Conquer Your Weight

Dr. Sarah Stombaugh: This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight Podcast, episode number 26. Announcer: Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Hey everyone, thanks for joining me today. It's crazy to even think about this, but by the time this episode airs, I am going to have a newborn at home, and I'm taking a pause from seeing my telemedicine patients over the next couple of months. But if you're interested in working together, please do still feel free to reach out to me at my website at www.sarahstombaughmd.com. That's S-A-R-A-H-S-T-O-M-B-A-U-G-H-M-D dot com, so you and I can start communicating. Typically, I respond within 48 hours to any messages from my website, but of course there might be a little bit of a delay as we settle into our new routine with a newborn at home. Today we are going to talk about hydration and beverages. I was reflecting back on episode 24, the practical tips for weight loss, and I realized we did not talk about hydration or beverages because yikes, that's insanely important. I don't know how I missed it, but we are going to talk about it today and we are going to dedicate the entire episode to doing so because you need to do two things. One, you need to stay hydrated, and two, you need to stop drinking your calories. Staying hydrated is one of the best things we can do to support ourselves on our weight loss journeys. If you are trying to lose weight and you're drinking like two glasses of water a day right now, it is time to change that habit. The reality is our human bodies are incredibly amazing, and it's amazing just how little liquid the human body actually needs to survive. When we try to get people to increase their water intake, we have people saying things like, oh, it's so important to flush out toxins and blah, blah, blah, but that's not true. You've got kidneys and a liver and they are amazing little organs, and if you've got a healthy liver and kidneys, you are doing just fine flushing at your toxins, even if you're drinking two cups of water a day. But just because you're surviving doesn't mean that you're thriving and getting enough water can be really important to thriving on your weight loss journey. Multiple studies have demonstrated that drinking water before can be helpful with decreasing the amount of calories consumed at the meal, which makes sense. When we're not well hydrated, we can easily confuse our thirst signals for hunger, and that leads to unnecessary eating when maybe a glass of water would've done the trick. Regularly drinking water before meals can lead to a five to 10 pound weight loss over a year. That's it. Just adding in water before meals. And while that doesn't sound like a huge amount of weight, it's significant. Who wouldn't want to lose an additional five to 10 pounds if it was as easy as drinking a couple of more glasses of water per day? In addition, drinking water can help you feel a lot better. Your bowels move more regularly, you feel less bloated because our bowels are extremely efficient at absorbing or resorbing water. If you're not drinking enough, your bowels will make sure to reabsorb every little last bit that they can, and the result of that is really hard or painful bowel movements. But for most people, if you have enough fiber and enough water in the diet, you can have soft and regular bowel movements. It's amazing what a difference a few cups of water can make. Getting plenty of water is such an easy step towards supporting your weight loss journey. So much of the weight loss journey feels like cutting things out or picking up new habits that feel big and challenging. So something like adding in water feels like a comparatively easy step. Last week we talked about developing habits. As we reviewed James Clear's book Atomic Habits, are there things you could do that would make it easier for you to drink water throughout the day? So for example, do you need to have a glass of water on your nightstand so you can start the day with a glass of water? Do you want to buy a cute water bottle so you're more inclined to carry it around with you? Do you need to time it with another habit? For example, every time you go to the bathroom, you fill up your water bottle or drink a glass before you start each meal. Maybe you work a busy job and you need to make it easy by preparing your drinks at the beginning of the day. It might sound funny to think about setting out all of your beverages for the day, but this is exactly what I did when I was breastfeeding my sons. When I was breastfeeding, I had to drink a lot of fluid throughout the day, like a lot, a lot. And as a physician in a busy clinic, I wasn't always good about carving out time to walk to the office kitchen to fill up my water bottle, and it was so easy for the whole day to slip by, and I hadn't taken the time to drink anything or sometimes even to use the restroom. And when I didn't plan my fluids, my breast milk supply took a hit. Maintaining my supply was really important to me, and it was the big why that encouraged me to implement a new habit to prepare all of my liquids at the beginning of the workday. So instead, I started out my day with all of the liquids I planned to drink throughout the day. I literally had almost a gallon of fluids in my office between my tea, water and diluted Gatorade. And as a side note, I don't encourage people to drink their calories, but there might be times where you make an exception. And for me, breastfeeding was one of those times. So I literally had four containers on my desk. There was a 16 ounce travel mug of black tea, a 30 ounce water bottle and 2 32 ounce Gatorade bottles. And by the end of the workday, consistently I would have finished all of those containers. I made it really easy to drink the fluids, and that's all it took for me to implement the new habit. So think about it. What are the things you could do in your life and your schedule to increase your water intake? On the other hand, what if you don't like water? An argument I always hear from people is, Dr. Stombaugh, I just don't like water. Well, stop and think about it. Could you, if it was important enough to you, could you figure out a way to make it more enjoyable? Maybe you've got weird tasting tap water and it's finally time to buy a water filter or get a water cooler system. Maybe you should drink your water cold with ice. Maybe you should drink it warm. Maybe you should add a splash of lemon or lime juice. Maybe you should infuse it with cucumbers or mint or berries. Maybe you should drink herbal tea. Maybe you should instead take the herbal tea, pour it over a big cup of ice and have a refreshing iced tea. Maybe you should have sparkling water, or maybe you can just keep making excuses because poor you, who doesn't like water. So hopefully I've convinced you it's a good idea. But the big question too is how much water should you be drinking? And good question, I don't know you, and so I don't know the answer, but here's some general rules of thumb. You want to take two thirds of your ideal body weight and then multiply that or put that in two ounces more if you live in a hot environment or a dry environment more if you're physically active and sweating often more if you're pregnant or breastfeeding, and there are going to be some people with very different fluid needs based on their medical conditions. So if you don't know, ask your doctor the next time you have an appointment with them. For the average healthy patient, I'll bet you a hundred bucks, they'll probably just say 64 ounces, which is eight cups of water per day. And if you are someone who's currently drinking two cups of water per day, that is certainly a good starting point. However, for most of us, 64 ounces would really be a minimum amount. And do please remember, there is such thing as too much water, so there's no need to overdo it. Please do not sit down and guzzle a gallon of water in one sitting. That can be bad even deadly for you. Two, there are also going to be some people who need to fail, follow careful timing of their liquids. So a person who's had bariatric surgery, for example, please follow the guidelines given to you by your surgical team. Usually it means separating liquids from food. If you haven't had bariatric surgery though, and you are on a weight loss journey, your goal is to drink plenty of water space throughout the day and definitely before and with your meals. And it doesn't have to be water, but it should be something with very few or no calories in it. Which brings me to my next point, stop drinking your calories. Drinking sugary and sweetened beverages is a huge waste of your calories. When we drink our calories, we don't register them in the same way as if we had eaten those same calories in a whole food form. Some of our body's hormonal responses to eating are based on the stretching or distension of the stomach. So when we eat solid food and it stretches the lining of the stomach, it helps us send fullness signals. Instead, if we drink liquids regardless of the calories, it doesn't stretch the stomach in the same way and we don't get the same fullness response. Think about going out to eat. Maybe you ordered a breakfast sandwich and a vanilla latte. I actually opened up the Starbucks app for y'all to check the nutrition for a grande vanilla latte, and there are 250 calories and 35 grams of sugar in a grande vanilla latte. 35 grams of sugar. To be fair, about half of that is just milk, sugar or lactose from the milk in the latte, but the remaining 17 grams is pure sugar. Well, it's actually high fructose corn syrup, which is even worse, and there are four grams of sugar in a teaspoon. So imagine you've got a plain grande latte and you're adding in a little over four teaspoons of sugar to your latte. That's a lot. If you compare that to a plain latte, which has 190 calories and 18 grams of sugar, and then all of those sugar come just from the milk sugar lactose. So imagine that today you sat down and ate a breakfast sandwich with a vanilla latte, and imagine that tomorrow you ate the same breakfast sandwich and a plain latte. Do you think you'd feel any differently afterwards? Would those additional 17 grams of sugar and 60 calories from the vanilla syrup make you feel any different, make you feel any more full? The answer is no. You're going to feel the exact same afterwards. And for what a huge load of sugar and an additional 60 calories, or if you go out to dinner and order a burger and fries and soda, is that going to feel any different in your body than burger fries and a sparkling water? The answer is no. Sure, maybe you have some thoughts around your taste preferences, but you're not gonna feel any more full or more satisfied having drank those additional calories from soda. And this is the point where people ask me, well, can I just drink diet soda instead? Great question. Do you wanna see a bunch of obesity medicine physicians get into a brawl, ask them about artificial or non-nutritive sweeteners. Studies about artificial or non-nutritive sweeteners have come to basically every imaginable conclusion. There are some studies that say if we replace regular soda with diet soda, there's no impact on weight loss in one year's time. There are other studies that say that non-nutritive sweeteners are even more effective than water at promoting weight maintenance after a year. There are studies saying that non-nutritive sweeteners are so sweet that they mess up how our brains interpret and crave sweetness leading to more sweet cravings. There are studies saying non-nutritive sweeteners are safe. There are other studies that say they can lead to an increased risk of heart disease or stroke, and it's hard to compare apples to oranges when we lump all artificial and non-nutritive sweeteners in one category and then try to make broad claims about 'em as a group, that's not really fair. Is it possible that some artificial sugars are just fine and others are more concerning? Yes, absolutely. Additionally, dietary studies are notoriously challenging because how much can we really infer about a 12 week or a 20 week or even a year long study? Can we draw conclusions about safety and effectiveness after just these short periods of time? The other issue is that very few dietary studies are well controlled in the sense that participants might be assigned a diet or a dietary invention or intervention, but very few studies actually provide all of the meals and beverages for a patient. A study participants are given guidelines and then left to their own devices. How strictly are they adhering to the study protocols? Studies certainly have ways to address this, like having their um, participants do food journaling or have them do regular check-ins. But the best studies would take thousands of people. They would have them locked in a room, they would feed them for years to see what those outcomes were. And as you can imagine, that's not just impractical, but it's literally unethical and therefore impossible. And so instead of answering the question, is it better to have real sugar or artificial sugar? Let me ask you a different question. Do we need sweeteners at all? I would argue that no, you don't. What if we just ate real food and had real beverages without added sugar? What if you drink unsweetened tea? What if you drink a plain latte? What if you drink water at your meals? Do you need Coke, whether it's diet or regular? Do you need fruit juice? Do you need sports drinks or energy drinks? Do you need a mocha frappuccino or a caramel macchiato? The answer is no. And if your brain is protesting and you want to yell at me and turn off the podcast right now, notice that reaction you're having. You're addicted to sweetness, whether it's real sugar or fake sugar. Your taste buds in your brain and your hormones. They're used to getting those hits of sweetness, and you're probably used to the resulting dopamine, that happiness hormone that comes every time we have sweetness. Quitting sugar in sweetened foods is not always easy, but I promise you it's possible. And the crazy thing is, once you've weaned yourself off these foods and beverages, you'll be shocked at how your taste buds respond. While I still choose to have sugary foods like ice cream and dessert, occasionally I have eliminated all fake and real sugar from my routine food pan. That means no sweetened yogurt, no sweetened cereal or bars, no sweetened applesauce or dried fruit, no sweetened coffee, drinks, or teas. If I want a fancy coffee, I order a plain latte. I eat plain Greek yogurt with berries. The only breakfast cereal I'll have is plain rolled oats or steel cut oats. And it's not because I'm so amazing and look at my lack of willpower. It's because I very intentionally and deliberately, deliberately remove these foods from my life. And now years later, I just don't have the same desire for them. And you know what? Occasionally happens now, I'll buy something or order something expecting it to have no sweetness, and if I take a bite or a gulp and find it sweetened unexpectedly, I will nearly spew it out. I ordered a Starbucks matcha latte a few months ago, and after taking a sip, it was clear that there was sweetener in the drink. I actually brought it back to the barista and said my order was wrong because I had ordered it unsweetened. And after a momentary back and forth in which they insisted, no, my drink was definitely not sweetened, no syrup had been added. A quick Google search taught me that Starbucks uses sweetened matcha powder. So even though I ordered an unsweetened matcha latte, it's actually literally impossible for them to make that order with the ingredients they have. Similarly, I ordered an iced coffee from Chick-fil-A last month. They had an option for plain and vanilla, and the calories were labeled next to each one based on the calorie difference. It was obvious that the vanilla iced coffee was sweetened. So I made the logical choice and I ordered a plain iced coffee. And you can imagine how disappointed I was when I took a gulp and tasted sweetened coffee. It turns out they add simple sugar made with cane sugar to their iced coffee. The vanilla flavor they have does indeed have much, much more sugar. But plain didn't mean plain coffee. It meant plain sugar. I was super disappointed. The good news is it is added, so you can order your drink without it, but you would have to know it's even in there in order to do so. And it's crazy how accustomed we've become to adding just a little sugar here or a little sugar there, or sometimes a lot of sugar here, and a lot of sugar there. And I promise you, it's not easy, but it's possible to eliminate sugar and sweetened foods from your diet. And as your taste buds recalibrate, it's amazing to find how sweet fruits and vegetables can be or how satisfying a plain latte can be. So there you have it. If you haven't been working on your beverages as part of your weight loss journey, now is the time. Make sure you're staying well hydrated. Cut that sweetened beverage habit. If I can help you with any of these habits, let me know how I can best support you on your journey. You can visit my website at www.sarahstombaughmd.com to learn more about me and enroll in my medical practice. If you live in Illinois or Virginia. If you live in another state and you'd like help getting connected with an obesity medicine physician or a life coach who might be a good fit for you, let me know. I'd love to help you out. Thanks so much for joining me today. I'll see you all in two weeks. Bye-bye.