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Meals in a Box: The Answer to Eating Your Vegetables?

More than a dozen companies will, for a price, send you the ingredients for a complete, relatively interesting dinner, or smoothie snacks even, if you choose that option. All you have to do is open the many large and small packages, read the instructions and in 30 minutes or so, eat your own freshly prepared entrée. The concept is practical for the many who do not have the time or energy after work to figure out what to prepare for dinner and then to make sure the ingredients are in the kitchen. Meal-in-the-box choices tend to be more imaginative than grilled chicken breast and frozen veggies because professional chefs devise the menus and make available the entire ingredient list from the main course protein to a tiniest pinch of some herb or spice that the customer probably never heard of and/or doesn’t have. No looking up recipes in a cookbook or on the Internet is needed, nor guess work about the cooking methods.  Detailed instructions are given, perishable foods are kept cold with icepacks, and preparation time is thirty minutes. The end product may not get you, the customer, a spot on the Food Network program “Chopped” in which professional chefs are given ingredients in a box and compete to make an original perfectly cooked entrée and sides in thirty minutes…But unlike the competitors who turn their food over to the judges? The customers of meals in a box get to eat their finished product.

However, making the meals from the ingredients in the box will cost about twice as much as making it from ingredients assembled yourself. According to Consumer Reports, one company’s blackened tilapia dish costs almost $12.00 per person, compared to a little more than $5.00 when put together oneself. A tofu and Chinese broccoli dish from another company costs over $11.00. These ingredients are very inexpensive and will cost approximately $3.50 if you buy the ingredients from the supermarket, and even less from a Chinese grocery store.  The prices for some of these dishes are less than in a restaurant (although perhaps not for the Chinese entrée) but add up quickly as the cost is per person. Moreover, unless the customers are small eaters, no leftovers for the next day’s lunch will remain. But it is also unlikely that there will be much wasted, thrown away, uneaten food. Nor will the refrigerator fill up with plastic containers full of tidbits from previous meals.

It is no surprise, given our current fixation of dietary restrictions that gluten-free, carbohydrate-free dairy-free, vegetarian, vegan, organic (of course) calorie-restricted meals are available depending on which company is providing the foods.

But are they healthy? Will eating a meal from a box provide you with some of the vegetable, fruit, grain, protein, and dairy servings you ought to be getting? It depends. Certainly compared to many takeout and restaurant meals that tend to be free of food groups containing nutrients your body needs, the boxed to-be-prepared meals often contain substantial amounts of vegetables, and sometimes whole grains. If you tend to ignore the vegetables in your refrigerator bin until they turn into a slimy green mass, then ordering meals with a substantial amount of vegetables will ensure that you are eating this essential food group.

Yet there is a possible nutritional caveat to some of the meals. The salt content may be higher than recommended, especially if some of the seasonings contain sodium, like garlic or onion powder, or if salt if added several times during preparation. Consumer Reports analyzed sodium content and found many dishes containing 30% more than recommended, and some dishes containing as much as 1 gram of salt per serving.

Are boxed meal ingredients a trend, or the beginning of a permanent shift in the way people prepare meals? Probably the latter because they appeal not only to those who don’t (and won’t) prepare meals from scratch, but also to a generation who have been preparing meals from scratch for decades. For those who have been afraid to boil water, learning how to cook from the boxes might eventually give them confidence to cook on their own. It is sort of comparable to shifting from paint-by-numbers to covering a blank canvas with one’s own creation. For those who are tired of figuring out what to cook for dinner and despair at the high prices and noise levels of most restaurants, boxed meals are an easy way of eating interesting food less expensively (and in a setting that doesn’t require either waiting or tipping.)

Many companies are selling meals for people on all sorts of diets and presumably are competing with portion-controlled, factory-prepared meals sold by some national weight-loss companies.  Since the meals in a box are portion and ingredient controlled, the dieter does not have to be concerned about going over a calorie limit. There is no guessing about whether the weight of the entrée or the teaspoons of olive oil will fit the calorie requirements for a particular meal. On the other hand, by requiring the dieter to get involved in food preparation, she may lose her fear of not being able to prepare a meal on her own that allows her to continue to lose weight and/or keep it off.

This trend is still relatively new, but its rapid growth indicates that it meets the lifestyles demands of large numbers of people. However, since spending a little time in meal preparation is still necessary, we should not be surprised if, a few years from now, some of the boxes will contain a robot that will do the cooking.

According to a 2016 Consumer Reports analyses, home delivery of meal ingredients is about a $400 million dollars a year industry. Although the major portion of the sales are focused along the coasts and in major urban areas, sales are projected to increase throughout the country. They may not be replacing all home delivered pizza and Chinese food, but certainly offer healthier and more varied options.

How Do You Know Whether Supplement Claims are Hype or True?

At a recent university-sponsored conference on innovations in nutritional and fitness products, there was a discussion about the increasing number of fraudulent claims associated with such products in the market. When one speaker, a principal in a firm investing in start-ups specializing in fitness and nutrition, was asked how to detect ineffective or fraudulent products, he was unable to give a useful answer.

“It’s very difficult because often the claims are made up or supported by faulty research published in company-owned or for-profit journals. If it works, it is probably not a fraud,” he concluded. Someone from the audience responded with, “Yes, but placebos work also.”

The Food and Drug Administration (“FDA”) can barely keep up with the proliferation of fraudulent health products. Some make claims that cannot possibly be produced by the ingredients; others contain substances which are not allowed to be sold due to serious side effects, or must be prescribed only by a physician. Oftentimes states, as well as the FDA, step in to expose the deceptive nature of claims made by supplement manufacturers. In a well-publicized case a few years ago the New York State Attorney General’s office tested the contents of several popular herbal supplements and found either none of the advertised active ingredients in the product or levels too low to be effective. This past winter, the New York State Attorney General and the Federal Trade Commission (“FTC”) charged a company that claimed its product was shown in clinical trials to improve memory and cognition with making, “false and unsubstantiated claims” because the study cited by the company actually showed the product not working any better than a placebo. Yet the advertisements, seen frequently on television, were so compelling that the sales topped $165 million.

The most common claims seen on the labels of such dubious products are for weight loss, sexual performance (erectile dysfunction), memory loss, and mood.  Some claims are almost magical in the sweep of their promises: A New York firm claimed its dietary supplement treated senile dementia, brain atrophy, atherosclerosis, kidney dysfunction, gangrene, depression and osteoarthritis along with lung, cervical and prostate cancer. Alas, for anyone now wanting to buy a product that will cure all that is wrong with you, it is no longer available. U.S Marshalls seized it after a request by the FDA in 2012.

Personal testimonials are often so compelling that they sell a product. Who hasn’t looked at the before and after pictures of someone who used a weight-loss product and marveled at the change? Statements like, “I am no longer hungry, depressed, diabetic, or bald!“ beckon to us from the Internet, tabloid magazines, newspaper advertisements and television spots. These people must be real, one thinks…and if he grows hair, maybe I will also.

Health products claiming a quick fix such as, “Cover your bald spot by next Tuesday!” or, “Lose your double chin by this afternoon!” are also hard to resist, but should be regarded with as much suspicion as someone trying to sell you a bridge. Glue is a quick fix; health products rarely are. The FDA tells us to beware of health products attempting to gain a marketing edge by claiming that they are all natural. By the way, snake venom is also natural.

One easy way to detect whether a claim is legitimate or not is whether the term, “Miracle” is used on the label. Look at it this way, if the words “miracle cure” are attached to the ad, consider it a miracle that anyone is foolish enough to buy the product.

But of course there are many over-the-counter (non-prescription) supplements that work, are safe, contain the dose of active ingredients printed on the label, and don’t hide drugs deemed illegal by the FDA. If a combination of vitamin D and calcium promises bone health in the amounts recommended by physicians, such a supplement will help to restore bone cell growth and decrease bone fragility.  Supplemental vitamins, minerals and protein will help restore depleted levels of these nutrients due to prolonged illness, chemotherapy, or gastrointestinal impairment. Again, it is imperative to check with a healthcare giver about quantities; more is not always better.

But what if you are not sure whether the claims are to be believed. What should you do?

Ask your health care provider. Take a picture of the ingredient label on a product you are thinking of buying, and ask whether any of the ingredients actually do what they are supposed to. Use the Internet to look up the ingredients to see what studies support the claims of the product. Write to the FDA.

Example:  A product relieving anxiety and stress claims that the ingredients, “…promote serotonin synthesis.” But the main ingredients are chamomile and valerian, herbal products that may cause drowsiness; these do not promote serotonin. A physician will know that the product is incapable of increasing serotonin synthesis.

Here’s another: A product containing saffron extract as its main ingredient claims, ”…Reduces cravings, boosts metabolism, blocks appetite, lowers blood pressure and increases energy.”  Investigating whether there are any studies linking saffron extract to all these wondrous health effects may seem like a nuisance, but will save money and possibly, ill side effects.

Signing up for the FDA Consumer Updates page is essential for anyone routinely buying supplements because of their weekly descriptions of products containing hidden drugs, fillers, or bits and pieces of insects or twigs. Recently, the agency has warned consumers about more than 100 products containing illegal drugs; most of these products are sold for sexual enhancement, weight loss and bodybuilding.

Avoiding supplements that may not work, may not contain the ingredients listed, or contain ingredients that are harmful cannot be ensured. But a little homework and help from the FDA make the odds better that what you buy is safe and effective.

Social Loneliness May Make the Depressed Even More So

Loneliness is a state that may affect everyone at some point in his or her life. It is not necessary to go on a trek across the continent, or row alone across the Atlantic to feel lonely. Sitting by oneself in a crowded movie theater or restaurant, or walking on your own on a lovely spring afternoon in a park filled with couples, families and friends can feel just as isolating.

Sometimes social isolation is a matter of choice or temporary circumstance. A relative of mine, who had to rewrite a 500-page thesis in order to turn it into a book, willingly isolated herself for months in order to accomplish this task. A parent unable to leave the house because of weather and sick children may not speak to anyone over the age of six for a few days, but knows that eventually this will change. A computer coder may shun company for days in order to finish a time dependent task; so too may anyone involved in a creative act.

Others are alone too much, but not by choice or a temporary situation. It is a fact of their lives. The groups one thinks about first are the elderly, and those we call “shut-ins.” They weren’t always so alone but sickness, frailty, lack of easy transportation, death of spouses, friends, and even adult children…potentially their declining eye sight and hearing, limited financial resources, and fear of crime may result in an extremely limited interaction with the social world.

“My friends are all dead,” my husband’s uncle used to tell us as he reached the late nineties. “All the guys I would play cards with and have a meal with, they are all gone.”

Residence in an assisted-living facility may surround an elderly individual with people, but social interactions and friendships do not necessarily follow. A sad scene familiar to those of us who have visited relatives in facilities is a row of residents, lined up in wheelchairs, who are not talking to each other, and indeed seem to be totally isolated despite the other people around.

But one does not have to live into old age to feel this social loneliness. People of all ages who are suffering from mental illness can experience it at any age. In a recent report put out by an Australian mental health support organization, about 66% of people with mental illness report feeling socially isolated compared with about 10% of the general population. The reasons for this vary from lack of money and/or transportation, misunderstanding among others as to the nature of the illness, and even fear of others prevent forming a close relationship. Those with mental illness often claim that they are stigmatized, or at the very least, treated differently.

“Maybe people believe we are going to behave in unpredictable, embarrassing, or violent ways,” said a friend who has suffered from bipolar disease for years. “There is reluctance for a casual interaction to go much further.”nability to become involved in activities that may decrease loneliness is sometimes generated by mental illness itself. Social phobia, fears about public spaces (although these days, this may just be commonsense), inability to leave the house, hold a job or even communicate without difficulty; all reduce the possibility of interacting with others. A weight-loss client of mine was very specific about the days she could come to my office, as they were dependent on her cycles of mania and depression. Another client who was depressed would stay up very late at night and sleep most of the day, thereby avoiding the necessity to interact with anyone.

Regardless of the causes of social isolation and the groups who are affected by it, being alone is not good for one’s mental and physical health. Being alone most of the time is associated with increased weight, poorer diet, decreased exercise, alcohol abuse, greater risk of sickness, and even a shorter life span. Cognitive functions decline, possibly as a result of few verbal interactions. Added to this is the emotional pain of being lonely. People whose circumstances prevent them from interacting with others for short periods of time report feeling depressed and out of touch with what is going on around them. Imagine the effect if social isolation is a way of life.

Fortunately, there are social spaces where people with mental illness can go and feel comfortable and accepted, as well as receive advice, support, and/or information about relevant services, are available in many communities. Volunteers in organizations like the National Alliance usually run these drop-in centers or peer support groups on mental illness. They provide a critical service, especially for those patients and their families who are seeking to interact with others experiencing the same problems.

Going to meetings is one way of decreasing time spent alone, and it is possible that a network of acquaintances with whom to spend time can develop from this. Several years ago, I led a weight-loss group made up of mentally ill individuals who had gained weight on their psychotropic medications. After a few meetings, the participants organized Sunday walks or, if the weather was bad, a meal and a movie.

Unfortunately, making available accessible and socially safe places for people with mental illness to meet is dependent on volunteer resources, and these may be limited to family and friends of the mentally ill. The sad fact is that many potential volunteers would probably prefer giving their time (and maybe money) to an animal adoption center than spend time socializing with mentally ill individuals.  An acquaintance in a mid-size southern city found that despite city resources to fund a drop-in center associated with a neighborhood health clinic, there were no volunteers available to staff the facility.

According to the previously mentioned SANE report, almost all people with mental illness consider social relationships important in helping them manage their symptoms and improve the quality of their life. They said that simply having someone to talk to about how they feel is critical to their feeling better. It doesn’t take many people to diminish the loneliness of an individual.

Just one will do.

We all should try to be that one.

How Can You Get Enough Nutrients If You Don’t Eat Very Much?

Some of the more popular reality shows on television display various mental health pathologies such as super rich housewives always fighting with each other (when they are not having their hair done and drinking wine), or a show about hoarding to the point of suffocation, or even a view into living inside a 600-pound body that is so heavy, any movement is difficult and painful. The latter program is particularly sad, in that it shows how obsessive eating is almost always the result of early trauma, and how difficult it is for the overeater to deal with the pain of such trauma when the emotionally deadening effect of food is removed.

 

What has not been depicted so far is a reality program on the struggles of people at the other end of the eating spectrum. These are the people who believe that, like the Duchess of Windsor, one can never be too rich or too thin. These are the people whose body weight is so low that they run the risk of death. These are the people whose obsession with being extremely thin is as unshakable as the 600-pound individual who seems to be addicted to food.  

 

Perhaps the stories of the too thin are not told because the viewer may not be interested in watching an anorectic chase an almost invisible morsel of food around the plate, before grudgingly eating it and then exercising for three hours to work off the 3 calories the food may have contained. Or perhaps it is because the fashion industry has convinced us that thinness is something to be coveted, even if the price of a too thin body may be malnutrition or, if it becomes anorexia, even death.

 

A few weeks ago I walked past a facility holding a fundraising event. What caught my attention was a group of extremely tall women wearing gowns that would have looked appropriate on someone’s red carpet. They must have been models; they had perfect features, either from genes or a plastic surgeon. I confess I stared at them, not just because they looked so exotic in my neighborhood but also because they were so THIN. They were not skeletal but just on the other side of being all bones and no flesh. Another woman stopped and looked with me. She said, “They don’t look quite real, do they? But it must be nice to be so thin.”

 

Somehow we don’t think of being model thin as associated with health issues. The warnings about the risks of eating too much or the wrong kinds of food are well known, they are hard to escape: Don’t eat too much, don’t eat too much sugar, exercise frequently, and get rid of belly fat.  But how many of us know what medical woes are awaiting the very thin? One has to go searching for them. And some can be as deadly as those associated with morbid obesity.

 

When very little food is eaten, as must be the case if someone is to maintain a weight 20 or so pounds less than normal, an inadequate consumption of nutrients can result. Calcium and vitamin D deficiencies are common, and can result in osteoporosis. This disease, which is mainly silent until the first of many bone fractures occurs, is characterized by the loss of bone mass. This disease usually shows itself around menopause, but the bone loss due to nutrient deficiencies may start decades earlier. Other symptoms of nutrient inadequacy such as thinning hair, fatigue, dry skin and bruising of the skin also may not show up for several years, but can be traced back to a very low nutrient sparse diet. A study of the nutritional adequacy of the Mediterranean Diet in Spain among thin women indicated that they were deficient in vitamins A, D, E, B2, B6 and folic acid, as well as several minerals such as iron. (Ortega, R, Lopez Sobaler, A, et al  Arch Latinoam Nutr. 2004 Jun54; 87-91.)

 

Even athletes, whom one assumes eat healthfully, may be nutrient deficient if they are dieting. Female volleyball players who play the game in the scantiest of uniforms were found to be deficient in a variety of vitamins and minerals, due to their dieting in order to reach a figure perfect weight. (Beals, K,  J Am Diet Assoc. 2002;102:1293–1296). And dancers who must maintain low weight and low body fat are particularly vulnerable to nutrient deficiencies ( Sousa, M, Carvalho, P et al ,Med Probl Perform Art 2013 28: 119-123).

 

Models, dancers and some athletes accept the necessity of maintaining an abnormally low weight as one of the demands of their profession. They may be able to compensate for their restricted calorie, and thus nutrient, intake with the use of supplements. However, supplements rarely provide all the nutrients they would get from food, if only they were allowed to eat more. 

 

Thinness is also prized among women whose weight is irrelevant to their profession but not to their social standing. And its potential nutritional toll and subsequent health problems may be ignored as thoroughly as by an obese individual who cannot stop overeating. A quasi-sociological analyses of the lifestyle of women who live in the rarified neighborhood of New York’s Upper East Side points this out. In her book, The Primates of the Upper East Side, Dr. Wednesday Martin describes the non-eating that takes place at social events. Women diet continually and subject their bodies to workouts that would make a Marine recruit weep in order to have a perfect body. So many foods are eliminated from their diet in order to achieve the desired thin state? It is a wonder that the residents of this neighborhood don’t suffer from scurvy, anemia and other nutrient deficiencies. They are not addicted to food, but rather they are addicted to their almost pathologically thin bodies.

 

And yet this bizarre eating behavior is not the subject of reality television, or urgent messages from health organizations warning about its long-term consequences of nutrient deficiency. We see the consequences of the massive overeating of the 600-pound individual and tsk tsk at what that person has done to his or her body. Maybe it is time to tsk tsk over the damage the too thin are also doing to their health.   

Are Reality Cooking Shows Really Fantasy Cooking Shows?

A group of us were chatting about a local restaurant whose chef was eliminated from the Food Network show, “Chopped.” The restaurant was popular; the show was not.

“The problem,” said someone, “is that the contestants are supposed to combine weird ingredients like Marshmallow Fluff and mushrooms into something edible and do it in 30 minutes or less.  How can of you make an entrée with side dishes in thirty minutes?  And using ingredients that are familiar, not Halloween candy and duck breast?”  We laughed but the question resonated and the group’s response was, “No way.”

As one person commented, it would be possible if we employed a full time assistant who would do all the basic prep work like chopping onions, peeling garlic, dicing carrots, and washing greens. And also making sure that water for pasta was always boiling, sauté pans were at the correct temperature and, we all chimed in, “Cleans up as the cooking goes along.”

“Watching the cooking shows, and then expecting to make the same dishes in 30 minutes or less, is like watching an international tennis match and then expecting to serve the same way,” said one of the women. “Even assuming I have all the ingredients on the counter before I start to cook—and that is a big assumption—it takes me twice as long, if not longer, to prepare the same meal.  And the shows are so deceptive. The cook will say something like, “…wilt the onions or beat the egg whites… and 3 seconds later it is done. Tell that to my onions! “

The women were of a certain age; that is, they had raised children, prepared thousands of meals, entertained, and had done this while working most, if not all, of these years. They may or may not have been good cooks, but they were experienced. And the consensus among us  was that cooking shows, whether competitive ones or in demonstrations by individual chefs, were deceptive. It looked too easy, too fast. Indeed, one woman said that she wondered if a younger generation, inexperienced in meal preparation, would end up serving undercooked food if they tried to imitate what they saw on television.

Wouldn’t it be useful to have one cooking program that was closer to reality? Onions would be burnt because the cook forgot to turn down the heat while answering the phone call from a telemarketer. The chicken would still be half frozen and dripping reddish chicken juice, the cat would leap onto the counter and poke around at the fish, the brownies would be overcooked around the edges and too moist in the center, and the food processor, used to puree the squash soup, would thrust its contents all over the floor like an erupting volcano.  But of course who needs to watch this on television when one can see it in one’s own kitchen?

Unrealistic menus or meal preparations are nothing new. During the 19th century and early 20th centuries, women studied and practiced a discipline called Home Economics, whose goals were to teach housewives basic nutritional requirements for their families and healthy cooking techniques on how to prepare food for the household. The goals were worthy, but some of the so-called nutritional meals were anything but. Cream sauces were poured over just about everything.  Salads consisting of Jell-O cubes, canned pineapple chunks and maraschino cherries were considered elegant enough for a luncheon. And, often disdain was shown toward ethnic dishes prepared by new immigrants, despite the fact that they were nourishing and familiar.  Women’s magazines often promoted recipes, not for their nutritional content, but because they used ingredients of their advertisers. The famous string bean dish in which the vegetable is drenched in canned cream of mushroom soup and sprinkled with canned fried onions rings certainly promoted the sales of these products.

But of course, in those far-off times in the last century, people were still cooking. Today one cannot assume that younger generations will or even want to cook at all.  Thus, if a non-cooking younger generation is to be weaned from supermarket or fast food take-out, prepackaged meals, or a diet of smoothies and shakes, they have to be shown, realistically, how to prepare a meal with more than two ingredients (salt and pepper).  Fortunately, the Internet is replacing the food channels in meeting this need. A little bit of searching will produce videos on how to prepare anything from baked potatoes to a soufflé.  And since they can be viewed as often as necessary, a refresher view is possible if it has been several months since the dish, say meatloaf or roast chicken, has been made.

Ingredients in a box that cook into a meal for two or more, delivered to your door, are becoming popular. Certainly the advertisements looks compelling, especially to cooks like this one who always seem to be lacking one or more ingredients essential to the recipe.  These could be considered starter meals. As they are more expensive than meals assembled from one’s own kitchen, they are unlikely to be a permanent substitute for reading a recipe, finding the ingredients, and cooking. Or maybe not.

Programs on the food channels are entertaining, which is their intent. If a recipe looks worth trying, it is always available on the website of the television personality who prepared it. But just don’t try making it in 30 minutes or less.

Should Santa Claus (and his wife) Stop Eating So Many Cookies?

Poor Santa, he certainly has not kept up with modern times. No internet, no computer, no 3-D printer assisted toy maker, and certainly no electric sleigh (or self driving one for that matter). And somehow Santa and his wife have not heard health professionals lament our excessive intake of sugar.

Consider this:

He used to be thin. Orginally, a long time ago, he started out life as a monk (and monks did not eat cookies) and eventually became a Bishop in a town in what is now Turkey. This was around 270, a time way before people thought much about the North Pole and its toy making factory. In his spare time, he gave away money he had inherited by throwing coins and gifts through the windows of homes in which children lived. But no one reciprocated by feeding him sweets.

Eventually, as St. Nicholas (this was long after his death) he became the patron saint of children. Still thin.

Then something happened several centuries later. St. Nicholas was transformed into a chubby (well more than chubby) jovial, cookie eating distributor of gifts because of a poem, meter and rhyme.

In l822, Clemet Clarke Moore, an Episcopal minister wrote the poem, The Night before Christmas, * and Santa lost his buff figure forever.  Others helped enlarge his figure; a cartoonist Thomas Nast drew Santa with a large belly in l890, and Washington Irving described him as a fat Dutch elf. And finally, Coca-Cola gave us the image we associate with him today by picturing St. Nick in a red suit with a white beard, of course.

Given the ubiquity of sugary snacks available to this now robust figure, it is really amazing that he does not grower fatter with every passing century or require a supply of insulin in his sleigh because surely he must have developed diabetes by now! Will he still eat cookies containing gluten, or might this affect his intestinal tract and mood?  Does he know about Grain Brain? We don’t want the presence of gluten to change his “HO HO HO!” into, “Oh, oh, oh….”

Why is he eating carbohydrates at all? That surely must be the reason he is still fat. If he followed the Paleo diet he might be thinner, and also be able to use wooly mammoths to drive his sleigh, rather than reindeer.

And really, what kind of example is he to our children? All year we try to get them to eat healthily, limit their snacks to baby carrots and plain yogurt, and make sure they eat nothing, or almost nothing, with sugar. We try to make sure they get enough exercise, and that they not depend on us to drive them everywhere. And then on Dec 24 along comes this guy who won’t even walk from house to house, no matter how close they are, but insists on riding to each one on a sleigh. He goes down a chimney (how much exercise is there in that? It is all downhill!) and his sleigh is waiting for him at the door. And there are those cookies. Does he even bring them home to his wife? Probably, because she is not exactly svelte herself.

Perhaps his focus on sweet carbohydrates means that like so many who live in northern part of the world, he is suffering from Winter Depression or Seasonal Affective Disorder (“SAD”). SAD suffers have an urgent need to consume sweets, especially in the late afternoon and evening. Maybe if he lived at the South Pole he would be not be so chunky and addicted to chunky chocolate chip cookies; seeing there it is summer in December, and the sun barely sets.

Of course none of us knows whether he and his spouse go on diets on January 2 like most of the world.  They may go the Weight Watchers equivalent at the North Pole, or endure a weeks-long cleanse or eat only meat (reindeer?).  But like most of the world, by next fall they will probably have gained back all the weight they lost, and Santa will be pudgy again. Should someone put out a diet book next to the cookies? Or at least some baby carrots?

But then again, if he loses masses of weight, his clothes will be too loose and worse yet, he will not be the Santa of Moore’s poem whose “little round belly laughed like a bowl full of jelly.”  So keep those cookies by the chimney. With care.

Will Preventing Male Baldness Cause Depression?

The symptoms sounded like a case of a male PMS: swelling in the hands or feet, swelling or tenderness in the breasts, dizziness, weakness, fatigue, cravings for carbohydrates, weight gain, depression, confusion, cold sweats, and sexual dysfunction. These are some of the side effects of a medication used to treat male pattern baldness. Finasteride, the generic name of the drug, was originally used to treat benign prostatic enlargement. During early clinical trials, however, researchers noticed that the volunteers were growing hair. It seemed too good to be true: finally, a solution to reverse age-related male baldness. The drug, known by the trade names Propecia and Proscar, seemed to be an effective treatment for the restoration of hair among men suffering from male baldness.

Finasteride’s effect on decreasing hair loss is related to its effect on a testosterone-like compound, dihydrotestosterone (DHT). DHT is an active form of testosterone and is responsible for prostate enlargement and the destruction of hair follicles on the top (but not the sides) of the scalp. Finasteride belongs to a group of compounds that inhibits, or slows this conversion of testosterone to DHT, thus making it an effective drug to slow prostate growth and, happily for many men, slow hair loss.

But unfortunately, getting a full head of hair comes with potential physiological and emotional costs. Soon after it was introduced to prevent male-patterned baldness, especially among young men (it works better among a younger population), anecdotal reports of depression and even suicidal thinking began to circulate. Even more disturbing, these critical changes in mood seem persistent even after the drug was discontinued. A small study to investigate the validity of these side effects was carried out by Dr. Michael Irwig of the George Washington University in Washington D.C.  He measured the moods of young men, average age 31, who had been treating their baldness with Propecia for an average of slightly more than two years. These men had developed persistent sexual dysfunction that continued for at least three months after they stopped taking the drug. He found 75 percent of those who had used the drug had symptoms of depression compared with 10 percent of controls who never took the drug. Over 30 percent reported having suicidal thoughts compared to only one from a control group. Were these young men depressed because they were experiencing sexual dysfunction or the converse? The study did not answer that question.

An increase in appetite, especially for sugary carbohydrates, and weight gain were two additional side effects that lasted well beyond discontinuing the drug. This was also unexpected, but reported as a side effect often enough to make the FDA add them to the list of side effects. And according to stories by men who used Finasteride, the weight does not come off after they stop using the drug. As one disgruntled user said,”I would rather be thin and bald than the way I am now, fat and hairy.”

What seems to be the link between Finasteride and depression? By altering the synthesis of the testosterone-like substance, it might be affecting two possible neurotransmitters in the brain involved with depression and anxiety. One is gamma-aminobutyric acid, commonly known as GABA, and the other is serotonin. Interestingly, serotonin activity also decreases when estrogen levels decline at the end of the menstrual cycle, and the resulting depression, anxiety, fatigue and overeating characterize PMS.

Evidence that the Finasteride-associated depression may be related to a change in serotonin activity comes mainly from animal studies looking at the effect of testosterone on certain serotonin receptors. But a hint that serotonin may be involved can also be found in reports of intense carbohydrate craving from men who have used the drug. PMS and Seasonal Affective Disorder (severe winter depression) are each characterized by carbohydrate cravings, depression, and decreased serotonin activity. And the consumption of carbohydrate by these groups seems to relieve their depression, anxiety and fatigue because of the resulting increase in brain serotonin synthesis.

Might men suffering from Finasteride-related mood changes also benefit from eating carbohydrates? Were they to consume 25-30 grams of a starchy, very low-protein carbohydrate snack two or three times a day, on an empty stomach, they will be increasing serotonin synthesis. The resulting improvement in mood may not dispel their depression entirely (after all, a cup of oatmeal is not an antidepressant), but at least will make it easier to cope with their negative moods and the possibility that they will now lose their hair.

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?

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.

At What Age Is It Alright To Act Old?

At a museum where I volunteer, a group of women and a handful of men came for a talk and a tour. They live in a retirement community, and ranged in age from their early seventies to mid-eighties. Most had difficulty walking, and gratefully sat down, even though they had been on a bus for two hours (traffic was bad). After hearing a talk and watching a video, many continued to sit even though visiting the exhibits required walking. The few who did stroll around the museum were conspicuous in their relative vigor despite, judging from their appearance, they did not look any younger than the rest of the group. Ninety minutes later, they climbed back on the bus, happy to be going off to lunch.

The reluctance of most of the group to walk around the museum they had come to visit may be typical of this age group. A review article by Drewnowski and Evans in the Journal of Gerontology pointed out that people 65 years of age and older significantly reduce the time they spend in voluntary physical activity. Some in this age group are unable to do any activity that requires muscular strength, such as getting up from a chair, carrying small items like dishes, or dressing themselves. Clearly the museum visitors have not fallen into dependency on others to assist them in what is called the activities of daily living, but if they had been forced to leave the museum quickly, say because of a fire alarm, I doubt most would have been able to walk, even in that circumstance, sufficiently fast enough to be safe.

Many of us take for granted that if we reach our ninth decade or even our eighth, we will be in a sense physically shackled by the decline of our bodies. And it is true that people who engaged in recreational sports such as skiing, tennis, running or biking when younger decide that they are too physically slow, their bones too fragile, their balance too uncertain to continue as they age. Indeed, I once had a weight-loss client who told me with great seriousness that, as she was soon to be forty, she was too old to exercise.

But does old age mean resigning oneself to a life of increasing frailty and limited mobility? Certainly joint and muscle pain or neurological degenerative diseases like Parkinson’s disease make movement difficult and often painful. But, as Drewnowski and Evans point out, the answer is no for the healthy elderly. If they engage in physical activities that improve muscular strength, endurance, and flexibility, they would find themselves walking more easily with improved balance and endurance. They would also decrease their risk of falling and fracturing their bones.

I wonder if people in this age group, like the museum visitors, consider themselves too old to be more physically fit? Perhaps they believe this, in part, because others reinforce that attitude by making it too easy for them to avoid walking or standing. When I asked one of the museum staff people why the visitors should be sitting for an hour of lecture and video after being on the bus for two hours, her reply was, “They are old. Let them sit.” Would she have said that if Jane Fonda,who is about to be 78, were in the group?

Do we make people behave old just because their age puts them in that category? Are we telling people that once they receive Social Security and Medicare, they can accept the inevitable deterioration of their bodies and should stop trying to slow it down by physical activity? Do we tell them, ‘You are old, so act your age!’?

And if they believe that they have the right to sit their way through their eighties, how are they going to fare as if they get into their nineties? If they enjoy reasonably good health now, they can expect to become part of the fastest growing group in the country–the ‘oldest old.’ The cohort of people 85 years of age and older is expected to triple between now and 2030. But if people 5-10 years younger than the oldest old are experiencing limited mobility and endurance, how will they manage as they age without needing to be dependent on others for their needs?

One problem is the absence of role models for this age group. There are too few like Jane Fonda, Lily Tomlin (76) and Morgan Freeman (78). Also, one can’t go to a newsstand or bookstore and find glossy magazines featuring exercise and healthy lifestyles for the over 70 crowd. Fitness facilities ignore this age group, who may feel uncomfortable with the density of twenty-something bodies in various states of uncover working out to blaring music. Even workout clothes are designed for the cellulite-free limbs of the younger cohorts. And exercise classes are rarely designed to protect aging knees or backs. If they are, they may be almost too protective and not push the participants hard enough.

The result is acceptance and complacency. I’ve heard the following: “If everyone around me is complaining of aches and pains and can’t walk far, or climb stairs, or lift packages, or do yoga stretches, why should I? If I go on a trip and the bus driver makes sure I don’t have to walk more than a few yards to a restaurant and I can sit down at the museum, why should I exert myself? I am too old.”

What is too old? Perhaps it time to tell the 75 year-old that if she wants to live a strong and healthy life into her 90′s, she better stop acting her age now.