of hard effort (including the rest periods) is enough cardio for you. A month into this, watch yourself improve your stamina and reduce the inches gradually (remember, you have to give your body time- think of one or two years, in many cases).

2. Push or pull your body weight in major, compound exercises like pull-ups (most women I see are unable to do this unless they are well advanced in fitness), push-ups (keep doing ten more than yesterday), squats, and burpees (the best of them all, I think).

3. Stop doing machine-bound training. In other words, don’t waste time in isolation exercises like biceps curls, preacher curls, pectoral decks, ab trainers, etc. You are not going into a bodybuilding competition, are you? If you want maximum bang for your buck, do the bodyweight exercises above, and also do weight training (squats, deadlifts, or anything that involves pulling or pushing a free weight against gravity).

4. Don’t waste time on ab exercises. Do a couple of planks, holding on till you die. You will have done more than enough for your abs and core stability.

5. Didn’t I say ‘crawl‘?! Yes, I did.
You can do mountain climbers, which is not really crawling, or you can actually go on your hands and feet and climb the stairs, first straight up (head first) or reverse (feet first). This would double as a great cardio workout as well.

Anything else about these exercises? Lots, but suffice it to say that you should train harder than you think possible, and not merely go through the motions. Only then can you see results! Each workout should have a decent volume, which means you could do, for instance, three sets of ten reps for each exercise, with 30-60 seconds rest in between sets. Be strict with the rest periods, avoiding chatting and vacantly meditating.

Let us now move on to nutrition, the cornerstone of fat loss management.

Most people are eating way too much to see results. They are also not eating enough proteins, which reduces their muscle building abilities.
One way to address a fat-loss diet is to cut down on carbs (carbohydrates). This is one of the most tried and tested ways of achieving fat loss. Most of the benefits of a low-carb diet accrue from a total caloric deficit. If you are given the liberty of eating loads of fats and proteins (as in the Atkins diet), you won’t be able to eat all that much for too long. Result: lack of variety in foods leading to weight loss. Someone even lost weight on one month’s continual fast food (McDonald’s, etc.) diet!

Low carb diets are often difficult for many people to follow, for cultural and habit reasons. In such a scenario, losing weight is more difficult, but a caloric deficit needs to be created.

Eating six meals a day (a popular advice for most people) is largely impractical in the long term, not least because designing a diet with such low calories is difficult. Imagine a meal with only 300 calories, for example (if you need to eat six meals within a caloric budget of 1800)! In this regard, a more doable lifestyle is IF: Intermittent Fasting.
In IF, you fast through the day, and then eat within a four hour window. You can choose to fast once a week, or every day, for 15 hours, or 24 hours. Your choice. One of the big things going for IF is that celebrities (like myself) endorse it. I fast for 24 hours once a week, and 15 to 18 hours one or two more days in the week. IF is a lot of posts on its own merit, and check my resources at the end of this chapter post, if you want to learn more. Suffice it to say that it reduces blood insulin levels, is a great way to eat ‘normally’ and yet maintain a caloric deficit. I have found that on the days I fast and then eat in the four hour window, I can’t exceed 1400 calories (I don’t pig out with junk food)!

Does when you eat matter in your fat loss plateau?

Is fasted cardio better than cardio in fed state?

Is breakfast the best meal?!

Dinner is the best meal, and you should avoid breakfast like the plague!

Controversies, controversies! Forget all this, and stick to the basics:
eat clean, work out hard, and be happy. Get enough sleep. Drink less. Be active physically. Read fitness articles and blogs. Enough!

So, if we can sum up, how does one overcome the fat loss plateau?
Reassess your diet (definitely keep an online food journal like FitDay), start IF, train harder than you ever have, change the way you are training, avoid long duration aerobic cardio in lieu of High Intensity Interval Training. Take adequate rest and get enough sleep.

Blogs on Fitness/ Primal Living I silently follow (in no particular order at all):
1. Turbulence Training
2. Fitness Black Book
3. Brian Devlin
4. Health Habits
5. Tom Venuto
6. Caleb Lee
7. Straight To The Bar
8. Mark Sisson’s The Daily Apple
9. Muscle Hack
10. Go Healthy Go Fit
11. Alwyn Cosgrove
12. Son Of Grok
13. Robertson Training Systems
14. The Nate Green Experience
15. Gym Junkies

IF Resources:
1. Brad Pilon
2. The IF Life
3. Leangains

Science-based Nutrition/Fitness sites (heavier stuff):
1. Lyle Macdonald’s Bodyrecomposition
2. Alan Aragon
3. Dr. Michael Eades

I heartily recommend any and all of the above, and I think they contribute hugely to the needs of the public seeking help over the internet. I am also very grateful to them for their advice and availability for people like me and you. I am quite sure I am missing out on some of the others I read, but I hope I can include them later.

Disclaimer: I am not a Fitness or Nutrition guru. I use my medical knowledge and apply it to my personal quest for health and fitness. If you feel the need to heed my advice, you are welcome to, at your own discretion and risk. If you suffer from any physical or mental disease or infirmity, please consult your doctor and get properly (mis)guided!

A FIRST, UNIQUE, UN-DESCRIBED BENEFIT OF STRETCHING!

You can get several resources in the web that give you sound advice on various aspects of physical fitness, like this one. In addition, you get comprehensive websites like Bodybuilding.com, where you can get videos of individual workouts you want to do perfectly, or get more knowhow. I prefer the blogs, finding them free of commercial disturbances.

In all these sites, you can find how exercise builds up your muscles, controls your blood pressure and your heart rate, bring your blood sugar levels down, and so many other things. The only thing exercise does not seem to do is to give you a hard-on.
Let us not, however, get distracted into that related minefield of calories and pelvic thrusts.

I have had a unique benefit from exercise, specifically stretching. This particular stretch consists of lying down supine, one knee folded on the other, and bringing the other knee to the chest, thereby stretching the folded one. I am sure this description is very clear, similar to the various descriptions of the Hadron Collider experiment and the physics behind it.

Okay, let me give it its proper name: the pyriformis-gluteus stretch.

(pic source: http://spyhunter007.com/Images/piriformis_gluteus_stretch.jpg)

This morning, as I was doing this, I heard an enormous pop from my right knee. If Usain Bolt had farted while running the 200 meter sprint, it must have been recorded in history as a similar sound. I am, rest assured, no Usain Bolt, either in running or in other matters. I checked my knee, and sure enough, it looked to be in one piece.

I had a long history of a cyst in the meniscus of my right knee. This was the result of an injury sustained in my college days, when I used to kick-start my Kawasaki motorbike every day, on the way to escorting pretty women who would hug me from behind. This used to be in the city of Bombay.

This cyst just ruptured today, and I am cured of the disease, thanks to my diligent exercising on my back.

Representative pictures only:

(source: here).
I am saved from one surgery.
I always knew I had it in me to be famous for doing something unique one day. Who would have known it would be for this!?

GETTING TO THE HEART OF ENHANCED CLAIMS

The recent controversy about the ENHANCE study is an important illustration of a serious and long-standing problem with the medical profession, and its allied siblings.

What is the ENHANCE study all about? Surely not a penis-enlargement issue, my readers may be forgiven for wondering even fleetingly. Well, it is a study on two treatment modalities for patients with high lipid (cholesterol, for example) levels. But, first, the basics.

You may have high lipid levels because of genetic reasons, or because you eat, drink, or smoke too much. Many of us are obese, too. Traditionally, if you have high cholesterol, apart from the usually discarded ‘lose weight-do exercise’ kind of advice to the patient, your doctor would give you drugs. These lipid-lowering drugs are called, broadly, statins. One of the most common ones today is Lipitor (atorvastatin).

Why is it important to lower cholesterol? Because high cholesterol can lead to fatty plaques being deposited in the coronary arteries (atherosclerosis), leading to a heart attack.

Statins are prescribed to millions of patients around the world, including those with heart disease, hypertension and diabetes (conditions commonly associated with high lipid levels). All statins act by blocking a liver enzyme that normally results in the formation of cholesterol.

The problems with statins are mostly with their cost and side effects. In addition, in a number of patients, they don’t work well enough. Increasing the dose may increase the side effects. So, what can your doctor do in this kind of scenario?

Enter Ezetimibe. This drug reduces the absorption of cholesterol from the intestines, which bear the brunt of all the cholesterol-rich good things in life that the mouth (along with the mind it carries) chases relentlessly.

With me so far?

So, you have statins that reduce cholesterol, and you have ezetimibe, that also does the same in a different way. Why not combine the two? Will surely work better, and reduce the fatty deposits in your coronary arteries, logically. Merck did that in collaboration with Schering-Plough, with Zetia (ezemitibe) and Vytorin (a $5 billion product).
A 30-day course of Vytorin costs around $100, while Zetia costs $93, compared to $32 for a course of generic simvastatin.

That is what the ENHANCE trial was supposed to prove. Unfortunately, it did not show any such benefit.

However, some experts are discounting the trial, saying it is not a fair representation of the truth, that it is botched, and that they would wait for further trials before changing their prescriptions away from Zetia. Around 60% of doctors, however, are likely to stop prescribing the drug. Obviously, it would be a catastrophe for the company, reeling as it still is from the Vioxx losses. Merck stocks have slid down after this trial has come to light.

The important issue that has come up again in this debate is captured in two quotes:

The main problem is that after six years on the market, there are no data for ezetimibe demonstrating any health outcome benefit. In the absence of any demonstrable effect beyond LDL lowering, nearly one million prescriptions per week are written for ezetimibe. Is this rational?

If the ENHANCE trial had shown regression of atherosclerosis or slowed progression, both the company and advocates of ezetimibe would be trumpeting the results as a landmark study. Now that the trial has failed, they describe ENHANCE as a small and unimportant imaging study. You can’t have it both ways!

THAT, ladies and gentlemen, captures a huge truth. Much of what we do as doctors stems from trials that prove one or the other. Products become available commercially, too, and we are tempted or habituated to use them, especially if treated well at cruises and exotic junkets. However, as clinicians, we would still want to do better for the patient, and refine our treatment methods as evidence improves. Therefore, it is vital that we know which data is proven, and which is putative, suggestive or alleged.

That, however, is a tall order!

(Sources: Heartwire and Medscape)

A RESTAURANT PREVIEW

An engraved letter was lying at my desk at home all week. It finally forced me to open it.

Dear Doc Rambo,
We could not help noticing that since the time you attempted to become a famoush blogger, you became a famished one. As this is the season of good will and that kind of popular shit, we have the pleasure of feeding you if you can drag your sorry ass to our new restaurant at Silver Spring, Kolkata within the next two weeks.
Regards,
Manager,
Sigree

Well, a slight exaggeration, actually. It sort of said (if memory serves me right):

Dear Doc Rambo,
We recently analysed the last Census results to form a data base for our new restaurant in Silver Spring, Kolkata, and noted with pleasure that your name figures first among the select list of Indians whose tongue-tips can reach their elbows. Sir, we would be privileged to have you at our new restaurant within the next two weeks, as we are unable to think of more practical ways to check the culinary skills of our new chef,whom we are paying enough for him to consider bonking Paris Hilton.
Regards,
Manager,
Sigree

So, when informed that tonight’s dinner at home (dal, roti, sabzi, dahi) was refused even by the alley cat, I decided to venture out to Sigree.
Located at the mall in Silver Spring (a swanky new condo complex near the ITC Sheraton Hotel), Sigree, for some reason, looked like a brand new restaurant.

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We (wife, kid and blogdoc) were welcomed so profusely that the last named got nervous. Are we the only family they have managed to coax entry into their restaurant, I wondered.
The ambience was warm and unpretentious. There were certain murals and jug-like structures on the walls that I couldn’t describe or name. If I could, I would have been writing for the New York Times, rather than being stuck in Blogsville, writing anonymous posts for you stinkers wonderful people.

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The restaurant manager, Debdatta, came up to us and explained that they were going to Beta test their cuisine prior to the opening in mid-January ’08 and would appreciate our comments on the food.

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They started off with a few starters.
Among the vegetarian starters, we had:
Dilli Wali Tikki (a large blob of potato pastry with chickpeas, onions, masala and a bit of sauce).
Hare Masale ki Paneer (cottage cheese kababs in green herb gravy).
Chutney Wali Makai (a sheekh kabab made out of blended vegetables and pulses, mildly spiced).
Multani Chat (fried sliced baby potatoes in a piquant sweet red sauce spiced with ginger).
(Notice how professional I sound? Piquant indeed!)
Kurkure Bhendi (thinly julienned okra in light batter, fried and lightly spiced).

The non-vegetarian starters were:
Gosht Sheekh (mutton kabab).
Murg Chandni Tikka (ginger-garlic flavored white chicken kabab).
Murg Kandahari Tikka (spicy chicken tikka kabab).
Bhuna Methi Tikka (bhetki fish kabab with fenugreek).

All of these were superb, save that the Chicken kababs were not really the kind I like (chandni tikka: a bit too garlicky, and kandahari tikka suffocated by spices). In particular, the okra was mind-blowing.
After all these were demolished, mostly by the hungry laborer who had been operating since 7 in the morning, I told my wife, “Let us not sit around any more. Let us leave before they bid us goodbye, please come again!”
As if they had heard me, a troupe of waiters came in with the main courses.
A point of digression. The proper collective noun I should have used is ‘an indifference’ or ‘an absence’ of waiters. However, the waiters today were devoutly solicitous, almost as if I was their son-in-law-married-to-ugly-daughter come to visit. No absence, and no indifference.

Main course:

Amritsari Kulcha (tomb-shaped soft breads stuffed with pomegranate, mashed potatoes, onions and a touch of red chilli pepper).
Butter Nans/Baby Nans/Ajwaini Rotis.
Yellow Masala Dal (with a slightly burnt garlic flavor).
Gosht Chilman Biryani (mutton chunks in spiced Basmati rice, sealed in dough and cooked in a tandoor).
Sabz Dum Handi (fresh veggies in a mild green sauce).
Murg Shiroudi Masala (Chicken in red sauce spiked with black pepper).
Chaap-e-Baluchistan (Rogan Josh by another name).

In short, the chaap was the best I have ever had, and the Chicken Shiroudi packed quite a bit of flavor, too. The others were all very stimulating, with the Amritsari Kulcha getting my gourmet vote.

At dessert time, the Firni captured the flavor well, but was a bit too sweet. I was too sated to really enjoy the Shahi Tukda, which turned to something like Farex in my tired mouth. Good, actually, because I heard a female voice (probably belonging to my wife) saying, “I will never come to a restaurant with such shameless gluttons. Ever!”. I thought she was talking of others, but there were no others in the restaurant at that time. Odd, that.

By the time of the dessert, the others had long given up on food, and were desperately searching for a place they could lie horizontally over.
They wrote profuse eulogies in the comment sheets, while I rolled out on all fours, ready for the drive back home.

Being an astute surgeon, I realised the reason this insane assault on the body’s system with so much of food did not cause any feeling of sickness. I could see the parietal cells of my stomach lining frantically secrete acid to digest the initial starters, and then slow down, finally collapsing under the onslaught, limply secreting H2O instead of HCl.

If you are the numerology sort, here is a rating (out of 10).
Food: 9
Decor: 5
Service: 10
Hospitality: 10
Price: 10
(complimentary for us)

(Pedantic note for the greedy visitor from Googledom: Sigree is part of the Mainland China group of restaurants. This is a 168 seater restaurant, and has been preceded by others in Pune and Chennai. Bangalore and South City, Kolkata, are the next sites to open soon. Its chef is Sandeep Pandey, formerly of Gucchi of the Hyatt Regency, Kolkata).

(Pictures mine. Once the food came, somehow, we forgot to take pictures.)