Can You Get Scurvy If You Eat Out Too Much?

Soon after arriving home from a short trip to Manhattan, I took a vitamin pill.  No, there was nothing arduous about the return journey that required a dose of nutrients. But on the train back to Boston, I reviewed in my mind the various places where we breakfasted and dined (lunch was usually skipped) and realized, that except for a shared salad at one dinner and some fruit at a breakfast, I had failed miserably at consuming the recommended daily servings of fruit and vegetables.  For a 2000-calorie diet, the recommendation is to consume about 2 -2 ½ cups of fruit and 2 cups of vegetables daily.

This wasn’t because I had left vegetables and fruits untouched on my plate. There were never any on the plate. The restaurants (Greek, French, and mixed American), chosen by consensus, had large selections and theoretically should have been able to supply some vegetables. Indeed, the Greek fish restaurant did have appetizers, i.e., Meze, that incorporated some vegetables like eggplant and cucumbers into purées, dips and wraps (like grape leaves).  But the main courses in all three restaurants presented an entrée on an otherwise naked plate. To be sure, vegetable side dishes and salads were available but the size and, quite frankly, the cost of these extras made them less attractive. Somehow spending the money for three grilled asparagus that one would spend for a pound of the same vegetable at Whole Foods seemed like an unjustifiable extravagance.

Desserts were not considered but quick polite scans of the dessert menu (after all, if a server puts one in your hand, the least one can do is look at it) showed a uniform absence of anything resembling a fruit.

Obviously eating away from home because of business, travel or vacations is not going to cause acute malnutrition. And is certainly possible and not that all difficult to choose restaurants that offer enough vegetable and fruit selections to satisfy the USDA nutrient intake recommendations as well as one’s mother. Had we been eating on our own, we would have done so.

But we have come a long way from the time when all restaurants put vegetables on the plate, gave you a salad along with the breadbasket, and included fresh fruit on the dessert menu. There was a time when cafeterias were as common as fast-food restaurants are today, and the number of cafeteria trays holding vegetables was as numerous as those containing meat, chicken or fish. To be sure, the salad may have consisted of watery iceberg lettuce and tasteless tomatoes, and the vegetables came straight from an industrial size can, but no one expected a lunch or dinner meal to consist only of a solitary protein entrée. Fifty or sixty years ago, if you were served a plate with two lonely lamp chops or a chunk of fish and nothing else, you might have thought the server forgot to put the two veg and a potato on your plate.

Like other cultural changes that creep up on and take hold (who remembers records and landlines?), we don’t notice the chronic absence of vegetable options in the “nice”’ restaurants, or our habit of putting together our own meals without including them.  And a result, we fail to notice that we may have stopped eating vegetables altogether. They have become a forgotten food.

In contrast to the ongoing debate over high and low-carb or high & low-fat diets, the extraordinary powers of protein to turn us back into Paleolithic cave people, and the devastating effects of gluten on the brain, no one discusses vegetables.  Who debates the merit of spinach over kale or Brussel sprouts over broccoli? When was the last time the Science section of leading newspapers had research on the merits of vegetable consumption? 

Fortunately, there are some recent trends that may forestall an outbreak of scurvy or other nutrient deficient diseases. Leading chefs are inventing ways of turning the ordinary carrot, string bean or beet into creative, original dishes that rival the importance of the protein selections on the menu. Vegetable-laden smoothies and juices are becoming ubiquitous; the selection of bottled vegetable juices go far beyond V8, and juice bars allow customization of vegetable and fruit mixtures. Mixed drinks containing vegetables haven’t found their way into wine bars yet but someone will come up with an alcohol beverage that somehow incorporates kale. Supermarkets have, for many years now, made vegetables available for immediate consumption. No washing, peeling, slicing or dicing necessary; just chewing.  And to remedy the “How do I get my family or spouse to eat vegetables?” problem, many frozen varieties are sold with sauces or suggestions on how to transform the pea or carrot into a gourmet dish.

But….the vegetables have to be bought and eaten at home, not left to gradually decompose in the vegetable bin. If eating away from home is more frequent than dining in one’s kitchen, restaurants should be chosen that offer healthy salads and vegetable side dishes with affordable prices.  Most restaurants display their menus on the Internet so it should be possible to find some that do not regard vegetables as a colorful garnish.  The cost of those vegetable side dishes could be decreased if both the entrée and the vegetables and/or salad, are shared.  Lunch is an easy meal at which to eat vegetables as these days many feature salads or salad bars; even airport restaurants offer a variety of freshly made salads. (Our problem in New York was that we skipped lunch).

It takes some effort to develop scurvy; even the British sailors who did so were not vulnerable until many weeks of vitamin C deprivation. But it also takes a little effort to remember that vegetables are part of a healthy diet and should be hunted and gathered, even if the gathering is at a salad bar.   

Why You Really Run Out of Gas Every Afternoon

As the sun begins an earlier dip into evening darkness at this time of year, our mood and mental energy seem to dip with it. Known as the afternoon slump (or the brain-dead zone), most of us feel a stronger urge to be in bed with a pillow over our heads than to continue with our work obligations for another few hours.

Indeed, the fatigue sometimes seems so overwhelming, especially when the work preceding late afternoon has been mentally and emotionally stressful, that our bodies feel as if we’ve been on a construction site all day. (Maybe we have.) A friend who is a litigator told me that doing a cross examination in a courtroom leave him more exhausted than two days of yard and house chores, even though his courtroom physical activity is limited to standing, sitting, and occasionally walking a few feet away from his chair.

“There is something peculiar about late afternoon,” he told me. “I consider myself a pretty calm guy and able to resist reacting to insults or challenges from other lawyers or a judge. But around 4 pm, I feel myself either feeling suddenly sensitive to the tension in the courtroom, or overcome with profound fatigue.”

A late afternoon slump can descend on anyone—a UPS delivery person, a daycare assistant, or a neurosurgeon—and it is more likely to occur as the days shorten and the light outside no longer feels like midday, but like the start of evening.

Magazines and websites are full of advice about this problem—most of it entirely wrong.

Many assume that this slump is caused by the body’s need for energy, and recommend eating a bigger lunch or snacking to increase low blood sugar. But the cause of this fatigue and mood change resides in the brain, not in the blood.

Is anyone really famished at four in the afternoon? Sure, if someone exercises at lunch but doesn’t eat afterward, he or she will be quite hungry by late afternoon. But the rest of us? Beyond infancy, we do not need to be fed every three, and so even if lunch is over at 1 pm, our bodies really do not have to be fed again three hours later.

But our brains are different.

To understand what lies behind the urge to nap rather than write a report in the late afternoon, we have to see what is going on with serotonin, the brain chemical which attempts to keep us energetic, focused, and in good humor.

Something happens late in the afternoon to the activity of serotonin. There may not be enough of this neurotransmitter, or its activity may slow down; whatever the mechanism, the result is a deadening of mood, motivation, and mobility.

We discovered this en route to studying something else: why many people wanted to eat a sweet or starchy carbohydrate snack late in the afternoon. Volunteers were living in a research residence where snacks where available 24/7. But they never snacked until late afternoon. Why then? They told us they felt their mood deteriorating at that time. They felt depressed, tense, impatient, and tired. They could not concentrate. But they claimed that after they ate some carbohydrates, they felt better.

This was all anecdotal, interesting, but not scientifically valid. We wanted to know: Did they really feel better after eating carbohydrates or just thought they did because they liked to snack?

The truth is, they really did feel better. We know because at one time, we gave them a drink that contained enough carbohydrate to increase the production of serotonin in the brain (serotonin is made only after carbohydrates are eaten, not protein) and at another time, we gave them a drink that did not increase serotonin; it contained protein.

Their moods and fatigue were tested before the drinks and then again an hour or so later. The carbohydrate drink did improve their moods, and they were less tired after having it. But they did not experience the same results after the protein drink.

The volunteers taught us something very useful: If you want to lift yourself out of a slump eat a carbohydrate snack. (This does not apply to baseball.)

As the sun begins an earlier dip into evening darkness at this time of year, our mood and mental energy seem to dip with it. Known as the afternoon slump (or the brain-dead zone), most of us feel a stronger urge to be in bed with a pillow over our heads than to continue with our work obligations for another few hours.

Indeed, the fatigue sometimes seems so overwhelming, especially when the work preceding late afternoon has been mentally and emotionally stressful, that our bodies feel as if we’ve been on a construction site all day. (Maybe we have.) A friend who is a litigator told me that doing a cross examination in a courtroom leave him more exhausted than two days of yard and house chores, even though his courtroom physical activity is limited to standing, sitting, and occasionally walking a few feet away from his chair.

With that in mind, here are two suggestions to lift late afternoon mental and emotional fog:

  1. Eat 25 grams of a starchy carbohydrate such as pretzels, popcorn, graham crackers, or a piece of bread. Avoid any starchy food with fat, which will make you feel lethargic and dull. And don’t eat fruit (at least, not for this specific purpose): No serotonin is made after consuming fructose.
  2. Move, vigorously. Swallow your snack, then get up from your chair and do something physical. Find a staircase and climb it a few times. Take 10 minutes to jog around the block. If you’re home, find a jump rope, set the egg timer, and jump for 3 minutes. Or if you have a treadmill or bike, run or pedal for 5 minutes until your heart rate goes up.

Your brain will thank you. Now go back to work.

If Your Shoes Don’t Fit, Then How Can You Walk?

Maybe it is because my dog, a dachshund, is so close to the ground that my eyes are often pointed in that direction.  Or perhaps it is because there are so many dogs where I live that it is a hazard not to watch out where one’s shoes are stepping. For whatever reason, I find myself studying shoes and the way people are walking in them.  I have no training in feet, or walking for that matter, but was taught in a workshop on running techniques to watch out for a common tendency of our feet to roll toward each other while ambulating. This is a condition known as pronation.  I remember the instructor holding up the soles of a pair of  running shoes and pointing to the area on the inner portion of the heel where there was much more wear than on the outside area. “The person who wore these shoes pronates. His feet roll towards his ankles when they hit the pavement,” he told us, “And if he continues running or walking this way? His knees, back and hips will begin to hurt.  He needs shoes that stabilize his feet and let him land squarely on the pavement. “

That running instructor’s words came to mind as I plodded along behind a woman with soft, slipper-like shoes so unequally worn that I wondered how her feet did not bump into each other. Each foot was rolling toward each so that instead of the soles of her feet hitting the pavement, it almost looked as if she was walking on her inner anklebones.  “How she can walk that way?” I thought. “Should I say something? Isn’t she in pain?” and yet of course, I said nothing. What was I going to say….get thee to a foot doctor?

Of course, not everyone walks on the side of their shoes rather than on the bottoms, but there must be many people, like this woman, who don’t have a clue about what kind of walking shoes  prevent pain and injuries from the way their feet hit the ground.  The unfit, the wannabe fit, and the already fit are all told to walk as much as possible. Smartphones and bracelets measure the number of steps we take everyday, and we are routinely advised to wear comfortable shoes with good support while we are doing this.

And most of us, going out for an exercise walk, probably do wear appropriate footgear. But what about all the other times we are walking? I somehow doubt that people, probably women (because men’s shoes are so much sturdier and sensible), have available to them much of a selection of shoes that support their feet, prevent them from rolling toward each other, keep their arches in alignment andlook good. Bright green, pink and yellow sneakers may be really cute, but don’t quite go with business attire. The clunky, oh so comfortable black or white shoes worn by restaurant workers or nurses just don’t have the fashion panache most of us would like.

Moreover, where do we go for advice before we go shoe shopping? Who is going to tell us to turn our shoes upside down to check for pronation? Who is going to tell the woman I described that, given her extreme pronation problem, she really ought not to wear shoes with the support of a pair of socks? When someone complains about knee or back pain, who is going to ask, “What kind of shoes do you wear… and let me see if they are responsible for your problem?” And is anyone advising people carrying around excess weight that maybe flip-flops are not giving them enough support; that ballet slippers with no arch support or 4-inch heels may cause them so much pain that sitting, rather than walking, will be the preferred activity?

So we put our feet into often quite dysfunctional shoes with all the comfort of the slipper tried on by Cinderella’s sisters.

But where are we going to get advice that Brand X will give us the support and cushioning and fit we need, and Brands Y and Z will not, even though the shoes look more or less alike? Think of where many women buy their shoes: on-line, at big box stores, at clothing/shoe discount stores, even at boutiques whose sales clerks may know the latest fashion, but couldn’t tell a bunion from a beet.  There are stores that specialize in walking shoes, but here too, very few of the people lugging boxes of shoes from the inventory room will turn your old shoes upside down to see if you are pronating, or ask you to walk around the store to check your stride.

And really, how many physicians, especially those specializing in injuries and /or pain in our legs, knees, hips and backs, ever talk about how we walk? I once had a physician who was a runner himself with the aches and pains common to runners. But in our discussion of knee problems and plantar fasciitis, neither of us ever looked at the bottoms of our shoes to see whether they were unequally worn down. And I would venture to guess that few health clubs  offering a free evaluation of a new member’s balance, muscular strength, and aerobic status, include an appraisal of how the new member walks, and whether his or her shoes are suitable.

Perhaps free walking evaluations should be available at health fairs, or during health awareness days in the workplace. What about putting out information in the waiting rooms of doctor offices?  Pictures of what the bottom of a shoe looks like when extreme pronation occurs could be posted near the ubiquitous shelves of corn removers and arch supports in drug stores.
Granted, feet that hurt are not problems in the same league as global warming or asteroids hitting the earth…But knowing what kind of shoes to wear so that walking from point A to point B will put a smile, rather than a grimace, on your face goes a long way to making you likely to continue to walk.  

Obesity Due to SSRIs Is Not a Chronic Disease

A comprehensive evaluation of the best ways to treat obesity was published in an early September issue of JAMA [1] and offers valuable advice to physicians dealing with obese patients. There is only one little problem: Almost no attention was paid to the subset of obese individuals whose weight gain is not related to their overeating and sedentary lifestyle, but rather a side effect of their medication.

Kushner and Ryan, the two authors, did state that unexpected weight gain could be a side effect of antidepressant medication, but their advice was limited to changing the drug. Although sensible, their recommendation did not consider that most of the drugs now prescribed for depression, anxiety and bipolar disorders and other mental illnesses can cause weight gain. There are very few which do not do so. Moreover, patients are often on more than one drug, each with its own weight-producing side effect.

The article failed to acknowledge that this subset of obese individuals had a “before” when they were thin, fit, energetic, not embarrassed to be seen in public, or the target of offensive remarks often directed toward the obese. Their obesity is not chronic; it is not an ongoing struggle to control overeating and under exercising. Were it not for their medication, they would not be obese.

But they are now. They are in the “after” and suffering from a transformation of their eating habits, physical activity, bodies, and even their social life, starting sometimes only weeks after beginning treatment with an SSRI or mood stabilizer.

And to the dismay and chagrin of this subset of obese individuals, no one is paying much attention.

When was the last time the media talked about the problem, if they have ever talked about it? Endless headlines fill our newspapers, computers and smartphones about whether we should be eating 40 grams of carbohydrate or 200 grams of carbohydrate, or whether fasting and feasting is a better way of losing weight or that 30 minutes of exercise broken into 10-minute intervals provides optimal results. But where are the weight loss organizations, clinics, and medical journal articles pinpointing specific weight loss interventions for those formerly thin who think that, because of their medication, they may be permanently fat?

These individuals can be helped to establish control over their food intake even while still being treated with the drugs that are causing their overeating. They can be helped to restart their exercise routines even with bodies sluggish from their drugs and excess weight. And they can be helped to deal with the stigma they share with all other obese individuals and the unfortunate responses by the public. But they need someone to notice.

1.) http://jama.jamanetwork.com/article.aspx?articleid=1900525

Why Most of Cannot Become, Nor Maintain, Thin

A few days ago, my husband and I were walking back from the farmer’s market lugging plastic bags full of corn and tomatoes. It was hot, dinner was still a few hours away, and we had all those ears of corn to shuck. Then I saw her. She was thin, almost wiry, carrying her own bags of farmer produce but one hand held a large soft serve chocolate ice-cream cone that she must have bought from the ice-cream truck parked near the food stalls. My mouth watering and stomach grumbling, I watched her take a large bite of the ice cream and smile. I would have smiled also had I just taken a bite. But then what she did astonished me. She walked over to a nearby trashcan and, with a napkin, dislodged most of the remaining ice cream into the can so that only a tiny bit remained barely visible above the rim of the cone. “Did you see that?” I asked my husband. “She threw away most of the ice cream!”

“No wonder she is thin,” he replied. “I couldn’t have done that. “ “Me neither,” I said, thinking that as hot and hungry as I was, the ice cream would have been inhaled by the time I walked home.

Indeed, how many of us practice what weight-loss professionals are forever suggesting: eat only half of what is served to you in a restaurant. If you want a fattening treat, take a few bites and throw the rest away. Don’t allow a micro drop of fat or sugar or salt to cross your lips even by accident. Never, ever, eat anything dipped in batter and fried. If you are at birthday party, eat a rice cake (bring it with you) rather than birthday cake. Don’t skip meals. Make sure breakfast consists of more than a cup of coffee and piece of toast. Don’t eat after 9PM. Avoid drinking more than one glass of wine and don’t do that too often. If you want to snack, eat fruit, fat-free yogurt or oven-roasted kale. Oh, and exercise as much as possible.

Many people are able to summon the compulsive discipline, and motivated aspects of themselves when they are determined to lose weight. “Set a goal and stick to it!” people are always advising the obese. Then you WILL lose weight. To be sure, we can do this whether it is going on a five-day cleanse, eating nothing but grapefruit and broiled salmon for a month, or living on a 500-calorie beverage that contains all the nutrients we need to stay alive until we lose 75 pounds. Years ago Oprah Winfrey did this and lost an enormous amount of weight, appearing on one of her shows dragging, in a wagon, bags full of the same amount of fat she had lost.

But then the diet is over. And as the professionals tell us, we now must practice discipline and rigor to KEEP OFF the weight. And sometimes, some people actually do. I have a friend who lost more than 70 pounds before she got married many years ago and has never deviated more than 2 or 3 pounds from her goal weight. If she finds herself weighing more than that, she races to her nearest Weight Watcher meeting. A life member, she goes back on a diet and loses those two or three pounds before they turn into 10 or 15. The woman who dumped most of her ice cream into the trash can may be another example of someone who took to heart the advice of eating a tiny amount of a treat and disposing of the rest. But as a neighbor who is always going on and off diets told me, “Who can live like that?”

Maybe we were not intended to live like that. Is it not unrealistic to expect that we humans should eat like machines, consuming the precise number of calories in relation to the precise amount of calories we use up? After all, we are not fitted out with a car-like fuel gauge, with the need for fuel, i.e. calories computed before and after we eat.

Obviously eating too many calories, meal after meal, day after day, will rather quickly elevate our weight to unhealthy levels with all the attendant health risks associated with obesity. But on the other hand, once we attain the weight we want, we should be able to feast occasionally on entire ice-cream cones, or a plate of fried clams during a once-in-the-summer trip to a clam shack, or a Sunday morning chocolate croissant from a French bakery. The key word is occasionally.

Exercise, the other factor keeping us at the weight we want to be should be a regular part of our daily activities. But this doesn’t mean going to the gym every day or walking around the block ten times or doing 200 push ups daily. It means being cognizant of how and when our bodies are moving so that we do not mimic a 200-year-old tortoise in the amount of energy we expend in physical activity. However, having an occasional lazy day is something that ought to be built into the post-diet exercise regimen as well. Once your body is accustomed to regular physical activity, it will want to get moving again after an afternoon lying in the sun watching dandelions turn to fluff or catching up with all your recorded television shows over a weekend.

Even our pre-civilization ancestors rested after chasing a wooly mammoth for three days and feasting on it until nothing was left but the wool. So if you find yourself hot and hungry on a sunny late summer afternoon, and a soft serve ice-cream cone crosses your path, indulge yourself. Just don’t do it too often.

Why Didn’t Subjects Stay on the Low Carb Diet?

The recent widely publicized study by Tian Hu and colleagues at Tulane University School of Public Health put a small number of subjects on a supposed low carb or low fat diet for a year and monitored cardiovascular health and weight loss. To the delight of carbohydrate bashers, subjects on the low carb diet lost 8 pounds more (over 12 months) and improved levels of their good cholesterol and triglycerides.  So the conclusion is that Dr Atkins diet is really better: fats are good and carbs are bad.

If one believes headlines, that is truly the case.

But…..look at what was not hyped by the media:

This ground breaking study had 148 subjects at the start, but by the end of the study 20% of the subjects in both groups dropped out.  If this study were testing blood pressure medication or the best way to treat poison ivy, results with the tiny number of subjects would have been considered interesting, not ground breaking.

More to the point: by the end of the year, many of the low carb subjects did not follow the strict low carb regimen.  Contrary to the study imposed limits of 40 grams of carbohydrate each day (slightly less than the carbohydrate in two servings of oatmeal), they increased, if you can call more than tripling a mere increase, their intake to 130 grams a day. Interestingly, the high carbohydrate group was allowed only 200 grams of carbohydrate a day, hardly a gigantic amount of starchy grains, legumes, beans, and rice.

A disturbing feature of the study purporting to be a definitive answer as to how to lose weight is that sedentary subjects were told NOT to exercise. That’s right. Just stay on your couch.

But this was probably a good idea since those not allowed to eat carbohydrates, wouldn’t have had the fuel, i.e. carbohydrate for their muscles.

And no one is talking about the lack of fiber in the low carbohydrate diet this research study espoused. Not even a serving of Fiber One cereal was allowed.

The next time such a study is done, call it by its correct name: low fat versus high fat. And make sure the subjects stick to the protocol.

But the good news is that when the baked potato is served, a pat of butter or sourcream might actually prolong your life, or at least be good for your good cholesterol.

Finally: An Explanation of Night Eating?

Even though many of us wake up in the middle of the night thirsty and/or needing a bathroom, few of us decide to stay awake to eat another dinner. To be sure, we may munch on a graham cracker, nibble on some leftover pie, or drink a glass of milk with some cookies. But with the exception of a category of people called night eaters, we rarely are hungry enough to eat a full meal, even though it has been hours since we last ate. The almost physical inability to put much food in our stomachs is evident with the lackluster appetite we may approach breakfast served on a transatlantic flight at two or three in the morning. We are awake, more or less, but our stomachs are not. Conversely, some of us can tell time by the mid-day and early evening rumbles in our stomach signaling, “Time to eat!” Why are we hungry for lunch or dinner five or fewer hours since the previous meal, and yet not hungry in the middle of the night, eight or nine hours after we had dinner? By the time we leave infancy, most of us are unlikely to wake up for a 2 A.M. feeding.

A hormone, secreted by the stomach, but acting on the brain, may be the answer. Ghrelin (rhythms with Mary Ellen) seems to initiate eating at certain times over a 24 hour cycle, but not at other times. Although it seems as if we eat by the clock as in, “It is noon so I must be hungry,” this is apparently not the case (At least not in a research situation). About seven years ago, in a study published in the American Journal of Physiology by D.E. Cummings and colleagues, ghrelin levels were measured in volunteers whenever they started eating a meal. The researchers found that when the volunteers were most hungry, right before they started a meal, their ghrelin levels were high. After eating, ghrelin levels in the blood decreased and, as time passed, slowly began to rise again. Five or six hours after the previous meal, hunger and ghrelin levels again were high, and the subjects started on their next meal.

So why are we all not in the kitchen at 1 or 2 A.M. looking for something to eat, 6 or 7 hours after dinner? Most of us are asleep and if awakened would probably turn down a sandwich or some scrambled eggs. We are not hungry. The reason? According to research reported in the European Journal of Endocrinology by Natalucci, et al, the level of the hunger hormone is lowest between midnight and 7 A.M.

But some people do wake up every night hungry enough to eat more than a few crackers and drink some milk. These so-called night eaters may actually consume as many calories as the rest of us eat at dinnertime. They are not eating in order to fall back asleep but because they are hungry. It is unclear if they wake up because they are hungry or notice how hungry they are when they wake up for other reasons such as noise or a need to go to the bathroom. Hungry they are, however, and apparently because night eaters have an abnormally high level of ghrelin in the blood between midnight and morning. It is as if this hormone is out of sync with the other hormones, primarily melatonin, that should be keeping them asleep, not microwaving pizza or defrosting a steak in the middle of the night.

No one quite knows what to do about the high levels of the hunger hormone in the wee hours of the morning. Researchers acknowledge that the rise of gherlin is delayed, so that instead of increasing late in the afternoon/early in the evening, when we normally would be eating our evening meal, it seems to peak five or six hours later. One thought is to expose night eaters to early morning light therapy similar to the light boxes used by people with SAD (Seasonal Affective Disorder). According to a paper by Goel N. Stunkard and others in the Journal of Biological Rhythms, night eaters who have been exposed to early morning light respond by eating at normal meal times and will decrease their nightly food consumption. Maybe the light changes the rhythm of ghrelin release so that it approximates the normal sleep/wake cycle. Or perhaps waking people up early to sit in front of a light box gets them to eat breakfast early in the morning (although it is hard to believe they will be hungry) and this sets up a normal ghrelin prior to lunch and then dinner time.

Or perhaps the answer is to move to Spain where everyone seems to eat supper after the late show.

Might Candy Now Be the Answer to Alcohol Dependence?

Australians now reserve two months of the year when they stop drinking and donate the money they might have spent on alcohol to charities. February and July are designated abstinence months and, according to reports in the Australian papers, the effect is by and large positive. Charities get sizable contributions and the temporary non-drinkers, according to self-reports, find themselves able to go to a gym on Sunday mornings or for a run rather than nursing a hangover. The one negative effect of giving up alcohol, according to a friend who is a health writer in Melbourne, seems to be a craving for sugary non-alcoholic drinks and sweet snacks.

The link between a decrease in alcohol intake and increase in carbohydrate intake is familiar to those who have gone through alcohol withdrawal. Sweet carbohydrates such as doughnuts are served at AA meetings, and stories of intense sugar cravings among the newly abstinent are common. It is assumed that the reason for this carbohydrate craving is the need to replace the carbs in alcohol with those in sweet and starchy foods like pastries, chips or crackers. But most alcohol contains very little or no carbohydrate unless it has been added to make an intensely sweet drink like Sacramental wine or as syrup or sweetened fruit juice in a mixed drink. (Distilled alcohol contains no carbohydrates; beer and wine have between 2 and 4 grams per drink.) You would have to drink gallons of beer to equal the amount of sugar in a doughnut or cookie. So why do people crave carbohydrates as they go through withdrawal?

The answer may reside in how alcohol and carbohydrates affect mood.

Both alcohol and carbohydrates have the ability to change mood. Both are sought to quell anxiety and other emotionally painful moods such as depression. They may work by different mechanisms in the brain, and each presents its own set of side effects (although no one yet has been charged with a DUIC (driving under the influence of carbohydrates). And the calming effects of both are time limited. When they wear off, more cookies or cocktails may be consumed to renew the sought-after mood elevation.

High protein, low-carbohydrate diets prevent the synthesis of serotonin, the mood calming brain chemical that alleviates depression and anxiety. Interestingly, such diets have been associated with greater alcohol intake than those offering more carbohydrate and less protein. According to a review in the Journal of Studies on Alcohol by O. A. Forsander published several years ago, high-carbohydrate diets were associated with a significantly lower alcohol intake than diets with a high-protein, low-carbohydrate content. Might people seek alcohol to relieve emotional distress if their diets prevent serotonin synthesis?

The answer to this question requires further research. But it may explain why some people who can no longer rely on alcohol to ameliorate their moods seek carbohydrates.

It makes sense.

If some drinkers are self-medicating with alcohol to feel better, when it is no longer available they are left with nothing to help their emotional distress. Sugar and other carbohydrates eaten in very small amounts (25 grams) are sufficient to increase serotonin, and take the edge off painful moods. Unfortunately, the effect lasts only about three hours and when it wears off the cravings and the bad moods may return. Thus, the consumption of more sweet carbohydrates repeats.

The solution may be for people in the early stages of withdrawal to imitate the eating patterns of people who successfully cope with weeks of depression, anger, lethargy and social withdrawal during the late fall and winter. These people who suffer from Seasonal Affective Disorder have a chronic need to consume sugary foods but if they eat whole grain, complex carbohydrates instead, they will experience the same relief that they get eating gumdrops and chocolate bars. Moreover, since the starchy carbohydrates are digested more slowly than sugary carbohydrates, their good moods may last even longer.

So no to candy but yes to rice, whole-grain bread, oatmeal, potatoes, pasta, polenta and low-fat granola. Obviously eating carbohydrates is only one of the many strategies necessary to support people in their quest for sobriety. But the calm, focused mood brought about by nature’s own tranquilizer, carbohydrates, may help in the recovery process.

Obsessed with Counting Calories? There’s an App for That!

It had to happen. Once digital electronic calorie tracking became available on the smartphone, uncounted numbers of diet-obsessed women began fixating over how many calories they were putting into their bodies every day. Of course, the Apps did not generate the calorie-counting obsession; rather it allowed the already compulsive mind to note and record the caloric value of every morsel of food swallowed. These Apps remove the guesswork from figuring out how many calories three Cheerios or a sprig of parsley contain. And none of this information has to be written down since it is all on the App.

The very many Apps available to inform the eater about his minute-to-minute calorie intake and to record it for eternity, if necessary, are useful for the diet newbie, the dieter in denial, and the dieter who is not losing weight. Presumably keeping a daily record of calories consumed, and perhaps calories expended, through physical activity will make losing weight less haphazard and more scientific and controllable. One can’t pretend or hope that a recently consumed snack has fewer calories than it actually contains, or excuse lack of weight loss to the phases of the moon or bad karma. No longer is it necessary to pore over a thick book of calorie counts to work out a meal plan that meets the diet plan’s calorie allowance, or add up at the end of the day how many calories you have consumed. The App will do all that for you and perhaps motivate you to use up 400 or 500 calories through exercise so you can indulge in a treat and still lose weight.

Unfortunately not everyone uses these calorie-counting Apps for healthy dieting. The down side of these Apps is that they reinforce compulsive dieting, and its unfortunate outcome of anorexia. Just a brief scan of personal anecdotes from self-described compulsive calorie counters sadly confirms how hard it is for some people, often women, to eat when they see how many calories they are consuming. Like a miser who cannot bring himself to spend money even when he needs to, the compulsive calorie counter has a hard time consuming calories, even when such behavior may jeopardize his/her health. If the goal is to become as thin as possible, then doing so requires eating as little as possible. So it is easy to see how individuals with this mindset can have their App tell them what foods contain the least amount of calories, i.e. a leaf of iceberg lettuce versus one leaf of spinach, or one radish versus one half of a cucumber.

One wonders whether compulsive calorie counters recognize that calorie intake keeps us alive? The non-intake of calories is called starvation, and its outcome is always the same, which is not good. Without calories coming in, the body has no way of obtaining the energy to carry out the functions that keep us alive. We are not plants that are able to convert the energy of light from the sun into chemical energy necessary for growth. Moreover, unlike plants that make their own food (remember photosynthesis?), we also must eat because our bodies require nutrients that we are unable to synthesize ourselves.

Thankfully in this country we are not vulnerable to the many diseases brought on by an inadequate intake of these essential nutrients, since we have available so many foods that provide them. But it wasn’t so long ago that people were dying from scurvy caused by lack of vitamin C, developed the malformed bones of rickets due to lack of vitamin D, or experienced nerve or cardiac disorders due to the absence of vitamin B1.

So, to be truly useful in keeping us healthy (as well as thinner), Apps should be designed to advise the user to make food choices according to nutrient content. Why not have an App suggest eating spinach or kale rather than cucumbers or iceberg lettuce as the former are much denser in nutrients? Why not build an App that suggests to the user that she is not getting enough calcium and should start eating some low-fat dairy products? Or what about an App that alerts the user that, according to her weekly food record, insufficient protein and fiber has been consumed? Designed to capture and motivate the user to alter food choices, such Apps can improve nutrient intake – or at least tell the user to call her mother and ask her what to eat.

The Frequent Flier Weight Loss Plan

Although it has been said that travel broadens the mind, travel may also shrink the body.  Jet lag, sleep deprivation, minor intestinal upsets due to foreign water and unfamiliar foods, necessity to walk  miles inside airport terminals, as well as the unavoidable need to use one’s feet rather than a car to sightsee at a museum or church, may allow you to return home thinner than when you left.

Weight loss can begin even before the trip begins.

Outrageous prices for junk food at airport newsstands and kiosks  may decrease the temptation to snack  while waiting to depart and once on the plane, eagerness to eat a meal (served if the flight is 3 or more hours) is tempered by its resemblance to high school cafeteria lunches. The timing of the meals on the plane also helps you resist consuming them. Typically flights that go cross country or across the ocean depart late in the evening. ‘Supper’ may be offered at 11 pm or midnight when the traveler’s tummy is ready for bed. Skipping that meal as well as the frozen bagel and plastic fruit served for breakfast the next morning at 3 am (well, it is morning isn’t it?) will further diminish your calorie intake.

Once at your destination, you should continue to lose weight if the following conditions exist:

1. Alien food…If restaurant specialties feature grilled octopus, marinated baby eels (they do indeed look like eels) or still living shrimp, dinner might consist of bread and water, or a protein bar back in your room.

2. Not understanding the language on the menu.  Ordering from a menu written in an incomprehensible language, may present you with dishes that contain ingredients you hate or don’t recognize.   (Years ago on a trip to Budapest for a meeting, my husband and I found that we had ordered , without knowing it, dishes made mainly of cabbage, including dessert of a cabbage strudel).

Caveat: If the  destination city is known for steak smothered in cheese sauce,  chowder made with heavy cream, fried clams with greasy  French fries and mayonnaise loaded coleslaw or half a pig’s worth of  barbecued ribs, weight can be accumulated as fast as used napkins at the barbecue.  The frequent flyer diet works best when the foods at the destination are more or less bizarre, or inedible.

3. Smaller portion sizes. The size of meals served outside the US are almost always smaller than those offered in the states.   Pasta in a restaurant in Florence may come on a salad size dish rather than on a platter large enough to hold a turkey, and almost nowhere will you be given 16 oz. steaks or half a chicken. Desserts tend to be tiny compared with our outsized offerings, and more likely to be a fruit and pastry combination, rather than a densely rich production of egg yolks, heavy cream and chocolate.  Sandwich fillings are sparse and do not require a veritable unhinging of the jaw in order to bite into them.

4. Contaminated food and/or water.  Sometime simply drinking the water may produce digestive discomfort ,and although most travelers avoid eating food that obviously does not meet US standards for hygienic preparation, even cautious eating may not prevent picking up a food born organism. Travelers may lose considerable amounts of weight if the problems persist, although often the weight lost is, alas , from muscle as well as from fat.

5. Increased exercise. Tour buses don’t pull up to the front door of a museum or church or monument; you often have to hike quite a distance from where the bus parks.  Moreover, you have to walk to see. How else can you look at art, botanical gardens and zoos, explore historical buildings ( think of the Tower of London) or marvel at the natural wonders of a  national park ? Some destination cities are so hilly ( think San Francisco, Seattle, Vancouver, Sydney) that your legs will feel as if they are on an elliptical trainer at the gym.  And  shopping requires walking ; open air markets, for example,  may cover blocks and walking is the only way to find something to buy.

6. Jet Lag. Even a three hour time difference, for example between coasts in the US, can disrupt normal eating schedules. Your hunger will be at odds with the meal schedules of your destination: if you are in Europe, your body may want  dinner when everyone is going to sleep and the restaurants are closed. Conversely, no matter how flaky the croissants served at a Parisian breakfast, if you are overcome with sleepiness at 8 am because it is 2 am back home, you may prefer to sleep through the first meal of the day.  Substantial time differences of 6 or more hours, can make eating seem physically impossible. When you desperately want to sleep, you simply cannot bring yourself to put any food in your mouth.

If  your destination is a  cruise or beach resort where you  can lie on a chaise and be brought drinks with umbrellas stuck in a piece of pineapple, the frequent flyer diet will not work. Otherwise you may find upon your return, that there is less of you than when you started.