Another SIde Effect of the Standard American Diet

In this blog, I spend a lot of time talking about the major health problems that go along with the standard American diet. There is no doubt that a western diet leads to multiple chronic health problems, obesity, and early death. I have seen it with my own eyes, both in myself and in my patients, many of whom suffer from hypertension, diabetes, obesity, heart disease, and various forms of cancer.

Today I was thinking about some of the other side effects of the western diet, mostly due to my daughter. Yesterday, she went to a small carnival at her elementary school, with a friend of hers. Christy and I were not there with her. She was with the parent of her friend.

Although our children are not completely vegan, only a tiny percent of their daily calories come from animal products. In general, they eat a diet of whole, unprocessed fruits and vegetables. At the little carnival, as you might imagine, the foods available were not the kinds we would usually feed her. She ate a couple of hot dogs, as well as several dessert foods made with processed sugar and flour.

Later that night, my daughter complained of abdominal pain. She had crampy abdominal pain, as well as several episodes of diarrhea. This lasted most of the night, and went away after about 12 hours or so. By morning she was all better.

I know what you are thinking: little kid ate too much and got a tummy ache. I was thinking the same thing, until I remembered that I used to get the same symptoms. Before I switched to a vegan diet, when I was very overweight, I used to get abdominal cramps and diarrhea so frequently that I had diagnosed myself with Irritable Bowel Syndrome. Until today I had never thought about it, but those symptoms stopped immediately after I switched to a whole foods vegan diet.

Apparently Irritable Bowel Syndrome is yet another side dish served with the standard american diet. If you have IBS, and don't believe what I am writing, I challenge you to switch to a whole foods vegan diet, and prove me wrong.

M. Jacob Ott

Milk: It Does(n't Do) a Body Good

Milk. I can think of no food or beverage that is more aggressively marketed. There are milk commercials on TV, celebrities sporting milk moustaches in magazines, and everyone knows the old slogan: "milk: it does a body good."

Milk is almost universally admired, and holds almost sacred status as a health food. Kids are told by their health teachers and parents to drink lots of milk, to build strong bones. Athletes are told to drink milk to help build muscle and give them energy. There is even a glass of milk on the picture beside the government's new plate graphic, which replaced the food pyramid. It would seem to indicate that milk should be a part of everybody's daily diet.

It's true that milk is the best thing for you and contains everything you need to grow and be healthy... if you happen to be an infant cow. That is the point most of us miss. Milk comes out of the mammary glands of adult cows, and is meant to be consumed by infant cows. Cows themselves even stop drinking milk within months of birth. In fact, humans are the only mammals who continue to consume milk past the stage of infancy.

In adults, milk can cause many problems. First and foremost, almost 30% of people are lactose intolerant. They lack the enzyme that breaks down the sugar. This leads to bloating, abdominal pain, and gas after eating or drinking dairy products. Why, you ask, would we lack this enzyme? Probably because we are not meant to eat lactose. It is basically only found in milk, which we are not meant to drink after we reach about 12 months of age.

As if that isn't enough, milk proteins can cause allergic reactions. Behind nuts, milk is one of the most allergenic substances in adults. In addition, those same milk proteins in experimental models can lead to the development and promotion of cancer. Animals fed milk proteins developed cancer at much higher rates than those fed only vegetable proteins.

Finally, people suffer from their own misconceptions about milk. If you ask almost anyone what food has the most calcium, they will say milk. Kale and bell peppers have approximately 100 times as much calcium as milk. Ask anyone what the most important thing they can do to prevent bone loss is, and they will say "drink milk." In reality, milk has little to do with bone formation, and load bearing exercise is the most important factor leading to strong bone development. Even if milk isn't actually bad for you, the misinformation which is sold about milk can be.

The last nail in the milk coffin is this simple fact: if the claims are true, and milk is important in preventing osteoporosis, then the countries that drink the most milk should be the ones who also have the lowest osteoporosis rates. Below is a graph of hip fractures (which are mostly caused by osteoporosis) vs milk consumption:

As you can see, the United States, which has by far the highest rate of hip fractures, also has one of the highest rates of milk consumption. Why does Hong Kong, who consumes less than half of the milk of the US have half the rate of hip fractures? Quite simply, because milk does not prevent bone loss.

I have nothing against milk. It just shouldn't be consumed by anyone except infant cows.

M. Jacob Ott

The Role of Hunger

Hunger. It is one of the earliest sensations we feel. Very little in the world has the power to drive us like hunger does. It is something that we can temporarily defer, but will always come back before too long. In fact, it is one of the few things in life that we can truly count on. Hunger will always come back.

How we are able to manage hunger plays a large role in determining our health. If we eat every time we get hungry, and eat typical modern processed foods until we are full, then the result is that we will be obese and unhealthy.

Why is it that this natural sensation leads us astray?

Just like with our sense of taste, the feeling of hunger was made to serve us in a primitive world where food was hard to come by, and getting it was hard work. Animals by and large are hard to catch, and plants while plentiful, often require quite a bit of work to expose or collect the edible parts. Our sense of hunger was designed to be a strong motivator, as a survival aide. We need strong motivation to make the difficult and time consuming search for food seem worthwhile. If we didn't have this, we would eventually have starved to death. For cavemen, hunger was a constant companion, which impelled them to spend much of their time searching for their next meal.

Fast forward to today. We live in a society where food is offered in nearly every building, and where high calorie, processed foods are as close as the next drive through. Animals are no longer hard to catch. They are factory farmed in ridiculous numbers and pre butchered for us. No work or preparation is needed on our part, other than tearing open a plastic wrapper.

Unfortunately, our sense of hunger has not changed at all. We still feel that consuming sensation that we must eat whenever our stomach empties. The problem is that we are no longer filling it up with low calorie veggies. We now eat pastries, meats, and candy as "snacks" to fill us up between our high calorie, processed, and unhealthy meals. Additionally, we now sit at desks all day, instead of working our bodies to catch and prepare our food. Is it any wonder we are obese?

We were made with this hunger sense as standard equipment, and we cannot get rid of it. There is a silver lining, however. We were also given a powerful brain as standard equipment, and it has the ability to override our basic instincts, such as hunger. In order to be healthy in a world full of poor quality calories, we must engage our rational brain.

The first step is to realize a basic truth. This truth is simple. In fact, it is so simple, that I did not realize it, because we are taught the opposite so routinely that I never questioned it. Here is the simple truth

IT IS OK TO BE HUNGRY!

Growing up, I was taught that you ate whenever you were hungry. From as early as I can remember to age 29, whenever the feeling of hunger struck, I ate something. I never bothered to question whether or not I needed to eat. I figured that the sensation of hunger meant that I needed to eat. Based on the above discussion, you can see that this is not the case.

In order to be free of the control of hunger, you need to become comfortable with being hungry. Practice not eating when you feel hungry. At first, it will be very hard, and you may not be able to hold off eating for more than 15 minutes. With practice, you will eventually be able to ignore the sensation of hunger for hours. Then it is time to put your rational brain to work. Now that the feeling of hunger does not consume you, when you feel hungry, ask yourself when you last ate, and if you need to eat, or if you merely need to live with the hunger for awhile.

Knowing that it is OK to be hungry, and that you can always eat later (unlike your primal ancestor, your food will not run away), you will be able to consume less per day, and only eat the amount of food that your body actually needs.

If it's so Easy, Then Why is it so Hard?

In my job in a physician, as well as my job as a health counsellor, I try to get people to change. Those people who are uninitiated in the medical world think that the Emergency Department is mainly a place of gunshot wounds, car accidents, and other major life threatening illnesses. In reality, these make up a minority of people who come through the doors of virtually any ED. These days, most of the patients we see are victims of what I like to call "diseases of lifestyle." These diseases are malfunctions of the brain and body caused by various voluntary activities that are not healthful. These diseases include:

Diabetes
High Blood Pressure
Obesity
Heart attack
Stroke
Gallstones (some cases)
Depression/ Anxiety (some cases)
Fibromyalgia or chronic pain syndrome
Cancer (some types and many cases)
Trauma (many types)

The activities that cause these diseases are as follows, in order of importance
Poor diet and lack of exercise
Poor diet and lack of exercise
Poor diet and lack of exercise (this is not a misprint. It is just that important)
Smoking
Excessive alcohol intake
Drug abuse

As such, I spend a lot of time speaking with people about how and what to change. The things that I am asking them to do seem so simple when I say them or write them out: Quit smoking, eat better, exercise a few times a week, pay attention to their health and follow through with routine medical exams. Despite how easy these changes seem, a surprisingly low percentage of people are able to change, even temporarily. Why?

As my wife reminded me yesterday when we were talking about this subject: "change is hard, even if it is from something you don't like." She is correct. Even if I can get someone to recognize that there is a problem with the choices they are making, and that they are responsible to change it (a very difficult proposition), habit is powerful. Even a habit that you don't want, and know is bad, like smoking or poor eating is difficult to change. We as human beings resist change, whether good or bad.

In order to create change once and for all, we must overcome that resistence. Fortunately, we were given one weapon to help us change. It is not our intellect. I can reason with a patient all day long about how smoking is going to kill them, and they will nod, say they understand, and light up the minute they leave the ER. The weapon that we have to aid us is our emotion. Strong emotions, like fear and guilt, can push us to act when we are faced with the necessity of change. Fear can be supplied by a medical scare, like a heart attack or a tumor, or by social consequences. That is why you often hear of people quitting smoking or beginning a diet and exercise plan after being diagnosed with cancer or a heart attack. Similarly, the alcoholic quits drinking when they experience enough pain or fear that they don't want things to get worse (rock bottom). The power of our rational mind is that we can create the fear without the bad consequences. Visualization in the brain is as real to us as reality is. If you explore your uncomfortable emotions and visualize the negative consequences of the decisions you make, it will be far easier to overcome them.

This is how I finally managed to change. I was forced by my circumstances to visualize the fact that my children would have to grow up without their father, and that I would not be around to see the important events in their lives if I did not change. In the span of a second, the change that had eluded me my entire life became simple. So to Christy and everyone else, I submit my version of her quote:

"Change is easy if you have the right reason." Find your reason.

Who Advertises for Apples?

So I was reading in the news the other day about a fight that is going on in Washington. This fight is between the government, who believes it is acting in the peoples' best interest, and the makers of processed foods and beverages, who are sure they are acting in their own best interest.

The fight is over what sorts of food are acceptable to market to children. In particular, the article was about Goldfish Crackers. The government was contending that Goldfish should be classified as junk food, and not marketed to children, on the basis of the fact that they are made with white flower and other processed ingredients, as well as the fact that they have saturated fat in them. The lobby group that represents Campbell's, the company who makes the Goldfish in question contends that they should be classified as 'healthful,' and thus acceptable to market to children.

I think that they are both wrong.

As a father of three, you might imagine that I have very strong opinions on this subject. Lets ignore for this post the association of TV with childhood obesity, and only consider the marketing aspects. What kind of foods should be OK to market to people who have poor impulse control, no or little rational capacity for decision making, and most importantly, no money of their own with which to buy those foods? The answer is none. Yet these corporations market directly to children. My children and yours. It is disgusting.

We all know why they do it. They figure if they implant enough images of their products in the minds of kids, those kids will grow up knowing and using their products, and they will have generations of brainwashed adults. Why not? It worked great with my generation. Earlier this month, I read that fewer than 25% of people my age remember that the USA used to be a British colony, but I'll bet that 80 or 90% can remember the Big Mac song:

Two all beef patties, special sauce, lettuce, cheese, pickles, onions on a sesame seed bun

It is clear that marketing is very effective. It is even more effective when done to children, who are more easily influenced and lack the impulse control that many adults possess. Why then does it occur?

I do not think this is the fault of the government. Not because I think the government is doing a good job, but mainly because as is true of most things they get involved in, the government has no role here. The government's job is not to tell people what to advertise and what not to advertise.

The blame goes only in one place: us. We are all to blame for this mess. We, the CEO's and marketers of corporations who should value their customers more than their bottom line, and recognize that they have violated basic ethics by marketing to children AT ALL. We, the people who permit this kind of unethical advertising by watching the TV programs in the first place. Finally, we who do not punish the companies who are harming our children by boycotting their products. Instead, we expect elected officials who listen to the selfsame companies via lobbyists to fix the problem, so that no lifestyle changes will be required by us.

Join me in taking responsibility for that blame, and help guide your children away from TV and advertising, and toward healthy activities and foods. Remember that the foods that no one advertises or lobbies for are probably the best ones for you and your children!

Thag Hot!

You may or may not have noticed the last week or two, but it is kind of hot out. If you live in Kansas, like me, it has been REALLY hot. Burn your feet on the pavement hot.

Heat like that brings up a few special considerations when it comes to health, so I thought I'd dedicate today's blog to dealing with the heat.

First, I will let the doctor in me talk for a minute about heat exhaustion and heat stroke. These are the two main heat related illnesses.

Heat Exhaustion is when you have been out in the heat too long, but not long enough to kill you yet. You begin to feel tired, weak, and sometimes lightheaded. You  are sweating profusely, and feel shaky. Passing out is possible at this stage. The symptoms are not subtle. You will know that something is wrong. The cure is to get out of the heat RIGHT AWAY, and drink something (non-alcoholic).

Heat Stroke is what occurs if you ignore your body's warning and don't (or can't) get out of the heat. You stop sweating (a very bad sign), and can get confusion and loss of consciousness which progress to coma and death. This is obviously not very good.

There. That is the public service announcement part of the show. Dr. Ott is satisfied. Now, on to how to exercise in the heat.

1. Choose a good time: OK, so you may be one of those people who love to run every afternoon at 3:00 exactly. If you have to wait until 3:02, you start to get the shakes. Believe me, I understand this kind of obsession, but temperature speaking, this is probably not the best time to run. Truly, the best time would be around 3AM, when temperatures are at their lowest, but since that is usually not practical, early morning and late evening are the next best choice

2. They invented the treadmill for a reason. I know that treadmills are boring, but they are infinitely better than dying of heat stroke. Trust me. When it gets super hot, sometimes discretion is the better part of valor, and just giving in and running on the treadmill is your best bet.

3. Drink water: Here is a news flash- when it is hot, you sweat. A lot. Those fluids need to be replaced. Unless you happen to be a frog (who can absorb water through their skin), the only way to replenish fluids is by drinking them. Drink water every 10 minutes or so. Drinking water also helps to lower your core body temperature, so it gives you a double benefit.

4. Take breaks as needed: You have your 20 mile long run scheduled for Friday. It is 100 degrees on Friday. That doesn't necessarily mean that you have to cancel your run (but you should consider it). You could instead break it down to four 5 mile runs, with a 10 minute inside break (to cool off). This strategy would keep your core temperature lower, so that you can finish, rather than overheat.

5. Protect yourself from the sun: If heat stroke doesn't get you, skin cancer might. Melanoma is the deadliest form of skin cancer, and your chance of getting it is greatly increased by sun exposure. Be sure to wear a had, and technical clothing which has a high SPF (a cotton shirt only has an SPF of 5, but you shouldn't be wearing that to run outside anyway, as it does nothing to wick sweat away). Wear sunblock, but don't be fooled by the hype- while it will prevent you from getting a sunburn, studies have not ever shown it to be effective in preventing melanoma.

Remember these steps, and your run in the heat will only be painful, but not deadly :)

Thag Write?

There was a great article in HealthDay today about food journaling. As part of my job, both as a physician, and as an health and weight loss advocate, I spend time reviewing the medical and lay literature for new developments, or ideas that may help my patients and my readers lose weight.

Food journaling is not a new idea, and it is one that I have long been a proponent of. I thought I would revisit the topic, since I read about it today. Like many things in our society nowadays, the mainstream idea is right in principle, but hits off the mark. Using a food journal as most nutritionists recommend will help you lose some weight. Effective food journaling, on the other hand, will help you lose A LOT of weight. Other than actually eating right and exercise, a food journal is probably the most important weapon in your weight loss arsenal.

Let me explain. A conventional weight loss journal would include things like what foods you ate, what times you ate them, and the calorie counts of those foods. If you use a pretty advanced food journal, it might also help you calculate your protein, fat, and carbohydrate intake. By looking at how many calories you have eaten, you know how many you have to go, and the mere act of writing down the foods you eat helps you to think about exactly what you are eating, so that you will hopefully make better choices.

This is all well and good, but it misses the point.

What you should really be journaling about is not only what you ate, but WHY you ate it. For most overweight people (myself included), the reason you carry extra weight is less about the what than it is about the why. I spend a lot of time talking about how the food culture in America sets up for failure, and it does. There is just too much food. We, however, set ourselves up for failure as well. I, for example, used food as an emotional coping device, entertainment, and a comfort aid. Most of my overeating occurred when I was stressed, bored, or lonely, but I never really realized it.

Part of the reason I write this blog is to share with you what I did wrong, so that you can hopefully benefit from my mistakes. One of my biggest is that I assumed that being overweight was purely a proposition of eating too many calories. Until I learned that there were triggers for my overeating, and how to avoid them, I had no chance.

When you write your food journal, I want you to concentrate on three things: what, why, and how. Write down:

1. What you ate- Write down everything you ate and drank, so that you can accurately review and eliminate poor food choices.

2. Why you ate- Write down why you chose that time to consume food. Were you hungry? If so, how hungry, on a 1-10 scale? Was it a mealtime, a planned snack time, or an impulse snack?

3. How you were feeling- This is the most important. Write down what emotions you were experiencing. Particularly note the negative ones, such as boredom, sadness, loneliness, or anger.

Finally, once a week or so, review your journal, and try to focus on patterns. Note if a particular emotion or reason stands out as an eating trigger. If so, whenever you feel that way, avoid food like the plague. You can't fight what you can't see, so this knowledge is key in your fight against obesity!