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 Sciencebasedmedicine.org 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 Amazon.com).  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.

It's (s)not true

Ah, cold season.  If you are not being bombarded with woo regarding vitamin C or zinc someone is likely telling you another one of my old favorites: if you do have a cold or allergies you need to avoid dairy products.  Is there any evidence to support this?

First of all, if you have already been skeptical, or you just wanted to have hot chocolate with milk because you thought it might be comforting, you're in luck.  There have been multiple studies that indicate that there is no evidence that consumption of dairy products significantly increases production of mucus. (Link
There are some people that do have a milk protein allergy that do experience respiratory problems when they consume milk, but if don't already have problems with dairy products, there's no reason to avoid them when you have a cold.

As far as why this myth is still around, for those of you who are interested, this is a great in example of a logical fallacy know as The Appeal to Ancient Wisdom.  In other words, since the avoidance of dairy products for respiratory difficulties has been mentioned by the Jewish physician Moses Maimonides and in Traditional Chinese medicine, people think it must be true because it's old (Link).  If this were really the case, then we would still need to engage in the practice of trepanning to cure headaches, and we would also believe that the earth was flat as well.  Old doesn't mean better, period.

Why do some people think they get increased mucus/phlegm when they consume dairy products?  One of my theories is that one of the most common symptoms that people start with in the cycle of a common cold is a sore throat, so some people attempt to soothe their sore throat with cold things like ice cream, pudding, etc.  Increased nasal secretions will usually appear on day 3-5 of the cold, which of course happens after the dairy products have been consumed.   By day 6-7 of the cold, people are starting to feel better, and they might put it down to ceasing their consumption of dairy, but this is also normal as far as a decrease in cold symptoms.  This brings us to another type of logical fallacy know as post hoc ergo propter hoc, or "because I did x, then y happens."  Remember, correlation does not equal causation.

Take home message--if you are someone who has to avoid dairy products for other reasons or you are one of the few people with a milk protein allergy, you probably need to keep doing so.  No reason to change from your usual dairy consumption if you have a cold.

Sunday, November 4, 2012

Add it in?

About two weeks ago, before I got sidelined by a cold, I came across this news in a few of the newsletters I subscribe to: Bring on the beans for diet health?

I wasn't surprised to see these results, since the people who ate legumes on a daily basis would up eating overall more fiber (thereby slowing down the emptying of the stomach and thereby slowing down the impact of the carbohydrate on the blood glucose levels); and beans, because of their lower net carbohydrate content per cup compared to some other carbohydrates like pasta or rice.  In other words if you have a cup of say, lentils, you would consume only about 24 grams of net carbohydrate and if you consumed a cup of pasta you would have consumed 33+ grams of net carbohydrate (and it comes out roughly the same if you eat "whole wheat" pasta), so chances are people who were getting their carbs from legumes had a better chance of eating less carbohydrate overall.

But there's the rub; you would have had to consume legumes INSTEAD OF SOMETHING ELSE to get the benefit.  Which is why I always wince whenever I see an article encouraging people to "add" something to their diet.  Rarely do I see the flip side mentioned; that in order to keep your calories and carbohydrates under control you also have to (most likely) give something up.  So if you do include legumes more often for whatever reason, you will have to sit down and figure out what else in your meals have to go--and usually it's other foods that fit in the carbohydrate category.  If you choose to stir some beans in the chili, you better be careful with the amount of cornbread you're eating with it.  If you are making a lentil stew, be careful with how much rice you have (and some people just forgo that all together).  And remember that this is true of pretty much any other food with caloric value that you are trying to "add" to your diet.  (The exception would be green leafy vegetables as their caloric density is pretty low, which is why it helps to add vegetables to a meal to make it look bigger and more satisfying to the eyes!)

The other reason that this article jumped out at me is that as a person with Irritable Bowel Syndrome, legumes happen to be on my personal "do not eat list" because beans contain galacto-oligosaccharides and are poorly absorbed by people like me; so if I added beans in that amount I would get to deal with serious abdominal pain for the next two days.*  I eat a variety of other protein and fiber sources, so I know I'm not going to be deficient if I don't eat beans (sure do miss that hummus though!).  Which brings me to another point, usually whenever I see an article like this published the comment section is full of people screaming "You want me to eat beans so I can die!" or something like that.  No, most of the time the people who publish these studies are perfectly aware that these results may not apply to everybody; the media source reporting on that does not always convey it, but when people do research they often are looking at only one subset of a population.

So if you see an article advocating that you add something to your diet, here's how to do it skeptically and safely.
1) Ask yourself if you are already eating other foods that give you that particular nutrient.  Maybe your intake is already just fine.  Doesn't mean you can't try something new, but there won't be anything "magical" about whatever that new food is.
2) Ask yourself if there is anything in that particular food that would cause problems for your health (like me and the legumes) or hinder you meeting your health goals.  For example, if you've heard that adding a square of dark chocolate a day might be good for you, but you have trouble eating just one square, then it may not be a good idea.
3) As stated above, think about what else you would have to eat less of so that you can substitute that food and still meet your nutritional goals.

Take home message--you have to add and subtract to stay in balance.

*I know what kind of advice you are all going to give me to help ease the GI distress that comes with eating beans.  Trust me, I have tried it and it's not right for me.  Thanks for trying to help though.

Thursday, November 1, 2012

Food and Mood

Pardon the lack of posting for the past week, I have suffered the death of a laptop and a return of my good friend Seasonal Affective Disorder (SAD)., compounded by a lovely head cold.  New laptop has arrived, happy light on, medications adjusted, and back to posting.  Which reminds me of another question/set of questions that I get frequently regarding whether or not there is a particular "diet for depression."

First of all, let's first try to get a definition of what depression is: Depression is a medical illness that causes a persistent feeling of sadness and loss of interest.  It's not just a bout of the blues, it's not a sign of weakness, it's not something you can just "snap out of."  It is a chronic illness requiring long term treatment, just like diabetes or high blood pressure.  The Mayo clinic website has a pretty good summary here

Second of all, when people usually ask this question what they are really asking is "is there one magic food that I can include in my diet that will lift my mood/keep me off medication, etc?"  The straight answer is no, there is no evidence that any one particular food or that one particular way of eating will cure your depression, cure cancer, cause you to live longer, etc.  Keep in mind that our moods are controlled by a complex interaction of neurotransmitters like serotonin, dopamine, beta-endorphins, norepinephrine, and epinephrine.  Be aware of diet plans that tell you that there are "magic foods" that somehow make all of these work together.

Now, all that said, if you are eating in such a way that your body is actually deficient in a particular nutrient, or you are eating in such a way that you are aggravating another chronic condition that you have, or possibly getting too much of a particular nutrient, then your diet might be aggravating your depression as well.  So there really is no "depression diet" but you do have to make sure you are meeting your particular needs.  So if you are trying to improve your mood by making sure that you are eating adequately, here are some tips.

1) If you do have another chronic condition, make sure that you are eating in such a way as to improve that condition.  For example, if you have type 2 diabetes (or another insulin-mediated condition like high blood pressure or heart disease), and you eat excessive amounts of carbohydrate, the subsequent elevations/fluctuations in blood glucose and blood pressure are going to make you feel pretty crummy.  If you have celiac disease and you eat gluten, your intestines won't even be able to absorb nutrients and the pain isn't going to make you feel so hot either.  Whatever you might have, if you can seek out the services of your friendly neighborhood evidence-based dietitian, please do.  Otherwise try to use evidence-based sources you find on the web.

2) Try to get your nutrition through food as oppossed to supplements.  Some of the nutrients of interest in treating depression are zinc, selenium, folic acid, dietary antioxidants, and omega-3 fats (Link).  Remember, "of interest" is the appropriate phrase here, and that correlation does not equal causation.  There are plenty of other good reasons to get these nutrients in our diets, but when it comes to minerals like zinc and selenium, the popping of pills can lead to some nasty side effects and might interact unfavorably with one another (1, 2).  If you are eating a variety of protein sources that include wild-caught fish, fats from pasture-raised animals, and leafy green vegetables, you are going to get what you need.  If you choose to supplement, make sure you find out what upper limits are safe.  One noteable exception in the supplement area is vitamin D.  If your levels are already low and you live in a place where it's hard to get year-round sunlight, you might want to consider a supplement.

3) Try to avoid concentrated sources of carbohydrate.  First of all, if you are loading up on processed carbs like pasta and bread you might not be allowing room for foods with higher nutrition density, and you are probably taking in more calories than you need anyway  Carbohydrate foods can also help us make serotonin, which at first sounds like a good thing, but if we have a lot of sertonin hanging around, it might interfere with dopamine production (Link). 

4) Get regular exercise.  This seems to boost endorphins in a way that doesn't lead to excess and is not addictive in a bad way.

5) Consider limiting caffeine.  Excessive amounts are likely going to interfere with the complex neurotransmitter interaction as stated above. (Link ) The problem here is that there haven't been a lot of studies to determine how much is too much, so at the very least cut out your sources that might also be providing you with excess calories (regular soda, energy drinks, etc).

6) If your depression is so severe that you can't even get out of bed, let alone get up to prepare healthy food, you do need to pick up your phone and make an appointment with your trusted physician.  It is very likely that you need some type of medication to help improve your depression, or if you're already on medication it might need to be adjusted.  Yes, you heard me, sometimes diet can't solve everything, despite what many natural health pseudoscience websites might say. As I've said before, if a person is having a heart attack, I'm not going to stand over them and tell them to stop eating the donuts (particularly since I don't even know what caused their heart attack), I'm going to help that person get the best that medical science has to offer in the form of pills and procedures, get them stable, then we will talk diet and exercise.    Sometimes you need help in the pill form to have the desire and ability to actually prepare healthy food and exercise.  Maybe after you've straightened out your eating and exercise you might be able to reduce the dose of medication or go off of it; maybe you will need to stay on something much longer.  Do what you need to do to take care of yourself.  And of course if you are suicidal you definitely need to call someone who can help.

Take home message--While there is no specific diet for depression, making sure that you follow an overall healthy plan that includes adequate protein, vegetables, good fats, and the appropriate carbohydrate level for you can give you an edge in treating your depression.