Many of us, particularly those of us from Western cultures, are in the habit of considering the mind and body as entities separate one from the other. Sir Ken Robinson, for example, in one of the most widely watched TED talks, describes an academic as an individual who employs the body to move their head from one meeting to another. In a less amusing example, this from medicine, mental illness is considered different, somehow, from physical illness, and the many aspects of care, coverage and chronicity reflect this. Has Descartes’s mind-body dichotomy outlived its usefulness? Continue reading
Category Archives: Strategies
Your Summer Plan, Your Winter Plan
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
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.
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, student at Barnard and JTS, 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.
Also, if you have a story to add to the MHH Project, you can contact Nora Feinstein at http://maxwellhousehaggadahproject.tumblr.com or mhhproject@gmail.com or @mhhproject.
Happy holidays, gut yuntif, to all!
Let’s Start at the Very Beginning
Wherever I go, people always want to talk with me about the blog. Lately, I’ve heard a lot of this: “I went to your website and saw a lot of interesting stories, but I didn’t know which ones to read first. Where should I start? What is the first thing you would want me to understand?”
There are two things I want everyone to understand: First, there’s a big difference between real food and manufactured calories. And second, manufactured calories cause all kinds of serious medical problems, like diabetes and obesity.
So today I want to take you on a field trip. We’re going to step out the back door, and into a field of wheat. Pick a single grain, and take a good look at that grain. What do you see? Each and every grain contains 1) a bran fiber coat; 2) an endosperm, composed primarily of starch; and 3) the wheat germ, where the nutritious oils are. If you strip away the bran coat and wheat germ, as we humans figured out in the past two hundred years or so, all that’s left is a pellet of white starch. This is also known as white flour.
Now, if you could look at that pellet of white starch under a microscope, you would see a long, simple chain of sugar molecules. Our bodies are able to break the links between those sugar molecules so efficiently that when you eat white flour, your blood sugar rises as fast as — if not faster — than when you eat sugar straight from a sugar bowl. How do I know this? I learned it from my diabetic patients who check their blood sugars after they eat. White flour and sugar both spike blood sugar.
You may have heard white flour and sugar referred to as “refined” carbohydrates. According to the dictionary, to refine is to remove coarse impurities. The term “refined” was selected to intimate that whole grain flour was coarse, or unrefined. With rare exceptions, like honey and maple syrup, refined carbohydrates are not found in nature. In nature, carbohydrates are almost always found attached to fiber. Consider dates and beets, for example. Both of these are used by industry as raw material for the manufacture of sugar. But in their original state, they are so rich in fiber and phytonutrients that they are considered superfoods.
When you eat, your gut breaks down food into sugar, which is then absorbed into your bloodstream. When foods are easily broken down (like white flour and sugar), absorption is quick and blood sugars rise rapidly. When food is broken down slowly (like produce, nuts, whole grains, beans, eggs, meats), it is absorbed slowly so that blood sugars remain more or less stable.
After food crosses the walls of your gut to enter the bloodstream, the body releases insulin to catch the incoming sugar and escort it to the cells of your body. The insulin is manufactured by your pancreas.
Here comes the most important part of this explanation: The more quickly you absorb sugar, the more insulin you need to escort it to its destination. The more slowly you absorb the sugar, the less insulin you need. This works like a valet service. Imagine you were invited to a huge party, and the invitation said to arrive at 7 pm. So at exactly 7 pm, 1000 cars show up at the party center, in which case there will need to be a great many valet staff to park those cars.
But let’s consider another scenario, one in which you receive an invitation to an open house from 3 to 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 all the sugar shows up all at once, you’re going to need a lot of insulin. But if the sugar gets absorbed bit by bit, you won’t need nearly as much insulin. The more insulin you use, the higher your levels go. The higher your insulin levels, the more fat you store in your belly. Insulin is a fat-storage hormone.
Which nutrients do we absorb slowly? Fiber, protein, fat. Think whole grains, dates, beets, avocados, peanuts, eggs, beans, fruits, vegetables. Which ones do we absorb quickly? Stripped carbs such as cake, sugar, breakfast cereals, doughnuts, bagels, cookies. Is it starting to make sense?
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.