Funeral Potatoes Comfort, But At A Caloric Cost

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

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

Why?

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

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

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

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

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

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

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

Fortunately no.

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

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

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

Why Weight Loss Is Rarely Permanent

Many years ago at a meeting that addressed the usefulness of prescribing appetite suppressants for weight loss, one of the speakers (whose name will not be mentioned in case my memory is incorrect) said,

Obesity is a chronic disease.  Don’t think that allowing a patient to use weight-loss drugs will produce a permanent weight loss, or that other weight-loss intervention will also stop future weight gain. Obesity, like depression, alcoholism or autoimmune diseases, is chronic, and chronic diseases may go into remission because of medication and/or effective behavioral changes….So while sometimes one treatment is sufficient, the depression or skin rash never reappears after the initial intervention. The alcoholic stays abstinent.  Rarely is it that the diet plan or diet drug or surgery produces a permanent, positive change and weight stays normal. More commonly? The disorder reappears, more than once, and requires repeated behavioral, and/or medical interventions. Indeed, chronic treatment may be the only way to prevent flare-ups, a return of drinking, or depression.”

He went on to say that there is a bias toward people who gain weight again and again. We all know this…From the cruel remarks we make when someone is on a diet (Another one? Not again!) or gaining back the weight lost from the previous one (See, I knew she would never keep the weight off! ) to the hopeless attitude of physicians who give up helping a patient deal with constant diet failures (There’s no point wasting time talking about losing weight; he/she never listens.)

Weight-loss advice ranges from suggesting the most ridiculous or severe diets, to the simplistic mantra of portion control and exercise. Or else we keep quiet and shake our heads. “See,” we say to each other, “she has gained back all the weight she lost last year.“ And then we judge the currently popular diet with the comment, “Too bad this didn’t work, either.”

Yet so many of us have friends, colleagues, relatives, and acquaintances who have been abstinent and suddenly are found drinking again, perhaps after years of not doing so. When they are able to resume their AA meetings or come out of rehab, we don’t berate them with, “You failed. What is the point of helping when you will fail again? “ Rather, we support their effects to succeed.

If we treat obesity as a disease with a high probability of reoccurrence, as is the case with depression or alcoholism, then our entire approach to treatment can differ. All interventions will be presented honestly as a means of bringing the patient into remission, which may last weeks, months, or years. Still, the interventions will not be presented as a permanent cure. Taking out a diseased appendix is a permanent cure for a diseased appendix. Staying abstinent, if not a cure for alcoholism, is remission one day at a time.  Losing weight is not a permanent cure for obesity. Rather, it is remission from overeating and underexercising, one day at a time.

Treating obesity as a chronic disease allows a variety of interventions to be tried without blaming the patient if he or she fails to succeed at one or the other. Depressed patients are often switched from drug to drug, and the patient is not blamed when the depression doesn’t respond to a particular medication. Just as talk therapy is considered as important as drug treatment for depression and related mental illness, so too talk therapy should be part of the obesity treatment. Recognising what might erode control over eating is essential for success on a current diet, but also in delaying the onset of another weight gain flare-up. Semi-annual check-ups of weight status must be mandatory so the patient and care provider can identify emotional, situational, or even hormonal changes that might start the weight gain process. Such check-ups should remove the inevitability of weight gain in the minds of the patients.

For example, people who suffer from winter depression resign themselves to gaining weight over the dark months of late fall and winter, since weight gain is one of the symptoms of this particular type of depression. People also assume and anticipate gaining weight over the holidays. But why should this be? Would we assume that a friend, a recovering alcoholic, would start drinking over the winter, or that someone who is depressed every winter not be treated because the depression will come back the next year? If a patient had an intolerable flare-up of psoriasis, which can be maddeningly itchy, then every winter wouldn’t a dermatologist take steps to prevent it from occurring?

Because we don’t view obesity as a chronic disease, we simply do not treat it when we should. We don’t say to someone gaining weight, “You are experiencing a weight gain flare-up. It is important for you to be treated now before the situation becomes intolerable or hard to reverse.” A patient who has reoccurring depression should obviously be treated long before the symptoms become life-threatening. When the weight gain flare-ups occur, treatments also should be initiated. They include appetite suppressants, therapy, consultation with a physical therapist about exercise, use of calorie-controlled meals until control over eating is resumed, and participation in weight-loss support groups.

Of course, none of this will work if the weight-gaining patient refuses to acknowledge what is happening and/or resists treatment. Not all alcoholics who have failed to remain abstinent acknowledge what is happening or seek treatment; when they do, many are able to go back into remission. We must tell the obese individual to stop hoping for permanent weight loss. Keep the weight off today, and we will be there to help you if tomorrow is a problem.

Peak Physical Fitness as Protection Against Dementia

“Good news,” a friend in the gym said, waving her cell phone in my direction. She showed me a news release about a study on the positive effects of exercise in preventing dementia among women. The article published in Neurology (link is external) showed the somewhat startling relationship between being very fit and reducing by almost 90%, the chance of becoming demented.
An air of self-congratulation rippled through the treadmill walkers as the news passed from machine to machine, and there seemed to be a perceptible increase in the intensity of the exercise we were all doing.

Unfortunately, a closer reading of the study revealed that even those who went to the gym pretty regularly were not guaranteed a dementia-free future. Unless we were extremely physically fit we were still vulnerable to cognitive problems as we age.

The study was initiated in l968 when researchers tested the cardiovascular capacity of Swedish women ranging in age from 38 to 60.  The women exercised on an exercise bike that monitored their cardiovascular stamina, and they were told to exercise until exhaustion. One hundred and ninety-one women participated and, based on how well they did on this test, were divided into high, medium and low fitness levels. Some in the low fitness group were unable to complete the exercise because of cardiovascular problems. Forty placed in the high fitness group, ninety-two in the medium-fitness group and fifty-nine in the lowest group.  Those in the high fitness group were not competitive athletes, but their physical stamina and energy utilization measured during the initial testing period indicated their ability to endure strenuous exercise.

Women were tested six times over the subsequent 44 years of the study to determine if and when dementia appeared. The bad and good news is that 32% of the least fit developed dementia, as did 25% of the medium-fit. However, only 5% of the fittest group were affected.

Dementia is not the same as memory loss, although it can be associated with it. Dementia is not a specific disease, but instead describes a cluster of symptoms that affect intellectual functioning, emotional control, the ability to solve problems, maintain language skills, and carry out the functions of daily life. One example of the difference between memory loss and dementia is a person who cannot remember the name of a fork but can still use it to eat. This person has memory loss, but may not be demented. A person who doesn’t know the name of a fork nor its function would be considered to be suffering from dementia.

In the Swedish study, the most common cause of dementia was Alzheimer’s disease (eighty women), although twelve women developed vascular dementia. The latter is usually associated with strokes, some so small they are not even detected. The other causes of dementia were not described.

Before giving up one’s day job to spend more time in the gym to increase physical fitness, it is important to consider that the authors of the study were not sure how being especially fit protected the women from dementia. Nor did were they able to explain why the least fit women were so vulnerable. Moreover, the study did not record whether the women continued to be fit or not during the several decades that followed the initial assessment, and their physical fitness was never measured again.

This sort of study is frustrating on many levels. It is not a cause and effect study, i.e., exercise causes something that protects against dementia. Rather it shows the linkage of two conditions: peak fitness in middle age and significantly decreased incidence of dementia almost 50 years later.

So is it the exercise itself that may alter the brain to prevent cognitive decline? If so, how? Do women with outstanding stamina have different lifestyles? Do they also do crossword puzzles more often or speak several languages, activities that are supposed to improve brain function? The study was done in Sweden, but perhaps the high fitness subjects followed a Mediterranean diet eating mostly grains, fish, olive oil and vegetables. Such a diet has loosely been linked to lower rates of Alzheimer’s disease.

Was there a connection between the levels of their female hormones and their exercise activity? Maybe those who exercised so well didn’t suffer from menopausal hot flashes. Or maybe they did. Who knows?

Does their fitness at fifty result from a childhood and early adulthood spent in strenuous physical activity?  If so, might the positive change in their brain preventing dementia be a result of decades of peak exercise performance and perhaps, along with that, food intake designed to enhance this performance? Should we encourage our children and grandchildren to take on sustained high levels of physical activity, so by the time they are fifty, their brains may be protecting them against dementia?

This study probably took fifty or more years to carry out because of the time spent gathering and testing subjects before it began, and the time spent analyzing the data after it was over. Such studies are difficult to do, and certainly repeat, which is impossible to do in the lifetime of the original investigators. The results are tantalizing and sufficiently compelling to make some, perhaps with a family history of dementia, commit to more exercise, more frequently, and with greater intensity. And if it works to prevent Alzheimer’s disease and other causes of dementia, then regardless of why or how it will be worth doing.

References

“Midlife cardiovascular fitness and dementia,” Hörder, H., Johansson, L., Gu, X., et al, Neurology Mar 2018, 10:1212

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Low Carb v Low Fat: What if Neither Diet Works For You?

Are you on a Paleo diet, a South Beach diet, a feast and famine diet, or an all-the-chocolate you can eat diet (I made this one up)? There are so many diets from which to choose where all give evidence of success, with the participants claiming increased energy, decreased blood pressure, and no hunger. Sometimes specific foods, rather than the diet, are given credit for the weight loss: the dieter stops eating all white foods, gives up eating fruits with pits in them, drinks only milk that comes from nuts, stops eating all fried food, or eats only fried foods. Arguments about the virtue or uselessness of various diets cause unwinnable arguments, because one person’s weight loss is someone else’s failure.

Now the arguments can stop. Recently, newspaper and publications on health matters reported the results of a 12-month weight-loss trial that seemed to halt discussions of “my diet is better than yours.” Published in JAMA, the study presented the results of a year-long weight-loss study in which the 609 participating adults were assigned to a either a low-fat or a low- carbohydrate diet. (“Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion,” The DIETFITS Randomized Clinical Trial, Gardner, C. , Trepanowski, J., Del Gobbo, L., JAMA, 2018;319(7):667-679.) At the end of the study period,their weight loss was similar.

The foods on the low-fat and the low-carbohydrate diets were carefully regulated; only healthy fats like avocado and nuts, and healthy carbs such as whole grains, lentils and beans, were allowed. The operative word influencing food choice was healthy. Both groups were encouraged to eat large quantities of fresh vegetables and instructed as to how to prepare foods that were relatively unprocessed.

The amount of weight loss was moderate; both groups lost about 6 kg, or about 13 pounds, in 12 months. This amount of weight loss cannot compete with claims made in television advertisements or tabloid magazine articles for commercial diets. However, unlike the “quick weight-loss” promises of such programs, the diets in the research study produced the type of weight loss that can be sustained over long periods of time and maintained after weight-loss goals are attained. Indeed, the food choices in both diets were similar to those recommended for everyone in order to avoid heart disease and diabetes.

But will this news make an impact on diet programs? Will it stop self-appointed nutrition experts from claiming that their method of weight loss is optimal? Will it decrease the claims that a particular herb, hormone, mineral, spice or berry has the power to alter metabolism so that weight will be lost easily? Might it stop celebrities from self-righteous statements about their total avoidance of a particular food group, usually carbohydrates but sometimes most food , in order to attain a perfect body? Probably not, because the diet plans tested were sensible, not sensational, and unlikely to sell tabloid magazines, books or magazines promoting the latest way to lose weight.
But there are reasons why the results from this study should not close the discussion on the best way to lose weight. People who suffer from morbid obesity often need an intervention that produces more than a 13 pound weight loss per year. Surgery that reduces the size of the stomach may be the only effective solution with the type of diet subsequently followed designed to ensure that patients eat enough protein. Besides, the JAMA study diets that include bulky vegetables, whole grains and other high-fiber foods may not be suitable for stomachs that can hold only tablespoon quantities of food after surgery. Of course eventually, when the stomach can receive larger quantities of food, patients might be able to follow the JAMA diets.

Obesity associated with emotional overeating, especially binge eating that is often linked to anxiety, will not respond to any dietary intervention without sufficient psychological counseling. When and if the emotional component no longer causes excessive food intake, then either low-fat or low-carbohydrate food plans may work.

Weight gained as a side effect of psychotropic drug treatment may be hard to reverse with either of the diets described in the JAMA article. Anti-depressants and related drugs cause a persistent craving for carbohydrates along with the absence of satiety. Patients who rarely had weight issues prior to treatment struggle to overcome their medication-induced need to eat. So far the only dietary intervention that increases satiety and decrease carbohydrate cravings is one which allows a small snack of carbohydrate to be consumed prior to meals and sometimes between meals. The carbohydrate increases brain serotonin which in turn increases satiety and turns off craving. Since the subjects in the JAMA study were not on such medications, there is no way of knowing if either or both diets might have been effective.

The weight-loss program in the study educated the participants in healthy meal preparation. In an ideal world, dieters have time to do just this: shop for the right foods, prepare them and clean up after the meal. One hopes that the advice and training given the participants also included what to eat when staying late at work, dealing with sick children, car pools, long commutes, bad weather, travel, holidays and other often unavoidable situations that make it difficult to make the right food choices.

However, the study presents the hopeful possibility of stopping the arguments over which type of diet is best. Now future studies can focus on the best weight-loss intervention for those whose weight loss may not respond to conventional diets and on how best to help the dieter adhere to whatever program is recommended.

If I Don’t Pay Attention to What I am Eating, Will the Food Contain Calories?

“What do you usually eat on a typical day when you are not dieting?”

I often ask this question when meeting a weight-loss client for the first time. Although I write down the information, I know that it is rarely complete. It is very hard for any of us to recall everything we have eaten yesterday or a few days ago, especially food that is not consumed as part of a meal. Did we munch on the potato chips that came with the lunchtime sandwich? Did we pop a few nuts in our mouths when we saw the bowl on the coffee table? Did we taste the food we are making for dinner and perhaps do more than just taste? Did we or didn’t we have a glass of wine with dinner, or was it two?

As hard as it is to remember what we ate it is even harder to remember how much. Few of us visually measure the size of the entrée put in front of us in a restaurant, or notice the quantity of food we eat at home. Was the chicken 4 ounces or 6? Was the rice a half a cup or two cups? How big was that piece of blueberry pie? And sometimes our best intentions to eat only a small part of what is put in front of us get lost when our attention is directed elsewhere while we are eating. I remember seeing a couple aghast at the size of their meals when it was put down in front of them in a restaurant known for their supersized portions. But they consumed everything on their plates because their attention was diverted to an intense discussion they began as they started to eat. The faster they talked, the faster they ate, and I suspect they never noticed how much they were eating until their plates were empty.

Reading emails on one’s smartphone, watching a video on a laptop device, or texting with the non-fork containing hand also interferes knowing how much is being eaten. When attention is elsewhere, the act of eating becomes automatic. The fork moves from plate to mouth to plate again, and the eater may not notice how much is being eaten until the plate is empty. If an hour later the eater was asked what and how much was eaten, he or she might be able to give only vague details. Indeed, sometimes the eater denies that much was eaten at all. “I just tasted the food and left most of it,” he will claim when the reality is that there was nothing left on the plate when he finished the meal.
Unless we must keep track of our food intake for health and weight-loss reasons (for example, a diabetic keeping track of grams of carbohydrate), we usually give only perfunctory attention to what we are eating. But even if we forgot what we put in our mouths, our metabolism does not. A calorie we do not notice eating still counts as a calorie we have eaten.

This absent-minded eating can make it very hard to lose weight. The heavily advertised weight-loss programs that restrict all food intakes to packaged drinks, snacks, and meals delivered to your door make paying attention unnecessary because the meal choices are programmed to enable weight loss. But if you are on a weight-loss program that gives you choice of what, and to some extent, how much you are eating, then often the only way to keep track of what you are eating is “to keep track.” There are apps for this, along with the traditional paper and pen food diary. Some people are able to keep track of everything they eat (they also balance their checkbooks), sometimes for months, and they are usually successful in losing weight and keeping it off. But for the rest of humanity for whom even keeping track of today’s date is difficult, recording everything that is eaten becomes very tedious very fast.

People who have maintained an appropriate weight for many years often follow an unchanging menu for breakfast and lunch. They don’t have to pay attention to what they are eating because their meal choices never vary. They often have rules about what they will eat for dinner as well: limited alcohol intake, salads with dressing on the side, eating only half the restaurant portion or sharing an entrée, avoiding fried foods and dishes with thick sauces or melted cheese, or avoiding all carbohydrates or all fats.

Weight-loss programs that do not make it necessary to pay attention to what and how much is eaten because all the foods are pre-measured rarely offer effective advice on how to pay attention to what is being eaten after the diet is over. The concept doesn’t sell very well in television advertisements for people who just want to lose the weight, but it is critically important to do so.

Making rules that limit food choices may be the most effective method, but may turn eating into more of a chore than delight. One thing that helps is spending 20 seconds to look at what is on the plate before eating. In those 20 seconds you can decide what you will eat in its entirety, what you will avoid and what you will eat sparingly. Taking a picture with a cell phone so the calories can be figured out later is also useful. It also may give you an idea of whether you have eaten anything healthy that day. Mindless snacking is a caloric hazard. Dipping one’s hand into a bowl or bag of snacks like nuts, cookies, or chocolate almost always causes excess calories to be eaten without any memory of doing so.

Not paying attention to what you are eating has a price: you may not know but, alas, your clothes and scale will eventually know only too well.

Should Cauliflower Be the Main Course at a Vegetarian Wedding?

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

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

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

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

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

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

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

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

Night Eating Syndrome: Is It Just Sleep That Is Disturbed?

Waking up in the middle of the night is an annoying event that most of us experience. Usually we are able to fall asleep again quickly, perhaps after drinking some water and/or making a trip to the bathroom. But for some, waking up is a signal to go into the kitchen and eat: a bowl of cereal, a peanut butter sandwich, or a dish of ice cream. And unhappily, going back to bed after the night time snack does not ensure that the remainder of the night will be restful. Waking may occur once again, or even several times during the rest of the night, and is always accompanied by eating. The next morning, the night time eater has no appetite for breakfast and may not eat for hours.

When the pattern of awakening and eating occurs regularly, it is defined as a type of eating disorder called Night Eating Syndrome (“NES”) described first by Albert Stunkard in l955. Dr. Stunkard was a professor of psychiatry at the University of Pennsylvania when he first put forth the criteria for diagnosing this poorly understood behavior. Simply eating leftover pie or pizza at midnight is not sufficient to meet the diagnosis, because people with NES consume about 25% of their total daily calories after the evening meal. The food can be consumed in the evening before sleep and/or during nocturnal awakenings. Those with NES suffer from insomnia at least four or five times a week and believe that they will not be able to go back to sleep unless they eat. Finally, if they have mood disturbances like depression and anxiety, their moods will worsen as the evening progresses.

Interestingly, as Stunkard points out in a paper he wrote on the subject almost fifty years later, people who engage in frequent night time eating are not necessarily obese, although it is a risk factor for obesity. Because they are unlikely to eat during the early part of the day, (skipping breakfast and delaying lunch) their total daily intake may be appropriate. On the other hand, many who are seeking help for their obesity often fail to report nighttime eating episodes. Plus, they are rarely asked about it, so it is not known to what extent this type of eating contributes to weight gain.

The inability to sleep through the night, or to do so with only infrequent awakenings of short duration, is certainly associated with NES, but is it the cause? Many people have insomnia, but they do not eat their way through every period of nighttime wakefulness. If the food eaten helps put the eater back to sleep, this would explain their seeking food once they wake up. But it is hard to find studies that test whether the foods chosen in order to put the insomniac to sleep actually work. Moreover, in a study that examined sleep cycles of NES subjects and controls, no difference was found in the duration of sleep, although the former did awaken earlier in the night and more often.

Perhaps the syndrome is not caused by disordered sleep, but by something else. Current research suggests someone with NES is not eating to go back to sleep, but rather waking up because of hunger. The “hunger” hormone ghrelin, which normally is secreted during the day when we normally feel hungry, seems to peak late in the evening and into the night in NES sufferers. Thus they may be awakening because of ghrelin-potentiated hunger.

A solution has been to reset the pattern of ghrelin secretion back to normal by exposing the patient to light very early in the morning. Anyone who has traveled east across enough time zones to feel out of sync and out of sorts during the first couple of days, knows the feeling of being forced to sleep and eat on another time zone’s timetable. It is hard to be hungry for breakfast when it is only 3 am back home, and it is hard to find food when you wake up hungry at 2 am because it is now 7 pm back home. If you stay in the new time zone long enough, your eating and sleeping hormones adjust. This is what researchers hope to accomplish for the night eaters using bright lights to make ghrelin levels high during daylight rather than at night.

Melatonin is also being tried because some studies have found that this sleep hormone is not as high as it should be in the late evening, and perhaps this is why it is so easy for the night eaters to wake up. There is a time-released melatonin preparation containing the low recommended dose of melatonin (0.3 mg); whether it might prevent frequent awakenings has not yet been tested. Anxiety and depression are also linked with NES, but it is unclear if they are the cause or consequence of disrupted sleep.

It is not unusual to wake up at 3 am and be assaulted with the worries that were successfully repressed 12 hours earlier. If one were prone to depression and anxiety, would these mood disorders cause sleep disturbances leading to frequent awakenings or, if awake, prevent the individual from falling back asleep unless something is eaten? Stunkard recommended antidepressants that increase serotonin activity to decrease anxiety and depression and calm the individual back into sleep. But a remedy that would help the sleep, as well as hunger and mood disturbances, is more simple and natural: a cup of low-fat, mildly sweet breakfast cereal eaten upon nighttime awakening. The carbohydrate will increase serotonin thus inducing relaxation, satiety and a more tranquil mood.

If the cereal is in a cup by the bed, it can be eaten without leaving it (as long as there are no crumbs.)

References

“The night-eating syndrome; a pattern of food intake among certain obese patients,” Stunkard, A.J.; Grace, W.; Wolff, H.,The American Journal of Medicine. 1955: 19: 78–86

“Two forms of disordered eating in obesity: binge eating and night eating,” Stunkard, A. and Allison, K.. Int J Obes Relat Metab Disord 2003, 27: 1-12

“Circadian eating and sleeping patterns in the night eating syndrome,” O”Reardon, J., Ringel, B., Dinges, D., et al, Obes Res. 2004; 12:1789-96

If Your Valentine Sweetheart is on a Diet, Should You Gift Chocolates?

Valentine ‘s Day is a sweet (pun intended) holiday. It comes in the middle of the winter doldrums; Christmas is long past and spring is nowhere to be seen. But the problem is that it also comes about six weeks into the weight-loss program many started after New Year’s Day.

“Give something to show your love,” we are told in a doughnut shop advertisement featuring heart- shaped pink doughnuts covered with white icing and pink sprinkles. Shelves in gourmet chocolate stores are filled with pinky-red, heart-shaped boxes decorated with tiny flowers; the boxes contain melt-in-your-mouth creamy chocolate that should be guaranteed to melt the heart of the recipient.  Russell Stover chocolates that are filed with hidden flavors revealed only when bitten into are waiting to be bought and sent to the relatives who remember the candy with fondness. M&M’s sport pink chocolate shells, while heart-shaped sugar candies waiting to cause instant tooth decay call to the drug store shopper who came in only looking for shampoo.

Not to be left out, bakeries feature several-layered heart-shaped cakes to be consumed with a glass or two of champagne.

To be sure, commercial romance for Valentine’s Day is not limited to food. Flowers are a welcome brightness in the gloom of early February and jewelry, especially diamond engagement rings, do not contain calories. Gifts of self-indulgence that the recipient may not get for her or himself, such as a massage, spa treatments, pedicures, and/or manicures, are also calorie-free and thoughtful.

However, sweet foods, especially chocolate, seem to be the most persistent symbol of romantic thoughts or intentions. Perhaps because for centuries chocolate has been considered an aphrodisiac. There is no scientific evidence for this, and even if it were true, there would be no reason to assume that chocolate consumed on Valentine’s Day has a greater impact on sexual arousal than if it were consumed on any other day. Perhaps if chocolate is wrapped in a heart-shaped box, it has more of an impact; nonetheless, this certainly has not been tested.

Giving a gift of chocolate also has its perils. What if the message it conveys has less to do with romantic intentions and more to do with the body image of the recipient? Give a pound of chocolate to someone skinny and it may convey the thought, “You need to gain some weight.”  Present that heart-shaped box to a chubby recipient and it can unintentionally convey the thought that, “You are fat already, so what difference does another pound of chocolate make?” instead of, “I like you the way you are.” Can you give chocolate to someone in the older generation who may be overweight, developing diabetes, or dealing with orthopedic problems because of excess weight?

Then there is the dieter. The continuing popularity of low or zero carbohydrate diets puts chocolate on the forbidden food list. The butterfat would be fine, and the more expensive the chocolate, the more butterfat it contains. But the sugar content that makes chocolate edible (otherwise it would taste like bitter cooking chocolate) would ruin the diet of anyone who is following a ketogenic diet in which fat, not carbohydrate, is used by the brain and body for energy.

But for those who are counting calories or the equivalent in food exchanges, there is good news. Small amounts of chocolate have fewer calories than they seem to have, given their luxurious taste and mouthfeel. A quick scan of Godiva, a popular gourmet brand of chocolate, reveals a lower calorie count for their chocolate than one would assume. Admittedly the actual pieces of chocolate are not large, maybe one or two bites. Still, you can eat four dark chocolate truffles for about 180 calories, and three pieces of assorted Belgian chocolates for 190 calories. A Lindt chocolate ball has 75 calories. To put this in perspective, a glass of champagne has 95 calories, an eight-ounce serving of fat-free yogurt around 80-90 calories, and 10 almonds, 70 calories. So certainly presenting your Valentine gift of chocolate to a dieter should not be a problem; one or two pieces of chocolate will not retard weight loss or cause the diet to fail.

But of course that is the problem. You can’t buy prepackaged chocolates wrapped in the colors of Valentine’s Day in amounts smaller than twenty or so pieces. Thus the recipient has to confront the problem of how to manage the consumption of the rest of the chocolate after February 14.  A highly disciplined dieter will be able to restrict consumption of a luscious piece of chocolate to one or possibly two a day. But this kind of restriction is not easy to accomplish, especially in the middle of the diet. And the romantic associations with the chocolate will be quickly dissipated when the dieter finds a “gift” of pounds after devouring the rest of the package.

One solution is to buy only one or two pieces of gourmet chocolate from the store; the chocolate can be boxed in the same fancy wrapping as would be used for a larger amount. But in this time of online rather than in person shopping, locating such shops and having the time to go to one seems much too inconvenient. Moreover, the dieter may misinterpret intentions behind the gift thinking that the giver:

1) Is cheap;

2) Thinks I am fat;

3) Thinks I will gobble everything in a bigger box; and therefore

4) Wants me to stay fat.

Maybe people should stick to flowers or diamonds.

 

 

 

Will the Bacteria in Sauerkraut Make You Thin?

Most of us pay less attention to the many colonies of bacteria living in our intestinal tract than we do to the possibility that there may be colonies living on Mars. Recent research suggests it is time to do so. Our gut contains densely packed colonies of bacteria that affect not only digestion and diseases of the intestinal tract, but also our immune system and, according to some research, perhaps hunger, weight, mood, and athletic performance as well.

According to an article by Drs. Zhang and Yang, our intestinal tract contains more than 1000 or more bacterial species. These varieties of bacteria, of which we are usually unaware unless we have “tummy troubles,” function to assist in digestion,  particularly of high fiber fruits and vegetables. They break down the chemical composition of fiber, thus transforming the indigestible carbohydrate to substances, as well as short chain fatty acids, which are used for energy. Our bacteria are also gatekeepers, helping the intestinal immune system deal with foreign antigens or proteins when they enter our body. Intestinal bacteria contain enzymes that make vitamin K, a critical component in the formation of blood clots. Intestinal bacteria also synthesize other vitamins: biotin, vitamin B12, folic acid, and thiamine.

That the bacterial flora can change is well known to anyone who has taken antibiotics for several days, and then confronted with less than optimal intestinal functioning. The antibiotic wipes out so-called healthy bacteria, and sometimes it takes several days or longer to restore normal functioning.

Zhang and Yang’s report asserts that diet also causes significant changes in gut bacteria. Consumption of a high-fat, high-sugar diet causes unhealthy bacteria to flourish. Conversely, diets low in those nutrients, but high in fiber, bring back a better class of bacteria. For somewhat obvious reasons, most of these studies are done on laboratory animals, since they require samples of intestinal bacteria found in the feces, and it is hard to find human volunteers for these studies.

Is it possible that our bacteria can affect our mood? Some scientists suggest that we can reduce anxiety and depression if we have the good kind of bacteria. This is based on evidence that intestinal bacteria make neurotransmitters, the chemicals that transmit messages in the brain. But it seems unlikely that our gut will control our mood since neurotransmitters made in the gut never get into the brain. (But interestingly, we do talk about our gut having feelings, i.e., our language is full of expressions that suggest our gut has moods: a feeling in my gut, gut response, gut reaction, etc…)

Intestinal microbes may affect the amount of ghrelin, a hormone that tells the brain whether we are hungry. But if so, no one has figured out what species of intestinal bacteria may do this—or whether they will make us feel so full we will eat less. Now athletes are allowing their intestinal bacteria to be analyzed to see if they differ from those of sedentary folk. According to an article in a recent issue of Outside magazine, some super-fit athletes do have varieties of bacteria not found in non-athletes. However, since they tend to follow extremely healthy, low-fat diets, is it their diets or their incredible athletic feats that change the bacteria? (Or, do the bacteria contribute to their athletic success?)

Much more research has to be carried out to show that intestinal bacteria are having a direct effect on hunger, athletic performance, or obesity before we can start manipulating our bacterial colonies to bring about certain desirable health effects.  To be sure, there are some studies now gaining interest, that have tested the effects of fecal transplants in which bacteria from healthy volunteers may be transplanted to the intestines of those suffering from an intestinal disease like irritable bowel syndrome. These studies are showing promise in helping people whose intestinal disorders do not respond to conventional therapies.

In the meantime, while we are waiting for more science to support some of the claims that our gut bacteria can alter our heath for better or for worse, we are told to load our intestinal tract with good bacteria. Supposedly, these good bacteria can be eaten if we consume fermented foods such as sauerkraut (fermented cabbage), miso and tempeh (fermented soybeans), kimchi (a Korean dish of fermented cabbage with hot spices), kombucha tea (a fermented drink made with tea, sugar, bacteria, and yeast). and kefir (a fermented yogurt drink). These foods contain probioticsor living bacteria, that when ingested populate our intestinal tract with good microbes. Pasteurization will kill the microbes, both good and bad, which is why many yogurts and canned sauerkraut are not on the list.

But there is a problem. Although scientists can identify many of the species of good intestinal bacteria, they are not listed on a package of tempeh or a bottle of kombucha. Moreover, how many bacteria are we actually eating? Probiotics may differ in their content of something called CFUs, or colony-forming units. CFUs describe the density of viable bacteria in a product. According to Dr. Shekhar K. Challa, a gastroenterologist who wrote Probiotics For Dummies, quantitating the CFUs of probiotics in most food products is almost impossible. CFUs are not listed under calories or any other place on the food label.

So will eating unpasteurized sauerkraut make enough good bacteria to make you thin (that is, if good bacteria will make you thin)? Probably not. But sauerkraut contains almost no calories, and chopping a cabbage, mixing it with salt and watching it turn into sauerkraut is something to do on a snowy afternoon. And after you eat it, its bacteria will have a happy home in you.

References

(“Effects of a high fat diet on intestinal microbiota and gastrointestinal diseases,” World Journal of Gastroenterology 2016, Oct 28; 22(40): 8905–8909) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5083795/