Don’t Avoid Exercise Because It Makes You Hungry

Among the many kinds of advice given to those who are trying to lose weight, exercise usually ranks just below diet. But just as weight-loss advice can be contradictory and confusing, so too are the recommendations for exercise. No one disputes the benefits of physical activity on everything from improved digestion to better cognition. The adverse effects of ignoring the prescription to move ones body are just as compelling: no exercise equates to bad sleep, bad bones, and bad mood, among other unpleasant symptoms.

But many dieters and weight maintainers are reluctant to exercise because they fear the effect on their hunger. Exercise seems like an ineffective, and indeed unworkable, way of losing weight when post-exercise appetite may lead to eating many more calories than those worked off. Anecdotal reports by dieters of feeling ravenous after a stint on the treadmill or weekly Zumba class supports the erroneous belief that exercise while dieting should be avoided to prevent overeating.

Curiously, highly-trained athletes (who, of course, don’t have to worry about their weight) are the least likely to want to eat after their highly intense exercise routines are completed. In a study published a few years ago on appetite among female athletes, the scientists found that intense exercise actually decreased subjective hunger. Moreover, ghrelin, the hormone in the gut and blood that regulates hunger, was decreased and another hormone that shuts off appetite, increased. (“No Effect of Exercise Intensity on Appetite in Highly-Trained Endurance Women,” Howe, S., Hand, T., Larson-Meyer, D., Austin, K. et al Nutrients, 2016; 8 ) The same effect had been found earlier in studies carried out with male endurance athletes.

Since most of us are not likely to devote a good portion of our lives to training for competitive athletic events, we cannot rely on this for suppressing appetite after exercise. However, it seems that even unfit obese men may also experience a decrease in hunger after intense exercise, at least for 30 minutes after the exercise session completed. Whether they overate several hours later was not reported. (“The Effects of Concurrent Resistance and Endurance Exercise on Hunger Feelings and PYY in Obese Men,” Asrami, A., Faraji, H., Jalali, S., International Journal of Sport Studies, 2014 4; 729-)

But one may ask: what is wrong with being hungry after physical activity? Isn’t hunger a natural and inevitable response of the body after calories are used up? A Food Network show featuring life on a ranch in some unnamed cattle-raising part of the country often features recipes for the “hungry” family and ranch hands after a day of especially hard work. It would be absurd for the workers to avoid physical labor just because they are very hungry when they return home to eat a substantial meal.

But most of us have traveled far from the natural progression of physical activity to hunger to eating to a return of energy, and thus being able to work again. The “I am so hungry that I could eat a horse” (or whatever animal comes to mind) statement after hours of manual labor or recreational physical activity seems to many like a prescription for weight gain, rather than the way nature intended us to feel.

But it is not. Hunger is natural. The hormones causing us to want to eat are there to make sure we do so in order to live. If hunger disappears, as is the case for some with late stage Alzheimer’s disease, the individual will not survive unless others make sure to feed the patient.
In short, we should stop being afraid of being hungry. Hunger means our bodies need food the way being thirsty means our bodies need water. How we satisfy our hunger is what we have to improve if we want to stop gaining weight and begin to lose it. Just as we could, but should not, satisfy our thirst by drinking gallons of champagne or sugary sodas; we should satisfy our hunger not by consuming junk food, but by eating foods that not only supply calories (to replace those used up in exercise) but also needed nutrients into our bodies.

Dieters are told to try to eat fewer calories than needed so the calories in their stored fat will be mobilized to make up the difference. But unless the dieter goes on a drastically low-calorie diet, or a diet that eliminates certain categories of foods, it is possible to eat less, satisfy hunger, and still lose weight. We often eat beyond feeling full, that is, beyond the cessation of hunger; this is why we eat dessert. If eating stops when hunger disappears—even if all the food has not—weight can be lost.
Should you eat before or after exercise? It depends on your body. Some cannot exercise after eating and will eat breakfast after, rather than before, working out in the morning. Others find that they don’t have the energy to play tennis or go hiking unless they have eaten. Therefore, they will eat enough to give their muscles fuel for their workout, but not so much that they feel too stuffed to move.

Sometimes during long bouts of exercise, such as a long bike ride or hike, the first sign that the body needs food is not hunger but fatigue. I remember once when I was cross-country skiing all day, I become too exhausted to move my skis up a hill to get back to the lodge. As I stepped outside the track to let a woman behind me pass, she handed me an energy bar. “You need food,” she said. “Eat this.“ She was right. Within a few minutes I felt my fatigue lift, and I was able to continue moving.

We are told to be in touch with our bodies. Exercising, being hungry, and eating healthfully are excellent ways of communicating with ourselves.

 

 

 

Is the US Becoming More Obese Because of Medication?

Despite a blizzard of weight-loss programs, touting novel fat-reducing foods, and innovative exercise devices, the country is getting fatter and fatter. The Centers for Disease Control and Prevention reports that nearly 4 in 10 U.S adults, according to their body mass index, can be classified as obese. Obesity is not evenly distributed among the states. The losers; i.e. the thinnest states, are Colorado, Hawaii, Massachusetts, and D.C. The gainer is West Virginia where almost 40% of adults are obese.

We have been becoming heavier for so many decades that we forget how thin we were as a country 80 or more years ago. It is only when viewing newsreels of the first half of the 20th century in which most adults look extremely thin that you realize what we now consider thin was considered normal weight back then.

The same old reasons are brought out yearly to explain why we, and indeed the rest of the world, is getting fatter: junk food, sugary drinks, dependence on motorized transport rather than our two feet, humongous restaurant portions, intestinal flora that make our bodies store fat, too much time on electronic devices, and too little time in the gym.

Might our growing obesity be related to the weight gain after smoking withdrawal? Weight gain is common among ex-smokers, and studies as reported by the National Bureau of Economic Research (Sharon Begley, “Gut Check”) suggest that it may be 11-12 pounds on average. But a close examination of who gains the most weight indicates that smokers with the lowest BMI are most likely to gain the most, and 11 or 12 pounds is not enough weight gain to make them obese.

Could medications used to treat mental disorders be another, mostly overlooked cause of national weight gain? That psychotropic drugs—the medications used to treat depression, anxiety, bipolar disorderschizophrenia and other mental diseases—cause weight gain is established. Sometimes the weight gain is only a few pounds, stops after a month or two, and is lost as soon as the treatment ends. But many drugs cause substantial weight gain because the patient experiences a relentless urge to eat. Moreover, to the chagrin, indeed horror of some patients, stopping the medications does not always cause weight loss even with dieting and exercise.

Data on the use of psychotropic drugs comes from a 2013 Medical Expenditure Panel Survey discussed in a Scientific American article by Sara Miller.  One in six Americans is taking a psychotropic drug, although not all are being prescribed for mental illness. There have also been many studies showing that depression itself is linked to future obesity. A common depression, Seasonal Affective Disorder, is diagnosed in part by the overeating and weight gain of patients during the increased darkness of winter. Often the depression of PMS and pre-menopause is accompanied by overeating and weight gain as well.

Yet in the list of causes for our increasing girth, reasons such as genes, inflammation, bad gut bacteria and bread are more likely to be found than the weight-gaining potential of depression and the drugs that treat it.

Where are the weight-loss programs specifically designed to help those whose overeating is caused by lack of sunlight, or hormones affecting appetite control centers in the brain, or drugs that hijack control over satiety? Where are the support services for those who are embarrassed to go to the gym because their medications have turned their formerly fit and slim body into a much heavier one?  Recently someone who has been struggling to lose the weight gained on her medication for obsessive-compulsive disorder told me that her dietician put her on a low- carbohydrate diet. “I was craving carbohydrates all the time,” she told me, “so the dietician figured the easiest way to take care of that problem was to remove them from my diet. She did not realize that my medication had caused the cravings even though I told her. And since I couldn’t stop my drugs, I just craved bread and pasta so much on her diet that I began to binge.”

 

This story is typical in that this patient was not seen as needing specialized weight-loss help because her weight gain was the result of a drug, and not related to emotional issuesor an inability to make healthy food choices. Moreover, the dietician’s advice to remove carbohydrates showed lack of knowledge on the effect of eating carbohydrates on serotonin synthesis. Serotonin levels drop when carbohydrates are not consumed and often lead to a worsening of the obsessive-compulsive disorder, depression, or other mental disorders.

How long is it going to be before weight-loss professionals acknowledge that many of the obese in the United States are that way because of their medications? How long will it be before thought, labor, and money are put into programs to address their special needs?

Will 2018 bring about needed innovations in weight-loss therapy for these individuals, or will we just become fatter?

Will Reducing Your Dress Size Reduce Your Bone Size?

“She got so thin!” a friend whispered to me, pointing to a mutual friend we had not seen for several months. The thin friend came over, and when complimented on her size, she told us she had lost weight following a diet than eliminated most food groups. “It was easy to lose weight,” she said, “because all I could eat were lean proteins and vegetables. I think I will stay on this diet forever!”

“You might want to add some dairy products to your diet,” I murmured. “You know, osteoporosis and all that.”

“Oh, I get plenty of calcium from vegetables,” she answered, “and anyway, dairy is fattening.”

Feeling like the bad witch who predicts dire consequences, I restrained myself from pointing out that she was a perfect storm for losing bone mass and breaking bones. She was beyond her menopause, which meant that the protective effect of estrogen on bone density was no longer functioning. It was unlikely that she did weight-bearing exercise to increase muscle mass and subsequently bone mass. Her arms and legs showed no obvious muscular development; they were visually just skinny tubes. Vitamin D intake, the last piece of the triad of interventions that support bone density, was probably also lacking, as the foods she ate were not fortified with vitamin D.

At her age—she was almost seventy—she should have been consuming about 1200 mg of calcium a day and 600 IU (international units) of vitamin D to maintain her bone mass.  But because of her weight-loss diet, she wasn’t.

After a several month struggle to lose weight, it seems unfair that my now thinner friend is vulnerable to this debilitating disease. But she fits the profile of people likely to develop osteoporosis even without her weight loss. (Osteoporosis can occur in both men and women but women are more likely to have it. White and Asian women are most at risk that also increases with age.) If she had a family history of osteoporosis, smoked, consumed excessive amounts of alcohol, and had been severely underweight as an adolescent when bone mass is rapidly expanding, she would be facing an even greater chance of developing the disease.

It is not possible to diagnosis osteoporosis without a bone density scan. Despite her skinny appearance, her bones may have been fine. But the only way to tell is to have a type of x-ray called dual-energy x-ray absorptiometry (DXA or DEXA). Many women ten years or so beyond menopause will have the test so their physician can have a base line measurement of their bone strength. If the results indicate that osteoporosis may be developing, then the patient will be told to consume calcium-rich foods like milk, cottage cheese, yogurt or some vegetables such as kale…and also may be told to take a vitamin D supplement. Exercise is also important to promote bone density.

There are several drugs now available prescribed for osteoporosis but they have substantial side effects. The drugs are called bisphosphonates. Fosamax and Actonel are taken daily or weekly and another, Boniva, is taken monthly. One, Reclast, is given intravenously once a year; for those who have the early signs of the disease, once every two years. Most of the side effects, i.e., nausea, are tolerable, but a minority may developed osteonecrosis of the jaw or jawdeath. Fosamax and Boniva have been associated with this problem in which the bones in the jaw don’t heal after a minor injury like having a tooth pulled. Another equally rare side effect is a particular kind of fracture in the femur, the long bone of the leg.

Why drugs that promote bone growth and density should have the opposite effect on specific bony areas in the body is not yet known.The incidence is 1 in 1,000. It happened to an acquaintance of mine who had been taking one of the bisphosphonates.  She had a dental procedure, and a few weeks later experienced severe jaw pain that was finally diagnosed as osteonecrosis. Now she was faced not only with osteoporosis, but also the fact that she could no longer take the drug that was supposed to halt it.

Preventing, or at least decreasing, the possibility of developing osteoporosis has to begin in adolescence but it is hard, if not impossible, to convince an 18 year-old to drink more or any milk or eat more, or any, yogurt or cottage cheese or kale. The American Academy of Pediatrics has warned that children are not consuming enough calcium during puberty when most bone growth occurs. Young women who are anorectic, or because of excessive exercise and low body fat stop menstruating, are at risk for developing bone loss at a young age. Teens should be getting 1000 to 1200 mg of calcium daily. This amount of calcium is not difficult to obtain with fat-free or low-fat dairy products, or calcium-fortified milk substitutes like soy or almond milk, which are also fortified with vitamin D.  Unfortunately, a diet drink, instead of milk, is often the beverage of choice.

It seems as if the most compelling motivation to consume enough calcium and vitamin D in an effort to prevent osteoporosis is having a relative who fractured a hip or wrist because of this disease. There has to be a better way of promoting concern about this problem than the broken hip of an aunt. Bone density tests are expensive, time consuming and rarely offered to patients before menopause. What is needed is a simple, inexpensive test that detects the early stages of the disease, so nutritional intervention can start decades before the disorder develops—and perhaps an ad campaign showing that life can be “magical” after drinking milk.

 

Losing Weight in a Weight-Loss Resort: Will It Stay Off?

The New York Times recently reported on the change of ownership of one of the better-known weight loss/fitness resorts, Canyon Ranch. The article described the resort’s comprehensive program for those who want to lose weight and improve their fitness. Like many other facilities frequented by those who can afford both the very high price and the time off from work, Canyon Ranch offers more than well-prepared low-calorie food and exercise opportunities that include hikes, exercise classes, a fitness center, and individual training. Massages, lectures on stress-reduction/mindfulness, consultations with nutritionists and physicians, and even wrinkle-reducing treatments prepare the guests for entry into the real world in a much-improved physical and mental state. Sometimes people will stay at facilities like Canyon Ranch or others such as Hilton Head for weeks if they have a considerable amount of weight to lose. Some places stress hours of strenuous exercise and all restrict portion size and variety of food. No alcohol, of course, is allowed.

It is hard to obtain information on whether, after returning home, participants are able to maintain their lower weight, increased fitness, and decreased stress. The article mentioned that at least half of the people who go to Canyon Ranch have gone there before; one woman had visited the facility more than 100 times. No information was provided as to whether she needed to return frequently to maintain her weight and fitness status, or because she simply loved the facility or both.

The transition from staying in a facility detached from the realities of daily life (some forbid the use of electronic devices, television, and newspapers) to the real world may jolt the individual out of his or her newly found healthy lifestyle and make the return to old eating and exercise habits unavoidable. The weight-loss resorts don’t have satellite ‘drop-in centers‘ to reinforce what was learned and practiced while participating in the residential program. Few can maintain the four or five hours of daily exercise in which they engaged while at the resort; at least, not without giving up their day job. Reproducing the low-calorie meals with their emphasis on vegetables, grains, and lentils takes more effort than ordering takeout. And eating away from home at work, meetings, social occasions, and while traveling limit further the ability to obtain the foods offered at the weight-loss facility.

In short, taking on and keeping new habits requires time and effort. Plunging immediately back into the life led before going to these weight-loss resorts may shatter the new lifestyle acquired there.

People whose weight-loss efforts begin at home with dieting, and perhaps some exercise, are familiar from the very beginning of their diet with the struggles they must overcome to lose weight. They are dealing with all the stress triggers- temptations to overeat, work, family matters, exhaustion and lack of time, that may have contributed to their gaining weight.

Those who opt for stomach reduction surgery face an additional struggle because they cannot overeat without making themselves sick, and yet may also face all the factors that caused their weight gain. In contrast, people whose path to better weight and fitness starts in the otherworldly atmosphere of a residential weight loss and fitness facility are helped enormously by the elimination of triggers to overeating.

That is, until they leave.

However, there could be an enduring positive effect to losing weight and becoming more fit as a result of participating in a residential weight-loss facility. Success at seeing oneself thinner, even if it is only by a couple of pounds, and gaining stamina and strength, could motivate and reinforce further weight loss and fitness efforts. Many people don’t start diets or refuse to do any physical activity because they assume they will fail, at one or the other, or both. Stories of people self-identified as unfit, who go to one of the more physically demanding weight-loss programs and find themselves able to hike four or five hours a day, and then participate in hours more of physical training, are often shocked at their ability to do so. People who at home have not been able to give up their high-calorie foods and instead resist eating “healthful” foods, learn to enjoy varieties of grains and vegetables at these facilities and may try to continue eating these foods when they return home.

Could they have initiated these activities and changes in food choices without going to a weight-loss resort? Of course. But at home, they have a choice not to. At the resort, they either do or do not eat what they are served and participate in often grueling physical activity programs, or drop out of the program.

Most adults will never have the opportunity to go to a resort where food, physical activity, stress, sleep, and pampering are designed to make them feel optimally healthy. But might it be possible to take some of the effective programs at these facilities, such as healthful menu selections, opportunities for recreational exercise, e.g., hiking, stress reduction techniques, and introduce them into the workplace for everyone?

These methods of weight loss and fitness seem to be reserved for the few who can afford them. But like many things in our society, from indoor plumbing to cell phones, eventually they become available for most. Perhaps someday, strategies to eat healthful foods, maintain a normal weight, and achieve fitness will be available without staying in a weight-loss resort.

Will Watering Your Stomach Increase or Decrease Food Intake?

His water glass at dinner needed constant refilling, and I was worried that he had some sort of metabolic condition. But that was not the case. My relative by marriage said he always gulped water with every bite because it decreased his need to chew his food. “I swallow faster so I can eat faster,” he told me. Growing up in a family where there was competition for seconds, he learned that if he was the first to clean his plate, he got the remainder of the food on the table. The habit never left him.

Using water to lubricate swallowing is also behind the success of competitive eaters. Such people’s ability to consume enormous amounts of food in short periods of time made overeating into a sport. They train their stomachs to accept 30 hot dogs or chicken wings in the amount of time it takes to unfold a napkin. An interview with Yasir Salem, a competitive overeater ranked #10 in world competition by Erin McCarthy on the Internet site, “Mental Floss,” revealed his use of water in his training. He stretches his stomach by drinking daily a gallon of water after eating several pounds of a bulky vegetable, e.g., broccoli. And during a competition, he dunks hot dog rolls into warm water to soften them, so they can be swallowed quickly and with little chewing.

Competitive overeaters, as well as members of a family competing for the last chicken leg, are not the only ones who use water to eat quickly. Binge eaters will also drink water or other liquids to make it easy to consume large amounts of food in a small period of time. Indeed, many of us probably drink water or soda with our food when we find ourselves needing to finish eating in a hurry.

Drinking water with food to increase the amount of food eaten contradicts general wisdom about the use of water during a meal to decrease food intake. The use of water to fill up the stomach before the meal begins has been recommended for decades. ”Drink one or two large glasses of water before you sit down to eat,” say most weight-loss advisers, “and you will find that you can’t put much food in your stomach.” This is contradicted by Mr. Salem, who told his interviewer that he drinks a gallon of water before starting the eating competition, to effectively flush out his digestive system and make it ready for large quantities of food.

Similarly, drinking water with every bite of food, or at least after two or three bites, is strongly recommended as a way of slowing food intake. If, as the theory goes, you have to put down your fork or spoon, pick up your water glass, take a sip or two, put down the water glass, pick up the eating utensil and start eating again, the rate of food intake will slow considerably. Unlike my relative or Mr. Salem, the food is presumably chewed and swallowed before the water is imbibed. The water is not a lubricant to make swallowing faster and easier, but instead as a “time-out” from putting more food in the mouth.

Drinking more water also completes the end of the meal. If the plate is cleaned, but the eater does not feel full, diet coaches recommend drinking one or two large glasses of water at the end of the meal to convey the sensation of fullness. Carbonated water may work even better because if enough bubbles are swallowed, the stomach feels bloated and incapable of receiving more food. Carbonated drinks such as beer or sugar-filled sodas are not recommended because they deliver excess calories.

Obviously water can increase or decrease food intake depending on how it is incorporated into the eating process. And since most people attempting to lose weight are not going to be competing for seconds or entering an eating competition, drinking water before, during, or after the meal will, hopefully, decrease food intake. The water intake between bites is supposed to slow eating sufficiently so the brain will signal to the eater to stop before the stomach is totally filled up with more food than necessary.

But curiously, this seemingly innocuous recommendation has met with some resistance by those who claim that drinking water with a meal decreases the ability of the stomach to digest food. Water will dilute the enzymes in the saliva that start the process of digestion, and then further dilute the stomach enzymes that work to break the food down more before sending it to the small intestine; so claim the anti-water folk. Although debunked thoroughly by scientists, the recommendation to avoid water during a meal continues to circulate.

One of the problems with relying on water to confer satisfaction and fullness after consuming less food than desired is that water doesn’t stay in the stomach very long. It passes through much more quickly than food and, once gone, may leave a sense that now there is room for more food. If the eater wants to eat less without using will power to do so, then the most natural, drug-free way is to increase the serotonin levels in the brain. This is accomplished by eating a pre-meal snack of about 20 grams of a starchy carbohydrate such as a small roll. Twenty minutes later, the brain will make new serotonin and this neurotransmitter will convey a sense of fullness or satiety to the roll eater.

Starting the meal with the feeling of not being very hungry is helpful to slow your eating. If you are feeling somewhat full, you are more likely to eat slowly and eat less—and leave the seconds to someone else

 

Could Being Obese Make You Lose Your Teeth?

Having one’s teeth cleaned is not as bad as undergoing a root canal procedure, but certainly not as pleasant as getting a manicure. However, it does give one time to think of the implications of not doing so frequently, and the importance of carrying out the in-between cleaning tasks such as brushing, flossing and not eating caramel apples. Many of us may be not as compulsive about doing so as our dentist would like, but if we are also obese there is a greater cost to the health of our teeth and gums if the basic requirements of good dental hygiene are ignored.

No one disputes the adverse effects of consuming simple sugar on tooth decay. Ideally, if we indulge in eating or drinking sugar (as in soda or juice), we should race to the sink and brush our teeth immediately.  Dentists see the unfortunate consequences of not doing so, especially among those whose weight was gained by frequent consumption of sugar-rich snacks and drinks. Very few people will stop in the middle of a chocolate chip cookie or ice cream binge to floss and brush their teeth.

Obesity puts teeth and gums at risk for other reasons as well. Gastroesophageal reflux (aka acid reflux or heartburn) tends to be common, and causes teeth to be in contact with acid from the stomach, thereby contributing to the breakdown of teeth enamel. If the obesity is associated with depression or other mood disorders, the medications used to treat these disorders often leave the mouth extremely dry. The absence of saliva is also associated with dental decay. (Obesity Complicates Dental Health – Be Proactive!” Obesity Action Coalition, Stillwell, D.)

Patients who choose bariatric surgery to reduce the size of their stomach may be even more vulnerable to dental problems. Often vomiting occurs after this stomach surgery if too much food is put in the now tiny digestive organ. As with acid reflux, the teeth are coated with stomach acid, and enamel demineralization may result.  Moreover, according to Stillwell, an increased craving for sweets has been seen after surgery along with a significant tooth sensitivity that may make exposure to water or pressure uncomfortable. Patients who were not diligent about caring for their teeth before surgery are not likely to improve their dental hygiene afterwards, unless the importance of doing so is stressed.

Complicating care of the teeth and gums for someone struggling with obesity is this unpleasantness of attempting to fit an oversized body into a dental chair sized for smaller bodies. For someone with morbid obesity who finds walking difficult, getting to a dentist’s office is often physically painful. Added to this is the psychological pain of attempting to squeeze onto the reclining chair underneath the hanging trays and instruments. Stillwell suggests in his article that obese patients seek out dental offices equipped to handle their needs, but admits that there are very dental few practices that even consider this a problem.

Ironically, dentists were involved in developing and inserting devices in the mouth that would markedly reduce food intake to produce significant weight loss. Wiring of the teeth to prevent chewing was popular several years ago, but interest in using this approach declined rapidly in proportion to the rapid regain of weight when the jaws were freed. A modified version using a retainer-like device custom made to fit the roof of the patient’s mouth has been used with some success. The mouth can open only partially, so the patient has to take very small bites and consequently must eat very slowly. Since it takes about 15-20 minutes for the brain to realize that food has been consumed, the idea behind the retainer is that forced slow eating will produce fullness or satiety before excessive amounts of food can be consumed. Of course, it is also possible that the eater loses patience or becomes bored with the length of time it takes to complete a meal and goes on to do something else.  (“Are dentists involved in the treatment of obesity?” Karma, M.,Aw, G., and Tarakji, B., J Int Soc Prev Community Dent 2016 183-188) Once the retainer is removed, weight can be regained, unless the patient is willing to continue to eat very slowly. .

Although dental devices to reduce food intake may not be the most effective way of producing weight loss, the dentist may be an effective “first responder” in offering help and advice to obese patients. Most of us are unaware of the health of our mouths since it is almost impossible to see the state of our teeth and gums except for what stares back at us in the mirror. The possibility of losing our teeth and/or going through the pain and expense of periodontal surgery for gum disease is enough to motivate or frighten us into practicing what the dentist preaches.  Unlike a physician who makes the obese patient confront his or her weight, a dentist does not deal with the size of the patient’s body. The advice and suggestions about modifying food choices to decrease sugar intake and pointing out the association of gastric reflux with enamel erosion focuses on what is above the neck.  It is hard to ignore advice which, if not followed, may cause loss of one of our basic functions— chewing—as well as negatively affecting our appearance.  The simple suggestion about brushing in association with snacking might be enough to decrease between-meal food intake. The feel of a clean mouth and teeth is sometimes enough to prevent eating from immediately starting again.

And the dentist has an immense advantage over everyone else trying to help an individual improve food intake and lose weight: the patient can’t talk back.

Does Running Holiday Errands Count as Exercise?

“I‘m exhausted!” a friend told me when I bumped into her at the supermarket. “I spent the entire weekend running around doing errands.”

“Sounds like a good way of getting exercise and errands done at the same time,” I replied, knowing what the response would be. “Well, obviously I am not running,” she retorted. “But fighting the traffic in the mall parking lot and standing in line every store is so tiring. I don’t have the energy even to get to the gym.”

Holiday preparations, with its multitude of obligations and looming deadline of December 25th, seem to cause a frenzy of multitasking and soak up scarce free time. Even before Thanksgiving leftovers are consumed, the holiday to-do list is made and the running begins.

There is a high mental and physical cost to transforming ordinary life into one characterized by holiday decorations, buying and wrapping presents, sending cards, cooking, entertaining, hosting company and/or traveling. Since these tasks are added to those normally carried out each day, such as going to work, caring for family and social activities, the result is that time normally spent preparing and eating meals and exercising is drastically decreased. Indeed, going to the gym, a yoga class, or for a run seems like an indulgence done at the cost of cramming even more holiday obligations into remaining hours of the day or week. And for some, like my friend, the fatigue that comes with probably too little sleep, too much stress, too much shopping in malls with recirculated air, and too much waiting in traffic…it all makes sitting on a couch rather than on an exercycle seem like the only option at the end of the day.

Weight gain during the holiday season is so common that right after New Year’s Day, dieting kicks in. Gaining five pounds or more from Thanksgiving to the next year is not unusual, and holiday food and drink are major contributors to increased calorie intake. But even without the eggnog, sugar cookies, mayonnaise, sour cream or melted cheese dips, and fruit cake, weight would probably be gained. Lack of time leads to food court dining, fast food drive-ins, pizza, or nibbling all day on nutritionally weak snacks. Steamed vegetables, grilled fish and large salads are for January, not for December with its endless errands.

Frequent exercise classes or solitary workout routines followed by a shower, hair drying, and make-up applying is not compatible with a mind-set of counting down to Christmas.  And for those who exercise at home rather than at a health club, the convenience of having a piece of exercise equipment nearby is often ignored, because household tasks call more loudly than 30 minutes on the treadmill.

The approach to getting through the next few weeks without compromising sleep, weight, emotional well-being and fitness?

Schedule time to keep the body and mood healthy. You are not running a toy workshop in the North Pole and setting up a sleigh (rather than Amazon) delivery system by Dec 24. Which is to say that if there is a choice between getting enough sleep, or eating a salad, lean protein and high fiber carbohydrate, or taking a brisk walk or an exercise class, or making another dash to the mall, or baking one more batch of cookies? Choose exercise you want to do. Study after study has shown the positive and immediately impact that exercise has on decreasing stress and improving mood and cognition. Over the long term? Exercise can improve general health, decrease risks from heart disease, and perhaps even neurological diseases like Alzheimer’s.  A fatigued, stiff, grumpy body dragged to the gym unwillingly will not be the same after exercising. Paradoxically, the fatigue seems to lift….probably because increased blood flow oxygenates the muscles and brain. Stiffness from sitting in a car or standing in line goes away as the heat from the exercise makes the muscles more limber. Grumpiness disappears as well. People do not scowl at themselves in a health club; they may grunt or groan from the difficulty of their particular exercise, but somehow nasty moods go away (except if there are no towels when you leave the shower).

But the best part of literally (not figuratively) running or doing any other form of physical activity is that you are doing something for yourself. You are the beneficiary. You are the one who feels better, more energetic, less irritable or worried. The time you spend in exercise belongs to you.

Giving yourself the pre-holiday gift of time to take care of yourself is not something that is done easily. Guilt and anxiety over what has to be done, and what might not get done, may interfere with your healthy intentions: “I will make that salad or take a walk after I do (fill in the blank),” you say to yourself.

Putting your need for healthy food, exercise and sleep at the top of the long to-do list is hard. And yet, what better gift can you give to your family and friends than a cheerful, not sleepy, energetic, and unstressed you?

If We Had More Time to Eat, Would We Eat More?

The national eating day, Thanksgiving, is unusual in several respects. People who rarely cook spend hours in the kitchen transforming a rather ungainly raw bird into something beautifully edible and making artistic creations out of mashed sweet potatoes with marshmallows.  Stale bread that otherwise might be fed to the birds is turned into a complex dish that may or may not cook inside the turkey.  The table is formally set, and many courses with numerous dishes are served.  And the meal will take time.

Unless they have another Thanksgiving meal to go to, or feel compelled to Christmas bargain shop, guests are happy to dine leisurely. The meal may take considerably more than an hour, and rushing through is restricted to getting seconds on desserts before they are gone.  In this respect, Thanksgiving and other major holiday dining differs significantly from the way many of us eat the rest of the year.

That we eat more on Thanksgiving than on other days is not disputable.  Serving excessive amounts of food is appropriate, and we are expected to eat until we feel stuffed, and then eat some more. But would we eat so much if there were less time to do so?  Would we eat less if, like so many other days of the year, late afternoon/early evening activities and obligations shorten supper to a grab-and-chew type meal, rather than a sit-down dinner? Would we change the amount of food we eat if we actually sat and ate breakfast and lunch, rather than standing in line for take-out and then quickly consuming it before going back to work? Is eating quickly a prescription for too much, or too little food intake?

A few weeks ago I was having lunch with a relative who works for a large law firm. She kept looking at her watch as we stood in line for our salads at a food court. “They don’t like us to take more than 30 minutes for lunch,” she told me. “I hope I have time to eat.”

She is not alone. For many of us, eating is something we fit into our busy schedules often while we are doing something else, e.g. sending messages on our cell phone, working at our desks, or driving.

Hypothetically, if we have very little time to eat, we should be eating very little. A muffin or bagel for breakfast and two slices of pizza or a tuna wrap for lunch feels like fewer calories than a traditional breakfast of eggs and toast… or a lunch of baked chicken, potato, vegetables, roll and dessert. However, often when we choose foods that can be eaten quickly, we don’t notice that they can be calorically dense. A muffin or bagel with cream cheese may contain 600 calories, and a tuna salad sub with mayonnaise and cheese delivers as many calories as the hot lunch.

When we do not have time to eat, we may do it so quickly that we dump more food than necessary in our stomachs, like someone competing in an “All the hot dogs you can eat!” contest.  Sometimes when we gulp our food we don’t even notice how much we are eating. This is also true if we are multi-tasking while putting food in our mouths.

Sitting for a long time at a meal has its own perils. We may find it impossible to resist eating more than we intended to because we have the time and the food, especially the desserts, are there to tempt us. We are no longer hungry, yet the cookies or nuts or chocolate or pies are still on the table and it is hard, unless we are sitting on our hands, not to reach for them. A friend who often hosts long, leisurely meals told me that guests who resist eating dessert when she first serves it will often reach for the cake or cookies later on if they are all still sitting and chatting. Of course, meals that are interrupted by speeches between courses are a perfect prescription for overeating. The guest is a hostage to someone’s boring talk and eating seems to be the only way to endure it.

On the other hand, if we have the time to have an “appetizer” of carbohydrate, e.g., a roll, rice cakes, or crackers about 20 minutes before we start our meal, we may find ourselves eating less.  The carbohydrate potentiates the production of the brain chemical serotonin, and that in turn will make us feel somewhat full before the meal begins. This helps control how much we eat subsequently (a critical aid for dieters), and causes us to stop eating before we clean our plates.  But when time is limited, eating quickly and without the benefit of the satiating effects of serotonin, we could be eating more than we should.

Either too much or too little time can disrupt moderate and reasonable food intake. But certainly we should take the time to enjoy Thanksgiving for its own sake regardless of how much, or how long it takes to eat.

Who Cares for the Caregivers?

Her husband’s Parkinson disease had progressed significantly since we’d last seen each other and her stress progressed along with it. The kitchen counter was covered with pill containers and dosing schedules; the wheelchair was sitting by the ramp to the car and her husband waiting patiently for his aide to help him get dressed.

My friend, let’s call her Mandy, barely said hello before launching into a description of the difficulty she had getting her husband ready for bed the previous night. Apparently, he sat in the wrong chair in the living room while watching a football game. The chair did not have the jack that would propel him to his feet. It took two hours to get him upright and ready for bed in a tiny room near the kitchen. He could no longer climb stairs to their bedroom. She was exhausted and near tears.

Her situation is repeated in homes throughout the country where one spouse or child or elderly parent is losing physical, and often cognitive, strength due to neurological diseases that get worse over time. My friend is one of the fortunate ones. She is able to afford the service of professional aides and a physical therapist because of insurance purchased many years earlier when they were both healthy. Someone much stronger than she is can carry out the actual “heavy lifting.” That person is experienced in how to move a body that cannot move itself without great difficulty. But like so many others, she is dependent on the aide showing up, and she has to scramble to find people to fill in on weekends and holidays.

The Family Caregiver Alliance, a non-profit organization that provides support for people like my friend, a so-called informal caregiver, states that the numbers of unpaid caregivers in the U.S. in 2015 is about 43.5 million. Their caregiving, if paid for, would cost more than 470 billion dollars a year. More than 75 percent of the caregivers are women, and more than two-thirds of those receiving care are also women. It is estimated that 20 hours or more each week is devoted to the needs of the spouse, child, or parent so the informal caregiving is akin to an unpaid part-time job, with few entire days off.

Anyone who has filled this position knows that the tasks range far beyond giving out medicine at the right time. Often the number of tasks increase to the point where the patient needs help in just about every activity of daily living, from dressing and undressing to personal hygiene and being fed, and the responsibility of running the household, paying bills, and making medical appointments. The must-do list simply grows longer as the impairment from the disease increases.

The toll this takes on those who give the care is well-characterized and predictable. Just about every aspect of life is affected: sleep, physical and psychological well-being, work, socializing, pursuing personal interests, and hobbies. They all give way to the needs of the patient. Simply getting out of the house to do more than a quick trip to the supermarket or dentist is a rarity for many.

Mandy lives in a residential neighborhood only a few blocks from a library, stores, restaurants, and a supermarket so she sees other people when she takes her husband for an outing in his wheelchair. And she manages to get to a yoga class once a week when her husband is with his aide. But she has rarely has time to work on a collection of essays she has been writing, and her former volunteering activities have been abandoned. But she is fortunate; at least she is able to leave the house a few times a week.

Some diseases are easier to deal with than others, but no one gets to choose. When the caregiver is able to still share an emotional and cognitive life with his or her spouse or partner, the caregiving is bearable. But if the patient is unable to communicate and respond to the caregiver, it makes the caregiving even more difficult. Despite that it is the disease, and not the individual, who is responsible for the changed behavior; it may be extremely hard for the caregiver to hold onto that fact when dealing with unexpected anger, depression, apathy and sometimes non-recognition. In a study of the emotional burden carried by the caregiver, Croog, Burleson, and their team reported that anger and resentment was a common complaint along with lack of personal time and social isolation. There are support groups for the ‘”informal” caregivers, and they are geared toward helping with the specific problems presented by a disease, for example, Alzheimer’s, Parkinson’s, or ALS.

Over a cup of coffee, Mandy told that that the one thing she did not expect, as her husband’s symptoms worsened, was being alone so much of the time. “We have many friends; we both lived in this community for decades. But very few come to visit anymore, and we rarely are invited to other people’s homes because of lack of wheelchair access. And some people just avoid us because somehow they don’t know how to act around someone with a debilitating illness.”

Fortunately, my friend is strong and resilient, an excellent manager and a person who is able to meet the unending obligations she encounters. But she, like so many others in her situation, would like to have someone who understands and can share with her the difficult emotions and conflicting feelings she is experiencing in fulfilling the “in sickness” part of her wedding vows.

She too would like some care.

References

Spouse caregivers of Alzheimer patients: problem responses to caregiver burden. Croog SH, Burleson JA, Sudilovsky A, Baume RM. Aging Ment Health. 2006 Mar;10(2):87-100.

Does Halloween Begin the Trifecta of Weight Gain?

Soon after Labor Day, almost before the bathing suits of summer have been put away, bags of miniature Halloween candy begIn to appear on supermarket and drugstore shelves. Those tiny candy bars will be devoured to celebrate a holiday that has nothing to do with candy, and the hundreds of calories they contain will initiate the fall season of weight gain. Soon the black and orange wrapped candy will be replaced by chocolate turkeys for the national binge day, Thanksgiving, and then towers of green and red wrapped candies, cookies, and cakes will be displayed for the December holidays.

It is understandable how Thanksgiving and Christmas became holidays characterized, in part, by excessive consumption of special foods that are usually replete with cream, butter, sugar, egg yolks and chocolate. In the old days, these holidays represented the few times a year when expensive, scarce food stuffs like sugar, chocolate, costly cuts of meat, and exotic fruits like oranges, and special alcoholic drinks were served in liberal portions.  Religious and national events like Christmas, the 4th of July, or the yearly fair have always been celebrated with copious amounts of food.  Often guests contributed their own special recipes to a gathering, and it was not unusual to have several main dishes, many sides and a large number of desserts. No one worried about how many calories were eaten because food intake was frugal and, for some, even scarce for the rest of the year.  But now, of course, the caloric excesses that begin with devouring miniature candy bars and end with New Year’s Eve buffets may not be compensated with frugal eating the rest of the time.

But how is that Halloween, a holiday which originated as a religious event, has metamorphosed into the opportunity to eat excessive amount of sugars, fat, artificial flavorings and color while wearing a costume? And how is it that the attempt by some food companies to reduce sugar content in many of their products is being offset by large confectionery companies marketing Halloween candy? And how, as our nation becomes fatter every year, are we going to continue to allow this?

Collecting, counting, and collating the candy gathered during an evening of trick or treating is a relatively new phenomenon. To be sure, hordes of face-painted or masked kids have been roaming the streets on Halloween, ringing doorbells and asking for handouts for many decades. Mid-20th century, the handouts were rarely commercially packaged miniaturized candy bars. Treats like cookies, popcorn balls, Rice Krispy squares, brownies and fudge were often homemade. Candy corn, invented in l880, Hersey’s Kisses in l907 and M+M’s in l941, along with a smattering of regular size candy bars, were available as treats, but competed with homemade chocolate chip cookies. Then we became scared of anything that was not made and sealed in a factory. The appearance of razor blades in apples and the possibility of toxic ingredients in homemade baked goods frightened us into allowing our children and ourselves to accept only commercially produced, sealed snacks like miniature candy bars and tiny bags of candy corn. And the confectionery companies responded. Any candy that could be shrunk, wrapped in Halloween colors, put in a large bag and sold in bulk, was.

Of course, the calories per candy item were also shrunk because the candies were one big bite.  Alas (and the candy makers know this), we think, “They are so small, how could they be fattening?” and pop three or four tiny Snickers or Butterfinger bars into our mouths.  The little candies can be stashed in drawers, brief cases, knapsacks, glove compartments, pocketbooks and pockets and constitute an almost endless supply of sugary, high-fat treats—and calories. And so the season of fattening ourselves up begins.

The over-consumption of sugary treats falls at the time of year when we may be feeling stressed because of after-summer vacation workload for adults and for kids, homework.  Are we craving candy because as darkness increases, our good moods decrease? Would chewing through a mound of candy corn be as appealing in the middle of July as it is at the end of October?  We know that the good mood brain chemical, serotonin, is made when any carbohydrate (sugar, starch) other than fruit is eaten. Is candy more appealing than a bowl of oatmeal that brings about the same feelings of calm and comfort?

It is hard to find any good reason for children or adults to consume mounds of candy. In an ideal world, the plastic bags of miniature candy bars would be replaced by bags of vacuum-packed apple slices, or oranges or baby carrots. Treats might also include pretzels, popcorn, miniature protein or high fiber, high-energy bars or breakfast bars. These have the virtue of being low or fat-free, have some nutritional value, and, after the holiday, can be put in a lunch box for a daily snack.

But how are we going to stop the avalanche of fall candy consumption? It means pushing back against the confectionery companies so that like the large soda manufacturers who have reduced sugar in their drinks, they see a profit in offering healthier Halloween treats. It means working within neighborhoods and schools to convince everyone to resist dumping handfuls of candy bars into plastic pumpkins held by seven year-old trick-or-treaters. Perhaps people can be convinced to donate some of the money that would have been spent on candy to a local food bank and contribute the rest to the local school or neighborhood center for a Halloween party.  Halloween is a holiday made for fun, and surely we can figure out how to have fun without the candy calories hanging on our hips the next day.