I spend a lot of time reading books written by people who really, REALLY, like to eat.  Lately I’ve been listening to Tony Bourdain, American chef and author of Kitchen Confidential: Adventures in the Culinary Underbelly and A Cook’s Tour: In Search of the Perfect Meal, as he traipses around the globe eating the most extraordinary assortment of what once slipped, slithered, slid, or flew straight into the hands of his hosts.  You think that’s gross?  In defense of his diet, and with tremendous concern about what now passes as acceptable fare in America, he says:

“Do I overstate the case?  Go to Wisconsin, spend an hour in an airport or a food court in the Midwest.  Watch the pale, doughy masses of pasty-faced, pringle-fattened, morbidly obese teenagers bulked up on cheese that contains no cheese, chips fried in oil that isn’t really oil, overcooked grey disks of what might once upon a time have been meat.  These are the end products of the masterminds of safety and ethics?  Then tell me I’m worried about nothin’. 

A steady diet of ho-hos and muffins, butterless popcorn, sugarless soda, flavorless lite beer.  A docile uncomprehending herd led slowly to a dumb, lingering, and joyless slaughter.”

I’m not the only one who’s noticed that there is something terribly wrong going on out there.  That’s Tony Bourdain, with his unique commentary on the monstrous consequences of eating a diet that consists largely of manufactured calories.  Very difficult to ignore.  Go, Tony!
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Quite a few years ago, I decided to make my home in northeast Ohio.  But my folks are still in New Jersey.  So over the past 25 years, I’ve made the trip between Ohio and Jersey at least a hundred times.  This has made me an expert at highway food offerings.  Which is not necessarily a good thing.  A few years ago I started seeing trail mixes among the fast food, doughnuts, potato chips, and pretzels being offered for sale at the highway stops.  For a while, I was trying to figure out why the amount of carbohydrate is so much higher in commercial trail mixes like, for example, Planters Trail Mix (R), than in virtually identical mixes of non-commercial trail mixes that I put together myself.  Yes, that is true.  But why?

I happened to be sitting in a meeting recently, listening to a creative bunch of people solve the latest interesting problem, when somebody mentioned that commercial trail mixes spray their dried fruit with sugar solutions to increase the shelf life.  What!?  Did I hear that right?!  Well, that explains that, doesn’t it!?  You just can’t let your guard down for a minute, can you?!  Even when you try to do the right thing, buy the healthier food, make the smart choice, you’re eating hidden sugar?!  That really frosts me, I gotta tell ya.  Planters also mixes cottonseed oil into their trail mix.  I don’t know anyone whose great-great-grandparents ate cottonseed oil.

So here’s my solution.  I make my own trail mix, and that’s that.  Today I’m going to teach you how.  First, make a list:
1. Choose a nut or two: pecans, walnuts, hazelnuts (filberts), pine nuts, cashews, peanuts, brazil nuts, almonds, macadamia nuts.  Did I miss any?
2. Then choose a seed:  Sunflower seeds, pumpkin seeds, flax seeds, chia seeds, sesame seeds.
3. Now choose a fruit or two or three:  raisins (gold and dark), apricots, dates, apples, papaya, mango (Trader Joe makes an interesting chili-covered version), bananas, strawberries, pears, pineapple, cranberry.  I know that some of these (especially cranberries) are made with sugar, but you can make your own choice about that.
4. Finally, add small pieces of dark chocolate (or mini-chips) if you don’t plan to put it in a place where the chocolate will melt.  Remember that dark chocolate is good for you.  Avoid “yogurt-covered” raisins and stuff like that.  
5. Now add your choices to the shopping list, and don’t forget to go buy them.  Mix them together in a large bowl, and use a 1/4 cup measure to measure out individual-sized servings into baggies.  A quarter cup may not seem like a lot, but this is real food, and real food is pretty dense.  It will be enough, I promise.  And anyway, if it isn’t, you can just open up another baggie.
6. The next time you make it, vary your mixture slightly so it doesn’t get boring.

If you have a tree nut allergy, use peanuts.  If you are allergic to peanuts, use sunflower and pumpkin seeds.  Lots of options here.  The simplest mix is just peanuts.  The next step would be peanuts and raisins, which is a fantastic combination, by the way.  If you don’t like pineapple, skip it.  If macadamia nuts are ridiculously expensive, ignore them.  This project doesn’t have to be complicated, although you can certainly make it that way if you want to.

If you carry homemade trail mix, you will never find yourself overly hungry and without a smart option.  I put some in my kids’ lunch bags for years.  Toss a few in your car, briefcase, backpack, purse, and/or suitcase.  If you weigh more than 250 lbs., toss in a few more.  If you regularly travel with life partners, business partners, colleagues, friends, children, or teenagers, toss in a few more yet.  

And everyone will thank you for sharing.

A couple of weeks ago I mentioned that I see changes in peoples’ appearances when they stop eating manufactured calories.  This week I thought I’d share what I see, before and after.

A few months ago, at her wedding, Chelsea Clinton looked truly radiant, in precisely the way I would wish for every bride.  Her father, Bill, looked great, too, fresh off a 15-pound weight loss courtesy of his daughter’s vegan diet, to which I’ve heard he’d agreed for the sake of the coronary artery disease that he’s working to reverse.  Hillary?  No bashing here — she simply had the look of an individual with high insulin levels. 

Here’s what I see on the faces of most people who eat the standard American diet:  Large deposits of fat under the cheek bones (buccal fat pads).  Mild swelling around the eye, especially under the eyebrows (periorbital edema).  Thickened skin with slightly enlarged pores and a doughy appearance.  Fat deposits under the jaw, well known as a “double chin.”  And a faint yellowish cast to the skin.

You can see these features on the faces of lots of celebrities who had them once and then lost them.  Google images of Al Roker, Jennifer Hudson, Roseann Barr (plus plastic surgery), or Maya Angelou for starters.  All of them were once obese and hyperinsulinemic (high blood insulin levels), and then, with hard work, they were not.  One thing you can see right away is that the most prominent improvements don’t require plastic surgery.

Last week, I happened to see a photograph of Hillary Clinton testifying before Congress, and I knew that she had, at last, joined the
ranks of “real food” eaters.  It was inevitable; for the most part, people eat like the rest of their family.  Hillary’s puffy cheeks are gone, the swelling above her eyes is gone, the yellowish cast has been replaced by pink, and her skin looks more elastic and resilient.  Don’t be fooled by the shiners — those are often caused by allergies, or fatigue.  Her double chin is gone, too. 

Is it ever normal to look puffy and round with big, fat, red cheeks?  Yes, because there is a time in life when it is normal to have high insulin levels.  In the earliest weeks and months of life, we grow very fast.  We are working to store calories as quickly as we can.  That’s why babies have fat cheeks.  They are in a high-insulin state. 

I like to imagine that Hillary’s family got her to realize that her health is on her face.  I’ve heard that she wants to be a grandmother.  So you might say that she has skin in the game.  
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My colleague Caldwell Esselstyn MD recommends a vegan diet that is virtually fat-free (10% or less) and completely devoid of all fish and animal products of any kind.  He has eaten that way himself for years now, and he has documented the reversal of severe coronary artery disease in a number of patients whom he has taught to eat the same way.  

Then there is Dr. Robert Atkins, of the renowned Atkins Diet, and Dr. Richard Feinman, a biochemist from SUNY Downstate Medical Center who conducted the first serious scientific research on the Atkins Diet.  Feinman observes that “the deleterious effects of fat have been measured in the presence of high carbohydrate.  A high fat diet in the presence of high carbohydrate [think doughnuts] is different than a high fat diet in the presence of low carbohydrate [think steak with buttered broccoli].”

Last week someone showed me a copy of the Mayo Clinic diet their doc had handed them a few weeks earlier. Low-fat chicken.  Grapefruit and tomato juice (They have a lower glycemic index than apple, grape and orange juices.).  Lots of produce.  Anyone can lose weight eating like that.  The question is whether you can eat like that for the next 50 years.  And when you get sick of this restrictive diet, what is the dieter supposed to add back next?  Anyway, that’s not what struck me most.  What I noticed first was — no manufactured calories.  That’s key to any successful eating plan.

Michael Pollan says we should “eat food, not too much, mostly plants.”  What does Michael Pollan mean when he says to eat “food”?  Well, he’s
written a whole book about it, and I won’t reproduce it here, only to
say that he means items that human beings have eaten throughout
evolution.  He does NOT mean items that are an invention of the 20th
century.  So we’re not talking about Crisco, or granola bars, or
ho-ho-ding-dongs, or shakin’ bakin’, or crisps or chips of any kind. 
These things aren’t food; they’re manufactured calories.  Food is
things our great-great-great-grandparents ate, and things that we
ourselves can prepare in the kitchen with ingredients that are easy
enough to grow ourselves or find at the market.

So which diet is the right one?  I believe they all are.  Esselstyn, Atkins, Feinman and Pollan are like the proverbial blind men all touching and describing a different part of the great big elephant in the living room.  

I love mixing metaphors.

Dr. Esselstyn has observed that if he can get people to eat ONLY vegetables, legumes (beans) and whole grains, their cholesterol improves, their blood sugar improves, their blood pressure improves, and they lose weight, especially around their midsection.  He even has data to show that coronary artery disease can be reversed, partial blockages be resorbed, and blood once again flow freely through open vessels.  Dr. Esselstyn reports that the only patients who “fail” the diet are the ones who “cheat” by going back to eating small amounts of processed foods containing very small amounts of processed fats (containing very small amounts of trans fats).    

Back in the 1970’s, Dr. Atkins observed that if he could get people to stop eating carbohydrate, their cholesterol improved, their blood sugars improved, their blood pressure improved, and they lost weight, especially around their midsection.  At first, Atkins didn’t realize that there was a difference between refined carbs (mainly white flour and sugar) and other carbs, such as produce, dairy, whole grains and legumes.  So he said not to eat any carbohydrate at all.  Later on, he did come to understand that we pay a huge metabolic price for eating refined carbohydrates, and then he created guidelines for incorporating only healthy carbs.

Michael Pollan’s approach?  I’ve been using my own version of it, and guess what?  Patients’ cholesterol improves, their blood sugar improves, their blood pressure improves, and they lose weight, especially around their midsection.  The way I see it, Esselstyn, Feinman, Mayo and Pollan are each touching a different part of an elephant called FOOD. 

My take-home message this week is that the ultimate effect of adopting any of these diets is to decrease immediately the amount of manufactured calories you eat, and to replace them with real food.  That real food might be sweet potato, sprinkled with cinnamon, wrapped in kale, and served with brown rice.  It might be lemon-butter sauce on roasted chicken.  It might be fried eggs and carrot soup.  It might be as simple as a spoonful of peanut butter.  What it isn’t is deep-fried tater tots and chicken nuggets. 

I’m not saying that all of us can eat any of these diets interchangeably.  We have to experiment and figure out what is right for us.  What I am saying is that, because these approaches are all based on real food, the answer will lie somewhere in and among them.

And the elephant in the living room?  The fact that the standard American diet is causing the obesity and diabetes epidemic.  We are doing this to ourselves, and it will end when we stop eating manufactured calories.  We hold the solution in our own hands.  Now…go make a pot of soup!
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Thank you, KevinMD.com, for picking up my post on a Virtual Visit to the Supermarket !  Check it out at KevinMD.com !
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Have you ever had a problem that turned out to be a blessing in disguise?     

A long time ago I used to know a family that had a daughter with a corn allergy.  The way they found out about it was that she used to get these terrible headaches, and then get sick to her stomach.  When it started, she was little, like 6 or 7 years old.  It got so bad that she practically couldn’t leave the house.  Often, she would get sick on the bus in the morning, so at first they thought it was all about school.  I don’t need to tell you that they tried EVERYTHING.  

Now this happened about 20 years ago.  Nowadays everybody talks about food, but it wasn’t like that 20 years ago.  So you can imagine how desperate they all must have been if the pediatrician recommended an “elimination diet.”  If you don’t know what that is, it’s a structured, programmed method for determining what foods are causing symptoms.  Basically, you completely stop eating a select food group for three weeks (dairy, for instance), and then you eat a ton of it (like pizza, ice cream, etc.) over one weekend.  If your symptoms slowly disappear for a few weeks, and then come back with a vengeance when you reintroduce the food, you’ve got your answer.  

In this kid’s case, the problem was so bad that they decided to do the elimination diet in a more drastic way — backwards.  They were going to give her just one food to start, and then reintroduce other things one at a time.  They used an interval of one week instead of three weeks because it made more sense under the circumstances.  I don’t remember what she ate the first week, maybe chicken.  Just chicken.  It was a long week.  

But I do remember what they gave her on week 2 — Cola.  I really have no clue why the pediatrician picked that.  Maybe she thought it was easy to digest.  Maybe she wanted to make it easier for the little girl to cooperate, and thought the soda would be a nice reward. 

As a doc, I am an inveterate people-watcher.  I watch people walk, move, and think.  I notice the angle of their shoulders, their hands, the looks on their faces, their skin.  When people start trading processed, food-like stuff for real food, the skin on their faces becomes smoother, less puffy, younger looking.  Its yellowish cast is replaced by a pink shine.  As the levels of insulin responsible for the deposition of central, visceral fat begin to plummet, even children lose the soft double chin hanging from their jaw bones.  I see these changes as readily as I see a week without sleep, or a new coat.  

The little girl’s case was even more dramatic.  Within minutes, she was sobbing and puking.  Her mom picked up the can, and turned it over to read the ingredients.  Then she picked up the phone to call the pediatrician.  It was the corn syrup.   

The story ends well.  With just a few mishaps over the years, the young girl grew up without symptoms, and without corn.  In the way that many families do to accommodate one member with a serious food allergy, her entire family stopped eating all products containing corn.  That means all processed food.  They stopped eating most breakfast cereals, candy, soda, store-bought baked goods.  No more cheap restaurants, cheap ice cream, corn starch, food starch, high-fructose corn syrup.  In a nutshell, they stopped buying things with an ingredient list.  It wasn’t something they chose.  They had to do it.  The health and wellbeing of their daughter was at stake.

Then something unexpected happened. 

Over the next few months the entire family became slender, more relaxed and more active.  At the time, no one could explain it.  But the mom said it was certainly the best thing that could ever have happened to them. 

Next week:  More on getting off the American food grid: what the vegan and Atkins diets have in common!
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