How Do You Know Whether Supplement Claims are Hype or True?

At a recent university-sponsored conference on innovations in nutritional and fitness products, there was a discussion about the increasing number of fraudulent claims associated with such products in the market. When one speaker, a principal in a firm investing in start-ups specializing in fitness and nutrition, was asked how to detect ineffective or fraudulent products, he was unable to give a useful answer.

“It’s very difficult because often the claims are made up or supported by faulty research published in company-owned or for-profit journals. If it works, it is probably not a fraud,” he concluded. Someone from the audience responded with, “Yes, but placebos work also.”

The Food and Drug Administration (“FDA”) can barely keep up with the proliferation of fraudulent health products. Some make claims that cannot possibly be produced by the ingredients; others contain substances which are not allowed to be sold due to serious side effects, or must be prescribed only by a physician. Oftentimes states, as well as the FDA, step in to expose the deceptive nature of claims made by supplement manufacturers. In a well-publicized case a few years ago the New York State Attorney General’s office tested the contents of several popular herbal supplements and found either none of the advertised active ingredients in the product or levels too low to be effective. This past winter, the New York State Attorney General and the Federal Trade Commission (“FTC”) charged a company that claimed its product was shown in clinical trials to improve memory and cognition with making, “false and unsubstantiated claims” because the study cited by the company actually showed the product not working any better than a placebo. Yet the advertisements, seen frequently on television, were so compelling that the sales topped $165 million.

The most common claims seen on the labels of such dubious products are for weight loss, sexual performance (erectile dysfunction), memory loss, and mood.  Some claims are almost magical in the sweep of their promises: A New York firm claimed its dietary supplement treated senile dementia, brain atrophy, atherosclerosis, kidney dysfunction, gangrene, depression and osteoarthritis along with lung, cervical and prostate cancer. Alas, for anyone now wanting to buy a product that will cure all that is wrong with you, it is no longer available. U.S Marshalls seized it after a request by the FDA in 2012.

Personal testimonials are often so compelling that they sell a product. Who hasn’t looked at the before and after pictures of someone who used a weight-loss product and marveled at the change? Statements like, “I am no longer hungry, depressed, diabetic, or bald!“ beckon to us from the Internet, tabloid magazines, newspaper advertisements and television spots. These people must be real, one thinks…and if he grows hair, maybe I will also.

Health products claiming a quick fix such as, “Cover your bald spot by next Tuesday!” or, “Lose your double chin by this afternoon!” are also hard to resist, but should be regarded with as much suspicion as someone trying to sell you a bridge. Glue is a quick fix; health products rarely are. The FDA tells us to beware of health products attempting to gain a marketing edge by claiming that they are all natural. By the way, snake venom is also natural.

One easy way to detect whether a claim is legitimate or not is whether the term, “Miracle” is used on the label. Look at it this way, if the words “miracle cure” are attached to the ad, consider it a miracle that anyone is foolish enough to buy the product.

But of course there are many over-the-counter (non-prescription) supplements that work, are safe, contain the dose of active ingredients printed on the label, and don’t hide drugs deemed illegal by the FDA. If a combination of vitamin D and calcium promises bone health in the amounts recommended by physicians, such a supplement will help to restore bone cell growth and decrease bone fragility.  Supplemental vitamins, minerals and protein will help restore depleted levels of these nutrients due to prolonged illness, chemotherapy, or gastrointestinal impairment. Again, it is imperative to check with a healthcare giver about quantities; more is not always better.

But what if you are not sure whether the claims are to be believed. What should you do?

Ask your health care provider. Take a picture of the ingredient label on a product you are thinking of buying, and ask whether any of the ingredients actually do what they are supposed to. Use the Internet to look up the ingredients to see what studies support the claims of the product. Write to the FDA.

Example:  A product relieving anxiety and stress claims that the ingredients, “…promote serotonin synthesis.” But the main ingredients are chamomile and valerian, herbal products that may cause drowsiness; these do not promote serotonin. A physician will know that the product is incapable of increasing serotonin synthesis.

Here’s another: A product containing saffron extract as its main ingredient claims, ”…Reduces cravings, boosts metabolism, blocks appetite, lowers blood pressure and increases energy.”  Investigating whether there are any studies linking saffron extract to all these wondrous health effects may seem like a nuisance, but will save money and possibly, ill side effects.

Signing up for the FDA Consumer Updates page is essential for anyone routinely buying supplements because of their weekly descriptions of products containing hidden drugs, fillers, or bits and pieces of insects or twigs. Recently, the agency has warned consumers about more than 100 products containing illegal drugs; most of these products are sold for sexual enhancement, weight loss and bodybuilding.

Avoiding supplements that may not work, may not contain the ingredients listed, or contain ingredients that are harmful cannot be ensured. But a little homework and help from the FDA make the odds better that what you buy is safe and effective.

Social Loneliness May Make the Depressed Even More So

Loneliness is a state that may affect everyone at some point in his or her life. It is not necessary to go on a trek across the continent, or row alone across the Atlantic to feel lonely. Sitting by oneself in a crowded movie theater or restaurant, or walking on your own on a lovely spring afternoon in a park filled with couples, families and friends can feel just as isolating.

Sometimes social isolation is a matter of choice or temporary circumstance. A relative of mine, who had to rewrite a 500-page thesis in order to turn it into a book, willingly isolated herself for months in order to accomplish this task. A parent unable to leave the house because of weather and sick children may not speak to anyone over the age of six for a few days, but knows that eventually this will change. A computer coder may shun company for days in order to finish a time dependent task; so too may anyone involved in a creative act.

Others are alone too much, but not by choice or a temporary situation. It is a fact of their lives. The groups one thinks about first are the elderly, and those we call “shut-ins.” They weren’t always so alone but sickness, frailty, lack of easy transportation, death of spouses, friends, and even adult children…potentially their declining eye sight and hearing, limited financial resources, and fear of crime may result in an extremely limited interaction with the social world.

“My friends are all dead,” my husband’s uncle used to tell us as he reached the late nineties. “All the guys I would play cards with and have a meal with, they are all gone.”

Residence in an assisted-living facility may surround an elderly individual with people, but social interactions and friendships do not necessarily follow. A sad scene familiar to those of us who have visited relatives in facilities is a row of residents, lined up in wheelchairs, who are not talking to each other, and indeed seem to be totally isolated despite the other people around.

But one does not have to live into old age to feel this social loneliness. People of all ages who are suffering from mental illness can experience it at any age. In a recent report put out by an Australian mental health support organization, about 66% of people with mental illness report feeling socially isolated compared with about 10% of the general population. The reasons for this vary from lack of money and/or transportation, misunderstanding among others as to the nature of the illness, and even fear of others prevent forming a close relationship. Those with mental illness often claim that they are stigmatized, or at the very least, treated differently.

“Maybe people believe we are going to behave in unpredictable, embarrassing, or violent ways,” said a friend who has suffered from bipolar disease for years. “There is reluctance for a casual interaction to go much further.”nability to become involved in activities that may decrease loneliness is sometimes generated by mental illness itself. Social phobia, fears about public spaces (although these days, this may just be commonsense), inability to leave the house, hold a job or even communicate without difficulty; all reduce the possibility of interacting with others. A weight-loss client of mine was very specific about the days she could come to my office, as they were dependent on her cycles of mania and depression. Another client who was depressed would stay up very late at night and sleep most of the day, thereby avoiding the necessity to interact with anyone.

Regardless of the causes of social isolation and the groups who are affected by it, being alone is not good for one’s mental and physical health. Being alone most of the time is associated with increased weight, poorer diet, decreased exercise, alcohol abuse, greater risk of sickness, and even a shorter life span. Cognitive functions decline, possibly as a result of few verbal interactions. Added to this is the emotional pain of being lonely. People whose circumstances prevent them from interacting with others for short periods of time report feeling depressed and out of touch with what is going on around them. Imagine the effect if social isolation is a way of life.

Fortunately, there are social spaces where people with mental illness can go and feel comfortable and accepted, as well as receive advice, support, and/or information about relevant services, are available in many communities. Volunteers in organizations like the National Alliance usually run these drop-in centers or peer support groups on mental illness. They provide a critical service, especially for those patients and their families who are seeking to interact with others experiencing the same problems.

Going to meetings is one way of decreasing time spent alone, and it is possible that a network of acquaintances with whom to spend time can develop from this. Several years ago, I led a weight-loss group made up of mentally ill individuals who had gained weight on their psychotropic medications. After a few meetings, the participants organized Sunday walks or, if the weather was bad, a meal and a movie.

Unfortunately, making available accessible and socially safe places for people with mental illness to meet is dependent on volunteer resources, and these may be limited to family and friends of the mentally ill. The sad fact is that many potential volunteers would probably prefer giving their time (and maybe money) to an animal adoption center than spend time socializing with mentally ill individuals.  An acquaintance in a mid-size southern city found that despite city resources to fund a drop-in center associated with a neighborhood health clinic, there were no volunteers available to staff the facility.

According to the previously mentioned SANE report, almost all people with mental illness consider social relationships important in helping them manage their symptoms and improve the quality of their life. They said that simply having someone to talk to about how they feel is critical to their feeling better. It doesn’t take many people to diminish the loneliness of an individual.

Just one will do.

We all should try to be that one.

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.

Feeding Your Guests to Decrease Their Stress

“I am reluctant to have friends over for dinner,” my neighbor confided in me recently. “By the time we are finished with the main course, everyone at the table is arguing about politics or sports. Once I had two guests get so upset that they stopped talking to each other for almost a year. “

“Maybe it is what you serve,” I responded.

She looked offended.

“No,” I said quickly, “You misunderstood…your food is delicious. I wasn’t criticizing your cooking. But maybe you could alter the menu to decrease their agitation. “

Usually contentious dinners are limited to family occasions, most notably holiday celebrations when relatives who may not like each other are forced to eat at the same table. Avoidance of either the relative, or avoidance of topics offensive to said relative, is the strategy many take when forced to attend such gatherings. But having friends over for dinner used to mean assembling people who enjoyed each other’s company, with the presumed mutual goal of a pleasant evening of food and conversation. Now it seems that the conversation may have to be limited to traffic, weather and vacation travel, unless all the guests have exactly the same political views and love of the same sports teams.

But why resort to such vetting of the guests or the topics?  A better option is to feed the guests in such a way that they become mellow, patient with the opinions of others and, in general, agreeable.

Years ago, in a book I co-authored called Managing Your Mind and Mood with Food, I described the culinary strategy of the CEO of a large French pharmaceutical company. The research department often invited scientific consultants to discuss and evaluate research on new drugs. One of the CEO’s associates told me that the lunch menu was designed to induce a state of benign drowsiness in the scientists so they would be agreeable to anything the company might discuss in the afternoon session. Having been witness to the aftermath of some of these meals, I can attest to the success of the strategy.

This being Paris, the meal contained different wines for each course including brandy with coffee. There was always an appetizer, main course, salad, cheese course and then, unusual for Paris, an elegant cake or elaborate pastry, sometimes with ice cream.  Sauces rich in butter, cream and possibly egg yolks were poured over the entrée and sometimes the vegetables as well. The cheeses were 95% or higher in fat and the desserts sweet enough to make one welcome the mild bitterness of the tiny cups of espresso. (There certainly was not enough caffeine in those tiny cups to counteract the soporific effects of the meal.) Interestingly, the host the CEO drank only water, and nibbled at the food.

An American host would need a sizable kitchen staff to prepare such meals. Fortunately, altering the mood of the guests so they also become tranquil and agreeable can be accomplished with much less effort and food.

To do so requires knowing only two facts about food and mood: carbohydrates consumed with little or no protein will make serotonin, and leave most people feeling relaxed. Fat, which can be consumed with protein, carbohydrate or both, may make the diners mentally fatigued and sometimes even a little befuddled. Befuddled is not a good state for scientists or dinner guests to be in, so it is probably best to use carbohydrates to alter mood rather than bacon, butter, egg yolks, cream and high-fat cheeses. Curiously, our American habit of serving appetizers of cheese and crackers may inadvertently potentiate mellower moods because of the combination of fat (cheese) and carbohydrate (crackers). The wine or other drinks will (usually) add to the relaxation effect.

Perhaps the ideal sequence of foods to produce happy, enjoyable guests is to be found in Italian homes. Carbohydrate, as in pasta and sometimes polenta, is usually served a first course. The amount is small, unlike American-size portions, but certainly contains at least the 30 grams of carbohydrate that must be consumed in order for serotonin to be made.  Because the pasta is eaten first, the eater benefits not only from the mood-soothing effects of serotonin but, in a value added sort of way, the beginnings of satiety as well.  This means that when the small portion of protein is served as a second course, it will not be viewed as too small, because the eater is already feeling a little full. Bread and wine accompanies the meal, and presumably even if arguments occur at the dinner table, there is enough serotonin being made to keep the arguments from becoming contentious.

Alas, our American avoidance of carbohydrates, and this incorrect insistence that eating copious amounts of protein may have the opposite effect on our temperament. Eating protein inhibits serotonin from being made because it prevents the amino acid tryptophan from getting into the brain (tryptophan being this from which serotonin is made.) Is it possible that our moods are deteriorating because we are not eating enough carbohydrates?

Eating carbohydrates to improve the group mood does not have to be restricted to your dinner guests. There are work environments so stressful that, as one employee told me; it feels as if her flight or fight responses are going off and on all day. “I am sure it is not healthy to be working in such a stressful culture where people think it is all right to continually shout, demand, berate, and insult those beneath them, “ she told me.

Would carbohydrates help? Apparently, no one in that volatile office touches them because not being fat is mandatory (unspoken), and everyone is convinced that eating a piece of bread will cause them to gain weight. What they don’t realize is that eating a piece of bread or a cup of breakfast cereal might make them a little less abrasive, and perhaps a little kinder. And that is a good thing.

Are You Sure That Food is Safe to Eat?

“I am not sure you ought to be eating that,” I said to one my fellow hikers as we unwrapped sandwiches that had been baking in our knapsacks all morning. It was hot, and the knapsacks that clung to our backs as we hiked up the mountain must have been as hot as our overheated bodies. “Why not?” he asked. He looked at his sandwich oozing mayonnaise from the chicken salad and took a bite.

“Does one do CPR for food poisoning”? I thought to myself as I ate my peanut butter sandwich and apple.

“What’s wrong with eating chicken salad?” I was asked again as the reminder of his sandwich was consumed.

“Normally nothing,” I replied, “but in this heat, the chicken and mayonnaise can become contaminated with bacteria and lead to food poisoning.”

“Thanks for spoiling my afternoon,“ he snarled at me and walked away.

True story …but he never disclosed whether his tummy was resilient to the bacteria that must have been multiplying in his sandwich, or whether that night he suffered from the stomach cramps, nausea, vomiting and diarrhea that follow eating food swarming with heat-generated bacteria.

Moist foods like mayonnaise and chicken are reservoirs for bacteria and heat increases their numbers.  The Centers for Disease Control (“CDC”) warns about this danger and insists that food be kept cold on a hot day, especially when the temperature is 90 or above.  The best foods to carry on a hot hike are those with little moisture: nuts, seeds, dried fruit, chocolate chips,  peanut butter, crackers, hard cheese encased in a waxy shell, canned fishes still in a can or sterile pouch, raw vegetables and fruit unpeeled (i.e., carrots and bananas), and protein/high energy bars.

Most of us face the possibility of suffering from a foodborne disease, even if we never go on a hike or picnic. Food contamination is believed to affect more than 76 million people each year and about 5,000 die. Some of this is preventable; some seemingly not.

We may pose the biggest risk if we don’t store and prepare foods properly. Leaving perishable foods in a hot car begins the process of food spoilage. But even if we get home quickly in a cool car, not putting foods that have to be kept refrigerated or frozen away as soon as possible increases risk of bacterial growth.

Our unwashed hands are even a more reliable cause of foodborne illness. And although our mothers told us innumerable times to wash our hands before touching food, how many of us may forget in the rush to get the groceries put away and start dinner?

What about the sponge on the counter that just wiped up juice dripping from the raw chicken package? Yuck. It is bacteria heaven. The CDC recommends using paper towels soaked in bleach to wipe up the counter. Sponges “sponge” up the contaminated juice and all other non-sterile substances and then, even if rinsed out, will spread them wherever it is used next. However, microwaving them on high for a minute, or putting them in the dishwasher with a long cycle including a drying cycle, can clean sponges.

Sponges are not alone in cross-contaminating food.  Chopping up raw chicken on a cutting board and then using the same board and knife to chop onions is not a good idea but again something we might do because we are in a hurry.

Another example? Once a year, on Thanksgiving Day, the country becomes conscious of getting food poisoning from our own kitchens due to improperly cooked and then stored turkey and other leftovers. One home cook I know is so worried that her guests will be calling from the E.R. due to severe gastrointestinal symptoms, that she removes dishes from the dining room table to put in the refrigerator almost before people have finished eating. That may be extreme, but keeping the food on the counter while watching a football game is risking tummy troubles. One useful piece of Thanksgiving advice is to use a thermometer to measure the internal temperature of turkey. This should not be limited to T-Day, by the way, and it’s a practice to be used whenever animal protein is being cooked. Why guess whether the meat or poultry or pork has cooked long enough?  It’s easy to check!

So with proper precautions, we can protect ourselves from homemade food contamination. But what about the safety of the foods we buy in the supermarket, eat at restaurants or consume at catered affairs… or in indeed, even someone else’s home? Years ago, as a dinner guest at the home of someone I did not know well, I saw the hostess scrape a thick layer of mold off some strawberry preserves she had made and stored too long in her basement. When she served the preserves, spooned over ice cream, I whispered to my husband to avoid the dessert. Had I not been in her kitchen bringing in dirty plates, we both would have eaten the preserves and probably would have gotten sick.

A quick summary of some recent instances of contaminated food cases can easily cause food paranoia:

One hundred people contracted hepatitis A from drinking smoothies containing strawberries imported from Egypt. The restaurant chain serving the drinks were located in the mid-Atlantic states, New York, Oregon, and Wisconsin, but none in the Middle East where the strawberries were grown.

Shiga toxin-producing Escherichia coli was found in flour from a major food producing company. The result: 63 people were affected and 17 had to be hospitalized. Although the flour and flour products were recalled, the CDC worries that, given the long shelf life of flour, many homes may still have the product. (Epidemiologic, laboratory, and traceback evidence indicated that flour produced at a General Mills facility in Kansas City, Missouri was the likely source of this outbreak.) Note to batter nibblers: don’t taste raw dough or batter whether made from recalled, or any other, flour.

Consuming cucumbers infected with salmonella caused 165 people to be hospitalized and four deaths occurred in Arizona, Texas, Oklahoma, and California.

Listeria, which causes serious, life-threatening illness, was found earlier this year in soft raw milk cheese made by a New York dairy. Eight people who contracted the Listeria were hospitalized and two, from Connecticut and Vermont, died.

Eating contaminated food may be impossible to avoid entirely. How could you know that cucumbers or smoothies are filled with bacteria? We don’t have food tasters (as did nobility in the olden days) to make sure we are not being poisoned. But at least we can decrease our vulnerability by following good hygienic practices in storing, preparing and serving food. And when in doubt, throw it out.

Getting the Super Obese to Lose Weight: It May Take a Family

Anyone who ever saw any of the television programs focused on the attempts of individuals 600 pounds (or heavier) to lose weight often wonders why their family members are enabling the obesity. The viewer watches the mostly bed-ridden obese individual demanding food, lots of it, and then being served large portions of whatever has been requested. The camera lingers over the individual crunching potato chips, spooning up macaroni dripping with melted cheese, or eating a gallon of ice cream. It is possible that the television crew doesn’t film the subject of the show when he or she is eating kale salad, or fat-free cottage cheese, so we get the wrong impression. But given the stated food demands of the obese individual, the viewer has the impression that if kale salad, or indeed anything resembling low-calorie healthy food were offered, he or she would be in the unique position of saying no to the food. The occasional trips to the supermarket by some of these TV stars who are able to ride in car (and use a motorized shopping cart) also focus on the purchase of junk food. Although it is obvious that some nourishing foods must be bought and eaten to avoid nutritional deficiencies like scurvy or anemia, the healthy menu items are rarely, if ever, shown being consumed.

The viewer wants to shout at the family members bringing food to the massively obese person, “Why are you enabling this?” Indeed, in one particularly poignant episode, a father buys a large pizza for his son who has been told he must lose 60 pounds before weight-loss surgery can be performed. The son has demanded the food and as the father watches the son gobble the entire thing, he asks for a piece for himself. “No,” was the reply, “I am going to eat the entire thing.”

Internet comments predictably share the bewilderment over the enabler function of family members as depicted on the show. As the fattening foods are prepared and served, the enabler expresses concern on air about the likelihood that the obese family member will die in a few years from the massive weight gain. And yet the food is served, and the concerned warning is absent. But to be fair, perhaps saying something is useless. The obese individual expresses concern over the pain caused by living in such a large body, and also worries about dying. So what good could it do if a family member states the obvious? It may even have the opposite effect. But still, we the viewers still wonder why the family members enable the continued weight gain.

What if the family member was a chronic alcoholic and developing liver disease, collapsing from frequent blackouts, and cognitive impairment? Would the same restraint be used, that is, “Don’t criticize, nag, cajole and threaten?” Would family members buy alcohol for the abuser who might be too drunk to get to the store?  Or drive the alcoholic to the nearest liquor store?

People say that one can’t compare alcoholics to excessive overeaters because the latter have to eat to live, so they cannot be abstinent. True, but one can live quite nicely without consuming highly caloric food in mega quantities, and drinking sugar-filled soda and juices.

Nevertheless, it is hard for family members to take corrective action alone. Professional help is needed, yet there is no process by which a concerned parent, for example, can force the adult extreme overeater to see a physician, dietician and/or therapist. Medical privacy laws forbid sharing the information with healthcare providers unless written permission from the family member is given. But waiting for the heart attack, stroke, skin infection, or cancer to occur in order to obtain medical intervention to start the weight- loss process is hardly an option either.

Family members of an alcoholic often turn to Al-Anon, whose meetings offer advice and support. Inpatient rehabilitation facilities often insist that family members be present for some of the therapeutic sessions to support recovery.

O-Anon is a spin-off of Al-Anon and runs with the same rules of privacy and espousal of the twelve-step process. But is this enough? Can a family take upon itself to provide only healthy, portion-controlled meals and beverages without medical and nutritional advice? Can the family handle the emotional fallout when the obese individual no longer has access to foods that for many are the only reason for living? What happens if anger, anxiety, and depression follow the imposition of a new eating regimen? Must someone be home all day to prevent fattening foods from being delivered, or the obese individual from finding these foods hidden in the house?

It is hard not to notice that often family members on the show are also obese, but may be 100 pounds overweight rather than 600. Will these folk be willing to change their eating habits to support the dietary changes they are imposing?

It may be as hard for the family to change its role with the patient as it is for the patient to lose the weight. In an ideal television series or world, such issues would be raised and solutions found. The bariatric surgeon would insist that both patient and family members meet privately, and as a group with a dietician, therapist, and even personal trainer instead of telling the patient to go home and lose sixty pounds.

People don’t gain 500 pounds simply because they like doughnuts or French fries. Their reasons for their morbid weight gain are complex, and their success in losing weight permanently depends on the family with whom they live and eat understanding these reasons. Maybe the producers of these television shows ought to realize this, even if it doesn’t make such interesting viewing.

Are You Merely Exhausted or Unrelentingly Exhausted?

My neighbor was sitting on the park bench watching her twin five year-old granddaughters feed bread to the ducks. After the obligatory remarks about the cuteness of the pair, I asked her how her weekend was. “Exhausting!” was her immediate response, “The twins stayed with us and I am bone tired. I may never get up from the bench!”

She did look exhausted, but we both knew that once the parents took the girls home, she would relax and by the next day feel, if not entirely rested, much better than today. She is one of the lucky ones. Her exhaustion is situational and an inevitable (but reversible) consequence of incessant care of two very active little girls.

Many of us can relate to her fatigue. We take upon ourselves too much to do both physically and mentally, and feel exhausted when our bodies and minds no longer can deal with yet another task. Sometimes we continue to do too much despite fatigue, because there is no other choice. Too long hours at work because of staffing problems, twenty-four hour care for a sick or elderly relative, a home renovation deadline that has passed: all kinds of situations cause tiredness. But eventually there comes a time when we can rest our bodies and minds and have our energy restored to us.

But what if the fatigue never goes away? What if the body feels weighted down with sleepiness, getting out of bed is a major accomplishment, or cutting through the mental fog seems an impossibility? What if instead of reversible weariness, the exhaustion is unrelenting?

According to a National Health Interview Survey about six years ago, more than 15% of women and 10% of men suffered from fatigue or exhaustion. Some reasons may be situational, such as excessive physical activity, lack of sleep because of insomnia, jet lag or shift work, medications that induce drowsiness like antihistamines and antidepressants, and excessive fat and alcohol intake. Some of these, such as shift work or constantly changing time zones because of work (like pilots and flight attendants experience), may be difficult to avoid and certainly diminish the quality of life.

Worse yet are medical conditions associated with unrelenting exhaustion: acute liver failure, anemia, chemotherapy and radiation, chronic fatigue syndrome, concussion, major depression, chronic infection, diabetes, underactive thyroid (hypothyroidism), multiple sclerosis, chronic kidney disease, fibromyalgia, stroke, drugs for hypertension, epilepsy, chronic stress, and major depression.

Some of these conditions, such as underactive thyroid, anemia and well-controlled diabetes, are correctable. And often the exhaustion will diminish as the body heals, for example, from a concussion or stroke (although it may take months for the post-stroke fatigue to disappear.)
The reason for the severe exhaustion is sometimes obvious and treatable, or disappears with recovery from the illness or treatment. Iron deficiency anemia responds to iron supplementation unless there is an underlying cause for loss of blood. Too low or high blood sugar in the diabetic that causes fatigue may require more intense monitoring of food intake and insulin dosing. Chemotherapy and radiation is usually of a limited duration, and people recover from concussions and infections.

But there don’t seem to be effective ways of overcoming the mental fog and intense tiredness of multiple sclerosis, major depression, chronic fatigue syndrome and other medical conditions, in large part because no one really knows what causes these symptoms. What causes cognitive sharpness to retreat into dullness? What causes well-nourished, developed muscles to feel too weighed down to move? How can a mental illness manifest itself in fatigue so great it is hard to get out of bed?

Because there is so much unknown about why fatigue seems to accompany illnesses from allergies to strokes, it is easy to point to available nutritional villains as the reason. Dairy products, gluten, fruits and vegetables belonging to the nightshade family like tomatoes, potatoes, peppers and gooseberries supposedly cause significant fatigue. Refined carbohydrates, saturated fats, and caffeine are also to be avoided. Conversely, foods that, not surprisingly, resemble those comprising a nutritionally sound diet, are recommended to fight fatigue: lean protein, fruit, vegetables, high-fiber foods, and low-fat dairy products. Of course, these food groups must be eaten not just for their supposed fatigue-fighting capacity, but also for the maintenance of general good health. Keeping hydrated is also very important.  However, there is little evidence that following a nutritionally sensible diet will alleviate the all-encompassing exhaustion associated with certain diseases.

Physical activity is recommended, although it should be low impact and of short duration. It seems counter-intuitive that using energy to exercise restores energy to the chronically tired, but it does seem to decrease fatigue. In fact, research showed athletes suffered from unrelenting exhaustion when they were not allowed to exercise for several weeks.

When exhaustion lingers, as it often does after a stroke or in chronic fatigue syndrome, the most usable advice is to accommodate to it. Frugality in using energy seems to be the most workable solution. Like budgeting one’s money, energy should be spent only on necessary activities. Simple things like sitting rather than standing to prepare a meal, consolidating errands, and avoiding unnecessary movements are helpful. Programming rest stops into the day’s routine and decreasing non-obligatory commitments are also important.  Meditation is thought to be helpful, as is simply sitting in a quiet room. When exhaustion includes a decrease in cognitive function, the so-called mental fog, it may be necessary to ask others to do the tasks, like paying bills, that seem impossible to carry out.

My friend’s exhaustion disappeared after a day without the grandchildren. Let us hope that research will make unrelenting exhaustion soon disappear as quickly.

If it is Easter or Passover, You Have Egg on Your Plate

I bumped into my neighbor at the supermarket checkout line, and commented on the three dozen eggs she was buying.

“I know!” she said. “What am I doing with all these eggs?” And then she recounted what she was going to be doing: one dozen or more for the egg hunt for her young nieces and nephews, two ricotta cheese pies that used at least 6 eggs each, also an egg yolk and flour mixture, deep fried and coated with honey, that’s called struffoli that used a dozen eggs. It’s early springtime holiday season, as evidenced by that a few days later? Another friend told me her menu for the Passover Seder she was hosting. Her use of eggs put my Italian neighbor to shame. The first course was hardboiled eggs in salt water, her soup had matza balls made with eggs, two vegetable casseroles made with matza pieces use several eggs as binding agents, and the meal was concluding with her mother’s recipe for a 12 egg sponge cake.

My cholesterol seems to bubble up in sympathy with this vast egg consumption.

Egg consumption statistics for 2015 found that across the United States, about 6.3 billion eggs were eaten during the Easter and Passover holidays (which fell that year between March 2 and April 5.) In Israel the average egg intake per person went from 20 to 22 a month during Passover, and that small country is the fourth largest consumer of eggs in the world.

So is there a problem with this? (No one is asking the chickens.)  A few years ago the answer may have been yes, because of the high cholesterol content of eggs. One egg yolk has 200 mg of cholesterol and until 2015, the recommended intake of cholesterol per day was 300 mg. Eat one egg for breakfast and you had better restrict your cholesterol intake from other foods such as dairy products and meat to very little.  Don’t even consider having bacon with that egg.

But recently, this has completely changed. A committee composed of nutrition, health, and medical experts decided that cholesterol from the diet was not a concern and had no bearing on levels of cholesterol in the blood.  (1, 2) This committee, The Dietary Guidelines Advisory Committee (“DGAC”) believes that cholesterol intake from an egg is not harmful if egg consumption is kept to moderate levels. Moreover, they regard the egg as an important and inexpensive source of nutrients. A large egg contains about 7 grams of protein ( more for extra large and jumbo), 70 calories,  about 5 grams of fat (mostly non-saturated, i.e. the good kind), vitamins A, D, E, and B12, as well as folate, selenium, choline , lutein and zeaxanthin. (These last two nutrients may be helpful in reducing age-related eye diseases).  Egg protein is considered the gold standard of protein because of its amino acid profile; the amino acids seems to meet our human protein needs as much as those of the developing chick inside a fertilized egg.

I asked a cardiologist friend who has been practicing long enough to have seen this drastic change in egg eating what he recommends to his patients.  “Eating two eggs a day, three times a week is fine,” was the response. “But don’t overdo it.” The DGAC says that eating one egg a day poses no risk to one’s heart health.  No one commented on how to handle the Easter/Passover glut of egg eating opportunities.

It would seem reasonable, however, for the more than 25% of Americans who are taking cholesterol lowering drugs ( according to 2010-11 statistics) to consider whether a second piece of ricotta cheese pie, or a second matza ball should be eaten.

“Heart disease and stroke remain the leading cause of illness and death in the United States,” said Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles.  But is there any relationship between the incidence of cardiovascular events and egg consumption habits during the spring holiday season?  Advice on egg consumption consistently limits egg intake to no more than 7 eggs per week. Eight days of Passover may easily double that amount because eggs are used in so many dishes to provide leavening, or a lightening of traditional Passover dishes. An Easter weekend of feasting may also result in week’s worth of egg intake over 36 hours. Might the holiday excessive egg consumer reap the negative effects months or years later by increased vulnerability to a heart attack or stroke?

An obvious solution is to maintain the healthy food choices that (one hopes) describe eating during the other 51 weeks of the year. Fortunately, spring increases the number of fresh vegetable and fruit options, and there is no law, religious or otherwise, stating that a 12 egg sponge cake or fried egg yolk and flour fritters must be consumed as part of a holiday celebration. These holidays are celebrated in a tradition spanning centuries of a baked foods with excessive numbers of eggs. Decreasing egg intake to more reasonable amounts will benefit the health of those celebrating them.

Sources for the scientific data reference are available upon request.

Eating Your Meals at Restaurants May Decrease Loneliness (But Increase Weight)

One of my neighbors, widowed about three years ago, never eats at home but goes to specific restaurants for breakfast, lunch and dinner. “I don’t want to sit in my kitchen and eat a microwaved dinner while watching the news,” she told me.

“Eating in restaurants makes me feel less invisible.”

Her social objectives to meet people and not eat alone are being met. She has made friends from the neighborhood who eat at the same restaurants, and she is less lonely.  But the cost of eating all her meals away from home has been a marked increase in her weight.  Never slim, she now had gained so much weight that her already compromised knees and back have made walking difficult without a  walker, and she is short of breath.

Her weight gain from eating in restaurants puts her in good company. It is thought that the doubling of the prevalence of obesity in the U.S. over the last 35 years is due in large part to the increase in meals eaten away from home. Fifty years ago, 30 percent of the food budget went toward meals at restaurants. Now it is almost 50 %.

Not all restaurants, of course, generate weight gain. But chain restaurants in particular promote calorically dense foods: fried chicken, chicken nuggets, double or triple cheeseburgers, meatball subs covered with cheese, sandwich fillings that are more mayonnaise than protein, and high fat salad dressings and special ‘sauces.’ Some food items may contain enough calories for the day, not just one meal.

But my friend, who after all had cooked for a husband and children and then grandchildren for decades, knows enough to avoid fried chicken, French fries, and a salad limp under a quarter of a cup of salad dressing. She thought she was making nutritionally wise food choices. The problem, when she asked me how to start losing weight, was that neither she nor I had much of an idea of what the foods she was eating contained.

“I try to avoid foods that I think will have too much salt or sugar but who knows what is in the food?, she told me. I try to pay attention to the calories if they are listed on the menu, but it is confusing. I don’t mind eating a lot of calories if they are from good protein, but what if the calories are from butter or mayonnaise, or some fatty meat like bacon? “

Jane (not her real name) did not want to stop going to restaurants and begin to eat at home in order to lose weight.  The cost of doing so would have been social isolation and even depression. The solution was to find out what she was eating, and to make some informed choices.

The solution: we spent a cold rainy afternoon in front of the computer looking up the nutrients and calories in the foods offered at the restaurants where she was eating. We were surprised at what we found. Oatmeal for example: She liked oatmeal for breakfast, and I couldn’t convince her to eat it at home. “If I don’t get out of the house when I wake up, I feel depressed,” she told me. She had been going to Dunkin Donut for coffee and a cup of oatmeal. The calorie content of the oatmeal was reasonable, 310 calories, but we were shocked to see that it contained more sugar than oatmeal: 40 grams of sugar and about 26 grams of the starchy carbohydrate. Choosing the flatbread veggie-egg white sandwich with diced pepper and cheddar cheese? She would be getting 18 grams of protein (the oatmeal had very little protein), and only 5 grams of sugar.  Had she gone instead to Au Bon Pain, a block away, for her oatmeal she would have eaten about the same number of calories, but only 1 gram of sugar.

On the other hand, when we checked the calorie contents of some calorically innocent sounding Au Bon Pain sandwiches, we were surprised at how many calories they contained.  A chicken sandwich which should have been a relatively low calorie option contained high fat ingredients like avocado and bacon and clocked in at more than 600 calories.  Other chicken or turkey sandwiches were also calorically high, especially for someone as sedentary as Jane.

“What about a roasted vegetarian wrap?” asked Jane, peering at the computer screen, “It sounds healthy.”  But that came through with a whopping 700 calories. Fortunately, half sandwich options were available, and if combined with a low calorie vegetable soup, this seemed like a good lunch option.

Eating dinner at a restaurant forestalled Jane’s returning to an empty apartment too early in the evening, so that meal became even more socially important than the previous two. Unfortunately, her favorite eating place served gigantic portions, which Jane tended to finish because she hated to waste food. She thought a solution might be to share an entree with a friend who also lived alone, and if her friend was not available, asking the waitperson for a half size portion. “They don’t have to put so much food on my plate,” she said. “Look, if you can ask for salad without dressing, or a dish without nuts or bacon or cheese, why can’t you ask for less food on the plate?“

The financial and caloric costs of eating away from home are higher than eating in one’s kitchen. But the social and mental health benefits, as in Jane’ case, are compelling.  If we can make nutritional information about restaurant food easier to obtain, portions smaller and healthier, then the choice does not have to be eating a lonely meal at home, or eating with the company of others away from home.