Refuse To Regain

Three Cheers for the Nanny State - NYTimes.com

Give me a 32-ounce soda or give me death! Seriously?

WHY has there been so much fuss about New York City’s attempt to impose a soda ban, or more precisely, a ban on large-size “sugary drinks”? After all, people can still get as much soda as they want. This isn’t Prohibition. It’s just that getting it would take slightly more effort. So, why is this such a big deal?

Obviously, it’s not about soda. It’s because such a ban suggests that sometimes we need to be stopped from doing foolish stuff, and this has become, in contemporary American politics, highly controversial, no matter how trivial the particular issue. (Large cups of soda as symbols of human dignity? Really?)

via www.nytimes.com

Why do we continually need to intensify this argument to include a "nanny state"? We have already demonstrated that making certain products less easily available does not abridge individual rights, nor does it take away an individual's ability to do what he pleases. Examples? Selling cigarettes from behind the counter rather than in vending machines. Removing full sugar sodas from vending machines in schools. Changing the menus of hospital cafeterias to conform to healthy guidlelines and to eliminate foods that don't make the cut. Curtailing cigarette and alcohol advertising. All of these moves serve to change public perception about certain products, make us more circumspect about choosing them, and make access to them slightly more difficult. None of these moves abridges ones rights to eat or drink whatever one chooses. The "Nanny State" debate only comes into play when we consider making a new change. It supposes the most extreme scenario: government control over our health habits. Nothing in our past experience, including the decreased availability of public spaces for smoking or the warnings on tobacco products, leads us to conclude that a government take-over of our habits is any kind of realistic threat.

How to Force Ethics On the Food Industry - NYTimes.com

Making people overweight is profitable. If we want change, we have to require it.

A COURT has struck down, at least for now, New York City’s attempt to slow the growth of obesity by limiting the portion size of sweetened beverages.

But governments should not be deterred by this and should step up their efforts to protect the public health by limiting the marketing tactics of food companies. Anyone who believes these interventions are uncalled-for doesn’t know the industry the way I do.

via www.nytimes.com

You are NOT weak. You are being manipulated. The next time you reach for those wonderfully salty chips, that pack of cookies or that breakfast cereal that claims to have myriad health benefits, remember that somewhere....some very rich person is feeling hugely satisfied at the success of a corporate strategy. You did exactly what the food scientists predicted you would do.

Morning Joe: The Food Wars in Microcosm

by Barbara Berkeley, MD

 I am a big fan of Morning Joe, MSNBC's thoughtful and viewer-friendly morning news program.  For those who have never seen it, this show is built on the sometimes warm, sometimes snarky relationship between its two hosts.

 Mika Brzezinski is the liberal daughter of former National Security Advisor Zbigniew Brzezinski and Joe Scarborough is the eloquent staunch conservative and former Florida congressman.   These two serve as effective foils for one another, each one looking as if he or she just stepped out of the pages of GQ or Vogue.  At the same time, this compelling pair maintains an intellectual repartee that is at turns affectionate, quizzical, testy and, at times, downright hostile.  

No topic serves to create as much tension between Brzezinski and Scarborough as diet and the obesity epidemic.  Mika, who is a runner and staunch supporter of clean eating, is about to publish a book about the poisonous qualities of modern food.   Joe is a fan of sweet tea, Twinkies and junk food.  He wants government out of the kitchen.  And he is especially set off by what he perceives as Mika's pontificating and moralizing about food.  This short interview in Parade will give you a good sense of the on-air feuding, but one senses that this is not simply schtick.  There is a sore spot here.  

You can get a better sense of where Mika is coming from in this short written piece which includes a video clip from the show.  You will have to fast forward a bit, but toward the end of the clip you will get a taste of the sparring that takes place between Mika and Joe.  Missing from this particular encounter is Joe's tendency to escalate the fighting by proclaiming doughnuts healthy, swigging full sugar drinks while Mika talks, or brandishing junk food in front of the camera.  In short, Mika comes off like the impossibly moralistic teacher or Mom, while Joe acts the part of the obnoxious, smart-aleck teenager.  

These confrontations usually elicit sympathetic chuckles from the other men on the panel.  At times, there will be some minor concessions to Mika's point of view.   What I can tell you as a viewer is that these increasingly frequent battles, probably intended to be light fare, make me deeply uncomfortable.

What is playing out on Morning Joe is a microcosmic re-enactment of the real world Food Wars.  Many of us in the medical and nutritional fields and many average Joes who are interested in health feel we have "seen the light".  Modern foods, sugars and starches are like drugs which both control and blind us.  Once their influence is lifted, certain truths comes into focus.  And the world that we see is one where, tragically, millions of our peers are destroying the only bodies they have in order to defend the right to eat food that is manipulated and designed for profit.   Part of the fiction that these foods create in our brains is the notion that eating them can be controlled.  Part of the fiction that mass media promulgates is that "just exercising more" can undo the harm of eating these foods.  

Those of us who feel we "see" do tend to be preachy, passionate and slightly hysterical at times.  It's like knowing that someone has a bomb in their backpack and trying to convince the people around you that he's not just a nice guy and that someone needs to DO SOMETHING!!   At times, being a voice that opposes the food industry feels like one of those nightmares in which you're trying to get somewhere but just keep running in the same place. No wonder we tend toward the shrill.  

In my own home, my husband the gastroenterologist fully subscribes to my views on food.  He's the first to suggest them to patients and to proselytize among other doctors.  On the other hand, the minute we start talking about a food-related subject in private, he shuts me down and says I'm getting on my soapbox.  He claims that I can be obnoxiously single-minded and that I lecture him and others way too much.  At least he doesn't eat a Twinkie while he's saying that.  

I suspect that most of us on this side of the food fence have our Mika and Joe moments.

Joe suggests that everything is healthy in moderation.  He uses the "way back then" defense.  "Way back then" his grandmother and everyone else ate a ton of sugar and unhealthy food.  They just ran around alot more.  They burned it off.  If we would only do that today, all would be well.  This is nonsense.  I would like Joe to meet the many tennis players, runners and gym rats who come to my practice for weight loss.  Despite prodigious amount of calorie burn, these patients are overly fat.  Burning is not the solution that food producers and the "way back then"-ers suggest it is. 

What's missing in Joe's simplistic explanation is the very real sense that many practicing clinicians have that, in the past thirty years, something has changed in us that is deeply physiologic. We are not as we were.  We are not our grandmothers nor are we who we were as skinny, active kids.  Something is very amiss.  We don't know whether it is a bodily mechanism that is broken as a result of chemical exposure, whether the billions of symbiotic organisms that live in our gut have been adversely changed by antibiotics, or whether we have simply been changed in some way by escalating our consumption of non-nutritive foods.  But changed we are.  The foods that we used to be able to tolerate are now destroying us, and part of what is wrong is that we no longer able to say no to them.  This view vastly changes the playing field.  Moderation is no longer a viable option.  Deep changes in the way we view and produce food are essential if we are to avoid catastrophic medical costs and consequences. 

So there, I've preached again.  I've pontificated.  But, like Mika, I do have the urgent sense of needing to say this over and over.  Unlike Mika, and in my defense, my world revolves around people who come to me battered and broken from the eating of "everything in moderation" foods.  Some of my patients are clearly on the way to very abbreviated futures.  Almost all of them are on a long list of medications.  Every one of them is either unhappy, miserable or desperate.  And for what?  For food that they are being told is harmless--if only they will control it.

The Food Wars will continue and there will be many more people who snicker at the idea that modern food can kill us.  The viewpoints put forth by the Mikas and Mike Bloombergs of the world will be seen as alarmist and silly.  And I will continue to get on my well-worn soapbox.  But, despite us,  the burden of food-related disease in the United States will continue to rise.  The only question is whether we will continue to look everywhere else but at what we are eating for the cause. 

 

 

 

Treat obesity as physiology, not physics : Nature News & Comment

“It is better to know nothing,” wrote French physiologist Claude Bernard in An Introduction to the Study of Experimental Medicine (1865), “than to keep in mind fixed ideas based on theories whose confirmation we constantly seek.”

Embracing a fixed idea is one of the main dangers in the evolution of any scientific discipline. Ideally, errors will be uncovered in the trial-by-fire of rigorous testing and the science will right itself. In rare cases, however, an entire discipline can be based on a fundamental flaw.

As a science journalist turned science historian, I have written at length about how and why this may have happened in obesity research. I have suggested that the discipline may be a house of cards — as, by extension, may much research into the chronic diseases associated with obesity, such as diabetes.

via www.nature.com

As readers of this blog know, I am a Gary Taubes admirer. The title of this opinion piece says it all for me. Obesity is driven by physiology...in other words, the complex hormonal logic of the body. NOT by physics, the laws that we mostly associate with non-human matter. While physics is immutable, the body is able to change the game from moment to moment and it does so by responding differently to varying situations, like the specific content of our food and our current nutritional status.

As you know, I also believe that the obesity epidemic may be multi-factorial and include many other causative agents that have, when taken together, reached a tipping point. But Gary Taubes' contention that our beliefs about calories/ in calories out have led us down the garden path is right on as far as I'm concerned. And his focus on carbohydrates and insulin fluxes as the final common pathway for weight gain echo what I've seen for many years in practice.

Circadian clock linked to obesity, diabetes and heart attacks | Research News @ Vanderbilt | Vanderbilt University

by David Salisbury | Posted on Thursday, Feb. 21, 2013 — 11:00 AM

(iStock)

Disruption in the body’s circadian rhythm can lead not only to obesity, but can also increase the risk of diabetes and heart disease.

via news.vanderbilt.edu

This is a very, very important study. For me, here's the take home: Stop eating early in the evening and extend your period of evening fasting. Turn off all those overhead lights in your home when it gets dark and allow your body to sense the evening time. Try not to overstimulate yourself with computer, TV, etc...late into the night. Allow your body to re-establish its planetary rhythm by getting sleepy early and waking with the sun. That's what Ben Franklin advised, and who would argue with Ben?

The Extraordinary Science of Addictive Junk Food - NYTimes.com

Inside the hyperengineered, savagely marketed, addiction-creating battle for American “stomach share.”

Stung by the rejection, Cadbury Schweppes in 2004 turned to a food-industry legend named Howard Moskowitz. Moskowitz, who studied mathematics and holds a Ph.D. in experimental psychology from Harvard, runs a consulting firm in White Plains, where for more than three decades he has “optimized” a variety of products for Campbell Soup, General Foods, Kraft and PepsiCo. “I’ve optimized soups,” Moskowitz told me. “I’ve optimized pizzas. I’ve optimized salad dressings and pickles. In this field, I’m a game changer.”

In the process of product optimization, food engineers alter a litany of variables with the sole intent of finding the most perfect version (or versions) of a product. Ordinary consumers are paid to spend hours sitting in rooms where they touch, feel, sip, smell, swirl and taste whatever product is in question. Their opinions are dumped into a computer, and the data are sifted and sorted through a statistical method called conjoint analysis, which determines what features will be most attractive to consumers. Moskowitz likes to imagine that his computer is divided into silos, in which each of the attributes is stacked. But it’s not simply a matter of comparing Color 23 with Color 24. In the most complicated projects, Color 23 must be combined with Syrup 11 and Packaging 6, and on and on, in seemingly infinite combinations. Even for jobs in which the only concern is taste and the variables are limited to the ingredients, endless charts and graphs will come spewing out of Moskowitz’s computer. “The mathematical model maps out the ingredients to the sensory perceptions these ingredients create,” he told me, “so I can just dial a new product. This is the engineering approach.”

via www.nytimes.com

Don't miss this article. I would have called it, "Don't Talk to Me About Nutrition!", a quote from one of the food giants profiled. I hope that no one bothers to make the case again that modern food isn't addictive. These foods are specifically created to addict...and they do. So treat them as drugs, not foods.

The Importance of What You Eat and How Doctors Are Lagging Behind

by Barbara Berkeley, MD

Here's a subject that most Americans don't want to discuss:  We need to seriously change the way we eat. 

Here's the drill:

• "We don't need to change what we eat.  We just have to make better choices."
• "The food isn't the problem.  It's just the fact that we have to be more responsible."
• "Every kind of food is ok.  In moderation."
• "We'd be fine if we'd just learn to eat only when we're hungry."
• "The food isn't the issue.  It's just that we are such emotional eaters."

The italicized words and phrases above are the ones that drive me to distraction.  Kind of my personal "Niagara Falls" (for those younger than 50, you may want to Google that.  See Abbot and Costello)

 Those who don't want to have the discussion about major diet change include doctors.   While all of us--docs and patients alike-- are waiting for the magic pill that will allow us mainline chocolate and McDonald's, we are rapidly becoming a nation of pill popping, insulin injecting, vascularly bypassed obeso-diabetics.   I don't fault doctors for defaulting to medications to treat food-related problems like high blood pressure and diabetes.  They have never been trained to do otherwise.  I do fault them, however, for not tryng to learn more about the importance of eating for health.   Twenty years ago, we were living in a different landscape.   Now, we are seeing patients who already have seriously malfunctions in the way their bodies (the pancreas, the fat cell mass, the gut) deal with modern food.   Why has treatment via diet remained so ignored?

This week in a publication called Gastroenterology and Endoscopy News, there was an article about irritable bowel syndrome.  Those who have IBS are often plagued with uncontrollable diarrhea, cramps and alternating periods of constipation.  As a former sufferer, I can tell you that I used to know the location of every clean public restroom in Manhattan.  I once seriously considered writing a guide to New York bathrooms for those with irritable bowel.  Bet it would have been a bestseller.  Needing to know where the nearest bathroom lies is an all too familiar imperative for IBS folks.    When I became primarily Primarian about 12 years ago, my IBS completely resolved.  Coincidence?  I don't think so.

The article on IBS is titled, "Expert Calls Diet 'Next Big Thing' in IBS".   Why oh why are we JUST discovering that diet is involved in most of what ails us??

Here are some exerpts from this article:

    "A large body of evidence suggests that diet modification can contribute to a substantial reduction in or elimination of symptoms associated with irritable bowel syndrome, according to an expert in the field."

    "..a majority of patients report that the amount and type of foods they eat influence the risk or worsening of their IBS symptoms."

    "...Dr. Chey recommended screening all patients with IBS for celiac disease.  He acknowledged that the diagnostic yield may be low but cited several studies demonstrating that gluten-free diets can reduce symptoms of IBS substantially.  For IBS patients who test negative for celiac disease, Dr. Chey considers a low carbohydrate diet."

    "It is very clear to me that diet is the next big thing in IBS," Dr. Chey said.

The article then requested a comment from a physician in another institution.  This doctor cautioned that all of these statements should be interpreted conservatively.  Diet and IBS is "an extremely complex subject", he said, and all of the elements "require much more formal and detailed prospective studies."

I support evidence based medicine and I certainly support formal and detailed studies of the many drugs that alter our body processes and which we give to trusting patients who believe they will be safe.  On the other hand, there is absolutely no reason not to try dietary change, particularly when the changes eliminate problematic foods that are not essential to human health anyway.  

Is diet the next "big thing" in IBS?  It has always been the "big thing" for every living organism!  It's the big thing in controlling fat, in making diabetes go into remission, in resolving blood pressure, in halting coronary artery disease, in lowering the chances of developing cancer, in decreasing inflammatory diseases, in modulating autoimmune diseases, in allowing us to be fully functional.  How much "bigger a thing" can it be??  

And when will we physicians start to look at real diet change as arguably the most serious weapon we have against modern disease?   

 

 

 

 

 

    

 

 

 

 

 

 

The Boy With a Thorn in His Joints - NYTimes.com

When 3-year-old Shepherd Strauss got sick, his parents turned to doctors and drugs. But they couldn’t anticipate that what would help him feel better didn’t come with a prescription.

I assumed that Shepherd would warm to his soccer lessons the next time around. He and Beau still donned their jerseys at bedtime and talked each night about “soccer school” at the dinner table. But the following Saturday, Shepherd burst into tears the moment he started to run.

That week we saw our pediatrician, who referred us to an orthopedist. When no injury showed up on the X-ray, the doctor said that arthritis was most likely the issue. Arthritis in a 3-year-old? It sounded more odd than alarming at first, but over the next few weeks, we watched Shepherd spend more and more time on the couch. His stiff-legged walk became more pronounced, though he claimed that he was just walking like a penguin. Then he started having trouble getting out of bed.

via www.nytimes.com

This article in last week's NY Times Magazine reflects my current belief that modern dietary elements may well trigger autoimmune disease. Autoimmune problems have become epidemic. Could grain and other dietary elements be contributing? Could their elimination make us better?  Does our profligate use of antibiotics result in an unrecognizable microbiome that turns against us?  Food for thought.

Are You a Nifty Over-Fifty? Weight Loss and Health on the "Second Side"

by Barbara Berkeley, MD

Over the hill?  That just means you suddenly got a brand new view.

According to AARP, the next 15 years will find 8,000 people turning 65 every single day.  Since I am about to hit that magic number imminently, it is a subject that's been on my mind. Actually, I find it both a source of curiosity and a chance for great creativity.  Turning 65 is also an odd combination of sobering and a laugh.  One thing is certain.  Technological and computer advancements assure us that the coming years will look nothing like the years before them.  We can assume, then, that those of us who are over 50 will have a very different experience of aging than our parents and grandparents.  This provides us with enormous opportunity: the chance to re-invent the experience of being on the "second side" of the hill.  Sign me up.

The large number of hits to Refuse to Regain that come from searches about "menopause" and "over fifty weight loss", speak to the fact that a great many of us are looking for guidance as we reach the Second Side.  Road maps for ascending the hill (the first 50 years) are detailed and plentiful.  Get to the top and you pretty much find just one well-worn sign.  It reads,   "Go ahead and coast from here."  But coasting means getting pulled downward by gravity.  Suppose we want to stay up at the top, enjoying the view?  To do that, we've got to stay mentally and physically engaged.  Medical technology will be able to help, but each of us has to lay the foundation in our own brain and body. 

I am interested in working on a book about the ways in which people on the Second Side have preserved health and weight.  I'd like to know how new habits and personal discoveries have enriched your life. If you are one of these people.... someone over 50 who has lost and maintained weight or changed your life in other ways that increased health and well-being, I would love to hear from you.  Please send me your story and let me know if you would be willing to be profiled (either by name or anonymously) in a book.  

We will all benefit from the discoveries of the group, so why don't we take this journey together?

Contact me at refusetoregain@gmail.com.

 

An Inconvenient Truth: Al Gore is Quite Large

by Barbara Berkeley, MD

In the interests of political equity, I feel it only fair to observe that Al Gore has become oversized.  I report this because I have written in the past about Mike Huckabee, a Republican who--during his political ascendancy---devoted energy and considerable lip service to the themes of healthy eating, exercise and weight loss.  He lost around 100 pounds, wrote a book about his successful lifestyle change and became a cheerleader for health.  Then he gained a whole lot of it back.  

Losing and gaining in the public eye is not limited to political figures.  As we all know, certain celebrities tend to weight cycle.  Following the fortunes of Kirstie Alley,  Jessice Simpson and Oprah is a pleasant exercise in schadenfreude for the tabloid reader.  But celebrities don't claim to be leaders or even role models.  Politicians, on the other hand, are theoretically supposed to be the people who represent us and provide leadership.

In 2009, Al Gore was in weight loss mode.  To see a photo of him after losing, click here.   Associates questioned about his new regimen were quoted as follows,

1. He decided this year it was time to buff up.
2. "The man's as healthy as a horse," a Gore confidant said.
3. Gore is doing a lot of running, walking and other exercises.
4. He has also developed a new-found commitment to eating the right foods, close associates report.

But an appearance on today's Morning Joe clearly shows that Gore has let those commitments slide. It

Visit NBCNews.com for breaking news, world news, and news about the economy

 

 might be a bit difficult to see on this smaller video, but on a large screen TV, Gore's increased girth was unmistakable.

As I've said in my blogs on Huckabee, I feel that politician weight-cycling makes two important points.  First, it is annoying when public figures lose weight for political expediency.  Sprucing oneself up strictly to gain votes is understandable, but maddening---especially when accompanied by moralizing and pronouncements about what needs to be done to achieve permanent weight loss.  Perhaps more importantly,though, the failure of public figures to keep weight off is sure confirmation of the extreme difficulty of weight maintenance. Surely no one wants to go in front of the camera looking less than their best.  Nor does anyone want to appear foolish after they have exhorted others to simply exercise more and eat better...and then seemingly have failed to do the same themselves.

Still, the ballooning size of those who struggle with weight in public has the benefit of allowing the rest of us to breathe a sigh of relief.  We are all imperfect and few of us have the answers.  For those of us who have to some small degree controlled the problem of weight regain, perhaps we can't be blamed for a small additional moment of pride and satisfaction.  It remains true that successful weight maintenance is a rare commodity in the U.S.  If you've got some of the answers, you've got something worthwhile indeed.  

 

Interested in more blogs on politics and current events?  click here, then scroll down