Will Watering Your Stomach Increase or Decrease Food Intake?

His water glass at dinner needed constant refilling, and I was worried that he had some sort of metabolic condition. But that was not the case. My relative by marriage said he always gulped water with every bite because it decreased his need to chew his food. “I swallow faster so I can eat faster,” he told me. Growing up in a family where there was competition for seconds, he learned that if he was the first to clean his plate, he got the remainder of the food on the table. The habit never left him.

Using water to lubricate swallowing is also behind the success of competitive eaters. Such people’s ability to consume enormous amounts of food in short periods of time made overeating into a sport. They train their stomachs to accept 30 hot dogs or chicken wings in the amount of time it takes to unfold a napkin. An interview with Yasir Salem, a competitive overeater ranked #10 in world competition by Erin McCarthy on the Internet site, “Mental Floss,” revealed his use of water in his training. He stretches his stomach by drinking daily a gallon of water after eating several pounds of a bulky vegetable, e.g., broccoli. And during a competition, he dunks hot dog rolls into warm water to soften them, so they can be swallowed quickly and with little chewing.

Competitive overeaters, as well as members of a family competing for the last chicken leg, are not the only ones who use water to eat quickly. Binge eaters will also drink water or other liquids to make it easy to consume large amounts of food in a small period of time. Indeed, many of us probably drink water or soda with our food when we find ourselves needing to finish eating in a hurry.

Drinking water with food to increase the amount of food eaten contradicts general wisdom about the use of water during a meal to decrease food intake. The use of water to fill up the stomach before the meal begins has been recommended for decades. ”Drink one or two large glasses of water before you sit down to eat,” say most weight-loss advisers, “and you will find that you can’t put much food in your stomach.” This is contradicted by Mr. Salem, who told his interviewer that he drinks a gallon of water before starting the eating competition, to effectively flush out his digestive system and make it ready for large quantities of food.

Similarly, drinking water with every bite of food, or at least after two or three bites, is strongly recommended as a way of slowing food intake. If, as the theory goes, you have to put down your fork or spoon, pick up your water glass, take a sip or two, put down the water glass, pick up the eating utensil and start eating again, the rate of food intake will slow considerably. Unlike my relative or Mr. Salem, the food is presumably chewed and swallowed before the water is imbibed. The water is not a lubricant to make swallowing faster and easier, but instead as a “time-out” from putting more food in the mouth.

Drinking more water also completes the end of the meal. If the plate is cleaned, but the eater does not feel full, diet coaches recommend drinking one or two large glasses of water at the end of the meal to convey the sensation of fullness. Carbonated water may work even better because if enough bubbles are swallowed, the stomach feels bloated and incapable of receiving more food. Carbonated drinks such as beer or sugar-filled sodas are not recommended because they deliver excess calories.

Obviously water can increase or decrease food intake depending on how it is incorporated into the eating process. And since most people attempting to lose weight are not going to be competing for seconds or entering an eating competition, drinking water before, during, or after the meal will, hopefully, decrease food intake. The water intake between bites is supposed to slow eating sufficiently so the brain will signal to the eater to stop before the stomach is totally filled up with more food than necessary.

But curiously, this seemingly innocuous recommendation has met with some resistance by those who claim that drinking water with a meal decreases the ability of the stomach to digest food. Water will dilute the enzymes in the saliva that start the process of digestion, and then further dilute the stomach enzymes that work to break the food down more before sending it to the small intestine; so claim the anti-water folk. Although debunked thoroughly by scientists, the recommendation to avoid water during a meal continues to circulate.

One of the problems with relying on water to confer satisfaction and fullness after consuming less food than desired is that water doesn’t stay in the stomach very long. It passes through much more quickly than food and, once gone, may leave a sense that now there is room for more food. If the eater wants to eat less without using will power to do so, then the most natural, drug-free way is to increase the serotonin levels in the brain. This is accomplished by eating a pre-meal snack of about 20 grams of a starchy carbohydrate such as a small roll. Twenty minutes later, the brain will make new serotonin and this neurotransmitter will convey a sense of fullness or satiety to the roll eater.

Starting the meal with the feeling of not being very hungry is helpful to slow your eating. If you are feeling somewhat full, you are more likely to eat slowly and eat less—and leave the seconds to someone else

 

Could Being Obese Make You Lose Your Teeth?

Having one’s teeth cleaned is not as bad as undergoing a root canal procedure, but certainly not as pleasant as getting a manicure. However, it does give one time to think of the implications of not doing so frequently, and the importance of carrying out the in-between cleaning tasks such as brushing, flossing and not eating caramel apples. Many of us may be not as compulsive about doing so as our dentist would like, but if we are also obese there is a greater cost to the health of our teeth and gums if the basic requirements of good dental hygiene are ignored.

No one disputes the adverse effects of consuming simple sugar on tooth decay. Ideally, if we indulge in eating or drinking sugar (as in soda or juice), we should race to the sink and brush our teeth immediately.  Dentists see the unfortunate consequences of not doing so, especially among those whose weight was gained by frequent consumption of sugar-rich snacks and drinks. Very few people will stop in the middle of a chocolate chip cookie or ice cream binge to floss and brush their teeth.

Obesity puts teeth and gums at risk for other reasons as well. Gastroesophageal reflux (aka acid reflux or heartburn) tends to be common, and causes teeth to be in contact with acid from the stomach, thereby contributing to the breakdown of teeth enamel. If the obesity is associated with depression or other mood disorders, the medications used to treat these disorders often leave the mouth extremely dry. The absence of saliva is also associated with dental decay. (Obesity Complicates Dental Health - Be Proactive!” Obesity Action Coalition, Stillwell, D.)

Patients who choose bariatric surgery to reduce the size of their stomach may be even more vulnerable to dental problems. Often vomiting occurs after this stomach surgery if too much food is put in the now tiny digestive organ. As with acid reflux, the teeth are coated with stomach acid, and enamel demineralization may result.  Moreover, according to Stillwell, an increased craving for sweets has been seen after surgery along with a significant tooth sensitivity that may make exposure to water or pressure uncomfortable. Patients who were not diligent about caring for their teeth before surgery are not likely to improve their dental hygiene afterwards, unless the importance of doing so is stressed.

Complicating care of the teeth and gums for someone struggling with obesity is this unpleasantness of attempting to fit an oversized body into a dental chair sized for smaller bodies. For someone with morbid obesity who finds walking difficult, getting to a dentist’s office is often physically painful. Added to this is the psychological pain of attempting to squeeze onto the reclining chair underneath the hanging trays and instruments. Stillwell suggests in his article that obese patients seek out dental offices equipped to handle their needs, but admits that there are very dental few practices that even consider this a problem.

Ironically, dentists were involved in developing and inserting devices in the mouth that would markedly reduce food intake to produce significant weight loss. Wiring of the teeth to prevent chewing was popular several years ago, but interest in using this approach declined rapidly in proportion to the rapid regain of weight when the jaws were freed. A modified version using a retainer-like device custom made to fit the roof of the patient’s mouth has been used with some success. The mouth can open only partially, so the patient has to take very small bites and consequently must eat very slowly. Since it takes about 15-20 minutes for the brain to realize that food has been consumed, the idea behind the retainer is that forced slow eating will produce fullness or satiety before excessive amounts of food can be consumed. Of course, it is also possible that the eater loses patience or becomes bored with the length of time it takes to complete a meal and goes on to do something else.  (“Are dentists involved in the treatment of obesity?” Karma, M.,Aw, G., and Tarakji, B., J Int Soc Prev Community Dent 2016 183-188) Once the retainer is removed, weight can be regained, unless the patient is willing to continue to eat very slowly. .

Although dental devices to reduce food intake may not be the most effective way of producing weight loss, the dentist may be an effective “first responder” in offering help and advice to obese patients. Most of us are unaware of the health of our mouths since it is almost impossible to see the state of our teeth and gums except for what stares back at us in the mirror. The possibility of losing our teeth and/or going through the pain and expense of periodontal surgery for gum disease is enough to motivate or frighten us into practicing what the dentist preaches.  Unlike a physician who makes the obese patient confront his or her weight, a dentist does not deal with the size of the patient’s body. The advice and suggestions about modifying food choices to decrease sugar intake and pointing out the association of gastric reflux with enamel erosion focuses on what is above the neck.  It is hard to ignore advice which, if not followed, may cause loss of one of our basic functions— chewing—as well as negatively affecting our appearance.  The simple suggestion about brushing in association with snacking might be enough to decrease between-meal food intake. The feel of a clean mouth and teeth is sometimes enough to prevent eating from immediately starting again.

And the dentist has an immense advantage over everyone else trying to help an individual improve food intake and lose weight: the patient can’t talk back.

Does Running Holiday Errands Count as Exercise?

“I‘m exhausted!” a friend told me when I bumped into her at the supermarket. “I spent the entire weekend running around doing errands.”

“Sounds like a good way of getting exercise and errands done at the same time,” I replied, knowing what the response would be. “Well, obviously I am not running,” she retorted. “But fighting the traffic in the mall parking lot and standing in line every store is so tiring. I don’t have the energy even to get to the gym.”

Holiday preparations, with its multitude of obligations and looming deadline of December 25th, seem to cause a frenzy of multitasking and soak up scarce free time. Even before Thanksgiving leftovers are consumed, the holiday to-do list is made and the running begins.

There is a high mental and physical cost to transforming ordinary life into one characterized by holiday decorations, buying and wrapping presents, sending cards, cooking, entertaining, hosting company and/or traveling. Since these tasks are added to those normally carried out each day, such as going to work, caring for family and social activities, the result is that time normally spent preparing and eating meals and exercising is drastically decreased. Indeed, going to the gym, a yoga class, or for a run seems like an indulgence done at the cost of cramming even more holiday obligations into remaining hours of the day or week. And for some, like my friend, the fatigue that comes with probably too little sleep, too much stress, too much shopping in malls with recirculated air, and too much waiting in traffic…it all makes sitting on a couch rather than on an exercycle seem like the only option at the end of the day.

Weight gain during the holiday season is so common that right after New Year’s Day, dieting kicks in. Gaining five pounds or more from Thanksgiving to the next year is not unusual, and holiday food and drink are major contributors to increased calorie intake. But even without the eggnog, sugar cookies, mayonnaise, sour cream or melted cheese dips, and fruit cake, weight would probably be gained. Lack of time leads to food court dining, fast food drive-ins, pizza, or nibbling all day on nutritionally weak snacks. Steamed vegetables, grilled fish and large salads are for January, not for December with its endless errands.

Frequent exercise classes or solitary workout routines followed by a shower, hair drying, and make-up applying is not compatible with a mind-set of counting down to Christmas.  And for those who exercise at home rather than at a health club, the convenience of having a piece of exercise equipment nearby is often ignored, because household tasks call more loudly than 30 minutes on the treadmill.

The approach to getting through the next few weeks without compromising sleep, weight, emotional well-being and fitness?

Schedule time to keep the body and mood healthy. You are not running a toy workshop in the North Pole and setting up a sleigh (rather than Amazon) delivery system by Dec 24. Which is to say that if there is a choice between getting enough sleep, or eating a salad, lean protein and high fiber carbohydrate, or taking a brisk walk or an exercise class, or making another dash to the mall, or baking one more batch of cookies? Choose exercise you want to do. Study after study has shown the positive and immediately impact that exercise has on decreasing stress and improving mood and cognition. Over the long term? Exercise can improve general health, decrease risks from heart disease, and perhaps even neurological diseases like Alzheimer’s.  A fatigued, stiff, grumpy body dragged to the gym unwillingly will not be the same after exercising. Paradoxically, the fatigue seems to lift….probably because increased blood flow oxygenates the muscles and brain. Stiffness from sitting in a car or standing in line goes away as the heat from the exercise makes the muscles more limber. Grumpiness disappears as well. People do not scowl at themselves in a health club; they may grunt or groan from the difficulty of their particular exercise, but somehow nasty moods go away (except if there are no towels when you leave the shower).

But the best part of literally (not figuratively) running or doing any other form of physical activity is that you are doing something for yourself. You are the beneficiary. You are the one who feels better, more energetic, less irritable or worried. The time you spend in exercise belongs to you.

Giving yourself the pre-holiday gift of time to take care of yourself is not something that is done easily. Guilt and anxiety over what has to be done, and what might not get done, may interfere with your healthy intentions: “I will make that salad or take a walk after I do (fill in the blank),” you say to yourself.

Putting your need for healthy food, exercise and sleep at the top of the long to-do list is hard. And yet, what better gift can you give to your family and friends than a cheerful, not sleepy, energetic, and unstressed you?

If We Had More Time to Eat, Would We Eat More?

The national eating day, Thanksgiving, is unusual in several respects. People who rarely cook spend hours in the kitchen transforming a rather ungainly raw bird into something beautifully edible and making artistic creations out of mashed sweet potatoes with marshmallows.  Stale bread that otherwise might be fed to the birds is turned into a complex dish that may or may not cook inside the turkey.  The table is formally set, and many courses with numerous dishes are served.  And the meal will take time.

Unless they have another Thanksgiving meal to go to, or feel compelled to Christmas bargain shop, guests are happy to dine leisurely. The meal may take considerably more than an hour, and rushing through is restricted to getting seconds on desserts before they are gone.  In this respect, Thanksgiving and other major holiday dining differs significantly from the way many of us eat the rest of the year.

That we eat more on Thanksgiving than on other days is not disputable.  Serving excessive amounts of food is appropriate, and we are expected to eat until we feel stuffed, and then eat some more. But would we eat so much if there were less time to do so?  Would we eat less if, like so many other days of the year, late afternoon/early evening activities and obligations shorten supper to a grab-and-chew type meal, rather than a sit-down dinner? Would we change the amount of food we eat if we actually sat and ate breakfast and lunch, rather than standing in line for take-out and then quickly consuming it before going back to work? Is eating quickly a prescription for too much, or too little food intake?

A few weeks ago I was having lunch with a relative who works for a large law firm. She kept looking at her watch as we stood in line for our salads at a food court. “They don’t like us to take more than 30 minutes for lunch,” she told me. “I hope I have time to eat.”

She is not alone. For many of us, eating is something we fit into our busy schedules often while we are doing something else, e.g. sending messages on our cell phone, working at our desks, or driving.

Hypothetically, if we have very little time to eat, we should be eating very little. A muffin or bagel for breakfast and two slices of pizza or a tuna wrap for lunch feels like fewer calories than a traditional breakfast of eggs and toast… or a lunch of baked chicken, potato, vegetables, roll and dessert. However, often when we choose foods that can be eaten quickly, we don’t notice that they can be calorically dense. A muffin or bagel with cream cheese may contain 600 calories, and a tuna salad sub with mayonnaise and cheese delivers as many calories as the hot lunch.

When we do not have time to eat, we may do it so quickly that we dump more food than necessary in our stomachs, like someone competing in an “All the hot dogs you can eat!” contest.  Sometimes when we gulp our food we don’t even notice how much we are eating. This is also true if we are multi-tasking while putting food in our mouths.

Sitting for a long time at a meal has its own perils. We may find it impossible to resist eating more than we intended to because we have the time and the food, especially the desserts, are there to tempt us. We are no longer hungry, yet the cookies or nuts or chocolate or pies are still on the table and it is hard, unless we are sitting on our hands, not to reach for them. A friend who often hosts long, leisurely meals told me that guests who resist eating dessert when she first serves it will often reach for the cake or cookies later on if they are all still sitting and chatting. Of course, meals that are interrupted by speeches between courses are a perfect prescription for overeating. The guest is a hostage to someone’s boring talk and eating seems to be the only way to endure it.

On the other hand, if we have the time to have an “appetizer” of carbohydrate, e.g., a roll, rice cakes, or crackers about 20 minutes before we start our meal, we may find ourselves eating less.  The carbohydrate potentiates the production of the brain chemical serotonin, and that in turn will make us feel somewhat full before the meal begins. This helps control how much we eat subsequently (a critical aid for dieters), and causes us to stop eating before we clean our plates.  But when time is limited, eating quickly and without the benefit of the satiating effects of serotonin, we could be eating more than we should.

Either too much or too little time can disrupt moderate and reasonable food intake. But certainly we should take the time to enjoy Thanksgiving for its own sake regardless of how much, or how long it takes to eat.

Who Cares for the Caregivers?

Her husband’s Parkinson disease had progressed significantly since we’d last seen each other and her stress progressed along with it. The kitchen counter was covered with pill containers and dosing schedules; the wheelchair was sitting by the ramp to the car and her husband waiting patiently for his aide to help him get dressed.

My friend, let’s call her Mandy, barely said hello before launching into a description of the difficulty she had getting her husband ready for bed the previous night. Apparently, he sat in the wrong chair in the living room while watching a football game. The chair did not have the jack that would propel him to his feet. It took two hours to get him upright and ready for bed in a tiny room near the kitchen. He could no longer climb stairs to their bedroom. She was exhausted and near tears.

Her situation is repeated in homes throughout the country where one spouse or child or elderly parent is losing physical, and often cognitive, strength due to neurological diseases that get worse over time. My friend is one of the fortunate ones. She is able to afford the service of professional aides and a physical therapist because of insurance purchased many years earlier when they were both healthy. Someone much stronger than she is can carry out the actual “heavy lifting.” That person is experienced in how to move a body that cannot move itself without great difficulty. But like so many others, she is dependent on the aide showing up, and she has to scramble to find people to fill in on weekends and holidays.

The Family Caregiver Alliance, a non-profit organization that provides support for people like my friend, a so-called informal caregiver, states that the numbers of unpaid caregivers in the U.S. in 2015 is about 43.5 million. Their caregiving, if paid for, would cost more than 470 billion dollars a year. More than 75 percent of the caregivers are women, and more than two-thirds of those receiving care are also women. It is estimated that 20 hours or more each week is devoted to the needs of the spouse, child, or parent so the informal caregiving is akin to an unpaid part-time job, with few entire days off.

Anyone who has filled this position knows that the tasks range far beyond giving out medicine at the right time. Often the number of tasks increase to the point where the patient needs help in just about every activity of daily living, from dressing and undressing to personal hygiene and being fed, and the responsibility of running the household, paying bills, and making medical appointments. The must-do list simply grows longer as the impairment from the disease increases.

The toll this takes on those who give the care is well-characterized and predictable. Just about every aspect of life is affected: sleep, physical and psychological well-being, work, socializing, pursuing personal interests, and hobbies. They all give way to the needs of the patient. Simply getting out of the house to do more than a quick trip to the supermarket or dentist is a rarity for many.

Mandy lives in a residential neighborhood only a few blocks from a library, stores, restaurants, and a supermarket so she sees other people when she takes her husband for an outing in his wheelchair. And she manages to get to a yoga class once a week when her husband is with his aide. But she has rarely has time to work on a collection of essays she has been writing, and her former volunteering activities have been abandoned. But she is fortunate; at least she is able to leave the house a few times a week.

Some diseases are easier to deal with than others, but no one gets to choose. When the caregiver is able to still share an emotional and cognitive life with his or her spouse or partner, the caregiving is bearable. But if the patient is unable to communicate and respond to the caregiver, it makes the caregiving even more difficult. Despite that it is the disease, and not the individual, who is responsible for the changed behavior; it may be extremely hard for the caregiver to hold onto that fact when dealing with unexpected anger, depression, apathy and sometimes non-recognition. In a study of the emotional burden carried by the caregiver, Croog, Burleson, and their team reported that anger and resentment was a common complaint along with lack of personal time and social isolation. There are support groups for the ‘”informal” caregivers, and they are geared toward helping with the specific problems presented by a disease, for example, Alzheimer’s, Parkinson’s, or ALS.

Over a cup of coffee, Mandy told that that the one thing she did not expect, as her husband’s symptoms worsened, was being alone so much of the time. “We have many friends; we both lived in this community for decades. But very few come to visit anymore, and we rarely are invited to other people’s homes because of lack of wheelchair access. And some people just avoid us because somehow they don’t know how to act around someone with a debilitating illness.”

Fortunately, my friend is strong and resilient, an excellent manager and a person who is able to meet the unending obligations she encounters. But she, like so many others in her situation, would like to have someone who understands and can share with her the difficult emotions and conflicting feelings she is experiencing in fulfilling the “in sickness” part of her wedding vows.

She too would like some care.

References

Spouse caregivers of Alzheimer patients: problem responses to caregiver burden. Croog SH, Burleson JA, Sudilovsky A, Baume RM. Aging Ment Health. 2006 Mar;10(2):87-100.

Does Halloween Begin the Trifecta of Weight Gain?

Soon after Labor Day, almost before the bathing suits of summer have been put away, bags of miniature Halloween candy begIn to appear on supermarket and drugstore shelves. Those tiny candy bars will be devoured to celebrate a holiday that has nothing to do with candy, and the hundreds of calories they contain will initiate the fall season of weight gain. Soon the black and orange wrapped candy will be replaced by chocolate turkeys for the national binge day, Thanksgiving, and then towers of green and red wrapped candies, cookies, and cakes will be displayed for the December holidays.

It is understandable how Thanksgiving and Christmas became holidays characterized, in part, by excessive consumption of special foods that are usually replete with cream, butter, sugar, egg yolks and chocolate. In the old days, these holidays represented the few times a year when expensive, scarce food stuffs like sugar, chocolate, costly cuts of meat, and exotic fruits like oranges, and special alcoholic drinks were served in liberal portions.  Religious and national events like Christmas, the 4th of July, or the yearly fair have always been celebrated with copious amounts of food.  Often guests contributed their own special recipes to a gathering, and it was not unusual to have several main dishes, many sides and a large number of desserts. No one worried about how many calories were eaten because food intake was frugal and, for some, even scarce for the rest of the year.  But now, of course, the caloric excesses that begin with devouring miniature candy bars and end with New Year’s Eve buffets may not be compensated with frugal eating the rest of the time.

But how is that Halloween, a holiday which originated as a religious event, has metamorphosed into the opportunity to eat excessive amount of sugars, fat, artificial flavorings and color while wearing a costume? And how is it that the attempt by some food companies to reduce sugar content in many of their products is being offset by large confectionery companies marketing Halloween candy? And how, as our nation becomes fatter every year, are we going to continue to allow this?

Collecting, counting, and collating the candy gathered during an evening of trick or treating is a relatively new phenomenon. To be sure, hordes of face-painted or masked kids have been roaming the streets on Halloween, ringing doorbells and asking for handouts for many decades. Mid-20th century, the handouts were rarely commercially packaged miniaturized candy bars. Treats like cookies, popcorn balls, Rice Krispy squares, brownies and fudge were often homemade. Candy corn, invented in l880, Hersey’s Kisses in l907 and M+M’s in l941, along with a smattering of regular size candy bars, were available as treats, but competed with homemade chocolate chip cookies. Then we became scared of anything that was not made and sealed in a factory. The appearance of razor blades in apples and the possibility of toxic ingredients in homemade baked goods frightened us into allowing our children and ourselves to accept only commercially produced, sealed snacks like miniature candy bars and tiny bags of candy corn. And the confectionery companies responded. Any candy that could be shrunk, wrapped in Halloween colors, put in a large bag and sold in bulk, was.

Of course, the calories per candy item were also shrunk because the candies were one big bite.  Alas (and the candy makers know this), we think, “They are so small, how could they be fattening?” and pop three or four tiny Snickers or Butterfinger bars into our mouths.  The little candies can be stashed in drawers, brief cases, knapsacks, glove compartments, pocketbooks and pockets and constitute an almost endless supply of sugary, high-fat treats—and calories. And so the season of fattening ourselves up begins.

The over-consumption of sugary treats falls at the time of year when we may be feeling stressed because of after-summer vacation workload for adults and for kids, homework.  Are we craving candy because as darkness increases, our good moods decrease? Would chewing through a mound of candy corn be as appealing in the middle of July as it is at the end of October?  We know that the good mood brain chemical, serotonin, is made when any carbohydrate (sugar, starch) other than fruit is eaten. Is candy more appealing than a bowl of oatmeal that brings about the same feelings of calm and comfort?

It is hard to find any good reason for children or adults to consume mounds of candy. In an ideal world, the plastic bags of miniature candy bars would be replaced by bags of vacuum-packed apple slices, or oranges or baby carrots. Treats might also include pretzels, popcorn, miniature protein or high fiber, high-energy bars or breakfast bars. These have the virtue of being low or fat-free, have some nutritional value, and, after the holiday, can be put in a lunch box for a daily snack.

But how are we going to stop the avalanche of fall candy consumption? It means pushing back against the confectionery companies so that like the large soda manufacturers who have reduced sugar in their drinks, they see a profit in offering healthier Halloween treats. It means working within neighborhoods and schools to convince everyone to resist dumping handfuls of candy bars into plastic pumpkins held by seven year-old trick-or-treaters. Perhaps people can be convinced to donate some of the money that would have been spent on candy to a local food bank and contribute the rest to the local school or neighborhood center for a Halloween party.  Halloween is a holiday made for fun, and surely we can figure out how to have fun without the candy calories hanging on our hips the next day.

Excessive Exercising: Is it About Fitness or a Compulsion?

Whenever I am in my gym, I see a skinny but well-muscled woman working out. She is there, already dripping with sweat, when I arrive, and she is there when I leave. My workout schedule is somewhat erratic, but regardless of when I arrive, she is there.

I suspect she is suffering from exercise bulimia, a disorder characterized by compulsive exercising to burn calories. Unlike bulimia, an eating disorder in which large quantities of food are consumed and then quickly removed from the body by vomiting or excessive laxative use, someone with exercise bulimia may be consuming only normal amounts of food. Normal, that is, to most of us. In a desire to attain a very low weight and keep it off, the exercise bulimic tracks every calorie consumed and makes sure that the exercise burns off enough calories so no (gasp!) weight is gained. If in a moment of weakness, a small bag of potato chips or a kiddie size ice cream cone is consumed, exercise to get rid of those calories begins as soon as possible.  And if for some reason it is impossible to exercise—for example, a cyclone has just destroyed the individual’s house—an overwhelming feeling of despair, agitation, and helplessness is experienced. These feelings may be similar to those experienced by someone who has consumed an enormous amount of food, and then is unable to get rid of it by vomiting.

It is difficult to distinguish a compulsive need to exercise, a need that may take priority over other activities, from the desire to excel in a competitive sports event. Someone who trains for a triathlon by swimming, biking and running long distances, can look as if he has exercise bulimia because the pressure to do well in these three activities requires hours and hours of physical activity. But there are two critical differences: the intense workouts required for a competitive event come to an end when the event is over, and the exercise is not coupled with the goal to work off calories. Indeed, the individual in training often increases significantly his or her calorie intake in order to replace the calories used in exercise and also to prevent muscle wasting.

Although weight loss, stamina, muscle strength, and overall fitness may increase because of the incessant exercising, the health risks of compulsively exercising eventually outweigh the benefits. When women lose too much body fat, they stop menstruating and become vulnerable to significant bone loss. Continuous fatigue, and injury to tendons, ligaments, muscles and bones (e.g. tendinitis and stress fractures) may result at any age; these injuries and fatigue rarely stop the exercise until the injury becomes too severe to continue.

Like the purging that occurs after the excessive eating of bulimia, excessive exercise is used to prevent calories from turning into fat and weight gain. To the person with this eating/exercise disorder, it is as if every item of food comes with a label that reads, ”Must exercise strenuously to use up calories in this food!” and then the food label lists the number of minutes or hours of exercise that have to be performed.

”You just ate a doughnut? Run on the treadmill at a high pace for 45 minutes!”

What makes this type of exercise “purging so destructive to health is that every morsel of food is regarded as an enemy of low weight.  It doesn’t matter if the food is healthy and required for nourishment or eaten for pleasure; its calories must not remain stored in the body.

Ironically and sadly, excessive exercise can increase the appetite and cause an inevitable need to eat more. Athletes in training consume much more food than when they are not preparing for a competitive event. So the exercise bulimic who has spent three hours in the gym may go home and eat a big meal because he is really hungry. And then he feels compelled to go back to the gym to work off the calories.

Breaking the cycle of exercising compulsively to get rid of the calories just consumed is difficult. There is the problem of the compulsion itself, a behavioral state of mind that is not easy to change. There is the guilt and anxiety that must be dealt with if exercise is prevented, and also the anxiety and depression that might drive overeating itself. And underlying all this is the uncertainty and bewilderment over what constitutes appropriate food intake. How does one convince an exercise bulimic that the body needs a certain amount of calories to function; that the body demands a variety of nutrients for basic physiological functions; and that the brain needs glucose for energy and other nutrients like amino acids in order to produce the cellular connections that allow it to communicate?

Might the exercise bulimic be helped if he or she stopped eating real food? If every morsel of food announces to the exercise bulimic how much exercise has to be done to remove unwanted calories from the body, why not switch to a food stuff that supposedly has the perfect number of calories for the exerciser’s body?  One possibility is a synthetic food called Soylent that was engineered to meet the needs of people such as programmers who don’t want to waste time eating real food. Rob Rhinehart developed Soylent, a liquid meal replacement, and it provides all the nutrients needed to meet daily caloric and nutritional needs.  Soylent is supposedly palatable, but not so wonderful in its taste and texture, so that anyone would be tempted to binge on it.

If the exercise bulimic is convinced that the food being consumed is in balance with the body’s caloric needs, the compulsion to exercise may diminish. If not, this will be indicating that the exercise is not really based on caloric intake, but instead a compulsive disorder played out in the gym.

Distracting Yourself Into a Better Mood

“My head is full of stuff I am worried about today,” a fellow gym member told me as we were about to start a yoga class. “So if I am standing up when everyone else is sitting down, it is probably because I am not paying attention to the instructor. “

She was right: She was so self-absorbed in her worries that she was always about two yoga positions behind everyone else. About halfway through the class, I noticed her keeping up with the instructor’s moves, and no longer looking so worried.

When the class was over, she said, “I feel so much better! Once I started to focus entirely on whether I was in the correct yoga position, I was distracted from the laundry list of problems that had been bothering me.“

Yoga is one of many distractions that work to relieve, or at least subdue, a variety of emotions from boredom (e.g. “HOW long do I have to wait on the telephone to speak to a representative?!?”) to depression, anxiety, anger, and worry. Think of the scene in a movie or television where people are waiting to hear news about an operation. Someone always says, “Let’s go to the cafeteria and get some coffee.” The coffee is not what is desired; it is the distraction of moving to another place and engaging in another activity (buying and drinking coffee) that may somewhat help relieve the tension.

Sometimes the lack of distraction makes a situation unbearable. Imagine sitting in a waiting area awaiting your own operation. You are awake and alone and there is nothing to distract you from your anxiety and worry. A friend of mine who recently had his cataracts removed told me that, while he was waiting to be operated on, all he could think was “What if something goes wrong and I became blind?” He said. But, “if someone had been there to talk to me, or even if I could have watched television, I might not have worked myself into a panic.”

So-called Retail Therapy has long been recognized as an effective, albeit short-lived, therapy for anxiety and depression. It works, but has its limitations and unfortunate financial consequences if shopping leads to buying items neither needed nor affordable. The distraction of finding something desired and buying it lasts very briefly, and it is a costly way of keeping away unwanted thoughts. But certain shopping venues like gigantic flea markets, or bargain warehouses that require lots of walking and poking through piles of stuff that ultimately are rejected for purchase? They effectively focus the mind and move it away from unpleasant emotions.

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Distracting Yourself Into a Better Mood

Redirecting your focus is a very healthy coping strategy.
Posted Sep 14, 2017
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“My head is full of stuff I am worried about today,” a fellow gym member told me as we were about to start a yoga class. “So if I am standing up when everyone else is sitting down, it is probably because I am not paying attention to the instructor. “

She was right: She was so self-absorbed in her worries that she was always about two yoga positions behind everyone else. About halfway through the class, I noticed her keeping up with the instructor’s moves, and no longer looking so worried.

When the class was over, she said, “I feel so much better! Once I started to focus entirely on whether I was in the correct yoga position, I was distracted from the laundry list of problems that had been bothering me.“

Yoga is one of many distractions that work to relieve, or at least subdue, a variety of emotions from boredom (e.g. “HOW long do I have to wait on the telephone to speak to a representative?!?”) to depression, anxiety, anger, and worry. Think of the scene in a movie or television where people are waiting to hear news about an operation. Someone always says, “Let’s go to the cafeteria and get some coffee.” The coffee is not what is desired; it is the distraction of moving to another place and engaging in another activity (buying and drinking coffee) that may somewhat help relieve the tension.

Sometimes the lack of distraction makes a situation unbearable. Imagine sitting in a waiting area awaiting your own operation. You are awake and alone and there is nothing to distract you from your anxiety and worry. A friend of mine who recently had his cataracts removed told me that, while he was waiting to be operated on, all he could think was “What if something goes wrong and I became blind?” He said. But, “if someone had been there to talk to me, or even if I could have watched television, I might not have worked myself into a panic.”

So-called Retail Therapy has long been recognized as an effective, albeit short-lived, therapy for anxiety and depression. It works, but has its limitations and unfortunate financial consequences if shopping leads to buying items neither needed nor affordable. The distraction of finding something desired and buying it lasts very briefly, and it is a costly way of keeping away unwanted thoughts. But certain shopping venues like gigantic flea markets, or bargain warehouses that require lots of walking and poking through piles of stuff that ultimately are rejected for purchase? They effectively focus the mind and move it away from unpleasant emotions.

Years ago, Boston had a two-story bargain store, Filene’s Basement, where the merchandise was marked down according to how long it had been on the racks. Shoppers hunted for a drastically marked-down piece of clothing or shoes; they rarely found one but considered the hunt itself to be a lot of fun. In order to deal with the death of both parents within a short period of time, one of my mother’s friends told me that she would go to the Basement every weekday during her lunch hour.

“I never bought anything, but searching for the ultimate bargain distracted me temporarily from my grief.”

In order for distraction to work; in other words, doing X to take your mind off of thinking about issue Y, it should absorb all of one’s attention. Moreover, the distraction must be easy to initiate, not necessarily require the participation of someone else, and be convenient. Skill-driven physical activities such as indoor rock climbing or paddle boarding, where loss of concentration means falling off the rock wall or the paddleboard, are effective distractions. Still, simpler and more accessible activities like going to a driving range or playing Ping-Pong also work. Games such as bridge or chess or even group activities such as singing in a choir, or joining a conversation group in a language you are learning? They require total concentration and thus, for a while, are a total distraction. Crossword and other word puzzles work, unless they add a level of frustration to an already difficult situation, like waiting for a long-delayed plane. And sometimes a conversation that forces you to concentrate on what the other person is saying is a distraction from an inner voice that talks too much about your concerns.

Overeating is unfortunately often used as a distraction but, like retail therapy, the distraction is short and the cost, in calories, considerable. Indeed, overeaters are advised to redirect to new distraction activities such as: take a bath, take a walk, make a phone call, see a friend, or read a magazine to decrease the eating. These activities, however, are weak distractions and often are accompanied by the eating they are supposed to halt.

Sometimes thinking outside the box is the only way to identify a distraction that will work. Years ago, a weight-loss client complained that he was eating at night to deal with problems from work he was bringing home with him. “You should find something to distract you,” I told him, listing the obvious contenders.

Nothing seemed to appeal to him. Throwing up my hands in frustration I said, “Well, what about learning to play the bagpipes? That will keep you from eating.”

“What a good idea,” he said. “I have bagpipes in my closet. I haven’t played them in years. I am going to l start playing them tonight.”

I really hope he had soundproof walls.

Moods for Overeating: Good, Bad and Bored

“I am in the mood for  . . .(fill in the blank.)“

How many times have we said this to ourselves or others as we plan lunch or dinner? (Very few people are in the mood for anything except more sleep in the morning.) Sometimes the “mood” for a particular type of ethnic cooking or a prime piece of beef is heightened because the meal is celebratory, or a respite between bouts of unrelenting work or home meal preparation.  But this type of mood-influenced eating rarely lasts beyond a meal or two, and rarely leads to sustained overeating and weight gain. Too many calories may be consumed at a dinner celebrating the completion of a difficult project or an anniversary, but this type of eating rarely results in continued excessive calorie intake.

Not so the type of eating generated by moods we would rather not have. Boredom, and its frequent companion loneliness, may lead to an overly important focus on what to eat as a distraction from a long weekend or evenings alone with little to do. Rainy vacation days with few places to go inside to escape the dreary weather often brings tourists into restaurants for meals for which they may not even be hungry. It is something to do.  Long distance flights generate an appetite for foods that if served on the ground would be rejected immediately. Yet flyers that are not hungry will eat them because, again, it is something to do.

Bad moods are different. Anxiety, depression, premenstrual syndrome, and posttraumatic stress disorder are among negative or dysphoric moods that can provoke overeating, sometimes for days every month (PMS) or years (like PTSD when undiagnosed or untreated). Anxiety seems to trigger the excessive eating of binge eating disorder.  (“Emotional eating, alexithymia and binge-eating disorder in obese women,” Pinaquy, S., Chabrol, H., Louvet, J., Barbe, P., Obes, Re., 2003 11:195-201.)  But anxiety may also cause chronic overeating without the dramatic bouts of excessive food intake seen in binge disorder. In that case, the overeating may be enough to hinder successful weight loss and /or cause small but continuous weight gain. (“The association between obesity and anxiety disorders in the population: a systematic review and meta-analysis,” Gariepy, G., Nitka, D., and Schmitz, N., International J of Obesity 21;2010 34: 407-419).

Sometimes the obesity, which results from “bad mood” overeating, does not appear until years after the mood disorder appears. Researchers who examine the results of longitudinal health surveys have identified participants who have mood disorders at a young age and then become obese many years later. Data from the Nurses’ Health Study that began in l989 was used to see whether women who were diagnosed with posttraumatic stress disorder during the early years of the survey were more likely to be obese in later years than women without this disorder.  They found that having PTSD was a risk factor for obesity; women with this disorder gained more weight than women who experienced trauma but not PTSD and much more than women with neither.  (“The weight of traumatic stress: a prospective study of posttraumatic stress disorder symptoms and weight status in women,” Kubzansky, L., Bordelois, P., Jun, H., Roberrts, A., et al, AMA Psychiatry 2014; 71: 44-51.)

Depression is also a predictor of obesity and, like PTSD, the obesity may not appear for years after the depressive episodes.  Several research groups have used health surveys following male and female participants over many years to look at the weight status of people who were clinically depressed when they entered the study as older adolescents or young adults.  A significant number of them became obese a few or several years after they no longer were depressed. (“Trajectories of Change in Obesity and Symptoms of Depression: The CARDIA study,” Needham, B., Epel, E., Adler, N., Kiefe, C., Am J Public Health 2010; 100: 1040-106. “Overweight, Obesity, and Depression,” Luppino, F., deWit, L., Bouvy, P., et al, Arch Gen Psychiatry 2010; 67: 220-229.) Because the obesity appeared much later than the depression, the weight gain is probably not due to treatment with antidepressants although the studies did not look at this specifically.

 

We know that obesity and emotional overeating are strongly linked; certainly eating in response to anxiety and stress is evidence of this. Sometimes an immediate response to a stress is to grab something to eat. A friend who was renovating an old house told me that the first thing she did after she found that the closets were too narrow to accept a normal-size hanger (after the renovation) was to go to a convenience store and buy candy.  But what explains the development of obesity years after women develop PTSD or among depressed individuals years after the depression is gone?

The problem with looking at survey data as opposed to being able to talk to the people who provided the data is that these questions can’t be answered.  Were levels of physical activity low because of stress-associated fatigue? Did the people who were depressed and then years later became obese suffer in the years in between from chronic “blue mood”? Might they too have been too tired to exercise?  Was food a solution for their moods?  Did they eat to feel better, heedless of the calories they were consuming? Did they eat what they wanted because they had had enough deprivation in their lives and did not want to add the deprivation of a diet to everything else?

More research is needed to know the answers. But what we do know is that when people overeat, the reasons are as likely to be due to their mood as to what is tempting them.