Are Supermarkets the New Take Out Restaurants?

A new supermarket opened a month or so ago in a building that once housed the one and only original Filene’s Basement. In the place of racks of designer clothing reduced to the cost of a cup of Starbuck’s coffee, there were gleaming cases of prepared foods from spareribs to salads, freshly baked breads, rolls and muffins, assorted cookies and pastries, plus an enormous area devoted to cheese. Samples of freshly made mozzarella were being given out by a woman pounding the cheese into submission and having taken one, I wandered around to see if someone was also handing out samples of crackers.

There were, of course, long aisles of packaged goods from dry pasta to an exorbitant display of mustards. And like any conventional supermarket, the produce, dairy, meat and fish sections offered up food items that had to be processed, i.e. cooked, in order to be edible. But what was so entrancing about this supermarket, right in the center of a busy shopping area and near the Financial District, was the accessibility of foods ready to eat. The choices ranged from the banal (fried chicken and mashed potatoes) to the gourmet (freshly cooked seafood, salads with fashionable ingredients such as farro and arugula, and freshly squeezed juices and smoothies). It is hard to think of a restaurant that could offer such a wide variety of foods with prices that would match those in the supermarket.

Markets are already feeding zones for those who prefer getting their meals from a cardboard container rather than going to their refrigerator and preparing their meals themselves.  This one happens to be a newer generation of markets, located in an area where a food court and food pushcarts had been the most accessible options. Unlike older, more conventional supermarkets, the most prominent feature is the prepared food area. When the shopper walks in, he or she is assaulted and beguiled by counter after counter of ready-to-eat foods. It takes some walking and a bit of scouting around to find the produce section, way in the back of the store, the fresh fish case scrunched up against a back corner and dairy products somewhere behind a maze of aisles.  The message sent to the shopper is, “Don’t even think of buying something that needs preparation. We have already made it for you.”

Given that many Americans eat at least one or more meals away from home every day (this includes school children as well as adults), buying meals at a supermarket may be a more practical and less expensive option than going to a restaurant, fast-food chain or coffee shop. And the prepared foods at a supermarket may offer a healthier option than those at a chain hamburger or burrito shop. This is because supermarkets offer a variety of cooked vegetables, a variety rarely duplicated in upscale restaurants, and missing entirely in less expensive restaurants.  How many fast-food chains offer curried carrots, roasted Brussels sprouts or cherry tomato, red pepper and spinach salad? .

And consider this: The shopper who may be vegetable adverse can buy a tiny portion of a vegetable dish for a taste. Unfortunately, the supermarkets don’t allow the shopper to try a vegetable dish for free the way ice cream stores allow the shopper to taste an unknown flavor.  But spending 75 cents on two tablespoons of curried carrot salad or broiled cauliflower might convince the reluctant and vegetable phobic eater that vegetables can taste good. 

Supermarkets offering a large selection of take-out foods are next best thing to having your mother cook your dinner (if she is a good cook), but they could go a little further in helping shoppers put together their meals, for instance suggesting that they choose foods that are moderate in calories and high in nutrients. Suggestions for side dishes to go with a main course of grilled chicken or sliced brisket or salmon stuffed with crabmeat would be useful so the shopper would be eating a nutritionally balanced meal.  For example, a display could suggest adding a high-calcium dairy product to the meal by featuring a dessert of fresh raspberries topped with low-fat yogurt. The shopper would be encouraged to buy the yogurt and the berries and combine them at home.  Nutrient information near vegetables that may be unfamiliar, like beets or lentils, might induce the shopper to consider trying them.  

The down side of this is that the foods are much more expensive than if prepared at home. There is a substantial cost differential between buying roasted Brussels sprouts in the take-out section or buying them fresh, sprinkling them with a little olive oil and salt and roasting them at home. The same is true for throwing a potato in the microwave or buying it already cooked. And the shopper should be aware of the high oil content in many prepared foods; this ingredient keeps the foods moist and looking attractive.  However, lack of time, lack of even rudimentary knowledge of how to prepare foods, and lack of motivation to come home and prepare foods from scratch makes the enormous array of the supermarket prepared foods so enticing.

 This trend to using the supermarket as a restaurant is growing, and in the near future it is possible that the prepared food section will overtake most of the space formerly occupied by the traditional food displays. Should this begin to happen, let’s hope the decision of what prepared foods to sell is based on health considerations, as much as profits.

Being A Newbie Dieter Is Hard

Is there anyone out there over the age of 25 who has never been on a diet? In my weight-loss practice, I rarely see anyone who had not followed the “Every Diet of the Month” plan, and can probably recite calorie charts more easily than the alphabet.

But a few days ago a young woman came to see me for weight-loss advice whom had never been on a diet, and probably would never have needed to be on one if she had not gained weight from a medication she had been taking.   Following the diet was not difficult; she had always eaten healthily and, unlike a typical dieter, she loved exercising.  What puzzled her, however, was how to behave as a dieter when she had to eat in public, namely at family gatherings, social events, business meetings and while traveling.

“How do I tell my mother-in-law that I can’t eat pizza for lunch? What do I eat at my college reunion dinner next week?  I am flying to the west coast for a meeting. Should I take my own food to eat on the plane ride? What happens if I can’t get the foods I should eat? ” I was asked. She was concerned that if she substituted spinach for kale, or salmon for chicken, her weight loss would halt.
These and similar questions made me realize that dieting, like any other new endeavor, has its own learning curve. The experienced dieter can eye ball the difference between a 6 or 10 ounce piece of chicken, and is aware of how many calories are in a tablespoon of blue cheese salad dressing or glass of orange juice. She also knows what to eat on a plane, what to bring for lunch and how to “drink” at a party without really drinking. She may attend weight loss support groups and/or have friends also on diets so that problems such as: the intrusive or insensitive family members; nasty comments from co-workers about how much or little weight the dieter may have lost; and the insistence by others that the dieter eat fattening foods, can be discussed and solutions offered.

But this young woman did not attend organized weight-loss meetings, nor did she have any friends who were on diets. She joined Weight Watchers but said she felt people were not terribly sympathetic toward her need to lose weight. This was understandable since at her heaviest weight she was a size 4, and members thought she was a group leader. Moreover, everyone she spoke to had been going to WW meetings for years and/or was a veteran of many previous diets. Her concerns and questions as a newbie dieter were answered, but she felt like an amateur.

Learning a new skill, whether it is playing the violin, watercolor painting, hitting a golf ball or writing a memoir, requires instruction if the endeavor is to succeed. Obviously a Mozart or Rembrandt needed less instruction than the average mortal musician or painter, and so-called natural athletes probably can figure out how to swing a golf club or hit a ball without more than a few suggestions.  Dieting is also a new skill and, like other enterprises, if the instruction is misguided, inadequate or wrong, failure to lose weight and keep it off may result. A new dieter scammed into buying into some quick weight-loss program, or put on a weight-loss drug without any dietary or exercise advice, has little chance of keeping off the weight if (and this is dubious) the weight-loss goal is even reached.  A new dieter talked into losing weight by eliminating entire categories of food or semi-starvation, has no idea how to reintroduce food back into his or her life without losing control and bingeing. Exercise programs designed for the already fit participant may leave a novice in pain and injured.

If you buy a new computer, smart phone, watch or electronically-programmed car, experts are available by phone, email, texts, and in person to help you figure out how to work the device. And I know from my own experience that these experts are patient and gentle even when being asked really dumb questions. Many of us have received help from a co-worker or young child who takes over our computer or smart phone and, in two milliseconds, shows us some technique to make using the device easier. That kind of instant help is rarely available for the beginning dieter facing her first buffet or dinner at her new in-law’s home.

Where are the experts to help, graciously and patiently, the new dieter unfamiliar with reading labels, calorie-cutting food preparation, portion sizes at restaurants, dealing with stress-induced overeating and alcohol intake at parties? To be sure, some of these questions can be answered on the many Internet sites concerned with weight loss, and also in meetings of national weight-loss organizations. But the answers are, in general, impersonal rather than targeted toward the individual’s personal needs and lifestyle.

And yet when such advice is available, and when the dieter is successful in losing weight, the results can be life changing.  She is able not only to lose weight, but also to gain an understanding of how to maintain the weight loss permanently. Like the golfer who does not develop bad habits while learning the game, the informed and aided dieter will avoid making mistakes that may lead to a lifetime of losing and gaining weight.

Sometimes it is hard to know how and when to offer advice. Dieting for many is a private matter, and one can no more go up to a dieter and say, “You are doing it all wrong!” than a golfer can say to another, “What a dreadful swing!” But if we know someone starting on a diet for the first time, we can look for opportunities to offer our help and advice assuming we are experienced ourselves in the art of weight loss.  And whenever possible, we can help to create an eating environment and exercise opportunities to make weight loss for the newbie dieter less of a struggle. It is a favor worth giving.

Accelerating the Diet Without Dieting

A friend of mine is about to dump her diet. She promised herself a total makeover once she lost the 25 pounds keeping her from her desired weight. Eighteen of those despised pounds came off fairly steadily, and she assumed the rest would follow at the same rate. But it never happened.  Her diet stalled. Why? Maybe her portion sizes became a little more flexible, her snacking a bit mindless, and her alcohol intake a bit more forgiving.

“Just let me make it to a twenty-pound weight loss, “she wailed to me over the Internet. Well, not exactly wailed, but the unheard sounds of despair were there.

“Why don’t you try the walking cure?” I suggested. “It will accelerate your weight los, and you may lose one or two pounds in a day.”  Then I told her about my unexpected weight loss after a young relative, graduating college, walked her family not only around the university, but the immense park across the street, her favorite neighborhood restaurants, off-campus housing, and even the shopping center where she bought her groceries. My MOVES app indicated that I had walked for almost 5 hours. Two days later, my scale read almost two pounds lighter.

Most dieters, like my friend, experience this “Diet Stall”.  Weight continues to be lost, but so slowly that changes on the scale resemble traffic during rush hour. The cars and your weight loss either creep along or don’t move at all.  In part, the weight loss slow down is physiologic. The body’s metabolism adapts to the reduced calorie intake of the diet by conserving, rather than burning energy. Some muscle mass may be lost simply because less is needed to support a lighter body, thus diminishing energy use even more. And unless dieters are following a packaged drink or food plan, they begin to be a little more generous with the food they allow themselves to eat than when they were at the beginning of a diet.

Substantially increasing physical activity for a day or two may jolt the body into revving up its metabolism and burning off extra calories. A couple of stuck-on pounds should drop off and motivate dieters, like my friend, to stay on track with their weight loss goals.

But how can we do this?  Spending hours walking or engaged in any physical activity as little as once or twice a month is, unfortunately, difficult for most of us. To be sure, going on vacation and strolling around Paris or San Francisco for several hours will produce weight loss as many tourists have, to their delight, discovered. But how does one do this on our already overcrowded schedules? Walking for the sake of walking is a luxury of time that most of us don’t have.  Indeed, squeezing physical activity into an overcrowded work week or weekend takes planning and commitment.

But losing weight must also be a commitment; otherwise diets will be abandoned long before a weight-loss goal is reached. The critical period for abandoning the weight-loss efforts comes around 10 or 12 weeks after the diet is started. This is when starting or ramping up physical activity may help get you to your diet goal rather than adding the current diet to previous failures.

Starting on an exercise routine immediately produces weight loss, because your body is now expending additional calories.   But, if weight loss stalls while you are exercising regularly, dramatically increasing exercise for a brief period may be sufficient to start it up again. The problem, of course, is fitting a longer period of exercise into a crowded schedule. Going on vacation to do so is rarely an option.

Do this: Look at your calendar, find a day when your commitments are light and you have the time to spend two or three hours walking. Obviously this is easier to accomplish with good weather so you can walk outside in a park, in a conservation area, a neighborhood with sidewalks, a botanical garden, a zoo, or along a waterfront or ocean boardwalk. A friend and I often plan a two or three hour walk once a month, with a very unwilling dachshund, along a newly finished waterfront walk that skirts the harbor, or through a wooded conservation area owned by a local university. Our conversation is as active as our feet, so the time passes quickly. When the weather is unfavorable we go to a nearby museum (without the dog) and spend two or three hours walking around the galleries. We don’t want simply to walk; we enjoy each other’s company and also the fun of exploring the city or new exhibitions in the museum. But the outcome is the same. Our bodies are using up more calories than they normally do, and so the result is a small but welcome drop in weight without having to drop our calorie intake.

And remember: If you do the ‘walking cure’ be sure to keep yourself hydrated. Carry water with you. Don’t justify eating more after the walk because you did so much exercise. This will defeat the purpose of the walk, be certain to move the next day to prevent stiffness….and don’t weigh yourself for two days. It may take that long for the weight loss to show up.

Once you see that you are able to push that scale down a little further just by increasing physical activity, use this technique whenever weight loss becomes sluggish. And link the walking to something enjoyable: good conversation, interesting sightseeing, enjoyment of seasonal changes in the landscape, a favorite piece of art in the museum, or even a walk to raise money for a favorite charity.

 What you will lose in pounds, you will gain in pleasure.

Who’s Helping You Lose Weight From Your Antidepressant?

Good news: By now even mental health care givers know what their patients have known for years. Most drugs taken to relieve the symptoms of mental illness cause weight gain.

Bad news: There are probably more places to buy larger size clothing than weight-loss programs specifically designed to remove the pounds the medications added to your body.

A few days ago, I was answering a questionnaire on-line about weight gain. The questionnaire was part of a comprehensive weight-loss program supported by a government agency. I did not weigh enough to qualify for their weight-loss program, but I wanted to see how helpful the advice would be if I were indeed obese and/or became obese because of antidepressant medication.

Only one question out of many asked if I was taking medication that caused weight gain. I answered yes to see, if by doing so, I would be taken to a site that would advise me on how to get rid of extra pounds added by the antidepressants. But no. The questions continued on to ask the predictable: How often do I exercise? Do I eat more than I should? Do I eat when I am bored and/or when stressed?

The screening survey did ask me if I was hungry all the time. I answered yes to see whether a follow-up question would ask whether this was associated with my medications. It is well known that many antidepressants and mood stabilizers leave people so unsatisfied after eating that they may eat a second large meal only an hour or so after the first. Many find themselves snacking incessantly due to medication-associated appetite. Unfortunately the questionnaire was unconcerned about this.

The diet program posted on the website was no more helpful. The potential dieter was shown how to fill a small plate with foods obviously from the four food groups, and the amounts suggested closely followed USDA recommendations for healthy eating.  Curious as to whether buried somewhere in the diet or exercise advice there would be specific suggestions for people whose excess weight was due exclusively to their medications, I scanned all the other options on the website but found nothing.

Ironically, many who gained weight from taking antidepressants, mood stabilizers, and related drugs for mental disorders, fibromyalgia or even hot flushes from menopause, probably made the healthy food choices recommended on the website before they went on their medication. They never had any problem maintaining a healthy weight, a healthy degree of fitness, or healthy-food eating habits before starting on their medications. They never had to be convinced to eat their vegetables and go to a gym; this was their lifestyle…before the meds.

Sadly, conventional weight-loss advice such as on this website fails to consider that if a dieter is taking a medication that promotes overeating, the drug may overwhelm his or her willpower.  Exercise is also difficult. Fatigue from their depression and/or their medication makes it hard to move even from a chair or bed. Moreover, someone who’s formerly fit toned body is now flabby and fat, may feel too embarrassed to go back to a health club. What can he or she say? I am obese because I am taking a mood stabilizer?

A former weight-loss client of mine told me, “I go for a walk only after dark, when the neighbors can’t see me, because I know they are talking about how much weight I have gained.” Isn’t that a terrible coping mechanism for a shame undeserved?

A personalized approach to weight-loss is considered the best way of dealing with the issues that may prevent success, and weight-loss organizations offer individualized support programs to maintain adherence to a diet or exercise program, and change dysfunctional eating behavior. But where are the personalized weight-loss programs designed to:

Stop the insatiable need to eat caused by the medications?
Help someone with fibromyalgia who now faces the painful burden of moving a body made obese from medications taken to relieve pain?
Aid a formerly fit, athletic guy face his buddies in the gym when he now weighs fifty pounds more than he did a year ago, because of his medication?
Help a 100-pound overweight woman attend an event with relatives who knew her, pre-medication, as a size two?

It is not enough to ask on a questionnaire whether you gained weight from your medication.

If you ask the question, then provide the solution.

Fat Treats from Your Neighborhood Newspaper Food Writer

Last week the front page of my newspaper’s food section was covered almost entirely with a picture of six life-size doughnuts: glazed, powdered with sugar, and coated with either shredded coconut or chopped nuts. The reader could go beyond salivating over the pictures by turning to an inside page to learn where they could be bought, hot and fresh. These were no ordinary doughnuts, but specialty items like the cream-filled doughnut dipped in hard shell chocolate and topped with Frosted Flakes, caramel, strawberries and blueberries.  Or the chocolate doughnut filled with cream, rolled in graham crackers and topped with peanuts and a drizzle of white chocolate.  And should the reader decide to make them at home, the newspaper happily provided recipes, including an artery-clogging one for brioche doughnuts that called for nine large egg yolks and one stick of butter. But wait! If you wanted to make dinner before eating your doughnuts, the newspaper printed a recipe for fettuccine carbonara that called for 12 egg yolks, sausage and cheese.

I eagerly awaited the arrival of this week’s food section. Would it feature low-calorie recipes so the readers who may have gained a few pounds chasing down those incredibly fattening doughnuts could finally have guidance and incentive on how to begin losing them? Might there be a pasta recipe with fresh tomatoes and sparse amounts of olive oil and cheese? Would they publish a recipe for a fruit-based dessert, rather than another cream and egg yolk confection?  Alas, no. There was no admission that the doughnut spread might have caused the readers to spread (out of their clothes). No compensatory low-calorie recipes were printed.

My newspaper is not alone in tempting readers with foods they have no business eating unless they just scaled Mt. Rainier or trekked the length of the Amazon River.  Many women’s magazines typically feature both a diet plan and recipes for foods that, if consumed, will undo the effects of the diet. The Food Network has several programs that never should be watched by those attempting to lose weight or maintain their weight loss. There is one program featuring a guy with a strange haircut who eats incredibly fattening foods made in diners and family-owned restaurants around the country. I stopped watching the program because it always left me hungry.

Do those who decide what foods to picture in a newspaper or magazine realize how illustrations of triple-layered chocolate cake, melted cheese bubbling over a pan of lasagna, bacon-wrapped pork roast or sizzling sausage casseroles undermine will power? And more to point, do they realize how (there is no other way of saying this) hypocritical it is to talk about diets, or the latest research on sugar or carbohydrates or fat on health, and then tell the reader where to buy or how to make foods that contain copious quantities of these unhealthful ingredients? In all fairness, my newspaper did post the calories per serving for the fettuccine recipe (588 calories) but neglected to mention what the serving size was.  Moreover, no calories were given for the doughnut recipes. I wonder why?

All of this would not matter were we all thin and most of us were not engaged in a lifetime struggle to halt weight gain and/or maintain a previous weight loss. But we are not all thin; most of us do not work in jobs that burn up hundreds of calories, and too few of us exercise on a regular basis. It’s also important to consider that too many of us do not daily eat the recommended number of servings of the good stuff: nutrient-dense vegetables and fruits, high-fiber carbohydrates, and low or fat-free dairy products.  And let’s be honest. If your breakfast choices were a hot, fluffy, chocolate doughnut straight from the fryer or a bowl of cottage cheese topped with bran flakes for breakfast, what would you choose? And even if you choose the cottage cheese, wouldn’t you like a small bite of the doughnut also?

Staying at a healthy weight and eating a healthy diet would be so much simpler if unhealthy foods were not being advertised, featured in the print media, and showcased on television food shows. People who go off to spas to lose weight know this. They remove themselves from temptation and lose weight easily. People who decide to stop eating entire categories of foods like carbohydrates know this as well. They don’t have to fight against the urge to eat a doughnut or fettuccine, because they are not eating any carbohydrates.

But what about the rest of us? We need help in eating healthily without going off to a residential diet program or following unnatural diets. What if, for one month, only healthy foods were featured in the media? Good tasting healthy foods, not boiled kale or poached tofu, would be showcased; bakeries that sold whole grain, chewy, crusty breads instead of pastries would be noted. Restaurants whose menus encouraged consumption of vegetable and fruits would be reviewed, and only cooking shows demonstrating recipes using fat-free dairy products rather than heavy cream, butter, and egg yolk would be produced. Plus magazine dessert recipes would be limited to those containing ingredients from the healthy food groups. 

Maybe, just maybe, some exposed to this information might find it useful for the other 11 months of the year.

Standing Up For Better Health

“How do you like your new job?” I asked an acquaintance, an accountant who used to work at an organization with which I was involved. “I like the work,” he said, “but what I don’t like is sitting all day in a small cubicle, staring at a computer screen. ” He told me that his former job at this nonprofit required going to meetings in several offices scattered all over the building. “Some days I would walk what seemed to be miles, when I had several people to see. Not anymore. If I don’t leave my cubicle for lunch, I don’t move for eight or nine hours. I think all this sitting is doing something to my body.”

He was right to be concerned. A study published in the Annals of Internal Medicine confirmed what he and many others chained to their chairs and computers for hours at a time have suspected: sitting too long is not good for our health. [1] Scientists in Toronto reviewed several studies that looked at the association between sedentary behavior, health and longevity. While it is true that sitting still does prevent certain dangers to our health like falling (unless one falls off a chair), or being attacked by a grizzly bear, there is now good evidence that not moving may shorten our lifespan. According to the journal article, sedentary behavior is associated with a higher risk of cardiovascular disease, diabetes, and perhaps even cancer. Exercising for 30 to 60 minutes a day helps, but it doesn’t help enough, to offset the health risks of being stuck in a chair or car or truck for 8 or 9 hours a day.

Commuting adds its own sitting time to that of the workplace. My acquaintance no longer can walk or bike to work as he did in his previous job, but now sits in a car from 45 minutes to an hour and a half morning and evening, and given the traffic he encounters, he is obviously not alone.

What are we going to do about this problem? Other than lunch or bathroom breaks, few people have an excuse or opportunity to leave their chairs or stools whether they are security guards or day traders. Ironically, the only people who seem to have an excuse to move off their seats are smokers who are permitted to go outside for a cigarette. This is not a recommendation to smoke, but it doesn’t seem fair that non-smokers can’t also go outside for a mini-recess.

A few years back I volunteered to visit people in an assisted living facility. What I noticed was that everyone were either lying on a bed or sitting. Even those who could still walk weren’t. Somehow this seemed all right because the average age was over 90 (although we know now how important exercise is at any age), and I assumed that after one became old enough, it was all right to sit out the rest of one’s life. However, I suspect if I were to visit a typical office or assembly-line person working at a conveyor belt, most people would be sitting as much as the old folk. It is a sobering thought.

The sitting problem has not received as much attention as it should, given the financial and physical costs from the increased incidence of high blood pressure, diabetes, heart attacks, strokes and cancer among the sedentary. We don’t even know how inert we are. Perhaps a way to start to change this situation is to find out. The many devices that can measure physical activity could be used to see how much we move at work, while commuting, and at home.

How much and how often should we be moving? An author of the study, Robert Alter, recommends standing or moving one to three minutes every half hour and standing or exercising during commercials while watching television. He claims that exercising 30 minutes a day does not compensate for, “23 and a half hours of doing nothing…” In a sense he is endorsing fidgeting, e.g., the inability to sit, as a way to stay healthier. Some offices give their workers desks that can be raised so it is possible to work standing up as well as sitting. And desk-like platforms that can be attached to a small treadmill have some popularity, as does a pedaling device under their desk but again these are not commonplace. Bringing a dog to work that needs constant walking is another option, but even fewer workplaces endorse this.

The most important aspect of moving while working is simply remembering to do it. Computer or cell phone beeps as reminders are really necessary, because it is too easy to become so involved in work that moving is forgotten. More difficult is convincing employers of the importance of allowing their employees to stop working long enough to take a moving break. It is hard to believe that a supervisor will stop the conveyor belt, or halt the line of people going through security check, to allow a worker to stretch and walk around for two minutes every half hour. Can one enforce more frequent rest stops for long-distance truck drivers or bus drivers? There are long term health implications to budget in, but isn’t investing in improved health worth it?

Alas it seems that improving our health by moving more frequently seems like such an easy intervention, but realistically, it’s an almost impossible one to bring about.



Are Diet Sodas Really a Diet Food?

“I’ll have a diet soda with my French fries and double bacon cheeseburger. Oh! And one of those apple things,” he added, pointing to a pastry. The guy giving the order then looked at me as I waited my turn to order coffee at the highway restaurant rest stop. “Might as well save some calories, ” he laughed as he patted his prominent abdomen. I nodded to him as I asked for my coffee to be sweetened with a packet of the blue non-calorie sweetener.

We all seem to do it: eat a high-calorie meal but drink a no-calorie beverage sweetened with something artificial, munch on a bag of potato chips along with a diet soda, dig into an obscenely rich dessert but add a non-calorie sweetener rather than sugar to our coffee or tea, and drink alcoholic beverages without concern for their calories but “freak out” if we discover we are drinking real soda, rather than the diet stuff.

But do we really think of our coffee sweetened with an artificial sweetener as diet coffee? If we add diet quinine water to a gin and tonic, is the drink now a diet drink? Is artificially-sweetened bottled cranberry juice or flavored iced tea a diet beverage? Do hard candies sweetened with a sugar substitute qualify as diet candies?

A petition just filed with the U.S. Food and Drug Administration by a California-based group, U.S. Right to Know, wants companies to stop using the word “diet” on products that use artificial sweeteners. The petition states that: “Consumers are using products — Diet Coke and Diet Pepsi — that are advertised to make us think they assist in weight loss, when in fact ample scientific evidence suggests that this is not true and (instead quite) the opposite may well be true.” [1]

Interesting. Do people really believe that they will lose weight by drinking these products? I doubt that the man standing in front of me contemplating his snack of a double cheeseburger, fries and dessert thought that he would be three pounds lighter because he drank a diet soda. And I suspect that my not ordering a doughnut (although I wanted to) along with my coffee had more of an impact on my weight than putting that stuff from that blue packet in my coffee.

The writers of the petition reviewed the research literature on diet beverages and weight gain that seemed to confirm the need to remove the word diet from sugar-free beverages. Some studies such one published in the Yale Journal of Biology and Medicine in 2010 suggested that artificial sweeteners may contribute to weight gain, [2] and another in 2012 found that an association between artificially sweetened beverages and weight gain might exist in children. [3] But just because an association exists between two events doesn’t mean there is a causative relationship between them. I have a relative who drinks copious quantities of a caffeinated diet beverage because she hates coffee and tea, but wants to consume caffeine throughout the day. She doesn’t like the taste of the fructose-sweetened version of the caffeinated sodas; they taste too sweet to her. If I asked her whether she thought drinking so much diet soda would help her lose weight, her answer would be, “In my dreams.”

However, might diet beverages indirectly cause weight gain? Might the man in front of me at the fast food restaurant justify ordering dessert because his beverage contained no calories? Do we have less guilt at gobbling up a rich dessert because there is no sugar in our tea? Do we reach for the sugarless chocolate ice cream in the freezer without a thought to its calories because it is artificially sweetened?

There is another, more biologically-subtle, reason why so-called sugar-free foods might cause weight gain. Many people have a natural and unavoidable craving for carbohydrates, especially in the afternoon and/or evenings. The craving arises from their brains and is related to the brain’s need to make the neurotransmitter serotonin. Often the craving is accompanied by a small, but very real, deterioration in mood. Eating a carbohydrate, sweet or starchy, will restore serotonin levels and improve mood soon after the carbohydrate is digested. [4 ]If the craver attempts to satisfy this need to eat something sweet with something artificially sweetened, there will be no restoration of serotonin levels in the brain and no improvement in mood. So what happens? The craver may eventually give in to his or her craving, which was, of course, not satisfied by the diet beverage. Consequently, this person may scarf down a snack food that is sugary but also high in fat like a chocolate chip cookie, an ice cream cone, a candy bar, or a cupcake with three inches of frosting.

Perhaps if the craver satisfied the craving immediately by eating a low-calorie, mildly-sweet snack like graham crackers or licorice sticks rather than attempting to quell it with the diet beverage, the impulse to eat a fattening carbohydrate snack could have been curtailed.

It will be interesting to see what becomes of the petition. Since so many of us order a diet (fill in the blank) drink without giving a nanosecond’s thought to the word diet on the label, it may be very difficult for us to get used to another name. We tend to use the work Xerox instead of copy as in, “I will Xerox this” or Kleenex rather than facial tissue as in, “I have a Kleenex.” So I suspect we will continue to call artificially sweetened beverages diet, even though we know they are not.


Will the Paleo Diet Turn You Into Attila the Hun?

For the followers of the Paleo diet, the one that allows you to eat mainly meat, with a few carefully chosen vegetables and fruits thrown in for garnish, it might be instructive to read about the exploits of a famous, infamous devourer of only flesh: Attila the Hun.

Attila is considered one of the most ferocious warriors in history. [1] Born in 406 A.D. in what is now Hungary, he and his brother (until Attila killed him) ruled over the tribes of the Hun kingdom. But soon his conquests went far beyond being the ruler of the neighborhood. Known as the Scourge of God, Attila attacked, devastated and conquered lands from the Black Sea to the Mediterranean with a ruthlessness that made his name synonymous with terror and savagery.

Could his Paleo-type diet have anything to do with his successful, murderous objectives? According to eyewitness accounts of those who dined with him, and as reported in Gibbons’ The Decline and Fall of the Roman Empire, Attila followed the Paleo diet:

“The royal table was served in wooden cups and platters, flesh was his only food, and the conqueror of the North never tasted the luxury of bread.” [2]

Many in the 21st century will applaud Attila’s diet, although not many might want him as a neighbor. “Down with bread!” these nouveau-Paleos will say. “Out with any carbohydrate! Dump the dairy, bump the beans, discard most fruit and vegetables and eat animal protein or perish!” Adherents of this diet, cleansed of the evil nutrient carbohydrate, claim unfettered amounts of energy, a lean strong body and an alert, mentally-active brain.

Attila died at 47, but the circumstances of his death are unclear. He either died from an unstoppable nose bleed or just as likely was poisoned or stabbed to death. But it is also possible that his “flesh” diet may have contributed to his early demise.

A highly-respected clinical researcher, Dean Ornish, in a recent article in the New York Times, elegantly described the health hazards of a predominantly animal protein diet. His research confirmed the dramatic improvement in cardiovascular health from eating high-fiber carbohydrates along with vegetables and fruits and eating only small amounts of animal protein. [3] Might Attila have died from an early heart attack?

Perhaps his cognitive abilities were impaired by his diet, so he did not take precautions to prevent himself from being murdered. A study published this March by the journal The Lancet [4] looked at changes in cognition, including executive function and mental alertness, among 2,654 Finnish subjects ages 60-77. Half were told to stay on their normal diet that was relatively high in animal protein, and the test group was given a diet in which over half the calories came from complex carbohydrates, fruits and vegetables, and minimal consumption of animal protein and fat. Those eating a diet somewhat similar to that proposed by Dean Ornish in this NYT op-ed did significantly better on tests of cognition such as executive function and mental alertness.

So did a diet only of animal meat leave Attila a little loopy?

Or maybe he was in such a bad mood all the time that he became impossible to live with. It is said that he died on his marital bed. (Lucky bride?) A zero carbohydrate diet all his life could have done a job on his serotonin levels. We know from decades of research on how eating carbohydrates indirectly causes serotonin to be made. [5] Without carbs in his diet, his brain may have had so little active serotonin that he was depressed, angry, or just apathetic about conquering more lands. Those familiar with two pesky mood problems, PMS and/or winter depression, know the feeling of fatigue, irritability, depression and anger associated with too little serotonin activity.

Of course, Paleo man and Attila would not have known that even though protein contains tryptophan, the amino acid out of which serotonin is made, very little tryptophan gets into the brain when protein is eaten. It took several more centuries for this to be discovered by some carbohydrate-eating scientists. [6]

But maybe we are judging Attila too harshly. Gibbons says that bread was a luxury. Could it be that Attila had tired of his Paleo diet and his conquests were driven by the need to find a good loaf?


2.) Gibbon Edward, The Decline and Fall of the Roman Empire, 1826 Vol 3. Chapter 28, p.210
6.) Ibid.

Why the Swiss Can Eat So Much Chocolate and Stay Thin (& We Can’t)

Living in Switzerland many years ago should have been prepared me for the onslaught of chocolate bars displayed in the Zurich supermarket during a recent visit. Perhaps the upcoming Easter holiday had amplified the shelf space devoted to this particular confection; chocolate bunnies and chicks in all sizes vied for space with seemingly miles of chocolate bars, boxes of expensive chocolate truffles, and elaborately wrapped balls of melted chocolate encased in slightly bitter chocolate shells. “This must be Swiss chocolate heaven,” I murmured to my husband as we gathered up armfuls of chocolate bars to take back to the States. “They eat all this chocolate, and yet they stay thin.”  Earlier that day, as I scanned the crowds of commuters exiting the central railroad station, as well as the pedestrians strolling near the lake in the unexpected spring-like weather, I saw only a handful that might be called obese. This contrasted dramatically with the travelers and airport personnel when we arrived back in the U.S. a few days later. There it was difficult to find anyone who was thin.

How to counter the so-called obesity epidemic in the States has occupied panels of obesity experts, researchers analyzing trends in nutrient intake, physicians prescribing the latest weight-loss regimens and/or medications, and enough Internet space on the best way to lose weight to fill a small planet.

The latest recommendation to cut back on sugar consumption (as that nutrient, not fat, seems to be what causes us to become obese) is yet one more attempt to solve what seems to be an insoluble problem. Although a casual reading of this recommendation might lead one to stop consuming anything that has sugar from milk (lactose) to apples (fructose and glucose) to ketchup (sucrose), the recommendation is an attempt to make people stop consuming soda and drinks that are high in fructose. A corollary interpretation from these recommendations could lead one to assume it is all right to eat butter, salt pork and pork rinds along with heaps of mayonnaise, heavy cream and bacon grease, because it is sugar, not fat, that is causing us to balloon into supersizes.

Which brings us back to the Swiss and their chocolate.

Chocolate contains a substantial amount of both fat (cocoa butter) and sugar. Eating small amounts of it may confer some health benefit because of some tiny amounts of antioxidants, but it hardly competes as a diet food compared to, for example, kale or broiled salmon. Indeed, reading the label of a bar of dark (72% cacao) chocolate bar purchased from the Swiss supermarket, I noticed that the 100 gram bar (3½ ounces) contains 591 calories. So how do the Swiss stay so thin, munching on their fat and sugar-filled snacks?

The answer, of course, has nothing to do with how much sugar or fat they eat. It has everything to do with portion size and exercise.

Like so much of the world outside the U.S., the Swiss do not eat the gigantic portions of food that we Americans typically consume. Dinner one evening at this conference we were attending was a buffet, but unlike those in American restaurants, diners did not serve themselves. Everything was served, even a sauce or salad dressing, and the portions were, to my American eye, exceedingly small: a few ounces of the entrees and tablespoon-size amounts of side dishes and desserts. Obesity specialists in the U.S. have pointed to our enormous portions as a major contributor to weight gain, but that has not yet translated into smaller burgers or bagels.

Exercise probably trumps portion size in preventing the Swiss from becoming fat from chocolate, because they never stop moving. Children are put on skis as soon as they can walk, and the elderly even hike in the summer and cross-country ski during the snow months. Sunday afternoons find entire families out walking, climbing, biking, sledding, sailing, or doing something other than watching sports on television or reading the newspaper in an armchair. They do not consider this exercise as in, “I have to workout or run in order to stay in shape and not gain weight.” Instead, all this national physical activity is their lifestyle, as basic to their routine as sleeping or brushing their teeth.

When we lived in Switzerland, and went for our own hikes, we noticed a fork and knife on signs along with the number of minutes it would take the hiker to reach the restaurant.  Of course.  After all, there had to be chocolate at the end of the road.

Isn’t it time to stop the battles over how much is too much, of what we are eating? Is it too much to ask that moderation in nutrient intake be promoted as a goal, rather than eliminating or excessively consuming one nutrient or another as a way to stay healthy? And isn’t it time to alter our work/leisure schedule to insert physical activity as a basic part of our lifestyle? If we stopped sitting in a chair, obsessively searching the Internet for a solution to obesity and started to move instead, we, like the Swiss, could enjoy our chocolate and stay thin.


Lydia Pinkham, Snake Oil and Herbal Supplements

,If you were an American woman living any time between the mid-19th and early 20th century, and if you suffered from women’s troubles, then you may have dosed yourself with Lydia Pinkham’s Vegetable Compound. Developed from a recipe sold, as the story goes, to her father for $25.00 as payment for a debt, the herbal-alcohol mixture was transformed through aggressive marketing into a wildly successful product. Lydia’s picture was on the label, as it should have been, since she concocted the potion in her kitchen. Eventually its manufacture moved into a commercial facility.

Pinkham’s Vegetable Compound promised to cure, or at least relieve, ailments that at the time had no treatment.1 Women with menstrual difficulties were treated with leeches, or even surgery, and premenstrual syndrome was often ascribed to either hysterical personalities or water on the brain. And of course, many women did not want to go to a male physician for their female problems. Treating themselves with the vegetable compound maintained their privacy and probably, through its placebo effect, took away some of their distress.

Today we chuckle at the naiveté of Lydia Pinkham’s’ customers and the many others who purchased products that in our modern eyes were clearly fake, and had nothing in them to relieve symptoms or cure disease. Patent medicines, aka Quack Medicines, claimed to cure or prevent ailments ranging from venereal disease to indigestion to cancer. Their promises were outrageous. One well-advertised product supposedly contained snake oil, an ingredient reportedly miraculous in its ability to cure. Subsequently if someone tried to sell an obviously fake medicine, he stood accused of selling snake oil. 2

Of course this could never happen today; we are much too sophisticated and medically knowledgeable to believe in such nonsense.

Or are we?

Lydia Pinkham’s Vegetable Compound contained many of the ingredients–like black cohosh root, fenugreek seed, dandelion root, motherwort, and gentian root–sold today to help women with menstrual and/or menopausal symptoms. However, unlike today’s elixirs for female problems, Pinkham’s beverage contained a substantial amount of alcohol, which may have relieved some of the stress the women were feeling from their cramps and bloating.

A recent issue of a popular tabloid magazine directed to women and sold at the supermarket checkout counter reported these medical claims:

A 500 mg dose of a flowering plant called Rhodiola (not sure if one is supposed to eat just the flowers or the stem and leaves as well)  will decrease stress and accelerate weight loss by making more serotonin (stress relief) and increasing energy output (weight loss). Fact:  Serotonin is made from the amino acid tryptophan. There is no evidence that this flower increases energy output.
Holy basil, which related to mint, will relieve stress by making a soothing hormone, dopamine. 

Dopamine is like amphetamine. It energizes and stimulates when it is released; it does not soothe. Also, it is not a hormone.

Siberian ginseng will reduce your tension, assuming that holy basil and the Rhodiola flower has not already done so. It soothes your adrenal gland, in case you were wondering. Really?

There are many more of these fascinating tidbits of ‘snake-oil’ recommendations, and this magazine is not alone in describing them. Just go to the Internet.

The Quack Medicines of the last two centuries were not only ineffective; many of them were dangerous and could even cause death. Morphine, opium, cocaine, and alcohol were added, sometimes in substantial quantities and given not only to adults, but also to babies and children who might have colic or were fussy because of teething. Not surprisingly, physicians and medical societies were skeptical and critical of this ‘alternative’ medicine and those who did not want alcohol and drugs like opium to be included in these potions reinforced their criticism. But also, not surprisingly, there was pushback from manufacturers of the quack goods, as well as from the newspaper owners who benefited from the advertisements. Finally, in l908, Congress passed the Pure Food and Drug Act under President Theodore Roosevelt’s administration and prohibited the sale of products with misleading advertising and unlabeled or mislabeled ingredients. 3 So the era of Lydia Pinkham and similar patent medicines came to an end.

Or did it?

More than 100 years later, the New York Attorney General investigated the contents of what we now call herbal supplements. And like the Emperor’s new clothes, whatever was supposed to be there wasn’t. Herbs like St John’s Wort and ginseng listed on the label were not in the bottles; only the fillers like starch were to be found.4 Was the testing accurate? The manufacturers fighting the inevitably swift to arrive class action suits claim that the testing may have been flawed.5 However others stated that this was not the first time the content of an herbal supplement was missing or the dose incorrectly stated.

What is the consumer of such products to believe? At least Lydia Pinkham’s beverage contained enough alcohol to give the user a slight buzz, even if she did not get relief from menstrual cramps. But what if you were taking Echinacea to prevent getting a cold, or St John’s Wort to help your depression? And now you find out that the Echinacea was missing from the bottle and it was filled with ground houseplants instead, or that your St John’s Wort bottle contained only rice, garlic or beans?

There are two conclusions: The first is that a placebo is mighty powerful and rarely causes side effects, so be happy you stayed healthy, didn’t get the cold and your depression got better, even if you were ingesting ground rice. The second is that it is time to hold the manufacturers of herbs, twigs, grasses, and root supplements to the same standards to which pharmaceutical manufacturers must adhere. And maybe we should bring Lydia Pinkham’s beverage back on the market. At least she labeled her potions correctly.