A Stomach Drain: The New Level of Combatting Obesity

The FDA approved, in mid-June, a new obesity device that seems to come from a medieval concept of how to prevent overeating. A tube is inserted into the stomach and the outside end fitted with a valve that can be opened or closed, sort of like a faucet. After eating, the patient opens the valve or faucet so the contents of the stomach can empty into the toilet (or a bucket or some container that can be washed out). The procedure is like throwing up to get rid of the contents of the stomach, but with this device you don’t have to gag. Just open the valve.

When I saw an announcement of this device I thought it was a hoax or something thought up by people who compete in ‘all the hot dogs you can eat’ contests. But no, the device, called AspireAssist, is recommended for those who cannot control their food intake. Instructions for its use are quite specific: At least 20 or 30 minutes have to elapse between the completion of a meal and the emptying of the stomach. This is to make sure that some nutrients and calories are passed into the intestines where they are absorbed into the body. If the stomach was emptied immediately, the result would be similar to starvation.  Moreover, the binge eaters and others with eating disorders such as anorexia are not to be allowed to use the device, as it would only enable such individuals to continue on with their disordered eating. And it is not to be used for a short period of time like a few weeks. It is not the modern day equivalent of the way Roman nobles would eat at one of their banquets when, if they had eaten to their full, they would disgorge the contents of their stomach (there really is no way of saying this euphemistically) so they could feast all over again. This means that you cannot take this device with you if you are going on a cruise, for example, and want to make sure that you are eating enough to justify the cost of the trip.

The FDA is limiting use of the device to patients who are obese with a body mass index of 35 to 55, and who are unable to lose or maintain their weight loss through non-surgical interventions.  In clinical trials of the device, it was very effective in supporting weight loss in this very obese population. After a year, patients using the stomach-emptying device lost 12 percent of their weight compared to control patients who lost 3.6 percent. The amount of weight loss is less than what is typically found among people who have had bariatric surgery such as the gastric sleeve. There are many obese patients who have too many health problems to risk having general anesthesia, yet their obesity is so severe that unless reversed it will shorten their life. An acquaintance who must be at least 250 pounds overweight can barely walk, and now has been diagnosed with a heart problem. She is unable to lose more than 10-15 pounds even when living in a residential weight-loss clinic and would be a candidate for bariatric surgery except for her cardiovascular problems. So perhaps a tube that empties partially digested food from the stomach into a pail might help her.

Safety features are built into the use of the AspireAssist device to make sure it is not abused by, for example, someone who sees it as a way of eating unlimited quantities of everything. It can only be used for a certain number of ‘drains’ and then will stop working. The patient must return to the physician who inserted it to get a replacement part and be evaluated for weigh-loss progress.

Aside from the mechanical disposal of food that otherwise would contribute unneeded calories, how will the patient benefit from this new obesity device? Ideally, food intake, or perhaps the frequency of eating, might decrease. Stopping for coffee and a pastry or piece of pizza while shopping is tempting, but the mechanics of draining the stomach in a small bathroom stall in a mall could be awkward. Also, there is the time factor. Does one go out to eat with friends and then on the way home, thirty minutes after dinner is over, look for a public restroom? Maybe there is a manual that comes with the device that answers these pesky questions.

But an obvious question remains: Why would a device, really a plumbing tool, that removes food from the stomach affect how the brain controls eating? If eating is an almost automatic response to stress – and who doesn’t have stress – this response is not going to be altered by draining the stomach.  If eating is a response to lack of sleep, or boredom, or too much work, or too little relaxation time, how can a device that removes semi-digested food in the stomach change this?  In a sense, allowing the stomach to feel somewhat empty after the food is removed may promote another bout of eating as it did with the Romans.

There has to be a better way to allow fewer calories into the body. A tapeworm perhaps?

Can Antidepressants Turn You Into a Food Addict?

What is a food addiction? Having heard several people explain their inability to lose weight due to this problem, I searched out the answers on, where else? The Internet. It appears there are addictions, and there are addictions.  Apparently, being addicted to your grandmother’s strudel or your brother-in-law’s barbecue is one type of addiction to be put in the same category as your impulse to drive 40 miles to eat homemade ice cream, or a fresh-from-the-sea lobster roll.  But these are not real addictions because if they were, you would be driving to eat the ice cream daily, even when the temperature was colder than the treat.

Real food addictions, according to many so-called food addict experts, are more grim and relentless. If you are a food addict you are unable to stop eating sweet, sometimes starchy, high-fat carbohydrates. Indeed, simply by consuming these foods, if you are susceptible, you will be thrown into the abyss of food addiction. If you have the misfortune or mindlessness to eat some refined carbohydrates, say some jelly beans or a piece of birthday cake, you will be assaulted by uncontrollable urges to continue to eat. You may find yourself eating the entire birthday cake or leaving the party to search out more carbohydrates.  Eventually, unable to stuff any more food in your stomach, you will stop…but the longing and urge to continue to eat will remain.  Not only will you experience a constant craving for more food, especially sugary snacks, you will, according to some food addiction websites, suffer from  emotional, social and spiritual deterioration. (Curiously, television networks do not seem to realize the profound damage caused by eating sugar as evidenced by programs devoted to making incredibly decorated cakes, or people fighting over who makes the best cupcakes.)

The solution, or sobriety, if this word can be applied to the sugar and refined carbohydrate addict, requires a life-long total abstinence from these addictive foods. Organizations like Food Addicts Anonymous exist to help people recover from their addiction.

Is it possible that for some, eating cookies or a slice of bread causes them to become food addicts? Maybe. But it is also possible that the reasons driving a compulsion to eat are more complex, and have to do as much with psychological and physiological factors as swallowing a piece of bread. Binge eating disorder and bulimia, two eating disorders characterized by compulsive overeating, are associated with complex psychological problems, not a simple food addiction. Someone who weighs 750 pounds or more, and cannot stop compulsive eating needs solutions to lose weight far more complex than eliminating flour and sugar. Self-described chocoholics (people addicted to chocolate) usually manage to eat normal amounts of ordinary non-chocolate foods most of the time.

Are there reasons people may find themselves with a compulsion to eat sugary carbohydrates other than the random digestion of a sugar cube? Below are some situations that cause people to crave carbohydrates:

People treated with antidepressants and related medications report intense cravings for carbohydrates, especially sweet ones. Why the medications cause these cravings is not understood, but the cravings are recognized as a side effect of the medications, not a food addiction. When medications are stopped, the cravings disappear.

Women crave sugary carbohydrates toward the end of their menstrual cycle, right before menstruation begins, and for some it is all they want to eat. Their longing for these foods are so intense that a cartoonist named Boynton pictured a premenstrual woman saying ‘I could kill for chocolate.’

Is this an addiction? Doubtful, since women return to eating normally as soon as menstruation begins.

A decrease in hours of daylight characteristic of late fall and winter is associated with a type of depression known as Seasonal Affective Disorder. A milder form is simply called the, ‘Winter Blues.’ Typically, the mood change is accompanied by an almost insatiable need to eat sweet carbohydrates; indeed, this is one of the ways this depression is diagnosed.  But how can it be an addiction if it mysteriously disappears as soon as daylight increases, and is usually gone by late spring?

High-protein diets that forbid or limit carbohydrate consumption may cause a sugar addiction due to a decrease in brain serotonin levels. Serotonin, a neurotransmitter responsible for affective mood, appetite, and pain perception, is made only when the consumption of carbohydrates allows the brain to receive the tryptophan it needs to make new serotonin. Craving carbohydrates, like thirst when not enough water has been consumed, may be the signal sent to indicate that the brain needs to make serotonin.

Stress and carbohydrate consumption go together like peanut butter and chocolate. Studies in which people were given, covertly, carbohydrate or protein-containing beverages decreased their feelings of depression only after consuming the carbohydrates. This is probably due to an increase in serotonin production. People tend to self-medicate with carbohydrates to decrease the emotional discomfort of stress. If the stress doesn’t go away, neither does the carbohydrate consumption. Therefore a so-called food addiction may last as long as the stress. The best way to stop the overconsumption of carbohydrates, if indeed that is occurring, is to stop the stress.

Is that plausible, really?

Our bodies and minds can certainly exist without the consumption of sugary carbohydrates. But let’s wait until there is evidence from a placebo-controlled, double-blind studies (neither the subject nor researcher know what is being consumed) that eating a graham cracker, a pancake with a drizzle of maple syrup or their equivalent in sugar grams is generating a food addiction. The situations that cause a craving for sweet carbohydrates such as depression or PMS are difficult enough without the additional burden of worrying that a few gumdrops are going to turn these eaters into addicts.

It’s Time to Give Your Exercise Some Fresh Air

Move your body out of the gym and go outside, into the fresh air. Soon, in a month or so, it may be too hot and humid to exercise outside, or in certain parts of the country, too wet and/or buggy. But now, despite the sometimes yo-yo effects of late Spring weather that bounces around the temperature scale, the weather is usually sufficiently benign to make walking, biking, running or playing tennis possible and enjoyable.

Switching to outside physical activity from the cardiovascular, weight-lifting machines, dance and yoga classes, may seem like an excuse to decrease the intensity and even duration of exercise. Obviously a stroll through a nearby park to look at the ducklings will not increase your heart rate or make you break a sweat, and it is doubtful you will enlarge your arm muscles plucking dandelions from the grass. And unlike a gym cardiovascular machine that measures your caloric output, your wearable activity-monitoring device may be unable to calculate accurately the calories you are using when sweeping out the garage, pushing your bike up a hill too steep to ride, or turning over the soil for spring planting. But the benefits of transferring at least some of your workout time to outside activities goes far beyond knowing exactly how many calories you are expending.

The most obvious benefit from exercising outside is fresh air (unless you are allergic to pollens, or the only air available is polluted from car and factory exhausts).  Replacing the recirculated air of a gym that probably contains the sweat of many members with the freshness of an early morning breeze on your face has to make you feel good.  Changing the exercise environment from the four walls of a health club to the openness of your neighborhood, park, nearby river bank, or lake, decreases boredom and makes physical activity feel more natural. Running or walking on the treadmill is excellent exercise, but after months of doing so, you begin to wonder whether you should be arriving at some destination after all the miles you have covered. When you do the same activity outside, you actually arrive at a destination and enjoy changes in scenery along the way, rather than only seeing old Kardashian reruns on the machine’s monitor.

And then there is always the shock to find that your well-trained body, capable of doing miles on an indoor bike or elliptical machine or treadmill, is struggling against wind gusts, uneven pavements, long hills, and not always winning.  A fellow gym member was amazed at how hard it was for her to bike during a weekend on Cape Cod. “First the wind was blowing in my face on my way out, but somehow it changed direction when I did… so it blew in my face on my way back! And then the hills…Endless. I thought I was in good shape, but by the time I reached the top of the last one, I was panting so hard I had to stop riding to catch my breath.And I can bike miles at a high resistance indoors.“

Another great aspect of an outdoor workout is that you are forced to exercise in a non-climate controlled environment, which sometimes makes physical activity more difficult, but of course, more realistic.You may have to adjust your exercise to unseasonably cold or hot temperatures, or plan what you are going to wear so you can shed clothes when you become hot, and put them back on when you stop and cool down.This adds another dimension to your exercise and in a sense, makes it feel considerably more natural than exercising inside.

Physical activity is not limited to an outdoor version of activities in the gym; obviously there are many activities that, with rare exceptions, cannot be done in a health club such as kayaking, mountain hiking, and softball.  Many of the chores that pop up like dandelions during the late spring require physical labor: washing windows, painting…with all the scraping and sanding that precedes it, yard and garden work (this can be endless), hauling stuff to the dump, cleaning and repairing boats, bikes, and prepping the backyard grill.  Several hours of washing windows may challenge even the best gym exercised arms and back. Digging and pulling out weeds and then raking winter debris from the lawn can feel like more of a workout than soul cycle.

Having a well-exercised body from a winter of exercising inside will make it easier to adapt to any type of outdoor activities. But if you are one of those people who thought about going to the gym but that’s about as far as you got, consider this: If you start now, doing some exercise outside – long walks, bike rides, gardening, a day hike through a nearby conservation area, painting the metal lawn furniture – and keep it up… by the time the weather gets cold, you might like it enough to continue, even inside a gym.

 

Relieving Pain Without Gaining Weight

Eating to deal with chronic pain is often overlooked as a cause of weight gain, overlooked by everyone, that is, but the over eater. Individuals who experience pain for days, or even years, also often suffer from the collateral damage of obesity or being overweight. The overeating occurs either as a response to pain itself, depression, and/or sleeplessness due to pain. Too much weight may exacerbate pain in bones, joints and muscles,* and make even gentle exercise difficult because it is so much harder to move.

Pain often seems less bearable at night; perhaps because there are fewer distractions. Often pain drives us from bed and we wander around the house hoping the pain will recede so we can go to sleep. Munching on snacks to relieve pain and the anxiety and frustration at not being able to go to sleep is common.  And the overeating carries over to the next day in an attempt to feed wakefulness into a drowsy body and mind.

Lack of sleep and chronic pain, not unexpectedly, are often accompanied by depression. Who wouldn’t be depressed if neither a good night’s sleep nor a life free of pain was attainable?  Anti-depressants are often prescribed, but they may cause intense cravings and overeating.

And, of course, pain itself may provoke excessive food intake.

I still remember the frantic way a co-worker raced into our office asking if anyone had any chocolate. Someone handed her a chocolate bar, and she tore off the paper and gobbled it down in seconds. She normally was extremely controlled and deliberate; the most impulsive thing she might do is kill a mosquito, so we were amazed at her behavior.

“I am getting a migraine,” she explained, after the chocolate had been eaten. “I usually carry something sugary with me to eat when I feel one coming on, but I didn’t have anything with me.  If I manage to eat some sugar, sometimes I can stop the pain from worsening. ”

Overeating as a result of chronic pain is probably even more common than eating during an acute painful episode. A young woman who came to me for weight-loss counseling after a painful recovery from a sinus operation told me, “I just wanted to eat sweets! I don’t know why, but they made it easier to bear the pain, and gaining weight was not as important as having some pain-free moments.”

Is it possible to eat to endure a painful condition and not gain weight?

Yes. If eating is not indiscriminate, but rather focused on foods which will reduce pain and are eaten in the correct portion size.  There is a specific class of foods that will decrease pain: these are sweet and starchy carbohydrates.  Protein has no effect mitigating pain, nor does fat. Eating a bacon cheeseburger or barbecued spare ribs may act as a distraction from pain because of the pleasure of eating these foods, but will not diminish your brain’s perception of painful signals from your nervous system.

Carbohydrates however, (except fruit sugar, fructose) will decrease discomfort by bringing about an increase in brain serotonin. Carbohydrates do this by potentiating the entry into the brain of tryptophan, the amino acid from which the brain makes serotonin.  (Even though tryptophan is found in protein, eating protein prevents serotonin from being made.)

Serotonin, a multi-tasking neurotransmitter involved in mood and eating regulation, is known to  diminish pain. In fact, this is why anti-depressants that increase serotonin activity are sometimes prescribed for the chronic pain of fibromyalgia, and even back pain. However, these drugs do not increase the amount of serotonin in the brain; only eating carbohydrates can do this.

Twenty-five or thirty grams of a fat-free or very low-fat carbohydrate food like pretzels, Cheerios or oatmeal are sufficient to raise brain serotonin levels. Eating two or three 25-gram snacks a day to reduce pain contributes no more than 300-400 calories to the day’s calorie total. This is less than the calorie content of a modern day bagel. It is important that the carbohydrate be consumed on an empty stomach, however, to speed up digestion so pain is decreased more quickly. It is also important to avoid carbohydrates that are processed with fat such as cookies, ice cream, piecrust, fries, chips, and chocolate, because fat slows down digestion and adds unwanted calories. Of course it is more pleasurable to snack on these foods than steamed rice or rice cakes. However, the long-lasting comfort carbohydrates provide comes not from their effect on taste buds, but from their effect on increasing serotonin.

Anyone who has suffered acute or chronic pain yearns for its end. Eating carbohydrates won’t bring this about. But doing so might make the pain bearable at least for a few hours and that small relief is welcome.

After Stress Stops, Overeating May Continue

Many of us are familiar with a tendency to eat in response to a non-catastrophic stress event. (Impending plane crashes, avalanches, or lighting strikes rarely call for snacks.) An income tax audit, burst water pipes, a fender bender, or a long delay in an airline departure may make us first gnash our teeth, and then put something in our mouths. Sooner or later, ways to cope with the stressful situation are generated (i.e., the plane departs), and we no longer feel the need to use food as an emotional pain reliever.

There are some stressful situations so prolonged that even the memory of them can provoke overeating for many weeks, even months, after the stress is over.  I recently visited with S, a friend whom I do not see often because we don’t live in the same city, and we hadn’t seen each other in over a year. I was shocked by how much weight she gained. Never thin during the time I knew her, she was now morbidly obese, and my plans for us to walk a few blocks to a restaurant were dropped because she couldn’t walk more than a few feet. Catching up with each other’s news, I waited to hear about some stressful situation that might explain her weight gain, but there was none. She had recently retired, but was actively developing a non-profit enterprise she had long dreamed of. Friends, financial situation, and family were all fine, according to her account of the past year.

So why the weight gain? She had told me many times that she ate out of stress, but there was no obvious recent stress to explain her adding at least 40 pounds to her frame over the past 12 or so months.

Later on, as we reminisced about her past job, the reason for her overeating became clear. She had taken on a project no one else in her company wanted to try, due to high risk of failure. She succeeded by tirelessly working, getting no more than 3 hours of sleep a night for months on end. Indeed, she had time for nothing else except work, and once told me that she caught herself dozing while standing up and another time, leaving for work, she’d forgotten to put a skirt on over her slip.

This was no recent event, the project was completed successfully at least five years earlier, but the emotion with which she described her work was as intense, as if she had finished it a few days before our lunch. She told me over and over again how hard she worked, how many more hours she clocked than her staff did, how her meals were eaten at the company cafeteria, and at night these meals were supplemented by snacks from the vending machines.

“I had time for nothing else but work. Nothing…” she recounted.

Now it seemed as though leaving work, this company that demanded so much from her, was causing a delayed stress response. Perhaps the overeating and subsequent weight gain was her way of coping with the stress from that time. Certainly she must have experienced not only intense fatigue, but also the fear that her coworkers were right and the project could nor would not succeed.

S is so obese that some type of bariatric surgery may be suggested to her as a way of bringing her weight to a manageable level. Certainly her inability to walk because of shortness of breath was very worrisome. Yet should she opt for such a procedure, or any other weight-loss intervention, it was doubtful that she or her medical/nutrition team would recognize the reason for her substantial weight gain. Nor is it likely that S would reveal the reason for her ballooning into morbid obesity, as she probably is unaware of it. And yet will she be able to keep her weight off unless she recognizes the reasons it was gained?

Overeating in response to a delayed stress reaction may be common, but it’s often unrecognized. Many times a physician will ask about previous stress in trying to understand why a new medical problem has arisen. The stressful event may have occurred months ago, but the aftermath may show itself in rashes or insomnia or mysterious aches and pains. The physician is probably less likely to look at someone who has gained a great deal of weight recently to ask about past stressful events. And to be fair, the patient may not be able to make the connection, either.

Stress may be close to the top of a long list of reasons why people gain/lose/regain weight, or can’t lose it at all. If it is ignored or underestimated in developing an effective weight loss intervention, then the probability of long-term weight loss success is diminished. The dieter might be better served by focusing on the emotions behind the overeating before being treated for the overeating, or at least at the same time. It may take longer to deal with the psychological aspects of weight gain, and required weight loss, as other than the physical, but doing so will guarantee a better long-term outcome.

Stopping After-Diet Weight Gain: Is It Possible?

A sobering report in the New York Times about the weight gained by contestants on “The Biggest Loser” confirms what every failed dieter knows: it is harder to keep weight off than to lose it. Research on post-dieting metabolism and eating behavior among these contestants might convince some wannabe dieters to indefinitely put off even starting a diet. The post-diet contestants were found to have such slow metabolisms that their bodies were using up far fewer calories than predicted, based on their height and weight. People of the same size who had not been on a prolonged diet were found to be using up less than 800 calories. It was no surprise that the contestants were gaining weight.

If that were not bad enough, the contestants experienced an almost constant need to overeat. The urges were strong enough to cause them to binge on foods that never should have been eaten, even in small quantities, if they were to remain thin.

These changes in metabolism and absence of self-control over eating are hardly unknown. Decades ago, scientists measured changes in calorie use before and following substantial weight loss. They put people in a room called a “respiration chamber” for 24-48 hours, and measured how many calories were used when the volunteer was in a relatively inactive state. The results were consistent with those reported for the Biggest Losers: After substantial weight loss the body uses markedly fewer calories than those of people of the same size that have not lost weight. Why this occurs is still not understood years after the first observations. Changes in the activity of certain thyroid hormones might cause a slowdown of metabolism, but other factors may also be involved which have not yet been identified. This is a significant problem since it means that at present there is no way of preventing others who endure a rapid weight loss caused, essentially, by low rations and excess exercise from suffering the same fate.

Other possible explanations for the post-diet side effect of weight gain are related to the reasons weight was added initially. Some of the contestants had been gaining weight since childhood and were unable to stop the weight gain. Why were they unable to halve their weight gain before it transformed them into morbidly obese individuals? Were they gaining weight because their bodies did not have the same control mechanisms to regulate their food intake? Were they always less active than their thinner peers? Did they drink soda instead of water, eat fried fatty food rather than lean protein and vegetables, and consume many large meals each day? Was food used to dampen emotional pain, or as entertainment?

Each of us have our own reasons for overeating, whether it is only a few extra calories, or several thousand. Not knowing why, or just as likely unable to change the “Why?” will make maintaining weight loss very difficult.

Undoing the side effect, weight gain, after successful weight loss requires:

• Decreasing post-diet hunger and lack of satiety;
• Developing strategies to halt overeating in response to emotional and situational triggers;
• Adherence to a food regimen compatible with anticipated post-diet metabolic slowing;
• Investigating whether changes in gut bacteria allow too many calories to enter the body;
• Decreasing sleep disturbances that trigger fatigue associated overeating; as well as
• Preventing overeating triggered by seasonal decrease in sunlight.

The immediate problem that requires intervention is making it possible for the ex-dieter to adhere to a reduced-calorie food plan. Unless the calories consumed correspond to those required by the now sluggish metabolism, weight will be gained again. And yet, the dieter is being asked to stay on a post-diet diet. How frustrating and difficult! After months of being caloric deprived, the dieter is being told to continue the deprivation.

Perhaps it is time to help the dieter by offering temporary treatment with an appetite-suppressing drug.

The FDA has approved several new appetite-suppressant drugs over the past three years. They all have side effects, some of which, such as elevated blood pressure or increased heart rate, might be dangerous for an obese individual who already suffers from cardiovascular problems. But if healthy, normal weight post-dieters used these drugs? Their side effects may be less potentially harmful.

These drugs decrease hunger and cravings and increase satiety. They might help the ex-dieter follow a reduced calorie regimen at least for some of the time it takes for their bodies to become metabolically normal. If they are no longer beset with the urge to overeat and the frustration of seeing their weight increase, they might have the mental and emotional energy to grapple with the triggers that caused them to become obese.

We still must figure out how to prevent the metabolic meltdown that makes it so easy to gain weight after a diet. We still must find out how to prevent post-diet weakening of the satiety signals and exacerbation of urges to binge. We still must develop counseling paradigms during and after the diet to address all the factors that caused weight to be gained. Without these answers, the dieter may not be able to escape the side effect of successful weight loss, i.e., weight regained.

Not All Vegetarian Meals Are Created Healthy

The dinner invitation seemed perfect. A restaurant located near a downtown farmer’s market was serving, once a week, a gourmet vegetarian meal. We would sit at long tables and be served, family style, several courses featuring locally grown, very fresh vegetables. A group of us decided to try the new menu. Gourmet food that was good for us. It seemed too good to be true.

Alas, it was too good to be true. To be sure, the farmer’s market was still selling vegetables when we arrived, but was about to close. We did sit at long tables and passed platters from diner to diner, and there were plenty of vegetables. The problem was that the vegetables no longer looked like vegetables. With the exception of a pinto bean, wild rice and lettuce dish, the vegetables were coated with a cornmeal or a flour crust, and fried or, chopped and shaped into pancakes and then fried.  Carefully dissecting the fried cornmeal crust encasing the slice of green tomato I found (no surprise) one slice of green tomato. The main dish was chicken-fried summer squash. A roundish piece of breaded something was placed on a dense pancake of cornmeal and corn kernels. When I detached the crust, I found a chunk of yellow summer squash that tasted like plain boiled yellow nothing; in fact the fried chicken batter was so thick and stiff that it retained the shape of the squash even after it had been removed.  Dessert was ice cream and apple crumble, a strange dessert for a spring farm produce menu, but gobbled by the diners who seemed to feel they deserved something sweet and gooey after eating all their vegetables.

The meal left the diners, at least our friends, discontented. We had expected to be eating a variety of vegetables that were on the A list of nutrient-dense foods and prepared in such a way that their innate vegetableness was featured. Instead, to be certain, we got vegetables ranging from green tomatoes, yellow squash, and corn, all with relatively few nutrients. The addition of high fat, high carb, coatings added calories without any nutritional benefit. The one dish without breading, the beans, wild rice and lettuce, was probably a little more nutritious, especially the beans, which would have delivered some protein if a cup or so had been eaten. But judging by the amount of food left on the platters as they were passed, people ate only cautious amounts of the somewhat hard-to-digest beans.

The take-away message from this meal was hardly likely to impress a dietician:

  • Many people are excited about eating vegetables that are transformed into vegetarian versions of fried chicken or fritters;
  • As long as we eat vegetables, we are, apparently, getting all the nutrients we need, and protein isn’t one of them;
  • All vegetables are nutritionally equal as long as they are fresh from the farm; and
  • If you serve a yummy dessert, people may forget they had only vegetables for their main course.

Of course, this was only one meal, and maybe it was a good way to get a recalcitrant spouse to go out to a restaurant that specialized in something other than meat and potatoes. If this unwilling vegetable eater enjoyed the southern style fried summer squash, perhaps the next time he or she would eat the squash without its case of fried breading.  The meal also highlighted the advantages of buying produce locally grown and sold, supposedly, only hours after being picked (although the wild rice was certainly not harvested in this south Florida town).

But the meal obscured the true delight in eating vegetables and fruits that make it from vegetable patch to table in under a day. It is not necessary to muck around with corn on the cob so fresh the sugar in the kernels has no chance of turning into starch. It is not necessary to fry tomatoes when their skin conveys the warmth of the sun and biting into them spurts their tangy juice over one’s hands. It is not necessary to combine an unusual vegetable like wild rice with odd companions like soggy cooked lettuce or mealy beans. This grass that looks and tastes like a grain deserves to be introduced alone to those who have never eaten it.

Fortunately, for those whose taste buds and curiosity motivate them to eat more main course vegetables, there are countless Internet recipes for every vegetable imaginable and cookbooks that span international cuisines. Yotam Ottolenghi’s new book Plenty More: Vibrant Vegetable Cooking from London has recipes that span several continents worth of vegetarian cooking. His last book, Plenty (Chronicle Books, 2011), was called,  “…(the) vegetarian cookbook of the decade…” by the Washington Post and just the pictures alone are mouth watering. No one misses animal protein after making these recipes. Moreover, vegetables that most of us walk past without buying, or are unaware of tend, to be featured in cookbooks specializing in vegetables. Certainly the recipes go far beyond fried green tomatoes and yellow squash. Ottolenghi’s recipes and those featured in other vegetarian cookbooks, are healthy and offer the variety of vegetables that dieticians are telling us we need to eat in order to meet our nutrient needs. The bad news is that one has to make these recipes at home. The good news is that they are so delicious you may find yourself going off to the farmer’s market and returning home for your own gourmet meal.

Running Into a Thin Body: It Is Harder Than It Looks

The body fat content of Boston dropped precipitously the weekend before Marathon Monday. Most of the blue and gold jacketed (the Marathon colors) people wandering in and out of stores, running the length of the river or on our long city blocks were thin… quite thin. And there were thousands of them.

“Maybe I should start running again,” a friend commented, as we waited behind a crowd of skinny legs for the light to change. “I need to lose some weight.”

It was a tempting thought, one that I had played with for the several years after a repair for a torn Achilles tendon had made me fearful of running too often and too far. The weather was getting warmer, so exercising outside was a pleasure… and who knows, maybe the pounds would roll off along with those miles.

The editors of Runner’s World must have heard our conversation because, a few days later, I was browsing the April edition of the magazine, devoted in large part to running and weight loss.

One section of the magazine was headlined “Why Can’t You Lose Weight?” with a sobering subtitle scolding the reader for thinking that weight loss was simply a matter of eating less and running more.

You mean it isn’t?

Well, no.

According to the magazine, chubby runners, like the rest of the overweight human race, tend to overestimate how many calories their runs are burning off and compensate for their calorie loss by overeating when they get home. Not moving much after the run is not uncommon; after all, why not take the car to do an errand a block away? There is no need for more exercise. And even worse, some (gasp) are even overeating on a day when they are not running. They rationalize, “Tomorrow I will exercise off the extra calories I ate today.”

Alas, there is no magical formula that produces weight loss just by putting on running shoes and cute running tights. The only way a runner can lose weight is to eat sensibly and to commit to a running schedule that increases in time and intensity, so the body never hits a fitness plateau. A generic diet that stresses avoiding high fat, high sugar and highly processed foods, which also provides sufficient carbs to replenish the stored carbohydrate in the muscles used up by exercise, will work to diminish calorie intake. Obviously, it must also include nutritious staples such as fruits and vegetables, as well as lean protein, low-fat dairy products, and high-fiber.

But the exercise component, like running, must be personalized so that the dieter is constantly training to increase both the intensity and duration of the activity. It is not necessary to train as though for a marathon or a long distance bike ride or a climb in the Himalayas. But it is necessary to make sure the body is not too comfortable with the exercise routine. If the effort level remains the same, fewer calories may be used up as time goes on. Runners who want to lose weight are advised, according to the article, to include high intensity runs like speed work, or running fast up hills along with adding, if possible, miles to the distance run. Presumably this can be done on a treadmill as well as outside.

Although running to lose weight may appeal to only a few, the concept behind increasing one’s fitness and stamina applies to anyone who wants to include exercise as a way of increasing weight loss. How many of us have complained, “I don’t know why I am not losing weight! After all, I go to the gym (or play tennis, or go for bike rides or walk) three times a week.” But are we exercising harder as time goes on, or maintaining the same level of physical activity for weeks, months, or even years? I have a friend, a runner (and a little pudgy), who told me quite proudly that he has been running three miles, 4 days a week, for years.

“Well, why don’t you run further?” I asked him. He was surprised at my question and shrugged his answer.

“Why should I? I am comfortable doing that distance.”

Dieters are often told to engage in some sort of physical activity, especially if their weight loss has stalled, and when they begin to do so, particularly if they have been inactive, weight loss often increases. But eventually, as their bodies become fitter and accustomed to this level of physical activity, the exercise will no longer push their weight loss as much as it did at the beginning.

They, and the rest of us who may wonder why exercise does not seem to be melting away our excess pounds, are rarely told that reaching an exercise plateau will slow down our weight loss. Unless we have a trainer or a coach, or read magazines and journals about physical activity and weight, we are unaware of how important it is to exercise harder and longer to increase the rate of our weight loss. Nor are we given information on how this can be done in such a way as to prevent injury and pain.

The solution is not to diet more strenuously, or give up on the exercise because it doesn’t seem to be working. The solution is to become your own trainer. Keep an exercise journal or use an app or wearable device that monitors your physical activity. This will tell you how much you are doing and how often. Resolve to do more. More can mean one minute or an hour, half a block, or several miles. Increase your speed or resistance, again for a few seconds or a few minutes. You don’t have to do this more than once or twice a week, but you must do it if you want to climb to a higher level of fitness and increased rate of weight loss. And who knows, one of these days, you may be in a large crowd waiting to run a marathon.

If They Can’t Eat Sugar, Let Them Eat Fat

Recently our government advised us to reduce our sugar intake as a way of decreasing obesity, Type 2 diabetes and a cluster of metabolic problems associated with consuming this nutritionally empty carbohydrate. No problem. Unless one were stranded in a hut in the middle of a 30 day blizzard, or floating on a raft in the middle of the Pacific Ocean, there is little reason to eat sugar except as a minimal flavoring agent.  As a simple carbohydrate, sugar provides 4 calories per gram, but so does any starchy carbohydrate and the latter always come packaged with nutrients as well as calories.

But even though the government, unlike Marie Antoinette, has told us not to eat cake (and by the way the cake she was referring to was the fermented starter used for making bread), our desire for sweet baked goods is as strong as ever.

The solution, according to an article in last week’s Saturday/Sunday section of the Wall Street Journal (April 9-10) is to eat pastries so loaded with fat they might melt if left in a warm place.

The recipes look luscious. The ingredients, however, seemed to come right out of a Paula Deen Food Network show. (Deen used to revel in adding almost pure fat ingredients such as heavy cream and egg yolk to every recipe, and became famous for her fried butter.) One example of the WSJ recipes, Strawberry Cream Cheese Fool, is a custard like dessert served with strawberries. Along with half a pound of cream cheese, the ingredient list included two cups of heavy cream and ½  cup of crème fraiche. There was sugar, in the form of frozen apple juice concentrate. Strawberries provided some vitamins.

A coconut chiffon cake recipe had somewhat less fat but contained a cup of full fat coconut milk, and 7 large eggs. More such cholesterol and fat elevating recipes were available in cookbooks from which the described recipes were taken.

Was it really the intention of the government that we substitute fat for sugar? An expert was quoted in the article affirming that sugar has no nutritional value. True. But at 9 calories per gram, fat not only has more than twice as many calories as sugar, it also elevates triglyceride and cholesterol levels in our bodies, and although some vitamins are fat soluble, it is not necessary to drink heavy cream to obtain these nutrients.  Moreover the weight gaining potential of fat is not to be underestimated.

We should be told that if we decrease our intake of sugar, we should not be compensating by increasing our consumption of fat. We should be told that if we eat a high fat diet, we change the population of bacteria living in our intestinal  tract and that this has negative health consequences.  When laboratory animals are fed diets high in saturated fat (butter, heavy cream) or unsaturated fat, (olive oil, avocado etc.) changes in their gut microbes occur depending on what they have eaten.  Animals eating the high saturated fat diet developed signs of elevated blood insulin and glucose levels, even after fasting, because of the type of bacteria residing in their gut.

A Scientific American article reports the research of Eugene Chang on the effect of consuming a high saturated fat diet. He has shown that changes in gut bacteria following consumption of high fat foods, especially dairy (heavy cream)  lead to the inflammatory responses associated with irritable bowel disease.  So why are recipes with enough fat to bring about a bacterial population exchange inside us being featured in a well-respected newspaper? Why is sugar being banned, but not bacon grease?  The answer is, in part, because of a spate of articles disputing the link between high cholesterol levels, fat intake, and heart disease.

‘Don’t believe the research linking lard with heart attacks and stroke,’ these articles claim. In other words, we should stop avoiding high fat foods; they are good for us. Full-fat food advocates dispute  decades worth of evidence amassed by the American Heart Association about prudent low fat food choices and must be delighted with these recipes in the WSJ.

So now how are we supposed to eat?

To some extent, it depends on your personal health history and your physician’s experience and advice. The empty calories in sugar should be avoided. If you have a family history of heart disease or stroke, you should ask you physician whether you can eat saturated fats with abandonment or caution.

But let’s be realistic. Maybe we shouldn’t even be concerned with whether desserts have too much sugar or fat.  Desserts were never meant to be eaten instead of a nutrient containing meal (unless you are seven years old and having a birthday celebration). When the government recommended eating less sugar, this expert nutrition panel, did not say, “Let them eat fat!” Obviously what they were hoping for is an increase in the consumption of vegetables, fruits, high fiber carbohydrates, low fat meat and dairy foods. If people want to eat dessert, they should…assuming that their weight and health allow them to. But let’s not fool ourselves into thinking that just because a pudding or cake has less sugar, it is as good for us as a salad or poached chicken breast.

Is the Acai Berry a Superfood or a Super Scam?

A juice bar/health food restaurant located along my dog walking route is always crowded with diners sitting at sidewalk tables and eating large mounds of a mud colored food with the consistency of chocolate pudding. The mud, upon closer inspection, is dark purple and served with chunks of banana and sprinkles of granola. The diners are usually wearing yoga pants, running shorts or biking gear, and are so fully engaged in eating their bowl of purple stuff that they are not even looking at their cell phones.

“Do you know what they are eating?” I asked my dog walking companion.

“It is Acai,” she responded. “It comes from a berry that is found in Brazil,” she said. “It is supposed to be superfood healthy.”

“So that is how you say it,” I responded. “I had seen a sign on the restaurant door promoting it, but did not realize it was pronounced ah-sigh-ee. What does it taste like?”

“Tart… not very sweet. I actually had some in Brazil. It’s very refreshing. People eat it because it is advertised as a superfood. They say it is good for weight loss, decreasing inflammation, and preventing aging,” she told me.

I was not tempted to try it, not liking gloppy foods, but I did wonder if Acai really was a health wonder food. Certainly the people eating it all looked exceptionally healthy, most were thin, and when I asked two guys, about 33, in their bike shorts and tank tops what was so special about the Acai, they responded, almost in unison, that it was a superfood.

“It is full of energy,” said one. The other added that it was full of vitamins.

How could I have missed out on eating such a spectacularly nutritious food? I had seen some claims for the Acai berry headlined in the tabloid magazines for sale at the supermarket check-out counter, but discounted them.

“Berry from the South American rainforest cures diabetes, heart disease, obesity!” the headlines blared.

“Another nutrition scam,” I thought, and forgot about it. But now I was curious to know what was so special about the Acai berry. According to Wikipedia, a powder made from the purified pulp and skin of the berry contains mostly high-fiber carbohydrate, with low-sugar content. The protein content is small, only 8 grams in l00 grams of powder, about the same as in a glass of milk. The fat content was compromised of unsaturated fatty acids. Unlike other berries, its vitamin and mineral content is minimal.

Continuing my investigative nutrition a little further, I asked one of restaurant employees why Acai was so special. “Oh, it’s full of antioxidants,” she responded. “It has more than any other food.”

So apparently the Acai berry is special because of its extraordinary antioxidant content.

Sometime in the l990s, people who were not biological chemists (that is, the rest of us…) started to hear about something called antioxidants. Antioxidants are important because they destroy bad substances in our body called free radicals. Free radicals alter the structure of molecules by removing electrons, thereby weakening membranes and making them more vulnerable to destruction. They can damage artery walls, allowing cholesterol to be deposited which then form artery blocking plaques, they potentiate cataracts and age related macular degeneration, and may be involved in certain types of cancer. It had been known for some time that vitamins like beta-carotene (the plant form of vitamin A) and vitamin E have antioxidant power.

Studies involving thousands of people over many years were undertaken to see if supplementing the diet with large doses of these vitamins might decrease heart disease, cancer, diabetes, and other diseases. Unfortunately most of the results were inconclusive, negative (no effect) or dangerous. In one study, supplementing smokers with large amounts of beta carotene increased risk of lung cancer.

But the lack of positive results did not stop food and supplement companies from promoting the antioxidant content of whatever edibles they were selling. Magazines, newspaper articles, even media personalities offered lists foods that should be eaten because they contain large quantities of antioxidants. No longer were foods simply “Good for You.” They were antioxidant missiles aimed at those nasty free radicals that, if not thwarted, would cause you to degenerate into a crumbling mass of membranes by the time you were sixty.

So this brings us back to the purple glop. How did the Acai berry become anointed as the queen of antioxidants? The berry contains several chemicals that act as antioxidants, and the strength of their chemical reactions to counteract free radicals has been measured, mostly in test tubes but in a small number of animal and human studies as well. (J. Agric. Food Chem.2006,54,8604−8610 ; J. Agric. Food Chem., 2008, 56 (18), pp 8326-8333).

So yes, this Amazon rain forest berry does have potent antioxidant qualities. But one does not have to go to Brazil, or even the sidewalk restaurant in my neighborhood to eat foods with antioxidant power. Any local supermarket contains dozens of foods with antioxidant properties: kidney beans, pinto beans, blueberries, cranberries, strawberries, apples, prunes, plums, pomegranates, artichokes, cabbage, broccoli, asparagus, avocados, beets, spinach, and many spices as well. (The Journal of Agricultural and Food Chemistry, 9th edition, June 2004). There is little evidence that Acai contains substantially more antioxidants than a bowl of blueberries. And I suspect that the blueberries will cost considerably less than the $9.00 charged in my neighborhood for a small bowl of Acai pudding.

The downside of eating ordinary fruits and vegetables is that they are not associated with the astonishing, although totally unproven, claims made for Acai… such as reversing diabetes, weight loss, and increasing sexual virility. (Funny the two guys in bike shorts never mentioned this.) No one eats an ordinary apple, or a bowl of blueberries with the expectation of turning into a nutritional version of superman. But it is nice to know that it is not necessary to eat a berry imported from Brazil and pulverized into a powder to obtain antioxidants. We can go to a farmer’s market and buy locally grown strawberries in late spring, blueberries still warm from a summer sun at a farm stand in July, or apples picked at an orchard in the fall and enjoy the “magic” of eating locally grown foods, as well as benefiting from their antioxidant power.