Monthly Archives: February 2017

How Can You Get Enough Nutrients If You Don’t Eat Very Much?

Some of the more popular reality shows on television display various mental health pathologies such as super rich housewives always fighting with each other (when they are not having their hair done and drinking wine), or a show about hoarding to the point of suffocation, or even a view into living inside a 600-pound body that is so heavy, any movement is difficult and painful. The latter program is particularly sad, in that it shows how obsessive eating is almost always the result of early trauma, and how difficult it is for the overeater to deal with the pain of such trauma when the emotionally deadening effect of food is removed.

 

What has not been depicted so far is a reality program on the struggles of people at the other end of the eating spectrum. These are the people who believe that, like the Duchess of Windsor, one can never be too rich or too thin. These are the people whose body weight is so low that they run the risk of death. These are the people whose obsession with being extremely thin is as unshakable as the 600-pound individual who seems to be addicted to food.  

 

Perhaps the stories of the too thin are not told because the viewer may not be interested in watching an anorectic chase an almost invisible morsel of food around the plate, before grudgingly eating it and then exercising for three hours to work off the 3 calories the food may have contained. Or perhaps it is because the fashion industry has convinced us that thinness is something to be coveted, even if the price of a too thin body may be malnutrition or, if it becomes anorexia, even death.

 

A few weeks ago I walked past a facility holding a fundraising event. What caught my attention was a group of extremely tall women wearing gowns that would have looked appropriate on someone’s red carpet. They must have been models; they had perfect features, either from genes or a plastic surgeon. I confess I stared at them, not just because they looked so exotic in my neighborhood but also because they were so THIN. They were not skeletal but just on the other side of being all bones and no flesh. Another woman stopped and looked with me. She said, “They don’t look quite real, do they? But it must be nice to be so thin.”

 

Somehow we don’t think of being model thin as associated with health issues. The warnings about the risks of eating too much or the wrong kinds of food are well known, they are hard to escape: Don’t eat too much, don’t eat too much sugar, exercise frequently, and get rid of belly fat.  But how many of us know what medical woes are awaiting the very thin? One has to go searching for them. And some can be as deadly as those associated with morbid obesity.

 

When very little food is eaten, as must be the case if someone is to maintain a weight 20 or so pounds less than normal, an inadequate consumption of nutrients can result. Calcium and vitamin D deficiencies are common, and can result in osteoporosis. This disease, which is mainly silent until the first of many bone fractures occurs, is characterized by the loss of bone mass. This disease usually shows itself around menopause, but the bone loss due to nutrient deficiencies may start decades earlier. Other symptoms of nutrient inadequacy such as thinning hair, fatigue, dry skin and bruising of the skin also may not show up for several years, but can be traced back to a very low nutrient sparse diet. A study of the nutritional adequacy of the Mediterranean Diet in Spain among thin women indicated that they were deficient in vitamins A, D, E, B2, B6 and folic acid, as well as several minerals such as iron. (Ortega, R, Lopez Sobaler, A, et al  Arch Latinoam Nutr. 2004 Jun54; 87-91.)

 

Even athletes, whom one assumes eat healthfully, may be nutrient deficient if they are dieting. Female volleyball players who play the game in the scantiest of uniforms were found to be deficient in a variety of vitamins and minerals, due to their dieting in order to reach a figure perfect weight. (Beals, K,  J Am Diet Assoc. 2002;102:1293–1296). And dancers who must maintain low weight and low body fat are particularly vulnerable to nutrient deficiencies ( Sousa, M, Carvalho, P et al ,Med Probl Perform Art 2013 28: 119-123).

 

Models, dancers and some athletes accept the necessity of maintaining an abnormally low weight as one of the demands of their profession. They may be able to compensate for their restricted calorie, and thus nutrient, intake with the use of supplements. However, supplements rarely provide all the nutrients they would get from food, if only they were allowed to eat more. 

 

Thinness is also prized among women whose weight is irrelevant to their profession but not to their social standing. And its potential nutritional toll and subsequent health problems may be ignored as thoroughly as by an obese individual who cannot stop overeating. A quasi-sociological analyses of the lifestyle of women who live in the rarified neighborhood of New York’s Upper East Side points this out. In her book, The Primates of the Upper East Side, Dr. Wednesday Martin describes the non-eating that takes place at social events. Women diet continually and subject their bodies to workouts that would make a Marine recruit weep in order to have a perfect body. So many foods are eliminated from their diet in order to achieve the desired thin state? It is a wonder that the residents of this neighborhood don’t suffer from scurvy, anemia and other nutrient deficiencies. They are not addicted to food, but rather they are addicted to their almost pathologically thin bodies.

 

And yet this bizarre eating behavior is not the subject of reality television, or urgent messages from health organizations warning about its long-term consequences of nutrient deficiency. We see the consequences of the massive overeating of the 600-pound individual and tsk tsk at what that person has done to his or her body. Maybe it is time to tsk tsk over the damage the too thin are also doing to their health.   

Can You Give a Man a Box of Chocolate for Valentine’s Day?

In former times, when women were courted (at least in books) with gifts, flowers, poems, and perfume, giving a box of ornately wrapped chocolate for Valentine’s Day was not only appropriate, but expected. Presenting a red velvet box tied with a glossy ribbon that contained fancy chocolates was a socially acceptable way of showing interest in the other, female, sex. Moreover, the price of chocolate varied sufficiently, so that brands and sizes were within most people’s budgets.

But this gifting of chocolate was, and seems still to be, unilateral.  Is it because women are not supposed to give Valentine gifts to men to express their interest in a relationship?  Is it because it is unmanly (whatever that means) to like chocolate, and thus giving a gift of chocolate raises the possibility of a diminished manhood?  Is it because cultural norms dictate that giving a six-pack of beer, tickets to a sporting event, or a chain saw are more acceptable gifts? Obviously, the traditional red ribbon wrapped box of chocolates might look out of place on a workbench, in the garage, or on the seat of a pickup truck. And the dainty flower-shaped, decorated chocolates that come in a sampler box are too small, and too  “precious” to appeal to someone who wants a brick-size chunk of chocolate to bit into. Before a woman can even consider giving chocolate to a man for Valentine’s Day, its size and packing have to look suitable for a man cave (maybe a chocolate chain saw?).

Giving Valentine chocolate to women (other than those in an older generation such as mothers, grandmothers and aunts) poses its own set of problems. Indeed, it can be quite tricky. If the recipient is thin, then the gift might be interpreted as a hint that the giver would like some soft curves over the bones and buff muscles. If the recipient is not thin, a can of metaphorical chocolate worms is opened: “Does he like me fat? “ “Does he assume that I will never lose weight?” “Do I look like someone who sits on a couch and eats bonbons?” “Doesn’t he know I am thinking of going on a diet?” “If he knew me better, he would know that I am addicted to chocolate and avoid it entirely.”

The problems do not end with the presentation of the gift. Is the box opened when it is received and chocolate offered to the giver? Does the recipient have to eat a piece of chocolate upon opening the box? Does the giver check to see how long the chocolate stays in the box? Too long a time and obviously the chocolate was not liked. Too short a time? The recipient must be a glutton.  If the box contains a sampling of chocolate pieces with different fillings, what does the recipient do with the chocolates whose insides are not appealing? Finally, Valentine chocolate is hard to re-gift. That red cloth covered box won’t do for Easter, and saving it for Christmas to give to a fellow worker is tricky. You have to take the chocolates out, and put them in a box with reindeer on the cover and hope they haven’t turned, by next December, a grayish color.

Centuries ago, chocolate was seen as an aphrodisiac… although double blind, placebo-controlled studies to see its effect on love relationships are still waiting confirmation. Chocolate comes from the cocoa bean, which is surrounded by a fibrous husk. The husk is broken and removed from the bean. Then the beans, called cocoa nibs, are ground up into cocoa liquor. (No, it is not the same as chocolate liqueur that forms the basis of several delicious and fattening drinks.) The liquor contains a caffeine-like substance, threobromine, which has similar stimulant effects as caffeine. Dark chocolate has more cocoa liquor than typical chocolate, and thus more of this stimulant-like substance. However, it is hard to see how caffeine or this first cousin has any effect on a relationship except to prevent sleepiness if the other person is boring.

The cocoa nibs also contain about 54% cocoa butter which may be similar in texture to peanut butter when ground. Trace amounts of mineral zinc or copper are found in the cocoa bean, along with phenethylamine or PEA. This substance can be made from an amino acid with the similar sounding name of phenylalanine, and results from microbial fermentation in the bean. Phenylalanine and PEA may have amphetamine-like functions, thus possibly stimulating the chocolate eater to say yes to another date. But the amount that actually reaches the brain is as vanishingly small as the amount of chocolate left in the box by a chocoholic.

The magic in chocolate comes in processing these ingredients with sugar, lecithin, an emulsifier made from soy, and vanilla or other flavorings into the final product.  Chocolate is considered a unique food, and to many there is no other food that can meet its immensely pleasing taste and texture. Indeed, so satisfying is chocolate that some might be tempted to exchange a mate for an eternity’s supply of this heavenly food. Years ago in a visit to Zurich’s finest chocolate store, my husband and I each consumed a just made chocolate truffle of such exquisite texture and taste that I thought I saw the pearly gates.

So perhaps the answer to whether men should get chocolate for Valentine’s day is this: Yes!
(as long as women get some too…)