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If We Had More Time to Eat, Would We Eat More?

The national eating day, Thanksgiving, is unusual in several respects. People who rarely cook spend hours in the kitchen transforming a rather ungainly raw bird into something beautifully edible and making artistic creations out of mashed sweet potatoes with marshmallows.  Stale bread that otherwise might be fed to the birds is turned into a complex dish that may or may not cook inside the turkey.  The table is formally set, and many courses with numerous dishes are served.  And the meal will take time.

Unless they have another Thanksgiving meal to go to, or feel compelled to Christmas bargain shop, guests are happy to dine leisurely. The meal may take considerably more than an hour, and rushing through is restricted to getting seconds on desserts before they are gone.  In this respect, Thanksgiving and other major holiday dining differs significantly from the way many of us eat the rest of the year.

That we eat more on Thanksgiving than on other days is not disputable.  Serving excessive amounts of food is appropriate, and we are expected to eat until we feel stuffed, and then eat some more. But would we eat so much if there were less time to do so?  Would we eat less if, like so many other days of the year, late afternoon/early evening activities and obligations shorten supper to a grab-and-chew type meal, rather than a sit-down dinner? Would we change the amount of food we eat if we actually sat and ate breakfast and lunch, rather than standing in line for take-out and then quickly consuming it before going back to work? Is eating quickly a prescription for too much, or too little food intake?

A few weeks ago I was having lunch with a relative who works for a large law firm. She kept looking at her watch as we stood in line for our salads at a food court. “They don’t like us to take more than 30 minutes for lunch,” she told me. “I hope I have time to eat.”

She is not alone. For many of us, eating is something we fit into our busy schedules often while we are doing something else, e.g. sending messages on our cell phone, working at our desks, or driving.

Hypothetically, if we have very little time to eat, we should be eating very little. A muffin or bagel for breakfast and two slices of pizza or a tuna wrap for lunch feels like fewer calories than a traditional breakfast of eggs and toast… or a lunch of baked chicken, potato, vegetables, roll and dessert. However, often when we choose foods that can be eaten quickly, we don’t notice that they can be calorically dense. A muffin or bagel with cream cheese may contain 600 calories, and a tuna salad sub with mayonnaise and cheese delivers as many calories as the hot lunch.

When we do not have time to eat, we may do it so quickly that we dump more food than necessary in our stomachs, like someone competing in an “All the hot dogs you can eat!” contest.  Sometimes when we gulp our food we don’t even notice how much we are eating. This is also true if we are multi-tasking while putting food in our mouths.

Sitting for a long time at a meal has its own perils. We may find it impossible to resist eating more than we intended to because we have the time and the food, especially the desserts, are there to tempt us. We are no longer hungry, yet the cookies or nuts or chocolate or pies are still on the table and it is hard, unless we are sitting on our hands, not to reach for them. A friend who often hosts long, leisurely meals told me that guests who resist eating dessert when she first serves it will often reach for the cake or cookies later on if they are all still sitting and chatting. Of course, meals that are interrupted by speeches between courses are a perfect prescription for overeating. The guest is a hostage to someone’s boring talk and eating seems to be the only way to endure it.

On the other hand, if we have the time to have an “appetizer” of carbohydrate, e.g., a roll, rice cakes, or crackers about 20 minutes before we start our meal, we may find ourselves eating less.  The carbohydrate potentiates the production of the brain chemical serotonin, and that in turn will make us feel somewhat full before the meal begins. This helps control how much we eat subsequently (a critical aid for dieters), and causes us to stop eating before we clean our plates.  But when time is limited, eating quickly and without the benefit of the satiating effects of serotonin, we could be eating more than we should.

Either too much or too little time can disrupt moderate and reasonable food intake. But certainly we should take the time to enjoy Thanksgiving for its own sake regardless of how much, or how long it takes to eat.

Does Halloween Begin the Trifecta of Weight Gain?

Soon after Labor Day, almost before the bathing suits of summer have been put away, bags of miniature Halloween candy begIn to appear on supermarket and drugstore shelves. Those tiny candy bars will be devoured to celebrate a holiday that has nothing to do with candy, and the hundreds of calories they contain will initiate the fall season of weight gain. Soon the black and orange wrapped candy will be replaced by chocolate turkeys for the national binge day, Thanksgiving, and then towers of green and red wrapped candies, cookies, and cakes will be displayed for the December holidays.

It is understandable how Thanksgiving and Christmas became holidays characterized, in part, by excessive consumption of special foods that are usually replete with cream, butter, sugar, egg yolks and chocolate. In the old days, these holidays represented the few times a year when expensive, scarce food stuffs like sugar, chocolate, costly cuts of meat, and exotic fruits like oranges, and special alcoholic drinks were served in liberal portions.  Religious and national events like Christmas, the 4th of July, or the yearly fair have always been celebrated with copious amounts of food.  Often guests contributed their own special recipes to a gathering, and it was not unusual to have several main dishes, many sides and a large number of desserts. No one worried about how many calories were eaten because food intake was frugal and, for some, even scarce for the rest of the year.  But now, of course, the caloric excesses that begin with devouring miniature candy bars and end with New Year’s Eve buffets may not be compensated with frugal eating the rest of the time.

But how is that Halloween, a holiday which originated as a religious event, has metamorphosed into the opportunity to eat excessive amount of sugars, fat, artificial flavorings and color while wearing a costume? And how is it that the attempt by some food companies to reduce sugar content in many of their products is being offset by large confectionery companies marketing Halloween candy? And how, as our nation becomes fatter every year, are we going to continue to allow this?

Collecting, counting, and collating the candy gathered during an evening of trick or treating is a relatively new phenomenon. To be sure, hordes of face-painted or masked kids have been roaming the streets on Halloween, ringing doorbells and asking for handouts for many decades. Mid-20th century, the handouts were rarely commercially packaged miniaturized candy bars. Treats like cookies, popcorn balls, Rice Krispy squares, brownies and fudge were often homemade. Candy corn, invented in l880, Hersey’s Kisses in l907 and M+M’s in l941, along with a smattering of regular size candy bars, were available as treats, but competed with homemade chocolate chip cookies. Then we became scared of anything that was not made and sealed in a factory. The appearance of razor blades in apples and the possibility of toxic ingredients in homemade baked goods frightened us into allowing our children and ourselves to accept only commercially produced, sealed snacks like miniature candy bars and tiny bags of candy corn. And the confectionery companies responded. Any candy that could be shrunk, wrapped in Halloween colors, put in a large bag and sold in bulk, was.

Of course, the calories per candy item were also shrunk because the candies were one big bite.  Alas (and the candy makers know this), we think, “They are so small, how could they be fattening?” and pop three or four tiny Snickers or Butterfinger bars into our mouths.  The little candies can be stashed in drawers, brief cases, knapsacks, glove compartments, pocketbooks and pockets and constitute an almost endless supply of sugary, high-fat treats—and calories. And so the season of fattening ourselves up begins.

The over-consumption of sugary treats falls at the time of year when we may be feeling stressed because of after-summer vacation workload for adults and for kids, homework.  Are we craving candy because as darkness increases, our good moods decrease? Would chewing through a mound of candy corn be as appealing in the middle of July as it is at the end of October?  We know that the good mood brain chemical, serotonin, is made when any carbohydrate (sugar, starch) other than fruit is eaten. Is candy more appealing than a bowl of oatmeal that brings about the same feelings of calm and comfort?

It is hard to find any good reason for children or adults to consume mounds of candy. In an ideal world, the plastic bags of miniature candy bars would be replaced by bags of vacuum-packed apple slices, or oranges or baby carrots. Treats might also include pretzels, popcorn, miniature protein or high fiber, high-energy bars or breakfast bars. These have the virtue of being low or fat-free, have some nutritional value, and, after the holiday, can be put in a lunch box for a daily snack.

But how are we going to stop the avalanche of fall candy consumption? It means pushing back against the confectionery companies so that like the large soda manufacturers who have reduced sugar in their drinks, they see a profit in offering healthier Halloween treats. It means working within neighborhoods and schools to convince everyone to resist dumping handfuls of candy bars into plastic pumpkins held by seven year-old trick-or-treaters. Perhaps people can be convinced to donate some of the money that would have been spent on candy to a local food bank and contribute the rest to the local school or neighborhood center for a Halloween party.  Halloween is a holiday made for fun, and surely we can figure out how to have fun without the candy calories hanging on our hips the next day.

Distracting Yourself Into a Better Mood

“My head is full of stuff I am worried about today,” a fellow gym member told me as we were about to start a yoga class. “So if I am standing up when everyone else is sitting down, it is probably because I am not paying attention to the instructor. “

She was right: She was so self-absorbed in her worries that she was always about two yoga positions behind everyone else. About halfway through the class, I noticed her keeping up with the instructor’s moves, and no longer looking so worried.

When the class was over, she said, “I feel so much better! Once I started to focus entirely on whether I was in the correct yoga position, I was distracted from the laundry list of problems that had been bothering me.“

Yoga is one of many distractions that work to relieve, or at least subdue, a variety of emotions from boredom (e.g. “HOW long do I have to wait on the telephone to speak to a representative?!?”) to depression, anxiety, anger, and worry. Think of the scene in a movie or television where people are waiting to hear news about an operation. Someone always says, “Let’s go to the cafeteria and get some coffee.” The coffee is not what is desired; it is the distraction of moving to another place and engaging in another activity (buying and drinking coffee) that may somewhat help relieve the tension.

Sometimes the lack of distraction makes a situation unbearable. Imagine sitting in a waiting area awaiting your own operation. You are awake and alone and there is nothing to distract you from your anxiety and worry. A friend of mine who recently had his cataracts removed told me that, while he was waiting to be operated on, all he could think was “What if something goes wrong and I became blind?” He said. But, “if someone had been there to talk to me, or even if I could have watched television, I might not have worked myself into a panic.”

So-called Retail Therapy has long been recognized as an effective, albeit short-lived, therapy for anxiety and depression. It works, but has its limitations and unfortunate financial consequences if shopping leads to buying items neither needed nor affordable. The distraction of finding something desired and buying it lasts very briefly, and it is a costly way of keeping away unwanted thoughts. But certain shopping venues like gigantic flea markets, or bargain warehouses that require lots of walking and poking through piles of stuff that ultimately are rejected for purchase? They effectively focus the mind and move it away from unpleasant emotions.

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Distracting Yourself Into a Better Mood

Redirecting your focus is a very healthy coping strategy.
Posted Sep 14, 2017
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“My head is full of stuff I am worried about today,” a fellow gym member told me as we were about to start a yoga class. “So if I am standing up when everyone else is sitting down, it is probably because I am not paying attention to the instructor. “

She was right: She was so self-absorbed in her worries that she was always about two yoga positions behind everyone else. About halfway through the class, I noticed her keeping up with the instructor’s moves, and no longer looking so worried.

When the class was over, she said, “I feel so much better! Once I started to focus entirely on whether I was in the correct yoga position, I was distracted from the laundry list of problems that had been bothering me.“

Yoga is one of many distractions that work to relieve, or at least subdue, a variety of emotions from boredom (e.g. “HOW long do I have to wait on the telephone to speak to a representative?!?”) to depression, anxiety, anger, and worry. Think of the scene in a movie or television where people are waiting to hear news about an operation. Someone always says, “Let’s go to the cafeteria and get some coffee.” The coffee is not what is desired; it is the distraction of moving to another place and engaging in another activity (buying and drinking coffee) that may somewhat help relieve the tension.

Sometimes the lack of distraction makes a situation unbearable. Imagine sitting in a waiting area awaiting your own operation. You are awake and alone and there is nothing to distract you from your anxiety and worry. A friend of mine who recently had his cataracts removed told me that, while he was waiting to be operated on, all he could think was “What if something goes wrong and I became blind?” He said. But, “if someone had been there to talk to me, or even if I could have watched television, I might not have worked myself into a panic.”

So-called Retail Therapy has long been recognized as an effective, albeit short-lived, therapy for anxiety and depression. It works, but has its limitations and unfortunate financial consequences if shopping leads to buying items neither needed nor affordable. The distraction of finding something desired and buying it lasts very briefly, and it is a costly way of keeping away unwanted thoughts. But certain shopping venues like gigantic flea markets, or bargain warehouses that require lots of walking and poking through piles of stuff that ultimately are rejected for purchase? They effectively focus the mind and move it away from unpleasant emotions.

Years ago, Boston had a two-story bargain store, Filene’s Basement, where the merchandise was marked down according to how long it had been on the racks. Shoppers hunted for a drastically marked-down piece of clothing or shoes; they rarely found one but considered the hunt itself to be a lot of fun. In order to deal with the death of both parents within a short period of time, one of my mother’s friends told me that she would go to the Basement every weekday during her lunch hour.

“I never bought anything, but searching for the ultimate bargain distracted me temporarily from my grief.”

In order for distraction to work; in other words, doing X to take your mind off of thinking about issue Y, it should absorb all of one’s attention. Moreover, the distraction must be easy to initiate, not necessarily require the participation of someone else, and be convenient. Skill-driven physical activities such as indoor rock climbing or paddle boarding, where loss of concentration means falling off the rock wall or the paddleboard, are effective distractions. Still, simpler and more accessible activities like going to a driving range or playing Ping-Pong also work. Games such as bridge or chess or even group activities such as singing in a choir, or joining a conversation group in a language you are learning? They require total concentration and thus, for a while, are a total distraction. Crossword and other word puzzles work, unless they add a level of frustration to an already difficult situation, like waiting for a long-delayed plane. And sometimes a conversation that forces you to concentrate on what the other person is saying is a distraction from an inner voice that talks too much about your concerns.

Overeating is unfortunately often used as a distraction but, like retail therapy, the distraction is short and the cost, in calories, considerable. Indeed, overeaters are advised to redirect to new distraction activities such as: take a bath, take a walk, make a phone call, see a friend, or read a magazine to decrease the eating. These activities, however, are weak distractions and often are accompanied by the eating they are supposed to halt.

Sometimes thinking outside the box is the only way to identify a distraction that will work. Years ago, a weight-loss client complained that he was eating at night to deal with problems from work he was bringing home with him. “You should find something to distract you,” I told him, listing the obvious contenders.

Nothing seemed to appeal to him. Throwing up my hands in frustration I said, “Well, what about learning to play the bagpipes? That will keep you from eating.”

“What a good idea,” he said. “I have bagpipes in my closet. I haven’t played them in years. I am going to l start playing them tonight.”

I really hope he had soundproof walls.

Travel Can Leave You Well Fed, But Not Well Nourished

The group of women with whom I was traveling stared at the menu in some dismay. For those who shunned gluten, meat, dairy, and a category of vegetables known to cause intestinal discomfort to some, there was almost nothing to eat.

“Maybe we can find a supermarket somewhere,” one suggested, but then realized that to do so required driving to a shopping mall a few miles away from the gift shop-congested town center. Fortunately, a few protein bars were discovered at the bottom of someone’s tote bag, and hunger was relieved momentarily. We were in a geographical part of the country noted for heat-infused food from chili peppers, the liberal use of melted cheese with pork products, beans refried in lard, gluten-containing flour tortillas, and a notable absence of soy or almond milk for those lactose intolerant.  Although the women were athletically fit and had traveled to spend a few days hiking in remarkable landscapes, their digestive systems did not have the same robustness as their muscles. Eventually, our finding a ride to a large supermarket provided enough food for dinner, as well as snacks for the hikes; an Internet search of restaurants revealed a few that met most of their dietary needs.

But their experience demonstrated how difficult it can be to obtain foods from restaurants in places not accustomed to altering menu options for those whose stomachs need special foods. These days, we assume when we travel, we will be able to get our personalized food needs met.  After all, it is no longer the early part of the 20th century when people traveling on the new highways had to content themselves with eating in small Mom and Pop restaurants their typically questionable cleanliness and food preparation skills.  Standardization of food for highway travelers came only when restaurants like the Howard Johnson franchises opened around the country. Today the ubiquitous fast-food restaurants and the next generation sandwich shops that make salads and sandwiches to order make it relatively easy to find safe and reasonably tasting food.

But even now, eating as a traveler may mean giving up trying to eat a well-balanced diet. The recommended five servings of vegetables and fruit to be consumed each day may not even be consumed in five days. Vegetables rarely appear on the plate with the main entrée, or are reduced in size to microscopic versions of the natural object. Salads and side orders of vegetables are costly, and the vegetables may come coated in cheese, drenched in butter, or breaded and fried.  It is possible, sometimes, to get fruit as a dessert but often the fruit is a few raspberries garnishing chocolate cake or in syrup topping a dish of ice cream. Foods we can obtain at home, such as low or fat-free dairy products (and milk substitutes), may also be hard to find. Many restaurants serving breakfast do not provide low or fat-free yogurt, cottage cheese and milk for cereal and coffee. And finding high fiber foods to maintain healthy and predictable digestion is harder than finding kale in a MacDonald’s.

When traveling is relatively brief—less than a couple of weeks—the scarcity of nutrients or fiber or food items suitable for a limited diet is not going to plunge the traveler into a state of malnutrition. We start our trip well-nourished and certainly are not going to develop scurvy or osteoporosis in a couple of weeks. But many people travel constantly for work and some have the time and financial freedom to travel for long periods for pleasure.  This type of travel can result in more than just piles of dirty laundry to take home; it can affect the nutritional status of the traveler. And curiously, we tend to ignore this problem when packing for a trip.

Packing requires anticipating weather conditions, activities ranging from work to sightseeing and entertainment and even sleeping comfort. But how many of us pack to ensure that we are not surprised by eating environments as unpredictable as the weather? Are we making sure that the eating culture at our destinations will provide food meeting our personal dietary needs? And if not, do we have in our carry-on luggage food items that will prevent us from returning several weeks later in a state of sub-optimal nutrition?

Some simple steps to take before a long trip:

Check out the types of foods typically eaten at the destinations. The Internet will provide this information both from a description of the food highlights of the destination, and also from a brief scan of moderately priced restaurants (these are the ones most likely to be visited, not the very pricey ones).

If breakfast is included in the lodging, try to learn what is served. Sometimes a breakfast buffet will provide foods from all the food groups. (Israeli hotel breakfasts have done this for decades.)

Pack multi vitamin-mineral supplements as insurance against many days of vegetable, fruit and dairy deficient menu options. Lactase pills to digest the milk sugar lactose are tiny, fit into a toiletries bag and allow you to add milk to your coffee or cereal if you have lactose intolerance.

Pack gluten-free baked goods if you must avoid gluten, because eventually a need for some digestible carbohydrate will arise.  Baby carrots, vacuum-packed apple slices, and a sandwich bag filled with high fiber breakfast cereal will provide some fiber. Oat bran cereal can be put in a sandwich bag as wel,l and if the hotel has a coffee maker, the hot water will reconstitute it as hot cereal.

Pack protein bars that contain 15 to 20 grams of protein. These will be useful when the protein on the menu is incompatible with a vegetarian, pescetarian (fish only), kosher, or low-fat diet.

Although these extra items take up space on the outbound trip, their consumption frees up space for the return home to be filled with whatever your heart, not stomach, desires.

How Do You Know If Supplement Claims Are Hype or Truth?

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. Often 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 Marshals 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.

With Whom You Eat May Affect How Much You Weigh

Two weeks ago we were dinner guests at an expensive steak restaurant. Our hosts, who were celebrating their anniversary, urged their guests to order the restaurant’s specialty steak: twenty-four ounces of aged beef.  Everyone, except for another guest and I, complied (we both ordered fish.) Many side dishes were ordered by the hosts to be passed around family style: a dish of fried potatoes oozing butter, asparagus coated with a creamy sauce, and broccoli covered with melted cheese. Despite protests of feeling stuffed, we were told to indulge in dessert: soup bowls of creampuffs filled with ice cream and drenched in hot fudge sauce.

As we waddled home I remarked that it was a good thing we didn’t eat like this more than once a year, if that. Working off all those calories would take hours at the gym, and a frugal meal plan for a few days.  My husband agreed. “I really didn’t want to order such a large piece of meat but since our hosts were so insistent, and everyone else was ordering it, I felt that I should, too. And I wasn’t hungry for dessert, but it was hard to refuse. “

Last week we experienced an opposite social pressure on how we should eat.  Invited to a buffet dinner following a lecture at a local museum, we were offered poached salmon, baked chicken, marble-size boiled potatoes, salad and rolls. No butter was served. The plates tiny, somewhat smaller than salad plates, and once a lettuce leaf, tomato slice, and a minute piece of fish or chicken was placed on it, there was barely room for one potato.  No dessert was available or, if it was, it was hidden in a remote part of the dining area. As one of the guests with whom we sat remarked, “I guess I don’t have to worry about eating too much at this meal!“

These two eating experiences confirm anecdotally what many studies have shown. Social eating can influence the amount and type of food we consume.

Indeed, web sites focused on helping dieters stay motivated suggest choosing eating companions who reinforce healthy, calorie-conscious food choices.  Eating with friends at a restaurant that offers low-fat, non-fried foods, including a variety of whole-grain and vegetable options, makes it so much easier to stay on a diet than eating at a place where the food is batter-coated, or sauced with cheese.  Conversely, going with others to a massive brunch buffet, or a clam shack known for its tower of fried clams, coleslaw drowning in mayonnaise, and unlimited French fries makes it extremely hard for the dieter to say no to these temptations or, in some cases, such as the clam shack, even find something diet-worthy to order.

However, it is not necessary to become an “eating hermit” in order to lose weight. Many restaurants post their menus on their web sites so it is possible for the weight or health conscious to see ahead of time whether there are calorically appropriate meal options. Admittedly, it is difficult to tell friends or co-workers that you prefer not eating at a particular place because you won’t find anything to eat (like at a fried clam shack) that is appropriate for your diet. But these days it may be easier to do so as now that so many have specific food restrictions.  Friends or family, one hopes, would not invite a Moslem or kosher Jewish guest to a barbecue place featuring pork, or suggest going out for pizza with someone who has gluten sensitivity. Since it would be fitting to suggest an alternative restaurant for someone who can’t eat gluten or pork, it is appropriate to identify a restaurant with choices compatible with the caloric needs of someone on a diet or trying not to gain weight.

A little discussed but annoying problem of social eating is the nosy invasiveness of eating companions who feel they have the right to make remarks about the type and amount of food you are eating. Too often comments will be made about portion size: “Is that all you are eating?” or lack of fattening ingredients: “That salad looks inedible without any salad dressing!” or a rejection of dessert: “You never eat it, do you?”  People who would never urge someone in alcohol recovery to “just have one drink” will cajole a fellow dinner who is attempting not to gain weight to “C’mon! Enjoy some of that chocolate cake; it won’t kill you!” It is rarely possible to respond by pointing out the rudeness of the remarks or offering unflattering comments about the speaker’s size or eating habits. Avoidance and seeking out like-minded eaters is probably the only solution.

And that may not be so easy anymore, because the world is getting fatter. A recent report found that 10% of the world’s population is now obese. One consequence is a global eating environment where dishes containing excessively fattening ingredients or mega-sized portions are becoming normative. The gigantic, but apparently typical portions of steak we encountered at the anniversary party are likely to become more common than the meager portions of the museum dinner.  If we succumb to accepting that we are expected to eat portion sizes inappropriate for healthy calorie intake, then we risk increasing our own size a few pounds every year until we are overweight, or even obese. And even worse, if everyone around us is larger than they should be and consuming portions much larger than they should be eating, who will notice?

Obviously, it is rarely possible to restrict the people with whom you eat to those who will reinforce your weight and heath goals. But it is important to resist the pressure of fellow diners to eat promiscuously, to choose food without heed for calories or saturated fat or sugar that have negative effects on health. It is important to realize that after the meal is over, only you will be standing on the scale.

Can E-Cigarettes Reduce Smoking Among the Mentally Ill?

Two young men were walking toward me, their faces obscured by clouds of vapor coming from tubes stuck in their mouths. They appeared to be in a fog bank of their own making.  As they walked past, I realized that they were smoking, or rather vaping, e-cigarettes.

This relatively new form of sending nicotine into the blood differs considerably from conventional cigarettes that depend on the combustion of tobacco, paper, and miscellaneous substances.

E-cigarettes are powered by a battery and look like a real cigarette (or a pacifier for grown-ups.)  Inside the device is a cartridge filled with a liquid containing nicotine, flavorings like candy, and other chemicals. The liquid is heated to a vapor, which is inhaled like a cigarette, and called vaping.

The smoker of e-cigarettes can determine the amount of nicotine he or she will be inhaling by purchasing a specific amount to be added to the heated liquid. Traditional cigarettes contain about 4mg-14mg of nicotine, depending on the brand.  According to the CDC, the average smoker absorbs about 1mg of nicotine from smoking one cigarette, but of course this varies depending on the amount of nicotine in the brand and how deeply the smoke is inhaled. People switching to an e-cigarette can turn to charts that show the amount of nicotine to use to equal the amount they used to get from a traditional cigarette. Hopefully, they will use the e-cigarettes to consume less nicotine.

Many people still smoke because nicotine seems to improve their mood and cognition.  Indeed, smoking has been described as a means of self-medication used to diminish depression, anxiety and even distractibility.  Perhaps because of this, those suffering from mental disorders comprise one of the largest subgroups of people who are still smoking.  According to the Substance Abuse and Mental Health Services Administration,about 18 percent of the U.S. population as a whole smoke.

However, the rate is much higher among those who are mentally ill.  NAMI, The National Alliance on Mental Illness, reported that 60 percent of those with depression smoke, and the number increases to 90 percent among those with schizophrenia.

Nicotine’s positive effect on mood is measurable, although not everyone may benefit. Brain cells containing neurotransmitters involved in our behavior and emotional state contain sites or receptors sensitive to the presence of nicotine. These nicotine receptors may strengthen the effect of dopamine, serotonin and other neurotransmitters on mood, thus making the smoker feel less anxious and depressed. People who suffer from ADHD also may use nicotine to enhance attentiveness and concentration, as it is thought to have an effect on the brain similar to that of drugs used for this disorder.

Regardless of the benefits on mood and cognition, one cannot minimize or ignore the negative consequences of bringing nicotine into the body. In a conventional cigarette, the tar, and a multitude of other substances involved in its combustion, may be the villains in the cancer-producing effects of smoking on the individual, alongside the respiratory and other problems suffered by those exposed to second-hand smoke. E-cigarettes have not been used for long enough to detect the health consequences of habitual use, but nicotine is a drug and thus has the potential for harm, regardless of how it is administered.  And the sad fact is that someone who begins to smoke as a way of lessening the pain of depression and anxiety, may remain addicted to cigarettes long after the mental illness has been helped by medication and therapy.

Might “vaping” e-cigarettes be the solution to breaking the addiction, or at the very least decreasing the health risk? The nicotine delivered in the heated liquid inhaled and puffed out by the smoker is not in a matrix of cancer-causing substances, but added in a measured form to a liquid in the cigarette’s receptacle. The amount of nicotine in the e-cigarette can be slowly reduced to wean the smoker gradually from dependence, and ultimately be removed altogether so that all that is left is the oral gratification of sucking on a tube and emitting vapor.

In a May 13, 2014 issue of Tobacco Control, Sharon Cummings, PhD, reported that smokers with mental health problems are more likely to use e-cigarettes to reduce the hazards of smoking than the general population. She found that 60 percent of smokers with mental illness indicated that they were somewhat likely or very likely to try e-cigarettes in the future for this reason, compared with 45.3 percent of smokers without mental health conditions.

But should people who dose themselves with nicotine to help their mental health withdraw from this drug without medical supervision? Anyone who has tried to stop smoking knows that the craving for nicotine takes a long time (or never) to disappear, and the early weeks of abstinence are accompanied by side effects such as disruptive sleep, distractibility, excessive eating, depression, anxiety and anger.  How much more vulnerable must people be who are already suffering from some of these symptoms before nicotine withdrawal? What if the smoker who suddenly decreases the nicotine in the e-cigarette experiences a flare up of anxiety, panic attacks or depression?

The use of vaping, which allows the smoker to inhale smaller and smaller doses of nicotine, may be an effective way of eradicating the addiction.  But if this is done by those who have used nicotine as an adjunct to their medication, or as a way of preventing themselves from needing medication, the medical community should supervise and support them as they would with any other type of drug withdrawal.

Feeding Your Guests to Decrease Their Stress

“I am reluctant to have friends over for dinner,” my neighbor confided in me recently. “By the time we are finished with the main course, everyone at the table is arguing about politics or sports. Once I had two guests get so upset that they stopped talking to each other for almost a year. “

“Maybe it is what you serve,” I responded.

She looked offended.

“No,” I said quickly, “You misunderstood…your food is delicious. I wasn’t criticizing your cooking. But maybe you could alter the menu to decrease their agitation. “

Usually contentious dinners are limited to family occasions, most notably holiday celebrations when relatives who may not like each other are forced to eat at the same table. Avoidance of either the relative, or avoidance of topics offensive to said relative, is the strategy many take when forced to attend such gatherings. But having friends over for dinner used to mean assembling people who enjoyed each other’s company, with the presumed mutual goal of a pleasant evening of food and conversation. Now it seems that the conversation may have to be limited to traffic, weather and vacation travel, unless all the guests have exactly the same political views and love of the same sports teams.

But why resort to such vetting of the guests or the topics?  A better option is to feed the guests in such a way that they become mellow, patient with the opinions of others and, in general, agreeable.

Years ago, in a book I co-authored called Managing Your Mind and Mood with Food, I described the culinary strategy of the CEO of a large French pharmaceutical company. The research department often invited scientific consultants to discuss and evaluate research on new drugs. One of the CEO’s associates told me that the lunch menu was designed to induce a state of benign drowsiness in the scientists so they would be agreeable to anything the company might discuss in the afternoon session. Having been witness to the aftermath of some of these meals, I can attest to the success of the strategy.

This being Paris, the meal contained different wines for each course including brandy with coffee. There was always an appetizer, main course, salad, cheese course and then, unusual for Paris, an elegant cake or elaborate pastry, sometimes with ice cream.  Sauces rich in butter, cream and possibly egg yolks were poured over the entrée and sometimes the vegetables as well. The cheeses were 95% or higher in fat and the desserts sweet enough to make one welcome the mild bitterness of the tiny cups of espresso. (There certainly was not enough caffeine in those tiny cups to counteract the soporific effects of the meal.) Interestingly, the host the CEO drank only water, and nibbled at the food.

An American host would need a sizable kitchen staff to prepare such meals. Fortunately, altering the mood of the guests so they also become tranquil and agreeable can be accomplished with much less effort and food.

To do so requires knowing only two facts about food and mood: carbohydrates consumed with little or no protein will make serotonin, and leave most people feeling relaxed. Fat, which can be consumed with protein, carbohydrate or both, may make the diners mentally fatigued and sometimes even a little befuddled. Befuddled is not a good state for scientists or dinner guests to be in, so it is probably best to use carbohydrates to alter mood rather than bacon, butter, egg yolks, cream and high-fat cheeses. Curiously, our American habit of serving appetizers of cheese and crackers may inadvertently potentiate mellower moods because of the combination of fat (cheese) and carbohydrate (crackers). The wine or other drinks will (usually) add to the relaxation effect.

Perhaps the ideal sequence of foods to produce happy, enjoyable guests is to be found in Italian homes. Carbohydrate, as in pasta and sometimes polenta, is usually served a first course. The amount is small, unlike American-size portions, but certainly contains at least the 30 grams of carbohydrate that must be consumed in order for serotonin to be made.  Because the pasta is eaten first, the eater benefits not only from the mood-soothing effects of serotonin but, in a value added sort of way, the beginnings of satiety as well.  This means that when the small portion of protein is served as a second course, it will not be viewed as too small, because the eater is already feeling a little full. Bread and wine accompanies the meal, and presumably even if arguments occur at the dinner table, there is enough serotonin being made to keep the arguments from becoming contentious.

Alas, our American avoidance of carbohydrates, and this incorrect insistence that eating copious amounts of protein may have the opposite effect on our temperament. Eating protein inhibits serotonin from being made because it prevents the amino acid tryptophan from getting into the brain (tryptophan being this from which serotonin is made.) Is it possible that our moods are deteriorating because we are not eating enough carbohydrates?

Eating carbohydrates to improve the group mood does not have to be restricted to your dinner guests. There are work environments so stressful that, as one employee told me; it feels as if her flight or fight responses are going off and on all day. “I am sure it is not healthy to be working in such a stressful culture where people think it is all right to continually shout, demand, berate, and insult those beneath them, “ she told me.

Would carbohydrates help? Apparently, no one in that volatile office touches them because not being fat is mandatory (unspoken), and everyone is convinced that eating a piece of bread will cause them to gain weight. What they don’t realize is that eating a piece of bread or a cup of breakfast cereal might make them a little less abrasive, and perhaps a little kinder. And that is a good thing.

Are You Sure That Food is Safe to Eat?

“I am not sure you ought to be eating that,” I said to one my fellow hikers as we unwrapped sandwiches that had been baking in our knapsacks all morning. It was hot, and the knapsacks that clung to our backs as we hiked up the mountain must have been as hot as our overheated bodies. “Why not?” he asked. He looked at his sandwich oozing mayonnaise from the chicken salad and took a bite.

“Does one do CPR for food poisoning”? I thought to myself as I ate my peanut butter sandwich and apple.

“What’s wrong with eating chicken salad?” I was asked again as the reminder of his sandwich was consumed.

“Normally nothing,” I replied, “but in this heat, the chicken and mayonnaise can become contaminated with bacteria and lead to food poisoning.”

“Thanks for spoiling my afternoon,“ he snarled at me and walked away.

True story …but he never disclosed whether his tummy was resilient to the bacteria that must have been multiplying in his sandwich, or whether that night he suffered from the stomach cramps, nausea, vomiting and diarrhea that follow eating food swarming with heat-generated bacteria.

Moist foods like mayonnaise and chicken are reservoirs for bacteria and heat increases their numbers.  The Centers for Disease Control (“CDC”) warns about this danger and insists that food be kept cold on a hot day, especially when the temperature is 90 or above.  The best foods to carry on a hot hike are those with little moisture: nuts, seeds, dried fruit, chocolate chips,  peanut butter, crackers, hard cheese encased in a waxy shell, canned fishes still in a can or sterile pouch, raw vegetables and fruit unpeeled (i.e., carrots and bananas), and protein/high energy bars.

Most of us face the possibility of suffering from a foodborne disease, even if we never go on a hike or picnic. Food contamination is believed to affect more than 76 million people each year and about 5,000 die. Some of this is preventable; some seemingly not.

We may pose the biggest risk if we don’t store and prepare foods properly. Leaving perishable foods in a hot car begins the process of food spoilage. But even if we get home quickly in a cool car, not putting foods that have to be kept refrigerated or frozen away as soon as possible increases risk of bacterial growth.

Our unwashed hands are even a more reliable cause of foodborne illness. And although our mothers told us innumerable times to wash our hands before touching food, how many of us may forget in the rush to get the groceries put away and start dinner?

What about the sponge on the counter that just wiped up juice dripping from the raw chicken package? Yuck. It is bacteria heaven. The CDC recommends using paper towels soaked in bleach to wipe up the counter. Sponges “sponge” up the contaminated juice and all other non-sterile substances and then, even if rinsed out, will spread them wherever it is used next. However, microwaving them on high for a minute, or putting them in the dishwasher with a long cycle including a drying cycle, can clean sponges.

Sponges are not alone in cross-contaminating food.  Chopping up raw chicken on a cutting board and then using the same board and knife to chop onions is not a good idea but again something we might do because we are in a hurry.

Another example? Once a year, on Thanksgiving Day, the country becomes conscious of getting food poisoning from our own kitchens due to improperly cooked and then stored turkey and other leftovers. One home cook I know is so worried that her guests will be calling from the E.R. due to severe gastrointestinal symptoms, that she removes dishes from the dining room table to put in the refrigerator almost before people have finished eating. That may be extreme, but keeping the food on the counter while watching a football game is risking tummy troubles. One useful piece of Thanksgiving advice is to use a thermometer to measure the internal temperature of turkey. This should not be limited to T-Day, by the way, and it’s a practice to be used whenever animal protein is being cooked. Why guess whether the meat or poultry or pork has cooked long enough?  It’s easy to check!

So with proper precautions, we can protect ourselves from homemade food contamination. But what about the safety of the foods we buy in the supermarket, eat at restaurants or consume at catered affairs… or in indeed, even someone else’s home? Years ago, as a dinner guest at the home of someone I did not know well, I saw the hostess scrape a thick layer of mold off some strawberry preserves she had made and stored too long in her basement. When she served the preserves, spooned over ice cream, I whispered to my husband to avoid the dessert. Had I not been in her kitchen bringing in dirty plates, we both would have eaten the preserves and probably would have gotten sick.

A quick summary of some recent instances of contaminated food cases can easily cause food paranoia:

One hundred people contracted hepatitis A from drinking smoothies containing strawberries imported from Egypt. The restaurant chain serving the drinks were located in the mid-Atlantic states, New York, Oregon, and Wisconsin, but none in the Middle East where the strawberries were grown.

Shiga toxin-producing Escherichia coli was found in flour from a major food producing company. The result: 63 people were affected and 17 had to be hospitalized. Although the flour and flour products were recalled, the CDC worries that, given the long shelf life of flour, many homes may still have the product. (Epidemiologic, laboratory, and traceback evidence indicated that flour produced at a General Mills facility in Kansas City, Missouri was the likely source of this outbreak.) Note to batter nibblers: don’t taste raw dough or batter whether made from recalled, or any other, flour.

Consuming cucumbers infected with salmonella caused 165 people to be hospitalized and four deaths occurred in Arizona, Texas, Oklahoma, and California.

Listeria, which causes serious, life-threatening illness, was found earlier this year in soft raw milk cheese made by a New York dairy. Eight people who contracted the Listeria were hospitalized and two, from Connecticut and Vermont, died.

Eating contaminated food may be impossible to avoid entirely. How could you know that cucumbers or smoothies are filled with bacteria? We don’t have food tasters (as did nobility in the olden days) to make sure we are not being poisoned. But at least we can decrease our vulnerability by following good hygienic practices in storing, preparing and serving food. And when in doubt, throw it out.

Getting the Super Obese to Lose Weight: It May Take a Family

Anyone who ever saw any of the television programs focused on the attempts of individuals 600 pounds (or heavier) to lose weight often wonders why their family members are enabling the obesity. The viewer watches the mostly bed-ridden obese individual demanding food, lots of it, and then being served large portions of whatever has been requested. The camera lingers over the individual crunching potato chips, spooning up macaroni dripping with melted cheese, or eating a gallon of ice cream. It is possible that the television crew doesn’t film the subject of the show when he or she is eating kale salad, or fat-free cottage cheese, so we get the wrong impression. But given the stated food demands of the obese individual, the viewer has the impression that if kale salad, or indeed anything resembling low-calorie healthy food were offered, he or she would be in the unique position of saying no to the food. The occasional trips to the supermarket by some of these TV stars who are able to ride in car (and use a motorized shopping cart) also focus on the purchase of junk food. Although it is obvious that some nourishing foods must be bought and eaten to avoid nutritional deficiencies like scurvy or anemia, the healthy menu items are rarely, if ever, shown being consumed.

The viewer wants to shout at the family members bringing food to the massively obese person, “Why are you enabling this?” Indeed, in one particularly poignant episode, a father buys a large pizza for his son who has been told he must lose 60 pounds before weight-loss surgery can be performed. The son has demanded the food and as the father watches the son gobble the entire thing, he asks for a piece for himself. “No,” was the reply, “I am going to eat the entire thing.”

Internet comments predictably share the bewilderment over the enabler function of family members as depicted on the show. As the fattening foods are prepared and served, the enabler expresses concern on air about the likelihood that the obese family member will die in a few years from the massive weight gain. And yet the food is served, and the concerned warning is absent. But to be fair, perhaps saying something is useless. The obese individual expresses concern over the pain caused by living in such a large body, and also worries about dying. So what good could it do if a family member states the obvious? It may even have the opposite effect. But still, we the viewers still wonder why the family members enable the continued weight gain.

What if the family member was a chronic alcoholic and developing liver disease, collapsing from frequent blackouts, and cognitive impairment? Would the same restraint be used, that is, “Don’t criticize, nag, cajole and threaten?” Would family members buy alcohol for the abuser who might be too drunk to get to the store?  Or drive the alcoholic to the nearest liquor store?

People say that one can’t compare alcoholics to excessive overeaters because the latter have to eat to live, so they cannot be abstinent. True, but one can live quite nicely without consuming highly caloric food in mega quantities, and drinking sugar-filled soda and juices.

Nevertheless, it is hard for family members to take corrective action alone. Professional help is needed, yet there is no process by which a concerned parent, for example, can force the adult extreme overeater to see a physician, dietician and/or therapist. Medical privacy laws forbid sharing the information with healthcare providers unless written permission from the family member is given. But waiting for the heart attack, stroke, skin infection, or cancer to occur in order to obtain medical intervention to start the weight- loss process is hardly an option either.

Family members of an alcoholic often turn to Al-Anon, whose meetings offer advice and support. Inpatient rehabilitation facilities often insist that family members be present for some of the therapeutic sessions to support recovery.

O-Anon is a spin-off of Al-Anon and runs with the same rules of privacy and espousal of the twelve-step process. But is this enough? Can a family take upon itself to provide only healthy, portion-controlled meals and beverages without medical and nutritional advice? Can the family handle the emotional fallout when the obese individual no longer has access to foods that for many are the only reason for living? What happens if anger, anxiety, and depression follow the imposition of a new eating regimen? Must someone be home all day to prevent fattening foods from being delivered, or the obese individual from finding these foods hidden in the house?

It is hard not to notice that often family members on the show are also obese, but may be 100 pounds overweight rather than 600. Will these folk be willing to change their eating habits to support the dietary changes they are imposing?

It may be as hard for the family to change its role with the patient as it is for the patient to lose the weight. In an ideal television series or world, such issues would be raised and solutions found. The bariatric surgeon would insist that both patient and family members meet privately, and as a group with a dietician, therapist, and even personal trainer instead of telling the patient to go home and lose sixty pounds.

People don’t gain 500 pounds simply because they like doughnuts or French fries. Their reasons for their morbid weight gain are complex, and their success in losing weight permanently depends on the family with whom they live and eat understanding these reasons. Maybe the producers of these television shows ought to realize this, even if it doesn’t make such interesting viewing.