Monthly Archives: November 2014

Hold the Gluten! Pass the Fat! The Contemporary Thanksgiving Meal

The Thanksgiving day menu from the Fall of 1621, when the Pilgrims and the Wampanoag Tribe feasted in gratitude for the newcomers first harvest, has gone through profound changes. Yes, turkey was on the menu but not the main dish. Turkeys in the early part of the 17th century were probably not unlike the drab, skinny, aggressive birds roaming the inner suburbs of Boston, terrorizing small dogs, children, and on occasion even postal workers.  These urban turkeys do not resemble the plump fowl we’ve come to expect for our contemporary Thanksgiving meal, and it is easy to see why duck, venison, lobster, oysters, and clams had pride of place, along with squashes, berries, and a baked cornmeal-like bread. They did not yet have wheat.

A century later, Alexander Hamilton proclaimed that turkeys should be eaten at Thanksgiving  (maybe the turkeys in his neighborhood were better looking) but it wasn’t until the mid-19th century, when Lincoln made Thanksgiving a national holiday, that turkey rather than lobster, venison or pot roast, for that matter, became the traditional dish.

Today’s Thanksgiving day menus barely resemble the foods eaten in the early 17th century:  the Pilgrims should be thankful that marshmallows had not yet been invented, and they might have been perplexed at how they could stuff those scrawny turkeys with a soggy mass of  bread , celery, apples, chestnuts, raisins, and sausage. If they had followed contemporary cooking fads and fried their turkey, Massachusetts might have been set on fire, and turkey made out of tofu would have sent many early settlers scrambling to get back to England, where birds were not made from soybeans.   

As our country became regionally and culturally diverse, so did the Thanksgiving menu. Years ago, I was invited to a Thanksgiving meal at the matriarch’s home of a large Sicilian family, and if there were turkey on the table, it was hidden by the bowls and platters of lasagna, sausage, escarole, meatballs, and fried eggplant. This one dish of stuffing, aka dressing, is our continental consistency, however, and its ingredients are a prime example of our regional and national diversity: in the South, cornbread is the main ingredient but in other areas stuffing came be made from white, wheat, or rye bread. Additional ingredients include oysters, apples, chestnuts, raisins, celery, sausage, and even cheese and raw eggs.  

Now home cooks are facing new challenges to their Thanksgiving Day meal that go beyond  whether to put marshmallows on the sweet potato casserole, or how to separate Aunt Mary from nephew Sam so they won’t spend the entire meal arguing politics.  These issues pale before the problem of: What can I serve to satisfy the never ending food issues of the guests? Should I have asked them to fill out a food preference list a few weeks ago so their specific needs will be addressed?  

Attending to the foods likes and dislikes of family members and friends is as probably old as Abraham serving goat (or maybe lamb?) to the three angels who appeared before his tent.  An older relative always had beef and chicken dishes available at any dinner party she hosted in case, as she always told me, “What if someone doesn’t like brisket?” My response, to serve them cornflakes, was ignored. But now, the needs of guests have expanded far beyond food allergies, low salt or low fat diets, and a persistent hatred of Brussel sprouts.  

Sensitivity to lactose, the sugar in dairy, must be noted before adding evaporated milk to the pumpkin pie, or butter (it contains milk solids) to mashed potatoes and string beans. Those adhering to the Paleo aka The Caveman Diet, should be given their turkey more or less raw with perhaps a hunk of wooly mammoth as dessert. The high fat advocates? They will want to skip the vegetables, unless they are saturated with butter and cream, but will ask that the layer of turkey fat on top of the gravy not be skimmed off before being poured over their meat. And of course the gluten-free folk will find foods compatible with their need to avoid this wheat protein, but only if the menu is kept as simple as that of the Pilgrims. Boiled squash, pumpkin, ground corn, and berries, along with the turkey should be a safe for them to ingest, and they must be warned away from touching the biscuits, cranberry bread or pies, as eating them will surely cause distress. (I suspect not eating those luscious pies should also cause them some distress.) The easiest guests to feed are those following the Cleanse Diet; just give them a glass of warm water and lemon juice.

Thanksgiving is a meal commemorating the survival of the plucky Pilgrims through the harsh winters, cold springs and uncertain summer harvest. They made it, thanks in large part to the help of the Native Americans with whom they shared this feast. Their meal, lavish in relation to what they had to eat daily, was a feast and they gave thanks to the abundance of food before them. Now, living in a society with a daily over abundance of food, it is not strange that for many, today’s Thanksgiving meal is a testimony to what we cannot eat rather, than being grateful for what we have been given? 

Chasing Away Insomnia With a Bowl of Oatmeal

Mike, the guy behind the desk at the gym, was yawning so much he could barely say good morning. “Late night?” I asked him. “No,” he yawned in reply. “I haven’t been sleeping well for days.”

“How long have you been on the high-protein diet?” I asked, knowing nothing about what he had been eating, but guessing he had fallen prey to the fitness hype about the benefits of avoiding carbohydrates.

I was right. Mike’s sleep problems started two weeks earlier because he had cut all starches and sugars from his diet. Now his sleep was like a yo-yo: asleep/awake/asleep/awake all night long.

“I go to sleep at midnight, and I wake up at 2 or 2:30. I then fall back asleep, and I’m up again in another hour. My mind is racing, and I feel agitated and simply can’t relax,” he told me.

If Mike had searched the Internet during those wakeful early morning hours, he would have read countless anecdotes from others describing similar sleepless nights. Whether the problem was failing to fall asleep easily, or get through the night without multiple awakenings, all the insomniacs had one thing in common: they were on high-protein, low or no-carbohydrate diets.

This is not to say that there are not many other causes of sleep disturbances from taking too long to fall asleep, trouble staying asleep, or waking up too early. Anxiety, age, sleep apnea (which awakens the sleeper many times during the night), drug side effects, some degenerative diseases, and even shift work are but a few of the obstacles preventing this most natural and wanted behavior. But if someone stops sleeping normally at the same time as he or she stops eating carbohydrates, it does not take a sleep disorder expert to figure why…too little serotonin is the cause.

Serotonin, the multi-functional brain neurotransmitter, normally soothes your brain into a calm and tranquil state so sleep comes easily. If you awaken, serotonin prevents the anxiety demons from leaping out and filling your brain with worries that prevent you from falling back asleep.

To some extent what we eat influences whether or not our brain is able to make serotonin. More than 30 years ago, research at MIT uncovered the connection between the consumption of any carbohydrate (except fructose) and serotonin synthesis. The release of insulin after carbohydrate is digested indirectly

helps an amino acid, tryptophan, get into the brain. Once there, tryptophan is converted through a biochemical process into serotonin. However, when more than small amounts of protein are eaten along with the carbohydrate, this process is blocked.

Serotonin synthesis was never in peril until recently. For most of our history, carbohydrates have been a staple of our diets, and being told to avoid them would have been as unimaginable as being told to walk on our fingers. Alas, the self-appointed nutrition gurus who are convincing us that the eating of carbohydrates will destroy our bodies, or at the very least, turn us into a human version of Humpty Dumpty, don’t understand that we have to eat carbohydrates if we are going to make serotonin.

When you are awake at 2AM searching the Internet for help with your insomnia, you will come across bland assurances that eating protein will give you the tryptophan you need to make serotonin. To borrow a phrase from the Gershwin’s Porgy and Bess,”… It ain’t necessarily so.”

Here are the facts: Eating protein prevents tryptophan from getting into the brain. Eating turkey does not increase the tryptophan in your brain (you are sleepy after the Thanksgiving Day dinner because of the fat you have just eaten). The research evidence conclusively shows that tryptophan is blocked from entering your brain after you eat protein.

So as you lie awake in your dark bedroom wondering whether you will fall asleep before the alarm goes off, contemplate your problem: sleep or a high-protein diet?

But good grief, you will say. If I eat carbohydrates, like the man in that Kafka novel, The Metamorphosis, I will wake up with my body horribly altered? (Kafka’s hero became an insect). Pounds will attach themselves to my body as I sleep, and I will need a tarpaulin to cover my now massive body!

Well, yes you might, if you eat croissants, doughnuts, mega-muffins, scones, French fries, potato chips, tortilla chips, baked potatoes leaking butter, and crackers covered with 80% fat cheese. Oh, and of course, weight gain is to be expected from consuming too much chocolate, ice cream, cookies, cake and piecrust. These foods are not just carbohydrate but full of fat, too. And since fat contains more than twice as many calories as carbohydrates, if you eat copious quantities of any high-fat foods, you will gain weight.

But you can get a decent night’s sleep, and leave the tarpaulin outside, if you eat very low-fat or fat-free carbohydrates like ¾ of a cup of plain Cheerios or Rice Chex, a small bowl of oatmeal, toast with strawberry jam (the sucrose supercedes the trace amount of fructose), or a graham cracker square. Don’t wait until the middle of the night before consuming the carbohydrate. Instead, eat a small, 120-calorie carbohydrate snack twice a day, before or several hours after you eat protein. This will help increase serotonin synthesis before you go to bed. If you have been on a low or no-carbohydrate diet for several weeks, it may take some time to restore your serotonin levels. So don’t worry if you still wake up during the night for a few more days. Eat another small snack. You will be back to sleep in about 20 minutes.

Try this. You have nothing to lose but your insomnia.

When Kids Grow Fat From Medication, Who Protects Them From Being Bullied?

The good news is that the increase in obesity in kids seems to be leveling off. Perhaps this is due, in part, to healthier school lunches and/or an attempt to get kids to exercise more. It’s a good thing, because fat kids are likely to be a verbal and physical punching bag at school, in their neighborhoods, and often at the family dinner table.

That obese adults are targets of verbal abuse, often from strangers as well as from officious relatives and nasty co-workers, is well known. Their ability to defend themselves is limited. Unlike hate speech, there is no legal penalty for laughing at the body of someone else, and it is hard to prove that obesity is involved in job discrimination. But adults sometimes have the option of escaping from situations in which they are victims. They don’t have to see offensive relatives or spend time with puny-brained fellow employees who feel good by making others feel bad.

Children don’t have escape routes from bullying, even when parents and school officials get involved. What happens on the walk home from school, or on the playground away from the eyes of a monitor, in the school bathrooms, or on Facebook, is often not preventable no matter how many meetings of school officials and declaration of no-bullying policies.

Obese children are the most likely to be bullied.

The National Education Association (School Psych Rev 2013; 42:280-297) reported weight-based bullying to be the most prevalent of all causes of bullying, and not just among younger children but among obese teens as well. Sadly, criticism and worse about their weight seems to come from parents and teachers as well (Pediatrics 2013; 131 abstract).

Now imagine a kid, formerly thin, who gains 50-75 pounds from medication he is taking to control uncontrollable rages or impulsive behavior or anxiety or depression. A pediatrician at one of Boston’s leading pediatric departments told me that such kids who are put on anti-psychotic medications to control severe behavioral problems might be able to be mainstreamed in school. But now the 7-year-old who weighs as much as a 13-year-old is the victim of bullying. He is still fragile emotionally, and perhaps not well socialized into his peer group because of his mental problems or autism or Asperger’s syndrome. He no longer can run fast, bend down to pick up a ball, do gymnastics, or climb a rope. He is alone in the proverbial school yard or bathroom. Who is protecting him from the inevitable teasing? These children are supposed to be helped and supported en route to being integrated into conventional schoolrooms, but bullying presents a barricade that many may not be able to overcome.

Putting such kids on a diet seems like an obvious solution, except that these kids can’t prevent themselves from overeating. Their medication is making them constantly hungry and unsatisfied with food portion levels that kept them full before going on their meds. And like adults who gain weight from the same medications, few, if any weight-loss interventions really grapple with the cause of the weight gain or come up with interventions that counteract the effect of the drugs on food intake.

Medications and other interventions like physical therapy have been developed to handle the side effects of chemotherapy and other medical treatments. Anti-nausea drugs, medications to control vertigo or mouth sores, and physical therapy to help overcome muscle and nerve weakness and pain are among only some of the ways drug side effects are being combated. But weight gain from drugs taken to help mental illness is the blind spot in the battle against drug side effects. The problem is ignored, rationalized as a small price to pay for the therapeutic benefits of the treatment. Or, the obese patient is handed off to a conventional weight-loss program with no experience in dealing with this specific cause of weight gain. If most of these programs have little or no permanent success treating obese individuals who gained weight the traditional way, how then can we expect any success among those whose meds are making them eat too much and too tired to exercise?

Prevention may be the only workable answer. When children are started on these medications, parents must be alerted to the increased appetite that will follow and advised to restrict or eliminate highly caloric foods in their homes, school lunches, and restaurants like fast-food chains. The child must also be encouraged to exercise constantly to prevent weight gain from becoming so excessive that it becomes difficult to do so.

And parents, teachers, school staff and relatives have to protect their child from becoming a target because of his or her weight gain. The child is already a victim of the side effects of the medications; more victimization is unthinkable.