How Can You Get Enough Nutrients If You Don’t Eat Very Much?

Some of the more popular reality shows on television display various mental health pathologies such as super rich housewives always fighting with each other (when they are not having their hair done and drinking wine), or a show about hoarding to the point of suffocation, or even a view into living inside a 600-pound body that is so heavy, any movement is difficult and painful. The latter program is particularly sad, in that it shows how obsessive eating is almost always the result of early trauma, and how difficult it is for the overeater to deal with the pain of such trauma when the emotionally deadening effect of food is removed.

 

What has not been depicted so far is a reality program on the struggles of people at the other end of the eating spectrum. These are the people who believe that, like the Duchess of Windsor, one can never be too rich or too thin. These are the people whose body weight is so low that they run the risk of death. These are the people whose obsession with being extremely thin is as unshakable as the 600-pound individual who seems to be addicted to food.  

 

Perhaps the stories of the too thin are not told because the viewer may not be interested in watching an anorectic chase an almost invisible morsel of food around the plate, before grudgingly eating it and then exercising for three hours to work off the 3 calories the food may have contained. Or perhaps it is because the fashion industry has convinced us that thinness is something to be coveted, even if the price of a too thin body may be malnutrition or, if it becomes anorexia, even death.

 

A few weeks ago I walked past a facility holding a fundraising event. What caught my attention was a group of extremely tall women wearing gowns that would have looked appropriate on someone’s red carpet. They must have been models; they had perfect features, either from genes or a plastic surgeon. I confess I stared at them, not just because they looked so exotic in my neighborhood but also because they were so THIN. They were not skeletal but just on the other side of being all bones and no flesh. Another woman stopped and looked with me. She said, “They don’t look quite real, do they? But it must be nice to be so thin.”

 

Somehow we don’t think of being model thin as associated with health issues. The warnings about the risks of eating too much or the wrong kinds of food are well known, they are hard to escape: Don’t eat too much, don’t eat too much sugar, exercise frequently, and get rid of belly fat.  But how many of us know what medical woes are awaiting the very thin? One has to go searching for them. And some can be as deadly as those associated with morbid obesity.

 

When very little food is eaten, as must be the case if someone is to maintain a weight 20 or so pounds less than normal, an inadequate consumption of nutrients can result. Calcium and vitamin D deficiencies are common, and can result in osteoporosis. This disease, which is mainly silent until the first of many bone fractures occurs, is characterized by the loss of bone mass. This disease usually shows itself around menopause, but the bone loss due to nutrient deficiencies may start decades earlier. Other symptoms of nutrient inadequacy such as thinning hair, fatigue, dry skin and bruising of the skin also may not show up for several years, but can be traced back to a very low nutrient sparse diet. A study of the nutritional adequacy of the Mediterranean Diet in Spain among thin women indicated that they were deficient in vitamins A, D, E, B2, B6 and folic acid, as well as several minerals such as iron. (Ortega, R, Lopez Sobaler, A, et al  Arch Latinoam Nutr. 2004 Jun54; 87-91.)

 

Even athletes, whom one assumes eat healthfully, may be nutrient deficient if they are dieting. Female volleyball players who play the game in the scantiest of uniforms were found to be deficient in a variety of vitamins and minerals, due to their dieting in order to reach a figure perfect weight. (Beals, K,  J Am Diet Assoc. 2002;102:1293–1296). And dancers who must maintain low weight and low body fat are particularly vulnerable to nutrient deficiencies ( Sousa, M, Carvalho, P et al ,Med Probl Perform Art 2013 28: 119-123).

 

Models, dancers and some athletes accept the necessity of maintaining an abnormally low weight as one of the demands of their profession. They may be able to compensate for their restricted calorie, and thus nutrient, intake with the use of supplements. However, supplements rarely provide all the nutrients they would get from food, if only they were allowed to eat more. 

 

Thinness is also prized among women whose weight is irrelevant to their profession but not to their social standing. And its potential nutritional toll and subsequent health problems may be ignored as thoroughly as by an obese individual who cannot stop overeating. A quasi-sociological analyses of the lifestyle of women who live in the rarified neighborhood of New York’s Upper East Side points this out. In her book, The Primates of the Upper East Side, Dr. Wednesday Martin describes the non-eating that takes place at social events. Women diet continually and subject their bodies to workouts that would make a Marine recruit weep in order to have a perfect body. So many foods are eliminated from their diet in order to achieve the desired thin state? It is a wonder that the residents of this neighborhood don’t suffer from scurvy, anemia and other nutrient deficiencies. They are not addicted to food, but rather they are addicted to their almost pathologically thin bodies.

 

And yet this bizarre eating behavior is not the subject of reality television, or urgent messages from health organizations warning about its long-term consequences of nutrient deficiency. We see the consequences of the massive overeating of the 600-pound individual and tsk tsk at what that person has done to his or her body. Maybe it is time to tsk tsk over the damage the too thin are also doing to their health.   

Can You Give a Man a Box of Chocolate for Valentine’s Day?

In former times, when women were courted (at least in books) with gifts, flowers, poems, and perfume, giving a box of ornately wrapped chocolate for Valentine’s Day was not only appropriate, but expected. Presenting a red velvet box tied with a glossy ribbon that contained fancy chocolates was a socially acceptable way of showing interest in the other, female, sex. Moreover, the price of chocolate varied sufficiently, so that brands and sizes were within most people’s budgets.

But this gifting of chocolate was, and seems still to be, unilateral.  Is it because women are not supposed to give Valentine gifts to men to express their interest in a relationship?  Is it because it is unmanly (whatever that means) to like chocolate, and thus giving a gift of chocolate raises the possibility of a diminished manhood?  Is it because cultural norms dictate that giving a six-pack of beer, tickets to a sporting event, or a chain saw are more acceptable gifts? Obviously, the traditional red ribbon wrapped box of chocolates might look out of place on a workbench, in the garage, or on the seat of a pickup truck. And the dainty flower-shaped, decorated chocolates that come in a sampler box are too small, and too  “precious” to appeal to someone who wants a brick-size chunk of chocolate to bit into. Before a woman can even consider giving chocolate to a man for Valentine’s Day, its size and packing have to look suitable for a man cave (maybe a chocolate chain saw?).

Giving Valentine chocolate to women (other than those in an older generation such as mothers, grandmothers and aunts) poses its own set of problems. Indeed, it can be quite tricky. If the recipient is thin, then the gift might be interpreted as a hint that the giver would like some soft curves over the bones and buff muscles. If the recipient is not thin, a can of metaphorical chocolate worms is opened: “Does he like me fat? “ “Does he assume that I will never lose weight?” “Do I look like someone who sits on a couch and eats bonbons?” “Doesn’t he know I am thinking of going on a diet?” “If he knew me better, he would know that I am addicted to chocolate and avoid it entirely.”

The problems do not end with the presentation of the gift. Is the box opened when it is received and chocolate offered to the giver? Does the recipient have to eat a piece of chocolate upon opening the box? Does the giver check to see how long the chocolate stays in the box? Too long a time and obviously the chocolate was not liked. Too short a time? The recipient must be a glutton.  If the box contains a sampling of chocolate pieces with different fillings, what does the recipient do with the chocolates whose insides are not appealing? Finally, Valentine chocolate is hard to re-gift. That red cloth covered box won’t do for Easter, and saving it for Christmas to give to a fellow worker is tricky. You have to take the chocolates out, and put them in a box with reindeer on the cover and hope they haven’t turned, by next December, a grayish color.

Centuries ago, chocolate was seen as an aphrodisiac… although double blind, placebo-controlled studies to see its effect on love relationships are still waiting confirmation. Chocolate comes from the cocoa bean, which is surrounded by a fibrous husk. The husk is broken and removed from the bean. Then the beans, called cocoa nibs, are ground up into cocoa liquor. (No, it is not the same as chocolate liqueur that forms the basis of several delicious and fattening drinks.) The liquor contains a caffeine-like substance, threobromine, which has similar stimulant effects as caffeine. Dark chocolate has more cocoa liquor than typical chocolate, and thus more of this stimulant-like substance. However, it is hard to see how caffeine or this first cousin has any effect on a relationship except to prevent sleepiness if the other person is boring.

The cocoa nibs also contain about 54% cocoa butter which may be similar in texture to peanut butter when ground. Trace amounts of mineral zinc or copper are found in the cocoa bean, along with phenethylamine or PEA. This substance can be made from an amino acid with the similar sounding name of phenylalanine, and results from microbial fermentation in the bean. Phenylalanine and PEA may have amphetamine-like functions, thus possibly stimulating the chocolate eater to say yes to another date. But the amount that actually reaches the brain is as vanishingly small as the amount of chocolate left in the box by a chocoholic.

The magic in chocolate comes in processing these ingredients with sugar, lecithin, an emulsifier made from soy, and vanilla or other flavorings into the final product.  Chocolate is considered a unique food, and to many there is no other food that can meet its immensely pleasing taste and texture. Indeed, so satisfying is chocolate that some might be tempted to exchange a mate for an eternity’s supply of this heavenly food. Years ago in a visit to Zurich’s finest chocolate store, my husband and I each consumed a just made chocolate truffle of such exquisite texture and taste that I thought I saw the pearly gates.

So perhaps the answer to whether men should get chocolate for Valentine’s day is this: Yes!
(as long as women get some too…)

Asking Why You Can’t Lose Weight After Your Medication?

The media is glutted with advertisements for weight loss: after all, this is January. And it is assumed that by denying calories and increasing physical activity, some weight will be lost by March at the very least. This assumption is based on the belief that the weight was gained because excess calories were consumed, and physical activity minimized.

But what if you were thin, fit, ate healthful foods, loved to exercise, and never been on a diet? Then sometime in 2016 you started on antidepressants for a variety of reasons: depression, anxiety, grief, fibromyalgia, or menopausal hot flushes. The medication helped, but there was a problem. Six weeks or so after starting treatment your clothes started to become tight. You no longer were satisfied with normal portions, but started eating larger amounts at meals. And, horrors of horrors, you could not stop snacking. Your physical activity decreased because the medication made you tired.  You ended up 23 pounds heavier at the end of 2016 than you were the beginning of last year.

So now you are off your medications, and you try one of the various weight-loss programs advertised. But weeks go by and you have lost practically nothing, even though you follow the plan exactly and exercise. Your distress is like someone who became bald during chemotherapy, and months later is still hairless.  You assume that like everyone else who is trying to lose weight in January, you should be successful. In fact more so, because unlike other dieters, you never had an overeating problem until you started taking antidepressants!

Help will not come from the people who develop the diet plans because the regimens are for the ordinary obese individual who gained weight the traditional way. Help won’t come from weight-loss support groups for the same reason. And so far no department of psychiatry has a weight-loss program for its patients who have gained weight on their medications, even though such programs are sorely needed.

So you alone are going to have to figure out how to lose the weight the medications caused you to gain.

Here’s what you need to know: Some medications stay stored in the body for some time after they have been discontinued. You can determine whether the medications are still affecting your appetite and physical activity even though you have stopped taking them; simply ask yourself if you are eating larger portions than you did before you started on the medication.

If you were craving and eating sugary, high-fat snacks when you were on the meds (cookies, cake, ice cream) do you still have these cravings?

Do you find it hard to feel satisfied even when you are eating enough food to make your stomach feel full?

Is your body still fatigued from the meds, or even from a residual depression? Does this make it hard to exercise with the same intensity and duration you had before you went on the medication?

Do you think you have lost muscle mass?

If you detect a lingering effect of your medication on your appetite and physical activity, then consider this one possible reason why it is so hard to lose weight.

Forget what the advertisements for weight-loss programs promise. They are not directed toward people whose appetite control and ability to exercise have been hijacked by their medications.

Instead, give yourself more time to lose your weight. If carbohydrate cravings persist, satisfy them with fat-free, healthy carbohydrates like steamed rice, oatmeal, whole grain pasta, polenta (an Italian version of grits, but without the cheese and butter), popcorn, pretzels, and whole grain bread. You need to eat only 30 grams of such carbohydrate on an empty stomach two or three times a day to take away your cravings, and increase your sense of being full.

And you may have to increase gradually your workout time and intensity since your body may not be able to jump into the type of exercise you did so easily before you took the antidepressants.

Be patient. Eventually the residual medication should leave your body, your control of appetite and ability to exercise will return, and you will lose weight.

But, if none of the above applies to you, seek medical advice. Before meeting with your health provider, accumulate data to show that your inability to lose weight is, a) not your imagination, b) not due to overeating and not admitting it, and c) not related to a sedentary lifestyle.

Keep a food log and exercise log. If possible, use apps that will do it for you and allow you to print out the results. The results will look more impressive than some pieces of paper covered with food stains or sweat. Allow at least three or four weeks of record keeping before presenting them to your physician. That is a long enough period of time to lose one or two pounds and if you have lost none, you can make a convincing case for something being wrong. At the very least, the health care provider should investigate possible reasons for the weight refusing to be lost.

Enough people have experienced difficulty in losing weight after they discontinued their antidepressants to make this a not rare occurrence. So far there has been mainly silence from both the psychiatric and obesity communities in response in part because of the belief that it should be possible to lose weight after the drugs are stopped. Presenting evidence that pounds gained during treatment are not lost with dieting after treatment is stopped, may indeed generate research to find a solution to this unwelcome side effect of antidepressants.

Are Reality Cooking Shows Really Fantasy Cooking Shows?

A group of us were chatting about a local restaurant whose chef was eliminated from the Food Network show, “Chopped.” The restaurant was popular; the show was not.

“The problem,” said someone, “is that the contestants are supposed to combine weird ingredients like Marshmallow Fluff and mushrooms into something edible and do it in 30 minutes or less.  How can of you make an entrée with side dishes in thirty minutes?  And using ingredients that are familiar, not Halloween candy and duck breast?”  We laughed but the question resonated and the group’s response was, “No way.”

As one person commented, it would be possible if we employed a full time assistant who would do all the basic prep work like chopping onions, peeling garlic, dicing carrots, and washing greens. And also making sure that water for pasta was always boiling, sauté pans were at the correct temperature and, we all chimed in, “Cleans up as the cooking goes along.”

“Watching the cooking shows, and then expecting to make the same dishes in 30 minutes or less, is like watching an international tennis match and then expecting to serve the same way,” said one of the women. “Even assuming I have all the ingredients on the counter before I start to cook—and that is a big assumption—it takes me twice as long, if not longer, to prepare the same meal.  And the shows are so deceptive. The cook will say something like, “…wilt the onions or beat the egg whites… and 3 seconds later it is done. Tell that to my onions! “

The women were of a certain age; that is, they had raised children, prepared thousands of meals, entertained, and had done this while working most, if not all, of these years. They may or may not have been good cooks, but they were experienced. And the consensus among us  was that cooking shows, whether competitive ones or in demonstrations by individual chefs, were deceptive. It looked too easy, too fast. Indeed, one woman said that she wondered if a younger generation, inexperienced in meal preparation, would end up serving undercooked food if they tried to imitate what they saw on television.

Wouldn’t it be useful to have one cooking program that was closer to reality? Onions would be burnt because the cook forgot to turn down the heat while answering the phone call from a telemarketer. The chicken would still be half frozen and dripping reddish chicken juice, the cat would leap onto the counter and poke around at the fish, the brownies would be overcooked around the edges and too moist in the center, and the food processor, used to puree the squash soup, would thrust its contents all over the floor like an erupting volcano.  But of course who needs to watch this on television when one can see it in one’s own kitchen?

Unrealistic menus or meal preparations are nothing new. During the 19th century and early 20th centuries, women studied and practiced a discipline called Home Economics, whose goals were to teach housewives basic nutritional requirements for their families and healthy cooking techniques on how to prepare food for the household. The goals were worthy, but some of the so-called nutritional meals were anything but. Cream sauces were poured over just about everything.  Salads consisting of Jell-O cubes, canned pineapple chunks and maraschino cherries were considered elegant enough for a luncheon. And, often disdain was shown toward ethnic dishes prepared by new immigrants, despite the fact that they were nourishing and familiar.  Women’s magazines often promoted recipes, not for their nutritional content, but because they used ingredients of their advertisers. The famous string bean dish in which the vegetable is drenched in canned cream of mushroom soup and sprinkled with canned fried onions rings certainly promoted the sales of these products.

But of course, in those far-off times in the last century, people were still cooking. Today one cannot assume that younger generations will or even want to cook at all.  Thus, if a non-cooking younger generation is to be weaned from supermarket or fast food take-out, prepackaged meals, or a diet of smoothies and shakes, they have to be shown, realistically, how to prepare a meal with more than two ingredients (salt and pepper).  Fortunately, the Internet is replacing the food channels in meeting this need. A little bit of searching will produce videos on how to prepare anything from baked potatoes to a soufflé.  And since they can be viewed as often as necessary, a refresher view is possible if it has been several months since the dish, say meatloaf or roast chicken, has been made.

Ingredients in a box that cook into a meal for two or more, delivered to your door, are becoming popular. Certainly the advertisements looks compelling, especially to cooks like this one who always seem to be lacking one or more ingredients essential to the recipe.  These could be considered starter meals. As they are more expensive than meals assembled from one’s own kitchen, they are unlikely to be a permanent substitute for reading a recipe, finding the ingredients, and cooking. Or maybe not.

Programs on the food channels are entertaining, which is their intent. If a recipe looks worth trying, it is always available on the website of the television personality who prepared it. But just don’t try making it in 30 minutes or less.

How To Stay Full In 2017 When You Are On A Diet

January can be depressing. The predictable cold, snow, ice, wind, and bills are accompanied by, for many, the need to go on a diet. It is hard to ignore the pounds you’ve accumulated since Thanksgiving, and even if you do try to disregard them, advertisements for weight-loss programs won’t allow you to.

Diets tend to be dismal, adding to January gloom, and they are often boring. If someone suggests that we have been all wrong in eating X and avoiding Y, then there is at least the possibility of talking about a novel approach to dieting. But, alas, a quick survey of the diet books appearing now indicates that most of them are still promoting low-or carbohydrate-free diets (ho-hum).

Promoting a low-carbohydrate weight-loss regimen while one is enduring the long hours of winter darkness seems somewhat counterproductive. Such diets exacerbate the toll the lack of sunlight takes on serotonin levels and the grumpy moods, excessive sleepiness, uncontrollable food cravings, and lack of motivation to exercise that may consequently follow. And most relevant for the dieter is the absence of a sense of satiety, or fullness, also conveyed by serotonin.

Eating carbohydrate is the only way the brain makes more serotonin, and a diet that denies or limits starchy carbs like potatoes, pasta, bread, cereals, rice, beans, lentils and corn meal will leave the brain serotonin deprived.  It is a better plan to wait until May or June to stop eating carbohydrates in order to lose weight. The days at this time of year are so long that serotonin levels are not affected by carbohydrate depletion.

But, New Year resolutions being what they are (here today, gone tomorrow), many people feel that they’d better grab onto their will power and start dieting immediately.

So if you can’t eat carbohydrates because the diet books tell you not to, then you might consider an extract from a magical fruit called Garcinia Cambogia. (The name sounds a new dance step.) If you missed hearing about this fruit whose extract not only melts away extra pounds but, based on pictures on the Internet, leaves dieters looking as if they have had head-to- foot plastic surgery, then here is the information.

The fruit is tropical, apparently shaped like a pumpkin but grows on a tree, not on the ground, and is also known as the Malabar tamarind. Its popularity as a promoter of weight loss has shifted on and off for the last 20 or more years and had a resurgence this past year. Its virtues were extolled by the television medical personality Dr. Oz a few months ago, and like dandelions after the rain, companies sprang up to sell a particular ingredient in the fruit. Carcinia Cambogia contains hydroxycitric acid, aka HCA. Rodent studies done many years ago suggested that HCA might cause weight loss by blocking chemical reactions in the body that transform glucose into fat.

Fat or triglycerides are composed of two parts: glycerol, which makes up the backbone of the molecule and three fatty acids. So if your body produces fewer fatty acids, then fewer fat molecules are produced. This is what HCA seems to accomplish. It decreases the conversion of glucose  (all carbohydrates are digested to glucose) to acetyl-CoA. Acetyl-CoA is the building block of fatty acids.Rat studies found that when a high carbohydrate diet was eaten, HCA prevented some of the glucose from being changed into fatty acids. Moreover, as a value added sort of feature, people claim that HCA gives them a feeling of fullness or satiety, so they eat less. Serotonin, the neurotransmitter responsible for satiety, is thought to be increased by HCA, but there is as of yet no evidence for this.

A couple of pesky problems are associated with using Garcinia to lose weight: cost and sketchy purity. It is not cheap. One company is selling the extract HCA at a cost of $50.00 for 60 caplets and since it is recommended that a dose be taken before each meal, the cost can add up. The quality of the preparation is inconsistent among brands. ConsumerLab.com analyzed the content of hydroxycitric acid in several supplements and found the actual amount far less than claimed on the package label. Moreover, the HCA seems effective only when a very high carbohydrate diet is eaten.

There is a much cheaper way to prevent the transformation of carbohydrates into fat, while increasing satiety. It’s simple….eat only moderate amounts of carbs so what is eaten is used for energy, not to build up the fat cells. And consume some of those carbs, such as a half a cup of oatmeal or a toasted English muffin, about a half an hour before meals. Serotonin will be made naturally, the appetite will be decreased naturally, and you will lose weight naturally. Stay on this plan and the weight will even stay off long after the snow has melted, and the rest of the New Year’s resolutions have been forgotten.

Should Santa Claus (and his wife) Stop Eating So Many Cookies?

Poor Santa, he certainly has not kept up with modern times. No internet, no computer, no 3-D printer assisted toy maker, and certainly no electric sleigh (or self driving one for that matter). And somehow Santa and his wife have not heard health professionals lament our excessive intake of sugar.

Consider this:

He used to be thin. Orginally, a long time ago, he started out life as a monk (and monks did not eat cookies) and eventually became a Bishop in a town in what is now Turkey. This was around 270, a time way before people thought much about the North Pole and its toy making factory. In his spare time, he gave away money he had inherited by throwing coins and gifts through the windows of homes in which children lived. But no one reciprocated by feeding him sweets.

Eventually, as St. Nicholas (this was long after his death) he became the patron saint of children. Still thin.

Then something happened several centuries later. St. Nicholas was transformed into a chubby (well more than chubby) jovial, cookie eating distributor of gifts because of a poem, meter and rhyme.

In l822, Clemet Clarke Moore, an Episcopal minister wrote the poem, The Night before Christmas, * and Santa lost his buff figure forever.  Others helped enlarge his figure; a cartoonist Thomas Nast drew Santa with a large belly in l890, and Washington Irving described him as a fat Dutch elf. And finally, Coca-Cola gave us the image we associate with him today by picturing St. Nick in a red suit with a white beard, of course.

Given the ubiquity of sugary snacks available to this now robust figure, it is really amazing that he does not grower fatter with every passing century or require a supply of insulin in his sleigh because surely he must have developed diabetes by now! Will he still eat cookies containing gluten, or might this affect his intestinal tract and mood?  Does he know about Grain Brain? We don’t want the presence of gluten to change his “HO HO HO!” into, “Oh, oh, oh….”

Why is he eating carbohydrates at all? That surely must be the reason he is still fat. If he followed the Paleo diet he might be thinner, and also be able to use wooly mammoths to drive his sleigh, rather than reindeer.

And really, what kind of example is he to our children? All year we try to get them to eat healthily, limit their snacks to baby carrots and plain yogurt, and make sure they eat nothing, or almost nothing, with sugar. We try to make sure they get enough exercise, and that they not depend on us to drive them everywhere. And then on Dec 24 along comes this guy who won’t even walk from house to house, no matter how close they are, but insists on riding to each one on a sleigh. He goes down a chimney (how much exercise is there in that? It is all downhill!) and his sleigh is waiting for him at the door. And there are those cookies. Does he even bring them home to his wife? Probably, because she is not exactly svelte herself.

Perhaps his focus on sweet carbohydrates means that like so many who live in northern part of the world, he is suffering from Winter Depression or Seasonal Affective Disorder (“SAD”). SAD suffers have an urgent need to consume sweets, especially in the late afternoon and evening. Maybe if he lived at the South Pole he would be not be so chunky and addicted to chunky chocolate chip cookies; seeing there it is summer in December, and the sun barely sets.

Of course none of us knows whether he and his spouse go on diets on January 2 like most of the world.  They may go the Weight Watchers equivalent at the North Pole, or endure a weeks-long cleanse or eat only meat (reindeer?).  But like most of the world, by next fall they will probably have gained back all the weight they lost, and Santa will be pudgy again. Should someone put out a diet book next to the cookies? Or at least some baby carrots?

But then again, if he loses masses of weight, his clothes will be too loose and worse yet, he will not be the Santa of Moore’s poem whose “little round belly laughed like a bowl full of jelly.”  So keep those cookies by the chimney. With care.

Is Mindless Eating Like a Dog Worrying a Bone?

One of our dinner guests, a thin older man who prided himself on his eating and exercise discipline, sat down next to a bowl of nuts and almost inhaled them. We were having cocktails before dinner, and as hostess I was paying more attention to whether there was a coaster under every glass and napkins next to the finger foods, more than to what our guest was eating. But his rapid almond-to-mouth movements caught my attention.

“Did you see how much Jake (not his real name) was eating?” my husband asked after everyone departed. “He is usually so deliberate and slow in his eating, but this evening he cleaned his plate almost before everyone had picked up his or her fork. “

We mused over his uncharacteristic behavior, and then one of us remembered a story he told later on in the evening about a possibly nasty legal situation he was facing with a neighbor.

“I don’t think he even knew what and how much he was eating,” I commented. “I suspect that if he had been asked what he had eaten for dinner, he would have no idea.“

Not paying attention to what, especially how much, we are eating is one of the unsolved causes of weight gain. Who has not munched on a sandwich or crunched baby carrots while staring at a cell phone? Peering at the screen while eating is so common that eventually restaurants will probably provide cell phone stands so the phone can be propped up while eating, thus relieving the necessity of eating with only one hand. However, the perils of attending to the cell phone screen rather than to your food on the plate is that everything on the plate is consumed (possibly even the toothpick holding the sandwich together) without the eater being aware of doing so. Have you ever eaten a large bag of popcorn in a movie theatre and found that your munching was faster or slower depending on what was on the screen in front of you? Your fingers were able to direct the popcorn to your mouth without much awareness of your part.

Psychologists and nutritionists tell us TO PAY ATTENTION to what we are eating. We are to look first at the food before biting into it and notice its texture, smell, and color, perhaps the same way we might look at a glass of wine. Then we are to chew slowly, savoring the release of flavors and how they change in the mouth. Finally we are allowed to swallow. I was at a workshop watching the facilitator demonstrate this with a strawberry. We all had several on our plates so we could practice along with her. One of the participants was so mesmerized by the slow motion consumption of the strawberry by the leader that she mindlessly munched on all the strawberries on her plate.

Of course, paying attention to what we are eating, and especially noticing when we are full so we don’t continue eating beyond fullness, is helpful in controlling our universal tendency to overeat.  But perhaps more important is noticing why we put our mouths on automatic pilot and eat and eat the way a dog gnaws and gnaws at a bone. The dog is probably not thinking much of anything except where the next bone might be coming from, but the automatic eater is, for sure, thinking of something other than the food.

Mindless eating should really be called “mind elsewhere” eating. Like the dog worrying a bone, or our dinner guest, the “mind elsewhere” eater is gnawing away at an unresolved, troublesome situation.  It is unlikely that the eating and the somewhat obsessive thinking will produce a solution at that moment, but is more likely to result in the consumption of excessive calories. (And, to my mild annoyance, probably no recollection of what the food tasted like.)

A dog owner will take away the bone when it is apparent that the dog should move on to something else.  As owners of our “elsewhere minds” we must take away our own bones. We must put away or move away from the food, set our forks down, determine how much we have already eaten, and halt the repetitive movement of either a utensil or a hand carrying food to the mouth.

Dogs usually sigh and then go to sleep when the bone is gone. We should learn from them. A few minutes of calmness, of allowing ourselves not to be consumed by the problem at hand, will bring our mind and our eating into harmony.  It will also bring the benefit of enjoying the food we are eating.

Are Kids Born, or Made Into, Emotional Overeaters?

Anyone who has eaten when frustrated, angry, bored, worried, exhausted, lonely, or depressed—but not hungry—has engaged in emotional eating
(So that makes most of us.)  And for most, the food eaten is less likely to be steamed broccoli, poached chicken breast, or fat-free yogurt and far more likely to be a member of the so-called carbohydrate junk food family.

We know this from studies carried out at the MIT clinical research center about 25 years ago. Emotional overeaters were offered a choice between protein snacks like miniature meatballs or luncheon meat and carbohydrate snacks like cookies and crackers. The choice was always the carbohydrate foods. The predictable choice of carbohydrates led to research confirming that the carbohydrates were chosen not from taste (the meatballs were delicious but ignored) but because eating crackers or cookies led to an increase in the mood-soothing activity of serotonin. Our conclusion, reinforced by many subsequent psychological studies, was that people used carbohydrates as a form of self-medication.

But how did we learn to do this? And indeed, did we learn to do this, or is medicating with food something we are born with?

Infants don’t eat to make their bad moods go away. They eat to make their hunger go away.   And infants don’t eat when they are not hungry.  Theoretically infants, especially those who are breastfed, do not overeat since it is almost impossible to get infants to swallow more milk when they are done feeding. The mouth closes, the head is turned away, and often sleep takes over.

So how does an infant who self-regulates her food intake turn into an emotional overeater? Some pediatric obesity researchers such as Savage, Birch, Marini, et. al.1 suggest that it is the mother’s fault. Mothers who interpret every sign of their infant’s distress as hunger will feed their infants too often. The baby may not eat but eventually, so the researchers surmise, the baby associates feeling bored, lonely, wet, annoyed or whatever emotions babies feel with being offered food.

This association seems to be strengthened when parents offer treats to the now older child to soothe her. Blisssett, Haycraft and Farrow measured cookie and chocolate consumption among preschool children when they were stressed in a research setting. Children whose mothers often gave them snacks to comfort them ate more sweet snacks than children whose mothers did not offer them snacks when they were upset.

Is this how it begins? The child grows up and, when experiencing the predictable stresses of childhood, adolescence and adulthood, turns to food as a means of coping?

But there is much unanswered about this assumption, i.e. that children will turn into emotional overeating adults because they were given treats as children to help them overcome distress, boredom, or anger.

Do children growing up in cultures where food is scarce become emotional eaters? They may worry as adults about not having enough food and hoard food or overeat because they learned as children that food is not always available. But is this emotional overeating?

Do all children in a family become emotional overeaters in response to being given comfort food while growing up? Often some children in a family overeat sweet or starchy junk food and others reject these items. What makes Sally, but not Sam, reach for cookies when experiencing a negative mood state? Why doesn’t Sam also use food to feel better?

Do children, and indeed adults feel comforted if given any food when upset or only specific foods? The answer is obvious, at least in our culture.  Foods offered and eaten in times of stress tend to be tasty, sweet or starchy and often high in fat (cookies, chocolate, ice cream).  If, theoretically, a toddler was always offered a piece of broccoli or spoonful of cottage cheese after bumping his head or feeling confined in a stroller, would he grow up and reach for the same foods when upset? Probably not, but this is testable. If a child grows up in a community where it is common to eat hot chili peppers or munch on dried seaweed or snack on avocado, then would these be comfort foods?

Are children nurtured from early infancy in a daycare center where meal and snack times are regulated and not dependent on a child’s mood less likely to become emotional overeaters?

Might children who are denied so-called tasty junk food because of their adverse effect on weight and health, feel compelled to eat such foods when they are old enough to get the food themselves? And might they overeat such foods to compensate for the years they were denied such treats?

Clearly much research has to be done before we understand whether an emotional overeater is born or made that way.  Answers may come from studies in which self-defined emotional overeaters are given covertly a food that they tend to eat when stressed, and a food that is never eaten  (crackers versus cottage cheese). Measurements of their emotional state before and following eating are measured. If the emotional overeater shows an improvement in mood to one or the other test food, then the change must have come about because of some change in the brain regulation of mood, and not because of taste or the anticipation that the food will help the mood.

And perhaps, eventually, we can find what in the food gives the child or adult an emotional hug, so we can strip away the calories and leave just the good feeling behind.

Strolling: Good for the Mind as Well as the Body

Walking has become the default mode of exercise. If going outside to walk is not convenient, then a walking treadmill is available for year-round use. You will get nowhere, but you will use up calories. We are exhorted to walk to lose weight, to avoid gaining weight, to refresh our minds, to unstiffen our muscles.  As someone whose steps per day are counted by an app on my cell phone, I am pleased when my daily walking miles increase. “Look at all the calories I am using up!“ I think when a congratulatory computer-generated message appears on the phone.

But before walking was reserved for burning calories, it used to be the predominant way of reaching a destination. Those who still depend on walking, rather than a car or public transportation, often find it a more efficient and cost-effective way of getting somewhere.  When the roads are clogged with traffic, it is a delight to realize that walking to a destination is faster than driving.  And in some situations like a mall, museum or zoo, walking is the only option other than a wheelchair. Tour buses get drive a sightseeing group to the ancient castle or botanical garden, but seeing it requires legs not wheels.

However, there is an aspect to walking that seems to have been forgotten or disregarded in an attempt to make more people move more. Walking is good for the mind, for thinking, daydreaming, and becoming aware of the details of our environment.  Indeed, those who meditate sometimes do a walking meditation in which the body, breathing, and mind become one. Usually too impatient to contemplate anything but a robust pace while walking, recently I have been forced to slow down because of my dog. He is almost blind due to a genetic problem associated with his breed. Fortunately, his hound genes allow him to sniff his way through the world as if there are eyes at the end of his nose; but his pace is about 90% slower than when he could see.  As I am at the other end of the leash, I too have slowed down my pace. 

Our walks have now become a stroll, a leisurely perambulation around the neighborhood. But as the number of miles we used to cover diminishes to a few blocks, moving slowly has the positive effect of increasing my awareness of the surroundings: There are fewer ducks in the pond today; the yellow leaves of the birch tree highlighted by the sun look painted; that trash can needs to be emptied; the moon is almost full tonight; the leaves on the sidewalk crunch delightfully when I scuff through them. Casual conversations with other walkers occur frequently, as I stop to allow the dog to smell his way to the next tree. But the best aspect of these leisurely strolls is giving me the time and privacy to think, to indulge in memories, even to daydream.     

A constant complaint of our over-committed lives is the absence of time to restore and renew ourselves.  We must always get to the next thing on our list. One of my friends jokingly told me that as she is lowered into her grave, she will toss out her ‘to -do’ list. Strolling gives us permission to forget the list, to stop temporarily multi-tasking and strategizing about how much we can accomplish over the next 24 hours. Ambling gives us the respite from the constant demands upon us. It gives us time to indulge in our private selves without having to worry about how we present ourselves to the world.  Strolling, if we think about it, should even make us aware and grateful that we can walk and see and hear.

Exercise is important; indeed, it is essential to good mental and physical health. But as my dog has taught me, sometimes a gentle walk can truly enhance our well-being.    

Lactose Intolerance: Can It Cause Weight Gain and Weak Bones?

I hadn’t seen my neighbor for several weeks, but we’d just met again while walking our dogs.  When I commented on how well she looked, she patted her mid-section and said, ”I finally got rid of my big stomach.” (that she had a large stomach was not apparent in our previous encounters.)  When I murmured something to that effect, she went into a long discourse on how she managed to vanquish her perceived girth by radically changing her diet.  She told me, “I cut out all dairy and carbohydrates, and I eat only protein and vegetables. But it’s strange. I haven’t lost any weight. I just lost the bloating.”

My nutritional antennae went up when she mentioned her dietary changes.  Further questioning revealed that she really hadn’t stopped eating carbohydrates, and had enjoyed an excellent pasta dish the previous night at a local restaurant.  But no dairy products had been eaten for weeks. “And as soon as I stopped putting milk on my cereal, and cut out yogurt and cottage cheese, my bloating stopped,” she proclaimed, patting her flatter stomach. “So obviously the dairy products were making me fat.”

As our dogs settled down on the grass, we continued talking. “ So maybe you have lactose intolerance,” I suggested. “That would account for the bloating after you eat dairy. “

She was unaware that as people age, the enzyme lactase that breaks down lactose, the sugar naturally found in milk, disappears or becomes much less active. Consuming milk and sometimes other dairy products such as ice cream, yogurt, cottage cheese, cheese and even butter (it contains milk solids) causes gas, bloating and diarrhea. This is due to bacteria in the intestine interacting with the undigested milk sugar. The intestinal discomfort is accompanied by cosmetic discomfort; skirts or pants strain to fit over a bloated stomach, and the abdomen may not retract to a flatter shape until all the lactose has been expelled.

“You can get lactose-free dairy products,” I told her. “Also, often the bacteria in yogurt have already broken down some of the sugar, so regular yogurt may not cause bloating. And you can take pills that contain the enzyme lactase. You chew them right before eating any dairy products. “

“Well, maybe I do have lactose intolerance… but it doesn’t matter,” she responded. “Why go back to eating dairy? I drink almond milk and eat broccoli. “ She bent down to pick up her dog who was eating grass. “I get all the calcium I need. “

I felt as if I was making a nutritional nuisance out of myself, but asked anyway, “ Didn’t your doctor tell you a few months ago that you may be developing osteoporosis? You were worried that calcium in supplements was not being absorbed as well as calcium in food. Are you sure you are getting enough calcium now?”  Her dog started barking, and she looked as if she was going to bark at me so, letting our dogs pull us in opposite directions, we parted company. But as I walked home, I wondered whether she could get enough calcium from almond milk and broccoli. She needed to get about 1200 mg of calcium daily.

She was right about the almond milk. Eight ounces of calcium-fortified milk contains as much of this mineral as cow’s milk: 300 mg.  But would she drink 4 glasses a day?  Yogurt has 400 mg of calcium, but because eating it supposedly made her fat, it was not on her allowable food list.  What else could or would she eat? Canned salmon or sardines with bones? Probably not, or only rarely. Vegetables? She said she ate broccoli.  Could vegetables provide the calcium she needed?

Broccoli is not a good option, unless she eats a bucket full.  A cup contains at most about 65 mg of calcium. Steamed kale, bok choy, turnip greens, and spinach are good sources (a relative term as they contain only about 100 g per cup of calcium) but there is a problem. These dark leafy vegetables have a pesky substance called oxalic acid that attaches to the calcium, and prevents the mineral from being absorbed from the intestine into the circulation. In fact, oxalic acid can even prevent the calcium in milk or yogurt from getting into the blood stream if these dairy products are eaten along with dark leafy vegetables.

What about orange juice? Calcium-fortified OJ is as good a source of calcium as milk, and has about the same number of calories as whole milk. But will my friend, worried about the size of her tummy, fret about the calories?

Maybe she could swallow 2 tablespoons of blackstrap molasses every day (400 mg). And she could eat chickpeas, black-eyed peas, soybeans, tofu processed with calcium sulfate, figs, and instant oatmeal fortified with calcium.

Bones are an excellent calcium source, but I suspect only her dog chewed on those. (These cook down in the canning process of sardines and salmon to boost calcium.)

So it seems that dairy products are the best natural sources of this essential mineral. But will my friend be willing to try lactose-free dairy products and/or the lactase containing pills so she can consume them? Maybe so, if her stomach remains flat.  Perhaps it will require another   walk with our dogs to convince her.