I joined a choir to find my voice. It took me three years until I was singing with gusto and
authority. As an adolescent, I
enjoyed food over everything else and paid for it with an unhappy, overweight
childhood. I sought the holy grail
of nutrition and weight control before I started medical school and found some
answers. As a physician, I
enlarged my understanding of nutrition and now have my writing voice.
I have shared my nutritional experiences with the public for
a long time. In fact, I discussed
food recently to a mixed Latino, African American, Anglo and Russian group at a
food bank in Venice, CA. The class
members ranged from thin to normal to overweight to obese. As a demonstration project, I brought a large bag of groceries
from the food bank to the class, which earlier had been distributed to each
family along with a half-gallon of milk.
The bag was especially heavy today due to the extra cans and the
abundant fruits and vegetables, not always available. I went through the contents of the cans (soup, pork and
beans, chili, tuna, vegetables), plastic containers (rice, pinto beans, English
muffins), boxes (juice, macaroni and cheese) and the fruits and vegetables (a
large cabbage, grapefruit, orange and zucchini). We finished with the milk and one half dozen eggs. Except for the fresh fruits and
vegetables, each of these food items has nutritional value documented on their labels.
The carbohydrate, protein, fat and
sodium (salt) content are essential in documenting the nutritional value. In our age of overconsumption, obesity
and epidemic diabetes mellitus, in both young and old, we must pay special
attention.
At the class today, I emphasized servings: what constitutes a serving of a fruit, a
vegetable (raw is twice the volume as the cooked) and a bread or starch
exchange. A serving is not as
standardized as it might appear.
My reference information designates a slice of bread or half an English
muffin as containing 80 calories.
The English muffin in the grocery bag appears smaller than usual and is
120 calories total, so half is 60 calories. My reference material is old. It appears even the commonplace staples we encounter every
day are not standard and are difficult to gauge. A slice of bread can vary from 50 to 150 calories depending
on its size and carbohydrate content (multi-grained and heavier breads contain
more calories from the increased carbohydrate load). English muffins and bagels contain more calories than a
slice of bread. Large bagels can
top out at over 300 calories without the cream cheese. Coincident with supersized portions at
fast food venues, the packages we buy in our super markets appear oversized for
the contents they contain.
The merry go round of food packaging eventually sees the
package size diminish to eventually fit the smaller contents followed by
another price rise. The scenario
speeds up during times of food price inflation, which seems to be with us all
the time now. I expect English
muffin sizes have decreased since my reference material was written a generation
ago. The standard measure for our
baked products is still weight, not size.
As with ice cream, breads seem to be pumped up with minute air bubbles. Ice cream packaging has seen the demise
of the half-gallon container; welcome to the pint and a half size.
Continuing our class discussion and demonstration, the carbohydrate,
protein and fat contents were compared, and varied considerably. The ratio of carbohydrate to protein is
an important indicator of a healthy food, the lower the ratio the healthier it
is (4:1 or lower is my ideal). The
protein in the eggs, milk and beans are good. Animal protein is generally better in fulfilling our body’s
needs with a more complete set of amino acids than vegetable protein. Saturated fat should be minimized while
monounsaturated and certain polyunsaturated ones encouraged. Low fat milk contains 2% saturated fat,
while regular milk has 3.5%; skim milk would be a better choice by avoiding the
saturated fats that add both calories and health adversity to our life equation. The sodium in the canned foods ranged
from 118 mg/serving for the mixed vegetables to 1100 mg/serving for the
chili. The beans and rice had no
sodium listed.
I discussed the central importance of protein in our
meals. I started the class asking
what their breakfast consisted of.
It was usually the quick and hurried one of coffee, juice, a slice of
bread, toast or tortilla with butter or jelly. If there is more time, the norm is oatmeal or dry cereal and
milk. Those who admit to bacon and
eggs or just eggs are a small number; surprisingly, guilt is less evident from
the extra calories of the bacon than eating the whole egg. Saturated fat drenches the bacon, while
none is in the egg. That is the
paranoia of cholesterol avoidance in our culture. The thin in the group are more truthful; they have less to
hide, less guilt to deal with.
Occasionally, I find the individual who proudly announces a
breakfast of egg whites and toast.
The abject fear of the yolk with its dreaded cholesterol is bothersome. The whole egg contains excellent
protein, vitamins and minerals, and is low in saturated fat. This fear is a nail in the coffin of
our national food policy. To avoid
the yolk and substitute the egg white or the egg substitute (e.g., Egg Beaters)
is nutritionally unsound and increases food costs. Might I be considered a whistle blower in exposing the
problems and limitations our government has with providing the best information
to all of us to be as healthy as we can?
It is a moral dilemma to ignore the larger truth. It is a matter of life and death.
After over 20 years of a worsening obesity epidemic that has
reached into the ranks of our children, where 40% of the American public is
obese, it is imperative we expose the truth. Besides the increased expenses for the health care that we
can no longer afford, we condemn a child to a shortened lifespan and with the
burden of countless health problems.
So what is the better breakfast? Ironically, the bacon and eggs without the toast has
adequate protein as well as fat, thought the less healthy kind, but it
satisfies hunger more effectively and for a longer period, so snacking is less
likely. The nature of satiety is
well documented in hormone studies involving insulin and gastrointestinal
hormones. Excessive carbohydrate
intake with inadequate protein and fat leads to higher insulin levels and subsequent
hypoglycemia, hunger, fatigue, weakness, and craving for a “sugar fix”. Proteins and fats slow carbohydrate absorption and stimulate
hormones that produce satiety and prevent hypoglycemia. Rats fed only fat do not gain weight. Add sugar to their food and weight gain
and fat deposition results.
An hour well spent, I left the class with a good
feeling: those present had started
on the path to understanding nutrition.
My mission is to empower people who are seeking answers to their weight
and nutrition problems. Most of us
have been frustrated by the mine fields we encounter in our supermarkets. Our imperfect government policy
toward health care has added to our obesity problem. I want to present the concepts that can give us all a
healthier future. We can all do
better.
I graduated medical school the year after the Surgeon
General came out with his report on smoking, condemning that practice once and
for all. The next year, 1965, saw
the adoption of Medicare, the most important social program for the elderly
since the social security program in the 1930s. Seniors would finally receive the health care protecting
them from the hazards of age during their retirement years without financial
disaster. With the economic
stresses on Medicare not handled well by Congress, I saw the golden age of
Medicare slip away and become a pariah to the physician and with less security
for the seniors. With the Medicare
Balanced Budget Act of 1997, reimbursements to physicians decreased 50% and
more. With the private health
insurers following the lead in diminished reimbursements, the physician was
under siege for survival. Medicaid
has always been underfunded and most physicians have dropped out. Medicare is not far behind. The privatization of Medicare Part D
with different tiered co-pays for ever more expensive drugs puts seniors in a
financial bind; many go without their prescribed medications.
