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

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

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

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

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

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

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

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

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

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

So now how are we supposed to eat?

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

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

Is the Acai Berry a Superfood or a Super Scam?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Alcohol Withdrawal Mood Swings: Might Eating Carbs Help?

My generally genial and placid neighbor was heard complaining about the number of dogs in our building. His comments seem strange, seeing that he once had a dog himself and was often seen petting the dogs of other owners.

“Be tolerant of him,” whispered another neighbor. “He just stopped drinking and has the bad mood (link is external) that goes along with alcohol withdrawal.” My informant had been sober for more than 25 years, as he often told me, so I asked how long the grumpiness and irritability lasts. “Could last up to two years,” he replied. “But the anxiety, difficulty focusing, tiredness, insomnia? They usually begin to get better after a couple of months. It has a funny acronym,PAWS…That stands for Post Alcohol Withdrawal Symptoms. Some people have terrific sugar cravings along with it. I sure did, but even though my waistline expanded  from eating cookies and ice cream? It really helped my mood. Maybe I ought to take Fred ( the cranky neighbor) out for some waffles.”

A craving for sweet carbohydrates is not unusual for people during the early months of abstinence from alcohol.  AA meetings traditionally provide doughnuts and other sweetened carbohydrate snacks. Many rehab facilities, as well as on-line self-help sites talk about the perils of replacing an addiction to alcohol with a sugar addiction, because so many people crave sugar.

Obviously a post-drinking diet of jelly beans, PEEPS ( those yellow and green marshmallow animals) and chocolate kisses is dreadful for one’s teeth and weight, and does nothing to meet the very critical need for several vitamins.  Folate (link is external), as one example, is very much needed by the recovering alcoholic.  Alcohol, despite its potent effect on the brain, does absolutely nothing to nourish the body, and many alcoholics may be malnourished because they consume up to 50%, if not more, of their daily calories as alcohol.

The longing for carbohydrates (sugar is a simple carbohydrate) may be driven not by a sweet tooth but by the need to restore a sense of emotional balance, calmness, and tranquility during the turbulent weeks following abstinence.  Many studies have shown how prolonged and excessive alcohol intake effects (not in a good way) several neurotransmitters in the brain (link is external). Like a thief who trashes a house, excessive drinking leaves a brain in disorder, and the severe symptoms of acute alcohol withdrawal are testimony to the damage left by the drinking.

Serotonin is one of the neurotransmitters whose normal activity is affected both by alcohol consumption and its cessation. The many symptoms of PAWS read like the behaviors seen with inactive serotonin: inability to concentrate, anxiety, irritability, lack of motivation, obsessive thoughts, and depression, among others.

Is it possible that the craving for carbohydrates is an attempt by the alcoholic in recovery to increase serotonin activity, and diminish these many unpleasant moods and behaviors?

Previous research with volunteers whose moods indicated reduced serotonin activity, such as women with premenstrual syndrome and people suffering from winter depression, suggests that the answer might be yes. In both these cases the mood, focus and sleep changes are very similar to those described in PAWS, and reflect diminished serotonin activity.  Extensive research with women who suffer from mild to moderate PMS showed that a small ‘dose‘ of carbohydrates relieves many of the unpleasant symptoms soon after the carbohydrate is digested. Carbohydrate intake seems to have the same effect among those with winter depression.

But it is not necessary or desirable for the recovering alcoholic to eat sugar or sugary, fatty foods like doughnuts, ice cream, chocolate, and cookies in order to smooth out the mood swings. It is critically important that the food choices made by the recovering alcoholic help to restore depleted nutrients.  Many carbohydrate foods which will increase serotonin will do this:Sweet potatoes, oatmeal, brown rice, beans, whole grain waffles, vitamin fortified breakfast cereals, quinoa, lentils…these are but a few of the many complex carbohydrates that, once digested, will elevate serotonin levels.  Not much is needed. Thirty grams of carbohydrate is enough (which is equivalent to about 1 cup of multi-grain Cheerios).

When carbohydrate is eaten to increase serotonin, it must be eaten with little or no protein, as eating protein prevents serotonin from being made. This should be noted by those promoting high protein, low carbohydrate diets for people in recovery, because such diets will prevent serotonin activity from being restored.  Fat should be limited also because it delays digestion, thus delaying the time it will take until the recovering alcoholic feels some relief from depression, anxiety and lack of concentration.

Many critics of carbohydrate intake point out that even though people feel better after eating sugar, they then ‘crash’ and feel much worse.  What they fail to note is that after three hours of so, serotonin levels may drop again and the feelings experienced before eating the carbohydrate return. It is similar to what happens when a pain reliever wears off; the pain medication doesn’t cause the pain. It temporarily relieves it. No one would suggest not taking a pain medication, such as aspirin, because its effects wear off.  Once the pain disappears, the pain medication is no longer needed. And so when the alcoholic moves through the months following alcohol withdrawal and sees that the emotional discomfort has lessened, he or she may no longer need to use carbohydrates as often to feel better.

Months following alcohol withdrawal are tough, and not recovery is not helped by waves of anxiety, depression, irritability and other negative emotional states. Eating a sweet potato or bowl of rice or oatmeal might take the edge off these mood swings, and help the recovering alcoholic gets through yet another day of sobriety.

Will Daylight Saving Time Lighten Your Mood AND Your Weight?

It is disorienting to wake up in darkness during these first weeks of daylight savings time. Before we changed the clocks, most of us found sunlight greeting us when we turned off the alarm. Now it is dark again. We are beginning to adapt to the daylight savings time zone, and most of us agree that it is pleasant to have a few more hours of sunshine at the end of the day. By the first day of spring, we will have 12 hours of light and 12 hours of darkness; a welcome change from the scarcity of sunlit hours during the early and mid-winter. And this brightening by Mother Nature will only improve as the calendar moves toward late spring and summer.

 

One consequence long noted by researchers studying the effect of seasons on our behavior is an increase in energy, decrease in the length of sleep, and (hooray!) a decrease in appetite.  This doesn’t happen all at once. We don’t just wake up on the Monday after daylight saving time begins to then activate our gym membership, then begin to rouse at 5:30 am to use the gym, and also do a kitchen cleanse, throwing away all fattening foods. But it could happen, perhaps three or four weeks into the spring season. Just as limited hours of daylight make us tired, grumpy, loathe to exercise, eager to eat more than we should, and resistant to waking up earlier than we have to; the opposite is known to occur as the number of hours of daylight increase.

 

These positive changes are a ‘Spring Break’ for dieters. Springtime is giving us a break, a deal to help lose the weight that we resolved to lose in January but did not. Indeed, going on a diet in the depths of the winter made no sense. Unless one lived in the southern tier of states where fluctuations in daylight hours are much less extreme than up north, the combination of darkness, cold, snow, ice, wind and too many snow days makes staying on a diet impossible.

 

And so with this arrival of Daylight Savings Time we have that weight loss season is now here and will last about six months, ending pretty much right before Thanksgiving. Sometimes weight is lost spontaneously without formal dieting during the spring and summer, because we find ourselves eating lower calorie foods, becoming more physically active, and sleeping less as a result of increased hours of daylight.  However if you decide to start on a diet now, don’t be seduced by the weight loss claims of drastic, low calorie diet or some hookey weight loss plan that promises to melt fat, boost muscles, and take away wrinkles. The weight loss plan you choose must help you change your life style so the weight lost will stay lost. Extreme diets work only in some alternate universe where the triggers that caused overeating don’t exist and the sun never sets before 8 pm. Even if you lose only small amounts of weight; for example, 3 or 4 pounds a month, this is enough to improve your health and certainly fit into smaller size clothing.  

 

To be sure however, spring weather is often as disappointing as someone you meet on internet dating. Blizzards, cold rain, and wind are frustrating reminders that spring on the calendar does not mean spring like temperatures. But it no longer seems unreasonable to consider going on a long walk or bike ride or cleaning up the yard when the temperature does creep up a little and darkness is delayed until after the evening news. Locally grown produce starts to appear in the markets, and suddenly grilled fish and chicken and salads become more appealing than heavy stews and potato dumplings. Getting out of the house in the evening to take a course, join a book club, or go for a long walk with the dog begins to be more appealing than laying on the couch, watching Netflix and snacking.

 

Moods become more upbeat this time of year. The change is subtle. No one floats on a cloud of euphoria unless the lottery tickets proved a winner, or a long anticipated good event finally occurred. (And even these feelings of utter joy don’t last that long).  But spring makes one more likely to smile, to appreciate the early flowers or ducklings and replacing the black down coat with a light jacket or sweater.

 

If you take advantage of the gift of longer hours of daylight, your scale and your mood will most certainly lighten simultaneously as well.

 

 

 

Potatoes: Good for the Mood, but Do They Really Cause Lung Cancer?

Decades ago, while staying with friends in Stockholm, we were introduced to their version of a midnight snack: steamed new potatoes on a bed of fresh dill. Karin, a medical doctor with a doctoral degree, and Bengt, her equally well-educated medical doctor, Ph.D. husband and we ate these tiny potatoes after returning to their home following a concert. And despite the late June sun never quite setting, we were able to fall asleep quickly and rest soundly, probably because eating the potatoes increased the soothing, soporific events of serotonin.

Had we only known then what a recent research publication has claimed a few weeks ago, we would never have let a potato touch our lips. Obviously our hosts, despite their scientific credentials, were not aware that potato eaters may increase the risk of lung cancer. A study asserting that potatoes and other carbohydrates with a high glycemic index (“GI”), are a risk factor for cancer was still in the future. Indeed as we sat eating our deliciously tender, dill-flavored potatoes, their high glycemic index was of little concern to us. At that time, the only people concerned with the glycemic index of foods were diabetics and their health care givers, as the GI of foods was involved in determining to insulin requirements. Now it is impossible to escape this concept as the GI of foods seems to affect every aspect of our health (at least according to self-appointed nutritional experts).

GI refers to how the rise in sugar (or glucose) levels in the blood two hours after a particular carbohydrate in a specific quantity is eaten on an empty stomach. Foods that cause glucose levels to rise quickly are called high GI foods and include potatoes, white bread, Fruit Roll-Ups, white rice, and Gatorade. Foods bringing about a slower rise have a moderate GI: Snickers bars, ice cream, macaroni and cheese, chicken nuggets, peanut M&M’s. The foods associated with a slow rise in blood sugar levels, such as lentils, soybeans, peanuts, cashew nuts and prunes have a low GI.

This means is that the GI depends on high rapidly carbohydrates are digested. Adding fat, protein and/or fiber to a carbohydrate food will slow down its digestion and decrease the GI. This is why a Snickers bar or pizza loaded with melted cheese would have a much lower GI than bread or steamed rice.

Insulin is released as soon as glucose enters the circulation and pushes the glucose into the cells where it is used for energy. Diabetics sometimes have too low glucose levels and need to consume a food or beverage with a high GI to elevate their glucose levels quickly. Not doing so may cause them to become unconscious. Endurance athletes may also consume a high GI food during a sporting event because their muscles have run out of the energy producing glucose and they want the energy immediately, not at the end of the race. Sometimes, eating a high GI food has an almost immediate positive effect on mood the same as what we experienced with our midnight potato snack. Serotonin is made soon after glucose enters the bloodstream and its increased activity soothes and subdues stress, lowers anxiety and calms. When our clients in our weight management center worried about binge eating, we suggested they eat a rapidly digested carbohydrate similar to those eaten by endurance athletes to switch on serotonin’s ability to brake the appetite.

So what does all of this have to do with cancer? The unexpected finding from a study done at the University of Texas Anderson Cancer Center that there is a “49 percent increased risk of lung cancer among people who consume the most foods with a high GI, compared to people who consume foods with a lower GI…” (presumably people who eat Snickers bars rather than rice). Does this mean that diabetics, endurance athletes, and people seeking serotonin’s help in curbing their excessive food intake are more likely to get lung cancer?

Well as it turns out, unlikely if they were educated beyond high school. “Participants who had less than 12 years of education were 77 percent more likely to develop lung cancer than those in the lowest GI group,” according to the results. This means that our Swedish friends are probably not likely to develop lung cancer from their midnight snacks of potatoes, having had considerably more than 12 years of education. But it still leaves unanswered the question of why someone who out of necessity or choice has less education will be more vulnerable to this type of cancer? What else were they eating or not eating?

Few of us live solely on high glycemic index potatoes as did the Irish during the early 1800s. It has been estimated that by the middle of the 19th century, about one third of the entire population was totally dependent on the potato and in some regions, the potato was the only food eaten. Obviously diets must include large quantities of vegetables, fruits, high fiber carbohydrates, low fat dairy products and lean protein. But one effect of the study linking a high GI with lung cancer may be a move to include high fat ingredients in foods because that lowers the GI. Clearly the take-away message is not to replace sweet potatoes with Snickers bars or eat a stack of bacon, lettuce and tomato with mayonnaise without the bread. Let us hope that in the near future, the headlines of a study will announce, “Moderation in all that is eaten is the best way to good health.”

Seven Minutes of Fitness During Unfit Weather

Winter is not an easy time, and complaints about the weather are truly justified. Dreadful cold, snow, ice, and wind are afflicting most of the country, along with unseasonable thunderstorms, torrential rains, and tornados. Even though spring (on the calendar) is about five weeks away, there is no guarantee that conditions will improve quickly by the middle of March.

One consequence of the perverseness of the weather is its effect on exercising outside. Going for a run, biking to work or for recreation, snowshoeing or skating, playing golf or tennis become almost impossible when temperatures and wind chill cause frost bite, or the heavy rains turn sidewalks into rivers. 

Exercising inside may be possible only if one has equipment at home or as part of an apartment complex or office building. Health clubs, even a few blocks from work or home, may be impossible to reach when weather conditions are disastrous. Those whose first response to bad weather is to think longingly of going back to bed may consider the inaccessibility of a place to exercise as irrelevant.  In fact, it may be looked upon positively, i.e. “No one will nag me about working out if we are told to stay home because of weather conditions.”

But there is an alternative to becoming a weather-related couch potato: exercise apps. These are available to anyone who owns a smartphone and/or a computer, most are free, and those that have to be paid for cost considerably less than the daily cost of a gym membership.  Moreover, most require nothing more than a carpeted floor (to prevent sore elbows and knees) and perhaps a low stool. One free and popular option is the, ‘Seven Minute Workout.’ This is exactly a seven-minute combination of aerobic exercise and muscle building moves that leave the heart pounding and the lungs seeking air. The very fit can move onto the advanced version, which as described in a New York Times review is torture but only seven minutes of torture and probably not as bad as having a cavity filled without Novocain.

“Sounds easy,” I thought to myself while researching exercise options for this article as I downloaded the beginner’s version on my smartphone. Warning: If you are one of those people who read directions only after you try to turn on a computerized version of a washing machine or the audio system in your new car, don’t do the same with the exercise program. For one thing, one exercise in the beginner’s version of the seven-minute workout requires standing and stepping down from a medium height chair or stool. The one chair without wheels in the room where I was trying out the program did not look sturdy enough for bouncing up and down on it with one leg and then the other. By the time I tentatively tried it, that exercise was over. Yoga and Pilates participants will be familiar with most of the positions but for those who think a plank is a long and narrow piece of wood, being told to get into the plank position for 30 seconds may seem bizarre. And while I can do push-ups fairly easily (a long stint on crutches a few years back strengthened my upper arms), single arm push-ups were beyond me even in this beginner’s exercise routine.

But if I had read the directions before starting the program I might have fared better. There are several videos that slowly and carefully demonstrate how to do the exercises and better yet, show options for those whose fitness levels are similar to the cushions on which they usually reside. Moreover, it is important to remember, as I reminded myself, that this is not a competition and unlike doing these moves in a class where everyone else seems more adapt and fit, no one can see me.

The limitation of such a brief but intense exercise program is that the aerobic component is very short but there is no penalty for continuing running in place, for example, for longer than the 30 seconds or so on the program. Adding stair climbing or jump roping or running around the cellar with a toddler or puppy will also increase the cardio-workout component. 

But the best thing about the indoor exercise option is its brevity. You may moan and groan at some of the exercises, especially when weather enforced immobility has left you stiff and short of breath.  But by the time you decide that maybe it was a mistake to attempt to exercise, the program is over.

Seven minutes of vigorous movement each day is less than accepted standards for daily exercise. Study after study has pointed to thirty minutes of physical activity three or four times a week as being the minimal amount of movement we should be doing to keep our physical and mental health from deteriorating. On the other hand, any exercise is better than none. And the relentless pace of the seven-minute workout may increase stamina faster than a slow stroll through an indoor shopping mall or around the block.

Now if someone could adapt this program so it could be used while standing in a long line at the supermarket, on a commuter train, or during those pesky endless commercial breaks, we all will be in great shape, regardless of the weather.    

Can You Cure Obesity, Migraines and Even Depression By Drinking Carrot Juice?

Walking my dog in my neighborhood, I pass a sandwich shop specializing in Cuban sandwiches. In good weather people perch outside on stools next to high tables and happily munch on loaves of toasted bread , almost as long as my dachshund. He stands near the table hoping to catch a few drips from the sliced pork, ham, mayonnaise, melted butter, melted cheese and pickles layered between white doughy bread.  Often the diner is also munching on French fries and drinking a sugar filled soft drink. Obviously the restaurant is not exactly a testimonial to nutritional dining.

Yet yesterday a poster appeared on one of the windows advertising juices that would confer upon the diners health and maybe even longevity.  Various drinks made of different combinations of vegetables and some fruits were now available.  Celery, carrots, spinach and something leafy, maybe kale, were pictured on the sign and underneath descriptions of the remedial benefits of various vegetable combinations .Suffer from migraines? A combination of carrots, celery, spinach and ginger will take away the pain. Depressed? Drink blended spinach and carrot. Cancer will disappear after having a beverage made from apple and carrots, and if several of the sandwiches have left the diner obese?  Well the restaurant has just the beverage: grapes, apple, lemon, ginger, carrot, celery and tomato. (V-8 anyone?)

The developers of dietary guidelines will be happy to see these vegetables/fruit concoctions offered at this restaurant.  The only green vegetable available until the appearance of this vegetable juice was the pickle, and there were only three or four thin slices in a sandwich. These were hardly enough to qualify for the 5 vegetable servings we should be eating each day.  Thus customers who choose to drink liquefied vegetables will be consuming vitamins and minerals not available, obviously, in a high fructose soda.

The potent health effects of drinking  blended vegetables and fruit has been advertised  for years, and usually the list of ‘cures’ go far beyond those I have described. Most do not promise relief of baldness as one of the promised outcomes, but in a nearby juice bar, the list of therapeutic benefits takes up two columns in a wall to ceiling display.  And given the popularity of these juice bars, people must be consuming juices for more than their taste.

 But really, would anyone come into this sandwich shop or a juice bar to seek relief from a variety of serious illness? Are they mistaking the restaurant for an urgent care facility?  Is it possible that someone walking by suffering from a migraine or having been diagnosed with cancer will read the poster’s claims for the juices and says to themselves, “I must have one of those drinks.  It will make me healthy again!”

The proliferation of vegetable-fruit blended juices in such restaurants and juice shops touting health benefits does not seem to fall under the scrutiny of local public health officials, the FDA or the Federal Trade Commission. (Indeed given the limited resources of municipal public health departments, it is probably more important that inspectors check for rodent infestation than evidence that celery juice will help migraines.)   Usually government agencies such as the  FDA become involved in the claims made for products only when national sales of a product are great enough to  affect a large number of buyers and/or the product contains ingredients with dangerous side effects .

Drinking blended juices does confer health benefits just not the ones touted on the posters in restaurants and juice bars.  Carrots and spinach are a good source of vitamin A, a vitamin necessary for the retina, cornea, and membranes of the eye to function optimally.  Folic acid works with another vitamin B12 in the production of red blood cells and is critically important in preventing a neurological defect, spina bifida, in the developing fetus.  Juices that contain broccoli, Brussel sprouts, spinach, peas, asparagus, or liver will be excellent sources of this vitamin.  (You don’t have to drink the liver.)

Vitamin B3, or niacin, a critically important vitamin for metabolic functions, is best found in white or sweet baked potatoes, but those are rarely blended or mashed into a drink.  Jerusalem artichokes and shiitake mushrooms are also good sources, but not likely to be eaten on a daily, or even monthly schedule. Peaches, oranges, and grapefruit are also good sources and happily, these fruits do make their way into blended drinks.

Vitamin C is usually abundant in blended juices because citrus fruits, strawberries, papaya, spinach, broccoli, and blueberries contain this vitamin. This vitamin multi-tasks in the body as it is involved in the production of collagen, helps the body absorb iron, participates in wound healing, and acts as an anti-oxidant. Few people are insufficient in this vitamin unless they scrupulously avoid fruits and vegetables and/or smoke; smoking cigarettes lowers vitamin C levels in the body. Going on long sea voyages with only salt pork and bread to eat also decreases vitamin C levels, but this is a scurvy joke of yore.

And there are countless other benefits to the body from drinking, or even chewing vegetables and fruits; this is why we are urged to eat several servings from a variety these food groups daily. Not doing so over several months may cause nutritional deficiencies and decrease the body’s ability to function optimally. But, and this is where science and juice poster claims part company; carrots, celery, spinach, ginger and apples are not a cure for anything except nutritional deficiencies. An apple a day is not going to keep the doctor away if one is suffering from depression or migraines or cancer. On the other hand, eating perfectly ripe sweet strawberries or handfuls of sun-warmed blueberries can be a joyous experience, and its memory may be able to beat back the depression from a cold, gray winter day. 

 

Shrinking Into Obesity

A close friend came back from her annual physical agitated and anxious.

“I’m fat!” she wailed. “According to the doctor, my BMI is 29!”

“Wait a minute,” I remonstrated, “How can that be? You told me only a few days ago that you rarely go clothes shopping since you are wearing the clothes you bought years ago, because you like them more than the clothes in the stores these days. How can you fit into these same clothes if you are suddenly fat?”

“But that is what the chart said. And if my BMI increases, I am going to be morbidly obese.”

I looked at her. I have known her for years, and her size has always been the same with one difference: I was looking down at her, and she used to be taller than me.

“Uh, did your doctor tell you how the BMI is calculated?” I asked.

“It has something to do about my height and weight. I was so upset, I didn’t pay much attention.”

“OK. I think I know why your BMI is in the fat range.” I told her. “Did the doctor measure your height? Have you shrunk?”

I was right. She lost two inches from her 5’4″ height over the past 18 months, a considerable loss, but not unusual for a woman of over 70.

“Open the calculator on your phone so you can figure out your BMI yourself. You will see why your height is making it appear as if you are fat.”

She weighed 131lbs and her height in inches was 62. She calculated her BMI by:

1. Squaring her height in inches (multiplying her height 62 by itself);
2. Dividing her weight, 131 lbs, by 3844, her height squared; and then
3. Multiplying that number by 703.

Her BMI was 23.9.

“You are not in the fat category,” I told her after checking BMI charts on several internet sites. “You would have to have a BMI of 25 to be considered obese. But anyway, that is not the point. Your BMI went up because of changes in your height, not weight. You may have to have your clothes shortened, but certainly not widened.”

After she left, feeling a little lighter in spirit (pun intended), it occurred to me that the BMI is certainly an unreliable measurement for people whose height changes due to age, or orthopedic problems that cause that they be bent over, or have spinal fusion. Shrinking into obesity is not the same as gaining weight without losing height.

Should measures other than the BMI be used to determine obesity?

Another common measurement of obesity is the waist/hip ratio. This is considered to be a good indicator of fat, especially around the mid-section and should not be affected by loss of height. I emailed my friend these instructions:

1. Measure your waist circumference. Locate your upper hipbone and put a tape measure (cloth, not metal) around your bare stomach just above the bone. Don’t squeeze the skin and breathe out while measuring.

2. Measure your hip circumference. This requires looking in the mirror and locating the widest part of your hips. Put the tape measure at this point and measure around your body.

3. Divide the waist circumference by the hip measurement.

I sent her the chart of waist-to-hip ratio data for men and women, in case her husband was curious about his own measurements.

The chart is simple. A 0.95 or below waist-to-hip ratio for men, and 0.80 or below for women, is considered normal and low risk for obesity-related disease like diabetes.
A ratio of 0.96-1.0 for men and 0.81-0.85 for women is considered a moderate risk. Above that, individuals are at high risk.

She did the calculations and was pleased to note that she was at a low risk but her husband was starting a diet.

The anxiety and concern my friend experienced when told she was obese (according to her BMI) could have been avoided by asking some obvious questions: Has your weight and clothing size increased during the past year? Certainly if the answer had been yes, then the BMI chart or waist-hip ratio measurements would have been useful to see whether she was hovering close to the obesity line.

Moreover, if her weight had decreased (so it appeared that it compensated for her diminished height), it would have been an oversight to ignore the reasons for the lower weight. She might have lost it dieting or through increased exercise. But what if she had lost weight due to a loss of muscle mass and not fat? The BMI chart would show her in a healthy weight category but a shrinking muscle mass would put her at risk for osteoporosis and falling due to lack of muscular strength. Models, for example, whom are forced to live on semi-starvation rations to look two-dimensional in photographs, may have envious BMI scores. But these scores do not reflect their scrawny muscles and fragile bones.

Lesson learned? Charts are useful, but should never replace common sense and simple observation.

“Oprah, I Told You So!”

She wouldn’t remember. Why would she? It was at least 15 years ago since I appeared as the only guest on her afternoon television program, discussing the benefits of carbohydrates on mood and controlling appetite. After I wrote a book on how nutrients can influence mental performance and mood, one of her many producers asked me to be on her show. We discussed our mutual craving for carbohydrates in the afternoon, and when asked for snack suggestions that would be diet appropriate, I mentioned baked sweet potatoes, popcorn, and toast and jam. The sweet potatoes and bread appealed to her. She understood immediately the connection between eating carbohydrates, increased serotonin levels in the brain, a better mood and decreased appetite. (She is a very smart woman.)

But alas, my advice to her was soon lost, smothered under a steamroller marketing campaign to promote high-protein, low-carbohydrate diets.  A movement to tarnish carbohydrates as the cause of obesity, and extolling the virtues of eating only protein and fat as the path to thinness nirvana, started around that time with Dr. Atkins. (His high-fat, high-protein diet caused him to exit the world not too long afterward.) Soon the low-carbohydrate South Beach diet (with mouth-watering pictures of low carbohydrate foods) followed, and the nation was hooked on eliminating carbs from their diet. (Interestingly, despite the popularity of the South Beach diet elsewhere, South Beach itself is  filled  with  Italian restaurants serving pasta and pizza; an Italian bakery selling gigantic loaves of freshly baked, crusty bread is so crowded it is often hard to get in the door!) 

Soon after it became popular in our culture, not eating carbohydrates was praised as a way of returning to the pre-Stone Age menu of raw meat, occasional berries, and edible twigs known as the Paleolithic Diet. Fear that eating a piece of bread would turn one into a look-alike Tubby the Tuba, eliminated bread baskets from the kitchen table, and recipes for sandwiches using lettuce wraps rather than bread became popular.  It did not matter that eliminating bread, potatoes, rice and pasta in favor of beef, chicken, fish, and cheese drained the brain of serotonin, and left the dieter with a personality that ranged from grumpy to Attila the Hun. No matter that the satiety-producing effects of serotonin no longer could turn off appetite, and serotonin’s soothing aura could no longer help people to fall asleep naturally without sleep aids. No credence was paid to that after a low-carb diet, weight was gained quickly and efficiently as the brain pummeled the ex-dieter into now overeating carbohydrates in an attempt to replenish serotonin stores. No matter that the previous Weight Watchers point system was rigged against carbohydrates except fruit, which does not increase serotonin levels.

Now, finally, Oprah has squashed the bread phobia.  Certainly the instant increase in the worth of her stock in Weight Watchers, after she announced her 26 pound weight loss eating bread on their new diet plan, must convince some that their portfolio, if not their scale, will benefit from a return to carbohydrates.   

It is unclear whether those in the Weight Watchers organization understand the relationship between eating carbohydrates, an increase in brain serotonin, a decrease in appetite and an improvement in mood. Dieters are deliberately given few limitations on what foods to eat and avoid. (However, the new Smart Point System does allow food choices to be more flexible and less directed.)  Moreover, it is unlikely that information about how to eat carbohydrates in order to harness the power of serotonin is conveyed. Unless the carbohydrate snack such as rice cakes, popcorn, pretzels or baked potato is eaten with very little protein and fat, i.e. five or fewer grams of each… no serotonin will be made. Weight Watcher dieters are probably unaware that two pieces of bread stuffed with protein foods like turkey or tuna will not produce the satisfying satiety of eating carbohydrates alone. The program likely does not inform them that protein interferes with the synthesis of serotonin, nor tells them to eat carbohydrates at least 30 minutes before protein is eaten, or two-to-three hours afterwards. They may not be able to translate the small amount of carbohydrate necessary to turn on serotonin synthesis, about 25 grams, into Smart Points.  

No matter.  They will listen to Oprah. She is someone whose pronouncements change people’s lives, almost always, for the better. Her cry of, “I love bread!” may be one of those pronouncements.  If she can convince the carbohydrate-avoiders to start eating foods that produce the calming, soothing, mellowing, and appetite-reducing effects of serotonin, then who knows? Maybe the rest of us will be thinner and happier.

Binge Eating Disorder: Hunger for Food or Something Else?

The advertisement for a drug to treat B.E.D. kept appearing in commercials during our favorite TV series.

“What is B.E.D.? “ I asked but my spouse had no idea. “Bad Energy Day?” he responded. “No,” I answered, “it must have something to do with hunger because the drug is similar to amphetamine.“

Then it hit me. Binge Eating Disorder, that’s what it is. Interesting that a drug to take away hunger has been approved by the FDA. People who binge never eat only from physical hunger. Otherwise they would stop eating when the hunger is gone.“

I treated patients with binge eating disorder but insisted that I would do so only if they were also being seen by a psychotherapist. Even though the major symptom of binge eating disorder is the ingestion of enormous quantities of food in relatively few hours, the disorder is a psychiatric problem. Interventions focus on psychotherapy, along with nutritional advice to undo the weight gained from constant bingeing.

Binge eating disorder may affect as many as 1-5% of Americans, according to the National Eating Disorder Association. In fact it has its own association, BEDA, which offers Internet support and information as well as Internet contact with others who are living with this problem.  It is only relatively recently that the binges have been viewed as more than a derangement of appetite, or an inability to adhere to a rational eating plan. People with this disorder feel helpless to prevent themselves from gorging.  And because they do not compensate for their high calorie intake by starvation, laxative abuse, vomiting or excessive exercise, they may be morbidly obese.  Women are more prone to having this disorder than men and the bingeing is often accompanied with anxiety, depression, guilt and self-loathing.  Bingeing can occur several times a week, and sometimes a few times each day.

But bingeing is not the same as being very hungry and unable to stop eating until feeling stuffed. Teenage boys who can clean off a buffet table faster than a swarm of locusts are not bingeing; they just eat an enormous amount of food.  Diners on a cruise ship may feel an obligation to eat gigantic quantities of food to compensate for the price of their trip, but they are not bingeing either.

Bingers eat in secret and often they consume only tiny amounts of food when they are eating with others. Moreover, binges are often planned for the time when the eater is alone. The binger goes food shopping so there will be food in the house that the binger enjoys eating. Or she might go to several restaurants in a crowded food court. Ordering take-out food from several restaurants is also done because it is embarrassing to order a large amount of food from the same restaurant all the time. I had a patient who shopped on Thursdays for weekend binges. She turned off her phone, pulled down her shades, and spent from Friday evening to Sunday afternoon eating until her stomach could no longer hold food. Then she would sleep and upon awakening, start bingeing again. She was never hungry. How could she be?

Bariatric surgery might seem to be an obvious solution to halting bingeing and restore normal weight. But according to experts, reducing the size of the stomach, or bypassing it altogether, might cause extreme side effects. Physically limiting the amount of food consumed doesn’t reduce the emotional pain causing the overeating.  Without the psychiatric counseling before and following surgery to detect and help the underlying cause of binge eating, the bariatric patient is at risk for consuming much more food than the surgery allows and becoming extremely ill in the process.

In the winter of 2015, the FDA approved Vyvanse for the treatment of B.E.D. The drug is classified as a central nervous system stimulant like amphetamine, and had been already approved in 2007 to treat ADHD.  Vyvanse decreases hunger when used for ADHD, and this may have been the reason it was tested on binge eating disorder patients. Two studies were carried out, each for 12 weeks, among 700 people with binge eating disorder.  Compared with placebo treated subjects, the drug decreased the number of days each week people binged and also decreased the number of binges each day.

According to eating disorder experts, it is unclear how the drug works to reduce bingeing.(It is important to note that bingeing did not stop entirely in the studies.) Moreover, long-term results have not been reported. Questions to consider are… does the effect of the drug wear off or become even more effective over time? It is possible that the amphetamine-like drug removes the compulsion to eat, thus giving binge eaters a respite from their pathological focus on food. Instead of dealing with the constant bingeing with the guilt and shame of the aftermath, they  now have  emotional  time to deal with the reasons for their overeating. In a sense they are like binge drinkers who go into recovery and while they are abstinent, attempt to deal with the causes for their excessive alcohol intake. It is obvious that helping such people would be useless while they are drinking. And so too, it may be that helping the binge eaters, while they are still bingeing constantly, would also be futile.

Vyvanse is not a magic pill, and its ability to decrease binges does not mean it can decrease the emotional antecedents to the binges.  Replacing food as a coping mechanism will require more than a pill that takes away hunger. Eliminating binges is a long, complicated process requiring emotional healing and learning non-eating strategies to deal with future emotional upheavals. Removing hunger is necessary but not sufficient. But at least it is a beginning.