We all know that death is a creepy topic, and we avoid serious discussion of it like the plague (oops, poor choice of cliche!). Well, Halloween is coming, and I highly recommend your listening to this half-hour interview on the subject of death. You will learn a lot, and be entertained as well. Then, to really get into the gory details (and learn a lot more), explore her website and watch some of her short videos.
Archive for the ‘Health and illness’ Category
DASH was developed to fight high blood pressure, not as an all-purpose diet. But it certainly looked like an all-star to our panel of experts, who gave it high marks for its nutritional completeness, safety, ability to prevent or control diabetes, and role in supporting heart health. Though obscure, it beat out a field full of better-known diets.
Therapeutic Lifestyle Changes, or TLC, is a very solid diet plan created by the National Institutes of Health. It has no major weaknesses, and it’s particularly good at promoting cardiovascular health. One expert described it as a “very healthful, complete, safe diet.” But it requires a “do-it-yourself” approach, in contrast to the hand-holding provided by some commercial diets.
Mayo Clinic Diet
This is the Mayo Clinic’s take on how to make healthy eating a lifelong habit. It earned especially high ratings from our experts for its nutrition and safety and as a tool against diabetes. Experts found it moderately effective for weight loss.
With its emphasis on fruits and vegetables, olive oil, fish, and other healthy fare, the Mediterranean diet is eminently sensible. And experts’ assessments of it were resoundingly positive, giving this diet an edge over many competitors.
Weight Watchers is a smart, effective diet. It surpassed other commercial diet plans in multiple areas, including short- and long-term weight loss and how easy it is to follow. It’s also nutritionally sound and safe, according to experts. Among its pluses: An emphasis on group support, lots of fruits and vegetables, and room for occasional indulgences.
Volumetrics outperformed its competitors in many categories. It earned particularly high marks for being safe and nutritious, and experts said it could have a positive effect on heart health and diabetes. “This is an eating plan that everyone can benefit from,” one expert said.
My recommendation is to read my previous post (here) and then choose the diet that appeals to you most, with the intention of sticking to it for at least a year. After that, choose another. The point is to stick to some kind of eating plan for the rest of your life.
It’s a new year and I resolve to write more blog posts this year than last. So, I’ll start with what is on many people’s minds now: which diet should I choose? Here is the latest from a respected source – Cleveland Clinic.
This New Year’s, losing weight will undoubtedly top many Americans’ list of resolutions – and it’s an important one. One reason? Heart disease is the main health threat caused by obesity. Make your efforts to slim down more successful this year by becoming wise to the “secret of calories!” …
Just follow these 5 rules:
1. Understand the basic principal of dieting for weight loss. With all of the opposing diet plans forbidding carbohydrates or preaching against fat, it’s easy to see why confusion prevails. But, Cleveland Clinic experts say, recent studies comparing these different diets have found that the proportion of carbohydrates, proteins and fats in your diet do not influence weight loss.
This means, in a nutshell, you can lose weight with any diet as long as you burn more calories than you take in. That’s the secret.
2. Know how many calories you need. Would you believe that of the half of Americans who are dieting at any given time, only 12 percent know how many calories they should consume daily? This number, which for adults ranges from 1,600 to 3,000 a day, depends on your age, gender and activity level. [Here is a useful daily calorie calculator]
3. Change your calorie intake to lose weight. If you want to lose weight, eat fewer calories than you burn. Eat 500 to 1,000 fewer calories per day and you will lose weight, often one to two pounds per week. But don’t be discouraged when weight loss begins to slow after a few weeks of dieting – this is a normal event as your body adjusts to your new diet. Keep watching calories and exercising and you will keep heading toward your weight loss goal!
4. Don’t be fooled by fad diets. More isn’t always better. In fact, it can be harmful. Any loss of more than two pounds a week is usually just water weight. Studies also show that the faster weight comes off, the quicker it is regained. Stick to a diet that has a goal of only one to two pounds weight loss a week [even better, in the long run, would be one pound per month].
5. Choose a diet you can live with. For your weight loss and weight maintenance efforts to succeed, you must continually manage your calories. No one diet is better than another. Studies show dieters tend to lose five to 10 pounds over the course of a year, regardless which diet they pick. What’s important is to pick a diet that works for you and that you can stick with. And if you’re not successful, pick a different diet next time.
Many years ago, when I was a young psychiatry resident, I went through a period of great confusion, in my personal life and as a neophyte professional. A trusted friend, a psychologist who was older and wiser than me, looked me straight in the eyes and demanded my full attention before asking me, in a tone fraught with meaning, “What do you want?” I sat there in stunned silence, my mind suddenly clear of the jumble of racing thoughts that had prompted her question. Instead, I had only one thought, echoing in my mind and making my head hurt: What, indeed, did I want?
Now, decades later, I often think of that moment and smile at the simplicity of the question and the obviousness of the answer. But it took me years of trial and error to really grasp the import of the question. What I want depends on the unstated part of the question: Right now, in this moment? Or, in the near future? Or, in the long run?
For example, if I am at a restaurant surrounded by people I enjoy and having a grand time, do I really want to order another martini? It would taste good, and the rush would certainly feel good. But, past experience tells me I would not sleep well that night, and would feel less than my best the next day. In the long run, if I regularly doubled my alcohol intake, I might put on some unwanted pounds and suffer other negative consequences. I have never regretted NOT having a second martini, but have often regretted having one. So the answer is obvious: No, I do not want another martini, thank you.
Little decisions mount up to big ones. And big ones, of course, may come at us all at once, as in “Do I want chemotherapy? Do I want to marry this person? Do I want a divorce? Do I want to adopt a baby?” I contend the same three parts apply: immediate gratification, short range implications, long term likelihoods. We may have to delay the decision pending some research, or the counsel of others.
What makes this point worth writing about is that so often, in my psychiatric practice and in my life, I have seen people fooled into thinking what they WANT is immediate gratification. The denial of that (saying “No, thanks” to the offer of a second martini) is not seen as what they want, but as what they SHOULD do, or what they KNOW, but not what they WANT. That, to me, is ridiculous, because there is no reason to define what we want, really-honestly-deeply want, as simply what is tempting in the moment.
Stating our decisions as what we WANT is a way of taking full responsibility for ourselves. That is why I say so often in this blog that the secret to happy, healthy living (at least that part we control) is re-framing our thinking from what we should do, to what we want to do — in the moment, for the short term, and for the long run. Striking a balance among the three versions of “want” can be tricky; no one promised it would be easy. Do you WANT that bag of french fries, or don’t you? What about that puppy?
I stated in my last post that we cannot trust “hunger” as a cue for when to eat. But how do we know when it IS time to eat? For me, and I suspect for many others, the three-meals-a-day “rule” works well. In fact, I believe that for most people who struggle with weight control, eating more often, “grazing,” or snacking between meals only adds to the problem.
Now, many of you believe that six or more small meals per day, or three meals plus two or three snacks, is best (e.g., see comment by Personal Trainer on my last post). And for some people there is a medical reason for eating more often than three times per day (e.g., people with dyspepsia, GERD, hypoglycemia, etc.). Some of these medical indications are valid, and some are not. I won’t get into that here. What I do know is that the more we snack, the more likely we are to consume excess calories (see this research report).
A survey reported this year in the American Journal of Clinical Nutrition found that in the thirty years between the 1970s to the early 2000s, for adults and children, the average time between eating occasions shrank by one hour (most recently, 3 hours apart for adults and 3.5 hours apart for children). Daily calories for both groups increased from roughly 2,090 in the 1970s to 2500 in the 2003 – 2006 period.
Calories from snacks more than doubled: for adults, from 200 calories per day in the 1970s to 470 calories in the recent time period; for children, from 240 to 500. A significant portion of snack calories came from beverages. It can be assumed that these numbers are underestimates, since surveys usually under-report the number of calories consumed. [The above research was described in the May 2010 issue of Nutrition Action Health Letter]
It makes sense to me that the more often one eats, the more one is exposed to temptation and calories. Also, we know that “willpower fatigue” occurs, so that the more often we have to decide what and how much to eat, the less “willpower” we are left with by the end of the day.
One known cause of overeating, which is also closely related to snacking, is “emotional eating.” The solution to that problem is mindful eating, plus tending to emotional issues in a more appropriate way.
Personally, one of the most effective things I have done over the years to maintain my weight in a healthy range is to eliminate snacking. It takes some getting used to — for example, eating dessert just before bed was a long time habit for me — but it really makes a difference. And I haven’t developed hypoglycemia, insomnia, or any other health problem as a result.
If eating three daily meals (assuming the portions are reasonable and the food is mostly “healthy”) works to maintain weight, would two meals be even better? Apparently not, according to several studies. People who skip breakfast, for example, tend to weigh more than people who don’t.
Why, I wonder, is it still so hard to fix a meal or go to a restaurant and not overdose on salt? This New York Times article, for example, claims one pastrami sandwich (with only two pickles) at Katz’s deli in NY City has 4,490 mg of sodium. That’s at least a two-day dose, going by the recommendation of the FDA that we consume a maximum of 2,300 mg per day, and only 1,500 if we’re at risk for hypertension (which is 69% of the U.S. adult population!). A large take-out container of Manhattan clam chowder at the Oyster Bar weighed in at a scary 3,100 milligrams.
“Oh, that’s just alarmist thinking,” you say. “Only some of us are salt-sensitive.” Well, before you relax too much, read the latest on sodium health risks from the New England Journal of Medicine (here).
If you eat meat (or dairy products), there is a lot you can do to minimize the damage to yourself, your family, the planet and the animal. A new book on this subject (Eating Animals by Jonathan Safran Foer) has gotten a lot of attention, and I have included some key links below.
Despite some controversy, there is widespread agreement that meat produced by factory farms causes a lot of problems, such as astounding energy inefficiency, vast amounts of toxic waste, production of antibiotic-resistant microbes that pose a threat to us, severe pollution, and shocking cruelty and suffering of animals on a massive scale.
And, there is growing evidence that red meat (especially beef, also pork) is unhealthy (see The Real Cost of Red Meat: does it boost your risk of cancer, heart disease, & diabetes?).
What can we do about it? The best answer is simple: Cut back on meat consumption, especially red meat. Even a small decrease will help. And, if you decide to include meat in your diet, at least try to buy meat (and dairy) raised on sustainable non-factory farms. Yes, it will cost more, but you can offset the increase in cost by just eating less meat. Go for quality over quantity.
Here are very interesting and helpful resources to check out:
- Food choices.
- NPR interview with Jonathan Safran Foer.
- New Yorker article.
- Excerpt from Eating Animals.
- Additional resources.
- Lessmeatatarianism and flexitarianism.
In closing, here is a quote from Jonathan Safran Foer:
Two friends are ordering lunch. One says, “I’m in the mood for a burger,” and orders it. The other says, “I’m in the mood for a burger,” but remembers that there are things more important to him than what he is in the mood for at any given moment, and orders something else. Who is the sentimentalist?
A very important new book (The End of Overeating: Taking Control of the Insatiable American Appetite by David Kessler) accurately describes major factors contributing to the obesity epidemic: cleverly formulated manufactured food designed to seduce us into overeating, addictive ingredients (salt, sugar and fat) which act like nicotine in cigarettes to keep us coming back for more, a profit driven system of marketing and government subsidies which works against our best interests, and the loss of boundaries limiting when and how much we eat. It is indeed frightening to think that a 2-year-old’s appetite “knows” to shut down when enough calories have been consumed, but by the time that child is four (in our culture) there is often a loss of that self-control mechanism.
Kessler’s solutions include re-training our minds to devalue unhealthy processed foods loaded with the Big Three (salt, sugar, fat); reforming our policies and practices which encourage this vicious cycle; and doing much more to educate people as to what they are consuming (such as requiring nutritional information in restaurants).
I agree with all this, but take issue with some of the concepts Kessler promotes. My main complaint is he oversimplifies the issue of food containing salt, sugar and fat by using an addiction model. Too much of these ingredients is indeed unhealthy, but a simple addiction model will not work.
Another problem is his use of the term “real food” (see NPR interview) which is a vague concept, at best. Many seemingly real foods contain salt, sugar and fat (either naturally, or because of the way they are produced), and not all “manufactured” foods are bad (e.g., some fish farmed in a sustainable way are better for us than some “wild-caught” fish). I can buy a chicken that has been doctored with added salt and fat, or I can buy one (usually smaller and more expensive) which has been grown almost organically. To the average consumer, both seem “real.” Also, I can buy “sea salt” and “unrefined real sugar” and think I am getting something healthier than standard table salt and corn syrup, but the bottom line (sodium and calories) may be exactly the same.
Finally, he promotes a black vs. white dichotomy between a disease-like state we cannot directly control (“conditioned hypereating”) and old fashioned willpower, telling us “it is not our fault” that we overeat. Fault, per se, may not be the issue; rather, we should learn ways to increase our resistance to external cues and marketing, educate ourselves about nutrition and portion size, and practice coping skills to enhance self-regulation. I have written about this at length elsewhere.
The results of the latest (and so far best) research on diets are in: most people won’t stick to them. The New England Journal of Medicine (2/26/09) published the study which has now been widely reported in the news. Over 800 men and women were followed on various diets for 2 years; the average weight loss was modest (about 9 pounds) and those who attended counseling sessions (an indirect measure of motivation) lost the most. No one adhered to the diet closely, despite frequent monitoring and much support. The conclusion is that eating less (calories) is what matters, not the specific content of the diet (in terms of low fat, high protein, low carbohydrate, etc).
These findings are not surprising, but what is most interesting is the accompanying editorial which describes a study in France where entire villages were used to counteract the obesity epidemic. Here is the summary from the NEJM editorial:
A community-based effort to prevent overweight in schoolchildren began in two small towns in France in 2000. Everyone from the mayor to shop owners, schoolteachers, doctors, pharmacists, caterers, restaurant owners, sports associations, the media, scientists, and various branches of town government joined in an effort to encourage children to eat better and move around more. The towns built sporting facilities and playgrounds, mapped out walking itineraries, and hired sports instructors. Families were offered cooking workshops, and families at risk were offered individual counseling.
Though this was not a formal randomized trial, the results were remarkable. By 2005 the prevalence of overweight in children had fallen to 8.8%, whereas it had risen to 17.8% in the neighboring comparison towns, in line with the national trend.11 This total-community approach is now being extended to 200 towns in Europe, under the name EPODE (Ensemble, prévenons l’obésité des enfants [Together, let’s prevent obesity in children]).12
Like cholera, obesity may be a problem that cannot be solved by individual persons but that requires community action. Evidence for the efficacy of the EPODE12 approach is only tentative,11 and what works for small towns in France may not work for Mexico City or rural Louisiana. However, the apparent success of such community interventions suggests that we may need a new approach to preventing and to treating obesity and that it must be a total-environment approach that involves and activates entire neighborhoods and communities. It is an approach that deserves serious investigation, because the only effective alternative that we have at present for halting the obesity epidemic is large-scale gastric surgery.
The NEJM research article is here: http://content.nejm.org/cgi/content/full/360/9/859.
The editorial is here: http://content.nejm.org/cgi/content/full/360/9/923.