Wellness is based on three major pillars: eating patterns, rest & relaxation patterns, and activity patterns. Today’s post focuses on activity patterns. There’s no need to train for the Olympics. Your goal is simply to increase opportunities to move. And for that, you need a plan. Continue reading
Category Archives: Strategies
Discipline Is Remembering What You Want
In the weeks prior to starting medical school, my brother-in-law gave me a small card with a calligraphed message: Discipline is remembering what you want. I soon affixed it to the wall of my new study carrel where it remained until, years later, I passed it along to a friend who needed it more than I.
Discipline is remembering what you want. What do you want? What do I want? Continue reading
Hungry After Thanksgiving?
Several conversations converged this weekend. First came a question from my friend Nazalee to a community of my colleagues: “Oh wise ones…why sooo hungry after Thxgiving? Does stomach stretch or what? Is it a hormone?” One reply: “Perhaps expl is longer than 140 words. Salad Wine turkey ham pumpkn pie not horrible food.”
Then, just two days later, a friend was telling me about his experience studying Talmud in Jerusalem last summer. While studying a different subject entirely, the rabbi made an aside that indulging drives makes them stronger. My friend’s ears perked up at that, and he saved that little pearl to think about at a later time
His comment returned my thoughts to Dr Mike Roizen’s and Dr Oz’s oft-stated opinions (in contrast to my own) that dietary changes must be made on an all-or-nothing basis. Hook, line, and sinker. Like AA. Might this truly be the best strategy for someone with a food addiction? It is certainly in line with the rabbi’s comment. The rabbi’s observation may also have a hormonal basis, as Nazalee conjectures above. Dr Richard Bernstein, from the Nutrition & Metabolism Society, taught me once that stomach stretching initiates a cascade of hormone release that raises blood sugars, which is why eating a whole cabbage will raise your blood sugar even if it is the only thing you eat.
In contrast to the all-or-nothing strategy, on the other hand, I have always been of the opinion that the most sustainable changes are the small ones. When a patient came to see me, I would identify the worst, most egregious, problem and try to work on that issue first. When a patient asks my opinion on a reasonable rate of weight loss, I joke that one-quarter pound a month for the rest of their life would be just about right! I feel that there must be accommodation for our humanness, our fallibility. We aren’t computers to be set at a particular setting. This seems right to me, both for myself and for my patients. The last thing I want to do is to increase stress-related eating. But maybe it’s exactly the wrong advice for someone whose overeating pattern is more in line with an addiction.
I, too, ate a lot more food than usual this weekend. Maybe it’s the change in routine, the distractions, the food itself: its availability, quality, flavor, or the love with which it is made. Whatever the reasons, tomorrow is another day, and I am sure my appetite will be back to normal within a day or two.
Michael and Mary Eades, of Protein Power, talk about coming upon “the honey tree.” This is their descriptor for the experience of taking a major detour from one’s usual way of eating, particularly eating more sweets than usual. Nazalee, it appears that you (and most Americans, probably) came upon the honey tree this week. Other than that, I don’t have an answer for you. It’s not the 140-space limit. I just don’t know. But I have faith and I believe, therefore, that with time you will figure it out.
Keep Your Enemies Closer
Yesterday morning I looked down and saw a tiny ant crawling along the inside of my left elbow. I felt an urge to flick it away, but not to squash it. Keep your friends close and your enemies closer, I thought.
Researchers have discovered that the communities of microbes living in the guts of normal-weight individuals differ significantly from those in the guts of obese individuals. Researchers are also finding evidence to suggest that some common autoimmune diseases (like asthma) may result from decreased early exposure to bacteria, viruses, and other microorganisms that, in previous centuries, would have primed our young and immature immune systems, and protected us—later on—from these sometimes devastating autoimmune diseases.
The extensive use of broad-spectrum antibiotics in beings of all kinds, including both humans and livestock, is being linked to a myriad of consequences, including severe secondary infections like C. dificile colitis, against which we might ordinarily be protected by the community of healthy bacteria harbored in a normally functioning gut.
You might say that the bugs are our friends. Maybe not that, but they are certainly our neighbors.
When my children were young and felt ravaged by the latest cold virus, I explained that it was helping them to grow their “antibody library,” which would be protect them as they grew. We strengthen the bugs and they strengthen us. We occupy the same space. We are not at war. We inhabit their world, and they inhabit ours.
Why does an obese individual’s gut harbor a different community of bugs? I am going to guess that one aspect may have something to do with what those bugs are fed. Perhaps if we feed them real food, the ones that work with us will thrive. And maybe if we feed them ultraprocessed, food-like items, the ones that work against us thrive, and the good neighbors cannot survive. Other bugs have moved in to take their place.
Have you ever made a project with papier mache? The recipe for papier mache, consisting of just flour, water, and salt, results in a glue that dries rock hard. You can count on that. Why does paper mache last so long? Simply put, it doesn’t disintegrate because bacteria don’t eat it. I am not sure what white flour does to the neighborly bacteria in our guts, but I will never be convinced that it nourishes them. Being fed bread and water puts me in mind of prisoners in solitary confinement.
The bugs in our gut are related to our health in every way we can imagine, and a great many more than that, I suspect. That’s why I recommend that you keep your microbiological friends close and your enemies closer. They may not be enemies at all.
The Maxwell House Haggadah Project
In honor of Passover, which begins this coming Friday evening, I decided to write today about the Maxwell House Haggadah Project, a project of Nora Feinstein, a graduate of Barnard and the Jewish Theological Seminary. The haggadah is a short book that retells the story of the exodus from Egypt of the Hebrew people, and from which almost every Jewish family reads aloud at the annual Seder meals during which we celebrate the first (and sometimes second) night of Passover.
The Maxwell House Haggadah remains the longest running commercial promotion in American history. Its story begins in 1923, when Rabbi Betzalel Rosen declared that coffee was made not from a bean, but rather a berry, which made it acceptable (kosher) for drinking during Passover. Since beans are considered a forbidden food to Eastern European Jews during Passover, this changed everything!
The Maxwell House Coffee company, owned by a small Tennessee company that was hoping to make Maxwell House a national brand, had an idea. To break into the northeast U.S. market, they hired Joseph Jacobs, who was working at the time as an advertising coordinator for a number of Yiddish newspapers in the NY area.
The new field of niche ethnic marketing was still in its infancy: In 1933, Jacobs crafted ads that ran in the Jewish Daily Forward, a periodical so popular that it is still in circulation today. In fact, an article of mine about trans fats in kosher food processing ran in the Forward a few years ago.
Joseph Jacobs had the idea of providing a free haggadah with the purchase of a can of Maxwell House coffee, and the idea caught on like wildfire! In a short time, the new haggadahs could be found in almost every American Jewish home. In fact, according to Feinstein, to this day, eighty years later, Maxwell House continues to be the most popular brand of coffee among American Jews. That’s a rather successful marketing strategy, especially considering that Folger’s, and not Maxwell House, is the most popular brand in America overall.
Why do I tell this story here? Because whereas coffee appears to have beneficial effects on our mood, our concentration, and even our blood sugars, most products of the American food industry cannot make that claim. Yet niche ethnic marketing became such an extraordinarily successful strategy that it was used to entice and teach entire communities of consumers (e.g., Latinos, African-Americans, non-Jewish Eastern Europeans, Greeks, Italians, and just about any other group you can think of) to purchase and use items that they had never heard of before. These strategies included the underlying, subliminal message that the more new stuff you bought, ate, and fed to your family, the more American you became. And that was an absolutely irresistible message for a nation of immigrants.
That’s why it’s time to take matters into your own hands. Read ingredient lists; avoid stripped carbs like white flour and sugar as best you can; discard all trans fat-containing items (vegetable shortening, anything partially hydrogenated); load your plate with produce; and (re)learn to cook for yourself if you’ve forgotten or never knew how. Your health is on your plate.
You can learn more about the Maxwell House Haggadah Project here.
Happy holidays, gut yuntif, to all!
Let’s Start at the Very Beginning
When people want to talk with me about the blog, these are the kinds of questions they usually ask: “I went to your website and saw a lot of interesting posts, but where should I start? What is the first thing I need to understand?”
First, there is a huge difference between real food and manufactured calories. Second, manufactured calories are a major factor in the epidemic of obesity and diabetes, as well as the rising rates of many other diseases, such as breast cancer, colon cancer, and prostate cancer.
Let’s take a field trip, out the back door, and into a field of growing wheat. Pick a single grain, and take a good look, and what do you see? Each grain contains a bran fiber coat; an endosperm (primarily starch); and a germ, which is rich in nourishing oils. Approximately 200 years ago, humans figured out how to strip away the coat and germ, so that only the pellet of white starch remained. Manufacturers call this “white flour.”
If you could look at a bit of white starch under a microscope, you would see a long chain of sugar molecules. We break the links between those sugar molecules so efficiently that eating white flour causes your blood sugar to rise as quickly — if not more so — as when you eat a spoonful of sugar. White flour and sugar both cause blood sugars to spike.
Manufacturers chose to call white flour and sugar refined carbohydrates. But to refine is to remove coarse impurities. The term refined was selected specifically to suggest that whole-grain flour was coarse, or unrefined. In nature, carbohydrates are almost always found in a fiber matrix. Consider dates and beets, both of which are used by industry as raw materials for the manufacture of sugar. In their original state, they are so rich in fiber and phytonutrients that they are classified as superfoods. With only rare exceptions (e.g., honey, maple syrup), refined carbohydrates are not found in nature.
After you eat, your gut breaks down food into sugar, which then gets absorbed into your bloodstream. White flour and sugar are broken down easily; they are rapidly absorbed, and they spike your blood sugars. Foods like produce (fruits and vegetables), nuts, whole grains, beans, eggs, and meats are absorbed slowly enough that blood sugars remain more or less stable.
Once food enters your bloodstream, your pancreas releases insulin to catch the incoming sugar and escort it to the cells of your body. The more quickly you absorb sugar, the more insulin you need. The more slowly you absorb the sugar, the less insulin you need. It works like a valet service. Imagine you were invited to a huge party. At exactly 7 p.m., one thousand cars show up at the party center. They’re going to need a lot of valet staff to park those cars.
But consider an alternate scenario. Imagine you receive an invitation to an open house for 3-9 p.m. At the end of the day, the party center will still park 1000 cars. But they won’t need nearly as many valet staff.
The sugar is the cars, and the insulin is the valet staff. If your sugar shows up all at once, you will need a lot of insulin. But if the sugar gets absorbed bit by bit, you won’t need nearly as much insulin. Insulin is a fat-storage hormone. The more you use, the more you need. This is called insulin resistance. The higher your insulin levels, the more fat you store in your belly. Insulin has many other deleterious effects on the body, and they begin decades earlier than we once thought.
Which nutrients are absorbed slowly? Fiber, protein, and fat. Foods like bulgur wheat, brown rice, buckwheat, quinoa, millet — all whole grains. Dates, beets, avocados, peanuts and tree nuts, seeds, eggs, beans, fruits, vegetables. All of these are absorbed slowly. Which items are absorbed quickly? Stripped carbs, like cake, sugar, breakfast cereals, doughnuts, bagels, cookies.
Please feel free to post questions.
I Drink 2 Pots of Coffee and I Don’t Do Breakfast
Originally posted 12/12/2010
When I was home for Thanksgiving a couple of weeks ago, I got to spend time not only with my family, but also with some old friends I hadn’t seen for a long time. This week’s mail brought some interesting questions from one of those old friends, who gave me permission to share them with you.
Dan wrote that he does not normally eat breakfast. He’s not that hungry early in the morning. He does, however, drink copious amounts of coffee. He described himself as “very overweight,” and said that he’s considering going on a “very low carb diet” to drop the weight. I asked exactly how much coffee he’s talking about, and he said close to 2 pots of coffee a day (7-8 mugs). He adds only half-and-half. No sweeteners.
Here’s what I say about skipping breakfast: Our bodies need a certain amount of energy to get through the day. If we have not eaten that amount of energy (calories) by the time we get up from the dinner table, we will eat the rest AFTER dinner. By and large, calories eaten after dinner are snacks, so they are not as nutritious as meals. Also, the later you eat them, the less likely it is that they will be completely digested by the time you go to bed. And then you aren’t hungry when you wake up. So you skip breakfast. Vicious cycle.
The way to put an end to this is to eat protein in the morning. It sends a message to your body to turn on your daytime metabolism. It doesn’t have to be King Henry VIII’s breakfast. Just a cheese stick. A hard-boiled egg, a leftover hamburger. No time? Eat a handful of nuts in the car on the way to work.
Now the coffee. Dan said each 12-cup pot of coffee makes 4 mugs of coffee, and that he doesn’t quite finish the second pot. So figure each mug is around 2 1/2 cups. I have a couple of mugs that big around here. American-sized. One tablespoon of cream? Yeh, right! Let’s assume Dan puts 4 tablespoons of half-and-half in each mug of coffee. If each tablespoon contains 2 1/2 grams of fat and 25 calories, Dan is drinking 700 calories of half-and-half every day. Even though the fat is more nutritious than you might think, there’s no two ways about it: that’s a lot of food. I’m guessing he eats at least a couple of meals, plus snacks, in addition.
One thing he could do would be to put cream in just the first cup or two of the morning, and drink it black for the rest of the day. And remember to have a high-protein breakfast. Or he could admit that he’s drinking one-and-a-half to two meals worth of calories a day, and factor that into what he chooses for lunch. Celery?
Now to answer the very-low-carb diet question. Do I recommend it? No, I don’t. At least not yet. I don’t believe in sudden change. I say he should take a careful look at the rest of his diet, and figure out the single largest source of processed carbohydrate – be it white flour, chips, high fructose corn syrup, or sugar.
His pants will get loose pretty fast once he identifies and decreases the amount of processed carbohydrate in his diet. He doesn’t need to do it all at once. He can pick one problem at a time, and see what happens. Two or three months of eating peppers and cucumbers with lunch, instead of chips, would be a great start. If he becomes a breakfast eater, a nutritious, high-protein breakfast instead of Frosty Crunchos would be a very good idea. The best answer depends on the the biggest problem. Soda/pop every afternoon? Donuts? The drive-thru for a sausage-on-the-go-go every morning? Everybody has different issues. At least we know Dan’s not ordering the extra-large sweet latte made with non-dairy whitener.
Next week (posted 12/19/2010) , we’ll be talking about another set of questions from Emily, who’s working on following Weight Watchers and my “Four Recommendations” at the same time.