After Stress Stops, Overeating May Continue

Many of us are familiar with a tendency to eat in response to a non-catastrophic stress event. (Impending plane crashes, avalanches, or lighting strikes rarely call for snacks.) An income tax audit, burst water pipes, a fender bender, or a long delay in an airline departure may make us first gnash our teeth, and then put something in our mouths. Sooner or later, ways to cope with the stressful situation are generated (i.e., the plane departs), and we no longer feel the need to use food as an emotional pain reliever.

There are some stressful situations so prolonged that even the memory of them can provoke overeating for many weeks, even months, after the stress is over.  I recently visited with S, a friend whom I do not see often because we don’t live in the same city, and we hadn’t seen each other in over a year. I was shocked by how much weight she gained. Never thin during the time I knew her, she was now morbidly obese, and my plans for us to walk a few blocks to a restaurant were dropped because she couldn’t walk more than a few feet. Catching up with each other’s news, I waited to hear about some stressful situation that might explain her weight gain, but there was none. She had recently retired, but was actively developing a non-profit enterprise she had long dreamed of. Friends, financial situation, and family were all fine, according to her account of the past year.

So why the weight gain? She had told me many times that she ate out of stress, but there was no obvious recent stress to explain her adding at least 40 pounds to her frame over the past 12 or so months.

Later on, as we reminisced about her past job, the reason for her overeating became clear. She had taken on a project no one else in her company wanted to try, due to high risk of failure. She succeeded by tirelessly working, getting no more than 3 hours of sleep a night for months on end. Indeed, she had time for nothing else except work, and once told me that she caught herself dozing while standing up and another time, leaving for work, she’d forgotten to put a skirt on over her slip.

This was no recent event, the project was completed successfully at least five years earlier, but the emotion with which she described her work was as intense, as if she had finished it a few days before our lunch. She told me over and over again how hard she worked, how many more hours she clocked than her staff did, how her meals were eaten at the company cafeteria, and at night these meals were supplemented by snacks from the vending machines.

“I had time for nothing else but work. Nothing…” she recounted.

Now it seemed as though leaving work, this company that demanded so much from her, was causing a delayed stress response. Perhaps the overeating and subsequent weight gain was her way of coping with the stress from that time. Certainly she must have experienced not only intense fatigue, but also the fear that her coworkers were right and the project could nor would not succeed.

S is so obese that some type of bariatric surgery may be suggested to her as a way of bringing her weight to a manageable level. Certainly her inability to walk because of shortness of breath was very worrisome. Yet should she opt for such a procedure, or any other weight-loss intervention, it was doubtful that she or her medical/nutrition team would recognize the reason for her substantial weight gain. Nor is it likely that S would reveal the reason for her ballooning into morbid obesity, as she probably is unaware of it. And yet will she be able to keep her weight off unless she recognizes the reasons it was gained?

Overeating in response to a delayed stress reaction may be common, but it’s often unrecognized. Many times a physician will ask about previous stress in trying to understand why a new medical problem has arisen. The stressful event may have occurred months ago, but the aftermath may show itself in rashes or insomnia or mysterious aches and pains. The physician is probably less likely to look at someone who has gained a great deal of weight recently to ask about past stressful events. And to be fair, the patient may not be able to make the connection, either.

Stress may be close to the top of a long list of reasons why people gain/lose/regain weight, or can’t lose it at all. If it is ignored or underestimated in developing an effective weight loss intervention, then the probability of long-term weight loss success is diminished. The dieter might be better served by focusing on the emotions behind the overeating before being treated for the overeating, or at least at the same time. It may take longer to deal with the psychological aspects of weight gain, and required weight loss, as other than the physical, but doing so will guarantee a better long-term outcome.

Stopping After-Diet Weight Gain: Is It Possible?

A sobering report in the New York Times about the weight gained by contestants on “The Biggest Loser” confirms what every failed dieter knows: it is harder to keep weight off than to lose it. Research on post-dieting metabolism and eating behavior among these contestants might convince some wannabe dieters to indefinitely put off even starting a diet. The post-diet contestants were found to have such slow metabolisms that their bodies were using up far fewer calories than predicted, based on their height and weight. People of the same size who had not been on a prolonged diet were found to be using up less than 800 calories. It was no surprise that the contestants were gaining weight.

If that were not bad enough, the contestants experienced an almost constant need to overeat. The urges were strong enough to cause them to binge on foods that never should have been eaten, even in small quantities, if they were to remain thin.

These changes in metabolism and absence of self-control over eating are hardly unknown. Decades ago, scientists measured changes in calorie use before and following substantial weight loss. They put people in a room called a “respiration chamber” for 24-48 hours, and measured how many calories were used when the volunteer was in a relatively inactive state. The results were consistent with those reported for the Biggest Losers: After substantial weight loss the body uses markedly fewer calories than those of people of the same size that have not lost weight. Why this occurs is still not understood years after the first observations. Changes in the activity of certain thyroid hormones might cause a slowdown of metabolism, but other factors may also be involved which have not yet been identified. This is a significant problem since it means that at present there is no way of preventing others who endure a rapid weight loss caused, essentially, by low rations and excess exercise from suffering the same fate.

Other possible explanations for the post-diet side effect of weight gain are related to the reasons weight was added initially. Some of the contestants had been gaining weight since childhood and were unable to stop the weight gain. Why were they unable to halve their weight gain before it transformed them into morbidly obese individuals? Were they gaining weight because their bodies did not have the same control mechanisms to regulate their food intake? Were they always less active than their thinner peers? Did they drink soda instead of water, eat fried fatty food rather than lean protein and vegetables, and consume many large meals each day? Was food used to dampen emotional pain, or as entertainment?

Each of us have our own reasons for overeating, whether it is only a few extra calories, or several thousand. Not knowing why, or just as likely unable to change the “Why?” will make maintaining weight loss very difficult.

Undoing the side effect, weight gain, after successful weight loss requires:

• Decreasing post-diet hunger and lack of satiety;
• Developing strategies to halt overeating in response to emotional and situational triggers;
• Adherence to a food regimen compatible with anticipated post-diet metabolic slowing;
• Investigating whether changes in gut bacteria allow too many calories to enter the body;
• Decreasing sleep disturbances that trigger fatigue associated overeating; as well as
• Preventing overeating triggered by seasonal decrease in sunlight.

The immediate problem that requires intervention is making it possible for the ex-dieter to adhere to a reduced-calorie food plan. Unless the calories consumed correspond to those required by the now sluggish metabolism, weight will be gained again. And yet, the dieter is being asked to stay on a post-diet diet. How frustrating and difficult! After months of being caloric deprived, the dieter is being told to continue the deprivation.

Perhaps it is time to help the dieter by offering temporary treatment with an appetite-suppressing drug.

The FDA has approved several new appetite-suppressant drugs over the past three years. They all have side effects, some of which, such as elevated blood pressure or increased heart rate, might be dangerous for an obese individual who already suffers from cardiovascular problems. But if healthy, normal weight post-dieters used these drugs? Their side effects may be less potentially harmful.

These drugs decrease hunger and cravings and increase satiety. They might help the ex-dieter follow a reduced calorie regimen at least for some of the time it takes for their bodies to become metabolically normal. If they are no longer beset with the urge to overeat and the frustration of seeing their weight increase, they might have the mental and emotional energy to grapple with the triggers that caused them to become obese.

We still must figure out how to prevent the metabolic meltdown that makes it so easy to gain weight after a diet. We still must find out how to prevent post-diet weakening of the satiety signals and exacerbation of urges to binge. We still must develop counseling paradigms during and after the diet to address all the factors that caused weight to be gained. Without these answers, the dieter may not be able to escape the side effect of successful weight loss, i.e., weight regained.

Not All Vegetarian Meals Are Created Healthy

The dinner invitation seemed perfect. A restaurant located near a downtown farmer’s market was serving, once a week, a gourmet vegetarian meal. We would sit at long tables and be served, family style, several courses featuring locally grown, very fresh vegetables. A group of us decided to try the new menu. Gourmet food that was good for us. It seemed too good to be true.

Alas, it was too good to be true. To be sure, the farmer’s market was still selling vegetables when we arrived, but was about to close. We did sit at long tables and passed platters from diner to diner, and there were plenty of vegetables. The problem was that the vegetables no longer looked like vegetables. With the exception of a pinto bean, wild rice and lettuce dish, the vegetables were coated with a cornmeal or a flour crust, and fried or, chopped and shaped into pancakes and then fried.  Carefully dissecting the fried cornmeal crust encasing the slice of green tomato I found (no surprise) one slice of green tomato. The main dish was chicken-fried summer squash. A roundish piece of breaded something was placed on a dense pancake of cornmeal and corn kernels. When I detached the crust, I found a chunk of yellow summer squash that tasted like plain boiled yellow nothing; in fact the fried chicken batter was so thick and stiff that it retained the shape of the squash even after it had been removed.  Dessert was ice cream and apple crumble, a strange dessert for a spring farm produce menu, but gobbled by the diners who seemed to feel they deserved something sweet and gooey after eating all their vegetables.

The meal left the diners, at least our friends, discontented. We had expected to be eating a variety of vegetables that were on the A list of nutrient-dense foods and prepared in such a way that their innate vegetableness was featured. Instead, to be certain, we got vegetables ranging from green tomatoes, yellow squash, and corn, all with relatively few nutrients. The addition of high fat, high carb, coatings added calories without any nutritional benefit. The one dish without breading, the beans, wild rice and lettuce, was probably a little more nutritious, especially the beans, which would have delivered some protein if a cup or so had been eaten. But judging by the amount of food left on the platters as they were passed, people ate only cautious amounts of the somewhat hard-to-digest beans.

The take-away message from this meal was hardly likely to impress a dietician:

  • Many people are excited about eating vegetables that are transformed into vegetarian versions of fried chicken or fritters;
  • As long as we eat vegetables, we are, apparently, getting all the nutrients we need, and protein isn’t one of them;
  • All vegetables are nutritionally equal as long as they are fresh from the farm; and
  • If you serve a yummy dessert, people may forget they had only vegetables for their main course.

Of course, this was only one meal, and maybe it was a good way to get a recalcitrant spouse to go out to a restaurant that specialized in something other than meat and potatoes. If this unwilling vegetable eater enjoyed the southern style fried summer squash, perhaps the next time he or she would eat the squash without its case of fried breading.  The meal also highlighted the advantages of buying produce locally grown and sold, supposedly, only hours after being picked (although the wild rice was certainly not harvested in this south Florida town).

But the meal obscured the true delight in eating vegetables and fruits that make it from vegetable patch to table in under a day. It is not necessary to muck around with corn on the cob so fresh the sugar in the kernels has no chance of turning into starch. It is not necessary to fry tomatoes when their skin conveys the warmth of the sun and biting into them spurts their tangy juice over one’s hands. It is not necessary to combine an unusual vegetable like wild rice with odd companions like soggy cooked lettuce or mealy beans. This grass that looks and tastes like a grain deserves to be introduced alone to those who have never eaten it.

Fortunately, for those whose taste buds and curiosity motivate them to eat more main course vegetables, there are countless Internet recipes for every vegetable imaginable and cookbooks that span international cuisines. Yotam Ottolenghi’s new book Plenty More: Vibrant Vegetable Cooking from London has recipes that span several continents worth of vegetarian cooking. His last book, Plenty (Chronicle Books, 2011), was called,  “…(the) vegetarian cookbook of the decade…” by the Washington Post and just the pictures alone are mouth watering. No one misses animal protein after making these recipes. Moreover, vegetables that most of us walk past without buying, or are unaware of tend, to be featured in cookbooks specializing in vegetables. Certainly the recipes go far beyond fried green tomatoes and yellow squash. Ottolenghi’s recipes and those featured in other vegetarian cookbooks, are healthy and offer the variety of vegetables that dieticians are telling us we need to eat in order to meet our nutrient needs. The bad news is that one has to make these recipes at home. The good news is that they are so delicious you may find yourself going off to the farmer’s market and returning home for your own gourmet meal.

Running Into a Thin Body: It Is Harder Than It Looks

The body fat content of Boston dropped precipitously the weekend before Marathon Monday. Most of the blue and gold jacketed (the Marathon colors) people wandering in and out of stores, running the length of the river or on our long city blocks were thin… quite thin. And there were thousands of them.

“Maybe I should start running again,” a friend commented, as we waited behind a crowd of skinny legs for the light to change. “I need to lose some weight.”

It was a tempting thought, one that I had played with for the several years after a repair for a torn Achilles tendon had made me fearful of running too often and too far. The weather was getting warmer, so exercising outside was a pleasure… and who knows, maybe the pounds would roll off along with those miles.

The editors of Runner’s World must have heard our conversation because, a few days later, I was browsing the April edition of the magazine, devoted in large part to running and weight loss.

One section of the magazine was headlined “Why Can’t You Lose Weight?” with a sobering subtitle scolding the reader for thinking that weight loss was simply a matter of eating less and running more.

You mean it isn’t?

Well, no.

According to the magazine, chubby runners, like the rest of the overweight human race, tend to overestimate how many calories their runs are burning off and compensate for their calorie loss by overeating when they get home. Not moving much after the run is not uncommon; after all, why not take the car to do an errand a block away? There is no need for more exercise. And even worse, some (gasp) are even overeating on a day when they are not running. They rationalize, “Tomorrow I will exercise off the extra calories I ate today.”

Alas, there is no magical formula that produces weight loss just by putting on running shoes and cute running tights. The only way a runner can lose weight is to eat sensibly and to commit to a running schedule that increases in time and intensity, so the body never hits a fitness plateau. A generic diet that stresses avoiding high fat, high sugar and highly processed foods, which also provides sufficient carbs to replenish the stored carbohydrate in the muscles used up by exercise, will work to diminish calorie intake. Obviously, it must also include nutritious staples such as fruits and vegetables, as well as lean protein, low-fat dairy products, and high-fiber.

But the exercise component, like running, must be personalized so that the dieter is constantly training to increase both the intensity and duration of the activity. It is not necessary to train as though for a marathon or a long distance bike ride or a climb in the Himalayas. But it is necessary to make sure the body is not too comfortable with the exercise routine. If the effort level remains the same, fewer calories may be used up as time goes on. Runners who want to lose weight are advised, according to the article, to include high intensity runs like speed work, or running fast up hills along with adding, if possible, miles to the distance run. Presumably this can be done on a treadmill as well as outside.

Although running to lose weight may appeal to only a few, the concept behind increasing one’s fitness and stamina applies to anyone who wants to include exercise as a way of increasing weight loss. How many of us have complained, “I don’t know why I am not losing weight! After all, I go to the gym (or play tennis, or go for bike rides or walk) three times a week.” But are we exercising harder as time goes on, or maintaining the same level of physical activity for weeks, months, or even years? I have a friend, a runner (and a little pudgy), who told me quite proudly that he has been running three miles, 4 days a week, for years.

“Well, why don’t you run further?” I asked him. He was surprised at my question and shrugged his answer.

“Why should I? I am comfortable doing that distance.”

Dieters are often told to engage in some sort of physical activity, especially if their weight loss has stalled, and when they begin to do so, particularly if they have been inactive, weight loss often increases. But eventually, as their bodies become fitter and accustomed to this level of physical activity, the exercise will no longer push their weight loss as much as it did at the beginning.

They, and the rest of us who may wonder why exercise does not seem to be melting away our excess pounds, are rarely told that reaching an exercise plateau will slow down our weight loss. Unless we have a trainer or a coach, or read magazines and journals about physical activity and weight, we are unaware of how important it is to exercise harder and longer to increase the rate of our weight loss. Nor are we given information on how this can be done in such a way as to prevent injury and pain.

The solution is not to diet more strenuously, or give up on the exercise because it doesn’t seem to be working. The solution is to become your own trainer. Keep an exercise journal or use an app or wearable device that monitors your physical activity. This will tell you how much you are doing and how often. Resolve to do more. More can mean one minute or an hour, half a block, or several miles. Increase your speed or resistance, again for a few seconds or a few minutes. You don’t have to do this more than once or twice a week, but you must do it if you want to climb to a higher level of fitness and increased rate of weight loss. And who knows, one of these days, you may be in a large crowd waiting to run a marathon.

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

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

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

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

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

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

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

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

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

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

So now how are we supposed to eat?

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

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

Is the Acai Berry a Superfood or a Super Scam?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Alcohol Withdrawal Mood Swings: Might Eating Carbs Help?

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

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

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

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

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

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

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

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

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

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

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

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

Will Daylight Saving Time Lighten Your Mood AND Your Weight?

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


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


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


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


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


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


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




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

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

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

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

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

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

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

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

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

Seven Minutes of Fitness During Unfit Weather

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

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

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

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

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

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

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

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

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

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