Chasing Away Insomnia With a Bowl of Oatmeal

Mike, the guy behind the desk at the gym, was yawning so much he could barely say good morning. “Late night?” I asked him. “No,” he yawned in reply. “I haven’t been sleeping well for days.”

“How long have you been on the high-protein diet?” I asked, knowing nothing about what he had been eating, but guessing he had fallen prey to the fitness hype about the benefits of avoiding carbohydrates.

I was right. Mike’s sleep problems started two weeks earlier because he had cut all starches and sugars from his diet. Now his sleep was like a yo-yo: asleep/awake/asleep/awake all night long.

“I go to sleep at midnight, and I wake up at 2 or 2:30. I then fall back asleep, and I’m up again in another hour. My mind is racing, and I feel agitated and simply can’t relax,” he told me.

If Mike had searched the Internet during those wakeful early morning hours, he would have read countless anecdotes from others describing similar sleepless nights. Whether the problem was failing to fall asleep easily, or get through the night without multiple awakenings, all the insomniacs had one thing in common: they were on high-protein, low or no-carbohydrate diets.

This is not to say that there are not many other causes of sleep disturbances from taking too long to fall asleep, trouble staying asleep, or waking up too early. Anxiety, age, sleep apnea (which awakens the sleeper many times during the night), drug side effects, some degenerative diseases, and even shift work are but a few of the obstacles preventing this most natural and wanted behavior. But if someone stops sleeping normally at the same time as he or she stops eating carbohydrates, it does not take a sleep disorder expert to figure why…too little serotonin is the cause.

Serotonin, the multi-functional brain neurotransmitter, normally soothes your brain into a calm and tranquil state so sleep comes easily. If you awaken, serotonin prevents the anxiety demons from leaping out and filling your brain with worries that prevent you from falling back asleep.

To some extent what we eat influences whether or not our brain is able to make serotonin. More than 30 years ago, research at MIT uncovered the connection between the consumption of any carbohydrate (except fructose) and serotonin synthesis. The release of insulin after carbohydrate is digested indirectly

helps an amino acid, tryptophan, get into the brain. Once there, tryptophan is converted through a biochemical process into serotonin. However, when more than small amounts of protein are eaten along with the carbohydrate, this process is blocked.

Serotonin synthesis was never in peril until recently. For most of our history, carbohydrates have been a staple of our diets, and being told to avoid them would have been as unimaginable as being told to walk on our fingers. Alas, the self-appointed nutrition gurus who are convincing us that the eating of carbohydrates will destroy our bodies, or at the very least, turn us into a human version of Humpty Dumpty, don’t understand that we have to eat carbohydrates if we are going to make serotonin.

When you are awake at 2AM searching the Internet for help with your insomnia, you will come across bland assurances that eating protein will give you the tryptophan you need to make serotonin. To borrow a phrase from the Gershwin’s Porgy and Bess,”… It ain’t necessarily so.”

Here are the facts: Eating protein prevents tryptophan from getting into the brain. Eating turkey does not increase the tryptophan in your brain (you are sleepy after the Thanksgiving Day dinner because of the fat you have just eaten). The research evidence conclusively shows that tryptophan is blocked from entering your brain after you eat protein.

So as you lie awake in your dark bedroom wondering whether you will fall asleep before the alarm goes off, contemplate your problem: sleep or a high-protein diet?

But good grief, you will say. If I eat carbohydrates, like the man in that Kafka novel, The Metamorphosis, I will wake up with my body horribly altered? (Kafka’s hero became an insect). Pounds will attach themselves to my body as I sleep, and I will need a tarpaulin to cover my now massive body!

Well, yes you might, if you eat croissants, doughnuts, mega-muffins, scones, French fries, potato chips, tortilla chips, baked potatoes leaking butter, and crackers covered with 80% fat cheese. Oh, and of course, weight gain is to be expected from consuming too much chocolate, ice cream, cookies, cake and piecrust. These foods are not just carbohydrate but full of fat, too. And since fat contains more than twice as many calories as carbohydrates, if you eat copious quantities of any high-fat foods, you will gain weight.

But you can get a decent night’s sleep, and leave the tarpaulin outside, if you eat very low-fat or fat-free carbohydrates like ¾ of a cup of plain Cheerios or Rice Chex, a small bowl of oatmeal, toast with strawberry jam (the sucrose supercedes the trace amount of fructose), or a graham cracker square. Don’t wait until the middle of the night before consuming the carbohydrate. Instead, eat a small, 120-calorie carbohydrate snack twice a day, before or several hours after you eat protein. This will help increase serotonin synthesis before you go to bed. If you have been on a low or no-carbohydrate diet for several weeks, it may take some time to restore your serotonin levels. So don’t worry if you still wake up during the night for a few more days. Eat another small snack. You will be back to sleep in about 20 minutes.

Try this. You have nothing to lose but your insomnia.

When Kids Grow Fat From Medication, Who Protects Them From Being Bullied?

The good news is that the increase in obesity in kids seems to be leveling off. Perhaps this is due, in part, to healthier school lunches and/or an attempt to get kids to exercise more. It’s a good thing, because fat kids are likely to be a verbal and physical punching bag at school, in their neighborhoods, and often at the family dinner table.

That obese adults are targets of verbal abuse, often from strangers as well as from officious relatives and nasty co-workers, is well known. Their ability to defend themselves is limited. Unlike hate speech, there is no legal penalty for laughing at the body of someone else, and it is hard to prove that obesity is involved in job discrimination. But adults sometimes have the option of escaping from situations in which they are victims. They don’t have to see offensive relatives or spend time with puny-brained fellow employees who feel good by making others feel bad.

Children don’t have escape routes from bullying, even when parents and school officials get involved. What happens on the walk home from school, or on the playground away from the eyes of a monitor, in the school bathrooms, or on Facebook, is often not preventable no matter how many meetings of school officials and declaration of no-bullying policies.

Obese children are the most likely to be bullied.

The National Education Association (School Psych Rev 2013; 42:280-297) reported weight-based bullying to be the most prevalent of all causes of bullying, and not just among younger children but among obese teens as well. Sadly, criticism and worse about their weight seems to come from parents and teachers as well (Pediatrics 2013; 131 abstract).

Now imagine a kid, formerly thin, who gains 50-75 pounds from medication he is taking to control uncontrollable rages or impulsive behavior or anxiety or depression. A pediatrician at one of Boston’s leading pediatric departments told me that such kids who are put on anti-psychotic medications to control severe behavioral problems might be able to be mainstreamed in school. But now the 7-year-old who weighs as much as a 13-year-old is the victim of bullying. He is still fragile emotionally, and perhaps not well socialized into his peer group because of his mental problems or autism or Asperger’s syndrome. He no longer can run fast, bend down to pick up a ball, do gymnastics, or climb a rope. He is alone in the proverbial school yard or bathroom. Who is protecting him from the inevitable teasing? These children are supposed to be helped and supported en route to being integrated into conventional schoolrooms, but bullying presents a barricade that many may not be able to overcome.

Putting such kids on a diet seems like an obvious solution, except that these kids can’t prevent themselves from overeating. Their medication is making them constantly hungry and unsatisfied with food portion levels that kept them full before going on their meds. And like adults who gain weight from the same medications, few, if any weight-loss interventions really grapple with the cause of the weight gain or come up with interventions that counteract the effect of the drugs on food intake.

Medications and other interventions like physical therapy have been developed to handle the side effects of chemotherapy and other medical treatments. Anti-nausea drugs, medications to control vertigo or mouth sores, and physical therapy to help overcome muscle and nerve weakness and pain are among only some of the ways drug side effects are being combated. But weight gain from drugs taken to help mental illness is the blind spot in the battle against drug side effects. The problem is ignored, rationalized as a small price to pay for the therapeutic benefits of the treatment. Or, the obese patient is handed off to a conventional weight-loss program with no experience in dealing with this specific cause of weight gain. If most of these programs have little or no permanent success treating obese individuals who gained weight the traditional way, how then can we expect any success among those whose meds are making them eat too much and too tired to exercise?

Prevention may be the only workable answer. When children are started on these medications, parents must be alerted to the increased appetite that will follow and advised to restrict or eliminate highly caloric foods in their homes, school lunches, and restaurants like fast-food chains. The child must also be encouraged to exercise constantly to prevent weight gain from becoming so excessive that it becomes difficult to do so.

And parents, teachers, school staff and relatives have to protect their child from becoming a target because of his or her weight gain. The child is already a victim of the side effects of the medications; more victimization is unthinkable.

I’ll Have a Glass of Grapefruit Juice With My Bacon Fat

How can it be? A dieting concept that is more than 80 years old and should have been laughed out of existence now suddenly may have some validity. The concept is grapefruit juice. My mother-in-law went on the grapefruit and lamp chop diet in the early 1930s (lamp chops were a lot cheaper then) to lose weight before her wedding. She told me about it years later, and wistfully recalled how quickly the weight came off.

Listening to her, my unspoken, but cynical take on this (she was my mother-in-law, so of course I did not say anything) was that restricting food intake to two or three items always causes weight loss. Boredom and even intestinal discomfort usually occur after a couple of weeks, if not sooner, and often the choice not to eat seems preferable to consuming, yet again, another grapefruit or well-done chop. Of course the weight came back, but that is true of most diets.

But the dieting world wasn’t done with grapefruit, even if my mother-in-law, after her wedding, was. It kept on popping up as a fat-burning food despite the lack of any credible research to support the claims. The Depression and WWII interfered with further promotion of grapefruit as a weight-loss stimulator. First, people didn’t have enough to eat and later, during the War years, rationing and limited food supplies must have made any dieting effort seem irrelevant and nonsensical.

But leaping ahead to the l970s, we find grapefruit emerging as the star food of the Hollywood Diet, or the Mayo diet, supposedly endorsed by the Mayo Clinic, which disdained to have anything to do with this fad. But here again, the diet was all smoke and mirrors. Of course the dieter would lose weight eating grapefruit at every meal. The dieter would have lost weight eating raw rhubarb at every meal. Only 800 calories a day were allowed on the diet, and like the Atkins program later on in the century, no carbohydrate was allowed. Only meat was okay to consume, although probably the cost of lamb chops was high enough so hamburger was substituted.

But the search went on for that elusive something in grapefruit that in some people seemed to promote more weight loss than expected from their daily calorie intake. It is known that grapefruit contains the chemicals naringin and hesperidin that have antioxidant activity. Could these be responsible for some unanticipated weight loss?

A study published in the journal Metabolism in 2012 by Dow, Going, Chow and others set out to answer conclusively whether grapefruit contained a potent weight reducer. The results were inconclusive. Overweight subjects who ate a half a grapefruit before each meal did not lose any more weight than control subjects who were not allowed to eat any grapefruit. Total cholesterol and the bad kind of cholesterol, LDL, decreased in the grapefruit group, as did their waist measurement but the differences were not statistically significant. However, the smaller waists of the subjects indicated that they might have lost belly fat, which is important in terms of cholesterol and blood pressure levels.

So is grapefruit moribund as a weight-loss activator? Apparently not. My mother-in-law may have lost weight not just because she became nauseated at the thought of eating another lamb chop and piece of citrus. Or to be precise, grapefruit juice now seems to be a potent inhibitor of weight gain if you are a mouse who loves to eat fat.

A few days ago, a group from University of California, Berkeley reported that mice that were fed a high-fat diet and drank pulp-free grapefruit juice gained 18 percent less fat than fat-eating mice that drank water. The grapefruit drinkers also had healthier glucose, insulin and triacylglycerol (a type of fat) levels in their blood. The study, conducted by Andreas Stahl and Joseph Napoli, was published in Plos One, a highly reputable online journal.

The mice were fed a diet that would have made Dr. Atkins weep with joy: it contained 60-percent fat and they ate it for 100 days. Mice in the fat-eating control groups were given water rather than grapefruit juice, and other groups were put on a healthier low-fat diet and given either the juice or water. And finally, the chemical naringin, which was assumed to be the reason people lost weight eating grapefruit, was given to two other mice groups also fed either high-fat or low-fat diets.

Against their expectations, the researchers found that the mice eating massive quantities of fat and drinking grapefruit juice gained substantially less weight than the water drinking, high-fat fed mice. Mice eating the more typical mouse-like, low-fat diet (mice normally do not feast on very fatty foods. They prefer grains, seeds and nuts) did not show much of a change in their weight regardless of what they were drinking. And naringin had no effect at all on decreasing weight gain.

These results perplexed the researchers, especially after they looked for typical explanations as decreased absorption of the food, increase in activity, and perhaps the fact that eating mostly high-fat food made the mice less hungry. None of these factors was responsible for the decrease in weight gain.

Obviously, human studies along with more animal studies must be done to find out how the juice from a particular citrus fruit could prevent weight gain on a diet that otherwise would provoke it. But this first report certainly raises intriguing possibilities.

Might a weekend of eating whipped cream-topped chocolate mousse and sausage, bacon and cheese omelets with butter drenched toast prevent the scale from imploding if you drink grapefruit juice along with your meals? Regardless of the answer, you can be sure that weeks from now there will be advertisements on the Internet promising magical grapefruit juice pills that will do just that.

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.