Monthly Archives: May 2016

Relieving Pain Without Gaining Weight

Eating to deal with chronic pain is often overlooked as a cause of weight gain, overlooked by everyone, that is, but the over eater. Individuals who experience pain for days, or even years, also often suffer from the collateral damage of obesity or being overweight. The overeating occurs either as a response to pain itself, depression, and/or sleeplessness due to pain. Too much weight may exacerbate pain in bones, joints and muscles,* and make even gentle exercise difficult because it is so much harder to move.

Pain often seems less bearable at night; perhaps because there are fewer distractions. Often pain drives us from bed and we wander around the house hoping the pain will recede so we can go to sleep. Munching on snacks to relieve pain and the anxiety and frustration at not being able to go to sleep is common.  And the overeating carries over to the next day in an attempt to feed wakefulness into a drowsy body and mind.

Lack of sleep and chronic pain, not unexpectedly, are often accompanied by depression. Who wouldn’t be depressed if neither a good night’s sleep nor a life free of pain was attainable?  Anti-depressants are often prescribed, but they may cause intense cravings and overeating.

And, of course, pain itself may provoke excessive food intake.

I still remember the frantic way a co-worker raced into our office asking if anyone had any chocolate. Someone handed her a chocolate bar, and she tore off the paper and gobbled it down in seconds. She normally was extremely controlled and deliberate; the most impulsive thing she might do is kill a mosquito, so we were amazed at her behavior.

“I am getting a migraine,” she explained, after the chocolate had been eaten. “I usually carry something sugary with me to eat when I feel one coming on, but I didn’t have anything with me.  If I manage to eat some sugar, sometimes I can stop the pain from worsening. ”

Overeating as a result of chronic pain is probably even more common than eating during an acute painful episode. A young woman who came to me for weight-loss counseling after a painful recovery from a sinus operation told me, “I just wanted to eat sweets! I don’t know why, but they made it easier to bear the pain, and gaining weight was not as important as having some pain-free moments.”

Is it possible to eat to endure a painful condition and not gain weight?

Yes. If eating is not indiscriminate, but rather focused on foods which will reduce pain and are eaten in the correct portion size.  There is a specific class of foods that will decrease pain: these are sweet and starchy carbohydrates.  Protein has no effect mitigating pain, nor does fat. Eating a bacon cheeseburger or barbecued spare ribs may act as a distraction from pain because of the pleasure of eating these foods, but will not diminish your brain’s perception of painful signals from your nervous system.

Carbohydrates however, (except fruit sugar, fructose) will decrease discomfort by bringing about an increase in brain serotonin. Carbohydrates do this by potentiating the entry into the brain of tryptophan, the amino acid from which the brain makes serotonin.  (Even though tryptophan is found in protein, eating protein prevents serotonin from being made.)

Serotonin, a multi-tasking neurotransmitter involved in mood and eating regulation, is known to  diminish pain. In fact, this is why anti-depressants that increase serotonin activity are sometimes prescribed for the chronic pain of fibromyalgia, and even back pain. However, these drugs do not increase the amount of serotonin in the brain; only eating carbohydrates can do this.

Twenty-five or thirty grams of a fat-free or very low-fat carbohydrate food like pretzels, Cheerios or oatmeal are sufficient to raise brain serotonin levels. Eating two or three 25-gram snacks a day to reduce pain contributes no more than 300-400 calories to the day’s calorie total. This is less than the calorie content of a modern day bagel. It is important that the carbohydrate be consumed on an empty stomach, however, to speed up digestion so pain is decreased more quickly. It is also important to avoid carbohydrates that are processed with fat such as cookies, ice cream, piecrust, fries, chips, and chocolate, because fat slows down digestion and adds unwanted calories. Of course it is more pleasurable to snack on these foods than steamed rice or rice cakes. However, the long-lasting comfort carbohydrates provide comes not from their effect on taste buds, but from their effect on increasing serotonin.

Anyone who has suffered acute or chronic pain yearns for its end. Eating carbohydrates won’t bring this about. But doing so might make the pain bearable at least for a few hours and that small relief is welcome.

After Stress Stops, Overeating May Continue

Many of us are familiar with a tendency to eat in response to a non-catastrophic stress event. (Impending plane crashes, avalanches, or lighting strikes rarely call for snacks.) An income tax audit, burst water pipes, a fender bender, or a long delay in an airline departure may make us first gnash our teeth, and then put something in our mouths. Sooner or later, ways to cope with the stressful situation are generated (i.e., the plane departs), and we no longer feel the need to use food as an emotional pain reliever.

There are some stressful situations so prolonged that even the memory of them can provoke overeating for many weeks, even months, after the stress is over.  I recently visited with S, a friend whom I do not see often because we don’t live in the same city, and we hadn’t seen each other in over a year. I was shocked by how much weight she gained. Never thin during the time I knew her, she was now morbidly obese, and my plans for us to walk a few blocks to a restaurant were dropped because she couldn’t walk more than a few feet. Catching up with each other’s news, I waited to hear about some stressful situation that might explain her weight gain, but there was none. She had recently retired, but was actively developing a non-profit enterprise she had long dreamed of. Friends, financial situation, and family were all fine, according to her account of the past year.

So why the weight gain? She had told me many times that she ate out of stress, but there was no obvious recent stress to explain her adding at least 40 pounds to her frame over the past 12 or so months.

Later on, as we reminisced about her past job, the reason for her overeating became clear. She had taken on a project no one else in her company wanted to try, due to high risk of failure. She succeeded by tirelessly working, getting no more than 3 hours of sleep a night for months on end. Indeed, she had time for nothing else except work, and once told me that she caught herself dozing while standing up and another time, leaving for work, she’d forgotten to put a skirt on over her slip.

This was no recent event, the project was completed successfully at least five years earlier, but the emotion with which she described her work was as intense, as if she had finished it a few days before our lunch. She told me over and over again how hard she worked, how many more hours she clocked than her staff did, how her meals were eaten at the company cafeteria, and at night these meals were supplemented by snacks from the vending machines.

“I had time for nothing else but work. Nothing…” she recounted.

Now it seemed as though leaving work, this company that demanded so much from her, was causing a delayed stress response. Perhaps the overeating and subsequent weight gain was her way of coping with the stress from that time. Certainly she must have experienced not only intense fatigue, but also the fear that her coworkers were right and the project could nor would not succeed.

S is so obese that some type of bariatric surgery may be suggested to her as a way of bringing her weight to a manageable level. Certainly her inability to walk because of shortness of breath was very worrisome. Yet should she opt for such a procedure, or any other weight-loss intervention, it was doubtful that she or her medical/nutrition team would recognize the reason for her substantial weight gain. Nor is it likely that S would reveal the reason for her ballooning into morbid obesity, as she probably is unaware of it. And yet will she be able to keep her weight off unless she recognizes the reasons it was gained?

Overeating in response to a delayed stress reaction may be common, but it’s often unrecognized. Many times a physician will ask about previous stress in trying to understand why a new medical problem has arisen. The stressful event may have occurred months ago, but the aftermath may show itself in rashes or insomnia or mysterious aches and pains. The physician is probably less likely to look at someone who has gained a great deal of weight recently to ask about past stressful events. And to be fair, the patient may not be able to make the connection, either.

Stress may be close to the top of a long list of reasons why people gain/lose/regain weight, or can’t lose it at all. If it is ignored or underestimated in developing an effective weight loss intervention, then the probability of long-term weight loss success is diminished. The dieter might be better served by focusing on the emotions behind the overeating before being treated for the overeating, or at least at the same time. It may take longer to deal with the psychological aspects of weight gain, and required weight loss, as other than the physical, but doing so will guarantee a better long-term outcome.

Stopping After-Diet Weight Gain: Is It Possible?

A sobering report in the New York Times about the weight gained by contestants on “The Biggest Loser” confirms what every failed dieter knows: it is harder to keep weight off than to lose it. Research on post-dieting metabolism and eating behavior among these contestants might convince some wannabe dieters to indefinitely put off even starting a diet. The post-diet contestants were found to have such slow metabolisms that their bodies were using up far fewer calories than predicted, based on their height and weight. People of the same size who had not been on a prolonged diet were found to be using up less than 800 calories. It was no surprise that the contestants were gaining weight.

If that were not bad enough, the contestants experienced an almost constant need to overeat. The urges were strong enough to cause them to binge on foods that never should have been eaten, even in small quantities, if they were to remain thin.

These changes in metabolism and absence of self-control over eating are hardly unknown. Decades ago, scientists measured changes in calorie use before and following substantial weight loss. They put people in a room called a “respiration chamber” for 24-48 hours, and measured how many calories were used when the volunteer was in a relatively inactive state. The results were consistent with those reported for the Biggest Losers: After substantial weight loss the body uses markedly fewer calories than those of people of the same size that have not lost weight. Why this occurs is still not understood years after the first observations. Changes in the activity of certain thyroid hormones might cause a slowdown of metabolism, but other factors may also be involved which have not yet been identified. This is a significant problem since it means that at present there is no way of preventing others who endure a rapid weight loss caused, essentially, by low rations and excess exercise from suffering the same fate.

Other possible explanations for the post-diet side effect of weight gain are related to the reasons weight was added initially. Some of the contestants had been gaining weight since childhood and were unable to stop the weight gain. Why were they unable to halve their weight gain before it transformed them into morbidly obese individuals? Were they gaining weight because their bodies did not have the same control mechanisms to regulate their food intake? Were they always less active than their thinner peers? Did they drink soda instead of water, eat fried fatty food rather than lean protein and vegetables, and consume many large meals each day? Was food used to dampen emotional pain, or as entertainment?

Each of us have our own reasons for overeating, whether it is only a few extra calories, or several thousand. Not knowing why, or just as likely unable to change the “Why?” will make maintaining weight loss very difficult.

Undoing the side effect, weight gain, after successful weight loss requires:

• Decreasing post-diet hunger and lack of satiety;
• Developing strategies to halt overeating in response to emotional and situational triggers;
• Adherence to a food regimen compatible with anticipated post-diet metabolic slowing;
• Investigating whether changes in gut bacteria allow too many calories to enter the body;
• Decreasing sleep disturbances that trigger fatigue associated overeating; as well as
• Preventing overeating triggered by seasonal decrease in sunlight.

The immediate problem that requires intervention is making it possible for the ex-dieter to adhere to a reduced-calorie food plan. Unless the calories consumed correspond to those required by the now sluggish metabolism, weight will be gained again. And yet, the dieter is being asked to stay on a post-diet diet. How frustrating and difficult! After months of being caloric deprived, the dieter is being told to continue the deprivation.

Perhaps it is time to help the dieter by offering temporary treatment with an appetite-suppressing drug.

The FDA has approved several new appetite-suppressant drugs over the past three years. They all have side effects, some of which, such as elevated blood pressure or increased heart rate, might be dangerous for an obese individual who already suffers from cardiovascular problems. But if healthy, normal weight post-dieters used these drugs? Their side effects may be less potentially harmful.

These drugs decrease hunger and cravings and increase satiety. They might help the ex-dieter follow a reduced calorie regimen at least for some of the time it takes for their bodies to become metabolically normal. If they are no longer beset with the urge to overeat and the frustration of seeing their weight increase, they might have the mental and emotional energy to grapple with the triggers that caused them to become obese.

We still must figure out how to prevent the metabolic meltdown that makes it so easy to gain weight after a diet. We still must find out how to prevent post-diet weakening of the satiety signals and exacerbation of urges to binge. We still must develop counseling paradigms during and after the diet to address all the factors that caused weight to be gained. Without these answers, the dieter may not be able to escape the side effect of successful weight loss, i.e., weight regained.

Not All Vegetarian Meals Are Created Healthy

The dinner invitation seemed perfect. A restaurant located near a downtown farmer’s market was serving, once a week, a gourmet vegetarian meal. We would sit at long tables and be served, family style, several courses featuring locally grown, very fresh vegetables. A group of us decided to try the new menu. Gourmet food that was good for us. It seemed too good to be true.

Alas, it was too good to be true. To be sure, the farmer’s market was still selling vegetables when we arrived, but was about to close. We did sit at long tables and passed platters from diner to diner, and there were plenty of vegetables. The problem was that the vegetables no longer looked like vegetables. With the exception of a pinto bean, wild rice and lettuce dish, the vegetables were coated with a cornmeal or a flour crust, and fried or, chopped and shaped into pancakes and then fried.  Carefully dissecting the fried cornmeal crust encasing the slice of green tomato I found (no surprise) one slice of green tomato. The main dish was chicken-fried summer squash. A roundish piece of breaded something was placed on a dense pancake of cornmeal and corn kernels. When I detached the crust, I found a chunk of yellow summer squash that tasted like plain boiled yellow nothing; in fact the fried chicken batter was so thick and stiff that it retained the shape of the squash even after it had been removed.  Dessert was ice cream and apple crumble, a strange dessert for a spring farm produce menu, but gobbled by the diners who seemed to feel they deserved something sweet and gooey after eating all their vegetables.

The meal left the diners, at least our friends, discontented. We had expected to be eating a variety of vegetables that were on the A list of nutrient-dense foods and prepared in such a way that their innate vegetableness was featured. Instead, to be certain, we got vegetables ranging from green tomatoes, yellow squash, and corn, all with relatively few nutrients. The addition of high fat, high carb, coatings added calories without any nutritional benefit. The one dish without breading, the beans, wild rice and lettuce, was probably a little more nutritious, especially the beans, which would have delivered some protein if a cup or so had been eaten. But judging by the amount of food left on the platters as they were passed, people ate only cautious amounts of the somewhat hard-to-digest beans.

The take-away message from this meal was hardly likely to impress a dietician:

  • Many people are excited about eating vegetables that are transformed into vegetarian versions of fried chicken or fritters;
  • As long as we eat vegetables, we are, apparently, getting all the nutrients we need, and protein isn’t one of them;
  • All vegetables are nutritionally equal as long as they are fresh from the farm; and
  • If you serve a yummy dessert, people may forget they had only vegetables for their main course.

Of course, this was only one meal, and maybe it was a good way to get a recalcitrant spouse to go out to a restaurant that specialized in something other than meat and potatoes. If this unwilling vegetable eater enjoyed the southern style fried summer squash, perhaps the next time he or she would eat the squash without its case of fried breading.  The meal also highlighted the advantages of buying produce locally grown and sold, supposedly, only hours after being picked (although the wild rice was certainly not harvested in this south Florida town).

But the meal obscured the true delight in eating vegetables and fruits that make it from vegetable patch to table in under a day. It is not necessary to muck around with corn on the cob so fresh the sugar in the kernels has no chance of turning into starch. It is not necessary to fry tomatoes when their skin conveys the warmth of the sun and biting into them spurts their tangy juice over one’s hands. It is not necessary to combine an unusual vegetable like wild rice with odd companions like soggy cooked lettuce or mealy beans. This grass that looks and tastes like a grain deserves to be introduced alone to those who have never eaten it.

Fortunately, for those whose taste buds and curiosity motivate them to eat more main course vegetables, there are countless Internet recipes for every vegetable imaginable and cookbooks that span international cuisines. Yotam Ottolenghi’s new book Plenty More: Vibrant Vegetable Cooking from London has recipes that span several continents worth of vegetarian cooking. His last book, Plenty (Chronicle Books, 2011), was called,  “…(the) vegetarian cookbook of the decade…” by the Washington Post and just the pictures alone are mouth watering. No one misses animal protein after making these recipes. Moreover, vegetables that most of us walk past without buying, or are unaware of tend, to be featured in cookbooks specializing in vegetables. Certainly the recipes go far beyond fried green tomatoes and yellow squash. Ottolenghi’s recipes and those featured in other vegetarian cookbooks, are healthy and offer the variety of vegetables that dieticians are telling us we need to eat in order to meet our nutrient needs. The bad news is that one has to make these recipes at home. The good news is that they are so delicious you may find yourself going off to the farmer’s market and returning home for your own gourmet meal.

Running Into a Thin Body: It Is Harder Than It Looks

The body fat content of Boston dropped precipitously the weekend before Marathon Monday. Most of the blue and gold jacketed (the Marathon colors) people wandering in and out of stores, running the length of the river or on our long city blocks were thin… quite thin. And there were thousands of them.

“Maybe I should start running again,” a friend commented, as we waited behind a crowd of skinny legs for the light to change. “I need to lose some weight.”

It was a tempting thought, one that I had played with for the several years after a repair for a torn Achilles tendon had made me fearful of running too often and too far. The weather was getting warmer, so exercising outside was a pleasure… and who knows, maybe the pounds would roll off along with those miles.

The editors of Runner’s World must have heard our conversation because, a few days later, I was browsing the April edition of the magazine, devoted in large part to running and weight loss.

One section of the magazine was headlined “Why Can’t You Lose Weight?” with a sobering subtitle scolding the reader for thinking that weight loss was simply a matter of eating less and running more.

You mean it isn’t?

Well, no.

According to the magazine, chubby runners, like the rest of the overweight human race, tend to overestimate how many calories their runs are burning off and compensate for their calorie loss by overeating when they get home. Not moving much after the run is not uncommon; after all, why not take the car to do an errand a block away? There is no need for more exercise. And even worse, some (gasp) are even overeating on a day when they are not running. They rationalize, “Tomorrow I will exercise off the extra calories I ate today.”

Alas, there is no magical formula that produces weight loss just by putting on running shoes and cute running tights. The only way a runner can lose weight is to eat sensibly and to commit to a running schedule that increases in time and intensity, so the body never hits a fitness plateau. A generic diet that stresses avoiding high fat, high sugar and highly processed foods, which also provides sufficient carbs to replenish the stored carbohydrate in the muscles used up by exercise, will work to diminish calorie intake. Obviously, it must also include nutritious staples such as fruits and vegetables, as well as lean protein, low-fat dairy products, and high-fiber.

But the exercise component, like running, must be personalized so that the dieter is constantly training to increase both the intensity and duration of the activity. It is not necessary to train as though for a marathon or a long distance bike ride or a climb in the Himalayas. But it is necessary to make sure the body is not too comfortable with the exercise routine. If the effort level remains the same, fewer calories may be used up as time goes on. Runners who want to lose weight are advised, according to the article, to include high intensity runs like speed work, or running fast up hills along with adding, if possible, miles to the distance run. Presumably this can be done on a treadmill as well as outside.

Although running to lose weight may appeal to only a few, the concept behind increasing one’s fitness and stamina applies to anyone who wants to include exercise as a way of increasing weight loss. How many of us have complained, “I don’t know why I am not losing weight! After all, I go to the gym (or play tennis, or go for bike rides or walk) three times a week.” But are we exercising harder as time goes on, or maintaining the same level of physical activity for weeks, months, or even years? I have a friend, a runner (and a little pudgy), who told me quite proudly that he has been running three miles, 4 days a week, for years.

“Well, why don’t you run further?” I asked him. He was surprised at my question and shrugged his answer.

“Why should I? I am comfortable doing that distance.”

Dieters are often told to engage in some sort of physical activity, especially if their weight loss has stalled, and when they begin to do so, particularly if they have been inactive, weight loss often increases. But eventually, as their bodies become fitter and accustomed to this level of physical activity, the exercise will no longer push their weight loss as much as it did at the beginning.

They, and the rest of us who may wonder why exercise does not seem to be melting away our excess pounds, are rarely told that reaching an exercise plateau will slow down our weight loss. Unless we have a trainer or a coach, or read magazines and journals about physical activity and weight, we are unaware of how important it is to exercise harder and longer to increase the rate of our weight loss. Nor are we given information on how this can be done in such a way as to prevent injury and pain.

The solution is not to diet more strenuously, or give up on the exercise because it doesn’t seem to be working. The solution is to become your own trainer. Keep an exercise journal or use an app or wearable device that monitors your physical activity. This will tell you how much you are doing and how often. Resolve to do more. More can mean one minute or an hour, half a block, or several miles. Increase your speed or resistance, again for a few seconds or a few minutes. You don’t have to do this more than once or twice a week, but you must do it if you want to climb to a higher level of fitness and increased rate of weight loss. And who knows, one of these days, you may be in a large crowd waiting to run a marathon.