Thursday, December 20, 2012

Gumming up the works

Today as I was scrolling through my news feed I came across a news article referencing this particular study on the use of gum arabic to help people lose weight. (Link)  I know this has been used before in weight loss products like Slim Fast and has been used as a food stabilizer for a long time, but apparently there isn't a lot of research done in humans as far as weight loss is concerned.  What kind of evidence do we have for using this in weight loss?

First of all, gum arabic (also called acacia gum) is a, well, gummy substance made from the sap of two different kinds of the acacia tree.  If you've ever eaten candy like gum drops, or marshmallows, or M & M's, or things like that, you have probably eaten acacia gum.  It's chemical structure is actually similar to other dietary fiber; edible but not digested by humans.  One of the reasons that it was thought to be useful in losing weight is that it has the potential to increase satiety; in other words, you feel fuller sooner and longer and you wind up eating less.    Gum arabic also doesn't seem to have any negative side effects when consumed by humans. (Link)

Some of the things that I like about this study is that they made an effort to find a large sample size and it was double blinded, which are major advantages.  They also noted that there were some side effects of mild nausea in the morning and mild diarrhea and/or bloating, so they were clear that this didn't come without its problems.

I do, however, see some limitations, meaning that we may not be able to generalize the results to other populations.  Note that the study was only done in women, all the participants were volunteers and may not represent a general population, they most likely ate a diet fairly unique to that part of Sudan, and the were listed as "healthy."  You might not have the same impact in men or someone who eats a culturally different diet.

Since there is potential here, though, and many people fight hunger pangs when trying to lose weight, I know some people are going to try it.  Keep in mind, though, that the problems w/nausea and bloating, etc were probably from the gum arabic slowing down the emptying of the stomach (which is why they felt fuller sooner and longer).  Some people are wanting/needing to lose weight bad enough that they are willing to put up with mild nausea and bloating.  But I think there are some people with certain health conditions that should stay away from this.  If you have any kind of condition that already slows down your digestion (such as diabetic gastroparesis or irritable bowel syndrome (IBS) with constipation predominant), or a history of a narrowing of your esophagus, or if you have had gastric bypass surgery or lap band surgery, or you take a drug like Victoza (a diabetes/weight loss drug made famous by Paula Deen), you want to AVOID using arabic gum because there is the potential to get an esophageal or intestinal blockage.  And if nausea/bloating/diarrhea just aren't on your top ten list of things to do period, then you probably don't want to use this.

So, if you are skeptical about using this and want other ways to increase your satiety, there are a few other things you can do:
1) Make sure you eat enough good fat and protein at each meal.
2) Load up on vegetables--you can consume a lot without worrying about carbs or calories and the fiber can be filling also.
3) Limit excess carbohydrate so that the resulting surge in insulin from eating these doesn't promote hunger.
4) When you do eat carbs choose higher soluble fiber/unprocessed ones like fruit and sweet potatoes.

Take home message--Gum arabic might help people lose weight by promoting fullness, but avoid if you already have digestive issues.

Tuesday, December 18, 2012

Boost Your Metabolism?

Today as I was scrolling through my feed I came across this lovely little headline: 16 Ways to Boost Your Metabolism Without Even Trying.  Now, anytime anyone tries to tell you that you can somehow change your body without work should be a big red flag, but I am sure that like me you were interested to see what they had to say.  So, please go ahead and read the article, and then let us examine each point to see if there is any substance there.


1) Eat Pineapple.  Yes, pineapple does contain bromelain, which might have some use in reducing inflammation associated with arthritis and asthma, but the evidence for it helping digestion is very weak. (Link)  I found it interesting that even the people at Dole did not tout pineapple for its digestive properties, and you think they would being trying to use every selling point they could get. (Link)  Also, you will notice that there is nothing in this little paragraph that implies that you will burn more calories by eating pineapple anyway.  If you decide you want to eat pineapple for the vitamin C and other healthy attributes, just try to stick with fresh and avoid the dried and canned versions as they often have sugar added.  And keep in mind the 83 calories and 19 grams of net carbs per cup of chunks.

2) Eat Organic.  Once again, if you are looking for any good evidence from human studies, you are out of luck here.  There are apparently some researchers that are looking at a possible role of industrial pollutants in obesity but there just aren't any good human studies out there.  And think about it, if you go into a store like Whole Foods and buy the organic potato chips or the organic sugar you are going to get the same calories.  There are other benefits to choosing local organic foods as far as a better taste (in my opinion), putting money back into the local economy, maybe even getting animal protein that has a healthier fat profile, etc, but when it comes to reducing your caloric intake or helping you burn more calories the evidence isn't there.

3) Get It On.  You probably thought you were going to learn that you burned a lot of calories during sex weren't you?  Well, you are out of luck here too, as what you got was some vague notion about elevating your sex hormones and your metabolism.  First of all, for women, if you could actually significantly elevate your estrogen levels through sex that could actually be a bad thing as you are putting yourself at more risk for breast and ovarian cancers, but fortunately sexual frequency does not seem to be linked to cancer of the breast or ovaries. (Whew!).  For men, if your testosterone is low you will likely have a harder time losing fat and gaining muscle, but you're not going to feel like having sex anyway.  What you want to do is talk to a good endocrinologist about testosterone replacement therapy and start improving your diet to lose body fat; then you might actually want to get it on.  And as far as calories burned--the pace of sexual activity is so varied among individuals that it is hard to pin down a number.  You might burn 86-100 calories in an hour of foreplay, but then you eat one piece of bread and you've just cancelled that out.  There are plenty of other reasons to enjoy sex, it being a basic human need as one of them; but you might want to use a healthy sex life as a reason to improve your diet, your exercise, quit smoking, etc.  A healthier daily lifestyle can result in better sex.

4) Meditate.  There have been a very few studies conducted on Buddhist monks who appeared to have been able to increase or decrease their metabolism via meditation (Link).  I happen to think that’s interesting, but what does that say about the rest of us?  First of all, I wouldn’t want to compare my own attempts at mediation to someone who essentially does that for a living, and second of all you can’t take three people and extrapolate the results to an entire population.  If you a person that goes after high caloric food when you are under stress and you need an alternative to eating your weight in doughnuts, and meditation helps, then by all means use it to decrease the impact of stress on your life.  But once again, I recognize that the meditation is a tool to help you decrease your caloric intake and not depend on it to burn more calories.
5) Sip Green Tea.  There are a very limited amount of studies that indicate that there is something to the claim about green tea increasing the metabolism (Link).  The downside, however, is that you are going to have to do more than sip the green tea; you will have to drink about three to five cups per day.  And even after you consume that amount you will maybe burn off an extra 80 calories per day.  Every little bit helps when  you are trying to lose weight, but keep in mind that about one smaller sized chocolate chip cookie will undo those 3-5 cups of green tea.
6) Take a Cold Shower.  Sounds like a good idea since your muscles are actually doing work by contracting to make you shiver.  There is an estimate that you might burn up to 400 more calories per hour if you are EXERCISING in the cold, but that’s cross country skiing, not standing under the shower head.  You probably don’t want to stand under the shower for an hour as you will have wasted a lot of water besides being miserable.  Keep in mind also that if you have a substantial fat layer that you are trying to lose; it is going to take you longer to start shivering when you are exercising because you are insulated against the cold.  As always, if you do choose to exercise in the cold, take precautions not to get hypothermia.
7) Limit Cocktails.  Since one cocktail may cause you to intake 150-250 calories depending on the type and size of the glass, this is good advice for keeping your caloric intake under control.  Alcohol can act like an appetite stimulant, and if your judgment is impaired on top of that, you can wind up taking in way more calories at the meal than you intended.  But does it actually slow your metabolism?   Not in the way you think it does.  Let’s say that you’re trying to lose body fat and you have reduced your caloric intake and also limited your carbohydrate intake so your body does not have blood glucose readily available to be used as fuel.  Your body will be more likely to use the fat for fuel.  If you take in alcohol, your body will use that for fuel and you may not use your fat for fuel in the next several hours.  So if you are a chronic user of alcohol you might have trouble losing fat and building muscle over time, but the problem is not because your overall ability to burn calories is slower.
8) Sniff peppermint or citrus.  There is a very small amount of evidence that peppermint oil may help reduce cramping and diarrhea in people with irritable bowel syndrome, but no evidence that drinking peppermint tea or sniff the essential oils will actually help you burn more calories.  Perhaps flavoring your water with peppermint or citrus will keep you away from high caloric sodas and fake fruit drinks though.
9) Drink Cold Water.  According to a small study done in Germany a couple years ago, if you drink at least six cups of cold water per day you will burn more calories—a whole whopping 50 calories per day.  (Link)  Once again, every little bit helps, but when you think about how about eating half a slice of bread can undo that, it really doesn’t make much of a difference in my book.  If you prefer your water cold and it helps you drink more, by all means go ahead, but you still better be careful with how much you are taking in.
10) Spice it Up. There was a very small study done by Purdue University that showed that you may have a slight increase in metabolism after eating a spicy meal (Link).  But, as I’ve mentioned several times before, the effect is so little that it can easily be undone by eating what seems to be a small amount of food.  The other problem is that the increase in metabolism only seemed to happen in people who weren’t used to eating spicy food, so it appears that if you made a habit of eating spicy food you wouldn’t get that effect after a while.  This shouldn’t stop you from spicing thing up though—if you are already restricting your caloric intake you want to make sure that what  you are eating actually tastes good and you will stay on your plan better if you have more variety.  So add those different spices to help you stay on the plan.
11) Take a stand at work.  If you are more active, you will burn more calories, so there is actually something good that is finally coming out of this list.  But as I have said before, you are very likely not going to burn enough calories to compensate for any high caloric snacks you might be eating at work.  Be more active at work or wherever you can, but watch what you are taking in too.
12) Have a Cup of Joe.  See what I said about drinking green tea as I know I am sounding like a broken record.  Sure, you may burn a few more calories, but not much to make a difference.  And if your caffeine source is a high calorie drink from Starbuck’s, or is a sugary soda, or comes from an energy drink, chances are the benefits of the caffeine was cancelled out by all the other calories you just had.  Some people may have trouble with their blood pressure or with their mood after too much caffeine, so you have to weigh that risk too.  If you still want to enjoy the coffee, minimize the caloric add-ons from milk/milk substitutes and sugar.
13) Breathe.  Let me preface this explanation by stating that I read a lot of detective and science fiction/fantasy novels.  If you were kidnapped and trapped in an underground bunker with no supplemental oxygen, your respiratory rate would naturally slow and you would start burning fewer calories so that you would be more likely to survive long enough for your favorite hero or heroine to rescue you.  Once you were rescued and able to “breathe the air” again your metabolism would return to normal as you took in more air.  For the rest us who do not have such exciting lives, however, breathing deeper will not increase your metabolism.  If you do deep breathing exercises like you might do meditation, to relieve/handle stress, you might be able to cope without eating high calorie foods, however.
14) Laugh.  Yes, you will burn calories by laughing, a whole 1 calorie per minute per a study done at Vanderbilt University (Link).  So if you were sitting listening to a comedian that actually kept you laughing for a straight 60 minutes, you could burn off about a half a slice of bread again.  See my above advice regarding stress relief.
15) Drizzle extra virgin olive oil.  First of all, there is no evidence to support that somehow eating something that contains 100 calories per tablespoon will actually help you burn more calories, period.  I did try to follow the convoluted path that someone’s brain must have taken to come up with this, and all I can figure out is that someone thought that since olive oil was metabolized (i.e. processed) differently than animal fats in the body it must somehow cause you to burn more calories.  But my mind fortunately does not take the same convoluted path.  Olive oil does not raise bad cholesterol, and having enough fat at a meal can satisfy your hunger sooner so you consume fewer calories, but you don’t actually burn more calories.
16) Get more sunshine.  Sunshine does help us make vitamin D which is essential for bone health, and low levels have also been associated with insulin resistance and depression.  There also seems to be a link between obesity and low vitamin D levels, but there isn’t any evidence that supplementing with vitamin D or getting more sunshine actually raises the body’s ability to burn calories.    Some people report less hunger when their vitamin D levels improve, but once again, their weight loss is likely from a caloric deficit, not from an increased metabolism.
Take home message—You have probably already figured it out, the only proven way to increase your body’s ability to burn calories is to exercise.  And fat loss only comes with making major changes in your caloric intake, especially if you are overeating on carbohydrate.

Monday, December 10, 2012

Where's the salt?

If you've ever been diagnosed with high blood pressure or you have a family history or condition that puts you more at risk for high blood pressure, you have probably been told to cut back on your sodium intake.  And I'm sure one of the first things that you were told was to put the salt shaker away.  But back in June you might have seen this article pop up in the New York Times questioning that "wisdom" and in my news feed I also saw another article reviewing that there doesn't seem to be a lot of hard evidence stating that merely focusing on the sodium intake does not prevent or help high blood pressure.  So does this mean those who cannot imagine having a meal without the salt shaker are vindicated?  Well, let's look at the evidence.

First of all, in my experience, a lot of people think of these different minerals as existing all by themselves.  When they hear "cut back on sodium" all they can think about is what it's the salt shaker (what I call "table salt" or a combination of sodium and chloride) but they don't necessarily think about what other foods they might also be eating that 1) contain a lot of sodium and 2) affect other systems in our body that regulate our blood pressure.  So a person may be avoiding the salt shaker, but if they are consuming a lot of breads, cured meats, fast food, canned soups, etc you probably haven't really reduced your sodium intake all that much.  So when it comes to good hard evidence that reducing sodium actually influences blood pressure, if we are looking at population studies that use those notoriously unreliable food frequency questionnaires, we maybe don't have a really good idea of how much sodium people really were taking in or how much they  might have actually reduced.  So that is problem number one is that without more double blind studies it's hard to make recommendations.

Now, we are also have to keep in mind that even if we did a double blind study, or if even one person really looks at labels to truly reduce their sodium intake, the people consuming this low sodium diet are going to wind up having to consume a lot less bread/bread products, pizza, fast food sandwiches, sandwiches with lunch meat, fried chicken, canned soups etc as listed in the linked article above.  Since they won't be eating as much processed food, they will probably have to eat meats without any added sodium (fresh meats), real cheeses (not processed), and more fruits and vegetables because they have to fill up their plate with something if they are not eating a ton of pasta at everymeal (or they get a chicken salad as opposed to a sandwich). So, they go from a diet that is sodium/carbohydrate but likely low in fiber/potassium/magnesium/calcium to a diet that is lower in sodium/carbohydrate and likely higher in fiber/postassium/magnesium/calcium.  If people make these radical changes in their diet and their blood pressure goes down--obviously the diet did change something, but it looks like more than the sodium might be at play here.

Keep in mind too that the pressure of blood flowing through your circulatory system is also regulated by a very complex interplay of body systems, and I think does a nice job of making it a little more understandable.  But what you need to know is that these complex systems are also affected by your fluid intake, your mineral intake (sodium and potassium, for example), and yes, your intake of carbohydrate foods.  For people that are already insulin resistant for whatever reason, if they eat too much carbohydrate they are going to have elevated insulin levels which can in turn impact your blood pressure. (Link)  So, if you are someone who has been consuming a lot of processed foods, maybe we do have to worry about your sodium intake, but it looks like your overconsumption of carbohydrate and your lack of vegetables is going to be a bigger problem.

So if you have high blood pressure or are at risk for such because of a family history, etc, before you remove the salt shaker take a long hard look at the rest of your intake.  If you know you're getting more than 30-45 grams of carbohydrate at a meal (that's just a ballpark number now) from bread, etc or you've been eating a lot of other processed foods, that's where you need to start cutting back or cutting out.  And if you know you're not getting a couple servings of fruit per day and non-starchy vegetables at every meal, you probably need to add those back in.  If you are still not noticing a difference in  your blood pressure (or you haven't noticed a reduction in ankle/wrist/abdominal swelling if that is a problem) then you should start using less of the salt shaker and more herbs and spices.  Give yourself a couple weeks to get used to the different tastes of things, and read more about the fascinating history of salt to get yourself in the mood for treating it as a precious commodity.

Take home message--it's your overall diet that will help control your blood pressure if you are at risk.  Concentrate on reducing the amount of processed meats and carbohydrate foods and increase fresh meats and fruits and vegetables.

P.S. Yes, there are certain medical conditions and medications that can cause low blood sodium (aka hyponatremia) but you need to check with your physician first and possibly get lab work done to make sure this actually applies to you.  Competitive athletes might also need to supplement with sodium but I've written before about how that's probably not you.

Sunday, December 2, 2012

What to do with soy?

Not too long ago I was having lunch with a new acquaintance and he asked me what I did for a living.  When I told him he wondered out loud if a lot of people start asking me questions when they find out about my chosen profession.  When I replied in the affirmative, he sighed and stated that he didnt have that problem, as he was a mathematician, and apparently not as many people found prime numbers fascinating.  Of course I get a lot of internet articles too, and someone asked me to chime in on this particular one: Dangers of Soy.

Of course, one of the things we all need to think about when reading something on the internet is the quality of the source.  Skeptoid and a few other skeptical bloggers have compiled this particular website which is a good place to start (Top Ten Worst Anti-Science Websites), but you might need to do a little bit more digging.  Another physician friend of mine beat me to it and started digging around on this particular website only to find a lot of other anti-science misinformation regarding vaccines, etc.  That is usually enough to make me want to ignore the information right there, as I would rather not give too much traffic to websites that are anti-science.

The other thing you need to do is examine how the information is presented.  One red flag that immediately jumped out at me was the phrase independent research.  Often this means that the reasearch was not accepted for peer review, meaning that there was no outside verification.  I did follow the links in this article and found that there was a lot of information on animal studies, but you cannot directly apply this information to humans.  We have peer review for a reason--not to stop people from coming up with ideas but to keep certain ideas from being taken too far.   And the physiology of humans is different than that of rats, chickens, felines, etc., so we really cannot make health decisions based on animal studies.

And just like human physiology differs from other animals, we are also different than, well, plants as well.  That might seem kind of obvious to many of us, but when people start tossing around phrases like estrogen like compounds it seems that people start thinking that isoflavones and estradiol concentrations as the same thing.  So we they talk about the isoflavone level of the plasma concentrations of formula fed infants vs. others---they are comparing isoflavone levels only, not actual levels of human estradiol.  That is like comparing the levels of iron to the levels of B12 in the blood stream--you are looking at components of cells in the blood but they are not the same thing.  We also have to keep in mind that when isoflavones do bond to estrogens in the human body it is a pretty weak bond.

The rest of the article contains a lot of other statements that are made to sound scary but we do not have the evidence to support them.  I could find some studies where they talked about soy being of concern in thyroid function because of animal studies, but it was just that, of concern.  We do not have enough information to start making doomsday proclamations.

All that said, we do have to consider what I like to call the culture of eating in the United States where we have trouble with overconsumption.  The author was right in that in cultures where soy is consumed it is usually done in MUCH smaller amounts and in different forms.  So, if a person consumes soy sausage for breakfast, soy milk in the coffee (a lot of coffee), then has soy yogurt for a snack, then has a soy burger at lunch, then has edamame for a snack (like the whole bag), then soybean oil on their vegetables in the  evening, followed up by some soy ice cream for dessert they MIGHT be getting a lot more isoflavones, phystic acid, and trypsin inhibitors than the human body has historically been able to handle. (And probably a few more pro-inflammatory omega-6 fats)  For those that do sometimes throw in a little miso soup/natto sometimes, or eat a handful of edamame (and they maybe do not even do that everyday), there really is not enough evidence to make you give that up. For those of us who are not able to consume dairy and have been using soy cheese/milk/yogurt, etc whenever you need to have some kind of dairy-like goodness, you can rejoice because there are soy free options available for those things too.

And always keep in mind this phrase from our friend Paraclesus:
"All things are poison, and nothing is without poison; only the dose permits something not to be poisonous."

Take home message--overconsumption of soy is probably not a good idea, but then neither is overconsumption of anything.   If you are not sure of where the soy might have crept into your diet, or you know that you have been consuming soy at every meal, it is time to start doing more label reading and time to get way more variety in your diet.

Tuesday, November 27, 2012

Hard Pill to Swallow: Opinion

Ah the holidays.  A time for friends and relatives to get together to share memories, food, and (if you have a family like mine) find out which of your relative(s) has/have been buying into the latest conspiracy theory or is seeing a nautropathic doctor.  This is why SkepticRD recommends taking a walk after dinner or having your favorite low calorie alcoholic beverage handy (to be consumed in moderation of course).  For those relatives who are following a new diet, or who are touting their latest supplement as a miracle drug, one of the reasons they often give is "I just don't like to take pills."  Sometimes if I have had more than my moderate share of dry red wine I will ask "Why?" Usually the answer is a blank stare or a rant about Big Pharma.  Any evidence given?  Not often.

Now, I will be the first to admit there are plenty of chronic health conditions, including my specialty of diabetes, that can be controlled with lifestyle changes, and there is even good scientific evidence to back it up.  I will also admit that there are plenty of people who want to try to rely on taking medications instead of changing their lifestyle for a variety of reasons (lack of education, etc) because I see people like that every single day.  I also see plenty of other people who are spending lots of money on herbal products that aren't working (wait, aren't those pills), and people who are in terrible pain or otherwise miserable because "I just don't like taking pills."  So when is it a good idea to actually take medication?

1) First of all, if you have an acute (i.e. short term) infectious process going on, such as strep throat, a urinary tract infection, etc, that is caused by bacteria, fungus, and/or certain parasites.  How do you know you have a bacterial infection as oppossed to a viral infection (like the common cold)?  By going to see your physician and getting tested, that's how.  And if you do get prescribed a course of anti-biotics, you must take the full course or your infection can come back much worse.   Sure, there are other things you might do to prevent yourself from becoming ill again in the future, but right now you need to clear up what you have.

2) If you are in pain and unable to carry out your daily functions and/or the pain is hindering you from getting better.  For example, someone who recently had surgery might be in so much pain that they feel nauseated and don't want to eat.  Because they are not eating properly they in turn feel weak and can't get out of bed, let alone do any therapeutic exercises, and they will be more likely to have trouble healing that surgical wound because of poor nutrition.  If they take the right amount of pain medication, however, they may be more likely to keep up good nutrition and heal faster.  Of course this can be taken to an extreme,  like when people take a bunch of cold medicine so they can come to work and then infect the whole office, or when someone takes enough pain medicine and continues walking on a broken ankle, but for those of you who do take something to help you feel better and get better, the evidence is skewed in your direction.  I also have plenty of people say to me (and on the internet), with the requisite smarmy attitude, "Well, I don't take anything, I just think about what I did to get myself sick."  Well, of course we should all do that!  If you haven't been washing your hands before you eat and you got a cold, then start washing your hands!  But you might also need to take something so that you sleep instead of laying awake all night so you can breathe.

3) When the condition you have is life threatening.  If someone is having a heart attack I am not going to stand by and tell them to eat more vegetables and get rid of the white bread.  I am going to dial 911, perform CPR, help them get admitted, and hopefully give them the best that medical science has to offer.  Once they are going to live and are stable, then we can start talking about lifestyle changes.   Sometimes, depending on the condition, a lifetime medication change must be instituted.  For example, Boyfriend of SkepticRD has Type 1 Diabetes (meaning his pancreas makes no insulin at all), and he needs to inject insulin up to four times per day in order to live.  Of course as long as he watches his carbohydrate intake he requires less of it, but he still needs take medicine to live.

4) When the lifestyle changes cannot be implemented overnight but you need to get some function now.  When my depression was at its worst, I could barely get out of bed, let alone exercise or cook myself healthy food.  If I was ever going to return to some semblance of normalcy I knew I had to take something.  Once I started taking medicine and felt better I was able to start returning to the gym and cooking much healthier meals, and keep better track of how what and when I was eating was affecting me. 

5) When the lifestyle changes just can't take care of the problem alone.  Sometimes by the time a person with Type 2 diabetes realizes they can actually eat better and lose weight they have already been walking around with out of control blood glucose levels for years and the cells in their pancreas that make insulin have begun to die off.  They may be able to reduce their medication and/or insulin injections but they may still have to take something to keep their blood glucose levels under control.  Some parents of children with Attention Defict Hyperactivity Disorder (ADHD) have tried every single dietary measure (those with or without evidence) known to humankind and still did not find focus until a medication regimen was implemented.

Some other tips for finding the right balance between lifestyle and medication so it favors you.

1) Before assuming that your physician really is in the hand of Big Pharma, stop and consider that maybe, just maybe this person actually does have your best interests at heart and is trying to help you get better.  If the person doesn't want to listen to your questions or point you to someone who can address them, maybe you do need to find a new physician, but don't make assumptions merely on the basis of them recommending a medication.

2) Ask if you can have a period of reprieve to work on lifestyle changes if you haven't yet done anything.  Usually if your blood glucose levels, or your blood pressure, or your weight, etc has not made a significant improvement after two weeks of lifestyle changes, you might need some outside help.  It might still be temporary, but you will need to get better.

3) When your doctor prescribes something, see if they can give you an idea of what the medication is supposed to do and any common side effects.  Pharmacists can also help you answer those type of questions, and doing research on an evidence-based website can help you as well.  They can also tell you if there are any alternatives if you are not happy with the side effects.  They can also give you tips on how to alleviate side effects, some of which are as simple as taking certain medications with food.

4) If you have side effects that are expected but unbearable, please let your doctor know so an alternative can be found or you can re-evaluate the need for the medication.

5) If you have side effects that are not expected, especially if it involves fever, chest pain, and/or shortness of breath contact your physician right away or go to an urgent care center.

6) If you think you are ready to reduce your dose of medication or stop it because you have a new and improved lifestyle, tell your physician what you are doing so you can taper off safely and/or set up a time for follow up.  A good physician or other health care provider will be happy that you are truly healthy.

7) Be very careful about how deal with the lifestyles of other people.  If someone eats as healthy as they are going to eat, and exercises how much they are going to exercise, and they still have to take an antidepressant, and they are content with their life, then they probably want to be left alone.  You can still share what worked for you, but don't try to impose it on anyone else.  (In other words, don't be "that guy" that destroys relationships by being arrogant and assuming what works for you works for everyone else).  Oh, and you might want to stop giving advice to people whose condition you know nothing about unless they asked for your advice or gave them permission.  Not that I ever have this trouble.  No.

Take home message--sometimes you just have to take medication, but you can make it an informed choice.

Monday, November 26, 2012

Think you can use the Twinkie Defense? Not so fast.

It's hard to be a citizen of the United States without hearing about the death of the Twinkie, that American icon of all things processed. It's endurance has been "tested" by the likes of popular food writers like Michael Pollan and the love that some possess for this little cake with a "cream-like" filling even made it into movie's like Zombieland with Woody Harrelson.  And then while catching up on post holiday work e-mails (I remembered  my laptop, just not the charger) I came across this little "mourning of the twinkie" article that even mentioned the "Twinkie Defense."  I knew I had my blog post for today.

The Twinkie Defense stems from the 1978 trial of Dan White for the murders of San Francisco mayor George Moscone and supervisor Harvey Milk.  In brief, the "Twinkie Defense" states Dan White ate so much junk food in the time period leading up to the murders that the amount of sugar coursing through his blood caused a mental defect and he therefore could not be guilty of pre-meditated murder.  Many articles, such as the one linked above, imply that White's lawyers really did use this argument.  The problem is, the term "Twinkie Defense" was never used in court.

White's lawyers did argue that he was depressed, and his depression was exhibited by him not taking care of his personal appearance, not exercising, and not eating properly.  In other words, they never said that the Twinkies CAUSED his depression; rather they argued that his junk food consumption (normally he was described as being "fanatical" about his health) was a SYMPTOM of his depression.  See the difference there?  I suppose that "Twinkie defense" sounds much more newsworthy than "he was depressed," but those who bring up that terminology usually are perpetuating a myth.  (Link)

Are there other reasons to avoid stocking up on Twinkies for consumption before they are gone from our shelves?  Of course.  I did mention in a previous post that if you do have issues with depression there is some evidence that reducing your excess carbohydrate consumption might be beneficial. 
And who wants to spend their hard earned dollars on something with no nutritional value that takes up your entire carbohydrate meal budget in one cake?  Not that we don't all treat ourselves sometimes (although the gluten would make it a painful treat for yours truly), espeicially if we are being chased by zombies, but as an everyday food, I can think of many things that are better to eat.

Take home message--chances are the devil didn't make you do it and neither did the Twinkies.  Even the lawyers didn't try that one.

Thursday, November 15, 2012

Really? A diet diary for the holiday?

Part of the path to becoming a Registered Dietitian is to go through a nine to 12 month intership where you actually get to put into practice some of the things you learn in school.  I used to have interns come and learn from me for a week at a time and I really enjoyed helping someone learn how people really behave (and misbehave) when you try to help them eat better.  My current position doesn't really permit the perceptorship side of things and I miss it, but one of the things I don't miss is finding busywork for them to do.  So the other day I got an e-mail from another dietitian who made her intern come up with a Thanksgiving meal calculator.  So, for your viewing pleasure and education:
FoodServing SizeCaloriesAmount EatenCalories
Roasted Turkey Leg (with skin)4oz192oz0
Roasted Turkey Breast (without skin)4oz153oz0
Ham, Cured, Boneless, Extra Lean & Regular, Roasted3oz140oz0
Tofurky® Vegetarian Roast1serving (1/5 roast)250serving0
Stovetop Stuffing, prepared0.5cup140cup0
Mashed Potatoes (Made with Whole-Milk/Margarine)1cup237cup0
2 in x 2 in Dinner Roll1oz (1 roll)80oz0
Baked Sweet Potato (Medium)5oz 100oz0
Candied Yams0.5Cup170cup0
Baked White Potato (Medium)5oz130oz0
Green Bean Casserole0.5cup110cup0
Corn Bread4oz350oz0
Turkey Gravy0.5cup60cup0
Cranberry Sauce4oz110oz0
Pumpkin Pie1slice (1/8 pie)290slice0
Pecan Pie1slice (1/8 pie)500slice0
Apple Pie1slice (1/8 pie)300slice0
Extra Calories100Portions0
Total Caloric Intake0

This is interesting information for some I suppose, but all I could think of was "I practice what I preach, but even I am not psychotic enough to record my intake on a holiday."

Now, if you really don't want to take a break from your food diary on a holiday because you like routine, I won't stop you.  My suggestion, however, would be that since you probably want to find that fine line between enjoying what you eat without guilt and not feeling miserable at the end of the day (or next day), you could actually use this to do a little planning ahead.  Maybe there are some things you can do without, or never really liked to eat in the first place, and you can do a little planning ahead as far as what things you want to avoid.  Maybe you would like that little reminder not to take that second helping and go for a walk instead.  Otherwise, enjoy your holiday and be glad you are not a Dietetic Intern.

Wednesday, November 14, 2012

Are you sure you want to boost your immunity?

We here in Skepticville are in for a long cold and flu season.  The downside is that everyday we will continue to be flooded with, often questionable, tips for "boosting our immune system."  The upside is that those of us who blog about skeptical things will not have a shortage of material to talk about, particularly when it comes to making medical terms a little bit less esoteric so that we can make better decisions. 

When it comes to the term/phrase "boosting your immunity," I really like the way Dr. Mark Crislip over at explained it.  Many people seem to think that the immune system is like the muscles in our arms; they are either weak, average, or can be made super strong by doing a lot of exercise and maybe boosting our protein intake.  Actually, the immune system is more like an automobile, you can have a gas tank that's empty (bad), topped off (good), or overfilled (also bad); you can also have tires that are flat (bad), optimum pressure (good), or overfilled (bad), or exploding (really bad).  So, you don't want a weak immune system (flat tire), but you also don't want one that's working over time either (overfilled or exploding tire).

If your immune system really was "boosted" you would essentially be causing an inflammation in your body that could lead to nasty things like blot clots, which could in turn cause a heart attack, a stroke, a pulmonary embolism, an amputation of one of your limbs, etc.  All things that most of us are trying to prevent by eating better, etc.  And think about it, for those of us that are miserable during "allergy season" the source of our misery is basically an immune reaction that is not normal (and who wants to be miserable longer than necessary).  Diseases like Type 1 diabetes mellitus and celiac disease are the result of an inappropriate immune response.  Have I convinced you that "boosting" your immune system is not something you want yet?

Ok, ok, so some of you are saying "Yeah, but I haven't exactly taken good care of myself lately.  Shouldn't I take this vitamin, or this herb, etc to optimize my immunity?"  Well, first of all there isn't any good evidence that any of the herbal products work, including one of my favorite's from the 1990's, echinacea.  Second of all, let me go back to the car analogy for a bit.  If you found out your car was running low on gasoline, you wouldn't put oil in the gas tank, you would put gasoline in the tank.  If you were using up the gasoline faster than you want, you will find ways to economize.  In the same vein,  if you haven't been getting enough sleep, then you need to work on getting more sleep, taking extra vitamin C, etc. will not fix your problem.  And if you have trouble getting enough sleep, then you need to figure out why and try to correct if possible (maybe you need a darker room, or not drink caffeine after a certain hour).  If your diet is poor, then work on correcting your diet.  If your vitamin D is low, then start supplementing.   In other words, figure out where you are operating at less than optimal and then try to fix that area, don't try to overcompensate somewhere else.

And don't forget, you can actually protect yourself against certain viruses (like certain kinds of influenza strains, measles, etc) by getting a vaccine against that particular virus.  In other words, you can activate your body's normal immunity by updating your vaccinations and encouraging family members to do the same.  I work around people who do have suboptimal immune systems for a variety of reasons, and so I make sure that I do my part to keep them from getting sick by getting my flu shot.

Take home message--get enough sleep, eat healthy, get exercise, wash your hands, and stay up to date with your vaccines.  Keep the machinery of your body running the way it's suppossed to and fix specific problems as they arise.

Tuesday, November 13, 2012

Can a Skeptic Eat Mindfully?

So this popped up in my newsfeed over the holiday weekend: 'Mindful eating' crucial for lowering weight and blood sugar in diabetics.  Basically the point of this article states we as educators need to stop focusing on telling people how many carbohydrates to eat at a meal and instead focus more on getting people "in tune with their body" to help them achieve their health goals.  Just the title had me putting my Skeptic Cranky Pants on, let me tell you why.

First of all, I really get tired of the whole "listen to your body" phrase because there is no definition as to how I am suppossed to do so and what exactly I am suppossed to be listening for.   For example, I have dealt with symptoms of hypoglycemia ("low blood sugar") since the age of seven (I'm now 38).  Before I figured out how to eat to prevent those symptoms, it was most likely that I would be sitting down a meal wanting nothing more than to devour the entire pot of pasta just so I could start to feel better.  I later found out that I was contributing to my "crashes" and sleepiness after meals by actually causing my body to overproduce insulin, but I didn't just figure that out by "listening to my body."  Second of all, a lot of times I have seen mindful eating associated with "expanding conciousness" and "third-eye-opening" and other phrases that don't really have much to do with rational thought.

All that said, I think a lot of our problems with nutrition come from not paying attention to what or how much we are eating.  I also think we could do better with enjoying what we do eat a little bit more.  So, here are my tips for eating Skeptically--which involves learning more about what you eat, how much you eat, and why you eat it by gathering objective data and quanitfying it as much as possible.

1) Start by planning out your menus for the week, and made provisions for any planned eating out you are going to do that week.  Do not do this while hungry if possible so that you are more likely to make rational choices.

2) Plan ahead for the grocery store.  Make up a list buy things only on that list, you will save money and time.  See my previous post on grocery shopping for more details.   You do want to take the time to read the labels for products on your list.

3) Keep a food diary for at least three days, if not longer.  Yes, I know it's work and not everyone enjoys record keeping (and there are some that get immense satisfaction out of it), but how else are you really going to get an idea of what and how much you are REALLY eating.  It's so easy to forget what we had later, or to ignore the realities of what you are eating.  Even if you record keep for a short period of time, it will give you some sort of idea of where you might need to make changes.
3a) Measure out or count out your portions at least once.  You will need to do this for your food diary to be accurate anyway.  Plus, it helps to have in front of your face how much a half cup of something really is!

4) Find ways to make your meal last longer, as there has been some research that indicates that people who eat slower do eat less (Link)  In one article I read about mindful eating it talked about how Buddhist monks used a chime at various intervals to help them to stop eating, think about what they were eating, etc.  If having a timer or bell go off every so often works for you, wonderful, but if the thought of a bell going off sets your teeth on edge, you can do other things like put down your utensils after each bite, chew your food a little bit longer, or set a timer nearby to see how much time you are using up for your meal.

5) Make a point of finding at least one descriptor for each of the foods on your plate, and be as specific as possible.   It might be one word (e.g. "salty") or it might be a phrase ("needs more hot sauce"). Sometimes we eat so fast we don't realize that the food really wasn't that enjoyable in the first place, and you can find other alternatives to that food.

6) If you have diabetes or pre-diabetes, consider testing your blood glucose levels before and after meals for a couple weeks (or every time you try a new type of food).    Search the internet for a test strips that can be purchased at a discount (I have found some pretty good deals on  See how much a particular amount of food really increases your blood glucose levels to help you make better choices in the future.

7) Take a moment to think about why you are eating that food before each meal and take responsibility for it.  Sometimes you might say "I'm eating this ice cream because I really like ice cream and I haven't eaten it for ages" or "I'm eating this piece of chocolate cake because I'm mad at my spouse."  You might find that sometimes you are eating for reasons that aren't exactly rational.  You might also find that sometimes you are just eating something because it tastes good and it really isn't more complicated than that.  Sometimes you will find that you are willing to dig deeper, just like me and my previous low blood sugar experiences.  You might say "I'm eating this to feel better, but how can I prevent feeling bad in the first place?"

Take home message--Just call it "paying attention to what you eat."  There are ways to do that without bringing on the woo.

Thursday, November 8, 2012

Honey, that almost made sense

Some of us here in Skepticville dread November and December.  Not only do you get bombarded with pseudoscience when it comes to colds and flu, but we also get to experience higher levels of the Juniperus plant, more commonly known as mountain cedar.  So while other parts of the world have to wait for spring for allergens, some of us get to spend autumn with the sneezing, itchy throat, and itchy eyes that comes with seasonal allergies.  And with allergies comes all sort of advice on "natural" ways to eliminate these problems.  One of the remedies that commonly comes up is to consume local honey (anywhere from a teaspoon to a tablespoon depending on whom you talk to).

This is one of those remedies that almost makes sense.  Almost.  I suppose someone had the idea that taking in local honey on a daily basis would eventually help the body recognize the pollen and stop attacking it as a foreign substance.  He or she must have figured that bees carry pollen from plant to plant in their search for nectar, bees use nectar to make honey, and they also feed the bee larva pollen; this same person must have figured that eating the honey would also help us eat the pollen and our bodies would get used to it.  Unfortunately, there are several flaws in this logic.

First of all, pollination is carried out by more than just bees and it is estimated that there are over 200,000 varieties of animal that carry the pollen, so if the theory was correct you could theoretically eat bat excrement and get the same allergy fighting benefits. (Link, Link2)  Second of all, there isn't enough pollen in honey to sneeze at (pun intended), in other words you will just be taking in fructose and glucose with a few dormant botulinum spores, but no actual pollen.  Third, and this is the biggest flaw in my opinion, the type of plants that typically cause allergies are pollinated without the use of animals, usually called abiotic pollinating.  So you won't be getting your body used to anything that you are allergic to.

It looks like you will have to take care of your allergies by limiting exposure; staying indoors when allergens are at the highest, changing filters frequently in the home, vaccuming frequently, washing bedding at least once per week, wrangling the outdoor pets for a bath and even taking allergy medication as needed to help you function.  The honey will not help.

Take home message--save the calories and do the housework when it comes to allergies.

Tuesday, November 6, 2012

Holiday Exercise

I saw another headline today that made me wince: Exercise before eating keeps families fit for holidays.  Now mind you, I actually really liked the story about the first family, instead of making the holiday all about food, they decided to actually do something that the whole family enjoys and create memories that weren't just about food.  I think that sounds like a lot of fun, and as a person who doesn't like crowds the idea of visiting a national park when it's not over-run with tourists sounds like a good idea.  No, it was "the other" message that I didn't like.

Both the headline and the quotes from some of the individuals in the article seem to imply that doing the exercise activities in the morning will somehow offset the pile of calories that you are likely going to consume later in the day.  I have already covered in a previous post that this is a fairly dangerous thought process as many of us greatly underestimate the calories we take in and greatly overestimate how many calories we burn when exercising.  So I'm going to remind you again about what many people ignore--that 5K fun run/walk is not going to fully cancel out you over indulging.

I still think these fitness activities are good for a variety of reasons.  If you take the route of the Kent family mentioned in the article, you are going to be having so much fun doing other things that you won't have time to overeat.  Also, usually the people who participate in activities the morning of Thanksgiving are going to spend less time nibbling away as they cook because they are more constrained for time (or they decided to cater in that year or have a potluck family meal).  If people decide to go for a walk after a meal they probably won't burn many calories, but since you won't be "picking" at the leftovers or inside consuming as much alcohol you won't be taking in as many calories as you otherwise would.  And if your family dinners are, um, less than perfect, and you sometimes find yourself wanting that extra piece of pie to "reward" yourself for not slugging your racist uncle (not that I would know), taking a walk can be a great way get out of that stressful situation and spend time with the people you do enjoy.  (And once again, you won't have the food readily available to you). 

Another reason I think these holiday exercise activities can help is that if you start off your day by doing something healthy, instead of using the holiday as an excuse not to exercise, you have already started paying more attention to your health more so than you might have in previous years.  You might be more aware of how many calories are in what you're eating so you take a smaller helping even if you do indulge.  There's nothing magic about it, you've just become more concious of what you are doing.

Take home message--holiday exercise events can give you an advantage in preventing overeating, but unless you are spending the day doing a triathalon, don't expect it to burn a lot of calories.