Lately quite a few people have asked me to explain how I became interested in nutrition, and in preventing diabetes (type 2) and obesity.  Some time ago, after I had been practicing medicine for a few years, I noticed something very odd.  Not only had I recently diagnosed more than the usual number of cases, but they were mostly in a select group of new patients.  This select group consisted almost entirely of spouses of my diabetic patients.  Now I had learned in medical school that the tendency to develop diabetes is genetic.  That means you would be more likely to become diabetic if one or especially if both of your parents were. 

But none of my professors had said anything about spouses.  Spouses are not generally related to one another.  But here it was.  One after another, the spouses of diabetic patients were arriving at my office with diabetes.  What did these husbands and wives have in common?  It was not their genes, of course.  It was their eating patterns. 

So I started to look at how, what, and when they ate.  They kept food logs.  They checked their blood sugars before meals, after meals, even in the middle of the night on occasion.  They collected nutrition labels and we worked together to make sense of them.  Then they began to make changes, big and small.  These changes developed into the four recommendations that I promulgate for preventing diabetes and obesity. 

There is more to this story.  Years later I, like all of America, watched the people of New Orleans struggle to survive in the aftermath of Hurricane Katrina.  I stared, horrified, at one particular news photograph of a blanket-covered, wheelchair-bound body, flattened over itself as if tying its orthopedic shoes for eternity.  My physician’s eye was seeing a second, deeper layer of tragedy below the surface, but what?  I continued to stare at the photograph until I realized that it symbolized to me the awful consequences of uncontrolled diabetes. 

For the individual in the photograph, Katrina was likely the last in a long series of humiliations.  The disease’s destructive course speeded up by the storm, there was no alternative ending.  Diabetes stole her ability to regulate her fluids, to monitor her sugars, to stand and walk.  Diabetes destroyed her ability to adapt to the environment.  Then came the storm.  Unable to survive the heat, dehydration, starvation and immobility in this inhospitable place from which there was no escape, she died. 

The twin tragedies of Katrina and diabetes became linked in my mind.  As harsh a blow as the storm was to the people of New Orleans, diabetes made it even more difficult to survive.  Diabetes does that.  No matter what your circumstances, it makes it that much harder to survive.  Katrina didn’t make diabetes more destructive, but it did show me how profound that destructiveness is — and how urgent is the need to prevent it.  After Katrina, I became more committed than ever to preventing diabetes.

Annual diabetes costs in the U.S. topped $218 billion in 2007 and are expected to rise to $336 billion by 2034.  Diabetes is devouring our healthcare dollars, felling our workforce, and exhausting the resources of millions of families.  Diabetes affects almost 21 million Americans, an estimated 6 million of whom have not yet been diagnosed.  It is the number one cause of acquired blindness, non-traumatic leg amputation, and kidney disease leading to dialysis.  Two-thirds of diabetic individuals die from cardiovascular disease, the number one cause of death in this country.  Diabetics are two to four times more likely to suffer a heart attack or stroke than non-diabetics.

If we are going to optimize our overall health as a nation, direct public health resources most effectively, and be in the best possible shape to prepare for emergencies if and when they do occur, we must all learn to tell the difference between real food and manufactured calories. 

I tell patients that my goals are a little different from theirs.  My goals include maintaining normal blood pressures, preventing kidney damage, monitoring blood sugars, updating immunizations and screenings.  But you have just one goal — to dance at your grandchildren’s weddings.  That is my wish for you.  To your good health!

This week I received a letter asking how insulin causes us to gain weight and store fat.  “How does too much insulin make one fat?,”  commented the writer.

And the answer is: “We don’t exactly know yet.”  But we’re figuring it out, a little at a time.  The biochemists, who work at the cellular level, appear to be figuring it out first.  The rest of us can tell firsthand that the information we get from TV advertisements and cereal boxes doesn’t help much.  The fact that our epidemic of obesity and diabetes is getting worse all the time shows that this information isn’t accurate.  If things continue to get worse no matter how hard you try, it’s time to reexamine the fundamentals.  If you can’t stop your head from hurting no matter what you do, it’s time to stop banging it against a wall.  There is a name for nutritional claims on food products.  It’s called advertising.
 
OK, so what do we understand?  We understand that insulin (and other enzymes) is released in response to some kind of signal that is sent to the pancreas (and other parts of the gut) when we start to eat.  There is new evidence that this signal is actually sent in anticipation of eating, in other words, BEFORE the food actually enters our mouths.  This is not a surprise to me.  Our own language actually contains evidence of this phenomenon in the expression “mouth-watering.” 

We understand that food causes your blood sugar to rise, as it should, and that the pancreas releases insulin in response to those rising blood sugars.  The insulin escorts the sugar to cells, sugar is thus removed from the bloodstream, and blood sugars return to their pre-meal levels. 

In a previous post, I discussed the fact that the faster you absorb your food, the faster your blood sugar rises, and the more insulin you need to catch the sugar and remove it from the bloodstream.  Insulin is the fat-storage hormone; the more insulin we use, the more fat we store.  Also, there is something about the RATE at which you absorb sugar that dictates how much insulin you are going to need.  If all the sugar shows up at once, you need a load of insulin to catch it.  If the sugar drips in bit by bit, you only need a little bit of insulin to catch it.  You can read more about this at my post, “Eating Toast and Jelly for Breakfast Wastes Your Insulin.”

Where does the sugar go next?  Some sugar molecules get used immediately by working muscles and thinking brains.  Some go to our liver, where they are collected into strands of glycogen.  Glycogen strands are like pearl necklaces whose pearls can be popped off later, one at a time, to keep our blood sugars normal between meals and while we sleep.

The rest of our blood sugar gets stored as fat.  That makes sense.  If you don’t need it now, and you have enough for later, then the rest should go into deep storage.  Fat is deep storage.  We store fat in the form of triglyceride, which is a molecule that consists of three fatty acid chains attached to a glycerol molecule.  Glycerol is made from the sugar that comes from the carbohydrates in our diet.  The more carbohydrate we eat, the more sugar becomes available to form glycerol.  The more glycerol we make, the more triglyceride we make and the more fat we store.  The amount of available glycerol dictates how much triglyceride we can make.  So carbohydrate is an essential component of fat storage.  That’s really important. 

Remember that triglycerides are composed of 1 glycerol plus 3 fatty acids.  The source of fatty acids is dietary fat.  Our brains are designed to be able to use as fuel not only sugar, but also fatty acids.  Interestingly, as far as insulin is concerned, fatty acids are a free ride.  You don’t need insulin to catch fat the way you do to catch sugar.  So after fat (in the food we eat) is digested and broken down into free fatty acids, those free fatty acids can either be used right away, or they can be attached to glycerol molecules to make triglyceride molecules.  Then all those triglycerides are stored in body fat.

Triglycerides are a big molecule.  They are too big to move across a cell membrane, so they must be transported across as individual components, and then reassembled into a triglyceride molecule inside the cell.  This reminds me of the huge breakfront that we inherited from my husband’s grandparents and which has sat in my dining room all the years of my married life.  It’s so big that we can’t get it through doorways, so when we have moved we have had to take it apart.  The top detaches from the bottom in a very clever way that always gets my admiration.  It’s an ingenious design that makes it simple to move what would be an unwieldy piece of furniture, and which would otherwise have been obliged to remain forever in the room in which it was built.  In much the same way, triglycerides circulate in the bloodstream and accumulate in cells, but the fatty acids of which they are composed continually pass across cell membranes, cycling into triglycerides and back. 

Now, let’s talk about insulin again.  A great number of hormones in our bodies help to break down triglycerides and release fatty acids for use (as fuel).  But not insulin.  Insulin is the one hormone that facilitates triglyceride storage.  In the presence of insulin, we will always store fat, and not release it.  Insulin is the stimulus for fat storage.  In order to release fatty acids, the level of insulin must be low.  For fat cells to release their fatty acids, there must be a relative deficiency of insulin in the body.  That makes sense, because our insulin levels should be high only when we have just eaten, and that is the one time when there is no need to break down fat to obtain nutrition. 

Therefore, because the high-insulin state prevents mobilization and use of fatty acids, it becomes impossible to lose weight in the presence of large amounts of insulin.  We store fat independent of our food intake, and we gain weight when insulin exerts its effect on body fat.  More as the story develops…

Yogurt is a food product that results from the fermentation of milk by a couple of specific types of bacteria.  It has been around for at least 4500 years, and is clearly a way to preserve dairy products without refrigeration.  Yogurt is real food.  It is delicious and nutritious.  I strongly recommend whole milk yogurt for the same reasons that I recommend whole milk.  Milkfat contains the widest possible variety of nutrients, including all the fat-soluble vitamins, and it helps to slow the absorption of carbohydrate eaten along with the fat.  The more slowly you absorb your food, the less insulin your body needs to release.  The less insulin you use, the more satisfied you are and the less fat you store. 

Now let’s talk about what’s on the shelves at the supermarket.  They may start as yogurt, but they don’t really end up that way.  They end up more like some kind of sweet pudding.  Very, very sweet pudding.  Well, actually, sweeter than pudding.  As we shall see, they contain signicantly more sugar than pudding. 
 
Yogurt without added flavors could be called “pure” yogurt, but it’s not.  It’s called “plain” yogurt.  That’s interesting. A glance at the yogurt flavors at my local supermarket supports the dessert motif.  Product flavors include amaretto cheesecake, white chocolate raspberry, black cherry cheesecake, chocolate eclair, coconut cream pie, caramel praline.  These make the strawberry flavor sound downright wholesome.  The target audience for other flavors, like “Sprinkl’ins Magic Crystals” and “Sprinkl’ins Rainbow Sprinkles,” is children.  See my posts on breakfast cereals, Most Cereals are Like Eating Candy for Breakfast  and  More on Breakfast Candy,  for more on marketing strategies that target children.

What’s bothering me about the yogurt at the supermarket?  Besides the bogus flavor names, it’s one thing and one thing only: the amount of sugar in each container.  I took pen and paper to the supermarket, and copied down the information from the nutrition labels.  The numbers I quote below were relatively consistent across the many different brands I reviewed.  These numbers held true whether the yogurt was made from skim, low-fat, or whole milk.  So here we go.

A single-sized serving of plain yogurt contains 11-12 grams of carbohydrate. These 11 grams of carbohydrate are from lactose, or milk sugar, which is an intrinsic nutrient in all yogurt.  In contrast, a serving of flavored (lemon, vanilla) or fruit (strawberry, peach) low-fat or skim milk yogurt contains 33-34 grams of carbohydrate.  Because milkfat takes up a little space in the container, whole-milk yogurt has slightly less, 31 grams. 

34 (total grams of carb) minus 11 (lactose) is 23.  That’s the amount of carbohydrate added to each single-serving container in the form of sugar.  Each 5 grams of carbohydrate is equivalent to a teaspoon of sugar.  So 23 grams of carbohydrate is equivalent to almost 5 teaspoons of sugar.  This means that each container of yogurt contains close to 5 teaspoons of added sugar.  By comparison, Swiss Miss’s chocolate and tapioca pudding flavors have 26 and 25 grams of carbohydrate, respectively.  Still a lot, but then no one’s trying to disguise the fact that these are desserts.

Now I like sugar in my tea and oatmeal, and even on a grapefruit half now and then.  But 5 teaspoons of sugar is a whopping amount of sweetener.  I’m not recommending that we stop eating our yogurt sweet, by the way.  I am saying that it would be a very good idea to consider buying plain yogurt, and then to add your own choice of fixings. 

Taste is acquired.  In the United States, we are taught from a very early age to prefer sweet flavors.  In the yogurt aisles, demand is met by Dannon, Breyers, Yoplait, and the like.  But restricting yogurt to sweet choices markedly limits your options.  Sweet is not the only way to eat and enjoy yogurt. 

For example, tsatsiki is a Greek condiment made with yogurt, cucumber, dill and garlic.  Indian raita is similar, though it is spiced instead with toasted cumin seed, cilantro, mint, and cayenne.  The cool temperature and flavor of the raita offsets the heat of the spicy curries and chutneys with which it is served.  Yogurt is also used as a chicken marinade in Indian cuisine.  My own father likes to eat his yogurt with fresh, chopped cucumbers and tomatoes, plus a bit of finely diced sweet onion.  He makes it for me sometimes when I come to visit, and you know what?  It’s delicious.  Bon appetit!

For more interesting facts about yogurt, check out http://en.wikipedia.org/wiki/yogurt. 

This month, a lot of people weigh more than they did in the fall at their last appointment.  The problem is so widespread that, especially in people who are working to lose, I make it a point to applaud their efforts even if they have simply maintained their weight at the same number over the last few months. That’s because December is probably the single time of year in which people are most likely to eat large amounts of sugar and white flour. 

Some folks don’t want to know what they weigh, so we make an agreement.  I get the number, and I don’t tell them what it is.  I remind them that I don’t really care about the number itself; I’m just looking for changes, up or down, from the last visit.  I really care a lot more about how their pants fit.  Are they looser, tighter, or the same?  That’s a lot more important to me. 

Why is December such a problem?  It has to do mainly with the amount of desserts.  What happens when you eat a lot of sugar or starch?  You use a lot more insulin.  What happens when you use a lot more insulin? You store fat more efficiently, and you lose the ability to tell when you are full.  Then you increase your food intake accordingly. 

In my experience, when a person first begins to eat a diet that requires less insulin to metabolize, it takes about three days for their appetite to modulate.  When you eat a diet that requires a lot of insulin, those high insulin levels coat the satiety centers in your brain and make it very hard to tell that you are full.  When you make changes like those in my “Four Recommendations,” you use less insulin.  On the third day, when your body finally realizes that it doesn’t need all the insulin that it’s making, your pancreas “downregulates” insulin production.  That’s how long it takes your body to begin to respond to the fact that it doesn’t need as much insulin. 

Less insulin translates into less hunger. Three days after you start eating an “insulin-conserving” diet, you wake up noticeably less hungry than you used to be. 

I tell patients not to worry, that the number will take care of itself as they get back on track making smart choices.  And it does.  So it’s okay to celebrate the holidays.  It’s okay to have a piece of wedding cake.  Or birthday cake.  It’s probably okay to have a slice of pie every weekend.  But you can’t have it every day.  Our insulin levels will manage fine if we ask them to spike only once in a while.  The problem comes when we eat foods that make them spike every day.  Because when your insulin levels are rising every day, they are no longer spiking.  Now they are just high. 

That’s why I say that what happens in December stays in December.  It’s not what we do once in a while that makes trouble for us.  It’s what we do all the time.  You can’t live in December and expect to remain healthy.  But you can visit it from time to time.

Last week I spent an hour watching Dr. Robert Lustig, Professor of Biochemistry at the University of California at San Francisco, deliver a lecture on the role that sugar, particularly fructose, is playing in our obesity epidemic.  The lecture included a section on cholesterol.  The first thing I’m going to say about cholesterol is that we don’t understand it well enough.  And what we think we know, we don’t know, because what we don’t understand fills a much bigger vessel than what we do understand.

On my first day of medical school in the early 1990’s, the Dean of Students came in to address us.  He said that half of what we would learn over the next few years would turn out to be false.  The problem was that no one knew which half!  Here are some of the things I was taught in medical school that have turned out to be false:

            LDL cholesterol is the bad cholesterol.

            Eggs and butter increase your bad cholesterol.

            There is no reliable way to increase your good cholesterol (HDL).

            We don’t really know how triglycerides fit in, but they don’t seem to really matter anyway.

Let’s discuss these false statements one at a time.

LDL comes in two major types, 1) small and dense or 2) big and fluffy.  Small, dense LDL is the bad one.  Large, fluffy LDL is ok.  Small, dense LDL is highly atherogenic (causing plaque formation, atherosclerosis, heart disease).  It’s like sand.  It gets stuck everywhere and starts plaque formation.  It reminds me of the grain of sand that irritates an oyster, which responds by coating that sand particle with layers of nacre, the shiny, luminescent stuff that results in pearls.  Humans don’t get pearls.  We get heart attacks and strokes.

Then there are the big, fluffy LDL particles that float through the blood stream without attaching to the walls of the blood vessels.  While it’s true that eggs and butter raise your cholesterol, it’s not true that they increase your bad cholesterol.  Eggs and butter increase the big, fluffy LDL.  That’s good.  If you want to know what kind of LDL you have, you can ask your doctor to run a VAP panel instead of a standard lipid profile.  The VAP panel will show how much of your LDL is small and dense, and how much is large and fluffy.

HDL cholesterol is called the good cholesterol.  H for healthy.  The lower your HDL, the greater your risk of developing hardening of the arteries.  There are a number of important research studies that show low HDL to be a much more serious risk factor than high LDL (just the small, dense kind as you now know).  There are a number of reliable ways to increase your HDL.  All of them have one thing in common.  They improve your insulin sensitivity, so it works more efficiently and you end up needing and using less insulin.  I see very low HDL levels in several kinds of patients. They are usually people whose diets consist of large amounts of 1) fast food, 2) processed food, and/or 3) refined [stripped] grains, with very little produce.

How can you raise your HDL?  By decreasing the amount of fast and processed food you eat.  By getting more exercise (to improve your insulin sensitivity).  By eating foods that are rich in B vitamins.  B vitamins are found in abundance in whole grains, fruits and vegetables, and nutritional yeast.

What are triglycerides?  If HDL is the good cholesterol, and small, dense LDL is the bad cholesterol, then triglycerides are the ugly cholesterol.  The goal from a medical standpoint is to get the triglycerides below 150, but the truth is that the lower they are, the better.  Triglycerides are the chemical compound form in which we store fat.  Triglycerides look like a capital letter “E.”  They consist of a single vertical sugar backbone (the glycerol) with three horizontal tails (the fatty acids). The more starch you eat, the more glycerol molecules you make.  The more glycerol molecules you make, the more triglyceride you can create.  You cannot make triglyceride without glycerol, and glycerol comes straight from the sugar and starch that you eat.

Remember that the more sugar we eat, the more insulin we need to catch it.  The more insulin floating in our blood stream, the more triglycerides we make.  So high triglycerides are associated with a hyperinsulinemic state.  The higher the insulin levels, the higher the triglycerides.  I see high triglycerides in several kinds of patients.  They are generally people whose diets contain large amounts of 1) sweets and starches, 2) fast food, and/or 3) alcohol.  I can predict with a fair degree of accuracy whether a patient has an elevated triglyceride level by taking a quick glance at their waistline.  Remember that the high insulin state tends to cause fat deposition in the abdomen.  Another name for this condition is a “beer belly.”  Now you know why.  Beer is made from grain.  A great many people noticed the connection long before me.

Now, low HDL is bad, and high triglycerides are ugly, but the combination of low HDL and high triglycerides is downright scary.  This combination is highly associated with hyperinsulinemia and arteriosclerosis, hardening of the arteries.  Any time I see a patient with the combination of low HDL and high triglycerides, I send them for a glucose tolerance test.  I am not waiting around for them to develop the symptoms of diabetes.  I already know they are at very high risk. If there’s a problem, I want to know about it now.  They deserve to know what’s wrong, and they certainly deserve a chance to fix it before it becomes a much bigger problem than it already is.

I also know that the metabolic picture showing a combination of low HDL and high triglycerides is strongly associated with the small, dense LDL pattern.  These are not coincidental combinations.  They are a predictable consequence of eating refined, processed, fast foods.  And that means they are not so hard to fix.  So I’m not looking at each measurement in the lipid profile as an individual entity.  I’m looking at the overall pattern. And I’m not looking at the numbers as an end in themselves.  I am looking at the person who carries those numbers.

If you would like to learn more about cholesterol, sugar, and triglycerides, you can access Dr. Lustig’s first in a series of lectures at http://www.youtube.com/watch?v=dBnniua6-oM.  This is a complex topic, and it raises a great many more questions than it answers. So please feel free to post your questions, and give me the opportunity to try to answer them.  Do not worry that your questions are simple.  I can guarantee you that many people are wondering the same thing.  I may even have attended medical school with some of them.

This year I decided that it was time, once and for all, for me to learn to knit.  I took some knitting books out of the library and began to page through. One of the books said you should make your projects with the best yarn you can afford; the results will be better, and you’ll be more pleased with the finished product.  I liked that.  It’s exactly what I say about food. 

When you cook, the results are only going to be as good as the raw materials.  If you start with the best ingredients, even simple recipes are likely to be extraordinarily delicious and satisfying.  Buying the best you can afford is one way of being good to yourself.

Cook slowly.  Don’t hurry.  Use high-quality ingredients.  This past Friday afternoon, I measured 1 heaping cup of dry white navy beans into a deep casserole dish.  I added 1 large onion (chopped), 4 carrots (sliced in small rounds), 3 tablespoons of my son’s favorite hot sauce, 2 tablespoons of brown sugar, and 1 teaspoon of salt.  That’s all.  Then I added about 4 cups of water, enough to cover the beans and other ingredients by two or three inches.  I covered the bean pot, put it into a 250 degree oven, and turned it down to 200 degrees before I went to bed.  When we woke up Saturday morning, the aroma was amazing.  I lifted the lid to check, and saw that the top was drying out a little.  So I added more water, just enough to cover the beans, and then cooked them for a few more hours.  Their rich, nourishing, and satisfying flavor added a lot to our otherwise simple lunch.  There is something so unbelievably good about slow cooking.

It does not take more time to eat well, but it does take more planning.  This dish took 10 minutes to prepare, and 2 minutes to check while it cooked.  I had to prepare it 18 hours before serving it.  I had to remember to buy navy beans at the grocery store.  But I bought enough to make it twice.  Next time I think I’ll add a can of tomato sauce, and see how that turns out. 

Eating well is all about being kind to yourself, and that’s especially important to remember at this time of year.  Around the holidays, when expectations and stress levels go straight up, it’s even more important to make time for yourself.  Ask yourself what gives you joy?  How can you be kinder to yourself?  What do you love to do most?  What do you love to do, but only get around to doing rarely, when you’re on top of your game?  It’s different for everyone, but those are the things you must do.  Consider it a holiday gift to yourself.

A friend recently told me that she was stressed out about my four recommendations.  She knew that she had some pretty lousy eating habits, but she felt unable to deal with them all at the same time.  So I told her not to try to tackle all four recommendations all at once.  Just pick one.  Want my opinion?  In my opinion, the most important recommendation of all is the first.  Do your very best to eat a high protein breakfast. What’s the hardest part of eating a high-protein breakfast?  Believe it or not, it isn’t eating breakfast.  It’s remembering to buy what you need at the grocery store.  The hardest part of eating a high-protein breakfast is being prepared, so you have what you need when you need it. 

Which recommendation is next most important?  That depends on you.  If you look down the list of recommendations, which one jumps out?  Do you drink juice every morning?  Do you drink a can of soda/pop at lunch every day?  Or a liter or two of soda/pop every day (that’s what I would call a serious soda habit)?  How much margarine and coffee whitener are in your refrigerator?  Is your kitchen filled with all kinds of low-fat products?  You’ll know which recommendation is next most important.  It will be the next one that speaks to you. 

Now what?  Now be kind to yourself.  Don’t stop drinking soda.  Just stop drinking it for breakfast.  Or set a daily limit of one liter instead of two, or two cans instead of six.  Be honest with yourself about what you can manage. Then try. 

As you use up the “candy-cereals” in your house, slowly replace them with whole grains.  Spend an hour making a bucket of homemade trail mix, and dividing it up into individual servings using small plastic bags.  Store them, along with the leftover, unused nuts and seeds, in the refrigerator or freezer in glass jars to increase their shelf life.  When you use up the poptarts and cereal bars, now you’ll have some wonderful trail mix to eat instead.  Remember to buy the best quality nuts, seeds and dried fruit you can afford.  Hearty appetite!

Happy holidays, and best wishes to all of you for a happy and healthy new year. 

Dear Readers:

I’m getting all kinds of questions and comments from a variety of places these days.  Some people comment directly to the blog, but others write to LinkedIn, Facebook, or drsukol@teachmed.com.  Some are letters of encouragement, whereas others are better described as letters of discouragement, like the one from the British gentleman who dreads coming to the U.S. on business because he can’t find a decent meal made with real food.  Any takers for that?

I have collected a few of these letters for you — maybe you’ve had some of the same questions or thoughts. 

Happy Holidays!

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Dear Dr Sukol,

“Thank you for your reply. I have now read, with interest, all the posts on your website. I posted comments on a couple of them and also used the calorie counter website to look at the carbohydrate content of plain oats.

As I said in one of the comments, my doctor has advised me that I am borderline diabetic and need to take action, so I am looking for new ideas and will implement various changes. I downloaded your “4 Recommendations,” which is excellent, and will keep checking back for more useful tips.

Thank you for highlighting this information.”
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Dear Dr. Sukol,

“Thank you for your post on “Butter is Better.”  I am obese, having hit my all-time high of 287 pounds in September.  I had put on 22 pounds just in the first nine months of this year.  I have tried all sorts of diets: cabbage soup, Hay diet, Atkins, low-carb and numerous others, but none seemed to provide a lasting solution.

Nevertheless, I always disliked processed food and avoid junk food: I prefer to prepare from fresh ingredients, including plenty of fruit and vegetables, but the problem was always that I simply ate too much.  I still believe that butter is better and that so-called “healthy foods” merit closer inspection and a degree of skepticism.

I have lost the 22 pounds I gained earlier in the year, just in the past two months, by changing what I eat: grapefruit or pomelo for breakfast and lunch, with a small portion of meat and two veg for dinner.  Eggs for breakfast is one of my favourites, but I have cut it out, thinking that it would make me hungry and slow down my weight loss.  Maybe it’s time to re-think that idea?”

My reply?  Yes, definitely.

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“I have to say that the one thing I would dread most about living in the US is the food.  On my frequent visits there,  I am amazed just how unhealthy some of it is.  Even simple foods like bread are sweetened and it must be very difficult to avoid fatty, sugary,unhealthy foods.  In our office I see people drinking huge cups of Coca-Cola (or Pepsi/whatever brand) – literally more than a pint of it in one serving.  It is not surprising that the US has a major problem with obesity and no doubt us Brits are following your lead.  By P-, United Kingdom www.linkedin.com=”” miniprofile?vieweeid=”35450468&context=anet&view””>

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“Yes – I must say that the U.S. just loves processed food in all shapes and sizes. We’re a big society of convenience and laziness! There’s a lot to be said about making something with all natural ingredients not coming from a box. I’m no health nut, but within the last year I’ve given up all table sugar and soda (even diet soda) and it’s made a difference in how I feel in general.”

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Here is my response to someone asking for information about a link between diabetes and high fructose corn syrup (HFCS):

Dear P-,
There is actually quite a lot of evidence demonstrating a link between diabetes and the consumption of HFCS. Here’s an article from Diabetes Health, a reputable journal that publishes especially for informed diabetic patients. http://www.diabeteshealth.com/read/2009/03/10/6113/link-seen-between-high-fructose-corn-syrup-consumption-and-insulin-resistance/

And his response–

“I appreciate the feedback. I understand this subject is quite touchy, especially if commented on by folks with links to the processed food or corn growing industry, which can both be biased. It is nice to have impartial 3rd sources!”
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Dr.Sukol-

I was interested in this product called Chia Seeds. What’s your take on this product and if recommended, how would you use it?

E- S-

Dear E.S.,

I did some checking and learned that chia is an edible seed that is extremely rich in fiber and omega 3 fatty acids.  A native plant of southern Mexico, it is becoming more well known globally. Seeds are available online and in health food stores.  I have never eaten it, but my daughter has, and she was delighted by your question.

If you have ever eaten flax seed, chia has a number of similarities.  It has a nutlike flavor, and can be sprinkled (ground or whole) in yogurt, cereal or salads; eaten plain as a snack; or ground and mixed with flour when making muffins or other baked goods.  It would also make a great addition to homemade trail mix with dried fruit and nuts.

Chia can be stored for very long periods because it is so rich in antioxidants and, unlike flax, it does not need to be ground to make its nutrients available to the body. 

I think I’ll buy some and try it next time I’m at the health food store…

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Last summer we built a chicken coop, and this summer it became home to a few Hamburg chickens and Golden Buffs.  Hamburgs are known for their distinctive, dramatic, black-and-white pattern.  They weigh approximately 5 pounds each, and produce a breathtaking, ivory-colored egg.  Ours are 2 years old, and were delivered to Cleveland this past May from their previous home on my parents’ New Jersey farm.  The Golden Buffs, from a nearby farm in Middlefield, Ohio, are somewhat larger.  They lay a lovely brown egg.  At least that’s what I’ve read.  Just 6 months old, they are still pullets, so we are awaiting their first eggs any day now.

Every morning we go out to greet the girls with the previous day’s scraps from our kitchen bin.  “Feed the birds, tuppence a bag…”  In the summer, the girls raced to pick out strawberry tops first, followed by the soft, seeded centers from the cantaloupes.  Now they are gobbling up all the apple cores, leftover bits of bread crust, and greens.  Then they spend the rest of the day working on the banana peels, radish tops, and squash skins.  Not to mention the grass, bugs and worms.  I toss a handful of crushed oyster shell into one corner of the coop, add some fresh straw all around, and sprinkle some scratch corn for good measure.  They recognize me now, and no longer run for cover as I cross the grass toward the coop.  On the contrary, the bravest among them flap their wings madly and make a jump for the coffee can full of chicken feed that I carry in my hands. 

The girls have recognizably different personalities, and use them to great comic effect.  Dora is our most fearless hen.  She has a necklace of white feathers.  She and Nora complained very loudly to me one morning last week after having inadvertently spent the entire night outdoors in a rainstorm.  They reminded me of disgruntled tourists, soaked through to the skin.  I recently heard a story about a hen who used to take new visitors to see her coop, and pecked at the shoes of those who interrupted her during the tour.

No, they are not being raised for meat.  And no, you don’t need a rooster to get eggs.  You only need a rooster if you want fertilized eggs.  Which we don’t.  In contrast to quiet hens, roosters are very noisy and don’t make for friendly, neighborly relations.

So why am I raising chickens?  For the eggs!  One day late last spring, my daughter and I came back from the Chagrin Falls Farmers Market with a bunch of asparagus that had been picked only hours before.  I found a recipe for Hollandaise sauce, which I had never made before, and whisked together 3 separated egg yolks with 2 tablespoons of fresh lemon juice and 2 tablespoons of water.  [Fry the whites separately and feed them to the first lucky person who enters the kitchen. Or the dog.]  Then I placed the mixture in a double boiler and continued to whisk until the contents turned a smooth, glassy yellow.  It took a little bit more water than the recipe indicated, which made me wonder if our homegrown egg yolks are extra-dense.  I removed the double boiler from the heat and slowly added ½ cup melted butter, a little at a time, continuing to whisk gently, until all the butter was incorporated.  I added salt (1/2 t.) and pepper (1/4 t.), poured half the sauce over the steamed asparagus and shared it around.  Three of us ate it for lunch, and and our taste buds and bellies remained satisfied all afternoon until dinner.  We finished the rest of the hollandaise sauce the next morning on scrambled eggs. Liquid sunshine.