Monthly Archives: February 2019

Valentine’s Day Chocolates: It Used to Be So Uncomplicated

When Richard Cadbury decided to package chocolates in heart-shaped boxes and sell them as gifts on Valentine’s Day in 1861, the most complicated result of his brilliant idea was difficulty in choosing a particular bonbon.  Should the chocolate be filled with chocolate or vanilla cream, chocolate truffle or a cherry in a cherry liquor? No one questioned the nutritional wisdom of eating a food whose ingredients included sugar, cocoa butter, full-cream milk powder, cocoa liquor, lecithin, vanilla and cocoa. Valentine’s Day was special and so was chocolate.

Jumping ahead many decades, chocolate Valentine’s Day gifts now have to be compatible with contemporary attitudes toward food. Chocolate itself has been clothed with health-giving properties; the darker, and often the more bitter, the better. Whatever ingredients chocolate contains to make it a health-giving food however, the amounts are really too small to make much of a difference (unless one eats a 3 ½ ounce chocolate bar containing a few hundred calories daily). But endowing chocolate with the same positive nutritional properties as say, kale…takes away the guilt at enjoying the delectable calories.

The most obvious nutritional hazard is the calories. Who should receive chocolates? Someone who is very thin? She or he probably wouldn’t eat them because it might cause weight gain. Someone who needs to lose weight? The gift conveys the message that the recipient is fat so what difference does it make if the gift makes her or him fatter. Is the giver saying, “I like you fat, so eat these chocolates?”

And then there are those whose personal eating profile makes eating a combination of sugar and fat problematic, so the type of chocolate edible presented as a gift might actually carry health risks. For example, there are many people these days with no tolerance for gluten or other chemicals found in grains, such as wheat and barley. There are others who cannot eat sugar, and still more who have embarked on a diet eliminating all carbohydrates.  None of these people can be the recipient of baked goods made with conventional wheat flour and, for some, sugar.

A friend of mine was in a quandary because she was making a special Valentine’s Day dinner for friends and learned that one of them was on a gluten-free regimen. However, he could eat small amounts of sugar. She searched the Internet for a flour-free chocolate cake and found a recipe with very positive reviews. Her only concern, as she told me later, was the combination of ingredients that made her wonder if she ought to have an EMT standing by when she served the cake.  She said, “I laid all the ingredients on the counter: two sticks of butter, six eggs, two cups of gourmet chocolate chips, sugar, and vanilla, and really thought aborting the recipe. I like this guy and didn’t want to send his cholesterol through the roof.”  She made the cake, which was delicious. She decided to serve such small portions that the heart-unfriendly ingredients couldn’t do much harm.

Since the gluten-sensitive guest could eat sugar and other carbohydrates, theoretically a Valentine’s dessert could have used ingredients like almond, rice or coconut flour. But what about those advocates of a totally carbohydrate-free way of eating? The so-called keto folk avoid carbohydrates entirely because they want their bodies to stop using glucose for energy and switch to using a byproduct of fat instead. Any morsel of carbohydrate that crosses their lips will cause the body to revert back to glucose. What is the giver of an edible Valentine gift going to do? Answer: Find or make foods that are mainly fat and sugar substitutes.

The popular keto diet limits the options, although not the calories. This diet forbids its users to eat carbohydrates in order to coerce the body into using a part of the fat molecule, fatty acids, for energy. These are converted into substances called ketones, and they supply energy formerly supplied by the natural source of energy in the body, glucose. The other half of the fat molecule, glycerol, is converted to glucose (don’t tell anyone) to be used for energy by the brain, which much prefers glucose to fat.  People on the keto diet may not know that this glucose is chemically identical to the glucose in chocolate or bran flakes or oatmeal when these foods are digested in the intestinal tract. What is worrisome about restricting intake to foods with little carbohydrate is that in addition to eliminating most of the fruits, vegetables, and high-fiber carbohydrates we should be eating, the foods can be extremely high in fat and calories. The Valentine Day’s keto edibles are a striking example.

Cheesecake sheathed in a chocolate shell, or drizzled with chocolate, is available commercially and as cheesecake itself is mainly cream cheese and sour cream (and in this case artificial sweetener), its high fat, sugar-free content makes it perfect for a keto Valentine food.  Peanut butter chocolate chip cookie dough works for all sorts of diets (raw, vegan, Paleo, gluten-free, sugar-free, grain-free) and looks like it would also be appropriate…but is not because it contains too much carbohydrate in the form coconut flour and almond flour. Most keto diet acceptable Valentine gifts have to be homemade and, like the flourless chocolate cake, may spread the waist while spreading love.  A chocolate truffle is made from cream cheese, cocoa powder and whipping cream. Chocolate hearts are made from coconut oil and cocoa powder, with artificial sweetener. Dipping bacon strips in chocolate makes a Valentine breakfast for your keto sweetheart’s breakfast or, if you live in England, you can buy a heart-shaped sausage from Marks and Spencer for the breakfast table.

Somehow these recipes don’t convey the traditional appeal of the old-fashioned Cadbury heart- shaped box and its many imitators.  Valentine’s Day was never meant to be celebrated by eating various cream cheese-based foods.

By definition, Valentine’ Day is a sweet holiday with a message of friendship, affection and love. Wouldn’t it be nice if we could take this day of uncomplicated messages to uncomplicate our dietary profiles as well? No one in 1861 receiving the first heart-shaped boxes of chocolate had to worry about whether eating the chocolates would throw the body into some sort of metabolic disaster. And why today should a person deciding what chocolate gift to buy for his or her sweetheart have to think about the food idiosyncrasies of the recipient?  Maybe, just as one hopes messages of friendship and love are not limited to February 14, one also hopes that a reasonable approach to eating can extend beyond the day as well.  Unless one has a medical reason to avoid certain foods, couldn’t we decide that foods that bring such pleasure and are associated with such positive emotions be allowed? After all, we don’t limit romance and love to one day. Why should we limit a piece of chocolate to one day either?

 

Getting Nutrients from Food is So Old-Fashioned: Try an Intravenous Drip Instead!

I looked at the remaining drugstore-brand vitamin pills in the container and wondered whether I ought to continue taking them. A few days ago, an advertisement from a local plastic surgery/wellness/anti-aging spa offered a reduced rate for a procedure in which I could get an intravenous of vitamins and minerals.  According to the blurb that accompanied the offer, the “drip” would allow these essential nutrients to bypass my stomach and intestinal tract, and go directly into my blood thus avoiding the risk of some nutrients not being fully absorbed or altered by the digestive process. The promotional material promised an enhanced glow to my skin, better sleep, and increased energy.

A quick search on the Internet revealed that the intravenous procedures offered by this spa will be the “new” health procedure this year and to expect to see these “drip” spas becoming as ubiquitous as nail salons.  The benefits of receiving a vitamin-mineral infusion a couple of times a week were compelling, according to the web site advertisements. One company calls its preparation a, “brain booster” and recommends its infusion before examinations (studying might help also). Improving immune function is a standard objective of most of the vitamin -mineral infusions, although none of these clinics said to skip getting the flu vaccine. What if someone with the flu comes into the spa to boost immunity?  Should they get the vitamin infusion or go home to bed? This was not addressed.

Someone who really hates vegetables, rarely eats fruits, and dislikes swallowing vitamin pills might welcome the chance to lie on a recliner, listen to soft music and have vitamins and minerals pumped into his or her body every few days. Throw in a pedicure and it is a perfect day of self-renewal.  But why would someone want another type of infusion offered by this spa, namely an infusion of amino acids?  Amino acids are in every protein we eat, and the only people who might need an extraneous source of amino acids are those whose medical condition such as stomach cancer or severe gastrointestinal disease makes digesting protein difficult.  Vegan diets limit protein to plant sources of protein, and some foods may lack adequate amounts of specific amino acids. But so far, vegans have not been advised to skip the quinoa, and instead get an infusion of amino acids.

On the other hand, getting essential nutrients without relying on food might appeal to someone attempting to maintain a pathologically low weight (models, for example). The infusions of vitamins, minerals and amino acids would be a big improvement over a diet of calorie-free soda and cigarettes.

But of course going to infusion spas rather than eating is not sustainable or sensible. There is no provision for an energy source; no infusions of glucose or fat are provided by these clinics.  And it is absurd to equate the nutritional value of a synthetic mixture of vitamins and minerals with the nutritional complexity of micronutrients in food.

But what is disturbing about these spas/clinics offering these nutrient drips is that they are making the same spurious claims that health food restaurants have been making for years.  There is a popular health food restaurant near me promising everything except immortality for their smoothies. A neighbor told us that he did not get the flu vaccine because of one of the smoothies claimed to confer resistance to the flu virus.

A quick scan of some Internet sites promoting nutrient infusions seem to be making similar claims.  Some intravenous clinics offer a seemingly random assortment of amino acids, minerals and vitamins to overcome depression, halt compulsive behavior, improve sleep, decrease the symptoms of mental disorders like bipolar disorder, prevent the symptoms of PMS, help smoking cessation, and of course, weight loss.

These infusion bags of health have about as much scientific validity as products sold by so-called snake oil hucksters who promised their powders and drinks would cure everything. One could shrug off the IV spas as harmless, but they aren’t. The client would not know whether the amounts of vitamins or specific amino acid or minerals are in the range of safe intake, the client would not know if any medication he or she is taking might be adversely affected by these infusions, and whether he or she might experience side effects. When vitamins, minerals and amino acids enter the body by mouth, they slowly enter the body and some of the nutrients may not make it out of the digestive tract into the blood stream. So the dose of vitamins, for example, that gets into the body by mouth tends to be smaller than when coming from an intravenous solution. Moreover, does the client know how much of the vitamins, minerals, and amino acids are retained by the body or eliminated through the urine?  Are the people formulating the solutions medically knowledgeable about the diseases they are supposedly treating? Would they offer medical care if the solutions have no benefit? Do these clinics use licensed personnel to administer the drip? Is the environment sterile to avoid contamination? If someone has an adverse response like a severe allergic response, is there a medical team to handle this?

The most serious aspect of these heathy drips is that there is no validity to their claims, and in some cases, may prevent people from seeking credible medical help. No one is going to lose weight or relieve the symptoms of obsessive-compulsive disorder or bipolar disorder with a drip of some vitamins and an amino acid. Relying on the “magic” of these drips, rather than interventions with scientific evidence supporting their utility, may work only because of a strong placebo effect. And if it does, that is fine. However, if we have truth in advertising, then the drips ought to be labeled “placebo” so the client knows what he or she is getting.

PMS Carbohydrate Craving and Personalized Weight Loss Plans

There is much talk these days about developing a personalized diet based on DNA analysis, lifestyle, food sensitivities, and the use of apps alerting a dieter to situations that might derail a diet. However, in developing an overeating profile, is enough attention being given to a condition that causes some women to eat foods that are expressively forbidden on their diets? Does the eating profile include the information that this condition occurs every month, often for five days or longer? Does the eating control app have in its database knowledge that if the dieter does not get the food she craves during that time she may become very angry, may even delete the app from her phone, or that cognitive changes may make her misplace the cell phone? This monthly change is premenstrual syndrome (“PMS”), and unfortunately, it may be overlooked or marginalized when planning an individualized food plan. Indeed, if the wrong foods are on the food plan, the dieter may find her symptoms worsening and her ability to stay on a diet eroded.

PMS is associated with a change in hormones that occurs in the luteal, or second half, of the menstrual cycle. Estrogen levels begin to decrease and progesterone to increase soon after day 14 or so of the cycle. PMS typically appears a few days before menstruation and can suddenly alter mood, sleep, energy, concentration, and food cravings. Not all women experience PMS; the severity of the symptoms vary from barely noticeable to hampering daily life. Women who experience PMS may not experience it every month and with the same degree of severity. The most severe form is called premenstrual dysphoric disorder and is similar to clinical depression except, unlike a typical depression, it goes away by the beginning of the next menstrual cycle. PMDD, as it is called, is often treated with anti-depressants.

Craving chocolate is commonly associated with PMS and is not to be taken lightly as anecdotes describe women braving blizzards to get a chocolate bar. However, the cravings encompass both sweet and salty crunchy carbohydrates. A weight-loss client told me, “I did not know I was premenstrual until I returned home from my weekly grocery shopping with bags of cookies, ice cream, chips, hot fudge sauce, and packaged cupcakes. My husband asked me why I hadn’t bought any real food, and I told him this was what I wanted to eat. I got my period the next day.”

Several years ago, we were able to admit normal weight women with PMS to our MIT clinical research center to evaluate their mood and directly measure what they were eating when they were at the beginning of their menstrual cycle. We then would evaluate three weeks later when they had PMS. Food was provided in pre-measured servings at meals, and a computerized vending machine allowed the women to obtain protein-rich snacks such as cold cuts and cheese, as well as sweet and starchy snacks such as cookies and potato chips between meals and in the evening. When these normal-weight women were premenstrual, their calorie intake increased by more than 1100 calories a day, compared to the first half of their menstrual cycle — and the calories came from carbohydrate meals and snack foods.

Because all of these women were active and did not overeat when they were not premenstrual, their weight remained stable. However, if they had been trying to lose weight, the obvious response in developing a personalized weight-loss plan would be to insist on cutting out carbohydrates. Indeed, it seems obvious that if they had been on a low-carbohydrate diet, PMS would not have affected their food intake, because carbs would not have been allowed.

Perhaps. But eliminating carbohydrates would have affected their mood, and done so negatively.

Our research team discovered that the deterioration in mood, energy, focus and control over carbohydrate intake was due to alternation in serotonin activity, probably caused by the shift in hormones at the end of the menstrual cycle. Our research was involved in the first use of an antidepressant (Sarafem) that increased serotonin activity to relieve the symptoms of severe PMS.

Women with PMS apparently crave both sweet and starchy carbohydrates because their consumption will increase the level of serotonin. Eating carbohydrates is a natural solution to easing the deterioration of mood, energy, and concentration. A two-year study on the effects of a carbohydrate-rich drink on these symptoms of PMS showed this to be the case. The small amount of carbohydrate in the drink decreased cravings for carbohydrate snack foods significantly. When the women were given a drink containing protein, the PMS symptoms were intense including alterations in cognitive function.

The test carbohydrate beverage used in our study was fat and protein-free, and thus its calories came only from a combination of a simple sugar, glucose, and a mixture of starchy carbohydrates. Some breakfast cereals could easily be substitutes for our drink with their sprinkling of sugar on a high-fiber, starchy crunchy square or flake.

Eliminating carbohydrates, as is still the fashion in many weight-loss plans, overlooks a significant connection between this nutrient and brain function. The brain needs carbohydrates to be consumed to maintain serotonin levels and activities, especially when hormonal changes decrease such activity. In short, to remove carbohydrates in the interest of weight loss may be akin to tampering with nature.

References

Wurtman J, Brzezinski A, Wurtman R, and LaFerrerre B, , “Effect of nutrient intake on premenstrual depression,” Am J of Obstetrics and Gynecology l989; 161(5): 1228-1234

Brzezinski, A, Wurtman J, Wurtman R, Gleason R, Greenfield J, and Nader T D, “Fenfluramine suppresses the increased calorie and carbohydrate intakes and improves the mood of women with premenstrual depression,” Obstetrics and Gynecology l990; 76: (2) 296-391

Sayegh R, Schiff I, Wurtman J, Spiers P, McDermott J, and Wurtman R, “The effect of a carbohydrate-rich beverage on mood, appetite and cognitive function in women with premenstrual syndrome,” Obstetrics and Gynecology 1995; 86: 520-528.