bearing blog

Teens/tweens and sleep.

This isn't new material for me, but something to think about anyway:

 As adolescents grow, their sleep cycles change (Carskadon, 1999).  During adolescence teens tend to stay up later and sleep later. Some of these changes are explained behaviorally...But some of the changes are due to intrinsic, biological changes. Even more seriously, researchers, doctors, and teachers are realizing that circadian rhythms and school schedules are out of synch (Carskadon, 1999). The result is excessive sleepiness, inferior academic performance, and even accidents.

Pioneering research has begun to focus on circadian rhythms and circadian rhythm disorders ...Measurable by biological events, like melatonin, circadian rhythms control the timing of rapid eye movement sleep (REM). Research is beginning to show that circadian rhythms are developmental and change with growth from childhood, to adolescence and adulthood.

One of the most fundamental benefits of homeschooling is that it leaves families freer to choose their own schedules.  That includes sleep schedules.  Most days of the week, I could, if I chose, arrange things so that the children and I could sleep very late or take naps in the middle of the day -- at least in theory.  We have no buses to catch, after all.  

Kids generally don't get enough sleep when they have to keep to a school schedule that starts early in the morning and leaves no room for a nap:

Early survey research at Stanford University, showed that as pubescent girls matured they preferred evening to morning schedules... In other words, as the girls' bodies changed so did their sleep cycles. This is more than staying up late to have fun. Changing sleep cycles are biologically based. Furthermore, parent surveys and teen sleep diaries indicate that during the school year, teens average about 2 hours/per night less sleep than in the summer. The effect is cumulative. So losing 2 hours sleep each night adds up to a total of 10 hours lost sleep by the end of the week.

As adolescents' bodies change, they stay up later but still show afternoon dips in alertness. Previously believed to be a sleep pattern of younger children, who once took naps in school, this "siesta" effect is pronounced even into later adolescence. Changing circadian rhythms of adolescent bodies and early school schedules are out of sync. 

Looking back at my own late adolescence, especially my first experiences with setting my own schedule in college (my freshman year, of course, but before that I attended a summer credit-earning residential program for high school students)  -- I vividly remember how quickly I (and many of the others my age) re-adopted the afternoon nap that hadn't been possible since kindergarten.  Often, after returning from classes, I'd pass out on my bunk and not get up till the dining hall was about to open.

Looking specifically at my preadolescent son -- he is 11 -- I could let him sleep as long as he wished almost every morning, and let him set his own schedule for schoolwork most of the time.  He's proven himself responsible and capable of plowing through his daily to-do list with little supervision, and it is obvious that he has developed the ability both to self-teach and to know when it's time to ask for help learning something.

Typically, though, I haven't given him total sleep/work freedom.  There are a few pressures that work against the "everybody can sleep as much as they need to" model, at least in our family.  The challenge is in finding the balance.

(1) The rest of us may not have to be out the door early in the morning, but Dad does.  If a teen sleeps in late, he misses time with his father (or whichever parent is the breadwinner) that he could otherwise be having.  Of course, he could get more by staying up late -- but many families prioritize early bedtimes because it gives Mom and Dad a block of time without interruptions.  

(2) I like there to be a time in my day when I'm "done" with school.  I get a feeling of satisfaction when everybody has cleared out of the schoolroom early enough that I can straighten it up and leave it  in the late afternoon.  

I realize that a mother's schedule is not meant to conform to outside-world expectations.  But deep down I like the illusion of having something less like a vocation to which I give myself fully in my my every moment, and more like a JOB, because JOBS eventually have a quitting time, after which I can crack open a beer and put my feet up and chat with my husband about his day.

(3) A fairly predictable school schedule is the tool that helps me give time and attention to each child over the course of the day.   This is a big deal.  I have to have enough time in the morning, and enough time in the afternoon, especially to work one-on-one with my five-year-old and my eight-year-old.  (Thank God my five-year-old learned to read precociously early, because that is one less time-intensive activity I need to work on with her.)  We have a rule around here:  "You may not interrupt me if I am teaching someone younger than you."  If my oldest were completely free to set his own schedule, it would be trickier for him to work with mine.  

Still, the daily schedule may not be optimized; perhaps I should re-evaluate it with tween-sleep as a high priority.

(4) I try to do a couple of school subjects, as well as lunch, together as a family.  This means calling my older kid away from his own work -- or his bed -- and bringing him "in touch" with the rest of the children.  

(5) We aren't totally isolated from the outside world and its schedules.  There's Sunday morning Mass, for one thing -- and if we sleep in and go to late Mass, there's just so much less of the day left to play.  Two days a week we co-school with another family, and that means getting up early (at least when it's our turn to drive and car-pool) so we can start early enough to get the work done and get home to Dad.  When doctor's appointments and such need to happen, first thing in the morning seems best because it interrupts our day the least.  

(6) There is pressure to teach conformity with the outside world.  Someday he's going to have a job, and it might make him get up in the morning and keep a traditional workday schedule, right?  

In theory, I reject the "but he'll have to learn it eventually, so we have to work on it now" philosophy.  Most lessons can wait for developmental readiness most of the time, and there is much more natural motivation to learn when the natural need arises.  Still, all homeschoolers (I think) have to make decisions like this all the time.  Even though as homeschoolers, our children don't have to jump through the same hoops as all those "normal" people, when they are adults they will be expected to act like "normal" people some of the time, and we want to prepare them to be able to  conform by choice when it's in their best interest.  

Sooner or later most people will need the skill to arrange sleep schedules in order to meet somebody else's demands.  The question is, do they need practice with this more than they need... well... sleep?

It's yet another are where we must decide how best to strike the balance among the natural needs of each individual living in the family, all with one eye to the sometimes unreasonable but often unavoidable demands of the outside world.  This is never a simple question, and parents encounter it and answer it -- not always easily, and not always willingly -- again... and again... and again.

Pandora's sugar bowl.

Monday evening I announced, "Muffins for breakfast tomorrow!"

And the children fell to their knees (okay, it was only the 11-year-old) and begged, "Please, Mom, don't make them completely whole wheat!  Put some white flour in!"

I raised my eyebrow (okay, not really; I am physically incapable of raising one eyebrow; probably I just made a frowny face) and said, "Oh, come on, they're not that bad.  Muffins are quick breads. You barely notice the difference in muffins."

"They don't taste as sweet as other people's muffins."

He probably has a point there.  I don't like to eat super sweet muffins, so the slight bitterness of whole wheat flour has never bothered me, and I usually do not add extra sugar to make up for it.   

Maybe if I could have kept my children's taste buds safely sheltered from the world, he would not know what he is missing.  But this past year the 11-year-old has acquired the freedom to range around our urban neighborhood unsupervised.  He has, I suspect, tasted the illicit luxury of coffeeshop muffins bought with his own money.  There is scant going back once innocence is lost.

"Or, Mom, at least could you put more sugar in them?"

Hmph.  Philistines.  "How about I sprinkle a little sugar crust on top?"

"No, it's the middle that isn't sweet enough."

"But it'll have blueberries!"

"They're sour."

I turned to my spouse, the food processing engineer, who (a) has to stay somewhat abreast of the nutrition literature, and (b) has perfected the art of rapid calculation followed by a guess that makes it sound like he knows exactly what he is talking about.  "Mark."

"Hm?"

"If we had to live on homemade muffins, would it be better for us to eat low-sugar muffins made with some whole grain flour and some white flour, or would it be better to eat whole-grain muffins with more sugar in them?"

He rolled his eyes at me (okay, he probably didn't roll his eyes, but I'm not sure how to describe what he did.  Let's say he made a "here's a caveat" face).  "You realize that all the relevant research about this sort of thing is inconclusive."

"Yeah, yeah."

"Well, if it is an either-or, my instinct -- just my instinct, mind you --"

"Duly noted."

"-- is that it's better to keep it 100% whole grain and add the sugar.  Because the relevant research does indicate that more whole grain is associated with better outcomes.  And also the white flour has the same effect on your body as sugar anyway.  So at least you're not leaving out the additional nutrition and fiber, even if it comes with sugar."

"Got it."  I turned back to the pleading child.  "Okay.  This time I will make sweet muffins."  I stormed into the kitchen (okay, I probably did not storm so much as stalk) and made these.  They weren't blueberry because I discovered the dried cherries while I was rooting around in the fridge.

Extra-Sweet Cherry Yogurt Muffins

• 1 cup yogurt thinned with a little milk, OR 1 cup buttermilk, plus extra if needed (which you will)
• Heaping 1/2 cup dried tart cherries
• 1/4 to 1/2 tsp almond extract
• 1 egg
• 3 Tbsp butter or coconut oil, melted and cooled, or other oil
• 2 cups whole wheat flour
• 3/4 cup sugar (it hurts my teeth just writing that -- a *tablespoon* in every muffin!)
• 1 Tbsp baking powder
• 1/2 tsp salt

The night before:  Put the dried cherries in a bowl and add enough thinned yogurt to moisten all the cherries.  Stir and let soak overnight in the refrigerator.  (Even a half-hour's soak will do some good, if you don't have overnight.)

In the morning, grease a 12-cup muffin tin and preheat the oven to 400° F.  Beat the egg and melted butter together with the remainder of the thinned yogurt.  Add the almond extract.  Mix the dry ingredients together in a medium bowl, then gently stir in the liquid ingredients and the cherry-yogurt mixture.  Add more yogurt and milk if needed to moisten all the dry ingredients (it's hard to say how much liquid will have been soaked up by the cherries).   Divide among the cups of the muffin tin and bake for 20 minutes; test with wooden pick before removing.  Allow to cool in the pan 5 minutes before taking the muffins out of the cups to finish cooling on a rack.

+ + + 

Now let me tell you something.  I do not (repeat, do not) like sweet muffins for breakfast.  And the idea of these terribly sweet muffins -- I used the amount of sugar suggested in Mark Bittman's "Sweet and Rich Muffins" recipe, but did not add the extra fat -- kind of horrified me, which is why I used yogurt instead of the ordinary whole milk I usually used; I thought perhaps it would balance the sweetness a little bit.

Fatal mistake.   I should have left it unbalanced.

These were very yummy muffins.  I had a taste "of Mark's, to evaluate it" and now I am personally responsible for demolishing three of them.  

So now I have this "aaaaagh, what have I done?!?!" feeling.  I fed my kids a tablespoon of sugar in their muffins and I liked it.  This is less sugar than in the most current formulation of Cocoa Puffs.  

Argh.

 Of course the kids liked them too.  I am still going to write "dried cherries" on my grocery list this week.

But, argh.

 

Well, this is a timely article: How to stick to your resolutions.

I was talking to Mark this evening about trying to nail down the general principles of behavioral change -- not the list of "handy weight loss tips," but the general principles that I've followed to choose my new, permanent habits and to make them stick.  

All right, I'm fessing up:  I've been tossing around the idea of putting these disconnected eating-and-exercise blog posts into a longer and more organized form.  What I'm not yet sure about is focus:  gluttony?  personal change in general?  willpower defeating?  straight-up weight loss?

Anyway, I was amused tonight to encounter this article from the NYT's John Tierney, "Be It Resolved," which is very much like the sort of thing I was envisioning writing.

IT’S still early in 2012, so let’s be optimistic. Let’s assume you have made a New Year’s resolution and have not yet broken it. Based on studies of past resolutions, here are some uplifting predictions:

1) Whatever you hope for this year — to lose weight, to exercise more, to spend less money — you’re much more likely to make improvements than someone who hasn’t made a formal resolution.

2) If you can make it through the rest of January, you have a good chance of lasting a lot longer.

3) With a few relatively painless strategies and new digital tools, you can significantly boost your odds of success.

Now for a not-so-uplifting prediction: Most people are not going to keep their resolutions all year long. They’ll start out with the best of intentions but the worst of strategies, expecting that they’ll somehow find the willpower to resist temptation after temptation. By the end of January, a third will have broken their resolutions, and by July more than half will have lapsed.

They’ll fail because they’ll eventually run out of willpower, which social scientists no longer regard as simply a metaphor. They’ve recently reported that willpower is a real form of mental energy, powered by glucose in the bloodstream, which is used up as you exert self-control.

Well, that explains a lot.  Dieting is hard because low blood sugar depletes your willpower!  

But this is the paragraph in the article that really resonated with me (emphasis mine):

One of their newest studies, published last month in the Journal of Personality and Social Psychology, tracked people’s reactions to temptations throughout the day. The study, led by Wilhelm Hofmann of the University of Chicago, showed that the people with the best self-control, paradoxically, are the ones who use their willpower less often. Instead of fending off one urge after another, these people set up their lives to minimize temptations. They play offense, not defense, using their willpower in advance so that they avoid crises, conserve their energy and outsource as much self-control as they can.

This.  This.  A thousand times this.  Using willpower sucks, so you have to exert it in advance.  So much of what worked for me is about this very principle.

The article goes on to give a somewhat outlandish anecdote and then from it derives some strategies that ring very true to me:

• Set one clear goal at a time
• Precommit (like Odysseus lashing himself  to the mast, remove your options to break your resolution)
• Be accountable to someone else, and plan to pay a real penalty if you don't reach your goal
• Keep track of how you are doing
• Don't overreact to a lapse by saying "what the hell" and figuring the day's already ruined
• Tell yourself you can have some later (rather than swearing off pleasures for good)
• Reward yourself, or find reward in your actions, often.

I will have to spend some time thinking about this -- but maybe the first step is to read the book about willpower that is referenced in the article.

"The Fat Trap."

I was going to blog about Tara Parker-Pope's recent article "The Fat Trap," but then I noticed a lively discussion at Megan McArdle's blog.  I participated as "bearing."  You may find that comment section interesting if you follow the weight loss/gluttony threads here.

Pope's article is about how hard it is for people to keep the weight off, when they have lost weight through medically supervised severe calorie restriction.  Some people do it through obsessive calorie counting and abnormally high exercise regimes.  

I am pinning my hopes on the "sustainable, real-life habit" approach to weight control, something that is almost the antithesis of the medically supervised fasting.   But I still find articles like Ms. Pope's article depressing -- and frightening.  It's not that I can't keep my weight within a good range now.  It's that I fear I will somehow lose the will to keep working on it.

Low-carb, low-impact.

Mark sent me a .pdf of a very interesting paper the other day:  "Nitrogen and Food Production:  Proteins for Human Diets," V. Smil,  Ambio vol 31 no 2, March 2002. It got me thinking about lower-carb living and sustainability.  

One way to think about farming:  "[A]griculture's principal objective is the production of digestible [nitrogen]."  Nitrogen is a proxy for protein, and its availability in the soil limits how much protein can be produced from the land.  That's why the advent of ammonia fertilizer led to such an explosion in land productivity.  But nitrogen fertilizers have environmental costs, and so we want to use them efficiently. 

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Back when I was trying to live low-carb, Atkins-style, one of the things that troubled me about it was that it seemed so... gratuitously meaty.    The Atkins folks are now recommending "at least 4 to 6 ounces of protein foods per meal," "8 ounces... if you're a tall guy," but five or six years ago I had gotten the distinct impression that you were supposed to eat "as much as you want" of bacon and beef and the like.  

Basically, the impression was:  Replace your bread, rice, and pasta with meat, eggs, and cheese.  Right?   And of course, even now, six ounces of protein-based foods per meal is more than a pound a day.   You've got to eat something, right?  And you don't want to be hungry?  And carbs are out?  So high-protein must be in.

But of course this is far more protein than individuals need.  Protein can't be stored,* so eating extra is wasted.   It's greedy, too, on a societal and environmental level; Americans overeat it, and pour nitrogen fertilizers into the soil in order to overproduce it, while in other parts of the world demand outstrips supply.

So why is the Atkins recommendation so high?  I think it's because the Atkins diet sells itself with that "you can eat as much as you want" theory.  The extra meat will fill your plate and your stomach, be satisfying to chew, and taste good; it is made of "normal" stuff that you're used to eating; and if the research on insulin resistance is to be believed, it won't contribute to your fatness.  You can, indeed, lose weight while eating lots of Atkins hamburger salads.

But it's still wasteful, if you're eating more protein than your body needs.  And the more people in affluent nations who try to fix their fatness by following Atkins-style high-meat low-carb, the more overall global demand for meat rises -- and for already-overnourished nations like us, that's shameful.

* * *

This is one reason why, even if we concede that high-refined-carb diets cause obesity and low-carb diets can cure it, we still have a gluttony problem.  A pound and a half of meat every day is a ridiculous amount of meat to eat, even for a "tall guy."  

Let's concede that a small number of obese, insulin-resistant people will not respond to a diet unless it contains virtually no carbohydrates at all.  These few folks will need a diet that's almost all protein and fat, of necessity based mostly on animal products.  They want to eat reasonably-sized meals with enough calories in them that they don't suffer terribly.  Okay, let those few people subsist on mostly meat, and more meat than their protein requirements call for.   Chalk it up as an expensive medical treatment.  But it's terribly wasteful to start there as a first resort for weight loss, or worse, for a lifelong way of eating.

* * *

Here are some things to keep in mind when designing a lower-carb, but more-sustainable way of eating.

1.  Too much protein and too little fat is an important cause of the famous constellation of side effects that accompany "Atkins-style" low-carb eating.

From Gary Taubes, Why We Get Fat, pg 214-216:

This shift [from running on carbohydrates to running on fat] can come with side effects.  These can include weakness, fatigue, nausea, dehydration, diarrhea, constipation, [postural hypotension], and the exacerbation of pre-existing gout.  ... This reaction is why some who try carbohydrate restriction give it up quickly. 

...The reason for the side effects now appears to be clear, and physicians who prescribe carbohydrate restriction say they can be treated and prevented.  These symptoms have nothing to do with the high fat content of the diet.  Rather, they appear to be a consequence of either eating too much protein and too little fat, of attempting strenuous exercise without taking the time to adapt to the diet, or... a web of compensatory responses [from the beneficial drop in insulin levels] that can lead to water retention and what are called electrolyte imbalances.

So too much protein is one cause of the unpleasant side effects.  Eat more fat and less protein -- which means you can eat less animal product and more vegetable oils like coconut, avocado, olive -- and the lower-carb adventure might feel a whole lot better.  (Meanwhile, make sure you get enough salt and don't overdo the exercise).

 2.  Don't overestimate your daily protein requirements.  Three grams for every ten pounds of body weight is slightly more than you probably need -- a number I get from using the recommendation of (0.6 g protein)/(kg body weight)*.  Another way to think about it is one gram per ten pounds of body weight at each of your three meals.  

I weigh 113, so it's doubtful I really  need more than 34 grams of protein per day.  Let's be generous and call it 36:  12 grams of protein at each of breakfast, lunch, and dinner.  So at each meal I can get enough protein from:

• 2 eggs; or
• 0ne-third of a small (5 oz) can of tuna; or
• one smallish chicken thigh; or 
• less than 3 ounces of not-particularly-lean ground beef; or
• almost two ounces of cheddar cheese; or
• a cup and a half of whole milk or yogurt.

Now, if I got most of my protein from plant sources like beans and grains, I might need to eat more, because the body uses the protein in these less efficiently.  And mind you, I don't weigh very much.  If you weigh 250 pounds, you might need twice what I need.  Oh, and growing children and pregnant women will need more than this.  So will someone who does a lot of heavy lifting.  But the point is, if low-carb living means you're going to eat globally-scarce animal protein at most meals, you don't have to consume more than your "fair" share (unless it turns out you have a medical need for it).

3.  Fill the rest of the plate with nutritious vegetables.  Flavor them with enough butter, sauce, oil, or cream to give you plenty of energy.    If you want a low-carb, moderate-protein diet, logically you must eat a good deal of fat.  There is nothing wrong with this.   And the thing that will give it to you, along with a nice lengthy eating experience and a sensation of fullness, is the dressed vegetable side dish.  Eat your veggies, and eat them with plenty of tasty, tasty fat -- not an excess, but enough to give you your daily calories.  This fat need not come from animal products.  The bulk of your calories can thereby come from veggies.

Atkins-style low-carb set an initial upper limit on even salad vegetables, which naturally means the dieters felt they had to eat more meat just to fill up their plates.  Some people might need such drastic limits, but I'm betting that most people will do fine eating as much broccoli, okra, cabbage, spinach, collards, cucumbers, cauliflower, asparagus, and the like as they want.   Might as well give it a try.  

4.  Don't waste so damn much food, especially protein.    Here is a sad statistic:  Somewhere between 25 and 55 percent of the food available to people living in North America, Oceania and Europe is simply wasted.*  Thirty-six hundred calories* are available to every American every day; that doesn't count exports.  We eat too much to begin with, and what we don't eat we waste.  

• A lot of these calories are wasted by retail sellers, who have to throw out expired meat and the like.  
• A huge amount is wasted by the restaurant industry; I don't know this, but I suspect that the fancier they are (i.e. the more operating expense they can pass on to the clientele), the more wasteful.  
• But we also waste a lot of food at the household level, by buying too much and cooking too much in the first place, by over-trimming, and generally by being too picky.   

 I've made this point before:  The first place you can reduce your carbon footprint is by wasting less so you can buy less.   What's more, unlike many other ways to go green, you'll actually spend less money (and maybe even time) on the effort.  (A somewhat frightening implication here is that every time we eat in a nice restaurant, we necessarily contribute to the problem.   Don't really want to go there....)

5.  Choose animal products that make efficient use of protein.  One way to compare protein sources is by feed protein to food protein conversion efficiency.    We could get protein by eating cereals and legumes; or we could feed some of the cereals and legumes to animals, and then eat the animals.  How much of the protein in those cereals and legumes can you get back?  We can accept a less-than-100-percent conversion because animal proteins are more bioavailable to us, and also because they come with valuable fats, nutrients, and iron (not to mention that most of us like to eat animals).  But how good can it get?

According to Smil, the best you can do is dairy products, which give you back 40 percent of the nitrogen (a proxy for protein) you fed to your cow.  Aquacultured fish are next, tied with eggs at 30 percent efficiency.  Eating chickens gives you back about 25 percent of what you "spent" in feed protein.  Pork:  only 13 percent.  And when you get to beef cattle, it's pretty abysmal:  five percent.

It does depend quite a bit on how your beef is raised:

Beef production is inherently the least efficient way of supplying dietary protein through animal feeding. ... This inefficiency is irrelevant in broader [nitrogen] terms as long as the animals are totally grass-fed, or raised primarily on crop and food processing residues (ranging from straw to bran, and from oilseed cakes to grapefruit rinds) that are indigestible or unpalatable by nonruminant species. Such cattle feeding calls for no, or minimal—because some pastures are fertilized—additional inputs of fertilizer-[nitrogen]. Any society that would put a premium on reducing [nitrogen] losses in agroecosystems would thus produce only those 2 kinds of beef. In contrast, beef production has the greatest impact on overall [nitrogen] use when the animals are fed only concentrates, now typically mixtures of cereal grains (mostly corn) and soybeans.

Switching from conventionally raised beef to grass-fed beef is expensive, and not even practically possible depending on the grocery options where you live.    But switching some of your conventional pork and beef consumption even to ordinary eggs and dairy is a cheap change, available to anyone anywhere, that can halve your meal's nitrogen footprint while still providing you high-quality protein, enough to support even a quite low-carb diet.

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*Asterisked information comes from the Smil paper.

When women have low iron, look more closely please.

An interesting post on an example of stupid medical nonsense about menstruation, this type of nonsense causing underdiagnosed internal bleeding.  

When I was thirteen years old, I got my period. Soon after, I remember going with my mother to the nurse practitioner's office -- her name was Debbie. Debbie told me that once girls got their periods, they were more likely to be anemic, and I would have to watch out for it. She suggested I start to take an iron supplement.

However, the sex difference in iron status in males and females derives from an increase in male iron stores at puberty, not a decrease in female iron stores...

...[T]he main culprit for iron-deficiency anemia (IDA) in men is upper-gastrointestinal bleeding, so when men present with IDA the first thing they do is an endoscopy. When women present with IDA they give her iron supplements and tell her to go home because it's just her ladybusiness. Kepczyk et al (1999) decided to actually do endoscopies on women for whom a gynecological source was diagnosed by a specialist for their IDA. They found a whopping eighty-six percent of these women had a gastrointestinal disease that was likely causing their IDA. Therefore, menses likely had nothing to do with their IDA, and the assumption that menses made them pathological actually obstructed a correct diagnosis.

 I may have to bookmark that blog, it looks like a good one.

New USDA recommendations... not new enough.

A brief link here to some criticism of the newest USDA guidelines.  I want to highlight two quotes in particular.  First:

Although the new guidelines appropriately decrease the emphasis on percentage of calories from fat, they still set 35 percent as the upper limit—a problem, especially given the way that the guidelines are used to set standards for schools and other federal food programs. The cap on fat can distort menus, since it means that a large intake of refined grains is still allowed. And often this cap on fat is wrongly applied to individual foods or meals, so that broccoli with olive oil would be seen as too high in fat, whereas mashed potato with butter would not.

I already complain about fat's bad rap, but this is another point that is worth noting:  A high-fat diet might mean that someone is eating a lot of bread and butter or a lot of fast-food cheeseburgers and fries.... but it also might mean that someone is eating a lot of vegetables made flavorful with dressings and oils.  This is the easiest way to dump empty calories and eat more nutrient-rich veggies that I know of: swap some of your helpings of grains and starches for an extra helping of veggies, and then give yourself back some calories and flavor in the form of fat on the veggies.  

Rediscover buttered steamed carrots, folks.  Second:

So what about red meat? Processed meat is clearly unhealthy. The harm caused by processed meat is basically clouding the signal about just how much red meat is optimal. Too many studies have looked at harm from meat without breaking it down enough between processed and unprocessed meat. 

A good point -- it has never occurred to me that "processed" and "red" might be confounding variables.  Maybe all of the evidence that pork and beef are worse for you than chicken, can be entirely blamed on hot dogs, bacon, and bologna.

"Dysphoric milk ejection reflex."

In this blog post at Babble, Katie Allison Granju tells about a tentatively-identified disorder called "Dysphoric Milk Ejection Reflex:"

 One of the things I mentioned...was how bizarrely agitated and unhappy I felt every time I used a breastpump. I described the feeling as being close to a low grade panic attack.

One of the commenters on that post left a link to a website about something called “Dysphoric Milk Ejection Reflex” or “D-MER.” I’d never heard of this, so I went and checked the site out, and what I found is truly fascinating, and has the potential to help a whole lot of women.

The site was started by a mother who found herself experiencing sudden and painful  feelings of sadness and disappointment every time she started to nurse her baby. She made the connection between her milk letdown (ejection reflex) and the onset of these feelings, and started trying to track down information and resources about this condition, which obviously has the potential to make it very hard for a woman to breastfeed her baby, and could also lead to more serious problems, like depression.

... I have personally known several mothers over the years who have described what I now believe to have been D-MER to me with regard to their personal breastfeeding experiences. These women recounted that they began to feel inexplicably empty and hopeless whenever they breastfed their babies; one friend told me that she had a sudden and powerful pang of what felt like homesickness when the baby would begin to nurse. Another explained that nursing her baby made her feel very anxious and agitated, like she was going to jump out of her own skin.

Check it out, and especially read some of the comments.   I didn't think I've ever experienced it, but some of the comments remind me eerily of the horrible feelings I got every time I tried to nurse the baby and the toddler at the same time (like, literally simultaneously, one on each breast).  I think I only ever attempted that about three times before I swore I would never, ever, ever do that again.

There's some more detail in Katie's post about the specific hormonal mechanisms that are implicated, and of course you can follow the link in the quote to the DMER website.

Why Why We Get Fat isn't really a comprehensive diet book: a review, part two.

(Part one of my review of Why We Get Fat and What to Do About It by Gary Taubes is here)

This is what I want out of my culinary lifestyle: 

Above all other concerns, it has to keep me physically healthy, so I can feel good, stay active, get my stuff done, and maintain my weight.  This is the natural purpose of food, so I have no problem putting it above every other desire in importance.   But as long as I can get this, I have other desires:

• I want to enjoy a variety of tasty, real, unprocessed food.
• I don't want to feel dependent on eating large quantities of food; I want to eat lightly.
• I would like to have at least a little bit of foods that make me happy even if they are biochemically not so good for me.
• I don't want my family to consume a whole lot of meat.
• I want to be a gracious dinner guest, accepting some (if not all) of what's offered me.  I don't want to require special treatment.
• I'd like to save money and preparation time.
• I want to be able to eat a meal in any restaurant whatsoever without resenting the choices.
• I want to obsess less about my diet.

These are not universal values.  Some of you might pipe up:  "Well, I'd like to grow as much of my own food as I can."  Or:  "I don't want to eat any meat at all."  Or:   "You'd like to save money in an abstract sense, but me, I have a food ceiling of $80/week."  Or:  "I love to try new restaurants and want to do it as often as possible."  Or:  "I have to have chocolate every day." 

If you peruse the list of culinary desires, including the first one, you should notice one thing:  I cannot satisfy all of them.   The more I emphasize one desire, the more I must compromise with another.  For example, the more I diversify the foods I eat, the more money I probably spend.  The less processed food I buy, the more time I spend preparing food.  The more-freely I eat in restaurants and the more I accept what the hostess offers me, the less control I have over things like sustainability and healthfulness.

 Another thing you should notice is that some of these desires require effort.  It feels good to eat food, and eating lightly requires that I stop before I might like to.  It's easy to plan dinner around plenty of meat, and so using less requires me to work harder.   It feels good to eat a large piece of cake; it's harder to stop after just a small one. 

So my desire of staying physically healthy, even though it has primacy, has to be satisfied in context.   I must also strike a balance among a number of other values in tension with each other and sometimes even in tension with the primary goal.   And I must do it in an environment where there are many temptations to act contrary to my desires.

A really comprehensive diet book can't tell you what your own values are, of course, but it will promote some of the author's values and show you the tensions that exist between those and other values you might have.  A really comprehensive diet book will devote some attention to strategies for balancing contrary desires, i.e., for living your life within the constraints of the eating plan:  a chapter of suggested restaurant orders,  advice on living with diet-sabotaging relatives, a section of recipes.   A really comprehensive diet book will also suggest strategies that keep the dieter motivated in the face of temptation, or ways to remove temptations from the environment. 

Why We Get Fat and What to Do About It devotes little, if any, attention to context.  This means it is not a comprehensive diet book.    But what it does provide is a crucial piece of information:  a detailed description of an evidence-based weight-loss menu, one that has the best-demonstrated track record of really helping people lose body fat in controlled clinical settings.

This information is undeniably useful.   It is also real-life-context-free.  Except for a couple of implications and hints strewn throughout the book, Taubes declines to provide any suggestions about how to integrate this information into your life.  Clearly, he does not think it is his job. 

 And I agree; it is not.  Taubes is a science journalist.  He is not a diet guru.  He is not a cognitive-behavioral therapist.  He is not a chef.  And more importantly, he is not you.   His job, it seems, is to tell you what the evidence demonstrates.  Your job is to figure out how you can incorporate it into your life and your own set of values.

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So what does the evidence demonstrate?  Remember the quote from the last post:

The one thing we absolutely have to do if we want to get leaner--if we want to get fat out of our fat tissue and burn it--is to lower our insulin levels and to secrete less insulin to begin with.

According to Taubes, evidence suggests that the only way to do this is to reduce the consumption of -- you've heard this before -- breads, cereal grains, white root vegetables, "foods containing much sugar" including a few fruits, and sweets.   This leaves quite a bit left that can be eaten freely and still promote weight loss in most people:  animal flesh, green vegetables, eggs, cheese, and many other fruits.   (A rephrasing of a set of successful clinical recommendations quoted on pages 155-156).

A key, oft-repeated point is that among obese individuals, sensitivity to the restricted foods varies a great deal. 

The fewer carbohydrates we consume, the leaner we will be... [T]here's no one-size-fits-all prescription for the quantity of carbohydrates we can eat and still lose fat or remain lean.  For some, staying lean or getting back to being lean might be a matter of merely avoiding sugars and eating the other carbohydrates in the diet, even the fattening ones, in moderation:  pasta dinners once a week, say, instead of every other day.  For others, moderation in carbohydrate consumption might not be sufficient, and far stricter adherence is necessary.  And for some, weight will be lost only on a diet of virtually zero carbohydrates, and even this may not be sufficient to eliminate all our accumulated fat, or even most of it.

Whichever group you fall into, though, if you're not actively losing fat and want to be leaner still, the only viable option... is to eat still fewer carbohydrates, identify and avoid other foods that might stimulate significant insulin secretion..., and have more patience....The more obese the patients, and the longer they had been obese, the more likely they were to remain obese [over the duration of the studies]....

What we don't know is whether these individuals could have succeeded had they further restricted carbohydratees, or had they simply had more patience, and maybe both.

So some people take a long time to begin losing weight even on a drastically low-carb diet, but others succeed immediately with even a little bit of carb restriction. 

This explains why some dieters, including me, lose weight on diets that aren't intentionally "low-carb."  Taubes insists that whatever they set out to change, be it reduced fat or reduced calories  or more exercise, their success is caused by an incidental reduction of carbs or of refined carbs.  If you eat less butter, maybe you don't want quite as much bread.  If you cut calories across the  board, well, some of that was by cutting carbohydrates.  If you took up exercising and lost weight that way, Taubes is betting you also aren't drinking as much beer and soda as you used to.    

Successful diets aren't low-carb, but they are all (Taubes says) fewer-carb-grams-than-before, or at least better-quality-carb-than-before.

That's the information in the book.  The evidence marshalled in the book is compelling.  Now you have to ask yourself:  How can I fit these recommendations into my life? 

Undoubtedly you'll want to know:  What kind of success can I expect if I only "sort-of" follow the recommendations, because of balancing them with other things I wish to get out of my way of eating?  And Taubes doesn't tell you the answer to that either.  You will just have to try it and see.

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All this being said, Taubes does point out that there is some variety in the application of the diets.  Taubes organizes the successful clinical diets into three different approaches:

(1)   "To establish an ideal amount of carbohydrates that you can and perhaps should eat -- say, ... three hundred calories' worth...  This is intended to minimize any potential side effects.... also assumes that it's easier to eat some fattening carbohydrates than to eliminate them entirely."  The example diet is one that allows "small amounts of sugar and an occasional dessert, some crumbs for breaded food, a little lactose (in milk), and small quantities of carbohydrate in vegetables and fruit." 

 (Note that you can still eat quite a lot of vegetables while receiving from them only "small quantities" of carbohydrate.  Many of the diets do not restrict green vegetables much except as a last resort for extremely sensitive individuals.) 

(2) "[A]im for minimal carbohydrates from the outset" and get used to the side effects. 

Here Taubes is talking about the physiological side effects of carbohydrate withdrawal -- but I would add that such an approach also has whole-life side effects as you transition to a meat-based lifeform.  Your experience as a restaurantgoer, dinner guest, and cook will be irrevocably changed, and you're going to have to deal with this.

(3) The Atkins compromise:  begin by drastically reducing carbohydrate to near-nothing (including limiting green vegetables), and then when weight loss is established, gradually add carbohydrates back in until the individual daily limit is discovered.

There are advantages and disadvantages to all these approaches.

A couple of other possible approaches are implied by Taubes' evidence, but he does not include them in this list because they are not represented among the clinical diets he has surveyed. 

(4) The low- or no-meat approach.  I was really hoping that Taubes would address the sustainability issue, but (other than a brief comment that it is more sustainable to eat fat with your protein)  it seems he has no evidence for a low- or no-meat diet that will reliably cure obesity.  Still, he has something to say about what a vegan or vegetarian (and by extension, a flexitarian like myself) can do:

[I]f you eat mostly plants... you're getting the bulk of your calories from carbohydrates, by definition.  This doesn't mean that you can't become lean or remain lean by giving up sugars, flour, and starchy vegetables, and living exclusively on leafy green vegetables, whole grains, and pulses (beans).  But it is unlikely to work for many of us... If you try to eat fewer carbohydrates by eating smaller portions, you'll be hungry, with all the problems that entails.

So if you're a vegan or a vegetarian you can still benefit from an understanding... You can always improve the quality of the carbohydrates you eat, even if you don't reduce the total quantity.  This change alone will assuredly improve your health, even if it's not sufficient to make you lean.

So you could classify the low- or no-meat approach as "worth trying, probably won't hurt, and might even help."

(5) The cut-the-worst-offenders-first approach.  This is not, I repeat, represented among the clinical studies that Taubes references.  However, what he writes implies that it might be a viable option.  "Clearly, as [Michael] Pollan points out, humans can adapt to a wide range of non-Western diets, from those exclusively animal-based to those mostly, if not exclusively, vegetarian.... [W]hat is it that distinguishes Western diets...?"  Japanese and sub-continent Indian populations remained healthy on diets that were rich in legumes and rice before they started adopting the Western diet, after all. 

 This, plus Taubes' evidence that some people lose weight with only moderate carbohydrate restriction, suggests to me that one way to cut carbs is to begin by eliminating the worst offenders, and if that isn't sufficient to induce weight loss after a while, or if a plateau is reached, to cut back some more.    First to go might be soda and sweets, then processed food with sugar, then white flour or polished grains.  Later the portions of even the whole grains might shrink, and those be served less often.  Eventually the obese person might find it necessary to cut categories of food entirely out of his diet; but by systematic and slow improvement and experimentation, perhaps the dieter can acquire good habits along the way to a sustainable lifestyle that also promotes better blood chemistry and eventually fat loss.

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I will continue this book review in a third part, where I want to address why, unlike Taubes, I conclude that--even if fatness isn't caused by gluttony--gluttony still isn't off the hook.

Commenter ChristyP on blogtalkradio.

Link here to blog-friend Christy P promoting the Creighton model study that she posted about here in a guest post.  She explains a little bit more about what the study's for.  If you're interested or know someone who's interested, check it out! 

Here's the link - audio will play at the link.

A blog post with no audio here.

Especially if you know someone who's looking for a new method, or is engaged, you might want to recommend it.  This strikes me as a good way to broach the subject of NFP with an engaged couple you know.