Monthly Archives: February 2015

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, “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.