Not a day goes by where the media isn't reporting another alarming study about the rapid expansion of the American waistline. Obesity rates continue to climb for both adults and -disturbingly- children. Americans, meanwhile, continue to embrace the less-than-healthy lifestyle consisting of dining out, little or no exercise, and -when they do choose to eat at home- a diet high in unhealthy processed foods. Dr. Steven Schnur is a cardiologist and author from south Florida. His new book, The Reality Diet, is a blue print people can use to live a healthy lifestyle in a real world filled with unhealthy alternatives. Thanks to Dr. Schnur for sharing his insight!

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1. What inspired you to write The Reality Diet?
   I saw many patients suffering side effects from low-carb diets, including headaches, nausea, constipation, lethargy, and foul breath. There wasn’t a diet book on the market that I felt comfortable recommending, so I decided to create my own. I found the diets that were out there to be too extreme, promoting quick fixes and not long-lasting results.
   
2. It's called "The Reality Diet", describe why you chose the "reality" theme?
   I wanted a diet that could easily be incorporated into the world we live in today--a simple and sensible plan that allows us to enjoy the foods we love like hamburgers, pizza, chocolate milkshakes, and even an alcoholic drink if we want. I also wanted people to know that it’s not the end of the world if they go crazy now and again and eat a piece of cheesecake or a generous handful of chocolate—the reality is that we all indulge once in a while; the trick is to learn how to compensate and get back on track. The Reality Diet is designed for real people living in the real world, which is why I include very basic tips on shopping, eating out in restaurants, and preparing quick, simple, tasty meals. It’s flexible, forgiving, and realistic about how we live our lives today.
3. Tell us about the 2:90 Rule:
   Fiber is the key ingredient of successful weight loss and maintenance, and the 2:90 Rule is the key to insuring that you get adequate fiber in your daily diet. If you follow the rule, you’re guaranteed to meet the recommended daily intake of fiber: 25 grams for women and 38 grams for men. It’s very simple: when you’re in the supermarket, just check the nutrition labels and make sure that any starch you buy—bread, pasta, rice, couscous, bagels, waffles, cereal, crackers—contains at least 2 grams of fiber per 90-calorie serving. If you follow the 2:90 Rule, you will automatically avoid nutrient-poor, calorie-dense food.
4. Reading the book, it doesn't take long to learn that you are a fan of fiber. What are some good sources of fiber of which the average person may not be aware?
   Most fruits and vegetables are good sources of fiber, including potatoes, carrots, and other root vegetables, as well as bananas and pineapples. Whole grains are also excellent sources of fiber as long as you use the 2:90 Rule to pick the fiber-rich alternatives and make sure that “whole grain” or “whole wheat” is high in the ingredient list. Whole grains also contain beneficial phytonutrients that, along with fiber, help fight disease. Finally, look for fiber-enriched juices and yogurts when you are shopping the dairy aisle.
5. How does fiber help "fight fat"?
   Fiber fights fat from the second it hits your mouth to the second it leaves your body. Simply chewing fiber-rich food sends a signal to your brain causing you to begin to feel full. While fiber is in your stomach, it causes a localized feeling of fullness. In your colon, fiber blocks the absorption of other macronutrients, including carbs, protein, and fat. In total, up to 120 calories a day can be flushed away through increased fiber intake. In addition, fiber helps to control your circulating levels of glucose, insulin, and other hormones that regulate appetite and make you feel full and satisfied. Not surprisingly, cultures that consume high-fiber diets have lower rates of obesity. In addition, studies show that individuals who consume a high-fiber diet fiber weigh less than individuals on a low-fiber diet.
6. The book discusses the benefits of fiber in relation to heart disease and colon cancer, how exactly does fiber help prevent these conditions?
   Fiber, especially soluble fiber, helps to reduce your cholesterol levels—LDL (“bad”) and total cholesterol, as well as triglycerides--which in turn decreases your risk of heart disease. Colon cancer is more controversial, but a recent study shows that people who increase their fiber intake by 10 grams a day decrease their risk of colon cancer by 40%. The theory is that fiber causes carcinogenic substances to pass through the colon quicker while simultaneously protecting the wall of the colon from being in contact with these carcinogenic substances. I believe that the other nutrients present in fiber-rich foods also contribute to the decreased risk of colon cancer.
7. What other health conditions does fiber help prevent?
   Fiber helps prevent both diabetes and metabolic syndrome, a pre-diabetes condition. Increasing fiber has been shown to decrease the incidence of diabetes by up to 40%. Fiber slows down the absorption of glucose by the intestine, thereby decreasing circulating insulin levels, increasing insulin sensitivity, and preventing insulin resistance.
8. Eating out is a big part of modern life. How does your book address this reality?
   Many of my patients are busy professionals who eat on the run, travel a lot, or rely on take-out foods, yet they have all succeeded on the Reality Diet. Throughout the book I provide advice on making healthful choices when eating prepared foods. I also devote a whole chapter to dealing with restaurants and holidays. In addition to general tips on portion control and avoiding unnecessary calories, I give specific advice on navigating a host of different ethnic and regional cuisines.
9. How much weight can a person expect to lose by following The Reality Diet?
   You can expect to lose approximately 30 pounds in 3 months, slightly more than 2 pounds per week. Unlike low-carb diets, which promise that you’ll lose 8 to 10 pounds in the first week, the weight you’ll lose on the Reality Diet is real weight—fat—not water and lean muscle mass. Losing more than 2 or 3 pounds a week is unhealthy, leaving you depleted of nutrients and more likely to gain the weight back.
10. What should a person expect to experience while following this diet?
    You will see results immediately. The first thing you will notice is that you will have plenty of energy. The reason for this is that you will be eating plenty of fiber-rich carbohydrates and not depriving yourself of the energy you need to exercise. Remember, exercise is crucial for weight maintenance and for any healthy weight-loss program. You’ll also feel very full—so much so that you may feel tempted not to eat all of the recommended food each day. I encourage you to do so, however, as adequate caloric intake is essential for maintaining your energy level and metabolism, and insuring proper nutrition.
11. What differentiates The Reality Diet from the gaggle of diet programs currently on the market?
    The Reality Diet is not an extreme diet or a quick fix. It is a healthy eating and exercise plan you can use for life. The Reality Diet does not just emphasize losing weight, but gives you concrete strategies for maintaining your weight loss long term. It also emphasizes exercise, which is neglected by many of the diet plans out today. Finally, the Reality Diet is realistic about how people live their lives today, allowing for daily desserts, optional consumption of alcoholic beverages, frequent dining out, and occasional all-out indulgences.
12. Besides losing weight, what other benefits should a person following The Reality Diet expect to derive? Following the Reality Diet will produce a healthier you, both inside and out. You will see improved cholesterol levels, improved blood pressure levels, and better control of your glucose levels. This translates into a longer and healthier life. Your energy level will be higher, and because you will be exercising, you will feel better both physically and emotionally.
13. As a cardiologist, obviously you are keenly aware of the relationship between diet and cardiovascular health. How would you describe the impact of all the low carb/high protein diets on patient health in the past 10 years?
    Since the low-carb craze has been around, we still have not seen any conclusive endpoint data showing a decrease in cardiovascular disease for those following these diets. There is, however, conclusive endpoint data showing that those on fiber-enriched carbohydrate diets have a definite decrease in cardiovascular death. Studies have been done comparing low-carb and low-fat diets, and after a year, the weight loss is the same. But low-carb diets have tremendous side effects, including heart arrhythmias, dizziness, lightheadedness, electrolyte abnormalities, and palpitations, so how can we justify them?
14. What are the best/worst trends you currently see in the average American diet? The worst trend I see is the increase in portion sizes coupled with a decrease in exercise. This trend leaves us with an increasing energy balance surplus—i.e. lots of extra unused calories--which fuels the obesity epidemic. The best trend is the U.S. government’s commitment to increasing fiber in our diet by increasing the recommended servings of fruit, vegetables and whole-grain products, and to promoting exercise. Also, we are seeing better food labeling, less trans- and saturated fats, and a trend toward increasing poly- and monounsaturated fats.
15. As a health expert, which foods, if any, do you simply refuse to eat due to their negative health impact? I refuse to eat in any fast-food restaurants because of the unhealthfulness of the majority of their food products. I do not drink regular soda and restrict my intake of diet soda as much as possible. I limit foods with trans fats such as chips, store-bought baked products, cookies, and deep-fried foods. I also try to curb my intake of fruit juices and eat whole fruits instead.
16. You get to be king for a day and as part of being king you get to mandate three changes to the American diet, what would they be?
    
    • I would eliminate all energy-dense, nutrient-poor foods, such as regular soda, candies, and cookies, as well as all advertisements promoting those types of foods on TV, radio, billboards, and in magazines.
    • I would close all fast-food restaurants and mandate portion control in restaurants that remain open.
    • I would retool our educational system with extensive education on good nutrition and more emphasis on exercise. I would also require that schools practice what they preach: providing nutritious, portion-controlled meals; eliminating unhealthful foods from vending machines; and insuring adequate physical activity during the school day.

17. What are your thoughts on the "childhood obesity epidemic"?
    While it’s easy to blame the fast-food industry, entertainment, and media industries for the epidemic in childhood obesity, the fact of the matter is that good nutritional habits begin at home. In addition to tackling problems in the public sphere, we need to educate parents so that they can be better role models in the privacy of their own homes. Schools can play an active role in this, as can food manufacturers, by making healthful products available and affordable.
18. Some common excuses people use for eating a poor diet or not exercising are "You have to die of something" or "What doesn't cause cancer or heart disease?" What's your answer for people who use these excuses? If you’re going to die of something, let it not be by your own hand. There are enough maladies in the world that you don’t need to inflict more on yourself. If we are good to our bodies, then our bodies will be good to us. We need to be role models for future generations.
19. What's the best success story you have personally encountered where someone changed their diet and lifestyle from bad health to good health?I have a patient who suffered a massive heart attack and, as part of his recovery, went on The Reality Diet and took up a vigorous exercise program. He has since lost 80 pounds, reduced his cholesterol and blood pressure levels to the point where he is now low risk for cardiovascular disease, and decreased his glucose so much that he no longer needs medication. Even better, his wife has gone on the diet with him and lost more than 50 pounds, most likely averting a serious cardiovascular event of her own.
20. The best part of being the author of the latest best selling diet book is :
    meeting so many people from all over the world and believing that I am making a difference.