One Order of Fried Chicken: Hold the Calories

Right before Thanksgiving, the FDA announced its new regulation requiring restaurant chains as well as those selling ready-to-eat food; from convenience stores to even movie theaters, to post the caloric contents of the food they are selling. It was not the most fortuitous time to do so, considering that people consuming at least 3,000 calories during the kickoff the holidays feast would not be worried about eating a measly 1,000 calories from a bucket of movie theater popcorn.

The regulations will not go into effect for a year, however, and might be delayed by the protests of some in the food business concerned with the difficulty of providing accurate calorie contents. Pizza chains are concerned with posting the calorie contents of their almost infinite combinations of toppings, and supermarkets announced that they might have to decrease the number of ready-to-eat foods because of the difficulty in calculating the calories in many of their dishes. Moreover, who is overseeing the actual calorie count? Is there to be a calorie inspector counting black olive slices on a piece of pizza or the number of drops of olive oil sprinkled on the cheese? Will the supermarket hire a portion control guard to make sure that customers serve themselves a portion size corresponding to the posted calorie count? Are there officials who will keep track of the chocolate sprinkles on a doughnut or raisins in a raisin bagel? The possibilities of calorie error, yea even calorie fraud, seem endless.

And will any of this have an impact on food choice and ultimately weight?

Those already alert to the pound elevating capacity of innocent-looking foods like whole-fat yogurt with granola or a grilled chicken sandwich with pesto and avocado, will no doubt use the calorie information to prevent themselves from gaining weight and/or continuing to lose it. Others who have a vague idea of the calories in ordinary breakfast or lunch foods may experience something akin to sticker shock.

A chain sandwich shop located down the street has posted calorie contents for its sandwiches, soups, and salads for a few years. A friend told me that several times she walked into the restaurant very hungry but then walked out without buying anything because she couldn’t decide between what she wanted to eat, that is, a tuna wrap, and what she felt she should eat, a kale and egg white salad. The salad contained two hundred fewer calories than the tuna wrap, but she hated kale and wasn’t crazy about egg whites. But she could not bring herself to eat the tuna fish salad sandwich once she knew how many calories it provided. Some, already obsessed with calories and reducing their already skeletal frames to a smaller size, will undoubtedly find that calorie information confirms their worst fears: everything is fattening. Others who want to get the most food for their dollar, like people on a cruise or a teenage boy, might opt for calorie dense food. Why not eat 3,000 calories rather than 500 for the same $5.95 price?

Moreover, how does one reconcile the FDA’s belief that knowledge about calories will affect our eating when a major international weight-loss organization, Weight Watchers, has not used calorie counting for years in their diet program? In fact, how many weight reduction programs ask the dieter to count calories, rather than concentrate on portion size and number of servings of various food groups? How many of us even know how many calories we should be eating?

A construction worker, a corporate lawyer, a mom with two toddlers and an infant, a senior citizen who plays 18 holes of golf daily and foregoes the cart to walk, a tuba player, a taxi driver: what should their calorie quota be? Charts of calorie quotas for different age groups and size are available, but rarely do these charts factor in daily calorie output, i.e. construction worker versus taxi driver. When the food truck comes to a construction site, it is doubtful that the guys buying their meatball subs really care about calories. They have been working for hours, are hungry, and need energy to continue working for several more hours.

The FDA and other agencies concerned with our nation’s weight should put its efforts into informing the public about their personal calorie requirements and how this is influenced by their current height, weight, size and usual energy expenditure. Does the construction worker understand that come Sunday, when he may spend hours in a recliner watching football, he does not and should not be eating as much as during the work week? Does the corporate lawyer who works at her desk for 12 or 14 hours a day know that she can eat more calories on the weekend after several hours of cross-country skiing or a long bike ride? Should a woman in her late seventies, who has shrunk two inches, be eating the same number of calories as she did twenty years earlier? She is shorter because of compression of her spinal cord. Does this mean she should eat less?

On the other hand, and there is always another hand, calorie information is useful for dieters and non-dieters. When we buy something, we obviously know the price. Very few (is there anyone?) would buy something without knowing how much the item costs. Except for the multi-billionaires in the world, almost no one has unlimited financial resources. The same is true for calories. Unless one is training for an Ironman triathlon or has an overactive thyroid, who can eat an unlimited amount of calories? Labeling restaurant food with its calorie content allows us, if we wish, to avoid foods that use up too quickly our limited calorie allotment. If you know that a ladle of blue cheese salad dressing has 500 calories and a light oil and vinegar salad dressing only 100, that information would allow you to save calories and spend them on another food item. The calorie differences between a baked potato even with a pat of butter and a heaping plate of French fries, or between fried clams and baked lobster, gives you the knowledge to decide whether to ‘spend or save’ the calories.

The FDA is not your mother attempting to make your food choices for you. You make choices all your life based on whatever information you have. Calorie content of restaurant foods is helping you makes informed choices. It is up to all of us to use the information wisely.

Should Couch Potatoes Wear Fitness Bracelets?

Looking for a gift for a runner in our family, I wandered into our nearby sports store and stopped by a large display of devices and gadgets that monitor activity: sleep, calories, heart rate, and perhaps in the near future, how well your investments are doing from minute to minute. The price, as well as the tendency of the gift recipient to lose anything not fixed to her body (she is a young teenager), made me look for something else, but it got me wondering who would get the most use out of such gadgets? I have seen the rubberized bracelets on the wrists of people going into spin class or lifting weights, and the ever-increasing variety of devices suggests an ever-increasing market for self-health monitoring. But like the proverbial preaching to the choir, are these fitness devices attractive primarily to the already fit? Or are they like scales, to be avoided if you know you are sedentary and have gained weight?

The relevance of devices that measure activity to those who shun it was pointed out to me by my dog, an exercise avoidant dachshund, who tends to combat me for every inch he walks. Worried that his already slothful ways would increase as the temperature dropped, I considered buying a canine fitness device that, like a human fitness bracelet, would measure his daily mileage or centimeters walked. I reconsidered when I realized that his walking was my walking as he was always on a leash. The free app, MOVES, would tell me how many steps I was taking and although I am too mathematically impaired to see how that corresponded to four footed steps, at least I would get some idea of how weather was changing activity for both of us. Indeed, on some exceptionally frigid days, we both were quite sedentary (except that I could go to the gym).

Everyone knows that we as a nation are growing fatter, and lack of physical activity still remains one of the most prominent causes. But how much physical activity do we not do? How sedentary are we?

Patients who come to see me for weight-loss counseling usually claim to exercise a few hours each week and only a few would acknowledge how little they actually do. Those with gym memberships are vague about how many times they worked out and walkers are equally vague about the frequency of their perambulations. In fact, their vagueness is matched only by their inability to recall with any accuracy what they eat every day, especially at non-meal times. And once on a diet, promises to increase their physical activity are made but unlike Robert Frost’s poem, rarely kept.

Measuring physical activity, either with a free APP or purchased device, might be extremely useful in helping my patients reach their weight-loss goal. Calorie intake is only one part of the weight-loss process, and if physical activity monitoring showed very little activity, it would explain why the pounds were coming off so slowly.

Conversely, most people on diets, or just those seeking to become fit, would respond positively to even a slight increase in the number of steps taken and miles walked each day. The MOVES app tells you, as soon as you turn on your cell phone in the morning, how much walking you did the day before. And sometimes the results are surprising in a good way. You the walker might think you did relatively little walking the previous day, and find that all that going and coming from the basement to the attic, shopping at the mall for holiday gifts or, in my case, walking the dog, adds up to a respectable number. Suddenly it doesn’t seem so hard to move off the couch and get moving. And the congratulations, “Today is an all-time personal best for you” message appearing on the phone is a virtual pat on the back, and must have some positive impact on continuing to move.

The days that show little activity are just as important. Why was there so little walking? Was it because you had to sit in meetings, at your desk, or in a plane all day? Were you stuck doing errands and chauffeuring kids around? Was it simply too cold or too hot to walk outside? Were you getting or getting over a cold? Some situations that prevent you from walking may be resistant to change; you can’t alter the polar vortex or stop a trial so you can go for a walk. But if your app or monitoring gadget shows about the same amount of activity as if a 200 year-old tortoise wore it, then this is a warning of transformation back into a couch potato. Even something as simple as walking rather than sitting if you are talking on the phone, or getting up from your desk chair rather than rolling it over to the printer add steps to your day, and therefore caloric burned.

It is not easy to get thin and fit, especially as we recover from Thanksgiving and head into the pudgy season of Christmas. But these monitors may help support you, each step along the way.

Hold the Gluten! Pass the Fat! The Contemporary Thanksgiving Meal

The Thanksgiving day menu from the Fall of 1621, when the Pilgrims and the Wampanoag Tribe feasted in gratitude for the newcomers first harvest, has gone through profound changes. Yes, turkey was on the menu but not the main dish. Turkeys in the early part of the 17th century were probably not unlike the drab, skinny, aggressive birds roaming the inner suburbs of Boston, terrorizing small dogs, children, and on occasion even postal workers.  These urban turkeys do not resemble the plump fowl we’ve come to expect for our contemporary Thanksgiving meal, and it is easy to see why duck, venison, lobster, oysters, and clams had pride of place, along with squashes, berries, and a baked cornmeal-like bread. They did not yet have wheat.

A century later, Alexander Hamilton proclaimed that turkeys should be eaten at Thanksgiving  (maybe the turkeys in his neighborhood were better looking) but it wasn’t until the mid-19th century, when Lincoln made Thanksgiving a national holiday, that turkey rather than lobster, venison or pot roast, for that matter, became the traditional dish.

Today’s Thanksgiving day menus barely resemble the foods eaten in the early 17th century:  the Pilgrims should be thankful that marshmallows had not yet been invented, and they might have been perplexed at how they could stuff those scrawny turkeys with a soggy mass of  bread , celery, apples, chestnuts, raisins, and sausage. If they had followed contemporary cooking fads and fried their turkey, Massachusetts might have been set on fire, and turkey made out of tofu would have sent many early settlers scrambling to get back to England, where birds were not made from soybeans.   

As our country became regionally and culturally diverse, so did the Thanksgiving menu. Years ago, I was invited to a Thanksgiving meal at the matriarch’s home of a large Sicilian family, and if there were turkey on the table, it was hidden by the bowls and platters of lasagna, sausage, escarole, meatballs, and fried eggplant. This one dish of stuffing, aka dressing, is our continental consistency, however, and its ingredients are a prime example of our regional and national diversity: in the South, cornbread is the main ingredient but in other areas stuffing came be made from white, wheat, or rye bread. Additional ingredients include oysters, apples, chestnuts, raisins, celery, sausage, and even cheese and raw eggs.  

Now home cooks are facing new challenges to their Thanksgiving Day meal that go beyond  whether to put marshmallows on the sweet potato casserole, or how to separate Aunt Mary from nephew Sam so they won’t spend the entire meal arguing politics.  These issues pale before the problem of: What can I serve to satisfy the never ending food issues of the guests? Should I have asked them to fill out a food preference list a few weeks ago so their specific needs will be addressed?  

Attending to the foods likes and dislikes of family members and friends is as probably old as Abraham serving goat (or maybe lamb?) to the three angels who appeared before his tent.  An older relative always had beef and chicken dishes available at any dinner party she hosted in case, as she always told me, “What if someone doesn’t like brisket?” My response, to serve them cornflakes, was ignored. But now, the needs of guests have expanded far beyond food allergies, low salt or low fat diets, and a persistent hatred of Brussel sprouts.  

Sensitivity to lactose, the sugar in dairy, must be noted before adding evaporated milk to the pumpkin pie, or butter (it contains milk solids) to mashed potatoes and string beans. Those adhering to the Paleo aka The Caveman Diet, should be given their turkey more or less raw with perhaps a hunk of wooly mammoth as dessert. The high fat advocates? They will want to skip the vegetables, unless they are saturated with butter and cream, but will ask that the layer of turkey fat on top of the gravy not be skimmed off before being poured over their meat. And of course the gluten-free folk will find foods compatible with their need to avoid this wheat protein, but only if the menu is kept as simple as that of the Pilgrims. Boiled squash, pumpkin, ground corn, and berries, along with the turkey should be a safe for them to ingest, and they must be warned away from touching the biscuits, cranberry bread or pies, as eating them will surely cause distress. (I suspect not eating those luscious pies should also cause them some distress.) The easiest guests to feed are those following the Cleanse Diet; just give them a glass of warm water and lemon juice.

Thanksgiving is a meal commemorating the survival of the plucky Pilgrims through the harsh winters, cold springs and uncertain summer harvest. They made it, thanks in large part to the help of the Native Americans with whom they shared this feast. Their meal, lavish in relation to what they had to eat daily, was a feast and they gave thanks to the abundance of food before them. Now, living in a society with a daily over abundance of food, it is not strange that for many, today’s Thanksgiving meal is a testimony to what we cannot eat rather, than being grateful for what we have been given? 

Chasing Away Insomnia With a Bowl of Oatmeal

Mike, the guy behind the desk at the gym, was yawning so much he could barely say good morning. “Late night?” I asked him. “No,” he yawned in reply. “I haven’t been sleeping well for days.”

“How long have you been on the high-protein diet?” I asked, knowing nothing about what he had been eating, but guessing he had fallen prey to the fitness hype about the benefits of avoiding carbohydrates.

I was right. Mike’s sleep problems started two weeks earlier because he had cut all starches and sugars from his diet. Now his sleep was like a yo-yo: asleep/awake/asleep/awake all night long.

“I go to sleep at midnight, and I wake up at 2 or 2:30. I then fall back asleep, and I’m up again in another hour. My mind is racing, and I feel agitated and simply can’t relax,” he told me.

If Mike had searched the Internet during those wakeful early morning hours, he would have read countless anecdotes from others describing similar sleepless nights. Whether the problem was failing to fall asleep easily, or get through the night without multiple awakenings, all the insomniacs had one thing in common: they were on high-protein, low or no-carbohydrate diets.

This is not to say that there are not many other causes of sleep disturbances from taking too long to fall asleep, trouble staying asleep, or waking up too early. Anxiety, age, sleep apnea (which awakens the sleeper many times during the night), drug side effects, some degenerative diseases, and even shift work are but a few of the obstacles preventing this most natural and wanted behavior. But if someone stops sleeping normally at the same time as he or she stops eating carbohydrates, it does not take a sleep disorder expert to figure why…too little serotonin is the cause.

Serotonin, the multi-functional brain neurotransmitter, normally soothes your brain into a calm and tranquil state so sleep comes easily. If you awaken, serotonin prevents the anxiety demons from leaping out and filling your brain with worries that prevent you from falling back asleep.

To some extent what we eat influences whether or not our brain is able to make serotonin. More than 30 years ago, research at MIT uncovered the connection between the consumption of any carbohydrate (except fructose) and serotonin synthesis. The release of insulin after carbohydrate is digested indirectly

helps an amino acid, tryptophan, get into the brain. Once there, tryptophan is converted through a biochemical process into serotonin. However, when more than small amounts of protein are eaten along with the carbohydrate, this process is blocked.

Serotonin synthesis was never in peril until recently. For most of our history, carbohydrates have been a staple of our diets, and being told to avoid them would have been as unimaginable as being told to walk on our fingers. Alas, the self-appointed nutrition gurus who are convincing us that the eating of carbohydrates will destroy our bodies, or at the very least, turn us into a human version of Humpty Dumpty, don’t understand that we have to eat carbohydrates if we are going to make serotonin.

When you are awake at 2AM searching the Internet for help with your insomnia, you will come across bland assurances that eating protein will give you the tryptophan you need to make serotonin. To borrow a phrase from the Gershwin’s Porgy and Bess,”… It ain’t necessarily so.”

Here are the facts: Eating protein prevents tryptophan from getting into the brain. Eating turkey does not increase the tryptophan in your brain (you are sleepy after the Thanksgiving Day dinner because of the fat you have just eaten). The research evidence conclusively shows that tryptophan is blocked from entering your brain after you eat protein.

So as you lie awake in your dark bedroom wondering whether you will fall asleep before the alarm goes off, contemplate your problem: sleep or a high-protein diet?

But good grief, you will say. If I eat carbohydrates, like the man in that Kafka novel, The Metamorphosis, I will wake up with my body horribly altered? (Kafka’s hero became an insect). Pounds will attach themselves to my body as I sleep, and I will need a tarpaulin to cover my now massive body!

Well, yes you might, if you eat croissants, doughnuts, mega-muffins, scones, French fries, potato chips, tortilla chips, baked potatoes leaking butter, and crackers covered with 80% fat cheese. Oh, and of course, weight gain is to be expected from consuming too much chocolate, ice cream, cookies, cake and piecrust. These foods are not just carbohydrate but full of fat, too. And since fat contains more than twice as many calories as carbohydrates, if you eat copious quantities of any high-fat foods, you will gain weight.

But you can get a decent night’s sleep, and leave the tarpaulin outside, if you eat very low-fat or fat-free carbohydrates like ¾ of a cup of plain Cheerios or Rice Chex, a small bowl of oatmeal, toast with strawberry jam (the sucrose supercedes the trace amount of fructose), or a graham cracker square. Don’t wait until the middle of the night before consuming the carbohydrate. Instead, eat a small, 120-calorie carbohydrate snack twice a day, before or several hours after you eat protein. This will help increase serotonin synthesis before you go to bed. If you have been on a low or no-carbohydrate diet for several weeks, it may take some time to restore your serotonin levels. So don’t worry if you still wake up during the night for a few more days. Eat another small snack. You will be back to sleep in about 20 minutes.

Try this. You have nothing to lose but your insomnia.

When Kids Grow Fat From Medication, Who Protects Them From Being Bullied?

The good news is that the increase in obesity in kids seems to be leveling off. Perhaps this is due, in part, to healthier school lunches and/or an attempt to get kids to exercise more. It’s a good thing, because fat kids are likely to be a verbal and physical punching bag at school, in their neighborhoods, and often at the family dinner table.

That obese adults are targets of verbal abuse, often from strangers as well as from officious relatives and nasty co-workers, is well known. Their ability to defend themselves is limited. Unlike hate speech, there is no legal penalty for laughing at the body of someone else, and it is hard to prove that obesity is involved in job discrimination. But adults sometimes have the option of escaping from situations in which they are victims. They don’t have to see offensive relatives or spend time with puny-brained fellow employees who feel good by making others feel bad.

Children don’t have escape routes from bullying, even when parents and school officials get involved. What happens on the walk home from school, or on the playground away from the eyes of a monitor, in the school bathrooms, or on Facebook, is often not preventable no matter how many meetings of school officials and declaration of no-bullying policies.

Obese children are the most likely to be bullied.

The National Education Association (School Psych Rev 2013; 42:280-297) reported weight-based bullying to be the most prevalent of all causes of bullying, and not just among younger children but among obese teens as well. Sadly, criticism and worse about their weight seems to come from parents and teachers as well (Pediatrics 2013; 131 abstract).

Now imagine a kid, formerly thin, who gains 50-75 pounds from medication he is taking to control uncontrollable rages or impulsive behavior or anxiety or depression. A pediatrician at one of Boston’s leading pediatric departments told me that such kids who are put on anti-psychotic medications to control severe behavioral problems might be able to be mainstreamed in school. But now the 7-year-old who weighs as much as a 13-year-old is the victim of bullying. He is still fragile emotionally, and perhaps not well socialized into his peer group because of his mental problems or autism or Asperger’s syndrome. He no longer can run fast, bend down to pick up a ball, do gymnastics, or climb a rope. He is alone in the proverbial school yard or bathroom. Who is protecting him from the inevitable teasing? These children are supposed to be helped and supported en route to being integrated into conventional schoolrooms, but bullying presents a barricade that many may not be able to overcome.

Putting such kids on a diet seems like an obvious solution, except that these kids can’t prevent themselves from overeating. Their medication is making them constantly hungry and unsatisfied with food portion levels that kept them full before going on their meds. And like adults who gain weight from the same medications, few, if any weight-loss interventions really grapple with the cause of the weight gain or come up with interventions that counteract the effect of the drugs on food intake.

Medications and other interventions like physical therapy have been developed to handle the side effects of chemotherapy and other medical treatments. Anti-nausea drugs, medications to control vertigo or mouth sores, and physical therapy to help overcome muscle and nerve weakness and pain are among only some of the ways drug side effects are being combated. But weight gain from drugs taken to help mental illness is the blind spot in the battle against drug side effects. The problem is ignored, rationalized as a small price to pay for the therapeutic benefits of the treatment. Or, the obese patient is handed off to a conventional weight-loss program with no experience in dealing with this specific cause of weight gain. If most of these programs have little or no permanent success treating obese individuals who gained weight the traditional way, how then can we expect any success among those whose meds are making them eat too much and too tired to exercise?

Prevention may be the only workable answer. When children are started on these medications, parents must be alerted to the increased appetite that will follow and advised to restrict or eliminate highly caloric foods in their homes, school lunches, and restaurants like fast-food chains. The child must also be encouraged to exercise constantly to prevent weight gain from becoming so excessive that it becomes difficult to do so.

And parents, teachers, school staff and relatives have to protect their child from becoming a target because of his or her weight gain. The child is already a victim of the side effects of the medications; more victimization is unthinkable.

I’ll Have a Glass of Grapefruit Juice With My Bacon Fat

How can it be? A dieting concept that is more than 80 years old and should have been laughed out of existence now suddenly may have some validity. The concept is grapefruit juice. My mother-in-law went on the grapefruit and lamp chop diet in the early 1930s (lamp chops were a lot cheaper then) to lose weight before her wedding. She told me about it years later, and wistfully recalled how quickly the weight came off.

Listening to her, my unspoken, but cynical take on this (she was my mother-in-law, so of course I did not say anything) was that restricting food intake to two or three items always causes weight loss. Boredom and even intestinal discomfort usually occur after a couple of weeks, if not sooner, and often the choice not to eat seems preferable to consuming, yet again, another grapefruit or well-done chop. Of course the weight came back, but that is true of most diets.

But the dieting world wasn’t done with grapefruit, even if my mother-in-law, after her wedding, was. It kept on popping up as a fat-burning food despite the lack of any credible research to support the claims. The Depression and WWII interfered with further promotion of grapefruit as a weight-loss stimulator. First, people didn’t have enough to eat and later, during the War years, rationing and limited food supplies must have made any dieting effort seem irrelevant and nonsensical.

But leaping ahead to the l970s, we find grapefruit emerging as the star food of the Hollywood Diet, or the Mayo diet, supposedly endorsed by the Mayo Clinic, which disdained to have anything to do with this fad. But here again, the diet was all smoke and mirrors. Of course the dieter would lose weight eating grapefruit at every meal. The dieter would have lost weight eating raw rhubarb at every meal. Only 800 calories a day were allowed on the diet, and like the Atkins program later on in the century, no carbohydrate was allowed. Only meat was okay to consume, although probably the cost of lamb chops was high enough so hamburger was substituted.

But the search went on for that elusive something in grapefruit that in some people seemed to promote more weight loss than expected from their daily calorie intake. It is known that grapefruit contains the chemicals naringin and hesperidin that have antioxidant activity. Could these be responsible for some unanticipated weight loss?

A study published in the journal Metabolism in 2012 by Dow, Going, Chow and others set out to answer conclusively whether grapefruit contained a potent weight reducer. The results were inconclusive. Overweight subjects who ate a half a grapefruit before each meal did not lose any more weight than control subjects who were not allowed to eat any grapefruit. Total cholesterol and the bad kind of cholesterol, LDL, decreased in the grapefruit group, as did their waist measurement but the differences were not statistically significant. However, the smaller waists of the subjects indicated that they might have lost belly fat, which is important in terms of cholesterol and blood pressure levels.

So is grapefruit moribund as a weight-loss activator? Apparently not. My mother-in-law may have lost weight not just because she became nauseated at the thought of eating another lamb chop and piece of citrus. Or to be precise, grapefruit juice now seems to be a potent inhibitor of weight gain if you are a mouse who loves to eat fat.

A few days ago, a group from University of California, Berkeley reported that mice that were fed a high-fat diet and drank pulp-free grapefruit juice gained 18 percent less fat than fat-eating mice that drank water. The grapefruit drinkers also had healthier glucose, insulin and triacylglycerol (a type of fat) levels in their blood. The study, conducted by Andreas Stahl and Joseph Napoli, was published in Plos One, a highly reputable online journal.

The mice were fed a diet that would have made Dr. Atkins weep with joy: it contained 60-percent fat and they ate it for 100 days. Mice in the fat-eating control groups were given water rather than grapefruit juice, and other groups were put on a healthier low-fat diet and given either the juice or water. And finally, the chemical naringin, which was assumed to be the reason people lost weight eating grapefruit, was given to two other mice groups also fed either high-fat or low-fat diets.

Against their expectations, the researchers found that the mice eating massive quantities of fat and drinking grapefruit juice gained substantially less weight than the water drinking, high-fat fed mice. Mice eating the more typical mouse-like, low-fat diet (mice normally do not feast on very fatty foods. They prefer grains, seeds and nuts) did not show much of a change in their weight regardless of what they were drinking. And naringin had no effect at all on decreasing weight gain.

These results perplexed the researchers, especially after they looked for typical explanations as decreased absorption of the food, increase in activity, and perhaps the fact that eating mostly high-fat food made the mice less hungry. None of these factors was responsible for the decrease in weight gain.

Obviously, human studies along with more animal studies must be done to find out how the juice from a particular citrus fruit could prevent weight gain on a diet that otherwise would provoke it. But this first report certainly raises intriguing possibilities.

Might a weekend of eating whipped cream-topped chocolate mousse and sausage, bacon and cheese omelets with butter drenched toast prevent the scale from imploding if you drink grapefruit juice along with your meals? Regardless of the answer, you can be sure that weeks from now there will be advertisements on the Internet promising magical grapefruit juice pills that will do just that.

Can You Get Scurvy If You Eat Out Too Much?

Soon after arriving home from a short trip to Manhattan, I took a vitamin pill.  No, there was nothing arduous about the return journey that required a dose of nutrients. But on the train back to Boston, I reviewed in my mind the various places where we breakfasted and dined (lunch was usually skipped) and realized, that except for a shared salad at one dinner and some fruit at a breakfast, I had failed miserably at consuming the recommended daily servings of fruit and vegetables.  For a 2000-calorie diet, the recommendation is to consume about 2 -2 ½ cups of fruit and 2 cups of vegetables daily.

This wasn’t because I had left vegetables and fruits untouched on my plate. There were never any on the plate. The restaurants (Greek, French, and mixed American), chosen by consensus, had large selections and theoretically should have been able to supply some vegetables. Indeed, the Greek fish restaurant did have appetizers, i.e., Meze, that incorporated some vegetables like eggplant and cucumbers into purées, dips and wraps (like grape leaves).  But the main courses in all three restaurants presented an entrée on an otherwise naked plate. To be sure, vegetable side dishes and salads were available but the size and, quite frankly, the cost of these extras made them less attractive. Somehow spending the money for three grilled asparagus that one would spend for a pound of the same vegetable at Whole Foods seemed like an unjustifiable extravagance.

Desserts were not considered but quick polite scans of the dessert menu (after all, if a server puts one in your hand, the least one can do is look at it) showed a uniform absence of anything resembling a fruit.

Obviously eating away from home because of business, travel or vacations is not going to cause acute malnutrition. And is certainly possible and not that all difficult to choose restaurants that offer enough vegetable and fruit selections to satisfy the USDA nutrient intake recommendations as well as one’s mother. Had we been eating on our own, we would have done so.

But we have come a long way from the time when all restaurants put vegetables on the plate, gave you a salad along with the breadbasket, and included fresh fruit on the dessert menu. There was a time when cafeterias were as common as fast-food restaurants are today, and the number of cafeteria trays holding vegetables was as numerous as those containing meat, chicken or fish. To be sure, the salad may have consisted of watery iceberg lettuce and tasteless tomatoes, and the vegetables came straight from an industrial size can, but no one expected a lunch or dinner meal to consist only of a solitary protein entrée. Fifty or sixty years ago, if you were served a plate with two lonely lamp chops or a chunk of fish and nothing else, you might have thought the server forgot to put the two veg and a potato on your plate.

Like other cultural changes that creep up on and take hold (who remembers records and landlines?), we don’t notice the chronic absence of vegetable options in the “nice”’ restaurants, or our habit of putting together our own meals without including them.  And a result, we fail to notice that we may have stopped eating vegetables altogether. They have become a forgotten food.

In contrast to the ongoing debate over high and low-carb or high & low-fat diets, the extraordinary powers of protein to turn us back into Paleolithic cave people, and the devastating effects of gluten on the brain, no one discusses vegetables.  Who debates the merit of spinach over kale or Brussel sprouts over broccoli? When was the last time the Science section of leading newspapers had research on the merits of vegetable consumption? 

Fortunately, there are some recent trends that may forestall an outbreak of scurvy or other nutrient deficient diseases. Leading chefs are inventing ways of turning the ordinary carrot, string bean or beet into creative, original dishes that rival the importance of the protein selections on the menu. Vegetable-laden smoothies and juices are becoming ubiquitous; the selection of bottled vegetable juices go far beyond V8, and juice bars allow customization of vegetable and fruit mixtures. Mixed drinks containing vegetables haven’t found their way into wine bars yet but someone will come up with an alcohol beverage that somehow incorporates kale. Supermarkets have, for many years now, made vegetables available for immediate consumption. No washing, peeling, slicing or dicing necessary; just chewing.  And to remedy the “How do I get my family or spouse to eat vegetables?” problem, many frozen varieties are sold with sauces or suggestions on how to transform the pea or carrot into a gourmet dish.

But….the vegetables have to be bought and eaten at home, not left to gradually decompose in the vegetable bin. If eating away from home is more frequent than dining in one’s kitchen, restaurants should be chosen that offer healthy salads and vegetable side dishes with affordable prices.  Most restaurants display their menus on the Internet so it should be possible to find some that do not regard vegetables as a colorful garnish.  The cost of those vegetable side dishes could be decreased if both the entrée and the vegetables and/or salad, are shared.  Lunch is an easy meal at which to eat vegetables as these days many feature salads or salad bars; even airport restaurants offer a variety of freshly made salads. (Our problem in New York was that we skipped lunch).

It takes some effort to develop scurvy; even the British sailors who did so were not vulnerable until many weeks of vitamin C deprivation. But it also takes a little effort to remember that vegetables are part of a healthy diet and should be hunted and gathered, even if the gathering is at a salad bar.   

Why You Really Run Out of Gas Every Afternoon

As the sun begins an earlier dip into evening darkness at this time of year, our mood and mental energy seem to dip with it. Known as the afternoon slump (or the brain-dead zone), most of us feel a stronger urge to be in bed with a pillow over our heads than to continue with our work obligations for another few hours.

Indeed, the fatigue sometimes seems so overwhelming, especially when the work preceding late afternoon has been mentally and emotionally stressful, that our bodies feel as if we’ve been on a construction site all day. (Maybe we have.) A friend who is a litigator told me that doing a cross examination in a courtroom leave him more exhausted than two days of yard and house chores, even though his courtroom physical activity is limited to standing, sitting, and occasionally walking a few feet away from his chair.

“There is something peculiar about late afternoon,” he told me. “I consider myself a pretty calm guy and able to resist reacting to insults or challenges from other lawyers or a judge. But around 4 pm, I feel myself either feeling suddenly sensitive to the tension in the courtroom, or overcome with profound fatigue.”

A late afternoon slump can descend on anyone—a UPS delivery person, a daycare assistant, or a neurosurgeon—and it is more likely to occur as the days shorten and the light outside no longer feels like midday, but like the start of evening.

Magazines and websites are full of advice about this problem—most of it entirely wrong.

Many assume that this slump is caused by the body’s need for energy, and recommend eating a bigger lunch or snacking to increase low blood sugar. But the cause of this fatigue and mood change resides in the brain, not in the blood.

Is anyone really famished at four in the afternoon? Sure, if someone exercises at lunch but doesn’t eat afterward, he or she will be quite hungry by late afternoon. But the rest of us? Beyond infancy, we do not need to be fed every three, and so even if lunch is over at 1 pm, our bodies really do not have to be fed again three hours later.

But our brains are different.

To understand what lies behind the urge to nap rather than write a report in the late afternoon, we have to see what is going on with serotonin, the brain chemical which attempts to keep us energetic, focused, and in good humor.

Something happens late in the afternoon to the activity of serotonin. There may not be enough of this neurotransmitter, or its activity may slow down; whatever the mechanism, the result is a deadening of mood, motivation, and mobility.

We discovered this en route to studying something else: why many people wanted to eat a sweet or starchy carbohydrate snack late in the afternoon. Volunteers were living in a research residence where snacks where available 24/7. But they never snacked until late afternoon. Why then? They told us they felt their mood deteriorating at that time. They felt depressed, tense, impatient, and tired. They could not concentrate. But they claimed that after they ate some carbohydrates, they felt better.

This was all anecdotal, interesting, but not scientifically valid. We wanted to know: Did they really feel better after eating carbohydrates or just thought they did because they liked to snack?

The truth is, they really did feel better. We know because at one time, we gave them a drink that contained enough carbohydrate to increase the production of serotonin in the brain (serotonin is made only after carbohydrates are eaten, not protein) and at another time, we gave them a drink that did not increase serotonin; it contained protein.

Their moods and fatigue were tested before the drinks and then again an hour or so later. The carbohydrate drink did improve their moods, and they were less tired after having it. But they did not experience the same results after the protein drink.

The volunteers taught us something very useful: If you want to lift yourself out of a slump eat a carbohydrate snack. (This does not apply to baseball.)

As the sun begins an earlier dip into evening darkness at this time of year, our mood and mental energy seem to dip with it. Known as the afternoon slump (or the brain-dead zone), most of us feel a stronger urge to be in bed with a pillow over our heads than to continue with our work obligations for another few hours.

Indeed, the fatigue sometimes seems so overwhelming, especially when the work preceding late afternoon has been mentally and emotionally stressful, that our bodies feel as if we’ve been on a construction site all day. (Maybe we have.) A friend who is a litigator told me that doing a cross examination in a courtroom leave him more exhausted than two days of yard and house chores, even though his courtroom physical activity is limited to standing, sitting, and occasionally walking a few feet away from his chair.

With that in mind, here are two suggestions to lift late afternoon mental and emotional fog:

  1. Eat 25 grams of a starchy carbohydrate such as pretzels, popcorn, graham crackers, or a piece of bread. Avoid any starchy food with fat, which will make you feel lethargic and dull. And don’t eat fruit (at least, not for this specific purpose): No serotonin is made after consuming fructose.
  2. Move, vigorously. Swallow your snack, then get up from your chair and do something physical. Find a staircase and climb it a few times. Take 10 minutes to jog around the block. If you’re home, find a jump rope, set the egg timer, and jump for 3 minutes. Or if you have a treadmill or bike, run or pedal for 5 minutes until your heart rate goes up.

Your brain will thank you. Now go back to work.

If Your Shoes Don’t Fit, Then How Can You Walk?

Maybe it is because my dog, a dachshund, is so close to the ground that my eyes are often pointed in that direction.  Or perhaps it is because there are so many dogs where I live that it is a hazard not to watch out where one’s shoes are stepping. For whatever reason, I find myself studying shoes and the way people are walking in them.  I have no training in feet, or walking for that matter, but was taught in a workshop on running techniques to watch out for a common tendency of our feet to roll toward each other while ambulating. This is a condition known as pronation.  I remember the instructor holding up the soles of a pair of  running shoes and pointing to the area on the inner portion of the heel where there was much more wear than on the outside area. “The person who wore these shoes pronates. His feet roll towards his ankles when they hit the pavement,” he told us, “And if he continues running or walking this way? His knees, back and hips will begin to hurt.  He needs shoes that stabilize his feet and let him land squarely on the pavement. “

That running instructor’s words came to mind as I plodded along behind a woman with soft, slipper-like shoes so unequally worn that I wondered how her feet did not bump into each other. Each foot was rolling toward each so that instead of the soles of her feet hitting the pavement, it almost looked as if she was walking on her inner anklebones.  “How she can walk that way?” I thought. “Should I say something? Isn’t she in pain?” and yet of course, I said nothing. What was I going to say….get thee to a foot doctor?

Of course, not everyone walks on the side of their shoes rather than on the bottoms, but there must be many people, like this woman, who don’t have a clue about what kind of walking shoes  prevent pain and injuries from the way their feet hit the ground.  The unfit, the wannabe fit, and the already fit are all told to walk as much as possible. Smartphones and bracelets measure the number of steps we take everyday, and we are routinely advised to wear comfortable shoes with good support while we are doing this.

And most of us, going out for an exercise walk, probably do wear appropriate footgear. But what about all the other times we are walking? I somehow doubt that people, probably women (because men’s shoes are so much sturdier and sensible), have available to them much of a selection of shoes that support their feet, prevent them from rolling toward each other, keep their arches in alignment andlook good. Bright green, pink and yellow sneakers may be really cute, but don’t quite go with business attire. The clunky, oh so comfortable black or white shoes worn by restaurant workers or nurses just don’t have the fashion panache most of us would like.

Moreover, where do we go for advice before we go shoe shopping? Who is going to tell us to turn our shoes upside down to check for pronation? Who is going to tell the woman I described that, given her extreme pronation problem, she really ought not to wear shoes with the support of a pair of socks? When someone complains about knee or back pain, who is going to ask, “What kind of shoes do you wear… and let me see if they are responsible for your problem?” And is anyone advising people carrying around excess weight that maybe flip-flops are not giving them enough support; that ballet slippers with no arch support or 4-inch heels may cause them so much pain that sitting, rather than walking, will be the preferred activity?

So we put our feet into often quite dysfunctional shoes with all the comfort of the slipper tried on by Cinderella’s sisters.

But where are we going to get advice that Brand X will give us the support and cushioning and fit we need, and Brands Y and Z will not, even though the shoes look more or less alike? Think of where many women buy their shoes: on-line, at big box stores, at clothing/shoe discount stores, even at boutiques whose sales clerks may know the latest fashion, but couldn’t tell a bunion from a beet.  There are stores that specialize in walking shoes, but here too, very few of the people lugging boxes of shoes from the inventory room will turn your old shoes upside down to see if you are pronating, or ask you to walk around the store to check your stride.

And really, how many physicians, especially those specializing in injuries and /or pain in our legs, knees, hips and backs, ever talk about how we walk? I once had a physician who was a runner himself with the aches and pains common to runners. But in our discussion of knee problems and plantar fasciitis, neither of us ever looked at the bottoms of our shoes to see whether they were unequally worn down. And I would venture to guess that few health clubs  offering a free evaluation of a new member’s balance, muscular strength, and aerobic status, include an appraisal of how the new member walks, and whether his or her shoes are suitable.

Perhaps free walking evaluations should be available at health fairs, or during health awareness days in the workplace. What about putting out information in the waiting rooms of doctor offices?  Pictures of what the bottom of a shoe looks like when extreme pronation occurs could be posted near the ubiquitous shelves of corn removers and arch supports in drug stores.
Granted, feet that hurt are not problems in the same league as global warming or asteroids hitting the earth…But knowing what kind of shoes to wear so that walking from point A to point B will put a smile, rather than a grimace, on your face goes a long way to making you likely to continue to walk.  

Obesity Due to SSRIs Is Not a Chronic Disease

A comprehensive evaluation of the best ways to treat obesity was published in an early September issue of JAMA [1] and offers valuable advice to physicians dealing with obese patients. There is only one little problem: Almost no attention was paid to the subset of obese individuals whose weight gain is not related to their overeating and sedentary lifestyle, but rather a side effect of their medication.

Kushner and Ryan, the two authors, did state that unexpected weight gain could be a side effect of antidepressant medication, but their advice was limited to changing the drug. Although sensible, their recommendation did not consider that most of the drugs now prescribed for depression, anxiety and bipolar disorders and other mental illnesses can cause weight gain. There are very few which do not do so. Moreover, patients are often on more than one drug, each with its own weight-producing side effect.

The article failed to acknowledge that this subset of obese individuals had a “before” when they were thin, fit, energetic, not embarrassed to be seen in public, or the target of offensive remarks often directed toward the obese. Their obesity is not chronic; it is not an ongoing struggle to control overeating and under exercising. Were it not for their medication, they would not be obese.

But they are now. They are in the “after” and suffering from a transformation of their eating habits, physical activity, bodies, and even their social life, starting sometimes only weeks after beginning treatment with an SSRI or mood stabilizer.

And to the dismay and chagrin of this subset of obese individuals, no one is paying much attention.

When was the last time the media talked about the problem, if they have ever talked about it? Endless headlines fill our newspapers, computers and smartphones about whether we should be eating 40 grams of carbohydrate or 200 grams of carbohydrate, or whether fasting and feasting is a better way of losing weight or that 30 minutes of exercise broken into 10-minute intervals provides optimal results. But where are the weight loss organizations, clinics, and medical journal articles pinpointing specific weight loss interventions for those formerly thin who think that, because of their medication, they may be permanently fat?

These individuals can be helped to establish control over their food intake even while still being treated with the drugs that are causing their overeating. They can be helped to restart their exercise routines even with bodies sluggish from their drugs and excess weight. And they can be helped to deal with the stigma they share with all other obese individuals and the unfortunate responses by the public. But they need someone to notice.

1.) http://jama.jamanetwork.com/article.aspx?articleid=1900525