Who’s Helping You Lose Weight From Your Antidepressant?

Good news: By now even mental health care givers know what their patients have known for years. Most drugs taken to relieve the symptoms of mental illness cause weight gain.

Bad news: There are probably more places to buy larger size clothing than weight-loss programs specifically designed to remove the pounds the medications added to your body.

A few days ago, I was answering a questionnaire on-line about weight gain. The questionnaire was part of a comprehensive weight-loss program supported by a government agency. I did not weigh enough to qualify for their weight-loss program, but I wanted to see how helpful the advice would be if I were indeed obese and/or became obese because of antidepressant medication.

Only one question out of many asked if I was taking medication that caused weight gain. I answered yes to see, if by doing so, I would be taken to a site that would advise me on how to get rid of extra pounds added by the antidepressants. But no. The questions continued on to ask the predictable: How often do I exercise? Do I eat more than I should? Do I eat when I am bored and/or when stressed?

The screening survey did ask me if I was hungry all the time. I answered yes to see whether a follow-up question would ask whether this was associated with my medications. It is well known that many antidepressants and mood stabilizers leave people so unsatisfied after eating that they may eat a second large meal only an hour or so after the first. Many find themselves snacking incessantly due to medication-associated appetite. Unfortunately the questionnaire was unconcerned about this.

The diet program posted on the website was no more helpful. The potential dieter was shown how to fill a small plate with foods obviously from the four food groups, and the amounts suggested closely followed USDA recommendations for healthy eating.  Curious as to whether buried somewhere in the diet or exercise advice there would be specific suggestions for people whose excess weight was due exclusively to their medications, I scanned all the other options on the website but found nothing.

Ironically, many who gained weight from taking antidepressants, mood stabilizers, and related drugs for mental disorders, fibromyalgia or even hot flushes from menopause, probably made the healthy food choices recommended on the website before they went on their medication. They never had any problem maintaining a healthy weight, a healthy degree of fitness, or healthy-food eating habits before starting on their medications. They never had to be convinced to eat their vegetables and go to a gym; this was their lifestyle…before the meds.

Sadly, conventional weight-loss advice such as on this website fails to consider that if a dieter is taking a medication that promotes overeating, the drug may overwhelm his or her willpower.  Exercise is also difficult. Fatigue from their depression and/or their medication makes it hard to move even from a chair or bed. Moreover, someone who’s formerly fit toned body is now flabby and fat, may feel too embarrassed to go back to a health club. What can he or she say? I am obese because I am taking a mood stabilizer?

A former weight-loss client of mine told me, “I go for a walk only after dark, when the neighbors can’t see me, because I know they are talking about how much weight I have gained.” Isn’t that a terrible coping mechanism for a shame undeserved?

A personalized approach to weight-loss is considered the best way of dealing with the issues that may prevent success, and weight-loss organizations offer individualized support programs to maintain adherence to a diet or exercise program, and change dysfunctional eating behavior. But where are the personalized weight-loss programs designed to:

Stop the insatiable need to eat caused by the medications?
Help someone with fibromyalgia who now faces the painful burden of moving a body made obese from medications taken to relieve pain?
Aid a formerly fit, athletic guy face his buddies in the gym when he now weighs fifty pounds more than he did a year ago, because of his medication?
Help a 100-pound overweight woman attend an event with relatives who knew her, pre-medication, as a size two?

It is not enough to ask on a questionnaire whether you gained weight from your medication.

If you ask the question, then provide the solution.

Fat Treats from Your Neighborhood Newspaper Food Writer

Last week the front page of my newspaper’s food section was covered almost entirely with a picture of six life-size doughnuts: glazed, powdered with sugar, and coated with either shredded coconut or chopped nuts. The reader could go beyond salivating over the pictures by turning to an inside page to learn where they could be bought, hot and fresh. These were no ordinary doughnuts, but specialty items like the cream-filled doughnut dipped in hard shell chocolate and topped with Frosted Flakes, caramel, strawberries and blueberries.  Or the chocolate doughnut filled with cream, rolled in graham crackers and topped with peanuts and a drizzle of white chocolate.  And should the reader decide to make them at home, the newspaper happily provided recipes, including an artery-clogging one for brioche doughnuts that called for nine large egg yolks and one stick of butter. But wait! If you wanted to make dinner before eating your doughnuts, the newspaper printed a recipe for fettuccine carbonara that called for 12 egg yolks, sausage and cheese.

I eagerly awaited the arrival of this week’s food section. Would it feature low-calorie recipes so the readers who may have gained a few pounds chasing down those incredibly fattening doughnuts could finally have guidance and incentive on how to begin losing them? Might there be a pasta recipe with fresh tomatoes and sparse amounts of olive oil and cheese? Would they publish a recipe for a fruit-based dessert, rather than another cream and egg yolk confection?  Alas, no. There was no admission that the doughnut spread might have caused the readers to spread (out of their clothes). No compensatory low-calorie recipes were printed.

My newspaper is not alone in tempting readers with foods they have no business eating unless they just scaled Mt. Rainier or trekked the length of the Amazon River.  Many women’s magazines typically feature both a diet plan and recipes for foods that, if consumed, will undo the effects of the diet. The Food Network has several programs that never should be watched by those attempting to lose weight or maintain their weight loss. There is one program featuring a guy with a strange haircut who eats incredibly fattening foods made in diners and family-owned restaurants around the country. I stopped watching the program because it always left me hungry.

Do those who decide what foods to picture in a newspaper or magazine realize how illustrations of triple-layered chocolate cake, melted cheese bubbling over a pan of lasagna, bacon-wrapped pork roast or sizzling sausage casseroles undermine will power? And more to point, do they realize how (there is no other way of saying this) hypocritical it is to talk about diets, or the latest research on sugar or carbohydrates or fat on health, and then tell the reader where to buy or how to make foods that contain copious quantities of these unhealthful ingredients? In all fairness, my newspaper did post the calories per serving for the fettuccine recipe (588 calories) but neglected to mention what the serving size was.  Moreover, no calories were given for the doughnut recipes. I wonder why?

All of this would not matter were we all thin and most of us were not engaged in a lifetime struggle to halt weight gain and/or maintain a previous weight loss. But we are not all thin; most of us do not work in jobs that burn up hundreds of calories, and too few of us exercise on a regular basis. It’s also important to consider that too many of us do not daily eat the recommended number of servings of the good stuff: nutrient-dense vegetables and fruits, high-fiber carbohydrates, and low or fat-free dairy products.  And let’s be honest. If your breakfast choices were a hot, fluffy, chocolate doughnut straight from the fryer or a bowl of cottage cheese topped with bran flakes for breakfast, what would you choose? And even if you choose the cottage cheese, wouldn’t you like a small bite of the doughnut also?

Staying at a healthy weight and eating a healthy diet would be so much simpler if unhealthy foods were not being advertised, featured in the print media, and showcased on television food shows. People who go off to spas to lose weight know this. They remove themselves from temptation and lose weight easily. People who decide to stop eating entire categories of foods like carbohydrates know this as well. They don’t have to fight against the urge to eat a doughnut or fettuccine, because they are not eating any carbohydrates.

But what about the rest of us? We need help in eating healthily without going off to a residential diet program or following unnatural diets. What if, for one month, only healthy foods were featured in the media? Good tasting healthy foods, not boiled kale or poached tofu, would be showcased; bakeries that sold whole grain, chewy, crusty breads instead of pastries would be noted. Restaurants whose menus encouraged consumption of vegetable and fruits would be reviewed, and only cooking shows demonstrating recipes using fat-free dairy products rather than heavy cream, butter, and egg yolk would be produced. Plus magazine dessert recipes would be limited to those containing ingredients from the healthy food groups. 

Maybe, just maybe, some exposed to this information might find it useful for the other 11 months of the year.

Standing Up For Better Health

“How do you like your new job?” I asked an acquaintance, an accountant who used to work at an organization with which I was involved. “I like the work,” he said, “but what I don’t like is sitting all day in a small cubicle, staring at a computer screen. ” He told me that his former job at this nonprofit required going to meetings in several offices scattered all over the building. “Some days I would walk what seemed to be miles, when I had several people to see. Not anymore. If I don’t leave my cubicle for lunch, I don’t move for eight or nine hours. I think all this sitting is doing something to my body.”

He was right to be concerned. A study published in the Annals of Internal Medicine confirmed what he and many others chained to their chairs and computers for hours at a time have suspected: sitting too long is not good for our health. [1] Scientists in Toronto reviewed several studies that looked at the association between sedentary behavior, health and longevity. While it is true that sitting still does prevent certain dangers to our health like falling (unless one falls off a chair), or being attacked by a grizzly bear, there is now good evidence that not moving may shorten our lifespan. According to the journal article, sedentary behavior is associated with a higher risk of cardiovascular disease, diabetes, and perhaps even cancer. Exercising for 30 to 60 minutes a day helps, but it doesn’t help enough, to offset the health risks of being stuck in a chair or car or truck for 8 or 9 hours a day.

Commuting adds its own sitting time to that of the workplace. My acquaintance no longer can walk or bike to work as he did in his previous job, but now sits in a car from 45 minutes to an hour and a half morning and evening, and given the traffic he encounters, he is obviously not alone.

What are we going to do about this problem? Other than lunch or bathroom breaks, few people have an excuse or opportunity to leave their chairs or stools whether they are security guards or day traders. Ironically, the only people who seem to have an excuse to move off their seats are smokers who are permitted to go outside for a cigarette. This is not a recommendation to smoke, but it doesn’t seem fair that non-smokers can’t also go outside for a mini-recess.

A few years back I volunteered to visit people in an assisted living facility. What I noticed was that everyone were either lying on a bed or sitting. Even those who could still walk weren’t. Somehow this seemed all right because the average age was over 90 (although we know now how important exercise is at any age), and I assumed that after one became old enough, it was all right to sit out the rest of one’s life. However, I suspect if I were to visit a typical office or assembly-line person working at a conveyor belt, most people would be sitting as much as the old folk. It is a sobering thought.

The sitting problem has not received as much attention as it should, given the financial and physical costs from the increased incidence of high blood pressure, diabetes, heart attacks, strokes and cancer among the sedentary. We don’t even know how inert we are. Perhaps a way to start to change this situation is to find out. The many devices that can measure physical activity could be used to see how much we move at work, while commuting, and at home.

How much and how often should we be moving? An author of the study, Robert Alter, recommends standing or moving one to three minutes every half hour and standing or exercising during commercials while watching television. He claims that exercising 30 minutes a day does not compensate for, “23 and a half hours of doing nothing…” In a sense he is endorsing fidgeting, e.g., the inability to sit, as a way to stay healthier. Some offices give their workers desks that can be raised so it is possible to work standing up as well as sitting. And desk-like platforms that can be attached to a small treadmill have some popularity, as does a pedaling device under their desk but again these are not commonplace. Bringing a dog to work that needs constant walking is another option, but even fewer workplaces endorse this.

The most important aspect of moving while working is simply remembering to do it. Computer or cell phone beeps as reminders are really necessary, because it is too easy to become so involved in work that moving is forgotten. More difficult is convincing employers of the importance of allowing their employees to stop working long enough to take a moving break. It is hard to believe that a supervisor will stop the conveyor belt, or halt the line of people going through security check, to allow a worker to stretch and walk around for two minutes every half hour. Can one enforce more frequent rest stops for long-distance truck drivers or bus drivers? There are long term health implications to budget in, but isn’t investing in improved health worth it?

Alas it seems that improving our health by moving more frequently seems like such an easy intervention, but realistically, it’s an almost impossible one to bring about.


1.) http://annals.org/article.aspx?articleid=2091327

Are Diet Sodas Really a Diet Food?

“I’ll have a diet soda with my French fries and double bacon cheeseburger. Oh! And one of those apple things,” he added, pointing to a pastry. The guy giving the order then looked at me as I waited my turn to order coffee at the highway restaurant rest stop. “Might as well save some calories, ” he laughed as he patted his prominent abdomen. I nodded to him as I asked for my coffee to be sweetened with a packet of the blue non-calorie sweetener.

We all seem to do it: eat a high-calorie meal but drink a no-calorie beverage sweetened with something artificial, munch on a bag of potato chips along with a diet soda, dig into an obscenely rich dessert but add a non-calorie sweetener rather than sugar to our coffee or tea, and drink alcoholic beverages without concern for their calories but “freak out” if we discover we are drinking real soda, rather than the diet stuff.

But do we really think of our coffee sweetened with an artificial sweetener as diet coffee? If we add diet quinine water to a gin and tonic, is the drink now a diet drink? Is artificially-sweetened bottled cranberry juice or flavored iced tea a diet beverage? Do hard candies sweetened with a sugar substitute qualify as diet candies?

A petition just filed with the U.S. Food and Drug Administration by a California-based group, U.S. Right to Know, wants companies to stop using the word “diet” on products that use artificial sweeteners. The petition states that: “Consumers are using products — Diet Coke and Diet Pepsi — that are advertised to make us think they assist in weight loss, when in fact ample scientific evidence suggests that this is not true and (instead quite) the opposite may well be true.” [1]

Interesting. Do people really believe that they will lose weight by drinking these products? I doubt that the man standing in front of me contemplating his snack of a double cheeseburger, fries and dessert thought that he would be three pounds lighter because he drank a diet soda. And I suspect that my not ordering a doughnut (although I wanted to) along with my coffee had more of an impact on my weight than putting that stuff from that blue packet in my coffee.

The writers of the petition reviewed the research literature on diet beverages and weight gain that seemed to confirm the need to remove the word diet from sugar-free beverages. Some studies such one published in the Yale Journal of Biology and Medicine in 2010 suggested that artificial sweeteners may contribute to weight gain, [2] and another in 2012 found that an association between artificially sweetened beverages and weight gain might exist in children. [3] But just because an association exists between two events doesn’t mean there is a causative relationship between them. I have a relative who drinks copious quantities of a caffeinated diet beverage because she hates coffee and tea, but wants to consume caffeine throughout the day. She doesn’t like the taste of the fructose-sweetened version of the caffeinated sodas; they taste too sweet to her. If I asked her whether she thought drinking so much diet soda would help her lose weight, her answer would be, “In my dreams.”

However, might diet beverages indirectly cause weight gain? Might the man in front of me at the fast food restaurant justify ordering dessert because his beverage contained no calories? Do we have less guilt at gobbling up a rich dessert because there is no sugar in our tea? Do we reach for the sugarless chocolate ice cream in the freezer without a thought to its calories because it is artificially sweetened?

There is another, more biologically-subtle, reason why so-called sugar-free foods might cause weight gain. Many people have a natural and unavoidable craving for carbohydrates, especially in the afternoon and/or evenings. The craving arises from their brains and is related to the brain’s need to make the neurotransmitter serotonin. Often the craving is accompanied by a small, but very real, deterioration in mood. Eating a carbohydrate, sweet or starchy, will restore serotonin levels and improve mood soon after the carbohydrate is digested. [4 ]If the craver attempts to satisfy this need to eat something sweet with something artificially sweetened, there will be no restoration of serotonin levels in the brain and no improvement in mood. So what happens? The craver may eventually give in to his or her craving, which was, of course, not satisfied by the diet beverage. Consequently, this person may scarf down a snack food that is sugary but also high in fat like a chocolate chip cookie, an ice cream cone, a candy bar, or a cupcake with three inches of frosting.

Perhaps if the craver satisfied the craving immediately by eating a low-calorie, mildly-sweet snack like graham crackers or licorice sticks rather than attempting to quell it with the diet beverage, the impulse to eat a fattening carbohydrate snack could have been curtailed.

It will be interesting to see what becomes of the petition. Since so many of us order a diet (fill in the blank) drink without giving a nanosecond’s thought to the word diet on the label, it may be very difficult for us to get used to another name. We tend to use the work Xerox instead of copy as in, “I will Xerox this” or Kleenex rather than facial tissue as in, “I have a Kleenex.” So I suspect we will continue to call artificially sweetened beverages diet, even though we know they are not.

1.) http://usrtk.org/sweeteners/diet-soda-fraud/

Will the Paleo Diet Turn You Into Attila the Hun?

For the followers of the Paleo diet, the one that allows you to eat mainly meat, with a few carefully chosen vegetables and fruits thrown in for garnish, it might be instructive to read about the exploits of a famous, infamous devourer of only flesh: Attila the Hun.

Attila is considered one of the most ferocious warriors in history. [1] Born in 406 A.D. in what is now Hungary, he and his brother (until Attila killed him) ruled over the tribes of the Hun kingdom. But soon his conquests went far beyond being the ruler of the neighborhood. Known as the Scourge of God, Attila attacked, devastated and conquered lands from the Black Sea to the Mediterranean with a ruthlessness that made his name synonymous with terror and savagery.

Could his Paleo-type diet have anything to do with his successful, murderous objectives? According to eyewitness accounts of those who dined with him, and as reported in Gibbons’ The Decline and Fall of the Roman Empire, Attila followed the Paleo diet:

“The royal table was served in wooden cups and platters, flesh was his only food, and the conqueror of the North never tasted the luxury of bread.” [2]

Many in the 21st century will applaud Attila’s diet, although not many might want him as a neighbor. “Down with bread!” these nouveau-Paleos will say. “Out with any carbohydrate! Dump the dairy, bump the beans, discard most fruit and vegetables and eat animal protein or perish!” Adherents of this diet, cleansed of the evil nutrient carbohydrate, claim unfettered amounts of energy, a lean strong body and an alert, mentally-active brain.

Attila died at 47, but the circumstances of his death are unclear. He either died from an unstoppable nose bleed or just as likely was poisoned or stabbed to death. But it is also possible that his “flesh” diet may have contributed to his early demise.

A highly-respected clinical researcher, Dean Ornish, in a recent article in the New York Times, elegantly described the health hazards of a predominantly animal protein diet. His research confirmed the dramatic improvement in cardiovascular health from eating high-fiber carbohydrates along with vegetables and fruits and eating only small amounts of animal protein. [3] Might Attila have died from an early heart attack?

Perhaps his cognitive abilities were impaired by his diet, so he did not take precautions to prevent himself from being murdered. A study published this March by the journal The Lancet [4] looked at changes in cognition, including executive function and mental alertness, among 2,654 Finnish subjects ages 60-77. Half were told to stay on their normal diet that was relatively high in animal protein, and the test group was given a diet in which over half the calories came from complex carbohydrates, fruits and vegetables, and minimal consumption of animal protein and fat. Those eating a diet somewhat similar to that proposed by Dean Ornish in this NYT op-ed did significantly better on tests of cognition such as executive function and mental alertness.

So did a diet only of animal meat leave Attila a little loopy?

Or maybe he was in such a bad mood all the time that he became impossible to live with. It is said that he died on his marital bed. (Lucky bride?) A zero carbohydrate diet all his life could have done a job on his serotonin levels. We know from decades of research on how eating carbohydrates indirectly causes serotonin to be made. [5] Without carbs in his diet, his brain may have had so little active serotonin that he was depressed, angry, or just apathetic about conquering more lands. Those familiar with two pesky mood problems, PMS and/or winter depression, know the feeling of fatigue, irritability, depression and anger associated with too little serotonin activity.

Of course, Paleo man and Attila would not have known that even though protein contains tryptophan, the amino acid out of which serotonin is made, very little tryptophan gets into the brain when protein is eaten. It took several more centuries for this to be discovered by some carbohydrate-eating scientists. [6]

But maybe we are judging Attila too harshly. Gibbons says that bread was a luxury. Could it be that Attila had tired of his Paleo diet and his conquests were driven by the need to find a good loaf?


1.) http://www.britannica.com/EBchecked/topic/42236/Attila
2.) Gibbon Edward, The Decline and Fall of the Roman Empire, 1826 Vol 3. Chapter 28, p.210
3.) http://www.nytimes.com/2015/03/23/opinion/the-myth-of-high-protein-diets.html?_r=0
4.) http://press.thelancet.com/FINGER.pdf
5.) http://www.ncbi.nlm.nih.gov/pubmed/8697046
6.) Ibid.

Why the Swiss Can Eat So Much Chocolate and Stay Thin (& We Can’t)

Living in Switzerland many years ago should have been prepared me for the onslaught of chocolate bars displayed in the Zurich supermarket during a recent visit. Perhaps the upcoming Easter holiday had amplified the shelf space devoted to this particular confection; chocolate bunnies and chicks in all sizes vied for space with seemingly miles of chocolate bars, boxes of expensive chocolate truffles, and elaborately wrapped balls of melted chocolate encased in slightly bitter chocolate shells. “This must be Swiss chocolate heaven,” I murmured to my husband as we gathered up armfuls of chocolate bars to take back to the States. “They eat all this chocolate, and yet they stay thin.”  Earlier that day, as I scanned the crowds of commuters exiting the central railroad station, as well as the pedestrians strolling near the lake in the unexpected spring-like weather, I saw only a handful that might be called obese. This contrasted dramatically with the travelers and airport personnel when we arrived back in the U.S. a few days later. There it was difficult to find anyone who was thin.

How to counter the so-called obesity epidemic in the States has occupied panels of obesity experts, researchers analyzing trends in nutrient intake, physicians prescribing the latest weight-loss regimens and/or medications, and enough Internet space on the best way to lose weight to fill a small planet.

The latest recommendation to cut back on sugar consumption (as that nutrient, not fat, seems to be what causes us to become obese) is yet one more attempt to solve what seems to be an insoluble problem. Although a casual reading of this recommendation might lead one to stop consuming anything that has sugar from milk (lactose) to apples (fructose and glucose) to ketchup (sucrose), the recommendation is an attempt to make people stop consuming soda and drinks that are high in fructose. A corollary interpretation from these recommendations could lead one to assume it is all right to eat butter, salt pork and pork rinds along with heaps of mayonnaise, heavy cream and bacon grease, because it is sugar, not fat, that is causing us to balloon into supersizes.

Which brings us back to the Swiss and their chocolate.

Chocolate contains a substantial amount of both fat (cocoa butter) and sugar. Eating small amounts of it may confer some health benefit because of some tiny amounts of antioxidants, but it hardly competes as a diet food compared to, for example, kale or broiled salmon. Indeed, reading the label of a bar of dark (72% cacao) chocolate bar purchased from the Swiss supermarket, I noticed that the 100 gram bar (3½ ounces) contains 591 calories. So how do the Swiss stay so thin, munching on their fat and sugar-filled snacks?

The answer, of course, has nothing to do with how much sugar or fat they eat. It has everything to do with portion size and exercise.

Like so much of the world outside the U.S., the Swiss do not eat the gigantic portions of food that we Americans typically consume. Dinner one evening at this conference we were attending was a buffet, but unlike those in American restaurants, diners did not serve themselves. Everything was served, even a sauce or salad dressing, and the portions were, to my American eye, exceedingly small: a few ounces of the entrees and tablespoon-size amounts of side dishes and desserts. Obesity specialists in the U.S. have pointed to our enormous portions as a major contributor to weight gain, but that has not yet translated into smaller burgers or bagels.

Exercise probably trumps portion size in preventing the Swiss from becoming fat from chocolate, because they never stop moving. Children are put on skis as soon as they can walk, and the elderly even hike in the summer and cross-country ski during the snow months. Sunday afternoons find entire families out walking, climbing, biking, sledding, sailing, or doing something other than watching sports on television or reading the newspaper in an armchair. They do not consider this exercise as in, “I have to workout or run in order to stay in shape and not gain weight.” Instead, all this national physical activity is their lifestyle, as basic to their routine as sleeping or brushing their teeth.

When we lived in Switzerland, and went for our own hikes, we noticed a fork and knife on signs along with the number of minutes it would take the hiker to reach the restaurant.  Of course.  After all, there had to be chocolate at the end of the road.

Isn’t it time to stop the battles over how much is too much, of what we are eating? Is it too much to ask that moderation in nutrient intake be promoted as a goal, rather than eliminating or excessively consuming one nutrient or another as a way to stay healthy? And isn’t it time to alter our work/leisure schedule to insert physical activity as a basic part of our lifestyle? If we stopped sitting in a chair, obsessively searching the Internet for a solution to obesity and started to move instead, we, like the Swiss, could enjoy our chocolate and stay thin.


Lydia Pinkham, Snake Oil and Herbal Supplements

,If you were an American woman living any time between the mid-19th and early 20th century, and if you suffered from women’s troubles, then you may have dosed yourself with Lydia Pinkham’s Vegetable Compound. Developed from a recipe sold, as the story goes, to her father for $25.00 as payment for a debt, the herbal-alcohol mixture was transformed through aggressive marketing into a wildly successful product. Lydia’s picture was on the label, as it should have been, since she concocted the potion in her kitchen. Eventually its manufacture moved into a commercial facility.

Pinkham’s Vegetable Compound promised to cure, or at least relieve, ailments that at the time had no treatment.1 Women with menstrual difficulties were treated with leeches, or even surgery, and premenstrual syndrome was often ascribed to either hysterical personalities or water on the brain. And of course, many women did not want to go to a male physician for their female problems. Treating themselves with the vegetable compound maintained their privacy and probably, through its placebo effect, took away some of their distress.

Today we chuckle at the naiveté of Lydia Pinkham’s’ customers and the many others who purchased products that in our modern eyes were clearly fake, and had nothing in them to relieve symptoms or cure disease. Patent medicines, aka Quack Medicines, claimed to cure or prevent ailments ranging from venereal disease to indigestion to cancer. Their promises were outrageous. One well-advertised product supposedly contained snake oil, an ingredient reportedly miraculous in its ability to cure. Subsequently if someone tried to sell an obviously fake medicine, he stood accused of selling snake oil. 2

Of course this could never happen today; we are much too sophisticated and medically knowledgeable to believe in such nonsense.

Or are we?

Lydia Pinkham’s Vegetable Compound contained many of the ingredients–like black cohosh root, fenugreek seed, dandelion root, motherwort, and gentian root–sold today to help women with menstrual and/or menopausal symptoms. However, unlike today’s elixirs for female problems, Pinkham’s beverage contained a substantial amount of alcohol, which may have relieved some of the stress the women were feeling from their cramps and bloating.

A recent issue of a popular tabloid magazine directed to women and sold at the supermarket checkout counter reported these medical claims:

A 500 mg dose of a flowering plant called Rhodiola (not sure if one is supposed to eat just the flowers or the stem and leaves as well)  will decrease stress and accelerate weight loss by making more serotonin (stress relief) and increasing energy output (weight loss). Fact:  Serotonin is made from the amino acid tryptophan. There is no evidence that this flower increases energy output.
Holy basil, which related to mint, will relieve stress by making a soothing hormone, dopamine. 

Dopamine is like amphetamine. It energizes and stimulates when it is released; it does not soothe. Also, it is not a hormone.

Siberian ginseng will reduce your tension, assuming that holy basil and the Rhodiola flower has not already done so. It soothes your adrenal gland, in case you were wondering. Really?

There are many more of these fascinating tidbits of ‘snake-oil’ recommendations, and this magazine is not alone in describing them. Just go to the Internet.

The Quack Medicines of the last two centuries were not only ineffective; many of them were dangerous and could even cause death. Morphine, opium, cocaine, and alcohol were added, sometimes in substantial quantities and given not only to adults, but also to babies and children who might have colic or were fussy because of teething. Not surprisingly, physicians and medical societies were skeptical and critical of this ‘alternative’ medicine and those who did not want alcohol and drugs like opium to be included in these potions reinforced their criticism. But also, not surprisingly, there was pushback from manufacturers of the quack goods, as well as from the newspaper owners who benefited from the advertisements. Finally, in l908, Congress passed the Pure Food and Drug Act under President Theodore Roosevelt’s administration and prohibited the sale of products with misleading advertising and unlabeled or mislabeled ingredients. 3 So the era of Lydia Pinkham and similar patent medicines came to an end.

Or did it?

More than 100 years later, the New York Attorney General investigated the contents of what we now call herbal supplements. And like the Emperor’s new clothes, whatever was supposed to be there wasn’t. Herbs like St John’s Wort and ginseng listed on the label were not in the bottles; only the fillers like starch were to be found.4 Was the testing accurate? The manufacturers fighting the inevitably swift to arrive class action suits claim that the testing may have been flawed.5 However others stated that this was not the first time the content of an herbal supplement was missing or the dose incorrectly stated.

What is the consumer of such products to believe? At least Lydia Pinkham’s beverage contained enough alcohol to give the user a slight buzz, even if she did not get relief from menstrual cramps. But what if you were taking Echinacea to prevent getting a cold, or St John’s Wort to help your depression? And now you find out that the Echinacea was missing from the bottle and it was filled with ground houseplants instead, or that your St John’s Wort bottle contained only rice, garlic or beans?

There are two conclusions: The first is that a placebo is mighty powerful and rarely causes side effects, so be happy you stayed healthy, didn’t get the cold and your depression got better, even if you were ingesting ground rice. The second is that it is time to hold the manufacturers of herbs, twigs, grasses, and root supplements to the same standards to which pharmaceutical manufacturers must adhere. And maybe we should bring Lydia Pinkham’s beverage back on the market. At least she labeled her potions correctly.

1.) http://www.mc.vanderbilt.edu/diglib/sc_diglib/hc/nostrums/pinkham.html
2.) http://www.npr.org/blogs/codeswitch/2013/08/26/215761377/a-history-of-snake-oil-salesmen
3.) http://history.house.gov/HistoricalHighlight/Detail/15032393280?ret=True
4.) http://www.ag.ny.gov/press-release/ag-schneiderman-asks-major-retailers-halt-sales-certain-herbal-supplements-dna-tests
5.) http://www.crnusa.org/CRNPR15-CRMCriticizesNYAGHerbal020315.html

Can We Have a Food-Free Zone?

The meeting was scheduled to begin at 9:30am, but traffic woes for many caused a half hour delay. The 50 or so women already present thus had extra time to eat the breakfast items laid out on the long table: bagels and cream cheese, croissants, muffins and coffee cake. And most of us did.

The woman sitting next to me complained that she had just started a diet and it was hard for her to resist eating one of everything on the table. “Of course I ate breakfast before leaving home,” she told me.  “I am not hungry. But it’s hard to resist a croissant or muffin. Why must there always be food wherever I go?”

Why indeed. I suspect every woman at the meeting had either eaten before leaving home or, if not, avoided eating because she was not hungry early in the morning. Was it really necessary to put out food, and so much of it that everyone there could have eaten a bagel, a croissant and a muffin without leaving the table empty? Why must refreshments accompany so many meetings, workshops as well as morning or afternoon programs? People attending these events must have food at home; they are not depending on the ‘refreshments’ to compensate for an empty refrigerator.

Food has become inextricably linked with activities outside the home. Performance venues always sell food although some, thankfully, like the theater or concert hall, do not do so during the actual performance but limit sales to before programming and during intermission. This is not the case at sporting events, where someone can spend as much time buying food and eating as they do watching the game. In fact, you can watch the game while you buy food and eat, courtesy of big screen TVs inside stadiums. Religious services are followed by an ‘eat and greet’ hour, parent-teacher evenings have snacks set out in the gym or lunchroom, and late afternoon lectures at universities provide snacks and drinks before the speaker begins. It begs the question, is the food provided to get people to leave their labs and libraries to come to a talk? I have a young relative, a law school student, who managed to avoid cooking dinner for an entire semester because so many of the afternoon and evening lectures were accompanied by substantial appetizers.

It is hard to resist eating when faced with an array of cookies, coffee cake, or chips and dip, even when we are not hungry. A cube of cheese, a cracker, a potato chip scooping up dip, perhaps a tiny sandwich: How much caloric harm can these do? They are so small! And then of course, if we are chitchatting while standing next to the table with the food, our hand may manage to snag some nuts or a cookie and pop it into our mouths without us really noticing.

So we nibble and snack at these situations unaware of how much we are eating.  We behave as if we are on, as that old joke goes, the Seafood diet: “Whatever we see, we eat.”

Are we, by being so generous with our culinary offerings at every gathering of more than two humans and a dog, contributing to weight gain? Might we be obesity enablers? Probably.

So one must then ask, is it time to change, unless we wish to continue, as a nation, to gain weight?  We should do two things: cut down, or cut out the food at all events not actually linked to a meal. (Obviously if there is to be an after-dinner speaker, one has to serve dinner first.)  It will take time to change people’s expectations that whenever someone is speaking, someone else is eating. And it is possible that some lectures might have fewer attendees because the lure of food is not longer present. One way of defusing the disappointment is to announce that the money that had been used to buy snacks is now being given to shelters or other charities.  

Resistance to making certain places and events into food-free zones will come from those who believe that many professional and/or social encounters work better when food (and drink) is available. How can people gather at an art exhibition or after a church service if only coffee, tea and soda water are served? What will people do with themselves if no cookies are offered at a parent-teacher night? No one will hang around for the last three talks of an all-day conference if they don’t get fed at the 3:30pm coffee break. Who will sit through a movie without buying something from the concession stand? (We all know that this is how theaters make their money…) Yet we manage to sit through a play, a concert, and a funeral without eating.

It is time to undo the almost unconscious expectation that someone will feed us whenever we go to an event. This was appropriate when we were toddlers and fed Cheerios to stop our whining. But we are grownups now, and if we don’t stop our almost constant eating, we will certainly start our own whining at our growing girth.

What Does the Paleo Diet Man Give His Sweetheart for Valentine’s Day?

The original cave dwellers, back in the pre-agricultural, pre-civilization neighborhood, didn’t have to worry about Valentine’s Day. Its invention was thousands of years in the future, and so Paleo man could live and die (his life span was exceedingly short) without guilt at not giving Paleo woman chocolate for that special day in February.

Not so today. The high protein and fat diet, mimicking the food supply of our distinct ancestors, may help some shed weight and keep it off, but it does cause some pesky problems. The most immediate: what would be an appropriate gift on this holiday that links romance with sweet goodies? How does someone who will defend to his last breath (bad breath, by the way, is a side effect of the diet) the dietary perfection of not eating carbohydrates, yet give his sweetheart a big box of chocolates? A friend suggested substituting cheesecake, but this baked good contains sugar and, alas, dairy, another food group avoided by modern Paleo dieting man.  Perhaps a bouquet of bones, the kind that are attached to rib steaks, would do. If the sweetie doesn’t want them, her dog will.

Valentine’s Day is a lovely example of sharing with others the pleasurable self-indulgence of eating chocolate, heart-shaped cookies iced with silly romantic messages, tiny sugar candies in yellow, pink, and green, or maybe those wildly expensive, melt-in-the-mouth pastel French macaroons.   But these delectable icons of Valentine’s Day are forbidden to those who lump sugar sweetened treats with poison, addictive drugs, and brain-altering medications. And just as one would not give one’s sweetheart a piece of chocolate laced with arsenic (well most people wouldn’t unless, they had another sweetheart in the wings), the true-blooded Paleo Diet man cannot give his beloved any yummy, mouth-watering, mood-elevating confection even on the day of days when this is done.

The grumpy, aggressive, distractible moods of the Paleo dieter are well known. One has only to go to blog sites and read about the aforementioned bad breath and PMS-like symptoms of those, mostly men, who believe that their weight, health and longevity are dependent on avoiding carbohydrates. The complaints from those who live, work, or socialize with a Paleo dieter give some idea of how mood, concentration, and even sleep can be deranged by lack of carbohydrates. The reason is simple: the absence of carbohydrates in the diet prevents the mood-soothing, sleep-producing, concentration-enhancing effects of serotonin from improving one’s life.

No serotonin is made when no carbohydrate is consumed.

This equates to that eventually the serotonin levels in the brain drop, leaving behind people with the empathy of a mosquito and the calm of a hummingbird.

Sacrificing one’s good nature and restful sleep for the supposed health benefits of eating only protein and fat on occasion, is a personal decision.  But when one’s eating ideology may affect others, as in “Can I give my honey chocolate for Valentine’s Day when I think it will cause her mental and physical distress?” the decision must be based on science, not myth.

Some myths take a while to be replaced by fact. The harm caused by smoking was not only disbelieved for decades, but people thought the reverse was true. The belief that smoking was good for you was changed only when it was indisputably shown that smoking was associated with respiratory distress, cardiovascular disease and cancer.

Fortunately, the role of carbohydrates as the basic energy source for the body including how their role in setting in motion a physiological process that results in serotonin synthesis, has been well established.  Moreover, humans have been eating carbohydrates as their staple food ever since the first human figured out how to plant, harvest and process grains. It is no accident that in ancient Hebrew the word for bread is also used for food. Bread is mentioned in the first line of the Lord’s Prayer, and breaking bread together describes positive social and indeed, political interactions. Somehow, despite Paleo Diet man’s assertions to the contrary, we have survived all these centuries of eating carbohydrates–and even sweets on Valentine’s Day. (Of course, there are medical conditions like diabetes that limit–but do not eliminate—carbohydrate consumption.)

So Paleo Diet man, why not replace that bouquet of steak bones with a small, sweet something that has a red bow on top? And maybe you have a nibble, too.


The New Generation of Weight-Loss Drugs: Which Is Best?

Suddenly, for the people struggling to lose weight but are failing to do so with diets and exercise alone? They now have help.  The FDA has approved four drugs for the treatment of obesity over the last two years.  While they will not have the potency of tapeworm eggs, a sure way of losing weight promoted about a hundred years ago, the drugs may prevent many from developing Type 2 diabetes and/or the health risks of high blood pressure or elevated cholesterol levels.

Unlike wrinkle cream or Botox, available even to those who do not need it, physicians are not supposed to prescribe them for skinny people who want to get skinnier. If your mother-of-the-bride dress may be snug for that May wedding, don’t expect a reputable physician to give you a weight-loss medication so you can go from a size 10 to a size 8. That is, unless you stand under four feet and wear a size 10 dress; this would mean that you really are obese.

Other limitations to the use of these drugs have been recommended as well by Dr. Caroline Apovian, a physician from Boston University School of Medicine. She chaired a group from the Endocrine Society; a group tasked with the job of providing guidelines for physicians prescribing these drugs. Endocrinologists tend to specialize in the treatment of diabetes, and thus would be likely to prescribe these drugs to help obese patients with Type 2 diabetes lose weight.  Although most of the advice centered on preventing drug-drug interactions, (avoiding weight-loss drugs that contain phentermine or buproprion if the patient has high blood pressure) Dr. Apovian stressed the importance of diet, exercise and counseling. Obviously one of these weight-loss drugs is the magic potion that will banish excess fat forever.

What are these drugs and how effective are they? The drugs are: BELVIQ (generic name: lorcaserin); QSYMIA (a combination of two drugs:the generic names are phentermine and topiramate); CONTRAVE (a combination of two drugs: the generic names are buproprion and naltrexone); and SAXENDA (generic name: liraglutide).

The drugs differ in how they bring about weight loss. They all affect the brain, but in different ways. BELVIQ works with serotonin to increase a sense of fullness before much food has been eaten.  OSYMIA relies on a combination of phentermine, a type of amphetamine that works on the brain chemical dopamine to decrease hunger, and topiramate, a drug originally prescribed as an anti-epileptic drug that also increases satiety or early fullness after eating.  However, regarding topiramate, according to an article on the web site Drugs.com, “the precise mechanism of action of topiramate on chronic weight management is not known.” The naltrexone in  CONTRAVE has been used to treat alcohol and opioid dependency and bupropion  (trade name Wellbutrin) treats depression and smoking cessation. It affects dopamine and thus may decrease hunger.  Some believe that naltrexone decreases the pleasure experienced in eating, so theoretically, the dieter will lose the urge to eat a piece of molten chocolate cake or a bacon cheeseburger with onion rings. Or if this Contrave user does give into temptation and eat these foods, they won’t get any pleasure from doing so.

Saxenda was just approved at the conclusion of 2014. Saxenda has the same composition as Victoza, a drug used to treat type 2 diabetes, but Saxenda has not beenapproved to treat diabetes, only obesity. This drug does not affect the brain directly, as do the other drugs. Saxenda’s composition is similar to a naturally found compound in the intestines called glucagon-like peptide-1 receptor agonist (this will not be on a test) or GLP-1. This GLP-1 and the drug combine to help cells in the pancreas make and release insulin so that blood sugar levels stay normal. This compound can get into the brain and may affect regions of the brain involved with appetite, but not too much more is known about how this drug makes people eat less.

The first three drugs are taken in pill form. Saxenda must be injected daily.

In order to be approved as a weight loss drug by the FDA, 5% of pre-treatment body weight had to be lost by 12 weeks in clinical trials.  Based on these results, physicians prescribing these drugs are told that if this doesn’t occur with their patients, then the drug may not be suitable for them and should not be taken any longer and/or the dose should be increased.

So who can get the medication? If a person is healthy except for obesity, which translates into that he or she must have a BMI (body mass index) of 30 or more. BMI can be calculated by dividing one’s weight in kilograms by height in meters squared. For the arithmetic challenged, charts that convert your weight in pounds and height in inches to these metric measurements are available on the Internet, along with highlighted areas indicating obesity. For example, a 5’5” woman who weighs 180 pounds has a BMI of 30. A 5’10” man who weighs 210 pounds also has a BMI of 30.  However, if another medical condition like high blood pressure is present, a weight-loss drug can be given if the person has a BMI of 27.

Alas, the side effects of weight loss drugs must be considered as well.  One consideration is whether other drugs are being taken that might interact with the weight-loss drug and lead to serious medical complications. Like the monotonous voice reciting the side effects of medications being advertised on television, the potential side effects list is long and for some of the weight-loss drugs, perhaps intolerable or dangerous. For example, someone with a family history of thyroid tumors cannot take Saxenda, and some may not tolerate the nausea it causes. Contrave must not be used in people with seizure disorders and contains a warning about an increased risk of suicidal thoughts and behavior. Qsymia can cause mood disorders as well as depression, and should be avoided by people with a history of depression. It also is associated with cognitive problems such as decrease in attention, memory and word retrieval.

Belviq comes with the warning that it must not be taken if the patient is on one of a long list of drugs or herbal supplements, including St John’s Wort and tryptophan, for mood disorders.

And yes, every one of the drugs will be effective only if…you know what is coming…the patient follows a diet and exercises regularly!

So which is the best for you?  The choice depends on your personal overeating profile: Is your hunger uncontrollable, or do you have difficulty stopping when you are full? Do you have addictive-like cravings? The choice also depends on your medical profile, which includes your current medications, and underlying health problems such as diabetes or depression. Your physician will be the best and only judge of this. But knowing something about these drugs before consulting your healthcare giver will make you a full participant in the decision.