“How many ways can I eat cottage cheese? “ Laura, my neighbor asked me. “My doctor told me the results of my bone scan. I have lost 18% of my bone density in the last five years. She told me to increase my calcium and vitamin D over the next year to see if it would help my bones. If it doesn’t work, I am going to have to start on one of those medications that makes your bones stronger.”
My neighbor was lucky. Her doctor had scheduled routine bone scans for her when she was relatively young and was able to pick up changes in her bone health before she developed osteoporosis. My neighbor was 51, petite and with a fair complexion. As she told me, she was a perfect candidate to develop this disease of thinning bones because she was slender, had small bones and avoided the sun because she was so fair. “I was probably a perfect set-up to develop weak bones,” she said.” I hate milk, rarely eat yogurt or cottage cheese and don’t take calcium supplements. I burn when I sit in the sun so I always cover myself up when the sun is strong. I guess my body never had a chance to make vitamin D from the sun and my doctor says that vitamin D is needed to make new bones. And she said that since I just went through menopause my hormones are no longer helping my body make new bone tissue. Oh, did I mention that I hate to exercise? I have never had a weight problem so I figured I would never have to bother with a gym or regular work-outs. If I keep this up, my bones are going to be so weak, I better order my wheelchair now.”
I assured her that her bones were not going to dissolve into something resembling overcooked pasta but that she really needed to follow her doctor’s recommendations immediately so her bones would regain their former strength.
Laura ‘s situation is unfortunately quite common. Menopause, a slight build, avoidance of calcium-rich and vitamin D rich foods, along with lack of weight-bearing exercise, may account for most of the bone loss seen among women middle-aged and older. Bone loss is also caused by heavy smoking and/or alcohol use, treatment with prednisone or other steroids for asthma, rheumatoid arthritis or psoriasis, severe weight loss, exposure to radiation and a genetic history of osteoporosis. If your mother and other female relatives has this disease, there is a good chance you will as well. Given all these factors that promote bone loss, it should be no surprise that 1.5 million fractures per year are caused by decreased bone density. In fact, when Secretary of State Clinton fell and broke her elbow, my first thought was that she may be suffering from fragile bones.
Building up bone density before developing osteoporosis is not difficult but it does require, as Laura found out, changing her food choices and starting to do exercise. Her doctor told her to consume about 1.5 grams of calcium a day and 1000 IU (international units) of vitamin D. Eating enough cottage cheese to do this was going to be difficult; even people who feel passionately about cottage cheese would have trouble consuming enough to meet their calcium intake. And if she relied on milk for her calcium, Laura would need to drink about four glasses of milk daily as she needed more than someone who still had healthy bones. Relying on these and other dairy products like yogurt was not realistic because Laura did not think she would consume them regularly enough to give her the calcium she needed. Sardines, a good source of calcium, are not a personal favorite of most people (including my neighbor) and she told me that she rarely, if ever, eats enough of another calcium source, that is, dark green leafy vegetables such as collard greens, bok choy and spinach. So for her as with many others, calcium supplements fortified with vitamin D were the best alternative. But her doctor told her to eat more dairy products anyway as they were the most natural source of this mineral.
Incorporating exercise into her life was going to be even harder than eating cottage cheese.
Laura and her husband had a successful store in a summer tourist town. Both worked seven days a week during the season and spent what little free time they had with their college-age children. As Laura tried to figure out where she could find that 25th hour in the day to exercise, she told me that she would simply have to make the time. “I am going to be no use to anyone if I fall and break something. “ She decided to work out with a trainer at a nearby gym so she could learn what exercises to do to increase her bone density. “And I will take long walks with the dog on the days I am not in the gym. Our store doesn’t open up l0 AM and I can manage to exercise an hour early in the morning. My doctor told me that I should have been worrying about my bones when I was in my early thirties. Why didn’t anyone tell me then to eat more dairy and to go to the gym?” “Would you have listened?” I asked her. “Oh probably not,” she said with a smile. “Fortunately it is not too late. And maybe I will try that cottage cheese with pineapple. I heard it was good.”
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( 3.1 / 30 )Carbohydrates have been regarded as comfort foods long before anyone understood how they comforted. When people think of what they want to eat when they are upset, they almost invariably think of starchy foods like cookies or potatoes or sweets such as ice cream or cookies. Very few people when stressed will turn to roasted chicken, broiled fish or cottage cheese to comfort themselves.
There are several misconceptions as to why carbohydrates are used to calm ourselves when we are stressed. The most common one is that our mothers fed us sweets when we came home from elementary school and were upset. So when we grow up, we turn to carbohydrates simply out of habit because we associate these foods with our parent’s attempt to make us happy. But we should ask ourselves why our moms gave us cookies rather than cheese when we failed an arithmetic test or were bullied in the playground. The answer is that sweet and starchy foods made us less upset, and the cheese or other protein foods like cold cuts had no effect on our mood.
Another explanation as to why we turn to carbs when we are stressed is that their taste makes us feel better. Although many carbohydrates do taste really good, it is hard to see how the few seconds of great taste can have a long lasting effect on mood. It is like saying that when people drink alcohol, they feel the effects on their mood because of the taste of the wine, beer or whiskey.
And another reason given as to why we choose carbohydrates as the edible tranquilizer of choice: There are more carbohydrate snack foods. But if eating carbohydrate snacks have no effect on mood, why would we continue to seek them out over and over again? If we need to take over-the-counter medications for headaches or allergy symptoms or acid reflux, we will buy the appropriate preparation for our problem. We don’t buy pain medication for acid reflux just because it is available. We buy the preparation for acid reflux because it works and ibuprofen does not.
Carbohydrates reduce stress because when they are digested, they increase the production of serotonin, the comfort chemical in the brain. Protein foods do not lead to serotonin production; indeed, they prevent this brain chemical from being made. Interestingly, one category of carbohydrates, fruits, have no effect on serotonin production, which may be why eating an apple a day will not make the stress go away.
Unfortunately, there are still many people who look at nature’s own tranquilizer, carbohydrates, with suspicion and distrust. They reject and even fear eating these foods because they assume they will become instantly obese if a piece of bread crosses their lips. And there are others who can’t keep themselves from eating carbohydrates but feel horribly guilty after they do so.
What the carbo-phobic folk don’t realize is that avoiding carbohydrates will only increase their stress. As serotonin levels drop due to the non-eating of carbohydrates, stress levels will rise. Serotonin acts as a buffer to take the sharp edges off of anxiety, depression, worry and frustration. Without sufficient serotonin, we confront stress without any brain support to help us cope.
The answer is to turn to the foods that have comforted us for centuries. The most effective way of getting the carbohydrate to soothe us is to eat it with no protein, little or no fat, in moderate amounts of about 120-140 calories and on a relatively empty stomach. The effect is consistent and predictable: Emotional tiredness goes away, calmness returns and coping with your problems seems doable. Not bad for a baked potato.
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( 3 / 56 )It is hard to diet and harder still to keep weight off once it has been lost. Successful dieters claim a tight control over their food choices and portion sizes and often a commitment to consistent physical activity. But what if you suffer from a chronic condition that makes you hurt all over, disrupts your sleep, causes gastrointestinal upsets, blankets you with fatigue, puts your brain into a fog and causes you to use food to diminish your discomfort? Your doctor gives you drugs to lessen the symptoms but the drugs cause you to eat out of control and gain substantial amounts of weight. This is the picture of someone suffering from fibromyalgia.
Fibromyalgia affects between 3 and 6 million people in the U.S. The number is imprecise because the diagnosis may be inexact. Fibromyalgia is termed a syndrome, not a disease, and its underlying cause is still not understood. However, people who suffer from this syndrome have had their lives disrupted and often find themselves unable to continue the lifestyle they had before developing the symptoms of this disorder.
Recently, I met a former college classmate who had gained a considerable amount of weight. She was walking with a cane and looked as if she had not slept for months. She must have noticed my consternation at her appearance because she immediately told me that she had fibromyalgia. “I rarely sleep more than a few hours at a time because I am in so much pain. My muscles hurt, I am stiff and it is hard for me to feel comfortable. I had to stop working because some days I just couldn’t get my brain to work. It’s called ‘brain fog.’ And I cannot control my eating. I eat when I am tired, when I am in pain and when I am trying to stay awake. I am so heavy now, I can barely drag myself around.”
Weight loss is desirable in someone with fibromyalgia because obesity puts an additional burden on already painful muscles. But how can someone follow conventional weight loss guidelines with this disorder? It is well known that people without this syndrome overeat when their sleep is disturbed and fibromyalgia patients may never have a good night’s sleep. We also know that people attempt to medicate themselves with food when they suffer from chronic pain, possibly because when they eat carbohydrates, serotonin is made. And serotonin may diminish the perception of pain. Someone with fibromyalgia endures daily pain and is more concerned about decreasing the hurt than with the calories consumed to bring about this effect. Following dietary guidelines to lose weight must be frustrating and ultimately futile. Complying with the other component of a weight-loss program, exercise, is just as impossible. The bone weary, muscle-heavy feeling of fibromyalgia fatigue makes it extremely hard to move about, let alone participate in aerobic activity or weight lifting. And, of course, it hurts to exercise.
Various types of antidepressant medications that are known to relieve pain and improve sleep have been used to treat these symptoms. Some of them, such as Elavil, have caused significant weight gain, which, of course, exacerbates some of the fibromyalgia symptoms. Recently, the FDA approved three drugs for this syndrome: Cymbalta, Lyrica, and the most recent, Savella. All three are able to relieve pain and improve overall functioning. But Cymbalta and Lyrica do cause weight gain and thus may exacerbate the symptoms associated with carrying too much weight and make it even harder for the patient to try to stay on a diet.
However, the most recently approved drug, Savella, did not cause weight gain. In fact, compared to patients on placebo, the drug was associated with a small weight loss. In addition, patients on the drug experienced less fatigue and “brain fog” than those on placebo. The drug increases the activity of two brain chemicals, the neurotransmitters norepinephrine and serotonin. Since the drug trials did not last longer than six months, no one knows yet the effect of longer treatment on these symptoms. But if this drug is able to diminish those symptoms that cause overeating, such as pain and sleep disruption, and increase energy so that physical activity does not seem impossible, then there is hope that weight loss will be able to follow.
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( 3.1 / 56 )Over the holiday weekend, we had a houseguest who was in the middle of a weight-loss program. She had joined a national weight- loss group and was very pleased with her results. Not only had she lost six pounds in under six weeks, but as she told us, her food choices were much more sensible and no longer impulsive.
However, as the weekend proceeded, I noticed that every afternoon she would wander around the kitchen looking hungry. But when I offered her a variety of healthy snacks, the only food she would eat was fruit. And then she would eat so much I wondered how her digestive system was handling it.
In what I hoped was a subtle discussion of her weight-loss program I asked how fruits fit into its caloric structure. “We are allowed to eat a lot of fruit because they are low in points,” she told me. “ I think I may overdo it but I feel hungry every afternoon and I don’t know what else to eat. I don’t want any yogurt or salad and even protein bars don’t satisfy me. In fact, I am wondering how much longer I can stay on this diet if I can’t get rid of this hunger.”
She went on to say that her hunger was different from being hungry at mealtime. “The funny thing is that there is plenty of food on the diet and most of the day I am really full. But there is something about the afternoon that starts me daydreaming about eating cookies or a piece of chocolate. I asked the group leader about this and she just told me to eat fruit as an afternoon snack. But no matter how much fruit I eat, I still feel hungry for something sweet. It’s crazy.”
I laughed and told her that she wasn’t crazy. She was simply experiencing a natural afternoon craving for carbohydrates that she probably had all her life.
“You are right,” she answered. “I always ate something sweet or starchy around 4 PM. But I assumed that was why I had gained weight. So I decided not to give into myself once I started the diet. But now I am worried I am not going to be able to stay on the diet much longer. I have 5 more pounds to lose but if I don’t do something about this hunger, I am not going to make it.”
I asked her if there was any reason why she couldn’t eat a sweet or starchy food around 4 PM and she told me she could eat anything she wanted as long as she didn’t go over her points. We were having this conversation late in the afternoon so I offered her some low-fat sweet crunchy breakfast cereal as a snack.
“Have about 2/3rd of a cup because that will be the same number of calories as two small pieces of fruit,” I suggested.” You will feel full about 10-15 minutes after you finish.”
“Why would the cereal work better than fruit to take away my hunger?” she asked. I explained that serotonin, the brain chemical that controls our mood, also shuts down our appetite. Sometimes, especially late in the afternoon, our brains need to make more serotonin and we feel a need to eat sweet or starchy carbohydrates as a result. The connection between carbohydrates and serotonin is through insulin. When starchy or sweet carbs are eaten and digested, insulin is activated and this leads to the amino acid tryptophan to get into the brain. As soon as tryptophan enters the brain, new serotonin is made.”
“So why does my eating this cereal have an effect on my appetite?”
“Serotonin seems to be the switch that turns off our appetite,” I told her. “ You will see. Very soon you are going to feel very content and satisfied.”
“You mean serotonin works like an appetite suppressant?” she asked. “So why do I still feel hungry after eating fruit?” The problem with fruit, I told her, is that no insulin is released after it is eaten. So no matter how much fruit you eat to take away your sweet cravings, you will still have them. I went on to say that fruit is still an important part of her diet but she was just wasting her points by eating fruit to stop her afternoon hunger. But any starchy or sweet food like pretzels, popcorn, sweetened breakfast cereal or even honey and toast will get the body to make serotonin. She just had to make sure that the carbohydrate did not contain much protein.
“When you eat protein, either with the carbs or right before you have a carbohydrate food, no serotonin is made. And obviously eat carbs that are very low in fat like this breakfast cereal. You don’t need to add those calories or points or whatever to your diet. By the way, are you still hungry?”
She smiled. “You know, for the first time since I started this diet program, I don’t have the afternoon munchies. I can’t believe just eating this small bowl of cereal filled me up so much.”
“ Well,” I answered, “thank your serotonin. “
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( 3 / 67 )Over the holiday weekend, we had a houseguest who was in the middle of a weight-loss program. She had joined a national weight- loss group and was very pleased with her results. Not only had she lost six pounds in under six weeks, but as she told us, her food choices were much more sensible and no longer impulsive.
However, as the weekend proceeded, I noticed that every afternoon she would wander around the kitchen looking hungry. But when I offered her a variety of healthy snacks, the only food she would eat was fruit. And then she would eat so much I wondered how her digestive system was handling it.
In what I hoped was a subtle discussion of her weight-loss program I asked how fruits fit into its caloric structure. “We are allowed to eat a lot of fruit because they are low in points,” she told me. “ I think I may overdo it but I feel hungry every afternoon and I don’t know what else to eat. I don’t want any yogurt or salad and even protein bars don’t satisfy me. In fact, I am wondering how much longer I can stay on this diet if I can’t get rid of this hunger.”
She went on to say that her hunger was different from being hungry at mealtime. “The funny thing is that there is plenty of food on the diet and most of the day I am really full. But there is something about the afternoon that starts me daydreaming about eating cookies or a piece of chocolate. I asked the group leader about this and she just told me to eat fruit as an afternoon snack. But no matter how much fruit I eat, I still feel hungry for something sweet. It’s crazy.”
I laughed and told her that she wasn’t crazy. She was simply experiencing a natural afternoon craving for carbohydrates that she probably had all her life.
“You are right,” she answered. “I always ate something sweet or starchy around 4 PM. But I assumed that was why I had gained weight. So I decided not to give into myself once I started the diet. But now I am worried I am not going to be able to stay on the diet much longer. I have 5 more pounds to lose but if I don’t do something about this hunger, I am not going to make it.”
I asked her if there was any reason why she couldn’t eat a sweet or starchy food around 4 PM and she told me she could eat anything she wanted as long as she didn’t go over her points. We were having this conversation late in the afternoon so I offered her some low-fat sweet crunchy breakfast cereal as a snack.
“Have about 2/3rd of a cup because that will be the same number of calories as two small pieces of fruit,” I suggested.” You will feel full about 10-15 minutes after you finish.”
“Why would the cereal work better than fruit to take away my hunger?” she asked. I explained that serotonin, the brain chemical that controls our mood, also shuts down our appetite. Sometimes, especially late in the afternoon, our brains need to make more serotonin and we feel a need to eat sweet or starchy carbohydrates as a result. The connection between carbohydrates and serotonin is through insulin. When starchy or sweet carbs are eaten and digested, insulin is activated and this leads to the amino acid tryptophan to get into the brain. As soon as tryptophan enters the brain, new serotonin is made.”
“So why does my eating this cereal have an effect on my appetite?”
“Serotonin seems to be the switch that turns off our appetite,” I told her. “ You will see. Very soon you are going to feel very content and satisfied.”
“You mean serotonin works like an appetite suppressant?” she asked. “So why do I still feel hungry after eating fruit?” The problem with fruit, I told her, is that no insulin is released after it is eaten. So no matter how much fruit you eat to take away your sweet cravings, you will still have them. I went on to say that fruit is still an important part of her diet but she was just wasting her points by eating fruit to stop her afternoon hunger. But any starchy or sweet food like pretzels, popcorn, sweetened breakfast cereal or even honey and toast will get the body to make serotonin. She just had to make sure that the carbohydrate did not contain much protein.
“When you eat protein, either with the carbs or right before you have a carbohydrate food, no serotonin is made. And obviously eat carbs that are very low in fat like this breakfast cereal. You don’t need to add those calories or points or whatever to your diet. By the way, are you still hungry?”
She smiled. “You know, for the first time since I started this diet program, I don’t have the afternoon munchies. I can’t believe just eating this small bowl of cereal filled me up so much.”
“ Well,” I answered, “thank your serotonin. “
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