I’m a physician who has been in private practice for over 25 years. You can imagine how many patients I have seen in over a quarter of a century. My medical specialty is Gastroenterology (GI), which means patients come to see me when they have problems in their gut or digestive tract. These are typically conditions like acid reflux (Gastroesophageal Reflux Disease), stomach and duodenal ulcers, Celiac disease, diverticulosis, irritable bowel syndrome (IBS), colon polyps, Crohn’s Disease, ulcerative colitis, hepatitis, pancreatitis, cancers and other conditions. In my specialty, I see the entire spectrum of digestive diseases.
Since so many GI conditions are affected by diet, much of my office time is spent counseling patients on appropriate eating habits. In the course of a typical day, I discuss diet and nutrition with at least half of my patients. The great majority of these discussions concern their excess weight. For most physicians this is a common topic, as two-thirds of the American population is overweight, meaning their Body Mass Index (BMI) is over 25. One-third of the population is obese with a BMI over 30. Obesity is a major health issue. Counseling patients on weight reduction is extremely important since weight is intricately related to good health.
Prevalence of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2016
Because of aging Baby Boomers, we’re also facing a “Silver Tsunami:”
The number of people over 65 will double in the next 20 years.
There are 10,000 new Medicare beneficiaries every day.
Currently, 40 million seniors make up 30 percent of the U.S. population. By 2030, this will grow to 72 million seniors.
Obesity in the senior population is way up: 38 percent of seniors were obese in 2009–2010, compared with 22 percent in 1988–1994.
In the aggregate, over 60 percent of American adults weigh more than is healthy. It costs our nation roughly $147 billion each year in medical expenses for the direct treatment of obesity and for the treatment of obesity-related diseases.
The reason for this expense is that people who are overweight are at-risk for serious diseases including heart disease, high blood pressure and diabetes which commonly occur together. The combination of these three conditions represents the Metabolic Syndrome which affects 25 percent of the population. These three disorders are clearly related. There is a direct reason for this.
Excess fat has an effect on the hormone insulin, which is supposed to control your blood sugar. When we ingest sugar, our pancreas secretes insulin. Insulin’s job is to move the sugar and the fat out of the bloodstream and into our cells where it can be used for energy. Unfortunately, excess total body fat causes insulin to lose some of its effectiveness. If your insulin is not working effectively—or if you don’t produce enough of it—sugar and fat build up in your blood vessels. Insulin also causes the kidneys to retain salt. This combination results in high blood pressure (hypertension), diabetes and cardiovascular disease which can lead to heart attacks and strokes. Ultimately, this is all due to the excess fat and almost always responds to weigh reduction. As you can see, people with a BMI greater than 25 definitely can benefit greatly from weight-reduction counseling.
Scientists have shown a relationship between high BMI and increased risk of other diseases and conditions, including:
Cancer (particularly uterine, breast and colon cancer)
Gallbladder disease (including gallstones)
Sleep disorders like sleep apnea
Gastroesophageal reflux (heartburn)
We must address obesity and its related disorders. Unfortunately, there is not a lot of time during the typical office visit to spend teaching about nutrition. Because of time constraints, many, if not most, physicians resort instead to handing out print materials for the patient to read after the visit or they refer their patients to dietitians. Since I have always had a passion for nutrition, I took a different route. While I work with dietitians, over the years I developed my own package of advice that I could explain in simple terms within the time confines of a typical office visit. I call it my PVC Diet. It’s designed to be a simple, easy to remember eating guide and has provided my patients with a lot of success in managing their weight. As a result, many of my patients want to know more about my approach and have requested I write this book.
There are times where I do advise my patients sit down with a dietitian to obtain more detailed instructions, especially if they have diabetes. For over a decade now, I have had the pleasure to work with a fantastic dietitian, Joan Kanute, MS, RD. She has a sound knowledge of nutrition and what it takes to maintain good eating habits over the long haul. We have worked on many projects together, and I am pleased that she agreed to co-author this book.
In addition to weight-reduction diets, I also commonly counsel patients on high-fiber diets. Americans do not eat enough fiber! As a result, 40 percent of us have diverticulosis – a condition where pockets form in the lining of the colon. This is probably due to most of us not being raised on a diet that contained enough fiber. Growing up in the 60s, breakfast was usually some kind of corn or rice-based cereal. Lunch was a couple of slices of white bread with one or two slices of ham or bologna. Dinner might have had meat, potatoes and vegetables, but the vegetables were often canned corn or peas. Not much fiber in this diet. The diet our children are eating today is not much better and in some ways is worse due to highly processed foods and fast foods.
I also see patients with irritable bowel syndrome, celiac disease, lactose intolerance and inflammatory bowel disease. The latter is very interesting as there are selections you can make in your food choices that will actually decrease your inflammation. Thus, I’m constantly discussing eating and nutrition with my patients.
The main topic we are going to address in this book is weight reduction through our PVC diet. I devised the PVC diet as a simple, easy-to-remember set of rules that I could explain to my patients in one sitting. Over the years, it has been very effective. With the help of Joan Kanute and my daughter, Danielle Sell, we created this book for you. I hope you will enjoy it.
I have to make one final note. As a physician, I am also a scientist. Therefore, I will at times bring in some biology and chemistry into our discussion. Don’t worry, it won’t be too complicated. It should actually be quite interesting and eye-opening and will help you understand the reasoning behind the PVC diet.
Through your journey with PVC, if you have any questions, feel free to reach out to us.
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