Monthly Archives: October 2014

I’ll Have a Glass of Grapefruit Juice With My Bacon Fat

How can it be? A dieting concept that is more than 80 years old and should have been laughed out of existence now suddenly may have some validity. The concept is grapefruit juice. My mother-in-law went on the grapefruit and lamp chop diet in the early 1930s (lamp chops were a lot cheaper then) to lose weight before her wedding. She told me about it years later, and wistfully recalled how quickly the weight came off.

Listening to her, my unspoken, but cynical take on this (she was my mother-in-law, so of course I did not say anything) was that restricting food intake to two or three items always causes weight loss. Boredom and even intestinal discomfort usually occur after a couple of weeks, if not sooner, and often the choice not to eat seems preferable to consuming, yet again, another grapefruit or well-done chop. Of course the weight came back, but that is true of most diets.

But the dieting world wasn’t done with grapefruit, even if my mother-in-law, after her wedding, was. It kept on popping up as a fat-burning food despite the lack of any credible research to support the claims. The Depression and WWII interfered with further promotion of grapefruit as a weight-loss stimulator. First, people didn’t have enough to eat and later, during the War years, rationing and limited food supplies must have made any dieting effort seem irrelevant and nonsensical.

But leaping ahead to the l970s, we find grapefruit emerging as the star food of the Hollywood Diet, or the Mayo diet, supposedly endorsed by the Mayo Clinic, which disdained to have anything to do with this fad. But here again, the diet was all smoke and mirrors. Of course the dieter would lose weight eating grapefruit at every meal. The dieter would have lost weight eating raw rhubarb at every meal. Only 800 calories a day were allowed on the diet, and like the Atkins program later on in the century, no carbohydrate was allowed. Only meat was okay to consume, although probably the cost of lamb chops was high enough so hamburger was substituted.

But the search went on for that elusive something in grapefruit that in some people seemed to promote more weight loss than expected from their daily calorie intake. It is known that grapefruit contains the chemicals naringin and hesperidin that have antioxidant activity. Could these be responsible for some unanticipated weight loss?

A study published in the journal Metabolism in 2012 by Dow, Going, Chow and others set out to answer conclusively whether grapefruit contained a potent weight reducer. The results were inconclusive. Overweight subjects who ate a half a grapefruit before each meal did not lose any more weight than control subjects who were not allowed to eat any grapefruit. Total cholesterol and the bad kind of cholesterol, LDL, decreased in the grapefruit group, as did their waist measurement but the differences were not statistically significant. However, the smaller waists of the subjects indicated that they might have lost belly fat, which is important in terms of cholesterol and blood pressure levels.

So is grapefruit moribund as a weight-loss activator? Apparently not. My mother-in-law may have lost weight not just because she became nauseated at the thought of eating another lamb chop and piece of citrus. Or to be precise, grapefruit juice now seems to be a potent inhibitor of weight gain if you are a mouse who loves to eat fat.

A few days ago, a group from University of California, Berkeley reported that mice that were fed a high-fat diet and drank pulp-free grapefruit juice gained 18 percent less fat than fat-eating mice that drank water. The grapefruit drinkers also had healthier glucose, insulin and triacylglycerol (a type of fat) levels in their blood. The study, conducted by Andreas Stahl and Joseph Napoli, was published in Plos One, a highly reputable online journal.

The mice were fed a diet that would have made Dr. Atkins weep with joy: it contained 60-percent fat and they ate it for 100 days. Mice in the fat-eating control groups were given water rather than grapefruit juice, and other groups were put on a healthier low-fat diet and given either the juice or water. And finally, the chemical naringin, which was assumed to be the reason people lost weight eating grapefruit, was given to two other mice groups also fed either high-fat or low-fat diets.

Against their expectations, the researchers found that the mice eating massive quantities of fat and drinking grapefruit juice gained substantially less weight than the water drinking, high-fat fed mice. Mice eating the more typical mouse-like, low-fat diet (mice normally do not feast on very fatty foods. They prefer grains, seeds and nuts) did not show much of a change in their weight regardless of what they were drinking. And naringin had no effect at all on decreasing weight gain.

These results perplexed the researchers, especially after they looked for typical explanations as decreased absorption of the food, increase in activity, and perhaps the fact that eating mostly high-fat food made the mice less hungry. None of these factors was responsible for the decrease in weight gain.

Obviously, human studies along with more animal studies must be done to find out how the juice from a particular citrus fruit could prevent weight gain on a diet that otherwise would provoke it. But this first report certainly raises intriguing possibilities.

Might a weekend of eating whipped cream-topped chocolate mousse and sausage, bacon and cheese omelets with butter drenched toast prevent the scale from imploding if you drink grapefruit juice along with your meals? Regardless of the answer, you can be sure that weeks from now there will be advertisements on the Internet promising magical grapefruit juice pills that will do just that.

Can You Get Scurvy If You Eat Out Too Much?

Soon after arriving home from a short trip to Manhattan, I took a vitamin pill.  No, there was nothing arduous about the return journey that required a dose of nutrients. But on the train back to Boston, I reviewed in my mind the various places where we breakfasted and dined (lunch was usually skipped) and realized, that except for a shared salad at one dinner and some fruit at a breakfast, I had failed miserably at consuming the recommended daily servings of fruit and vegetables.  For a 2000-calorie diet, the recommendation is to consume about 2 -2 ½ cups of fruit and 2 cups of vegetables daily.

This wasn’t because I had left vegetables and fruits untouched on my plate. There were never any on the plate. The restaurants (Greek, French, and mixed American), chosen by consensus, had large selections and theoretically should have been able to supply some vegetables. Indeed, the Greek fish restaurant did have appetizers, i.e., Meze, that incorporated some vegetables like eggplant and cucumbers into purées, dips and wraps (like grape leaves).  But the main courses in all three restaurants presented an entrée on an otherwise naked plate. To be sure, vegetable side dishes and salads were available but the size and, quite frankly, the cost of these extras made them less attractive. Somehow spending the money for three grilled asparagus that one would spend for a pound of the same vegetable at Whole Foods seemed like an unjustifiable extravagance.

Desserts were not considered but quick polite scans of the dessert menu (after all, if a server puts one in your hand, the least one can do is look at it) showed a uniform absence of anything resembling a fruit.

Obviously eating away from home because of business, travel or vacations is not going to cause acute malnutrition. And is certainly possible and not that all difficult to choose restaurants that offer enough vegetable and fruit selections to satisfy the USDA nutrient intake recommendations as well as one’s mother. Had we been eating on our own, we would have done so.

But we have come a long way from the time when all restaurants put vegetables on the plate, gave you a salad along with the breadbasket, and included fresh fruit on the dessert menu. There was a time when cafeterias were as common as fast-food restaurants are today, and the number of cafeteria trays holding vegetables was as numerous as those containing meat, chicken or fish. To be sure, the salad may have consisted of watery iceberg lettuce and tasteless tomatoes, and the vegetables came straight from an industrial size can, but no one expected a lunch or dinner meal to consist only of a solitary protein entrée. Fifty or sixty years ago, if you were served a plate with two lonely lamp chops or a chunk of fish and nothing else, you might have thought the server forgot to put the two veg and a potato on your plate.

Like other cultural changes that creep up on and take hold (who remembers records and landlines?), we don’t notice the chronic absence of vegetable options in the “nice”’ restaurants, or our habit of putting together our own meals without including them.  And a result, we fail to notice that we may have stopped eating vegetables altogether. They have become a forgotten food.

In contrast to the ongoing debate over high and low-carb or high & low-fat diets, the extraordinary powers of protein to turn us back into Paleolithic cave people, and the devastating effects of gluten on the brain, no one discusses vegetables.  Who debates the merit of spinach over kale or Brussel sprouts over broccoli? When was the last time the Science section of leading newspapers had research on the merits of vegetable consumption? 

Fortunately, there are some recent trends that may forestall an outbreak of scurvy or other nutrient deficient diseases. Leading chefs are inventing ways of turning the ordinary carrot, string bean or beet into creative, original dishes that rival the importance of the protein selections on the menu. Vegetable-laden smoothies and juices are becoming ubiquitous; the selection of bottled vegetable juices go far beyond V8, and juice bars allow customization of vegetable and fruit mixtures. Mixed drinks containing vegetables haven’t found their way into wine bars yet but someone will come up with an alcohol beverage that somehow incorporates kale. Supermarkets have, for many years now, made vegetables available for immediate consumption. No washing, peeling, slicing or dicing necessary; just chewing.  And to remedy the “How do I get my family or spouse to eat vegetables?” problem, many frozen varieties are sold with sauces or suggestions on how to transform the pea or carrot into a gourmet dish.

But….the vegetables have to be bought and eaten at home, not left to gradually decompose in the vegetable bin. If eating away from home is more frequent than dining in one’s kitchen, restaurants should be chosen that offer healthy salads and vegetable side dishes with affordable prices.  Most restaurants display their menus on the Internet so it should be possible to find some that do not regard vegetables as a colorful garnish.  The cost of those vegetable side dishes could be decreased if both the entrée and the vegetables and/or salad, are shared.  Lunch is an easy meal at which to eat vegetables as these days many feature salads or salad bars; even airport restaurants offer a variety of freshly made salads. (Our problem in New York was that we skipped lunch).

It takes some effort to develop scurvy; even the British sailors who did so were not vulnerable until many weeks of vitamin C deprivation. But it also takes a little effort to remember that vegetables are part of a healthy diet and should be hunted and gathered, even if the gathering is at a salad bar.   

Why You Really Run Out of Gas Every Afternoon

As the sun begins an earlier dip into evening darkness at this time of year, our mood and mental energy seem to dip with it. Known as the afternoon slump (or the brain-dead zone), most of us feel a stronger urge to be in bed with a pillow over our heads than to continue with our work obligations for another few hours.

Indeed, the fatigue sometimes seems so overwhelming, especially when the work preceding late afternoon has been mentally and emotionally stressful, that our bodies feel as if we’ve been on a construction site all day. (Maybe we have.) A friend who is a litigator told me that doing a cross examination in a courtroom leave him more exhausted than two days of yard and house chores, even though his courtroom physical activity is limited to standing, sitting, and occasionally walking a few feet away from his chair.

“There is something peculiar about late afternoon,” he told me. “I consider myself a pretty calm guy and able to resist reacting to insults or challenges from other lawyers or a judge. But around 4 pm, I feel myself either feeling suddenly sensitive to the tension in the courtroom, or overcome with profound fatigue.”

A late afternoon slump can descend on anyone—a UPS delivery person, a daycare assistant, or a neurosurgeon—and it is more likely to occur as the days shorten and the light outside no longer feels like midday, but like the start of evening.

Magazines and websites are full of advice about this problem—most of it entirely wrong.

Many assume that this slump is caused by the body’s need for energy, and recommend eating a bigger lunch or snacking to increase low blood sugar. But the cause of this fatigue and mood change resides in the brain, not in the blood.

Is anyone really famished at four in the afternoon? Sure, if someone exercises at lunch but doesn’t eat afterward, he or she will be quite hungry by late afternoon. But the rest of us? Beyond infancy, we do not need to be fed every three, and so even if lunch is over at 1 pm, our bodies really do not have to be fed again three hours later.

But our brains are different.

To understand what lies behind the urge to nap rather than write a report in the late afternoon, we have to see what is going on with serotonin, the brain chemical which attempts to keep us energetic, focused, and in good humor.

Something happens late in the afternoon to the activity of serotonin. There may not be enough of this neurotransmitter, or its activity may slow down; whatever the mechanism, the result is a deadening of mood, motivation, and mobility.

We discovered this en route to studying something else: why many people wanted to eat a sweet or starchy carbohydrate snack late in the afternoon. Volunteers were living in a research residence where snacks where available 24/7. But they never snacked until late afternoon. Why then? They told us they felt their mood deteriorating at that time. They felt depressed, tense, impatient, and tired. They could not concentrate. But they claimed that after they ate some carbohydrates, they felt better.

This was all anecdotal, interesting, but not scientifically valid. We wanted to know: Did they really feel better after eating carbohydrates or just thought they did because they liked to snack?

The truth is, they really did feel better. We know because at one time, we gave them a drink that contained enough carbohydrate to increase the production of serotonin in the brain (serotonin is made only after carbohydrates are eaten, not protein) and at another time, we gave them a drink that did not increase serotonin; it contained protein.

Their moods and fatigue were tested before the drinks and then again an hour or so later. The carbohydrate drink did improve their moods, and they were less tired after having it. But they did not experience the same results after the protein drink.

The volunteers taught us something very useful: If you want to lift yourself out of a slump eat a carbohydrate snack. (This does not apply to baseball.)

As the sun begins an earlier dip into evening darkness at this time of year, our mood and mental energy seem to dip with it. Known as the afternoon slump (or the brain-dead zone), most of us feel a stronger urge to be in bed with a pillow over our heads than to continue with our work obligations for another few hours.

Indeed, the fatigue sometimes seems so overwhelming, especially when the work preceding late afternoon has been mentally and emotionally stressful, that our bodies feel as if we’ve been on a construction site all day. (Maybe we have.) A friend who is a litigator told me that doing a cross examination in a courtroom leave him more exhausted than two days of yard and house chores, even though his courtroom physical activity is limited to standing, sitting, and occasionally walking a few feet away from his chair.

With that in mind, here are two suggestions to lift late afternoon mental and emotional fog:

  1. Eat 25 grams of a starchy carbohydrate such as pretzels, popcorn, graham crackers, or a piece of bread. Avoid any starchy food with fat, which will make you feel lethargic and dull. And don’t eat fruit (at least, not for this specific purpose): No serotonin is made after consuming fructose.
  2. Move, vigorously. Swallow your snack, then get up from your chair and do something physical. Find a staircase and climb it a few times. Take 10 minutes to jog around the block. If you’re home, find a jump rope, set the egg timer, and jump for 3 minutes. Or if you have a treadmill or bike, run or pedal for 5 minutes until your heart rate goes up.

Your brain will thank you. Now go back to work.

If Your Shoes Don’t Fit, Then How Can You Walk?

Maybe it is because my dog, a dachshund, is so close to the ground that my eyes are often pointed in that direction.  Or perhaps it is because there are so many dogs where I live that it is a hazard not to watch out where one’s shoes are stepping. For whatever reason, I find myself studying shoes and the way people are walking in them.  I have no training in feet, or walking for that matter, but was taught in a workshop on running techniques to watch out for a common tendency of our feet to roll toward each other while ambulating. This is a condition known as pronation.  I remember the instructor holding up the soles of a pair of  running shoes and pointing to the area on the inner portion of the heel where there was much more wear than on the outside area. “The person who wore these shoes pronates. His feet roll towards his ankles when they hit the pavement,” he told us, “And if he continues running or walking this way? His knees, back and hips will begin to hurt.  He needs shoes that stabilize his feet and let him land squarely on the pavement. “

That running instructor’s words came to mind as I plodded along behind a woman with soft, slipper-like shoes so unequally worn that I wondered how her feet did not bump into each other. Each foot was rolling toward each so that instead of the soles of her feet hitting the pavement, it almost looked as if she was walking on her inner anklebones.  “How she can walk that way?” I thought. “Should I say something? Isn’t she in pain?” and yet of course, I said nothing. What was I going to say….get thee to a foot doctor?

Of course, not everyone walks on the side of their shoes rather than on the bottoms, but there must be many people, like this woman, who don’t have a clue about what kind of walking shoes  prevent pain and injuries from the way their feet hit the ground.  The unfit, the wannabe fit, and the already fit are all told to walk as much as possible. Smartphones and bracelets measure the number of steps we take everyday, and we are routinely advised to wear comfortable shoes with good support while we are doing this.

And most of us, going out for an exercise walk, probably do wear appropriate footgear. But what about all the other times we are walking? I somehow doubt that people, probably women (because men’s shoes are so much sturdier and sensible), have available to them much of a selection of shoes that support their feet, prevent them from rolling toward each other, keep their arches in alignment andlook good. Bright green, pink and yellow sneakers may be really cute, but don’t quite go with business attire. The clunky, oh so comfortable black or white shoes worn by restaurant workers or nurses just don’t have the fashion panache most of us would like.

Moreover, where do we go for advice before we go shoe shopping? Who is going to tell us to turn our shoes upside down to check for pronation? Who is going to tell the woman I described that, given her extreme pronation problem, she really ought not to wear shoes with the support of a pair of socks? When someone complains about knee or back pain, who is going to ask, “What kind of shoes do you wear… and let me see if they are responsible for your problem?” And is anyone advising people carrying around excess weight that maybe flip-flops are not giving them enough support; that ballet slippers with no arch support or 4-inch heels may cause them so much pain that sitting, rather than walking, will be the preferred activity?

So we put our feet into often quite dysfunctional shoes with all the comfort of the slipper tried on by Cinderella’s sisters.

But where are we going to get advice that Brand X will give us the support and cushioning and fit we need, and Brands Y and Z will not, even though the shoes look more or less alike? Think of where many women buy their shoes: on-line, at big box stores, at clothing/shoe discount stores, even at boutiques whose sales clerks may know the latest fashion, but couldn’t tell a bunion from a beet.  There are stores that specialize in walking shoes, but here too, very few of the people lugging boxes of shoes from the inventory room will turn your old shoes upside down to see if you are pronating, or ask you to walk around the store to check your stride.

And really, how many physicians, especially those specializing in injuries and /or pain in our legs, knees, hips and backs, ever talk about how we walk? I once had a physician who was a runner himself with the aches and pains common to runners. But in our discussion of knee problems and plantar fasciitis, neither of us ever looked at the bottoms of our shoes to see whether they were unequally worn down. And I would venture to guess that few health clubs  offering a free evaluation of a new member’s balance, muscular strength, and aerobic status, include an appraisal of how the new member walks, and whether his or her shoes are suitable.

Perhaps free walking evaluations should be available at health fairs, or during health awareness days in the workplace. What about putting out information in the waiting rooms of doctor offices?  Pictures of what the bottom of a shoe looks like when extreme pronation occurs could be posted near the ubiquitous shelves of corn removers and arch supports in drug stores.
Granted, feet that hurt are not problems in the same league as global warming or asteroids hitting the earth…But knowing what kind of shoes to wear so that walking from point A to point B will put a smile, rather than a grimace, on your face goes a long way to making you likely to continue to walk.  

Obesity Due to SSRIs Is Not a Chronic Disease

A comprehensive evaluation of the best ways to treat obesity was published in an early September issue of JAMA [1] and offers valuable advice to physicians dealing with obese patients. There is only one little problem: Almost no attention was paid to the subset of obese individuals whose weight gain is not related to their overeating and sedentary lifestyle, but rather a side effect of their medication.

Kushner and Ryan, the two authors, did state that unexpected weight gain could be a side effect of antidepressant medication, but their advice was limited to changing the drug. Although sensible, their recommendation did not consider that most of the drugs now prescribed for depression, anxiety and bipolar disorders and other mental illnesses can cause weight gain. There are very few which do not do so. Moreover, patients are often on more than one drug, each with its own weight-producing side effect.

The article failed to acknowledge that this subset of obese individuals had a “before” when they were thin, fit, energetic, not embarrassed to be seen in public, or the target of offensive remarks often directed toward the obese. Their obesity is not chronic; it is not an ongoing struggle to control overeating and under exercising. Were it not for their medication, they would not be obese.

But they are now. They are in the “after” and suffering from a transformation of their eating habits, physical activity, bodies, and even their social life, starting sometimes only weeks after beginning treatment with an SSRI or mood stabilizer.

And to the dismay and chagrin of this subset of obese individuals, no one is paying much attention.

When was the last time the media talked about the problem, if they have ever talked about it? Endless headlines fill our newspapers, computers and smartphones about whether we should be eating 40 grams of carbohydrate or 200 grams of carbohydrate, or whether fasting and feasting is a better way of losing weight or that 30 minutes of exercise broken into 10-minute intervals provides optimal results. But where are the weight loss organizations, clinics, and medical journal articles pinpointing specific weight loss interventions for those formerly thin who think that, because of their medication, they may be permanently fat?

These individuals can be helped to establish control over their food intake even while still being treated with the drugs that are causing their overeating. They can be helped to restart their exercise routines even with bodies sluggish from their drugs and excess weight. And they can be helped to deal with the stigma they share with all other obese individuals and the unfortunate responses by the public. But they need someone to notice.