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When Competing Athletically Ends, Does Weight Gain Begin?

“I used to be able to eat anything and in any amount,” a young graduate student who had come to me for weight-loss consultation told me. Since I began competitive swimming in high school, I would burn off so many calories that keeping my weight on was a problem. And I swam all through college as well.  But I stopped now that I am getting my Ph.D., and after a couple of years sitting in class or in the library, I have gained 40 pounds. My anxiety as well as my weight has increased.”

Donna (not her real name) was in the enviable position of eating everything and never worrying about portion size. Even on school days, she would spend at least five hours training and when preparing for competition, more hours. And when she felt anxious over college applications and then later about getting into graduate school, for example, several minutes of doing laps decreased her anxiety and left her feeling calm and in control. But all that changed and she now had to learn how to eat like the rest of us who can never approach the level and intensity of a training regimen for a competitive athlete.

Donna’s predicament was not unique. Indeed, she joined the ranks of young athletes whose participation in sports, even at an Olympic level, stopped when they did not transition to professional status. And this group is folded into the company of professional athletes who at some point in their lives (Tom Brady notwithstanding) decide that age, injury, and competition from younger players are good reasons to hang up their bathing suits or shoulder pads. And many experience changes in their body, food intake, mood and general satisfaction. As a trainer in a gym told me, “How can they not feel depressed when no one is cheering for them or they are no longer feeling that adrenaline rush from a perfect gymnastic performance or another home run?”

Gymnasts are only one category of athlete who must deal with body image, weight, eating issues and mood changes after withdrawing from competition. In a small study,  the authors found the excessive concern over body image, weight gain and the use of laxatives and excessive exercise to restrict weight gain. (1)

Heightened concern over body weight extends to other sports as well. In the article “The Inextricable Tie Between Eating Disorders and Endurance Athletes” (Outside Magazine June 2017) Nora Caplan-Bricke describes the pressure on Tyler Hamilton, a Tour de France cyclist to lose a considerable amount of weigh in order to compete more successfully. Even though he was 5’8”, his racing weight of 130 pounds was achieved by hours of training followed by little or no food. Hamilton, like other athletes she describes, felt that a low weight gave him a competitive advantage for a while. Women athletes from marathon runners to professional climbers have also spoken out about an obsession with achieving a pathologically low weight in order to perform better and the eating disorders that inevitably accompany such goals.

But skinny athletes aren’t the only ones facing problems in controlling their eating after retiring from competition. Consider the massively large football players whose weight is an advantage while on the playing field but once they retire can lead to a variety of obesity-related disorders. According to an article “Obesity Could Be the True Killer for Football Players” by Rose Eveleth in Smithsonian.com (January 31, 2013), football players are becoming supersized.  She quotes research showing that since l942, the weight of linemen has increased by almost l00 pounds. To be sure massive muscles contribute to the weight and, under the supervision of coaches, the players’ food intake is monitored and exercising regularly is hardly a problem. But when they retire, the players do not automatically (or ever) drastically reduce their calorie intake because they are no longer in training and no longer need to maintain a massive size to be competitive on the football field.

Moreover (and this is not limited to ex- football players), anecdotal reports indicate that it is very hard for players to continue their intense workouts when they are no longer playing /competing professionally. Thus they lose their edge, their stamina, and their ability to endure pain and find it very hard to resume their workouts at a lower level of intensity and skill. Donna reported the same thing. Once she stopped her very long swims, it was hard for her to be content with doing only 30-45 minutes of laps rather than the hours she used to spend in the pool. She told me she mourned her decreasing endurance and speed.

When an individual entering a new sport exhibits the potential to become competitive he or she is coached to attain higher and higher levels of competence and success. Specific training programs often based on scientific analyses of how best to enhance performance are offered, along with nutritional and even psychological counseling. But when the same athlete withdraws from the sport, for whatever reason, there is no compatible oversight to help transition back into a normal life. Although there are nutritionists who specialize in sports nutrition, they by and large do not specialize in “leaving the sport” nutrition. Nor are there personal trainers with similar “retiring from competitive training” specialties or many therapists who know how to deal with the loss of withdrawing from an activity that dominates much of the individual’s life.  Gaining weight may be a visible sign that the individual needs help in adapting to an ordinary life but doing so must be emotionally as well as physical difficult. The ex-athlete deserves well-informed support services to be successful at doing so.

1.) “Influence of Retirement on Body Satisfaction and Weight Control Behaviors: Perceptions of Elite Rhythmic Gymnasts,” J of Applied Sports Psychology, Stirling, A., Cruz, L., and Kerr, G., 2012: l24; 129-143

 

 

 

 

The Most Overlooked Benefit of Exercise: The Ability to Get from Point A to Point B

A friend who just returned from Seattle was recounting the unexpected steepness of the city streets. ”Nothing is flat,” she told me. “You are either going up or down.” She was not young and had been worried about spending time exploring the city with a relative at least 10 years her junior. The younger woman was athletic and her favorite leisure activity was going on very long walks.“One day we walked up hills so steep I wondered how cars could drive up them! She took me up flight after flight of outdoor steps to get into certain neighborhoods. But I kept up with her and I don’t think I was puffing anymore than she was…“

My friend ascribed her stamina to her favorite gym activities: either walking on an elevated treadmill that mimicked walking uphill, or the elliptical climber which required a motion similar to climbing a shallow set of steps.

“I exercise because it is a habit,” she said as we discussed her unexpected physical prowess. “If I skip more than a day or two, I don’t feel right and have trouble sleeping. And of course it is good for my bones, especially since my mother suffered from osteoporosis and fractured her hip. But it never occurred to me that it would improve my, I guess I would call it, functionality.”

“You mean your ability to move better, longer, more efficiently and with less fatigue?” I asked.

“Yes, all of the above,” she laughed, “almost like a real athlete.”

Her experience of finding herself able to handle the demands on her body of trudging up hills because she exercised regularly should not have been a surprise. This, after all, is the point of training for competitive athletes or people setting off to climb mountains in the Himalayas or bike ride across the continental U.S. But those of us who are not planning on competing in athletic events and prefer to watch mountain climbing on a National Geographic special forget the most basic benefit of exercise: It prepares our body to engage in physical activity that may at times become demanding and strenuous.

The converse is painfully obvious. Someone who is unfit because of a voluntary disregard for any type of regular physical activity will have trouble climbing the steps out of a subway station or walking down a seemingly endless airport terminal corridor on the way to a gate or exit. Breathing becomes labored, muscles begin to ache and there may even be the feeling that unless help in the form of an escalator or one of the airport moving people carriers comes along, the goal of getting out of the subway or to the departure gate will not be achievable.

Of course, there are many who would, but cannot, exercise because of physical limitations. For example, a painfully bad back or severe asthma are obstacles to physical activity that may be difficult to overcome. And there are many whose lifestyle severely limits time to go on a long walk, work out at a gym or have time on a day off to engage in recreational sports. Convincing those who could, but don’t exercise, usually relies on listing the benefits to one’s weight, skeletal infrastructure, digestive system, sleep, cognition, mood, vulnerability to diseases like diabetes or high blood pressure, and life span. For example, there are some studies claiming that weight loss can be achieved through exercise alone without dieting, and that exercise is important in decreasing stress and depression.

But why do we ignore the obvious? If we rely only on vehicular transportation, we will diminish our stamina, endurance, the ability to oxygenate muscle cells sufficiently for prolonged contractions, and our muscle mass.

In short, we will find it more and more difficult to go from point A to point B.

It is possible to go through adult life with minimal need to engage in physical activity to arrive at a destination. Cars that sit in a garage next to the kitchen, or in a parking space a few steps from the elevator in the office building, reduce the need to walk. Malls that allow parking in front of a store or restaurant, or valet services that bring the car back to where you are standing on a sidewalk, also eliminate the need to move very much. One can even find scooters in supermarkets so walking can be avoided, and ordering groceries on line eliminates the need to even go to the market.

However, there are consequences to a lifetime of little voluntary physical activity beyond the obvious ones of physical well-being. It means not being able to explore a new city or museum or zoo on foot. It means not being able to walk through the woods, around a lake, or a botanical garden. It means a casual stroll with a child or friend or spouse is not pleasurable because fatigue and muscle pain quickly limit distance and enjoyment.

My friend concluded her description of her tramp through the city with an ecstatic description of the flagship Starbucks restaurant that sits on top of a steep hill. The restaurant, part museum, part coffee grinding factory and mostly a place where the city folk gather to drink coffee and eat incredible pastries from Italy was the treat her relative had planned for her. “She told me parking is impossible around that neighborhood, and she hoped I was going to be able to get there on foot. My days of exercising really paid off.”

Is It Safe to Eat Food This Summer? Or Ever?

If you want to feel paranoid about eating in restaurants, or buying packaged fruits and vegetables that may be also be pre-cut, and cooking chicken and eggs, then don’t look up current food-borne illnesses on the Internet. I have a relative who gets alerts from the CDC about the latest source of food poisoning, and immediately passes the information on to me before I read about it in the newspapers. She told me to avoid Del Monte packages of cut-up vegetables as they contain a microscopic parasite, and also to dodge Cyclosporai via pre-cut melon because of a multi-state salmonella outbreak, and a few months ago, she alerted me not to buy Romaine lettuce in the supermarket or eat salads containing this leafy vegetable at restaurants because it was contaminated with E.coli. Thankfully, it is now again safe to have salads with this lettuce.

My food contamination alerts decreased temporarily when she went on vacation, so I decided to find out for myself what other aggressive pathogens might be lurking in my food supply. A quick scan of websites devoted to reports of food-borne illnesses uncovered a report about Kellogg’s breakfast cereal Sugar Smacks linked to a Salmonella outbreak across 31 states, Canadian restaurant workers in danger of Salmonella if they handle raw or frozen uncooked chicken, and one horrifying story in the British press about a man who nearly died after he ate a chicken liver parfait (we would call it a mousse) at a dinner at which he got an award from his employer. His situation sounds like something out of an Agatha Christie novel: disgruntled employee kills co-worker who received an award.  But actually many of the 500 people who attended the event got sick as well. However, this individual spent seven weeks in intensive care because he was unable to move his arms and legs and could neither talk nor blink. His eyes remained opened and he could not sleep. This ghastly set of symptoms was due to the Campylobacter bacteria. According to the report, the chicken liver “parfait” should have been heated to a much higher temperature than it was in order to kill off the bacteria lurking within.

How was the awardee, or any of the others who attended the catered dinner, supposed to know this?

And this is the problem. It is all very well to read about the outbreaks and then check the refrigerator to see whether the contaminated item is there. But obviously we know about the problem only after people become ill. In the back of our minds we may find ourselves thinking, maybe I will be the one getting sick from the next contaminated food outbreak. When the Romaine lettuce recall occurred a few months ago, and people shared information about this with their family and friends, I saw more than a few horrified expressions that seemed to say, “Didn’t I just have a salad at a restaurant or homemade with Romaine lettuce?”

The same thing is true of food poisoning from restaurants. There is a website, “I was poisoned.com”, on which victims of contaminated restaurant food write about the unpleasant aftermath of the meals they ate at a particular restaurant. I suspect that fewer people check that website before going out to eat than looking up the menu options in a restaurant they are considering visiting. But maybe one should start on the website first.

It is disheartening to realize that all of us are in jeopardy. Even if you never eat in a restaurant, unless you grow your own fruits and vegetables, raise chickens for eggs and baked chicken breasts, and also make your own bread from your hand-milled flour (flour from certain mills was contaminated last year), you could be next.

Of course, we can and should use precaution in our own food preparation: cooking foods at a high enough temperature to kill the pathogens, refrigerate foods as quickly as possible, keep counters and sponges clean, wash our hands after handling raw eggs and poultry, and prevent what is called cross-contamination. This means not wiping the counter with the sponge you used to mop up raw chicken juice (ugh) or making a salad with hands not washed after touching same chicken.  Perhaps decreasing the number of meals we eat away from home might also help. Preparing your own container of cut-up fruit or chicken salad or smoothie rather than buying these items eliminates the uncertainty of where the food comes from and the whether it was prepared under strict sanitary conditions. Avoid eating foods at catered buffets that look as if they could shelter bacteria. A mousse of chicken liver , assuming one likes chicken liver, should be consumed with caution if only because unless it is kept cold, one doesn’t know whether it is a culture medium for bacteria.

But how does one protect oneself against an outbreak of food-borne illness if the food is something as unprocessed as lettuce or cantaloupe? Or how is the consumer to know that Kellogg had another company manufacture the cereal that was contaminated?

A start would be to stop being complacent about food safety. Rather, perhaps a bit of paranoia is worth having when reading a restaurant menu, checking out the cleanliness of a restaurant rest- room  (where unwashed restaurant workers’ hands may cause hepatitis A outbreaks) and taking a peak at the “I was poisoned” website.

Just don’t look at it after you eat.

Losing Your Sense of Smell to Lose Weight

A friend who went through an intense treatment of chemotherapy two years ago is still unable to smell, and thereby taste, most foods. She was warned this might be a treatment side effect, and when it would disappear was unknowable.  She used to eat chocolate, any kind of chocolate, as long as it was chocolate. “I don’t eat chocolate anymore,” she told me. “It tastes funny.”

That chocolate tastes funny to her is more likely to be from a loss of a sense of smell than taste.  According to Nancy E. Rawson, Ph.D. who is on the staff at the Monell Chemical Senses Center, Philadelphia, and Scientific Advisor to the Anosmia Foundation, it is our sense of smell, our olfactory system that gives us our taste sensitivity.  When people loss this olfactory function, when they have anosmia, they may not be able to taste the difference between an orange and a piece of chocolate.

As she and others explain, our ability to taste is almost totally dependent on our ability to smell. Of course, we can detect the basic tastes: sweet, salty, sour, bitter and umami, a savory taste sometimes associated with the taste of protein, even if we lose our sense of smell. But smell is the conduit to taste; without it the tastes of most foods are unrecognizable. We have cells high inside the nose, the olfactory sensory neurons, that connect directly to the brain. When we smell coffee brewing or popcorn popping, the microscopic “odor” molecules released by the food stimulate these neurons, and they message the brain, which then identifies the odor for us. (Dogs are much better at this than humans.) Interestingly, the smells come in not only through our nose, but also through a neuronal path connecting the roof of the throat to the nose. So when we chew our food, odors are also released that are picked up by the olfactory sensory neurons and sent to the brain.

A stuffy nose makes us aware of how important smell is in tasting what we are eating, and influences how much we enjoy or reject a particular food (think smelly cheese). But although it is frustrating to be unable to taste food when we have a cold, we know that once our stuffy nose disappears, we will be able to smell and enjoy eating once again.

It is this aspect of eating, enjoying the taste of food brought about by our ability to smell it, that has spawned interest in preventing the dieter from doing so.  If the food is tasteless, might the dieter eat less? Would the dieter stop eating when full, rather than continue to eat beyond fullness because the food tastes so good? Would impulsive eating of freshly baked chocolate chip cookies or French fries be thwarted because, without their scent, they lose their irresistible taste?

Apparently this occurred among subjects participating in a study in which they wore a nasal insert designed to redirect airflow in the nose away from those sensory olfactory neurons that tell the brain what we are smelling. Dror Dicker, MD, Rabin Medical Center, Israel, at the European Congress of Obesity a few weeks ago, described the device called Noznoz. The 65 subjects who wore the device while following a calorie-controlled diet lost significant weight; they especially reduced their consumption of sweet foods. In a sense, they had a perpetually stuffed nose.

Although the use of a custom-fitted nose device to reduce food intake is new,  the link between loss of the olfactory sense and altered food intake is well known. (“Olfactory Dysfunction Is Associated with the Intake of Macronutrients in Korean Adults,” Kong, Il, Kim, So, Kim, Min-Su et al, PLoS One 2016 ;11: 0164495)  Food intake among more than 1300 participants who had olfactory dysfunction (or inability to smell) was altered, compared to those who did not have this problem. Protein intake was reduced among males, the intake of sweet foods among young women, and consumption of high-fat food among young and middle-aged women. How the loss of the sense of smell differentially affected what was eaten or rejected was not explained in the paper.

Loss of the ability to smell odors may be one of the unwelcome aspects of aging. (“Effects of aging on smell and taste,”  Boyce, J. and Shone, G., Postgrad Med J. 2006 Apr; 82(966): 239–241)  The effect of aging on the deterioration of the sense of smell is so prevalent that one wonders if there ought to be generational-based recipes; foods made for an older population might have ingredients such as vinegar or lemon that can be tasted without a good sense of smell. Boyce and Shone state that in a recent survey almost 65% of 80-97 year olds have an impaired sense of smell.  The effects can be far ranging from the addition of too much salt and other spices to food in order to taste it, to malnutrition. Just as the loss of the sense of smell affects food intake among a younger population and decreases their food intake, so too the very old may eat less indiscriminately. They not only might avoid sweet or fat-rich foods, but food in general, thus causing them to be at risk for malnutrition. This is especially worrisome if their food intake is not sufficient to provide essential nutrients like protein, vitamins and minerals.

Fortunately the NozNoz and other interventions like a nasal spray that numbs the nose to smells, do not permanently eradicate this important sense. Indeed, its greatest utility might be putting them on when passing by sources of enticing food odors like sausages and onions cooking at a street fair that might tempt one into eating. It remains to be seen whether weight will be regained when and if the dieter removes the nose plugs. And of course, they may be helpful in cleaning up after a baby or dog.

 

 

Funeral Potatoes Comfort, But At A Caloric Cost

What are funeral potatoes? People were asking this after an advertisement from Walmart for a packaged version of this dish appeared on their web site. Funeral potatoes are a well known dish in Mormon communities in Utah and Idaho, although it is popular as a cheesy potato casserole in many areas in the mid-west. Funeral potatoes is the name of a casserole traditionally brought to the home of the bereaved to be served at the after funeral lunch. The appearance of an instant version of this dish in Walmart may simply be evidence that in our busy lives, some do not have time to buy and assemble the ingredients. It is easier to find them all in a bag.

The ubiquity of this dish in homes of the newly bereaved, whether it comes from a package or is made from scratch, indicates that it may have an important function during the mourning process. The dish is considered the premier comfort food for after funeral repasts. One reason is that when made correctly, and probably not from a box, it tastes wonderful. Anyone who loves the combination of a creamy, cheesy, and crispy potato dish will have satisfied taste buds after eating funeral potatoes. (See below for generic recipe)  But long minutes after the food is consumed, the eater may experience a feeling of calmness, comfort, and decreased stress. The taste of the dish has disappeared from the mouth, but the effect on the emotions continues to grow.

Why?

The brain, not the gut, i.e., the intestinal tract, is involved in producing this emotional change. Twenty minutes or so after the last mouthful of the funeral potatoes are swallowed and digestion is in full swing, changes begin to occur leading to perceptible improvements in mood. Feelings of calm begin to take the edge off the sorrow and distress felt after the funeral. This occurs because of an increase in the synthesis and activity of the ‘feel-good‘ brain chemical, serotonin.

Funeral potatoes do not contain serotonin. (Indeed, even if one could eat something with serotonin in it, this very large molecule never, ever gets into the brain.) But potatoes are a starchy carbohydrate, and as happens when any starchy carbohydrate is digested, insulin is released. This sets in motion a process that allows an amino acid, tryptophan, to get into the brain . And as soon as tryptophan arrives, serotonin is made and one’s mood improves.

In the interests of good nutrition, or bringing food for a bereaved individual who may be on a Paleo or ketogenic diet, or any adherent to the, “Carbohydrates are Terrible Foods and Should be Avoided!’ diets, shouldn’t the traditional funeral potatoes be replaced by something else? Funeral potatoes may taste wonderful and make everyone feel better, but a dish of chopped egg whites is certainly a preferable dish for people avoiding carbohydrates. Or if not egg whites, perhaps roast chicken or baked fish or a smoked ham? These high protein foods certainly seem more nutritious than hash brown potatoes soaked in cream of chicken soup and covered with melted cheese, butter and crumbled cornflakes.

However, as important as eating protein is for our nutritional well-being, it has no effect on our emotional well-being. The carbohydrate, this funeral potato will nourish the mind, soothe the emotions. Potatoes are not an antidepressant, and of course cannot take away the pain and sorrow of a death of a family member or friend. But the synthesis of serotonin after eating carbohydrate is nature’s gift to us. It allows us to console and comfort ourselves simply by eating the right foods.

Eating protein prevents serotonin from being made. This is due to the absence of insulin secretion after protein foods are digested. The blood stream is flooded with amino acids that come from the digested protein, and although tryptophan is among the amino acids coming into the body, it is unable to get into the brain since the other amino acids crowd entry points to the brain. Eating protein does not truly comfort or console.

There is a problem, however. If going to an after-funeral lunch is something that is thankfully rare, eating funeral potatoes should have no lasting effects on weight and longevity. But if based on the traditions of your community or the ages of the people with whom you spend most of your time, and you are making frequent condolence calls? Eating funeral potatoes may deposit extra pounds you do not want. It is a very fattening dish mainly because of the number of high fat ingredients, e.g. sour cream, cheese, and butter.

Does this mean that you should eat egg whites instead, despite the lack of comfort bestowed by protein consumption?

Fortunately no.

Your brain does not care whether the carbohydrate that will ultimately lead to more serotonin is loaded with sour cream and shredded Cheddar cheese, or is a dry rice cake, bowl of bran flakes, or a boiled potato. Indeed the absence of fat as in a plain boiled potato will lead to a more rapid digestion, more rapid serotonin synthesis, and more rapid feeling of comfort.

Funeral potatoes are a great comfort. But for the sake of a healthy weight and avoidance of one’s own funeral, a plain baked potato (no butter or sourcream) should be eaten instead.

Generic recipe for Funeral Potatoes
Can Cream of Chicken soup
1 ½ – 2 cups shredded Cheddar cheese
2 cups sour cream
2 pounds package of frozen hash brown potatoes
1 stick butter
Chopped onions-1/2 cup
1-2 cups crushed corn flakes

Eating When You Are Not Hungry: It’s Called Appetite

The woman who came to see me for weight loss, let’s call her Ann, was about 40 pounds overweight and frustrated, in her words, by, “…a lifetime of weight loss followed by weight gain.” Her problem, she thought, was that when she felt hungry she liked to eat protein because it filled her up. But then she still wanted to eat carbohydrates even though she was full from the protein.

“Why do I feel hungry all the time?” she asked. “Or, more to the point, why do I want to eat when I am not sure that I am really hungry? All the diet plans I have gone on promise to take away my hunger, but I still want to eat.”

“Perhaps you are feeling two different kinds of hunger,” I ventured. “One might be actual hunger and the other, appetite.”

Feeling as if I was wading into the quicksand of definitions of hunger and appetite, I gingerly offered my own explanation. “Being hungry is natural, and it means your body is telling you that you need calories and nutrients. It is a signal, like thirst, indicating that your body needs you to take action. If you are thirsty, you drink water. If you are hungry, you eat. Now appetite, on the other hand, is what you feel when you are not hungry but want to eat.  Perhaps not a very scientific definition, but I think it works.”

I told her that it we often think appetite is hunger, perhaps because we are so rarely really hungry. Hunger is often accompanied by symptoms such as a headache, fatigue, feeling faint or weak (as in weak from hunger), nausea, irritability, and emptiness in the stomach.  Most of us do not approach that dire state before being able to feed ourselves. Conversely, we often, perhaps too often, decide that we are hungry, and need to eat for reasons unrelated to our body’s need for calories.

The difference between hunger driven by the body’s need to sustenance and hunger, aka appetite driven by perhaps emotional or situational needs, can be seen by looking at the eating behavior of an infant, a young child and an adult.

A hungry infant will cry when his or her body demands to be fed. Once fed, the baby often relaxes and falls asleep. But consider the toddler, sitting in a stroller and whining. Mom takes out a sandwich bag of breakfast cereal, often Cheerios, and the toddler spends the next fifteen minutes eating, a distraction from whatever caused the whining. Is the toddler hungry? No. But the toddler has an appetite for Cheerios.

Jump ahead a few decades. The adult misses breakfast and lunch is delayed because of work or other demands. It is three o’clock and she finds it hard to work because lack of food is causing a headache, a growling stomach, and fatigue. An ancient protein bar stuck in the drawer is detected and, even though it tastes like pressed sawdust, is gobbled down. Hunger is at partially sated, and she is able to go back to work.

Two days later, the same adult has consumed breakfast and lunch, and is busily working on a complicated but teeth-gnashing boring document. The adult is grumpy, impatient, and distracted. “I need to get something to eat,” she thinks and leaves the office to go to the lobby snack shop. After buying and gobbling a large chocolate chip cookie, she goes back to her office and is able to resume work. It is no less boring, but she can deal with it more easily. The cookie was eaten because of appetite.

There seems to be a bias against giving in to appetite. We are told not to eat between meals, after supper, or when we are stressed, bored, tired, angry, lonely, anxious, and/or depressed. And yet the impulse to do so is often as great as the need to eat when we experience hunger. Indeed, many of us may experience genuine hunger, the kind that makes even a stale piece of bread desirable, much less frequently than we experience appetite, the kind of hunger that make us debate over what we feel like eating for dinner.

Isn’t it appetite rather than hunger that makes us consider eating dessert? Isn’t it appetite rather than hunger that causes us to polish off all the French fries or continue to nibble at the edges of the apple pie after we have eaten a large piece? Isn’t it appetite that suddenly makes getting an ice cream imperative after we see someone else eating one? Or, when we go to a street fair and smell sausages and onions grilling, isn’t it our appetite that makes our mouth water even though five minutes earlier we were not hungry?

Weight-loss programs promise to curb or eliminate hunger. None mentions appetite. Some say that their program allows the dieter to eat what she wants, so if a brownie is desired rather than cottage cheese? That is fine. But the program guidelines do not distinguish between wanting the brownie out of hunger or out of appetite.

Ann and I analyzed her eating habits to see when she ate out of hunger and when out of appetite. She had the option of trying to eliminate her appetite-associated eating but decided it was unrealistic. She wanted her carbohydrate snack in the afternoon and the option of having another in the evening, even though she wasn’t hungry when she ate these snacks. “If I am going to lose weight and keep it off this time… I have to allow myself to eat the way I want, not the way some diet plan wants me to eat.” She continued to eat protein when she was hungry and allocated a certain number of calories for the carbohydrate foods her appetite urged her to eat.

“I guess I can have my cake, eat it,” she told me paraphrasing a well-known French queen, “and lose weight!”

Should Cauliflower Be the Main Course at a Vegetarian Wedding?

I could have chosen the fish entrée at the wedding we went to a few weeks ago. But since we eat fish several times a week, and since the caterer was known for creative healthy main courses, I opted for the vegetarian choice. Maybe I would discover a novel way of preparing non-animal protein to add to my cooking repertoire.

But alas it was not to be. The mix of vegetables, grains, and lentils that were described in the printed menu was like a bait and switch. The plate arrived containing a mound of steamed cauliflower surrounded by two tiny pieces of sautéed mushrooms. I looked wistfully at the perfectly grilled fish my spouse was eating. Next time I will know better.

But why? Why shouldn’t a caterer prepare a vegetarian entrée with the same balance of protein, vegetables and starch that would appear on a traditional meat or fish dish? Why do caterers or chefs in general assume that vegetarians eat only vegetables? People who identify themselves as meat and potato eaters surely must eat other foods for breakfast or lunch. And why do caterers and chefs conflate vegetarian and vegan? They are not the same.

Indeed, the menu said “ vegetarian” entrée, not vegan. This meant that protein from dairy products and eggs could have been incorporated into a main course, thus allowing for a large variety of possible dishes. Moreover, if the entrée had been listed as vegan—meaning no dairy or eggs—then other protein sources such as beans, lentils, soy, and quinoa could have been used.
It is not necessary for the chef preparing a vegetarian meal to reinvent the wheel. Because animal protein has always been expensive and out of reach for much of the population, each culture has developed signature non-animal protein dishes from cheese blintzes to bok choy stir-fry with crispy tofu. Moreover, the Lenten season restricts the consumption of animal protein, and over the centuries many vegetarian dishes have also been developed to feed families unable to eat meat or chicken.

But none of this seems to be considered when the catering kitchen or many restaurants plans the components of a vegetarian meal. Unfortunately, despite the protein sources that could be incorporated into a vegetarian dish, the protein is usually omitted. Sometimes this is because the caterer simply takes the vegetables from other entrées and dumps them on the plate for the token vegetarian. But protein is often left off of the plate because the chef doesn’t take the time to learn how to include it.

Ironically, eating a vegetarian entrée at a catered affair that serves the main course often hours after one normally eats is a wise choice. Ingesting a slab of filet mignon or heavily sauced chicken at 9 or even 10 pm does not make for a sound sleep a few hours later. Digesting the fat in these animal protein dishes sometimes causes sleep disturbances or a lighter sleep than normal as well as a feeling of heaviness upon awakening the next morning. Vegetarian options tend to contain less fat (unless substantial amounts of cheese are used) and are less likely to demand heroic digestive function late at night.

Until the education of chefs at well-known culinary institutes includes an intensive education in preparing protein-rich vegetarian dishes, there is little hope that vegetarian entrée options at catered affairs will improve. And until cooking shows feature vegetarian dishes that provide at least 25-30 grams of protein and which seem “yummy” enough to be reproduced in the viewer’s kitchen, there is little hope that home cooks will find making a well-balanced vegetarian meal as desirable as grilling chicken or a hamburger. Fortunately, there are many excellent cookbooks and some gourmet cooking magazines that provide ample recipes for the vegetarian home chef. And in fairness to the caterers and restaurant chefs who have developed nourishing vegetarian main courses that look and taste good, it is hoped that they will be able to stimulate others to provide nourishing meals for those who abstain from animal protein.

However, until this occurs, it may be necessary to plan on eating before going to a catered event or bringing protein bars to nibble, discreetly, along with that cauliflower. And if there is any benefit to being denied a substantial vegetarian meal at a catered affair… it is that you will be one of the few who don’t feel your wedding finery is getting snug.

Who Cares for the Caregivers?

Her husband’s Parkinson disease had progressed significantly since we’d last seen each other and her stress progressed along with it. The kitchen counter was covered with pill containers and dosing schedules; the wheelchair was sitting by the ramp to the car and her husband waiting patiently for his aide to help him get dressed.

My friend, let’s call her Mandy, barely said hello before launching into a description of the difficulty she had getting her husband ready for bed the previous night. Apparently, he sat in the wrong chair in the living room while watching a football game. The chair did not have the jack that would propel him to his feet. It took two hours to get him upright and ready for bed in a tiny room near the kitchen. He could no longer climb stairs to their bedroom. She was exhausted and near tears.

Her situation is repeated in homes throughout the country where one spouse or child or elderly parent is losing physical, and often cognitive, strength due to neurological diseases that get worse over time. My friend is one of the fortunate ones. She is able to afford the service of professional aides and a physical therapist because of insurance purchased many years earlier when they were both healthy. Someone much stronger than she is can carry out the actual “heavy lifting.” That person is experienced in how to move a body that cannot move itself without great difficulty. But like so many others, she is dependent on the aide showing up, and she has to scramble to find people to fill in on weekends and holidays.

The Family Caregiver Alliance, a non-profit organization that provides support for people like my friend, a so-called informal caregiver, states that the numbers of unpaid caregivers in the U.S. in 2015 is about 43.5 million. Their caregiving, if paid for, would cost more than 470 billion dollars a year. More than 75 percent of the caregivers are women, and more than two-thirds of those receiving care are also women. It is estimated that 20 hours or more each week is devoted to the needs of the spouse, child, or parent so the informal caregiving is akin to an unpaid part-time job, with few entire days off.

Anyone who has filled this position knows that the tasks range far beyond giving out medicine at the right time. Often the number of tasks increase to the point where the patient needs help in just about every activity of daily living, from dressing and undressing to personal hygiene and being fed, and the responsibility of running the household, paying bills, and making medical appointments. The must-do list simply grows longer as the impairment from the disease increases.

The toll this takes on those who give the care is well-characterized and predictable. Just about every aspect of life is affected: sleep, physical and psychological well-being, work, socializing, pursuing personal interests, and hobbies. They all give way to the needs of the patient. Simply getting out of the house to do more than a quick trip to the supermarket or dentist is a rarity for many.

Mandy lives in a residential neighborhood only a few blocks from a library, stores, restaurants, and a supermarket so she sees other people when she takes her husband for an outing in his wheelchair. And she manages to get to a yoga class once a week when her husband is with his aide. But she has rarely has time to work on a collection of essays she has been writing, and her former volunteering activities have been abandoned. But she is fortunate; at least she is able to leave the house a few times a week.

Some diseases are easier to deal with than others, but no one gets to choose. When the caregiver is able to still share an emotional and cognitive life with his or her spouse or partner, the caregiving is bearable. But if the patient is unable to communicate and respond to the caregiver, it makes the caregiving even more difficult. Despite that it is the disease, and not the individual, who is responsible for the changed behavior; it may be extremely hard for the caregiver to hold onto that fact when dealing with unexpected anger, depression, apathy and sometimes non-recognition. In a study of the emotional burden carried by the caregiver, Croog, Burleson, and their team reported that anger and resentment was a common complaint along with lack of personal time and social isolation. There are support groups for the ‘”informal” caregivers, and they are geared toward helping with the specific problems presented by a disease, for example, Alzheimer’s, Parkinson’s, or ALS.

Over a cup of coffee, Mandy told that that the one thing she did not expect, as her husband’s symptoms worsened, was being alone so much of the time. “We have many friends; we both lived in this community for decades. But very few come to visit anymore, and we rarely are invited to other people’s homes because of lack of wheelchair access. And some people just avoid us because somehow they don’t know how to act around someone with a debilitating illness.”

Fortunately, my friend is strong and resilient, an excellent manager and a person who is able to meet the unending obligations she encounters. But she, like so many others in her situation, would like to have someone who understands and can share with her the difficult emotions and conflicting feelings she is experiencing in fulfilling the “in sickness” part of her wedding vows.

She too would like some care.

References

Spouse caregivers of Alzheimer patients: problem responses to caregiver burden. Croog SH, Burleson JA, Sudilovsky A, Baume RM. Aging Ment Health. 2006 Mar;10(2):87-100.

Excessive Exercising: Is it About Fitness or a Compulsion?

Whenever I am in my gym, I see a skinny but well-muscled woman working out. She is there, already dripping with sweat, when I arrive, and she is there when I leave. My workout schedule is somewhat erratic, but regardless of when I arrive, she is there.

I suspect she is suffering from exercise bulimia, a disorder characterized by compulsive exercising to burn calories. Unlike bulimia, an eating disorder in which large quantities of food are consumed and then quickly removed from the body by vomiting or excessive laxative use, someone with exercise bulimia may be consuming only normal amounts of food. Normal, that is, to most of us. In a desire to attain a very low weight and keep it off, the exercise bulimic tracks every calorie consumed and makes sure that the exercise burns off enough calories so no (gasp!) weight is gained. If in a moment of weakness, a small bag of potato chips or a kiddie size ice cream cone is consumed, exercise to get rid of those calories begins as soon as possible.  And if for some reason it is impossible to exercise—for example, a cyclone has just destroyed the individual’s house—an overwhelming feeling of despair, agitation, and helplessness is experienced. These feelings may be similar to those experienced by someone who has consumed an enormous amount of food, and then is unable to get rid of it by vomiting.

It is difficult to distinguish a compulsive need to exercise, a need that may take priority over other activities, from the desire to excel in a competitive sports event. Someone who trains for a triathlon by swimming, biking and running long distances, can look as if he has exercise bulimia because the pressure to do well in these three activities requires hours and hours of physical activity. But there are two critical differences: the intense workouts required for a competitive event come to an end when the event is over, and the exercise is not coupled with the goal to work off calories. Indeed, the individual in training often increases significantly his or her calorie intake in order to replace the calories used in exercise and also to prevent muscle wasting.

Although weight loss, stamina, muscle strength, and overall fitness may increase because of the incessant exercising, the health risks of compulsively exercising eventually outweigh the benefits. When women lose too much body fat, they stop menstruating and become vulnerable to significant bone loss. Continuous fatigue, and injury to tendons, ligaments, muscles and bones (e.g. tendinitis and stress fractures) may result at any age; these injuries and fatigue rarely stop the exercise until the injury becomes too severe to continue.

Like the purging that occurs after the excessive eating of bulimia, excessive exercise is used to prevent calories from turning into fat and weight gain. To the person with this eating/exercise disorder, it is as if every item of food comes with a label that reads, ”Must exercise strenuously to use up calories in this food!” and then the food label lists the number of minutes or hours of exercise that have to be performed.

”You just ate a doughnut? Run on the treadmill at a high pace for 45 minutes!”

What makes this type of exercise “purging so destructive to health is that every morsel of food is regarded as an enemy of low weight.  It doesn’t matter if the food is healthy and required for nourishment or eaten for pleasure; its calories must not remain stored in the body.

Ironically and sadly, excessive exercise can increase the appetite and cause an inevitable need to eat more. Athletes in training consume much more food than when they are not preparing for a competitive event. So the exercise bulimic who has spent three hours in the gym may go home and eat a big meal because he is really hungry. And then he feels compelled to go back to the gym to work off the calories.

Breaking the cycle of exercising compulsively to get rid of the calories just consumed is difficult. There is the problem of the compulsion itself, a behavioral state of mind that is not easy to change. There is the guilt and anxiety that must be dealt with if exercise is prevented, and also the anxiety and depression that might drive overeating itself. And underlying all this is the uncertainty and bewilderment over what constitutes appropriate food intake. How does one convince an exercise bulimic that the body needs a certain amount of calories to function; that the body demands a variety of nutrients for basic physiological functions; and that the brain needs glucose for energy and other nutrients like amino acids in order to produce the cellular connections that allow it to communicate?

Might the exercise bulimic be helped if he or she stopped eating real food? If every morsel of food announces to the exercise bulimic how much exercise has to be done to remove unwanted calories from the body, why not switch to a food stuff that supposedly has the perfect number of calories for the exerciser’s body?  One possibility is a synthetic food called Soylent that was engineered to meet the needs of people such as programmers who don’t want to waste time eating real food. Rob Rhinehart developed Soylent, a liquid meal replacement, and it provides all the nutrients needed to meet daily caloric and nutritional needs.  Soylent is supposedly palatable, but not so wonderful in its taste and texture, so that anyone would be tempted to binge on it.

If the exercise bulimic is convinced that the food being consumed is in balance with the body’s caloric needs, the compulsion to exercise may diminish. If not, this will be indicating that the exercise is not really based on caloric intake, but instead a compulsive disorder played out in the gym.