My doctors have looked at the obvious: They have checked my thyroid and for any digestive disorders. I love food and eat a lot of pasta with veggies sauteed in olive oil. I also love cheese but don’t want to raise my cholesterol levels higher. Other than the weight loss, I’m in excellent shape.

Can you give me any suggestions?

DEAR READER: There are a number of common causes for weight loss, but you don’t appear to fit the norm. They include malnutrition, depression, chronic diarrhea, drug use, cancer, excessive alcohol consumption, eating disorders and loss of appetite. One thing that might be an issue is a dental problem or mouth ulcers. Should you have ill-fitting dentures or canker sores, this might be addressed. If you faint or feel lightheaded, sweat excessively, have increased thirst, palpitations, have hair loss are on laxatives or diuretics, these issues, too, might be considered. They may lead to an underlying cause that your physician has not addressed.

You might consider speaking with your doctor regarding a nutritional assessment and making sure that you have had complete laboratory analysis. A vegetarian diet is commonly a healthful one and far better than consuming fast foods on a regular basis. You might choose to speak with a dietician at your local hospital for some fine-tuning that will allow your weight to stabilize.

You apparently are burning more calories than you are consuming. A way around this is to supplement your meals with snacks throughout the day. Granola bars, fruit and raw vegetables would be good choices. I don’t know what your breakfast consists of, but you might consider making your own cereal with a variety of nuts, cranberries, honey and raisins. Top it with skim milk, and have a glass of orange juice and tea or black coffee.

There are countless ways of incorporating good foods into your diet without packing on the pounds, but it may take a little preparation on your part to make this happen.

To provide related information, I am sending you a copy of my Health Report “A Strategy for Losing Weight: An Introduction to the No Flour, No Sugar Diet.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure mention the title or print an order form off my website at www.AskDrGottMD.com.

Although they are not overweight, they have terrible eating habits. I went to the supermarket with one of them and watched as she loaded her cart with pancake mix, syrup, diet soda and several boxes of processed frozen dinners that were advertised as healthy but contained huge amounts of sodium.

Her concession to the fact that she has diabetes was buying light syrup and some bananas. She did not have a single vegetable other than what was included in her frozen meals. She also leads a sedentary life.

She is constantly complaining about her “bad genes.” When I suggested that her diabetes might be due to her eating and exercise habits, she explained that she is not obese and therefore did not cause herself to become diabetic.

I don’t know what her doctor has told her regarding lifestyle, but in general it does seem to me that type 2 diabetes is looked upon as your fault if you are heavy but beyond your control and the result of “bad genes” if you are thin. I think this is a dangerous mentality and also quite untrue.

DEAR READER: Absolutely. Type 2 is the most common form of diabetes. It is commonly associated with being overweight, but this does not mean that simply being overweight will cause you to develop diabetes. Rather, excess weight is simply a risk factor. Other risk factors include a family history, leading a sedentary life, age, ethnicity and more. Diabetes may be associated with other health conditions, such as high blood pressure and abnormal cholesterol levels.

Type 2 diabetes is caused when cells become resistant to insulin and the pancreas is unable to make enough insulin to overcome the resistance. When this occurs, the cells no longer take in sugar, causing it to build up in the bloodstream. The exact reason why this happens is unknown.

Symptoms can include increased thirst, extreme hunger, slow-healing sores, frequent urination, unexplained weight loss, fatigue, frequent infections and blurred vision.

Complications can arise from untreated or poorly managed diabetes. Short-term complications need to be addressed immediately because, if left untreated, they can lead to seizures and/or coma. Short-term issues include hyperglycemia (high blood sugar), hypoglycemia (low blood sugar) and increased ketones (potentially toxic acids) in the urine.

Long-term complications develop gradually. If the diabetes is left untreated or poorly treated, these can become permanent or life-threatening. Long-term issues include cardiovascular disease, bone and joint problems, skin and mouth conditions, and nerve, eye or kidney damage.

Type 2 diabetes is often preventable if proper steps are taken to manage risk factors. It is important to maintain a healthful diet and exercise routine. Remember to include plenty of fruits, vegetables and whole grains while reducing your intake of animal products and sweets. Simply substituting sugar-free products for normally sugar-laden treats is not helpful. Any excessive intake of simple or complex sugars (carbohydrates) can result in high blood-sugar levels. A registered dietician is an excellent resource in developing a meal plan.

Exercise can lower blood sugar and decrease insulin resistance. For those with diabetes, aerobic exercise is the most beneficial and should be included most days of the week for at least 30 minutes per day.

In those who develop the condition regardless of lifestyle changes, treatment is available. These include medication to stimulate the pancreas to produce more insulin, inhibit the production and release of glucose causing cells to need less insulin to transport sugar, block the action of enzymes that break down carbohydrates, or make tissues more sensitive to insulin and insulin injections.

As you can see, simply being overweight isn’t enough to cause diabetes. While your friends may be thin, they likely have risk factors for developing diabetes and have, thus far, failed to make the necessary changes. They are accountable for their health, and blaming “bad genes” is just an excuse. They must change their lifestyles and not rely only on medication to solve this problem.

People who are overweight can benefit greatly from losing weight, and in some cases, that may be all that is necessary to improve or even reverse type 2 diabetes (or high cholesterol or high blood pressure). Those with normal weights still need to be accountable and make changes.

To provide related information, I am sending you a copy of my Health Report “Living with Diabetes.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: You have several options. The first is to order my “A Strategy for Losing Weight: Introduction to the No Flour, No Sugar Diet.” Simply send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com. My books, “Dr. Gott’s No Flour, No Sugar Diet” and “No Flour, No Sugar Cookbook,” can be ordered by following the links on my website. You’re on the right track, and it is never too late to take steps to improve your health. Good luck.

DEAR READER: PCOS is a hormonal disorder that commonly begins when a female begins menstruation; however, it can develop later in life.

Obesity presents in nearly half of all patients with PCOS and is often the initial complaint. Abnormalities in the menstrual cycle, infertility, pre or type II diabetes and the presence of polycystic ovaries diagnosed through ultrasound are but a few of the other symptoms. It should be noted, however, that having polycystic ovaries is not a firm indication of PCOS.

There is no specific testing for diagnosis. Rather, it is one of exclusion, meaning that a physician will rule out a number of related possibilities prior to deciding on PCOS. The disorder makes other conditions, such as type II diabetes, hypertension and sleep apnea, more likely to occur.

Only you and your granddaughter can determine the sequence of events. When was she diagnosed? Could the PCOS be a result of her obesity? Is that issue under control? I cannot tie in high-cholesterol levels with her excess weight; however, thyroid disorders are often linked with obesity, elevated cholesterol and menstruation abnormalities.

There is help and hope that focuses primarily on her major symptoms. She should exercise and become involved with a regular weight-control program.

Diet modification appears essential. There is some initial evidence of success on a low-carbohydrate diet without discrimination between carbs on either end of the glycemic index. Her caloric intake should be reduced. She should avoid simple carbohydrates such as soda, sugary drinks, doughnuts, cakes and pastries. Any carb intake might focus on choices high in fiber, such as brown rice, whole-grain breads, fortified cereals and beans.

Her physician might decide to place her on low-dose birth control as a means of regulating her menstrual cycles.

She should continue to see her primary-care physician and endocrinologist on a regular basis.

To provide related information, I am sending you a copy of my Health Report “A Strategy for Losing Weight: Introduction to the No Flour, No Sugar Diet.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

Seriously, I am a 56-year-old female teacher, and I wanted to get in shape before I retired a year ago. I also wanted to be healthier and have a long retirement life. At my previous weight, I was unhappy, unhealthy and unfit to do anything physical, so I tried your diet plan. It worked and it has just kept on working.
It took me two years to get the weight off, and I still have around 27 pounds to go, but my doctor says I have probably added 10 years to my life. I used to be on three different high-blood-pressure medications and had to use a c-pap machine every night because of sleep apnea. Now I am medication-free, and my sleep apnea has disappeared.

I have taken up walking each day now, and last week, even at my age of 56, was able to walk 34 miles! I truly believe you have saved my life, so I wanted to send you my belated thanks. You rock, Dr. Gott!

DEAR READER: Congratulations! You have made a remarkable change in your life, and I commend your efforts. Making the decision to turn your life around and work toward better health is often the most difficult part of losing weight.

Healthful weight loss will not happen overnight. It takes time to gain weight and it takes time to lose it. You averaged a weight loss of about 1-1/2 pounds per week, which is appropriate.

I am pleased to hear that you are now able to be more active. If you continue to walk four to five miles a day, you will increase your muscle tone and further improve your health.

Keep up the good work and enjoy your retirement. You deserve it.

Readers interested in learning more about my no-flour, no-sugar diet should order my Health Report “A Strategy for Losing Weight: An Introduction to the No Flour, No Sugar Diet” by sending a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

I swam competitively in high school with up to four hours per day of heavy training, ate as little as possible, and still gained. I continued to swim in college and met with doctors, trainers and nutritionists who claimed I had a healthful and appropriate diet and got plenty of exercise despite my ever increasing weight.

Today, I continue a steady routine of exercise — a minimum of two hours each day doing both strength and aerobic activities. I mix up the routine so my body won’t get adjusted to doing the same thing every day. During weekends and vacations, I increase my activity levels.

I’ve studied to become a trainer, read anything I can get my hands on about how to exercise properly and tried many, many ways to lose weight. I started with the basic expend more calories than you consume. I used a weightlifter’s competition diet of 1,000 calories a day for three weeks and gained six pounds. I’ve weighed, measured, and kept a food journal in order to keep my calories at a minimum.

My doctor has ordered all sorts of blood work that always comes back normal. It was discovered that I have an airway-obstruction issue (apparently my tongue is too big for my mouth), and my physician told me that the sleep issue caused my weight issues and that a CPAP machine would help. I started using this in November and have put on 10 pounds since then.

I continue to question my doctor, but he maintains that if I reduce my calories enough, I will lose weight. I don’t drink soda or alcohol, nor do I eat white flour or sugar. At one point in a depressed, desperate mood, I consumed 500 calories per day for two weeks, kept up my workouts, and gained four pounds. Needless to say, I was crabby.
I’m sad, depressed, and at my wits’ end. I’m seriously disappointed with my ability to conquer this hurdle. What is wrong with me?

DEAR READER: It certainly appears you have done all the right things and even some “not so right” things to keep your weight down .

There are several reasons why individuals can experience difficulty losing weight, including the consumption of too many calories without expending them, hypothyroidism, alcohol use, certain medications, emotional factors such as depression, slow metabolism, Cushing syndrome and more. Some individuals may even be weight-loss intolerant.

Based on your letter, I don’t believe you are weight-loss intolerant. The fact that you continue to gain weight despite drastic calorie cuts is a concern to me. It indicates that either you are not being truthful about your diet and exercise habits or there is some underlying medical problem causing the unintentional weight gain. For the record, I would like to say, that I do not believe you are being untruthful and the sheer desperateness of your letter is proof of that.

You claim to have had blood work but because you did not elaborate, I do not know what you were tested for. Because of this, I will again review some of the testing you should undergo or perhaps have repeated.

First, a complete blood count and work-up should be done. Several endocrine disorders such as hypothyroidism and Cushing syndrome can lead to unwanted weight gain and difficulty losing weight as well as other problems. Hypothyroidism is often easy to resolve with inexpensive prescription hormone replacement. Cushing syndrome is more complex. It often results from a benign pituitary-gland tumor, a benign adrenal gland or an ectopic adrenocorticotropic hormone (ACTH) secreting tumor (typically found in the lungs, thyroid, thymus gland or pancreas).

Alcohol use, quitting smoking, depression and certain medications may be contributing factors. I believe your current issues with depression are stemming from the persistent weight gain, not the other way around.

In my opinion, your physician is being negligent about your situation. Despite your repeated attempts to get help, he has essentially ignored the situation. Now is the time to find a new physician who will take you seriously and work with you to get to the bottom of this very frustrating problem.

To provide related information, I am sending you copies of my Health Reports “Thyroid Disorders” and “A Strategy for Losing Weight: An Introduction to the No Flour, No Sugar Diet.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order for each copy to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: If you have had a knee replacement, I bet your knee problems were severe enough to affect your exercise routine. If you did not change your eating habits, you likely started gaining weight that was otherwise held off by the exercise. If you are healthy now, the exact cause of the weight gain doesn’t matter.
I applaud your efforts to increase your exercise and start a diet plan. The good thing about my plan is that it can be as strict or as relaxed as the user wants or needs and is implemented easily. It doesn’t involve special brand foods, weighing, measuring, or counting. Four simple words encompass the whole thing: no flour, no sugar.

Now, to your specific concerns about inconsistent weight loss: Daily weigh-ins often lead to anxiety and frustration that a diet isn’t working, even if it is. Our weights change daily based on time of day, amount of food or fluids ingested, absorption and expulsion, the amount of urine in the bladder and more. Unless you do the exact same activities, eat the same foods, and urinate and defecate the same precise amounts at exactly the same time each day, your weight will never be the same.
The solution? Don’t weigh yourself daily. Instead, do it once a week. This will provide a more accurate account of how much weight you have actually lost (or gained).

As for muscle weight, it is possible to become slimmer without losing weight. One pound of fat takes up more space than one pound of muscle. If you gain one pound of muscle for every pound of fat you lose, your weight will not change, but your appearance will.

If your clothes fit better and you are feeling stronger, stick with the plan and continue to exercise. Weigh yourself only once a week. An average weight loss of one to two pounds per week is healthful. My diet plan often results in more drastic losses in the first few weeks, sometimes up to six or eight pounds the first week, and then slowly tapers off to the lesser amounts. Some people may find that they lose three or four pounds one week but none the next. The important factor, however, is the end goal and its maintenance once reached.

In October 2008, a blood clot was found between his knee and ankle on the back of one of his legs. He is currently taking Coumadin to keep the blood flowing and reduce the possibility of further clotting.

In November 2008, he was found to have an incisional hernia in his abdominal area, which was the result of the August surgery. No one would operate on it until six months had passed from the discovery of the blood clot because of the risk. Every physician we spoke to said something about this being “generally accepted medical theory” regarding blood clots and surgery, etc.

In April 2009, the surgery for the hernia occurred. During the time that elapsed, it had become huge. It made his abdomen look as if he were nine-months pregnant, and he had significant discomfort.

As part of the hernia surgery, they made a big incision to try to reposition everything as it should be and added the mesh. After the surgery, the hernia was contained and everything looked terrific, but within a day or two, it was obvious that it had failed. The surgeon finally admitted this in June 2009.

At that point, the surgeon told my husband that he needed to lose weight before surgical repair could be considered again. We were told that this is necessary because his first hernia repair had failed because his stomach muscles were too weak to hold due to the fat in his abdominal area. I told the doctor that the reason my husband’s stomach muscles had become weakened was caused by the six-month delay in doing the surgery in the first place. If it had been done sooner, the muscles would not have become weakened to this degree. The surgeon then told me that he had no input into that decision or in advising us in that regard.

My husband is now trying to lose weight, but he can only walk because other exercises put too much strain on the hernia. He currently weighs 300 pounds. If he is to lose a significant amount of weight, it will take a huge amount of time, and the hernia will continue to go unresolved.

Is there anything that can be done in the interim to try to contain the hernia?

DEAR READER: Blood clots can develop for a number of reasons, including clotting disorders, being over 60 years of age, obesity, pregnancy, prior surgery, cancer and more. Because your husband had major surgery to remove a cancerous tumor, he was at an even greater risk of developing a blood clot.

Incisional hernias are also a possibility following surgery. They are typically associated with traditional surgeries that involve larger incisions.

Because I am not a surgeon, I do not know what standard guidelines are followed in treating a patient with a blood clot for an unrelated condition. Those with blood clots or other clotting disorders that require the use of anticoagulant therapy, such as the Coumadin your husband is taking, who require any type of surgery, are usually told to discontinue the medication a week or two prior to prevent hemorrhage or excessive blood loss. However, this recommendation is likely for those who are well established on the anticoagulant and have been stable for an extended period.

As to your husband’s worsening hernia and why his surgeon waited for the six-month mark, I am not only surprised but disappointed. He should have been informed of other options in the interim. Even though it’s not a cure, your husband probably would have benefited from the use of a girdle or elastic support garment that would have put pressure on the area of the hernia, helping it to stay in place. It is also important to avoid activities such as bending or heavy lifting that place excessive strain on the abdomen. Obesity can worsen hernias.

I am shocked that your husband’s current surgeon blamed his hernia on abdominal fat and weakened muscles. Clearly, he had just undergone major surgery to remove a diseased organ and was probably still recovering from that when the blood clot and hernia developed. After such an ordeal, one can hardly be blamed for not being as active and fit as before, especially immediately following the situation.

While I believe your husband would be better off losing some of his excess weight, I do not think that postponing the hernia repair is in his best interests. I suggest he begin his weight loss by following a simple diet plan, such as my no-flour, no-sugar diet, exercising as much as possible without overdoing it, and seeking a second opinion.