Monthly Archives: June 2017

With Whom You Eat May Affect How Much You Weigh

Two weeks ago we were dinner guests at an expensive steak restaurant. Our hosts, who were celebrating their anniversary, urged their guests to order the restaurant’s specialty steak: twenty-four ounces of aged beef.  Everyone, except for another guest and I, complied (we both ordered fish.) Many side dishes were ordered by the hosts to be passed around family style: a dish of fried potatoes oozing butter, asparagus coated with a creamy sauce, and broccoli covered with melted cheese. Despite protests of feeling stuffed, we were told to indulge in dessert: soup bowls of creampuffs filled with ice cream and drenched in hot fudge sauce.

As we waddled home I remarked that it was a good thing we didn’t eat like this more than once a year, if that. Working off all those calories would take hours at the gym, and a frugal meal plan for a few days.  My husband agreed. “I really didn’t want to order such a large piece of meat but since our hosts were so insistent, and everyone else was ordering it, I felt that I should, too. And I wasn’t hungry for dessert, but it was hard to refuse. “

Last week we experienced an opposite social pressure on how we should eat.  Invited to a buffet dinner following a lecture at a local museum, we were offered poached salmon, baked chicken, marble-size boiled potatoes, salad and rolls. No butter was served. The plates tiny, somewhat smaller than salad plates, and once a lettuce leaf, tomato slice, and a minute piece of fish or chicken was placed on it, there was barely room for one potato.  No dessert was available or, if it was, it was hidden in a remote part of the dining area. As one of the guests with whom we sat remarked, “I guess I don’t have to worry about eating too much at this meal!“

These two eating experiences confirm anecdotally what many studies have shown. Social eating can influence the amount and type of food we consume.

Indeed, web sites focused on helping dieters stay motivated suggest choosing eating companions who reinforce healthy, calorie-conscious food choices.  Eating with friends at a restaurant that offers low-fat, non-fried foods, including a variety of whole-grain and vegetable options, makes it so much easier to stay on a diet than eating at a place where the food is batter-coated, or sauced with cheese.  Conversely, going with others to a massive brunch buffet, or a clam shack known for its tower of fried clams, coleslaw drowning in mayonnaise, and unlimited French fries makes it extremely hard for the dieter to say no to these temptations or, in some cases, such as the clam shack, even find something diet-worthy to order.

However, it is not necessary to become an “eating hermit” in order to lose weight. Many restaurants post their menus on their web sites so it is possible for the weight or health conscious to see ahead of time whether there are calorically appropriate meal options. Admittedly, it is difficult to tell friends or co-workers that you prefer not eating at a particular place because you won’t find anything to eat (like at a fried clam shack) that is appropriate for your diet. But these days it may be easier to do so as now that so many have specific food restrictions.  Friends or family, one hopes, would not invite a Moslem or kosher Jewish guest to a barbecue place featuring pork, or suggest going out for pizza with someone who has gluten sensitivity. Since it would be fitting to suggest an alternative restaurant for someone who can’t eat gluten or pork, it is appropriate to identify a restaurant with choices compatible with the caloric needs of someone on a diet or trying not to gain weight.

A little discussed but annoying problem of social eating is the nosy invasiveness of eating companions who feel they have the right to make remarks about the type and amount of food you are eating. Too often comments will be made about portion size: “Is that all you are eating?” or lack of fattening ingredients: “That salad looks inedible without any salad dressing!” or a rejection of dessert: “You never eat it, do you?”  People who would never urge someone in alcohol recovery to “just have one drink” will cajole a fellow dinner who is attempting not to gain weight to “C’mon! Enjoy some of that chocolate cake; it won’t kill you!” It is rarely possible to respond by pointing out the rudeness of the remarks or offering unflattering comments about the speaker’s size or eating habits. Avoidance and seeking out like-minded eaters is probably the only solution.

And that may not be so easy anymore, because the world is getting fatter. A recent report found that 10% of the world’s population is now obese. One consequence is a global eating environment where dishes containing excessively fattening ingredients or mega-sized portions are becoming normative. The gigantic, but apparently typical portions of steak we encountered at the anniversary party are likely to become more common than the meager portions of the museum dinner.  If we succumb to accepting that we are expected to eat portion sizes inappropriate for healthy calorie intake, then we risk increasing our own size a few pounds every year until we are overweight, or even obese. And even worse, if everyone around us is larger than they should be and consuming portions much larger than they should be eating, who will notice?

Obviously, it is rarely possible to restrict the people with whom you eat to those who will reinforce your weight and heath goals. But it is important to resist the pressure of fellow diners to eat promiscuously, to choose food without heed for calories or saturated fat or sugar that have negative effects on health. It is important to realize that after the meal is over, only you will be standing on the scale.

Can E-Cigarettes Reduce Smoking Among the Mentally Ill?

Two young men were walking toward me, their faces obscured by clouds of vapor coming from tubes stuck in their mouths. They appeared to be in a fog bank of their own making.  As they walked past, I realized that they were smoking, or rather vaping, e-cigarettes.

This relatively new form of sending nicotine into the blood differs considerably from conventional cigarettes that depend on the combustion of tobacco, paper, and miscellaneous substances.

E-cigarettes are powered by a battery and look like a real cigarette (or a pacifier for grown-ups.)  Inside the device is a cartridge filled with a liquid containing nicotine, flavorings like candy, and other chemicals. The liquid is heated to a vapor, which is inhaled like a cigarette, and called vaping.

The smoker of e-cigarettes can determine the amount of nicotine he or she will be inhaling by purchasing a specific amount to be added to the heated liquid. Traditional cigarettes contain about 4mg-14mg of nicotine, depending on the brand.  According to the CDC, the average smoker absorbs about 1mg of nicotine from smoking one cigarette, but of course this varies depending on the amount of nicotine in the brand and how deeply the smoke is inhaled. People switching to an e-cigarette can turn to charts that show the amount of nicotine to use to equal the amount they used to get from a traditional cigarette. Hopefully, they will use the e-cigarettes to consume less nicotine.

Many people still smoke because nicotine seems to improve their mood and cognition.  Indeed, smoking has been described as a means of self-medication used to diminish depression, anxiety and even distractibility.  Perhaps because of this, those suffering from mental disorders comprise one of the largest subgroups of people who are still smoking.  According to the Substance Abuse and Mental Health Services Administration,about 18 percent of the U.S. population as a whole smoke.

However, the rate is much higher among those who are mentally ill.  NAMI, The National Alliance on Mental Illness, reported that 60 percent of those with depression smoke, and the number increases to 90 percent among those with schizophrenia.

Nicotine’s positive effect on mood is measurable, although not everyone may benefit. Brain cells containing neurotransmitters involved in our behavior and emotional state contain sites or receptors sensitive to the presence of nicotine. These nicotine receptors may strengthen the effect of dopamine, serotonin and other neurotransmitters on mood, thus making the smoker feel less anxious and depressed. People who suffer from ADHD also may use nicotine to enhance attentiveness and concentration, as it is thought to have an effect on the brain similar to that of drugs used for this disorder.

Regardless of the benefits on mood and cognition, one cannot minimize or ignore the negative consequences of bringing nicotine into the body. In a conventional cigarette, the tar, and a multitude of other substances involved in its combustion, may be the villains in the cancer-producing effects of smoking on the individual, alongside the respiratory and other problems suffered by those exposed to second-hand smoke. E-cigarettes have not been used for long enough to detect the health consequences of habitual use, but nicotine is a drug and thus has the potential for harm, regardless of how it is administered.  And the sad fact is that someone who begins to smoke as a way of lessening the pain of depression and anxiety, may remain addicted to cigarettes long after the mental illness has been helped by medication and therapy.

Might “vaping” e-cigarettes be the solution to breaking the addiction, or at the very least decreasing the health risk? The nicotine delivered in the heated liquid inhaled and puffed out by the smoker is not in a matrix of cancer-causing substances, but added in a measured form to a liquid in the cigarette’s receptacle. The amount of nicotine in the e-cigarette can be slowly reduced to wean the smoker gradually from dependence, and ultimately be removed altogether so that all that is left is the oral gratification of sucking on a tube and emitting vapor.

In a May 13, 2014 issue of Tobacco Control, Sharon Cummings, PhD, reported that smokers with mental health problems are more likely to use e-cigarettes to reduce the hazards of smoking than the general population. She found that 60 percent of smokers with mental illness indicated that they were somewhat likely or very likely to try e-cigarettes in the future for this reason, compared with 45.3 percent of smokers without mental health conditions.

But should people who dose themselves with nicotine to help their mental health withdraw from this drug without medical supervision? Anyone who has tried to stop smoking knows that the craving for nicotine takes a long time (or never) to disappear, and the early weeks of abstinence are accompanied by side effects such as disruptive sleep, distractibility, excessive eating, depression, anxiety and anger.  How much more vulnerable must people be who are already suffering from some of these symptoms before nicotine withdrawal? What if the smoker who suddenly decreases the nicotine in the e-cigarette experiences a flare up of anxiety, panic attacks or depression?

The use of vaping, which allows the smoker to inhale smaller and smaller doses of nicotine, may be an effective way of eradicating the addiction.  But if this is done by those who have used nicotine as an adjunct to their medication, or as a way of preventing themselves from needing medication, the medical community should supervise and support them as they would with any other type of drug withdrawal.