Monthly Archives: June 2016

‘Don’t Ask, Don’t Tell’ : Convincing Grownups to Eat Their Vegetables

Conversations about eating vegetables are usually infrequent, unless one is at the farmer’s market wondering how to cook a strangely striped squash or white baby radishes. Yesterday, however, I had a long-ish discussion about produce with an elderly Navy veteran seated by me on a van ride to a local hospital.  His passion was growing a large assortment of vegetables in his ½ acre backyard. Despite the vagaries of a New England spring and summer, his planting is so successful he has to give away much of what he grows. One reason that he distributes his harvest to his neighbors is that his wife is, “…Strictly meat and potatoes…She will only eat iceberg lettuce that she buys in the supermarket, even though I grow several varieties of lettuces,” he told me rather sadly.  He was convinced that his superb health, except for some arthritic aches and pains, was due in part to his healthy eating: large salads every day and cooked vegetables as well for dinner. His wife, sort of like Jack Spratt and his spouse, was overweight, hypertensive and diabetic.

“Can’t you convince her to eat what you grow?” I asked, wishing I was a neighbor and could receive some of his harvest. “Nope, she won’t listen to anyone,” he replied.

Later on that morning I sat in on a weight-loss group meeting of mostly obese males, aged about 68 to 80. The dietician leading the meeting suggested I attend in preparation for some research we were planning to do together.

Eating vegetables was the topic du jour.

Brightly colored charts listing vegetables according to their nutrient components were on the screen, and copies of the charts also appeared in front of each participant. The guys were quiet and attentive but, as I listened, I wondered how many would translate the information they were hearing into food on their plates. Some cooked for themselves, as I learned after the meeting; others relied on their spouse or partner. If they increased their consumption of vegetables, it probably would not only improve their nutritional status; it might help them lose weight, the point of the dietician’s talk.

My conclusion at the end of the session was that most of these men, probably like the Navy vet’s spouse, would still prefer their meat and potatoes. No one asked how to prepare vegetables like kale, winter squash, beets and turnips. No one asked whether frozen or canned vegetables could be substituted for fresh, whether sweet potatoes were better than white potatoes, or was corn considered a vegetable or just starch. No one asked how to get enough vegetables when eating out in a restaurant, especially a fast-food chain. No one asked if it was all right to cook the vegetables in butter or oil, or to add cheese or bacon bits to the dish. I suspect that no one asked these questions because few of them seriously decided to buy the vegetables that the dietician told them to eat.  No one said, “I don’t like vegetables.” But I wonder how many were thinking that?

The distance between making a sensible nutritional recommendation to eat X and avoid Y, and having the recommendation translated into eating, can be insurmountable. The recipients of nutritional information may be adults, but they maybe just as resistant to trying new vegetables, or eating them at all, as children. Perhaps even more so because like the wife of the Navy veteran, it is what they have been doing all their lives.

A better approach might be to figure out with the recipients of the information, i.e. the guys in the nutrition class, how, when, and where they might increase their vegetable consumption.

Might they be encouraged to drink their vegetables in a juice that includes enough fruit as well as spinach, carrots, and kale so the drink is tasty?

Should they be encouraged to try vegetables from a supermarket salad bar so they can learn what they like and are willing to eat without having to prepare the vegetables at home?

Could they go to a farmer’s market or supermarket, take pictures of vegetables that are unfamiliar and at the next meeting discuss with the dietician how these vegetables can be prepared?

Perhaps the person cooking for them could sneak vegetables into mixed ingredient dishes like stews, meatloaf, tomato sauce, and blended soups. To borrow a well-known phrase, ‘Don’t ask, don’t tell.’ This may be the easiest way to increase their consumption. I should have mentioned this to the Navy veteran as he told me he does much of the cooking.

Ethnic cuisines do a good job of turning vegetables into carefully prepared, well-seasoned dishes. Think of Japanese tempera, which, if correctly prepared, is greaseless…what an interesting way to introduce asparagus or string beans or carrots to the recalcitrant vegetable eater. Other Asian cuisines also do magical things with vegetables. They suddenly become as tasty (or tastier) as protein. Middle Eastern cuisines rely on vegetables as vehicles for flavorful fillings, or mixed with unlikely pairings like yogurt and garlic.

I wonder if the dietician had shown a video of how to grill vegetables from a cooking network show, passed around cookbooks featuring pictures of mouth-watering vegetable dishes, or asked the participants to cook some produce during the following week for a potluck vegetable session, so that interest and enthusiasm might have been increased.

Getting non-vegetables eaters to allow some room on their plate for vegetables is not hopeless. But it will take more than colored charts and a monologue about eating kale and carrots to bring this about.

A Stomach Drain: The New Level of Combatting Obesity

The FDA approved, in mid-June, a new obesity device that seems to come from a medieval concept of how to prevent overeating. A tube is inserted into the stomach and the outside end fitted with a valve that can be opened or closed, sort of like a faucet. After eating, the patient opens the valve or faucet so the contents of the stomach can empty into the toilet (or a bucket or some container that can be washed out). The procedure is like throwing up to get rid of the contents of the stomach, but with this device you don’t have to gag. Just open the valve.

When I saw an announcement of this device I thought it was a hoax or something thought up by people who compete in ‘all the hot dogs you can eat’ contests. But no, the device, called AspireAssist, is recommended for those who cannot control their food intake. Instructions for its use are quite specific: At least 20 or 30 minutes have to elapse between the completion of a meal and the emptying of the stomach. This is to make sure that some nutrients and calories are passed into the intestines where they are absorbed into the body. If the stomach was emptied immediately, the result would be similar to starvation.  Moreover, the binge eaters and others with eating disorders such as anorexia are not to be allowed to use the device, as it would only enable such individuals to continue on with their disordered eating. And it is not to be used for a short period of time like a few weeks. It is not the modern day equivalent of the way Roman nobles would eat at one of their banquets when, if they had eaten to their full, they would disgorge the contents of their stomach (there really is no way of saying this euphemistically) so they could feast all over again. This means that you cannot take this device with you if you are going on a cruise, for example, and want to make sure that you are eating enough to justify the cost of the trip.

The FDA is limiting use of the device to patients who are obese with a body mass index of 35 to 55, and who are unable to lose or maintain their weight loss through non-surgical interventions.  In clinical trials of the device, it was very effective in supporting weight loss in this very obese population. After a year, patients using the stomach-emptying device lost 12 percent of their weight compared to control patients who lost 3.6 percent. The amount of weight loss is less than what is typically found among people who have had bariatric surgery such as the gastric sleeve. There are many obese patients who have too many health problems to risk having general anesthesia, yet their obesity is so severe that unless reversed it will shorten their life. An acquaintance who must be at least 250 pounds overweight can barely walk, and now has been diagnosed with a heart problem. She is unable to lose more than 10-15 pounds even when living in a residential weight-loss clinic and would be a candidate for bariatric surgery except for her cardiovascular problems. So perhaps a tube that empties partially digested food from the stomach into a pail might help her.

Safety features are built into the use of the AspireAssist device to make sure it is not abused by, for example, someone who sees it as a way of eating unlimited quantities of everything. It can only be used for a certain number of ‘drains’ and then will stop working. The patient must return to the physician who inserted it to get a replacement part and be evaluated for weigh-loss progress.

Aside from the mechanical disposal of food that otherwise would contribute unneeded calories, how will the patient benefit from this new obesity device? Ideally, food intake, or perhaps the frequency of eating, might decrease. Stopping for coffee and a pastry or piece of pizza while shopping is tempting, but the mechanics of draining the stomach in a small bathroom stall in a mall could be awkward. Also, there is the time factor. Does one go out to eat with friends and then on the way home, thirty minutes after dinner is over, look for a public restroom? Maybe there is a manual that comes with the device that answers these pesky questions.

But an obvious question remains: Why would a device, really a plumbing tool, that removes food from the stomach affect how the brain controls eating? If eating is an almost automatic response to stress – and who doesn’t have stress – this response is not going to be altered by draining the stomach.  If eating is a response to lack of sleep, or boredom, or too much work, or too little relaxation time, how can a device that removes semi-digested food in the stomach change this?  In a sense, allowing the stomach to feel somewhat empty after the food is removed may promote another bout of eating as it did with the Romans.

There has to be a better way to allow fewer calories into the body. A tapeworm perhaps?

Can Antidepressants Turn You Into a Food Addict?

What is a food addiction? Having heard several people explain their inability to lose weight due to this problem, I searched out the answers on, where else? The Internet. It appears there are addictions, and there are addictions.  Apparently, being addicted to your grandmother’s strudel or your brother-in-law’s barbecue is one type of addiction to be put in the same category as your impulse to drive 40 miles to eat homemade ice cream, or a fresh-from-the-sea lobster roll.  But these are not real addictions because if they were, you would be driving to eat the ice cream daily, even when the temperature was colder than the treat.

Real food addictions, according to many so-called food addict experts, are more grim and relentless. If you are a food addict you are unable to stop eating sweet, sometimes starchy, high-fat carbohydrates. Indeed, simply by consuming these foods, if you are susceptible, you will be thrown into the abyss of food addiction. If you have the misfortune or mindlessness to eat some refined carbohydrates, say some jelly beans or a piece of birthday cake, you will be assaulted by uncontrollable urges to continue to eat. You may find yourself eating the entire birthday cake or leaving the party to search out more carbohydrates.  Eventually, unable to stuff any more food in your stomach, you will stop…but the longing and urge to continue to eat will remain.  Not only will you experience a constant craving for more food, especially sugary snacks, you will, according to some food addiction websites, suffer from  emotional, social and spiritual deterioration. (Curiously, television networks do not seem to realize the profound damage caused by eating sugar as evidenced by programs devoted to making incredibly decorated cakes, or people fighting over who makes the best cupcakes.)

The solution, or sobriety, if this word can be applied to the sugar and refined carbohydrate addict, requires a life-long total abstinence from these addictive foods. Organizations like Food Addicts Anonymous exist to help people recover from their addiction.

Is it possible that for some, eating cookies or a slice of bread causes them to become food addicts? Maybe. But it is also possible that the reasons driving a compulsion to eat are more complex, and have to do as much with psychological and physiological factors as swallowing a piece of bread. Binge eating disorder and bulimia, two eating disorders characterized by compulsive overeating, are associated with complex psychological problems, not a simple food addiction. Someone who weighs 750 pounds or more, and cannot stop compulsive eating needs solutions to lose weight far more complex than eliminating flour and sugar. Self-described chocoholics (people addicted to chocolate) usually manage to eat normal amounts of ordinary non-chocolate foods most of the time.

Are there reasons people may find themselves with a compulsion to eat sugary carbohydrates other than the random digestion of a sugar cube? Below are some situations that cause people to crave carbohydrates:

People treated with antidepressants and related medications report intense cravings for carbohydrates, especially sweet ones. Why the medications cause these cravings is not understood, but the cravings are recognized as a side effect of the medications, not a food addiction. When medications are stopped, the cravings disappear.

Women crave sugary carbohydrates toward the end of their menstrual cycle, right before menstruation begins, and for some it is all they want to eat. Their longing for these foods are so intense that a cartoonist named Boynton pictured a premenstrual woman saying ‘I could kill for chocolate.’

Is this an addiction? Doubtful, since women return to eating normally as soon as menstruation begins.

A decrease in hours of daylight characteristic of late fall and winter is associated with a type of depression known as Seasonal Affective Disorder. A milder form is simply called the, ‘Winter Blues.’ Typically, the mood change is accompanied by an almost insatiable need to eat sweet carbohydrates; indeed, this is one of the ways this depression is diagnosed.  But how can it be an addiction if it mysteriously disappears as soon as daylight increases, and is usually gone by late spring?

High-protein diets that forbid or limit carbohydrate consumption may cause a sugar addiction due to a decrease in brain serotonin levels. Serotonin, a neurotransmitter responsible for affective mood, appetite, and pain perception, is made only when the consumption of carbohydrates allows the brain to receive the tryptophan it needs to make new serotonin. Craving carbohydrates, like thirst when not enough water has been consumed, may be the signal sent to indicate that the brain needs to make serotonin.

Stress and carbohydrate consumption go together like peanut butter and chocolate. Studies in which people were given, covertly, carbohydrate or protein-containing beverages decreased their feelings of depression only after consuming the carbohydrates. This is probably due to an increase in serotonin production. People tend to self-medicate with carbohydrates to decrease the emotional discomfort of stress. If the stress doesn’t go away, neither does the carbohydrate consumption. Therefore a so-called food addiction may last as long as the stress. The best way to stop the overconsumption of carbohydrates, if indeed that is occurring, is to stop the stress.

Is that plausible, really?

Our bodies and minds can certainly exist without the consumption of sugary carbohydrates. But let’s wait until there is evidence from a placebo-controlled, double-blind studies (neither the subject nor researcher know what is being consumed) that eating a graham cracker, a pancake with a drizzle of maple syrup or their equivalent in sugar grams is generating a food addiction. The situations that cause a craving for sweet carbohydrates such as depression or PMS are difficult enough without the additional burden of worrying that a few gumdrops are going to turn these eaters into addicts.

It’s Time to Give Your Exercise Some Fresh Air

Move your body out of the gym and go outside, into the fresh air. Soon, in a month or so, it may be too hot and humid to exercise outside, or in certain parts of the country, too wet and/or buggy. But now, despite the sometimes yo-yo effects of late Spring weather that bounces around the temperature scale, the weather is usually sufficiently benign to make walking, biking, running or playing tennis possible and enjoyable.

Switching to outside physical activity from the cardiovascular, weight-lifting machines, dance and yoga classes, may seem like an excuse to decrease the intensity and even duration of exercise. Obviously a stroll through a nearby park to look at the ducklings will not increase your heart rate or make you break a sweat, and it is doubtful you will enlarge your arm muscles plucking dandelions from the grass. And unlike a gym cardiovascular machine that measures your caloric output, your wearable activity-monitoring device may be unable to calculate accurately the calories you are using when sweeping out the garage, pushing your bike up a hill too steep to ride, or turning over the soil for spring planting. But the benefits of transferring at least some of your workout time to outside activities goes far beyond knowing exactly how many calories you are expending.

The most obvious benefit from exercising outside is fresh air (unless you are allergic to pollens, or the only air available is polluted from car and factory exhausts).  Replacing the recirculated air of a gym that probably contains the sweat of many members with the freshness of an early morning breeze on your face has to make you feel good.  Changing the exercise environment from the four walls of a health club to the openness of your neighborhood, park, nearby river bank, or lake, decreases boredom and makes physical activity feel more natural. Running or walking on the treadmill is excellent exercise, but after months of doing so, you begin to wonder whether you should be arriving at some destination after all the miles you have covered. When you do the same activity outside, you actually arrive at a destination and enjoy changes in scenery along the way, rather than only seeing old Kardashian reruns on the machine’s monitor.

And then there is always the shock to find that your well-trained body, capable of doing miles on an indoor bike or elliptical machine or treadmill, is struggling against wind gusts, uneven pavements, long hills, and not always winning.  A fellow gym member was amazed at how hard it was for her to bike during a weekend on Cape Cod. “First the wind was blowing in my face on my way out, but somehow it changed direction when I did… so it blew in my face on my way back! And then the hills…Endless. I thought I was in good shape, but by the time I reached the top of the last one, I was panting so hard I had to stop riding to catch my breath.And I can bike miles at a high resistance indoors.“

Another great aspect of an outdoor workout is that you are forced to exercise in a non-climate controlled environment, which sometimes makes physical activity more difficult, but of course, more realistic.You may have to adjust your exercise to unseasonably cold or hot temperatures, or plan what you are going to wear so you can shed clothes when you become hot, and put them back on when you stop and cool down.This adds another dimension to your exercise and in a sense, makes it feel considerably more natural than exercising inside.

Physical activity is not limited to an outdoor version of activities in the gym; obviously there are many activities that, with rare exceptions, cannot be done in a health club such as kayaking, mountain hiking, and softball.  Many of the chores that pop up like dandelions during the late spring require physical labor: washing windows, painting…with all the scraping and sanding that precedes it, yard and garden work (this can be endless), hauling stuff to the dump, cleaning and repairing boats, bikes, and prepping the backyard grill.  Several hours of washing windows may challenge even the best gym exercised arms and back. Digging and pulling out weeds and then raking winter debris from the lawn can feel like more of a workout than soul cycle.

Having a well-exercised body from a winter of exercising inside will make it easier to adapt to any type of outdoor activities. But if you are one of those people who thought about going to the gym but that’s about as far as you got, consider this: If you start now, doing some exercise outside – long walks, bike rides, gardening, a day hike through a nearby conservation area, painting the metal lawn furniture – and keep it up… by the time the weather gets cold, you might like it enough to continue, even inside a gym.