Would Walkable Sidewalks Keep Us Thinner?

A few weeks ago on a trip to a picture perfect Vermont town, we asked the proprietor of our B&B if we could walk to the concert that night.

“You can, sure… it is less than a mile, but it will be dangerous walking home in the dark. There are no sidewalks and no street lights,” she told us.  So we drove, despite feeling silly at using the car for such a short distance, but happy we had done so when we left the concert. Ground fog was adding to the darkness in concealing the road, and we were sure we would not have felt safe walking back up the hilly, winding route.

The next day, we chatted about the lack of sidewalks and street lights with our hostess. She told us that daytime walking on the roads was manageable in the non-snow months, but not in the winter; the snow banks reduced the width of the roads and eliminated any possibility of stepping off the pavement.  “See, there’s is no side of the road to stand on when a pick-up truck comes speeding down the mountain….no one walks; it’s just too easy to be hit.”

There is no lack of activities in Vermont to provide opportunities to exercise, even if taking long walks in the winter is not one of them (Unless it is on a packed snow trail.) But unlike the quick convenience of going out the door to take a walk when sidewalks (plowed, of course) do exist, the lack of sidewalks in suburban or rural areas makes this simple activity difficult to carry out.

For the exercise committed, there are, of course, numerous opportunities to engage in physical exercise regardless of weather or environment. Not so for those who prefer being sedentary and are unlikely to seek out opportunities to move. In an episode of a television program focused on finding a house to buy, the client announced that she was too old (she was in her fifties) to buy a house with stairs. “Too much walking, “she told her realtor. Not surprisingly, the community in which she was house hunting had no sidewalks. If this woman had been advised to walk for her health and weight, she would have had a ready excuse. “Where? There is no place to walk where I live!”

No one has to be told about the rising incidence of obesity. Simply looking around confirms its prevalence, although the effects such as diabetes, back & leg pain, as well as the increased risk of certain types of cancer are silent.  One obvious culprit is that we eat too much, in part because portion sizes of just about everything have increased. Another fault lay in that we no longer live a lifestyle readily allowing us to burn off those excess calories. When physical activity was unavoidable in order to earn a living and maintain a household, a large caloric intake provided the fuel for the constant physical activity.  Now caloric intake has remained the same, or most likely increased, while physical activity has become optional for the most of us most of the time.

Because they eliminate a source of calorie use, might the absence of walkable sidewalks be a contributing factor to the continuous rise in obesity? The Journal of the American Medical Association (“JAMA”) published a study in 2016 showing that residents living in walkable urban neighborhoods had a slower increase in obesity and diabetes than those living in less walkable ones.  For this specific research, almost 9,000 urban neighborhoods in southern Ontario were studied over more than 11 years.  This study’s “Walkability Index” was based on safety of the sidewalks, the residential and commercial density, cross walks at intersections, schools, coffee shops, banks, and other retail establishments which might be walkable destinations.  People living in the walkable neighborhoods, and New York City is another example; they use sidewalks not only to get to their routine destinations like work, stores and restaurants but as places for urban hikes. These city dwellers may spend an entire day outside, hiking and exploring different parts of their city. The seemingly limitless places to walk allow them to do so.

However, it’s important to note the benefits of walking by city dwellers are not available to residents of towns such as the one we visited in rural Vermont. The population density is too low to justify the expense of sidewalks, and indeed many of roads are not even paved. Of course there are numerous places to hike, but this activity is not only seasonally limited, but also limited to people whose stamina and age enable them to climb mountain trails.

Perhaps the answer is to emulate many European cities which have set aside parkland filled with paved paths for walking. From my limited experience of these parks which I have seen in Holland, France and Germany, they are usually filled with walkers early in the day and then especially in the summer, after dinner. Benches are numerous for those who need to rest or just admire a view.  Strolling through one of these walking parks has the additional advantage of allowing members of a community to see and talk with each other. People often walk in small groups, or stop and greet others coming in the opposite direction. When so many members of a neighborhood are out walking?  It is easy to see this activity as a routine and healthful aspect of the day.

Eating less to prevent weight gain and/or lose weight is difficult because potential temptation lurks in the next meal. Walking may not compensate entirely for excess calories, but it can have a positive effect on preventing weight gain… unless of course, one walks to the doughnut shop.

Cite: Association of Neighborhood Walkability With Change in Overweight, Obesity, and Diabetes. Creatore M, Glazier R, Moineddin R.  JAMA  2016, 315; 2211-2220

The Covert Bullying of Obese Adults

When I congratulated a friend on her promotion to the head of a non-profit organization, she smiled and then told me it almost did not happen. “I learned that someone on the board did not want me to get the position and campaigned actively against me,” she told me.

“Why?” I asked. “You were obviously the front-runner.”

“Because I am fat,” she replied. “He told everyone on the board that he would not hire anyone who was fat. At least he is not criticizing my competence, only my size.”

But she was wrong.

The board member was likely not rejecting her solely because he believed her size or shape might affect her stamina in wearing the hats of an administrator, fundraiser, and creative director of a mid-size organization. He may have believed that her obesity reflected a deficit in her overall ability. A review of many studies of employer attitudes toward obese workers presented evidence that obese people are thought to have less leadership potential than normal-weight individuals. The obese are viewed as lazy, undisciplined, slow, unmotivated, and incapable of advancing to positions of responsibility. Thus my friend, whose resume indicated an unusually strong record of leadership and creativity in a previous position, could have been judged as inferior on these traits simply because she was fat.

Had she been male and obese, her size may not have been considered a detriment unless the job required physical skills that were difficult to perform because of weight. But an obese woman whose job requires some visibility—while fundraising, representing the organization at meetings, or giving presentations—might be passed over because of her appearance.

Had she failed to win the position, a claim that she was being discriminated against would have had no legal impact in the state in which she worked. The state of Michigan and some cities, including San Francisco and the District of Columbia, have outlawed employment discrimination against the obese.

Proving that a job is not offered or advancement not received because of size discrimination is very difficult. The board member did not publicly announce the reason for his opposition to anyone, but secretly told other members of the search committee. Happily, there were leaks, and eventually everyone in the organization knew and so did she. But even though he wished to deprive her of the position because of her weight, there was little she could do about it. What real proof did she have?

Obese employees face the same type of discrimination that smokers do, although 29 states prohibit the non-hiring of smokers. However, one justification of the employment discrimination against smokers is based on health risks to the smoker and thus increased medical costs to the employer. Other reasons include leaving the work site to smoke in a designated area, although this is a weaker argument since breaks for everyone are often built into the workday.

Many assume that the smoker, or indeed the obese individual, could quit or lose weight if he or she wanted to. Thus discrimination against these groups is sometimes justified by the belief that it’s their fault.

An article in the New England Journal of Medicine refutes the argument that smokers irresponsibly raise healthcare costs because they don’t want to stop smoking. What is rarely understood, except by ex-smokers, is how hard it is to break the addiction to nicotine. Surveys have shown that 69 percent of smokers want to quit but are unable to do so.

Losing weight and maintaining weight loss is similarly difficult, and the same uninformed attitudes persist. “Just stop eating so much and start exercising!“ (As if they hadn’t tried to do so.) The reasons for gaining weight are so varied and often so psychologically complex that simplistic solutions make about as much sense as trying to prevent the oceans from rising by stacking sandbags on a beach. I have a neighbor who gained a substantial amount of weight while she was on large doses of prednisone to reduce inflammation, and a distant relative who gained 125 pounds on a combination of antidepressants and mood stabilizers. Would they be unemployable?

The laws protecting the obese from workplace discrimination are insufficient or nonexistent. Children bullied on the playground may have more protection, because sometimes there is a teacher who can intervene. No one is watching or reprimanding the adult bully who refuses to hire or promote someone who is overweight.

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

At a recent university-sponsored conference on innovations in nutritional and fitness products, there was a discussion about the increasing number of fraudulent claims associated with such products in the market. When one speaker, a principal in a firm investing in start-ups specializing in fitness and nutrition, was asked how to detect ineffective or fraudulent products, he was unable to give a useful answer.

“It’s very difficult because often the claims are made up or supported by faulty research published in company-owned or for-profit journals. If it works, it is probably not a fraud,” he concluded. Someone from the audience responded with, “Yes, but placebos work also.”

The Food and Drug Administration (FDA) can barely keep up with the proliferation of fraudulent health products. Some make claims that cannot possibly be produced by the ingredients; others contain substances which are not allowed to be sold due to serious side effects, or must be prescribed only by a physician. Often states, as well as the FDA, step in to expose the deceptive nature of claims made by supplement manufacturers. In a well-publicized case a few years ago the New York State Attorney General’s office tested the contents of several popular herbal supplements and found either none of the advertised active ingredients in the product or levels too low to be effective. This past winter, the New York State Attorney General and the Federal Trade Commission (FTC) charged a company that claimed its product was shown in clinical trials to improve memory and cognition with making, “…False and unsubstantiated claims…” because the study cited by the company actually showed the product not working any better than a placebo. Yet the advertisements, seen frequently on television, were so compelling that the sales topped $165 million.

The most common claims seen on the labels of such dubious products are for weight loss, sexual performance (erectile dysfunction), memory loss, and mood.  Some claims are almost magical in the sweep of their promises: A New York firm claimed its dietary supplement treated senile dementia, brain atrophy, atherosclerosis, kidney dysfunction, gangrene, depression and osteoarthritis along with lung, cervical and prostate cancer. Alas, for anyone now wanting to buy a product that will cure all that is wrong with you, it is no longer available. U.S Marshals seized it after a request by the FDA in 2012.

Personal testimonials are often so compelling that they sell a product. Who hasn’t looked at the before and after pictures of someone who used a weight-loss product and marveled at the change? Statements like, “I am no longer hungry, depressed, diabetic, or bald!“ beckon to us from the internet, tabloid magazines, newspaper advertisements and television spots. These people must be real, one thinks…and if he grows hair, maybe I will also.

Health products claiming a quick fix such as, “Cover your bald spot by next Tuesday,” or, “Lose your double chin by this afternoon!” are also hard to resist, but should be regarded with as much suspicion as someone trying to sell you a bridge. Glue is a quick fix; health products rarely are. The FDA tells us to beware of health products attempting to gain a marketing edge by claiming that they are all natural. By the way, snake venom is also natural.

One easy way to detect whether a claim is legitimate or not is whether the term, “Miracle” is used on the label. Look at it this way, if the words “miracle cure” are attached to the ad, consider it a miracle that anyone is foolish enough to buy the product.

But of course there are many over-the-counter (non-prescription) supplements that work, are safe, contain the dose of active ingredients printed on the label, and don’t hide drugs deemed illegal by the FDA. If a combination of vitamin D and calcium promises bone health in the amounts recommended by physicians, such a supplement will help to restore bone cell growth and decrease bone fragility. Supplemental vitamins, minerals and protein will help restore depleted levels of these nutrients due to prolonged illness, chemotherapy, or gastrointestinal impairment. Again, it is imperative to check with a healthcare giver about quantities; more is not always better.

But what if you are not sure whether the claims are to be believed. What should you do?

Ask your health care provider. Take a picture of the ingredient label on a product you are thinking of buying, and ask whether any of the ingredients actually do what they are supposed to. Use the internet to look up the ingredients to see what studies support the claims of the product. Write to the FDA.

Example: A product relieving anxiety and stress claims that the ingredients, “…promote serotonin synthesis.” But the main ingredients are chamomile and valerian, herbal products that may cause drowsiness; these do not promote serotonin. A physician will know that the product is incapable of increasing serotonin synthesis.

Here’s another: A product containing saffron extract as its main ingredient claims, ”…Reduces cravings, boosts metabolism, blocks appetite, lowers blood pressure and increases energy.” Investigating whether there are any studies linking saffron extract to all these wondrous health effects may seem like a nuisance, but will save money and possibly, ill side effects.

Signing up for the FDA Consumer Updates page is essential for anyone routinely buying supplements because of their weekly descriptions of products containing hidden drugs, fillers, or bits and pieces of insects or twigs. Recently, the agency has warned consumers about more than 100 products containing illegal drugs; most of these products are sold for sexual enhancement, weight loss and bodybuilding.

Avoiding supplements that may not work, may not contain the ingredients listed, or contain ingredients that are harmful cannot be ensured. But a little homework and help from the FDA make the odds better that what you buy is safe and effective.

Meals in a Box: The Answer to Eating Your Vegetables?

More than a dozen companies will, for a price, send you the ingredients for a complete, relatively interesting dinner, or smoothie snacks even, if you choose that option. All you have to do is open the many large and small packages, read the instructions and in 30 minutes or so, eat your own freshly prepared entrée. The concept is practical for the many who do not have the time or energy after work to figure out what to prepare for dinner and then to make sure the ingredients are in the kitchen. Meal-in-the-box choices tend to be more imaginative than grilled chicken breast and frozen veggies because professional chefs devise the menus and make available the entire ingredient list from the main course protein to a tiniest pinch of some herb or spice that the customer probably never heard of and/or doesn’t have. No looking up recipes in a cookbook or on the Internet is needed, nor guess work about the cooking methods.  Detailed instructions are given, perishable foods are kept cold with icepacks, and preparation time is thirty minutes. The end product may not get you, the customer, a spot on the Food Network program “Chopped” in which professional chefs are given ingredients in a box and compete to make an original perfectly cooked entrée and sides in thirty minutes…But unlike the competitors who turn their food over to the judges? The customers of meals in a box get to eat their finished product.

However, making the meals from the ingredients in the box will cost about twice as much as making it from ingredients assembled yourself. According to Consumer Reports, one company’s blackened tilapia dish costs almost $12.00 per person, compared to a little more than $5.00 when put together oneself. A tofu and Chinese broccoli dish from another company costs over $11.00. These ingredients are very inexpensive and will cost approximately $3.50 if you buy the ingredients from the supermarket, and even less from a Chinese grocery store.  The prices for some of these dishes are less than in a restaurant (although perhaps not for the Chinese entrée) but add up quickly as the cost is per person. Moreover, unless the customers are small eaters, no leftovers for the next day’s lunch will remain. But it is also unlikely that there will be much wasted, thrown away, uneaten food. Nor will the refrigerator fill up with plastic containers full of tidbits from previous meals.

It is no surprise, given our current fixation of dietary restrictions that gluten-free, carbohydrate-free dairy-free, vegetarian, vegan, organic (of course) calorie-restricted meals are available depending on which company is providing the foods.

But are they healthy? Will eating a meal from a box provide you with some of the vegetable, fruit, grain, protein, and dairy servings you ought to be getting? It depends. Certainly compared to many takeout and restaurant meals that tend to be free of food groups containing nutrients your body needs, the boxed to-be-prepared meals often contain substantial amounts of vegetables, and sometimes whole grains. If you tend to ignore the vegetables in your refrigerator bin until they turn into a slimy green mass, then ordering meals with a substantial amount of vegetables will ensure that you are eating this essential food group.

Yet there is a possible nutritional caveat to some of the meals. The salt content may be higher than recommended, especially if some of the seasonings contain sodium, like garlic or onion powder, or if salt if added several times during preparation. Consumer Reports analyzed sodium content and found many dishes containing 30% more than recommended, and some dishes containing as much as 1 gram of salt per serving.

Are boxed meal ingredients a trend, or the beginning of a permanent shift in the way people prepare meals? Probably the latter because they appeal not only to those who don’t (and won’t) prepare meals from scratch, but also to a generation who have been preparing meals from scratch for decades. For those who have been afraid to boil water, learning how to cook from the boxes might eventually give them confidence to cook on their own. It is sort of comparable to shifting from paint-by-numbers to covering a blank canvas with one’s own creation. For those who are tired of figuring out what to cook for dinner and despair at the high prices and noise levels of most restaurants, boxed meals are an easy way of eating interesting food less expensively (and in a setting that doesn’t require either waiting or tipping.)

Many companies are selling meals for people on all sorts of diets and presumably are competing with portion-controlled, factory-prepared meals sold by some national weight-loss companies.  Since the meals in a box are portion and ingredient controlled, the dieter does not have to be concerned about going over a calorie limit. There is no guessing about whether the weight of the entrée or the teaspoons of olive oil will fit the calorie requirements for a particular meal. On the other hand, by requiring the dieter to get involved in food preparation, she may lose her fear of not being able to prepare a meal on her own that allows her to continue to lose weight and/or keep it off.

This trend is still relatively new, but its rapid growth indicates that it meets the lifestyles demands of large numbers of people. However, since spending a little time in meal preparation is still necessary, we should not be surprised if, a few years from now, some of the boxes will contain a robot that will do the cooking.

According to a 2016 Consumer Reports analyses, home delivery of meal ingredients is about a $400 million dollars a year industry. Although the major portion of the sales are focused along the coasts and in major urban areas, sales are projected to increase throughout the country. They may not be replacing all home delivered pizza and Chinese food, but certainly offer healthier and more varied options.

How Do You Know Whether Supplement Claims are Hype or True?

At a recent university-sponsored conference on innovations in nutritional and fitness products, there was a discussion about the increasing number of fraudulent claims associated with such products in the market. When one speaker, a principal in a firm investing in start-ups specializing in fitness and nutrition, was asked how to detect ineffective or fraudulent products, he was unable to give a useful answer.

“It’s very difficult because often the claims are made up or supported by faulty research published in company-owned or for-profit journals. If it works, it is probably not a fraud,” he concluded. Someone from the audience responded with, “Yes, but placebos work also.”

The Food and Drug Administration (“FDA”) can barely keep up with the proliferation of fraudulent health products. Some make claims that cannot possibly be produced by the ingredients; others contain substances which are not allowed to be sold due to serious side effects, or must be prescribed only by a physician. Oftentimes states, as well as the FDA, step in to expose the deceptive nature of claims made by supplement manufacturers. In a well-publicized case a few years ago the New York State Attorney General’s office tested the contents of several popular herbal supplements and found either none of the advertised active ingredients in the product or levels too low to be effective. This past winter, the New York State Attorney General and the Federal Trade Commission (“FTC”) charged a company that claimed its product was shown in clinical trials to improve memory and cognition with making, “false and unsubstantiated claims” because the study cited by the company actually showed the product not working any better than a placebo. Yet the advertisements, seen frequently on television, were so compelling that the sales topped $165 million.

The most common claims seen on the labels of such dubious products are for weight loss, sexual performance (erectile dysfunction), memory loss, and mood.  Some claims are almost magical in the sweep of their promises: A New York firm claimed its dietary supplement treated senile dementia, brain atrophy, atherosclerosis, kidney dysfunction, gangrene, depression and osteoarthritis along with lung, cervical and prostate cancer. Alas, for anyone now wanting to buy a product that will cure all that is wrong with you, it is no longer available. U.S Marshalls seized it after a request by the FDA in 2012.

Personal testimonials are often so compelling that they sell a product. Who hasn’t looked at the before and after pictures of someone who used a weight-loss product and marveled at the change? Statements like, “I am no longer hungry, depressed, diabetic, or bald!“ beckon to us from the Internet, tabloid magazines, newspaper advertisements and television spots. These people must be real, one thinks…and if he grows hair, maybe I will also.

Health products claiming a quick fix such as, “Cover your bald spot by next Tuesday!” or, “Lose your double chin by this afternoon!” are also hard to resist, but should be regarded with as much suspicion as someone trying to sell you a bridge. Glue is a quick fix; health products rarely are. The FDA tells us to beware of health products attempting to gain a marketing edge by claiming that they are all natural. By the way, snake venom is also natural.

One easy way to detect whether a claim is legitimate or not is whether the term, “Miracle” is used on the label. Look at it this way, if the words “miracle cure” are attached to the ad, consider it a miracle that anyone is foolish enough to buy the product.

But of course there are many over-the-counter (non-prescription) supplements that work, are safe, contain the dose of active ingredients printed on the label, and don’t hide drugs deemed illegal by the FDA. If a combination of vitamin D and calcium promises bone health in the amounts recommended by physicians, such a supplement will help to restore bone cell growth and decrease bone fragility.  Supplemental vitamins, minerals and protein will help restore depleted levels of these nutrients due to prolonged illness, chemotherapy, or gastrointestinal impairment. Again, it is imperative to check with a healthcare giver about quantities; more is not always better.

But what if you are not sure whether the claims are to be believed. What should you do?

Ask your health care provider. Take a picture of the ingredient label on a product you are thinking of buying, and ask whether any of the ingredients actually do what they are supposed to. Use the Internet to look up the ingredients to see what studies support the claims of the product. Write to the FDA.

Example:  A product relieving anxiety and stress claims that the ingredients, “…promote serotonin synthesis.” But the main ingredients are chamomile and valerian, herbal products that may cause drowsiness; these do not promote serotonin. A physician will know that the product is incapable of increasing serotonin synthesis.

Here’s another: A product containing saffron extract as its main ingredient claims, ”…Reduces cravings, boosts metabolism, blocks appetite, lowers blood pressure and increases energy.”  Investigating whether there are any studies linking saffron extract to all these wondrous health effects may seem like a nuisance, but will save money and possibly, ill side effects.

Signing up for the FDA Consumer Updates page is essential for anyone routinely buying supplements because of their weekly descriptions of products containing hidden drugs, fillers, or bits and pieces of insects or twigs. Recently, the agency has warned consumers about more than 100 products containing illegal drugs; most of these products are sold for sexual enhancement, weight loss and bodybuilding.

Avoiding supplements that may not work, may not contain the ingredients listed, or contain ingredients that are harmful cannot be ensured. But a little homework and help from the FDA make the odds better that what you buy is safe and effective.

Social Loneliness May Make the Depressed Even More So

Loneliness is a state that may affect everyone at some point in his or her life. It is not necessary to go on a trek across the continent, or row alone across the Atlantic to feel lonely. Sitting by oneself in a crowded movie theater or restaurant, or walking on your own on a lovely spring afternoon in a park filled with couples, families and friends can feel just as isolating.

Sometimes social isolation is a matter of choice or temporary circumstance. A relative of mine, who had to rewrite a 500-page thesis in order to turn it into a book, willingly isolated herself for months in order to accomplish this task. A parent unable to leave the house because of weather and sick children may not speak to anyone over the age of six for a few days, but knows that eventually this will change. A computer coder may shun company for days in order to finish a time dependent task; so too may anyone involved in a creative act.

Others are alone too much, but not by choice or a temporary situation. It is a fact of their lives. The groups one thinks about first are the elderly, and those we call “shut-ins.” They weren’t always so alone but sickness, frailty, lack of easy transportation, death of spouses, friends, and even adult children…potentially their declining eye sight and hearing, limited financial resources, and fear of crime may result in an extremely limited interaction with the social world.

“My friends are all dead,” my husband’s uncle used to tell us as he reached the late nineties. “All the guys I would play cards with and have a meal with, they are all gone.”

Residence in an assisted-living facility may surround an elderly individual with people, but social interactions and friendships do not necessarily follow. A sad scene familiar to those of us who have visited relatives in facilities is a row of residents, lined up in wheelchairs, who are not talking to each other, and indeed seem to be totally isolated despite the other people around.

But one does not have to live into old age to feel this social loneliness. People of all ages who are suffering from mental illness can experience it at any age. In a recent report put out by an Australian mental health support organization, about 66% of people with mental illness report feeling socially isolated compared with about 10% of the general population. The reasons for this vary from lack of money and/or transportation, misunderstanding among others as to the nature of the illness, and even fear of others prevent forming a close relationship. Those with mental illness often claim that they are stigmatized, or at the very least, treated differently.

“Maybe people believe we are going to behave in unpredictable, embarrassing, or violent ways,” said a friend who has suffered from bipolar disease for years. “There is reluctance for a casual interaction to go much further.”nability to become involved in activities that may decrease loneliness is sometimes generated by mental illness itself. Social phobia, fears about public spaces (although these days, this may just be commonsense), inability to leave the house, hold a job or even communicate without difficulty; all reduce the possibility of interacting with others. A weight-loss client of mine was very specific about the days she could come to my office, as they were dependent on her cycles of mania and depression. Another client who was depressed would stay up very late at night and sleep most of the day, thereby avoiding the necessity to interact with anyone.

Regardless of the causes of social isolation and the groups who are affected by it, being alone is not good for one’s mental and physical health. Being alone most of the time is associated with increased weight, poorer diet, decreased exercise, alcohol abuse, greater risk of sickness, and even a shorter life span. Cognitive functions decline, possibly as a result of few verbal interactions. Added to this is the emotional pain of being lonely. People whose circumstances prevent them from interacting with others for short periods of time report feeling depressed and out of touch with what is going on around them. Imagine the effect if social isolation is a way of life.

Fortunately, there are social spaces where people with mental illness can go and feel comfortable and accepted, as well as receive advice, support, and/or information about relevant services, are available in many communities. Volunteers in organizations like the National Alliance usually run these drop-in centers or peer support groups on mental illness. They provide a critical service, especially for those patients and their families who are seeking to interact with others experiencing the same problems.

Going to meetings is one way of decreasing time spent alone, and it is possible that a network of acquaintances with whom to spend time can develop from this. Several years ago, I led a weight-loss group made up of mentally ill individuals who had gained weight on their psychotropic medications. After a few meetings, the participants organized Sunday walks or, if the weather was bad, a meal and a movie.

Unfortunately, making available accessible and socially safe places for people with mental illness to meet is dependent on volunteer resources, and these may be limited to family and friends of the mentally ill. The sad fact is that many potential volunteers would probably prefer giving their time (and maybe money) to an animal adoption center than spend time socializing with mentally ill individuals.  An acquaintance in a mid-size southern city found that despite city resources to fund a drop-in center associated with a neighborhood health clinic, there were no volunteers available to staff the facility.

According to the previously mentioned SANE report, almost all people with mental illness consider social relationships important in helping them manage their symptoms and improve the quality of their life. They said that simply having someone to talk to about how they feel is critical to their feeling better. It doesn’t take many people to diminish the loneliness of an individual.

Just one will do.

We all should try to be that one.

With Whom You Eat May Affect How Much You Weigh

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

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

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

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

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

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

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

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

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

Can E-Cigarettes Reduce Smoking Among the Mentally Ill?

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

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

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

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

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

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

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

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

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

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

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

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

Feeding Your Guests to Decrease Their Stress

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

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

She looked offended.

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

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

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

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

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

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

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

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

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

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

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

Are You Sure That Food is Safe to Eat?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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