How Being Poor Made Me Healthy

What did you eat as a child?

Was the food that you ate as a child nourishing or full of empty calories?  As a nutritionist I typically begin patient appointments with a Health History that includes a general description of the diet they followed as a child along with a description of what they are eating now.  Most, if not all of my patients, rail against their parents for feeding them sugar-laden cereals and microwavable meals. I initially thought that I belonged to this group as well until I gave my childhood diet some serious consideration.

While my mother was no Julia Child (although we all faithfully sat around our black and white TV watching Mrs. Child and the always-inebriated Galloping Gourmet) she innately understood the concept of nourishment.  Every morning she would call out to the four of her daughters “What would you like for breakfast?”.  “I get the first breakfast”… I get second….” was our response (we are a competitive bunch).  The thought of skipping breakfast never even occurred to us.  Yes, we had lots of processed cereal but largely limited to Corn Flakes or Rice Krispies®.  Although these cereals were not the healthiest of options the grains back then were not as refined as they are today and there was NO added sugar.  As a matter of fact, my mother would let us sprinkle a teaspoon of sugar on our cereal before adding the milk (whole milk from cows that were not inundated with hormones or antibiotics). Breakfast also consisted of ONE egg, scrambled or “over-easy”, with two slices of buttered toast.  We all drank Hi-C or orange juice made from frozen concentrate. We probably could have done without the added sugar but at least we started the day with a healthy dose of Vitamin C.

Not once during my eight years of grammar school did my mother give me the 15 cents needed to purchase a juice or milk and a pretzel at snack time…and I didn’t even care.  The thought of eating more food, before lunch or after, just didn’t appeal to me.  I had to go home for lunch because our school was not large enough to contain all 1,000+ students in the café-audi-nasium.  If you lived less than five blocks from the school then eating your lunch at school was not an option.  Lunch at home was always a sandwich and milk.  No cookies or snack. I may have had an apple or an orange after school but only if I was hungry.  In the summertime we inhaled peaches, plums and watermelon purchased from a fruit truck, like a traveling farmers market.  I much preferred these fresh fruits to candy.

Dinner consisted of a meat, starch and vegetable although we never had meat on Friday.  Portions were tiny by todays’ standards but not because we were poor (even though we were).  We ate seemingly small portions because that is what was, and is, considered nutritionally adequate.  If we had lamb chops, each person was given one lamp chop.  When we had steak my mother would purchase two steaks and cut each into three portions (for our family of six).  I loved my mother’s broiled chicken basted with vegetable oil and seasoned with salt, pepper and paprika.  The starch was typically potatoes or rice prepared a variety of ways and the vegetables usually came from the freezer section of the grocery store.  I admit these meals were not very nutrient dense but certainly a better option than frozen meals and fast food.  How ironic that we pay a premium today for anything that is Organic but back then, everything was Organic. 

I don’t recall ever eating a whole grain food as a child although I can remember sprinkling wheatgerm, which we kept in the refrigerator, on my cereal in the morning.  We usually ate white bread and occasionally rye bread-which did not contain added wheat gluten as it does today.  On meatless Fridays we had pasta that we sometimes made from scratch.  It was quite a production and if I am not mistaken, my middle sister still has the original pasta maker.  One reason why making home-made pasta was not as onerous as it is today is because we did not need to make very much.  My mother made one pound of macaroni for six people.  That’s it! 

The five pillars of a nutritious diet are variety, moderation, calorie control, balance and adequacy.  I can only thank my mother for ensuring that each of these components were met.  As a result, my sisters and I have never suffered from high blood pressure, elevated cholesterol or elevated blood sugar and we are all at a healthy weight.  Although my current diet contains more fruits and vegetables the diet that I grew up on would be commendable by today’s standards.  Thanks, Mom!

Still Alice was Brilliant!

A Look at Alzheimer’s Disease

On Wednesday, June 10, 2015 I hosted a viewing of the movie Still Alice in my office as a vehicle to broach the subject of Alzheimer’s disease (AD) with my community.  The movie was absolutely riveting and Julianne Moore’s portrayal of an intellectual woman succumbing to early-onset AD could not have been more poignant.  In the movie Ms. Moore portrays a linguistics Professor who teaches at Columbia (the Ivy League position supports her academic prowess).  During the course of the movie she gradually loses her ability to recall course material, encounters with new people (eg. her son’s new girlfriend), the location of the bathroom in her summer home and eventually, her ability to recognize one of her own daughters. As a college professor myself, I found it particularly straining to see her lose her faculty position after her students submitted a complaint for delivery of confusing lecture content and lack of preparedness.

 

Although Alzheimer’s disease is a concern for all aging populations the Early-Onset or Familial form of the disease is relatively rare, accounting for only 5-10% of all Alzheimer's cases.  It is caused by genetic mutations that accelerate the production of plaques in the brain, ultimately leading to profound neurodegeneration.  As we learn in the movie genetic testing is available so two of Alice’s three adult children get tested.  Her youngest daughter learns that she is a carrier which means that she too, will be affected by this form of Alzheimer’s disease, and her children will have a 50% chance of inheriting the disease as well.

Since there is no cure for Alzheimer’s disease the decision to be tested is not an easy one.  Even James Watson, a Nobel Laureate, who co-discovered the structure of DNA, refused to divulge his AD status after publishing the entire sequence of his genome.  During the movie I could not help but notice that we never really observe any significant therapeutic intervention for Alice.  There is a brief mention of some of the therapeutic targets that are the focus of current R&D efforts but the actors never show Alice undergoing any sort of treatment.  Having spent decades working in the Pharmaceutical Industry on these targets, I can assure you that we are a long way off from developing a treatment that can reverse the neurodegeneration caused by plaque buildup in the brains of AD patients.

The two main pharmaceutical agents currently prescribed for AD are Aricept and Namenda, agents that are vaguely palliative but certainly not curative.  Recent clinical trials on drug entities that inhibit plaque buildup have not demonstrated measurable efficacy in patients with frank AD.  Clinical efforts are now focused on treating patients who are “prodromal” i.e. before they are cognitively impaired.  However, this can be as long as 30 years before Alzheimer’s disease is officially diagnosed. Prodromal treatment is a perfectly fine option for someone like Alice’s daughter who carries the gene for Familial AD but not an acceptable option for the majority of cases.

Do You Have The Sugar Blues?

Insulin:  The Good, The Bad, The Ugly

Insulin is such a necessary evil.  Without this hormone our bodies would not be able to harvest energy from the food we eat.  Following the ingestion of carbohydrates and subsequent breakdown to glucose, insulin is secreted from the pancreas, acting as a signal to remove this sugar from the blood and transport it to cells where it can be used to make energy.  Glucose that is not used immediately for energy can be stored in the liver in the form of glycogen.  However, there is a limit to the amount of glucose that can be stored in the liver.  This limit is about 2,000 calories (500g).  Any glucose above this amount is converted to fat and unlike liver cells, fat cells have an infinite storage capacity.  On the other hand, if glucose has been depleted from the blood the pancreas will secrete a different hormone called glucagon that tells the liver to release glucose from glycogen. If your glycogen stores are completely tapped your body can make glucose through a process called gluconeogenesis.

This whole process of depleting glucose from the blood and then replenishing it is exhausting!  Typically, instead of waiting for the body to restore glucose on its own we demand instant gratification by simply eating more food.  The foods that we crave during moments of fatigue tend to be those with a high glycemic index which are carbohydrate-rich foods that rapidly increase blood glucose and subsequent insulin levels. Eating carbohydrates will provide us with the energy we seek but we also pay a metabolic penalty for being impatient.  By not allowing insulin levels to dissipate completely before the next meal we will continue to store fat. 

This particular habit of never allowing insulin levels to drop is a primary contributor to the many symptoms of metabolic disease:  obesity, elevated blood sugar, elevated lipids, cardiovascular disease, etc.  Eventually, we lose our ability to use insulin properly.  The pancreas secretes insulin but it fails to drive energy production.  Instead, insulin becomes a signal for fat storage and ensuing diabetes because the glucose is not removed from the blood as it should be. 

In order to manage our blood sugar levels and body weight we need to give ourselves breaks between meals.  This allows insulin levels to dissipate which, in turn, promotes fat burning.  To do this we must be more attentive to total calorie and carbohydrate consumption.  A healthy diet should emphasize consumption of whole, unprocessed carbohydrates with a low glycemic index.  We should also consume healthy fats and proteins at every meal to promote satiety and to delay gastric emptying so that we stay full for a longer period of time.  This will prevent you from overindulging between meals.  More information on managing blood sugar through diet and nutrition can be found on the Joselin Diabetes center website: https://www.joslin.org/jstore/staying_healthy_with_diabetes_nutrition_and_meal_planning.html 

Sports Nutrition

Diet and Exercise

Whether you’re an exercise enthusiast or an elite athlete, it helps to understand how nutrients are used to power your body. Carbohydrates, fats and protein are energy-yielding macronutrients while water, vitamins and minerals are non-energy yielding micronutrients.  All carbohydrates are broken down to make glucose which is the body’s primary source of energy.  Proteins and fats also provide energy but through a more circuitous route. 

Whether you are planning a trip to the gym or are getting ready for the big game or race then it may be prudent to carefully plan your pre-workout meal.  Such meals should be high in carbohydrate content but low in fat and fiber.  If your stomach is full of fat and fiber during exercise your body will use more resources on digestion than to power your workout.   Of course, fiber at any other time ensures good health.

A suitable pre-game meal might consist of whole wheat toast with sliced banana and cinnamon or a fruit smoothie made with non-dairy milk. The following table is a recommendation for daily macronutrient levels.

Macronutrient	% Total Daily Calories
Carbohydrates	45-65
Fats	20-35
Proteins	10-30

 

The glucose derived from carbohydrates that is not used immediately for energy is stored in the liver in the form of glycogen.  However, this storage form has a limited capacity of approximately 2,000 calories.  Any glucose above this amount is converted to fat. 

Some athletes who follow a Ketogenic diet actually rely on fatty acids for energy.   In this regimen, fats comprise 75% of total calorie consumption.  Although this type of diet promotes fat burning and muscle development it should only be followed under the guidance of a healthcare practitioner.   

Dietary protein is critical for muscle development.  Consumption within two hours following a vigorous workout will facilitate muscle repair.  Proteins are comprised of amino acids, nine of which are “essential” meaning that your body MUST get them from your diet.  Animal proteins are Complete meaning that they contain all of the essential amino acids.  Vegans and vegetarians must reply on Soy, since this is the only plant protein known to contain all of the essential amino acids.  Some athletes will take amino acid supplements to ensure adequacy but this can lead to an imbalance of amino acid levels.  When amino acids are over supplied the body cannot store them so it will either convert them to glucose for storage as glycogen or it will convert them to fat.  Since the body can also use amino acids for fuel it may burn the amino acids instead of fat.

Do athletes really need to take supplements?  A well-nourished athlete consumes all of the vitamins and minerals they need from whole food.  However, there is no down side to taking a Multi-vitamin with or without iron, depending on the individual needs. Creatine is an amino-acid-like supplement thought to be helpful in muscle development.  In actuality, your muscles make all the creatine they need.  A protein powder may be useful as a meal replacement, so long as it is complete (eg. Whey or Soy-based).  Powders with added nutrients from additional plant sources (pea, rice, green vegetables, etc) make an especially healthy choice.