bearing blog

The past and future of celiac disease.

An interesting article at Scientific American.  War-related food shortages can save lives, it turns out.

CD [celiac disease] acquired a name in the first century A.D., when Aretaeus of Cappadocia, a Greek physician, reported the first scientific description, calling it koiliakos, after the Greek word for “abdomen,” koelia. British physician Samuel Gee is credited as the modern father of CD. In a 1887 lecture he described it as “a kind of chronic indigestion which is met with in persons of all ages, yet is especially apt to affect children between one and five years old.” He even correctly surmised that “errors in diet may perhaps be a cause.” As clever as Gee obviously was, the true nature of the disease escaped even him, as was clear from his dietary prescription: he suggested feeding these children thinly sliced bread, toasted on both sides.

Identification of gluten as the trigger occurred after World War II, when Dutch pediatrician Willem-Karel Dicke noticed that a war-related shortage of bread in the Netherlands led to a significant drop in the death rate among children affected by CD—from greater than 35 percent to essentially zero. He also reported that once wheat was again available after the conflict, the mortality rate soared to previous levels. Following up on Dicke’s observation, other scientists looked at the different components of wheat, discovering that the major protein in that grain, gluten, was the culprit.

Celiac disease is of special interest among autoimmune disorders because

it is the only example where the addition or removal of a simple environmental component, gluten, can turn the disease process on and off. (Although environmental factors are suspected of playing a role in other autoimmune diseases, none has been positively identified.)

Many more interesting details in the article, including recent research on the mechanism of the autoimmune reaction and prospects for non-dietary treatments of the disease.  Finally, something to think about if you've got celiac in the family and are still having babies:  The author and colleges have

...begun a long-term clinical study to test whether having infants at high risk eat nothing containing gluten until after their first year can delay the onset of CD or, better yet, prevent it entirely. “High risk,” in this case, means infants possess susceptibility genes and their immediate family has a history of the disorder.

We suspect the approach could work because the immune system matures dramatically in the first 12 months of life and because research on susceptible infants has implied that avoiding gluten during the first year of life might essentially train that developing immune system to tolerate gluten thereafter, as healthy people do, rather than being overstimulated by it. So far we have enrolled more than 700 potentially genetically susceptible infants in this study, and preliminary findings suggest that delaying gluten exposure reduces by fourfold the likelihood that CD will develop. It will be decades, however, until we know for certain whether this strategy can stop the disease from ever occurring.

Interesting.

Malnourished: a head game.

I posted some time ago that I'd given up bedtime snacks for good -- after dinner, I'm done with solid food.  Last night I learned a little more about that

I had a late afternoon/early evening bit of volunteer work to do at church, so I made dinner for my family and left it in the oven, dropping the kids with Mark on the way, and headed out.  I'd brought some paperwork with me, thinking I would stop in a little sandwich shop/bakery on the way home, catch a sandwich for dinner and a cup of coffee while I looked the papers over.    

The plates other people were eating from looked too big.  A sandwich by itself should be the right size.  I ordered a cheese-and-other-yummy-stuff sandwich. When the server came around and plopped my dinner in front of me, the plate was indeed too big, but the sandwich was normal-sized. The rest of the plate supported a good-sized pile of beautifully crisp and brown, curly, sparkling-with-large-crystals-of-sea-salt, batch-cooked potato chips.   I suspect them of having been made in-house.

I cleaned my plate.  

As I was finishing my water, I looked around, and I saw a family near me who had ordered a side dish of Szechuan green beans.  They were bright green and lovely.  They filled a plate.  And I began to wish that I had ordered the green beans to go with my sandwich, and that I had asked the cashier "Hold the chips."  Oh, my plate would have looked ever so much more beautiful with the veggies on it!  And I would have felt so much nicer about myself!

A little voice in my head told me, "You should go right up to the counter and order some green beans right now.  You need vegetables.   Those potato chips gave you no nutrition at all.  Go on!  Eat your vegetables!  They're good for you.  YOU NEED TO BUY SOME GREEN BEANS AND EAT THEM ALL UP.  Do you want to get rickets or scurvy or whatever it is that comes from a diet of cheese sandwiches and potato chips?"

This is what gluttony always sounds like to me:  I convince myself I really need to eat more.

I said no.  That meal is behind me now, I told myself.  I ate a whole plate of food.  No, the potato chips weren't ideal (tasty though).  Yes, the giant pile of green beans would have been better for me.  You know what?  IT'S OVER.  Better luck next time.  There will be other meals.  Even, maybe, meals in this sandwich shop.  Yes, the beans are more healthy, but more important is sticking to and reinforcing the don't-stuff-myself habit, the one-plate-meal habit.   I AM DONE EATING.

(That all sounds very glib.  Actually, as I sat there in the restaurant, I was gritting my teeth and clutching the table edge with the effort of making up my mind whether to go buy and eat a half-pound of stir-fried green beans.  I know.  Sad.)

Potato chips are not terribly filling.  I got hungry again a couple of hours later.  I lay in bed listening to my stomach growl and  telling myself I'd learned my lesson:  Order the big pile of veggies up front.

I am going out for breakfast now.  I am going to a place not far from my house where they serve salads with breakfast, a little pile of organic mixed greens tossed with a nice vinaigrette.  I am totally craving that salad.

Loss mode. Also known as The Bearing Diet.

Mark, who you will remember is a process engineer, wants me to come up with a list of rules for "loss mode" as a weight maintenance tool.  He has cheerfully volunteered set up an SPC (statistical process control) chart on which I will plot my weight every morning, watching for trends.  When the data indicates that I am so many standard deviations above my target, I will switch to the loss mode rules until the data returns to the target.  

This is the idea, anyway.  Right now I'm more than a few sigma away from that target, and so should be in loss mode all the time.

What are the rules?  If I were to distill The Bearing Diet to simple, objective instructions (eschewing judgment-requiring stuff like "only eat when you're hungry"), what would it be?

The first set of rules have to do with the content of meals and snacks:

1) Breakfast is one egg and a half-glass of tomato juice, plus coffee or tea-with-milk.

2) The optional 10:30 AM snack is zero to ten nuts, zero to one ounce of cheese, and zero to 1.5 ounces fruit. 

3)  Lunch is a single plateful, half of which is simply prepared vegetables.

4)  The mandatory 3:30 PM snack is zero to ten nuts, zero to one ounce of cheese, and zero to 1.5 ounces fruit, plus coffee or tea-with-milk.

5)  Dinner is a single plateful, half of which is vegetables, plus one extra helping of vegetables or salad, if I want.

6) No solid food after dinner.

The others are general ones:

7)  Always measure the foods I have trouble limiting:  for me, bread, crackers, pastries, grains, and pasta.  

8)  Periodically, pre-plan and measure a day's meals and snacks to ensure it's in the weight-loss calorie range:  for me,  1200-1500 calories.

9)  Stick to one serving of alcohol at a meal.

10) Dining out or in a pinch where the other rules are tough to follow, eat only half of whatever's not a plain vegetable.  Faced with desserts or sweets, the limit is three bites.*  

*I think of this one as The Annie Rule, named after my stepmother.  She swears by it as the single strategy with which she has maintained a healthy weight for, like, forty years.

That's it:  The Bearing Diet For Not Eating So Damn Much.  Does it look hard to follow?  Or complicated?  It hasn't felt complicated or even very difficult to me -- although the rules developed gradually.  I tried some rules that I later threw out; for instance, I tried and abandoned "no sweets" and "no snacks," but did settle on "no bedtime snack."

The big question -- still theoretical, I might add -- is, how would my behavior change if I wasn't in loss mode?  It's going to happen eventually -- either I'll hit my target, or I'll get pregnant.  One of these things will happen.  I won't be trying to lose weight forever.

I guess I'd allow myself a larger breakfast, I'd drink more alcohol, I'd serve myself bread/pasta/grains more freely.  I'd still periodically pre-plan my day's meals, only for a higher calorie range -- maybe something like 1850-2150 calories (gleaned from this nutritional needs calculator that takes lactation into account, and within a couple hundred calories, reinforcing my previous engineering estimate based on my weight loss rate).  I'd probably drink more milk and use more butter on purpose.  

I think I'd still stick to the one-plate meals, the Annie Rule, and the fruit-cheese-nuts snack regime.   They're pretty powerful at maintaining the habit of moderation. 

Eight hundred and seventy-five calories.

Per day.

This seems almost surreal, or impossible, but -- I have to learn how to eat eight hundred seventy-five more calories a day.

As a first, linear, "engineering" approximation, that is.

Bear with me.  The approximation goes like this:   One must run a calorie deficit of 3,500 calories to lose one pound of human fat, more or less.  This is a convenient number, because it is divisible by seven; it means that, in order to lose one pound per week, each day one must eat 500 fewer calories than one burns.

I have been losing one and three-quarters pounds per week.  Pretty steadily. (My expected standard deviation once I get to maintenance is approximately 1.1 pounds, according to Mark's OpenOffice spreadsheet.)

I'm almost at goal (108 pounds) and when that happens I will be trying to lose zero pounds per week.  So will be trying to run a calorie deficit of, um, zero.  Since all signs point to a current daily calorie deficit of 875 calories, the first-order approximation is to eat 875 calories more per day than I'm eating now.

Enter the two giant, dressing-soaked, Parmesan-and-crouton-laden Caesar salads.

 

Of course, I am a highly nonlinear system, and it could well be that the first-order approximation is off by a few hundred calories.  Maybe I need to add only 650 calories.  Maybe I need to add 1,000.  We will find out as I continue to graph my weight loss. 

 (You may recall that my husband is a process engineer.  He is not only making spreadsheets to figure out nerdy little things like the variance and standard deviation of my weight.  He is planning a full-fledged statistical process control scheme.  Believe me, you will hear more of this later, cross-posted to the Homemaking for Engineers category.  And if you wonder why I put up with this, you must have forgotten what I spent twelve years of my life studying.)

But the bigger question facing me now is:  OMG HOW AM I GOING TO EAT THAT MUCH FOOD?

Cathie and Amy F and CJ all guessed, one way or another, that 875 calories is the difference between what I eat now and what I ate before.  Since the slope of the weight-time graph is pretty constant, we can indeed infer that, too, as a first approximation.  I wasn't measuring before, so I can't say for sure.  

This is nearly (not quite, but nearly) two meals' worth of calories (meal size being what it is for me now).

I don't think it would be easy to do it again.  My hunger signals have adjusted.  At the end of my dinners -- just one eight-and-a-half-inch plateful -- I am stuffed.  I no longer get hungry for snacks except right before bed, and then only if I've just come back from a swim workout.  

And I'm a little bit afraid to try.  I'm afraid to stuff extra calories in.  I'm afraid to re-start the habit of snacking when I'm not hungry.  I still fight the mental urge to wander into the kitchen to pop something into my mouth when I'm bored.  I feel like I have a long way to go to cure the psychological habit of eating when I'm not hungry.  I finally understand how it can be that some women say they have trouble eating all the food they're supposed to when they're pregnant.   

I think I understand anorexia a little bit more than I did before.  It's not the fear that this one apple, this one slice of bread, will make you fat.  It's the fear that giving in to the one apple, the one slice of bread, will open the floodgates.  If I can eat one saltine cracker today when I'm not hungry, tomorrow I might allow myself two, and then before you know it it's a whole sleeve.  

Or 1.8 sleeves.

 (yes, that's how many saltines equals 875 calories)

I apologize to anyone who finds it hard to, er, feel sympathy for me being in this situation.  I am sure I would have thought so before I lost 40 pounds.  As it is, I find it more than a little surreal.  I really am not sure how I'm going to do it.

More on less meat.

Apropos my earlier post:  Mark Bittman, one of my favorite cookbook writers, has a NYT column on eating less meat.  The suggestions are exactly the sort of sensible, low-stress ones I'm trying to implement:  

1. Forget the protein thing....For anyone eating a well-balanced diet, protein is probably not an issue.
2. Buy less meat. How many ounces of meat is a serving? For years, the U.S.D.A.’s recommendation has been four ounces a person, yet most of us have long figured one-and-a-half to two pounds of meat is the right amount for four people. ...Change that amount, and both your cooking style and the way the plate looks will change, and quickly.   Remember that most traditional styles of cooking use meat as a condiment or a treat....
3. Get it out of the center of the plate.... If you think of meat stews or soups, chicken pot pie, even lasagna, you’ll quickly recognize that the decision to load them up with meat or to use meat as an ingredient of equal importance to the others is entirely yours. The same is true when you’re grilling. Compare these statements: “We’re grilling a leg of lamb and throwing a few vegetables on there,” and “We’re grilling vegetables and breads, and will throw a few chunks of lamb on there.”     

There's more -- read it all.