Monthly Archives: November 2015

At What Age Is It Alright To Act Old?

At a museum where I volunteer, a group of women and a handful of men came for a talk and a tour. They live in a retirement community, and ranged in age from their early seventies to mid-eighties. Most had difficulty walking, and gratefully sat down, even though they had been on a bus for two hours (traffic was bad). After hearing a talk and watching a video, many continued to sit even though visiting the exhibits required walking. The few who did stroll around the museum were conspicuous in their relative vigor despite, judging from their appearance, they did not look any younger than the rest of the group. Ninety minutes later, they climbed back on the bus, happy to be going off to lunch.

The reluctance of most of the group to walk around the museum they had come to visit may be typical of this age group. A review article by Drewnowski and Evans in the Journal of Gerontology pointed out that people 65 years of age and older significantly reduce the time they spend in voluntary physical activity. Some in this age group are unable to do any activity that requires muscular strength, such as getting up from a chair, carrying small items like dishes, or dressing themselves. Clearly the museum visitors have not fallen into dependency on others to assist them in what is called the activities of daily living, but if they had been forced to leave the museum quickly, say because of a fire alarm, I doubt most would have been able to walk, even in that circumstance, sufficiently fast enough to be safe.

Many of us take for granted that if we reach our ninth decade or even our eighth, we will be in a sense physically shackled by the decline of our bodies. And it is true that people who engaged in recreational sports such as skiing, tennis, running or biking when younger decide that they are too physically slow, their bones too fragile, their balance too uncertain to continue as they age. Indeed, I once had a weight-loss client who told me with great seriousness that, as she was soon to be forty, she was too old to exercise.

But does old age mean resigning oneself to a life of increasing frailty and limited mobility? Certainly joint and muscle pain or neurological degenerative diseases like Parkinson’s disease make movement difficult and often painful. But, as Drewnowski and Evans point out, the answer is no for the healthy elderly. If they engage in physical activities that improve muscular strength, endurance, and flexibility, they would find themselves walking more easily with improved balance and endurance. They would also decrease their risk of falling and fracturing their bones.

I wonder if people in this age group, like the museum visitors, consider themselves too old to be more physically fit? Perhaps they believe this, in part, because others reinforce that attitude by making it too easy for them to avoid walking or standing. When I asked one of the museum staff people why the visitors should be sitting for an hour of lecture and video after being on the bus for two hours, her reply was, “They are old. Let them sit.” Would she have said that if Jane Fonda,who is about to be 78, were in the group?

Do we make people behave old just because their age puts them in that category? Are we telling people that once they receive Social Security and Medicare, they can accept the inevitable deterioration of their bodies and should stop trying to slow it down by physical activity? Do we tell them, ‘You are old, so act your age!’?

And if they believe that they have the right to sit their way through their eighties, how are they going to fare as if they get into their nineties? If they enjoy reasonably good health now, they can expect to become part of the fastest growing group in the country–the ‘oldest old.’ The cohort of people 85 years of age and older is expected to triple between now and 2030. But if people 5-10 years younger than the oldest old are experiencing limited mobility and endurance, how will they manage as they age without needing to be dependent on others for their needs?

One problem is the absence of role models for this age group. There are too few like Jane Fonda, Lily Tomlin (76) and Morgan Freeman (78). Also, one can’t go to a newsstand or bookstore and find glossy magazines featuring exercise and healthy lifestyles for the over 70 crowd. Fitness facilities ignore this age group, who may feel uncomfortable with the density of twenty-something bodies in various states of uncover working out to blaring music. Even workout clothes are designed for the cellulite-free limbs of the younger cohorts. And exercise classes are rarely designed to protect aging knees or backs. If they are, they may be almost too protective and not push the participants hard enough.

The result is acceptance and complacency. I’ve heard the following: “If everyone around me is complaining of aches and pains and can’t walk far, or climb stairs, or lift packages, or do yoga stretches, why should I? If I go on a trip and the bus driver makes sure I don’t have to walk more than a few yards to a restaurant and I can sit down at the museum, why should I exert myself? I am too old.”

What is too old? Perhaps it time to tell the 75 year-old that if she wants to live a strong and healthy life into her 90’s, she better stop acting her age now.

Cruising Into Obesity

It’s true what is said about gaining weight on a cruise. Well, at least for some people. Having recently ended a seven-day trip on a riverboat, I have direct evidence that if an enormous supply of food is available, some will certainly eat enormous amounts. When I remarked on the seemingly endless opportunities to overeat I was assured, by those who had been on ocean cruises, that the food supply on this riverboat was paltry in comparison. But buffet style breakfasts and lunches, with the option of ordering extra dishes from the kitchen, offered more food than one plate or most stomachs could hold. And the four courses at dinner with the possibility of more than one dessert ensured that no one went to bed hungry. Supposedly there was a midnight snack of pastries and sandwiches, but I had to rely on second-hand information to verify this.  Cookies and chocolates were put in the rooms to stave off any hunger during the night.

And people ate, and ate, and ate.  At lunch, for example, after a morning of sitting on a bus or strolling through a cathedral, people returned to the boat to pile their plates high with cold meats, sausage, cheese, mayonnaise-coated cold vegetables and then order a hot entrée, vegetables and potatoes to eat along with it.  One reason so much food could be consumed was that the plates were quite large.

Long lines formed in front of the person scooping out several scoops of homemade ice cream and topping them with fudge sauce. A variety of pastries could be selected to eat along with the ice cream.   People often went back for a second serving.

The large calorie consumption might have been justified if the diners had spent the day engaged in vigorous hikes, long bike rides, or many hours of walking.  Instead, the distance from dockside to the center of the towns being visited required long bus rides that often continued to sites that were  too far from each other to be easily visited in a morning or afternoon.  Once the group was able to walk around a historic site or visit a museum, the pace was sufficiently slow to allow for mini-lectures and cell phone pictures.  A small gym was available on the boat, but since many excursions started right after breakfast, working out required waking up too early for anyone still on U.S time to exercise and eat breakfast.  It was not a popular destination. And for those who did not want to walk the half flights up or down from one deck to another (there were only three), an elevator was available.

By the end of the week, mutterings about going on a diet after the return home were heard as people waited to enter the dining room, and indeed some seemed to be wearing looser fitting clothes.

Much research effort, money and scientific forums have been devoted to understanding why so many in our country are obese. The reasons given include genetics, alien microbes in the intestinal tract, the carbohydrate content of breast milk (really?), side effects of certain medications, insane diets, fructose-filled soft drinks, fast foods; the list goes on. Some of these factors are probably operative for some individuals.  But the real reason for many was amply demonstrated on the cruise:  eating too much and moving too little.

We are not going to be able to reverse the high rate of obesity until we understand why people ignore recommendations about making healthy, non-weight gaining food choices. An editorial in the Boston Globe lamented the refusal of people to listen to WHO and 2015 Dietary Guidelines Advisory Committee advisories to decrease consumption of processed meats such as sausage, luncheon meat, and bacon and instead eat more vegetables and whole grains.   Calorie labeling allows informed food choices in many restaurants known for high calorie items, but its effect on decreasing calorie intake has been barely noticeable. Pleas to do more physical activity because of its positive effect on health and indeed weight are largely ignored except by those already doing it.

Might the cruise boat be a good research environment to study the eating behavior of people who presumably know how to eat healthfully but won’t? Might we be able to understand why an abundance of food makes people eat abundantly? Certainly it is not because they have just come from a war-torn or famine beset country. A passenger in such an environment does not have to be a rocket scientist to know that a week or so of eating three large meals (and in most cases alcohol) combined with a paucity of exercise is going to increase his or her weight. So why does it occur? No one goes on a cruise to gain weight, and the necessity of going on a diet upon returning home is as annoying as jet lag but lasts longer. It has been said that people eat and drink more than they normally do because the food and drink are included in the price of the trip. Perhaps this accounts for some of the excessive food consumption, but would this also mean that at home all leftovers are eaten, and food is never thrown out just because it is already paid for? Maybe people overeat because they feel themselves in an alternate reality as they float on a river or ocean, detached from the real world.

Not all passengers deviate from a sensible diet even when surrounded by non-sensible but tempting foods. Others allow themselves to eat foods they might not at eat at home, but calculate the benefit /risk of eating extra calories in the form of a regional specialty they can obtain only on the trip.  How are these folks different? Why don’t they throw caloric caution to the winds and eat whatever they want in whatever quantities they can swallow?

Such people are not dieting. Rather they are maintaining their weight. Since it is widely accepted that  95% or more of people who are on a diet gain back their lost weight within five years, even without going on a cruise, perhaps the focus of obesity research should be on weight maintenance.  Thus, a cruise should be the perfect natural laboratory to study eating behavior of those who will be gaining weight and those who will not. But somehow I doubt if there will be people in white lab coats peering at the food on the plates of those going through a buffet and asking, ‘Why are you eating this?’  


Will a Low Carb Diet Deepen Your Winter Blues?

Pity the poor (and misinformed) dieter who has been led to believe that losing weight depends on NOT eating carbohydrates. And pity everyone who knows him or her during the next several months. The said dieter’s moods will fall as naturally and inevitably as the leaves falling from the trees. Contentment will be replaced by agitation, altruism by anger, and emotional energy by a ‘down in the dumps’ mood. Indeed, by the end of the winter, the personality of a low-carbohydrate dieter will be as engaging as a hungry bear emerging from hibernation (and both the bear and the low-carb dieter will have bad breath).

The switch to standard time is this weekend, and the seasonal shortening of daylight hours that coincide, will once again bring to the forefront of how the longer hours of darkness each day dampen our mood. This phenomenon, known clinically as Seasonal Affective Disorder (“SAD”), and colloquially as the Winter Blues, affects almost all of us. Those who are spared usually live in the southern tier of states where the days are not quite as short and where the sun usually shines, even in the winter. But those who live in the other half of the country begin to feel the mood misery of day after day of brief sunshine often hidden by clouds, rain, fog, or snow. Even when the sun is bright, it appears long after many of us are at work, and disappears before we get home again.

Strange as it seems, this environmental event brings about changes inside our brain. Despite the fact that our brain is hidden inside our skulls, it is not impervious to changes in the relative hours of daylight and darkness. When the behavioral changes of SAD were first described, in l984 by researchers at the NIH, it was thought that the hormone melatonin was responsible for the depression, tiredness, increased appetite for sweets, and sleepiness that characterize this syndrome. And this initial theory generated the use of a sunbox or light box therapy, i.e. sitting in front of a light source that emits the spectrum of natural sunlight. Light is responsible for metabolically removing melatonin from the bloodstream and since melatonin seemed to be the culprit behind SAD, this therapy made sense.

Now, many years later, the picture is more complicated.  The activity of the neurotransmitter serotonin seems to be slowed by the decrease in daylight hours. Also the symptoms—craving for carbohydrates, rapidly changing emotions, tiredness, irritability, anger and depression—resemble some of the behavioral changes seen in other disorders linked to too little serotonin activity, such as premenstrual syndrome (PMS). Consequently, people suffering from SAD have been treated with antidepressants that enhance serotonin activity.

And this is where our carbohydrate avoidant dieters take an emotional hit. Eating carbohydrates – any carbohydrate except fructose – is the first step involved in the brain making more serotonin. Serotonin isn’t made from carbohydrates; rather, eating a potato or a bowl of popcorn will allow an amino acid, tryptophan, to get into the brain. As soon as that happens it is changed into serotonin. Eating protein prevents this from happening, so the carbs either have to eaten before protein is consumed (a snack before dinner) or in a meal containing very little protein (for instance, pasta with tomato sauce or a rice bowl with stir-fried vegetables).

Carbohydrate craving is one of the main symptoms of SAD; it may be the way the brain gets you, the eater, to realize that you need to make more serotonin. Certainly it is a lot nicer reminder than a spouse or friend telling you that you better eat some carbs because you are grumpy and impossible to live with.

But what if, by following a misguided and unnatural diet, very few carbohydrates are eaten? Or maybe none at all? Well, the dieter might consider seeing if Airbnb rents cave so he or she can crawl into one and wait until spring. The alternative is a four-month siege of bad mood brought on by darkness and diet-induced scarcity of serotonin. Maybe Paleolithic people experienced the latter since they could not board a jet to Florida or Arizona for the winter. But the modern-day Paleolithic dieter does not have either the cave option nor employment that allows for four months on a beach in the Caribbean.

The choice is simple: eat small amounts of carbohydrate, about 30 grams, twice a day as snacks, and if possible, eat a largely starchy carbohydrate dinner to boost serotonin and mood.  Or, go into social hibernation until spring arrives and the increasing hours of daylight vanquish the winter blues.